Externalizing Problems in Head Start Children: An Ecological Exploration

Externalizing Problems in Head Start Children: An Ecological Exploration

Brenda Jones Harden University of Maryland

Monique B. Winslow

Research Triangle Institute

Kimberly T. Kendziora American Institutes for Research

Ariana Shahinfar

LaSalle University

Kenneth H. Rubin University of Maryland

Nathan A. Fox

University of Maryland

Michael J. Crowley University of Maryland

Carolyn Zahn-Waxler

National Institute of Mental Health

Running Head: Externalizing Problems in Head Start Children The authors are grateful for the financial support of the MetLife Foundation in the implementation of this study. We would also like to extend our gratitude to the Head Start children, families, and teachers without whom this research would not have been possible.

Externalizing Problems in Head Start Children


ABSTRACT

The increased familial and environmental stressors affecting Head Start families over the

last two decades have precipitated an escalation of mental health difficulties among participant

children (Yoshikawa & Knitzer, 1997). Using an ecological framework (Bronfenbrenner, 1979),

this study explored externalizing behavior problems among a group of Head Start children in a

suburban county. Children (N=155) were assessed for externalizing behavior problems in the

home and classroom. Additionally, parents participated in interviews about a variety of

ecological factors related to children’s behavior problems. Almost one-quarter of the children

were identified by their parents as having externalizing behavioral problems in the borderline or

clinical range. Twice as many girls as boys had borderline or clinical levels of behavioral

problems. Child externalizing behavior was positively associated with child internalizing

behavior, parent psychological symptomatology, child temperament, family environment, and

exposure to community violence. Children with parent-identified externalizing behavior did

have specific social problem-solving skills deficits. Additionally, they were observed to have

high levels of specific inappropriate behavior, but did not exhibit high levels of teacher-rated

behavior problems. The implications of these findings for Head Start program planning are

discussed.



Children reared in poverty are experiencing unprecedented challenges to their mental

health, including exposure to family and community violence, familial drug involvement, and

dwindling community and societal resources. Current evidence points to a strong association

between adverse environmental factors, such as poverty, and externalizing (i.e., outer-directed)

behavioral problems in children (Sanson, Smart, Prior & Oberklaid, 1993; Bolger, Patterson,

Thompson & Kupersmidt, 1995). However, factors within the child (e.g., temperament) and

within the proximal ecologies of children (e.g., parent factors) seem to have a greater impact

than more distal factors, such as poverty (Shaw, Owens, Vondra, Keenan & Winslow, 1996).

Head Start, with its emphasis on serving children living in poverty, is a prime venue for

advancing research on the individual and ecological contributions to externalizing problems in

young children from low-income backgrounds. Using an ecological framework

(Bronfenbrenner, 1977), we examined herein the intra-individual and environmental factors

which potentially relate to externalizing behavior problems in Head Start children. Because of

the evidence on the primacy of the family ecology, it is a particular focus of this investigation.

Externalizing Behavior in Preschool Children

Externalizing behavior problems in young children are receiving increasing empirical

attention (Campbell, 1995). Research indicates that the most prevalent mental health difficulty

in preschool children is externalizing behavior, defined as non-compliance, poor self-control,

and problematic social relationships (Campbell, 1990). Empirical interest in preschool behavior

problems has also been fueled by evidence of a link between early onset of externalizing

behavior problems and antisocial behavior disorders in later childhood and adolescence

Externalizing Problems in Head Start Children (Campbell, 1995; Tremblay, Pihl, Vitaro & Dobkin, 1994; Patterson, Reid & Dishion, 1992;

Farrington, 1991).

Given that externalizing behavior has been identified as a major mental health concern of

the preschool years, research which investigates the rate at which this phenomenon occurs in

specific populations is important. Campbell (1995) states that approximately 10-15% of

preschool children have mild to moderate behavior problems. Data about the prevalence of

externalizing behavioral problems in young children from impoverished backgrounds are

limited. Although Head Start scholars and practitioners have called for documentation of the

prevalence of externalizing behavior among participant children, such data are sparse.

There is a growing body of evidence on the prevalence of emotional problems in general

in the Head Start population. A national study of Head Start children revealed that 0.5% had

emotional or behavioral disabilities based on information received from programs (Piotrkowski,

Collins, Knitzer & Robinson, 1994). However, Forness and colleagues (1993) have posited that

Head Start children with emotional disturbance remain underidentified at a rate of perhaps 50%

of what the rate actually may be. Yoshikawa and Knitzer (1997) have pointed to

underestimation of the mental health needs of Head Start children as well, citing the discrepancy

between Head Start Program Information Reports (PIR’s) and empirical studies of this

phenomenon. These findings suggest that externalizing behavior problems, as one class of

mental health difficulty, are underidentified among Head Start children as well.

The Ecology of Externalizing Behavior

There are multiple risk and protective factors which influence the emergence of

externalizing behavior in young children. An ecological framework emphasizes the contribution

Externalizing Problems in Head Start Children of the individual and the environment to developmental outcome. Preschool behavioral

difficulties have been found to be the result of a complex interplay of intrapersonal and

interpersonal factors, including gender (Campbell, 1990), difficult temperament (Sanson et al.,

1993), compromised cognitive development (McGee, Partridge, Williams & Silva, 1991), and

deficits in social cognition and relationships (Patterson, DeBaryshe & Ramsey, 1989).

In terms of gender, a preponderance of evidence exists which indicates that male

children, at least in middle childhood and adolescence, are more vulnerable to externalizing

behavioral symptoms (Kazdin, 1995). However, the literature is more inconsistent about gender

differences during the preschool period (Campbell, 1995). Difficult temperament is predictive of

children’s social and behavioral adjustment in preschool and beyond (Rubin, Coplan, Fox &

Calkins, 1995; Eisenberg & Fabes, 1992). Recent definitions for difficult temperament in

children include emotional lability, poor soothability, distractibility, and hyperactivity (Rothbart

& Bates, 1998).

Cognitive and social competence are important protective factors which ward against

externalizing behavior by giving children psychological resources to manage stressful situations.

The resilience literature points to the protective influence of IQ on the development of

psychopathology (Masten, Garmezy, Tellegen, Pellegrini & Larsen, 1988). More specifically,

cognitive ability has been associated with fewer externalizing behavior problems in studies of

young children (e.g., McGee et al., 1991; Lyons-Ruth, Alpern & Repacholi, 1995). Similarly,

the capacity to understand social relationships and situations fosters children’s ability to inhibit

externalizing behavior (Dodge, 1993). Evidence on one aspect of social cognition - children’s

social problem solving - reveals that children who can solve social dilemmas in an appropriate

Externalizing Problems in Head Start Children manner have better behavioral adjustment (Dubow, Tisak, Causey, Hryshko & Reid, 1991).

Many ecological issues influence the emergence of externalizing behavior in young

children. Individual characteristics of parents, such as psychological well-being, have been

found to be concurrently and prospectively related to child behavioral problems (Campbell,

1995). A wealth of data exists which points to the relation between maternal depression,

quality of parenting, and child outcome (Lyons-Ruth et al., 1993; Zahn-Waxler, Iannotti,

Cummings & Denham, 1990). Some studies have documented the tendency of depressed parents

to inflate the level of their children’s behavior problems (Fergusson, Lynskey & Horwood, 1993;

Webster-Stratton & Hammond, 1988), while other research has suggested that depressed mothers

provide veridical appraisals of their children’s problems (Richters, 1992).

Family structure and processes have been associated with children’s behavior problems.

For example, single parent families are more likely to have children with externalizing behavior

problems than families with two parents (Weintraub & Gringlas, 1995). Conflict and

disorganization within families result in poor adjustment for children in these environments

(Meyers, Taylor, Alvy, Arrington & Richardson, 1992). Discord between marital partners

(Webster-Stratton, 1989) and coercive interactions between parents and children (Patterson et

al., 1992; Patterson, 1982) are among the factors which have been found to create family

climates which breed behavior problems.

Children’s experiences in the ecology of the school have a significant impact on their

psychological outcomes. Preschool programs, such as Head Start, serve as major socializing

agents for young children which can foment or inhibit the emergence of conduct problems in

children (Zigler, Taussig & Black,1992). Additionally, young children’s presentation of

Externalizing Problems in Head Start Children behavioral difficulties has been found to vary across settings, such as the home, school and clinic

(Tynan & Nearing, 1994). This may be partially attributable to the documented disparity

between different reporters’ perception of behavior problems (e.g., teacher and parent)

(Achenbach, 1987).

In the larger ecology, poverty and its concomitants greatly contribute to the development

of behavioral difficulties in children. Children from disadvantaged neighborhoods report more

stress and as such are prone to exhibit higher rates of aggressive behaviors when compared to

their more economically advantaged counterparts (Eamon, 1994). The work of McLoyd (1990)

suggests that parental psychopathology is exacerbated by conditions of chronic poverty, which in

turn leads to increased psychopathology among children reared in poverty. These less than

optimal family environments, engendered by the circumstances of poverty, have been found to

be directly related to behavior problems in children (Raadal, Odont, Milgram, Cauce & Mncl,

1994; McLoyd, 1990). Finally, children’s exposure to community violence has an association

with emotional problems in young children (Osofsky, 1995). The bulk of this research has

focused on psychological outcomes in the internalizing domain, such as Post-Traumatic Stress

Disorder (PTSD) as a consequence of community violence exposure.

Investigating Behavior Problems in Young Children

An abiding theme in the many recent empirical investigations of behavior problems in

children is the importance of assessing behavior problems from multi-modal, cross-contextual,

and developmental perspectives. Kazdin (1995) argues for a more refined empirical approach,

which includes assessing the diverse behaviors that fall within the rubric of conduct problems

and using multiple measurement modalities from various significant others. Emphasizing a

Externalizing Problems in Head Start Children developmental perspective, Campbell (1995) urges consideration of the potential transient nature

of young children’s behavior problems and the environmental factors most likely to affect their

functioning (i.e., the family as the primary context for early childhood development). Given that

growing numbers of young children are spending time in preschool and child care settings, it has

become increasingly important to address their psychological functioning in these contexts as

well.

With these issues in the foreground, the current study was undertaken to contribute to the

literature on the mental health functioning of Head Start children. Specifically, its aim was to

inform Head Start program planning relevant to the needs of the growing numbers of participant

children with behavior problems. Thus, a major goal of the study was to explore the individual

and ecological factors related to behavior problems. Secondly, the study was designed to

investigate the problematic behaviors children exhibit in the classroom, from multiple

perspectives. A final goal was to examine the social competence of these children, based on

scholars’ call for an exploration of this phenomenon in Head Start children (e.g., Raver & Zigler,

1997).

Five research questions guided the design of this study. First, what proportion of our

sample of Head Start children was reported by parents to have behavior problems? It was

anticipated that the rate of behavior problems in our population would exceed the rate reported in

normative populations, and would be greater than the proportion which Head Start programs

identify in their Program Information Reports. The second question focused on what individual

characteristics were associated with externalizing behavior problems in this population of Head

Start children. Our hypotheses in this vein were that: 1) a greater number of male than female

Externalizing Problems in Head Start Children children would be susceptible to behavioral problems; 2) children with more difficult

temperament (i.e. increased emotionality and activity, decreased attention and soothability)

would present more externalizing problems; and 3) children with lower cognitive ability (i.e.

poorer language skills) would have higher rates of externalizing problems.

Third, we sought to identify the ecological factors which were associated with higher

levels of externalizing problems. We hypothesized that children with higher levels of behavioral

problems would have increased exposure to: 1) parental psychopathology; 2) family conflict; and

3) community violence. A fourth question was whether children’s display of behavior problems

at home was reflected in their behavior at school. Our hypothesis relevant to this question was

that children who were identified as having high rates of behavioral problems at home (i.e., by

their parents) would exhibit high rates of similar behavioral problems at school. Finally, we

were interested in the question of how children’s social competence was related to their

externalizing behavior. More specifically, we wanted to explore the strategies children with

behavior problems used to solve social dilemmas. In addition, we hypothesized that children

with more prosocial skills would have lower levels of behavioral problems.

In sum, this study was implemented to expand upon the empirical evidence on young

children with externalizing disorders by investigating a poor, minority population from a within-

group perspective. Given the call to address mental health issues in Head Start, this research was

conducted to contribute to the Head Start literature specifically by examining the multiple

ecological factors which are associated with behavior problems in participant children.

Additionally, the study was designed to augment available research by employing a multi-modal

approach to explore child-specific and environmental factors related to externalizing behavior.


Method

This study was part of a larger project to design, implement, and evaluate an intervention

for Head Start children with behavior problems. The study described herein represents the pre-

intervention component of the project. All children and their caregivers in the target settings

were initially interviewed (Phase 1). A subset of children, who were to comprise intervention

and comparison groups, participated in a second set of interviews, allowing for a more in-depth

analysis of the characteristics of children with behavioral problems (Phase 2). Following is a

description of the methods employed to gather these baseline data.

Participants. All the children registered to enter ten classrooms of a Head Start program

in a suburban county within the greater Washington, DC metropolitan area were initially

recruited to participate in the study. These ten classrooms were selected because they were in

two public elementary schools serving adjacent communities with similar characteristics. Other

Head Start classrooms in this area were dispersed throughout various other schools in dissimilar

communities. The schools were also selected because they contained the largest number of Head

Start children in the county.

A total of 155 children (81% of total population) received parental permission to

participate in the first phase of the project. Basically, the children were African-American (99%)

and lived in homes with incomes below the poverty line (100%). The average age of the

children was 4.1 years (SD=.35). Boys comprised 51% (n=79) of the sample, and girls 49%

(n=76). Children (88.4%) were overwhelmingly in the care of their mothers. Caregivers were

predominantly single (81.2%), high school graduates (74.2%), and unemployed (69.7%). The

average age of the children’s caregivers was 29.9 years (SD=9.1). Further demographic

Externalizing Problems in Head Start Children information on the caregivers of these children is found in Table 1.

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Insert Table 1 about here

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For the second phase of the study, the Child Behavior Checklist (CBCL) was used to

identify specific sub-groups of children (see Measures section for a description of the CBCL). A

sub-group of children with behavior problems in the clinical or borderline range based on CBCL

T scores above 60 (i.e., externalizers) was selected based on parent report (n=42). This sub-

group was similar demographically to the larger group of children.

Procedures. The data for the current study were collected at two different time points.

The first phase of the data collection occurred in the summer before the beginning of the Head

Start program year and included the entire sample (N=155). The second phase of data collection

occurred in the fall of the Head Start program year and only included a sub-group of the children

identified by their parents as having high levels of externalizing behavior. Following are the

procedures for each of the phases.

Phase 1. Initial assessment of the children and families was conducted in the homes of

study participants. Two interviewers completed each visit. While one researcher interviewed

the child, the other interviewed the parent. Every measure was read to the children and to the

adults to control for differential reading abilities. The home visits lasted about 90 minutes. Each

parent was paid $20 for study participation and each child was given a developmentally-

appropriate gift.

Phase 2. The second data collection phase was completed in the school. Teachers

Externalizing Problems in Head Start Children completed their questionnaires independently and were given a monetary contribution to their

classroom as an incentive. Children were individually interviewed at school using a

hypothetical-reflective social problem solving test in the second month of the academic year.

Each child was taken from the classroom to a private room by a trained interviewer. Behavioral

observations occurred in the classroom during this same time period. Observations were

conducted by trained observers in the classroom in five 1-minute intervals during unstructured

and structured activities interspersed throughout the Head Start day on three different occasions

(total of 15 minutes per child).

Measures and Assessment Protocols. A combination of parent-report, teacher-report,

independent observation, and child assessment was used for this study. The initial assessment of

the child included a cognitive evaluation and parent-report questionnaires on child behavior

problems, temperament, and exposure to violence. The parent assessment included self-report

questionnaires regarding parental psychopathology, family functioning, and social support. In

the second phase of the study, classroom behavior problems, social competence, and social skills

were assessed, as well as the parenting capacity of the caregivers of the children.

Parent Questionnaires:

Child Behavior. The Child Behavior Checklist (CBCL/4-18; Achenbach, 1991) was used

to assess children’s behavioral problems. This is a well established parent-report measure which

can be used with children from ages 4 through 18 years. It has been used with normative and

clinical samples, including children from minority and low-income backgrounds. Parents state

whether 112 behavioral problems apply to their children, using a 3-item response set (i.e., “not

true”, “sometimes or somewhat true”, and “very or often true”). Summary scores are derived for

Externalizing Problems in Head Start Children the Internalizing behavioral domain (comprised of somatic, anxious-depressed, and withdrawn

subscales) and Externalizing behavioral domain (comprised of aggressive and delinquent

subscales). Sample items from the aggressive subscale are: “cruelty, bullying, or meanness to

others” and “destroys his/her own things”. Sample items from the delinquent subscale are:

“doesn’t seem to feel guilty after misbehaving” and “steals at home”. Clinical and borderline

cut-off scores have been derived for this measure, based on research with clinical and normative

samples. Raw scores are converted into T scores; a T score of 60-63 is in the borderline range,

and 64 or over is in the clinical range. Test-retest reliability ranges from 0.87 to 0.95.

Child Temperament. The Colorado Child Temperament Inventory (CCTI; Rowe &

Plomin, 1977) is a parent-report instrument used to identify temperament types for young

children. It is a 30-item questionnaire which yields the following subscales: emotionality;

activity; attention; soothability; shyness; and sociability. Rubin and colleagues (1995) have

created an emotion dysregulation variable using this measure by subtracting soothability from

emotionality, which will be used in this study. Internal reliability data garnered from this study

are as follows: emotionality - 0.67; activity - 0.44; attention - 0.28; soothability - 0.46; shyness -

0.60; and sociability - 0.55.

Parental Psychopathology. The Brief Symptom Inventory (BSI; Derogatis & Spencer,

1982) was used to assess the mental health status of each parent. It is a 53-item self-report

questionnaire, which requires respondents to rate each symptom on a 5-point scale of distress

(from not at all to extremely) during the last week. There are nine primary symptom dimensions

for this scale, but only two of these were selected for this study based on their documented

association with child externalizing behaviors. These two subscales and their corresponding

Externalizing Problems in Head Start Children internal reliability estimates from this study (presented first in parentheses) and from Boulet &

Boss (1991) are: 1) depression (0.86; 0.89); and 2) hostility (0.60; 0.78). The total symptom

score (i.e., global severity index) was also ascertained for this study, which had an alpha of 0.95.

Family Environment. The Family Environment Scale (FES; Moos & Moos, 1993) was

administered to measure the degree of commitment, openness, and disagreement among family

members. The short form of this self-report instrument, which contains 54 items, was used in

this study. Respondents state whether each statement is true or false for their family. Following

are the 6 subscales which comprise this measure with their corresponding alpha coefficients

based on data from the current study: conflict (0.63); cohesion (0.62); control (0.27);

expressiveness (0.43); organization (0.55); and religiosity (0.54). The overall alpha coefficient

for this version has been reported to be 0.65 (Green & Plank, 1994). It is a widely used

instrument which, although initially developed with a middle income sample, has been found to

be valid with higher risk populations (Moos & Moos, 1993).

Child Exposure to Violence. The Violence Exposure Scale for Children - preschool

version (VEX-P; Fox & Leavittt, 1995) was used to determine the level of violence to which

each child was exposed. Parents were asked to state whether their child had witnessed or

experienced 22 different types of violent events occurring at school, at home, and in the

neighborhood. This measure was designed for use with this population. Cronbach’s alpha was

0.72 for mild exposure items. Because there was so little variability for severe violence, alpha’s

could not be determined in this domain (Shahinfar, Fox, Leavitt & Richters, in press).

Family Background. A family information form was devised for this project to obtain

data on the families’ socioeconomic status, race/ethnicity, household composition, time child

Externalizing Problems in Head Start Children spends with each parent, housing status, religion, and other background issues.

Child Assessments:

Behavior Problems. Because this was the central variable of interest in this study, three

strategies for obtaining these data were employed. First, the parents of the children were

interviewed regarding the existence of various behavior problems (see parent questionnaires).

Teachers rated the children on the presentation of a variety of behaviors. Finally, independent

observers recorded the frequency of children’s display of specific behaviors.

Teachers rated the classroom based behavior of the children identified by parents as

having high levels of externalizing problems, using the Preschool Behavior Questionnaire (Behar

& Stringfield, 1974). This 30-item measure contains 3 subscales: Hostile-Aggressive;

Hyperactive-Distractible; and Anxious-Fearful. The responses for this measure are: 1) does not

apply; 2) sometimes applies; and 3) frequently applies. The reported reliability for the overall

measures is 0.84, and subscale alphas are 0.81 (Hostile-Aggressive), 0.67 (Hyperactive-

Distractible), and 0.71 (Anxious-Fearful) (Behar, 1977).

The children with identified externalizing behavior problems were assessed by trained

observers. Training included practice coding of children’s behavior via observing videotapes

and children in classrooms. Researchers observed children during five one-minute intervals on

three different program days, during structured and unstructured activities (total of 15 minutes).

The frequency of children’s appropriate and inappropriate behavior was coded by objective

observers. The appropriate category included competent responses to environmental demands.

These events were also classified into one of the following categories: solitary play; group play;

dramatic play; rough-and-tumble play; and on-task behavior. The inappropriate category

Externalizing Problems in Head Start Children included incompetent responses to environmental demands such as withdrawn behavior, negative

affect (i.e., sadness and anxiety), hyperactive-inattentive-impulsive behavior, aggressive-reactive

and aggressive-initiating behavior. For reliability purposes, a second researcher observed 29%

of the observations. Cohen’s kappas averaged 0.93 across all behaviors (SD=0.04; range 0.88-

0.97) and 0.92 for the appropriate/inappropriate distinction (SD=0.05; range 0.83-0.98).

Social Competence. Two types of data were collected which pertained to this variable.

Teachers responded to ten items adapted from the social competence subscale of the Preschool

Socioaffective Profile (LaFreniere, Dumas, Capuano, & Dubeau, 1992) for children in the high

and low externalizing sub-groups. Socially competent behaviors delineated included

cooperating with others, comforts or assists others, and takes pleasure in own accomplishments.

Teachers stated whether each behavior “does not apply”, “sometimes applies” or “frequently

applies” to a specific child. Scores for responses ranged from 0-2, with a total possible score for

this subscale of 20. Internal reliability for this subscale ranged from 0.79 to 0.91.

In addition, the Social Problem Solving Test - Revised (SPST-R; Rubin, 1988; Rubin &

Rose-Krasnor, 1986) was administered only to the sub-group of children with high rates of

parent-identified externalizing behavior problems. The SPST-R is an interview in which

children are asked to respond to eight stories, which are accompanied by pictures drawn on 8" by

10" cards, depicting hypothetical social situations. Specifically, they are asked what the central

character would do or say to resolve the given social problem, involving either object acquisition

or friendship initiation. Children are also asked what they would do if faced with the same

situation. Each response was coded for its category membership (i.e. prosocial, agonistic,

trade/bribe, inappropriate, authority intervention, and manipulate affect) and for its flexibility

Externalizing Problems in Head Start Children (response differed in category from other responses). Incompetent social problem solving skills

were determined by the combined score for agonistic and inappropriate strategies. Competent

social problem solving skills were defined as the use of prosocial strategies and the receipt of a

high score (>2) on flexibility. One third of the children’s responses were coded by two

researchers, which yielded a kappa of 0.88.

Cognition. The Peabody Picture Vocabulary Test - Revised (PPVT-R; Dunn & Dunn,

1981) was administered to each child in the first phase of the study. The PPVT-R is a widely

used test of receptive vocabulary which is highly correlated with child cognitive functioning.

Children are shown a group of four pictures and are asked to point to the picture which

corresponds to the word given by the examiner. The measure can be used from the preschool

period to adulthood. A standard score is derived from the measure which is based on a large,

nationally representative sample.

Results

Following are the results from the two phases of the project. The first phase of the

project included all 155 children and parents in the study. Analysis of data collected during this

phase addresses the proportion of children with externalizing problems and the relations between

child externalizing behavior and child-specific and ecological factors. The second phase of the

project focused on a sub-group of children, with high rates of parent-identified behavioral

problems (n=42). Data analyses in this phase explores the social competence and classroom

behavior of the sub-group of children and the relations between these variables. Descriptive data

on the full sample and the externalizing sub-group are presented in Table 2.

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Phase 1. Prevalence and correlates of externalizing behavior in Head Start children

Based on the T scores of the parent-report of the CBCL, 23.7% of the children assessed

had externalizing behavior problems in the clinical (15.8%) or borderline (7.9%) range. An

examination of the externalizing subscales of the CBCL revealed that 9.7% of the children were

reported to have aggressive behavior and 11.0% delinquent behavior in the clinical or borderline

ranges. Further, 6.5% of the children were identified as having internalizing difficulties in the

clinical or borderline range.

Although there was no difference between the average CBCL externalizing behavior T-

scores of boys and girls in this study, twice as many girls exhibited externalizing behavioral

problems as boys. Fifteen percent of boys and 32% of girls were reported by their parents to

have externalizing behavior problems in the clinical or borderline range. Chi square analysis

revealed a significant difference between the proportions of boys and girls with externalizing

behavior (X2(1)=5.8, p<.02) . This pattern persisted with specific types of externalizing

behavior. In regard to aggressive behavior, 14.4% of the girls but only 5.1% of the boys

reached the borderline or clinical range. Similarly, 14.4% of the girls were reported to have

delinquent behavior and 7.6% of the boys were. Graphic depictions of the proportion of girls

and boys who have borderline or clinical externalizing behavior problems are presented in

Figures 1 and 2.


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Insert Figures 1&2 about here

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As portrayed in Table 3, externalizing behavior problems in children were significantly

associated with several child-specific variables. Externalizing problems were positively related

to internalizing symptoms, r(154)=.53, p<.001, and negative emotionality (temperament),

r(154)=.55, p<.001. Significant negative associations were found between externalizing

behavior and the temperament variables of attention, r(154)=-.23, p<.01, and soothability,

r(154)=-.17, p<.05. Externalizing behavior was significantly related to emotion dysregulation

(i.e., temperament variables of emotionality minus soothability), r(154)=.49, p<.001. Non-

significant relations emerged between externalizing behavior and PPVT scores.

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Several ecological variables had significant associations with externalizing behavior in

children. Every symptom of parental psychopathology assessed was strongly associated with

child externalizing problems (for total BSI: r(154)=.42, p<.001). Although caregiver marital

status was not correlated with child externalizing problems (the majority of the sample was

single), the amount of time children spent with their biological mothers, fathers, or other

caregivers was. Higher rates of externalizing problems were associated with less time spent with

the child’s father, r(154)=.25, p<.01. Chi square analysis comparing children who were with

their fathers more than half the time and less than half the time revealed a significant difference

Externalizing Problems in Head Start Children between the numbers of children with externalizing behavior in each group (X2 (1)=5.2; p=.02.

Children who spent less than half the time with their fathers were more likely to have

externalizing behavioral problems.

Family environment was also highly correlated with child externalizing problems. Child

behavior problems were positively related to family conflict, r(154)=.30, p<.01, and negatively

associated with family organization, r(154)=-.21, p<.01. Regarding larger ecological variables,

exposure to community violence was positively related to externalizing problems, r(154)=.25,

p<.01. Because of the gender findings in this study, correlations were conducted separately for

boys and girls; similar patterns of association were found for both groups. The correlations

between externalizing behavior and the ecological variables for the total sample are presented in

Table 4.

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Phase 2. Classroom behavior and social competence in Head Start children with high rates of

parent-identified externalizing behavior

Classroom behavior was assessed for the sub-group of children who were identified with

high levels of externalizing behavior problems. Teachers reported an average of 13 out of 30

possible classroom behavior problems overall. Following are the average levels of behavior

problems reported by teachers in each of the three categories: Anxious-Fearful M=2.6 (SD=3.1);

Hostile-Aggressive M=3.5 (SD=4.8); and Hyperactive-Distractible M=2.6 (SD=2.6). The mean

for teacher-rated social competence was 9.9 (SD=5.0) out of a possible total score of 20.


Descriptive data on behaviors in the classroom as observed by independent raters are

summarized in Table 5. Provided is the proportion of the 15-minute observation period in which

children were engaged in specific behaviors. Children with externalizing problems spent the

majority of the observed time displaying appropriate behavior. Most of the appropriate observed

behavior were when children were involved in on-task activities during structured and

unstructured times (e.g., attention at circle time, compliance with teacher, focused exploratory

play). They played in groups more than they did in a solitary manner. The majority of their

inappropriate behavior consisted of hyperactive-impulsive behaviors. These children did not

tend to exhibit aggressive behavior nor display negative affect.

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-----------------------------------

The relation between teacher-rated social competence and specific child variables was

explored. There was a significant relation between teacher ratings of social competence and

teacher ratings of three types of behavior problems: Hostile-Aggressive, r(40)= -.46, p<.01;

Anxious-Fearful, r(40)= -.44, p<.01; and Hyperactive-Distractible, r(40)= -.58, p<.001. In

contrast, a non-significant relation was found between teacher-rated social competence and

social problem-solving skills.

The relation between teacher-rated behavioral problems and the types of solution to

hypothetical social dilemmas which children selected was also explored for the group of children

with high levels of parent-identified externalizing behavior. Children rated as hostile-aggressive

by their teachers had less relevant social problem solving strategies, r(40)= -.34, p<.05. The

Externalizing Problems in Head Start Children more anxious-fearful children were, the less likely they were to use relevant solutions, r (40) =

-.37, p<.05, flexible solutions, r(40)= -.39, p<.05, and prosocial solutions, r(40)=-.56, p<.01 to

solve social dilemmas. Children identified by teachers as having hyperactive-distractible

behaviors were less likely to provide prosocial solutions, r(40)= -.39, p<.05. The correlations

between teacher-rated behavior problems and social problem-solving skills are summarized in

Table 6.

-----------------------------------


-----------------------------------

Further examination of the social problem solving skills of children with high levels of

externalizing problems revealed that they generated prosocial solutions to social dilemmas but

also relied on more problematic strategies. Following are the mean proportions of specific

strategies children utilized in their solutions to social dilemmas: prosocial strategies - 49%

(SD=0.23); authority intervention strategies - 8% (SD=0.14); agonistic strategies (e.g. hitting,

biting) - 19% (SD=0.23); manipulate affect strategies - 3% (SD=0.07); trade/bribe strategies -

1% (SD=0.03); and inappropriate strategies - 21% (SD=0.27).

Discussion

There is a solid evidentiary base for the high rates of externalizing behavior problems

among children in poverty (Bolger et al., 1995). Consistent with this literature, the present

study documented that almost one quarter of Head Start children present with externalizing

behavior problems in a sample of children from low-income, minority backgrounds. In this

Head Start sample, a higher proportion of children was identified by their parents as having

Externalizing Problems in Head Start Children externalizing behavior problems than in normative samples and in other Head Start samples

(Sinclair, Del Homme & Gonzalez, 1993; Lopez, Tarullo, Forness, & Boyce, 2000). However,

the children in such studies were identified by their teachers as having behavior problems, not by

their parents as occurred in the present study. In a study that included parent reports and

observational data, Webster-Stratton and Hammond (1998) documented rates similar to those

found in the current study. Kazdin (1995) has suggested that parent and teacher reports are

distinct in perspective but equally important for understanding child behavior problems. Parent-

reports, in particular, have been found to correlate with clinical judgments about externalizing

problems.

Individual-Level Contributions: Gender, Temperament, and Cognition

The disparity between the proportion of boys and girls with externalizing behavior was

unanticipated. Reviews of the literature on gender differences and externalizing behavior during

the preschool period reveal inconsistent results (Campbell, 1995). A preponderance of evidence

suggests that boys are generally more likely to have externalizing behavioral problems during

childhood and adolescence. However, recent evidence indicates that externalizing behavior is

increasing among adolescent female populations (i.e., increase in arrest rates overall, and for

violent crimes and thefts, etc.) (Office of Juvenile Justice and Delinquency Prevention, 1998).

Typically, externalizing females have been understudied despite the data that when

compared to non-externalizing females, they are more likely to be psychiatrically impaired,

adolescent mothers, single parents, less competent mothers, and mothers of children who become

externalizers themselves (Tremblay, 1991). However, empirical attention to externalizing

females is increasing. For example, Keenan and Shaw (1997) have reviewed several major

Externalizing Problems in Head Start Children studies which address young girls’ behavior problems, underscoring the different presentation

and trajectory of psychopathology found among females. One of the issues considered in this

review is that language serves as a protective factor for girls who are vulnerable to behavioral

problems. The girls in the current study had similarly impoverished language as the boys, which

may partially explain their high rates of behavior problems.

The higher rates of externalizing behavior problems in girls found in this study may be

also attributable to the demographic composition of the sample. For example, African-

American parents have been found to have higher expectations for their female children than

their male children. This is particularly salient among single, low-income mothers who expect

their female children to have more responsibility and maturity than their male counterparts

(Randolph, Koblinsky, Beemer, Roberts, & Letiecq, 2000; Randolph, 1995). It may also be that

boys and girls show the same levels of externalizing problems, but that mothers may view this

behavior as more normative in boys than in girls. Further, there is some evidence that adolescent

females from low-income families may have poorer outcomes than their male counterparts due

to their heightened reaction to family stress and interpersonal conflict (Luthar, 1999).

As expected, other child-specific characteristics were also associated with externalizing

behavior. Certain temperamental factors may render children more vulnerable to psychological

difficulties (Sarason et al., 1993). In the current study, the temperamental variables of negative

emotionality, attentional problems, and poor soothability were associated with behavior

problems reported by parents. This is consistent with a growing body of research which suggests

that children who are hypersensitive and easily emotionally aroused are more likely to

demonstrate problems of an externalizing nature (Rubin et al., 1995).


The relations between externalizing behaviors and attentional difficulties and

internalizing behavior were also anticipated. There is substantial evidence on children with

Attention Deficit Hyperactivity Disorder which supports the connection between distractibility

and behavior problems (Kazdin, 1995; Barkley, 1990). The relation between externalizing and

internalizing behaviors has been increasingly documented among low-income children. There is

substantial evidence pointing to the comorbidity between externalizing and internalizing

difficulties (see Zahn-Waxler, Klimes-Dougan & Slattery, in press; Zoccolillo, 1992). Although

the correlations in this study are partially attributable to response bias (i.e. same respondent is

reporting on temperament and both types of behavioral problems), they corroborate findings that

have been widely reported in the literature.

In contrast, cognitive competence (i.e. PPVT score) did not serve as a protective factor

for these Head Start children. This finding is inconsistent with the evidence that cognitive and

language ability in children are associated with better psychological adjustment (Olson et al.,

1990; Masten et al., 1988; Beitchman, Wilson, Brownlie, Walters, Inglis & Lance, 1996).

Perhaps in this sample, because cognition/language was universally low (i.e. mean PPVT score

of 62.7 for this sample, which is in the deficit range), it did not have the same buffering effect

which it does in normative populations. Additionally, because many of these children had not

experienced formal education, their scores on the PPVT may not have been an adequate

representation of their cognitive competence, but may have been a reflection of understimulation

in their environments.

Ecological Influences: The Role of the Family and Community

The current investigation corroborated findings of the influence of specific aspects of the

Externalizing Problems in Head Start Children family ecology on child outcome in this sample of Head Start children. As expected, parental

psychopathology was strongly correlated with child adjustment and behavior. Such findings

must be considered seriously in the face of evidence pointing to the exacerbation of the effects of

poverty by parental psychopathology (McLoyd, 1998). There is a large corpus of literature

which documents the deleterious effects of maternal depression on child outcome, including

social and academic difficulties at school, and internalizing and externalizing behavior problems

(see Downey & Coyne, 1990 for a review). Recent research has underscored the synergistic

impact of maternal depression and poverty on child outcome (McLoyd, 1990; 1998). Another

symptom of parental psychopathology explored was hostility. The association between the

maternal symptom of hostility and externalizing behavior highlights the negative impact of

parental negative emotionality on child adjustment, particularly when poverty is a salient factor

(Ackerman, Izard, Schoff, Youngstrom & Kogos, 1999).

Similarly, family conflict and disorganization can be particularly damaging for poor,

minority children who need structure and stability to counter the effects of poverty on their

psychological well-being. One important family factor is underscored by the finding that

children who spend less time with their fathers have more externalizing problems. The role of

the father, whether living in the home or not, in diminishing behavioral problems in young

children has been documented in studies of parenting processes as well as intervention efficacy

(Black, Dubowtiz & Starr, 1999; Crockett, Eggebeen, & Hawkins, 1993; Webster-Stratton,

1989).

That exposure to community violence is related to externalizing problems in preschool

children is also a fairly far-reaching finding. Young children may have an early-onset trajectory

Externalizing Problems in Head Start Children toward conduct disorder not only because of the family influences which have been documented

in many studies (e.g., Walker et al., 1998), but also due to the impact of factors within the larger

ecology such as community violence. Additional findings from this study in relation to violence

exposure are described elsewhere (Shahinfar, Fox, Leavitt, and Richters, in press). Other

investigations of the effects of violence exposure suggest that parents can buffer the effects of

community violence on child psychological adjustment as well (Richters & Martinez, 1993).

Behavior Problems in the Context of the Classroom

The classroom-focused examination of children with high levels of externalizing

difficulties yielded a mixture of anticipated and unanticipated findings. Overall, the data

confirmed the disparity found in previous studies between teachers and parents on their

perceptions of children’s behavior (e.g., Achenbach et al., 1987). Some studies indicate that

teachers are more likely to identify behavior problems in children than parents (Zimmerman et

al., 1995), whereas others report they are less likely to do so (Webster-Stratton & Hammond,

1998). In this study of Head Start children, parents identified a large group of children with

externalizing problems, and teachers did not concur with their perceptions. One potential reason

for this lack of congruence emanates from the evidence that mothers who are depressed perceive

their children as more problematic (Field, 1995). The difference in parent and teacher

instrumentation is also an issue. The CBCL delineates a much wider range of behaviors than the

PBQ does.

Additionally, Kazdin (1995) suggests that teachers are basing their assessments on peer

interactions and other factors distinct from those which parents consider in their evaluations of

child behavior. Finally, teachers in this Head Start system may experience fewer behavioral

Externalizing Problems in Head Start Children challenges in their classroom due to the provision of the structure that children need to facilitate

the regulation of impulses and affect. Thus, it may be that the behavioral problems of these

children are more controlled in the classroom. Clearly the school environment is a necessary

venue for intervention with children who have behavioral problems, but it may not be sufficient.

Addressing the behavioral issues that arise in the home setting may be just as crucial for

children’s optimal development.

Independent observers discerned varying levels of specific behaviors in externalizing

children. These children were observed to be primarily appropriate in their behavior, a finding

which was counter to what was expected. What parents observed in the home was not congruent

with what was seen at school by teachers and independent observers, specifically in terms of

aggressive behavior. Again, the context of the Head Start environment may have provided

children with the structure, rules, and adult support which assisted them to refrain from

aggressive acts. Nevertheless, the children’s display of hyperactive and impulsive behavior

suggests that their capacity to self-regulate is still compromised. Early difficulties with self-

regulation and control may portend later aggressive behavioral difficulties and other socially

incompetent behaviors(Campbell, 1995; Eisenberg & Fabes, 1992).

Social Competence and Externalizing Behavior

There was great variability in the level of social problem-solving skills that these children

displayed. Studies of normative populations report variability as well, but also report less

generation of incompetent problem-solving strategies (Rubin et al., 1991). Previous research

has also pointed to the higher levels of incompetent social problem solving strategies used by

aggressive children (Rubin et al., 1991). Because the children whose social problem solving

Externalizing Problems in Head Start Children ability was evaluated in this study were in the externalizing group, their incompetence in solving

social dilemmas was not surprising. Similarly, the inverse relation found between competent

social problem-solving and teacher-rated behavioral problems was expected.

In contrast, significant relations were not found between social problem solving and

teacher rated social competence. As has been found in studies of social problem solving

interventions, children’s ability to solve hypothetical dilemmas does not necessarily translate

into behavioral competence in social situations (Shure & Spivak, 1980). Additionally, with the

advent of more sophisticated perspective-taking, preschool children are capable of fairly

complex prosocial behavior such as sharing, helping, and offering comfort (Eisenberg & Fabes,

1998). The children in the current study demonstrated these qualities overall, but tended to have

more difficulty with the arguably more emotionally demanding tasks of negotiating social

conflicts and regulating negative behaviors.

Methodological Issues

Although this investigation has provided insight into the home and school factors related

to externalizing problems in Head Start children, there are limitations to this study which should

be acknowledged. First, the prevalence data offered by this study should be viewed with

caution. This was not an epidemiological study which was population based; the two Head Start

centers were not selected based on their representativeness. In addition, behavioral observations

and teacher reports were not obtained on the entire population of children (i.e. 155). Thus, some

modicum of response bias exists for the first part of the study, since the primary respondent was

the child’s parent. In the second phase of the study, the sub-sample was small, which has

implications for the adequacy of statistical power to conduct specific analyses. Behavioral

Externalizing Problems in Head Start Children observations at baseline were also limited. Additionally, a measure of parenting capacity was

not included in the current study. Thus, it was not possible to address the mediating role of

parenting skill, style, and interaction with the child on the effect of environmental factors on

child outcomes. Finally, the influence of the classroom (e.g. teacher-child relationships,

structure) on the display of externalizing behaviors was not examined.

Future research should incorporate such a comprehensive, multi-modal approach into an

investigation of a group of Head Start children representing entire Head Start systems and

classrooms. A more in-depth examination of children’s behavioral problems in the home would

be beneficial for understanding the high numbers of behavioral problems identified by parents,

as well as for informing program development efforts which incorporate parents and children.

Moreover, an exploration of the unique needs and capacities of female children with behavioral

problems seems warranted. Observational data could be expanded to include teacher-child and

parent-child interactions which could be videotaped for later coding. Finally, a comparison of

children receiving and not receiving Head Start services would provide valuable information

about the contribution of the school environment to behavioral problems in young children.

Implications for Educational and Mental Health Intervention

There are multiple practice implications of this study. First, as advocated by Yoshikawa

and Knitzer (1997), Head start programs need to place more resources into meeting the mental

health needs of their populations. Given that one quarter of children in this study exhibited

externalizing behavior problems, interventions should be integrated into Head Start program

designs which specifically address this issue. This would be a boon to Head Start teachers, who

too often cite having to use precious classroom time for behavior management. Teachers need

Externalizing Problems in Head Start Children additional preparation to assist them to understand the needs of these children, as well as to

increase their repertoire of effective responses to these behaviors in the classroom. Mental

health strategies should be designed to meet the needs of both genders. Although research and

intervention often target boys, the findings of this study point to the import of incorporating girls

into programmatic initiatives and of addressing their unique needs.

Prevention programs on all levels (Simeonsson, 1991) should be established with a goal

of assisting all Head Start children to behave optimally in the classroom. Models such as the

FAST Track program (Bierman, Coie, Dodge, Greenberg & McMahon, in press) and First Steps

to Success (Walker et al., 1998) are examples of school-based comprehensive interventions for

young children which have resulted in improved child and family outcomes. Such models can

be easily adapted for Head Start populations. This comprehensive, program-driven approach

would be more appropriate than the current practice in many Head Start programs to “parachute

in” part-time consultants to address the mental health needs of children.

Child-targeted interventions can be designed to address the emotional, social, and

behavioral needs of all Head Start children (see Forness, Serna, Kavale & Nielsen, 1998;

Walker, Colvin & Ramsey, 1995; Greenberg, Kusche, Cook & Quamma, 1995; Shure & Spivak,

1980). Programs with the goal of promoting the social competence of young children, in areas

such as social problem solving skill and prosocial peer relationships can be adapted for Head

Start populations. Similarly, strategies to foster young children’s self-regulation and impulse

control can be incorporated into the Head Start curriculum. Finally, Head Start teachers can be

taught to use basic behavior management techniques to address the needs of children with an

identified externalizing problem.


Family support and parent education are crucial components of any intervention to

diminish behavior problems in children. The Partners Parent Program (Webster-Stratton &

Herbert, 1994) is an example of a parent-focused intervention that has documented effectiveness

with severely oppositional preschool children. Parents need to be informed about what is

normative in preschool children, and about the developmental and emotional underpinnings to

young children’s negative behavior. Providing parents with concrete strategies for managing

their children’s behavior also seems paramount. Learning from the structure and management

strategies offered in the classroom should assist them in socializing their children at home in a

more developmentally-appropriate manner.

Additionally, emphasis should also be placed on improving the parents’ psychological

well-being. There are multiple data sources which point to the strong relation between parent

and child psychological adjustment. Thus, linking parents with adult mental health providers,

assisting them to minimize the stress in their lives, and conducting activities for supporting their

mental health should be central to the parent programming. In line with this, family-centered

interventions which maximize family cohesion, mutual support, and emotional connections

would be beneficial to parents and children alike. Fatherhood programs, which have gained

some momentum in Head Start programs, should be widely implemented, with a goal of

enhancing the relationship (and thus increasing the amount of time spent) between fathers and

their preschool children.

Home visitation would seem to be an important service delivery strategy for Head Start

programs to maintain in order to address all of these family-centered issues. It is essential that

Head Start produces a cadre of home visitors who are trained to deliver family support services,

Externalizing Problems in Head Start Children as well as to provide mental health intervention, specifically that which is prevention focused.

Finally, assisting parents to manage the impact of larger ecological stressors (e.g., violence,

poverty) on their families, as well as advocating with them for improving social conditions are

both central to Head Start’s family and community support and collaboration mission.

Conclusions

This study has expanded on previous research on behavior problems in preschoolers by

investigating a population of Head Start children using a multi-modal, multi-dimensional design.

The findings of the study offer empirical validation of the anecodotal reports of high rates of

problematic behaviors among Head Start children. In addition, the study offers insight into

child-specific and ecological factors which are associated with behavior problems in this

population. Such evidence allows for a consideration of strategies that go beyond managing the

“bad behavior” to those that focus on what may be at the core of children’s externalizing

difficulties, such as difficult temperament, parental psychopathology, and family stress.

Additionally, capitalizing on the prosocial capacities (e.g. social problem solving and positive

play behaviors) of preschool children seems an important target of intervention strategies. This

set of findings argues for a comprehensive approach to addressing Head Start children’s

behavior problems, in which teachers, parents, and mental health professionals work in an

integrated way to improve the functioning of the whole child - across developmental domains

and across settings.


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Figure Captions

Figure 1 - Proportion of Girls (n=76) with Externalizing Behavior in the Normal (68.4%; n=52),

Borderline (10.5%; n=8), and Clinical (21.1%; n=16) Ranges

Figure 2 - Proportion of Boys (n=79) with Externalizing Behavior in the Normal (84.8%; n=87),

Borderline(5.1%; n=4), and Clinical (10.1%; n=8) Ranges

Externalizing Problems in Head Start Children Table 1 Sample Characteristics: Primary Caregiver of Child (n=155) ______________________________________________________________________________ Characteristic Proportion ______________________________________________________________________________ Relationship to child Biological Mother 88.4%

Biological Father 2.6%

Grandmother 6.5% ______________________________________________________________________________ Religion Baptist 56.6%

Catholic 15.0%

None 10.4% ______________________________________________________________________________ Race/Ethnicity African-American 98.8%

Asian 0.6%

Bi-racial 0.6% ______________________________________________________________________________ Highest grade completed <High School 25.8%

High School/GED 51.6%

Some post high school 22.6% ______________________________________________________________________________ Employment status Unemployed 69.7%

Part-time 15.5%

Full-time 14.8% ______________________________________________________________________________ Marital status Single/separated 81.2%

Married to child’s parent 11.0%

Married to another 7.8% ______________________________________________________________________________

Externalizing Problems in Head Start Children Table 2 Means and Standard Deviations for Child and Parent Characteristics for Total Sample (N=155) and Externalizing Group (n=42) _______________________________________________________________ Characteristic Total Sample Externalizing

M SD M SD _______________________________________________________________ CBCL Externalizing 10.9 6.4 20.5 3.8 CBCL Internalizing 4.5 0.4 7.6 5.0 CTI Emotionality 2.6 0.9 3.4 0.7 CTI Activity 4.1 0.7 4.1 0.7 CTI Attention 3.4 1.3 3.1 0.8 CTI Soothability 3.8 0.7 3.6 0.7 CTI Shyness 2.3 0.8 2.2 0.8 PPVT Receptive Vocabulary 62.7 17.9 64.4 20.1 BSI Total 6.2 5.4 7.3 5.0 BSI Depression 0.4 0.7 0.6 0.6 BSI Hostility 0.4 0.5 0.8 0.7 BSI Symptom Distress 1.6 0.7 2.0 0.6 FES Conflict 2.8 1.9 3.6 2.1 FES Expressiveness 5.2 1.7 5.0 1.8 FES Cohesion 7.3 1.7 7.0 1.6 FES Organization 6.6 1.8 6.3 2.0 VEX-P Violence Exposure 2.0 2.0 3.1 2.4 _______________________________________________________________ Table 3

Externalizing Problems in Head Start Children Intercorrelations Between Child-Specific Variables and Externalizing Behavior (n=155) ______________________________________________________________________________ Variable 1 2 3 4 5 6 7 8 9 ______________________________________________________________________________ 1. Externalizing 1.00 2. Internalizing .53***-- 3. Emotionality .55***.48 -- 4. Activity .08 -.13 -.06 -- 5. Attention -.23**-.14 -.21* .08 -- 6. Soothability -.17* -.07 -.18* .20* .11 -- 7. Shyness -.13 .28** .14 -.40** -.03 -.17* -- 8. Dysregulation .49***.39** .82***-.16* -.21* -.71*** .20* -- 9. PPVT .04 .01 .08 .20* -.01 -.09 -.06 .10 1.00 ______________________________________________________________________________ * p<.05 ** p<.01 ***p<.001 Table 4

Intercorrelations Between Ecological Variables and Externalizing Behavior (n=155) ______________________________________________________________________________ Variable 1 2 3 4 5 6 7 8 9 10 ______________________________________________________________________________ 1. Externalizing 1.00 .45*** .29** .50***.32*** .29** -.02 -.14 -.18* .31** 2. BSI Global Symptoms -- .84***.68*** .57***.27** -.14 -.37** -.20* .30** 3. BSI Depression -- .48** * .43** .20* -.13 -.41 -.12 .13 4. BSI Hostility -- .39** .28** -.10 -.23** -.31** .27** 5. BSI Symptom Distress -- .22** -.14 -.28** -.14 .21* 6. FES Conflict -- -.16 -.50***-.38** .23* 7. FES Expressiveness -- .32** .15 .12 8. FES Cohesion -- .31** -.09 9. FES Organization -- -.08 10. Violence Exposure 1.00 ______________________________________________________________________________ *p<.05 **p<.01 Table 5 Means and Standard Deviations for Observed Behaviors Among Externalizing Group (n=42)

____________________________________________________________ Observed Behavior M SD ____________________________________________________________ Appropriate Behaviors 80.35 7.97

Solitary Play 4.17 4.37

Group Play 11.58 8.50

Dramatic Play 3.54 4.95

Rough-and-Tumble Play 1.10 2.76

On-Task Behavior 59.97 14.24 Inappropriate Behaviors 19.54 8.17

Hyperactive-Impulsive Behavior 13.44 7.53

Withdrawn Behavior 4.58 4.60

Aggressive-Initiating Behavior 0.81 0.93

Aggressive-Reactive Behavior 0.29 0.63

Negative Affect 0.42 1.37 ____________________________________________________________ Table 6 Intercorrelations Between Social Problem Solving and Teacher Ratings of Behavior Problems (n=40)

______________________________________________________________________________

Socially Anxious Hyperactive Hostile Social Problem Solving Competent Fearful Distractible Aggressive ______________________________________________________________________________ Prosocial Strategies .13 -.56** -.36* -.10 Agonistic Strategies -.06 .03 .21 -.01 Trade/Bribe Strategies -.08 .29 .06 -.03 Inappropriate Strategies .32 .33 .24 -.22 Manipulate Affect Strategies -.18 .27 .17 .15 Authority Strategies -.01 .44** -.05 -.12 Flexibility -.06 -.39* -.24 -.28 Relevancy -.08 -.37* -.28 -.34* ______________________________________________________________________________ *p<.05 **p<.01

HEAD START AND MENTAL HEALTH:

A FERTILE FIELD FOR PRACTICE AND RESEARCH

Preface to the Special Issue

For over three decades, Head Start has been a national laboratory for inquiry into the

functioning and experiences of young children from low-income backgrounds (Zigler &

Valentine, 1997). Research involving Head Start children, families, and programs has become

one of the best exemplars of the use of applied developmental research for informing policy

(Zigler & Styfco, 1993). Although some scholars have criticized the use of this evidence as the

basis for our knowledge of minority child development (e.g., Washington & Oyemade, 1987),

Head Start research initiatives continue to be the primary source of data on the needs and

competencies of young children in impoverished minority families.

The proliferation of studies on Head Start children in the last few decades has generated a

large body of evidence on participant children’s cognitive and academic functioning, but

comparatively little on their social competence and mental health (Raver & Zigler, 1997;

Yoshikawa & Knitzer, 1997). Despite the identification of child social competence as the

overall goal of Head Start programs, and in spite of the regulatory mandate to address the mental

health needs of participant children (Head Start Program Final Rule, 1996), the mental health

and social competence of Head Start children remain underexplored.

Because of the documented association between low socioeconomic status and

psychological difficulties, the Head Start program presents the research community with a

unique opportunity to expand the knowledge base about the prevalence of mental health

problems and the factors that contribute to emotional functioning in this segment of the

preschool population. Although children’s mental health is receiving more attention from

clinical and research perspectives, there is still a paucity of data relevant to the mental health

functioning of young children from impoverished backgrounds, such as those in Head Start.

This lack of knowledge in the field as a whole presents a clear rationale for incorporating a

mental health focus in empirical investigations involving Head Start.

Another rationale for exploring mental health issues in Head Start emanates directly from

the experiences of participant children and teachers. In their investigation of the mental health

strategies employed in Head Start programs, Yoshikawa and Knitzer (1997) cite the increasing

levels of stress encountered by Head Start children in their home environments, and the

mounting reports by Head Start staff of escalating behavior problems in participant children.

Both these issues have led to a renewed emphasis on identifying and intervening with children

with psychological difficulties. Similarly, scholars and practitioners have called for an increase

in research investigating which mental health interventions are most effective for specific

populations and particular mental health issues (O’Brien, 1994).

The goal of this special issue is to present and integrate current knowledge about the

mental health needs of Head Start children. Accordingly, papers have been selected which

address historical and current trends in Head Start mental health services, the prevalence of

mental health problems in Head Start children, andchild-specific and environmental influences

on the psychological functioning of these children. Through this exploration of this specific

group of children, papers in this special issue contribute to the understanding of emotional

problems in young children as well as inform policy and programmatic initiatives designed to

address the mental health needs of children in the Head Start population.

Three papers in this issue approach the subject of mental health broadly, from program-

and system-level perspectives. First, Yoshikawa and Zigler explore the historical and future

landscape of mental health in Head Start. They consider some of the major challenges of

maintaining a focus on mental health in a 21st century Head Start program, including definitional

issues, program-level services, system level coordination, and macro-level policy factors. Lopez

and colleagues use program information reports (PIR’s) to provide national data on the numbers

of children identified with emotional problems in all Head Start programs. These data are

contextualized with a thoughtful discussion of prevalence evidence from other research

initiatives, including studies of individual programs and from other sources such as parents.

Lara, McCabe and Brooks-Gunn offer a qualitative exploration of the strategies employed by

Head Start staff in 5 different centers to deliver mental health services. They discuss the role of

management style in how teachers and other staff intervene with children and families who

present with emotional difficulties.

The remainder of the papers in this special issue examine the characteristics of

participant children and families relevant to their mental health. Fagan and Iglesias investigate

an often ignored area of research - the contribution of fathers to children’s developmental

outcomes. Specifically, they address the influence of father’s communication styles on

children’s language and behavioral competence. Koblinsky, Gordon and Anderson explore the

functioning of Head Start children experiencing homelessness. They compare the social skills

and behavior problems of homeless and housed children at two points during the Head Start

year.

Two studies address individual and ecological influences on behavioral problems in Head

Start children. Randolph and colleagues investigate the role of gender and community violence

on the existence of behavioral problems in Head Start children. Jones Harden and colleagues

address several factors in their investigation of externalizing behaviors in Head Start children,

including individual characteristics such as gender, cognition, and temperament, and ecological

issues such as parental characteristics, family environment, and community violence. This study

explores the relation between parent-identified behavioral problems and children’s presentation

of socially competent or behavioral difficulties in the classroom.

This special issue is devoted to understanding mental health issues affecting children who

participate in Head Start, as well as exploring programs’ delivery of mental health services. The

papers individually and collectively amplify the magnitude of the gap between policy, practice,

and research in the mental health domain. Several specific directions for practice and research

have emerged from the analyses presented here.

Addressing infrastructure issues, Yoshikawa and Zigler call for increased program

incentives and enhanced training and technical assistance efforts in providing mental health

services through Head Start. Lara, McCabe and Brooks-Gunn highlight the importance of

infusing a mental health focus in staffing, supervision, and management strategies. Consistent

with the comprehensive program philosophy of Head Start, the paper by Jones Harden and

colleagues suggests that mental health services in Head Start should address the needs of

children and families, through classroom-based and home-based interventions at the preventive

and targeted levels. Fagan and Iglesias point to the importance of providing targeted support to

fathers in family-centered interventions. Finally, the papers by Koblinsky et al. and Randolph et

al. underscore that interventions must address the external stressors that impinge upon mental

health functioning, such as homelessness and community violence.

Research directions for Head Start and mental health have been described richly and

succinctly by Lopez, Tarullo, Forness and Boyce. They describe a new generation of

collaborative research which includes careful evaluation of sophisticated program designs.

Further, they delineate five key areas for future research: “1) population prevalence estimates

and developmental trajectories for young children’s mental health problems; 2) new measures

and methodologies for assessing developmental psychopathology; 3) cost-effective approaches

to early identification, prevention, and intervention; 4) improved understanding of mental health

service utilization patterns; and 5) better approaches to implementing high quality, community-

based systems of care”.

Given the ascendancy of interest in early intervention in current political, funding, and

research circles, the time is ripe for programmatic and empirical initiatives on mental health in

Head Start populations. The paradoxical situation in which Head Start scholars and practitioners

find themselves is one in which mental health services are mandated but do not yet receive the

national or individual program emphasis that they should. Resultant gaps in program and

research implementation around mental health issues create fertile soil for generating new

knowledge about the mental health functioning of children in poverty, as well as effective

intervention strategies to promote their optimal mental health. The authors, reviewers and

editorial board and staff who invested time and energy in this special issue hope that we have

contributed to moving the mental health of Head Start children to a place of prominence for

policy-makers, practitioners, and researchers.

Brenda Jones Harden

References

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O’Brien, James. (1994). Head Start and mental health (special issue). National Head Start

Bulletin, 49.

Raver, C. & Zigler, E. (1997). Social competence: An untapped dimension of Head

Start’s success. Early Childhood Research Quarterly, 12, 363-385.

Washington, V. & Oyemade, U. (1987). Project Head Start: Past, present and future

trends in the context of family needs. New York: Garland.

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expansion. Society for Research in Child Development Social Policy Report, 7(2).

Zigler, E. & Valentine, J. (Eds.)(1997). Project Head Start: A legacy of the War on

Poverty (2nd edition). Alexandria, VA: National Head Start Association.

Externalizing Problems in Head Start Children: An Ecological Exploration

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