Longitudinal pathways between mental health difficulties and academic performance during middle childhood and early adolescence

Hot and cool executive function in the development of behavioral problems in grade school

Despite the well-established link between children's executive function and behavioral adjustment, it remains unclear whether the hot and cool aspects of executive function are uniquely associated with children's behavioral problems. Using longitudinal data spanning in the grade school (N = 1,140), this study aimed to examine whether hot and cool executive function skills may be uniquely related to the development of behavioral problems. Hot and cool executive function skills were measured with tasks, standardized tests, and questionnaires at 54 months and in the first grade, respectively. Internalizing and externalizing problems were evaluated by teachers using questionnaires throughout the grade school. The results indicated that, independent of each other, hot and cool executive function skills were uniquely and negatively related to the development of internalizing and externalizing problems over time at the between-individual level, adjusting for within-individual fluctuations. Moreover, internalizing and externalizing problems were positively related at the between-individual level across the grade school. Findings provide needed evidence to clarify the relations between hot and cool executive function and children's behavioral problems, emphasizing the importance of both aspects of executive function in understanding the development of behavioral problems in school-age children.

Predictors of Academic Performance Trajectories Across Early and Middle Adolescence: Links with Internalizing and Externalizing Problems

Although there is ample evidence linking academic and behavioral domains, few studies have examined the long-term, varied impacts of academic performance trajectories on problem behavior outcomes, particularly in early and middle adolescence. This study examined the different three-year academic performance trajectories, their links with behavioral outcomes, and the demographic and educational predictors that distinguish these patterns. The sample consisted of 10,279 Chinese adolescents (46.43% girls; Mage = 12.97 years, SD = 0.89). Three trajectory groups emerged: Moderate Start with Steady Growth (45.93%), High Start with Accelerated Growth (36.89%), and Low Start with Minimal Growth (17.17%). Demographic and educational factors (i.e., age, parents' education, family income, family size, school climate, rank, and sector) predicted group membership. The High Start with Accelerated Growth group exhibited fewer externalizing problems than the other groups. The results underscored the differences in academic performance trajectories and their associations with the predictors and outcomes of problem behaviors, which has implications for academic and behavioral development.

The impact of physical exercise on internalizing and externalizing problem behaviors among middle school students: correlation and regression prediction analysis

BACKGROUND

This study explored the impact of physical exercise on internalizing and externalizing problem behaviors among Chinese middle school students.

METHODS

A cross-sectional survey was conducted among 6368 middle school students from Sichuan, Guangdong, Shandong, Henan, and Jiangxi provinces, using the International Physical Activity Questionnaire (IPAQ), Achenbach Youth Self-Report (YSR), and Depression-Anxiety-Stress Scales (DASS). Latent class analysis, multiple linear regression, and Kendall's tau coefficient tests were employed to analyze the data.

RESULTS

Physical exercise significantly reduced externalizing problem behaviors, including impulsivity (β = 0.188, p < 0.001), hostility (β = 0.129, p < 0.001), and aggressiveness (β = 0.158, p < 0.001), and also alleviated depression (β = 0.087, p < 0.01). Latent class analysis revealed that students with high levels of exercise had significantly fewer externalizing behaviors compared to low-level exercisers (p < 0.001). High-intensity exercise had greater effects, particularly on impulsivity and hostility. Rural male students exhibited higher levels of aggressiveness and hostility, while urban female students benefited more from exercise interventions.

CONCLUSION

Physical exercise has a significant positive impact on reducing externalizing problem behaviors, especially impulsivity, hostility, and aggressiveness, among middle school students. However, its effects on internalizing behaviors are relatively limited. Intervention strategies should consider individual characteristics such as gender and location to maximize effectiveness.

How robust is the association between school-related stress and internalizing mental health problems? A specification curve analysis

BACKGROUND

A recent review of research on the association between school-related stress and internalizing problems found growing scholarly interest in the topic, but also raised questions concerning the quality and reliability of the existing knowledge base. The aim of this study was to investigate how robust the association between school-related stress and internalizing problems is to differences in model specifications.

METHODS

Longitudinal survey data from between 2,991 and 4,845 Swedish adolescent students aged 13-16 years were used. A total of 57,322 different models were estimated, varying the choice of sample, measure of internalizing problems, functional form, statistical method, and combinations of included control variables. The results were summarized using specification curve analysis.

RESULTS

Most estimates of the association between school-related stress and internalizing problems were statistically significant at the 5% level. The choice of sample, outcome, functional form, and control variables had a limited influence on the size and significance of the estimates, but the estimates were markedly smaller and mostly non-significant in models investigating lagged effects.

CONCLUSIONS

This study showed that school-related stress is a robust predictor of internalizing problems as long as the association is assumed to be contemporaneous, while evidence for lagged effects was weaker. A key conclusion is that the choice of whether to estimate lagged or contemporaneous effects may be the most consequential in studies on school-related stress and internalizing problems or similar topics.

Prenatal exposure to persistent organic pollutants and emotional and behavioral outcomes from early childhood to adolescence: Rhea Cohort Study in Crete, Greece

Background

Persistent organic pollutants (POPs) are widespread, hazardous chemicals, but their impact on emotional and behavioral development is not well understood. This study aimed to investigate whether prenatal exposure to POPs influences internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) symptoms from early childhood to adolescence.

Methods

We utilized longitudinally collected data from 467 mother-child pairs in the Rhea study. Concentrations of hexachlorobenzene, dichlorodiphenyldichloroethylene, and six polychlorinated biphenyl congeners (PCBs) were determined in maternal serum samples collected during early pregnancy. Mothers reported their children's internalizing, externalizing, and ADHD symptoms at ages 4 (Strengths and Difficulties Questionnaire, ADHD Test), 6, 11, and 15 years (Child Behavior Checklist, Conners' Parent Rating Scale). The associations between prenatal pollutant exposure and longitudinally studied outcomes were assessed using generalized estimating equation models.

Results

In utero exposure to hexachlorobenzene and dichlorodiphenyldichloroethylene was not associated with emotional or behavioral outcomes. Prenatal exposure to PCBs was associated with decreased internalizing symptoms from childhood through adolescence and reduced ADHD symptoms at age 4 (adjusted β [95% confidence interval]: -0.17 [-0.29, -0.05], and -0.16 [-0.30, -0.02], per doubling of exposure, respectively). Sensitivity analyses confirmed these findings, though the association between PCB exposure and internalizing symptoms was not observed in women with sufficient gestational weight gain.

Conclusions

Our findings suggest that prenatal POP exposure does not adversely affect emotional and behavioral development from preschool age through adolescence. Further research is warranted to elucidate the potential impact of gestational POP exposure on developmental trajectories.

Longitudinal Relationship between Aggressive Behavior and Non-Suicidal Self-Injury among Adolescent Boys and Girls: The Mediating Role of Peer Victimization

Although a large body of research has found associations between aggressive behavior and non-suicidal self-injury (NSSI), evidence for the directionality, underlying mechanisms, and potential gender differences in their associations remain unclear. To address the gaps, this study investigated the bidirectional relationship between aggressive behavior and NSSI, the mediating role of peer victimization (physical and relational victimization), and gender differences in these associations among a sample of Chinese adolescents. Using a longitudinal design, a total of 1394 Chinese adolescents (Mage = 13.39, SD = 0.59, 43.3% girls) completed surveys across three waves, with intervals of nine and six months, respectively. The results revealed that within the total sample, T1 aggressive behavior positively predicted T2 physical victimization, and T2 physical victimization positively predicted T3 NSSI. T1 NSSI positively predicted T2 relational victimization, and T2 relational victimization positively predicted T3 aggressive behavior. However, the indirect effect of T1 aggressive behavior on T3 NSSI mediated by T2 physical victimization was significant only for boys. The indirect effect of T1 NSSI on T3 aggressive behavior mediated by T2 relational victimization was significant only for girls. These findings highlighted the importance of considering the gender-specific process underlying the relationship between aggressive behavior and NSSI, thus guiding the development of gender-informed prevention and intervention strategies.

Depression symptom severity and behavioral impairment in school-going adolescents in Uganda

BACKGROUND

During adolescence, a critical developmental phase, cognitive, psychological, and social states interact with the environment to influence behaviors like decision-making and social interactions. Depressive symptoms are more prevalent in adolescents than in other age groups which may affect socio-emotional and behavioral development including academic achievement. Here, we determined the association between depression symptom severity and behavioral impairment among adolescents enrolled in secondary schools of Eastern and Central Uganda.

METHODS

This cross-sectional study was conducted among 1,669 adolescents enrolled in secondary schools in Eastern and Central Uganda. Our outcome variable was behavioral impairment defined as self-reported behavior that interferes with an individuals' ability to do schoolwork (school performance) or get along with others (peer interaction) (yes/no). The key independent variable was depression symptom severity assessed using the Child and Adolescent Symptom Inventory-5 (CASI-5), a behavior rating scale for symptoms of DSM-5 emotional and behavioral disorders. Modified Poisson regression models tested the independent association between depressive symptom severity and behavioral impairment. Prevalence Rate Ratios (PRR) and 95% confidence intervals (95%CI) were reported.

RESULTS

Participants' mean age was 15.3 years (SD = 1.8), 58.5% were female, 86.8% witnessed domestic violence, 47.4% had behavioral impairment, and 2.8% had mild depression symptoms. School-going adolescents with mild depression symptoms had two times higher risk of behavioral impairment when compared to those with no or slight depression symptoms, after controlling for potential confounders. Other factors independently associated with higher risk for behavioral impairment were female sex (Adj. PRR 1.27, 95%CI 1.12, 1.43) compared to males, taking alcohol (Adj. PRR 1.42, 95%CI 1.25, 1.61) compared to not taking alcohol, boarding school enrollees (Adj. PRR 1.62, 95%CI 1.33, 1.98), and day school enrollees (Adj. PRR 1.46, 95%CI 1.21, 1.76) compared to mixed (day and boarding) school enrollees respectively, advanced level enrolment (Adj. PRR 1.25, 95%CI 1.05, 1.48) compared to ordinary level enrolment, and attending urban schools (Adj. PRR 1.27, 95%CI 1.11, 1.45) compared to rural secondary school attendance.

CONCLUSIONS

Behavioral impairments are widespread among Ugandan secondary students. Mild depression symptoms adversely affect adolescents' academic and social lives, potentially leading to long-term consequences. Where feasible, early detection of depressive symptoms and treatment may mitigate their negative effects on student school performance ability and peer/social interaction. Future research should examine school-level factors influencing academic performance by depression status. Policymakers in education and gender sectors should prioritize mental health programs in secondary schools.

Associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018

BACKGROUND

Rising rates of internalizing disorders and rising rates of school failure among adolescents are growing concerns. Despite the strong association between academic achievement and internalizing disorders, possible links between these two trends have not been investigated. Thus, the aim of this study was to investigate the development of the cross-sectional associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018.

METHODS

Register data on specialist psychiatric care and prescriptions of psycholeptic and psychotropic drugs were linked to data on students' school grades in the last year of compulsory school. The total sample size was 3,089,674 students. Logistic regression models with internalizing disorders as the dependent variable, and graduation year and academic achievement as independent variables, were estimated.

RESULTS

Throughout the period, there was a strong negative association between academic achievement and internalizing disorders. Low-achieving students had by far the highest risks of internalizing disorders. In absolute terms, the increase in internalizing disorders was clearly largest for low-achieving students. The relative risks for low-achieving compared to higher achieving students increased between 1990 and 2010 and declined after 2010.

CONCLUSIONS

This study found consistently large, and at least until 2010 growing, achievement-related inequalities in internalizing disorders among Swedish adolescents between 1990 and 2018, with the lowest achieving students having disproportionally high risks. The increasingly pronounced concentration of internalizing disorders in the lowest rungs of the achievement distribution suggests that preventive interventions should focus on supporting this doubly disadvantaged group of students.

Association between Academic Performance, Physical Activity, and Academic Stress in Compulsory Secondary Education: An Analysis by Sex

OBJECTIVES

The main objective of this study is to analyze the relationships between academic performance, physical activity, and academic stress in secondary education students, while the secondary objective is to establish differences by gender in the physical activity and academic stress levels of secondary students based on academic performance.

METHODS

The sample was composed of students from both sexes who attended public institutions. Data collection was conducted applying an ad hoc questionnaire for academic performance, the PAQ-C questionnaire for physical activity, and the QASSE questionnaire for academic stress. Data analysis was performed using descriptive statistics: Spearman's correlation coefficient was used for associations, while comparisons were conducted via the Mann-Whitney U test and Kruskal-Wallis H test.

RESULTS

The results show that academic stress is negatively correlated with physical activity and academic performance. Men present significantly higher values in physical activity, while women present higher mean values in general academic stress and the academic overload dimension. Lastly, regarding academic performance, significant differences were observed in the family pressure dimension, with students who perform better academically presenting lower mean values in this dimension of academic stress.

CONCLUSIONS

In conclusion, the more the general academic stress, the lower the physical activity levels and academic performance. In addition, physical activity appears as a potential coping strategy for academic stress, and its influence on academic performance should be further studied in secondary education.

Is neighbourhood deprivation in primary school-aged children associated with their mental health and does this association change over 30 months?

As both socioeconomic deprivation and the prevalence of childhood mental health difficulties continue to increase, exploring the relationship between them is important to guide policy. We aimed to replicate the finding of a mental health gap that widened with age between those living in the most and least deprived areas among primary school pupils. We used data from 2075 children aged 4-9 years in the South West of England recruited to the STARS (Supporting Teachers and childRen in Schools) trial, which collected teacher- and parent-reported Strength and Difficulties Questionnaire (SDQ) at baseline, 18-month and 30-month follow-up. We fitted multilevel regression models to explore the relationship between Index of Multiple Deprivation (IMD) quintile and SDQ total difficulties score and an algorithm-generated "probable disorder" variable that combined SDQ data from teachers and parents. Teacher- and parent-reported SDQ total difficulties scores indicated worse mental health in children living in more deprived neighbourhoods, which was attenuated by controlling for special educational needs and disabilities but remained significant by parent report, and there was no interaction year group status (age) at baseline. We did not detect an association between probable disorder and IMD although an interaction with time was evident (p = 0.003). Analysis by study wave revealed associations at baseline (odds ratio 1.94, 95% confidence interval 0.97-3.89) and 18 months (1.96, 1.07-3.59) but not 30 months (0.94, 0.54-1.57). These findings augment the existing, highly compelling evidence demonstrating worse mental health in children exposed to socioeconomic deprivation.

Trajectories of risk and resilience: The role of empathy and perceived social support in the context of early adversity

BACKGROUND

Evidence overwhelmingly suggests that adverse childhood experiences (ACEs) is a risk factor for poor mental health outcomes. However, the specific mechanisms via which ACEs confer an increased risk of psychopathology are less well understood.

OBJECTIVE

The study modelled the effect of empathy and perceived social support (PSS) on mental health outcomes in a mixed clinical and non-clinical population, within the context of exposure to ACEs.

PARTICIPANTS AND SETTING

A total of 575 participants (comprising a treatment-receiving and community-based sample), aged 18 to 65 completed self-report measures assessing early adversity, PSS, empathy, and mental health outcomes.

METHODS

Multiple mediation analyses were used to investigate whether empathy and PSS mediated the relationship between self-reported ACEs and mental health outcomes, and whether affective and cognitive empathy affected differentially the link between emotional neglect and psychological distress.

RESULTS

Results revealed a statistically significant indirect effect of ACEs on adult mental health through affective empathy and PSS. Emotional neglect was the only type of adversity significantly correlated with both dimensions of empathy. The indirect effect of emotional neglect on mental health outcomes via cognitive and affective empathy was also statistically significant.

CONCLUSIONS

Study results highlight the role of affective empathy and PSS as transdiagnostic mechanisms influencing the pathway between early adversity and adult mental health, and the importance of taking these into account when designing interventions aiming to promote well-being among those who have experienced childhood adversity.

The effects of art therapy interventions on anxiety in children and adolescents: A meta-analysis

OBJECTIVE

This study aimed to assess the effects of art therapy on anxiety among children and adolescents.

METHODS

We searched several databases, including PubMed, Web of Science, Embase (via Ovid), PsychINFO (through EBSCO), and The Cochrane Library, comprising the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials. Additionally, Chinese databases such as CNKI (China National Knowledge Infrastructure) and Wan Fang Data were explored from their beginnings until October 22, 2023. Studies that investigated the impact of art therapy on anxiety compared to a control group were included. The methodological quality of these randomized controlled trials was evaluated using the Cochrane Handbook's risk of bias instrument.

RESULTS

Six studies involving 422 participants were included. The findings indicated a notable decrease in anxiety symptoms due to art therapy, with a Standardized Mean Difference (SMD) of -1.42, 95% Confidence Interval (95%CI -2.33, -0.51), p < 0.002. Notably, there was pronounced heterogeneity, as evidenced by Tau2 = 1.41, Chi2 = 101.19, df = 6, and I² = 94%, with Z = 3.06.

CONCLUSION

Art therapy significantly improved the anxiety symptoms of children and adolescents, positioning it as an effective means of treating anxiety.

School Connectedness and Mental Health Among Black Adolescents

Black students' school experiences are important for their mental health. The current study explored the link between school connectedness in middle childhood and depressive symptoms and aggressive behaviors among Black adolescents. Participants were Black youth (Mage = 9.36 years, SD = 0.38 at time 1), (Mage = 15.59 years, SD = 0.60 at time 2), and 50.2% female. The findings demonstrated a significant association between school connectedness assessed at age nine and reduced depressive symptoms and aggressive behaviors reported at age fifteen. Notably, gender moderated the relationship between school connectedness and depressive symptoms, with a stronger association found for girls. These results offer valuable insights into how early perceptions of school connectedness impact the mental health of Black adolescents as they grow older. These findings also indicate that girls might be more attuned to the social and emotional aspects of their schools. These findings validate the significance of a sense of connection to school with mental health outcomes among Black adolescents and indicate the possibility of school connectedness interventions to enhance their overall well-being.

The role of social cognition in mental health trajectories from childhood to adolescence

We investigated the association between an aspect of Theory of Mind in childhood, false-belief understanding, and trajectories of internalising (emotional and peer) and externalising (conduct and hyperactivity) problems in childhood and adolescence. The sample was 8408 children from the UK's Millennium Cohort Study, followed at ages 5, 7, 11, 14, and 17 years. Social cognitive abilities were measured at 5 and 7 years through a vignette version of the Sally-Anne task administered by an unfamiliar assessor in a socially demanding dyadic interaction. Internalising and externalising problems were measured via the Strengths and Difficulties Questionnaire at 7-17 years. Using latent growth modelling, and after controlling for sex, ethnicity, maternal education, verbal ability, and time-varying family income, we found that superior social cognitive abilities predicted a decrease in emotional problems over time. In sex-stratified analyses, they predicted decreasing conduct problem trajectories in females and lower levels of conduct problems at baseline in males.

Identifying subgroups of attention-deficit/hyperactivity disorder from the psychopathological and neuropsychological profiles

The Research Domain Criteria (RDoC) advocates the dimensional approach in characterizing mental disorders. We followed RDoC to characterize children with ADHD using profiling based on the cognitive and psychopathological domains. We aimed to identify and validate ADHD subtypes with different clinical characteristics and functional impairments. We recruited 362 drug-naïve children with ADHD and 103 typically developing controls. The cluster analysis was used to identify subgroups based on the Child Behaviour Checklist (CBCL) and the Behaviour Rating Inventory of Executive Function (BRIEF). The subgroups' clinical characteristics and functional impairments were assessed using the WEISS Functional Impairment Rating Scale-Parent Report (WFIRS-P) and the Conners Parent Symptom Questionnaire (PSQ). The cluster analysis yielded four subgroups: (1) ADHD with severe impairment in psychopathology and executive functions (EF), (2) ADHD with mild executive dysfunctions and normal-level psychopathology, (3) ADHD with severe externalizing problems and (4) ADHD with severe executive dysfunctions. These subgroups showed different clinical characteristics and degrees of functional impairment. The EF impairment group displayed more serious learning problems and worse life skills than the externalizing group. The two groups with externalizing problems (i.e. the severe impairment group and the externalizing group) both exhibited higher rates of the combined subtype of ADHD and higher rates of comorbid ODD. Different subtypes of ADHD displayed different profiles of internalizing and externalizing problems and levels of executive dysfunctions. In particular, the subtype with severe impairment in EF exhibited more learning problems and worse life skills, suggesting EF is a critical target for intervention in children with ADHD.

Variation in global network properties across risk factors for adolescent internalizing symptoms: evidence of cumulative effects on structure and connectivity

BACKGROUND

Identifying adolescents at risk of internalizing problems is a key priority. However, studies have tended to consider such problems in simple ways using diagnoses, or item summaries. Network theory and methods instead allow for more complex interaction between symptoms. Two key hypotheses predict differences in global network properties for those at risk: altered structure and increased connectivity.

METHODS

The current study evaluated these hypotheses for nine risk factors (e.g. income deprivation and low parent/carer support) individually and cumulatively in a large sample of 12-15 year-olds (N = 34 564). Recursive partitioning and bootstrapped networks were used to evaluate structural and connectivity differences.

RESULTS

The pattern of network interactions was shown to be significantly different via recursive partitioning for all comparisons across risk-present/absent groups and levels of cumulative risk, except for income deprivation. However, the magnitude of differences appeared small. Most individual risk factors also showed relatively small effects for connectivity. Exceptions were noted for gender and sexual minority risk groups, as well as low parent/carer support, where larger effects were evident. A strong linear trend was observed between increasing cumulative risk exposure and connectivity.

CONCLUSIONS

A robust approach to considering the effect of risk exposure on global network properties was demonstrated. Results are consistent with the ideas that pathological states are associated with higher connectivity, and that the number of risks, regardless of their nature, is important. Gender/sexual minority status and low parent/carer support had the biggest individual impacts on connectivity, suggesting these are particularly important for identification and prevention.

Do Municipal Contexts Matter for Adolescent Mental Health? A Within-Municipality Analysis of Nationwide Norwegian Survey Data Across Six Years

Despite growing concerns about substantial socio-economic differences between districts in many developed nations, limited attention has been paid to how adolescent mental health may be shaped by district characteristics. A few studies have shown that adolescent mental health is related to contextual factors such as district socio-economic status, neighborhood disorder, and quality of infrastructure. However, prior estimates may be an artifact of unmeasured differences between districts. To address these concerns, we used data from the nationwide Norwegian Ungdata surveys (N = 278,764), conducted across the years 2014 to 2019. We applied three-level hierarchical linear models to examine within-municipality associations between municipal factors and adolescent mental health in the domains of internalizing problems (i.e., depressive symptoms), externalizing problems (i.e., behavioral problems), and well-being (i.e., self-esteem), thereby accounting for all time-invariant municipality-level confounders. Our results showed that municipal-level safety, infrastructure, and youth culture are associated with adolescent mental health problems. Further, cross-level interaction models indicated gender-specific associations, with stronger associations of municipality infrastructure and community belongingness with increased self-esteem and reduced delinquent behaviors among girls than boys. Our findings highlight that municipality-level interventions may be a feasible strategy for adolescent mental health, even in a society characterized by low inequality and high redistribution.

Relations among parenting, academic performance, and psychopathology: An investigation of developmental cascades and their interplay with maternal and paternal parenting

Little effort has been made to integrate developmental cascades with maternal/paternal parenting in a single investigation. The present study seeks to test cascading effects among academic and internalizing/externalizing symptoms and their associations with maternal/paternal parenting across three time points from 8 to 10 years. Data for this investigation came from a nationally representative prospective cohort study of children born in April through July of 2008 in South Korea who were followed up annually. The sample included 1,598 families (48.5% girls). Parents rated their parenting and teachers rated children's internalizing/externalizing problems and academic performance. Structural equation modeling showed that externalizing problems were negatively related to academic performance. Academic performance was negatively related to internalizing problems and positively related to maternal/paternal authoritative parenting, which in turn led to children's higher academic performance. Bidirectional relations were found between academic performance and externalizing problems and between paternal authoritative parenting and children's internalizing problems. Findings suggested cascading effects and their associations with parenting were not attributable to child gender, intelligence, or socioeconomic differences. These findings lend support to adjustment erosion and academic incompetence models and underscore the need for greater attention to the role that fathering may play in children's development and mothering.

Considering between- and within-person relations in auto-regressive cross-lagged panel models for developmental data

Longitudinal data can provide inferences at both the between-person and within-person levels of analysis, but only to the extent that the statistical models chosen for data analysis are specified to adequately capture these distinct sources of association. The present work focuses on auto-regressive cross-lagged panel models, which have long been used to examine time-lagged reciprocal relations and mediation among multiple variables measured repeatedly over time. Unfortunately, many common implementations of these models fail to distinguish between-person associations among individual differences in the variables' amounts and changes over time, and thus confound between-person and within-person relations either partially or entirely, leading to inaccurate results. Furthermore, in the increasingly complex model variants that continue to be developed, what is not easily appreciated is how substantial differences in interpretation can be created by what appear to be trivial differences in model specification. In the present work, we aimed to (a) help analysts become better acquainted with the some of the more common model variants that fall under this larger umbrella, and (b) explicate what characteristics of one's data and research questions should be considered in selecting a model. Supplementary Materials include annotated model syntax and output using Mplus, lavaan in R, and sem in Stata to help translate these concepts into practice.

A longitudinal examination of school-related and mental health mediators linking emotion regulation to academic achievement

Emotion regulation is assumed to underlie academic achievement through different mechanisms (e.g., a positive orientation toward school and schoolwork, better mental health). However, few studies have contrasted these mediating mechanisms within a longitudinal analytic framework, which is necessary to determine which mechanism(s) are most likely to translate emotion regulation into academic success over time. The present study addressed this gap by examining whether children's emotion regulation capacities were associated with later academic achievement through school-related (i.e., school bonding and academic motivation) and mental health mediators (i.e., internalizing and externalizing symptoms). Participants included 300 4- and 8-year-old children (n = 150 in each age cohort; 50% female) and their caregivers from Canada. Measures were collected over 4 years. Path analyses indicated that higher emotion regulation (T1; age 4/8 years) was associated with better academic achievement 3 years later (T4; age 7/11 years) through stronger school bonding and lower internalizing symptoms in the interim (T2; age 5/9 years; the indirect effect through internalizing symptoms held after controlling for initial levels of internalizing symptoms). Significant effects were derived from both caregiver and child informants when applicable and indirect effects held across age cohorts and genders. Findings highlight the interplay of social-emotional, academic, and mental health development across childhood, as well as the potential benefits of extending academic interventions to the social-emotional and mental health domains.

Eating behaviour, body image, and mental health: updated estimates of adolescent health, well-being, and positive functioning in Aotearoa New Zealand

Introduction Body image dissatisfaction and its associated challenges have been related to poorer health outcomes among adolescents worldwide, including disordered eating behaviour, depression, and anxiety. However, current prevalence estimates of these issues in Aotearoa New Zealand or, relatedly, the estimates of positive attitudes and behaviours, such as intuitive eating and body appreciation are dated. Aim The primary aim of this paper was to provide updated estimates for a variety of constructs related to eating behaviours and body image, sourced from a diverse range of early adolescent participants. Methods For this report, a brief online survey was advertised to adolescents throughout Aotearoa New Zealand (n  = 893) via school and community noticeboards. Results Approximately one-in-three male participants and one-in-two female participants reported body image dissatisfaction. One in four participants reported clinically significant symptoms of depression and anxiety. Discussion Given such issues, there is clearly still much progress to be made in advancing positive health among early adolescents. Identifying potentially protective constructs such as intuitive eating and body appreciation may offer guidance into the best targets for prevention and early intervention.

Middle school students' mental unwellness and academic performance in China: The effects of parental involvement

This study investigated the relationship between the mental unwellness of middle school students in China and their academic performance in the subjects of Chinese, mathematics, and English. Additionally, this study explored the potential ameliorating effects of parental involvement variables (parental non-academic activity involvement and parent-child communication) on the adverse impact of mental unwellness on academic performance. The examination of the effects of parental involvement also considered the differential effects of involvement by mothers and fathers. This study utilized national longitudinal representative data from the China Education Panel Survey (CEPS). Findings of the two-level Hierarchical Linear Modeling (HLM) analyses indicated that mental unwellness in Grade 7 negatively impacted academic performance in the aforementioned subjects in Grade 8. Nonetheless, these adverse impacts were alleviated when the parental involvement variables were taken into account. Furthermore, the results revealed that mother-child communication and father-child communication had moderating effects on the negative relationship between mental unwellness and academic performance in Chinese and English, respectively. This study contributes to the existing literature by shedding light on the beneficial effects of parental involvement and highlighting the differential involvement of mothers and fathers.

Social jetlag longitudinally predicts internalizing and externalizing behavior for adolescent females, but not males

Biological changes contribute to preferences for later bed and wake times during adolescence, yet the social constraints of school start times necessitate early wake times. This often results in social jetlag (i.e. misalignment between preferred sleep timing on weekends and school days). We examined whether social jetlag predicts adolescent internalizing and externalizing behavior over time and/or whether associations differ based on sex. We used data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development Study (n = 767) to test whether social jetlag at 6th grade (ages 12-13 years) predicted internalizing and externalizing behavior at age 15 years and whether child sex moderated associations. Controlling for internalizing and externalizing behavior at 6th grade (ages 12-13 years), results were that social jetlag at 6th grade (ages 12-13 years) predicted more internalizing and externalizing behaviors at age 15 for females, but not males. These findings show that social jetlag during early adolescence confers risk for internalizing and externalizing behavior in females at mid-adolescence. Greater attention should be placed on identifying and addressing social jetlag in adolescent females.

The impact of area level mental health interventions on outcomes for secondary school pupils: Evidence from the HeadStart programme in England

In light of the dramatic rise in mental health disorders amongst adolescents seen in the past decade across the world, there is an urgent need for robust evidence on what works to combat this trend. This paper provides the first robust evaluation of the impacts on school outcomes of 6-year funding programme (HeadStart) for area-level mental health interventions for adolescents. Exploiting educational administrative data on ten cohorts of state-educated secondary school students, we use the synthetic control method to construct counterfactual outcomes for areas that received the funding. We show that the funding did not affect students' absenteeism or academic attainment, but it prevented around 800 students (c. 10% of students typically excluded yearly) from being excluded in its first year. The transient nature of this effect suggests that sustained funding for intervention may be a necessary but not sufficient condition to maintain programme effectiveness over time.

Mental health, gender, and higher education attainment

We compared the mental health of higher education students with that of nonstudents. Moreover, we examined whether the mental health of students predicts their probability of obtaining a higher education degree, and whether the extent to which mental health affects educational attainment varies by gender. Drawing on a risk and resilience framework, we considered five facets of mental health that may be implicated in distinct ways in the educational attainment process: positive attitude towards life, self-esteem, self-efficacy, negative affectivity, and perceived stress. We used data from a nationally representative panel study from Switzerland (Nstudents = 2070, 42.8% male; Nnonstudents = 3755, 45.9% male). The findings suggest that overall, the mental health of higher education students was relatively similar to that of nonstudents, although students exhibited slightly higher self-esteem, slightly weaker self-efficacy, greater negative affectivity, and higher levels of perceived stress. The effects of different facets of mental health on higher education degree attainment were mostly statistically and/or practically insignificant. However, positive attitudes towards life had a substantial positive effect on the probability of being awarded a higher education degree. Mental health was equally important for male and female students' educational attainment.

Supplementary Information

The online version of this article (10.1007/s11618-023-01187-3) contains supplementary material, which is available to authorized users.

Gender difference in the change of adolescents' mental health and subjective wellbeing trajectories

Gender differences in adolescents' mental health problems have been extensively reported. Yet, there is limited research in exploring longitudinal trends in mental health and wellbeing between boys and girls. This study investigated any emerging developmental trends of gender differences in mental health problems and subjective wellbeing for young people from early to mid-adolescence in England. A longitudinal group of 8612 young people's mental health and subjective wellbeing trajectories were investigated between the period of ages 11/12 and 13/14. Mental health difficulties and subjective wellbeing were measured using the child self-report Strengths and Difficulties Questionnaire (SDQ) and Short Warwick and Edinburgh Wellbeing Scale (SWEMWBS), respectively. Any gender difference in the change of adolescents' mental health and subjective wellbeing over 3 year period were estimated using multi-level regression while accounting for various socio-demographic and resilience factors. Young people are at increased risk of mental health problems between the ages of 11 and 14, particularly girls. The overall difficulty levels reported by girls were significantly higher than boys across a range of mental health problems and subjective wellbeing. These developmental trends persisted after controlling for a broad range of potential confounders. Young people has shown clear signs of mental distress as they get older. This escalation was particularly evident among girls. Distress can come at the time of significant physical, emotional, and social changes in an adolescents' life, and can be heightened during secondary school transition. This evidence highlights the importance of early intervention to reduce risk of distress.

Co-Creation of a School-Based Motor Competence and Mental Health Intervention: Move Well, Feel Good

Low motor competence (MC) and inhibited psychosocial development are associated with mental health difficulties. Improving children's MC through school-based physical activity interventions emphasising psychosocial development may therefore be a mechanism for promoting positive mental health. This study describes and provides reflective insights into the co-creation of 'Move Well Feel Good', a primary school physical activity intervention to improve children's MC and mental health. Class teachers, school leaders, physical activity specialists, and children (aged 8-9 years) participated in a series of co-creation workshops. Stakeholders' knowledge and experiences were integrated with existing research evidence using creative methods (e.g., post-it note tasks, worksheets, and drawings) to facilitate discussion. The co-creation process culminated in stakeholder consensus voting for one of three proposed intervention ideas. Children cited physical and mental health benefits, enjoyment with friends, and high perceived competence as motives for being physically active. Opportunities to develop MC across the different segments of the school day were identified by adult stakeholders, who perceived children's lack of resilience, an overloaded curriculum, and poor parental support for physical activity as barriers to intervention implementation. The chosen intervention idea received six out of a possible twelve votes. Co-creation projects are specific to the contexts in which they are implemented. This study reinforces the complex nature of school-based intervention development and highlights the value of engaging with stakeholders in co-creation processes.

Conducting school-based health surveys with secondary schools in England: advice and recommendations from school staff, local authority professionals, and wider key stakeholders, a qualitative study

BACKGROUND

Improving the health and well-being of young people is a public health priority. Schools present an ideal setting to implement strategies to improve young people's health and well-being. A key strategy involves conducting surveys to assess student health needs, inform interventions, and monitor health over time. Conducting research in schools is, however, challenging. Schools can find it difficult to participate and adhere to research processes, even when they are keen to be involved in research, because of competing priorities (e.g., attendance and educational achievement), as well as time and resource constraints. There is a lack of literature on the perspectives of school staff and other key stakeholders working in young people's health on how best to work with schools to conduct health research, and in particular, health surveys.

METHODS

Participants (n = 26) included members of staff from 11 secondary schools (covering students aged 11-16 years), 5 local authority professionals, and 10 wider key stakeholders in young people's health and well-being (e.g., a school governor, a national government member), based in South West England. Participants took part in semi-structured interviews that were conducted either over the phone or via an online platform. Data were analysed using the Framework Method.

RESULTS

Three main themes were identified: Recruitment and Retention, Practicalities of Data Collection in Schools, and Collaboration from Design to Dissemination. It is important to acknowledge the role of local authorities and academy trusts in the English education system, and work closely with these when conducting school-based health surveys. School staff prefer to be contacted about research via email and in the summer term, following exams. Researchers should contact a member of staff involved in student health/well-being, as well as senior leadership, during recruitment. Data collection during the start and end of the school year is undesirable. Research should be collaborative with school staff and young people, consistent with school priorities and values, and flexible and tailored to school timetables and resources.

CONCLUSIONS

Overall the findings demonstrate that survey-based research methods should be school-led and tailored to each school.

Educational level, attention problems, and externalizing behaviour in adolescence and early adulthood: the role of social causation and health-related selection-the TRAILS study

Social causation and health-related selection may contribute to educational differences in adolescents' attention problems and externalizing behaviour. The social causation hypothesis posits that the social environment influences adolescents' mental health. Conversely, the health-related selection hypothesis proposes that poor mental health predicts lower educational attainment. From past studies it is unclear which of these mechanisms predominates, as attention problems and externalizing behaviour have the potential to interfere with educational attainment, but may also be affected by differences in the educational context. Furthermore, educational gradients in mental health may reflect the impact of 'third variables' already present in childhood, such as parental socioeconomic status (SES), and IQ. We investigated both hypotheses in relation to educational differences in externalizing behaviour and attention problems throughout adolescence and young adulthood. We used data from a Dutch cohort (TRAILS Study; n = 2229), including five measurements of educational level, externalizing behaviour, and attention problems from around age 14-26 years. First, we evaluated the directionality in longitudinal associations between education, externalizing behaviour, and attention problems with and without adjusting for individual differences using fixed effects. Second, we assessed the role of IQ and parental SES in relation to attention problems, externalizing behaviour, and educational level. Attention problems predicted decreases in education throughout all of adolescence and young adulthood. Differences in parental SES contributed to increases in externalizing behaviour amongst the lower educational tracks in mid-adolescence. Childhood IQ and parental SES strongly predicted education around age 14. Parental SES, but not IQ, also predicted early adolescent attention problems and externalizing behaviour. Our results provide support for the health-related selection hypothesis in relation to attention problems and educational attainment. Further, our results highlight the role of social causation from parental SES in determining adolescent educational level, attention problems, and externalizing behaviour.

The Relationship Between First-Grade Psychosocial Functioning and Educational Outcomes through Eighth Grade in a Large Sample of Chilean Youth

BACKGROUND

The association between early childhood psychosocial problems and poorer educational outcomes is well-documented, but the extent to which this association persists is less understood. The current study assessed the correlations between first-grade psychosocial functioning and educational outcomes through eighth grade in a large longitudinal sample of Chilean students.

METHODS

The Pediatric Symptom Checklist-Chilean (PSC-CL) and Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) assessed psychosocial functioning for 9736 students who were screened four times from first through eighth grade through the Skills for Life program. Adjusted linear mixed effects models assessed the association between first grade PSC-CL and TOCA-RR risk and third, sixth, and eighth grade GPA and school attendance.

RESULTS

First-grade PSC-CL and TOCA-RR risk both significantly predicted lower third, sixth, and eighth grade GPAs; all p < .001. The relationships between first-grade psychosocial functioning and later school attendance rates were less consistent but still significant at certain time points.

CONCLUSIONS

First-grade psychosocial risk was persistently associated with lower academic performance in a longitudinal sample of Chilean students followed through elementary and middle school.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Early school-based psychosocial screening and follow-up interventions have the potential to improve students' long-term educational outcomes.

Children's Lived Experiences of Wellbeing at School in England: a Phenomenological Inquiry

This phenomenological inquiry investigated children's wellbeing experiences at school, including their hedonic (feeling good) and eudaimonic (doing good) accounts, a distinction often overlooked. Further, while phenomenological inquiries of children's mental ill-health exist, wellbeing, a fundamental part of mental health, is neglected. This is at odds with positive psychology which favours strengths-based approaches to studying human development. Phenomenology provides rich detail, facilitating deeper understanding of why and how certain factors affect wellbeing, as described by children themselves. A sample of 15 children (aged 9-11), attending one English primary school broadly representative of the national socio-demographic, engaged in interviews. Children's experiences of 'feeling good' at school were characterised by: an interdependence on peers' emotional states (described as 'a domino effect'), a need to feel cared for by, and trust, adults, and desire for autonomy over their time. Children attributed mistrust in adults to adults disregarding seemingly incidental events which felt significant to children. Children experienced 'doing well' as equating to academic attainment, conveying a fixation with test scores, using language of 'correctness' and efficiency. Shame pervaded when 'correctness' was not achieved, with children describing being ridiculed for poor test scores. Recommendations for schools to support children's hedonia include prioritising wellbeing curricula and emotional literacy, greater staff reflexivity, and prioritisation of pupil voice. To foster children's eudaimonia, recommendations include the need for teachers to provide formative, personalised feedback for pupils focused on the learning process, and the need for Government to embrace a range of ways pupils can feel successful beyond academic attainment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12187-023-10016-2.

Predictors of educational failure at 16 and 19 years of age-SESBiC longitudinal study

BACKGROUND

Educational attainment is highly associated with future health and independence. Throughout childhood, children are exposed to factors that may promote educational attainment and factors that may be associated with a reduced likelihood of being able to complete their education. The purpose of the current study was to investigate which factors, measured from birth up to finishing upper secondary school, were associated with a lower mean grade point average from lower and upper secondary school as well as eligibility to upper secondary school and college/university.

METHODS

This is a longitudinal study on 1723 children born in 1995/1996 who have been followed until they were 20 years old. Information with respect to maternal sociodemographics, maternal stress factors during pregnancy and childhood, birth characteristics of the child, child behavior at 3 and 12 years of age, and mean grade point average from lower and upper secondary school, including eligibility to upper secondary school and college/university was collected.

RESULTS

Children exhibiting high problems scores on the child behavior checklist at 12 years of age and children or having other living arrangements (e.g. foster parents or institutional care) were less likely to fulfill the requirements for upper secondary school (OR = 0.35, 95% CI = 0.17-0.71 and OR = 0.33 95% CI = 0.17-0.65, respectively). The likelihood of fulfilling the requirements to college/university was lower if the child had divorced parents at three years of age (OR = 0.30, 95% CI = 0.16-0.58) and exhibited externalizing problems at 12 years of age (OR = 0.45, 95% CI = 0.24-0.86) and if the mother had experienced high level of stress at (OR = 0.32, 95% CI = 0.14-0.77).

CONCLUSION

Identifying mothers with high level of stressors as well as children with externalizing behaviour problems to provide guidance and support is very important as these two factors appear to be associated with future study performance in both lower and upper secondary school.

Longitudinal associations between academic achievement and depressive symptoms in adolescence: Methodological considerations and analytical approaches for identifying temporal priority

Failure to meet educational expectations in adolescence can derail an individual's potential, leading to hardship in adulthood. Lower academic achievement is also associated with poorer mental health, and both share common pathways to adult functional outcomes like employment status and economic security. Although linked in adolescence, and predictive of similar outcomes in adulthood, methodological and analytical limitations of the literature do not permit the assessment of the temporal priority between academic achievement and mental health. This omission of directionality hampers intervention and prevention efforts. In this narrative review, we summarize the literature on the temporal ordering between academic achievement and depressive symptoms in adolescence, a particularly vulnerable developmental period. We propose methodological and analytical strategies to guide future research to disentangle the chronological ordering between academic achievement and depressive symptoms-recommendations that can be used to examine other sets of correlated variables over time. Specifically, we highlight methodological issues that require attention such as the need to understand reciprocal and cascading influences over time by attending to repeated measures and timing, measurement consistency, reporter effects, examination of processes and mechanisms, and missing data. Finally, we discuss the need to embrace analytical methods that separate within-person from between-person effects; account for heterogeneity in associations using person-centered approaches; and use the two approaches as complementary, rather than competing, for a more holistic examination of temporality.

Externalizing problems mediate the relation between teacher and peer violence and lower school performance

BACKGROUND

The association between children's exposure to family violence and poor academic outcomes is well-established. Less is known about how exposure to violence in the school context, i.e., by teachers and by peers, affects academic functioning. Moreover, the role of children's mental health problems in this link has hardly been examined.

OBJECTIVES

We examined direct and indirect associations between children's experiences of violence by teachers and peers and children's mental health and school functioning while controlling for children's experiences of parental violence.

PARTICIPANTS

Using a multistage random sampling approach, we obtained a representative sample of 914 students (50.5 % girls, M_age = 12.58 years) from 12 primary schools in Tanzania.

METHODS

In structured interviews, students' experiences of violence and mental health problems were assessed. Students' academic performance and absenteeism were documented using school records. Associations were examined using structural equation modeling.

RESULTS

Experiences of more teacher and peer violence were each significantly associated with higher externalizing problems (teachers: β = 0.27 [95 %-CI: 0.12, 0.47]; peers: β = 0.17, [95 %-CI: 0.07, 0.32]). Higher externalizing problems were significantly associated with poorer academic performance (β = -0.13, [95 %-CI: -0.23, -0.02]), implying significant indirect associations between students' experiences of teacher violence (β = -0.04, [95 %-CI: -0.08, -0.01]) and peer violence (β = -0.02, [95 %-CI: -0.05, -0.01]) and their academic performance via externalizing problems.

CONCLUSION

Exposure to violence at school may impair children's academic performance indirectly by increasing attention and behaviour problems. Further investigations in longitudinal studies and implementation of interventions to reduce violence in schools are indicated.

Assessing the Feasibility of Peer Coach Training for Disruptive Middle School Youth: A Mixed Methods Pilot Study

In U.S. schools, disruptive behavior is by far the primary reason for disciplinary referrals, including suspensions and expulsions. School-based interventions targeting disruptive behavior usually position struggling youth as treatment recipients and neglect the psychosocial benefits of helping others. In this mixed methods pilot study, we evaluate the preliminary feasibility and acceptability of Peer Coach Training (PCT), a novel, school-based intervention for youth referred for disruptive behavior that deemphasizes the youth's existing problems and focuses instead on training youth to help their peers. We used quantitative and qualitative methods to evaluate the feasibility and acceptability of PCT on two cohorts of disruptive youth (N = 9) in an urban middle school in Southern California. Youth and teachers completed assessments at baseline, post-treatment, and three-month follow-up. At posttreatment and follow-up, youth reported significant reductions in externalizing problems, as well as reductions in conduct problems, attention problems, and aggressive behavior; in contrast, teacher ratings yielded null findings. Qualitative interviews revealed that youth and teachers observed positive changes in peer interactions, self-confidence, and classroom participation efforts. Youth satisfaction data indicated that youth enjoyed participating in PCT and would highly recommend it to their friends. Results from this pilot evaluation suggest that training youth to help their peers is an appealing, feasible, and promising strategy for reducing disruptive behavior, however, controlled trials are needed to provide evidence for treatment efficacy.

Desempenho escolar e saúde mental em alunos do Ensino Fundamental II da Região Sul do Brasil

O estudo do desempenho acadêmico e sua relação com a saúde mental de crianças e adolescentes é uma área de interesse crescente entre educadores e profissionais de saúde. O objetivo deste artigo é identificar o grau de associação entre desempenho acadêmico, saúde mental e dados sociodemográficos, e avaliar se o desempenho acadêmico é uma variável associada à saúde mental em uma amostra de 83 estudantes do Ensino Fundamental II de escolas públicas e seus responsáveis. O estudo utiliza uma metodologia quantitativa de corte transversal, e os dados foram obtidos utilizando os seguintes instrumentos: ficha de dados sociodemográficos, Questionário de Capacidades e Dificuldades (SDQ) para estudantes e responsáveis; e uma pontuação de desempenho acadêmico. A análise dos dados foi realizada por meio de estatística descritiva, correlação e regressão linear múltipla. Dentre os resultados destaca-se a alta percepção entre os estudantes de "total de dificuldades" no SDQ, indicando a presença de problemas de saúde mental clinicamente relevantes. Os resultados também mostraram que os estudantes com desempenho médio e baixo apresentam níveis significativamente mais altos de problemas de saúde mental. O artigo examina a prevalência de problemas de saúde mental infantil e adolescente, possíveis fatores de risco e estudos futuros que possam ampliar a população da amostra. As conclusões gerais indicam altos níveis de adoecimento psíquico, particularmente entre estudantes com desempenho médio e baixo.

Mental disorders and their impact on school performance and high school completion by gender in Australia: A matched population-based cohort study

BACKGROUND

Young people with a mental disorder often perform poorly at school and can fail to complete high school. This study aims to compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder health condition by gender.

METHOD

A population-based matched case-comparison cohort study of young people aged ⩽18 years hospitalised for a mental disorder during 2005-2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers.

RESULTS

Young males with a mental disorder had over a 1.7 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.71; 95% confidence interval: [1.35, 2.15]) and reading (adjusted relative risk: 1.99; 95% confidence interval: [1.80, 2.20]) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the national minimum standard for numeracy (adjusted relative risk: 1.50; 95% confidence interval: [1.14, 1.96]) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a sixfold increased risk and young females with multiple disorders had up to an eightfold increased risk of not completing high school compared to peers.

CONCLUSION

Early recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance.

Geographic, Socio-Demographic and School Type Variation in Adolescent Wellbeing and Mental Health and Links with Academic Competence in the United Arab Emirates

Interest in adolescents' wellbeing and mental health is growing worldwide, but little research in this area has been conducted in certain world regions and countries such as the United Arab Emirates (UAE). Geographic, socio-demographic and school type differences in adolescent wellbeing and mental health are commonly observed in the field, and the UAE is a diverse country where these types of differences have been found for other outcomes (notably, academic). Yet, no prior national study has explored these differences in terms of wellbeing and mental health in the nation. We address this gap by investigating differences across emirates, gender, socio-economic status, immigrant status, school sector and school curriculum for overall life satisfaction, positive affect, negative affect, meaning and purpose in life, and internalizing difficulties. We use linear regression to analyse cross-sectional data from the Programme for International Student Assessment (PISA) study from 2015 and 2018. We find substantial geographic, socio-demographic and school type differences in levels (2018) of wellbeing and mental health -which vary across distinct domains- and declines (2015-2018) of wellbeing. Better wellbeing and mental health are observed in the northern emirates and among boys. Better wellbeing and poorer mental health are observed among nationals (compared to expatriates) and in public schools (compared to private schools). Despite presenting the best academic outcomes, British schools present the worst wellbeing and mental health outcomes. However, results show the absence of a trade-off between academic competence and wellbeing and mental health, with evidence of a small positive association with wellbeing.

Learning outcomes in primary school children with emotional problems: a prospective cohort study

BACKGROUND

Academic difficulties are common in adolescents with mental health problems. Although earlier childhood emotional problems, characterised by heightened anxiety and depressive symptoms are common forerunners to adolescent mental health problems, the degree to which mental health problems in childhood may contribute independently to academic difficulties has been little explored.

METHODS

Data were drawn from a prospective cohort study of students in Melbourne, Australia (N = 1239). Data were linked with a standardised national assessment of academic performance at baseline (9 years) and wave three (11 years). Depressive and anxiety symptoms were assessed at baseline and wave two (10 years). Regression analyses estimated the association between emotional problems (9 and/or 10 years) and academic performance at 11 years, adjusting for baseline academic performance, sex, age and socioeconomic status, and hyperactivity/inattention symptoms.

RESULTS

Students with depressive symptoms at 9 years of age had lost nearly 4 months of numeracy learning two years later after controlling for baseline academic performance and confounders. Results were similar for anxiety symptoms. Regardless of when depressive symptoms occurred there were consistent associations with poorer numeracy performance at 11 years. The association of depressive symptoms with reading performance was weaker than for numeracy if they were present at wave two. Persistent anxiety symptoms across two waves led to nearly a 4 month loss of numeracy learning at 11 years, but the difference was not meaningful for reading. Findings were similar when including hyperactivity/inattention symptoms.

CONCLUSIONS

Childhood anxiety and depression are not only forerunners of later mental health problems but predict academic achievement. Partnerships between education and health systems have the potential to not only improve childhood emotional problems but also improve learning.

Parental Autonomy Support and Mental Health among Chinese Adolescents and Emerging Adults: The Mediating Role of Self-Esteem

Guided by the dual-factor model and self-determination theory, this study explored the relationship between parental autonomy support and mental health (i.e., life satisfaction and emotional problems) in adolescents and emerging adults, with a focus on the mediating role of self-esteem. We conducted two studies among independent samples in China, including 1617 adolescents aged 10 to 17 years (Mage =12.79, SD = 1.63; 50.7% girls; Study 1) and 1274 emerging adults aged 17 to 26 years (Mage = 20.31, SD = 1.63; 56.6% women; Study 2). All participants completed a set of self-reported questionnaires. The results of both studies validated our hypothesis; specifically, parental autonomy support was positively associated with life satisfaction, but negatively associated with emotional problems (emotional symptoms in Study 1 and depressive symptoms in Study 2). Meanwhile, self-esteem partially mediated the positive relationship between parental autonomy support and life satisfaction (R² = 0.33 in Study 1; R² = 0.38 in Study 2), and partially mediated the negative relationship between parental autonomy support and emotional problems (R² = 0.16 in Study 1; R² = 0.42 in Study 2). In summary, this suggests that the common antecedents of positive and negative indicators of mental health addressed in this study are prevalent in adolescents and emerging adults. These findings have important implications for preventive and interventional efforts aimed at mental health problems in both demographics.

Implementation and Outcomes of a National School-Based Mental Health Program for Middle School Students in Chile

Background

Chile's national school-based mental health program, Skills for Life (SFL), has demonstrated effectiveness in improving behavioral and academic outcomes in first- through third-grade students. The current study assessed the feasibility and outcomes of SFL's program for sixth- through eighth-grade students.

Methods

We assessed the percentage of students who participated in the program and longitudinal changes on teacher-reported Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) scores, youth-reported Pediatric Symptom Checklist-Chile (PSC-Y-CL) scores, grade-point average, and school attendance from sixth to eighth grade (2016-2018) for SFL's workshop intervention. Linear mixed effects models analyzed the association between outcome variables and workshop attendance.

Results

Of the 30,649 sixth graders who attended the 754 participating schools in 2016, 28,204 (92.0%) were screened with the TOCA-RR. Of the 1829 students who screened at risk, 1344 had available workshop data for seventh grade, with 86.9% of them participating in most (≥ 7) workshop sessions. Workshop attendance was significantly associated with improvements in school attendance and peer relationships (a TOCA-RR subscale) in eighth grade.

Conclusions

With high rates of behavioral health screening and workshop attendance, this study demonstrated the feasibility of implementing SFL's middle school program on a national scale. Higher workshop attendance by at-risk students was associated with better school attendance and peer relationships in eighth grade, as well as better but not significantly different outcomes on other measures (e.g., teacher-rated school performance and aggressive behavior in the classroom). Overall, these findings provide preliminary evidence of the feasibility and benefits of SFL's middle school program.

Transactions between Problem Behaviors and Academic Performance in Early Childhood

This study aimed to further the understanding of transactional relationships that exist between problem behaviors and academic performance in early childhood. Early academic and behavior difficulties increase the risk of school disengagement, academic failure, and dropout. Although children’s academic and behavioral difficulties have been shown to be intercorrelated, little research has focused on how the relationship reciprocates and progresses in early childhood. This study investigated how problem behaviors (i.e., externalizing and internalizing) influence and are influenced by academic performance (i.e., poor reading and math) from kindergarten to third grade. Participants included 18,135 students (51.22% boys) derived from a nationally representative sample in the Early Childhood Longitudinal Study, Kindergarten Class of 2011 (ECLS-K: 2011). Teacher ratings of children’s internalizing (low self-esteem, anxiety, loneliness, or sadness) and externalizing (fighting, arguing, showing anger, impulsively acting, and disruptive behaviors) problem behaviors, as well as direct assessments of children’s academic performance (reading and math), were collected yearly. Cross-lagged panel modeling (CLPM) was employed to examine reciprocal relationships between problem behaviors and academic performance over time from kindergarten to third grade. The results supported the transactional relationships in early childhood, with higher externalizing as well as internalizing problem behaviors predicting lower academic performance and lower academic performance predicting higher externalizing and internalizing problem behaviors. The implications for research, prevention, and early intervention regarding the progression of academic and behavioral problems are discussed.

Can dogs reduce stress levels in school children? effects of dog-assisted interventions on salivary cortisol in children with and without special educational needs using randomized controlled trials

Prolonged or excessive stress negatively affects learning, behavior and health across the lifespan. To alleviate adverse effects of stress in school children, stressors should be reduced, and support and effective interventions provided. Animal-assisted interventions (AAI) have shown beneficial effects on health and wellbeing, however, robust knowledge on stress mediation in children is lacking. Despite this, AAIs are increasingly employed in settings world-wide, including schools, to reduce stress and support learning and wellbeing. This study is the first randomized controlled trial to investigate dog-assisted interventions as a mediator of stress in school children with and without special educational needs (SEN) over the school term. Interventions were carried out individually and in small groups twice a week for 20 minutes over the course of 4 weeks. We compared physiological changes in salivary cortisol in a dog intervention group with a relaxation intervention group and a no treatment control group. We compared cortisol level means before and after the 4 weeks of interventions in all children as well as acute cortisol in mainstream school children. Dog interventions lead to significantly lower stress in children with and without special educational needs compared to their peers in relaxation or no treatment control groups. In neurotypical children, those in the dog interventions showed no baseline stress level increases over the school term. In addition, acute cortisol levels evidenced significant stress reduction following the interventions. In contrast, the no treatment control group showed significant rises in baseline cortisol levels from beginning to end of school term. Increases also occurred in the relaxation intervention group. Children with SEN showed significantly decreased cortisol levels after dog group interventions. No changes occurred in the relaxation or no treatment control groups. These findings provide crucial evidence that dog interventions can successfully attenuate stress levels in school children with important implications for AAI implementation, learning and wellbeing.

Maternal Functioning and Child's Externalizing Problems: Temperament and Sex-Based Driven Effects

This study examines how maternal adverse parenting (hostility, neglect, low warmth) and psychological distress explain the associations between child temperament factors and externalizing problems. It also examines if these associations differ according to the child's biological sex. The sample consists of 339 school-age children receiving in-school services for conduct problems. Data were collected through questionnaires completed by mothers at 3 time points, at one-year intervals. Results from path analyses revealed that maternal psychological distress partly explained the associations between each child temperamental factors (negative affectivity, surgency/extraversion, effortful control) and levels of externalizing problems. Specifically, the indirect effect of psychological distress between child negative affectivity and externalizing problems was only significant for boys, not girls. Maternal hostility, on the other hand, mediated the association between child surgency/extraversion and externalizing problems in both boys and girls. Interestingly, neglectful parenting and maternal warmth did not explain the association between child temperamental factors and externalizing problems. The findings suggest small but significant temperament child-driven effects on maternal psychological distress and hostility, in turn, translating into higher levels of externalizing problems. These findings support the relevance of temperament-based interventions for children with conduct problems and of increased mental health support for their mothers. By aiding mothers in developing a larger repertoire of parenting strategies, mothers may be better equipped to respond appropriately to their child's various temperamental characteristics, hence, reducing their psychological distress and hostile behaviors and limiting the development of child externalizing problems.

The impact of psychopathology on academic performance in school-age children and adolescents

Psychiatric symptoms have consistently been associated with negative educational outcomes. However, possible confounding variables, such as comorbid mental and environmental conditions, have not been well addressed. This study examined whether mental health problems were significantly linked to academic performance in a Spanish school-based sample, after adjustment for co-occurring psychiatric symptoms and multiple contextual factors. Parents completed a questionnaire regarding child's sociodemographic characteristics (i.e., gender, age, type of school, socioeconomic status, ethnicity), stressful events (i.e., adoption, parental divorce/separation, grade retention) and lifestyle (i.e., diet, sleep, screen time), along with the Child Behavior Checklist (CBCL). Academic performance was obtained from school records. The sample comprised 7036 students aged 5-17 with full data on the CBCL. Mixed-effects ordinal logistic regression analyses were conducted to investigate the association between psychopathology and academic achievement, controlling for potential confounders. When examined separately, higher scores on the CBCL scales were related to lower grades, regardless of sociodemographic factors. However, after controlling for the presence of other psychiatric symptoms, we found that students who reported more anxious/depressed and thought problems were less likely to perform poorly, while those with increased levels of attention problems and delinquent behavior had higher risk for academic underachievement. These associations remained mainly the same once stressful events and lifestyle were taken into account. This investigation demonstrates that anxious/depressed symptoms, thought problems, attention problems, and delinquent behavior are independently associated with academic performance, which emphasize the need for preventive and treatment interventions targeted at students' mental health to improve their psychological well-being and functioning at school.

Mental health needs in a large urban school district: Findings from a web-based survey

OBJECTIVE

To explore the mental health needs of students, and the professional development and support needs of teachers and school health professionals, as a way to foster community engagement and help set priorities for a comprehensive school mental health system in the Detroit Public Schools Community District (DPSCD).

SETTING

The study team surveyed all DPSCD staff in June 2019 and all students in grades 8-12 between October and December 2019.

STUDY DESIGN

A descriptive study based on anonymous, web-based surveys focused on student trauma exposure and mental health symptoms, student mental health resource utilization, staff burnout, and professional development needs.

DATA COLLECTION

All students (grades 8-12) and district staff were eligible to participate; the student survey was made available in six languages. Parents/guardians could opt children out; schools could exclude children unable to complete the survey independently. Student surveys were administered in school; staff surveys were sent via email.

PRINCIPAL FINDINGS

Thirty-four percent of DPSCD students reported moderate/severe depression symptoms; 22% had seriously considered suicide in the past year. Rates exceed national averages; 37% of students with severe depression and 34% of those with suicidal ideation had not accessed mental health supports. Staff indicated high levels of burnout and substantial interest in learning about self-care strategies or coping with vicarious trauma. Over 75% of teachers and school mental health professionals expressed interest in learning about best practices for supporting students impacted by trauma or mental illness.

CONCLUSIONS

A large number of DPSCD students are experiencing symptoms of depression and anxiety, and many students who need care are not accessing it. Addressing the mental health needs of students is a high priority for staff, but they need more training and support, as well as support for their own vicarious trauma and high levels of burnout.

The Contributing Role of Family, School, and Peer Supportive Relationships in Protecting the Mental Wellbeing of Children and Adolescents

Globally, mental disorders are the leading cause of disability in children and adolescents. Previous research has demonstrated that supportive relationships are a key protective factor against poor mental health in children, particularly amongst those who have experienced adversity. However, fewer studies have examined the relative impact of different types of supportive relationships. The current study examined the association between level of family adult support, school adult support, and school peer support and mental wellbeing in a sample of children (age 8-15 years, N = 2,074) from schools in the UK. All three sources of support were independently associated with mental wellbeing. Analyses demonstrated a graded relationship between the number of sources of support and the odds of low mental wellbeing (LMWB), reflecting a cumulative protective effect. While all three sources of support were best, it was not vital, and analyses demonstrated a protective effect of school sources of support on LMWB amongst children with low family support. Peer support was found to be particularly important, with prevalence of LMWB similar amongst children who had high peer support (but low family and school adult support), and those who had high family and school adult support, (but low peer support), indicating that high peer support has an equivalent impact of two other protective factors. Findings from the study highlight the crucial context schools provide in fostering positive peer relationships and supportive teacher-student relationships to promote mental health and resilience for all children, including both those with and without supportive home environments.

Sport Participation and Academic Performance in Children and Adolescents: A Systematic Review and Meta-analysis

INTRODUCTION

Physical activity can improve academic performance; however, much less is known about the specific association between sport participation and academic performance, and this evidence has not been synthesized. Our aim was to systematically review and combine via meta-analyses evidence of the association between sport participation and academic performance in children and adolescents.

METHODS

We conducted searches of five electronic databases using sport and academic performance related terms. We combined evidence from eligible studies using a structural equation modeling approach to multilevel meta-analysis.

RESULTS

From 115 eligible studies, most of which had a high risk of bias (k = 87), we meta-analyzed 298 effect sizes. Overall, sport participation had a small positive effect on academic performance (d = 0.26, 95% confidence interval = 0.09, 0.42). Moderator analyses indicated that sports participation was most beneficial for academic performance when it was at a moderate dose (i.e., 1-2 h·wk-1), compared with no sport or a high dose of sport (3+ h·wk-1).

CONCLUSIONS

Sports participation during school hours was more beneficial for academic performance compared with sport participation outside school hours. Based on mostly low-quality studies, we found some evidence that sport could positively affect academic performance in children and adolescents. It appears that sport participation of a moderate dose and at school could be used to promote academic performance. However, if this field were to inform policy, high-quality studies are needed that provide insight into the effect of dose and sport characteristics on academic performance.

A National Cross-Sectional Study of the Characteristics, Strengths, and Challenges of College Students With Attention Deficit Hyperactivity Disorder

Introduction: A substantial proportion of college students experience challenges transitioning from pediatrics to the adult healthcare system. Combined internal medicine and pediatrics (Med-Peds) providers are frequently tasked with facilitating this transition and promoting the health and well-being of this population. There is an increasing proportion of college students with Attention Deficit Hyperactivity Disorder (ADHD) in the U.S. This population experiences particularly pronounced challenges navigating the healthcare system and, as a result, often contends with fragmented healthcare. These issues are due to a range of factors, including lack of physician training, education, and resources, as well as a dearth of available research that can inform Med-Peds providers' efforts to support college students with ADHD.

Methods: The current study compared a nationally representative sample of U.S. college freshmen with ADHD to those without ADHD on health, academic, and non-academic capacities. This study analyzed population-weighted data from the Cooperative Institutional Research Program’s Freshman Survey.

Results: Students with ADHD were more likely to report co-occurring conditions and feelings of depression and overwhelm. They were less likely to report emotional health that was above average or in the highest 10^th percentile. Although they reported lower overall academic aspirations, they were more likely to rate themselves in the highest 10th percentile on a range of non-academic capacities.

Conclusion: The results from this study can inform efforts among Med-Peds providers seeking to promote the health and well-being of college students with ADHD.