Early Predictors of
Behavior Problems
Journal of Early Intervention
Volume 32 Number 1
December 2009 3-16
© 2009 SAGE Publications
10.1177/1053815109349113
http://jei.sagepub.com
hosted at
http://online.sagepub.com
Two Years after Early Intervention
Darcy B. Mitchell
Penny Hauser-Cram
Boston College
Positive outcomes for children with developmental disabilities (DD) can be affected by children’s
behavior problems. This study examined the family environment of 125 children with DD at
age 3, and the extent to which that environment, as well as children’s cognitive and adaptive
functioning, predicted the problematic behaviors that children with DD exhibited at age 5. The
family environment included marital status, poverty status, stressful life events, and family
climate, consisting of the extent of cohesiveness, expressiveness, and conflict in the family.
Analyses indicated that children’s behavior problems at 5 were predicted by the numbers of
stressful events experienced by their families when the children were 3 years old. Consistent
with developmental systems models, family climate added significant unique variance in
predicting both externalizing and internalizing behavior problems. The findings support the
need for practices in early intervention programs that promote the positive climate of families
of children with DD.
Keywords: child development; disabilities and development delays; at risk for school readiness and disabilities and development delays; cerebral palsy and disabilities and
development delays; down syndrome and disabilities and development delays;
mental retardation and disabilities and development delays
I
mproving positive outcomes for children with developmental delays and their families
has been a longstanding goal of early intervention programs (Turnbull et al., 2007).
Nevertheless, positive outcomes may be undermined by young children’s behavior problems, also known as challenging behavior. Children’s problem behaviors have been found
to affect their school adjustment (e.g., Campbell, 2002; Campbell, Spieker, Burchinal, Poe,
& NICHD Early Child Care Research Network, 2006; Kaiser, 2007) as well as outcomes
in adolescent and adult life (e.g., Kroes et al., 2002; Reid & Patterson, 1989). Unfortunately,
the prevalence of challenging behaviors in young children has appeared to be increasing
(e.g., Kaiser, Cai, Hancock, & Foster, 2002; Webster-Stratton, 2000), and children with
developmental delays are more likely to demonstrate these problems than children without
Authors’ Note: This research was supported by Grants R40MC 08956 and R40MC 00333 from the Maternal
and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration,
Department of Health and Human Services. We wish to thank the many children and families who have participated in this investigation.
3
4 Journal of Early Intervention
developmental delays (Baker et al., 2003; Einfeld & Tonge, 1996). In a synthesis about
identification and service delivery for young children with behavior problems, Powell,
Fixsen, Dunlap, Smith, and Fox (2007) found that challenging behavior of young children
with developmental delays was both underidentified and insufficiently addressed in early
intervention programs. In addition, Kaiser (2007) asserted that practitioners’ attempts to
improve children’s pre-academic skills (e.g., fine motor, language, cognitive development)
have taken priority over behavioral interventions in numerous early childhood programs.
As a result, many children with developmental delays may make the transition to schoolbased IDEA Part B services exhibiting challenging behaviors and beginning a developmental trajectory for later school difficulties.
Researchers have proposed several reasons for the common finding that children with
developmental delays are more likely to exhibit behavior problems than similar-age peers.
For example, Eisenhower, Baker, and Blacher (2005) reported that as early as age 3 challenging behaviors were associated with certain syndromes and conditions. Specifically,
they determined that children with cerebral palsy or autism exhibited the highest levels of
behavior problems. The lowest ratings for challenging behaviors were demonstrated by
children without developmental delays and children with Down syndrome, and ratings for
those groups were similar to one another. Children with undifferentiated developmental
delays were rated between the other groups in the level of behavior problems exhibited.
The investigators speculated that the association had a neurological basis that influences
distinct patterns of behavior. Second, researchers have proposed that children’s cognitive
functioning may be related to behavioral difficulties (Guralnick, 1999). Specifically, investigators have found that children who are delayed in their development have difficulties in
the self-regulatory skills necessary to maintain appropriate behavior (Baker, Fenning,
Crnic, Baker, & Blacher, 2007; Wilson, 1999). Researchers focusing on children without
developmental delays but with challenging behaviors have noted a third reason for children’s behavior problems. Specifically, family factors have been associated with challenging behaviors exhibited by children (Campbell, 2002). Hence, family behavioral patterns
along with their social and economic circumstances have been related to children’s social
and behavioral development.
From a developmental systems perspective, families have been considered the proximal
environmental context for young children’s optimal development (e.g., Bronfenbrenner &
Morris, 1998; Guralnick, 2005). For example, Shonkoff and Phillips (2000) concluded that
relationships within families influence their children’s social-emotional functioning.
Hence, supporting families has been a primary aim of early intervention services (cf.,
McWilliam & Scott, 2001), and family support has been inherent in Part C of IDEA
(Hauser-Cram & Warfield, in press; Meisels & Shonkoff, 2000).
Behavior problems of children with and without developmental delays are more likely
to occur in families who undergo adverse events or who live in difficult circumstances.
Specifically, death of a family member or limited employment (e.g., Campbell, 2002; Laucht
et al., 2000), single-parent families (e.g., Carlson & Trapani, 2006; Hilton & Desrochers,
2002), or families with fewer economic resources (e.g., Dwyer, Nicholson, & Battistutta,
2003; McLeod & Shanahan, 1996; Shaw, Vondra, Hommerding, Keenan, & Dunn, 1994)
may affect young children’s social emotional development. These difficult family
Mitchell, Hauser-Cram / Early Predictors of Behavior Problems 5
c­ ircumstances place stress on families, perhaps diverting attention of family members from
their children’s well-being and possibly affecting the mental health of individual family
members. Moreover, McHale and Rasmussen (1998) reported that when relationships in
families were disrupted through lack of harmony, young children were likely to demonstrate aggressive behavior several years later. Some investigators have argued (e.g., Cox &
Paley, 2003; Minuchin, 2002) that family climate serves as an emotional regulator for individual family members, and either poor regulation or disruption in regulation is likely to
affect the young children’s self-regulation and result in maladaptive behavior.
Researchers studying children with developmental delays have considered one aspect of
families, parenting stress, and its relation to children’s challenging behaviors. These investigators have found a bidirectional relationship between parental stress and children’s
behavior problems (e.g., Baker et al., 2003; Hastings, Daley, Burns, & Beck, 2006).
Although these findings have been important, parenting stress may be an indicator of the
dyadic relationship between parents and their children, not the family systems more generally.
Investigations into family systems have yielded valuable information about the socialemotional development of children with developmental delays. For example, Mink, Nihira,
and Meyers (1983) categorized families of children with intellectual disabilities into distinct
types based on the (a) emotional climate, (b) management style, and (c) value orientation
of the family. They found that children exhibited higher levels of socio-emotional functioning when they lived in families in which relationships were harmonious and cohesive.
Hauser-Cram, Warfield, Shonkoff, and Krauss (2001) also reported a similar result in their
longitudinal analyses of children’s adaptive skills. Specifically, we determined that the
family climate (i.e., the family relational environment) when children with developmental
delays were age 3 predicted children’s growth in social skills to age 10. Given the theoretical
model posed by family system theories in its relation to emotional regulation, we expect
that when family climate (e.g., family members’ actions to promote cohesion, express emotions, and deal with conflict) has been well regulated, it predicts lower levels of deleterious
social-emotional outcomes such as challenging behaviors.
Because we investigated children who transitioned out of the early intervention system
at age 3, we focused on families with children age 3 and followed them until age 5, when
many children enroll in kindergarten. We reasoned that if family process indicators of later
behavior problems were evident, then practitioners may be better informed about interventions directed at those transitional difficulties. We hypothesized that family climate was
associated with children’s challenging behaviors. Four research questions guided our investigation. Specifically, the questions were as follows:
1. To what extent does children’s cognitive and adaptive functioning relate to their behavior
problems?
2. To what extent are behavior problems of children with developmental delays predicted by
structural aspects of the family system, such as poverty and marital status?
3. Over and above the effects of child characteristics and family demographics, what role do
stressful life events play in the development of behavior problems in children with disabilities?
4. While statistically controlling for significant correlates in the first three analyses (i.e.,
cognitive and adaptive skills, poverty and marital status, and stressful life events), to what
extent does the family climate predict children’s behavior problems?
6 Journal of Early Intervention
Method
Participants
The children and families represented in our study were enrolled in the Early Intervention
Collaborative Study (EICS), a longitudinal investigation of 190 children with disabilities
and their families (Hauser-Cram et al., 2001; Shonkoff, Hauser-Cram, Krauss, & Upshur,
1992). Families were recruited when they entered early intervention services in
Massachusetts or New Hampshire because of the special needs of their infants or toddlers
(less than 24 months of age). The current investigation focused on data collected when the
children were 3 and 5 years old. A total of 179 mothers continued to participate in the EICS
investigation when children were age 3 and 159 participated at age 5. Of these, only those
families who completed all measures used in these analyses were included in our final
sample, for a total of 125 mothers and children.
The sample included 40 children with Down syndrome, 41 children with motor impairments, and 44 children who had demonstrated delays (of unknown etiology) in two or more
areas of development at time of enrollment in the original study and again at age 3 years.
The average cognitive performance, as measured by test composite scores on the McCarthy
Scales of Children’s Abilities (McCarthy, 1972) or the Mental Scale of the Bayley Scales
of Infant Development (Bayley, 1969), for the children at age 3 was 62.5 (SD = 23.7), and
the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984) was 65.9
(SD = 13.2). Fifty-five percent of the participants were boys, and the children were predominantly European American (90%). The child demographics for our study were not significantly different from those of the larger sample of 179 children at age 3. In regards to
family characteristics, the average family income was between $25,000 and $30,000, and
reported income ranged from less than $5,000 per year to greater than $40,000. Twenty-two
participating families (i.e., 18%) were living in poverty according to federal guidelines.
Mothers had completed an average of 14.1 years of education (SD = 2.4), with a range of
10 to 19 years, and 80% of them were married at the time of data collection. Similar to child
demographics, parent demographics were not significantly different from those reported
for the larger sample of parents (N = 179).
Procedure
Families were contacted prior to the children’s birthdays and asked for their continued
participation in the EICS study. Interview dates typically were scheduled with parents
within a month. Data were collected through home visits by trained staff members who
were blinded to our hypotheses. During home visits, one staff member conducted interviews with mothers while another one completed multidimensional and structured child
assessments. Mothers also completed self-administered questionnaires. Home visits ranged
from 2 to 3 hours in length. If children were ill or their mothers determined that their children’s behavior was not typical during the initial home visits, second home visits were
conducted.
Mitchell, Hauser-Cram / Early Predictors of Behavior Problems 7
Measures
Child behavior. We administered the Child Behavior Checklist for Ages 2-3 (CBCL/2-3;
Achenbach & Edelbrock, 1983), which is a 100-item measure of young children’s behavioral problems. Items were scored 0 to 2, depending on the degree to which each statement
about children’s behavior characterizes the child being assessed. We used the six subscales
of the CBCL to establish two commonly employed dimensions of problem behaviors:
externalizing (aggressive and destructive behavior) and internalizing (withdrawn, somatic
complaints, and anxious/depressed) behaviors. T-scores for each behavioral dimension
were used for subsequent analyses. The Cronbach’s alphas for externalizing and internalizing behavior problems for our sample were .94 and .82, respectively.
Child disability and gender. We established participants’ type of disability from their
initial information at the time of their enrollment in the study and again at age 3. The children were categorized into three disability groups: (a) Down syndrome, (b) motor impairment, and (c) developmental delay. We confirmed children’s diagnoses through medical
record reviews and by interviews with the primary caregivers. In addition, participants’
genders were also drawn from their demographic data.
Cognitive and adaptive skills. We based participants’ cognitive scores on their standard
scores from their individual assessments with either the McCarthy Scales of Children’s
Abilities (McCarthy, 1972) or the Bayley Scales of Infant Development (Bayley, 1969).
The Cronbach’s alpha for these scales were .92 and .98, respectively. Children’s adaptive
skills were measured with the Vineland Adaptive Behavior Scale (Sparrow et al., 1984),
which was completed by mothers during home interviews. The Cronbach’s alpha for the
Vineland Adaptive Behavior Scale was .95. Given that the cognitive and adaptive behaviors scores were highly correlated in our sample (r = .78), we combined standard scores for
each of the two scales and averaged them to form a composite measure of child skills.
Poverty status. We used the United States Department of Health and Human Services
(2009) poverty guidelines for the year in which participants’ data were collected, and
families were coded as “1” if living below the poverty guidelines or “0” if not living in
poverty. Information from mother interviews was used to determine annual family income
and number of persons living in the households.
Stressful life events. We assessed the number of stressful life events in the lives of mothers with the Abidin Life Events Scale (Abidin, 1983). The Life Events Scale measured the
occurrence of 19 stressful life events over the previous 12 months in the lives of mothers.
Items were added to create a total number of stressful life events.
Family climate. We evaluated family climate with the family relations index from the
Family Environment Scale (FES; Moos, 1974). This index is calculated by summing
the scores of the Cohesion and Expressiveness subscales and subtracting the score for the
Conflict subscale. Cronbach’s alpha for this index was .72.
8 Journal of Early Intervention
Statistical Analyses
Because of the modest sample size and resulting power considerations, we conducted
initial analyses to determine if specific child characteristics were related to the outcomes
of interest. We reasoned that if such relations were not significant, then a more limited set
of family and child characteristics could be controlled for in the final analyses to test our
hypothesis about family context. Correlations among variables were tested to determine
multicollinearity prior to the primary analyses. Specifically, we employed hierarchical
multiple regression analysis to test hypothesized relations between family climate and the
two outcome variables, externalizing and internalizing behavior problems. We selected the
order of variables in the equations based on the theoretical model proposed, with child
variables entered first and family variables entered next followed by the main variable of
interest, family climate (Pedhazur, 1997).
Results
Descriptive Statistics
We performed descriptive statistics on all variables of interest (see Table 1). Clinical
cutoffs for externalizing and internalizing child behavior problems (i.e., scores above
which one recommends referrals) were not used in these analyses but are reported here for
descriptive purposes. The mean total score of externalizing behavior problems on the
CBCL was 48.6 (SD = 11.3); 17% of children scored above the clinical cutoff of 60. The
most commonly reported externalizing behavior problems for this sample were not being
able to wait (80%), quickly shifting between activities (72%), becoming frustrated easily
(71%), inability to concentrate (69%), and disobedience (69%). For internalizing behavior
problems, the mean score was 55.0 (SD = 9.5), with 32% of children scoring above the
cutoff of 60. As expected for a sample of children with developmental delays, the most
common internalizing problem was acting too young for one’s age (82%), followed by
speech problems (75%). Other frequently reported internalizing problems included constantly seeking help (66%), being afraid to try new things (57%), and being disturbed by
any change in routine (56%). Parent reports of stressful life events in the past year ranged
from none to 12 stressful events, with an average of 2.6 (SD = 2.3). Stressful events
included loss of income (19%), going into debt (19%), death in the family (14%), death of
a friend (11%), marital separation (11%), legal problems (11%), alcohol or drug problems
(8%), and divorce (8%).
Statistical Analyses
Preliminary analyses included group comparisons using Analysis of Variance (ANOVA)
to determine if children’s challenging behaviors varied by the children’s type of disability
and gender. For internalizing problems, main effects for gender, F(1, 123) = .68, p = .411, and
type of disability, F(2, 122) = 1.19, p = .309, were not significant, nor was their interaction,
F(2, 119) = 1.05, p = .352. Similarly, no differences were found for externalizing problems
by children’s gender, F(1, 122) = .13, p=.719, type of disability, F(2, 122) = .32, p = .730,
or their interactions, F(2, 119) = .32 p = .725.
Mitchell, Hauser-Cram / Early Predictors of Behavior Problems 9
Table 1
Descriptive Statistics of Predictor and Outcome Variables
Cognitive Score at child age 3
Adaptive score at child age 3
Parent marital statusa at child age 3
Family poverty statusb – child age 3
Parent stressful life events – child age 3
Family climate at child age 3
Child internalizing problems at age 5
Child externalizing problems at age 5
Minimum
Maximum
M
SD
21
42
0
0
0
–2
29
28
124
106
1
1
12
18
86
81
62.5
65.9
0.8
0.2
2.6
11.3
55.0
48.6
23.73
13.2
0.4
0.4
2.38
3.8
9.508
11.272
a. 80% of mothers were married.
b. 18% of families were living in poverty according to Federal Guidelines.
We analyzed the two criterion measures, children’s internalizing and externalizing
behavior problems, separately despite their correlations (r = .67, p < .001) to determine if
a different pattern of predictors emerged for either one. Regression analyses were conducted to predict the extent to which variables (i.e., children’s cognitive and adaptive skills,
family poverty, maternal marital status, family stressful life events, and family climate)
added prediction in turn to children’s internalizing and externalizing behavior problems.
Externalizing Behavior Problems
Patterns of correlations can be found in Table 2, and results from the regression equation
can be found in Table 3. Externalizing behavior problems at age 5 were not predicted by
children’s cognitive or adaptive skills (β = –.13, p = .153) or by family poverty (β = .05,
p = .646). Mother’s marital status (β = –.20, p = .027), and reports of stressful life events
(β = .361, p < .001), however, related to externalizing behavior problems, with unmarried
mothers and families experiencing greater numbers of stressful events reporting more child
behavior problems. Finally, the family climate added significantly in the last step of the
equation (β = –.24, p = .005). Mothers who reported a more positive family climate at the
termination of early intervention at age 3 had children who exhibited fewer externalizing
behavior problems 2 years later when children were 5 years of age.
Internalizing Behavior Problems
Internalizing behavior problems at age 5 were predicted by the children’s cognitive and
adaptive scores (β = –.32, p < .001), with higher scores predicting fewer internalizing problems (Table 4). Family poverty (β = .01, p = .949) and maternal marital status (β = –.20,
p = .814) did not add significantly to predicting internalizing behavior problems. Reports
of stressful life events in the family also added significant variance (β = .28, p = .003), as
greater numbers of life events predicted more internalizing problems. Finally, the family
climate added significantly (β = –.22, p = .009) over and above the other predictors.
Mothers who reported a more positive family climate at the end of early intervention when
10 Journal of Early Intervention
Table 2
Correlations Among Predictor and Outcome Variables
Variables
1
1. Cognitive/adaptive skills 3 2. Marital status
3. Poverty status
4. Parent stressful life events
5. Family climate
6. Child internalizing problems at 5
7. Child externalizing problems at 5
2
3
4
5
6
7
1
–.087
1
.044
–.504**
1
–.045
–.188*
.407*
1
.006
.150
–.170
–.222*
1
–.319** .008
.000
.250** –.257**
1
–.128
–.186*
.129
–.358** –.314** .607** 1
*p < .05 (2-tailed). **p < .01 (2-tailed).
Table 3
Summary of Hierarchical Regression Analysis for Variables Predicting
Externalizing Behavior Problems at Age 5 (N =125)
Predictor Variable
1. Cognitive and adaptive score
2. Marital status
3. Poverty status
4. Stressful events
5. Family climate
B
SE B
b
ΔR2
R2
–1.55
–5.56
1.39
1.78
–.70
1.01
2.48
3.01
0.45
0.25
–.13
–.20
.05
.36
–.24
.02
.04*
.00
.11**
.05**
.02
.06
.06
.17
.22
Note: Overall model: R2 = 0.22, F = 8.16, p = .005, R2 adjusted = 0.19.
*p < .05. **p < .01. ***p < .001.
children were 3 years of age had children who exhibited fewer internalizing behavior problems at 5 years of age.
Discussion
We hypothesized that children’s family climate is related to their challenging behaviors at age
5. For young children with developmental delays in our sample, the results underscore the
importance of a family systems approach to better understand the developmental course of
behavioral difficulties. Although no differences emerged in these analyses of challenging behaviors for children with three categories of developmental delays or by children’s gender, two
aspects of families’ circumstances related to children’s externalizing and internalizing problem
behaviors. Both stressful life events and family climate, even after controlling for stressful life
events, were related to and appear to be especially important to the development of challenging
behaviors of young children with developmental delays.
Stressful life events in the lives of adults (Esbensen & Benson, 2006) and children
(Dekker & Koot, 2003) with disabilities have been shown to be strong predictors of behavior problems. Our study replicates previous findings and shows that adverse family events
Mitchell, Hauser-Cram / Early Predictors of Behavior Problems 11
Table 4
Summary of Hierarchical Regression Analysis for Variables Predicting
Internalizing Behavior Problems at Age 5 (N = 125)
Predictor Variable
1. Cognitive and adaptive score
2. Marital status
3. Poverty status
4. Stressful events
5. Family climate
B
SE B
b
–3.24
–.48
.16
1.15
–.55
.87
2.04
2.48
.38
.21
–.32
–.02
.01
.28
–.22
ΔR2
.10***
.00
.00
.06**
.05**
R2
.10
.10
.10
.17
.21
Note: Overall model: R2 = 0.21, F = 7.06, p = .009, R2 adjusted = 0.18.
*p < .05. **p < .01. ***p < .001.
are predictors of both externalizing and internalizing problems in young children with
developmental delays as they transition from early intervention programs into preschools.
Simply put, stressful life events, particularly multiple episodes, are likely to destabilize the
families, putting pressures on family relationships and possibly adding to children’s emergent behavioral difficulties.
When families are functioning well, the family climate, especially as defined here as
consisting of harmonious relationships, may serve to provide additional support to children
even when stressful events affect family members. If family members cope adaptively to
stressful life events and maintain positive relationships with each other, their young children may be protected from factors that promote the development of challenging behaviors.
We considered two structural aspects of the family climate in our study: (a) marital status and (b) poverty. Marital status has been shown to be related to the emotional outcomes
of children without developmental delays (American Academy of Pediatrics, 2002) and to
the level of their behavior problems (Sanders, Markie-Dadds, Rinaldis, Firman, & Baig,
2007). Similarly, with our sample of children with developmental delays, we determined
that children of unmarried mothers were more likely to exhibit externalizing behavior problems. With respect to internalizing behavioral difficulties, marital status was not found to
be related. We believe that unmarried mothers found parenting their children to be more
stressful without the support of significant partners to provide emotional support and
respite from day-to-day activities. Moreover, we speculate that single parents may have
been less effective in their parenting and had perceptions of more behavioral problems in
their children with developmental delays than two-parent families.
Poverty has been shown to be an important factor in the development of behavior problems of children without developmental delays (e.g., Dodge, Pettit, & Bates, 1994; McLeod
& Shanahan, 1996; Raadal, Milgrom, Cauce, & Mancl, 1994). Nevertheless, the relationship of poverty to challenging behaviors has not been studied frequently in children with
developmental delays. We did not find higher levels of problem behaviors among young
children with developmental delays living in poverty. Contemporary evidence indicates
that persistent poverty is more detrimental to children’s development and behavior than
transient poverty (e.g., Dearing, McCartney, & Taylor, 2006; McLeod & Shanahan, 1996).
This common finding indicates that behavioral problems of children living in chronic
12 Journal of Early Intervention
poverty might become evident as they age. Although child characteristics are often considered to be important predictors of children’s challenging behaviors, with our sample we did
not find evidence for those relationships. Researchers have shown variation in the level of
behavior problems demonstrated by children with different developmental delays (e.g.,
Cormack, Brown, & Hastings, 2000; Eisenhower et al., 2005), but we did not determine
any robust differences in either the externalizing or internalizing behavior problems of
children with Down syndrome, motor impairment, or developmental delay. We note, however, that our study included very few children diagnosed with autism spectrum disorder
(ASD) and that children with ASD often display high levels of challenging behaviors
(Eisenhower et al., 2005). Similarly, gender is often a factor in behavior problems of children without developmental delays. Specifically, boys often present more externalizing
problems (e.g., Lee, Baillargeon, Vermunt, Wu, & Tremblay, 2007; Offord et al., 1987) and
girls demonstrate similar or greater internalizing difficulties (e.g., Keenan & Shaw, 1997;
Offord et al., 1987). With our sample, we determined that gender was unrelated to the
behavior problems of children with developmental delays.
Finally, children’s cognitive and adaptive skills are often related to the development of
challenging behavior. In our sample, we did not find the composite skill scores to be significant in predicting externalizing behavior problems. The cognitive and adaptive behavior scores, however, were related to children’s internalizing problems. Children with
relatively lower cognitive and adaptive scores appeared to have higher levels of internalizing problems. We believe that the inclusion of speech problems in the definition of internalizing behavior problems may, in part, explain our findings because those difficulties are
often related to and confounded with cognitive levels. For example, children with language
impairments have demonstrated more internalizing problems, including greater withdrawal, than children without language impairment (Stanton-Chapman, Justice, Skibbe, &
Grant, 2007).
Taken as a whole, our findings point to areas in which early intervention service providers might better support families and assist them in the reduction of children’s behavior
problems. First, service providers need to be aware of the stressors occurring in the lives
of families in their programs and to provide support and resources to the family during such
times. Second, single-parent families may benefit from additional resources related to
respite and better understanding and responding to their children’s day-to-day demands,
especially during high-stress situations. Finally, given the importance of the family climate,
providers need to recognize the benefits of harmonious relationships within families and
provide services that recognize, respect, and enhance such relationships. The findings from
our investigation support the need for evidence-based practices that promote improved
behavioral outcomes for young children with developmental delays (cf., Powell et al.,
2007). Moreover, evidence-informed family support should be provided in a manner that
promotes the positive family climate of families. For example, Dunst, Trivette, and Hamby
(2007) in their meta-analysis determined that family-centered practices improve parent
well-being in general and reduce children’s behavior problems in particular. In addition, the
involvement of families through training, information provision, and integration into program planning is considered critical to promoting positive behavior in early childhood
settings (cf., Hemmeter, Fox, Jack, & Broyles, 2007).
Mitchell, Hauser-Cram / Early Predictors of Behavior Problems 13
Study Limitations and Future Research
Our investigation has several limitations worth noting. The sample was modest and
restrictive, especially in terms of ethnicity and average income, and it lacks the diversity
among families seen in many early intervention programs. In addition, the three categories
of participants’ developmental delays did not include the full range of developmental difficulties, although they are fairly representative of children who have entered early intervention services before the age of 24 months (Scarborough et al., 2004). Methodologically,
issues of shared variance should be considered as mothers were the reporters of most of the
instruments we used. Finally, because data were collected over a decade ago, other limitations apply. First, current choices for some of the measures used in this study may vary
from those originally selected to assess children’s cognitive performance (e.g., the Bayley
Scales). Second, early intervention services differ today as more services are provided in
child care settings than previously (Hebbeler et al., 2007). Nevertheless, the majority of
early intervention services continue to be provided in the children’s homes, and the family
focus of services, which was evident when these data were collected, has remained a consistent feature of early intervention service models (Dunst et al., 2007).
Despite the limitations of our study, we believe that important implications may be
derived from our findings. We found only one factor, cognitive and adaptive skills, to relate
to the level of internalizing, but not externalizing, behavior problems they exhibited at age
5. Early intervention service providers should continue to focus on children’s cognitive and
adaptive skills to prepare them for school. Nevertheless, family factors and the overall
nature and tone of family relationships appear to have a critical role in the development of
children’s social emotional behaviors. Numerous investigators have documented in the
literature with children without developmental delays that factors in the lives of parents
affect their children’s behavior (e.g., Reid & Patterson, 1989; Yeung, Linver, & BrooksGunn, 2002). Our descriptive investigation indicates that such factors may also operate in
the lives of families of children with developmental delays, especially marital status for
children’s externalizing behaviors and stressful life events for both children’s externalizing
and internalizing behavior problems. Although early intervention service providers have
very limited control over adverse life events, services and programs can be offered or
secured to provide support for parents dealing with family stressors. The absence of a relationship between family poverty and the behavior problems of young children with developmental delays in our sample was unexpected and indicates that additional research with
more diverse socioeconomic status samples should be performed. We hope this investigation will stimulate future research into the antecedents of behavior problems in children
with developmental delays, particularly in the area of family support by early intervention
service providers.
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