جستجوی مقالات مرتبط با کلیدواژه « externalizing problems » در نشریات گروه « پزشکی »

Psychological problems in children are a significant public health concern. These problems can affect the well-being of children, their families, and peers and negatively impact the quality of their lives in adulthood. The present research aims to assess the relationship between mothers’ adverse childhood experiences (ACEs) and the internalizing and externalizing problems of children mediated by mothers’ emotional dysregulation and mental capacity.

This is a correlational study using structural equation modeling. The study population consists of all married women with children aged 6-12 in Bushehr Province, Iran, who had registered information in the electronic comprehensive health services system in 2022. Utilizing a random cluster sampling method, 700 women were selected, of whom 632 completed the online questionnaires, including the child behavior checklist, the ACE questionnaire, the difficulties in emotion regulation scale, and the parental reflective functioning questionnaire. All analyses were performed in SPSS Software, version 26 and AMOS version 24 software.

The ACE of mothers had a direct and significant relationship with their emotion regulation difficulties (β=0.363, P<0.001) and internalizing (β=0.182, P<0.001) and externalizing problems (β=0.201, P<0.001) of children. Additionally, the ACE in mothers had an indirect and significant relationship with their mental capacity (β=-0.125, P=0.006). The ACE of mothers also had an indirect and significant relationship with internalizing (β=0.126, P<0.001) and externalizing (β=0.134, P<0.001) problems of children through emotion dysregulation. The ACE of mothers also had an indirect and significant relationship with externalizing problems of children (β=0.011, P=0.039) through mental capacity.

Mothers’ ACEs have a direct impact on their children’s internalizing and externalizing problems. This relationship can also be mediated by their emotional dysregulation and mental capacity.

Externalizing problems are associated with numerous unpleasant consequences, i.e., among the most frequent reasons for children’s referral to mental healthcare centers. Various factors were proposed respecting this issue’s etiology, ranging from genetic to environmental and familial features. However, mother-child interactions, and especially the mother-child discourse during preschool can impact the formation or reduction of numerous problems in such children. As per different theories, the components of the mother-child discourse are related to the child’s mental representations of attachment as well as the child’s narrative coherence ability. However, few interventions focusing on children’s behavioral problems have particularly addressed the significance of mother-child discourse. Therefore, the present study aimed to investigate the effects of a formulated intervention based on the mother-child discourse model on reducing externalizing problems by reducing negative mental representations and increasing the narrative coherence of children with externalizing problems.

This was a quasi-experimental study with a pretest-posttest-follow-up and a control group design. The statistical population of the study consisted of 4- to 6-year-old children with externalizing problems in the kindergartens of the Welfare Organization of Tehran City, Iran, and their mothers in 2018. Twenty-six mother-child couples whose children had externalizing problems were selected using the convenience sampling method. After homogenization based on demographic variables (children’s age & gender, and the educational level & occupation of the mothers), they were randomly divided into two groups; 15 couples were assigned per group. At the end of the study, 3 couples in the experimental group (n=12 couples( and 4 couples in the control group )n=11 couples( were excluded. The inclusion criteria of the research for the mothers included having a diploma and the lack of anxiety disorders and depression based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5); for children, the same was an age range of 4 to 6 years, receiving a score within the range of externalizing problems (65-69) according to the Child Behavior Checklist (CBC; Achenbach & Rescorla, 2001), and not taking psychiatric drugs. Then, the children were assessed by the CBC concerning externalizing problems. Moreover, the MacArthur Story Stem Battery (Emde et al., 2003) was applied to examine the negative mental representations of attachment and narrative coherence in them. Furthermore, the intervention sessions were entitled "intervention based on mother-child discourse", i.e., a short-term approach to reduce externalizing problems in children. This package was prepared under the supervision of child psychologists; the content validity method was used to validate the package. The study was conducted in seven 2-hour weekly sessions with 4 sessions for mothers and 3 sessions for the mothers and children. Repeated-measures Analysis of Variance (ANOVA) and Bonferroni posthoc test were used for data analysis in SPSS at the significance level of 0.05.

The repeated-measures ANOVA data revealed that the main effect of time was significant on externalizing problems (p<0.001), the negative mental representation of attachment to the mother (p<0.001), and the child’s narrative coherence (p=0.020). Moreover, the main effect of intergroup was significant on externalizing problems (p=0.040) and the negative mental representation of attachment to the mother (p<0.001). Accordingly, the mean scores of the experimental and control groups were significantly different; however, children's narrative coherence was not significantly different between the two groups, suggesting that the change over time was the same for both study groups. Besides, the intervention for externalizing problems (F1.22=116.89, p<0.001, Ƞ=0.84), the negative mental representation of attachment to the mother (F1.22=165.00, p<0.001, Ƞ=0.82), and the child’s narrative coherence (F1.22=5.90, p<0.020, Ƞ=0.21) were significant. In terms of externalizing problems, the difference between pretest and posttest stages (p<0.001), and pretest and follow-up steps (p<0.001) was significant; however, there was no significant difference between the posttest and follow-up stages, indicating the persistence of the intervention (p=0.460). Respecting negative mental representation, the difference between pretest and posttest stages (p<0.001) and pretest and follow-up steps (p<0.001) was significant; however, there was no significant difference between the posttest and follow-up stages, reflecting the persistence of the intervention effects (p=0.170). There was a significant difference between pretest and posttest (p=0.010) and pretest and follow-up stages (p=0.040) in narrative coherence; however, there was no significant difference between the posttest and follow-up stages, demonstrating the persistence of the intervention effects (p=0.560).

According to the present research results, the intervention based on the mother-child discourse model was useful for reducing externalizing problems, reducing negative mental representations, and increasing the narrative coherence of children with externalizing problems.

The problems of childhood can be generally divided into two large, but overlapping groups of internalizing and externalizing problems. Internalizing and externalizing behavioral problems can negatively affect the different functions of children and adolescents. Present study aimed to investigate the role of parenting styles, parental stress and children’s executive functions deficits in predicting the childrenchr('39')s internalizing and externalizing problems.

The present research was a descriptive correlational study. The study population included all the male primary school students in district 2 of Rasht city in the academic year of 2018-2019 and their parents. From this population, a sample of 375 students was selected by multistage cluster sampling. They completed Parenting Stress Index (Abidin, 1990), Parenting Questionnaire (Frick, 1991), Barkley Deficits in Executive Functioning Scale (Barkley, 2011), and Child Behavior Checklist (Achenbach & Rescorla, 2001). Data were analyzed by Pearson correlation coefficient and step-wise regression method.

Findings showed that there was a significant negative correlation between positive parenting, father involvement and awareness and childrenchr('39')s internalizing and externalizing problems. It was also found that corporal punishment, poor monitoring and authority had a significant positive correlation with childrenchr('39')s internalizing and externalizing problems. Also, results showed that parental stress and childrenchr('39')s executive functions deficits (and its components) had a significant positive correlation with childrenchr('39')s internalizing and externalizing problems (P> 0.01). Results of regression indicated that executive functions, father involvement, corporal punishment, authority, awareness, positive parenting, and poor monitoring were predictors of internalizing problems, whereas father involvement, executive functions, positive parenting, stress, corporal punishment, emotional self-regulation, awareness, authority, and poor monitoring were predictors of childrenchr('39')s externalizing problems (P> 0.01).

Based on the findings of this study, it can be concluded that positive parenting, father involvement and awareness are negative predictors of childrenchr('39')s internalizing and externalizing problems, whereas corporal punishment, poor monitoring, authority, parental stress, and childrenchr('39')s executive functions deficits are positive predictors of childrenchr('39')s internalizing and externalizing problems. Findings of the present study can help to the development and implementation of effective preventive and therapeutic interventions for behavioral disorders in children.