Gail M. Houck

The measurement of child characteristics from infancy to toddlerhood: temperament, developmental competence, self-concept, and social competence.

Maternal report on four characteristics was obtained for 126 infants at 8, 12, 24, and 36 months of age. Temperament was assessed using the Revised Infant and Toddler Temperament Scales; the Infant/Child Monitoring Questionnaires were used to screen developmental competence. The Self-Concept Questionnaire and the Adaptive Social Behavior Inventory were outcome measures at 12, 24, and 36 months. Temperament and developmental competence were found to be relatively stable but unrelated over time. The second year, 12-24 months, was a salient period of development in which the greatest increases in self-concept and social competence were observed. Correlation analyses revealed temperament difficulty was negatively related to social competence yet unrelated to self-concept; developmental competence was more strongly related to the developing self-concept than social competence. The strongest relationships between social competence and self-concept were obtained by earlier social competence in relation to subsequent self-concept.

MATERNAL LIMIT-SETTING IN TODDLERHOOD: SOCIALIZATION STRATEGIES FOR THE DEVELOPMENT OF SELF-REGULATION

Early findings from the Prohibition Coding Scheme (PCS; Houck & LeCuyer, 1995; LeCuyer-Maus & Houck, 2002; Medvin & Spieker, 1985) revealed that maternal limit-setting styles with toddlers were differentially related to later child social competence, self-concept, and delay of gratification. For this study, the PCS was revised to provide more information about the specific strategies mothers used during limit-setting in relation to those outcomes. Results from the PCS-Revised (PCS-R; LeCuyer & Houck, 2004) included that the more time mothers spent actively distracting their toddlers away from a prohibited object during limit-setting, as early as 12 months, the longer their children could delay gratification at age 5 years. Mothers who spent more time sensitively following and being engaged in their toddlers own interests (other than the prohibited object), again as early as 12 months, had more socially competent children with more developed self-concepts at age 3 years. Maternal use of reasoning statements later in toddlerhood also related to higher levels of social competence. Maternal limits and prohibitions were not related to these outcomes, and appeared to contribute to the development of self-regulation mainly by creating the opportunity for the use of other, less directive strategies. The findings indicate that these strategies may be important to include in intervention programs for the promotion of toddler and child development of self-regulation.

Child Maltreatment: Family Characteristics and Developmental Consequences

Although it has been suggested that certain family characteristics and experiences may mediate the effects of child abuse and neglect, pertinent research conceptualized from this perspective is limited. In this literature review, the cognitive, social, and emotional outcomes for maltreated children are reviewed, and the literature concerned with a variety of family characteristics that may potentially mediate or compensate for the effects of maltreatment is examined. The inherent developmental perspective in conjunction with a family systems orientation reflects a nursing perspective that can be used to understand and intervene with the multivariate phenomenon.

Self-Concept in Children and Adolescents With Attention Deficit Hyperactivity Disorder

Children with attention deficit hyperactivity disorder (ADHD) struggle with behavioral symptoms, yet little research has provided information about how behavioral symptoms impact their self-concept, especially in terms of gender, age, and ethnicity. Data were collected from 145 children and adolescents with ADHD and their mothers. African Americans, Hispanic Americans, and Caucasians were nearly equally represented in the sample, with approximately one third each. The Child Behavior Checklist was used to assess ADHD symptom severity, and Piers--Harris Childrens Self-Concept Scale was used to measure self-concept. Older ages and more internalizing behavior problems predicted lower self-concept. There were no significant differences between ethnic groups on behavior problem and self-concept scores, although post hoc analyses revealed a trend for Caucasian children with ADHD to have lower self-concept scores than those of African American or Hispanic children. The findings indicate that there is a need to assess self-concept in children and adolescents with ADHD, especially those who are older and have comorbid conditions of anxiety and depression.

MATERNAL LIMIT-SETTING PATTERNS AND TODDLER DEVELOPMENT OF SELF-CONCEPT AND SOCIAL COMPETENCE

In 126 mother-toddler dyads, the relationships between maternal limit-setting patterns at 12, 24, and 36 months were examined in relation to toddler self-concept and social competence at 3 years. Maternal limit-setting patterns differentiated toddler self-concept and social competence scores, demonstrating effects of socialization as well as cognitive maturation. Less optimal toddler outcomes at 36 months were associated with an inconsistent maternal limit-setting style and an indirect style. Children of mothers with a teaching-based pattern yielded the most positive outcomes. Although a power-based maternal limit-setting style was related to diminished self-regulatory behavior in a concurrent limit-setting context, outcomes for children of power-based mothers in terms of self-concept and social competence were not as negative as expected.

A Program to Educate School Nurses About Mental Health Interventions

Concerned with the increasing incidence of mental health problems in children and adolescents and the impact of these problems on students’ school success and predisposition to self- and other-directed violence, the Multnomah Education Service District Department of School Health Services determined to become proactive by providing preventive interventions for students experiencing actual or potential mental health problems. An educational program was designed to assist school nurses in the identification of potential mental health problems. In addition, information about appropriate interventions for students at risk for aggression, violence, and other mental health pathology was presented. The program involved education on mental health assessment and intervention, as well as expert psychiatric clinical support for the development of student support groups. School nurses were then challenged to develop practice improvement projects incorporating this knowledge for a group of students in their work setting. This introductory article describes the project’s general rationale and implementation process. The four articles following in this issue of The Journal of School Nursing describe the goals, implementation, and outcomes of the practice improvement projects developed for early intervention with students exhibiting attention disorders, school absenteeism, social withdrawal, and depression.

Growing Old With Fibromyalgia: Factors That Predict Physical Function

Background:Fibromyalgia, a persistent, widespread pain condition, significantly limits physical function, threatening an older adult’s health and ability to live independently. Objectives:The aim of the study was to identify predictors of physical function in older adults living with fibromyalgia and to examine the influence of resilience on the relationship between fibromyalgia pain and physical function. Methods:This was a descriptive correlational, cross-sectional design using mailed questionnaires to analyze relationships between health-related variables and physical function in a convenience sample of community-dwelling older adults diagnosed with fibromyalgia (n = 224; age M = 62.1 years, SD = 6.75 years). Multiple regression was used to identify a priori predictors of physical function; hierarchical multiple regression was used to examine resilience as a moderator of pain and physical function. Results:The sample was predominantly women, Caucasian, married, well educated, had moderate levels of income and tangible social support, and had low levels of physical function. Three-fourths were overweight or obese. Despite impaired physical function (Late Life Function and Disability Index, M = 51.5/100, SD = 9) and moderate levels of pain (Numeric Rating Scale, M = 5.47/10, SD = 2.6), resilience was moderately high (Resilience Scale, M = 137/175, SD = 20). An eight-variable disablement-based model accounted for 48% of variance in physical function: age, income, education, depressive symptoms, body mass index, and physical activity accounted for 31%; pain added 14%; and resilience contributed an additional 3%. Resilience was not a moderator of fibromyalgia pain and physical function; resilience did contribute uniquely to physical function variance. Discussion:Resilience, a novel variable in fibromyalgia research, was a unique predictor of physical function. Further research is needed to learn more about the relationships between resilience, fibromyalgia impact, and the aging process.

Breast-feeding Success Among Infants With Phenylketonuria

Breast milk is the nutrition of choice for human infants (American Academy of Pediatrics, 2005; American Association of Family Physicians, 2008; Association of Womens Health Obstetric and Neonatal Nurses, 2005; Canadian Paediatric Society, 2005; U.S. Preventive Services Task Force, 2008; World Health Organization, 2009). In comparison to standard commercial formula, human breast milk has a lower concentration of protein and a lower content of the amino acid phenylalanine (Phe). For infants with phenylketonuria (PKU), these attributes of human breast milk make it ideal as a base source of nutrition. The purpose of this study was to compare the incidence and duration of breast-feeding and corresponding Phe levels of breast-fed and formula-fed infants with PKU in the caseload of a pediatric metabolic clinic at an urban tertiary-care medical center. Charts were reviewed for infants diagnosed with PKU beginning with 2005 and ending with 1980, the year no further breast-feeding cases were identified in the PKU population. During the first year of life, most of the infants, whether breast-fed or formula-fed, had similar mean Phe levels. However, the frequency distributions revealed that more breast-fed infants with PKU had Phe levels within the normal range (120-360 μmol/L) and were less likely to have low Phe levels (<120 μmol/L) than formula-fed infants with PKU. Further research is needed to understand how mothers manage breast-feeding in the context of PKU.

Assessing the feeding/eating interaction as a context for the development of social competence in toddlers.

Social competence likely develops through the reciprocal nature of mother–child interactions. Interactions around food provide the young child with consistent and predictable social experiences with the mother, which may establish templates for interactive patterns with others. The Toddler Snack Scale (TSS) assesses the pattern of toddler social behaviors in relation to maternal behaviors during an eating episode. Scale reliability was examined with a sample of 126 dyads at the childs ages of 12, 24, and 36 months. Significant associations were found between TSS classifications and concurrent measures assessed with the Nursing Child Assessment Teaching Scale (NCATS), the Control–Autonomy Balance Scale (CABS), and the Adaptive Social Behavioral Inventory (ASBI). Child temperament contributed to child expressions of social competence, but not to the assignment of maternal or child interaction styles. The scale identifies salient areas for parent–child assessment and intervention throughout infancy and toddlerhood.

A Support Group Intervention for At-Risk Female High School Students

School nurses have an opportunity to engage in early intervention with high-risk adolescents. School-based support groups for depressed adolescents have been effective when aimed at providing skills training as well as emotional support. In this practice improvement project, 14 high-risk female adolescents from two high schools were identified on the basis of signs associated with depression. The students completed a questionnaire about risk and protective factors during the assessment and at the end of the intervention. Twelve students participated in a weekly support group designed to enhance coping skills and to provide emotional support. Assessment revealed that the students were at suicide risk. At the conclusion of the group intervention, there was a 55% decrease in suicidal ideation, a 27% decrease in perceived stress, and a 26% decrease in family distress. In addition, most of the students became engaged in formal treatment for the first time.