Frühkindliche Prädiktoren externalisierender Verhaltensauffälligkeiten
Evidenzen aus Längsschnittstudien
Abstract
Zusammenfassung. Externalisierende Verhaltensauffälligkeiten sind mit hohen gesellschaftlichen Kosten verbunden. Damit wirksame Präventions- und frühe Therapieprogramme entwickelt werden können, ist es notwendig, bereits in den ersten Lebensjahren Risiken für einen externalisierenden Entwicklungsverlauf zu identifizieren. In einer systematischen Literaturrecherche konnten aus 21 Publikationen zu 12 längsschnittlichen Geburtskohorten mit insgesamt 55 077 Kindern frühe Risiken bezogen auf eine elterliche Psychopathologie, einen niedrigen sozio-ökonomischen Status und ungünstige Eltern-Kind-Interaktionen identifiziert werden. Insbesondere eine mütterliche Depression, ein niedriger sozio-ökonomischer Status und ein harsches Erziehungsverhalten in den ersten Lebensjahren waren prädiktiv für externalisierende Verhaltensauffälligkeiten im Kindergarten und bei Schuleintritt. Implikationen für die klinische Praxis werden vorgestellt.
Abstract. As externalizing behavior is associated with long-term economic costs (e. g., related to additional health care, school problems, and criminality), several programs aim at reducing the risk of developing externalizing symptoms from early on. Yet, although prevention programs and early interventions are most effective during the first years of life (Heckman, Pinto & Savelyev, 2013), most programs have been developed for preschool and primary school children (Buchanan-Pascall, Gray, Gordon, & Melvin, 2018). Early prevention programs for externalizing behavior problems, however, need to address risk factors in the first 3 years of life. Cross-sectional and older longitudinal studies suggested parental psychopathology, a low socioeconomic status, and maladaptive parent–child interactions to be associated with externalizing behavior problems. Therefore, this systematic review aims at summarizing evidence from longitudinal studies on these risk factors during the first 3 years of life predicting externalizing behavior problems in preschool and up to school enrollment. Using the search terms birth cohort AND temperament and birth cohort AND externali*, 21 studies covering 12 birth cohorts from Europe (France, UK), USA, Asia (Taiwan), South America (Brazil), and Oceania (Australia, New Zeeland) comprising a total sample of 55,077 children were identified. These studies related to three different clusters of predictors of externalizing behavior, namely, (a) parental psychopathology, (b) a low socioeconomic status, and (c) maladaptive parent–child interactions. With regard to parental psychopathology, depressive symptoms of the mother were the most important predictor for the development of externalizing behavior problems in the first years of life across various cohorts and countries; paternal depressive symptoms, however, were investigated in only one of the studies. In addition to maternal depressive symptoms, a low socioeconomic status predicted the development of externalizing behavior symptoms – despite various different operationalizations between studies (e. g., level of education, occupation, income, quality of the residential area). Finally, maladaptive parent–child relations, in particular inconsistent and harsh parenting with little parental control, were observed as one of the most important factors predicting externalizing behavior problems in early childhood. Maternal sensitivity, on the other hand, did not have a direct effect, but rather showed an interaction with a difficult temperament of the child when predicting externalizing behavior. The results of this review suggest that there is a lack of knowledge on how paternal variables affect externalizing behaviors of children; future longitudinal studies should therefore try to not only obtain maternal data but also to consider paternal influences. They should also examine the interaction of different risk factors for the development of externalizing behavior problems with more dense measurement points in order to be able to describe the specific influences on the course of development in a more differentiated way. The review supports the notion that early childhood intervention programs that support families in various areas are of great importance and that health professionals should pay attention to the development of early childhood behavioral symptoms and consider them along with the psychopathology of the parents when working with families.
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