Effects of the Family Check-Up on Childhood Parent-Child Relationships and Co-occurring Internalizing and Externalizing Problems

• In Event: Continuing the Quest Towards Understanding Co-occurring Internalizing and Externalizing Problems: Methodologies, Risks, and Clinical Implications

Abstract

Introduction. The goal of this study was to examine the contribution of parent-child interaction in early childhood to later externalizing and internalizing problems and how random assignment to the Family Check-Up (FCU) intervention affected these connections. Early onset internalizing and externalizing problems are among the most potent risk factors for a host of adverse outcomes later in life, including adult psychiatric disorders, violence, and substance use. Researchers have examined the association between different facets of the parent-child relationships with child externalizing and internalizing problems extensively. The bulk of research has examined associations between risk factors for early onset internalizing and externalizing problems as separate and distinct entities. However, high rates of comorbidity among psychiatric disorders suggest that co-occurring and unique components of problem behaviors should be systematically studied. We applied bi-factor confirmatory factor analysis to uncover the co-occurring and unique dimensionalities of child internalizing and externalizing problems across early and middle childhood. We then used parallel and sequential growth curve modeling (GCM) to examine the effects of parent-child constructive interaction (i.e., more positive engagement and less coercion) across early childhood (age 2-4) on children’s common and specific internalizing and externalizing factors in early childhood and middle childhood (ages 7.5-10.5 years). We also examined how the FCU affects these associations, especially the mediation effects of FCU on these common and specific factors through parent-child interaction. Methods. The sample consisted of 731 children (49% female; 47% White, 28% African American, 13% Hispanic, 10% biracial, and 2% others) and parents who were recruited from WIC programs at three geographically diverse communities and randomly assigned to the FCU (n = 367 FCU) or usual care (n = 364 control) conditions. The FCU was offered across childhood annually through age 10.5 beginning when the children were 2 years except at age 6. Parent report on the age-appropriate Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000, 2001) was used as outcome measures at ages 2, 3, 4, 7.5, 8.5, 9.5, and 10.5. Reliable coding of positive engagement and coercion from videotaped parent-child interaction tasks at ages 2-5 were used as the parent-child relationship variables. Results. The bifactor model that included a general psychopathology (P) factor and domain-specific factors of internalizing and externalizing problems fit adequately at all seven ages. Equivalence of the bi-factor structure was also established separately by early and middle childhood after removing ill-fitted items. GCM modeling showed that the FCU predicted steeper declines in the early childhood P factor trajectory, which in turn, predicted lower middle childhood P factor intercept but not slope. However, the FCU was not related reductions in the specific internalizing and externalizing problems factors. The preliminary two-stage GCM indicated that families assigned to the FCU showed improvement in parent-child engagement and coercion from age 2 to age 3 with differences stabilizing across later development. The preliminary analysis also indicated that the intervention effect of the FCU on strengthening early parent-child relationships was further related to reduced general, co-occurring psychopathology across early and middle childhood.

Authors

• Jenn-Yunn Tein, Arizona State University
  Presenting Author

• Cheuk Hei Cheng, Arizona State University

• David P. MacKinnon, Arizona State University

• Daniel S. Shaw, University of Pittsburgh

• Melvin N Wilson, University of Virginia -Charlottesville

• Kathryn Lemery-Chalfant, Arizona State University