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Parent Identification of Early Emerging Child Behavior Problems
Predictors of Sharing Parental Concern With Health Providers
Katherine D. Ellingson, BS;
Margaret J. Briggs-Gowan, PhD;
Alice S. Carter, PhD;
Sarah M. Horwitz, PhD
Arch Pediatr Adolesc Med. 2004;158:766-772.
Objectives To better understand the predictors of parental discussions with pediatric care providers (pediatricians, psychologists/psychiatrists, social workers, early intervention providers, or other medical specialists) regarding early child behavior problems and to suggest strategies for eliciting early identification from parents in health care settings.
Design A cross-sectional survey of parents of children from a representative healthy birth cohort. The survey included the Infant-Toddler Social Emotional Assessment, measurement of parental worry regarding problematic behavior, and demographic factors.
Setting Fifteen urban and suburban towns in the northeastern United States.
Participants The study sample consisted of all parents of 11- to 39-month-olds (n = 269) who exceeded the 90th percentile on 1 or more Infant-Toddler Social Emotional Assessment problem domain scores (representing elevated problematic behavior symptoms) from an original sample of 1278.
Results Few parents (17.7%) who reported elevated problematic behavior spoke to a provider about such problems. In adjusted models, speaking to a provider was associated with reported worry about behavior (odds ratio [OR], 3.47 [95% confidence interval (CI), 1.74-6.92]) and with low reported child social-emotional competence (OR, 2.68 [95% CI, 1.23-5.84]). In adjusted models, worry was most likely among parents who reported low child competence (OR, 2.18 [95% CI, 1.07-4.22]) and disruption in family routines attributed to the child's behavior (OR, 2.38 [95% CI, 1.31-4.33]).
Conclusions Parental worry is a robust predictor of help seeking among parents of children with behavioral problems. Further, lags in social competence contribute to both parental worry and help seeking. These findings, in conjunction with previous evidence that child behavior problems amenable to early intervention are often unidentified, suggest that systematic inquiry by health care providers about parental concerns is important in the identification of early emerging behavioral health problems.
From the School of Epidemiology and Public Health, School of Medicine (Ms Ellingson and Dr Briggs-Gowan), and the Department of Psychology (Dr Briggs-Gowan), Yale University, New Haven, Conn; the Department of Psychology, University of Massachusetts, Boston (Dr Carter); and the Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Horwitz).
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