Parenting and children's behavioural problems: Micro- and macro-processes at play in the context of intervention

儿童心理健康问题是一个公众关注的问题：目前有5-10%的儿童被诊断患有心理健康障碍。其中大约一半与行为问题有关（例如，发脾气，侵略性）。如果得不到治疗，儿童更有可能被学校排斥，遇到社会困难，后来出现心理健康障碍。行为问题是父母要求或被转介接受专业支持（“干预”）的最常见原因之一。干预可能有效，但三分之一的儿童没有改善。了解这些问题的起源和发展，以及如何，何时以及为什么干预工作是至关重要的。一个共同的信念是，父母“造成”儿童的行为问题，因为他们如何养育或表现自己。父母影响孩子，孩子也影响父母。例如，父母的压力可能对养育子女和儿童行为产生负面影响。但同样，当孩子表现出困难的行为时，父母的压力也会增加。另一个例子是，打孩子会增加攻击性的机会，但孩子的攻击性也会增加父母使用严厉纪律的可能性。打破父母和孩子之间的“负面循环”是改善行为问题的最佳方法之一，也是常见的干预重点。尽管我们知道负面循环对儿童心理健康和良好的支持目标很重要，但我们对一些关键问题知之甚少。什么样的儿童、家庭、学校和邻里因素能预测负面周期？获得心理健康服务是否对养育子女、儿童行为和负面循环产生积极的长期影响？这些就是我们所说的宏观层面的问题，也有微观层面的问题。当我们测试干预效果时，我们寻找改善的育儿和儿童行为。但我们往往不把两者放在一起看，也就是负周期本身。如果我们要对家庭产生持久的影响，这一点至关重要，因为即使我们减少严厉的养育或改善儿童行为，也有可能因为以前的历史而再次开始消极的循环。在支持会议之间，家里会发生什么？在干预过程中，负周期是否会发生变化？什么时候？为什么？为什么？宏观和微观层面的问题对于基本理解和最终了解如何改进干预方法以使更多的家庭受益都很重要。为了回答这些问题，我们的项目有两个部分。首先，在一般人群中，我们将研究负面的亲子周期，并考虑随着时间的推移，哪些儿童，家庭，学校和邻里因素有助于更健康的互动。我们还将研究干预在育儿，儿童行为和负面周期如何在童年时期发展和变化中的作用。为了做到这一点，我们将使用多年来从ALSPAC收集的信息，ALSPAC是英国一个大型的家庭研究样本，并将其与心理健康服务使用数据联系起来。第二，我们将与英国儿童和青少年心理健康服务合作，在干预进行的同时观察负面周期的变化。在这里，我们将从目前接受支持的家庭收集新的信息。为了收集足够详细的数据来回答我们的研究问题，我们与父母和干预提供者一起设计了一个名为CALMS（心理健康支持中的情境化和增强学习）的应用程序。CALMS允许父母每天两次告诉我们他们自己和孩子的行为。这是第一次，CALMS让我们在干预进行期间跟踪有关家庭负亲子周期的信息。我们将在活动中与包括父母，临床医生和学者在内的一系列利益相关者分享我们的发现。我们将征求他们的意见，我们的研究结果如何可以用来通知我们的理解和未来的研究在专业支持的背景下，亲子动态。

Child mental health problems are a public concern: 5-10% of children are currently living with a diagnosed mental health disorder. Around half of these relate to behaviour problems (e.g., tantrums, aggression). Left untreated, children are at higher risk of school exclusion, social difficulties and later mental health disorder. Behaviour problems are one of the most common reasons parents ask for or are referred for professional support ("intervention"). Intervention can be effective, but a third of children don't improve. Understanding the origins and development of these problems as well as how, when and why intervention works is crucial.A common belief is that parents "cause" children's behaviour problems because of how they parent or behave themselves. However, while parents influence children, children also affect parents. For example, parents' stress can have a negative impact on parenting and child behaviour. But equally, when children show difficult behaviour, parent stress can increase. Another example is that smacking children can increase the chances of aggression, but children being aggressive can also increase the likelihood of parents using harsh discipline like smacking. Breaking these "negative cycles" between parents and children is one of the best ways to improve behaviour problems and is a common intervention focus.Although we know that negative cycles are important for child mental health and good targets for support, there are key questions about which we know little. What child, family, school and neighbourhood factors predict negative cycles? Are there positive long-term effects of accessing mental-health services on parenting, child behaviour and negative cycles? These are what we call macro-level questions.There are also micro-level questions. When we test intervention effects we look for improved parenting and child behaviour. But we tend not to look at the two together, the negative cycle itself. This is crucial if we are to make lasting differences to families because, even if we reduce harsh parenting or improve child behaviour, there is a risk that the negative cycle starts again because of previous history. What happens at home between support sessions? Do negative cycles change during intervention? When? Why?Both macro- and micro-level questions are important for basic understanding and ultimately knowing how to improve intervention approaches so that more families benefit. To answer them, our project has two parts.First, in the general population, we will look at negative parent-child cycles and consider what child, family, school and neighbourhood factors help healthier interactions over time. We will also look at the role of intervention in how parenting, child behaviour and negative cycles develop and change across childhood. To do this, we will use information collected over many years from ALSPAC, a large UK research sample of families and link it with mental health service use data.Second, we will look at changes to negative cycles while intervention is going on, working in partnership with UK child and adolescent mental health services. Here, we will collect new information from families currently receiving support. To collect data that is detailed enough to answer our research questions, we have designed-with parents and intervention providers-an App called CALMS (Contextualising and Augmenting Learning in Mental Health Support). CALMS allows parents to tell us about their own and their child's behaviours twice a day. For the first time, CALMS lets us track information about negative parent-child cycles at home between sessions while intervention is on-going.We will share our findings with a range of stakeholders including parents, clinicians and academics at an event. We will seek their views on how our study's findings can be used to inform our understanding of and future research on parent-child dynamics in the context of professional support.