Elizabeth B. Owens

The Development of Early Externalizing Problems Among Children from Low-Income Families: A Transformational Perspective

The present study examined pathways leading to early externalizing problems from age 1 to 31/2 in a design that took advantage of our knowledge of normative progression and normative socialization as well as findings from research on risk. A sample of 130 low-income participants was followed longitudinally from 12 to 42 months using observational measures of developmentally salient parenting and child disruptive behavior to predict early externalizing problems. Results are best accommodated by concepts such as transformation and transaction from developmental psychology. For boys, both child and parent variables predicted later externalizing. For girls and boys, the interaction between child noncompliance and maternal rejection was significant.

Early risk factors and pathways in the development of early disruptive behavior problems

This study examined risk factors from infancy associated with the development of preschool disruptive behavior problems across child, parent, and sociodemographic domains. Risk factors that consistently were associated with the prediction of disruptive behavior at age 5 years included disorganized attachment classification at 12 months, and maternal personality risk and child-rearing disagreements during the second year. In addition, infants with disorganized attachment status at 12 months whose mothers perceived them as difficult in the second year showed significantly higher aggressive problems at age 5 years than those with only one of the two risk factors present. When pathways leading to clinically elevated aggression at age 5 were explored, infant disorganized attachment status, maternal personality risk, and child-rearing disagreements demonstrated equivalent predictive validity as child aggression assessed at age 3 years.

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in childrens social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in childrens disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.

Which Treatment for Whom for ADHD? Moderators of Treatment Response in the MTA

Using receiver operating characteristics, the authors examined outcome predictors (variables associated with outcome regardless of treatment) and moderators (variables identifying subgroups with differential treatment effectiveness) in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD; MTA). Treatment response was determined using parent- and teacher-reported ADHD and oppositional defiant symptoms, with levels near or within the normal range indicating excellent response. Among 9 baseline child and family characteristics, none predicted but 3 moderated treatment response. In medication management and combined treatments, parental depressive symptoms and severity of child ADHD were associated with decreased rates of excellent response; when these 2 characteristics were present, below-average child IQ was an additional moderator. No predictors or moderators emerged for behavioral and community comparison treatments. The authors discuss conceptual and clinical implications of research on treatment moderators.

Prospective Follow-Up of Girls With Attention-Deficit/Hyperactivity Disorder Into Adolescence: Evidence for Continuing Cross-Domain Impairment

The authors performed 5-year prospective follow-up (retention rate = 92%) with an ethnically diverse sample of girls, aged 11-18 years, who had been diagnosed in childhood with attention-deficit/ hyperactivity disorder (ADHD; N = 140) and a matched comparison group (N = 88). Hyperactive-impulsive symptoms were more likely to abate than inattentive symptoms. Across multiple domains of symptoms and functional impairment, girls with ADHD continued to display deficits of moderate to large effect size in relation to the comparison girls, but few differences emerged between the inattentive versus combined types. Follow-up effects withstood statistical control of crucial covariates for most outcomes, meaning that there were specific effects of childhood ADHD on follow-up status; in other instances, baseline disruptive disorders accounted for adolescent effects. For outcomes identical at baseline and follow-up, girls with ADHD showed more improvement across time than comparison girls (except for math achievement). Overall, ADHD in girls portends continuing impairment 5 years after childhood ascertainment.

Effects of Preschool Parents' Power Assertive Patterns and Practices on Adolescent Development

SYNOPSIS Objective . The authors investigated the effects of preschool patterns of parental authority on adolescent competence and emotional health and differentiated between confrontive and coercive power-assertive practices which accounted partially for differential long-term effects of the preschool patterns. Design . Participants were 87 families initially studied when children were preschool students, with outcomes assessed during early adolescence. Families were drawn from Baumrinds Family Socialization and Developmental Competence longitudinal program of research. The authors used comprehensive observational and interview data to test hypotheses relating preschool power-assertive practices and patterns of parental authority to the childrens attributes as adolescents. Person-centered analyses contrasted adolescent attributes associated with 7 preschool patterns of parental authority. The authors used variable-centered analyses to investigate the differential effects of 5 coercive power-assertive practices that they hypothesized were authoritarian-distinctive and detrimental and 2 confrontive practices (behavioral control and normative spanking) that they hypothesized were neither authoritarian-distinctive nor detrimental. Results. Adolescents whose parents were classified as directive, democratic, or authoritative (grouped as balanced-committed) when these adolescents were preschool students were competent and well-adjusted relative to adolescents whose parents were classified as authoritarian, permissive, or disengaged (grouped as imbalanced-uncommitted). Adolescents from authoritarian families were notably incompetent and maladjusted. Variable-centered analyses indicated verbal hostility and psychological control were the most detrimental of the authoritarian-distinctive coercive power-assertive practices. Severe physical punishment and arbitrary discipline were also authoritarian-distinctive and detrimental. Normative physical punishment and confrontive discipline were neither. Confrontive discipline and maturity demands contributed to authoritative parentings effectiveness, whereas normative physical punishment was neutral in its effects. Conclusions. The findings extend the consistently negative outcomes of authoritarian parenting and positive outcomes of authoritative and authoritative-like parenting to 10-year outcomes that control for initial child differences. Differential outcomes can be partially attributed to the coercive practices of authoritarian parents versus the confrontive practices of authoritative parents.

Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury.

OBJECTIVE We performed a 10-year prospective follow-up of a childhood-ascertained (6-12 years), ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; N = 140: combined type [ADHD-C] n = 93; inattentive type [ADHD-I] n = 47) plus a matched comparison group (N = 88). Girls were recruited from schools, mental health centers, pediatric practices, and via advertisements; extensive evaluations confirmed ADHD versus comparison status. METHOD Ten-year outcomes (age range 17-24 years; retention rate = 95%) included symptoms (ADHD, externalizing, internalizing), substance use, eating pathology, self-perceptions, functional impairment (global, academic, service utilization), self-harm (suicide attempts, self-injury), and driving behavior. RESULTS Participants with childhood-diagnosed ADHD continued to display higher rates of ADHD and comorbid symptoms, showed more serious impairment (both global and specific), and had higher rates of suicide attempts and self-injury than the comparison sample, with effect sizes from medium to very large; yet the groups did not differ significantly in terms of eating pathology, substance use, or driving behavior. ADHD-C and ADHD-I types rarely differed significantly, except for suicide attempts and self-injury, which were highly concentrated in ADHD-C. Domains of externalizing behavior, global impairment, service utilization, and self-harm (self-injury and suicide attempts) survived stringent control of crucial childhood covariates (age, demographics, comorbidities, IQ). CONCLUSIONS Girls with childhood ADHD maintain marked impairment by early adulthood, spreading from symptoms to risk for serious self-harm. Our future research addresses the viability of different diagnostic conceptions of adult ADHD and their linkages with core life impairments.

Predicting growth curves of externalizing behavior across the preschool years.

Hierarchical linear modeling was used to examine 2 facets of externalizing behavior: its level at age 6 and its rate of change from age 2 to 6 among 299 boys from low-income families. As for age-6 level of externalizing behavior, maternal depressive symptoms, maternal acceptance of child behavior, parental conflict, and the interaction between maternal acceptance and maternal depressive symptoms were each uniquely associated with this outcome. Regarding the interaction, maternal acceptance was associated with externalizing behavior primarily when maternal depressive symptoms were low, and maternal depressive symptoms were related to externalizing behavior only when maternal acceptance was high. Externalizing behavior gradually decreased between ages 2 and 6; interactions between infant negative emotionality and maternal depressive symptoms and between parental conflict and maternal acceptance were associated with rate of change. Plots suggested a protective effect of low infant negative emotionality when maternal depressive symptoms were high and a larger effect of maternal acceptance when parental conflict was low compared to when it was high. Results add to a small but growing literature regarding predictors of continuity and change in early child externalizing behavior.

Attachment stability and emotional and behavioral regulation from infancy to preschool age.

Relations between attachment and child emotional and behavioral regulation were studied longitudinally in a sample of 223 children from urban, low-income families. Attachment in the Strange Situation at 12 and 18 months was scored using the infant classification system and at 24 months was scored using a preschool classification system. Only modest stability was found in attachment whether within or across classification systems, with the percentage of insecure attachments consistently increasing over time. Results indicated both concurrent and predictive associations with indices of child regulation based on observer ratings or maternal report. However, only the 24-month classification predicted maternal report of externalizing and internalizing behavior problems at age 3.5 years. with additional variance accounted for by selected measures of child emotional and behavior regulation from the same assessment. Attachment security (B) and atypical attachment classifications (D, A/C, and AD) appear to provide the most consistently useful information about child functioning. Results are discussed in terms of continuity and change from the perspective of developmental psychopathology.

Young Children's Adjustment to Chronic Family Adversity: A Longitudinal Study of Low-Income Families

OBJECTIVE To test the relation between multiple family stressors and young childrens adjustment problems. METHOD Longitudinal data were collected on 300 low-income, ethnically diverse, male subjects beginning during infancy and followed until age 31/2. RESULTS General support was found for the family stressor hypothesis. Stressor groups at 18 and 24 months predicted Child Behavior Checklist Externalizing and Internalizing factors at 24 and 42 months, including clinically elevated problems. CONCLUSIONS The results confirm and extend previous investigation of the family stressor hypothesis. They suggest that psychological evaluations of young children need to be ecologically based, including intra- and extrafamilial factors that appear to cumulatively increase risk of behavior problems.