A latent class analysis of psycho-behavioural adaptation in children and its relationship with sense of parenting competence and psychological distress of parents

doi:10.21203/rs.3.rs-2988884/v1

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A latent class analysis of psycho-behavioural adaptation in children and its relationship with sense of parenting competence and psychological distress of parents

https://doi.org/10.21203/rs.3.rs-2988884/v1

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Background

The healthy development of psychological behaviour among children has been widely concerned by the whole society. However, little is known about different categories or attributes of their psycho-behavioural adaptation. The purpose of this study to identifies the latent classes of psycho-behavioural adaptation in children and explores the relationships of these classes with sense of parenting competence and psychological distress of parents

Methods

The cross-sectional study was conducted in one primary and secondary education school in mainland China from September 2022 to December 2022. The parents of children (3–18 years old) were invited to participate in the study. We used standardized questionnaires to collect data. A latent class analysis was performed to identify children's psycho-behavioural adaptation classes.

Results

The study recruited 242 participants. Two classes of psycho-behavioural adaptation were identified, namely, the psycho-behavioural problems group and the psycho-behavioural health group. The differences between latent classes were statistically significant regarding the child's age and parental health. The differences between latent classes were statistically significant in terms of sense of parenting competence, satisfaction, efficacy, and psychological distress score. The sense of parenting competence and parental psychological distress influenced the latent class of psycho-behavioural adaptation in children.

Conclusion

There is heterogeneity in the psycho-behavioural adaptation of children and differences in the sense of parenting competence and psychological distress of parents in each category. Targeted interventions should be developed and implemented based on the characteristics of each psycho-behavioural adaptation class to maximize interventions' effectiveness and promote parental and child well-being.

psycho-behavioural adaptation

latent class analysis

sense of parenting competence

psychological distress of parents

children

nursing

Childhood and adolescence are important periods in which individuals undergo physical, psychological, cognitive, and social changes. During this period, the social environment in which they live, learn, and interact is constantly developing and changing, and children and adolescents need to constantly adapt their cognition and behaviour to the social environment around them(Weiwei Wang, 2021). For children aged 3 to 12 years, social adaptation of main tasks is an interpersonal adaptation, academic adaptation, and cognitive adaptation development(Hernández et al., 2016; Ladd et al., 1997). As they grow older, adolescents aged 13 and 18 undergo important social adjustment developments and are gradually moving towards physical and psychological maturity(Fuentes et al., 2011). During this period, adolescents' social adjustment goes through a process of decline followed by a gradual development, with the primary task being the development of socialization and the main core being behavioural adjustment.

The term "psycho-behavioural adaptation" refers to the process by which people modify their psychological processes and actions to better suit their developmental needs and account for the constantly changing world outside. Psycho-behavioural adaptation is an important element in the development of children and adolescents and is an important indicator of an individual's mental health. Good social adjustment includes self-esteem and confidence, positive coping, and compliance with norms. However, maladjustment includes low self-esteem, depression, social withdrawal, social isolation, and peer aggression(Dupere et al., 2015). The pre-longitudinal and cross-sectional study suggests an association between psychosocial maladjustment and obesity in early adolescence, such as overeating, depression, and aggression often beginning to emerge(Chang & Halgunseth, 2015). Furthermore, childhood maladjustment is closely linked to delinquency in maturity(Weiwei Wang, 2021). Children who experience peer rejection may be socially isolated and marginalized, negatively affecting their mental health(Matthews et al., 2015). Therefore, to ensure that children have healthy physical and psychological growth, it is crucial to identify children at risk for psycho-behavioural maladaptation at an early age(Dupéré et al., 2008).

The family is a critical context for adolescent development and a source of risk and protection related to psycho-behavioural adaptation(Garthe et al., 2019). Psychological distress in parents and sense of parenting competence are the main factors to consider regarding youth risk and development. For example, Murray Bowon's family system theory contends that families interact and that elements of the home environment, such as parental emotions, parenting methods, and parent-child relationships, directly impact psychosocial and behavioural adaptation in children(Paclikova et al., 2020). As the children's primary caregivers, parents are physically, mentally, and parenting-stressed and prone to psychological distress, which impacts parenting efficacy and satisfaction. A previous study demonstrated significant associations between co-parenting conflict and children’s adjustment problems(Riina et al., 2020). The higher the sense of parenting competence, the lower the children's behavioural problems (Ludmer et al., 2018). However, it is unclear whether sense of parenting competence and psychological distress in parents influence latent classes of children's psycho-behavioural adaptation.

Whether there is consistency in the development of psycho-behavioural adaptation in children is currently open to debate. Most quantitative studies showed that school-aged children score in the normal range for emotional regulation, behavioural styles, and social interactions. In contrast, some qualitative analyses revealed that school-aged children have psycho-behavioural adaptation problems and were limited by cognitive and physical functioning(Visser et al., 2004). Until recently, the primary research method for psychological behaviour was to compute a scale score to judge children's psychological behaviour levels. However, judging by a total score is excessively simple and cannot differentiate between subgroups with possible different features and screen for the presence of risk problems like depression and isolation in the child population(Parkes et al., 2014).

Latent class analysis (LCA) is a helpful tool for identifying subgroups of individuals based on the intersection of multiple observed characteristics(Lanza & Rhoades, 2013). It explains the relationship between observed variables and unobserved latent variables using the latent class model and assumes that the probability distribution of various responses to each observed variable can be explained by a small number of mutually exclusive latent classes. Using the identified latent classes, researchers can further analyze the characteristics of subgroups and obtain in-depth results. LCA has been widely applied in behavioural analyses and psychosocial investigations(Zhou et al., 2018). Researchers have applied LCA to determine the subgroups of symptom clusters, emotional and behavioural in children; this has enabled them to understand the specific effects of subgroups on the well-being of children, delineate the differences in demographic information between subgroups and thereby formulate targeted interventions(Hu et al., 2021).

Because there is limited empirical quantitative research using latent variable methods to identify the different latent classes of children's psycho-behavioural adaptation. Based on previous empirical research, the current study was guided by two exploratory questions. First, is there heterogeneity in children's psycho-behavioural adaptation, showing significant individual differences? Second, whether sense of parenting competence and psychological distress in parents influence latent classes of children's psycho-behavioural adaptation? Given the exploratory nature of this study, hypotheses and expectations for results were not established.

Study setting

A cross-sectional study was conducted in one school of primary and secondary education in mainland China.

Participants

The parents of children (3–18 years old) were eligible for inclusion in the study if they had no disorders. Parents who did not spend much time living with the child were excluded. From September 2022 to December 2022, mothers or fathers who were the primary caregivers of the children were invited to participate in this study.

Instruments

Demographic characteristics

The basic information of participants includes child's age, child's gender, parental roles, parental age, parental educational level, monthly income, physical health, and marital status parental.

Parenting Sense of Competence Scale (PSOC)

The PSOC, a self-rating scale designed by Gibaud-Wallston(Gibaud-Wallston J), was used to measure parents' parenting confidence and perceived competence in the parenting process. The original scale consists of 17 items, and five entries were removed after the factor structure analysis. The Chinese version was revised and tested on adolescent parents and found it displayed a sufficiently high degree of reliability and validity(Xiao Zhang, 2017). The revised PSOC scale was used in this study. The scale consists of 12 items, of which the sense of efficacy and satisfaction subscales each have 6 items. The higher the score, the higher the sense of competence in childcare. The Cronbach’s α of this scale in this study was 0.61.

The Kessler Psychological Distress Scale (K10)

The K10 includes 10 items established by Kessler and Mrocze(Kessler et al., 2010) and was widely used to assess individual’s psychological distress. The 10 items were rated on a 5-point Likert from 1 (hardly) to 5 (very much). Higher scores indicated higher levels of psychological distress. A total score of greater than 16 indicated psychological distress(Andrews & Slade, 2001). The Chinese version of the scale has shown a sufficiently high degree of internal consistency and reliability(Bu et al., 2017). The Cronbach’s α of this scale in this study was 0.92.

Strength and Difficulties Questionnaire (SDQ)

The SDQ designed by Goodman(Goodman, 1997) was widely used to assess children's psychological and behavioural adaptation characteristics, including emotional symptoms, conduct problems, hyperactivity and attention disorders, peer interaction problems, and pro-social behaviour. The SDQ was a 25-item scale with five subscales that each had 5 items. Each item was rated on a 3-point Likert scale: not true (0), somewhat true (1), and certainly true (2). The first four dimensions together assessed the degree of difficulty in psycho-behavioural adaptation, with higher total scores indicating more difficulty in psycho-behavioural adaptation; higher scores in the pro-social behaviour dimension indicated more positive behaviours. According to the Shanghai Standing Model(Du et al., 2008), normal emotional symptoms received a score of 0–3, normal conduct issues received a score of 0–2, normal hyperactivity and attention disorders received a score of 0–6, normal peer interaction issues received a score of 0–4 and normal pro-social behaviour received a score of 6–10. The Cronbach’s α of the first four dimensions and pro-social behaviour dimension in this study were respectively 0.76, 0.73.

Data collection

The method of onsite investigation was used to collect data by systematically trained researchers. At the beginning of this study, participants were informed of the purpose of the study and required to provide informed consent. Before data collection, researchers were under the obligation to inform participants of the matters needing attention in the process of filling in the questionnaire, to ensure the authenticity and completeness of the data. The questionnaire comprised four sections, parents' psychological distress, sense of parenting competence, children's emotional behaviour and participants' demographic characteristics.

Data analysis

LCA was conducted using Mplus 8.0 software. Several models, from initial (one class) to final (five classes), were estimated by gradually increasing the class number until the best-fit indices were achieved. The Akaike information criterion (AIC), Bayesian information criterion (BIC), and aBIC (Adjusted Bayesian Information Criteria) were first used to select a range of potential models, with lower information criterion scores indicating better model fits. LMRT (Lo–Mendell–Rubin Test) was considered the crucial index to determine whether the model best fits the data. When a LMRT probability value was significant (P < 0.05), the current model significantly better fit the data compared with the previous one. Otherwise, if the LMRT value became nonsignificant (P > 0.05), the previous model would be the best. Other main fit indices, including BLRT (Bootstrapped likelihood ratio test) and Entropy value, were also considered.

Other data analysis was conducted using IBM Statistical Package for Social Sciences (SPSS) v25.0 software (IBM Corporation 2017, Armonk, NY, USA). Descriptive statistics were used to calculate the frequency and percentage of the categorical variables and the mean and standard deviation (SD) of the continuous variables. After the optimal model was chosen, chi-square tests were used to compare the difference in sociodemographic variables in each class's allocation. The t-test of two independent samples was applied to compare correlated variable scores in each latent class. Finally, statistically significant variables in univariate analysis were incorporated into binary Logistic regression analysis, and the entry-level was set as 0.05, and the exclusion level was set as 0.10. In the above statistical analysis, P < 0.05 was used as the standard for statistical significance of data difference.

Latent classes of psycho-behavioural adaptation among children

Five models were estimated during exploration. The second-class model was identified as the best-fitting one due to its small AIC, BIC, and aBIC and significant LMRT P value, as well as BLRT P value. When we compared the second-class and third-class models, the BLRT P value and LMRT P value were non-significant, indicating that the third-class model was not better than the second-class model. The model fit statistics for latent class estimation are shown in Table 1.

Table 1

Fit indices of each model
Model	AIC	BIC	aBIC	LMRT	BLRT	Entropy	Classification probability(%)
1	1208.62	1226.07	1210.22	-	-	-	-
2	1187.11	1225.49	1190.62	< 0.01	< 0.01	0.66	16.12/83.88
3	1189.41	1248.73	1194.84	0.25	0.38	0.81	83.06/12.81/4.13
4	1195.03	1275.27	1202.37	0.14	0.43	0.88	7.03/4.13/5.37/83.47
5	1205.53	1306.71	1214.78	0.57	1.00	0.73	5.37/6.20/11.57/7.03/69.84

AIC, Akaike Information Criteria; BIC, Bayesian Information Criteria; aBIC, Adjusted Bayesian Information Criteria; LMRT = Lo–Mendell–Rubin Test; BLRT = Bootstrapped likelihood ratio test.

Features and name of each latent class

Each class was named based on five dimensions: emotional symptoms, conduct problems, hyperactivity and attention disorders, peer interaction problems, and pro-social behaviour (Fig. 1). According to a previous study, values of ≥ 0.60 was considered as high probability, with values of < 0.60 and ≥ 0.15 moderate probability, and values of < 0.15 low probability(Burstein et al., 2012).

Class 1 (n = 39, 16.12%) children had high conduct problems and emotional symptoms, with moderate levels of hyperactivity and attention disorders, peer interaction problems, and pro-social behaviour; therefore, this class was named the psycho-behavioural problem group.

Class 2 (n = 203, 83.88%), children's emotional symptoms, conduct problems, hyperactivity and attention disorders, and peer interaction problems dimensions were at low levels, while pro-social behaviour was at moderate levels, naming this class as the psycho-behavioural health group.

Sociodemographic characteristics of latent classes

The differences in sociodemographic factors in each class were shown in Table 2. Regarding child's gender, parental roles, parental age, parental educational level, monthly income, and marital status, there was no difference between those two classes. However, as to the parental health aspect, parents with poorer health were more likely to be in the psycho-behavioural problems group (ꭓ²=8.81, P < 0.05). Those aged 3–6,7–12 years showed progressively higher proportions in the psycho-behavioural health group (ꭓ² =9.66, P < 0.05).

Table 2

Socio-demographic features by class membership (n = 242, %)
Variable	Total Sample	Class1(n = 39)	Class2(n = 203)	ꭓ2
Child's age(years)
3~	105(43.4)	9(23.1)	96(47.3)	9.66	0.008*
7~	86(35.5)	16(41.0)	70(34.5)
13~	51(21.1)	14(35.9)	37(18.2)
Child's gender				0.003	1.00
Female	117(48.3)	19(48.7)	98(48.3)
Male	125(51.7)	20(51.3)	105(51.7)
Parental roles				0.61	0.53
Mother	187(77.3)	32(82.1)	155(76.4)
Farther	55(22.7)	7(17.9)	48(23.6)
Parental age (years)				2.89	0.24
20~	42(17.4)	5(12.8)	37(18.2)
30~	144(59.5)	21(53.8)	123(60.6)
40~	56(23.1)	13(33.3)	35(21.2)
parental health				8.81	0.004*
Bad	65(26.9)	18(46.2)	47(23.2)
Good	177(73.1)	21(53.8)	156(76.8)
Parental educational level				4.10	0.1313
≤High school degree	95(39.3)	20(51.3)	75(36.9)
Undergraduate/ Junior college	128(52.9)	15(38.5)	113(55.7)
≥Master's degree	19(7.9)	4(10.3)	15(7.4)
Monthly income (¥, CNY a¹⁾)				4.36	0.23
≤ 3000	53(21.9)	13(33.3)	40(19.7)
3001~	51(21.1)	9(23.1)	42(20.7)
5001~	92(38.0)	11(28.2)	81(39.9)
10001~	46(19.0)	6(15.4)	40(19.7)
Marital status²⁾				2.7520	0.10
with a spouse	232(95.9)	35(89.7)	197(97.0)
without a spouse	10(4.1)	4(10.3)	6(3.0)

*P< 0.05; Class1:psycho-behavioural problems group; Class2:psycho-behavioural health group；

¹⁾CNY China Yuan, US$ 1.00 = ¥ 7.02

²⁾ There are four types of marital status, including first married, divorced, unmarried, and remarried. Because the sample sizes in certain types are very small, they are merged into ‘with a spouse’ and ‘without a spouse’.

The sense of parenting competence and psychological distress in parents of latent classes

T-test was used to examine the difference between the two classes' sense of parenting competence and psychological distress (Table 3). The t-test showed that parents in the psycho-behavioural health group scored significantly higher on sense of parenting competence, satisfaction, and efficacy than those in the psycho-behavioural problem group(P < 0.05). However, parents in the psycho-behavioural health group scored significantly lower than those in the psycho-behavioural problem group on measures of parental psychological distress(P < 0.05).

Table 3

The sense of parenting competence and psychological distress of two classes (scores, *x ± s*)
Variable	Class1(n = 39)	Class2(n = 203)	t	P
Sense of parenting competence	26.85 ± 2.85	30.04 ± 3.35	-5.57	< 0.01
Efficacy	13.49 ± 2.48	15.22 ± 2.24	-4.35	< 0.01
Satisfaction	13.36 ± 2.13	14.82 ± 2.17	-3.85	< 0.01
Psychological distress of parents	23.74 ± 5.29	17.72 ± 5.33	6.47	< 0.01

Class1:psycho-behavioural problem group; Class2:psycho-behavioural health group；

Factors influencing the latent classes of psycho-behavioural adaptation among children

The values of variables entered in the binary logistic regression analysis. Were detailed in Table 1 in Appendix 1 of the supplementary materials. Results indicated that sense of parenting competence and parental psychological distress impacted latent classes of psychological behaviour adaptation among children. See Table 4 for details.

Table 4

binary logistic regression analysis for the latent classes of psychological behaviour adaption among children
Variable	B	SE	Waldꭓ2	P	OR	95%CI
Constant	3.12	2.43	1.64	0.20
Child's age
3 ~ 6	-0.87	0.53	2.71	0.10	0.42	0.15–1.18
7 ~ 12	0.12	0.50	0.06	0.81	1.13	0.42–3.02
Parental health	-0.60	0.42	2.00	0.16	0.55	0.24–1.26
Parental psychological distress	0.12	0.04	11.30	0.001*	1.13	1.05–1.21
Sense of parenting competence	-0.23	0.08	9.69	0.002*	0.79	0.68–0.92

*P < 0.05. The reference group is class 2, the psycho-behavioural health group.

Referred to: Child's Age (13 ~ 18), parental health (bad)

This study showed that children's psycho-behavioural adaptation characteristics had clear class characteristics. All statistical fit indicators demonstrated that they were divided into two class models, namely the psycho-behavioural problem group and the psycho-behavioural health group. This classification highlighted the diversity of children's psycho-behavioural adaptation traits across latent classes, showing the individual differences between children.

Psycho-behavioural health group, comprising 83.88%, had a low probability of almost all the dimensions. Most children belonging to this class were well-adjusted psychologically and behaviorally, capable of better controlling negative feelings, friendly with peers, and less likely to show anti-social and aggressive behaviours (Memmott-Elison et al., 2020; Paulus, 2018). However, the psycho-behavioural problem group, comprising 16.12%, had a high probability in almost all the dimensions. Children in this class had more major emotional and behavioural problems, including persistently low mood, excitement, and anxiety. They also tended to steal, lie, and exhibit irritable, argumentative, and provocative behaviour. The possible reason was that the majority of children in this class are preschool- and school-aged. Research shows that children acquire emotional regulation skills between ages 2–5. Still, due to their lack of ability to manage their feelings, they often exhibit emotional dysregulation, conduct disorder, and oppositional defiant disorder(Mitchison et al., 2020). Previous studies reported that parental mental health is one of the predictors of children's functional maturation and behavioural problems(BeLue et al., 2015; Kerker et al., 2016). In this study, parents' poor physical health in this class might affect children's psycho-behavioural adaptation. In addition, children in this class also displayed poorer social adaptation, attention deficits, hyperactivity, and social avoidance. This finding was consistent with extant research, which reported that there is a negative relationship between pro-social behaviour and children's internalization problems(Memmott-Elison et al., 2020; Padilla-Walker et al., 2018). Low pro-social children might experience a variety of maladaptations, such as depression, feelings of loneliness, and rejection by peers (Padilla-Walker et al., 2018). Therefore, medical professionals should pay attention to children with psycho-behavioural problems while strengthening screening for hyperactivity, attention deficit disorder, and low pro-social behaviour. They should also fully utilize peer interaction by creating a child-friendly environment to promote psychological health development.

This study found that parents in the psycho-behavioural health group had higher parenting competence, efficacy, and satisfaction levels than those in the psycho-behavioural problem group. Logistic regression analysis suggested that sense of parenting competence was a protective factor for the group with psychological-behavioural problems (OR = 0.79, 95%CI 0.68–0.92). Our finding agrees with previous studies that sense of parenting competence was closely related to children's emotional-behavioural development and can buffer the harmful effects of an adverse family environment(Zhao et al., 2022). Parents with a high sense of parenting competence were empathic and aware of their shortcomings. They frequently used tolerant and encouraging parenting techniques to help their kids avoid emotional and behavioural issues(Sege & Siegel, 2018). As a result, parents should pay attention to parenting knowledge education, perfect the right parenting approach, and continuously improve levels of parenting satisfaction and efficacy.

Children in the psycho-behavioural health group scored significantly lower than those in the psycho-behavioural problem group on measures of parental psychological distress. Logistic regression analysis suggested that parental psychological distress was a risk factor for the psycho-behavioural problem group (OR = 1.13, 95%CI 1.05–1.21). Our finding was in line with most studies, suggesting that children who experience negative parental emotions were more stressed and prone to internalizing problem behaviours like academic failure, dropping out of school, and alcohol and drug abuse(Studts et al., 2019). A recently published study pointed out that psycho-behavioural maladaptation in children was one of the main factors contributing to parental psychological distress. The more severe the maladaptation, the more painful feelings parents experience, such as anxiety and depression(Khusaifan & El Keshky, 2022). Therefore, medical professionals should concentrate on parents who have severe psychological issues, such as anxiety and depression, pay attention to the impact of early intervention on parents' psychological distress, and carry out mental health education and group interventions to strengthen this population's social support system and buffer the subjectively unpleasant experiences brought on by parenting. (Belschner et al., 2020; Weitlauf et al., 2022).

Several limitations in this study need to be acknowledged. First, the study population was selected from Hunan Province, and the sample size was relatively small, so the representation of the sample and the generalization of the findings may be limited. Second, the cross-sectional design makes it impossible to infer any causal relationship. There may be subjective bias in the process of parents filling out the questionnaire, which cannot fully reflect children's psychological and behavioural adaptation. Future longitudinal studies are required to explore the pattern of changes in psycho-behavioural adaptation in children during the transition to adolescence and the role of relevant variables, in order to improve targeted interventions for different classes of children's behaviour.

This study finds heterogeneity in the psychology and behaviour of healthy children, and some children have psycho-behavioural adaptation problems. These results bridging shortcomings of previous studies, which focused on the psycho-behavioural adaptation characteristics of children with illness, such as children with mental illness and children with chronic diseases. In addition, healthcare professionals and parents should play a significant role in identifying children at risk for psycho-behavioural adaptation at an early age. On the one hand, parents should create a harmonious and caring peer environment, and help children communicate with their peers. On the other hand, healthcare professionals should pay more attention to parents with parenting problems and psychological distress, and take targeted interventions to help these parents better adapt to their children’s changes, reduce the psychological burden, and buffer the negative emotions caused by parenting.

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No competing interests reported.

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A latent class analysis of psycho-behavioural adaptation in children and its relationship with sense of parenting competence and psychological distress of parents

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Abstract

Background

Methods

Results

Conclusion

Figures

Background

Method and measures

Study setting

Participants

Instruments

Demographic characteristics

Parenting Sense of Competence Scale (PSOC)

The Kessler Psychological Distress Scale (K10)

Strength and Difficulties Questionnaire (SDQ)

Data collection

Data analysis

Results

Features and name of each latent class

Sociodemographic characteristics of latent classes

The sense of parenting competence and psychological distress in parents of latent classes

Factors influencing the latent classes of psycho-behavioural adaptation among children

DISCUSSION

Conclusion

References

Additional Declarations

Supplementary Files

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