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involvement, Economic category, parents’ perceived Quality of life, Time spent in family and child’s Self-efficacy as potential predictors. The prediction model was statistically significant and accounted for approximately 27% of the variance of externalizing behavior. Externalizing behavior was primarily predicted by lower levels of family relationships, and to a lesser extent by lower levels of parents’ perceived quality of life. In other words, better family relations contribute to the decrease of children’s externalizing behavior and so does better quality of life. A further investigation was then carried out to assess whether family relationships mediate the effect of caregiver’s perceived quality of life on children’s externalizing behavior. Though still a weak percentage of variance was explained, the result revealed that there was mediator effect for family relationships in the relationship between parents’ perceived quality of life and children’s externalizing behavior. That is, better perceived quality of life leads to increased good family relationships, which in turn leads to the decrease of child’s externalizing behavior. This result is in line with Graf, Landolt, Mori, & Boltshauser (2006) who found that good quality of life affected positively both family relationships and psychological adjustment of children. It can be assumed that positive perception of quality of life implies positive rating of the child’s behavior and the child will avoid being perceived as difficult (Lochman & Dodge, 1998). On their turn, family relationships contribute to child’s socialization. A study found that schemas acquired through socialization may have powerful effects on how children appraise the meaning of interpersonal behavior (Kendall, 2012).
Our results is contrary to Costello, Compton, Keeler, & Angold (2003) who found that poverty had an effect specifically to symptoms of conduct and oppositional defiant disorders. Present results emphasize rather the importance of perceptions of quality of life and family relationships.
2. Internalizing behavior
Deinstitutionalized and never-institutionalized children were assumed to have less internalizing problems than children who remained in institution. Using mixed-group analysis of variance we found significant difference between the three groups. Unexpectedly, results showed that internalizing behavior problems were higher among deinstitutionalized children and never-institutionalized children than children who remained in institution. As well, denever-institutionalized children had higher internalizing problems than never institutionalized children. The interaction
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effect of institutionalization status and living status of the parents on internalizing behavior was not significant, meaning that the above group differences do not depend on whether a child is orphan or non-orphan.
One of explanation is to be found in the change overtime. It was hypothesized that after deinstitutionalization, internalizing behavior problems would decrease among deinstitutionalized children while it would remain the same for never-institutionalized children and for children who remained in institution. Results revealed that main effect of time as well as interaction effect of time and biological living status on internalizing behavior were significant. This means that there was a significant increase of internalizing behavior over time and this increase depends on institutionalization status. A significant increase was noted only among deinstitutionalized children. The three-way interaction between time, institutionalization status and biological living status was not significant, meaning that pattern of scores are the same among orphans and non-orphans before and after de-institutionalization.
Results of this study are in line with a study conducted by Lau, Litrownik, Newton, & Landsverk, (2003). They followed reunified children for approximately 2 years and found that reunification did not have a direct effect on internalizing problems as they had first to adapt to stressful events in the family environment which subsequently may increase the risk for poor internalizing behavioral outcomes.
Although, deinstitutionalized children in this sample presented more internalizing problems, their general risk for behavior problems is somewhat lessened over time. Results of the present study showed that internalizing behavior decrease with time a child spent in family. Contrary to studies that demonstrated that longer time in institution is associated to higher behavioral problems, this result is conform with MacKenzie et al., (2014) who observed that internalizing problems of reunified children decrease with time as children adjust to a prior move.
Internalizing problems usually increases with age over the life course and generally have a cumulative prevalence (Chan, Dennis, & Funk, 2008b). There was evidence that such problems may either emerge or exacerbate as children enter adolescence (Verhulst, Althaus, & Versluis-Den Bieman, 1990). However, in our sample we controlled for age and assumed that all participants
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were at the average age. The observed higher rate of internalizing problems is not to be solely attributed to the placement into family.
Deinstitutionalized children were a group that had also higher internalizing problems compared to other two groups before deinstitutionalization. One possible explanation would be that caregivers in orphanage report fewer internalizing behavior as compared to parents or legal guardians in family (Stanger & Lewis, 1993). In their study of agreement among parents, teachers, and children on internalizing and externalizing behavior problems, the Stanger & Lewis (1993), teachers, comparable to tierce adult caring for the child, rated the lowest scores on internalizing behavior.
Contrary, teachers rated the highest externalizing behavior. In a Turkish study, Externalizing prevalence was higher than Internalizing both in the orphanage and community samples (Simsek et al., 2007).
A child with internalizing behavior is more likely to be seen as a “good” child “easy to rear” than being seen as a child with reportable difficulties. In the setting like institution where children have less well-developed verbal skills in general and specifically an even more limited capacity to describe internal feeling states, internalizing disorders may be more difficult to detect (Tandon et al., 2009). The other way round, for various reasons, some caregivers may find it hard to accept that children may experience unpleasant psychological states such as internalizing behavior (Hazell, 2002).
Nevertheless, children with internalizing behavior problems are more likely to grow up to become depressed and anxious (APA, 1994). The nature of orphanage where caregivers work in shift and where a ratio caregiver/child is high (Dozier et al., 2012) make it difficult to pay attention and identify potential internalizing symptoms. Institutionalized children receive little response and attention from caregivers and might express little affect, which lets internalizing problems stay unnoticed (Matthew Colton & Roberts, 2007). In contrast to externalizing behaviors, which are disruptive or harmful to others, internalizing problems are intropunitive (Muhtadie, Zhou, Eisenberg, & Wang, 2013), symptoms may fluctuate in intensity (Hazell, 2002), and thus more difficult to detect in children. In addition, internalizing disorders tend to be viewed as less problematic caregivers (Tandon et al., 2009).
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At the other hand, parents may also have overrated de-institutionalized children as a result of considering them as most vulnerable a priory or stress caused by receiving a new family member.
In their study, Landsverk, Davis, Ganger, Newton, & Johnson, (1996), indicated that reunification was significantly associated with greater parent reported stressful life events which, in turn, may underpin the overrating of children’s internalizing behavior. The reunification experience could take a toll on caregivers' mental health as they readjust to parenting roles (Bellamy, 2008). Also, having a history of living in orphanage is associated with stereotypies which may lead the assessor to under-rate the deinstitutionalized child (K. J. Bos, Zeanah Jr, Smyke, Fox, & Nelson III, 2010) in the effort of empathy.
Another explanation would be that children living in families in Rwanda are not set apart from developing internalizing behavior. At one hand, social perfectionism and authoritarian parenting have been linked to higher ratings of internalizing problems among children (Cook & Kearney, 2009). Socially prescribed perfectionism which refers to a belief that significant others expect one to be perfect is dominant in such cultures (Cook & Kearney, 2009). Rwandan families, as most collectivist cultures constitute such example (Bornstein, 2012; Cummings & Cummings, 2002).
Contrary, in orphanage discipline is more liberal (Ministry of Gender and Family Promotion &
Hope and Homes for Children, 2012), which may rather explain the high rates of externalizing behavior.
At the other hand, in a study of Bellamy (2008), parents' poorer mental health, have been associated with an increased risk for children’s internalizing behavior problems. The history of Rwanda affected by compounded adversity where the dual agents of the legacy of the 1994 Genocide and HIV/AIDS have had devastating consequences for families may explain the higher rates of children’s internalizing behavior. In community samples rates for PTSD range from 24.8% to 46.4% , for depression from 15.5% to 46.4% and add up to 58.9% for anxiety symptoms (Heim &
Schaal, 2014). The risk for externalizing disorders was found to increase for those individuals with a contextual history of multiple adversities (Van der Vegt, van der Ende, Ferdinand, Verhulst, &
Tiemeier, 2009).
Empathy towards a child may differ in orphanage where one is playing the role of employed staff and in family where one is playing the role of parental responsibilities. Studies have shown that
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the more empathetic you are the more you notice others’ mental health problems (Batson et al., 1996). In communities that experienced violence, studies observed high rate of empathy among victims (Batson et al., 1996). However, Learning to respond to others’ distress with well-regulated empathy is an important developmental task linked to positive health outcomes and moral achievements (Tone & Tully, 2014). As noted by the latter authors, this important interpersonal skill set may also, paradoxically, confer risk for internalizing problems like depression and anxiety when present at extreme levels and in combination with certain individual characteristics or within particular contexts.
The last explanation of development of internalizing behavior within the family is to be found in child and family characteristics. In the present study, results revealed that internalizing behavior was primarily predicted by lower levels of family relationships, and to a lesser extent by lower levels of parents’ perceived quality of life. In families where family relations are good, children have less risk to develop internalizing problems. Also children living in families that perceive their quality of life as good have lower risk to develop internalizing behavior. A further analysis revealed the moderating role of parenting involvement and perceived quality of life in the relationship between family relations and children’s internalizing behavior. Analysis showed that among families who perceive their quality of life as moderate or low, family relationships contribute to the significant decrease of internalizing behavior when parenting involvement is moderate or high. However, among families who perceive their quality of life as high, family relationships don’t contribute significantly to the decrease of child’s internalizing behavior whether parenting involvement is high, moderate or low. A stable and caring family context was found to provide children with emotional security, physical defense, and access to resources. As well, effective parenting and monitoring can protect children from the negative impact of risk environments (Li, Chi, Sherr, Cluver, & Stanton, 2015). Findings from this study suggest the importance of supporting caregiver mental health as a target for intervention to improve behavioral health outcomes for children following reunification (Bellamy, 2008).