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Topics in Early Childhood Special

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DOI: 10.1177/02711214030230040201

2003 23: 188Topics in Early Childhood Special EducationCathy Huaqing Qi and Ann P. Kaiser

Behavior Problems of Preschool Children From Low-Income Families: Review of the Literature

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188 TECSE 23:4 188216 (2003)

Behavior Problems of Preschool Children

From Low-Income Families:

Review of the Literature

Research on the prevalence of behavior problems in preschool children fromlow-income families, and the risk factors associated with these behaviors, wasreviewed. A systematic search of studies conducted between 1991 and 2002

yielded a total of 30 research reports that met all of the preestablished criteria. Thesestudies yielded several findings. Children from low socioeconomic status (SES) back-grounds were found to have a higher incidence of behavior problems as compared tothe general population. Behavior problems were associated with multiple risk factorsfound in these childrens lives related to child, parent, and socioeconomic characteris-

tics. The results are discussed in terms of implications for early identification and in-tervention and directions for future research.

Cathy Huaqing QiAnn P. KaiserVanderbilt University

Address: Cathy Huaqing Qi, Dept. of Childhood Special Education, School of Education,

West Chester University of Pennsylvania, West Chester, PA 19383.

Early identification of and interventions for preschoolchildren who are at increased risk for the development ofbehavior problems are critical. Preschoolers with earlyemergent behavior problems are likely to evince seriousbehavior problems (Duncan, Brooks-Gunn, & Klebanov,1994; Stormont, 2002), social skill deficits (Mendez, Fan-

tuzzo, & Ciccetti, 2002), and academic difficulties (Tom-blin, Zhang, Buckwalter, & Catts, 2000) later in life.Empirical studies have also indicated that peer rejectionin childhood is associated with early emergent behaviorproblems (Wood, Cowan, & Baker, 2002) and can lead tomore serious problems during adolescence (Laird, Jordan,Dodge, Pettit, & Bates, 2001). The likelihood of develop-ing behavior problems is exacerbated when preschoolersare exposed to multiple risk factors and chronic psycho-social stressors (Brooks-Gunn, Duncan, & Aber, 1997).Many studies have revealed a complex pattern of vari-ables associated with behavior problems, including childcharacteristics, family characteristics, and environmental

stressors (Eiden, 1999; Fagan & Iglesias, 2000; Keenan& Wakschlag, 2000).

Relatively few researchers have focused on the prev-alence rate of behavior problems in the general, nonclin-ical population of preschool children (ages 35 years). Theactual prevalence of behavior problems among young

children is difficult to determine with any certainty be-cause the prevalence rates reported in the literature varygreatly. In addition, most studies that reported preva-lence of behavior problems in preschool children gener-ally defined the children as having behavior problems onthe basis of cutoff scores on adult informant checklist-

type measures (Campbell, 1995). Despite these limitations,the prevalence of behavior problems has been estimatedat between 3% and 6% in the general child population(Achenbach & Edelbrock, 1981; Institute of Medicine,1989), with a higher incidence (30%) among low-incomepreschool children (Feil, Walker, Severson, & Ball, 2000;Gross, Sambrook, & Fogg, 1999).

Although Campbell (1995) summarized well the bodyof research on the development of behavior problemsin young children, no comprehensive review of recentstudies on the behavior problems of children from low-income families has appeared in the literature. The pre-sent article offers an overview of the empirical literature

from 1991 to 2002. Our goals were to (a) synthesize in-formation on the prevalence rates of behavior problemsof young children from low-income families reported inthe studies over this 12-year period and (b) identify spe-cific risk factors related to behavior problems in thesechildren.

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Behavior Problems of Preschool Children 189

METHOD

Systematic searches were conducted of several major on-line databases in the fields of education and psychology:The Educational Resources Information Center (ERIC),PsycINFO, and Exceptional Children databases. We useddifferent combinations of the following key words andphrases: behavior disorder, behavior problem, languagedisorder, social skills, language impairment and behavior

problems, psychiatric disorders, Head Start, low income,poverty, low socioeconomic status (SES). The indices ofthe following journals were then hand-searched for arti-cles that did not emerge from the computer search: Be-havioral Disorders, Child Development, Development andPsychopathology, Early Education and Development,

Journal of Abnormal Child Psychology, andJournal of theAmerican Academy of Child and Adolescent Psychiatry.

A data summary was prepared for each study, and

these summaries were reviewed with the aim of exclud-ing those studies that did not meet the criteria that follow:

1. Studies had to be descriptive studies of be-havior problems in children ages 2 yearsto 6 years from a general population oflow-income families; intervention studieswere excluded.

2. Longitudinal studies with at least one as-sessment of behavior problems within thepreschool-age range were included, butonly the preschool data were selected forreview.

3. Studies had been published in peer-reviewed journals between 1991 and2002.

4. Studies reported the number of partici-pants, and the definition of case status(i.e., behavior problems) was based onstandardized teachers or parents report ofbehavior problems or by observationalmethods.

5. The majority of children in the samplewere from a low-SES environment. Thedesignation of a family as low income in

the studies reviewed was made accordingto the following criteria: falling below a certain level on the

income-to-needs ratio (obtained bydividing the total family income bythe federal poverty threshold, which isdetermined by family size and numberof children under 18)

living below the poverty limit (as cal-culated from the federal poverty guide-lines based on income and number ofdependents)

qualifying for public assistance (e.g.,food stamps)

having a household income at least50% below the states median monthlyhousehold income

Each article that met the inclusion criteria was readby both authors to provide a common basis for discussingmethods, findings, and interpretations of these findings.Each study was examined and coded along a number ofdimensions. A coding sheet was developed to record in-formation about each article, and the coding categorieswere the purpose of the study; the population (sample size,age, gender, ethnicity, SES); design of the study; behaviormeasurements; observation procedures (if applicable); themajor findings pertaining to behavior problems indicat-ing the prevalence rates or correlates/predictors of be-havior 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 considerednecessary for a study to be considered a quality empiri-cal study: (a) a clear statement of purpose, (b) detailed in-formation about the participants and methods, (c) use ofsound and reliable measurements, (d) adequate internalvalidity, (e) adequate external validity, (f) adequate and ap-propriate statistical analyses, and (g) conclusions sup-ported by the data. Each study included in the reviewwas judged to meet these requirements.

SUMMARY OF STUDIES INCLUDED

Sample sizes in the studies ranged from 42 to 3,860, with20 studies having more than 100 participants and 10studies having fewer than 100 participants. The majorityof participants from all the studies reviewed were of alow-income background and from a minority population.In 17 studies, more than 50% of the sample consisted ofAfrican American children, whereas only 5 studies hadsamples of more than 50% Euro American participants.Twenty-two studies provided some demographic infor-mation about the parents and their children. In most

cases (95%), the informant was the biological mother ofthe child. There was not a consistent measure of familyincome across studies. The average monthly householdincome of the families who provided information in thestudies was about $900. This amount was close to the1998 figure of $1,100 for the median monthly householdincome of for Head Start families (U.S. Department ofHealth andHuman Services, 1998).

All 30 studies used behavior checklists that hadbeen validated or standardized. The most frequently usedinstrument was the Child Behavior ChecklistParent Re-

port (CBCL; Achenbach & Edelbrock, 1983; Achenbach,

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190 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 SocialSkills Rating System (SSRS; Gresham & Elliot, 1990), Ey-berg 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 Question-naire (Goyette, Conners, & Ulrich, 1978), and BehaviorScreening Questionnaire (BSQ; Richman & Graham,1971). Fifteen studies used parent reports only, 6 usedteacher reports only, and 6 used both teacher and parentreports. Seven studies combined teacher ratings or parentratings with direct observations to assess the behaviorsof the young children. In 9 studies, the behavior prob-lems of preschoolers were measured using direct obser-vations in different contexts, such as at home and in theclassroom. The length of the observation period across

all studies ranged from 15 minutes to 40 minutes, with amean of 21 minutes.

RESULTS

Prevalence Rates for Problem Behaviors

Generally, two approaches to the classification of child-hood behavior disorders are used at present. The majorityof studies reviewed here employed a quantitative ap-proach, which considers behavior problems as occurringalong a continuum rather than dichotomously. For eachchild, informants indicate how often each of a specific set

of problem behaviors occurs (e.g., never, sometimes, al-ways). A score is derived by summing the indicated itemsand their ratings. Cutoff scores are used to assign a clas-sification to the child (e.g., nonclinical, subclinical, clini-cal) based on his or her total score. Two studies (Keenan,Shaw, Delliquadri, Giovannelli, & Walsh, 1998; Lavigneet al., 1996) used a taxonomic approach based on expertinterview of informants and direct interaction with thechild (e.g., the Diagnostic and Statistical Manual of Men-tal DisordersFourth Edition [DSM-IV]; American Psy-chiatric Association, 1994).

The prevalence rates of the behavior problems of

preschool children enrolled in Head Start were reportedin six studies enrolling a total of 2,765 children (age =42954 children per study). In these studies, the percent-ages of children with externalizing problems ranged from16% to 30%, and the percentages of children with in-ternalizing problems ranged from 7% to 31%. For ex-ample, DelHomme, Sinclair, and Kasari (1994) reportedthat approximately 23% of their sample of 42 childrenwere identified as at risk for behavior problems based onteacher reports on the SSBD. Feil et al. (2000) reportedthat in their study, 30% of Head Start children met thecutoff criteria for externalizing problems, and 31% were

rated as having internalizing problems on the Teacher Re-port Form (TRF) of the CBCL. In the Harden et al. study(2000), 23.7% of the sample met the cutoff criteria forexternalizing behavior problems in the clinical (15.8%)or borderline (7.9%) range, and only 6.5% of the chil-dren were reported to have internalizing behavior prob-lems in the clinical or borderline range.

The prevalence rates of internalizing and externaliz-ing problems in boys and girls as determined by parentreports of the CBCL were specifically explored in two stud-ies (Kaiser, Hancock, Cai, Foster, & Hester, 2000; Ran-dolph, Koblinsky, Beemer, Roberts, & Letiecq, 2000).Kaiser and colleagues reported that 21% of boys scoredin the clinical/subclinical range (t> 60) for externalizingbehavior and 27% in the clinical/subclinical range for in-ternalizing behavior; 13% of girls scored in the clinical/subclinical range for externalizing behavior and 24% inthe clinical/subclinical range for internalizing behavior.

Of the 21% of boys who scored in the clinical range forexternalizing behavior, 75% were also in the clinicalrange for internalizing behavior. There was a similar over-lap of internalizing and externalizing behaviors amongthe girls. Randolph et al. reported similar percentages ofproblem behavior for boys: approximately 25% of boysexhibited internalizing behaviors, 27% exhibited exter-nalizing behaviors, and 27% exhibited both (1 SD abovethe normative mean; see note). Prevalence rates reportedby Randolph and colleagues for girls with internalizing,externalizing, and total behavior problems on the CBCLwere 12%, 40%, and 30%, respectively, in contrast to therates 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 com-munity childcare centers (Gross et al., 1999; Leadbeater& Bishop, 1994), behavior clinics (Keenan & Watschlag,2000; Keenan et al., 1998), and hospitals serving mainlylow-income neighborhoods (Black, Papas, Hussey, Dub-owitz, et al., 2002; Duncan et al., 1994; Eiden, 1999;Lequerica & Hermosa, 1995; Liaw & Brooks-Gunn,1994; Linares et al., 2001; Owens, Shaw, Giovannelli, Gar-cia, & Yaggi, 1999). Levels of problem behavior in thesestudies appeared to be related to the specific population

sample. For example, children from behavior clinics(Keenan & Watschlag, 2000) and children with adoles-cent mothers who were at risk for substance abuse (Ei-den, 1999) had rates of problem behavior higher thanthose of Head Start children. When samples includedchildren from a broader range of SES backgrounds (La-vigne et al., 1996), the rates of problem behavior werelower. Lavigne et al. screened a primary-care pediatricsample of 3,860 children ages 2 years to 5 years, the ma-jority of whom were from low-income families. The au-thors reported that the prevalence of behavior problemsas scored on the Total Behavior Problems scale of the



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parents CBCL was 8%. Specifically, the rates of total be-havior problems and externalizing and internalizing be-havior problems for the 3-year-olds (n = 1,052) were7%, 4%, and 4%, respectively. The rates of total behav-ior problems and externalizing and internalizing behav-ior problems for the 4-year-olds (n = 846) were 13%,6%, and 5%, respectively. The variability in prevalencerates appears to be related to the sample selection.

Keenan and Wakschlag (2000) found that the prev-alence rate of behavior problems in a clinic sample washigher than the rates reported for children in Head Startprograms and low-income day care centers. In this study,based on a tscore above 70 on the parents CBCL as acutoff, 41% of the clinic children were identified as hav-ing behavior problems. Eiden (1999) examined the rela-tionship between child behavior problems and maternalsubstance use, maternal and childhood exposure to vio-lence, and caregiving instability based on the reports of

61 minority mothers with children ranging in age from24 months to 69 months who were from low-incomebackgrounds. Two groups were formed: a group whosemothers used cocaine and a control group (children whosemothers did not acknowledge using cocaine). Eiden re-ported that among the children ages 4 years and younger,33% were in the clinical range based on maternal reportson the CBCL/2-3; among children older than 4 years,50% were in the clinical range based on scores on theCBCL/4-18. Spieker, Larson, Lewis, Keller, and Gilchrist(1999) found that based on reports by teachers and useof a cutoff tscore of 60 on the CBCL, 36% of their sam-ple of children with teenage mothers had externalizing

behaviors. Black, Papas, Hussey, Dubowitz, et al. (2002)examined the behavior problems of 139 preschool-agechildren born to adolescent mothers from low-incomefamilies and reported that 33% of these children had tscores in the clinical range on the externalizing scale ofthe CBCL/4-18, based on mother reports.

A few studies used a taxonomic approach (e.g.,DSM-IVor DSM-III[Diagnostic and Statistical Manualof Mental DisordersThird Edition; American Psychi-atric Association, 1987]) to examine prevalence rates ofbehavior problems of preschool children in clinical set-tings. For example, Keenan et al. (1998) reported that

rates of DSM-IIIdefinite and subthreshold externalizingdisorders were both close to 15%; in addition, based onclinician assessments, 15% of the children in their studymet subthreshold criteria for internalizing disorders.

Across studies, the prevalence of behavior problemsin preschool children from low-SES backgrounds rangedfrom 6.5% (Harden et al., 2000) to 57% (Feil et al.,2000). Based on teacher reports, the prevalence rates ofbehavior problems ranged from 14% to 52%. Motherreports showed a range from 7% to 57%. These differ-ences in the prevalence rates reflected several method-ological variations. First, the studies employed different

informantsparents versus teacherswho may havehad different perceptions of the childs behavior or dif-ferent standards for what constituted problem status.The children also may have behaved differently at homeversus at school. Second, different behavior instruments,such as the CBCL and the SSRS, yielded different rates ofbehavior problems, even when reported by the same par-ents and teachers (Kaiser et al., 2000). Using different in-struments for parents and teachers sometimes furtherconfounded the differences in reported prevalence. Third,different cutoff parameters were used to define the pres-ence of a problem (e.g., 1 SD or 1.5 SD, or scores thatidentified the upper 10% of the distribution). The use ofsubclinical thresholds to identify potential problems iswarranted but also contributes to variability in preva-lence rates. Finally, in almost half of the studies reviewed,more than 50% of the children in the sample were fromculturally and linguistically diverse backgrounds. Few

studies directly addressed reliability of informant reportsor discussed issues related to objective behavior criteriathat considered cultural norms. The issues surrounding useof nondiscriminatory testing, with objective criteria, ac-ceptable reliability, unbiased scoring (e.g., without raterbias), and direct observational data, to assess this popu-lation merit further study.

Risk Factors Associated withBehavior Problems

A large body of research exists that links multiple riskfactors with childhood behavior problems (Brooks-Gunn

et al., 1997). Even so, it has been difficult to determinewhich specific risk factors lead to the behavior problemsof children within low-SES environments because of thecomplex factors associated with this population. It maybe that particular child characteristics, parent character-istics, and socioeconomic characteristics, when occurringtogether, result in heightened behavior problems in low-income children.

Sameroff and Chandler (1975) proposed a transac-tional model of development based on the idea that achilds development is a product of dynamic reciprocalrelationships among child characteristics, parental char-

acteristics, and environmental influences over time. UsingSameroff and Chandlers model as a guide, associationsamong multiple risk factors and child behavior problemswere examined in all the studies reviewed, and a modi-fied model was developed (see Figure 1) to illustrate themultiple risk factors related to the problem behaviors oflow-SES young children as indicated in the review of lit-erature. Child problembehaviors appear to be the result ofan interaction among child characteristics (e.g., languagefunctioning, social skills, attachment status, cognitiveability, gender); parent characteristics (harsh discipline,mothers stress, depression, absent father); and sociode-



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mographic risk factors (education, number of children,income) associated with poverty. Children in poverty areexposed to multiple risks, and interrelationships amongthese risk factors influence a childs behavioral develop-ment. This model provides a comprehensive frameworkfor studying the problem behaviors of young children

from low-income families by indicating the range of fac-tors that should be considered in order to understandearly emergent problem behaviors. The model does not,however, specify the pathways by which the factors in-teract to influence problem behaviors.

Child Characteristics

Child characteristics measured in the reviewed studies in-cluded attachment, temperament, prematurity, cognitivedevelopment, language ability, social skills, and gender.

Ten of the 30 studies of preschool children from low-SESbackgrounds measured one or more of these factors.

Attachment. Only a handful of researchers haveexamined infant precursors of problem behaviors in tod-dlers and preschoolers. The focus of this work has been

primarily on perinatal problems, maternal perceptions ofinfant temperament, and co-occurring risk factors. In gen-eral, studies have shown that in high-risk samples, suchas the one studied by Shaw, Owens, Vondra, Keenan,and Winslow (1996), lack of infant attachment securitywas related to later externalizing problems. Shaw et al.sdata indicated that disorganized attachment classifica-tion at 12 months was a predictor of aggressive behaviorat age 5 years (R2 change = .11,p < .003). In addition,infants with disorganized attachment status at 12 monthswhose mothers perceived them as difficult in the second

FIGURE 1. Transactional model.



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year showed significantly higher aggression problems atage 5 than did children with only one of the two risk fac-tors present.

Temperament. In a longitudinal study of tempera-ment, Keenan et al. (1998) followed a sample of 104 moth-ers from low-income backgrounds who were consideredto be at high risk and their infants ages 12 months to36 months, with the purpose of identifying the earliestchild markers of psychopathology. They examined therisk factors from infancy associated with the developmentof preschool disruptive behavior problems across child,parent, and sociodemographic groups. Motherinfantinteraction was observed in several laboratory contextsat 12, 18, and 24 months of age to derive measures ofinfant aggression and noncompliance. For girls, difficulttemperaments assessed at 12 months and 18 months weredifferentially 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, dif-ficult temperaments assessed at 18 months and 24 monthspredicted later internalizing problems on the CBCL at36 months of age (18 months: r = .33,p < .05; 24 months:r = .44,p < .01). For the externalizing behavior, noncom-pliance behavior assessed at 24 months predicted girlsexternalizing problems at 36 months of age (r = .37,

p < .05) whereas for boys, early aggression assessed at24 months predicted later externalizing problems (r = .32,

p < .05). Harden et al. (2000) studied 155 Head Start chil-dren and found that specific aspects of child tempera-ment (emotionality, attention, soothability, dysregulation)

were associated with childrens externalizing behaviors.Specifically, significant positive associations were foundbetween childrens externalizing behavior problems andnegative emotionality (r = .55,p < .001). Significant neg-ative associations were found between externalizing be-havior and temperament variables of attention (r = .23,

p < .01) and soothability (r = .17,p < .05). Emotion dys-regulation was significantly related to childrens exter-nalizing behaviors (r = .49, p < .001) and internalizingbehaviors (r = .38,p < .01).

Prematurity. In prospective studies beginning in in-

fancy, researchers have examined biological risk factorssuch as prematurity as predictors of later problem behav-iors in children from low-SES backgrounds. These stud-ies have linked premature birth with slightly higher ratesof problem behaviors at preschool age. For example, in alongitudinal study, Rose, Feldman, Rose, Wallace, andMcCarton (1992) compared maternal and teacher reportsof problem behaviors on three behavior rating scales ofpreterm children with those of children born at full term.They found that preterm children showed more prob-lem behaviors than did full-term children on all measures.

Parents of preterm children reported more hyperactivityby their children than did parents of full-term children. Onthe CBCL, the parents rated half of the preterm childrenas displaying clinically significant problems, and nearly20% of these children were judged to be hyperactiveaccording to their teachers. Half of the preterm pre-schoolers identified at 3 years of age as having significantproblem behaviors continued to manifest high levels ofproblem behaviors at age 6 (r = .24.25).

Duncan et al. (1994) examined links between eco-nomic deprivation and childrens development (IQ,externalizing problem behavior, internalizing problembehavior) using longitudinal data from a multisite de-velopmental study of nearly 900 low-birthweight, prema-ture young children (the Infant Health and DevelopmentProgram [IHDP]). Mother reports on the Revised ChildBehavior Checklist/4-5 (CBCL/4-5; Achenbach & Edel-brock, 1984) were used to measure child behavior. In con-

trast to the study by Rose et al. (1992), the Duncan et al.study indicated that low birthweight was a significantpredictor of delayed IQ but not of problem behaviors.

Cognition. Researchers who examined the cognitivecorrelates of behavior problems in preschool children fromlow-income families indicated that these children oftenhave lower overall intelligence as measured by IQ tests(Lavigne et al., 1996; Owens et al., 1999). Using a logisticregression model, Lavigne et al. (1996) found that a childslower IQ showed strong associations with a higher levelof 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 re-ported that a higher level of child intelligence was thebest predictor of lower levels of externalizing problemsat school (R2 change = .07; Fchange = 11.39,p < .01).IQ accounted for a significant variance in childrens be-havior, regardless of risk type or form of behavior prob-lem. When SES and other sociodemographic risks werecontrolled, higher intelligence scores at age 5.5 years pre-dicted better classroom behavior and fewer symptoms ofpsychopathology as noted by teachers 6 months later.

Language Development. Language competence was

also explored in several studies of preschoolers behaviorproblems. Language difficulties are common features ofchildren with externalizing behavior problems (Love &Thompson, 1988; Qi & Kaiser, 2003), and preschoolerswith language delays are at heightened risk for later be-havior problems (Beitchman et al., 2001; Benasich, Cur-tiss, & Tallal, 1993). Eighteen studies that were reviewedincluded measures oflanguage. In general, these studiesreported mixed findings about the relationship betweenlanguage delays and behavior problems. An associationbetween childrens behavior problems and language de-



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lays was reported in 2 studies (Fagan & Iglesias, 2000;Owens et al., 1999). Fagan and Iglesias examined thecommunication interactions of 65 fathers with their HeadStart children and the relationship of fathers and chil-drens communication skills and child problem behaviorsearly and late in the school year, based on teacher reports.They found that children whose fathers had stronger lan-guage skills tended to also have better language abilities.Children with stronger language skills at the beginningof the school year were perceived to have fewer exter-nalizing behaviors (r = -.22,p < .05) and fewer internal-izing behaviors (r = .24,p < .05) at the end of the schoolyear. Kaiser et al. (2000) reported that boys with prob-lem behaviors were significantly more likely to have lowlanguage scores than were boys without problem behav-iors. Specifically, of the boys with internalizing problemsin the clinical/subclinical range, 46% scored below 80 onthe subscales of the third edition of the Preschool Lan-

guage Scale (PLS-3; Zimmerman, Steiner, & Pond, 1992)as compared to 33% of the boys without internalizingproblems. A similar pattern was seen for boys with andwithout externalizing problems (48% vs. 33%) and forboys with and without high total problem behavior scoreson CBCL/2-3 parent reports (46% vs. 33%). Differentialoverlap between high levels of problem behavior and lowlanguage ability was not found for girls.

Social Skills. Five studies examined the relationshipbetween behavior problems and social skills of preschoolchildren from low-SES families using informant reports(Bain & Pelletier, 1999; Kaiser et al., 2000) and a combi-

nation of reports and observational systems (Feil et al.,2000; Harden et al., 2000; Olson, 1992). All five studiesindicated that behavior problems were associated with thelack of social skills. For example, in a study of 96 HeadStart children (Bain & Pelletier, 1999), three groups weredelineated through cluster analysis based on results of theglobal scale tscores and the HYPER Index tscores fromthe Conners Teacher Rating Scales-28 (CTRS-28; Conners,1990). Bain and Pelletier reported that children in the grouplabeled average were characterized by well-developed so-cial skills, a marked absence of disruptive behavior, andan assertive willingness to help others. In a longitudinal

study, Harden et al. investigated a subgroup of childrenwho were identified with high levels of externalizing be-havior problems. Their findings indicated a significantrelationship between teacher ratings of social competenceand 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 whohad higher CBCL total scores tended to have lower socialskills. Parents reported that among the boys, 13.9% had

high CBCL/2-3 total scores and low social skills; amongthe girls, 9% had both high CBCL/2-3 total scores andlow social skills. Eighteen percent of the boys and 14%of the girls had high levels of internalizing behavior andlow social skills, compared with 12% of the boys and 7%of the girls who exhibited high levels of externalizing be-havior problems and low social skills. The relationshipbetween social skills and internalizing behavior problemswas significant for both boys and girls, whereas the rela-tionship between externalizing behavior problems andsocial skills was significant for neither. Of the boys withhigh levels of internalizing behavior, 70% had low levelsof social skills, compared to 41% of boys without highlevels of internalizing behavior problems. Similarly, girlswith internalizing behavior problems were more likely tohave low levels of social skills than were girls without in-ternalizing behavior problems (64% vs. 40%).

Peer Interactions. The relationship between adultratings of problem behaviors and observations of chil-drens interactions with peers was examined in one study(Olson, 1992). Olson observed 60 boys ages 4 years to5 years who were attending Head Start programs. In thisstudy, children who were perceived as behaviorally deviantby teachers, based on the Conners Teacher Question-naire (Goyette et al., 1978), and by peers, based on in-terviews, were found to respond to their peers behaviorswith relatively high rates of verbal and physical aggres-sion. Negative initiation behaviors by the target childrenwere correlated with peer and teacher measures of rejec-

tion and conduct problems at both the beginning andend of the preschool year (Olson, 1992). Children whowere perceived as maladjusted by peers tended to initiatemore aggressive social exchangesincluding physicallyand verbally assaulting others, grabbing objects away, andsmashing or hurling play materialsthan did other chil-dren. These children exhibited more negative behaviorswith peers and were especially likely to respond to peerinitiations with aggressive and negative behavior, verbaland physical. These observational findings supportedthe validity of teacher ratings. Children who were ratedby teachers as higher on externalizing behaviors, such asaggression, were observed to have less positive interac-

tions with teachers and peers in the classroom.

Gender Differences. Researchers have suggested arelationship between a childs gender and problem behav-iors, but the nature of that relationship is complex. Boysusually have been reported to present more problem be-haviors (Kazdin, 1995). Specifically, externalizing behav-ior problems have been found to be much more prevalentin boys than in girls (American Psychiatric Association,1994); however, the evidence regarding problem behaviorsin early childhood is ambiguous. Campbell (1995) stated



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that preschool boys and girls may be similar in their pre-sentation of problem behaviors. In only 5 out of 16 studiesthat considered gender did researchers find gender dif-ferences based on maternal reports of behavior problems.Each of these studies found that boys had significantlyhigher levels of problem behaviors than did girls (Dun-can et al., 1994; Eiden, 1999; Kaiser et al., 2000; Lavigneet al., 1996; Spieker, Larson, Lewis, Keller, & Gilchrist,1999). Specifically, boys had significantly more external-izing problems (Duncan et al., 1994; Kaiser et al., 2000;Lavigne et al., 1996), more total problem behaviors, andmore aggressive and destructive behaviors than did girls(Kaiser et al., 2000). No significant gender differenceswere found on internalizing problems in the Duncan et al.and Kaiser et al. studies, and no gender differences inrates of CBCL internalizing problems were reported byLavigne et al. The differential developmental trajectoriesof behavior problems in boys and girls beginning in pre-

school were examined in only one study (Spieker et al.,1999), which found that boys exhibited higher levelsof disruptive behavior than did girls. In contrast, Eiden(1999) reported that contrary to expectations, in a sam-ple of 61 high-risk minority children from low-incomebackgrounds, girls had higher behavior problem scoresthan 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 characteris-tics and behavior problems in the preschool period. Dif-ficult temperament, low language skills, deficits in socialskills, compromised cognitive development, and gender

have all been shown to be associated with behavior prob-lems. Findings regarding the relationship between behav-ior problems and language delays and between behaviorproblems and gender are not clear-cut. The questions ofwhether low language ability is a consistent predictor ofbehavior problems and whether there are significant gen-der differences in early behavior problems remain openat the present. Many factors, including sample selection,limited and different language testing procedures, differ-ent methods for assessing behavior (teachers or parentsreport vs. observation), and different behavior measuresand cutoff criteria, might contribute to the different find-

ings across studies.

Parent Characteristics

Longitudinal research has indicated that parenting charac-teristics are associated with childhood behavior problems(see Stormont, 1998, for a review). Parenting character-istics include parenting stress (Gross et al., 1999; Lead-beater & Bishop, 1994; Liaw & Brooks-Gunn, 1994;Shaw, Winslow, Owens, & Hood, 1998), depression in themother (Duncan et al., 1994; Harden et al., 2000; Grosset al., 1999; Leadbeater & Bishop, 1994; Liaw & Brooks-

Gunn, 1994; Shaw, Winslow, Owens, & Hood, 1998;Shaw, Winslow, Owens, Vondra, et al., 1998; Spieker etal., 1999), harsh discipline (Gross et al., 1999; Spieker etal., 1999), and time spent with father (Harden et al.,2000; Keenan & Wakschlag, 2000). Parents of childrenwith problem behaviors are more likely to be depressedand stressed by daily hassles and to use harsher disciplinestrategies than are parents of children without problembehaviors. Stressful family life events, such as separationor divorce and maternal depression, have been shown tobe associated with higher ratings of behavior problemsin young children by mothers (Beautrais, Fergusson, &Shannon, 1982; Fergusson, Horwood, & Shannon, 1984).These findings have been consistent in indicating thatchildren from low-income backgrounds who were identi-fied as having more problem behaviors in their preschoolyears tended to come from relatively more dysfunctionalfamilies, and these findings were consistent across a

range of different sample selection approaches and be-havior assessment methods and measurements.

Parent Stress. Authors of several studies previouslyreviewed in this article suggested that mothers of childrenwith behavior problems report having experienced morestressful life events (Beautrais et al., 1982; Fergusson etal., 1984). Mothers stress was significantly correlated withhigher levels of total childrens behavior problems (r =.35,p < .001; Gross et al., 1999). In two longitudinal stud-ies, parenting stress was consistently a predictor of behav-ior problems in young children (Leadbeater & Bishop,1994; Shaw, Winslow, Owens, & Hood, 1998). For ex-

ample, Leadbeater and Bishops findings indicated that re-ports of more stressful life events at child age of 12 monthswas significantly correlated with higher levels of total be-havior problems, as was the birth of another child by thetime the child was between 28 and 36 months of age.Similarly, daily parenting stress predicted both external-izing problems (r = .40,p < .001) and internalizing prob-lems (r = .32, p < .001) in children at age 42 months(Shaw, Winslow, Owens, & Hood, 1998). Lequerica andHermosa (1995) reported that externalizing, internalizing,and total behavior scores were not significantly relatedto stressful family life events in a sample of 52 Hispanic

children recruited from a pediatric clinic serving mainlyfamilies of low-income backgrounds. Because this was asmall sample of convenience, these findings should be in-terpreted with caution. The number of studies examiningthe relationship between stress and behavior problems infamilies with low SES is small, and studies from differentsamples of different ethnicities yielded somewhat conflict-ing results; however, these findings are important. Stress-ful life events, which are often associated with poverty,may have an effect on the parents of young childrenand, directly and indirectly, an effect on their childrensbehavior.



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Maternal Depression. Findings from eight studiesusing a variety of methodologies have suggested thatchildren whose mothers reported higher levels of depres-sive symptoms were at heightened risk for both external-izing 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 etal., 1999). Black, Papas, Hussey, Dubowitz, et al. (2002)reported that children who experienced maltreatment andhad mothers with depressive symptoms had the highestscores on the Externalizing subscale of the CBCL; chil-dren who experienced neither risk had the lowest scores.Mothers who had negative perceptions of the quality oftheir partner relationship were more likely to report de-pressive symptoms (r = .25,p < .05) and tended to reportmore externalizing problems (r = .32,p < .05) and inter-

nalizing 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 longitudi-nal study, found that the children with the greatest num-ber of externalizing behavior problems had experiencedboth maltreatment and maternal depressive symptomsand lived in three-generation households (grand-mothermother child), F= 7.16,p = .008. These resultsare consistent with research that has associated maternalmental health with child behavior problems (r = .28,p

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