90 - Associations Between Parenting Behaviors and Child Aggression in a Longitudinal Cohort

Publication Number: 2086.90

Chandler H. Sullivan, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Ellen L. McMahon, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Kelsi Mellin, VUMC, Nashville, TN, United States; Grant Mercer, Vanderbilt University School of Medicine, Oakland, CA, United States; Kirsten Nguyen, Los Angeles General Medical Center/University of Southern California, Los Angeles, CA, United States; Mary S.. Dietrich, Vanderbilt University School of Medicine, Nashville, TN, United States; Seth Scholer, Vanderbilt University School of Medicine, Nashville, TN, United States; Tina S. Chai, Johns Hopkins Children's Center, Baltimore, MD, United States; Margaret Benningfield, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States

Background: Aggressive behavior is prevalent, often begins in early childhood, and is associated with many poor mental and physical health outcomes. Children who display aggressive behaviors are more likely to both experience and be perpetrators of bullying (i.e. emotional or physical aggression towards a peer) and violence (e.g. child abuse, intimate partner violence, gun violence) [Figure]. Excessive caregiver use of unhealthy discipline strategies (e.g. spanking, yelling, threatening) is a modifiable risk factor for developing aggressive behaviors in childhood. Screening for and intervening on these parenting risk factors in the pediatric clinical setting has the potential for significant public health benefit, yet is not routinely performed at this time.

Objective: To assess the associations between a brief parenting assessment tool and aggressive behavior in children over a five-year period.

Design/Methods: The Quick Parenting Assessment (QPA) is a 12-item tool that screens for unhealthy caregiver discipline practices and is feasible for integration into primary care pediatrics. Baseline QPA was collected prospectively from caregivers (N=1475) of 6-month to 10-year-old children presenting for a well child visit. Caregiver-reported concern for aggressive behavior in children was identified via chart review at five years. We used Chi-square and logistic regression methods to assess the association between baseline QPA score, categorized as low- (0), medium- (1-4), and high- (>4) risk, and child aggression at follow-up.

Results: Caregiver-reported child race and ethnicity was 36.9% Black/African American, 33.8% Hispanic/Latino, 18.9% White, 2.9% Asian, and 7.5% multiple or other, and 50.7% were male. Median (IQR) child age at baseline was 2.0 (1.0, 4.8) years. At baseline, 25.2% of QPA scores were low-, 55.1% were medium-, and 19.7% were high-risk. Compared to low-risk QPA, high-risk QPA was associated with an increase in caregiver-reported concern for child aggression (OR=22.39; 95%CI 2.95-169.85; p=0.003) [Table 1].

Conclusion(s): These findings provide preliminary evidence that a brief parenting assessment tool, which measures modifiable risk factors and is scalable for implementation in clinical pediatric care, is predictive of aggressive behavior in children. Our findings have important public health implications for the prevention of bullying, violence, and other child- and community-level outcomes influenced by the early-life socioecological and caregiving environment.

Image 1
Bullying and violence are subsets of aggression. All acts of bullying are acts of unwanted aggression. All acts of violence are extreme acts of aggression. Some acts of bullying can be violent.

Table 1
Associations between Quick Parenting Assessment (QPA) score and caregiver-reported concern for child aggression over 5 years