Internalizing problems, externalizing problems, and prosocial behavior - three dimensions of the strengths and difficulties questionnaire (SDQ): A study among South African adolescents

Reallocating 24-hour movement behaviors and its impact on mental health in preschool children: a compositional data and dose-response analysis

BACKGROUND

Mental health issues in preschool children are a significant public health concern with long-term developmental implications. Understanding how reallocations of time among different 24-hour movement behaviors-moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior (SED), and sleep (SLP)-affect various dimensions of mental health is essential for designing effective interventions.

METHODS

In this cross-sectional study, 828 Chinese preschool children aged 3 to 6 years were assessed. Physical activity and sleep were objectively measured using accelerometers to capture MVPA, LPA, SED, and SLP. Mental health was evaluated using the Strengths and Difficulties Questionnaire (SDQ), assessing Total Difficulties, Internalizing Problems, Externalizing Problems, and Prosocial Behavior. Compositional data analysis was conducted using isometric log-ratio (ilr) transformation, followed by multivariate linear regression to assess associations. Additionally, isotemporal substitution modeling and dose-response analysis were applied to examine the effects of reallocating time between behaviors on mental health outcomes, adjusting for age, gender, BMI, parental education, and parental attitudes toward physical activity.

RESULTS

Increased MVPA was significantly associated with lower Total Difficulties (ßMVPA= - 1.587; P < 0.001) and Internalizing Problems (ßMVPA= - 0.663; P = 0.017). Increased SED was associated with higher Total Difficulties (ßSED= 1.512; P < 0.05), while increased SLP was linked to improved Externalizing Problems (ßLPA= - 1.792; P = 0.008). Reallocating as little as 1 min from LPA or SED to MVPA or SLP significantly reduced Total Difficulties and Internalizing Problems (P < 0.05). Conversely, replacing SED or SLP with LPA increased Externalizing Problems, particularly Conduct Problems and Hyperactivity/Inattention (P < 0.05). A critical threshold at 30 min was identified, beyond which the effects on mental health outcomes became more pronounced.

CONCLUSIONS

Reallocating time from LPA or SED to MVPA or SLP significantly improves Total Difficulties and Internalizing Problems in preschool children, even with brief substitutions. However, increasing LPA at the expense of SED or SLP exacerbates Externalizing Problems, especially Conduct Problems and Hyperactivity/Inattention. Interventions should promote MVPA and adequate sleep while considering the critical 30-minute threshold where effects become more pronounced to enhance emotional and behavioral well-being.

The mindful movement program in primary schools: a single-arm pilot intervention study

BACKGROUND

The early primary school years provide a unique opportunity for improving executive functions on a classroom-wide scale. While mindfulness, music, and movement have each demonstrated effectiveness in enhancing executive functions in early primary classrooms, no previous studies have integrated these modalities into a single program. The aim of this study was to assess the feasibility, acceptability, and preliminary impact of a novel program that combines mindfulness with movement to music: the Mindful Movement Program (MMP).

METHODS

This single-arm within-subjects study evaluated the feasibility of teachers delivering the MMP within the early primary years classroom setting. The program was integrated into the classroom curriculum and delivered across two school terms, to seven primary school classes, with a total of 133 students (mean age 6.61 years; standard deviation 0.90).

RESULTS

High rates of student recruitment (91%), and both student and teacher retention were obtained (98% and 100% respectively). Fidelity of implementation was moderate for core practices (68%) and video resource use (66%); and acceptability of the intervention high, despite teacher absences due to COVID-19 restrictions. Mixed-effects modelling showed that teacher-reported global executive functioning (b = -2.95, p < .001), externalising (b = -1.06, p < .001), and internalising (b = -0.52, p < .01) behaviour problems significantly reduced from baseline after receiving the intervention. A subset of students (n = 50) who were directly assessed on general motor skill and specific body coordination skills also showed significant improvements (p < .001) with medium to large effects.

CONCLUSIONS

This study demonstrated the feasibility and acceptability of a structured approach to movement and mindfulness developed by an experienced dance teacher, and delivered by teachers within the existing classroom setting. The program showed encouraging findings of improvement in a pre-post assessment. Further research is warranted to establish effectiveness in a controlled study design.

Migrant parent-child separation in the first three years of life and mental health problems at preschool age: A cross-sectional study

Background

Parent-child separation is one of the adverse childhood experiences, becoming more common due to economic migration worldwide today. However, there is a lack of understanding of the association between this separation during the critical first three years of life and the development of mental health issues in early childhood. This study aimed to determine the association of parent-child separation in the first three years and its specific patterns with mental health problems that emerged at preschool age.

Methods

We conducted a kindergarten-based parent-reported questionnaire survey in Nanling, Anhui Province, from October 30 to November 3, 2023. Data on parent-child separation in the first three years and its specific patterns concerning parental number, gender, accumulated separation period, and present separation status at preschool age were collected. The parent version of the Strengths and Difficulties Questionnaire (SDQ) was adopted to assess outcomes of interest, including children's total difficulties, internalizing problems, externalizing problems, and pro-social behaviors.

Results

A total of 7487 children from eighty-one kindergartens were included, with a mean (SD) age of 4.2 (0.92) years, and 52.3 % were male. After adjusting for socio-demographic characteristics, compared to non-separation, parent-child separation within the first three years was significantly and positively associated with preschool-aged children's internalizing problems (β = 0.19, [95 % CI, 0.10-0.28]), externalizing problems (β = 0.24, [95 % CI, 0.12- 0.35]), and total difficulties (β = 0.42, [95 % CI, 0.25-0.59]), but not with pro-social behavior. The associations were significant when separated from either one parent or both parents, whether the separation lasted for less than or more than three years in total, and whether the separation occurred previously or persisted into preschool age.

Conclusions

Our findings illustrated the association between early parent-child separation and developing mental health in early childhood, indicating potential opportunities for cost-efficient prevention and intervention for the health and development of vulnerable children separated in the highly mobile society to achieve sustainable development.

Interplay between Children's Electronic Media Use and Prosocial Behavior: The Chain Mediating Role of Parent-Child Closeness and Emotion Regulation

In the contemporary digital milieu, children's pervasive engagement with electronic media is ubiquitous in their daily lives, presenting complex implications for their socialization. Prosocial behavior, a cornerstone of social interaction and child development, is intricately intertwined with these digital experiences. This relation gains further depth, considering the significant roles of parent-child relationships and emotion regulation in shaping children's social trajectories. This study surveyed 701 families to examine the association between children's electronic media use and prosocial behavior, specifically exploring the mediating roles of parent-child closeness and emotion regulation. Structural equation modeling was employed for the analysis. Children's electronic media use negatively correlated with prosocial behavior, parent-child closeness, and emotion regulation. In contrast, a positive association emerged between parent-child closeness, emotion regulation, and prosocial behavior. Emotion regulation also correlated positively with prosocial behavior. Statistical analyses revealed that parent-child closeness and emotion regulation function as both individual and sequential mediators in the relation between electronic media use and prosocial behavior. The study's analyses reveal that fostering children's prosocial behavior in the digital era requires strong family ties, effective emotional management, and balanced digital exposure, which are pivotal for their comprehensive development.

A Shared Multivariate Brain-Behavior Relationship in a Transdiagnostic Sample of Adolescents

BACKGROUND

Internalizing and externalizing psychopathology typically present in early childhood and can have negative implications on general functioning and quality of life. Prior work has linked increased psychopathology symptoms with altered brain structure. Multivariate analysis such as partial least squares correlation can help identify patterns of covariation between brain regions and psychopathology symptoms. This study examined the relationship between gray matter volume (GMV) and psychopathology symptoms in adolescents with various psychiatric diagnoses.

METHODS

Structural magnetic resonance imaging data were collected from 490 participants with various internalizing and externalizing diagnoses (197 female/293 male; age = 14.68 ± 2.35 years; IQ = 104.05 ± 13.11). Cortical and subcortical volumes were parcellated using the Desikan-Killiany atlas. Partial least squares correlation was used to identify multivariate linear relationships between GMV and the Strength and Difficulties Questionnaire difficulties domains (emotional, peer, conduct, and hyperactivity issues). Resampling approaches were used to determine significance (permutation test), stability (bootstrap resampling), and reproducibility (split-half resampling) of identified relationships.

RESULTS

We found a significant, stable, and largely reproducible dimension that linked lower Strength and Difficulties Questionnaire scores (less impairment) across all difficulties domains with greater widespread GMV (singular value = 1.17, accounts for 87.1% of the covariance; p < .001). This dimension emphasized the relationship between lower conduct problems and greater GMV in frontotemporal regions.

CONCLUSIONS

Our results indicate that the most significant and stable brain-behavior relationship in a transdiagnostic sample is a domain-general relationship, linking lower psychopathology symptom scores to greater global GMV. This finding suggests that a shared brain-behavior relationship may be present across adolescents with and without clinically significant psychopathology symptoms.

Examining the relationship between meeting 24-hour movement behaviour guidelines and mental health in Chinese preschool children

Background

Limited research has explored the relationship between adhering to 24-h Movement Behaviour guidelines and mental health in Chinese preschool children. The objectives of this study encompassed two primary goals: (1) to investigate the adherence of preschool children in China to the 24-h Movement Behaviour guidelines; and (2) to analyze the relationship between fulfilling various combinations of these guidelines and mental health, identifying the most advantageous combination.

Methods

Utilizing a convenience sampling approach, this study included 205 preschool children (117 boys and 88 girls, average age 4.8 ± 0.51 years) from five kindergartens in Hengyang, Hunan Province. The physical activity (PA) and sedentary behaviour of preschool children were objectively assessed using waist-worn accelerometers, while sleep duration and screen time were reported by the children's parents. To evaluate mental health, the parent version of the internationally validated Strength and Difficulties Questionnaire (SDQ) was employed, which measures externalizing problems, internalizing problems, and prosocial behaviour. Employing Mplus 8.0 for Structural Equation Modeling analysis, while controlling for demographic variables, the study explored the connection between preschool children's mental health and their adherence to the 24-h Movement Behaviour guidelines.

Results

Worryingly, merely 14.6% of preschoolers met the recommended guidelines for all three aspects (PA, sleep duration, and screen time). Positive correlations were identified between meeting PA guidelines and displaying prosocial behaviour (β = 0.184; p < 0.05), while screen time adherence exhibited a negative correlation with externalizing problems (β = -0.207; p < 0.05). Similarly, there was a negative association between sleep duration adherence and externalizing problems (β = -0.191; p < 0.05). Meeting all three recommended guidelines was notably linked to enhanced prosocial behaviour (β = 0.464; p < 0.05), while following the screen time and sleep duration guidelines was negatively associated with externalizing problems (β = -0.246; p < 0.05).

Conclusion

This study underscores the limited adherence of Chinese preschoolers to the comprehensive 24-h Movement Behaviour guidelines. Noteworthy findings include the positive influence of PA on prosocial behaviour, alongside the significant roles that sleep duration and screen time play in mitigating externalizing problems within this age group. Alignment with the 24-h Movement Behaviour guidelines is associated with more favorable mental health indicators in preschoolers.

Isotemporal substitution effect of 24-hour movement behavior on the mental health of Chinese preschool children

The 24-h movement behavior of preschoolers comprises a spectrum of activities, including moderate-to-vigorous intensity physical activity (MVPA), light-intensity physical activity (LPA), screen-based sedentary behavior (SCSB), non-screen-based sedentary behavior (NSCSB), and sleep. While previous research has shed light on the link between movement behaviors and children's mental health, the specific impacts on the unique demographic of Chinese preschoolers remain underexplored. This study significantly contributes to the literature by exploring how 24-h movement behavior affects the mental health of preschoolers in a Chinese context. The study involved205 Chinese preschool children (117 boys and 88 girls) between the ages of 3 and 6 years wore accelerometers to measure their LPA, MVPA, and sedentary behavior (SB), while their parents reported the time spent on sleep and SCSB. The parents also completed the Strength and Difficulties Questionnaire to assess their children's mental health. The study used compositional regression and isotemporal substitution models to examine the relationship between the various components of 24-h movement behavior and mental health. The results showed that greater NCSSB compared to MVPA, LPA, sleep, and SCSB was associated with good prosocial behavior and lower scores on externalizing problems. This highlights the potential of NSCSB as a beneficial component in the daily routine of preschoolers for fostering mental well-being. Replacing 15 min of sleep and SCSB with 15 min of NSCSB was associated with a decrease of 0.24 and 0.15 units, respectively, in externalizing problems. Reallocating 15 min of sleep to NSCSB was linked to an increase of 0.11 units in prosocial behavior. There were no significant substitution effects between LPA and MVPA time with any other movement behavior on prosocial behavior and externalizing problems. Given the positive associations observed, further longitudinal studies are necessary to explore the link between 24-h movement behavior and mental health in preschool children.

Relationship between physical activity and behaviour challenges of adolescents in South Africa

Background

Four out of five adolescents worldwide are physically inactive based on recommended standards.

Aim

We determined whether physical activity is associated with lower behavioural challenges in adolescents to promote buy-in from stakeholders.

Setting

KwaZulu-Natal province, South Africa, from January 2020 to March 2020.

Methods

A cross-sectional study was conducted among 187 adolescent learners (12-18 years) from three government schools in KwaZulu-Natal Province, South Africa, from January to March 2020. We fitted linear regression models between the Strengths and Difficulties Questionnaire scores (total, internalising, externalising, and prosocial) and hours of physical activity exposure, adjusting for demographic covariates, and depression history.

Results

The median age was 14.4 years (interquartile range = 1.36) and 75.9% of the participants were females. Overall average and weekday physical activity were each associated with lower total and externalising but higher pro-social scores. Depression was associated with higher inactivity scores (total, internalising and externalising).

Conclusions

The article shows that physical activity can reduce the behavioural and emotional problems in adolescents.

Contribution

Physical activity is critical for a healthy adolescent hood and needs to be actively included in childhood development.

The mental health rewards of interpersonal strengths: kindness and social intelligence are linked to lower internalizing and externalizing problems in Chinese children with autism spectrum disorders

Past studies show that character strengths matter for well-being outcomes in typically developing students. However, there is scarce evidence on the psychological benefits of these strengths among students with autism spectrum disorders (ASD). This study aims to examine the associations of humanity-oriented character strengths (i.e. social intelligence, love, and kindness) with internalizing and externalizing problems among children with ASD. 304 caregivers of children with ASD (72.7% boys) completed a survey on demographic information, humanity-oriented character strengths, parental awareness of child's emotions, internalizing and externalizing problems, and repetitive behaviors. Results of structural equation modeling demonstrated that when controlling for the effects of other strengths and covariates (e.g. repetitive behaviors and parental awareness of child's emotions), social intelligence and kindness negatively predicted internalizing behaviors while social intelligence negatively predicted externalizing problems. This study corroborates existing evidence on the psychological rewards associated with humanity-oriented character strengths among individuals with ASD.

Association between Electronic Media Use and Internalizing Problems: The Mediating Effect of Parent-Child Conflict and Moderating Effect of Children's Age

In today's digital world, children are exposed extensively to electronic media, making it an integral part of their daily lives. However, excessive use of electronic media during childhood has been associated with various internalizing problems. Moreover, parent-child conflict and children's age may be closely associated with children's problem behaviors. The current study employed a cross-sectional design and conducted a questionnaire survey of 711 parents to examine the association between children's electronic media use and their internalizing problems. Furthermore, this study probed the mediating role of parent-child conflict within this association and the moderating effect of children's age. The results of structural equation modeling showed a positive correlation between children's use of electronic media and their internalizing difficulties. Parent-child conflict served as a mediating factor in this association. Results also showed that the association between parent-child conflict and internalizing problems becomes more pronounced as children grow older. These findings imply that parents should encourage their children to develop healthy habits in using electronic media while fostering positive relationships. Parents should also be mindful of the psychological changes as children age and provide guidance to help them become proficient digital citizens.

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis

Background

Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis).

Methods

The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8–26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety.

Results

Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class.

Conclusions

Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood.