Parental Supervision and Its Relation With Emotional and Behavioral Problems in Secondary School Children

Background Emotional and behavioral problems of children are a common concern for parents and mental health stakeholders alike. Poor parenting is a well-known factor associated with behavioral problems in children. There is unanimity regarding the correlation between parental supervision and emotional and behavioral problems. This present study aimed to establish a relationship between parental supervision and emotional and behavioral problems, as it could make way for further research based on the concept of parental supervision, which parents can quickly adopt as an intervention strategy for children with behavioral and emotional problems. Aim We aim to assess parental supervision and its relation with emotional and behavioral problems in secondary school children. Method This is a community-based cross-sectional observational study among 770 parents of children from schools in Dibrugarh, Assam, over a period of one year. Multistage random sampling was applied to obtain the sample size. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children’s emotional and behavioral problems, the Alabama Parenting Questionnaire (APQ) was used to assess parental supervision, and sociodemographic proforma was used to study various demographic variables. The observed data were analyzed using the computer program Statistical Package for the Social Sciences for Macintosh version 24.0 (IBM SPSS Statistics, Armonk, NY, USA). Results The study revealed that participants’ poor supervision had a positive correlation with emotional and behavioral problems. Poor monitoring/supervision had a positive correlation with total difficulty score levels, and positive parenting practices such as involvement and positive parenting had a negative correlation with emotional and behavioral problems. There was a statistically significant association between behavioral problems and selected demographic variables such as parents’ education, socioeconomic status, and family type. The study also found that there was a significant statistical association between sociodemographic variables such as age and negative parenting practices such as poor monitoring/supervision, inconsistent discipline, and corporal punishment. Conclusion It was found that factors such as inconsistent discipline and poor supervision had a significant impact on emotional and behavioral problems in children. In future monitoring research, one can adopt a constructional approach, where the goal should be to explain and distinguish good parental supervision behaviors from poor supervision. This knowledge can be used to develop good intervention strategies to halt such emotional and behavioral problems.


Introduction
A child undergoes various physical, emotional, and social stages from birth to adulthood. Emotional and behavioral problems in a child develop from any interference in their mental development. Most issues commence during childhood and have significance for later life, such as scholastic abilities, learning new skills, using a substance, engaging in violent activities, and developing warm relations, and tend to continue 1 2 1 1 into adulthood [1]. These emotional and behavioral problems of children are a common concern for parents and mental health professionals. These problems form a significant portion of psychiatric disorders in children.
According to Malhotra (1992), the percentage of children living in developing countries is around 80%, with poor mental healthcare services [2]. A review of Indian studies reported that the prevalence of mental health problems in school-going children ranges from 6.33% to 43.1% [1]. Unfortunately, the majority of parents, teachers, relatives, and other adults fail to perceive such subtle behavioral changes. Early improvement is encouraged by early identification, and a healthier and adaptive path is achieved by pushing such evolving course. Regarding supervision and parenting practices, studies have highlighted the significance of parental supervision in the progress and independence of the child. However, it remains a debatable component owing to its complex nature. There is unanimity regarding the negative correlation between parental supervision and emotional and behavioral problems [3].
The study focuses on the relationship between parental supervision and emotional and behavioral problems in school children in the northeastern part of India, which has not been extensively analyzed before. Additionally, the study proposes parental supervision as a potential intervention strategy for children with behavioral and emotional problems, which is a unique approach that could pave the way for further research and interventions.

Materials And Methods
This is a community-based cross-sectional study carried out in eight schools in Dibrugarh over a period of one year. A multistage random sampling technique was applied to obtain a 770 sample size. The study participants were selected using multistage random sampling as shown in Table 1 and Figure 1.

Inclusion criteria
Parents of students from Class IX and Class X of government and private schools from the rural area of Dibrugarh who gave their informed consent were included in this study.

Exclusion criteria
Parents and children suffering from any chronic debilitating mental/physical illness were excluded.

Tools
The tools used in the study comprised an informed consent form, sociodemographic proforma, Modified Kuppuswamy Socioeconomic Scale, Strengths and Difficulties Questionnaire (SDQ), and Alabama Parenting Questionnaire (APQ) (Appendices).

Sociodemographic Proforma
A self-designed proforma to collect sociodemographic details of the subject has been used. It was developed in the Department of Psychiatry, Assam Medical College and Hospital.

Modified Kuppuswamy Scale (2020) for Socioeconomic Status
This scale was used to find out to which class of socioeconomic status the parents and children belonged [4].

Strengths and Difficulties Questionnaire
Strengths and Difficulties Questionnaire is developed to assess behavioral problems in children and adolescents. It is a screening tool that is used among children and adolescents aged about two to 17 years old to assess their mental health. It exists in several versions that have been applied to various studies. All versions include 25 items on emotional and behavioral features [5].

Alabama Parenting Questionnaire
The Alabama Parenting Questionnaire (APQ) is a 42-item self-reporting assessment tool developed by Dr. Paul Frick. It has five theoretical constructs: parental involvement, positive parenting, poor monitoring/supervision, inconsistent discipline, and corporal punishment [6].

Procedure
After taking permission from the Office of Inspector of Schools, Dibrugarh, and the principal of all eight schools, brief interactions with the class teachers were held. Thereafter, the students were instructed about the study, and a manual was handed to them for their parents containing information about the study, anonymity, and implications. Written informed consent was obtained from parents after a week. The Modified Kuppuswamy Socioeconomic Scale was applied for assessing the socioeconomic class of parents. Permission for translation and use of the questionnaires was obtained from the authors. The questionnaires were translated to the target language, Assamese, and then, back translation was done by a different bilingual expert who was blinded to the source language. The questionnaires were validated. The Strengths and Difficulties Questionnaire was used to study emotional and behavioral problems, and the Alabama Parenting Questionnaire was used to assess parental supervision. The questionnaires were handed to the students with an instruction manual for the parents and collected after a period of seven days. The questionnaires were distributed to 800 students to obtain a sample of 770, considering dropouts and nonresponders. In this study, there were eight dropouts, and 22 nonresponses and incomplete responses.

Data analysis
The observed data were analyzed using the computer program Statistical Package for the Social Sciences for Macintosh version 24.0 (IBM SPSS Statistics, Armonk, NY, USA). Results were presented as proportions, ratios, percentages, and mean. The different statistical tests used in the study were unpaired t-test, chisquare test, and Pearson correlation coefficient. For all analyses, the statistical significance was fixed at a 5% level (p<0.05). The study was approved by the Institutional Ethics Committee of Assam Medical College bearing certificate number AMC/EC/PG/5612. Table 2 shows that among 770 participants, the majority of fathers were in the age group of 41-50 years (50%) and the majority of mothers were in the age group of 31-40 years (67%). The majority of children were male (55%) and were in the age group of 15-16 years (51%). The study showed that most of the participants belonged to the upper-lower class of socioeconomic status (57%) and nuclear families (85%) and followed Hinduism (75%).      Table 5 shows that poor monitoring/supervision had a positive correlation with emotional symptoms (r=0.079, p=0.027), hyperactivity (r=0.134, p=0.001), peer problems (r=0.108, p=0.002), and total difficulty score (r=0.143, p=0.001), which were statistically significant. Positive parenting practices such as positive parenting had a negative correlation with conduct problems (r=-0.091, p=0.01) and total difficulty score (r=-0.062, p=0.041). Inconsistent discipline had a weak positive correlation with hyperactivity (r=0.058, p=0.01). Corporal punishment had no significant correlation with the total difficulty score.   On studying the association between emotional and behavioral problems and sociodemographic variables, there was a statistically significant association between total difficulty score and selected demographic variables such as parents' education (χ2=389.411, p=0.001), occupation (χ2=364.57, p=0.01), income (χ2=198.78, p=0.012), socioeconomic class (χ2=110.925, p=0.002), and family type (χ2=53.823, p=0.001).

Discussion
The present study was a community-based cross-sectional study carried out in eight schools in Dibrugarh from July 2021 to June 2022 with a sample size of 770 to assess parental supervision and its relation with emotional and behavioral problems.
A prevalence of 14.04% of behavioral and emotional problems was found in the studied sample of children. When compared to the study done by Wang et al. in Beijing (1989) [7], who reported a prevalence rate of around 7%-8%, we found that the prevalence in this study was slightly higher. One possible reason could be the reported marginal increase observed in time trends due to factors such as changing family structure, increasing urbanity, and parenting styles. Another reason could be the selection of our sample where a school catering to predominantly lower socioeconomic status was chosen, and it is well known from the literature that children from lower and middle socioeconomic status tend to have more observed problems compared to children from higher socioeconomic status [8].
Another study conducted by Ahmed et al. (2021) reported the prevalence rate to be 77.5%, which was much higher compared to our study [9]. The possible reason can be that the participants were children who were chosen from a tertiary mental healthcare center and were already diagnosed with a mental disorder, whereas we have attempted to screen children in the community and those with no previous diagnosis of mental disorder. A study from Singapore reported a rate of behavioral and emotional problems in children of 12.5%, which was similar to that of our study [10].
The mean±standard deviation for the SDQ for the total difficulty level scored by parents was 6.06±4.13, with the minimum score being 0 and the maximum being 20. The mean±SD for the individual subscales for parents for emotional symptoms, conduct problems, hyperactivity, and peer problems was similar to the findings in the studies conducted by Bryant et al. (2020) [11] and Ortuño-Sierra et al. (2015) [12].
A positive correlation was found between poor supervision and emotional and behavioral problems. Poor monitoring/supervision (r=0.143, p=0.001) had a positive correlation with the total difficulty score, which was statistically significant. Positive parenting practices such as involvement (r=-0.046, p=0.01) and positive parenting (r=-0.062, p=0.05) had a negative correlation with emotional and behavioral problems. Corporal punishment had no significant correlation with the total difficulty score. This is in accordance with other studies where they have found that when the negative parenting score increases, the total difficulty score also increases, indicating that behavioral problems in children also increase [13,14]. Positive parenting practices had a negative correlation with emotional and behavioral problems, and this was in accordance with a study that found similar results [15].
In this study, we assessed associations using the chi-square test and found that positive parenting practice had an association with socioeconomic class (chi-square=71.56, p=0.03). In the case of negative parenting practices, we found that poor monitoring/supervision had a statistically significant association with age group (chi-square=274.03), education (chi-square=275.72), and family type (chi-square=53.82). Inconsistent discipline had a significant association with age (chi-square=305.73), gender (chi-square=24.47), and parental occupation (chi-square=234.98). This is in accordance with a study where they found an association between sociodemographic variables such as age and gender and negative parenting practices such as poor supervision and inconsistent discipline [16].
The study also found that emotional and behavioral problems had an association with sociodemographic variables. The total difficulty score level had an association with parents' education, socioeconomic status, and family type, which was statistically significant. Conduct problems had an association with socioeconomic status (chi-square=169.84), and hyperactivity had an association with education (chi-square=210.72) and occupation of the parents (chi-square=372.46). This is in line with a study conducted by Feng et al., where they found that sociodemographic factors such as occupation and socioeconomic class had an association with emotional and behavioral problems in children [17].
The study however had its limitations. We have tried to assess if there was a relationship between parental supervision and emotional and behavioral problems in children. Whether a causal relationship exists or not was not studied. As self-reporting questionnaires were used in this study, there can be a probability that parents might have given more acceptable or socially desirable answers. The sample selection was based only on the rural blocks of Dibrugarh district and did not include urban blocks; therefore, the study results cannot be generalized.

Conclusions
Our study revealed that poor parental supervision had a positive correlation with emotional and behavioral problems. Therefore, factors such as inconsistent discipline and poor monitoring had a significant impact on secondary school children. Parents who have practiced positive parenting had children with fewer or no behavioral problems. This finding could be useful in clinical practice where interventions based on parental supervision for emotional and behavioral problems in children can be attempted. In the future, one can adopt a constructional approach, where the goal should be to explain and distinguish good parental supervision behaviors from poor supervision. Education for parents may include supervision behaviors, for example, setting limits and restrictions, knowing about their whereabouts and the company they have, asking them about their activities, listening to their emotional turmoil, and encouraging disclosure. In this way, parental supervision may help in providing information to parents and professionals on appropriate ways to prevent such emotional and behavioral problems in children. Table 8 and Table 9 show the Strengths and Difficulties Questionnaire and Alabama Parenting Questionnaire items, respectively.   of Assam Medical College and Hospital, Dibrugarh, was held in the College Council Room on 07/06/2021, and after a detailed and careful scrutinization, discussion, and assessment, the members of the ethics committee arrived at a unanimous conclusion and resolution approving the project entitled, "Parental Supervision and its Relation with Emotional and Behavioural Problems in Secondary School Children.". Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.

Conflicts of interest:
In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.