Elsevier

Academic Pediatrics

Volume 10, Issue 5, September–October 2010, Pages 330-337
Academic Pediatrics

Children and Adolescents Who Are at Risk
The Importance of Early Parenting in At-Risk Families and Children’s Social-Emotional Adaptation to School

https://doi.org/10.1016/j.acap.2010.06.011Get rights and content

Abstract

Objective

The aim of this study was to determine the specific aspects of early parenting in psychosocially at-risk families most strongly related to children’s social-emotional adaptation to school.

Methods

A cohort study of families (N = 318) identified as at risk for maltreatment of their newborns was conducted. Quality of early parenting was observed in the home when the child was 1 year old. Social-emotional adaptation to school was reported by teachers in first grade. Multivariable models assessed the independent influence of early parenting variables on social-emotional adaptation.

Results

Early parenting and social-emotional adaptation to school varied greatly across families. Parental warmth was associated with lower teacher ratings of shyness, concentration problems, and peer rejection. Parental lack of hostility was associated with decreased teacher ratings of concentration problems and peer rejection. Parental encouragement of developmental advance was associated with lower ratings of aggression and peer rejection. Provision of materials to promote learning and literacy was associated with lower ratings of concentration problems.

Conclusions

In this sample of families with multiple psychosocial risks for child maltreatment, specific aspects of early parenting were associated with better social-emotional adaptation to school in the first grade in theoretically predicted ways. Improving parental knowledge about positive parenting via anticipatory guidance should be a focus of well-child visits. Well-child visit-based interventions to improve the quality of early parenting, especially among at-risk families, should be studied for their impact on parenting behavior and on children’s successful social-emotional adaptation to school. Primary care providers should reinforce complementary services, such as home visiting, that seek to promote positive parenting.

Section snippets

Study Design and Sample

This was a cohort study of families enrolled in a randomized trial of Hawaii’s Healthy Start Program (HSP), a paraprofessional home visiting program for families at risk for abuse or neglect of their newborns. The program serves families at risk for maltreatment of their newborns. The early identification component of the HSP identifies at-risk families through population-based screening and assessment using the Kempe Family Stress Checklist.10 Families in which either parent scored ≥25 are

Family Attributes

Table 1 summarizes key attributes of the families included in the main analyses (N = 318). One tenth of the children were premature. About 60% of mothers self-identified their sole or primary racial/ethnic affiliation as Native Hawaiian, other Pacific Islander, or Asian; over a quarter reported multiple races/ethnicities but no primary affiliation. At the time the child was born, about a third of mothers were not high school graduates and about two thirds lived in households with incomes below

Discussion

In this sample of children from psychosocially at-risk families, there was notable variation in the quality of early parenting and the children’s social-emotional adaptation to school in the first grade. Specific aspects of early parenting—parental warmth, lack of hostility, encouragement of developmental advance, and promotion of learning and literacy—were associated with more favorable teacher ratings of 1 or more domains of children’s social-emotional adaptation to school in the first grade.

Conclusions

The findings from this study point to the importance of early positive parenting skills, specifically parental warmth, lack of hostility, encouragement of developmental advance, and learning and literacy materials for at-risk children’s social-emotional adaptation to school. Pediatric primary care providers are in a unique position to promote positive parenting.30 In addition, a recent technical report by the American Academy of Pediatrics emphasized the importance of aligning well-child care

Acknowledgments

This study was funded to the Johns Hopkins University School of Medicine (Anne Dugan, Principal Investigator) by the Federal Maternal and Child Health Bureau (R40 MC00029 (formerly MCJ240637) and R40 MC00123 (formerly MCJ240838), the Robert Wood Johnson Foundation (18303); The Annie E. Casey Foundation (9404014); the David and Lucile Packard Foundation (93-6051, 94-7957, 97-8058, and 98-3448); the Hawaii State Department of Health (99-29-J); National Institute of Mental Health and National

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