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A PersonCentered Approach to Understanding Risk for Early Externalizing Problems in Young Children

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Threatens Steals At Home. Attacks. DELINQUENT. Sets Fires Truancy. Steals Outside Runs Away. Alcohol/drug Use Vandalism. The Sociology of Risk ... – PowerPoint PPT presentation

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Title: A PersonCentered Approach to Understanding Risk for Early Externalizing Problems in Young Children


1
A Person-Centered Approach to Understanding Risk
for Early Externalizing Problems in Young Children
  • Mark Greenberg, Ph.D.
  • Penn State University
  • Prevention Research Center

2
EARLY STARTERDEVELOPMENTAL PATHWAY
  • PRESCHOOL/EARLY SCHOOL-AGE ONSET
  • OVERT AND COVERT BEHAVIORS
  • HIGH DEGREE OF CONTINUITY
  • POOR PROGNOSIS

3
Developmental Progression of Disruptive Behavior
Problems
  • OPPOSITIONAL
  • Argues Temper Tantrums
  • Bragging Stubborn
  • Demands Attention Teases
  • Disobeys At Home Impulsive
  • OFFENSIVE
  • Cruelty Fights
  • Disobeys At School Swears
  • Poor Peer Relations Lying/cheating
  • AGGRESSIVE
  • Destroys Associate with Deviant Peers
  • Threatens Steals At Home
  • Attacks
  • DELINQUENT
  • Sets Fires Truancy
  • Steals Outside Runs Away
  • Alcohol/drug Use Vandalism

4
The Sociology of Risk
  • Some outcomes (interpersonal violence) are almost
  • universally raise concern
  • Other outcomes are very specific to a given
    social, economic and religious structures and
    values
  • Political/cultural factors strongly influence
    outcomes of concern not a neutral or value-free
    process
  • Teen pregnancy in the 70s and 80s
  • Decade of obesity
  • CDC declares violence a public health problem
  • Social change modifies risk
  • If the rate of an outcome varies dramatically
    over time, then both the meaning of the outcome
    (and the role of risk factors may change) e.g.
    dramatic rise in obesity or delinquency
  • Given the flux of modern society, risk is
    indeterminate and only partially predictable

5
The Sociology of Risk Outcome
  • Some risks are objective some are socially
    constructed
  • Genetic risk for cancer (objective)
  • Poverty and mental disorder (Costello)
  • Even the role/effect of objective risks will vary
    by context
  • All risks are considered in a historical context
    that gives them meaning (Douglas)
  • Powerful organizational and political factors
    strongly influence what is seen as risk
  • Blaming the poor
  • Minimum wage rates and mental disorders (see Pres
    Debates)
  • U.S. Govt does not act as if gun ownership as a
    risk in spite of clear within culture and
    cross-cultural data

6
The Sociology of Risk Outcome
  • My epistemological perspective is primarily
    social constructionist but crosses approaches
    depending on the risk and the outcome
  • E. Rosa
  • Risk are real (ontological reality)
  • Risk estimates are socially constructed
  • Knowledge about the risks exists on a continuum
  • well-grounded
  • empirically understood
  • quantifiable
  • We can speak more confidently about certain
    risk-related phenomena because they are easier to
    measure
  • There is plenty of unexplained variance for past
    lives

7
Risk Factors What do they tell us?
  • Single cause/risk rarely predict outcomes
  • More risk factors are bad!
  • Traditional Model ala Sameroff/Rutter
  • 0 or 1 risk factor 2 are disordered
  • gt 4 risks 20 chance of disorder
  • Are all risk factors created equal?
  • Can we create subtypes of risk factors?
  • Do risk factors changes with development?
  • True causes vs. correlational association?
  • Combinatorial interactions?
  • Risk is a population-level construct it can never
    accurately predict the outcome for an individual
    nomthetic vs. idiographic levels of analysis

8
Four Domains of Risk in the Prediction of
Continuing Disruptive Behavior Disorder
  • Child Biologic Factors
  • Temperament
  • Neuropsychological Integrity
  • Psychophysiology
  • Gender
  • Child Attachment Factors
  • Patterns of Proximity Regulation
  • Childs Cognitive Affective Working Model
  • Family Ecology
  • Family Adversity
  • Parental Physical and Mental Status
  • Marital and Family Relationships
  • Environmental Provisions
  • Familys Social Support Network
  • Parenting Practices
  • Management of conflict
  • Positive Parenting Skills

9
How do risks combine?
  • Mazaide
  • Temperament and Parenting depends!
  • Lyons Ruth
  • 50 of Disorganized Att/Low Infant IQ had later
    behavior problems at age 4-5 5 rate alone
  • Shaw
  • Disorganized Att and Difficult Temp 99 on
    aggression at age 5 normal range for one risk
  • Concept of equifinality
  • Different combinations of risk factors lead to
    the same disorder
  • Concept of multifinality
  • Effect of risk factor will depend on its timing
    and relation to other risk factors

10
Factors in the Etiology of Early Behavior
Problems
Insecure Attachment
4
1
High Family Adversity
Ineffective Parent Management
10
7
9
11
8
2
3
Atypical Child Characteristics
2-factor intersection (visible) Areas 1
thru 4 2-factor intersection (invisible) Area
5 (High Family Adversity Parent
Management 2-factor intersection (invisible)
Area 6 (Insecure Attachment Child
Characteristics) 3-factor intersections
Areas 7 thru 10 4-factor intersections
Area 11
11
Preschooler Styles of Attachment
  • Secure 65-75
  • Avoidant 10-15
  • Ambivalent 5-10
  • Controlling 5-10

12
Child Attachment Classification by Group Study 2
13
Percentage of Cases by Number of Domains of Risk
Percent
Number of Risk domains
14

Intercorrelations among Four Risk Domain Factors
Child NegPar Attach FamilyChild
Risk 1.00Neg Par Risk .15
1.00Attach Risk .25
.25b 1.00Family Risk .21b
.14 .18c 1.00 a p.lt
.001 b p.lt .01 c p.lt .05

15
Ability of Four Risk Domain Factors To Predict
Clinic Group Status

Risk Domain Factor Chi Square
LambdaChild Risk 35.06 .
35Negative Parent Risk 23.92
.35Positive Parent Risk 42.12
.48Family Risk 8.71 .21
plt.001
16
Logistic Regression Analyses for Four for Risk
Domain Factors
Model Variables Order Entered p-value
Sensitivity Specificity Classify1
Child Risk .001 86.3 75.0
80.6 Negative
Parent Risk .001 Positive
Parent Risk . 001

17
Prevalence Ratios and Attributable Risk of
Different Combinations of Risk Factors
of Risks Child NegPar Attach Family
N Preval Ratio Attrib Risk 2
X X O
O 4 1.3
0.4 X O
X O 8
1.0 0.0 X
O X O 40
0.7 0.0

18
Prevalence Ratios and Attributable Risk of
Different Combinations of Risk Factors
of Risks Child NegPar Attach Family
N Preval Ratio Attrib Risk 4
X X X X
19 2.1 13.7
3 X X
X O 3 2.0
2.7 X X
O X 12 1.6
3.3
X O X X
19 1.9
13.0 O X
X X 2
2.0 2.9
PREVALENCE RATIO THE PROBABILITY THAT Ss WITH
RISK ARE CLINIC SUBJECTSATTRIBUTABLE
RISK MAXIMUM OF REDUCTION IN DISORDER
EXPECTED BY ELIMINATING EXPOSURE TO RISKS

19
Factors in the Etiology of Early Behavior
Problems
40
Insecure Attachment
0
0
Ineffective Parent Management
88
High Family Adversity
6
100
57
100
88
75
44
0
Atypical Child Characteristics
27
2-factor intersection (invisible) Area 5 (High
Family Adversity Parent Management
50 2-factor intersection (invisible) Area 6
(Insecure Attachment Child Characteristics)
33
20
Domains to add to the Model in Childhood and
Adolescence
  • Domains
  • School Context
  • Peer Context
  • Extra-curricular and Work Context
  • Neighborhood Context
  • Methods
  • Use both quantitative and qualitative measures
  • Ethnography can identify new concepts of risk
    that can then be applied to population-level
    models
  • Understand the process from perspectives of
    adults, youth, as well as current and historic
    policy and other factors

21
Risk Factors Six Conclusions
  • Single cause models are naive
  • Corollary most disorders will be not be
    successfully treated focusing on within the
    child risks
  • There are multiple pathways to and from disorder
  • There is a non-linear relation between risk and
    outcome
  • Many risks are not disorder specific (e.g.,
    poverty, family violence)
  • Some risk factors will have greater influence in
    specific developmental periods
  • Risk factors occur and should be measured at
    different levels (ala Bronfenbrenner) and with
    varying methods
  • Risk research is important for developing
    rational prevention models (both universal and
    indicated)
  • Multiple levels of intervention (with multiple
    risk factors) are likely to be most effective
    (child,family,school,regulatory)
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