No abstract

Prior studies have shown that birth complications interact with psychosocial risk factors in predisposing to increased externalizing behavior in childhood and criminal behavior in adulthood. However, little is known about the direct relationship between birth complications and externalizing behavior. Furthermore, the mechanism by which the birth complications predispose to externalizing behavior is not well explored. This study aims to assess whether birth complications predispose to early adolescent externalizing behavior and to test whether Intelligence Quotient (IQ) mediates relationships between predictor and outcome variables. We used data from a prospective, longitudinal birth cohort of 1,795 3-year-old boys and girls from Mauritius to test hypotheses. Birth complications were assessed from hospital record data, malnutrition from a pediatric exam at age 3 years, psychosocial adversity from parental interviews at age 3 years, and externalizing behavior problems from parental ratings at age 11 years. We found that babies with birth complications are more likely to develop externalizing behavior problems at age 11. Low IQ was associated with birth complications and was found to mediate the link between early predictors and later externalizing behavior. These prospective, longitudinal findings have potential clinical implications for the identification of early adolescent externalizing behavior and for public health attempts to prevent the occurrence of child externalizing behavior problems.

The process of relational control, that is, the negotiation of "who's in charge," was examined in 40 families of persons with schizophrenia and bipolar disorder. Verbal interaction recorded during problem-solving tasks was coded with the Relational Control Coding System (RCCS). Patterning of message and response sequences was compared by diagnosis of the patient and level of expressed emotion (EE) of the family. Results indicated that patients with either diagnosis assert control more than their parents, that high-EE families compete for control more than low-EE families, and that families of bipolar patients compete for control whatever their EE status. The most dramatic differences in control patterns were in the dual-parent, high-EE families of persons with schizophrenia, in which the patients successfully challenged parents for control, and parents often yielded. It was concluded that EE reflects transactional processes in families that vary by diagnosis of the patient.

Interaction in 40 families of persons with bipolar disorders or schizophrenia was analyzed as a stochastic process to examine communication patterns between patients and parents relative to parents' level of expressed emotion (EE). Interaction sequences were coded with the Relational Control Coding System, and Markov process characteristics of order (degree of sequential dependency), stationarity, and role homogeneity were assessed with log-linear analysis. Communication patterns in high-EE families with both disorders showed more serial dependence--were more "tightly joined"--than low-EE families. However, both low- and high-EE families of persons with bipolar disorders competed for control, while there were marked differences in control patterns in low- and high-EE families of persons with schizophrenia, with low-EE families not at all competitive and high-EE families highly competitive. Difference in both responsiveness and competition for control were much stronger in dual-parent families. It was concluded that high-EE families have a family system that combines over-responsiveness with conflict about "who's in charge".