Parent identification of early emerging child behavior problems: predictors of sharing parental concern with health providers.

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.

[1]  Ana Mari Cauce,et al.  Cultural and contextual influences in mental health help seeking: a focus on ethnic minority youth. , 2002, Journal of consulting and clinical psychology.

[2]  E. Costello,et al.  Perceived parental burden and service use for child and adolescent psychiatric disorders. , 1998, American journal of public health.

[3]  C. Gardner,et al.  How people get into mental health services: stories of choice, coercion and "muddling through" from "first-timers". , 1998, Social science & medicine.

[4]  M. Bax,et al.  Behaviour problems in pre-school children. , 1980, Journal of child psychology and psychiatry, and allied disciplines.

[5]  Todd D. Little,et al.  The Infant–Toddler Social and Emotional Assessment (ITSEA): Factor Structure, Reliability, and Validity , 2003, Journal of abnormal child psychology.

[6]  D. Satcher.  Executive summary: a report of the Surgeon General on mental health. , 2000, Public health reports.

[7]  A. Erkanli,et al.  Children's mental health service use across service sectors. , 1995, Health affairs.

[8]  Margaret J. Briggs-Gowan,et al.  Prevalence of social-emotional and behavioral problems in a community sample of 1- and 2-year-old children. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[9]  J. Steven Reznick,et al.  Short-form versions of the MacArthur Communicative Development Inventories , 2000, Applied Psycholinguistics.

[10]  Margaret J. Briggs-Gowan,et al.  Do needs drive services use in young children? , 2003, Pediatrics.

[11]  F. Glascoe,et al.  Obstacles to Effective Developmental Surveillance: Errors in Clinical Reasoning , 1993, Journal of developmental and behavioral pediatrics : JDBP.

[12]  E. Foster,et al.  An economic analysis of developmental detection methods. , 1997, Pediatrics.

[13]  R. Andersen,et al.  Societal and individual determinants of medical care utilization in the United States. , 1973, The Milbank Memorial Fund quarterly. Health and society.

[14]  W. Stone,et al.  The Importance of Parents' Concerns About Their Child's Behavior , 1991, Clinical pediatrics.

[15]  A. Brannan,et al.  Distinguishing Caregiver Strain from Psychological Distress: Modeling the Relationships Among Child, Family, and Caregiver Variables , 2001 .

[16]  J. Weisz,et al.  Adult attitudes toward over- and undercontrolled child problems: urban and rural parents and teachers from Thailand and the United States. , 1991, Journal of child psychology and psychiatry, and allied disciplines.

[17]  I. Rosenstock.  Why people use health services. , 1966, The Milbank Memorial Fund quarterly.

[18]  A. Kleinman,et al.  Sociocultural Determinants of the Help‐seeking Behavior of Patients with Mental Illness , 1982, The Journal of nervous and mental disease.

[19]  F. Verhulst,et al.  Factors associated with child mental health service use in the community. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[20]  E. Costello,et al.  How can epidemiology improve mental health services for children and adolescents? , 1993, Journal of the American Academy of Child and Adolescent Psychiatry.

[21]  A. Beck,et al.  An inventory for measuring clinical anxiety: psychometric properties. , 1988, Journal of consulting and clinical psychology.

[22]  Margaret J. Briggs-Gowan,et al.  The Brief Infant-Toddler Social and Emotional Assessment: screening for social-emotional problems and delays in competence. , 2004, Journal of pediatric psychology.