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Towe-Goodman N, McArthur KL, Willoughby M, Swingler MM, Wychgram C, Just AC, Kloog I, Bennett DH, Berry D, Hazlehurst MF, James P, Jimenez MP, Lai JS, Leve LD, Gatzke-Kopp L, Schweitzer JB, Bekelman TA, Calub C, Carnell S, Deoni S, D’Sa V, Kelly C, Koinis-Mitchell D, Petriello M, Thapaliya G, Wright RJ, Zhang X, Kress AM. Green Space and Internalizing or Externalizing Symptoms Among Children. JAMA Netw Open 2024; 7:e245742. [PMID: 38598238 PMCID: PMC11007572 DOI: 10.1001/jamanetworkopen.2024.5742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare. Objective To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms. Design, Setting, and Participants Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included. Exposures Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment. Main Outcome and Measures Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples. Results Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood. Conclusions and Relevance In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.
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Affiliation(s)
- Nissa Towe-Goodman
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kristen L. McArthur
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael Willoughby
- Education and Workforce Development, RTI International, Research Triangle Park, North Carolina
| | - Margaret M. Swingler
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
| | - Cara Wychgram
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Allan C. Just
- Department of Epidemiology, Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
| | - Itai Kloog
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deborah H. Bennett
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Daniel Berry
- Institute of Child Development, University of Minnesota, Minneapolis
| | - Marnie F. Hazlehurst
- Department of Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health, Boston, Massachusetts
| | - Marcia Pescador Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene
| | - Lisa Gatzke-Kopp
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
| | - Julie B. Schweitzer
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Traci A. Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Catrina Calub
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - Susan Carnell
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sean Deoni
- Maternal, Newborn, and Child Health Discovery & Tools, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carrie Kelly
- Department of Pediatrics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Petriello
- Institute of Environmental Health Sciences, Department of Pharmacology, Wayne State University, Detroit, Michigan
| | - Gita Thapaliya
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rosalind J. Wright
- Department of Epidemiology, Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xueying Zhang
- Education and Workforce Development, RTI International, Research Triangle Park, North Carolina
| | - Amii M. Kress
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Friedman LM, Eckrich SJ, Rapport MD, Bohil CJ, Calub C. Working and short-term memory in children with ADHD: an examination of prefrontal cortical functioning using functional Near-Infrared Spectroscopy (fNIRS). Child Neuropsychol 2024; 30:462-485. [PMID: 37199502 DOI: 10.1080/09297049.2023.2213463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Working memory impairments are an oft-reported deficit among children with ADHD, and complementary neuroimaging studies implicate reductions in prefrontal cortex (PFC) structure and function as a neurobiological explanation. Most imaging studies, however, rely on costly, movement-intolerant, and/or invasive methods to examine cortical differences. This is the first study to use a newer neuroimaging tool that overcomes these limitations, functional Near Infrared Spectroscopy (fNIRS), to investigate hypothesized prefrontal differences. Children (aged 8-12) with ADHD (N = 22) and typically developing (N = 18) children completed phonological working memory (PHWM) and short-term memory (PHSTM) tasks. Children with ADHD evinced poorer performance on both tasks, with greater differences observed in PHWM (Hedges' g = 0.67) relative to PHSTM (g = 0.39). fNIRS revealed reduced hemodynamic response among children with ADHD in the dorsolateral PFC while completing the PHWM task, but not within the anterior or posterior PFC. No between-group fNIRS differences were observed during the PHSTM task. Findings suggest that children with ADHD exhibit an inadequate hemodynamic response in a region of the brain that underlies PHWM abilities. The study also highlights the use of fNIRS as a cost-effective, noninvasive neuroimaging technique to localize/quantify neural activation patterns associated with executive functions.
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Affiliation(s)
| | - Samuel J Eckrich
- Department of Psychology, University of Central Florida, Orlando, FL, USA
- Department of Neuropsychology, Kennedy Krieger/Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark D Rapport
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Corey J Bohil
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Catrina Calub
- Department of Psychiatry, University of California, Sacramento, CA, USA
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