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%的儿童患有精神健康障碍。其中大约一半与行为问题有关(例如，发脾气、攻击性)。如果不治疗，儿童面临着更高的学校排斥、社交困难和后来的心理健康障碍的风险。行为问题是父母要求或被转介寻求专业支持(“干预”)的最常见原因之一。干预可能是有效的，但三分之一的儿童没有改善。了解这些问题的起源和发展，以及干预如何、何时和为什么有效，是至关重要的。一个普遍的信念是，父母因为他们的父母方式或行为举止而导致孩子的行为问题。然而，在父母影响孩子的同时，孩子也会影响父母。例如，父母的压力可能会对育儿和孩子的行为产生负面影响。但同样，当孩子表现出难相处的行为时，父母的压力可能会增加。另一个例子是，打孩子会增加攻击性的机会，但孩子咄咄逼人也会增加父母使用严厉管教的可能性，比如打人。打破父母和孩子之间的“负面循环”是改善行为问题的最好方法之一，也是一个常见的干预重点。尽管我们知道负面循环对孩子的心理健康很重要，也是很好的支持目标，但仍有一些关键问题我们知之甚少。哪些儿童、家庭、学校和邻里因素预示着负面循环？获得心理健康服务对育儿、儿童行为和消极循环是否有积极的长期影响？这些都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，我们希望改善育儿方式和孩子的行为。但我们往往不会把这两者放在一起看，也就是负循环本身。如果我们要给家庭带来持久的改变，这一点至关重要，因为即使我们减少严厉的育儿方式或改善孩子的行为，由于过去的历史，负面循环仍有再次开始的风险。在支持会议期间，在家里会发生什么？干预过程中会改变负循环吗？什么时候?为什么？宏观和微观层面的问题对于基本理解和最终知道如何改进干预方法以使更多家庭受益都是重要的。为了回答这些问题，我们的项目分为两个部分。首先，在普通人群中，我们将观察负面的亲子循环，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父母教养、儿童行为和消极循环如何在整个童年期间发展和变化方面的作用。为此，我们将使用从ALSPAC收集的多年信息，ALSPAC是英国一项针对家庭的大型研究样本，并将其与精神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精神健康服务机构合作，在干预进行期间观察负循环的变化。在这里，我们将收集目前正在接受援助的家庭的新信息。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款名为Calms(心理健康支持中的情境学习和增强学习)的应用程序。Calms允许父母一天两次告诉我们他们自己和孩子的行为。这是第一次，当干预正在进行时，CALMS允许我们在两次治疗间歇期间跟踪家庭中关于负面亲子周期的信息。我们将在一次活动中与包括父母、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。我们将就如何利用我们的研究结果在专业支持的背景下了解我们对亲子动态的理解和未来的研究征求他们的意见。

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.