Journal of Child Psychology and Psychiatry 45:4 (2004), pp 779–788
Psychosocial determinants of behaviour problems in Brazilian preschool children Luciana Anselmi,1 Cesar A. Piccinini,1 Fernando C. Barros,2 and Rita S. Lopes1 1
Institute of Psychology, UFRGS, and Post-Graduate Programme in Epidemiology, UFPel, Brazil; 2PAHO/WHO, Latin American Center for Perinatology, Uruguay
Background: This investigation aimed at examining, through an epidemiological study, the social demographic, family and individual determinants of behaviour problems in preschool children. Method: Six hundred and thirty-four children, age four years, and their mothers, belonging to a cohort of 5,304 children being followed from birth, took part in the study. During a home visit, the child’s behaviour problems and IQ were examined, as well as the prevalence of maternal psychiatric disorder, the quality of the home environment, and other social demographic, family and individual factors. Results: The results revealed a prevalence of children’s behaviour problems of 24% (clinical and borderline groups). Regression analysis showed that maternal psychiatric disorder, education and age, number of younger siblings and quality of the home environment explained 28% of the variance of the child’s behaviour problems. Conclusions: The results point to the multi-determination of child behaviour problems. Keywords: Behavioural problems, externalising disorders, longitudinal studies, preschool children, prevalence, Third World children.
Young children frequently show behaviours that worry adults but only recently have researchers examined the clinical significance of these behaviours in children of less than six years of age. The literature does not offer a precise concept of behaviour problems, confining it to operational definitions based on the instrument used to measure the construct. For Achenbach (1991), behaviour problems in young children involve symptom patterns of internalisation and externalisation. Internalising problems involve withdrawal, somatic complaints, sadness, fear, depression and anxiety. Externalising problems refer to aggressive behaviours, hyperactivity, disobedience, low impulse control, displays of anger and delinquent behaviour. The prevalence of behaviour problems in preschool children has been of approximately 10% to 15% (Campbell, 1994), even though studies have indicated an increase in this prevalence in North American children and adolescents (Achenbach & Howell, 1993). Studies show a greater frequency of these problems in boys (Murray, 1992) and in children of non-white ethnic groups (Dubow & Luster, 1990). Several social demographic factors have been associated to behaviour problems in children. Parental age, and especially younger maternal age, is associated with a higher probability of physical, emotional and cognitive problems in children. For example, there is evidence that younger mothers show a distinct interaction pattern with their child, being less responsive, showing less tendency to engage in affective interactions and giving less linguistic stimulation to the child (Osofsky, Hann, & Peebles, 1993). Another important factor is parental education, since it is a family social and cultural indicator, as well as having affective implications for
the relationship with the child. Parents with higher education tend to adopt values, attitudes and beliefs that promote child development. These parents tend to have a conception of development as a complex process and not as determined by unique factors, constitutional or environmental. They also have expectations of more independent and self-directed behaviour for their children (Sameroff, Seifer, Zax, & Barocas, 1987) and hold greater knowledge of the child’s developmental needs (Lewis, 1993). The family’s socioeconomic status has been widely investigated as an important determinant of behaviour problems. Low family income affects the child’s social life, leaving him/her in geographically and socially isolated communities and, as a result, depriving him/her of support networks. The immediate environment is also of influence, affecting their daily routines, the caregiversÕ roles and responsibilities and the overall home interpersonal environment (Halpern, 1993). Since the home environment is the main developmental context for children, several family factors have been investigated, as they contribute to children’s behaviour problems, such as family cohesion or environment quality and maternal affective disorders. Maternal affective disorder increases significantly the risk of a child developing psychopathology from preschool age onwards (Caplan et al., 1989). There is ample epidemiological evidence suggesting that mental illness is intergenerational (Weissman et al., 1987). However, it has been difficult to specify the precise nature of this association between parentsÕ and children’s mental disorder (Murray, 1992). The mediating mechanisms through which this transmission occurs are considered more powerful than parental pathology itself and have received
Association for Child Psychology and Psychiatry, 2004. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
780
Luciana Anselmi et al.
attention in the literature (Rutter, 1996). For example, attachment theory (Bowlby, 1982) has contributed towards the understanding of the mechanisms through which maternal psychopathology may be associated with poor infant development through disorders in the dyad’s relationship. Studies have indicated that maternal mental illness is associated with poor affective interaction and an insecure attachment relationship (Goodyer, 1990). Large-size families have also been considered as a risk factor for the development of behaviour problems. This association has been attributed, in particular, to financial and educational resources worn down to the point of impairing parental functions (Dubow & Luster, 1990) or to the imitation of deviant behaviours among siblings (Lewis, 1995). The birth order among siblings has also been widely studied, the firstborn being considered as a risk group for behaviour problems. There is evidence that firstborn children are more frequently referred by parents for psychological assistance (Gimeniz & Silvares, 1993). They not only receive greater care from the parents but also more negative responses which may be a result of more severe patterns and greater parental expectations regarding the firstborn child (Baskett, 1984). The birth of a sibling is a difficult transition in a child’s development and has also been considered a stressful event for the child, who usually reacts with anxiety, feelings of abandonment and anger (Winnicott, 1964/1966). These reactions have been seen, together with the reduction of attention and of maternal individual care, an increase in negative and controlling interactions directed towards the child and a decrease in the quality of attachment to the child who has gained a brother or sister (Teti, Sakin, Kucera, Corns, & Eiden, 1996). Concern with the new baby has been frequently associated with the decrease in attachment behaviour towards the other children (Goodyer, 1990). Finally, individual factors of the child him/herself (i.e., prematurity, sex, illnesses, ethnic background and IQ) are always investigated as being associated with child behaviour problems. Studies on perinatal predictors of behaviour problems in children have mainly investigated birth weight and gestational age but their consequences have also been attributed to psychological factors related to the infant’s interaction with the environment and not only to biological risk itself. Therefore, parental care practices are different when the infant is preterm or of low weight and the mother–preterm infant interaction is impaired. Mothers of preterm babies show greater anxiety and little confidence in their ability to care for the baby (Crnic, Greenberg, Ragosin, Robinson, & Basham, 1983). They do not know how to stimulate the babies properly since they change rapidly from a state of hypo- to hyperactivity (Barnard, Bee, & Hammond, 1984), they perceive their babies as less physically developed, less active, less responsive and less intellectually competent (Stern & Karraker,
1990), and experience a feeling of loss of the perfect baby (Minde, 1993). The child’s sex is another individual factor which has been associated with behaviour problems. Males have been considered a risk group in studies of child mental health. In a recent review on attention deficit disorder, Rohde et al. (1998) explains that the ratio of boys and girls affected is around 2:1 in population-based studies, and up to 9:1 in clinical trials. This difference in ratio in study designs is probably due to the fact that girls present fewer behaviour symptoms in comorbidity, causing less discomfort to families and school, and therefore receiving less consideration for treatment. There is evidence showing that boys are more exposed to family hostility than girls – who are more protected from these situations – and have more biological vulnerability to developing physical illnesses (Rutter, 1996). This greater propensity to physical illness may be an important factor in the development of boys, especially when the illness requires hospitalisation. Hospitalisations during childhood have been shown to be a risk factor for child development, particularly in the case of children unable to understand the need for hospitalisation and separation from the parents (Minde, 1993). Recurrent hospital admissions are associated with an increase in the risk of emotional problems, since the first hospitalisation predisposes the child to react in an adverse manner on the next occasion (Rutter, 1981). Some studies have suggested that between the first and fourth years of life the child may be especially sensitive to hospitalisation (Mrazek, Anderson, & Strunk, 1985), given his/her cognitive limitations to deal with stressful events. Children belonging to ethnic minorities tend to have more behaviour problems than those belonging to dominant ethnic groups (Velez, Johnson, & Cohen, 1989), even in countries where non-white groups are not minorities (Bird et al., 1988). Stress due to stigmatisation created by racial prejudice plays an important role in determining this prevalence (Miranda, 1996). Clinical experience indicates a similarity among races, but differences among different socioeconomic levels, being more frequent in less privileged classes and in countries where the population falls predominantly into the lower SES groups. Nevertheless, a low SES may not necessarily be the determining factor, since other determinants of psychopathology may also be more prevalent in families of low SES (Bird et al., 1988). The child’s IQ has also been associated with child behaviour problems. The literature has revealed that, in general, children with an IQ above the average have lower rates of psychiatric morbidity (Rutter, 1981), whereas children with an IQ below the average are more vulnerable to the development of behaviour problems, showing a greater prevalence (Grizenko, Cvejic, Vida, & Sayegh, 1991). A possible explanation for these differences is that children with a high IQ have more ability to solve problems
Psychosocial determinants of behaviour problems in Brazilian preschool children
and to cope with environmental stressors (Dubow & Luster, 1990). However, children who are cognitively more advanced than their peers may cope with frustrations which also generate behaviour problems (Achenbach, 1991). The first aim of the present study was to investigate the prevalence of behaviour problems in Brazilian preschool children. Studies using the Child Behavior Checklist (CBCL) have described the prevalence of behaviour problems in developed countries (i.e., Achenbach & Howell, 1993), but there are few studies on their prevalence in developing countries. Furthermore, several of the existing studies involve school-age children and fewer studies have investigated prevalence in preschool children. The second aim was to investigate which of the factors comprising each of the three domains suggested by Bronfenbrenner (1994/1996) – social, family and individual organisation – are significant predictors of behaviour problems in children.
Method Participants Six hundred and thirty-four children and their mothers took part in the study which involved 5304 hospital births occurring during the calendar year 1993 in Pelotas, Brazil (population 300,000), where over 99% of city births take place in hospitals. The history of the study and of the sample was described by Victora et al. (1996). In Phase I of the study, sub-samples of the cohort were followed up at 1, 3, 6 and 12 months. A total of 655 children, chosen by systematic sampling with a fixed weekly quota, were scheduled to be visited at 1 and 3 months. Of these, 649 (99.1%) were located successfully at 1 month and 644 (98.3%) at 3 months. At the age of 6 and 12 months, 1460 infants were selected to be visited, representing a 20% systematic sample of the whole cohort (including the 655 children studied at 1 and 3 months) plus all children born with a birth weight below 2500 g. Of these 1460 children, 1414 (96.8%) were located at 6 months and 1363 (93.4%) at 12 months. In Phase II, when children were around four years old, 1273 (93.6% of the sub-sample of 12 months) were
located and visited. Approximately half of this subsample (n ¼ 634) was randomly selected in order to investigate behaviour problems in the child. Out of the total number of children selected there was only one loss (due to residential mobility) and one refusal to carry on with the study. The mean age of the children was 4 years and 5 months (SD ¼ 3.6 months). As low birth-weight children were over-sampled at 6 and 12 months, they were down-weighted on every analysis to correct the over-sampling. Table 1 shows the social demographic characteristics of the children from the sample and their families. As can be seen, the sample is representative of the target population recruited when the infant was born.
Design and procedures A longitudinal design of an epidemiological nature was used in which the participants were followed prospectively from birth to the child’s fourth year of life. During this period, several visits to the familiesÕ homes were carried out when data were collected on growth, morbidity, development, and feeding habits, as well as social demographic and family data (Victora et al., 1996). In Phase I of the study, the mothers and the newborns (5304) were visited in the hospital when mothers answered a questionnaire, and the babies were submitted to the evaluation of gestational age. In the infant’s sixth and twelfth month of life a sub-sample of families (n ¼ 1363) were visited at home. On both occasions mothers answered a questionnaire evaluating social demographic and infant health and development factors. The data collection in the twelfth month also included an anthropometric evaluation and an assessment of neuropsychomotor problems. In Phase II, 1273 families were located and visited. The mother answered a questionnaire assessing social demographic and infant health and development factors and a later visit was agreed for a randomly selected half of the sample (n ¼ 634 children). One week later, a psychologist made another visit at a time when the mother and the child were present. Initially the mothers answered a questionnaire evaluating family composition and an assessment of the home environment was also carried out. Next, the child’s IQ was assessed and the mother evaluated the child’s behaviour problems. Finally, the mother answered a questionnaire on maternal psychiatric disorders.
Table 1 Social demographic characteristics of the children and families from the sample Characteristics of the children and their families at birth Girls White children Family income (minimum wage) Maternal education (total years) Maternal age* Paternal education (total years) Paternal age Father absence Number of siblings
Birth (N ¼ 5304) 50.3 77.4% 4.34 7 26 7 30 12.1% 1
*13.4% of mothers were adolescents (63) and borderline groups (T-score ‡60 and £63), was 24% (n ¼ 153), and 15% (n ¼ 99) considering only the clinical group. Examining the two scales that comprise the CBCL, it is found that externalising problems show greater prevalence (clinical and borderline groups ¼ 31.8%) than internalising problems (clinical group and borderline ¼ 15.2%). In the present study, a chi-square test revealed no significant differences regarding children’s sex (boys ¼ 21.9%; girls ¼ 26.2%). Moreover, no significant differences were found in the prevalence of behaviour problems as far as the child’s ethnic group is concerned (white ¼ 23.6%; non-white ¼ 25.7%). One of the aims of the present study was to investigate the association between social demographic, family and individual factors and the child’s behaviour problems. Table 2 shows Pearson correlations between the factors investigated. Among the social demographic factors, maternal age (14 to 46 years), paternal age (15 to 75 years) and maternal education (0 to 17 years) were significantly correlated with the CBCL scores, indicating that the greater the parentsÕ age and maternal education, the lower the scores of behaviour problems. Father presence also correlated with lower scores of behaviour problems. As far as family factors are concerned, Table 2 shows that an indicator of maternal psychiatric disorder (SRQ score from 0 to 19) is most correlated with behaviour problems, followed by home environment quality (HOME score from 15 to 53), the number of younger siblings (none to 3 siblings) and paternal care (score from 0 to 7). The greater the prevalence of maternal psychiatric disorder and the greater the number of younger siblings, the higher the scores of behaviour problems. On the other hand, the better the home environment quality and the more the father cared for the child, the lower the prevalence of behaviour problems. The three subscales of the HOME show the same pattern of significant negative correlations with the CBCL. The subscale affective interaction in particular was correlated with the CBCL, indicating that high scores in
783
Table 2 Correlation between social demographic, family and individual factors with CBCL T scores (n ¼ 634) Factors 1 CBCL/behaviour problems Social demographic 2 Family income/birth 3 Maternal age/birth 4 Maternal education/birth 5 Paternal age/birth 6 Paternal education/birth 7 Father presence/birth 8 Mother’s partner/4th yr 9 Maternal work/6 months Family 10 Paternal care/1 year 11 SRQ/Maternal Psych Disorder/4 yr 12 Number of younger siblings/4 yr 13 Bed sharing with parents/4 yr 14 Home/family envrionment/4 yr 14.1 /Affective interaction 14.2 /Play 14.3 /Experiences Individual 15 Birth weight 16 Gestational age 17 Perinatal complications 18 Neuropsychomotor problem/1 yr 19 Number of hospitalisations/1–4 yr 20 Nutritional state/1 yr 21 WPPSI/QI/4 yr
r – ).01 ).19** ).08* ).13** ).03 .11** ).06 .03 ).10* .48** .20** ).01 ).21** ).22** ).14** ).11** ).08* ).06 ).01 .03 .18** ).05 ).16**
*p £ 05. **p £ 01.
this scale were associated with a lower number of behaviour problems. Among the factors associated with the child him/ herself, the number of hospitalisations (none to 5 hospitalisations) was shown to be significantly correlated with the CBCL. The greater the number of hospitalisations, the greater the number of behaviour problems. The child’s birth weight (960 to 4.700 g) and his/her IQ (53 to 144 points) were shown to be negatively correlated with the CBCL, indicating that the greater the weight at birth and the greater the child’s IQ, the fewer behaviour problems were shown by the child. Given the diversity of factors correlated with the child’s behaviour problems, a hierarchical multivariate linear regression was carried out aiming at examining the variance explained by these factors. The conceptual model of the multivariate analysis was based on the bio-ecological model of development (Bronfenbrenner, 1994/1996), which allowed for considering behaviour problems as a hierarchical determination phenomenon from a psychological perspective. It was also based on time considerations, such as year of data collection and children’s first or fourth year of life. The hierarchical relationship established between the factors follows the different levels of organisation proposed by the author (social, family and individual systems) as far as the most distant and most proximal determinants of child development are concerned.
784
Luciana Anselmi et al.
Table 3 Summary of the hierarchical linear regression analysis of CBCL T scores (n ¼ 634)
Step of regression 1
Social demographic factors (birth)
2 3
Child factors (1st–4th year) Family factors (4th year)
4
Home environment quality (4th year)
Predictor factors
B
SE ß
ß
T sig
Total R2 adjusted**
Maternal age Maternal education* No. of hospitalisations Maternal psychiatric disorder – SRQ No. of younger siblings HOME
).15 )1.31 1.64 1.03
.05 .51 .46 .08
).10 ).10 .13 .43
.00 .01 .00 .00
.04 .07 .27
1.35 ).14
.58 .06
.09 ).09
.02 .04
.28
*Maternal education in years: no education ¼ 0; 1 to 4 ¼ 1; 5 to 8 ¼ 2; 9+ ¼ 3. **F-test: F £ 001.
In the first step of the equation, social demographic factors were introduced (maternal age and education and father presence). Paternal age did not integrate with the model because it correlated too highly with maternal age. These factors are considered distant determinants as they usually have an indirect effect on the child, acting through proximal factors, and because, theoretically, they do exist independent from the child. In addition, social demographic data were collected when the baby was born. As they were collected in the first year, some factors regarding the child him/herself, such as birth weight, number of hospitalisations and paternal care, were introduced in the second step of the equation. In a third step, information on maternal psychiatric disorder and number of younger siblings were introduced. These data were collected when the child was four and influence the child, but are less influenced by the child. Finally, in the fourth step of the equation, information concerning the quality of family environment and the child’s IQ were introduced, both collected when the child was four. These factors are considered proximal determinants of development because the child plays an active role in this relationship. Besides children’s characteristics, they refer to other people and objects in the close environment. Table 3 briefly illustrates the findings from the hierarchical linear regression analysis. The results indicate that for each additional year of maternal age and education, the mean scores on the CBCL decreased ().15 and )1.31, respectively). Each hospitalisation led to an increase of 1.64 in the CBCL mean scores. For each higher score on the SRQ and each additional sibling, the mean scores on the CBCL increased (1.03 and 1.35, respectively). On the other hand, for each higher score on the HOME, the mean on the CBCL decreased ().14). The social demographic factors included in the analysis (maternal age and education and father presence) explained 4% of the variance of the CBCL. Among these factors, maternal age and education remained significant in the equation after controlling the effects on the CBCL of the other factors included in the same level of the equation. The value of the
variance changed to 7% with the inclusion of factors of the child him/herself, such as birth weight and the number of hospitalisations and of paternal care in the first year of life. Of these factors, only the number of hospitalisations remained significant in the equation after controlling the effects on the CBCL score of the other factors included in the same level, as well as in the previous level of the equation. The entry into the equation of family factors regarding the number of younger siblings and maternal psychiatric disorder (SRQ) considerably increased the variance explained by the model, reaching 27%. In reality, this substantial increase occurred mainly due to the entry of the SRQ into the equation, which by itself increased the variance by 19%, thus reaching 26%. The introduction of the remaining factors, home environment quality (HOME) and child’s IQ, increased the variance explained by only a little, and only HOME remained significant in the equation. Together, all the factors explained 28% of the variance in the child’s behaviour problems.
Discussion The prevalence of behaviour problems in the present study was quite high (24%) and is similar to the one found in other Brazilian epidemiological studies, such as Almeida Filho (1985) and Miranda (1996). The first found a prevalence of 23.4% in children aged 5 to 14 and the second found a prevalence of 21% using CBCL in children starting schooling. The results of the present study also show that the rate of children classified in the clinical group (15%) is similar to the prevalence of psychiatric disorders (16%) in preschool population-based samples (Gould, Wunsch-Hitzig, & Dohrenwend, 1981). Apart from the overall prevalence of behaviour problems, the results showed high prevalence of externalising (31.8%) and internalising behaviour problems (15.2%), two categories of the CBCL. The greater prevalence of problems of externalisation in the CBCL tends to decrease with increasing age, which did not happen with the children from the present study, who were only four years old and were found to be in the minimum age limit of the
Psychosocial determinants of behaviour problems in Brazilian preschool children
instrument. At this age, the rates tend to be high because the symptoms are usually confounded with manifestations pertaining to the younger child’s developmental level, such as crises of aggressiveness and disobedience, which are usual in the young child who is searching for autonomy and needs to affirm his/her position. This can make it difficult for mothers to discriminate common reactions to the child’s developmental phase from eventual psychopathological symptoms. Moreover, children with externalising problems tend to present more cognitive deficit, school and socialisation difficulties than children with internalising problems. With more evident characteristics, it is easier for mothers to identify externalising behaviour problems. The high prevalence of externalising problems may also be explained by the fact that a number of child pathologies manifest themselves as conduct problems, using action to express conflicts and anxieties (Campbell & Ewing, 1990). The present study did not reveal any association between sex and ethnic group and the child’s behaviour problems. This is in contrast to the findings of Velez et al. (1989), which showed a greater prevalence of behaviour problems among African American and Hispanic children. The absence of ethnic differences in the present study may be related to the miscegenation found in Brazil, making black children less stigmatised and not more vulnerable than white children living under the same socioeconomic conditions. Another hypothesis is that since in this age group children do not go to school and live most of the time in the home environment, they have not experienced the difference and consequent stigmatisation which may provoke stress and make them vulnerable to developing emotional disorders. Furthermore, there are methodological differences in the definition of ethnic groups. Some studies use the observation of the interviewer, as in the present study, whereas in others the mother informs the interviewer. This tends to produce different results, making comparisons between studies difficult. As far as the lack of association between sex and total score of behaviour problems is concerned, this was also found in other studies which have used the CBCL in preschool (Samantiego, 1995; Rae-Grant, Thomaz, Offord, & Boyle, 1989) and school children (Jensen, Bloedau, Degroot, Ussery, & Davis, 1990). Overall, studies have been inconsistent, although the bulk of the evidence suggests that gender differences are not marked in preschool children. This is so, despite the converging evidence in school-age children that indicates higher rates of externalising problems in boys, as well as a shift towards more internalising problems in girls by early adolescence. Unfortunately, studies of preschoolers do not appear to clarify when these gender differences emerge (Campbell, 1994). Several of the factors investigated from the infant’s birth to the fourth year of life were significantly
785
correlated with the behaviour problem scores (11 out of the 20 studied) and the effects found followed the expected direction, showing a trend consistent with the literature on the psychosocial determinants of behaviour problems. Many of the factors present in each of the three levels studied, social demographic, family and individual, also contributed to the prediction of the child’s behaviour problems as seen in the regression analysis. The final regression equation showed that behaviour problems were significantly associated with two social demographic factors (maternal age and education), three family factors (maternal psychiatric disorder, quality of the home environment and number of younger siblings) and one individual factor (number of hospitalisations). These results corroborate those of other studies reported in the literature which identified maternal age and education (Dubow & Luster, 1990), presence of maternal psychiatric disorder (Seifer et al., 1996), quality of the home environment (Bastos & Almeida Filho, 1990), number of younger siblings (Teti et al., 1996) and hospitalisations (Rutter, 1981) as factors associated with the child’s behaviour problems. Among family factors, it was maternal psychiatric disorder, assessed in the child’s fourth year of life, that most explained the variance in behaviour problems. This was the factor most correlated with the child’s behaviour problems when analysed in isolation, as well as when adjusted for the other factors comprising the final equation of the multivariate regression analysis. It is understood that maternal psychiatric disorder may affect the child, mainly through her interactional pattern. The greater the suspect of maternal psychiatric disorder, the lower the quality of the home environment as assessed by the HOME (r ¼ ).27), the less demonstration of positive affect on the mother’s part (r ¼ ).15), the less stimulation with play (r ¼ ).24) and the less variety of experiences (r ¼ ).26) offered to the children. The results of the present study suggest that maternal psychopathological symptoms constitute an important factor to be investigated for determining the child’s behaviour problems. However, when the relationship between psychiatric symptoms in the mother and in the child is discussed, one ought to be cautious regarding the direction of the effect. It is important to note the dynamic character of this association and the mutual influence which both the mother and the child exert on each other (Sameroff, 1993). One can infer that not only may the parentsÕ behaviour have a role in the determination of the child’s behaviour problems but also the presence of an emotionally disturbed child may affect the family dynamics, especially the parents. Even though it is the parents who more extensively direct the interaction with young children, the child’s characteristics interact with the quality of parenting and this may be at the origin of behaviour problems. The relationship
786
Luciana Anselmi et al.
between low maternal age and child behaviour problems, found in the present study, suggests the importance of adolescent pregnancy prevention programmes. The number of younger siblings was also significantly correlated with the behaviour problems of the children who took part in the present study. The literature has pointed out that an increase in the number of children tends to lead to a decrease in attention and individual responsiveness to the child by mothers who are dealing with younger children (Teti et al., 1996). This can be shown through the results of the present study which revealed that the greater the number of children, the poorer the quality of the family environment (r ¼ ).21), affective interaction (r ¼ ).23), stimulation with play (r ¼ ).22) and variety of experiences (r ¼ ).22) provided to the child. Finally, among the child’s individual factors examined, only the number of hospitalisations was a predictor of their behaviour problems. Hospitalisation has traumatic consequences for the child, representing a stressful event in his/her life which may contribute to the onset of behaviour problems. Hospitalisation may also be an indicator of an unfavourable physical condition in the child and the findings would therefore indicate an expected comorbidity of physical and mental illnesses, already widely published in studies on infant mental health (Eiser, 1990). The fact that birth weight and gestational age did not appear to be associated with the child’s behaviour problems may be related to the fact that they do not have a long-standing effect, affecting the child mainly in the first years of life. In the preschool years, social and family factors gain more importance, outweighing the eventual effect of biological factors. Another hypothesis to be examined in future studies is that the biological factors operate as a vulnerability factor and, as a consequence, only exert influence when other stressors are present. The results of the present study show that the greater part of the variance of the behaviour problems was explained by factors associated with the social and psychological context of the family members and less by the characteristics intrinsic to the child him/herself. The associations found between the social demographic factors present at the child’s birth and the behaviour problems in his/her fourth year of life support the idea that certain early experiences increase the risk of psychiatric disorders in later developmental periods (Knorring, Bohman, & Sivgardsson, 1982). Moreover, these associations show the importance of the first year of life in child development (Hay & Kumar, 1995). These results may also be interpreted considering the continuity in the risk situation in which the child lives. For example, family income and parental education were similar in the child’s first and fourth year of life,
indicating the continuity of the adverse situation. Therefore, the children who lived with poor and loweducation mothers in the first year of life carried on living in this situation when they were four years old. Therefore it is difficult to determine whether the effect of certain factors on the child’s behaviour problems is due to the previous adversity, the present adversity or, more probably, both. The results of the present study suggest that the presence of behaviour problems is not determined solely by individual or social demographic factors present at the child’s birth, but also by present conditions, especially the experiences in the home environment. In reality, child development is also a product of the child’s developmental history, which includes not only genetic characteristics and past experiences but also present circumstances (Bowlby, 1982). The results of this study showed that several factors present in each of the three domains suggested by Bronfenbrenner (1994/1996) constitute significant predictors of the child’s behaviour problems. The findings corroborate the perspective of multi-determination of children’s behaviour problems, suggesting that they are the result of the interaction of factors of different origins which operate concomitantly (Sameroff, Seifer, Baldwin, & Baldwin, 1993). Therefore, being exposed to a great number of adverse conditions, children of developing countries, such as those of this sample, end up showing a high prevalence of behaviour problems.
Acknowledgements The study received grant support from PRONEX/ CNPq, Brazil, PPGE-UFPel, and was partially submitted as a Master’s thesis by the first author to the PPG Psychology/UFRGS/Brazil, under supervision of the second author.
Correspondence to Luciana Anselmi, FURG, Rua Eng. Alfredo Huch 475, DECC, CEP: 96201900. Rio Grande – RS – Brazil; Email:
[email protected]
References Achenbach, T.M. (1991). Manual for the Child Behaviour Checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont, Achenbach, T.M., & Howell, C.T. (1993). Are American children’s problems getting worse? A 13-year comparison. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 6. Almeida Filho, N. (1985). Epidemiologia das desordens ´ tricas da infa ˆ ncia no Brasil. Salvador: Centro psiquia Editorial e Dida´tico da UFBA. Barnard, K., Bee, H., & Hammond, M. (1984). Developmental changes in maternal interactions with term
Psychosocial determinants of behaviour problems in Brazilian preschool children
and preterm infants. Infant Behaviour and Development, 14, 203–215. Baskett, L.M. (1984). Ordinal position differences in children’s family interactions. Developmental Psychology, 20, 1026–1031. Bastos, A.C.S., & Almeida Filho, N. (1990). Variables econo´micosociales, ambiente familiar y salud mental infantil en un a´rea urbana de Salvador (Bahia), ´ rica Brasil. Acta Psiquiatrica Psicologica da Ame Latina, 3, 147–154. Bird, H.R., Canino, G., Rubio-Stipec, M., Gould, M.S., Ribera, J., Sesman, M., Woodbury, M., Huertas, S., Pagan, A., Sanchez-Lacay, A., & Moscoso, M. (1988). Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. Archives of General Psychiatry, 45, 1120–1126. Bird, H.R. (1996). Epidemiology of childhood disorders in a cross-cultural context. Journal of Child Psychology and Psychiatry, 37, 35–49. Bordin, I., Mari, J., & Caeiro, M. (1995). Validac¸a ˜ o da versa ˜ o brasileira do ÔChild Behavioural ChecklistÕ (CBCL) (Inventa´rio de Comportamentos da Infaˆncia e Adolesceˆncia): Preliminary data. Revista ABP-APAL, 17, 55–66. Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment (2nd edn). New York: Basic Books. Bradley, R.H., & Caldwell, B. (1984). Home Observation for the Measurement of Environment (rev. edn). Mimeo, AR: University of Arkansas. Bronfenbrenner, U. (1996). A ecologia do desenvolvimento humano: Experimentos naturais e planejados (M.A. Veronese, Trad.). Porto Alegre: Artes Me´dicas (Original paper published in 1994). Campbell, S.B., & Ewing, L.J. (1990). Hard-to-manage preschoolers: Adjustment at age nine and predictors of continuum symptoms. Journal of Child Psychology and Psychiatry, 31, 871–889. Campbell, S.B. (1994). Behaviour problems in preschool children: A review of recent research. Journal of Child Psychology and Psychiatry, 36, 113–149. Caplan, H.L., Cogill, S.R., Alexandra, H., Robson, K.M., Katz, R., & Kumar, R. (1989). Maternal depression and the emotional development of the child. British Journal of Psychiatry, 154, 818–822. Crnic, K.A., Greenberg, M.T., Ragosin, A.S., Robinson, N.M., & Basham, R.B. (1983). Effects of stress and social support on mothers and premature and fullterm infants. Child Development, 54, 209–217. Cunha, J.A. (1992). Manual do WPPSI: Administrac¸˜ao e ´ dito dos testes. Unpublished manuscript. cre Dubow, E.F., & Luster, T. (1990). Adjustment of children born to teenage mothers: The contribution of risk and protective factors. Journal of Marriage and the Family, 52, 393–404. Dubowitz, V., & Goldberg, C. (1970). Clinical assessment of gestational age in newborn infants. The Journal of Pediatrics, 1, 77. Eiser, C. (1990). Psychological effects of chronic disease. Journal of Child Psychology and Psychiatry, 31, 85–98. Frankenburg, K.W., Dodds, I., Archer, P., & Bresnick, B. (1990). Denver II: Technical manual and training manual. Denver: Denver Developmental Materials. Gimeniz, S.R., & Silvares, E.F.M. (1993). Relac¸a ˜ o entre ¨ eˆncia de encaminhaordem de nascimento e frequ
787
mento de crianc¸as brasileiras a uma clı´nica-escola de Psicologia. Revista Interamericana de Psicologia, 28, 61–72. Goodyer, I.M. (1990). Family relationships, life events and childhood psychopathology. Journal of Child Psychology and Psychiatry, 31, 161–192. Gould, M.S., Wunsch-Hitzig, R., & Dohrenwend, B. (1981). Estimating the prevalence of childhood psychopathology: A critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 20, 462–476. Grizenko, N., Cvejic, H., Vida, S., & Sayegh, L. (1991). Behaviour problems of the mentally retarded. Canadian Journal of Psychiatry, 36, 712. Halpern, R. (1993). Poverty and infant development. In Charles H. Zeanah Jr. (Ed.), Handbook of infant mental health (pp. 73–86). New York: The Guilford Press. Hay, D., & Kumar, R. (1995). Interpreting the effects of mothersÕ posnatal depression on children’s intelligence: A critique and re-analysis. Child Psychiatry and Human Development, 25, 165–181. Jensen, P.S., Bloedau, L., Degroot, J., Ussery, T., & Davis, H. (1990). Children at risk: I. Risk factors and child symptomatology. Journal American Academy of Child and Adolescent Psychiatry, 29, 51–59. Kaufman, S. (1972). A short form of the Wechsler Preschool and Primary Scale of Intelligence. Journal Consulting and Clinical Psychology, 39, 361–369. Knorring, A.L., Bohman, M., & Sigvardsson, S. (1982). Early life experiences and psychiatric disorders: An adopted study. Acta Psychiatrica Scandinava, 65, 283–291. Lewis, M.D. (1993). Emotion–cognition interactions in early infant development. Cognition and Emotion, 7, 145–170. ˆ ncia e Lewis, M. (1995). Tratado de Psiquiatria da Infa ˆ ncia. (I.S. Trad.). Porto Alegre: Artes Me´diAdolesce cas. (Original paper published in 1991). Mari, J., & Williams, P. (1986). A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sa ˜ o Paulo. British Journal of Psychiatry, 118, 23–26. Minde, K. (1993). Prematurity and serious medical illness in infancy: Implications for development and intervention. In C.H. Zeanah Jr. (Ed.), Handbook of infant mental health (pp. 87–105). New York: The Guilford Press. ` Miranda, M. (1996). Fatores psicossociais associados a ´ de mental de crianc¸as no inı´cio da escolarizac¸˜ao. sau Master’s Thesis, Universidade Federal de Sa ˜ o Paulo, Sa ˜ o Paulo. Mrazek, D.A., Anderson, I.S., & Strunk, R.C. (1985). Disturbed emotional development of severely asthmatic preschool children. Journal of Child Psychology and Psychiatry, 26, 81–94. Murray, L. (1992). The impact of posnatal depression on infant development. Journal of Child Psychology and Psychiatry, 33, 543–561. Osofsky, J.D., Hann, D.M., & Peebles, C. (1993). Adolescent parenthood: Risks and opportunities for mothers and infants. In C.H. Zeanah Jr. (Ed.), Handbook of infant mental health (pp. 106–119). New York: The Guilford Press.
788
Luciana Anselmi et al.
Rae-Grant, N., Thomaz, H., Offord, D.R., & Boyle, M.H. (1989). Risk, protective factors and the prevalence of behavioral and emotional disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 262–268. Rohde, L.A., Busnello, E., Chachamovich, E., Vieira, G., Pinzon, V., & Ketzer, C. (1998). Transtorno de de´ficit de atenc¸a ˜ o/hiperatividade: revisando conhecimentos. Revista da Associac¸˜ao Brasileira de PsiquiatriaAPAL, 20, 166–178. Rutter, M. (1981). Stress, coping and development: Some issues and some questions. Journal of Child Psychology and Psychiatry, 22, 323–336. Rutter, M. (1996). Stress research: Accomplishments and tasks ahead. In (R.J. Haggerty, L.R. Sherrod, N. Garmezy, & M. Rutter (Eds.), Stress, risk, and resilience in children and adolescents: Process, mechanisms, and interventions (pp. 355–385). Cambridge: Cambridge University Press. Sameroff, A.J., Seifer, R., Zax, M., & Barocas, R. (1987). Early indicators of developmental risk: Rochester Longitudinal Study. Schizophrenia Bulletin, 13, 383– 394. Sameroff, A.J. (1993). Models of development and developmental risk. In C.H. Zeanah Jr. (Ed.), Handbook of infant mental health (pp. 120–142). New York: The Guilford Press. Sameroff, A.J., Seifer, R., Baldwin, A., & Baldwin, C. (1993). Stability of intelligence from preschool to adolescence: The influence of social and family risk factors. Child Development, 64, 80–97. Samantiengo, V.C. (1995). El Child Behaviour Checklist: ´ n y aplicacio ´ n en un estudio episu estandartizacio ´ gico: Problemas comportamentales y sucessos demiolo de vida en nin ˜ os de 6 a 11 an ˜ os de edad. Master’s Thesis, Universidad de Buenos Aires, Buenos Aires. Seifer, R., Sameroff, A., Dickstein, S., Keitner, G., Miller, I., Rasmussen, S., & Hayden, L. (1996).
Parental psychopathology, multiple contextual risks, and one-year outcomes in children. Journal of Clinical Child Psychology, 25, 423–435. Stern, M., & Karraker, K.H. (1990). The prematurity stereotype: Empirical evidence and implications for practice. Infant Mental Health Journal, 11, 3–11. Teti, D.M., Sakin, J.W., Kucera, E., Corns, E., & Eiden, R.D. (1996). And baby makes four: Predictors of attachment security among preschool-age firstborns during the transition to siblinghood. Child Development, 67, 579–596. Velez, C.N., Johnson, J., & Cohen, P. (1989). A longitudinal analysis of selected risk factors for childhood psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 861–864. Victora, C.G., Barros, F.C., & Vaughan, J.P. (1988). Epidemiologia da desigualdade. Sa ˜ o Paulo: Hucitec. Victora, C.G., Barros, F.C., Halpern, R., Menezes, A., Horta, B., Tomasi, E., Weiderpass, E., Cesar, J., Olinto, M., Guimara ˜ es, P., Garcia, M., & Vaughan, J. (1996). Estudo longitudinal da populac¸˜ao maternoinfantil da regia ˜ o urbana do sul do Brasil, 1993: ´ gicos e resultados preliminares. Aspectos metodolo ´ de Pu ´ blica, 30, 34–45. Cadernos de Sau Wechsler, D. (1991). Test de Inteligencia Para Preescolares (WPPSI) Manual. Buenos Aires: Paidos.(Original paper published in 1963). Weissman, M.M., Gammon, D.G., John, K., Merinkas, K.R., Warner, V., Prusoff, B.A., & Sholomskas, D. (1987). Children of depressed parents: Increased psychopathology and early onset of major depression. Archives of General Psychiatry, 44, 847–853. Winnicott, D.W. (1966). A crianc¸a e o seu mundo. (A. Cabral, Trad.). Rio de Janeiro: Zahar. (Original paper published in 1964). Manuscript accepted 24 June 2003
