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Caregivers of children with health problems have been demonstrated to show poorer physical and psychological health than caregivers of healthy children. It has been suggested that child behavioural problems are key and account for a large proportion of the variance in caregiver health. Currently, the relation between behaviour problems and caregiver health remains unclear. We conducted a meta-analysis and a secondary data analysis using national data to describe and compare the associations between internalizing and externalizing behaviour problems and caregiver health. Meta-analytical results suggest an association between child behaviour problems and parental stress, depression, and presence of psychiatric symptoms. National data analyses suggested an important association between child behaviour problems, particularly externalizing behaviour problems, and caregiver physical and psychological health when accounting for socioeconomic variables. Results suggest mothers may be more impacted than fathers, and that externalizing behaviour problems may contribute to bigger caregiver health effects than internalizing behaviour problems.

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Background: A key driver for early years strategies is the reduction of oppositional and defiant behaviour in childhood to prevent a negative life course of poor educational attainment and criminality. Despite a robust evidence base, manualised parent skills training programmes (PT) for externalising behaviour problems are only effective for approximately two-thirds of families. A limited number of variables that account for variance in outcome have been discovered. Finding further predictor, moderator and mediator variables will explain who benefits most, and how change occurs. This will ensure that families receive the most appropriate treatments for their profile of needs, and services deliver the available interventions in an efficient and effective way. Objectives: A systematic review of the literature was conducted to explore progress in this area since two key meta-analyses published in 2006. A primary study was carried out to examine whether parent attachment style, parenting self-efficacy and dysfunctional parental attributions predict, moderate or mediate the levels of externalising child behaviour problems reported by parents attending the Incredible Years PT. Methods: Studies exploring variables influencing outcome in child behaviour following attendance at a manualised, evidence-based PT group for parents of children and adolescents aged 0-18 years were sought. Psychinfo, Medline, ERIC and Embase databases were searched for articles published between August 2004 and March 2013 with keywords ‘parent’, ‘child’, ‘training’, ‘indirect effects’ and ‘oppositional behaviour’ or related terms. 2853 articles were retrieved, from which 12 studies fulfilled criteria. Study quality was appraised and co-rated. A pre-post, within subjects design was conducted with 79 parents attending the Incredible Years PT delivered in a Child and Adolescent Mental Health Service. Participants completed a battery of pre-treatment questionnaires measuring attachment style, attributions, self-efficacy and child behaviour. 52 parents completed the same battery post-treatment, and missing data was carried forward in an intent to treat analysis. Data was analysed using multiple regression techniques, and mediation and moderated mediation analyses. Results: The recent evidence base is populated by secondary analyses of intervention RCTs, and less robust non RCTs. The selection of maternal mood, parenting stress, parenting style and child demographics dominate, and the exploration of unique variables is limited. Significant findings are mixed and add no new variables to our understanding. Significant changes in parenting self-efficacy and dysfunctional attributions were found post-treatment, and attachment style remained stable. A main treatment effect size of d=.3 was estimated, and a significant number of children fell below sub-clinical levels of problem behaviour (n=13, 15.7%). Baseline child-responsible attributions and self-efficacy accounted for up to 40% of the variance in baseline child behaviour. Attachment style did not contribute significantly to the model, but moderated parent-causal attributions. Post-treatment, attachment avoidance had a moderating effect on self-efficacy and child-responsible attributions, and a significant direct effect on outcome. The indirect effect of parental-attributions on child behaviour through self-efficacy was moderated by attachment avoidance which reduced the number of significant paths. Conclusions: The call for PT studies delivered with fidelity in real world settings has been recognised, and more sophisticated statistical models of mediation are being adopted. There remains an exhaustive list of novel potential variables that future research needs to select and explore in primary research designs. An evidence based PT is achieving statistically and clinically significant results for children referred for problem behaviour. Dysfunctional parent attributions and self-efficacy are predictors of both pre- and post-treatment levels of child behaviour, which could be screened for in the referral process. The evidence for a direct and indirect role of attachment style on parent training outcomes adds a new candidate variable to the literature that warrants further exploration.

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A baby’s early experiences have a crucial effect on their later development and adjustment. Early maternal sensitivity is a concept which has been associated with a crucial influence on these later child outcomes, including behavioural outcomes. Results from large longitudinal population based studies have provided conflicting evidence in relation to early maternal sensitivity, particularly sensitivity to non-distress, and later child behaviour and a need for further research in this area exists. The current study investigated early maternal sensitivity and its association with later child behaviour in a UK based population sample using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). The study used a subsample of 766 mother-infant pairs who had data on observed maternal responsiveness at 12 months and on child behavioural difficulties derived from the Revised Rutter Parent Scale for Preschool Children at 42 months. Data for a number of potentially confounding variables, including maternal and child-based variables were also included in the analysis. Hypotheses were tested regarding an association between lower maternal responsiveness and higher child behavioural difficulties as well as regarding associations with further behavioural subscales of the Rutter scale, including a prosocial behaviour subscale. Results were analysed using a linear regression model with adjustments for groups of confounding variables. There was no evidence to support a relationship between lower maternal responsiveness and higher behavioural difficulties at 42 months although there was suggestion of a trend in the expected direction. Similar results were found for the subscales of the Rutter scale. The conclusion is that maternal sensitivity measured in this way does not have a strong relationship with child behaviour. One interpretation of these results is that there is a need to distinguish between maternal sensitivity to non-distress and to distress and ensure that the appropriate aspect of maternal sensitivity in relation to child behavioural outcomes is assessed. Limitations of the study are discussed and the effects of potential improvements are considered.

This thesis addresses the issue of environmental influences on the manifestation of unwanted child behaviours (UCBs) in early childhood services. Specifically it examines the evidence for UCBs that result from the interface of physical, social, structural, and cultural components of the environment of a child care centre with the psychological habitats of individual children over the full day of their attendances. The identified unwanted behaviours are used as starting points to analyse children’s behaviour streams for indication of environmental influences in the production of UCBs and to establish common patterns of influence across different children. To facilitate a systematic investigation of the complex child:environment relationships in a child care centre, a conceptual framework was developed to describe time-space locations of settings and situations, the basic components of environmental influence, the child’s psychological habitat, UCBs, and the contextualisation of child behaviours in situ. The framework was utilised to review literature associated with components of both the child’s psychological habitat and the environment of a child care centre, implement an appropriate data collection strategy, as well as guiding data analysis and interpretation of findings. The qualitative approach to data collection involved full-day observations of individual children and recording on audio-tape a continuous concurrent narrative of their actions within a variety of settings and situations. Observations of 30 different children over 54 days yielded almost 400 hours of recordings, which were transcribed onto more than 1000 typed pages. Examination of the transcripts provided evidence of 1384 manifestations of UCBs embedded in 1028 distinct sequences of unwanted behaviours within behaviour streams. Analysis of the behaviour streams and interpretation of antecedent events implicated a variety of interrelated physical, social, structural, and cultural factors in the production of UCBs, which are considered in light of findings from previous studies. Overall, no single factor was found to influence the behaviours of all children, or the same child across different settings and situations. The findings serve to reinforce the known complexity of person:environment relationships, which is further intensified in children between the ages of 3-5 years by their developing socio-emotional and cognitive systems, innate and learned within-child characteristics, and different experiences of centre-based child care. The findings also reinforce the need for practitioners and researchers to consider more fully the individuality of each child when planning programs and investigations into the impact of child care on children. Implications of the findings for practitioners are stated and recommendations are made for future research. / PhD Doctorate