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Pediatrician Identification of Child Behavior Problems: The Roles of Parenting Factors and Cross-Practice Differences

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Abstract

While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child’s behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care.

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References

  • Acock, A. C. (2005). Working with missing values. Journal of Marriage and Family, 67, 1012–1028.

    Article  Google Scholar 

  • Alvarez, H. K., & Ollendick, T. H. (2003). Individual and psychosocial risk factors. In C. A. Essau (Ed.), Conduct and oppositional defiant disorders: Epidemiology, risk factors, and treatment (pp. 33–59). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.

    Google Scholar 

  • Ardelt, M., & Eccles, J. S. (2001). Effects of mothers’ parental efficacy beliefs and promotive parenting strategies on inner-city youth. Journal of Family Issues, 22, 944–972.

    Article  Google Scholar 

  • Arnold, D. S., O’Leary, S. G., Wolff, L. S., & Acker, M. M. (1993). The Parenting Scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5, 137–144.

    Article  Google Scholar 

  • Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20, 55–77.

    Article  PubMed  Google Scholar 

  • Baumrind, D. (1968). Authoritarian vs. authoritative parental control. Adolescence, 3, 255–272.

    Google Scholar 

  • Bentler, P. M. (2004). EQS 6 structural equations program manual. Encino, CA: Multivariate Software, Inc.

    Google Scholar 

  • Brestan, E. V., & Eyberg, M. (1998). Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5, 272 kids. Journal of Clinical Child Psychology, 27, 180–189.

    Article  PubMed  CAS  Google Scholar 

  • Briggs-Gowan, M., Horwitz, S., Schwab-Stone, M., Leventhal, J., & Leaf, P. (2000). Mental health in pediatric settings: Distribution of disorders and factors related to service use. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 841–849.

    Article  PubMed  CAS  Google Scholar 

  • Briones, D., Heller, P., & Chalfant, H. (1990). Socioeconomic status, ethnicity, psychological distress, and readiness to utilize a mental health facility. American Journal of Psychiatry, 147, 1333–1340.

    PubMed  CAS  Google Scholar 

  • Brown, J. D., Riley, A. W., & Wissow, L. S. (2007). Identification of youth psychological problems during pediatric primary care visits. Administration and Policy in Mental Health and Mental Health Services Research, 34, 269–281.

    Article  PubMed  Google Scholar 

  • Brown, J. D., & Wissow, L. S. (2008). Disagreement in parent and primary care provider reports of mental health counseling. Pediatrics, 122, 1204–1211.

    Article  PubMed  Google Scholar 

  • Carter, A. A., Wagmiller, R. J., Gray, S. A. O., McCarthy, K. J., Horwitz, S. M., & Briggs-Gowan, M. J. (2010). Prevalence of DSM-IV disorder in a representative, healthy birth cohort at school entry: Sociodemographic risks and social adaptation. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 686–698.

    PubMed  Google Scholar 

  • Cheng, T. L., Savageau, J. A., DeWitt, T. G., Bieglow, C., & Charney, E. (1996). Expectations, goals, and perceived effectiveness of child health supervision: A study of mothers in a pediatric practice. Clinical Pediatrics, 35, 129–137.

    Article  PubMed  CAS  Google Scholar 

  • Chisolm, D. J., Gardner, W., Julian, T., & Kelleher, K. J. (2007). Adolescent satisfaction with computer-assisted behavioural risk screening in primary care. Child and Adolescent Mental Health, 13, 163–168.

    Article  Google Scholar 

  • Clarizio, H. F. (1997). Conduct disorder: Developmental considerations. Psychology in the Schools, 34, 253–265.

    Article  Google Scholar 

  • Coid, W. (2003). Formulating strategies for the primary prevention of adult antisocial behaviour: ‘High risk’ or ‘population’ strategies? In D. P. Farrington & J. Coid (Eds.), Early prevention of adult antisocial behaviour (pp. 32–78). Cambridge: Cambridge University Press.

    Google Scholar 

  • Coleman, P. K., & Karraker, H. (1998). Self-efficacy and parenting quality: Findings and future applications. Developmental Review, 18, 47–85.

    Article  Google Scholar 

  • Costello, E. J. (1986). Primary care pediatrics and child psychopathology: A review of diagnostic, treatment, and referral practices. Pediatrics, 78, 1044–1051.

    PubMed  CAS  Google Scholar 

  • Costello, E. J., & Edelbrock, C. S. (1985). Detection of psychiatric disorders in pediatric primary care: A preliminary report. Journal of the American Academy of Child and Adolescent Psychiatry, 24, 771–774.

    Article  CAS  Google Scholar 

  • D’Zurilla, T. J., Maydeu-Olivares, A., & Gallardo-Pujol, D. (2011). Predicting social problem solving using personality traits. Personality and Individual Differences, 50, 142–147.

    Article  Google Scholar 

  • Dulcan, M. K., Costello, E. J., Costello, A. J., Edelbrock, C., Brent, D., & Janiszewski, S. (1990). The pediatrician as gatekeeper to mental health care for children: Do parents’ concerns open the gate? Journal of the American Academy of Child and Adolescent Psychiatry, 29, 453–458.

    Article  PubMed  CAS  Google Scholar 

  • Estrada, C. A., Isen, A. M., & Young, M. J. (1994). Positive affect improves creative problem solving and influences reported source of practice satisfaction in physicians. Motivation and Emotion, 18, 285–299.

    Article  Google Scholar 

  • Eyberg, S. M., & Pincus, D. (1999). Eyberg Child Behavior Inventory and Stutter-Eyberg Student Behavior Inventory–Revised. professional manual. FL: Psychological Assessment Resources.

  • Fabes, R. A., Leonard, S. A., Kupanoff, K., & Martin, C. L. (2001). Parental coping with children’s negative emotions: Relations with children’s emotional and social responding. Child Development, 72, 907–920.

    Article  PubMed  CAS  Google Scholar 

  • Gardner, W., Kelleher, K. J., Wasserman, R., Childs, G., Nutting, P., Lillenfeld, H., et al. (2000). Primary care treatment of pediatric psychosocial problems: A study form pediatric research in office settings and ambulatory sentinel practice network. Pediatrics, 106, 1–9.

    Article  Google Scholar 

  • Glied, S., Hoven, C. W., Moore, R. E., Garrett, A. B., & Regier, D. A. (1997). Children’s access to mental health care: Does insurance matter? Health Affairs, 16, 167–174.

    Article  PubMed  CAS  Google Scholar 

  • Halfon, N. H., Olson, L., Inkelas, M., Mistry, R., Sareen, H., Lange, L., Hochstein, M., & Wright, J. (2002) Summary statistics from the National Survey of Early Childhood Health 2000. National Center for Health Statistics, Vital Health Statistics, 15.

  • Harwood, M. D., O’Brien, K. A., Carter, C. G., & Eyberg, S. M. (2009). Mental health services for preschool children in primary care: A survey of maternal attitudes and beliefs. Journal of Pediatric Psychology, 34, 760–768.

    Article  PubMed  Google Scholar 

  • Hinshaw, S. P. (2005). The stigmatization of mental illness in children and parents: Developmental issues, family concerns, and research needs. Journal of Child Psychology and Psychiatry, 46, 714–734.

    Article  PubMed  Google Scholar 

  • Horwitz, S. M., Kelleher, K. J., Stein, R. E. K., Storfer-Isser, A., Youngstrom, E. A., Park, E. R., et al. (2007). Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics, 119, 208–218.

    Article  Google Scholar 

  • Horwitz, S. M., Leaf, P. J., Leventhal, J. M., Forsyth, B., & Speechly, K. N. (1992). Identification and management of psychosocial and developmental problems in community-based, primary care pediatric practices. Pediatrics, 89, 480–485.

    PubMed  CAS  Google Scholar 

  • Johnston, C., & Mash, E. J. (1989). A measure of parenting satisfaction and efficacy. Journal of Clinical Child Psychology, 18, 167–175.

    Article  Google Scholar 

  • Jones, S., Eisenberg, N., Fabes, R. A., & MacKinnon, D. P. (2002). Parents’ reactions to elementary school children’s negative emotions: Relations to social and emotional functioning at school. Merril-Palmer Quarterly, 48, 133–159.

    Article  Google Scholar 

  • Judd, F., Jackson, H., Komiti, A., Murray, G., Fraser, C., Grieve, A., et al. (2006). Help-seeking by rural residents for mental health problems: The importance of agrarian values. Australian and New Zealand Journal of Psychiatry, 40, 769–776.

    Article  PubMed  Google Scholar 

  • Karaszia, B. T., van Dulmen, M. H. M., & Wildman, B. G. (2008). Confirmatory factor analysis of arnold et al’.s Parenting Scale across race, age, and sex. Journal of Child and Family Studies, 17, 500–516.

    Article  Google Scholar 

  • Kazdin, A. E., & Weisz, J. R. (Eds.). (2003). Evidence-based psychotherapies for children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Keller, J., & McDade, K. (2000). Attitudes of low-income parents toward seeking help with parenting: Implications for practice. Child Welfare, 79, 285–312.

    PubMed  CAS  Google Scholar 

  • Lagace-Seguin, D. G., & d’Entremont, M. L. (2006). The role of child negative affect in the relations between parenting styles and play. Early Child Development and Care, 176, 461–477.

    Article  Google Scholar 

  • Loeber, R., & Farrington, P. (2000). Young children who commit crime: Epidemiology, developmental origins, risk factors, early interventions, and policy implications. Development and Psychopathology, 12, 737–762.

    Article  PubMed  CAS  Google Scholar 

  • Luis, T. M., Varela, E., & Moore, K. W. (2008). Parenting practices and childhood anxiety reporting in Mexican, Mexican American, and European American families. Journal of Anxiety Disorders, 22.

  • Lynch, T. R., Wildman, B. G., & Smucker, W. D. (1997). Parental disclosure of child psychosocial concerns: Relationship to physician identification and management. Journal of Family Practice, 44, 273–280.

    PubMed  CAS  Google Scholar 

  • Murphy, J. M., Arnett, H. L., Bishop, S. J., Jellinek, M. S., & Reid, J. Y. (1992). Screening for psychosocial dysfunction in pediatric practice: A naturalistic study of the Pediatric Symptom Checklist. Clinical Pediatrics, 31, 660–667.

    Article  PubMed  CAS  Google Scholar 

  • Ohan, J. L., Leung, D. W., & Johnston, C. (2000). The Parenting Sense of Competence Scale: Evidence of a stable factor structure and validity. Canadian Journal of Behavioural Science, 32, 251–261.

    Article  Google Scholar 

  • Pagano, M. E., Cassidy, L. J., Little, M., Murphy, J. M., & Jellinek, M. S. (2000). Identifying psychosocial dysfunction in school-age children: The Pediatric Symptom Checklist as a self-report measure. Psychology in the Schools, 37, 91–106.

    Article  PubMed  Google Scholar 

  • Pottick, K. J., Bilder, S., Vander Stoep, A., Warner, A. L., & Alvarez, M. F. (2007). US patterns of mental health service utilization for transition-age youth and young adults. Journal of Behavioral Health Services and Research, 35, 373–389.

    Article  PubMed  Google Scholar 

  • Pottie, C. G., Cohen, J., & Ingram, K. M. (2009). Parenting a child with autism: Contextual factors associated with enhanced daily parental mood. Journal of Pediatric Psychology, 34, 419–429.

    Article  PubMed  Google Scholar 

  • Reitman, D., Currier, R. O., Hupp, S. D., Rhode, P. C., Murphy, M. A., & O’Callaghan, P. M. (2001). Psychometric characteristics of the Parenting Scale in a head start population. Journal of Clinical Child Psychology, 30, 514–524.

    Article  PubMed  CAS  Google Scholar 

  • Sayal, K., Tischler, V., Coope, C., Robotham, S., Ashworth, M., Day, C., et al. (2010). Parental help-seeking in primary care for child and adolescent mental health concerns: Qualitative study. British Journal of Psychiatry, 197, 476–481.

    Article  PubMed  Google Scholar 

  • Schultz, J. R., & Vaughn, M. (1999). Learning to parent: A survey of parents in an urban pediatric primary care clinic. Journal of Pediatric Psychology, 24, 441–445.

    Article  PubMed  CAS  Google Scholar 

  • Sourander, A., Helstela, L., Ristkari, T., Ikaheimo, K., Helenius, H., & Piha, J. (2001). Child and adolescent mental health service use in Finland. Social Psychiatry and Psychiatric Epidemiology, 36, 294–298.

    Article  PubMed  CAS  Google Scholar 

  • Steele, M. M., Lochrie, A. S., & Roberts, M. C. (2010). Physician identification and management of psychosocial problems in primary care. Journal of Clinical Psychology in Medical Settings, 17, 103–115.

    Article  PubMed  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th ed.). Needham Heights, MA: Allyn & Bacon.

    Google Scholar 

  • Telleen, S. (1990). Parental beliefs and help seeking in mothers’ use of a community-based family support program. Journal of Community Psychology, 18, 264–276.

    Article  Google Scholar 

  • U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services.

    Google Scholar 

  • Watson, D., & Clark, A. (1997). Measurement and mismeasurement of mood: Recurrent and emergent issues. Journal of Personality Assessment, 68, 267–296.

    Article  PubMed  CAS  Google Scholar 

  • Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.

    Article  PubMed  CAS  Google Scholar 

  • Webster-Stratton, C., & Reid, M. J. (2003). The incredible years parents, teachers and children training series: A multifaceted treatment approach for young children with conduct problems. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 224–240). New York: Guilford Press.

    Google Scholar 

  • Weisz, J., & Weiss, B. (1991). Studying the referability of child clinical problems. Journal of Consulting and Clinical Psychology, 59, 266–273.

    Article  PubMed  CAS  Google Scholar 

  • Wildman, B. G., Stancin, T., Golden, C., & Yerkey, T. (2004). Maternal distress, child behaviour, and disclosure of psychosocial concerns to a paediatrician. Child: Care, Health and Development, 30, 385–394.

    Article  CAS  Google Scholar 

  • Wissow, L., Gadomski, A., Roter, D., Larson, S., Lewis, B., & Brown, J. (2011). Aspects of mental health communication skills training that predict parent and child outcomes in pediatric primary care. Patient Education and Counseling, 82, 226–232.

    Article  PubMed  Google Scholar 

  • Wolfradt, U., Hempel, S., & Miles, J. N. V. (2003). Parenting styles, depersonalisation, anxiety, and coping behaviour in adolescents. Personality and Individual Differences, 30, 521–532.

    Article  Google Scholar 

  • Yerkey, T. M., & Wildman, B. G. (2004). Use of information about maternal distress and negative life events to facilitate identification of psychosocial problems in children. Family Practice, 21, 261–265.

    Article  PubMed  Google Scholar 

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Acknowledgment

This project was supported by a grant from the Ohio Board of Regents and a grant from the Akron Children’s Hospital Foundation.

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Correspondence to Robert M. Dempster.

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Dempster, R.M., Wildman, B.G., Langkamp, D. et al. Pediatrician Identification of Child Behavior Problems: The Roles of Parenting Factors and Cross-Practice Differences. J Clin Psychol Med Settings 19, 177–187 (2012). https://doi.org/10.1007/s10880-011-9268-x

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