Research On The Family System Of Preschool Children With Aggressive Behavior

Background and ObjectivesThe aggressive behavior is one of the most common behavior problems among children and adolescences with high prevalence. The aggressive behavior in early childhood would influence children’s physical and psychological development continuously, result in behavior disorders in their adolescent years or even crime and mental disorders in adulthood. Family is the fundamental environment for preschool children to live in and learn from, and the aggressive behavior in early childhood is correlated closely with family factors. Therefore, exploring the family factors of children’s aggressive behavior and family intervention strategies in young children is of great importance to reduce their aggressive behavior and facilitate their health physically and psychologically. This study would investigate on the status of aggressive behavior and family factors among preschool children, explore the patterns of parent-child interaction related to children’ aggressive behavior, and formulate and evaluate family intervention strategies aiming at preschool children’s aggression.MethodsUnder the guidance of Ecological Theory and Family System Theory, this study described the status quo of aggressive behavior among preschool children, analyzed family factors correlated with children’s aggression, and formulated and evaluated family intervention strategies aiming at children’s aggressive behavior. The main methods included cross-sectional investigation, semi-structural group interview and pilot semi-experimental study. There are five parts in this study. In the first part, a pilot study was implemented in2kindergartens in Putuo District, Shanghai using convenient sampling method. The validities and reliabilities of the instruments were tested and the feasibility of the study was demonstrated in this part. In the second part,10kindergartens located in5districts of Shanghai were recruited using cluster sampling method. The status quo of the aggressive behavior and its subtypes was investigated, and influencing family factors were analyzed among preschool children. In the third part, semi-structural group interviews were carried out in children with aggressive behavior and without aggressive behavior using purpose sampling method. Parent-child interaction patterns correlated with children’s aggressive behavior were explored in this part. In the fourth part, family intervention strategies aiming at children’s aggressive behavior was formulated based on the previous results and literature review. In the last part, a pilot semi-experimental study was implemented in2kindergartens of Yangpu District to evaluate the feasibility and effectiveness of family intervention.OutcomesThe First Part:Pilot Study148children recruited from2kindergartens of Putuo District, Shanghai were investigated in the pilot study from November to December,2010. It was found that the prevalence of aggressive behavior was high (8.8%) among preschool children, with the level of reactive aggression being higher markedly than proactive aggression. The aggressive behavior of preschool children was also discovered to be correlated with their family environment and parenting style in univariate analyses. It was also illustrated that the study on the family system among preschool children with aggressive behavior is feasible and essential.The results showed that each item of Chinese version of Aggressive Behavior-Teacher’s Checklist (TCL) was significantly correlated with the subscale it belongs to (0.821～0.902, P<0.01) after translation using Brislin model. The criterion validities of reactive aggression and proactive aggression subscale were0.708(P<0.01) and0.519(P<0.01) respectively. The construct validity was confirmed by factor analysis with78.489%variance explained by two factors. Cronbach’s alpha coefficient of TCL was0.891. The test-retest reliability coefficient of reactive aggression and proactive aggression subscale was0.977(P<0.01) and0.954(P<0.01) respectively, and the inter-rater reliability coefficients of two subscale were0.986(P<0.01) and0.981(P<0.01) respectively. Each item of the Chinese version of Parent Behavior Inventory (PBI) was significantly correlated with the subscale it belongs to (0.322±0.707, P<0.01). The criterion validities of PBI were from0.196to0.380(P<0.01). The construct validity of PBI was also confirmed by factor analysis with55.698%variance explained by two factors. Cronbach’s alpha coefficient of PBI was0.672, and the test-retest reliability coefficients of supportive/engaged and hostile/coercive subscale were0.964(P<0.01) and0.986(P<0.01) respectively. Moreover, Cronbach’s alpha and the test-retest reliability coefficients of Family Environment Scale-Chinese Version (FES-CV) and Child Behavior Checklist (CBCL)-Aggressive Subscale were all found to be above0.7.The Second Part:Investigation on the Aggressive Behavior and Family Factors among Preschool Children1600preschool children recruited from10kindergartens of Shanghai were investigated from February to June,2011, and1234(77.13%) completed questionnaires were taken back. It was found that the prevalence of aggressive behavior among preschool children was12.9%. Logistic regression analysis showed that children with increased activity (OR=1.309,95%CI:1.041-1.647), increased intensity of reaction (OR=1.366,95%CI:1.052-1.773), more uncomfortable symptoms within one year old (OR=1.322,95%CI:1.105-1.582) had more aggressive behavior. Compared with children without difficulty in falling asleep, those who often (OR=2.723,95%CI:1.522-4.869) or sometimes (OR=1.878,95%CI:1.108-3.182) had difficulty in falling asleep at night had more aggressive behaviors. While pleasure mood (OR=0.669,95%CI:0.501-0.894), and watching TV less than1hour each day (OR=0.245,95%CI:0.134-0.449) were protective factors of children’s aggression. The family factors that influenced children’s aggressive behavior included more family conflicts (OR=1.195,95%CI:1.073-1.331) and parents’ hostile/coercive parenting (OR=1.065,95%CI:1.031-1.100).It was found that the level of reactive aggression (2.12±0.93) was higher than that of proactive aggression (1.39±0.68), with the former being closely correlated with the latter (r=0.683, P<0.01). Multiple linear analyses showed that self-factors correlated with children’s reactive aggression included being boys, increased activity, and increased approach, while family factors included more family conflicts, parents’ hostile/coercive behaviors, younger mother and low education of mother. Children’s self-factors correlated with proactive aggression included being boys, increased activity, and high level of persistence, while family factors correlated with children’s proactive aggression included more family conflicts, increased achievement orientation, parents’increased hostile/coercive behaviors, younger mother and low education of father. Therefore, early appropriate family intervention should be planned to prevent and reduce children’s aggression.The Third Part:Study on Parent-child Interaction related to Children’s Aggression14parents or other caregivers of children with aggressive behavior and15parents or other caregivers of children without aggressive behavior were recruited for semi-structural group interviews from July to September,2011. It was found through interviews that the parent-child interaction in families of preschool children was not adequate; some children were entirely looked after by grandparents or others.In families of aggressive children, parents have not paid adequate attention to these children about their psychological needs or feelings, and they often used destructive strategies, such as beating, scolding, concession or negligence, rather than reasoning, or distracting attention when facing parent-child conflicts or children’s excessive requests. Children with aggressive behavior couldn’t express their needs or feelings appropriately by using crying and angry ways during parent-child interaction. No matter whether these children had aggressive behavior, they could accept parents’ constructive ways such as reasoning more easily than destructive ways during interaction. Moreover, grandparents’ involvement might also influence the development of positive parent-child interaction in these families. Therefore, parents should aware the importance of parent-child interaction, encourage children to express themselves and pay more attention to their psychological needs or feelings, and use constructive ways during interaction.The Fourth Part:Family Intervention Strategies aiming at Children’s AggressionFamily intervention strategies aiming at children’s aggressive behavior was formulated based on the previous investigation, group interviews and literature review. Main strategies focused on family environment intervention and parent-child interaction intervention. Family environment intervention included creating favorable family environment, such as reducing family conflicts, increasing family cohesion, intellectual-cultural orientation, active-recreational orientation and organization, and so on; improving parenting, such as reducing hostile/coercive parenting behaviors and using supportive/engaged parenting behaviors; helping children to develop good behavioral habits, such as limiting media time and contents. Parent-child interaction intervention included ensuring adequate parent-child interaction time; helping children to express themselves appropriately; paying more attention to children’s needs and giving feedback timely; dealing with parent-child conflicts appropriately, and facilitating positive parent-child interaction.The Last Part:Family Intervention to Children’s Aggressive Behavior1public kindergartens in Yangpu District, Shanghai were recruited to implement pilot family intervention to children’s aggressive behavior from September,2011to January,2012. The time of intervention was5months, and the main intervention aspects included family environment factors and parent-child interaction. The forms of intervention included health education, parent-child activities and family counseling. It was found that family intervention reduced the level of aggressive behavior and reactive aggression of both aggressive and non-aggressive children significantly. It was also discovered that the intervention decreased aggressive children’s family conflicts and control, and increased their family cohesion, intellectual-cultural orientation and active-recreational orientation markedly. For the non-aggressive children, family intervention also decreased their family control and increased their family intellectual-cultural orientation and active-recreational orientation. Moreover, the family intervention reduced the hostile/coercive parenting behaviors and improved supportive/engaged parenting behaviors for the whole intervention group. In contrast, the hostile/coercive parenting behaviors of aggressive children in the control group increased significantly after5months. Therefore, implementation of family intervention through the platform of kindergarten is effective and feasible to prevent and intervene children’s aggressive behavior, and facilitate the dynamics of family system.ConclusionsThe prevalence of aggressive behavior among preschool children was high, and the level of reactive aggression was higher than that of proactive aggression. Family is the main place for preschool children to live and socialize, thus it is essential to explore family factors and intervention strategies for children’s aggressive behavior. The individual factors related to children’s aggressive behavior and its subtypes included being boys, inappropriate temperament traits and habits, while family influencing factors mainly included poor family environment, parents’ hostile/coercive behaviors, and inappropriate parent-child interaction. The pilot intervention study showed that family intervention could help children to decrease the level of aggression, especially reactive aggression, improve their family environment, and reduce parents’ or caregivers’ hostile/coercive parenting behaviors. Therefore, based on the ecological theory and family systems theory, the family intervention strategies aiming at children’s aggressive behavior mainly include improving family environment, transforming parenting style, facilitating positive parents-children interaction, and so on. Further researches may revise family intervention strategies for the aggressive children and develop health education planning for the non-aggressive children in their early childhood, and explore its long-term effectiveness on the aggressive behavior of preschool children and their family system.