Research has evidenced support for the spillover model, which posits that parents' marital functioning influences child adjustment by eroding parenting and coparenting in dyadic (mother–child and father–child) and triadic (mother–father–child) contexts. However, prior work has not simultaneously investigated dyadic and triadic parenting as mechanisms of spillover. Furthermore, although evidence indicates that the marital system affects child adjustment by influencing parents' behavior, research has not explored whether child behaviors in parent–child interactions also serve as mechanisms. To address these gaps, we examined the spillover model using observational measures of parent and child behavior in parent–child dyadic interactions as well as coparenting in triadic interactions. We also explored parent and child gender differences in spillover effects. Participants were families with children 3 to 6 years of age (n = 149; 62% Caucasian). Findings indicated that marital functioning influences child adjustment by disrupting parent–child interactions in dyadic and triadic contexts, although results differed by child/parent gender and outcome examined. First, children's responsiveness to their mothers emerged as a significant mechanism of spillover effects for boys' internalizing and girls' externalizing behavior. Second, for girls and boys, marital functioning was indirectly related to children's internalizing and externalizing behavior through reductions in coparenting warmth. Finally, there was little evidence that parent gender moderated the indirect effect of dyadic parenting, except that child responsiveness to mothers (vs. to fathers) was more strongly related to child adjustment. These findings underscore the need for interventions targeting dyadic and triadic parent–child interactions in the face of marital distress.

OBJECTIVE : To examine the classification accuracy of measures of overall psychopathology recommended for pediatric primary care screening.  METHOD : A systematic review identified relevant instruments described in the literature. Subsequent systematic reviews identified studies of sensitivity (SE) and specificity (SP) of each measure for various cutoffs and different criteria for disorder (e.g., caseness determined by structured interview, exceeding a cutoff score, referral for psychiatric evaluation).  RESULTS : Measures include the Child Behavior Checklist (CBCL), Pediatric Symptom Checklist (PSC), Strengths and Difficulties Questionnaire (SDQ), Brief Infant-Toddler Social Emotional Assessment (BITSEA), and the Ages and Stages Questionnaire: Social-Emotional scale (ASQ:SE). For three measures (CBCL, PSC, and SDQ) studied extensively, achieving relatively high SE and SP values (≥ .70) simultaneously occurred in only 30-55% of the studies reviewed. There are relatively few studies of the ASQ:SE and BITSEA, or of relatively new measures.  DISCUSSION : Documented utility of these measures as screening instruments is limited.

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Objective To examine the association of psychological factors and pediatric health care utilization. Method Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria. Results There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38). Conclusions Child and parent MH problems are significantly associated with increased HCU.