The role of parent–child dysfunctional interaction and difficult child on early childhood neurodevelopment: Cross-sectional study from rural Limpopo, South Africa

Background: Parent–child dysfunctional interaction (PCDI) has been linked to poor child neurodevelopment and adverse outcomes. In South Africa, little is known about how dysfunctional parent–child dynamics and difficult child (DC) behaviours contribute to developmental delays. Aim: To examine the prevalence of elevated PCDI and DC scores and their association with early neurodevelopmental outcomes. Setting: The research was conducted in rural Limpopo province of South Africa. Methods: This cross-sectional analysis used data collected when children in the ‘Birth-to-2’ trial were 17 months old. PCDI and DC were measured using the Parenting Stress Index-Short Form (PSI™-4-SF). Clinically elevated scores (PCDI >27; DC > 33) were analysed in relation to neurodevelopmental outcomes assessed using the Caregiver-Reported Early Development Instruments (CREDI) tool. Results: The analysis included 178 mother–child pairs. At 17 months, 16.3% had clinically elevated PCDI scores and 28.7% had elevated DC scores. The trial arm showed no association with PCDI or DC scores. Higher PCDI scores were significantly associated with poorer cognitive outcomes, while higher DC scores were linked to poorer social-emotional development. Conclusion: Negative parent–child interactions and DC behaviours were associated with poorer early neurodevelopment. These findings underscore the importance of early interventions that strengthen parent–child relationships and address structural barriers such as poverty and limited access to child support grants. Further research should explore these pathways and develop context-specific support strategies for rural families. Contribution: This study adds to evidence on parent–child interactions, DC behaviours and neurodevelopment in rural South Africa. It highlights psychosocial and structural factors associated with developmental outcomes and informs context-specific interventions in rural Limpopo.