Effect of socioeconomic status on behavioral problems from preschool to early elementary school - A Japanese longitudinal study

(Not So) Lost in Translation: Considering the GA4GH Diversity in Datasets Policy in the Japanese Context

The genomics community has long acknowledged the lack of diversity in datasets used for research, prompting various stakeholders to confront this issue. In response, the Global Alliance for Genomics and Health (GA4GH) formulated a policy framework that recognizes the multiplicity of perspectives on diversity and proposed a systemic approach for more optimal data diversity. Given the importance of the research context, assessing this policy's applicability within countries where diversity is less discussed is important. This study investigated the feasibility of implementing the GA4GH policy in Japan, a nation with a smaller genetic diversity than many Western countries. As the proportion of East Asian genomic research is limited internationally, focusing on the Japanese genome contributes to enhancing diversity. Meanwhile, labelling findings as "Japanese" can inadvertently reinforce perceptions of homogeneity and overlook ethnic minorities. Regions and socioeconomic status are also recognized as substantial factors of diversity within academia, yet concerns persist among the public regarding the heritability of stigmatized conditions. Social inclusion of sexual minorities has begun in Japan, but research surveys generally still use binary sex and gender categories, which underscores the need for additional variables. This study found that both academia and the public need to confront the overemphasis on homogeneity within Japanese society and hesitancy in addressing genetic factors. By doing so, more inclusive and diverse datasets can advance the field both ethically and scientifically. Perhaps the most important impact of the GA4GH policy will be to draw greater attention to the complex diversity challenges ahead in Japan.

Helping the Noncompliant Child and Child Behavior Outcomes: An Exploratory Examination of Financial Strain

Theoretical models and empirical research have highlighted the impact of economic disadvantage on children's psychosocial development broadly and the onset, maintenance, and treatment of early-onset (3-8 years) behavior disorders (BDs) more specifically. In the context of intervention, evidence suggests that economic disadvantage may pose risk for diminished parent-mediated treatment efficacy (e.g., Behavioral Parent Training [BPT]) given its impact on salient factors in the family system. Though, studies have shown significant variability in BPT outcomes within families experiencing economic disadvantage, suggesting that additional influences may further contribute to disparities in the trajectory of treatment and maintenance of treatment gains for this population. To address this gap in existing knowledge, financial strain, or the inability to meet financial needs, was examined in families (N = 54) of young children (3-8 years old) with low-income and clinically elevated behavior problems participating in one BPT program, Helping the Noncompliant Child (HNC). Results demonstrated that families who experienced greater levels of financial strain prior to engaging in HNC exhibited diminished maintenance of parent reported child behavior gains following treatment. Financial strain did not significantly influence rate of change or maintenance of treatment gains for HNC clinician-coded child compliance. Clinical implications and directions for future research are discussed. ClinicalTrials.gov Identifier: NCT02191956, registered on 6/18/2014.

Early onset and increasing disparities in neurodevelopmental delays from birth to age 6 in children from low socioeconomic backgrounds

OBJECTIVE

To analyze the complex relationship between socioeconomic status (SES) and neurodevelopmental achievements by investigating the temporal dynamics of these associations from birth to age 6.

METHODS

This retrospective cohort study was conducted over 6 years using population-based data from the National Health Insurance Service and integrated data from the National Health Screening Program for Infants and Children. Participants were children born between 2009 and 2011 in Korea without neurodevelopmental delays with potential developmental implications. We analyzed results from the Korean Developmental Screening Test, administered at age 6, which covered overall assessment and six domains of gross and fine motor function, cognition, language, sociality, and self-care. The secondary outcome was to determine when neurodevelopmental outcomes began after birth and how these differences changed over time.

RESULTS

Of 276,167 individuals (49.2% males), 66,325, 138,980, and 60,862 had low, intermediate, and high SES, respectively. Neurodevelopmental delays observed across all developmental domains were more prevalent in the low-SES group than in the high-SES group. Disparities in neurodevelopment according to these statuses were apparent as early as age 2 and tended to increase over time (interaction, P < 0.001). The cognition and language domains exhibited the most substantial disparities between SES levels. These disparities persisted in subgroup analyses of sex, birthweight, head circumference, birth data, and breastfeeding variables.

CONCLUSIONS

Low SES was significantly associated with an increased risk of adverse neurodevelopmental outcomes in preschool children, particularly those affecting cognitive and language domains. These differences manifested in early childhood and widened over time.

Negative family expressiveness and adolescents' externalizing problems: Respiratory sinus arrhythmia as a moderator and anger regulation as a mediator

Family environment, emotion regulation and biological sensitivity have been shown to be associated with adolescents' externalizing problem behaviours. However, findings regarding respiratory sinus arrhythmia (RSA) reactivity are mixed and sometimes contradictory. This study aims to clarify the roles of RSA reactivity and anger regulation in the relationship between negative family expressiveness (NFE) and adolescents' externalizing behaviour by measuring RSA reactivity during the Parent-Adolescent Interaction Task (PAIT), designed to simulate a naturalistic negative family environment. In this study, 125 Chinese adolescents (M = 13.95 years, SD = 0.95; 48% male) completed questionnaires assessing negative family expressiveness, anger regulation and externalizing problems. Additionally, we collected electrocardiogram and respiration data during both the resting period and a 10-min PAIT. Results showed that anger regulation mediated the relationship between NFE and externalizing problem behaviours. Moreover, adolescents' RSA reactivity moderated this mediation effect, even after controlling for baseline RSA. Greater RSA suppression potentially indicated greater susceptibility, with the relationship between NFE and anger regulation being more pronounced in adolescents with greater RSA suppression compared to those with lesser RSA suppression. These findings highlight the importance of considering physiological systems, especially within the context of adverse family environments, when studying the relationships with externalizing problems.

A PERMA model approach to well-being: a psychometric properties study

Psychological well-being influences all the facets of adolescent success. This study examined the psychometric properties of PERMA, a subjective well-being measure consisting of five domains: positive emotions, engagement, relationships, meaning, and accomplishment. The sample size consisted of 502 high school students from public schools in Qatar. Contrary to expectations, the five-factor structure for PERMA did not fit our data well; however, after refining the model by the errors of the covariances between items, the one-factor model was found to be applicable. Multivariate analysis revealed that socioeconomic status (SES) and level of academic performance were independently and positively associated with overall well-being scores, whereas internalizing and externalizing behaviors were negatively associated. Notably, no significant effects of gender or age on well-being were observed. These findings suggest that interventions specific to socioeconomic status, academic excellence, and internalizing and externalizing behaviors in the school setting can produce more effective outcomes concerning student well-being.

The Effects of Breastfeeding on Childhood Behavioral and Emotional Development: A Prospective Cohort Study in China

BACKGROUND

Breastfeeding could improve a child's health early on, but its long-term effects on childhood behavioral and emotional development remain inconclusive. We aimed to estimate the associations of feeding practice with childhood behavioral and emotional development.

METHODS

In this population-based birth cohort study, data on feeding patterns for the first 6 mo of life, the duration of breastfeeding, and children's emotional and behavioral outcomes were prospectively collected from 2489 mother-child dyads. Feeding patterns for the first 6 mo included exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF, including mixed feeding or formula feeding), and the duration of breastfeeding (EBF or mixed feeding) was categorized into ≤6 mo, 7-12 mo, 13-18 mo, and >18 mo. Externalizing problems and internalizing problems were assessed with the Child Behavior Checklist (CBCL) and operationalized according to recommended clinical cutoffs, corresponding to T scores ≥64. Multivariable linear regression and logistic regression were used to evaluate the association of feeding practice with CBCL outcomes.

RESULTS

The median (interquartile range) age of children at the outcome measurement was 32.0 (17.0) mo. Compared with non-EBF for the first 6 mo, EBF was associated with a lower T score of internalizing problems [adjusted mean difference (aMD): -1.31; 95% confidence interval (95% CI): -2.53, -0.10], and it was marginally associated with T scores of externalizing problems (aMD: -0.88; 95% CI: -1.92, 0.15). When dichotomized, EBF versus non-EBF was associated with a lower risk of externalizing problems (aOR: 0.54, 95% CI: 0.34, 0.87), and it was marginally associated with internalizing problems (aOR: 0.75, 95% CI: 0.54, 1.06). Regarding the duration of breastfeeding, breastfeeding for 13-18 mo versus ≤6 mo was associated with lower T scores of internalizing problems (aMD: -2.50; 95% CI: -4.43, -0.56) and externalizing problems (aMD: -2.75; 95% CI: -4.40, -1.10), and breastfeeding for >18 mo versus ≤6 mo was associated with lower T scores of externalizing problems (aMD: -1.88; 95% CI: -3.68, -0.08). When dichotomized, breastfeeding for periods of 7-12 mo, 13-18 mo, and >18 mo was associated with lower risks of externalizing problems [aOR (95% CI): 0.96 (0.92, 0.99), 0.94 (0.91, 0.98), 0.96 (0.92, 0.99), respectively].

CONCLUSIONS

Exclusive breastfeeding for the first 6 mo and a longer duration of breastfeeding, exclusively or partially, are beneficial for childhood behavioral and emotional development.

Childhood behavioral problems are associated with the intergenerational transmission of low education: a 16-year population-based study

The intergenerational transmission of low educational attainment is well-documented, but little is known about how behavioral problems in childhood explain this association. Drawing upon a population-based cohort study (n = 3020) linked to administrative records, we investigated the extent to which inattentive, internalizing, externalizing, and prosocial behaviors at child ages 6-8 years accounted for associations between parental education and child's risk of failing to graduate from high school. We adjusted for economic, demographic, cognitive, and perinatal factors, as well as parental mental health. Using logistic regressions and the Karlson-Holm-Breen decomposition method, we found that childhood behaviors together explained 19.5% of the association between mother's education and child's high school graduation status at age 22/23, and 13.7% of the association between father's education and this same outcome. Inattentive behaviors were most strongly associated with failure to graduate from high school, while the role of other behaviors was modest or negligible. Inattentive behaviors may represent a mediational pathway between parental education and child education. Early interventions targeting inattentive behaviors could potentially enhance the prospects of intergenerational educational mobility.

Developmental delay and its demographic and social predictors among preschool-age children in Palestine

PURPOSE

This study was designed to assess the developmental outcomes among preschool-aged children and its associated factors in Palestine.

METHODS

A cross-sectional, descriptive-correlational design involved a representative sample of preschool-aged children from kindergarten in Ramallah governorate. Data were collected using the Ages and Stages Questionnaire, Arabic version-3. Associations between developmental delay (DD), parent, child and family characteristics were analyzed utilizing SPSS-25 version.

RESULTS

A total of 249 preschoolers participated in the study. The overall rate of children with Global Developmental Delay (GDD) was 23.7%. The most prevalent DD were in gross motor, personal social, and fine motor skills (25.3%, 17.7%, and 16.5%, respectively). Binary logistic regression analysis revealed that the male gender of a child (OR = 2.66, 95% CI [1.37, 5.19]), the mother's part-time work (OR = 6.01, 95% CI [1.68, 21.52]), low family income (OR = 3.67, 95% CI [1.05, 12.73]), and families with three or more children (OR = 1.43, 95% CI [1.15, 1.781]) were statistically significant independent predictors of GDD.

CONCLUSION

The study findings revealed higher rate of DD among preschoolers in Palestine than regional areas, especially in gross motor, fine motor, and personal social skills, which has consequences for both national and global health. According to the results, factors related to the child, the mother and the family are associated with the cumulative risk of preschoolers having DD.

IMPLICATIONS

It is a crucial role for pediatric nurses to detect DD early and its related risk factors through screening programs to limit the burden of problems in childhood and later adulthood.

Maternal adverse childhood experiences and behavioral problems in preschool offspring: the mediation role of parenting styles

BACKGROUND

Maternal history of adverse childhood experiences (ACEs) has been found to be associated with children's health outcomes. However, the underlying mechanisms were unclear. This study aimed to examine the association between maternal ACEs and behavioral problems in their preschool offspring and to explore the potential mediating role of maternal parenting styles in the association.

METHODS

A cross-sectional study was conducted involving 4243 mother-child dyads in Chengdu, China. Mothers completed the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) to assess their history of ACEs (i.e., physical abuse, emotional abuse, physical neglect, emotional neglect, witnessing domestic violence, household substance abuse, household mental illness, incarcerated household member, parental separation or divorce, parental death, bullying, and community violence), the short Egna Minnen Beträffande Uppfostran Parent Form (S-EMBU-P) to evaluate their parenting styles (i.e., emotional warmth, rejection, and overprotection), and the 48-item Conners' Parent Rating Scale (CPRS-48) to measure behavioral problems in their children. Logistic regression models were established to examine the association between cumulative number of maternal ACEs and children's behavioral problems. The mediating role of parenting styles in this association was explored by generalized structural equation models (GSEM).

RESULTS

Of the participating mothers, 85.8% (n = 3641) reported having experienced at least one type of ACE. Children of mothers with ≥2 ACEs showed a significantly increased risk of behavioral problems across all dimensions, including conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive, anxiety, and hyperactivity index, in both crude and adjusted models (all p-values < 0.05). Dose-response patterns were also observed between the cumulative number of maternal ACEs and children's behavioral problems. In addition, maternal parenting styles of rejection emerged as a significant mediator, accounting for approximately 8.4-15.0% of the associations.

CONCLUSIONS

Our findings indicated an intergenerational association of maternal ACEs with behavioral problems in preschool offspring, which was mediated by maternal parenting styles of rejection. Early screening and targeted intervention strategies are critical to mitigate the downstream consequences of maternal ACEs on young children's outcomes. Providing support and resources to improve parenting skills may prove beneficial.

Effect of applying the health promotion model in stunting prevention and behavior control in Indonesia

BACKGROUND

Stunting is a condition of failure to thrive in children, due to chronic malnutrition and recurrent infections. This study aimed to evaluate the effectiveness of implementing the health promotion model in stunting prevention and control behavior.

MATERIALS AND METHODS

This cross-sectional quantitative analytic study was conducted using a survey method involving 228 mothers of stunted children in Indonesia. Cluster random sampling was used. Data were collected using a questionnaire with a Likert scale, and then, they were analyzed using univariate analysis, multiple linear regression, and pathway analysis to determine the direct and indirect effects.

RESULTS

All respondents were of non-risk age (20-45 years), most had height >150 cm (83.8%), moderate weight (93.4%), multigravida parity (87.3%), middle education (70.2%), unemployed (91.7%), monthly income of less than 1,800,000 rupiahs (89.9%), and exclusive breastfeeding (97.4%). Sanitation, self-efficacy, and social support had a significant effect on stunting prevention and control behavior (P < 0.05). Socioeconomic and sanitation effects through self-efficacy indirectly had a significant positive, while parenting through food or nutritional intake had a significant influence on the stunting incidence (P < 0.05). Variables that had a significant positive effect on stunting prevention and behavior directly were perceived vulnerability, perceived severity, perceived obstacles, self-efficacy, social support, community organizing, and facilitator (P < 0.05). Parenting through the health of diarrhea or acute respiratory infection (ARI) had no significant positive effect on the stunting incidence (P = 0.121).

CONCLUSION

Almost all variables have a significant direct and indirect effect on stunting prevention and control behavior, as well as the stunting incidence, except parenting through the health of diarrhea or ARI.

Maternal weight, gut microbiota, and the association with early childhood behavior: the PREOBE follow-up study

BACKGROUND AND AIM

Maternal overweight and breastfeeding seem to have a significant impact on the gut microbiota colonization process, which co-occurs simultaneously with brain development and the establishment of the "microbiota-gut-brain axis", which potentially may affect behavior later in life. This study aimed to examine the influence of maternal overweight, obesity and/or gestational diabetes on the offspring behavior at 3.5 years of age and its association with the gut microbiota already established at 18 months of life.

METHODS

156 children born to overweight (OV, n = 45), obese (OB, n = 40) and normoweight (NW, n = 71) pregnant women participating in the PREOBE study were included in the current analysis. Stool samples were collected at 18 months of life and gut microbiome was obtained by 16S rRNA gene sequencing. Behavioral problems were evaluated at 3.5 years by using the Child Behavior Checklist (CBCL). ANOVA, Chi-Square Test, ANCOVA, Spearman's correlation, logistic regression model and generalized linear model (GLM) were performed.

RESULTS

At 3.5 years of age, Children born to OV/OB mothers showed higher scores in behavioral problems than those born to NW mothers. Additionally, offspring born to OB mothers who developed gestational diabetes mellitus (GDM) presented higher scores in attention/deficit hyperactivity and externalizing problems than those born to GDM OV/NW mothers. Fusicatenibacter abundance found at 18 months of age was associated to lower scores in total, internalizing and pervasive developmental problems, while an unidentified genus within Clostridiales and Flavonifractor families abundance showed a positive correlation with anxiety/depression and somatic complaints, respectively. On the other hand, children born to mothers with higher BMI who were breastfed presented elevated anxiety, internalizing problems, externalizing problems and total problems scores; likewise, their gut microbiota composition at 18 months of age showed positive correlation with behavioral problems at 3.5 years: Actinobacteria abundance and somatic complaints and between Fusobacteria abundance and withdrawn behavior and pervasive developmental problems.

CONCLUSIONS

Our findings suggests that OV/OB and/or GDM during pregnancy is associated with higher behavioral problems scores in children at 3.5 years old. Additionally, associations between early life gut microbiota composition and later mental health in children was also found.

Socioeconomic changes predict genome-wide DNA methylation in childhood

Childhood socioeconomic position (SEP) is a major determinant of health and well-being across the entire life course. To effectively prevent and reduce health risks related to SEP, it is critical to better understand when and under what circumstances socioeconomic adversity shapes biological processes. DNA methylation (DNAm) is one such mechanism for how early life adversity 'gets under the skin'. In this study, we evaluated the dynamic relationship between SEP and DNAm across childhood using data from 946 mother-child pairs in the Avon Longitudinal Study of Parents and Children. We assessed six SEP indicators spanning financial, occupational and residential domains during very early childhood (ages 0-2), early childhood (ages 3-5) and middle childhood (ages 6-7). Epigenome-wide DNAm was measured at 412 956 cytosine-guanines (CpGs) from peripheral blood at age 7. Using an innovative two-stage structured life-course modeling approach, we tested three life-course hypotheses for how SEP shapes DNAm profiles-accumulation, sensitive period and mobility. We showed that changes in the socioeconomic environment were associated with the greatest differences in DNAm, and that middle childhood may be a potential sensitive period when socioeconomic instability is especially important in shaping DNAm. Top SEP-related DNAm CpGs were overrepresented in genes involved in pathways important for neural development, immune function and metabolic processes. Our findings highlight the importance of socioeconomic stability during childhood and if replicated, may emphasize the need for public programs to help children and families experiencing socioeconomic instability and other forms of socioeconomic adversity.

Sociodemographic and clinical characteristics of children with tic disorders and behavioral problems: A real-world study and development of a prediction model

BACKGROUND

Tic disorders (TD) are complex neuropsychiatric disorders frequently associated with a variety of comorbid problems, whose negative effects may exceed those of the tics themselves. In this study, we aimed to explore the sociodemographic and clinical characteristics of children with TD and behavioral problems, and develop a prediction model of behavioral problems based on the predictors under real-world conditions.

METHODS

A hospital-based cross-sectional study was conducted on children with TD. Behavioral problems were surveyed using the Achenbach Child Behavior Checklist (CBCL). Sociodemographic information was collected from face-to-face interviews using an electronic questionnaire administered during the initial ambulatory visit. Clinical data were collected from medical records, and quality control was performed. The sociodemographic and clinical characteristics of patients with and without behavioral problems were statistically compared, and a nomogram prediction model was developed based on multivariate logistic regression analysis. The discriminatory ability and clinical utility of the nomogram were assessed by concordance index (C-index), receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and clinical impact curve (CIC).

RESULTS

A total of 343 TD cases were included in the final analysis, of which 30.32% had behavioral problems. The prediction model showed age 12-16 years, abnormal birth history, parenting pattern of indulgence, parent/close relatives with psychiatric disorders, chronic motor or vocal tic disorder (CTD)/Tourette syndrome (TS) and moderate/severe tic severity were associated with behavioral problems in children with TD. The C-index of the prediction model (nomogram) was 0.763 (95% confidence interval, 0.710 ~ 0.816). The nomogram was feasible for making beneficial clinical decisions, according to the satisfactory results of the DCA and CIC.

CONCLUSIONS

A nomogram prediction model for comorbid behavioral problems in children with TD was established. The prediction model demonstrated a good discriminative ability and predictive performance for beneficial clinical decisions. This model further provides a comprehensive understanding of associated sociodemographic and clinical characteristics by visual graphs and allows clinicians to rapidly identify patients with a higher risk of behavioral problems and tailor necessary interventions to improve clinical outcomes.

Behavioral outcome of very preterm children at 5 years of age: Prognostic utility of brain tissue volumes at term-equivalent-age, perinatal, and environmental factors

OBJECTIVE

Prematurity is associated with a high risk of long-term behavioral problems. This study aimed to assess the prognostic utility of volumetric brain data at term-equivalent-age (TEA), clinical perinatal factors, and parental social economic risk in the prediction of the behavioral outcome at 5 years in a cohort of very preterm infants (VPT, <32 gestational weeks).

METHODS

T2-weighted magnetic resonance brain images of 80 VPT children were acquired at TEA and automatically segmented into cortical gray matter, deep subcortical gray matter, white matter (WM), cerebellum (CB), and cerebrospinal fluid. The gray matter structure of the amygdala was manually segmented. Children were examined at 5 years of age with a behavioral assessment, using the strengths and difficulties questionnaire (SDQ). The utility of brain volumes at TEA, perinatal factors, and social economic risk for the prediction of behavioral outcome was investigated using support vector machine classifiers and permutation feature importance.

RESULTS

The predictive modeling of the volumetric data showed that WM, amygdala, and CB volumes were the best predictors of the SDQ emotional symptoms score. Among the perinatal factors, sex, sepsis, and bronchopulmonary dysplasia were the best predictors of the hyperactivity/inattention score. When combining the social economic risk with volumetric and perinatal factors, we were able to accurately predict the emotional symptoms score. Finally, social economic risk was positively correlated with the scores of conduct problems and peer problems.

CONCLUSIONS

This study provides information on the relation between brain structure at TEA and clinical perinatal factors with behavioral outcome at age 5 years in VPT children. Nevertheless, the overall predictive power of our models is relatively modest, and further research is needed to identify factors associated with subsequent behavioral problems in this population.

Cross-sectional investigation of quality of life determinants among children with tic disorders: The roles of family environmental and clinical factors

Objective

To examine the association between family environmental and clinical factors with the whole range of quality of life (QOL) in children with tic disorders (TD).

Methods

A hospital-based cross-sectional study was conducted among children with TD. All participants were given a family environmental survey and scale evaluations with Yale Global Tic Severity Scale (YGTSS), Achenbach Child Behavior Checklist (CBCL) and PedsQL-Generic Core Scale of the Chinese Version (PedsQL). Variable selection and data analysis was done by the least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression analysis.

Results

A total of 363 TD cases were included in the analysis. YGTSS scores, total CBCL score had significant negative correlations with PedsQL scores (P < 0.05). Of the total 15 factors, 8, 6, 11, 7, 5, 10 potential predictors with nonzero coefficients were identified by LASSO regression models of physical functioning, emotional functioning, social functioning, school functioning, social-psychological domain and PedsQL total scale respectively. Results of multivariate logistic regression analysis showed older age (physical functioning, ORs: 1.77, 3.67; total scale: ORs: 1.73, 2.28), no presence of chronic conditions (school functioning, OR: 1.61), moderate/severe tic severity (physical functioning, OR: 0.57; social functioning, OR: 0.44; social-psychological domain, OR: 0.57), co-morbid behavioral problems (physical functioning, OR: 0.52; emotional functioning, OR: 0.31; social functioning, OR: 0.30; school functioning, OR: 0.35; social-psychological domain, OR: 0.34; total scale, OR: 0.30), no fully parental involvement in care (physical functioning, OR: 0.62), higher paternal (physical functioning, ORs: 2.89, 2.07) and maternal education level (social functioning, ORs: 1.74, 2.03), democratic parenting pattern (emotional functioning, OR: 1.89; social functioning, OR: 2.17; social-psychological domain, OR: 2.33; total scale, OR: 2.11) and inharmony family relationship (emotional functioning, OR: 0.47; total scale, OR: 0.50) were the most important determinants to QOL of TD.

Conclusions

This study identifies several QOL determinants among children with TD. Clinicians should be encouraged to screen for family environmental and clinical factors in TD patients, and take tailored interventions to help TD children improve their QOL.

Association between parental occupations, educational levels, and household income and children's psychological adjustment in Japan

OBJECTIVES

Most research on the association between parental or family socio-economic status and psychological adjustment in children has been performed mainly in Western countries, while there is limited evidence of such research in Asian countries. We examined the association of parental occupation and educational levels and household income with children's psychological adjustment in Japan.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Study subjects were 6329 children aged 3 years. Children's psychological adjustment was assessed using the Strengths and Difficulties Questionnaire.

RESULTS

Compared with having an unemployed father, having a father who worked in an administrative and managerial or clerical job was associated with a lower prevalence of peer problems. Compared with having an unemployed mother, having a mother who worked in the professional and engineering, sales, service, or manufacturing process area was associated with a lower prevalence of low prosocial behaviors, whereas having a mother who worked in the clerical, service, or manufacturing process area was associated with an increased prevalence of emotional problems. Having a mother who worked in a clerical area was associated with a higher prevalence of conduct problems. Higher paternal and maternal educational levels were inversely associated with the prevalence of conduct problems and hyperactivity but were positively associated with low prosocial behaviors. A higher household income was inversely associated with the prevalence of emotional problems, conduct problems, and hyperactivity.

CONCLUSION

Parental occupation, educational levels, and household income may affect children's psychological adjustment in Japan.

Financial stress during COVID-19: implications for parenting behaviour and child well-being

BACKGROUND

Family financial stress and parenting behaviours are each associated with child behaviours. We sought to explore the association between parent financial stress and child socioemotional and behavioural difficulties during the COVID-19 pandemic and examine parenting behaviour, including overreactive and lax parenting approaches, as a potential mediator to this relationship.

METHODS

Cross-sectional sample of parent and child data pairings in Ontario, Canada between April and November of 2020. Linear models were used to describe the relationships between financial worry, child Strengths and Difficulties Questionnaire (SDQ) total difficulties and parenting behaviours measured by the Parenting Scale 8-item (PS-8), which includes measures of both overreactive and lax parenting tendencies. Formal mediation testing was performed to assess the potential mediating role of parenting behaviour.

RESULTS

528 parent and child pairs were enrolled from largely European ancestry (78%), female (93%) and varied household income levels. Analysis revealed increased financial worry during the COVID-19 pandemic was significantly associated with increased child SDQ total difficulties scores (β=0.23, SE=0.10, p=0.03). This relationship was mediated by reported parenting behaviour, independent of parent education, household income, parent age, parent sex, parent anxiety and child sex (total effect: β=0.69, p=0.02, average causal mediation effects: β=0.50, p=0.02, average direct effects: β=0.19, p=0.08).

CONCLUSION

Financial stress during the COVID-19 pandemic was associated with poorer child social and emotional well-being. Parenting behaviours measured by the PS-8 significantly mediated these effects. This work supports the importance of policies aimed to alleviate family financial stresses and highlights the potential impact such policies have on child well-being.

Early Prediction of At-Risk Students in Secondary Education: A Countrywide K-12 Learning Analytics Initiative in Uruguay

This paper describes a nationwide learning analytics initiative in Uruguay focused on the future implementation of governmental policies to mitigate student retention and dropouts in secondary education. For this, data from a total of 258,440 students were used to generate automated models to predict students at risk of failure or dropping out. Data were collected from primary and secondary education from different sources and for the period between 2015 and 2020. Such data contains demographic information about the students and their trajectories from the first grade of primary school to the second grade of secondary school (e.g., student assessments in different subjects over the years, the amount of absences, participation in social welfare programs, and the zone of the school, among other factors). Predictive models using the random forest algorithm were trained, and their performances were evaluated with F1-Macro and AUROC measures. The models were planned to be applied in different periods of the school year for the regular secondary school and for the technical secondary school ((before the beginning of the school year and after the first evaluation meeting for each grade). A total of eight predictive models were developed considering this temporal approach, and after an analysis of bias considering three protected attributes (gender, school zone, and social welfare program participation), seven of them were approved to be used for prediction. The models achieved outstanding performances according to the literature, with an AUROC higher than 0.90 and F1-Macro higher than 0.88. This paper describes in depth the characteristics of the data gathered, the specifics of data preprocessing, and the methodology followed for model generation and bias analysis, together with the architecture developed for the deployment of the predictive models. Among other findings, the results of the paper corroborate the importance given in the literature of using the previous performances of the students in order to predict their future performances.

Patterns and Correlates of Changes in Emotional and Behavioral Problems Among Children with Congenital Heart Disease

OBJECTIVE

The objective of this study was to examine patterns of changes in emotional and behavioral problems among children with congenital heart disease (CHD) and investigate associated factors in different domains.

METHOD

The study sample comprised 327 pairs of children with CHD (aged 1.5-12 yrs) and their parents who participated in 2 waves of a survey in Taiwan from 2017 to 2019. The Child Behavior Checklist was used to evaluate the children's emotional and behavioral problems during both waves. The scores were later used to determine the patterns of changes in emotional and behavioral problems. Multinomial logistic regression was then applied to examine factors associated with varied patterns of changes in emotional and behavioral problems.

RESULTS

Five patterns of changes in emotional and behavioral problems were identified: "persistent normal," "initial problematic," "worsening," "persistent problematic," and "subclinical." Among the factors examined, parenting stress was consistently associated with different patterns of change in emotional and behavioral problems. Specifically, children with parents who had higher levels of parenting stress were more likely to belong to the "initial problematic," "persistent problematic," or "subclinical" groups than to the "persistent normal" group. Other significant factors included sex, number of surgeries, and perceived health of parents.

CONCLUSION

This study highlights the potential role of parenting stress in changes in emotional and behavioral problems. Accordingly, intervention programs aimed at relieving parenting stress may help reduce the development and worsening of emotional and behavioral problems among children with CHD.

Integrating Objective and Subjective Social Class to Advance Our Understanding of Externalizing Problem Behavior in Children and Adolescents: A Conceptual Review and Model

Extant research has identified both objective measures of socioeconomic status (SES) and subjective social class (SSC) as important predictors of psychosocial outcomes in childhood and adolescence, particularly with regard to externalizing symptoms. Given the importance of the associations with SES and SSC, a more nuanced and integrated conceptual understanding of early pathways of vulnerability implicated in the development and maintenance of youth externalizing problems is warranted. Thus, this review will: (1) operationalize both SES and SSC and their current standards of measurement; (2) examine current literature describing their respective associations with a range of externalizing symptoms in both children and adolescents; (3) review current theoretical models connecting SES and SSC and youth development and the strengths and limitations of those approaches; (4) propose a new conceptual socioecological model situating the impact of SES and SSC on youth externalizing problems in the context of parents and peers as a framework to further integrate existing research and guide future work; and (5) discuss potential clinical implications at the intersection of this work.

Family correlates of emotional and behavioral problems in Nepali school children

Background

There is a substantial gap in our knowledge about family correlates of child emotional and behavioral problems in low- and middle-income countries (LMIC). The present study contributes to filling this gap by examining such correlates in a larger population study in Nepal.

Methods

Our study is a cross-sectional, observational study among 3840 Nepali children aged 6–18 years from 64 schools and 16 districts in the three main geographical regions in the country. We used the Nepali version of the Child Behavior Checklist (CBCL)/6-18 to assess children’s internalizing and externalizing problems and an additional background information questionnaire to assess possible family correlates which included parental education, family structure, migrant worker parents, parental mental and physical illness, family conflicts, and child-rearing. The associations between family variables and child internalizing and externalizing problems were analyzed using bivariate correlations and multiple regression.

Results

Using bivariate analysis, we found that mental and physical illness in parents, conflict in the family, parental disagreement in child-rearing, and physical punishment of child correlated positively with both Internalizing Problems and Externalizing Problems. The same associations were found by using multiple regression analysis. In addition, parental education, family structure, and migrant worker mothers were associated with Externalizing Problems. However, the effect sizes were small.

Conclusion

The results suggest that in Nepal, child mental problems were associated with several family risk factors. Further, the study points to the need of strengthening prevention- and intervention measures to minimize family risk factors of child mental health disorders.

Cingulo-opercular and Cingulo-parietal Brain Networks Functional Connectivity in Pre-adolescents: Multiplicative Effects of Race, Ethnicity, and Parental Education

Introduction

A growing body of research has shown a diminished association between socioeconomic status (SES) indicators and a wide range of neuroimaging indicators for racial and ethnic minorities compared to majority groups. However, less is known about these effects for resting-state functional connectivity between various brain networks.

Purpose

This study investigated racial and ethnic variation in the correlation between parental education and resting-state functional connectivity between the cingulo-opercular (CO) and cingulo-parietal (CP) networks in children.

Methods

This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study; we analyzed the resting-state functional Magnetic Resonance Imaging (rsfMRI) data of 8,464 American pre-adolescents between the ages of 9 and 10. The main outcome measured was resting-state functional connectivity between the CO and CP networks calculated using rsfMRI. The independent variable was parental education, which was treated as a nominal variable. Age, sex, and family marital status were the study covariates. Race and ethnicity were the moderators. Mixed-effects regression models were used for data analysis, with and without interaction terms between parental education and race and ethnicity.

Results

Higher parental education was associated with higher resting-state functional connectivity between the CO and CP networks. Race and ethnicity both showed statistically significant interactions with parental education on children's resting-state functional connectivity between CO and CP networks, suggesting that the correlation between parental education and the resting-state functional connectivity was significantly weaker for Black and Hispanic pre-adolescents compared to White and non-Hispanic pre-adolescents.

Conclusions

In line with the Minorities' Diminished Returns theory, the association between parental education and pre-adolescents resting-state functional connectivity between CO and CP networks may be weaker in Black and Hispanic children than in White and non-Hispanic children. The weaker link between parental education and brain functional connectivity for Blacks and Hispanics than for Whites and non-Hispanics may reflect racism, racialization, and social stratification that collectively minimize the returns of SES indicators, such as parental education for non-Whites, who become others in the US.

Shaping classroom social experiences through collaborative small-group discussions

BACKGROUND

Students form interpersonal and intrapersonal classroom social experiences with peers. While diverse intervention programmes have been developed, few have integrated social-emotional learning into academic activities to maximize the potential for learning and development.

AIMS

This study examined the effects of collaborative small-group discussions on students' classroom social experiences at the interpersonal and intrapersonal levels.

SAMPLE

The study included 250 students (M_age  = 10.98, female = 52%) and six teachers from 12 English language arts fifth-grade classrooms in two public schools in the United States.

METHODS

Students were assigned to one of three conditions: Collaborative Social Reasoning (CSR), Read-Aloud (RA), or Regular Instruction (RI). Students in the CSR condition participated in recurrent collaborative small-group discussions about stories related to complex social-moral issues, including friendship, social exclusion, ethics of care, and responsibility. Students in the RA condition read the same stories without discussions.

RESULTS

Collaborative Social Reasoning students were more socially accepted by peers and were less aggressive to others compared to students in the other conditions. RA students revealed more aggressive behaviour than other groups. In a post-intervention interview, CSR students reported improved communication and group work strategies, ability to maintain harmonious relationships, and class participation. A higher proportion of CSR students in the CSR than the other conditions reported experiencing positive change in classroom relationships. Teacher interviews were used in conjunction with student interviews to triangulate conclusions from qualitative interview data.

CONCLUSION

Findings suggest effective ways to structure collaborative small-group discussions to foster positive classroom social experiences with peers.

A Longitudinal Study of the Relation between Childhood Activities and Psychosocial Adjustment in Early Adolescence

BACKGROUND

Although an increasing body of research shows that excessive screen time could impair brain development, whereas non-screen recreational activities can promote the development of adaptive emotion regulation and social skills, there is a lack of comparative research on this topic. Hence, this study examined whether and to what extent the frequency of early-life activities predicted later externalizing and internalizing problems.

METHODS

In 2012/13, we recruited Kindergarten 3 (K3) students from randomly selected kindergartens in two districts of Hong Kong and collected parent-report data on children's screen activities and parent-child activities. In 2018/19, we re-surveyed the parents of 323 students (aged 11 to 13 years) with question items regarding their children's externalizing and internalizing symptoms in early adolescence. Linear regression analyses were conducted to examine the associations between childhood activities and psychosocial problems in early adolescence.

RESULTS

Early-life parent-child activities (β = -0.14, p = 0.012) and child-alone screen use duration (β = 0.15, p = 0.007) independently predicted externalizing problems in early adolescence. Their associations with video game exposure (β = 0.19, p = 0.004) and non-screen recreational parent-child activities (β = -0.14, p = 0.004) were particularly strong.

CONCLUSIONS

Parent-child play time is important for healthy psychosocial development. More efforts should be directed to urge parents and caregivers to replace child-alone screen time with parent-child play time.

Longitudinal association of nighttime sleep duration with emotional and behavioral problems in early childhood: results from the Danish Healthy Start Study

STUDY OBJECTIVES

To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among preschool children.

METHODS

Data of children aged 2 to 6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores.

RESULTS

With adjustment for child, family factors, and parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (p = 0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β = -1.28, p = 0.02) compared with those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations.

CONCLUSIONS

Among preschool children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood.Clinical trials: The Healthy Start Study: https://clinicaltrials.gov/ct2/show/NCT01583335Trial registration: ID NCT01583335.

Neural correlates of socioeconomic status in early childhood: a systematic review of the literature

It is now established that socioeconomic variables are associated with cognitive, academic achievement, and psychiatric outcomes. Recent years have shown the advance in our understanding of how socioeconomic status (SES) relates to brain development in the first years of life (ages 0-5 years). However, it remains unknown which neural structures and functions are most sensitive to the environmental experiences associated with SES. Pubmed, PsycInfo, and Google Scholar databases from January 1, 2000, to December 31, 2019, were systematically searched using terms "Neural" OR "Neuroimaging" OR "Brain" OR "Brain development," AND "Socioeconomic" OR "SES" OR "Income" OR "Disadvantage" OR "Education," AND "Early childhood" OR "Early development". Nineteen studies were included in the full review after applying all exclusion criteria. Studies revealed associations between socioeconomic and neural measures and indicated that, in the first years of life, certain neural functions and structures (e.g., those implicated in language and executive function) may be more sensitive to socioeconomic context than others. Findings broadly support the hypothesis that SES associations with neural structure and function operate on a gradient. Socioeconomic status is reflected in neural architecture and function of very young children, as early as shortly after birth, with its effects possibly growing throughout early childhood as a result of postnatal experiences. Although socioeconomic associations with neural measures were relatively consistent across studies, results from this review are not conclusive enough to supply a neural phenotype of low SES. Further work is necessary to understand causal mechanisms underlying SES-brain associations.

Incidence of and improvement in inappropriate parental behaviors of mothers with young children: a retrospective cohort study conducted in collaboration with a local government

Background

Inappropriate parental behaviors of mothers toward young children require further study; few epidemiological studies have utilized longitudinal analysis of region-based cohorts. This study examined the frequency of incidence of and improvements in inappropriate parental behaviors of mothers with young children and related factors.

Methods

Among the mothers who underwent a checkup in Fukushima City in 2017, 586 mothers with data from 4-, 18-, and 42-month-old checkups were included in analysis. In this retrospective cohort study, an anonymous database was created by transcribing and matching health checkup records with questionnaires stored at the city health center. Data were analyzed using chi-square tests and logistic regression analysis, using the SPSS Ver.20.0.

Results

In 28.5% of mothers, inappropriate parental behaviors were not reported in the 18-month-old data but were reported in the 42-month-old data. In 3.8%, inappropriate parental behaviors were reported in the 18-month-old data but were not reported in the 42-month-old data. The most common inappropriate parental behavior reported was “yelling at the child using emotional words” (18-month-old data, 16.2%; 42-month-old data, 39.5%). Mothers with financial difficulties were 2.19 times (95%CI: 1.13–4.26) more likely to begin inappropriate parental behaviors between 18 and 42 months. Improvements in parental behaviors were significantly higher in mothers under 30 years old (p = 0.03).

Conclusions

It is necessary to identify mothers with financial difficulties early and to examine how to provide childcare and financial support from a local government at the time of child health checkup.

Emotional and behavioral problems in children with epilepsy attending the pediatric neurology clinic at a referral hospital in Kenya

INTRODUCTION

Epilepsy is a common neurological condition, with a lifetime prevalence of 1% in children. Research has shown a high prevalence of emotional and behavioral problems in children with epilepsy. The aim of this study was to determine the prevalence of emotional and behavioral problems in children with epilepsy attending the pediatric neurology clinic in a referral hospital in Kenya and examine associated sociodemographic and clinical variables.

METHODS

This was a cross-sectional descriptive study. Children with epilepsy aged between 6 and 12 years attending the Kenyatta National Hospital pediatric neurology clinic were recruited. Inclusion criteria for the study were children diagnosed with epilepsy, age between 6 and 12 years, accompanied by a primary caregiver, and the primary caregiver being willing to participate in the study. A sociodemographic questionnaire as well as the Child Behavior Checklist school-age version (CBCL/6-18) was administered to the caregiver accompanying the child.

RESULTS

One hundred and seventy-seven children with epilepsy were recruited (66% males) with a mean age of 8.9 (standard deviation (SD): 2) years. The mean age at onset of seizures was 4.5 years; 48% of the children had first seizure while aged less than 2 years, 76% reported generalized tonic-clonic seizures, and 58% were on antiepileptic drugs (AEDs). The overall prevalence of emotional and behavioral problems was 46%, and the four leading symptom clusters were attention problems, aggressive behavior, social problems, and withdrawal/depression. The risk of emotional and behavioral problems was increased in children using more than one AED (odds ratio (OR) = 2.21, 95% confidence interval (CI), 1.18-4.14) and those aged ten years and above (OR = 2.7, 95% CI, 1.3-5.64). The risk of emotional and behavioral problems was reduced in children with infrequent seizures (OR = 0.08, 95% CI, 0.01-0.06) and in children reporting no seizure in the past year (OR = 0.08, 95% CI, 0.01-0.65).

CONCLUSION

Emotional and behavioral problems are common among children with epilepsy in Kenya. This highlights the need to screen for these problems in children on treatment for epilepsy for early identification and subsequent management to improve outcome.

Parenting discipline styles and child psychopathology in a clinical sample of Egyptian children in the Nile Delta region

Background

Few, if any, studies evaluated the effect of violent parenting discipline on children’s psychological well-being in the Nile Delta region. The current study aimed to explore the spectrum of violent versus non-violent parenting discipline styles practiced by a sample of Egyptian families who came for psychiatric advice in Tanta Psychiatry and Neurology Center and the effects of such styles on youth’s problem behavior and psychiatric diagnoses. Two hundred and seven families were recruited and interviewed using the Kiddie Schedule of affective disorders and schizophrenia-present and life-time version “K-SADS-PL.” Arabic translated and validated versions of the conflict tactics scale–parent child version (CTS-PC) and the child behavioral checklist questionnaire (CBCL) for ages 6–18 years were used to evaluate parenting discipline styles and child psychopathology, respectively.

Results

Youth (n = 207) had an average age of 10.8 ± 2.8 years and 30% were females. A significant association was noted between all forms of psychological and physical violence against children, in addition to neglectful parenting, and both internalizing and externalizing problems in offspring with no significant differences between mild and severe forms of violence. Parents who were sexually abused as children had more tendency to practice violent discipline strategies on their own children.

Conclusions

All forms of child maltreatment, even mild forms, have a considerable effect on the child psychological development. National policies and legalization should be implemented to decrease child maltreatment and protect children from all forms of physical and sexual abuse.

Independent contributions of family and neighbourhood indicators of socioeconomic status and migrant status to risk of mental health problems in 4-12 year old children

Rationale

A range of family and neighbourhood indicators of socioeconomic status and migrant status have been shown to be associated with risk of mental health l problems (MHP) in children. In this study we determined the independent contributions of these indicators.

Objectives

The main objective is to examine independent associations of family and neighbourhood socioeconomic status indicators and migrant status with risk of MHP in children.

Methods

We analyzed data from an anonymous public health survey among 5010 parents/caretakers of children aged 4–12 years living in Rotterdam, The Netherlands, gathered in 2018. Outcome of interest was risk of MHP measured using the total difficulties score of the Strengths and Difficulties Questionnaire. Associations of parent-reported perceived financial difficulties, material deprivation (not being able to provide certain goods, or leisure, educational or cultural activities or care use for children due to financial restrictions), parental educational level, child's migrant status and neighbourhood socioeconomic status with risk of MHP and with the total difficulties score were assessed using multilevel multivariable logistic and linear regression models.

Results

In total, 473 (9.5%) children had a high risk of MHP. We observed independent associations of perceived financial difficulties, material deprivation and parental educational level with risk of MHP and with an increase in total difficulties score (P < 0.05). Migrant status and neighbourhood socioeconomic status were not independently associated with risk of MHP or a change in total difficulties score.

Conclusions

Already in early life, perceived financial difficulties by parents, material deprivation reported by parents and lower parental education appeared to be independently associated with the risk of MHP in 4–12 year olds. Health professionals should be aware of the relatively higher risks in these subgroups and consider policies address this.

•

Uses multilevel models to examine associations with child mental health problems.

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Mat erial deprivation increases risk of child mental health problems.

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Lower parental education increases risk of child mental health problems.

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Studies risk of SES indicators and migrant status on child mental health problems.

Association between problematic behaviors and individual/environmental factors in difficult children

BACKGROUND

Difficult children are ones whose behavior deviates from the norm, which manifests as restlessness, violence, and difficulty in separating from the mother. Such problematic behaviors usually exhaust their parents during child rearing. This study aimed to identify individual and environmental factors that influence children's problematic behavior, which could be helpful in supporting parents' child rearing.

METHODS

Records of children's problematic behaviors and their individual or environmental information were collected from 8691 children at their 5-year-old health checks. Problematic behaviors were divided into three categories; anxious behaviors, developmental behaviors, and personal habits. Individual factors included sex, parental age, birth order, birth weight, and birth abnormalities. The environmental factors were mother's smoking during pregnancy or currently, partner's cooperation in child rearing, having someone to consult about child rearing, and television viewing time. Using logistic regression, we identified the association between such behaviors and aggravating factors.

RESULTS

Problematic behavior was identified in 2.2%, 11.5%, and 16.1% of cases, respectively, with regard to anxious behaviors, developmental behaviors, and personal habits. The individual factors (including birth order and birth abnormality), and the environmental factors (including mothers currently smoking, lack of someone to consult about child rearing, and long television-watching time) were associated with the odd ratio of increased risk for some problematic behaviors.

CONCLUSION

Behaviors in difficult children are not influenced by individual factors but by several environmental factors. To reduce the parental child rearing burden, health providers should be aware of these aggravating factors.

Behavioral development in children with prenatal substance exposure and neonatal abstinence syndrome: Associated factors and implications

PROBLEM

Prenatal substance exposure and neonatal abstinence syndrome (NAS) are risk factors for adverse behavioral outcomes in children at 24 months of age.

METHODS

The purpose of this study was to examine factors associated with abnormal behavioral development in children with prenatal substance exposure or NAS through 10 years of age. A retrospective, nonexperimental, longitudinal design to examine the effects of prenatal substance exposure and NAS on behavioral development at 1, 5, and 10 years of age, while controlling for intrapersonal, interpersonal, community, organizational, and public policy characteristics. A hierarchical multivariate logistic regression model was used to evaluate the influence of substance exposure and NAS on behavioral outcomes.

FINDINGS

Abnormal behavioral development was predicted at 10 years of age with polysubstance exposure to three substances (odds ratio [OR] = 2.711, p < 0.01) and NAS (OR = 2.077, p < .001).

CONCLUSION

Psychiatric nursing care for children with prenatal substance exposure and NAS should include implementation of early and continued behavioral evaluation and childhood trauma and adversity surveillance in children through middle childhood.

Emotional and behavioral problems, social competence and risk factors in 6-16-year-old students in Beijing, China

Introduction

Child emotional or behavioral problems and insufficient social development has been a heavy burden on family and society. However, currently large-scale studies on emotional and behavioral problems as well as social competence among school children in China are still lacking. This cross-sectional study analyzed the current status and risk factors of behavioral problems and social competences in Beijing students.

Method

A total of 9,295 students, with ages ranging from 6 to 16 years old, were enrolled in the study. The Child Behavior Checklist (CBCL) was used to screen emotional and behavioral problems, social competences of students. We then assessed significant predictors factors associated with children behavioral problems and social competences.

Results

The total detection rate of behavioral problems of this cohort was 16.7%. All kinds of social competence scores of boys were lower than girls (P <0.05). The scores of social and learning ability in children with behavioral problems were significantly lower than those without behavior problems (P <0.05). Gender, developmental delay, recent life events, negative relationships and negative child-rearing styles were the shared influencing factors for behavioral problems and social competence. In addition, age, macrosomia, threatened abortion, hospitalization for physical illness, physical illness, poor sleep were independent risk factors for children's emotional and behavioral problems, and non-breastfeeding was an independent risk factor for abnormal social competence.

Conclusion

The social competence, emotional and behavioral problems are serious among students in Beijing. More attention should be paid to mental health and effective intervention measures should be provided.

Manganese transporter genetics and sex modify the association between environmental manganese exposure and neurobehavioral outcomes in children

There is increasing evidence that environmental manganese (Mn) exposure early in life can have negative effects on children's neurodevelopment and increase the risk of behavioral problems, including attention deficit hyperactivity disorder (ADHD). Factors that may contribute to differences in sensitivity to Mn exposure are sex and genetic variation of proteins involved in the regulation of Mn concentrations. Here we investigate if sex and polymorphisms in Mn transporter genes SLC30A10 and SLC39A8 influence the association between Mn exposure and ADHD-related behavioral problems in children. The SNPs rs1776029 and rs12064812 in SLC30A10, and rs13107325 in SLC39A8 were genotyped by TaqMan PCR or pyrosequencing in a population of Italian children (aged 11-14 years; n = 645) with a wide range of environmental Mn exposure. Mn in surface soil was measured in situ using XRF technology or modeled by geospatial analysis. Linear regression models or generalized additive models (GAM) were used for analyzing associations between soil Mn and neurobehavioral problems assessed by the Conners' behavior rating scales (self-, and parent-reported). Gene-environment interactions (Mn transporter genotype x soil Mn) were evaluated using a genetic score in which genotypes for the three SNPs were combined based on their association with blood Mn, as an indication of their influence on Mn regulation. We observed differences in associations between soil Mn and neurobehavior between sexes. For several self-reported Conners' scales, girls showed U-shaped relationships with higher (worse) Conners' scoring at higher soil Mn levels, and several parent-reported scales showed positive linear relationships between increasing soil Mn and higher Conner's scores. For boys, we observed a positive linear relationship with soil Mn for one Conner's outcome only (hyperactivity, parent-reported). We also observed some interactions between soil Mn and the genetic score on Conner's scales in girls and girls with genotypes linked to high blood Mn showed particularly strong positive associations between soil Mn and parent-reported Conners' scales. Our results indicate that sex and polymorphisms in Mn transporter genes contribute to differences in sensitivity to Mn exposure from the environment and that girls that are genetically less efficient at regulating Mn, may be a particularly vulnerable group.

Elevated Gestational IL-13 During Fetal Development Is Associated With Hyperactivity and Inattention in Eight-Year-Old Children

Maternal immune activation (MIA) during fetal development leads to behavioral and psychological disorders in the offspring. Concomitantly, insufficient supply of polyunsaturated fatty acids (PUFAs) is suspected to contribute to early neuronal maldevelopment due to the immune modulatory capabilities of PUFAs. However, human data are missing considering both of these aspects and their impact on children's behavioral outcomes. In line, this study aimed to elucidate the influence of gestational cytokines and PUFA-containing lipids during late pregnancy on behavioral sequelae in childhood, particularly focusing on an immune activation shaped by a history of maternal atopic diseases instead of a pathogen-mediated immune response. Based on the prospective mother-child cohort LINA we assessed the unstimulated blood cytokine profiles and concentrations of PUFA-containing lipids of 293 mothers at the 34th week of pregnancy. Maternal history of atopic diseases was obtained from questionnaires and behavior in eight-year-old children was assessed by the standardized Strength and Difficulties Questionnaires (SDQ) generating scores for hyperactivity/inattention, emotional symptoms, conduct problems, and peer relationship problems. Elevated IL-13 increased the risk for the child to show behavioral difficulties, in particular, hyperactive/inattentive behavior [adj. OR (95% CI): 2.47 (1.51-4.02), n = 255 vs. 38] at the age of eight years. Although the presence of maternal atopic dermatitis (AD) was associated with increased gestational IL-13 concentrations [adj. MR (95% CI): 1.17 (1.04-1.32)], no effect on children's behavioral difficulties was observed. However, a decrease in the PUFA containing lipid species PC aa C38:6 was not only associated with an increased gestational IL-13 concentration but also mediated the indirect effect of low PC aa C38:6 concentrations on children's abnormal behavior independent of maternal AD. We additionally assessed whether maternal IL-13 and PC aa C38:6 concentrations translate their effect by altering children's cord blood PC aa C38:6 and IL-13. While also the children's cord blood IL-13 was related to children's behavior, no effect of children's PC aa C38:6 was observed. This is the first study demonstrating that elevated gestational IL-13 increases the risk for children to develop behavioral difficulties. Analyses suggest that a reduced supply of gestational PC aa C38:6 contributes to elevated gestational IL-13 leading to behavioral sequelae in the offspring.

Role of Parenting Style in Children's Behavioral Problems through the Transition from Preschool to Elementary School According to Gender in Japan

While ineffective discipline can be attributed to authoritarian and permissive parenting styles, little research has examined the role of gender in the association between parenting style and early childhood behavioral problems. Thus, this study aimed to clarify the effects of authoritarian and permissive parenting on children’s externalizing and internalizing behaviors during the preschool-to-elementary-school transition according to gender in Japan. A sample of 1668 Japanese children (853 boys and 815 girls) were followed longitudinally over one-year intervals, and assessed based on parenting styles (the Parenting Scale), children’s behavioral problems (the Strengths and Difficulties Questionnaire), and family characteristics. Multivariate analyses revealed that, when analyzed by gender, authoritarian discipline influenced externalizing problems in boys (β = 0.048, p = 0.047) and girls (β = 0.067, p = 0.023), while permissive discipline influenced externalizing problems in boys only (β = 0.049, p = 0.038). The results document the relationship between family processes and the development of disruptive behavior disorders in children. Support for parents employing such child-rearing styles in early childhood may be effective in reducing school maladjustment.