A Developmental Model of Children’s Early Conduct Problems:

Theory, Validation, and Implications

 

Identification and Prevention of Early Conduct Problems

Introduction

This paper describes and applies a developmental model of early conduct problems proposed earlier this decade.  For a more complete description of the model, please see the following papers.1, 2  This task will be carried out by reviewing the model’s original tenets, examining its validity using two cohorts of at-risk families, and offering recommendations for basic and applied studies.

The rationale for developing a model beginning during infancy was based on the high stability of antisocial behavior beginning in early childhood, the difficulty of treating antisocial youth, and the disruption antisocial youth cause for other individuals and society.3  Despite the plethora of research on the treatment of antisocial behavior in childhood, efforts to prevent its development have proven to be difficult. 4, 5  This limited success may be due to our inability to fully understand either the developmental trajectories leading to the disorder or the most appropriate content and timing of the intervention.  As an example, past research on treatment of conduct problems has shown that interventions implemented prior to school-age have a higher probability of success.6  In response to the need to more fully understand the origins of early conduct problems,7, 8 Shaw and Bell2 proposed a bridging model of early conduct problems beginning in early childhood. 

Initial Bridging Model of Antisocial Behavior

 

The goal of the bridging model was to integrate theory and normative empirical work on young children’s development with studies of correlates of older children’s conduct problems1 (CP).  The work of several investigators figured prominently in the development of the bridging model.  At a broad level, Hirschi’s9 social control theory provided a mechanism from which to understand parental influence, as the antisocial child’s lack of self-control was postulated to emerge from his inability to form an attachment to parents in early development.  Sroufe’s10 conceptualization and application of attachment theory to early conduct problems was also instrumental, describing how avoidant working models are formed during infancy and demonstrating how they predisposed children to show later noncompliant and hostile acting out behavior.11  Greenberg’s and Speltz’12 cognitive-affective model, also conceptualized from an attachment perspective, provided specific examples of how parent-child interchanges from ages 2 to 4 would lead to early disruptive behavior based on the dyad’s inability to form a goal-corrected partnership.  Finally, Patterson’s13 model of coercion applied principles from social learning theory to explain how patterns of family interaction might produce conduct problems in school-age children, a model adapted and validated in early childhood by Martin.14  Martin’s work provided the critical empirical link for the model by demonstrating longitudinal associations between unresponsive caregiving and coercive parent-child interaction, thereby establishing a bridge between attachment and social learning models.

Methodologically, we adopted the reciprocal effects model of Bell15 and the transactional perspective of Sameroff.16  We also considered it critical to incorporate the normal cognitive and emotional changes that children undergo from infancy to school entry.  Thus, our framework considered (1) ongoing influences that parents and children have on each other,15 and (2) the previous behavior of both parents and children in accounting for their later behavior16 within the context of children’s rapidly evolving development.  As is evident from our use of several other earlier theoretical frameworks, the model is an attempt to combine and integrate previous perspectives on developmental psychopathology.  Its novelty rests primarily on its ability to synthesize perspectives from disparate theoretical frameworks and different developmental periods to provide a cohesive framework for understanding processes leading to the antecedents of conduct problems in early childhood.

Integration of Attachment and Social Learning Models

 

A primary goal of the model was to account for sequencing of early disruptive behaviors using a developmental framework.  One paradigm that has been used to understand the development of conduct problems is coercion, a process that Patterson13 utilized to describe the conflictual pattern of interaction exhibited by disruptive school-age children and their families.  In a coercive cycle, parent and child each behave in a way that is aversive to the other in order to control the other's behavior.  As the child becomes increasingly irritating, the parent escalates power assertion techniques.  As the child's aversive behaviors increase in intensity and frequency, the parent acquiesces, unwittingly reinforcing them.  These cycles eventually lead to the child's open defiance and behavior problems that in later development include being away from home excessively, lying, stealing, and more serious behaviors such as fire-setting.  Patterson and colleagues8 formalized the "early starter model," which is one of two pathways by which children may emerge as chronically offending delinquent adolescents and antisocial adults.  The other pathway, the late starter trajectory, emerges in early adolescence and in most cases has been associated with less chronic and serious offending.  According to Patterson’s early starter model, families provide direct training in antisocial behavior for young boys through their family management practices.  While Patterson13 acknowledges that children contribute to parent’s ineffective parenting, greater emphasis is placed on parent than child characteristics.  Alternatively, Moffitt’s17 early-starter model emphasizes impairments in child’s early neuropsychological functioning, as manifested by the cognitive deficits associated with ADHD (inattention, poor organization, and planning), which in turn are postulated to elicit ineffective parent management strategies and a trajectory of persistent conduct problems.

Attachment theory has also been used to provide a framework for understanding the origins of early conduct problems.18  Psychoanalysts such as Anna Freud and Spitz were among the first to point out the importance of the social role played by the mother in socioemotional development.  The mother's interaction with the infant was seen as leading the infant to perceive her as accessible and supportive, thus promoting ego development and movement through the normative stages of socioemotional development.  Ethological and evolutionary theory placed still greater emphasis on the communicative function of emotions and social relationships, as well as on the adaptive value of the mother-infant relationship.  Bowlby19 extended this theory by pointing out that signals such as smiles and cries provide the foundation for attachment bonds that promote the infant's proximity to protective adults and thus have survival value.  Ainsworth's and Wittig’s20 differential theory, in turn, applied Bowlby's general theory to individual differences.  She specified the characteristics of the caregiver, such as contingent and appropriate responsiveness, that are presumed to produce secure versus anxious attachments.  Attachment security is thought to reflect the infant’s internal working schema or model.  This model lays the groundwork for patterns of social information processing in early childhood, which in turn underlie the child’s social and antisocial behavior.21  Securely attached infants would also be expected to function more harmoniously with their mothers in compliance situations because they are motivated to please the mothers, and attend to what she approves or disapproves.22  Moving into the preschool period, Greenberg and Speltz12 contend that disruptive behavior is an attempt to get attention or control the behavior of unresponsive or unpredictable caregivers in the absence of a goal-corrected partnership.  Accordingly, secure preschoolers and their parents should be working together effectively in household work and problem situations as the child becomes more adept at managing his own emotions, and at enlisting the help of caregivers when emotions threaten to become disorganizing.14

In integrating attachment theory with Patterson’s coercion model, we believed it was important to account for the quality of the parent-infant affective relationship in influencing the course of social learning processes.  Thus, infants who were shown less contingently sensitive caregiving in the first 12 months would be more oppositional and defiant in responding to parental requests for attention.  The potential for dyadic conflict was thought to peak between 18 and 30 months (i.e., the terrible twos), when toddlers’ newfound mobility and potential for naive mischief would stimulate parents to use control strategies and increase demands for socially appropriate behavior.  While coercion theory posits that parental use of inconsistent, permissive, or overly harsh discipline would reinforce children’s oppositional and aggressive behavior, attachment theory suggests that in the first two years the quality of the parent-child relationship would place specific dyads at greater risk for engaging in these aversive interchanges, which in turn would set the stage for escalating parent-child conflict and conduct problems at preschool-age.

Importantly, several types of child attributes could potentially compromise the quality of the parent-infant relationship, increase the likelihood of coercive parenting, and ultimately, escalate the frequency and intensity of child disruptive behavior.  In addition to aggressive and oppositional behavior, other forms of aversive child behavior include overactivity, emotional reactivity or unresponsivity, or low behavioral inhibition, the latter expressed by an attraction to unknown or even scary stimuli (e.g., electric plugs, high pitched sounds, walking across streets).  There is some evidence to suggest that each of these factors may be directly related to later conduct problems without considering parental influence.  However, the effects of child factors are likely mediated by the parent’s interpretation of their offspring’s behavior, which is hypothesized to play a critical role in both the formation of attachment bonds and the use of coercive discipline practices.  It also is important to know how such aversive child behaviors are influenced by parental intervention.  For example, an infant whose fussiness persists in the face of parental unresponsiveness or attempts to soothe the infant’s discomfort would be expected to have more adverse outcomes than an infant who desists from fussing on his/her own or in response to parental comforting.

Influence of Siblings

Patterson's13 model of coercion also links sibling interaction to the development of conduct problems, hypothesizing that in homes in which family management practices were disrupted, the additional stress of an older sibling would reinforce and exacerbate the coercive style of the younger child.  Data from Patterson’s 198423 study were consistent with the notion that siblings train younger children to be coercive by modeling and then reinforcing aversive behavior.  However, this was a cross-sectional study of school-age children; research on sibling influence of early conduct problems is relatively limited.24 

 

Contextual Factors

The model would be incomplete without integrating the influence of less proximal contextual factors in the family’s environment.  Some theorists have suggested that the detrimental effects of family and community risk factors should be mediated through more proximal interactions parents have with young children.13, 2  Thus, the effects of such factors as parental psychopathology, parental conflict, and social support may be at least partially accounted for by the quality of the parent-child relationship.13, 2  Alternatively, there is evidence to suggest that exposure to severe parental discord and neighborhood deviancy may exert a direct influence on children’s CP.  Children exposed to such environments may show higher rates of CP because it is modeled in the home and the neighborhood, or more indirectly because it initially causes anxiety that may be channeled into aggressive and oppositional behavior.  For instance, following exposure to a heated argument between parents, some children may have a short fuse in interacting with family members and peers).  Note these mechanisms are not mutually exclusive.  Research on parental adjustment and intrafamily factors, such as parental depression,25 parental conflict,26 parenting hassles,27 social support,28 and neighborhood dangerousness29 all indicate significant associations with child conduct problems.   Particularly in low-income contexts marked by sociodemographic risks such as impoverished housing, high crime, and limited community resources, it would be expected that the effects of within-family contextual factors would be exacerbated by sociodemographic risk.  For example, tolerance of deviant behavior in the neighborhood may influence young children’s propensities to engage in disruptive behavior.29  Just as siblings reinforce power assertive methods parents model to resolve parent-child and parent-parent conflict in the home, neighborhood peers, particularly older ones, model coercive and conflictual behavior in the neighborhood and thereby reinforce children’s tendencies to show aggressive and hostile behavior within and outside of the family context.

In summary, we concur with the observations of earlier investigators taking a developmental perspective towards childhood psychopathology that early conduct problems are generated as a result of transactions between children and their environments over time.30, 31  Particularly during early childhood, it is important to take into account transformations that occur in both child and parent behavior as the child matures.  For example, temperamentally difficult infants might be more noncompliant as toddlers, compared to easy infants.  Moreover, parents who are not responsive during infancy might be less involved and more permissive with their toddlers.  At the same time, transactions between parent and child might help maintain continuity: persistently noncompliant behavior makes enforcing rules more difficult, and hostile parenting reinforces child aggression.  In addition to child and parent behavior, it is also necessary to consider the potential effects of stressors within and outside the family that compromise the quality of the caregiving environment.  We now turn to examining the model’s empirical validity.

Main Findings

Empirical Validation of the Model

Data from two sources have permitted us to test several of the model’s primary tenets from infancy to the early school-age period.1  These include examining direct, additive, and interactional effects of child, parenting, family, and contextual factors on the emergence of early conduct problems (e.g., for parenting, responsiveness during infancy and rejection during the toddler period).  Cohort I involves a sample of 100 children (60% boys), recruited prior to 12 months of age and followed until school-age.32, 33  Cohort II is a sample of 310 boys and 55 girls recruited prior to 18 months of age and at present, followed until age 8.34, 35  Because of funding constraints, follow-up has been more intensive for boys than girls in Cohort II.

Participants

In both cohorts, low-income mothers and their infants were recruited from the Women, Infants, and Children (WIC) Nutritional Supplement Program of Allegheny County, PA.  WIC provides monetary support for the purchase of nutritionally sound foods for low-income families with children ages 0 to 5.  At the time of the infant's birth, mothers in Cohort I ranged in age from 17 to 36, 46% were either married or living together, the majority of families were Caucasian (61%) and the remainder were African-American (39%).  The mean family income in Cohort I was approximately $14,000 per year with 72.5% of the families having yearly earnings equal to or less than $12,000.   Sociodemographic characteristics in Cohort II were comparable, but because families in this cohort were required to have an additional sibling living at home, mother’s age was higher (i.e., x = 28 years, range = 17 and 43 years).  In addition, significantly more mothers in Cohort II were married or living together (62% versus 46% in Cohort I).

Procedures 

In Cohort I, mothers were recruited at WIC offices when infants were between 6 and 11 months old and first seen in our laboratory at age one.  Successive follow-ups for Cohort I occurred in the lab at age 2, and at participants’ homes at 1.25, 5, and 7-8 years, and through the mail at age 3.  Because of Cohort II’s more intensive follow-up and larger sample size, for the purposes of the present paper, a review of data from Cohort I will be limited to assessments conducted in the child’s first three years.  In Cohort II, families were recruited at WIC sites when infants were between 6 and 17 months old.  A  sub-sample of these families (n = 65 boys and 55 girls) were initially seen in our lab at age one.  The remaining 245 boys were initially seen at 1.5 years in the lab, with all boys successively assessed at 2 (lab and home visit), 3.5 (lab), 5 and 5.5 (home), 6 (lab), and 8 (home) years of age.  Follow-ups for girls included assessments at age 1.5 and 2, with questionnaires completed by mail at 3.5 years.   In both samples, family members completed interactive tasks during laboratory and home assessments and parents completed questionnaires on child and parental functioning and family circumstances.

Testing the Model’s Primary Tenets

A couple of issues are important to note before proceeding to a discussion of our results.  First, in all cases experimenter-wise error was controlled for in testing associations to ensure results were not attributable to chance.  The reader is referred to the specific journal articles in which each finding was originally reported for more details.  Second, to date, nearly all of our results are based on measures of conduct problems that tap a heterogeneous constellation of symptom patterns, including defiant, aggressive, impulsive, and hyperactive behaviors.  We have not considered, for example, specific subtypes of children with co-occurring patterns of ADHD and/or oppositional/conduct problems or children who show covert versus overt conduct problems.  There are exceptions to this trend;35, 36 however, we are still in the process of examining the antecedents of other specific patterns of conduct problems, including children with co-occurring externalizing and internalizing problems and those who show predominantly overt versus covert antisocial behavior.  This represents a limitation of the research and its support of the model, which is primarily directed at uncovering antecedents of early onset conduct problems, characterized by high emotional reactivity and a pattern of overt and (eventually) covert antisocial activity. 

Maternal Responsivity and Conduct Problems

Using these two samples of low-income boys, we have been able to test the predictive validity of several of the model’s primary hypotheses.  A primary goal was to validate parental and child contributors of early conduct problems beginning in infancy.  With regard to parental influences, the model’s focus during the first year has been on maternal unresponsiveness.  In accord with attachment theory19 and coercion theory,13 we postulated that a lack of sensitivity to the infant during the end of the first year would be related to later coercive exchanges between parents and children and ultimately to higher rates of children’s conduct problems.  This issue has been investigated using two different observationally-based methodologies.  The first strategy was to measure the mother’s contingent level of responsiveness in relation to infant bids for attention.  Using Martin’s14 high-chair procedure, in which one-year olds are placed in a high-chair with nothing to do while mothers are instructed to complete a questionnaire and attend to the infant, maternal unresponsiveness to the infant’s bids for attention was related to observed noncompliant and/or aggressive behavior at age 2 and maternal report of conduct problems at ages 3 to 3.5 in both cohorts.32, 34  Relations between responsiveness and maternal reports of CBCL Externalizing problems at 24 and 42 months are displayed for Cohort II in Figure I below.  This replicates the work of Martin,14 who found maternal unresponsiveness associated with noncompliance at age 2 and coercive child behavior at 3.5.  It is also consistent with the findings of Wakschlag and Hans,37 who found an association between maternal unresponsiveness during infancy and later conduct problems.  Interestingly, in both of our studies and Martin’s, these relations were valid only for boys.  While both of our cohorts involve low-income boys, Martin’s used a middle-class sample, suggesting generalizability of the findings to lower risk populations of boys.  The issue of sex differences is addressed later in the paper.

                                                

Insert Figure 1 about here

                                                

We also examined the construct of maternal responsivity using the Strange Situation.  The infant’s behavior during the Strange Situation is believed to reflect the quality of the caregiver’s contingent sensitivity with the infant.  Consistent with studies of high-risk samples,11, 38, 39 relations were found between infant attachment insecurity at 1 and 1.5 years and conduct problems when children were age 340 and age 5.41  The magnitude of relations between infant attachment status and later conduct problems was stronger at age 5 than at age 3, particularly for infants with the disorganized pattern of attachment.  This finding is consistent with a recent meta-analysis of the relation between the disorganized pattern and later conduct problems.42

Infant Characteristics, Parenting, and Conduct Problems

Another primary component of the model is infant characteristics, particularly behaviors that would be directly linked to later disruptive behavior or be viewed as aversive by parents, thereby evoking coercive interchanges and escalating levels of conduct problems.14, 17  Findings from both Cohorts I and II reveal direct and interactive effects of observed infant characteristics on later conduct problems.  Infant persistence, a measure of how often the infant makes initial bids for attention and continues to fuss in relation to the mother’s unresponsiveness, was related to observed aggression at age 2 in Cohort I and maternal report of conduct problems at age 3.5 in Cohort II (see Figure 1).  In both cases, these relations were significant only for boys.  Finally, in both Cohorts, observed aggression and noncompliance at age 2 have been significantly associated with maternal report of conduct problems at ages 3 to 3.5 (Figure 1).32, 34 

The model also postulates that the interaction of parent and infant characteristics should add unique variance to the prediction of early conduct problems after accounting for each factor’s direct effects.  Evidence also supports this supposition.  In Cohort I, the interaction between maternal responsiveness at age 1 and observed aggression at age 2 contributed additional variance to maternal report of conduct problems at age 3.32  In Cohort II, the interaction between high infant persistence and low maternal responsiveness on the high-chair task also contributed unique variance to maternal report of age 3.5 conduct problems after accounting for each factor’s direct effects.34  In both cases, more aversive child behavior coupled with unresponsive parenting appeared to heighten risk for later outcome, and in both cases the interaction was valid only for boys.  A similar approach was applied to our findings regarding infant attachment status.  In Cohort I, there was a strong association between the disorganized classification during infancy and preschool conduct problems (i.e., 6 out of 10 disorganized infants attained clinical-level symptomatology on the CBCL Aggression factor at age 5).  When maternal perception of infant difficultness was examined in interaction with attachment security, prediction of risk status was further improved.  Among mothers who rated their infant as being above the median in difficulty and who had infants with a disorganized attachment classification, rates of clinically-significant aggressivity were 100% (6 out of 6 cases), whereas those with disorganized attachments and below-median perceived difficulty were all below clinical threshold on aggression.41

Moving from the first to second year, the model’s emphasis shifts to how parents respond to the infant’s increase in mobility and expression of anger.  Unfortunately for parents, toddling is accompanied by an increased desire to “own” most toys the infant comes in contact with (i.e., ‘mine’), evoking frustration and expression of anger when these desires are not met.  In addition to responding appropriately to the infant’s disruptive behavior, the parent must also set limits to protect the infant, other family members, pets, and valuable/dangerous objects from the infant’s limited cognitive understanding of such concepts as gravity, electricity, and differentiation of living versus nonliving organisms.  Thus, a primary objective has been to assess parent’s ability to maintain a positive and nonhostile approach to these shaping and ‘coaching’ tasks during this challenging period.  For both boys and girls, children whose parents were observed to be rejecting at age 2 during a laboratory-based clean-up task demonstrated a heightened risk for conduct problems at age 3.5 (see Figure 1).34  Furthermore, a composite score of observed rejecting parenting at ages 1.5 and 2 differentiated clinically-significant levels of boys’ conduct problems at ages 5.5-6 and 8 according to both parent and teacher reports.36  These findings are consistent with previous studies on the effects of rejecting or overcontrolling parenting conducted with preschool-age children,43 school-age children and adolescents,44, 45 and the model’s emphasis on the significance of parenting practices during the toddler period.

Coercion and Intra-Family Conflict

Another primary goal has been to trace the spread of coercive and conflictual relationships within families to relationships in other contexts.  According to Patterson,13 coercive interactions should extend from the parent-child relationship to the behavior of siblings, then generalize to other adult-child and peer relationships outside of the home.  We would add to this the significance of interparental conflict, which may provide modeling of conflict resolution strategies above and beyond the ‘direct’ training children receive from parents and siblings. In support of the spread-of-coercion hypothesis, interparental conflict at ages 2 and 3.5 and parent-child and inter-sibling conflict assessed at age 5 were related to parent-child conflict at age 5, and teacher-child and peer conflict at age 6.  Both additive and interactive effects were found for these dyadic predictor variables according to both parental and teacher reports.46  Patterson also suggests that older siblings help in the “training” of younger sibling’s aggression.  In support of this hypothesis, we found prolonged and aggressive sibling conflict to be associated with maternal report of aggressive child behavior at ages 5 and 6, after accounting for the influence of the target child’s early externalizing symptoms and rejecting parenting.  Interactive effects of rejecting parenting, assessed at age 2, and sibling conflict assessed at age 5, were also found for both parent and teacher reports of age 6 aggressive behavior at school after accounting for main effects,35 the results of which are displayed in Figures 2A and 2B below.  According to both parental and teacher report, in cases where parental rejection at age 2 and sibling conflict at age 5 were high, reports of child aggressive behavior were elevated.  These findings suggest that in addition to direct relations between rejecting parenting, early disruptive behavior, sibling conflict, and conduct problems at school entry, the presence of more than one of these risk factors further increases children’s vulnerability for conduct problems at home and at school.

                                                                

Insert Figures 2A and 2B about here

                                                                    

Early Predictors of School-Age Conduct Problems

A further test of the model’s validity is to examine if early caregiving and contextual factors that compromise the quality of caregiving differentiate clinically-meaningful conduct problems across contexts during the school-age period.  We employ a person-oriented approach for these analyses to trace the differential pathways of individuals sharing common risk factors or a common outcome.  

In the first study of this type, we identified groups of families who shared characteristics across four domains: child characteristics, maternal parenting behavior, family context, and sociodemographic characteristics.47  We then examined how such groups of children fared on measures of conduct problems according to both parents and teachers at school-age.  Importantly, this study compared findings from our community sample of low-income, ethnically diverse infants with those of Susan Campbell’s predominantly middle-class, European American (EA) preschoolers identified on the basis of ADHD symptomatology.  In both samples, the children who showed the most consistent pattern of conduct problems at school-age (age 6 in the Shaw sample, age 9 in the Campbell sample) were marked by risk across child, parent, family, and sociodemographic domains.  At the time of the study entry (age 1.5 in the Shaw sample, age 3 to 4 in the Campbell sample), in both cohorts the multiple risk group demonstrated elevated hyperactivity and aggression, more negative and less positive parenting, and higher rates of maternal depressive symptoms, stressful life events, and sociodemographic risk than families in clusters with fewer risk factors (e.g., no-risk group, child-risk-only group).  In both samples, boys in the multi-problem group were observed to show the most disruptive behavior at study entry and display more conduct problems and lower social competence at follow-up relative to other risk groups. 

To test the validity of early starter models proposed by Moffitt48 and Patterson,13 we identified clinically-meaningful cases at school-age and looked back at factors that discriminated group status in early childhood.36  The Kiddie-Schedule for Affective Disorders - Epidemiologic Version (K-SADS-E)49 was administered to mothers about their 8 year-old sons, from which diagnoses of DSM-IV disruptive disorders were derived.  Teachers completed the Teacher Report Form50 at age 8, from which scores greater than or equal to the 90th percentile on the Aggression factor were used to establish clinical impairment.  This cutoff score was chosen to ensure that children in the clinical group were qualitatively and clinically distinct from their peers, but permitted a sufficiently large sub-sample of impaired children to conduct comparative analyses.  Children who met criterion for Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), or ODD or CD and Attention Deficit Hyperactivity Disorder (ADHD) at age 8 according to K-SADS interviews were marked by early problem behavior and multiple family risk factors (e.g., maternal depression, low social support, rejecting parenting) that were evident in the second year of life.  However, because many of the measures of early child and family functioning were derived from maternal report, the sole exception being observed rejecting parenting and quality of the home environment (i.e., the HOME Inventory), it was important to corroborate the results using teacher reports.  Maternal reports of infant negative emotionality and age 2 externalizing problems were not related to clinically-meaningful conduct problems at school-age as rated by teachers.  However, teacher-identified aggressive children were more likely to live in families characterized by maternal depression, neighborhood dangerousness, low social support, and impaired parenting when children were 1.5 to 2 years old.

Finally, we applied a semiparametric mixture model51 to examine developmental trajectories of overt CP from ages 2 to 8, including assessments at ages 3.5, 5, and 6.52  This technique permits the identification of groups of individuals who share similar patterns of behavior over time, and to identify risk factors that differentiate trajectories. Consistent with research on older children,53 four developmental trajectories were identified: a persistent problem trajectory, a moderate-level desister trajectory, a low-level desister trajectory, and a persistent low trajectory.  Risk factors evaluated when children were between ages 1.5 and 2 included child behavioral inhibition, maternal depressive symptoms, and rejecting parenting, all three of which discriminated the developmental trajectories of children in the persistent high group from those in the persistent low group even after the effects of other risk factors were accounted for in the analysis.  Children who were less inhibited, whose mothers reported higher rates of depressive symptoms and showed higher rates of rejecting parenting were more likely to be in the chronic group.

All three sets of person-oriented analyses suggest that young children’s pathways leading to serious conduct problems across context are marked by multiple risk factors across domains rather than merely the perception of the child as difficult or behaviorally disruptive during infancy.  These findings have implications for interventionists and preventionists interested in identifying target populations during early childhood.  From our findings and those of others studying the early antecedents of conduct problems,54, 39 it is clear that the development of antisocial behavior in children is embedded within a context of biological characteristics of the child and caregiver, developmental history, and community disruption.55  To be effective, interventions will need to address the ecology within which the most serious forms of antisocial behavior emerge.  However, one must take seriously the reservations of others who have tried to intervene with high-risk families and failed because they neglected to address contextual factors.56  Salvador Minuchin, the founder of structural family therapy, gave up working with low-income, high-risk families because he concluded it was analogous to putting band-aids on people who require surgery.57  Interventions that adopt the principles of multi-systemic therapy,58 which address both within-family (e.g., parent-child relations, parental support and adjustment) and extra-familial issues (neighborhood safety, accessibility to resources), are recommended.  It also is imperative that interventions are targeted to the developmental challenges of early childhood and tailored to the demands of the environments in which the child operates, including coordination of ‘parenting’ techniques with day care or preschool personnel.  This latter approach is consistent with the recent work of Webster-Stratton.59  In working with Head Start samples, her interventions have been coordinated to ensure parents and teachers employ similar techniques across setting.

Overall there is broad support for the validity of the components of the model that have been tested.  We have found that from ages 1 to 8, child and parenting variables contribute additively and often interactively to an escalation in child conduct problems, distant and rejecting parenting, and coercive parent-child relationships.  Parental and sibling conflict appear to exacerbate child and parenting risk factors in an additive and interactive manner, reinforcing patterns of disruptive behavior and conflictual relations with adults and peers.

Discussion

Applying a Developmental Perspective

Implicit in the model is an integration of developmental processes to the study of child psychopathology.  Part of the marriage between developmental psychology and psychopathology has involved taking advantage of normative milestones of childhood to capture points of transition.47  The FAST Track Project4 is a prime example of this approach, in which the transition to full-day schooling was used to study the onset and prevention of serious conduct problems.  Several prospective studies have also been initiated in early childhood to take advantage of transitions in the parent-child relationship.60  Still, there remains a dearth of treatment and prevention studies initiated in early childhood that have been guided by developmental theory.  Interventions that capitalize on the challenges of parental responsiveness in the first year, and the integration of sensitive caregiving with firm, but not hostile, parenting in the second and third years are recommended.  In addition and as noted above, it behooves treatment researchers to consider the impact of all family members and to test their approach with families characterized by risk factors across child, parenting, family, and sociodemographic domains.  Our research and that of several other investigative teams61, 47, 62, 63 suggest that children from multi-problem contexts pose the greatest likelihood of early onset and maintenance of psychopathology, particularly conduct problems.

There is also a need for developmentally-sensitive studies initiated in early childhood that incorporate behavior genetic designs.  Without a genetic design it is not possible to tease apart genetic from environmental influence.  In particular, adoption studies have the potential to uncover evocative gene-environment correlations between heritable child characteristics (e.g., impulsivity, activity) and environmental responses (e.g., rejecting parenting).  Additionally, they can identify gene x environment interactions which involve the potential moderating effects of the environment in relation to genetic risk for problem behavior (e.g., parenting of adoptive parents may increase or decrease the risk of infant negative emotionality).64

Another concern is our lack of understanding of the development of conduct problem among girls.  Girls are less likely to show serious conduct problems compared to boys in middle childhood and adolescence; however, sex differences do not emerge consistently until age 4 or 5.65, 66  Several hypotheses have been offered to account for girls’ more rapidly decreasing rates of oppositional and aggressive behavior from ages 2 to 5 (e.g., socialization pressures for girls to be more compliant and less physically aggressive), but longitudinal research is needed to test these suppositions.  We also lack knowledge about the developmental trajectories of girls who continue to show clinically-significant rates of conduct problems throughout the preschool and school-age periods.  In following our own two cohorts, we have been struck by sex differences in the magnitude of relations between early child and parenting risk factors and later conduct problems.  Boys consistently exhibit greater vulnerability to the effects of environmental adversity (e.g., parental unresponsiveness) and infant negative emotionality, findings that also have been replicated by Martin.14  These results are consistent with sex differences found for neuropsychological disorders of early childhood such as ADHD, learning disabilities, and autism, for which boys outnumber girls by a wide margin.66

A similar lack of knowledge is available on the effects of ethnicity. In following our two cohorts over the past decade, the disparity in risk factors continues to impress upon us the need for more research and attention to the lack of resources within urban, minority communities.  In our longitudinal studies, this inequality  has been most evident among African American (AA) families in comparison to European American families.  A large percentage of our AA families live in segregated housing projects marked by poor housing, high crime rates, low accessibility to resources (e.g., shopping, transportation, medical care) and employment opportunities.  Thus, neighborhood quality and ethnicity are confounded because of the over-representation of AA families living in impoverished conditions.  Nonetheless, it is worth discussing the issue of ethnicity separately because of idiosyncratic issues associated with minority status.67

It is only recently that researchers have begun to seriously consider the effects of ethnicity on child conduct problems substantively, rather than as a factor to be “controlled.”  In some studies, sociodemographic factors have been found to account for differences in antisocial behavior between European American (EA) and AA families;68 however, in other cases differences persist.69, 29  For example, ethnic differences in both relevant child and parenting characteristics (e.g., hostile attributional bias, authoritarian parenting style) have been identified among AA families,29,  70 but not always linked to higher rates of CP particularly in low-income, urban samples.

Summary and Conclusions

This paper has described a developmental model of early conduct problems and reported findings about its validity with two samples of high-risk children.  Major tenets of the model have been confirmed and advance our understanding of the processes by which early parent and child characteristics and other familial and extra-familial factors influence the development of child conduct problems at school entry.    In terms of the implications of our findings for prevention, it is clear that children with risk factors in multiple domains face the greatest risk of becoming persistent early starters. Thus, successful interventions with these families will need to be comprehensive and tailored to the issues that compromise individual parent’s abilities to provide safe and caring environments for their offspring.


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