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This chapter focuses on supporting families to promote optimal child development. It takes a systems-based approach to examining factors that influence child development, explores some of the most common problems and concerns that nurses who care for children and young people encounter on a regular basis, and draws on the latest research evidence to outline foundational principles for improving health and developmental outcomes.
The chapter is grounded in an understanding that the family environment has a tremendous influence on children’s health and development, and that a strong working partnership with parents and caregivers is essential. It begins with a brief overview of current challenges faced by children in Australia and New Zealand before examining important social and environmental determinants of children’s development. The remainder of the chapter comprises a series of case studies illustrating common child development concerns and outlines current best-practice, evidence-based strategies to support families with child behaviour, sleep, nutrition, physical activity and technology use.
Effective and consistent engagement in personal hygiene practices is important for preventing the acquisition and transmission of communicable diseases in childhood. This study aimed to investigate trends in adherence to recommended hygiene practices and identify factors contributing to difficulties in establishing good hygiene habits with young children (0–4 years) in Australia. A self-selected community sample of parents (N = 426) completed an online survey assessing children's adherence to recommended hygiene practices and barriers and enablers of establishing good personal hygiene habits. Parents reported interest in receiving information/tips on children's personal hygiene (yes/no) and nominated topics of interest. Less than half of children in any age group consistently (always/almost always) covered coughs and sneezes, washed hands after toileting, or washed hands before meals or when dirty. Children's non-compliance (i.e. resistance, refusal) was the most commonly reported barrier to establishing good personal hygiene habits, while children's compliance (i.e. cooperative behaviour, following or complying with caregivers’ instructions) was the most commonly cited enabler. Despite low levels of adherence, less than half (41.2%) of parents wanted information/tips on children's hygiene. Results suggest a disconnect between parents’ knowledge about recommended hygiene practices and actual behaviour. Development and testing of approaches to behaviour change that incorporate evidence-based strategies to manage children's resistance and support parents to encourage the development of healthy hygiene habits is warranted.
Harsh punishment by parents is common in low- and middle-income countries (LMIC), yet there is limited evidence from LMIC of the effects of harsh punishment on child outcomes.
Methods.
A longitudinal, prospective study was conducted with children with conduct problems to examine the associations between parents’ use of harsh punishment during the preschool years on child behaviour and school achievement in grade one of primary school. As part of an efficacy trial in 24 preschools, 225 children with the highest level of teacher-reported conduct problems were evaluated and their parents reported on how often they used harsh punishment. Outcome measures in grade one included child conduct problems by independent observation, teacher and parent report, child social skills by teacher and parent report, direct tests of children's academic achievement and language skills, and tester ratings of child attention and impulse control.
Results.
Children had a mean age of 6.92 years and 61% were boys. All parents reported using harsh punishment. After controlling for child age and sex, socio-economic status, parents’ involvement with child and maternal education, frequency of harsh punishment was associated with growth in child conduct problems by independent classroom observations (p = 0.037), parent (p = 0.018) and teacher (p = 0.044) report, a reduction in child social skills by teacher (p = 0.024) and parent (p = 0.014) report and poorer attention during the test session (p = 0.049).
Conclusion.
The associations between frequency of parents’ use of harsh punishment with their preschoolers with conduct problems and later child behaviour indicate a need to train parents in non-violent behaviour management.
Adverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children’s behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children’s behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children’s behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children’s internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children’s behavioural psychopathology.
Based on extensive piloting work, we adapted the Incredible Years (IY) teacher-training programme to the Jamaican preschool setting and evaluated this adapted version through a cluster-randomised trial.
Methods.
Twenty-four community preschools in Kingston, Jamaica were randomly assigned to intervention (12 schools, 37 teachers) or control (12 schools, 36 teachers). The intervention involved training teachers in classroom management through eight full-day training workshops and four individual 1-h in-class support sessions. Outcome measurements included direct observation of teachers’ positive and negative behaviours to the whole class and to high-risk children and four observer ratings: two measures of class-wide child behaviour and two measures of classroom atmosphere. Measures were repeated at a six-month follow-up.
Results.
Significant benefits of intervention were found for teachers’ positive [effect size (ES) = 3.35] and negative (ES = 1.29) behaviours to the whole class and to high-risk children (positive: ES = 0.83; negative: ES = 0.50) and for observer ratings of class-wide child behaviour (ES = 0.73), child interest and enthusiasm (ES = 0.98), teacher warmth (ES = 2.03) and opportunities provided to share and help (ES = 5.72). At 6-month follow-up, significant benefits of intervention were sustained: positive behaviours (ES = 2.70), negative behaviours (ES = 0.98), child behaviour (ES = 0.50), child interest and enthusiasm (ES = 0.78), teacher warmth (ES = 0.91), opportunities to share and help (ES = 1.42).
Conclusions.
The adapted IY teacher-training programme produced large benefits to teacher's behaviour and to class-wide measures of children's behaviour, which were sustained at 6-month follow-up. Benefits were of a similar magnitude to those found in a pilot study of the minimally adapted version that required significantly more in-class support for teachers.
Parents’ adjustment, co-parenting conflict, and parenting style are often intervention targets for parents following divorce. However, little is known about how these three aspects together relate to child outcomes. The aim of this study was to examine how parent adjustment (distress and anger), parenting conflict, and parenting style (laxness and over-reactivity) predict child internalising, externalising, and prosocial behaviours. Participants were a community sample of 109 divorced parents with a child aged 4–17 years. Results showed that increased parental distress and co-parent conflict predicted increased child emotional and behavioural problems; and increased lax parenting also predicted increased externalising behaviour problems. However, greater prosocial behaviour was predicted only by lower lax parenting. The results highlight the differential impact of parenting factors on child outcomes following divorce and have implications for the content and tailoring of interventions for divorced parents.
Prior research has shown that teacher-child relationship quality predicts school emotional wellbeing and academic engagement, but it is unclear whether the relationship quality reflects teachers’ perceptions of children's social-emotional behaviours differently for girls and for boys. The purpose of this study was to examine whether teachers’ reports of relationship quality were differentially associated with children's behaviours depending on child gender. Teachers provided behavioural reports and ratings of closeness and conflict for children from kindergarten (n = 598), pre-primary (n = 496), and year 1 (n = 451). Of 19 significant associations, only 5 were moderated by gender, including hyperactivity and emotional problems. The findings suggest that, primarily, gender does not moderate how teachers’ perceptions of behaviours correlate with their ratings of relationship quality, but that gender role expectations may affect teacher-child relationship quality in some behavioural domains. Suggestions for counsellors working with teachers are presented that target teacher self-reflection on gender expectations, behavioural expectations and their intersection, to improve teacher-child relationship quality.
To explore whether changes in parenting self-efficacy after attending a parenting programme are related to changes in parenting stress and child behaviour.
Background
Adverse parenting is a risk factor in the development of a range of health and behavioural problems in childhood and is predictive of poor adult outcomes. Strategies for supporting parents are recognised as an effective way to improve the health, well-being and development of children. Parenting is influenced by many factors including the behaviour and characteristics of the child, the health and psychological well-being of the parent and the contextual influences of stress and support. Parenting difficulties are a major source of stress for parents, and parenting self-efficacy has been shown to be an important buffer against parenting stress.
Methods
In all, 63 parents who had a child under the age of 10 years took part in the research. Of those, 58 returned completed measures of parenting self-efficacy, parenting stress and child behaviour at the start of a parenting programme and 37 at three-month follow-up.
Findings
Improvements in parenting self-efficacy and parenting stress were found at follow-up, but there was less evidence for improvements in child behaviour. The findings clearly suggest a relationship between parenting self-efficacy and parenting stress; parents who are feeling less efficacious experience higher levels of stress, whereas greater parenting self-efficacy is related to less stress. This study adds to the evidence that parent outcomes may be a more reliable measure of programme effectiveness than child outcomes at least in the short term.
Although routine Fe supplementation in pregnancy is a common practice, its clinical benefits or risks are uncertain. Children born to mothers in the Fe group in a trial of Fe supplementation in pregnancy have been found to have a significantly higher risk of abnormal behaviour at 4 years of age than those born to mothers in the placebo group. The objective of the present study therefore was to determine whether Fe supplementation in pregnancy influences child behaviour at early school age. The study was a follow-up of children at 6–8 years of age after women (n 430) were randomly allocated to receive a daily Fe supplement (20 mg) or placebo from 20 weeks gestation until delivery. The supplement reduced the incidence of Fe-deficiency anaemia at delivery from 9 % to 1 %. Child behaviour and temperament were assessed using the Strengths and Difficulties Questionnaire and the Short Temperament Scale for Children. Of the children, 264 (61 %) participated in the follow-up. Mean behaviour and temperament scores and the proportion of parent-rated and teacher-rated abnormal total difficulties scores did not differ between the Fe and placebo groups. However, the incidence of children with an abnormal teacher-rated peer problems subscale score was higher in the Fe group (eleven of 112 subjects; 8 %) than in the placebo group (three of 113 subjects; 2 %); the relative risk was 3·70 (95 % CI 1·06, 12·91; P = 0·026). We conclude that prenatal Fe supplementation had no consistent effect on child behaviour at early school age in this study population. Further investigation regarding the long-term effects of this common practice is warranted.
There is a substantial literature reporting the co-occurrence of maternal depression and child behaviour problems. Behavioural interventions have proven efficacy in the treatment of conduct problems, and a number of studies have reported gains in parental mental health following parent training. The mechanisms by which this is achieved are not clear, but it is likely that interventions that include parent training in observation skills and exposure to success will impact on both the child's conduct problems and maternal depression. This paper reports on the outcomes of two treatments for children with severely disruptive behaviour, the standard treatment offered by a Child and Adolescent Mental Health Service, and an intensive parent training intervention. It was predicted that the more specific skills training in the intensive treatment would make improvements in maternal health and child behaviour more likely. Significant overall improvements were found in measures of child behaviour, parental practices and maternal mental health. A correlation emerged between the improved child behaviour and the improved parenting strategies. Significant improvements for the intensive treatment group were seen on every measure. Significant improvement in the measure of maternal mental health contrasted with little change for the standard treatment group.
The phenotypic and genetic interrelationships underlying ADHD symptomatology assessed by various instruments were examined on a sample of 735 male and 819 female same-sex twin pairs, aged 8 to 16 years, participating in the first phase of the Virginia Twin Study of Adolescent Behavioral Development (VTSABD). Multivariate analyses were applied to parental and teacher ratings from an investigator-based interview, the CAPA, and three questionnaires (the CBCL and the Rutter Parent and Teacher Scales). Results from patterns of intercorrelations and factor analyses of maternal measures suggested that at the phenotypic level, these assessed the same underlying behavioural construct, which differed from other emotional and behavioural constructs. However, genetic analyses showed that in addition to a common factor underlying the expression of ADHD as assessed across the range of measures, additional genetic factors were identified that were method- and rater-specific. The findings suggest that although the investigator-based interview and the behavioural checklists tap similar aspects of ADHD behaviour, there is additional rater-specific variance.
The construct representation of the cross-informant model of the Child Behavior Checklist
(CBCL) and the Teacher Report Form (TRF) was evaluated using confirmatory factor
analysis. Samples were collected in seven different countries. The results are based on 13,226
parent ratings and 8893 teacher ratings. The adequacy of fit for the cross-informant model
was established on the basis of three approaches: conventional rules of fit, simulation, and
comparison with other models. The results indicated that the cross-informant model fits
these data poorly. These results were consistent across countries, informants, and both
clinical and population samples. Since inadequate empirical support for the cross-informant
syndromes and their differentiation was found, the construct validity of these syndrome
dimensions is questioned.
The aim of this postal survey was to highlight differences in temperament
and behaviour between 32 toddlers in Japanese families living temporarily
in London and 36 in British families, all in London. Mothers completed
questionnaires about demography, perinatal events, and their child's
temperament and behaviour. UK toddlers were described as exhibiting
fewer behavioural symptoms than Japanese toddlers. Significantly more
of the Japanese toddlers scored above the cutoff on the Behaviour Check
List, indicating higher levels of behavioural disturbance. An interesting
item is ‘sleeping with parent’, which occurs commonly in Japanese
families and is considered to be normal for that culture. On the Toddler
Temperament Scale the Japanese toddlers proved more distractable and
more intense than the UK toddlers when age had been allowed for. It was
of interest that Japanese girls proved more distractable than Japanese
boys and UK girls. Possible explanations for the differences are advanced.
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