Topics in Early Childhood Special Education-2003-Huaqing Qi-188-216 PDF

Topics in Early Childhood Special
Education
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Behavior Problems of Preschool Children From Low-Income Families: Review of the Literature
Cathy Huaqing Qi and Ann P. Kaiser
Topics in Early Childhood Special Education 2003 23: 188
DOI: 10.1177/02711214030230040201
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TECSE 23:4 188216 (2003)
Behavior Problems of Preschool Children

From Low-Income Families:
Review of the Literature
Cathy Huaqing Qi
Ann P. Kaiser
Vanderbilt University
esearch on the prevalence of behavior problems in preschool children from

low-income families, and the risk factors associated with these behaviors, was
reviewed. A systematic search of studies conducted between 1991 and 2002
yielded a total of 30 research reports that met all of the preestablished criteria. These
studies yielded several findings. Children from low socioeconomic status (SES) backgrounds were found to have a higher incidence of behavior problems as compared to
the general population. Behavior problems were associated with multiple risk factors
found in these childrens lives related to child, parent, and socioeconomic characteristics. The results are discussed in terms of implications for early identification and intervention and directions for future research.
Early identification of and interventions for preschool

children who are at increased risk for the development of
behavior problems are critical. Preschoolers with early
emergent behavior problems are likely to evince serious
behavior problems (Duncan, Brooks-Gunn, & Klebanov,
1994; Stormont, 2002), social skill deficits (Mendez, Fantuzzo, & Ciccetti, 2002), and academic difficulties (Tomblin, Zhang, Buckwalter, & Catts, 2000) later in life.
Empirical studies have also indicated that peer rejection
in childhood is associated with early emergent behavior
problems (Wood, Cowan, & Baker, 2002) and can lead to
more serious problems during adolescence (Laird, Jordan,
Dodge, Pettit, & Bates, 2001). The likelihood of developing behavior problems is exacerbated when preschoolers
are exposed to multiple risk factors and chronic psychosocial stressors (Brooks-Gunn, Duncan, & Aber, 1997).
Many studies have revealed a complex pattern of variables associated with behavior problems, including child
characteristics, family characteristics, and environmental
stressors (Eiden, 1999; Fagan & Iglesias, 2000; Keenan
& Wakschlag, 2000).
Relatively few researchers have focused on the prevalence rate of behavior problems in the general, nonclinical population of preschool children (ages 35 years). The
actual prevalence of behavior problems among young
children is difficult to determine with any certainty because the prevalence rates reported in the literature vary
greatly. In addition, most studies that reported prevalence of behavior problems in preschool children generally defined the children as having behavior problems on
the basis of cutoff scores on adult informant checklisttype measures (Campbell, 1995). Despite these limitations,
the prevalence of behavior problems has been estimated
at between 3% and 6% in the general child population
(Achenbach & Edelbrock, 1981; Institute of Medicine,
1989), with a higher incidence (30%) among low-income
preschool children (Feil, Walker, Severson, & Ball, 2000;
Gross, Sambrook, & Fogg, 1999).
Although Campbell (1995) summarized well the body
of research on the development of behavior problems
in young children, no comprehensive review of recent
studies on the behavior problems of children from lowincome families has appeared in the literature. The present article offers an overview of the empirical literature
from 1991 to 2002. Our goals were to (a) synthesize information on the prevalence rates of behavior problems
of young children from low-income families reported in
the studies over this 12-year period and (b) identify specific risk factors related to behavior problems in these
children.
Address: Cathy Huaqing Qi, Dept. of Childhood Special Education, School of Education,
West Chester University of Pennsylvania, West Chester, PA 19383.
METHOD
Systematic searches were conducted of several major online databases in the fields of education and psychology:
The Educational Resources Information Center (ERIC),
PsycINFO, and Exceptional Children databases. We used
different combinations of the following key words and
phrases: behavior disorder, behavior problem, language
disorder, social skills, language impairment and behavior
problems, psychiatric disorders, Head Start, low income,
poverty, low socioeconomic status (SES). The indices of
the following journals were then hand-searched for articles that did not emerge from the computer search: Behavioral Disorders, Child Development, Development and
Psychopathology, Early Education and Development,
Journal of Abnormal Child Psychology, and Journal of the
American Academy of Child and Adolescent Psychiatry.
A data summary was prepared for each study, and
these summaries were reviewed with the aim of excluding those studies that did not meet the criteria that follow:
1. Studies had to be descriptive studies of behavior problems in children ages 2 years
to 6 years from a general population of
low-income families; intervention studies
were excluded.
2. Longitudinal studies with at least one assessment of behavior problems within the
preschool-age range were included, but
only the preschool data were selected for
review.
3. Studies had been published in peerreviewed journals between 1991 and
2002.
4. Studies reported the number of participants, and the definition of case status
(i.e., behavior problems) was based on
standardized teachers or parents report of
behavior problems or by observational
methods.
5. The majority of children in the sample
were from a low-SES environment. The
designation of a family as low income in
the studies reviewed was made according
to the following criteria:
falling below a certain level on the
income-to-needs ratio (obtained by
dividing the total family income by
the federal poverty threshold, which is
determined by family size and number
of children under 18)
living below the poverty limit (as calculated from the federal poverty guidelines based on income and number of
dependents)
189
qualifying for public assistance (e.g.,

food stamps)
having a household income at least
50% below the states median monthly
household income
Each article that met the inclusion criteria was read
by both authors to provide a common basis for discussing
methods, findings, and interpretations of these findings.
Each study was examined and coded along a number of
dimensions. A coding sheet was developed to record information about each article, and the coding categories
were the purpose of the study; the population (sample size,
age, gender, ethnicity, SES); design of the study; behavior
measurements; observation procedures (if applicable); the
major findings pertaining to behavior problems indicating the prevalence rates or correlates/predictors of behavior problems; and rating of the quality of the study.
Data for each category were reviewed and synthesized.
The studies are summarized in the appendix.
All the studies were critiqued to assess the quality of
the research. The following characteristics were considered
necessary for a study to be considered a quality empirical study: (a) a clear statement of purpose, (b) detailed information about the participants and methods, (c) use of
sound and reliable measurements, (d) adequate internal
validity, (e) adequate external validity, (f) adequate and appropriate statistical analyses, and (g) conclusions supported by the data. Each study included in the review
was judged to meet these requirements.
SUMMARY
OF
STUDIES INCLUDED
Sample sizes in the studies ranged from 42 to 3,860, with

20 studies having more than 100 participants and 10
studies having fewer than 100 participants. The majority
of participants from all the studies reviewed were of a
low-income background and from a minority population.
In 17 studies, more than 50% of the sample consisted of
African American children, whereas only 5 studies had
samples of more than 50% Euro American participants.
Twenty-two studies provided some demographic information about the parents and their children. In most
cases (95%), the informant was the biological mother of
the child. There was not a consistent measure of family
income across studies. The average monthly household
income of the families who provided information in the
studies was about $900. This amount was close to the
1998 figure of $1,100 for the median monthly household
income of for Head Start families (U.S. Department of
Health and Human Services, 1998).
All 30 studies used behavior checklists that had
been validated or standardized. The most frequently used
instrument was the Child Behavior ChecklistParent Report (CBCL; Achenbach & Edelbrock, 1983; Achenbach,
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Topics in Early Childhood Special Education 23:4
1990, 1991a, 1991b, 1992), which was used in 22 studies

(73%). Other behavior checklists used included the Social
Skills Rating System (SSRS; Gresham & Elliot, 1990), Eyberg Child Behavior Inventory (ECBI; Eyberg & Ross,
1978), Systematic Screening for Behavior Disorders (SSBD;
Walker & Severson, 1990), Kohn Problem Checklist (KPC;
Kohn, 1977), Preschool Behavior Questionnaire (PBQ;
Behar & Stringfield, 1974), Conners Teacher Questionnaire (Goyette, Conners, & Ulrich, 1978), and Behavior
Screening Questionnaire (BSQ; Richman & Graham,
1971). Fifteen studies used parent reports only, 6 used
teacher reports only, and 6 used both teacher and parent
reports. Seven studies combined teacher ratings or parent
ratings with direct observations to assess the behaviors
of the young children. In 9 studies, the behavior problems of preschoolers were measured using direct observations in different contexts, such as at home and in the
classroom. The length of the observation period across
all studies ranged from 15 minutes to 40 minutes, with a
mean of 21 minutes.
RESULTS
Prevalence Rates for Problem Behaviors
Generally, two approaches to the classification of childhood behavior disorders are used at present. The majority
of studies reviewed here employed a quantitative approach, which considers behavior problems as occurring
along a continuum rather than dichotomously. For each
child, informants indicate how often each of a specific set
of problem behaviors occurs (e.g., never, sometimes, always). A score is derived by summing the indicated items
and their ratings. Cutoff scores are used to assign a classification to the child (e.g., nonclinical, subclinical, clinical) based on his or her total score. Two studies (Keenan,
Shaw, Delliquadri, Giovannelli, & Walsh, 1998; Lavigne
et al., 1996) used a taxonomic approach based on expert
interview of informants and direct interaction with the
child (e.g., the Diagnostic and Statistical Manual of Mental DisordersFourth Edition [DSM-IV]; American Psychiatric Association, 1994).
The prevalence rates of the behavior problems of
preschool children enrolled in Head Start were reported
in six studies enrolling a total of 2,765 children (age =
42954 children per study). In these studies, the percentages of children with externalizing problems ranged from
16% to 30%, and the percentages of children with internalizing problems ranged from 7% to 31%. For example, DelHomme, Sinclair, and Kasari (1994) reported
that approximately 23% of their sample of 42 children
were identified as at risk for behavior problems based on
teacher reports on the SSBD. Feil et al. (2000) reported
that in their study, 30% of Head Start children met the
cutoff criteria for externalizing problems, and 31% were
rated as having internalizing problems on the Teacher Report Form (TRF) of the CBCL. In the Harden et al. study
(2000), 23.7% of the sample met the cutoff criteria for
externalizing behavior problems in the clinical (15.8%)
or borderline (7.9%) range, and only 6.5% of the children were reported to have internalizing behavior problems in the clinical or borderline range.
The prevalence rates of internalizing and externalizing problems in boys and girls as determined by parent
reports of the CBCL were specifically explored in two studies (Kaiser, Hancock, Cai, Foster, & Hester, 2000; Randolph, Koblinsky, Beemer, Roberts, & Letiecq, 2000).
Kaiser and colleagues reported that 21% of boys scored
in the clinical/subclinical range (t > 60) for externalizing
behavior and 27% in the clinical/subclinical range for internalizing behavior; 13% of girls scored in the clinical/
subclinical range for externalizing behavior and 24% in
the clinical/subclinical range for internalizing behavior.
Of the 21% of boys who scored in the clinical range for
externalizing behavior, 75% were also in the clinical
range for internalizing behavior. There was a similar overlap of internalizing and externalizing behaviors among
the girls. Randolph et al. reported similar percentages of
problem behavior for boys: approximately 25% of boys
exhibited internalizing behaviors, 27% exhibited externalizing behaviors, and 27% exhibited both (1 SD above
the normative mean; see note). Prevalence rates reported
by Randolph and colleagues for girls with internalizing,
externalizing, and total behavior problems on the CBCL
were 12%, 40%, and 30%, respectively, in contrast to the
rates of 24% internalizing, 13% externalizing, and 16%
total problems for girls found by Kaiser and colleagues.
Eighteen studies described children of low-income
backgrounds from a wide range of settings, including community childcare centers (Gross et al., 1999; Leadbeater
& Bishop, 1994), behavior clinics (Keenan & Watschlag,
2000; Keenan et al., 1998), and hospitals serving mainly
low-income neighborhoods (Black, Papas, Hussey, Dubowitz, et al., 2002; Duncan et al., 1994; Eiden, 1999;
Lequerica & Hermosa, 1995; Liaw & Brooks-Gunn,
1994; Linares et al., 2001; Owens, Shaw, Giovannelli, Garcia, & Yaggi, 1999). Levels of problem behavior in these
studies appeared to be related to the specific population
sample. For example, children from behavior clinics
(Keenan & Watschlag, 2000) and children with adolescent mothers who were at risk for substance abuse (Eiden, 1999) had rates of problem behavior higher than
those of Head Start children. When samples included
children from a broader range of SES backgrounds (Lavigne et al., 1996), the rates of problem behavior were
lower. Lavigne et al. screened a primary-care pediatric
sample of 3,860 children ages 2 years to 5 years, the majority of whom were from low-income families. The authors reported that the prevalence of behavior problems
as scored on the Total Behavior Problems scale of the
parents CBCL was 8%. Specifically, the rates of total behavior problems and externalizing and internalizing behavior problems for the 3-year-olds (n = 1,052) were
7%, 4%, and 4%, respectively. The rates of total behavior problems and externalizing and internalizing behavior problems for the 4-year-olds (n = 846) were 13%,
6%, and 5%, respectively. The variability in prevalence
rates appears to be related to the sample selection.
Keenan and Wakschlag (2000) found that the prevalence rate of behavior problems in a clinic sample was
higher than the rates reported for children in Head Start
programs and low-income day care centers. In this study,
based on a t score above 70 on the parents CBCL as a
cutoff, 41% of the clinic children were identified as having behavior problems. Eiden (1999) examined the relationship between child behavior problems and maternal
substance use, maternal and childhood exposure to violence, and caregiving instability based on the reports of
61 minority mothers with children ranging in age from
24 months to 69 months who were from low-income
backgrounds. Two groups were formed: a group whose
mothers used cocaine and a control group (children whose
mothers did not acknowledge using cocaine). Eiden reported that among the children ages 4 years and younger,
33% were in the clinical range based on maternal reports
on the CBCL/2-3; among children older than 4 years,
50% were in the clinical range based on scores on the
CBCL/4-18. Spieker, Larson, Lewis, Keller, and Gilchrist
(1999) found that based on reports by teachers and use
of a cutoff t score of 60 on the CBCL, 36% of their sample of children with teenage mothers had externalizing
behaviors. Black, Papas, Hussey, Dubowitz, et al. (2002)
examined the behavior problems of 139 preschool-age
children born to adolescent mothers from low-income
families and reported that 33% of these children had t
scores in the clinical range on the externalizing scale of
the CBCL/4-18, based on mother reports.
A few studies used a taxonomic approach (e.g.,
DSM-IV or DSM-III [Diagnostic and Statistical Manual
of Mental DisordersThird Edition; American Psychiatric Association, 1987]) to examine prevalence rates of
behavior problems of preschool children in clinical settings. For example, Keenan et al. (1998) reported that
rates of DSM-III definite and subthreshold externalizing
disorders were both close to 15%; in addition, based on
clinician assessments, 15% of the children in their study
met subthreshold criteria for internalizing disorders.
Across studies, the prevalence of behavior problems
in preschool children from low-SES backgrounds ranged
from 6.5% (Harden et al., 2000) to 57% (Feil et al.,
2000). Based on teacher reports, the prevalence rates of
behavior problems ranged from 14% to 52%. Mother
reports showed a range from 7% to 57%. These differences in the prevalence rates reflected several methodological variations. First, the studies employed different
191
informantsparents versus teacherswho may have

had different perceptions of the childs behavior or different standards for what constituted problem status.
The children also may have behaved differently at home
versus at school. Second, different behavior instruments,
such as the CBCL and the SSRS, yielded different rates of
behavior problems, even when reported by the same parents and teachers (Kaiser et al., 2000). Using different instruments for parents and teachers sometimes further
confounded the differences in reported prevalence. Third,
different cutoff parameters were used to define the presence of a problem (e.g., 1 SD or 1.5 SD, or scores that
identified the upper 10% of the distribution). The use of
subclinical thresholds to identify potential problems is
warranted but also contributes to variability in prevalence rates. Finally, in almost half of the studies reviewed,
more than 50% of the children in the sample were from
culturally and linguistically diverse backgrounds. Few
studies directly addressed reliability of informant reports
or discussed issues related to objective behavior criteria
that considered cultural norms. The issues surrounding use
of nondiscriminatory testing, with objective criteria, acceptable reliability, unbiased scoring (e.g., without rater
bias), and direct observational data, to assess this population merit further study.
Risk Factors Associated with

Behavior Problems
A large body of research exists that links multiple risk
factors with childhood behavior problems (Brooks-Gunn
et al., 1997). Even so, it has been difficult to determine
which specific risk factors lead to the behavior problems
of children within low-SES environments because of the
complex factors associated with this population. It may
be that particular child characteristics, parent characteristics, and socioeconomic characteristics, when occurring
together, result in heightened behavior problems in lowincome children.
Sameroff and Chandler (1975) proposed a transactional model of development based on the idea that a
childs development is a product of dynamic reciprocal
relationships among child characteristics, parental characteristics, and environmental influences over time. Using
Sameroff and Chandlers model as a guide, associations
among multiple risk factors and child behavior problems
were examined in all the studies reviewed, and a modified model was developed (see Figure 1) to illustrate the
multiple risk factors related to the problem behaviors of
low-SES young children as indicated in the review of literature. Child problem behaviors appear to be the result of
an interaction among child characteristics (e.g., language
functioning, social skills, attachment status, cognitive
ability, gender); parent characteristics (harsh discipline,
mothers stress, depression, absent father); and sociode-
192
FIGURE 1. Transactional model.
mographic risk factors (education, number of children,

income) associated with poverty. Children in poverty are
exposed to multiple risks, and interrelationships among
these risk factors influence a childs behavioral development. This model provides a comprehensive framework
for studying the problem behaviors of young children
from low-income families by indicating the range of factors that should be considered in order to understand
early emergent problem behaviors. The model does not,
however, specify the pathways by which the factors interact to influence problem behaviors.
Child Characteristics
Child characteristics measured in the reviewed studies included attachment, temperament, prematurity, cognitive
development, language ability, social skills, and gender.
Ten of the 30 studies of preschool children from low-SES

backgrounds measured one or more of these factors.
Attachment. Only a handful of researchers have
examined infant precursors of problem behaviors in toddlers and preschoolers. The focus of this work has been
primarily on perinatal problems, maternal perceptions of
infant temperament, and co-occurring risk factors. In general, studies have shown that in high-risk samples, such
as the one studied by Shaw, Owens, Vondra, Keenan,
and Winslow (1996), lack of infant attachment security
was related to later externalizing problems. Shaw et al.s
data indicated that disorganized attachment classification at 12 months was a predictor of aggressive behavior
at age 5 years (R2 change = .11, p < .003). In addition,
infants with disorganized attachment status at 12 months
whose mothers perceived them as difficult in the second
year showed significantly higher aggression problems at

age 5 than did children with only one of the two risk factors present.
Temperament. In a longitudinal study of temperament, Keenan et al. (1998) followed a sample of 104 mothers from low-income backgrounds who were considered
to be at high risk and their infants ages 12 months to
36 months, with the purpose of identifying the earliest
child markers of psychopathology. They examined the
risk factors from infancy associated with the development
of preschool disruptive behavior problems across child,
parent, and sociodemographic groups. Motherinfant
interaction was observed in several laboratory contexts
at 12, 18, and 24 months of age to derive measures of
infant aggression and noncompliance. For girls, difficult
temperaments assessed at 12 months and 18 months were
differentially associated with later internalizing problems
on the CBCL at 36 months of age (12 months: r = .31,
p < .05; 18 months: r = .33, p < .05), while for boys, difficult temperaments assessed at 18 months and 24 months
predicted later internalizing problems on the CBCL at
36 months of age (18 months: r = .33, p < .05; 24 months:
r = .44, p < .01). For the externalizing behavior, noncompliance behavior assessed at 24 months predicted girls
externalizing problems at 36 months of age (r = .37,
p < .05) whereas for boys, early aggression assessed at
24 months predicted later externalizing problems (r = .32,
p < .05). Harden et al. (2000) studied 155 Head Start children and found that specific aspects of child temperament (emotionality, attention, soothability, dysregulation)
were associated with childrens externalizing behaviors.
Specifically, significant positive associations were found
between childrens externalizing behavior problems and
negative emotionality (r = .55, p < .001). Significant negative associations were found between externalizing behavior and temperament variables of attention (r = .23,
p < .01) and soothability (r = .17, p < .05). Emotion dysregulation was significantly related to childrens externalizing behaviors (r = .49, p < .001) and internalizing
behaviors (r = .38, p < .01).
Prematurity. In prospective studies beginning in infancy, researchers have examined biological risk factors
such as prematurity as predictors of later problem behaviors in children from low-SES backgrounds. These studies have linked premature birth with slightly higher rates
of problem behaviors at preschool age. For example, in a
longitudinal study, Rose, Feldman, Rose, Wallace, and
McCarton (1992) compared maternal and teacher reports
of problem behaviors on three behavior rating scales of
preterm children with those of children born at full term.
They found that preterm children showed more problem behaviors than did full-term children on all measures.
193
Parents of preterm children reported more hyperactivity

by their children than did parents of full-term children. On
the CBCL, the parents rated half of the preterm children
as displaying clinically significant problems, and nearly
20% of these children were judged to be hyperactive
according to their teachers. Half of the preterm preschoolers identified at 3 years of age as having significant
problem behaviors continued to manifest high levels of
problem behaviors at age 6 (r = .24.25).
Duncan et al. (1994) examined links between economic deprivation and childrens development (IQ,
externalizing problem behavior, internalizing problem
behavior) using longitudinal data from a multisite developmental study of nearly 900 low-birthweight, premature young children (the Infant Health and Development
Program [IHDP]). Mother reports on the Revised Child
Behavior Checklist/4-5 (CBCL/4-5; Achenbach & Edelbrock, 1984) were used to measure child behavior. In contrast to the study by Rose et al. (1992), the Duncan et al.
study indicated that low birthweight was a significant
predictor of delayed IQ but not of problem behaviors.
Cognition. Researchers who examined the cognitive
correlates of behavior problems in preschool children from
low-income families indicated that these children often
have lower overall intelligence as measured by IQ tests
(Lavigne et al., 1996; Owens et al., 1999). Using a logistic
regression model, Lavigne et al. (1996) found that a childs
lower IQ showed strong associations with a higher level
of behavior problems on the CBCL (odds ratio = 1.02).
Owens et al. followed a sample of boys ages 18 months
to 72 months who were considered to be at risk and reported that a higher level of child intelligence was the
best predictor of lower levels of externalizing problems
at school (R2 change = .07; F change = 11.39, p < .01).
IQ accounted for a significant variance in childrens behavior, regardless of risk type or form of behavior problem. When SES and other sociodemographic risks were
controlled, higher intelligence scores at age 5.5 years predicted better classroom behavior and fewer symptoms of
psychopathology as noted by teachers 6 months later.
Language Development. Language competence was
also explored in several studies of preschoolers behavior
problems. Language difficulties are common features of
children with externalizing behavior problems (Love &
Thompson, 1988; Qi & Kaiser, 2003), and preschoolers
with language delays are at heightened risk for later behavior problems (Beitchman et al., 2001; Benasich, Curtiss, & Tallal, 1993). Eighteen studies that were reviewed
included measures of language. In general, these studies
reported mixed findings about the relationship between
language delays and behavior problems. An association
between childrens behavior problems and language de-
194
lays was reported in 2 studies (Fagan & Iglesias, 2000;

Owens et al., 1999). Fagan and Iglesias examined the
communication interactions of 65 fathers with their Head
Start children and the relationship of fathers and childrens communication skills and child problem behaviors
early and late in the school year, based on teacher reports.
They found that children whose fathers had stronger language skills tended to also have better language abilities.
Children with stronger language skills at the beginning
of the school year were perceived to have fewer externalizing behaviors (r = -.22, p < .05) and fewer internalizing behaviors (r = .24, p < .05) at the end of the school
year. Kaiser et al. (2000) reported that boys with problem behaviors were significantly more likely to have low
language scores than were boys without problem behaviors. Specifically, of the boys with internalizing problems
in the clinical/subclinical range, 46% scored below 80 on
the subscales of the third edition of the Preschool Language Scale (PLS-3; Zimmerman, Steiner, & Pond, 1992)
as compared to 33% of the boys without internalizing
problems. A similar pattern was seen for boys with and
without externalizing problems (48% vs. 33%) and for
boys with and without high total problem behavior scores
on CBCL/2-3 parent reports (46% vs. 33%). Differential
overlap between high levels of problem behavior and low
language ability was not found for girls.
Social Skills. Five studies examined the relationship
between behavior problems and social skills of preschool
children from low-SES families using informant reports
(Bain & Pelletier, 1999; Kaiser et al., 2000) and a combination of reports and observational systems (Feil et al.,
2000; Harden et al., 2000; Olson, 1992). All five studies
indicated that behavior problems were associated with the
lack of social skills. For example, in a study of 96 Head
Start children (Bain & Pelletier, 1999), three groups were
delineated through cluster analysis based on results of the
global scale t scores and the HYPER Index t scores from
the Conners Teacher Rating Scales-28 (CTRS-28; Conners,
1990). Bain and Pelletier reported that children in the group
labeled average were characterized by well-developed social skills, a marked absence of disruptive behavior, and
an assertive willingness to help others. In a longitudinal
study, Harden et al. investigated a subgroup of children
who were identified with high levels of externalizing behavior problems. Their findings indicated a significant
relationship between teacher ratings of social competence
and teacher ratings of three types of behavior problems:
HostileAggressive, r = .46, p < .01; AnxiousFearful,
r = .44, p < .01; and HyperactiveDistractive, r = .58,
p < .001.
Kaiser et al. (2000) studied 259 3-year-old children
in Head Start. Their data indicated that children who
had higher CBCL total scores tended to have lower social
skills. Parents reported that among the boys, 13.9% had
high CBCL/2-3 total scores and low social skills; among

the girls, 9% had both high CBCL/2-3 total scores and
low social skills. Eighteen percent of the boys and 14%
of the girls had high levels of internalizing behavior and
low social skills, compared with 12% of the boys and 7%
of the girls who exhibited high levels of externalizing behavior problems and low social skills. The relationship
between social skills and internalizing behavior problems
was significant for both boys and girls, whereas the relationship between externalizing behavior problems and
social skills was significant for neither. Of the boys with
high levels of internalizing behavior, 70% had low levels
of social skills, compared to 41% of boys without high
levels of internalizing behavior problems. Similarly, girls
with internalizing behavior problems were more likely to
have low levels of social skills than were girls without internalizing behavior problems (64% vs. 40%).
Peer Interactions. The relationship between adult
ratings of problem behaviors and observations of childrens interactions with peers was examined in one study
(Olson, 1992). Olson observed 60 boys ages 4 years to
5 years who were attending Head Start programs. In this
study, children who were perceived as behaviorally deviant
by teachers, based on the Conners Teacher Questionnaire (Goyette et al., 1978), and by peers, based on interviews, were found to respond to their peers behaviors
with relatively high rates of verbal and physical aggression. Negative initiation behaviors by the target children
were correlated with peer and teacher measures of rejection and conduct problems at both the beginning and
end of the preschool year (Olson, 1992). Children who
were perceived as maladjusted by peers tended to initiate
more aggressive social exchangesincluding physically
and verbally assaulting others, grabbing objects away, and
smashing or hurling play materialsthan did other children. These children exhibited more negative behaviors
with peers and were especially likely to respond to peer
initiations with aggressive and negative behavior, verbal
and physical. These observational findings supported
the validity of teacher ratings. Children who were rated
by teachers as higher on externalizing behaviors, such as
aggression, were observed to have less positive interactions with teachers and peers in the classroom.
Gender Differences. Researchers have suggested a
relationship between a childs gender and problem behaviors, but the nature of that relationship is complex. Boys
usually have been reported to present more problem behaviors (Kazdin, 1995). Specifically, externalizing behavior problems have been found to be much more prevalent
in boys than in girls (American Psychiatric Association,
1994); however, the evidence regarding problem behaviors
in early childhood is ambiguous. Campbell (1995) stated
that preschool boys and girls may be similar in their presentation of problem behaviors. In only 5 out of 16 studies
that considered gender did researchers find gender differences based on maternal reports of behavior problems.
Each of these studies found that boys had significantly
higher levels of problem behaviors than did girls (Duncan et al., 1994; Eiden, 1999; Kaiser et al., 2000; Lavigne
et al., 1996; Spieker, Larson, Lewis, Keller, & Gilchrist,
1999). Specifically, boys had significantly more externalizing problems (Duncan et al., 1994; Kaiser et al., 2000;
Lavigne et al., 1996), more total problem behaviors, and
more aggressive and destructive behaviors than did girls
(Kaiser et al., 2000). No significant gender differences
were found on internalizing problems in the Duncan et al.
and Kaiser et al. studies, and no gender differences in
rates of CBCL internalizing problems were reported by
Lavigne et al. The differential developmental trajectories
of behavior problems in boys and girls beginning in preschool were examined in only one study (Spieker et al.,
1999), which found that boys exhibited higher levels
of disruptive behavior than did girls. In contrast, Eiden
(1999) reported that contrary to expectations, in a sample of 61 high-risk minority children from low-income
backgrounds, girls had higher behavior problem scores
than did boys on parents CBCL reports F(1, 59) = 4.14,
p < .05.
The results from these reviewed studies suggest there
are predictable relationships between child characteristics and behavior problems in the preschool period. Difficult temperament, low language skills, deficits in social
skills, compromised cognitive development, and gender
have all been shown to be associated with behavior problems. Findings regarding the relationship between behavior problems and language delays and between behavior
problems and gender are not clear-cut. The questions of
whether low language ability is a consistent predictor of
behavior problems and whether there are significant gender differences in early behavior problems remain open
at the present. Many factors, including sample selection,
limited and different language testing procedures, different methods for assessing behavior (teachers or parents
report vs. observation), and different behavior measures
and cutoff criteria, might contribute to the different findings across studies.
Parent Characteristics
Longitudinal research has indicated that parenting characteristics are associated with childhood behavior problems
(see Stormont, 1998, for a review). Parenting characteristics include parenting stress (Gross et al., 1999; Leadbeater & Bishop, 1994; Liaw & Brooks-Gunn, 1994;
Shaw, Winslow, Owens, & Hood, 1998), depression in the
mother (Duncan et al., 1994; Harden et al., 2000; Gross
et al., 1999; Leadbeater & Bishop, 1994; Liaw & Brooks-
195
Gunn, 1994; Shaw, Winslow, Owens, & Hood, 1998;

Shaw, Winslow, Owens, Vondra, et al., 1998; Spieker et
al., 1999), harsh discipline (Gross et al., 1999; Spieker et
al., 1999), and time spent with father (Harden et al.,
2000; Keenan & Wakschlag, 2000). Parents of children
with problem behaviors are more likely to be depressed
and stressed by daily hassles and to use harsher discipline
strategies than are parents of children without problem
behaviors. Stressful family life events, such as separation
or divorce and maternal depression, have been shown to
be associated with higher ratings of behavior problems
in young children by mothers (Beautrais, Fergusson, &
Shannon, 1982; Fergusson, Horwood, & Shannon, 1984).
These findings have been consistent in indicating that
children from low-income backgrounds who were identified as having more problem behaviors in their preschool
years tended to come from relatively more dysfunctional
families, and these findings were consistent across a
range of different sample selection approaches and behavior assessment methods and measurements.
Parent Stress. Authors of several studies previously
reviewed in this article suggested that mothers of children
with behavior problems report having experienced more
stressful life events (Beautrais et al., 1982; Fergusson et
al., 1984). Mothers stress was significantly correlated with
higher levels of total childrens behavior problems (r =
.35, p < .001; Gross et al., 1999). In two longitudinal studies, parenting stress was consistently a predictor of behavior problems in young children (Leadbeater & Bishop,
1994; Shaw, Winslow, Owens, & Hood, 1998). For example, Leadbeater and Bishops findings indicated that reports of more stressful life events at child age of 12 months
was significantly correlated with higher levels of total behavior problems, as was the birth of another child by the
time the child was between 28 and 36 months of age.
Similarly, daily parenting stress predicted both externalizing problems (r = .40, p < .001) and internalizing problems (r = .32, p < .001) in children at age 42 months
(Shaw, Winslow, Owens, & Hood, 1998). Lequerica and
Hermosa (1995) reported that externalizing, internalizing,
and total behavior scores were not significantly related
to stressful family life events in a sample of 52 Hispanic
children recruited from a pediatric clinic serving mainly
families of low-income backgrounds. Because this was a
small sample of convenience, these findings should be interpreted with caution. The number of studies examining
the relationship between stress and behavior problems in
families with low SES is small, and studies from different
samples of different ethnicities yielded somewhat conflicting results; however, these findings are important. Stressful life events, which are often associated with poverty,
may have an effect on the parents of young children
and, directly and indirectly, an effect on their childrens
behavior.
196
Maternal Depression. Findings from eight studies

using a variety of methodologies have suggested that
children whose mothers reported higher levels of depressive symptoms were at heightened risk for both externalizing and internalizing behavior problems (Black, Papas,
Hussy, Dubowitz, et al., 2002; Duncan et al., 1994;
Gross et al., 1999; Harden et al., 2000; Leadbeater &
Bishop, 1994; Shaw, Winslow, Owens, & Hood, 1998;
Shaw, Winslow, Owens, Vondra, et al., 1998; Spieker et
al., 1999). Black, Papas, Hussey, Dubowitz, et al. (2002)
reported that children who experienced maltreatment and
had mothers with depressive symptoms had the highest
scores on the Externalizing subscale of the CBCL; children who experienced neither risk had the lowest scores.
Mothers who had negative perceptions of the quality of
their partner relationship were more likely to report depressive symptoms (r = .25, p < .05) and tended to report
more externalizing problems (r = .32, p < .05) and internalizing problems (r = .38, p < .01) among their children.
In another study, Black, Papas, Hussey, Hunter, et al.
(2002), using the sample from the same larger longitudinal study, found that the children with the greatest number of externalizing behavior problems had experienced
both maltreatment and maternal depressive symptoms
and lived in three-generation households (grandmothermother child), F = 7.16, p = .008. These results
are consistent with research that has associated maternal
mental health with child behavior problems (r = .28, p <
.001; Gross et al., 1999) and mothers depression (r =
.29, p < .01; Harden et al., 2000). Contrary to these findings, scores for externalizing problems, internalizing
problems, and total behavior were not significantly related to maternal depression in a sample of Hispanic children (Lequerica & Hermosa, 1995).
Maternal Education. In general, children from lowSES backgrounds had mothers with a lower average
education level than did children from middle-SES backgrounds. Of the three studies that examined the relationship between the mothers education level and the childs
behavior problems (Dawkins, Fullilove, & Dawkins, 1995;
Duncan et al., 1994; Eiden, 1999), only Duncan et al.
found that more schooling had a highly significant, beneficial association with childrens externalizing and internalizing behaviors.
Low Social Support. In contrast, social support from
family members has been shown to be negatively associated with child behavior problems (Leadbeater & Bishop,
1994), with externalizing problems (Shaw et al., 1996),
and with co-occurring externalizing and internalizing behavior problems (Shaw, Winslow, Owens, & Hood, 1998).
Leadbeater and Bishop found that adolescent mothers
who lived with their mothers and who received higher
levels of emotional support reported fewer child behav-
ior problems. Shaw, Winslow, Owens, and Hood (1998)

found that social support measured at the 18-month assessment was negatively correlated with externalizing and
internalizing behavior problems at child age 3.5 years
and that social support measured at the 24-month assessment was negatively correlated with externalizing and
internalizing behavior problems on the CBCL/2-3 and associated only with internalizing problems at child age
3.5 years. In general, children of mothers who received
more social support were reported to have fewer behavior problems.
Harsh Discipline. In addition to examining the association between child behavior problems and parental
psychopathology, numerous researchers have assessed
mothers discipline styles as correlates of problem status
(e.g., Lequerica & Hermosa, 1995; Spieker et al., 1999).
There is considerable evidence that harsh discipline by
parents is associated with behavior problems in school
and childcare settings (Nix et al., 1999). Harsh parental
discipline in preschool years significantly predicted childrens aggressive behavior in later years (Spieker et al.,
1999). Children whose mothers reported the use of negative control strategies had significantly greater numbers
of disruptive behavior problems (Spieker et al., 1999).
Based on the CBCL scores reported by Hispanic mothers
(Lequerica & Hermosa, 1995), externalizing behavior
scores were significantly related to the use of yelling (r =
.36, p = .008) and hitting/spanking (r = .42, p = .002).
Mothers of African American children reported significantly higher maternal negative control (used more harsh
and physical discipline) than did mothers of Euro American children (Spieker et al., 1999); however, child behavior problems were significantly correlated only with more
overreactive discipline strategies (r = .28, p < .001) and,
to a lesser extent, with lax discipline (r = .15, p < .05;
Gross et al., 1999). Eiden (1999) examined the relationship between child behavior problems and maternal substance use, maternal and childhood exposure to violence,
and caregiving instability or inadequacy in a sample of
61 minority children. Eiden reported an association between harsh maternal discipline and higher total behavior problem scores (r = .25, p < .05).
In summary, findings have been consistent in indicating that children from low-income backgrounds identified as having more behavior problems in preschool
years tend to have parents who are more stressed, more
depressed, and harsher in their use of child discipline.
These findings have been consistent across a range of
studies using different sample selection approaches and
behavior assessment methods and measurements, and
they are consistent with data on older children and their
families. Because family support appears to ameliorate
some child behavior problems, the presence of a support
system may explain the lack of associations among
stressful family events, maternal depression, and behavior problems in the small samples of Hispanic children
we reviewed (Lequerica & Hermosa, 1995). It is worth
noting that mothers depression is also associated with
negative bias in perceiving and rating child behaviors. A
depressed mother tended to report higher levels of child
problem behavior than an independent observer of the
child (Youngstrom, Izard, & Ackerman, 1999).
Sociodemographic Risk Factors

The sociodemographic milieu is also a contributor to
childrens development, and children of families living in
poverty tend to exhibit elevated behavior problems. Sociodemographic effects can be difficult to separate because
families with low SES are also more likely to experience
the child and parent risk factors addressed previously, as
well as other related risk factors. Poverty, minority status, domestic violence, family instability, and other risk
factors taken together have a negative impact on students
at home and at school (Duncan et al., 1994). According
to Duncan et al., African American or Hispanic children
are more likely to live in poverty and to experience persistent poverty than are Euro American children.
Ethnicity. Researchers found significant differences
in behavior problems related to ethnicity (Duncan et al.,
1994; Gross et al., 1999; Lavigne et al., 1996; Leadbeater & Bishop, 1994). Leadbeater and Bishop reported
that based on parent reports, (a) boys of African American mothers had more behavior problems than did boys
of Hispanic mothers and (b) girls of Hispanic mothers
had more behavior problems than girls of African American mothers. In contrast, Gross et al. found that Latino
parents rated themselves and their children as having
more difficulties than did the rest of the sample, which
consisted mainly of African American parents. Latino
parents viewed their children as more intense and as having more behavior problems than did the other parents.
In addition, these Latino parents reported greater everyday stress and depressive symptomology. They were more
likely to use discipline strategies that were angry and
coercive in nature, and they reported lower parenting
self-efficacy. Because only a few studies have examined
ethnicity as a factor in childrens behavior, these results
should be interpreted cautiously. One possible explanation for the differences between Latinos and non-Latinos
and African Americans and nonAfrican Americans is that
the instruments used in these studies may not have been
culturally sensitive. The instruments used in the Gross et
al. study, such as the ECBI with the parents and the KPC
with the teachers, were developed initially on non-Latino
populations or other minority populations. Second, different values and parenting styles among parents of dif-
197
ferent cultures might explain the differences in parents

ratings of their own children.
Family Instability. The results of three studies
provided evidence for a relationship between family instability and child behavior problems in families from
low-income backgrounds. Family instability factors included residence changes, changes in intimate caregiver
relationships, and recent negative life events. In a longitudinal study, Ackerman, Kogos, Youngstrom, Schoff,
and Izard (1999) followed a sample of 169 Head Start
children to examine the relationships between behavioral
adjustment in preschool and first grade and family instability and child variables. Ackerman et al. stated, Family
instability was conceptualized as an aggregate of several
kinds of events that challenge the daily continuity and
cohesiveness of family life for a child (p. 258). They
found direct, concurrent relationships between family instability and externalizing problems (r = .38, p <.01) and
internalizing problems (r = .28, p <.01), based on parent
reports, and between family instability and total problem
scores, based on teacher reports (r = .24, p <.01), at child
age 5 years. Similar associations were found between family instability and externalizing problems (r = .24) and
internalizing problems (r = .34), based on parent reports,
and between family instability and internalizing problems
(r = .26), based on teacher reports, at child age 6 years.
Boys appeared to be more sensitive than girls to current
family instability. In another study, Duncan et al. (1994)
reported that the short-term effect of transition to a singleparent household was disruptive to children. Undergoing
a transition from a two-parent household to a one-parent
household was as likely to affect observed behavior in
children as was living for an extended time in a oneparent family. Dawkins et al. (1995) reported that children with higher behavior problem scores were those
whose mothers were separated from their husbands, F(3,
53) = 3.70, p < .01, compared to children whose mothers
were single, married, or divorced.
Family Conflict. Family environment was also associated with child behavior problems. In two studies, researchers found that family conflict had a negative impact
on childrens behaviors (Dawkins et al., 1995; Harden et
al., 2000). Children with higher levels of behavior problems were those whose mothers experienced physical
fights with their spouse, that is, family violence (F(1, 58)
= 4.71, p < .05; Dawkins et al., 1995). Child externalizing behavior problems were positively associated with
family conflict (r = .30, p < .01; Harden et al., 2000).
Community Violence. Linares et al. (2001) reported
that community violence, maternal distress, and early child
behavior problems were significantly intercorrelated. Regardless of the childs exposure to community violence,
198
however, mothers who were of lower SES and mothers on

public assistance were more likely to report child behavior problems than were mothers who were of higher SES
and mothers who were not receiving public assistance.
Children of mothers who reported high levels of community crime and who cowitnessed community violence with
their mothers displayed more internalizing and externalizing behavior problems. Harden et al. (2000) reported
similar findings in regards to exposure to community violence being highly correlated with externalizing problems (r = .25, p < .01). Children with more behavior
problems were those whose mothers lived in neighborhoods too rough for children to play outdoors (Dawkins
et al., 1995).
Randolph et al. (2000) examined the role of gender
in the relationship between community violence and behavior problems. Within the sample of children living in
violent neighborhoods, a significantly higher percentage
of boys (10%) than girls (1%) had severe internalizing
problems, 2(1, N = 312) = 12.40, p < .001; whereas a
significantly higher percentage of girls (18%) than boys
(8%) had severe externalizing problems, 2(1, N = 312)
= 6.86, p < .009.
In general, the problem behaviors of children living
in poverty are associated with high levels of family stress
and sociodemographic risk factors. Specifically, family
conflict, marital disorder, family instability, negative parenting styles, and community violence appear to predict
problem behaviors in childrens later lives. The relative
multiple risks associated with economic disadvantages are
evidenced in early-onset problem behaviors, which are
the type most likely to continue throughout life (Patterson, Reid, & Dishion, 1992). Thus, early screening and
identification of the problem behaviors of children during preschool years or earlier is crucial; early intervention may prevent problems when children enter school.
DISCUSSION
Results of the studies reviewed support the premise that
preschool children who live in poverty are at greater risk
for the development of behavior problems than are children from higher SES backgrounds. Although there is
variability in reported prevalence rates, almost 30% of
children from low-SES backgrounds were reported to
have behavior problems, compared to the 3% to 6% of
children in the general population who were expected to
have behavior problems. This strongly suggests a need
for screening and intervention programs and for research
addressing the efficacy of early intervention with highrisk children.
The current review suggests that the interaction of
child, parent, and socioeconomic characteristics may pro-
duce and sustain behavior problems in preschoolers from

low-income backgrounds, but no studies have examined
these interactions directly. These preschoolers also tend
to have lower language abilities and relatively more deficits in social skills; however, the manner in which these
deficits specifically contribute to behavior problems remains unclear. Children with behavior problems who are
from low-SES backgrounds are somewhat more likely to
have temperament difficulties. Difficult aspects of temperament may be exacerbated when children are reared
by mothers who are experiencing a relatively higher rate
of family life stressors and who receive limited social
support. These children are also more likely to be the recipients of harsh parental discipline and to observe violence in their families and communities.
Methodological Issues
Many studies used clear criteria for inclusion of children,
assessment, multiinformant evaluation, detailed description of demographic information, and a somewhat narrow
age range of participants. All studies used behavioral rating scales that reported good reliability and validity.
Some of the studies reviewed incorporated information
from multiple methods (behavior ratings, observation);
multiple sources (parent, teacher, researcher); and multiple settings (home, school) to assess childrens behavior
in order to produce reliable diagnoses. According to Nix
et al. (1999), The reliance on multiple informants is
likely to yield superior measures of latent variables and
reduce confounds of rater bias and shared method variance (p. 897). Seven of the eight studies that employed
observational methods reported acceptable observer agreement and reliability. In general, there was some indication of a growing sophistication in descriptive research
on behavior problems in young children (e.g., Linares et
al., 2001).
As noted earlier, 22 studies (73%) reviewed relied exclusively on behavioral rating scales and informant interviews in the assessment of behavior. Studies that based
their assessment of childrens behaviors on a single measure
were more likely to embed bias. Furthermore, informant
characteristics were strongly associated with estimates of
the prevalence of child behavior problems (Cai, Kaiser,
& Hancock, 2002; Cai, Kaiser, Hancock, & Lipsey,
2003). A multimethod approach using independent observers and reliable observational methods will provide
the most objective and accurate information about the
behaviors of young children at high risk.
A problem in the use of observational methods as
the sole measurement is the criterion used to indicate behavior status, particularly when used to validate the standardized rating scale, such as teachers or parents reports
of child problem behaviors. Only 11 studies used both
rating scales and observational systems. The frequency

and duration criteria for indicating problem behaviors
were not established a priori in any of these studies; instead, the researchers relied on correlations between observed rates of a behavior and scores on report measures
to indicate cross-informant agreement.
Establishing correspondence between observed and
reported behaviors is further complicated because rating
scales provide information only about the presence of
problem behaviors. For example, many behavior rating
scales score the occurrence only as rarely, sometimes,
or as often. The functional definition of these anchor
points is left to the informant. Children who are scored
as often on the behavior rating scale might exhibit different individual rates of frequency and types of behavior
and yet receive the same score on the outcome measure
if both frequency and severity were not considered. In
addition, researchers have used different behavior rating
scales in different studies, with somewhat varied anchor
points. Various rating scales measure somewhat different
constructs of behavior and include varying numbers of
items for each construct.
Methodological approaches affected specific findings in this area. First, comparisons of incidence rates of
behavior problems across studies were difficult because
different standardized measures were used. The rates of behavior problems might vary according to the approaches
used for identification, for example, using behavior screening instruments versus diagnostic measures (Lavigne et al.,
1996). Second, studies varied in the criteria used to indicate level of problem behavior; some used 1 SD or 2 SD,
whereas other studies used test criteria for clinical or
subclinical level problems. Third, parent and teacher reports produced different incidence rates, and it has been
found that parent and teacher agreement on reports of
child behavior problems typically is low (Cai et al., 2003).
The fact that mothers reported more behavior problems
than did teachers is not surprising because mothers perceptions of their young childrens behavior are often intertwined with family stress, daily hassles, and maternal
depression. Fourth, the cultural bias and cultural appropriateness inherent in standardized behavior reports have
not been assessed systematically. Behavior rating scales
that are normed on primarily Euro American children
from middle income backgrounds might not reflect the
true levels of problem behaviors of children from families
of different cultural backgrounds and with low incomes.
Fifth, context effects have not been analyzed in informant report or observational studies (i.e., quality of classroom, teacher skill, and teacher experience; number of
peers with problems behaviors; teacherchild ratio; adult
child interaction). More observational studies conducted
at home and school that directly assess context concurrent with observations of behavior are needed to supple-
199
ment reports by teachers and parents and to validate

their observations.
Implications for Future Research

Researchers and special education professionals have lamented the lack of screening instruments validated for use
with children in families with low SES, particularly minority children (DelHomme et al., 1994; Lopez, Tarullo,
Forness, & Boyce, 2000). It is critical that culturally unbiased and appropriate screening and diagnostic behavior instruments and observational systems be developed.
Existing instruments must be reexamined, and newly
developed instruments and criteria must be refined on
children from culturally and linguistically diverse backgrounds (Lopez et al., 2000).
Longitudinal studies are needed to examine long-term
outcomes for children with early emergent behavior problems. These studies should include the child, family, and
sociodemographic factors that appear to contribute to or
moderate childrens behavioral outcomes. Gender, child
temperament, and parenting skill should be examined as
both risk and protective factors. Longitudinal studies also
offer the opportunity to examine the co-occurrence of
language, behavior, and social skill problems that may exacerbate poor developmental outcomes in this population.
Future research should focus on employing observational methods in addition to behavior rating scales in
examining the behavior problems in preschool-age children from low-income families who are at significant risk
in order to describe specific behaviors to be targeted in
intervention and to assess the effectiveness of intervention. Observational strategies that are conceptually consistent with the behaviors reported on commonly used
informant measures should be developed. In addition,
data on normative ranges of problem behaviors in the
home and school need to be obtained. Furthermore, studies that index observed problem behaviors to the salient
features of the environment (e.g., adultchild interaction
patterns, childteacher ratio) would support more functional assessment of the nature and severity of childrens
observed behaviors.
The findings of this review suggest a pressing need
for prevention efforts with preschool children whose
poverty status places them at increased risk for behavior
problems. It is critically important to identify these children during their preschool years and to deliver effective
and appropriate interventions to prevent further problems in behavior and academics in later years. These interventions must include providing more stimulating and
supportive home and school environments as well as focusing on the individual to increase childrens language
development and social skills. The research reviewed here
also suggests that intervention should focus on increasing
200
positive parentchild interactions (Kaiser & Hester, 1997),

including changing parental patterns of harsh discipline
and increasing the time children spend with their fathers
(Fagan & Iglesias, 2000). Other supports for children require public policy changes and larger scale environmental interventions. For example, programs for decreasing
community violence may be needed.
Fundamentally, poverty seems to be at the root of
many factors that place young children at risk for problem
behaviors. Families with low incomes have urgent needs
for collaborative and comprehensive services, including
health care, child care, housing, nutrition, mental health,
parenting, and education. Affordable counseling programs
and systematic parent training need to be provided for
mothers of children from low-income families. Because
lower education levels for mothers tend to be related to
higher levels of problem behaviors in their children (Duncan et al., 1994), more effort should be made to help
these mothers further their education in general and, in
particular, their knowledge of child development and
parenting. Clearly, other factors that were not addressed
in the reviewed studies must also be identified in order to
prevent children from developing problem behaviors and
to deliver effective and appropriate interventions to those
children who have already been identified as having problem behaviors.
Overall, this review represents one incremental step
in understanding how poverty leads to the development
of behavior problems during the preschool years in children from low-income families. The results of this review
suggest a need for continued research on early identification of behavior problems of young children from lowincome families, particularly for families from culturally
and linguistically diverse backgrounds, and provide an
impetus for developing comprehensive and practical prevention and interventions efforts for these children.
AUTHORS NOTES
1. Cathy Huaqing Qi is now at the Department of Early Childhood
and Special Education, West Chester University of Pennsylvania.
2. This study was supported from grants by the Administration on
Children, Youth, and Families (90YD0086 to Cathy H. Qi and
90YM002 to Ann P. Kaiser) and the National Institute of Mental
Health (RO1 MH54629 to Ann P. Kaiser).
3. We would like to extend our appreciation to the families who participated in the study for their cooperation and to the Metropolitan
Action Commission, Head Start Program, for its continuing partnership in our research.
NOTE
One standard deviation on the CBCL and the criterion for the subclinical category are approximately the same.
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(continues next page with appendix)
N = 139 (48% girls)

65% African American,
(Achenbach, 1991a)
20% Euro American,
4% Hispanic, 11% Mixed
Mean age = 56.4 mos
Clinic
Descriptive study
Bivariate analyses
Multiple regression analyses
Black, Papas, Hussey,

Dubowitz, Kotch, &
Starr (2002)
Teacher: Conners Teacher

Rating Scales (CTRS;
Conners, 1990); Social
Skills Rating System (SSRS;
Gresham & Elliot, 1990)
N = 96 (51% girls)
2% Euro American
Mean age = 57.83 months,
range = 36 to 69 months
Head Start
Descriptive study
Cluster analyses
Parent: Child Behavior

Checklist/4-18 (CBCL/4-18;
Achenbach, 1991a)
Teacher: CBCLTeacher
Report Form/4-18
CTRF/418; Achenbach,
1991a)
Teacher/parent
reports
Bain & Pelletier

(1999)
Method
Preschool: n = 169
(51% girls)
First grade: n = 151
24% Euro American
Preschool assessment:
Mean age = 60 months;
First-grade assessment:
Mean age = 84 months
Head Start
Longitudinal study
Hierarchical regression
Definition of
problem behavior
Ackerman et al.
(1999)
Study
SUMMARIES
Parent: CBCL/4-18
Center for Epidemiologic StudiesDepression
Scale (CES-D; Radloff,
1977); Autonomy and
Relatedness Inventory(Schaefer & Edger
ton, 1982)
Mothers Behavioral
Style Questionnaire
(BSQ; McDevitt &
Carey, 1978);
Modified Life Events
Survey (MLES;
Sarason, Johnson, &
Siegel, 1978)
Other risk
variables
APPENDIX:
OF THE STUDIES REVIEWED
Observation
(appendix continues)
1. Externalizing scores in clinical range:

36% of children; internalizing scores
in clinical range: 10.8% of children
2. Children who had been maltreated
had more internalizing and externalizing
behavior problems.
3. Children whose mothers reported a
negative relationship with their partners
had more internalizing behavior
1. Children labeled as average (based

on CTRS scores) tended to have welldeveloped social skills, to follow classroom instructions, & to be able to
control their emotions under duress,
marked by an absence of disruptive
behavior.
2. Children in the moderate group were
reported to participate in free-time activities without disruptive behavior but
tended to have more disruptive behavior
during organized activities.
3. Children in the high group were qualitatively different from both the average
& moderate groups; they tended to be
unlikely to play quietly & were highly
impulsive.
1. There was a relationship between

family instability & child adjustment in
the context of family variables. At preschool assessment, instability measure
accounted for significant unique
variance in caregiver reports of child
externalizing behavior & teachers total
problem scores.
2. Boys were more sensitive than girls
to current family instability.
3. Preschool adaptability moderated the
effects of family instability at first grade
in predicting caregiver reports about
child internalizing behavior at the firstgrade assessment.
Findings
204
Teacher/parent
reports
N = 42 (37% girls)
71% Hispanic
Age: Preschool
Head Start
Observation study
MANOVA
DelHomme et al.
(1994)
Teacher: SSBD (Walker &

Severson, 1990)
Parent: Eyberg Child Behavior

Inventory (ECBI; Eyberg
& Ross, 1978)
N = 194 (48% girls)

Parent: CBCL/4-18
(Achenbach, 1991a)
20% Euro American,
4% Hispanic, 11% Mixed
Mean age = 56.4 mos
Clinic
Descriptive study
Multiple regression analyses
Method
N = 99 (gender not
specified)
Age: 3 & 4 yrs
Head Start
Descriptive study
ANOVA
Definition of
problem behavior
Dawkins et al. (1995)
Black, Papas, Hussey,

Hunter, Dubowitz,
Kotch, et al.
(2002)
Study
(appendix continued)
CES-D (Radloff,
1977)
Other risk
variables
Hinshaws Behavior
Coding System
(Hinshaw, Han,
Erhardt, & HuberDressler, 1992)
Length: 40 min per
child
Setting: Instructional
and free play
Behaviors observed:
on-task & prosocial;
noncompliance, aggression, disengagement,
solitary behavior
Observation
1. Approximately 23% of children were

identified as at risk for behavior problems.
2. Significant effect on context & group
(externalizing, internalizing, comparison);
more on-task behavior observed in
instructional context than in free-play
context.
3. More on-task behavior exhibited by
internalizers than by externalizers.
4. More aggressive behavior exhibited by
externalizers than by internalizers in
free-play context; virtually no group
differences in aggression in instruc-
1. Mean behavior problem score: substantially lower than for the normative
sample of children with problem behaviors
in the Eyberg and Ross study (1978) but
higher than the mean of their nonproblem
problem group.
2. Parent characteristics: Children with
higher problem scores: Mothers lived in
the city for more than 10 yrs (length of
residence in the city), were separated
from their husbands (marital status),
experienced physical fights with their
spouses (family violence), & lived in a
neighborhood too rough for children to
play.
1. Children who had been reported for

maltreatment & had mothers with
depressive symptoms had more externalizing behavior problems when
compared to children who experienced
either no risk or only one risk.
2. Residential status considered: children
with the greatest number of externalizing
behavior problems were those who had
experienced maltreatment & maternal
depressive symptoms & lived in threegeneration households.
problems but only a tendency toward

more externalizing problems than children whose mothers reported a positive
partner relationship.
Findings
205
N = 61 (79% girls)
4% Hispanic
Mean age = 43.21 mos
Recruited from word of
mouth, advertisement,
substance abuse treatment
center
Descriptive study
Multivariate analyses
N = 65 (43% girls)
6% Euro American,
Eiden (1999)
Fagan & Iglesias

(2000)
Method
N = 895 (51% girls)

34% Euro American,
11% Hispanic
Assessment: age 5
Longitudinal data from
ages 1 to 6 yrs
Clinic
Longitudinal study
Ordinary least squares
Multiple linear regression
Definition of
problem behavior
Duncan et al.
(1994)
Study
Teacher: The Problem

Behavior subscale of the
SSRS (Gresham & Elliott,
Parent: CBCL-R
(Achenbach & Edelbrock,
1983)

ChecklistRevised (CBCL-R;
Achenbach & Edelbrock,
1983)
Teacher/parent
reports
C-unit segmentation
(Loban, 1976)
Spontaneous
The National Household Survey of Drug

Abuse (National
Institute of Drug
Abuse, 1992);
Survey of Exposure
to Community
Violence (Richters
& Saltzman, 1990)
Wechsler Preschool
and Primary Scales
of Intelligence
(WPPSI; Wechsler,
1967);
Home Observation
for Measurement of
the Environment
(HOME; Bradley &
Caldwell, 1980);
The General Health
Questionnaire
(Goldberg, 1978)
Other risk
variables
Observation
Correlateschild characteristics:
1. Children with higher MLUs (mean
length of utterance) perceived to have
1. Among children ages 4 yrs and

younger, 33% were in the clinical range
based on CBCL 2/3; among children
older than 4 yrs, 50% were in the
clinical range.
Correlates:
2. Girls had higher levels of behavior
problems than did boys.
3. Children in the high-risk group
witnessed violent events more frequently,
& their mothers had more frequent
experiences with violence.
1. Mothers reported boys had more

problems than girls.
2. Mothers education level had a highly
significant beneficial association with
childs IQ & with externalizing &
internalizing behavior problems.
3. Living arrangements in which a female
head was present all the time, or at
least at the time of the 60-mo measurement, had significantly detrimental
effects on childrens internalizing &
externalizing behaviors.
4. Mother-reported depression had an
impact on childrens internalizing &
externalizing behavior problems.
5. African American children had fewer
reported behavior problems than
nonAfrican American.
6. Family economic status a powerful
predictor of IQ & externalizing & internalizing behavior problems.
tional context. Externalizers thus exhibited more aggressive behavior in free-play

context than did internalizers & comparison group.
5. Internalizers & comparison group
exhibited significantly more on-task
behavior in the instructional context than
did externalizers.
Findings
206
Cutoff scores: 1 SD
from the mean for ESP
& SSRS, & 1.5 SD for
the CBCL
Used cutoffs established

by Robinson, Eyberg,
& Ross (1980)
Gross et al.
(1999)
Definition of
problem behavior
Feil et al. (2000)
Study
N = 133 (46% girls)

25% Hispanic,
9% multiracial
Age: 2 & 3 yrs
Day care centers serving
low-income families
Descriptive study
Correlational analyses
Screening N = 954
Study N = 126 (49% girls)
45% Euro American,
25% Hispanic,
11% Native American
Age = 3 & 4 yrs
Head Start
Descriptive study
22% Hispanic
Mean age = 52.83 mos
Head Start
Longitudinal study
Structural models
Method
Teacher: Kohn Problem

Checklist (KPC; Kohn,
1977)
Parent: ECBI (Robinson
et al., 1980)
Teacher: (CTRF/4-18)
(Achenbach, 1991);
Early Screening Project
(ESP; Walker, Severson, &
Feil, 1995); SSRS (Gresham
& Elliot, 1990)
Parent: SSRS (Gresham &
Elliot, 1990)
1990)
Teacher/parent
reports
CES-D (Radloff,
1977)
Observation
Codes: Peer social behavior (Walker et al.,

1995)
Length: Not specified
Setting: Academic,
playground
language samples:
16 min
Setting: A quiet room
in the childs Head
Start center
Other risk
variables
1. Seventeen (12.8%) of sample children

fell above cutoff on behavioral intensity;
31.6% above cutoff for behavior problems. (Based on parent report, 31.6%
of children had significant behavior
problems.) Only 14.3% of children
judged by teachers to have significant
behavior problems.
Correlates:
2. Childrens behavior problems significantly related to their behavioral intensity and to parents stress.
3. Child behavior problems significantly
correlated with more overactive discipline strategies & to a lesser extent, with
lax discipline.
3. Latino children were seen by their
parents as significantly more intense &
problematic than were non-Latino
children by their parents. Latino parents
also tended to use more overreactive
discipline strategies with their children
than did non-Latinos.
1. ESP teacher ratings resulted in 43%

52% of children exceeding cutoff criteria
for externalizing measures, 25%34%
exceeding cutoff for internalizing, &
13% exceeding cutoff on direct observation of peer social behavior.
2. Most criterion measures showed
slightly smaller percentages (7%25%)
exceeding cutoff criteria, with SSRS
parent reports (32% & 57%) and overall
CBCL teacher reports (31% & 30%) for
internalizing and externalizing behaviors,
respectively, having larger numbers
exceeding cutoff criteria.
fewer externalizing behaviors at Time 1.

2. No significant paths from child
communication to Time 1 internalizing
behavior; however, higher child MLUs
at Time 1 associated with fewer internalizing behaviors at Time 2.
3. A causative relationship between
childrens communicative competence
and behavior problems was found.
Findings
207
Kaiser et al.
(2000)
Harden et al.
(2000)
Study
Cutoff score =
T score > 60
Children with behavior

problems in the clinical
or borderline range,
based on parents
CBCL T scores
> 60 ( i.e., externalizers)
Definition of
problem behavior
N = 259 (49% girls)

88% African American
Mean age = 42 mos
Head Start
Descriptive study
N = 155 (49% girls)

0.6% Asian, 0.6 biracial
Mean age = 4.1 yrs
Head Start
Longitudinal study
Observation
Method

Checklist/2-3 (CBCL/2-3;
Achenbach, 1992); SSRS
(Gresham & Elliott,
1990)
Teacher: Preschool Behavior

Questionnaire (PBQ; Behar
& Stringfield, 1974)
Parent: CBCL/4-18 (Achenbach, 1991a)
Teacher/parent
reports
Observation
Length: 15 min (5min
per observation for
3 days)
Setting: Classroom
structured &
unstructured
Behaviors observed:
Appropriate &
inappropriate
Reliability: Cohens
kappa averaged
0.93 across all
behaviors
Preschool Language
Scale-3 (PLS-3,
Zimmerman, Steiner,
& Pond, 1992);
Peabody Picture
Vocabulary TestThird
Edition (PPVT-3; Dunn
& Dunn, 1997)
Peabody Picture
Vocabulary Test
Revised (PPVT-R;
Dunn & Dunn,
1981); The Colorado
Child Temperament
Inventory (CCTI;
Rove & Plomin,
1977); Brief Symptom Inventory (BSI;
Derogatis & Spencer,
1982)
Other risk
variables
1. Boys showed elevated levels of

behavior problems across all measures
(t scores, externalizing, internalizing);
21.2% had total problem score in
clinical range, 21.2% scored in clinical range for externalizing behavior
26.5% scored in clinical range for
internalizing problems.
Phase 1:
1. Based on t scores of parent
CBCL, 23.7% of children had
externalizing behavior problems
in clinical (15.8%) or borderline
(7.9%) range; 6.5% had internalizing
difficulties.
Correlates:
2. Significant negative associations
between externalizing behavior
and temperament variable of
attention.
3. Every symptom of parental
psychopathology strongly associated
with child externalizing problems.
4. Amount of time children spent with
their biological mothers, fathers, or
other caregivers correlated with externalizing behavior; higher rates of
externalizing associated with less time
spent with father.
5. Exposure to community violence
positively related to externalizing
problems.
Phase 2:
1. Children with externalizing behavior spent majority of observed time
displaying appropriate behavior (e.g.,
on task during structured & unstructured activities). Majority of inappropriate behavior was hyperactive
impulsive behavior; no exhibition of
aggressive or negative affect.
2. Teacher-rated social competency
negatively associated with three types
of behavior (hostileaggressive,
anxiousfearful, & hyperactive
distraction).
Findings
208
Keenan et al.
(1998)
Keenan &
Wakschlag
(2000)
Study
Cutoff score 70
in clinical range
on the CBCL
Definition of
problem behavior
N = 104 (42.3% girls)

61% Euro American
Age ranges: 611 mos
to 60 mos
Clinical
Longitudinal study
N = 79 (22.8% girls)
13% Euro American.
7% other
Mean age = 48 mos
Clinical
Descriptive study
Observation study
Method
Parent: CBCL/2-3 (Achenbach, 1992); Child Aggression Codes (adapted from

Cummings, Iannotti, &
Zahn-Waxler, 1989); Noncompliance Codes (Martin,
1981); Schedule for Affective
Disorders and Schizophrenia
for School-Age Children
Parent: CBCL, Achenbach,

1991a, 1991b)
Teacher/parent
reports
Infant Characteristics Questionnaire

(ICQ; Bates, Freeland, & Lounsbury,
1979)
Other risk
variables
Length: 15 min
Setting: Free play
Behaviors observed:
Noncompliance,
aggression
Codes: Adapted from

Matas, Arend, & Sroufe
(1978) validated.
Length: 12 min
Setting: Clinic2 parent
child interaction tasks
Behaviors observed:
Noncompliance,
interpersonal aggression,
and destructiveness
Observation
1. Child problem behaviors decreased

from infancy to toddler period. Mean
scores on ICQ and noncompliance
decreased from 1st to 2nd yr of life.
Mean scores on CBCL/2-3 at 36 mos
in nonclinical range.
2. Rates of DSM-III-R definite and
subthreshold externalizing disorders
both close to 15% (n = 13 for each).
1. Starting fights most commonly

endorsed symptom of conduct
disorder (CD; 44.3%), followed by
bullying (40.5%), using a weapon
(34.2%).
2. Close to 80% of preschoolers met
criteria for a disruptive behavior or
attention-deficit disorder; 59.5% met
criteria for oppositional defiant
disorder.
3. ADHD associated with marital
status and lack of father involvement.
4. Rates of noncompliance fairly high
but rates of aggression low.
5. Prevalence of disruptive behavior
problems significantly higher than
those reported for low-income and
community samples of nonreferred
preschoolers.
2. For girls: 23.6% scored in clinical

range for internalizing behavior,
13.4% for externalizing, 15.7% for
total problem scores.
3. Boys & girls differed significantly
only on mean difference between
mean scores for the externalizing
subscale. No difference between
genders on internalizing.
4. Of the 21% of boys who scored in
clinical range for externalizing behavior, 75% also in the clinical range for
internalizing behavior. Only 14% of
boys below the clinical range for
externalizing behavior had clinical
range internalizing behavior; similar
overlap among girls.
Findings
209
N = 3,860 (screened)
Parent: CBCL (Achenbach,
N = 510 (41.1% girls)
1991a, 1991b)
Received full evaluation
18.8% African American,
67.1 Euro American,
7.2% Hispanic
Majority of sample
low-income
Cross-sectional study
Logistic regression
analyses
Prevalence rates
calculated for total
behavior problems,
internalizing problems
(internalizing scale score
exceeded 90th percentile;
externalizing score below
90th percentile), externalizing problems (externalizing score exceeded
90th percentile; internalizing score below 90th
percentile), & comorbidity
(externalizing & internalizing scores both exceeded
90th percentile)
Teacher: Types of Aggressive

Behavior Scale (TABS;
Willoughby, Kupersmidt,
& Bryant, 2000)
Epidemiologic Fourth Version

(Kiddie-SADS; Orvaschel &
Puig-Antich, 1987)
Teacher/parent
reports
Lavigne et al.
(1996)
Method
N = 440 (Head Start

sample 50% girls);
N = 131 (comparison
group 40% girls)
5% Euro American
(Head Start);
63% Euro American
(Comparison group)
Mean age = 48 mos
Head Start
Descriptive study
MANOVA
Definition of
problem behavior
Kupersmidt,
Bryant, &
Willoughby
(2000)
Study
Moos Family Environment Scale (FES;

Moos & Moos, 1981);
Life Events Scale
(LES; Coddington,
1972)
Other risk
variables
Each dyad observed in

child-directed & parentdirected activities
(Forehand & McMahon,
1981)
Observation
1. Prevalence of behavior problems

on Total Behavior Problems scale of
parent CBCL = 8.3%. Rates significantly higher for boys than for girls
(e.g., 95% CLs do not over lap).
Significant increase between 3 and
4 yrs of age on Total Behavior Problems scale, but changes between 2 &
3 yrs, & between 4 & 5 yrs
nonsignificant.
2. Logistic regression analyses indicated significant demographic correlates for behavior problems (older
age, minority status, male gender,
lower SES, father absence, small
family size).
1. More than 50% of Head Start

preschoolers exhibited aggression
once a mo or less for 9 out of 12
items. Pushing, arguing, & being
sneaky exhibited most often. Hitting,
kicking, & threatening exhibited by
about 16% of the sample once a day
or more.
2. Head Start preschoolers reported
by their teachers as exhibiting more
hitting & kicking; pushing, shoving,
& grabbing; and sneaky behaviors
than the random sample of preschoolers. In contrast, children in
random sample reported by teachers
as calling other children names more
often than Head Start sample.
3. Boys scored higher on 7 out of 12
aggressive behavior items.
Thirteen children (14.9%) met subthreshold criteria for internalizing

disorder. Co-occurrence of internalizing and externalizing disorders not
significantly more common than
would be expected by chance.
3. Difficult temperament differentially
associated with later internalizing
problems; aggression and noncompliance specifically associated with externalizing problems for boys & girls.
Findings
210
N = 704 (50% girls)

39% Euro American,
9% Hispanic American
Assessed at 12, 24, &
36 mos
Clinic
Longitudinal study
Hierarchical regressions
Liaw &
Brooks-Gunn
(1994)
N = 83
56.1% African American,
38.6% Puerto Rican
Mean age = 31 mos,
range = 2143 mos
Low-income urban
day care
Longitudinal study
Hierarchical regression
analysis
Method
N = 52 (ages 25 yrs)
(61.5% girls)
100% Hispanic
Mean age = 41.9 mos
Clinic
Descriptive study
Pearson correlations, chi
squares, analysis of
variance
Dichotomized behavior
problem measure used
to signify severe behavior
problems (total score > 63)
vs. less severe problems
(total score 63)
Total behavior problem

raw scores > 63 (90th
percentile for normative
sample) indicated clinical
range of disturbance
(Achenbach, 1992)
Definition of
problem behavior
Lequerica
& Hermosa
(1995)
Leadbeater
& Bishop
(1994)
Study
Parent: CBCL/2-3
(Achenbach, 1992)

Checklist (CBCL/416;
Achenbach & Edelbrock,
1981)
Parent: CBCL/2-3
(Achenbach, 1992)
Teacher/parent
reports
Bayley Scales of
Infant Development
(Bayley, 1969); Beck
Depression Inventory
(BDI; Beck, 1967)
Other risk
variables
Observation
Correlates:
1. Mothers with low verbal ability,
high levels of depression, frequent
stressful life events, and age younger
than 18 yrs at childs birth more
likely to report more severe behavior
problems in their children.
1. Four to 5-year-olds obtained

higher frequencies than control
group and even the psychiatrically
referred non-Hispanic 4- to 5-yr-olds
in Achenbachs sample.
Correlates:
2. Significant correlations between
discipline methods mothers used
often and problem behavior scores.
Externalizing behavior score significantly related to use of both yelling
and hitting/spanking.
1. Total behavior problem raw scores

> 63 indicated clinical range of
disturbance. Eleven (13%) children
scored above cutoff.
Correlates:
2. Mother depressive symptoms consistently associated with total
behavior problems. Maternal age,
welfare status, & delayed educational attainment not significantly
correlated with child problem
behaviors.
3. Mothers stress significantly
correlated with higher levels of total
behavior problems
4. Main effect for ethnicity and for
interaction effect. Boys of African
American mothers had more behavior
problems than Hispanic boys; girls of
Hispanic mothers had more behavior
problems than girls with African
American mothers.
5. Support from family was negatively
associated with total behavior
problems.
Findings
211
Olson (1992)
Linares et al.
(2001)
Study
Definition of
problem behavior
N = 60 (0% girls)
98% Euro American
Mean age = 54 mos
range = 4865 mos
Head Start
Longitudinal design
N = 160 (48% girls)

10% African Caribbean,
9% other African heritage,
22% Hispanic, 6% others
Mean age = 49 mos,
range = 3671 mos
Majority low SES,
some moderate SES
Pediatric patients in
clinic
Structural equation
modeling, latent variables
Method
Teacher: Conners Teacher

Questionnaire (Goyette,
Conners, & Ulrich, 1978)
Parent: CBCL/2-3 (Achenbach, 1992); CBCL/4-18

(Achenbach, 1991a)
Teacher/parent
reports
Peer sociometric
interviews
Community Survey
Questionnaire (Earls,
1994); Maternal Fear
of Crime Scale
Co-witnessed Violence
(Richters & Martinez,
1993); Conflict Tactics
Scale (CTS; Straus,
1990); General Symptom Index (GSI) of
the Symptom
Checklists 90Revised
Scale (SCL-90-R;
Derogatis, 1994)
Other risk
variables
Length: (10 min x

3 sessions = 30 min)
Setting: Play area outside preschool classrooms
Behaviors observed:
Social conversation,
cooperative play,
conflict-relevant verbal
behavior, assertive behavior, affection &
helping, verbal aggression, physical coercion
aggression, other
Observation
1. Relatively few categories of social

initiation behaviors on the part of target children significantly related to maladjustment scores. Overall rate of
coerciveaggression initiations to peers
was associated with peer perceptions of
disability & aggressiveness at both time
periods & with teachers ratings of conduct problems at the end of year.
2. Negative responses of target
children to peers consistently
correlated with measures of social
maladjustment. Children perceived
by teachers and peers as behaviorally
deviant tended to respond to peers
behaviors with relatively high rates of
verbal & physical aggression.
3. During final observation period,
aggression initiations & responses on
part of target children associated
with teachers ratings of behavioral
maladjustment.
4. During second half of preschool yr,
boys who eventually received high
peer rejection & behavioral maladjustment scores showed relatively high
rates of verbally & physically aggressive initiations to peers; tended to
respond aggressively to nonaggressive
peer initiations.
1. Lower SES correlated with

partner aggression toward mother
and internalizing & externalizing
child behaviors.
2. Internalizing child behaviors
correlated with maternal SES,
perceived crime, social disorder, fear
of crime, cowitnessing violence,
partner aggression toward child,
partner aggression toward mother,
PTSD symptoms, & maternal
global distress.
3. Externalizing child behaviors correlated with maternal SES, perceived
crime, fear of crime, partner aggression toward child, partner aggression
toward mother, PTSD symptoms, &
maternal global distress.
Findings
212
Rose et al.
(1992)
N = 109 (41% girls of

full-term births,
59% girls preterm
births)
Ethnicity not specified
First assessment: 36 mos;
second assessment:
72 mos
Longitudinal study
N = 312 (53% girls)

Mean age = 53 mos
Head Start
Descriptive study
Independent t test
and chi square
1 SD above the normative mean of CBCL
Randolph et al.
(2000)
Method
N = 159 (100% boys)
63% Euro American,
1% mixed
Children assessed at 18,
24, 42, 60, 64 mos
Clinic
Longitudinal study
and hierarchical
regression equations
Definition of
problem behavior
Owens et al.
(1999)
Study
Parent: Behavioral Screening

Questionnaire (BSQ; Richman
& Graham, 1971); CBCL-R
(Achenbach & Edelbrock,
1983); CRS-R (Goyette et al.,
1978)
Teacher: CRS-R (Goyett et al.,
1978)
Parent: CBCL/4-18 (Achenbach, 1991a)
Teacher: Child Teacher Rating

Form (CTRF; Achenbach,
1991a)
Teacher/parent
reports
MLES (Sarason et al.,

1978)
Structured interview
protocol
Neighborhood Questionnaire (StouthamerLoeber, Loeber, &

Farringtown, 1993);
CTS (Straus, 1979);
Personality Research
Form (PRF; Jackson,
1967); Anger Expression Scale (AX; Spielberger et al., 1985)
Other risk
variables
Observation
1. Cutoff points: score 10 for BSQ,

scores identified upper 10% of
distribution for three CBCL scales,
& scores > 2 SD above mean for
two Conner scales.
2. High prevalence rate of behavior
problems on BSQ at age 3 yrs (30%)
for preterm group.
3. 50% prevalence for problem
behavior rate on the CBCL by 6-yr-
1. Boys: approximately 25% exhibited internalizing, 27% externalizing, & 27% total behavior problems
at 1 SD severity level. Percentage of
girls with externalizing (40%) & total
behavior problems (30%) in the
latter severity level considerably
higher than that for previous samples.
Correlates:
2. Boys & girls differed from normative sample on externalizing subscales. Boys & girls had significantly
more total behavior problems than
normal time sample.
3. Important differences between
boys & girls with respect to severity
of internalizing & externalizing
behavior problems.
4. Within sample of children living in
violent neighborhoods, significantly
higher percentage of boys than girls
had severe internalizing problems;
significantly higher percentage of girls
than boys had severe externalizing
behaviors.
1. Child intelligence best predictor

of lower levels of behavior problems
at school in that it accounted for
significant variance, regardless of
risk type or form of behavior
problem.
2. When SES & other sociodemographic risks controlled, higher
intelligence scores at age 5.5 yrs
predicted better classroom behavior
& fewer symptoms of psychopathology noted by teachers 6 mos later.
Findings
213
n = 310 children assessed

at age 18 mos (0% girls),
n = 302 assessed at
24 mos, n = 282 assessed
at 42 mos
Shaw, Winslow,
Owens, & Hood
(1998)
Method
N = 100 (gender not

specified)
611 mos (n = 129),
12 mos (n = 100),
18 mos (n = 89),
24 mos (n = 89)
Clinic
Longitudinal study
& multiple regression
Definition of
problem behavior
Shaw et al.
(1996)
Study
Parent: CBCL/2-3
(Achenbach, 1992)
Parent: CBCL/2-3 &

CBCL/4-16 (Achenbach,
1991a, 1992)
Teacher/parent
reports
Observation
BDI (Beck et al., 1961;

Reynolds & Gould,
1981); GLS (Crnic et al.,
1983); Maternal Social
Support Index (MSSI;
Pascoe, 1988);
BDI (Beck, Ward, Mendelon, Mock, & Erbauch, 1961; Reynolds

& Gould, 1981);
General Life Circumstances Questionnaire
(GLS; Crnic, Greenberg,
Ragozin, Robinson, &
Basham, 1983);
Marital Adjustment
Test (MAT; Locke &
Wallace, 1959);
Parenting Daily Hassles
(PDH; Crnic & Greenberg,
1990)
Other risk
variables
1. Individual stressors involving

maternal adjustment & family
environment & aggression/crime
associated with externalizing &
internalizing behavior problems at
ages 2 & 3.5 yrs.
1. Year 1 significant correlates of

both age 5 yrs aggression and
externalizing behavior included
insecure attachment, disorganized
attachment, maternal personality
risk. Low social support & low
marital satisfaction predictive of
externalizing problems only.
2. At Year 2, difficult temperament
& several parent variables (e.g.,
marital satisfaction, maternal adjustment, & resources) predictive of both
aggression and externalizing
problems.
old preterm group.

4. 15.2% preterm group were identified with clinically significant behavior problems at age 6 yrs by parents,
& 19% by teachers.
5. Preterm group showed more behavioral problems than full-term
group on all measures (3-year BSQ,
6-year CBCL, 6-year Conners
Hyperactivity Index)significantly so
for both CBCL total score & teachers
rating of hyperactivity on Conners
scale.
6. Lower SES & greater number of
negative life events associated with
more behavior problems at age 6 yrs.
7. Early behavior problems alone
strongest predictor of later externalizing problems, uniquely accounting for
9% of variance. Low SES & family
stress stronger contributors to internalizing problems; each independently
accounted for 7% of variance.
Findings
214
N = 21 (37% girls)
5% Euro American/other,
70% Hispanic
Mean age = 4.2 yrs
Sinclair, DelHomme,
& Gonzalez (1993)
53% Euro American,

4% other
Mean age = 42 mos
Clinic
Longitudinal study
Method
n = 130 assessed at
12 mos (45% girls),
n = 125 assessed at
24 mos (47% girls),
n = 103 assessed at
42 mos (42% girls)
57% Euro American,
4% other
Longitudinal study
Definition of
problem behavior
Shaw, Winslow,
Owens, Vondra,
et al. (1998)
Study
Other risk
variables
Personality Research
FormThird Edition
(PRF-3; Jackson, 1989);
Neighborhood Ques
tionnaire (NQ; Pittsburgh Youth Study,
unpublished); MAT
(Locke & Wallace, 1959);
Multiple Stressor Groupings (MSG; Rutter,
Cox, Tupling, Berger,
& Yule, 1975)
Stage II: Critical Events Index

(CEI; Walker & Severson, 1990);
Combined Frequency Index
for Adaptive and Maladaptive
Behavior (CFI; Walker &
Teacher/parent
reports
1. 24% of Stage III participants

& 6% of entire six-classroom sample
passed through screening process.
2. Differences between play settings
noted, but no clear patterns emerged
Length: 10 min 4
occasions (2 outdoors,
2 indoors)
Setting: Classroom,
playground
1. SES at 12 mos negatively related

to CBCL externalizing at 24 mos
(r = .-31, p < .05).
2. For boys, maternal responsiveness
at 12 mos negatively related to
24- & 42-mo CBCL externalizing,
& maternal rejection at 24 mos
positively related to 24-mo noncompliance & 42-mo externalizing.
Relationship between CBCL externalizing factor from 2442 mos was
high, r = .70, p < .001.
3. For girls, maternal responsiveness
at 12 mos not related to 24- & 42mos CBCL externalizing, & maternal
rejection at 24 mos positively related
to 24-mo noncompliance 42-mo
externalizing. Relationship between
CBCL externalizing factor from
2442 mos was high, r = .66, p <
.001. Association between 24-mo
noncompliance & 42-mo externalizing did not attain significance.
4. Most consistent predictor of early
externalizing problems across gender
was maternal rejection.
2. Sociodemographic risk factors

(family income, overcrowding) less
consistently related to child problem
behaviors.
3. When stressor groups formed,
increase in family stress associated
with increase in behavior problems
in accord with previous crosssectional & longitudinal studies of
school age & preschool-age children.
4. Families with 3 or more stressors
appeared to have significantly higher
CBCL externalizing problem
behaviors.
Findings
Length: 11 min
Setting: home
Behaviors observed:
Noncompliance
walking away,
changing task,
passive nonresisting,
struggling or resisting
Observation
215
Spieker et al.
(1999)
Study
Bottom of clinical
range for TRF
externalizing scale;
T = 60 (84th percentile)
Definition of
problem behavior
N = 183 (40% girls)

37% Euro American,
8% Black/White,
5% American Indian,
17% other
Age range: 4172 mos
Clinical
Longitudinal design
Hierarchical linear
modeling growth curve
analysis
Head Start
Method
Parent: CBCL/2-3 (Achenbach,

1992); Behavior Problem
Index (BPI; Baker & Mott,
1989); CBCL/4-18 (Achenbach, 1991a)
Teacher: CTRF (Achenbach,
1991a)
Severson, 1990); SSBD

(Walker & Severson, 1990)
Teacher/parent
reports
SCI-90-R (Derogatis,
1994) assessed depression and anxiety; CTS
(Straus, 1974) assessed
maternal negative
control
Other risk
variables
Observation
1. 36% of sample scored in borderline clinical range on TRF.

2. Significant difference by gender on
disruptive behaviors reported, with
boys exhibiting more disruptive
problems than girls.
3. Children whose mothers reported
more depression/anxiety symptoms
had significantly greater disruptive
behavior problems at age 6 but no
significant difference in rate of
change of problem behaviors.
4. Children whose mothers reported
the use of negative control strategies
had significantly higher disruptive behavior problem scores at age 6. These
children had significant difference in
rate of change of disruptive problem
behaviors.
5. Mothers of African American
children reported significantly higher
CTS scores (used more harsh & physical discipline) than mothers of Euro
American children.
that allowed for comparisons among

groups. Externalizers not consistently
engaging in more negative behavior
outdoors as opposed to indoors.
Internalizers not consistently playing
by themselves to greater degree in
either setting.
Findings
216

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Topics in Early Childhood Special

>> Version of Record - Jan 1, 2003

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TECSE 23:4 188216 (2003)

Behavior Problems of Preschool Children

esearch on the prevalence of behavior problems in preschool children from

Early identification of and interventions for preschool

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Behavior Problems of Preschool Children

qualifying for public assistance (e.g.,

Sample sizes in the studies ranged from 42 to 3,860, with

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Topics in Early Childhood Special Education 23:4

1990, 1991a, 1991b, 1992), which was used in 22 studies

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Behavior Problems of Preschool Children

informantsparents versus teacherswho may have

Risk Factors Associated with

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Topics in Early Childhood Special Education 23:4

FIGURE 1. Transactional model.

mographic risk factors (education, number of children,

Ten of the 30 studies of preschool children from low-SES

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Behavior Problems of Preschool Children

year showed significantly higher aggression problems at

Parents of preterm children reported more hyperactivity

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Topics in Early Childhood Special Education 23:4

lays was reported in 2 studies (Fagan & Iglesias, 2000;

high CBCL/2-3 total scores and low social skills; among

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Behavior Problems of Preschool Children

Gunn, 1994; Shaw, Winslow, Owens, & Hood, 1998;

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Topics in Early Childhood Special Education 23:4

Maternal Depression. Findings from eight studies

ior problems. Shaw, Winslow, Owens, and Hood (1998)

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Behavior Problems of Preschool Children

Sociodemographic Risk Factors

ferent cultures might explain the differences in parents

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Topics in Early Childhood Special Education 23:4

however, mothers who were of lower SES and mothers on

duce and sustain behavior problems in preschoolers from

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Behavior Problems of Preschool Children

rating scales and observational systems. The frequency

ment reports by teachers and parents and to validate

Implications for Future Research

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Topics in Early Childhood Special Education 23:4

positive parentchild interactions (Kaiser & Hester, 1997),

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Behavior Problems of Preschool Children

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Topics in Early Childhood Special Education 23:4

Lequerica, M., & Hermosa, B. (1995). Maternal reports of behavior

Letiecq, B. L. (2000). Behavior problems of African American boys

Downloaded from tec.sagepub.com at Uni Babes-Bolyai on November 9, 2013

Behavior Problems of Preschool Children