overview of indicators of emotional or behavioral …...based on parent-reported data, key findings...

Based on parent-reported data, key findings related to indicators of emotional or behavioral difficulties for Delaware’s children, youth, and families include the following:

• Children and youth with moderate/severe difficulties were inpoorer overall physical health compared to children andyouth with no difficulties and utilized more medical care, mental health, and/or educational services.

• Children and youth with moderate/severe difficulties were lesslikely than those with no difficulties to resolve conflicts, showempathy, get along with others, or show respect for adults.

• Children or youth with moderate/severe difficulties were usually or always stubborn, argumentative, and disobedient,or bullied others compared to children or youth with no difficulties.

Additionally:• Parents of children or youth with no difficulties reported that

they were less likely to shout or argue heatedly and hit orthrow things compared to parents of children or youth withmoderate/severe difficulties.

• Parents of children with no difficulties report that they are in better overall health and have better overall mental andemotional health than parents of children or youth with moderate/severe difficulties.

Chapter 4 examines the severity of parent-reported emotional orbehavioral difficulties of Delaware’s children, youth, and familiesacross a range of indicators. These indicators represent multiple

levels of NHPS’ emotional and behavioral health framework based onthe social ecological model—child, relationship, parent, and environ-ment (see Chapter 2). The indicators selected do not provide a completeview of the factors related to children’s emotional and behavioral health,but serve as benchmark measures to help identify areas that may needfurther study or programmatic attention.

The National Survey of Children’s Health (NSCH) provides national andstate-specific prevalence estimates for a variety of physical, emotional,and behavioral health indicators.1 NHPS selected 69 questions from theNSCH results to represent a variety of relationships and environmentalinfluences on the health and well-being of children. In this chapter,NHPS organized the results according to the 15 factors addressed in theframework (see Figure 4.1).

Overview of Indicators of Emotional or Behavioral Difficulties for Delaware’s Children and Youth

21O v e r v i e w o f I n d i c a t o r s

Figure 4.1: Factors for Examining Emotional and Behavioral Health in Children

O v e r v i e w o f I n d i c a t o r s22

Health1. Physical Health2. Mental Health

Child3. Positive Behaviors4. Problem Behaviors5. Emotional Difficulties6. Engagement in Community

Relationship7. Parent-Child Relationship8. Parent Engagement9. Parental Monitoring

Parent10. Parent Conflict Resolution11. Parenting Stressors12. Parent Health

Environment13. School Inhibitors14. Safe Environments15. Supportive Neighborhoods

Health Child Parent EnvironmentRelationship

Categories Based on Severity of Emotional/BehavioralDifficultiesFor this descriptive analysis, NHPS grouped children and youth intothree categories based on parental reports indicating whether the childor youth had emotional or behavioral difficulties and, if so, the severityof the difficulties.* Children and youth identified by their parents ashaving moderate emotional or behavioral difficulties or severe emotionalor behavioral difficulties were classified into a single category called“moderate or severe,” also referred to as moderate/severe difficulties in thetext. The second category consists of those children and youth whoseparents indicated they had minor emotional or behavioral difficulties,labeled “minor” and referred to as minor difficulties in the text. Theremaining category, “none,” referred to as no difficulties in the text, consists of children and youth who did not have emotional or behavioral difficulties.

Comparisons of Selected IndicatorsThe tables and charts presented in this chapter illustrate two types ofcomparisons of selected indicators:

• A comparison between all children and youth in Delaware and the nation

• A comparison among children and youth in Delaware within the three categories of severity of parent-reported emotional or behavioral difficulties: moderate/severe, minor and none

Comparisons are based on statistically appropriate tests and significantdifferences are highlighted.

Key Findings Key findings based on a comparison between data reported by parentsin Delaware and data reported by parents nationwide indicate the following:

• Although the rate of ADD and ADHD is higher in children andyouth ages 3–17 in Delaware than children and youth nationwide,findings were similar on all other mental health indicators.

• More Delaware children and youth ages 6–17 have ever repeated a grade compared to children nationwide.

• Parents of children and youth in Delaware are less likely to keeptheir opinions to themselves during an argument and are morelikely to argue heatedly or shout than parents nationwide.

• More parents in Delaware report that they have day-to-day helpwith parenthood compared with parents nationwide.

Comparisons between Delaware and the nation on selected indicatorsare shown in the tables for each level of the framework and a summaryis provided for each question. Overall, this analysis shows that Delawarechildren and youth ages 3–17 were not significantly different than theircounterparts nationwide on most physical and mental health indicators,except asthma, Attention Deficit Disorder (ADD), or Attention Deficitand Hyperactivity Disorder (ADHD).

The charts are used to illustrate comparisons among children and youthin Delaware based on levels of severity of emotional or behavioral diffi-culties for selected indicators that represent risk and protective factorsthat are important to an exploration of emotional and behavioral health.Some of these indicators have been used in a multivariate analysis andthe results are detailed in Chapter 5. More information on statisticalmethods and results can be found in Appendix A: Technical Notes andAppendix B: Data Tables.


*Children and youth were grouped into three categories based on parental responses totwo questions: (1) Overall, do you think that [your child] has difficulties with one ormore of the following areas: emotions, concentration, behavior, or being able to getalong with other people?; and (2) Would you describe these difficulties as minor, moderate, or severe?

Children’s Physical HealthParents’ assessments of the overall health status of their children areimportant first steps in understanding emotional or behavioral difficultiesin children and youth. Children’s physical health is determined by

• Overall health,

• The need for or use of excessive medical care, mental health, oreducational services,

• The presence of disease or physical impairments, and

• Lifestyle factors.

Delaware children were comparable to their counterparts nationwide onselected physical health indicators except for asthma. Compared withparents nationwide, a higher percentage of parents in Delaware reportedbeing told by a physician or health professional that their child or youthhad asthma.

Health


Figure 4.2: Children’s Physical Health in Delaware Versus the Nation

Characteristic NSCH Measure National % Delaware % Summary

Overall Child Health Status Percent of children in excellent or very good health 83.6% 85.1% Comparable

Health Care or Educational Services Percent of children using more health care and educational services 12.2% 12.4% Comparable

Health Care or Educational Services Use Percent of children using more health care and educational services 73.2% 73.2% Comparable

Due to Mental Health Needs because of any behavioral, health, or mental condition

Limited Ability Percent of children limited in ability 6.1% 6.4% Comparable

Limited Ability Due to Health Condition Percent of children limited in ability because of health condition 74.2% 74.8% Comparable

Parent Told by Physician or Health Percent of children with developmental delay or physical impairment 3.6% 4.5% Comparable

Professional That Child Has Developmental

Delay or Physical Impairment

Parent Told by Physician or Health Percent of children having asthma 13.6% 16.8% Higher

Professional That Child Has Asthma

Sleep Percent of children getting enough sleep everyday for a whole week 68.8% 70.4% Comparable

(ages 6–17)

Physical activity Percent of children participating in 20 minutes of physical activity 26.0% 25.6% Comparable

every day for a week (ages 6–17)

Speech problems Percent of children having stuttering, stammering, or 3.5% 3.1% Comparable

other speech problems

Data Source: National Survey of Children’s Health, 2003. Note: All data are parent-reported.

The majority of parents reported their children or youth as being in“excellent/very good” overall physical health regardless of level of emotional or behavioral difficulties. One in ten parents of children oryouth with moderate/severe difficulties reported that their child or youthwas in “fair or poor” overall physical health. In contrast, only 1.7% ofparents of children or youth with no difficulties reported their child oryouth as being in “fair or poor” overall physical health. When asked iftheir child used more health care (for example, medical care or mentalhealth services) or educational services than other children of the sameage, parents of children or youth with moderate/severe difficulties weremore likely to respond “yes” than parents of children or youth withminor or no difficulties.

Figure 4.3: Parental Report of Child’s or Youth’s Overall PhysicalHealth and Utilization of Health Care Services

A higher percentage of parents of children or youth with moderate/severedifficulties reported that their child had health problems compared withparents of children or youth with no difficulties. For example, only 1.3%of parents of children or youth with no difficulties reported that theirchild had speech problems as compared to 15.5% of parents of childrenor youth with moderate/severe difficulties.

Figure 4.4: Parent-Reported Health Problems in Children or Youth by Level of Severity of Emotional orBehavioral Difficulty

Almost one in five children and youth with moderate/severe difficultieshave some type of parent-reported developmental delay (18.5%) or limited ability (for example, physical impairment (27.7%)). This isabout 10 times higher when compared with children or youth with no difficulties (2.2% and 3.2% respectively).


0

10

20

40

30

50

60

Overall Physical Health = Fair/Poor

50.9%

10.0%

22.2%

4.1%7.0%

1.7%

Used More Health Care Services = Yes

MinorModerate/Severe None

Data Source: National Survey of Childrenís He alth, 2003. Note: All data are parent-reported.

0

5

10

15

20

25

3024.9%

21.2%

15.5% 15.5%

18.5%

9.8%

27.7%

12.6%

3.2%2.2%1.3%

5.5%

None

Speech Problems DevelopmentalDelays

Limited AbilityAsthma

MinorModerate/Severe


Children’s Mental HealthIndicators of children’s mental health include the presence or absenceof any emotional, developmental, or behavioral problem and the duration and burden of the emotional or behavioral problem on thefamily. Parents were asked to indicate if their doctor or other healthcare professional had told them their child had a specific condition:

ADD/ADHD, depression/anxiety, behavioral or conduct problems, and autism. Children and youth in Delaware had a significantly higherpercentage of parent-reported ADD or ADHD compared with theircounterparts nationwide, but were similar on all other mental healthindicators.


Figure 4.5: Children’s Mental Health in Delaware Versus the Nation


Treatment or Counseling for Emotional, Percent of children with emotional, developmental, or behavioral 7.4% 8.5% Comparable

Developmental, or Behavioral Problems problems needing treatment or counseling

Long-lasting Emotional, Developmental, Percent of children with emotional, developmental, or behavioral 84.1% 74.5% Comparable

or Behavioral Problems problems lasting or expecting to last 12 months

Parent Told by Physician or Health Percent of children with learning disability 9.7% 10.2% Comparable

Professional That Child Has Learning Disability

Socio-Emotional Difficulties Percent of children having difficulties with emotions, 17.8% 18.3% Comparable

concentrations, or behaviors

Moderate or Severe Emotional, Percent of children having moderate/severe emotional, 51.6% 46.9% Comparable

Developmental, or Behavioral Problems developmental, or behavioral problems

Impact of Child’s Mental and Emotional Percent of children whose mental and emotional health problem 28.0% 27.8% Comparable

Health on the Family has a great or medium impact

Parent Told by Physician or Health Percent of children having ADD/ADHD 7.2% 9.2% Higher

Professional That Child Has ADD/ADHD

Parent Told by Physician or Health Percent of children having depression/anxiety 4.4% 4.8% Comparable

Professional That Child Has Depression/Anxiety

Parent Told by Physician or Health Percent of children having behavioral or conduct problems 5.6% 5.2% Comparable

Professional That Child Has Behavioral or

Conduct Problems

Figure 4.5: Children’s Mental Health in Delaware Versus the Nation (continued)


Parent Told by Physician or Health Percent of children having autism 0.5% 0.6% Comparable

Professional That Child Has Autism

Parental Concern about Eating Disorders Percent of children whose parents were concerned “a lot” about 12.2% 10.8% Comparable

eating disorders (ages 6–17)

Parental Concern about Self-esteem Percent of children whose parents were concerned “a lot” about 29.0% 29.6% Comparable

self-esteem (ages 6–17)

Parental Concern about Substance Abuse Percent of children whose parents were concerned “a lot” about 14.1% 13.5% Comparable

substance abuse (ages 6–17)

Parental Concern about Depression/Anxiety Percent of children whose parents were concerned “a lot” about 16.0 % 15.0% Comparable

depression/anxiety (ages 6–17)


According to parents surveyed, five out of ten children or youth withmoderate/severe difficulties have been diagnosed by a doctor or healthprofessional with attention deficit disorder (ADD) or attention deficitand hyperactivity disorder (ADHD), and four out of ten have been diagnosed with a learning disability. Approximately 2% of children

or youth with no difficulties were reported as being diagnosed with ADD or ADHD and 5% with a learning disability. The prevalence of parent-reported autism was highest among children and youth withmoderate/severe difficulties at almost seven percent, compared with fewer than one percent for those children and youth with no difficulties.


0

10

20

30

40

50

60

None

2.1%0.1%

33.1%

0.2%

50.8%

4.9%

24.6%

43.6%

6.5%

Minor Moderate/Severe

None Minor Moderate/Severe


Autism = Yes ADD or ADHD (age 24 months) = Yes

Learning Disability(age 36 months) = Yes


Figure 4.6: Children or Youth with Learning Disabilities, ADD or ADHD, and Autism

Parents of children or youth with moderate/severe difficulties were morelikely to have been told by a health professional that their child had abehavioral or conduct problem than parents of children or youth withno difficulties (27.3% versus 1.1%). A higher percentage of childrenand youth with moderate/severe difficulties experienced depression oranxiety compared with children and youth with no difficulties.

Figure 4.7: Children and Youth Ages 24 Months or Older withDepression or Behavior Problems

Parents of children and youth with moderate/severe difficulties reportedthat their child’s mental and emotional health puts a “great deal” of burden on their families compared with children and youth with minordifficulties (13.3% vs. 4.5%). A higher percentage of parents who reportedchildren with minor difficulties did not feel burdened by their child oryouth’s difficulties (59.3%) compared with parents who reported theirchild or youth had moderate/severe difficulties (27.7%).

Figure 4.8: Burden Child’s or Youth’s Emotional Health Puts onthe Family


0

5

10

15

20

25

30

None

19.3%

14.0%

1.1% 1.6%

27.3%

24.2%



Behavioral or Conduct Problems = Yes

Depression or AnxietyProblems = Yes


0

20

40

60

80

100

59.3%

27.5%

8.8%4.5%

27.7%

28.1%

30.9%

13.3%


Medium Amount

Great Deal

Not at All

A Little


When compared to parents of children or youth with no difficulties,three times as many parents of children or youth ages 6–17 with moderate/severe difficulties reported being concerned about their child

or youth’s depression or anxiety (36.2% vs. 11.2%), self-esteem (54.3%vs. 25.2%), or eating disorders (17.4% vs. 8.8%). Parents of children ineach group expressed similar levels of concern about substance abuse.


0

20

40

60

None

11.2%

23.8%

36.2%

18.5%15.4 %12.6%

25.2%

39.7%

17.4%19.4%

8.8%

54.3%





Parental Concernabout Depressionor Anxiety = A Lot

Parental Concern about Substance

Abuse = A Lot

Parental Concern about

Self-esteem = A Lot

Parental Concernabout Eating

Disorders = A Lot


Figure 4.9: Parental Concern About Depression, Substance Abuse, Self-Esteem, and Eating Disorders in Child or Youth Ages 6–17

Child


Children’s Positive BehaviorsShowing respect for adults, getting along well with others, empathy, the ability to resolve conflicts and ability to cope with stress are allexamples of positive behaviors in children and youth. Compared with

the nation, Delaware children and youth (ages 6-17) were equally likelyto demonstrate the positive behaviors reported in Figure 4.10.

Figure 4.10: Children’s Positive Behaviors in Delaware Versus the Nation


Respect for Adults Percent of children usually/always showing respect for 92.0% 92.6% Comparable

teachers and neighbors during the past month (ages 6–17)

Gets Along with Others Percent of children usually/always getting along well with 90.0% 90.0% Comparable

other children during the past month (ages 6–17)

Empathy Percent of children usually/always try to understand others’ 74.0% 72.7% Comparable

feelings during the past month (ages 6–17)

Conflict Resolution Percent of children usually/always trying to resolve conflicts 67.1% 66.0% Comparable

with others during the past month (ages 6–17)

Parents’ Concern about Child Coping Percent of children whose parents are concerned “a lot” 29.0% 30.7% Comparable

about their child’s coping with stress (ages 6–17)


Children and youth with moderate/severe or minor difficulties were lesslikely than children and youth with no difficulties to demonstrate all ofthe positive behaviors illustrated in this figure. Children and youth who“usually or always” demonstrated all four of these positive behaviorswere less likely to be classified by their parents as having

moderate/severe difficulties. Children and youth with parent reportedmoderate/severe difficulties were less likely than those with no difficultiesto demonstrate positive behaviors such as conflict resolution and empathy. The majority of children (>80%) show respect for adults,regardless of the level of emotional or behavioral difficulties.


0

20

40

60

80

100

None

71.0%

50.0%43.0%

61.6%54.5%

76.5%

93.5%

76.2%

65.6%

95.3%

82.3% 82.5%





Conflict Resolution Empathy Gets Alongwith Others

Respect for Adults


Figure 4.11: Children and Youth Ages 6–17 with Positive Behaviors = Usually/Always

Two-thirds of parents of children or youth with moderate/severe difficul-ties reported “a lot” of concern about how their child or youth copes

with stress. However, only 24.6% of parents of children or youth withno difficulties also reported “a lot” of concern about their child’s coping.


0

20

40

60

80

10065.2%

44.5%

24.6%


None


Figure 4.12: Parental Concern About How Child or Youth Ages 6–17 Copes with Stress = A Lot

Children’s Problem BehaviorsChildren and youth with emotional or behavioral difficulties were more likely to display at least one of the following problem behaviors:arguing, bullying, disobedience, or stubbornness. Parents of Delawarechildren and youth were equally likely as their national counterparts

to report their children as usually or always argumentative, mean, disobedient, or stubborn. However, parents both in Delaware andnationwide reported that a small percentage ( 20%) of children demonstrated these problem behaviors.


Figure 4.13: Children’s Problem Behaviors in Delaware Versus the Nation


Argumentative Percent of children usually/always argue too much 19.2% 20.1% Comparable

during the past month (ages 6–17)

Bullies Percent of children usually/always bully or are cruel/mean 2.0% 2.1% Comparable


Disobedient Percent of children usually/always are disobedient 4.7% 5.2% Comparable


Stubborn Percent of children usually/always are stubborn/sullen/ 9.2% 10.4% Comparable

irritable during the past month (ages 6–17)


Compared with parents of children or youth with no difficulties, parentsof children or youth with moderate/severe difficulties were more likely tothink that their child “usually or always” argued too much (15.3% vs.44.8%) or was stubborn (6.8% vs. 30.9%).

Figure 4.14: How Often Child or Youth Ages 6–17 Argues and Is Stubborn

More than one in ten parents of children or youth with moderate/severedifficulties reported that their child “usually or always” bullied or wascruel or mean to others (13.5%). Fewer than 1% of parents of childrenor youth with no difficulties felt that their child “usually or always” bullied or was cruel or mean to others.

Figure 4.15: How Often Child or Youth Ages 6–17 Bullied or Was Disobedient


0

10

20

30

40

50

None

6.8%

18.3%

30.9%33.9%

44.8%

15.3%



Stubborn = Usually/Always

Argumentative = Usually/Always


0

5

10

15

20

None

3.4%

6.8%

17.3%

3.3%

13.5%

0.6%



Disobedient Bullied


Children’s Emotional DifficultiesA child or youth who is feeling worthless, is unhappy, sad, depressed,or is withdrawn and does not get involved with others is displaying an emotional difficulty. Delaware children and youth were equally

likely as their nationwide counterparts to display emotional difficultiesas evidenced by feelings of inferiority, unhappiness and withdrawal from others.


Figure 4.16: Children’s Emotional Difficulties in Delaware Versus the Nation


Feelings of Inferiority Percent of children usually/always feel worthless/ 2.5% 1.5% Comparable

inferior during the past month (ages 6–17)

Child Unhappy Percent of children usually/always are unhappy/sad/ 2.0% 2.4% Comparable

depressed during the past month (ages 6–17)

Withdrawn Percent of children usually/always are withdrawn/not 2.7% 1.6% Comparable

involved with others during the past month (ages 6–17)


Almost 13% of parents of children or youth with moderate/severe difficulties reported their child or youth was “usually or always”

unhappy, sad, or depressed in comparison to fewer than 1% of parentswith children or youth with no difficulties.


0

3

6

9

12

15

None

0.5%

5.0%

6.9%

5.4%

12.8%

0.7% 0.2%

6.7%7.3%




Withdrawn = Usually/Always

Unhappy =Usually/Always

Feelings of Inferiority =Usually/Always


Figure 4.17: Emotional Difficulties of Children and Youth Ages 6–17

Child-Community EngagementA child’s engagement in his/her community is measured by participationin a sport, clubs or organizations, or any other organized event or activ-ity. For youth ages 12–17, being involved in any type of communityservice or volunteer work is also considered a measure of community

engagement. Delaware youth (ages 12–17) were equally likely as youthnationwide to participate in sport, activities outside of school, and community service.


Figure 4.18: Child-Community Engagement in Delaware Versus the Nation

National % Delaware % Summary

Sport Participation Percent of children on a sports team/taking sports 57.6% 56.8% Comparable

lessons after school/weekends (ages 6–17)

Activities Outside of Percent of children in a club/organization after school/ 52.6% 52.0% Comparable

School weekends (ages 6–17)

Community Service Percent of children involved in any community service/ 60.2% 56.6% Comparable

volunteer work (ages 6–17)


Children and youth with no difficulties were more likely than those withmoderate/severe difficulties to participate in sports.

Figure 4.19: Child-Community Engagement of Children and Youth Ages 6–17


0

10

20

30

40

50

60

70

80

None

54.5%

43.4% 42.2%

49.6%

37.8%

60.2%



Activities Outside ofSchool = Yes

Sports Participation = Yes


Parent-Child RelationshipThe bond, communication, and quality time spent between a parentand child are an important part of a child or youth’s life. Parents of

Delaware children and youth are as concerned about having enoughtime to spend with their child as their counterparts nationwide.

Relationship


Figure 4.20: Parent-Child Relationship in Delaware Versus the Nation


Relationship with Parent Percent of children who have “very close” relationship 85.7% 85.6% Comparable

with parents (ages 6–17)

Communication Percent of children who share ideas “very well” with parents 75.2% 74.0% Comparable

(ages 6–17)

Quality Time Percent of children whose parents are concerned “a lot” about 32.0% 33.1% Comparable

having enough time with them (ages 6–17)

Parental Concerns about Relationship Percent of children whose parents are concerned “a lot” about 28.7% 29.4% Comparable

their relationship (ages 6–17)


Approximately 8% of parents of children or youth with moderate/severedifficulties reported that their relationship with their child or youth was“not very close or not close at all.” This is higher than parents whosechildren or youth have no difficulties (0.3%).

Figure 4.21: Parent’s Relationship with Child or Youth Ages 6–17 = Not Very Close/Not Close

When asked how well they shared ideas or talked about things thatreally mattered with their child or youth, a higher percentage of parentsof children or youth with moderate/severe difficulties reported “not verywell or not well at all” compared to parents of children or youth with no difficulties (10.8% vs. 0.8%).

Figure 4.22: How Well Parent and Child or Youth Ages 6–17 Can Share Ideas or Talk About Things That ReallyMatter = Not Very and Not Well


0

1

2

3

4

5

6

7

8

Moderate/Severe

7.9%

0.4% 0.3%

Minor None


0

2

4

6

8

10

12

Moderate/Severe

10.8%

4.7%

0.8%

Minor None


Compared with parents of children and youth with no difficulties, ahigher percentage of parents of children and youth with moderate/severedifficulties expressed “a lot” of concern about their relationship withtheir child and about having enough time to spend with them.

Figure 4.23: Parental Concern about Relationship with Child orYouth Ages 6–17

Parent EngagementMeasures of parental engagement in their children’s lives include attending events and eating meals together as a family. Whereas the frequency of parents’ attendance at events was comparable with thenation, Delaware families were less likely to eat meals together through-out the week.


0

10

20

30

40

50

None

26.9%

35.0%

41.8% 41.3%44.7%

30.5%



Concern about Relationship = A Lot

Concern about Having Enough Time with Child = A Lot


Figure 4.24: Parent Engagement in Delaware Versus the Nation

Characteristic NSCH Measure National % Delaware % SummaryParent Percent of children 79.0% 79.7% Comparable Attendance whose parents at Events usually/always

attended their events or activities during the past year (ages 6–17)

Family Percent of children 45.4% 41.3% LowerMeals whose family eat

meals together thoughout the whole week


Parents of children and youth with minor difficulties were less likely toreport that they “always” attended their child’s activities when comparedto parents of children and youth with no difficulties. Just over half of theparents with children or youth who have moderate/severe difficulties“always” attended their child’s events or activities in the past twelvemonths.

Figure 4.25: Parental Attendence at Events or Activities ThatChild or Youth Ages 6–17 and Participated inDuring the Last 12 Months = Always

Parental MonitoringA child’s friends are an important part of his or her life. One way forparents to monitor their child’s life is to meet his or her friends. Themajority of parents nationwide reported that they have met all or mostof their child’s friends. Compared with parents nationwide, a similarpercentage of Delaware parents reported they have met all or most oftheir child’s friends.

Note: Although no differences were found between children of varyinglevels of severity of emotional or behavioral difficulties, this was the onlyindicator of parental monitoring available in the 2003 National Survey ofChild Health and has been included for informational purposes.


0

10

20

30

40

50

60

Moderate/Severe

52.4%

40.3%

56.0%

Minor None


Figure 4.26: Parental Monitoring in Delaware Versus the Nation


Friends Percent of children 80.7% 80.5% Comparablewhose parents have met all/most of their friends (ages 6–17)


Despite the severity of the emotional or behavioral difficulty, the majorityof parents of children and youth reported meeting “all” or “most” of their

child’s friends. The differences noted in this figure are not statistically significant.


Most of Them

Some of Them

None/No Friends

All of Them

0

20

40

60

80

100

Moderate/Severe

33.6%

48.6%

16.5%

1.3%

46.4%

18.5%

32.3%

2.8%

39.6%

30.4%

26.4%

3.7%

Minor None


Figure 4.27: Amount of Friends of Child or Youth Ages 6–17 That Parents Have Met

Parental Conflict Resolution Behaviors Parents have various ways of managing serious disagreements or conflicts. Some positive ways parents communicate during disagree-ments are through the sharing of opinions, having calm discussions,and maintaining composure. Compared with the nation, Delaware

parents are equally likely to discuss disagreements calmly with house-hold members, and to maintain composure during serious disagree-ments. Delaware parents were, however, more likely to share opinionsand to shout during serious disagreements with household members.

Parent/Caregiver


Figure 4.28: Parental Conflict Resolution Behaviors in Delaware Versus the Nation


Share Opinions Percent of children whose parents never/rarely keep their opinions 57.4% 60.9% Higher

to themselves when having a serious disagreement with

household members

Calmly Discuss Percent of children whose parents usually/always discuss their 70.3% 67.5% Comparable

disagreement calmly when having a serious disagreement with

household members

Never Shout Percent of children whose parents never/rarely argue heatedly or 58.9% 54.1% Lower

shout when having a serious disagreement with household members

Maintain Composure Percent of children whose parents never/rarely end up hitting or 97.0% 95.8% Comparable

throwing things when having a serious disagreement with

household members


Parental conflict management, as measured by the ability to discussdisagreements calmly (usually/always), in combination with theabsence or low frequency (never/rarely) of three of the four remainingbehaviors illustrated below, is an important indicator for children’s

emotional or behavioral health. The relationship of these conflictmanagement behaviors to the presence of emotional and behavioralhealth in children and youth is discussed in Chapter 5.


0

20

40

60

80

100





96.1%92.7% 95.4%

Parent Hits or Throws Things = Never/Rarely

36.2%39.8%

57.8%

Parent Argues Heatedlyor Shouts = Never/Rarely

68.7%

58.5%

67.2%

Parent Discusses Disagreement Calmly = Usually/Always

66.7%58.4%60.6%

Parent Keeps Opinions toHimself/Herself = Never/Rarely


Figure 4.29: Parental Conflict Resolution Behaviors

Stressful ParentingSeveral experiences or events in a parent’s life can affect a parent’s ability to cope. Experiences that can increase the amount of stress on parents include being bothered or angered by the behavior of theirchild and making unexpected sacrifices. Having someone to turn to for help or a child that is easy to care for may alleviate parental stress.

Overall, Delaware parents reported coping equally well as parentsnationwide, almost 90% have someone to turn to for day-to-day helpwith parenthood, and 71% have never felt that their child is muchharder to care for than most children the same age.


Figure 4.30: Stressful Parenting in Delaware Versus the Nation


Parental Coping Percent of children whose parents feel “very well” coping with the 56.0% 56.3% Comparable

day-to-day demands of parenthood

Parents Bothered by Child Percent of children whose parents have never felt the child does 35.9% 33.6% Comparable

things bothers them a lot during the past month

Parental Sacrifices for Child Percent of children whose parents “never” felt they gave up more of 58.7% 61.4% Comparable

their lives to meet child’s needs than expected during the past month

Parents Angered by Child Percent of children whose parents “never” felt angry with them 22.5% 22.4% Comparable

during the past month

Day-to-Day Help with Parenthood Percent of children whose parents have someone to turn to 86.2% 89.7% Higher

day-to-day help with parenthood

Ease of Caring for Child Percent of children whose parents “never” felt their child is much 69.1% 71.0% Comparable

harder to care for than most of children the same age during the

past month


Most parents of children or youth with no difficulties reported that theywere able to cope “very well” with the day-to-day demands of parent-hood. Six out of ten parents of children or youth with no difficulties

reported coping “very well” in comparison to four out of ten parentsof children or youth with minor difficulties and with moderate/severedifficulties.


0

20

40

60

80

100

Moderate/Severe

Minor None


59.6%

40.1%

0.4%

53.9%

44.6%

1.4%

54.2%

40.2%

5.6%

Somewhat Well

Not Very Well/Not Well at All

Very Well

Figure 4.31: Parental Coping with Day-to-Day Demands of Parenthood

Parents of children or youth with moderate/severe difficulties experiencemore stressful parenting than parents of children or youth with no diffi-culties. Compared with parents of children with no difficulties, ten timesas many parents (26% vs. 2.5%) of children with moderate/severe diffi-

culties felt their child was much harder to care for than other childrenhis or her age and seven times as many (23.0% vs. 3.3%) felt their childdid things that are really bothersome.


0

5

10

15

20

25

30

None

2.5%

11.7%

26.0%

9.2% 9.3%

1.7%

9.6%

20.9%

3.3%

13.7%

23.0%22.2%





Child Is Much Harder toCare for = Usually/Always

Parent Felt Angry withChild = Usually/Always

Parent Felt He/She Is GivingUp More of His/Her Life to

Meet Child’s Needs = Usually/Always

Child Does Things That Are Really Bothersome =

Usually/Always


Figure 4.32: Stressful Parenting

Almost three times as many parents with children or youth who havemoderate/severe difficulties reported that they did not have someone to

turn to for day-to-day emotional help with parenting in contrast to thosewho have children or youth with no difficulties (21.8% versus 8.1%).


0

5

10

15

20

25

Moderate/Severe

21.8%

17.1%

8.1%

Minor None


Figure 4.33: Parent Has Someone to Turn to for Day-to-Day Emotional Help with Parenting = No

Parent HealthParents’ overall physical health and mental and emotional health havean impact on a child’s life. Delaware parents were equally likely astheir counterparts nationwide to report being in excellent or very

good overall physical health (65.8%) as well as mental and emotionalhealth (71.3%). Most Delaware parents (60.9%) reported engaging inregular physical activity.


Figure 4.34: Parent Health in Delaware Versus the Nation


Parent Overall Health Percent of children whose parents have excellent/very 64.0% 65.8% Comparable

good overall health

Parent Physical Activity Percent of children whose parents have enough regular 61.7% 60.9% Comparable

physical activity during the past month

Parent Mental and Emotional Health Percent of children whose parents have excellent/very 70.4% 71.3% Comparable

good mental and emotional health


Almost 20% of parents of children or youth with moderate/severe difficulties (18.8%) reported being in fair/poor overall physical health

as well as mental or emotional health (18.3%), compared with fewerthan 10% of parents of children with no emotional difficulties.


0

5

10

15

20

None

4.2%

14.2%

18.3%

13.9%

18.8%

8.5%



Overall Mental and EmotionalHealth of Parent = Fair/Poor

Overall Parent Health= Fair/Poor


Figure 4.35: Parent Help

School InhibitorsSeveral barriers may prevent a child from succeeding in school. Issuessuch as missing school, learning difficulties, repeating grades, lowachievement, and being bullied all inhibit a child’s success. A larger proportion of Delaware students, compared with students across the

nation, have repeated grades since starting kindergarten. Comparedwith the nation, similar percentages of Delaware parents were concerned about student achievement and about their children beingbullied by classmates.

Environment


Figure 4.36: School Inhibitors in Delaware Versus the Nation

National % Delaware % Summary

Missed School Days Percent of children missing school because illness or injury fewer 94.8% 95.4% Comparable

than 11 days during the past 12 months (ages 6–17)

Repetition of Grades Percent of children not repeating any grades since starting 88.7% 85.1% Lower

kindergarten (ages 6–17)

Parental Concern with Learning Difficulties Percent of children whose parents are concerned “a lot” about 21.9% 21.9% Comparable

child’s learning difficulties (ages 6–17)

Parental Concern with Achievement Percent of children whose parents are concerned “a lot” about 35.9% 37.9% Comparable

child’s achievements (ages 6–17)

Parental Concern with Child Being Bullied Percent of children whose parents are concerned “a lot” about 13.9% 12.0% Comparable

child being “bullied” by classmates (ages 6–17)


In Delaware, twice as many parents with children or youth who havemoderate/severe difficulties reported “a lot” of concern about their child’sor youth’s achievement in school compared with parents of children

with no difficulties. Overall, 6 out of 10 parents of children or youthwith moderate/severe difficulties were concerned about their child’sachievement, and 5 out of 10 were concerned about learning difficulties.


0

10

20

30

40

50

60

70

80

None

10.2%

19.8% 17.8%

49.6%

65.9%

32.8%

16.0%

34.9%

55.1%




Concern about ChildBeing “Bullied” at

School = A Lot

Concern about Child’sAchievement = A Lot

Concern about Child’sLearning Disabilities = A Lot


Figure 4.37: Parental Concern About School Experiences and Performance of Child or Youth Ages 6–17

Children and youth with moderate/severe difficulties were more likely tomiss “11 or more days” of school compared to children and youth withno difficulties (10.3% versus 3.5%).

Figure 4.38: Days of School Missed by Child or Youth Ages 6–17in One Year = 11 or More Days

Twenty-eight percent of parents reported that their child or youth withmoderate/severe or minor difficulties had repeated a grade since kinder-garten—two times higher than children or youth with no difficulties.

Figure 4.39: Child or Youth Ages 6–17 Repeated Any GradeSince Kindergarten = Yes


0

5

10

15

20

25

30

Moderate/Severe

28.0% 28.1%

11.5%

Minor None


0

2

4

6

8

10

12

Moderate/Severe

3.5%

6.7%

10.3%

Minor None


Safe EnvironmentParents generally felt children lived in a safe environment characterizedby safety at home, at school, and in the neighborhood. Similar to all

children nationwide, nearly all Delaware parents felt their child wasusually or always safe at home.


Figure 4.40: Safe Environment in Delaware Versus the Nation


Safe in Neighborhood Percent of children whose parents feel child usually/always is 83.7% 83.2% Comparable

safe in community/neighborhood

Safe at School Percent of children whose parents feel child usually/always is 11.6% 11.6% Comparable

safe at school (ages 6–17 and enrolled in school)

Safe at Home Percent of children whose parents feel child usually/always is 97.8% 98.5% Comparable

safe at home

Violence in Child’s Environment Percent of children whose parents are concerned “a lot” 14.6% 14.6% Comparable

about violence in the home/school/community (ages 6–17)


Twice as many parents of children and youth with moderate/severe diffi-culties reported being concerned “a lot” about violence in the home,

school, or neighborhood when compared with responses of parentswhose children or youth have no difficulties (24.2% versus 12.9%).


0

5

10

15

20

25

Moderate/Severe

24.2%

17.4%

12.9%

Minor None


Figure 4.41: Parental Concern About Violence in Home, School or Neighborhood for Their Child or Youth Ages 6–17 = A Lot

Overall, parents reported feeling that their child or youth was safe athome. A smaller proportion felt their child or youth was safe in thecommunity or neighborhood.

0

20

40

60

80

100

None

98.8%95.0%

98.6%

89.9%84.5%

88.8%85.1%

74.4% 75.9%




Parent Feels Child Is Safe atHome = Usually/Always

Parent Feels Child Is Safe atSchool = Usually/Always

Parent Feels Child Is Safein the Community or

Neighborhood = Usually/AlwaysData Source: National Survey of Children’s Health, 2003. Note: All data are parent-reported.


Figure 4.42: Parental Concern About Child’s Safety

Supportive Neighborhood The majority (>80%) of parents indicated that they lived in a supportiveneighborhood as defined by neighbors who are willing to help, to lookout for each other, and to count on each other. However, almost 50%

were concerned that neighbors might be a bad influence on their child.Compared to the nation, Delaware parents were equally likely to reportthat they have people they can count on in the neighborhood.


Figure 4.43: Supportive Neighborhoods in Delaware Versus the Nation


Neighbors Willing to Help Percent of children whose parents agree “people in this 84.6% 82.8% Comparable

neighborhood help each other out”

Neighbors Look Out for Each Other Percent of children whose parents agree “we watch out 87.5% 85.5% Comparable

for each other’s children in this neighborhood”

Neighbors Can Count On Each Other Percent of children whose parents agree there are 87.2% 85.0% Comparable

“people I can count on this neighborhood”

Neighbors Who Are Bad Influence Percent of children whose parents disagree there are 50.0% 47.1% Comparable

“people in the neighborhood who might be a bad

influence on child”

Neighbors Help Child in Need Percent of children whose parents agree “adults nearby 91.7% 90.7% Comparable

trusted to help child if child got hurt/scared”


In Delaware, 76% of parents with children or youth who have moder-ate/severe difficulties reported that they “definitely agree/agree” there arepeople they can count on in their neighborhoods. This is a lower per-

centage than for parents of children or youth with no difficulties. Overall,most parents agreed that there were people they can count on in theirneighborhoods.


0

20

40

60

80

100

None

86.8%

76.7% 76.1%

86.1%

77.0%

86.4% 84.1%77.5% 76.5%




Parents Feel There Are Peoplein Their Neighborhood They Can

Count On = Definitely Agree/Agree

Parents Feel People in TheirNeighborhood Watch Out for Each Other’s Children = Definitely Agree/Agree

Parents Feel People in TheirNeighborhood Help Each Other

Out = Definitely Agree/Agree


Figure 4.44: Parent’s Thoughts on Supportive Neighborhoods

Figure 4.45: Parent’s Thoughts on Supportive Neighborhoods(continued)

References

1 Blumberg, S.J., et al. (2003). Design and operation of the national survey of

children’s health. www.cdc.gov/nchs/data/series/sr_01/sr01_043.pdf


0

20

40

60

80

100

None

91.7%

82.7%

90.9%

62.3%

54.0%51.6%



Neighbors Help Child in Need = Definitely Agree/Agree

Neighbors Are Bad Influences = Definitely Agree/Agree


overview of indicators of emotional or behavioral …...based on parent-reported data, key findings...

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