Search

Objective: Parenting practices and cognitions are associated with child externalizing behavior problems. Parenting programs targeting these areas are effective in improving child behavior but are limited to the extent to which they reach at-risk families. This study compared the parenting practices and cognitions of parents with high and low tolerance for misbehavior to parents of children with clinically significant behavior problems to evaluate the utility of assessing parental tolerance for identifying children at risk for externalizing behavior problems., Methods: Participants were 1014 parents of children between the ages of 2 and 16 years presenting for primary care. Parents completed the Eyberg Child Behavior Inventory, Parenting Scale, and Parenting Sense of Competence Scale., Results: Parents with high and low tolerance resembled the clinically significant problem groups in both parental behaviors and cognitions. Differences regarding parental cognitions were consistent across all age groups assessed., Conclusions: This study demonstrated the clinical utility of interpreting caregiver responses to questions about the intensity of their child's behavior problems and parental tolerance for these problems separately. Results indicated that parents with high or low tolerance for their child's behavior are at risk of having children with clinically significant behavior problems. Parents who are concerned about their child's behavior, even if their child does not currently exhibit clinically significant behavior problems, are likely to profit from early intervention for behavior problems.

BACKGROUND. Between 15% and 25% of children who visit primary care physicians have emotional, behavioral, or psychiatric problems that affect their functioning. The majority of these children are treated by primary care physicians. The purpose of this study was to examine the presentation and treatment of children's psychosocial problems in primary care and to investigate ways in which physician management of a problem is related to parent-physician agreement that the problem exists. METHODS. Twenty-six physicians at an ambulatory care center of a community-based, university-affiliated family medicine training program collected data during outpatient visits of 898 children aged 2 to 16 years. The physicians used a checklist to collect data on children's developmental problems, parents' concerns about the psychosocial functioning of their children, whether physicians and parents were in agreement about these concerns, and the parents' influence on physicians' management of the problems. RESULTS. Family physicians and parents agreed that 10% of the children were experiencing psychosocial problems. For 5% of children, physicians recorded emotional or behavioral concerns when parents did not disclose any such concerns. For only 1.8% of children, parents raised psychosocial concerns while physicians did not. Physicians diagnosed and managed psychosocial concerns during both acute-care and well-child visits. When parents and physicians agreed on the presence of pediatric psychosocial problems, referral to a mental health professional was more likely than when they disagreed (60% vs 16%). CONCLUSIONS. Pediatric psychosocial concerns are raised by parents during acute-care and well-child visits. Family physicians identified and managed these problems at rates consistent with past research. Management strategies appeared to differ as a function of agreement between physicians and parents on whether a problem existed. [ABSTRACT FROM AUTHOR]