Prevention Services for Externalizing and Anxiety Symptoms in Low-Income Children: the Role of Parent Preferences in Early Childhood.

Dissemination of prevention programs targeting young children is impeded by challenges with parent engagement. Matching program characteristics to parent preferences is associated with increased retention in clinical/intervention settings, but little is known about the types of prevention programs that interest parents. The objectives of this study were to better understand parents' preferences for services designed to prevent externalizing and anxiety disorders and to identify factors associated with preferences. Ethnically diverse, low-income caregivers (n = 485) of young children (11-60 months) completed surveys on child anxiety and externalizing symptoms, parental worry about their children, parent anxiety symptoms, and preferences for prevention group topics. Parents were more likely to prefer a group targeting externalizing behaviors compared to anxiety. Cluster analysis revealed four groups of children: low symptoms, moderate anxiety-low externalizing, moderate externalizing-low anxiety, and high anxiety and externalizing. Parents' preferences varied according to co-occurrence of child anxiety and externalizing symptoms; interest in a program targeting externalizing problems was associated with elevated externalizing problems (regardless of anxiety symptom level), parent anxiety symptoms, and parent worry about their child. Only parent anxiety symptoms predicted parents' interest in an anxiety-focused program, and preference for an anxiety-focused program was actually reduced if children had co-occurring anxiety and externalizing symptoms versus only anxiety symptoms. Results suggest that parents' interest in a program to prevent externalizing problems was well-aligned with the presenting problem, whereas preferences for anxiety programming suggest a more complex interplay among factors. Parent preferences for targeted programming are discussed within a broader framework of parent engagement.

Targeted prevention of childhood anxiety: engaging parents in an underserved community.

Selective prevention programs hold the promise of alleviating child anxiety symptoms, decreasing the risk for emotional problems across the lifespan. Such programs have particular public health import for young children of poor, underserved communities. Identifying factors related to parent engagement, and methods to improve engagement, are paramount in the effort to develop anxiety-focused, community prevention programs. This feasibility study investigated the effect of an enhanced recruitment strategy to maximize parent engagement, as well as factors related to attendance in a single session focused on anxiety prevention. Participants were poor, ethnic minority parents of children aged 11-71 months (n = 256) who completed a survey that assessed anxiety risk according to trauma exposure, child anxiety, or parent anxiety, as well as preferences for preventive services (phase 1). Those meeting risk criteria (n = 101) were invited to a preventive group session (phase 2). Half of parents received enhanced recruitment (ER), which included personalized outreach, matching parent preferences, and community endorsement. Other parents were invited by mail. Chi square analyses indicated that ER was associated with planning to attend (49 vs. 6% of control). Parents receiving ER were 3.5 times more likely to attend. Higher sociodemographic risk was correlated with higher child anxiety symptoms but not attendance. Results highlight the need for improved strategies for engaging parents in preventive, community-based interventions.

Pathways to service receipt: modeling parent help-seeking for childhood mental health problems.

Understanding parent appraisals of child behavior problems and parental help-seeking can reduce unmet mental health needs. Research has examined individual contributors to help-seeking and service receipt, but use of structural equation modeling (SEM) is rare. SEM was used to examine parents' appraisal of child behavior, thoughts about seeking help, and receipt of professional services in a diverse, urban sample (N = 189) recruited from women infant and children offices. Parents of children 11-60 months completed questionnaires about child behavior and development, parent well-being, help-seeking experiences, and service receipt. Child internalizing, externalizing, and dysregulation problems, language delay, and parent worry about child behavior loaded onto parent appraisal of child behavior. Parent stress and depression were positively associated with parent appraisal (and help-seeking). Parent appraisal and help-seeking were similar across child sex and age. In a final model, parent appraisals were significantly associated with parent thoughts about seeking help, which was significantly associated with service receipt.

Student-teacher relationship stability across early school years for children with intellectual disability or typical development.

Student-teacher relationships of 37 children with moderate to borderline intellectual disability and 61 with typical cognitive development were assessed from child ages 6-8 years. Student-teacher relationship quality was moderately stable for the typical development group, but less so for the intellectual disability group. At each assessment these relationships were poorer for children with intellectual disability. Child behavior problems consistently predicted more conflict, whereas social skills predicted more closeness. Accounting for these child characteristics reduced the status group difference to nonsignificance. Earlier student-teacher relationships predicted subsequent changes in child behavior problems and social skills. Student-teacher relationships in the intellectual disability group were significantly lower for children in regular than special classes by age 8.

Early Student-Teacher Relationships of Children With and Without Intellectual Disability: Contributions of Behavioral, Social, and Self-Regulatory Competence.

We investigated the student-teacher relationships (STRs) of 6-year-old children with (n=58) and without (n=82) intellectual disability (ID). We also examined early (age 3) and concurrent (age 6) child behavioral, self-regulatory, and social characteristics as predictors of age 6 STR quality. Children with ID experienced significantly poorer relationships with their teachers, marked by less closeness and more conflict and dependency, compared to typically-developing children. This group difference was not accounted for entirely by IQ differences. The relation between ID status and STR quality was fully mediated by four age 6 child variables: mother- and teacher-reported behavior problems and mother- and teacher-reported social skills. The quality of children's relationships with teachers was also predicted by child characteristics as early as age 3, including early behavior problems, self-regulation, and behavior during parent-child interactions. The relation of ID status to STR quality at age 6 was fully mediated by children's self-regulatory abilities at age 3. Our findings demonstrate the importance of child behavioral and social characteristics in predicting relationships with teachers for children with and without ID.