Susan B. Campbell

Early externalizing behavior problems: Toddlers and preschoolers at risk for later maladjustment

The early emergence and developmental implications of externalizing behavior problems in toddlers and preschoolers are discussed with an emphasis on which young children are truly at risk for continuing problems. The extant literature is reviewed with a focus on the stability of early externalizing behavior and the diverse pathways that young children, primarily boys, with early-emerging problems may follow. Findings from a number of studies, both epidemiological and high risk, suggest that the small subgroup of boys with multiple risk factors that include especially high levels of early hyperactivity and aggression, and high levels of negative parenting and family stress, are most likely to evidence continuing problems at school entry. Sociodemographic and neighborhood influences are also discussed, as are implications for future research and policy.

Face-to-Face Interactions of Postpartum Depressed and Nondepressed Mother-Infant Pairs at 2 Months

Depressions influence on mother-infant interactious at 2 months postpartum was studied in 24 depressed and 22 nondepressed mothex-infant dyads. Depression was diagnosed using the SADS-L and RDC. In Ss homes, structured interactions of 3 min duration were videotaped and later coded using behavioral descriptors and a l-s time base. Unstructured interactions were described using rating scales. During structured interactions, depressed mothers were more negative and their babies were less positive than were nondepressed dyads. The reduced positivity of depressed dyads was achieved through contingent resixmfiveness. Ratings from unstructured interactions were consistent with these findings. Results support the hypothesis that depression negatively influences motherinfant behaviol; but indicate that influence may vary with development, chronicity, and presence of other risk factors.

Depression in first-time mothers: Mother-infant interaction and depression chronicity.

Married, middle-class women who met diagnostic criteria for depression and a comparable group of nondepressed women were videotaped interacting with their infants at home at 2, 4, and 6 months. When depression was defined in terms of 2-month diagnosis, there were no differences between depressed and comparison mothers or babies in either positive interaction during feeding, face-to-face interaction, or toy play. However, women whose depressions lasted through 6 months were less positive with their infants across these 3 contexts than women whose depressions were more short-lived, and their babies were less positive during face-to-face interaction. These data highlight the need to distinguish between transient and protracted depression effects on the mother-infant relationship and infant outcome

Boys' externalizing problems at elementary school age: Pathways from early behavior problems, maternal control, and family stress

Hard-to-manage preschool boys and comparison boys were studied at age 4 years and followed at ages 6 and 9 years. Externalizing problems at ages 4 and 9 were associated with concurrent family stress, but this relationship was partially mediated by negative maternal control. Cross-lagged regressions indicated that despite the high stability in childrens problem ratings, observed negative maternal control at age 4 and self-reported negative discipline at age 9 predicted externalizing problems at age 9 years, controlling for earlier levels of symptoms. Hierarchical regression analyses revealed that problems were more likely to persist in the context of chronic family stress, defined as negative life events, marital dissatisfaction, and maternal depressive symptoms. When problem boys who met diagnostic criteria for Oppositional Disorder and/or Attention Deficit Disorder were compared with boys who were improved by age 9 years, family stress and earlier symptom levels, as well as maternal control differentiated between them. Teacher ratings suggested that these boys were on a clear pathway to persistent problems by age 6 years. A small sample of comparison boys with emerging problems also were living in more dysfunctional families and their mothers reported using more negative discipline at age 9 years.

Postpartum depression. A role for social network and life stress variables.

Depressed (N = 11) and nondepressed (N = 19) women who had recently given birth were compared on several life stress measures and indices of structural and qualitative characteristics of their social networks. We predicted that depressed subjects diagnosed on the basis of Research Diagnostic Criteria would have experienced more stressful life events since the beginning of pregnancy and since delivery. We also predicted that depressed subjects would have fewer confidants and receive less instrumental and emotional support from their network members. These predictions were largely confirmed, except that the two groups did not differ on number of confidants. The social support provided by spouses appeared to be especially important. Implications of these findings for life events and social network research are discussed.

The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months

We examined the course of maternal depressive symptoms and childrens attachment security at 36 months in a large sample of mother-child pairs from 10 sites across the country participating in the NICHD Study of Early Child Care (N = 1077). Maternal depressive symptoms predicted higher rates of insecure attachment. Women who reported intermittent symptoms across the first 36 months had preschoolers who were more likely to be classified as insecure C or D; women with chronic symptoms were more likely to have preschoolers who were classified as insecure D. Symptoms reported only during the first 15 months were not associated with elevated rates of later insecurity. After controlling for potentially confounding demographic variables, maternal sensitivity (observed at 6, 15, 24, and 36 months) did not meaningfully account for links between attachment security and patterns of depressive symptoms. However, the course and timing of maternal depressive symptoms interacted with maternal sensitivity to predict insecurity. Women with late, intermittent, or chronic symptoms who were also low in sensitivity were more likely to have preschoolers who were insecure, in contrast to symptomatic women who were high in sensitivity. These data have implications for understanding the combined impact of maternal depressive symptoms and maternal sensitivity on childrens socioemotional development.

Trajectories of Maternal Depressive Symptoms, Maternal Sensitivity, and Children's Functioning at School Entry.

Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, the authors modeled trajectories of maternal depressive symptoms from infant age 1 month to 7 years. The authors identified 6 trajectories of maternal depressive symptoms: high-chronic, moderate-increasing, high-decreasing, intermittent, moderate-stable, and low-stable. Women on these depression trajectories varied in sociodemographic risk and in changes in observed maternal sensitivity over time. Maternal sensitivity was generally higher and increased when depressive symptoms were low; sensitivity was lower and decreased when depressive symptoms were either high or increasing. Child outcomes at 1st grade were examined by trajectory group. The authors discuss the complexity of disentangling maternal symptoms from maternal sensitivity and sociodemographic risk when predicting childrens functioning.

Course and correlates of postpartum depression during the transition to parenthood

The transition to parenthood marks a major milestone in family development that is especially difficult for roughly 10% of postpartum women who develop clinical depressions serious enough to interfere with daily functioning. Relatively little is known about the course of postpartum depression, the factors associated with its onset or severity, or its impact on the quality of mother-infant interaction. We studied 70 depressed women and 59 demographically matched nondepressed women delivering their first child and then followed them longitudinally through 24 months. Although the majority of depressions had remitted by 6 months postpartum, some women were depressed throughout the follow-up period, and others continued to evidence subclinical symptoms, indicating that depression in postpartum women can be relatively chronic. Depressed women differed from comparison women on measures of personal and family history, their adaptation to pregnancy, and minor pregnancy and delivery complications. They also perceived their infants as more difficult to care for and their husbands as less supportive. A combination of these variables accounted for 49% of the variance in depression severity scores at 2 months. Depressed women also showed less positive engagement and more negative affect when observed with their infants at 2 months. Spouse support and maternal positive engagement with the baby at 2 months differentiated between those with more chronic versus short-lived depressions. The implications of these findings for the womans and her infants development are discussed.

Hard-to.Manage Preschool Boys: Externalizing Behavior, Social Competence, and Family Context at Two-Year Followup

Boys, identified as hard to manage in preschool, were followed up 2 years after initial assessment. Mothers, fathers, and teachers continued to rate hard-to-manage boys as having more problems with attention and impulse control, and as more oppositional, than comparison boys who had been problem-free at intake; problem boys also were rated as less socially competent by all three informants. Differences in severity were apparent as a function of initial referral source. Boys identified as showing significant problems by at least two informants (28% of the problem boys) were especially low in social competence and their mothers reported more symptoms of depression and parenting stress. Family adversity, lower IQ, and severity of symptoms at intake discriminated boys with continuing problems from those with less serious difficulties at followup. Control boys with potentially emerging problems were characterized by more family problems than the remaining control boys. Implications for the development of problems in young children are discussed.

Correlates and predictors of hyperactivity and aggression: a longitudinal study of parent-referred problem preschoolers.

Forty-six parent-referred problem 3-year-olds and 22 comparison children were assessed with parent report and observational measures; 54 were followed up at age 4, and 53 were followed again at age 6. Lower social class and greater family stress were associated with higher symptom ratings at initial referral and age 6 follow-up. Negative and directive maternal behavior and negative and noncompliant child behavior observed in the lab at age 3 were associated with higher maternal ratings of child aggression and hyperactivity; these observed behaviors continued to be highly predictive of maternal ratings of persistent problems at ages 4 and 6. A laboratory index of inattention and overactivity at intake also predicted hyperactivity ratings at age 6. These findings suggest that externalizing problems identified in early childhood are likely to persist when they are associated with more family disruption and a negative mother-child relationship.