Developmental Trajectories of Anxiety and Depression Symptoms from Early to Middle Childhood: a Population-Based Cohort Study in the Netherlands

Latent trajectories of mental health service use in an Australian state population cohort of children

OBJECTIVES

Mental health service use among young people is increasing, and small groups within the population disproportionately account for the majority of mental health service use. The aims of this study were to identify population-based trajectories of mental health service use across childhood and adolescence and associated sociodemographic/other risk factors.

METHODS

Mental health trajectories between birth and 17 years of age were identified using zero-inflated Poisson latent-class growth mixture modelling, in a New South Wales cohort of 9510 children (born between 2002 and 2005) who had at least one primary diagnosis of a mental disorder recorded in 'Emergency Department', 'Admitted Patients' and/or 'Mental Health Ambulatory' data collections.

RESULTS

A two-trajectory solution provided the optimal fit to the data: One trajectory displayed high increasing service use (n = 1861, 19.6%) and accounting for more than 68% of the days treated for mental disorder among the entire cohort. The other trajectory (n = 7649, 80.4%) was distinguished by a consistently low level of service use. Membership in the high mental health service use trajectory was associated with parental mental disorder, child maltreatment exposure and diagnoses of psychosis spectrum and personality disorders.

CONCLUSION

Less than one-fifth of children account for more than 68% of hospital and ambulatory services used up to age 17 years; these children are more likely to have parents with mental disorder and to have been exposed to child maltreatment, pointing towards multi-disciplinary supports as a basis for early intervention.

Preschool Mood Disorders: A Review of the Literature from 2017 to 2024

Depression symptoms that onset during early childhood are increasingly recognized as a significant public health concern. A proliferation of research over the last 2 decades has identified preschool depression as a diagnostic reality that is associated with a severe and persistent course of depression throughout the lifespan. The current review summarizes the research on preschool depression from the last 7 years (2017-2024), with a particular focus on the assessment of, factors and outcomes associated with, neurobiological underpinnings of, and treatments for preschool depression. We also discuss potential avenues of inquiry that further elucidate the nature of preschool depression.

The impact of universal mental health screening on stigma in primary schools

BACKGROUND

Primary school students struggling with mental health are less likely than high school students to access mental health care, due to barriers such as mental health stigma and low mental health literacy among children and parents. The near universal reach of schools offers a potential avenue to increase access to mental health care through early identification. The potential risks of this approach also need to be understood. This study monitored the impact of universal screening for mental health symptoms on stigma and mental health outcomes for primary school students.

METHODS

Across 6 primary schools, a cluster randomised controlled trial allocated schools to one of two conditions. Conditions varied based on the order and frequency of symptom and stigma questionnaires. A sample of 798 children (8 to 13 years; Mage = 10.29) completed assessments at baseline, 6-week, and 12-week follow-ups.

RESULTS

Significant time-by-group interaction effects were present, indicating differing changes in mental health stigma between groups. Follow-up analyses of subscales showed significant time-by-group interaction effects for concerns around self-stigma and secrecy, but not for public stigma. The frequency and presentation order of the questionnaires impacted on mental health stigma. Initially, children reporting on mental health symptoms before stigma, reported heightened stigma, but over time, those receiving more frequent presentations of the symptom check experienced an overall stigma reduction, contrasting with an increase in the comparison group.

CONCLUSION

The frequency and presentation order of mental health symptom assessments impact children's reports of mental health stigma, underscoring the importance of screening context. Potential screening harms, such as exacerbating self-stigma and secrecy, warrant consideration. Addressing stigma-related barriers is crucial for enhancing mental health care access for children in schools. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12622001114730) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384472 Date of trial registration: 12th August 2022.

Childhood correlates and young adult outcomes of trajectories of emotional problems from childhood to adolescence

BACKGROUND

Emotional problems, especially anxiety, have become increasingly common in recent generations. Few population-based studies have examined trajectories of emotional problems from early childhood to late adolescence or investigated differences in psychiatric and functional outcomes.

METHODS

Using the Avon Longitudinal Study of Parents and Children (ALSPAC, n = 8286, 50.4% male), we modeled latent class growth trajectories of emotional problems, using the parent-reported Strength and Difficulties Questionnaire emotional scale (SDQ-E) on seven occasions (4-17 years). Psychiatric outcomes in young adulthood (21-25 years) were major depressive disorder (MDD), generalized anxiety disorder (GAD), and self-harm. Functional outcomes were exam attainment, educational/occupational status, and social relationship quality.

RESULTS

We identified four classes of emotional problems: low (67.0%), decreasing (18.4%), increasing (8.9%), and persistent (5.7%) problems. Compared to those in the low class, individuals with decreasing emotional problems were not at elevated risk of any poor adult outcome. Individuals in the increasing and persistent classes had a greater risk of adult MDD (RR: 1.59 95% CI 1.13-2.26 and RR: 2.25 95% CI 1.49-3.41) and self-harm (RR: 2.37 95% CI 1.91-2.94 and RR: 1.87 95% CI 1.41-2.48), and of impairment in functional domains. Childhood sleep difficulties, irritability, conduct and neurodevelopmental problems, and family adversity were associated with a persistent course of emotional problems.

CONCLUSIONS

Childhood emotional problems were common, but those whose symptoms improved over time were not at increased risk for adverse adult outcomes. In contrast, individuals with persistent or adolescent-increasing emotional problems had a higher risk of mental ill-health and social impairment in young adulthood which was especially pronounced for those with persistent emotional problems.

The effects of child maltreatment and exposure to intimate partner violence on the co-occurrence of anxious/depressive symptoms and aggressive behavior

BACKGROUND

Child maltreatment (CM) and exposure to intimate partner violence (IPV) pose significant threats to child behavioral health, particularly for young children in toddlerhood and early childhood. Children who experience CM and/or are exposed to IPV are more likely to develop anxious/depressive symptoms and aggressive behavior.

OBJECTIVE

This study is a three-year longitudinal examination of the effects of CM and exposure to IPV on the co-occurrence of anxious/depressive symptoms and aggressive behavior.

PARTICIPANTS AND SETTING

The sample included 459 children drawn from the National Survey of Child and Adolescent Well-Being II, a national longitudinal study that investigated the outcomes and well-being of children and families that were involved in Child Protective Services (CPS).

METHODS

Latent growth curve modeling was conducted to examine the correlation between the trajectories of anxious/depressive symptoms and aggressive behavior, and the effect of CM and IPV exposure on child behavioral outcomes.

RESULTS

A positive correlation was observed between anxious/depressive symptoms and aggressive behavior intercepts, and the slope parameters of both growth models were also positively correlated. CM and IPV exposure was associated with worse anxious/depressive symptoms and aggressive behavior over time.

CONCLUSIONS

The findings suggest the co-occurrence of anxious/depressive symptoms and aggressive behavior among CPS-involved children and demonstrate the negative effects of CM and IPV exposure on children over time. The findings pinpoint the necessity of comprehensive methodological considerations for research and a lens of trauma-informed care for practice.

The effect of childhood depression trajectories on sugar-sweetened beverage habit trajectories in adolescence: Exploring sleep problems as a mediator

Although depression has been linked to the habit of consuming sugar-sweetened beverages (SSBs), little is known about their long-term relationships and the mediating role of sleep problems. This study examines the associations between childhood depressive symptoms trajectories and adolescent SSB-habit trajectories and whether these associations were mediated by sleep problems. Data came from 1560 adolescents participating in a longitudinal study across grades 1 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depressive symptoms and an SSB habit in adolescence. Multinomial logistic regression was conducted to examine the influence of childhood depressive symptoms and adolescent SSB habit. Mediation analysis was conducted to test whether sleep problems mediated the associations examined. Four distinct trajectories of childhood depressive symptoms were identified: low-stable (30.79%), moderate-stable (42.32%), increasing (12.29%), and high-stable (11.60%). Three distinct trajectories of SSB habit in adolescence were identified: low-stable (44.32%), increasing (15.02%), and high-stable (40.65%). Children who had moderate-stable (aOR = 1.35; CI: 1.04-1.77), high-stable (aOR = 2.01; CI: 1.28-3.15), or increasing (aOR = 1.97; CI: 1.26-3.06) trajectories of depressive symptoms relative to those in the low-stable group were significantly more likely to belong to the high-stable trajectory of SSBs than to the low-stable SSBs group. The Z-mediation test showed that sleep problems significantly mediated the associations between trajectories of childhood depressive symptoms and trajectories of SSBs during adolescence (all p < 0.05). Childhood depressive symptoms conferred risks for adolescent SSB habits; and the effects were seen, in part, through increasing sleep problems.

Effects of Helicopter Parenting, Tiger Parenting and Inhibitory Control on the Development of Children's Anxiety and Depressive Symptoms

Helicopter parenting and tiger parenting may increase the risks of anxiety and depression in children. However, it is unclear how these parenting styles affect the developmental outcomes and trajectories of anxiety and depressive symptoms, and how children's internal inhibitory control (IC) moderates such effects. The present study aimed to examine this issue. A sample of 172 typically developing children (77 girls; Mage = 7.14, SDage = 0.33) and their parents participated in the study. Parents reported children's anxiety and depressive symptoms using the Child Behavior Checklist each year from the first measurement (T1) to the third measurement (T3) and reported their helicopter parenting and tiger parenting at T1. Children completed the Go/No-go task at T1 to measure their IC. Higher T1 helicopter parenting impeded the declines in anxiety and depression over time, and higher T1 tiger parenting predicted more anxiety and depressive symptoms at T3. However, such effects were only observed in children with low IC, and higher IC buffered the adverse impacts of both helicopter parenting and tiger parenting on children's anxiety and depressive symptoms. These findings revealed that helicopter parenting and tiger parenting had negative impacts on the developmental trajectories and outcomes of anxiety and depression in children and suggest that IC plays an important role in alleviating the risks of anxiety and depression among children in adverse environments.

Prenatal Stress Exposure Amplifies Effect of Maternal Suicidal Ideation on Early Childhood Behavioral Trajectories

The in utero environment influences fetal development and may predispose to disease later in life. This study examines whether maternal suicidal ideation during pregnancy is associated with children's behavioral trajectories across early childhood, and whether prenatal maternal traumatic stress accelerates the trajectories. The study included mother-child dyads (N = 331, 51.1% boys) from the longitudinal Stress In Pregnancy study; 31.1% (n = 103) mothers were Exposed to Superstorm Sandy. During their second trimester, 12.4% (n = 41) women reported suicidal ideation during pregnancy. Mothers completed the Behavior Assessment Scale for Children-2 annually from ages 2- to 6-years-old to assess multiple behavioral domains. Hierarchical linear modeling estimated within-person longitudinal trajectories of clinical behaviors, and between-person effects of maternal suicidal ideation and disaster-related stress in utero on changes in child behavior. For children exposed to both risks, Atypical behaviors (i.e., unusual behaviors, social disconnection) increased linearly across early childhood. Exposure to Superstorm Sandy and maternal suicidal ideation were independently associated with non-linear increases in Anxiety severity and maternal suicidal ideation during pregnancy was associated with a linear increase in Attention problems across early childhood. Maternal suicidal ideation during pregnancy is associated with increased risk for a range of behavioral and emotional difficulties in early childhood and the trajectory of atypical behaviors was amplified by disaster-related traumatic stress. Findings highlight the need for health professionals to screen for suicidal ideation among their pregnant patients. Pregnant women who experience severe stress may require additional monitoring and support to reduce risk for poorer early childhood outcomes.

Neurobiological, Psychosocial, and Behavioral Mechanisms Mediating Associations Between Physical Activity and Psychiatric Symptoms in Youth in the Netherlands

Importance

Understanding the mechanisms by which physical activity is associated with a lower risk of psychiatric symptoms may stimulate the identification of cost-efficient strategies for preventing and treating mental illness at early life stages.

Objective

To examine neurobiological, psychosocial, and behavioral mechanisms that mediate associations of physical activity with psychiatric symptoms in youth by testing an integrated model.

Design, setting, and participants

Generation R is an ongoing prospective population-based cohort study collecting data from fetal life until young adulthood in a multiethnic urban population in the Netherlands. Pregnant women living in Rotterdam with an expected delivery date between April 2002 and January 2006 were eligible for participation along with their children born during this time. Data were collected at a single research center in the Erasmus Medical Center Sophia Children's Hospital. For the current study, data were analyzed from 4216 children with complete data on both exposure and outcome at ages 6, 10, and 13 years. Data were analyzed from January 2021 to November 2022.

Exposures

Physical activity was ascertained at age 6 years (visit 1) via parent report and included weekly frequency and duration of walking or cycling to or from school, physical education at school, outdoor play, swimming, and sports participation.

Main Outcomes and Measures

Psychiatric symptoms (internalizing and externalizing symptoms) were assessed at age 6 years (visit 1) and at age 13 years (visit 3) using the Child Behavior Checklist. Several mechanisms were explored as mediators, measured at age 10 years (visit 2). Neurobiological mechanisms included total brain volume, white matter microstructure, and resting-state connectivity assessed using a 3-T magnetic resonance imaging scanner. Psychosocial mechanisms included self-esteem, body image, and friendship. Behavioral mechanisms included sleep quality, diet quality, and recreational screen time. Pearson correlations between physical activity measures and psychiatric symptoms were calculated, with false discovery rate correction applied to account for the number of tests performed. Mediation analyses were performed when a correlation (defined as false discovery rate P < .05) between exposure and outcome was observed and were adjusted for confounders.

Results

Among the 4216 children included in this study, the mean (SD) age was 6.0 (0.4) years at visit 1, and 2115 participants (50.2%) were girls. More sports participation was associated with fewer internalizing symptoms (β for direct effect, -0.025; SE, 0.078; P = .03) but not externalizing symptoms. Self-esteem mediated the association between sports participation and internalizing symptoms (β for indirect effect, -0.009; SE, 0.018; P = .002). No evidence was found for associations between any other neurobiological, psychosocial, or behavioral variables. No association was found between other types of physical activity and psychiatric symptoms at these ages.

Conclusions and Relevance

The integrated model presented in this cohort study evaluated potential mechanisms mediating associations between physical activity and psychiatric symptoms in youth. Self-esteem mediated an association between sports participation in childhood and internalizing symptoms in adolescence; other significant mediations were not observed. Further studies might explore whether larger effects are present in certain subgroups (eg, children at high risk of developing psychiatric symptoms), different ages, or structured sport-based physical activity interventions.

Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age

Importance

Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children.

Objective

To characterize children's emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood.

Design, Setting, and Participants

This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022.

Exposures

Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities.

Main Outcomes and Measures

Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression).

Results

The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks' gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005).

Conclusions and Relevance

In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.

Mother-child cohesion, friendship quality, and depressive symptoms in children: Direct and indirect associations between developmental trajectories

BACKGROUND

Mother-child cohesion and friendship quality have been shown to be protective factors against the development of children's depressive symptoms. However, the possible direct and indirect pathways from these two important interpersonal relationships to children's depressive symptoms need to be further elucidated. Moreover, these associations have not been examined from a developmental perspective. Therefore, this study examined the direct and indirect relations among developmental trajectories of mother-child cohesion, friendship quality, and depressive symptoms in children.

METHODS

A total of 4078 Chinese children (45.2 % girls, M_age = 9.90 years, SD = 0.73) participated in assessments at five time points across 2.5 years, employing six-month intervals. Latent growth curve modeling was conducted to examine the direct and indirect relations among the developmental trajectories of mother-child cohesion, friendship quality, and depressive symptoms.

RESULTS

The developmental trajectories of both mother-child cohesion and friendship quality were negatively and directly associated with the developmental trajectory of children's depressive symptoms. The developmental trajectory of friendship quality was indirectly associated with the developmental trajectory of depressive symptoms through the mediating role of mother-child cohesion.

LIMITATIONS

This study did not investigate father-child cohesion and other important psychological mechanisms linking interpersonal relationships to depressive symptoms.

CONCLUSIONS

The findings documented the direct and indirect relations among mother-child cohesion, friendship quality, and depressive symptoms from a developmental perspective, which suggested that prevention and intervention efforts target improving mother-child cohesion and friendship quality to reduce children's depressive symptoms.

Parental relationship satisfaction, reflective functioning, and toddler behavioral problems: A longitudinal study from pregnancy to 2 years postpartum

Parent relationship satisfaction and parental reflective functioning (PRF) are significant factors in the transition to first-time parenting and are likely to affect a child’s later wellbeing. However, little is known about their joint longitudinal effects from pregnancy onward. Starting in the prenatal period, this follow-up study of 1016 Finnish first-time parents (358 fathers and 658 mothers at baseline) examined the stability and the reciprocal associations between relationship satisfaction and PRF in predicting child behavioral problems (CBCL) at age 2. First, the results of the random-intercept cross-lagged panel models showed that both relationship satisfaction and PRF were stable from pregnancy onward for both mothers and fathers, with the exception of mothers’ prenatal PRF. Second, there were significant reciprocal associations between low prenatal PRF and low relationship satisfaction at age 1, and vice versa. Third, for both mothers and fathers, a low level of relationship satisfaction, but not PRF, predicted consistently higher levels of child behavioral problems at age 2. These results suggest that parent relationship satisfaction and PRF are stable but largely independent parental factors during the transition to parenthood. In addition, our results highlight the significant role of parent relationship satisfaction in predicting toddler behavior problems, which indicates the relevance of early relationship-orientated help for first-time parents.

Profiles and transition of mental health problems among Chinese adolescents: The predictive role of friendship quality, parental autonomy support, and psychological control

INTRODUCTION

Mental health problems have become a global crisis of the 21st century, with adolescence being a typical period of the outbreak of these problems. However, the profiles and transition of mental health problems in Chinese adolescents remain unclear. In addition, protective and risk factors that shape mental health problems require further clarification.

METHODS

We measured depression, anxiety, and stress as indicators to identify the profiles and transition patterns of mental health problems among Chinese adolescents, as well as environment-related predictors (i.e., friendship quality, parental psychological control, and autonomy support). A total of 722 participants (376 females; M_age  = 15.21, SD_age  = 0.74) completed a set of questionnaires at two time points with a 1-year interval (T1: November 2018; T2: November 2019).

RESULTS

The profile analysis revealed two groups: healthy and troubled. The development of mental health problems included four trajectories: steady low, steady high, increasing, and decreasing. Results indicated that parental autonomy support and friendship quality exerted protective and buffering effects, whereas parental psychological control acted as a risk factor for mental health problem profiles. Furthermore, friendship quality had a unique predictive effect on the decreasing trajectory.

CONCLUSIONS

The profiles of mental health problems showed high concurrency of depression, anxiety, and stress symptoms, and developmental trajectories were largely stable over time. Friendship quality, parental autonomy support, and psychological control predicted the profiles of the mental health problems of Chinese adolescents, and only friendship quality predicted the transition from a troubled to healthy profile over 1 year.

The longitudinal role of early family risks and early social-emotional problems for friendship quality in preadolescence-A regression model

The quality of a best friendship provides information about how developmentally beneficial it is. However, little is known about possible early risk factors that influence later friendship quality. The present study examined the role of family risks and social-emotional problems (behavioral problems, peer problems, anxious, and depressive symptoms) in early childhood for positive (i.e., support and help) and negative (i.e., conflicts and betrayal) dimensions of friendship quality with their best friend in preadolescence. 293 children (47.9% female) aged 2–4, their parents and teachers participated in the study with three measurement occasions (T1; M_age = 2.81, T2; M_age = 3.76, T3; M_age = 9.69). The last measurement occasion was at the age of 9–11 years. Results of the longitudinal regression model showed that depressive symptoms in early childhood were associated with a lower positive dimension of friendship quality in preadolescence. In contrast, early anxious symptoms were related to a higher positive dimension of friendship quality six years later. Neither family risks, nor behavioral problems and peer problems in early childhood were linked to the positive dimension of friendship quality in preadolescence. No early predictors were found for the negative dimension of friendship quality. Possible reasons for the lack of associations are discussed. Findings suggest that children with early depressive symptoms at 3–5 years of age should be the targets of potential interventions to form high quality friendships in preadolescence. Possible interventions are mentioned.

Cognitive vulnerabilities to anxiety symptoms among Chinese adolescents: A 3-year longitudinal study

OBJECTIVE

This study established cognitive vulnerability of anxiety symptoms among high school students.

METHOD

A total of 72 grade 9-11 students completed measures on levels of anxiety sensitivity (AS), selective attentional processing, and anxiety symptoms annually between 2016 and 2018.

RESULTS

Latent class growth analysis (unconditional model) showed a four-class model: High (stable) (6.94%), low (stable) (11.11%), medium (decreasing) (61.11%), and medium (increasing) (20.83%). The conditioned model controlling for the physical-concerns dimension of AS and negative attentional bias demonstrated that a two-class model consisted of a low anxiety class (n = 59, 81.9%) and a high anxiety class (n = 13, 18.1%) provided the best fit for the data. Negative attentional bias is a significant factor related to the development of anxiety trajectories.

CONCLUSION

Attentional bias modification to disengage from negative stimuli may serve as a potential target of intervention to reduce chronic anxiety among high school students.

Co-Developmental Trajectories of Specific Anxiety Symptoms from Middle Childhood to Early Adolescence: Associations with Psychological Well-Being and Academic Achievement

Different types of specific anxiety symptoms commonly co-occur but also display distinct developmental trajectories over time in children and adolescents. Nevertheless, little is known about the co-developmental trajectories of specific anxiety symptoms among youth during the transition into adolescence and how identified trajectories are associated with important psychological and academic outcomes. This study thus aimed to determine the (a) heterogeneous co-developmental trajectories of five specific anxiety symptoms (generalized anxiety, separation anxiety, social anxiety, school anxiety, and panic disorder) from middle childhood to early adolescence, and (b) associations between the identified, distinct trajectories and youth's psychological well-being and academic achievement. A total of 715 Chinese elementary school students (45.6% girls, M_age = 8.96, SD = 0.76) completed measures on six occasions across three years, using 6-month intervals. Parallel process latent class growth modeling revealed five distinct anxiety trajectory groups: "congruent-low" (49.8%), "moderately low with predominant social anxiety" (18.5%), "moderately low with predominant school anxiety" (12.6%), "moderately high with predominant generalized and social anxiety" (8.6%), and "congruent-high" (10.5%). The lowest psychological well-being and academic achievement were observed for youth who persistently experienced the co-occurrence of two or more specific anxiety symptoms, followed by those who persistently experienced one predominant anxiety symptom, and finally, youth who persistently experienced low levels of all five specific anxiety symptoms. The identification of five heterogeneous groups with differential outcomes highlights the importance of individual differences considerations in understanding the co-developmental patterns of specific anxiety symptoms from middle childhood to early adolescence and the need for more sophisticated intervention programs tailored to members of specific groups to promote optimal psychological well-being and academic success.

Bullying Victimization and Developmental Trajectories of Internalizing and Externalizing Problems: The Moderating Role of Locus of Control Among Children

This longitudinal study examined the developmental trajectories of internalizing and externalizing problems, as well as the moderating role of children's locus of control on the relations between traditional and cyberbullying victimization and developmental trajectories of internalizing and externalizing problems. A total of 4180 Chinese elementary school students (M_age = 9.90 years) completed measures of bullying victimization (Time 1), locus of control (Time 1), internalizing and externalizing problems (from Time 1 to Time 5, 6-month intervals). Latent growth curve analyses indicated (a) internalizing problems first gradually decreased and then increased across time, whereas externalizing problems decreased slowly and remained steady over time; (b) both traditional and cyberbullying victimization served as risk factors for internalizing and externalizing problems; however, the effects of traditional bullying victimization on internalizing and externalizing problems were stronger than those for cyberbullying victimization; (c) locus of control moderated the relations between traditional bullying victimization and developmental trajectories of internalizing and externalizing problems. Consistent with cognitive diathesis-stress models, children who experienced higher levels of traditional bullying victimization and reported an external locus of control were more likely to experience internalizing and externalizing problems. This study also identified meaningful gender differences. Implications for the prevention of behavior problems were discussed.

Prenatal Diet and Children's Trajectories of Anxiety and Depression Symptoms from 3 to 8 Years: The EDEN Mother-Child Cohort

BACKGROUND

Maternal diet quality during pregnancy has been linked to offspring's physical and mental health outcomes across the lifespan. However, few studies have examined its association with subsequent offspring's anxiety and depression issues.

OBJECTIVES

The objective of the study was to examine the relationship between maternal prenatal dietary patterns and offspring's anxiety and depression symptoms from 3 to 8 years.

METHODS

We used data from 1242 children enrolled in the French EDEN (Etude des déterminants pré- et postnatals précoces du développement et de la santé de l'enfant) birth cohort. Maternal third trimester dietary patterns-namely, "Healthy" (i.e., high intake in fruit, vegetables, fish, and whole-grain cereals) and "Western" (i.e., high intake in processed and snacking foods) patterns-were evaluated using a validated qualitative FFQ. Children's anxiety and depression symptoms (i.e., fears, worries, misery, nervousness, and somatic symptoms) were assessed by mothers using the Strengths and Difficulties Questionnaire at ages 3, 5, and 8 years, from which trajectories were derived using group-based trajectory modeling. We used logistic regressions to analyze the associations between maternal dietary patterns and children's anxiety and depression symptom trajectories.

RESULTS

We identified 2 trajectories of anxiety and depression symptoms from 3 to 8 years of age: low to moderate (n = 1058; reference group) and moderately high (n = 184). Maternal low adherence to the Healthy dietary pattern in the third trimester was significantly associated with moderately high children's anxiety and depression symptom trajectories from 3 to 8 years (OR, 1.87; 95% CI, 1.40-2.51), in crude and adjusted analyses. The maternal Western dietary pattern was not significantly associated with anxiety and depression symptom trajectories.

CONCLUSIONS

High maternal prenatal adherence to a Healthy dietary pattern was negatively related to anxiety and depression symptoms in children. As maternal diet is a key lifestyle factor, further research should investigate its association with subsequent offspring anxiety and depression symptoms in aiming to later inform prevention strategies focusing on pregnancy.

Revisit the Effectiveness of Educational Kinesiology on Stress and Anxiety Amelioration in Kindergarteners With Special Needs Using Biological Measures

Background: Educational kinesiology is a popular intervention that aims to improve brain functioning via physical movements. Yet, it lacks supporting scientific evidence and is regarded as pseudoscience. Given the popularity of educational kinesiology in school settings, it is important to revisit its effectiveness through scientific research. Previous studies that evaluated the effectiveness of educational kinesiology relied mainly on subjective measures, in which subjective bias is inevitable. Cortisol and oxytocin levels in saliva have been reported to be reliable stress and anxiety markers that provide unbiased objective data. This study explores the effect of educational kinesiology on the changes in salivary cortisol and oxytocin levels in kindergarteners with special needs. Methods: A quasi-experimental design was adopted in this study. Thirty-seven kindergarteners (3.5-6.5 years old) who were either diagnosed with one type of special needs or referred by school principals due to the requirement of special supports at school were assigned to either the intervention group, which received 1-h educational kinesiology intervention weekly for a total of 10 weeks, or the wait-list control group. Saliva samples were collected at baseline and after the completion of intervention programme for the measurement of cortisol and oxytocin levels. Scores of Parent-rated Preschool Anxiety Scale (PAS-TC) were also collected at pre- and post-intervention. Because of the small samples, non-parametric tests such as Mann-Whitney U test, Quade test, and Fisher's exact tests were used in this study where appropriate. Results: After controlled for the effect at baseline, gender and types of special needs, the changes in oxytocin levels were significantly higher in the intervention group compared with control [F _{(1, 35)} = 4.747, p = 0.036, eta² = 0.119], whereas no significant between-group difference in changes of cortisol levels was observed [F _{(1, 35)} = 0.306, p = 0.584, eta² = 0.009]. Results from PAS-TC showed significant improvement in anxiety levels after the intervention in the intervention group (p = 0.048, ϕ = 0.344, p = 0.037). Conclusions: Our findings suggest a plausible anti-anxiety effect of educational kinesiology in kindergarteners with special needs by elevating the oxytocin levels. Future studies are warranted to further confirm our findings with a larger sample.

Co-occurring trajectories of anxiety and insistence on sameness behaviour in autism spectrum disorder

BACKGROUND

Children with autism spectrum disorder (ASD) have increased susceptibility to anxiety disorders. Variation in a common ASD symptom, insistence on sameness behaviour, may predict future anxiety symptoms.

AIMS

To describe the joint heterogeneous longitudinal trajectories of insistence on sameness and anxiety in children with ASD and to characterise subgroups at higher risk for anxiety.

METHOD

In a longitudinal ASD cohort (n = 421), insistence on sameness behaviour was measured using the Autism Diagnostic Interview-Revised at approximately ages 3, 6 and 11 years. Anxiety was quantified at 8 time points between ages 3 and 11 years using the Child Behavior Checklist (CBCL) (parent report). Clusters of participants following similar trajectories were identified using group-based and joint trajectory modelling.

RESULTS

Three insistence on sameness trajectories were identified: (a) 'low-stable' (41.7% of participants), (b) 'moderate-increasing' (52.0%) and (c) 'high-peaking' (i.e. increasing then stabilising/decreasing behaviour) (6.3%). Four anxiety trajectories were identified: (a) 'low-increasing' (51.0%), (b) 'moderate-decreasing' (16.2%), (c) 'moderate-increasing' (19.6%) and (d) 'high-stable' (13.1%). Of those assigned to the 'high-peaking' insistence on sameness trajectory, 95% jointly followed an anxiety trajectory that surpassed the threshold for clinical concern (T-score >65) by middle childhood (anxiety trajectories 3 or 4). Insistence on sameness and anxiety trajectories were similar in severity and direction for 64% of the sample; for 36%, incongruous patterns were seen (e.g. decreasing anxiety and increasing insistence on sameness).

CONCLUSIONS

The concurrent assessment of insistence on sameness behaviour and anxiety in ASD may help in understanding current symptom profiles and anticipating future trajectories. High preschool insistence on sameness in particular may be associated with elevated current or future anxiety symptoms.

The behavioral profile of children aged 1-5 years with sex chromosome trisomy (47,XXX, 47,XXY, 47,XYY)

Children with SCT have an increased risk of suboptimal neurodevelopment. Previous studies have shown an elevated risk for neurobehavioral problems in individuals with SCT. However, not much is known about neurobehavioral problems in very young children; knowledge that could help with early identification of children at risk for suboptimal development, and that could help establish targets for early intervention. This study addressed the question of what the behavioral profile of children with SCT aged 1–5 years looks like. In total, 182 children aged 1–5 years participated in this study (N_SCT=87, N_{nonclinical controls} = 95). Recruitment and assessment took place in the Netherlands and the United States. The SCT group was recruited through prospective follow‐up (50%), information seeking parents (31%), and clinical referral (18%). Behavioral profiles were assessed with the child behavior checklist and the ages‐and‐stages social–emotional questionnaire.

Levels of parent‐rated problem behavior were higher in children with SCT. Difficulties with overall social–emotional functioning were already present in 1‐year‐olds, and elevated scores were persistent across the full age range. Affective and pervasive developmental behaviors were seen in late toddlerhood and prominent at preschool age. Anxiety, attention deficit, and oppositional defiant behaviors were seen in preschool‐aged children. Within this cross‐sectional study, the developmental trajectory of affective, pervasive developmental, and oppositional defiant behaviors seemed to be different for SCT children than nonclinical controls.

Collectively, these results demonstrate the importance of behavioral screening for behavioral problems in routine clinical care for children with SCT from a young age. Social–emotional problems may require special attention, as these problems seem most prominent, showing increased risk across the full age range, and with these problems occurring regardless of the timing of diagnosis, and across all three SCT karyotypes.