Academic journal article Australian Journal of Early Childhood

The Service Needs of Families Caring for Preschool-Aged Children with Disruptive Behaviours

Academic journal article Australian Journal of Early Childhood

The Service Needs of Families Caring for Preschool-Aged Children with Disruptive Behaviours

Article excerpt

This study was funded by the Hunter Area Health Service and the NSW Department of Education.

Introduction

Defiance, tantrums, inattentiveness, and high levels of motor activity are commonly seen in preschool children. Yet preschools and child care centres also encounter children with excessive and developmentally inappropriate disruptive behaviours. Such behaviours can represent symptoms of a disruptive behaviour disorder, such as Attention-Deficit Hyperactivity Disorder (ADHD), or alternatively may be a consequence of developmental conditions such as intellectual disability (Einfeld & Tonge, 1996) or autistic spectrum disorders (American Academy of Child and Adolescent Psychiatry, 1999). Such conditions can entail serious implications for a child's development and for family functioning. Excessive disruptiveness is likely to persist beyond early childhood (Koot & Verhulst, 1992). Early onset of ADHD symptoms is associated with higher rates of co-morbidity with conduct disorder and also predicts more severe symptoms and disability by age eight to nine years (McGee, Partridge, Williams & Silva, 1991). Aside from behavioural symptoms, preschoolers with ADHD are also more likely to have problems with language and emergent literacy skills that are not related to general intellectual functioning or to socio-economic status (Lonigan et al., 1999). Children's disruptive behaviour also contributes adversely to family functioning and to parenting stress (Sheridan, Dwyer & Sanders, 1997). This suggests an imperative for families to gain early access to assessment, treatment, early education, and family support services. In spite of this, the diagnosis and treatment of disruptive behaviour in preschoolers, particularly ADHD, remains controversial. Published practice guidelines for the assessment and management of ADHD consider the very young a special population and generally advise caution (Dulcan & Benson, 1997).

While the efficacy of treatment for disruptive behaviour and models of family support have been extensively reviewed (American Academy of Child and Adolescent Psychiatry, 1999; National Institutes of Health, 2000; Sheridan, Dwyer, & Sanders, 1997), there has been a conspicuous absence of research input by consumers of such services. The present study examines the perceived service needs of the families of preschool-aged children with disruptive behaviour problems attending centre-based child care services in the Hunter region, NSW, Australia. It was nested in a larger study of perceived service needs for children aged four to 17 years.

Method

(i) Sample

The sampling frame was families residing in the Hunter region with a four or five-year-old child with clinically significant disruptive behaviour, attending a centre-based child care (CBC) service. A CBC service was defined as a preschool or childcare centre, excluding occasional care centres. Moderate to severe intellectual disability was excluded, because services for such children are usually provided on the basis of their disability status. While the nominal minimum age was to be four years, questionnaires were returned for 16 three-year-olds (some referral agents had neglected to apply the age criteria). Rather than lose the information, the data for those three-year-olds was included in the analyses.

(ii) Survey instrument

The questionnaire measured demographic variables, service utilisation, family stress, and perceived service needs. Family stress/burden of care was measured using several scales from the Australian Adaptation of the Child Health Questionnaire (CHQ PF50) (Waters et al. 1999). These were the Family Activities (FA), Emotional Impact on Parent (PE), and Time Impact on Parent (PT) scales, as well as the Family Cohesion (FC) item. All perceived service needs identified by respondents in the focus groups and in the 1996 Treatment of Children with ADHD--TOCA study (Hazell, McDowell, & Walton, 1996) were included in the questionnaire. …

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