How Do Parents Influence Child Disruptive Behavior After Acquired Brain Injury? Evidence From a Mediation Model and Path Analysis

Abstract

Objectives: Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact. Methods: Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis. Results: Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents’ executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were >0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25. Conclusions: A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237–248)

The Australian and New Zealand brain injury lifespan cohort protocol: Leveraging common data elements to characterise longitudinal outcome and recovery

“…One of the major challenges faced by professionals working with children with TBI is the difficulty in predicting outcome and determining priorities for intervention. Research evidence and clinical impressions suggest that outcome is highly variable and multidetermined: (1) premorbid or ‘constitutional’ factors in areas including behaviour, learning and/or psychiatric status are often major determinants of postinjury function;13 (2) injury-related findings demonstrate a clear dose–response relationship for severity and outcome, particularly for cognitive skills;11 (3) developmental factors (eg, age and developmental stage at TBI), where earlier age at TBI or TBI at critical times of development is associated with poorer outcomes4 24 and (4) psychosocial factors including lower socioeconomic status, low levels of parental education, parental mental health problems, family dysfunction, preinjury behavioural and psychosocial problems have all been linked to poor outcome 5 25. While preinjury and injury-related risk factors are often not modifiable, they allow us to identify children most ‘at risk’ and therefore a preventative approach to intervention can be implemented.…”

The Relationship between Head Injury and Behaviour Problems for Children in Aotearoa New Zealand: The Impact of Individual, Whānau and Societal Factors

“…These factors exacerbate negative outcomes for children who experience a TBI, particularly uninvolved parents who fail to support the children's natural development (Chavez-Arana et al, 2019). Children who have unvigilant parents tend to experience more TBI symptoms and are less likely to have their needs met (Lalonde et al, 2019).…”

“…Authoritative parenting is the balance between the two other styles (Chavez-Arana et al, 2019) and involves effective parenting behaviours such as strong communication, positive reinforcement, warmth, and responsiveness (Schorr et al, 2019). This parenting style can buffer the long-term effects of TBI for children and has been shown to improve executive functioning (Schorr et al, 2019), and reduce BP (Chavez-Arana et al, 2019).…”

“…For example, the variance in children's behaviour is associated with changes in parental warmth and directiveness (Wade et al, 2008). BP as a result of TBI can be reduced with authoritative parenting style, as the parents effectively manage the children's resultant disinhibited behaviours (Chavez-Arana et al, 2019), (Shaw et al, 2019).…”

“…Authoritative parenting style, which is characterised by high levels of parental warmth, supportiveness, clear rules, and expectations for behaviour, has been linked to a decrease in child behaviour problems in prior research by Chavez-Arana et al (2019) and Shaw et al (2019). However, an authoritative parenting style may not be as effective in addressing the unique challenges faced by children with head injuries such as headaches, irritability, frustration, and fatigue (Starkey et al, 2018).…”