The Relationship of Parental Warm Responsiveness and Negativity to Emerging Behavior Problems Following Traumatic Brain Injury in Young Children
ABSTRACT Parenting behaviors play a critical role in the child's behavioral development, particularly for children with neurological deficits. This study examined the relationship of parental warm responsiveness and negativity to changes in behavior following traumatic brain injury (TBI) in young children relative to an age-matched cohort of children with orthopedic injuries (OI). It was hypothesized that responsive parenting would buffer the adverse effects of TBI on child behavior, whereas parental negativity would exacerbate these effects. Children, ages 3-7 years, hospitalized for TBI (n = 80) or OI (n = 113), were seen acutely and again 6 months later. Parent-child dyads were videotaped during free play. Parents completed behavior ratings (Child Behavior Checklist; T. M. Achenbach & L. A. Rescorla, 2001) at both visits, with baseline ratings reflecting preinjury behavior. Hypotheses were tested using multiple regression, with preinjury behavior ratings, race, income, child IQ, family functioning, and acute parental distress serving as covariates. Parental responsiveness and negativity had stronger associations with emerging externalizing behaviors and attention-deficit/hyperactivity disorder symptoms among children with severe TBI. Findings suggest that parenting quality may facilitate or impede behavioral recovery following early TBI. Interventions that increase positive parenting may partially ameliorate emerging behavior problems.
SourceAvailable from: Nicholas P. Ryan[Show abstract] [Hide abstract]
ABSTRACT: Objectives: To investigate rates of clinically significant externalizing behavior in young adult survivors of pediatric TBI, and evaluate the contribution of pre- and post-injury risk and resilience factors to externalizing behaviour outcomes 16 years after injury. Setting: Melbourne, Australia Participants: Fifty-five young adults (M age = 23.85; Injury Age: 1.0 - 12 years) admitted to an emergency department following TBI between 1993 and 1997. Design: Longitudinal prospective study with data collected at the acute, 10-year and 16-year post-injury time points. Main Measures: Severity of TBI, adaptive functioning, family functioning, full scale IQ, executive functioning, social communication, and symptoms of externalizing behavior (EB). Results: One of every four young people with a history of pediatric TBI demonstrated clinical or sub-threshold levels of EB in young adulthood. More frequent externalizing behavior was associated with poorer pre-injury adaptive functioning, lower full scale IQ and more frequent pragmatic communication difficulty. Conclusion: Pediatric TBI is associated with elevated risk for externalizing disorders in the transition to adulthood. Results underscore the need for screening and assessment of TBI among young offenders, and suggest that early and long-term targeted interventions may be required to address risk factors for EB in children and young people with TBI.Journal of Head Trauma Rehabilitation 12/2014; 30(2). DOI:10.1097/HTR.0000000000000123 · 3.00 Impact Factor
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ABSTRACT: Background Persistent behavioural difficulties are common following paediatric acquired brain injury (ABI). Parents and families also experience heightened stress, psychological symptoms and burden, and there is evidence of a reciprocal relationship between parent and child functioning, which may be mediated by the adoption of maladaptive parenting practices. Despite this, there is currently a paucity of research in family interventions in this population. The aim of this study was to determine the efficacy of Stepping Stones Triple P: Positive Parenting Program (SSTP), with an Acceptance and Commitment Therapy (ACT) workshop, in improving child outcomes and parenting practices following paediatric ABI.Methods Fifty-nine parents of children (mean age 7 years, SD 3 years, 1 month; 35 males, 24 females) with ABI (Traumatic injuries 58%, Tumour 17%, Encephalitis or meningitis 15%, Cardiovascular accident 7%, Hypoxia 3%) who were evidencing at least mild behaviour problems were randomly assigned to treatment or care-as-usual conditions over 10 weeks. Mixed-model repeated-measures linear regression analyses were conducted to compare conditions from pre- to postintervention on child behavioural and emotional functioning (Eyberg Child Behavior Inventory, Strengths and Difficulties Questionnaire) and dysfunctional parenting style (Parenting Scale). Assessment of maintenance of change was conducted at a 6-month follow-up. The trial was registered on Australian New Zealand Clinical Trials Registry (ID: ACTRN12610001051033, www.anzctr.org.au).ResultsSignificant time-by-condition interactions were identified on number and intensity of child behaviour problems, child emotional symptoms and parenting laxness and overreactivity, indicating significant improvements in the treatment condition, with medium-to-large effect sizes. Most improvements were maintained at 6 months.Conclusions Group parenting interventions incorporating Triple P and ACT may be efficacious in improving child and parenting outcomes following paediatric ABI.Journal of Child Psychology and Psychiatry 03/2014; 55(10). DOI:10.1111/jcpp.12227 · 5.67 Impact Factor
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ABSTRACT: This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic brain injury (TBI). Thirty-seven families with a child between 3 and 9 years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training (n = 20) or access to internet resources on managing brain injury (n = 17). Parent–child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized Estimating Equations and mixed models were used to examine changes in parenting skills and child behavior problems and the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant increases in observed positive parenting skills relative to participants in the internet resource group. Income moderated improvements in parent ratings of child behavior, with individuals in the low-income parenting skills group and high-income internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds.Behavior Therapy 07/2014; DOI:10.1016/j.beth.2014.02.003 · 2.43 Impact Factor