Child Behaviour Problems Research Articles

Respiratory sinus arrhythmia as a moderator of early maltreatment effects on later externalizing problems.

Physiological regulation may interact with early experiences such as maltreatment to increase risk for behavior problems. In the current study, we investigate the role of parasympathetic nervous system regulation (respiratory sinus arrhythmia [RSA] at rest and in response to a frustration task) as a moderator of the association between early risk for maltreatment (i.e., involvement with Child Protective Services; CPS) and externalizing behavior problems in middle childhood. CPS involvement was associated with elevated externalizing problems, but only among children with average to high RSA at rest and average to high RSA withdrawal in response to frustration. Effects appeared to be specific to CPS involvement as the association between cumulative risk (i.e., nonmaltreatment experiences of early adversity) and externalizing problems was not significantly moderated by RSA activity. These findings are consistent with the theoretical idea that the consequences of early maltreatment for later externalizing behavior problems depend on children's biological regulation abilities.

The association of community and individual parental social capital with behavior problems among children in Japan: results from A-CHILD longitudinal study.

The purpose of this study was to determine the association of individual-level and community-level parental social capital with childhood behavior problems using population-based longitudinal data in Japan. We analyzed data from a population-based longitudinal survey study which followed first-grade elementary school children (6-7years old) in Adachi City, Tokyo, Japan. At baseline, the parents of first-grade students from all 69 elementary schools in Adachi City were asked to respond to a questionnaire assessing behavior problems and prosocial behavior (using the Strengths and Difficulties Questionnaire) and parental social capital in the community (N = 5494). Data on follow-up questionnaires on behavior problems were collected when children were second grade. Among both surveys, 3656 parents returned valid responses. The association between individual-level and community-level parental social capital and children's behavior problems were analyzed using multilevel analyses adjusting for covariates. Community-level social capital was positively associated with prosocial behaviors, but not for total difficulties, after adjustment for covariates (coefficient = 0.19, 95% CI 0.03 to 0.36). Individual-level parental social capital was also positively associated with prosocial behaviors (coefficient = 0.27, 95% CI 0.12 to 0.41) and negatively associated with total difficulties (coefficient = -0.54, 95% CI -0.89 to -0.19). This study showed that greater community-level social capital can benefit children with increased prosocial behaviors. Individual-level parental social capital can be protective of youth by increasing prosocial behaviors and reducing difficult behaviors. Boosting both community and individual social capital can be a promising means to enhance children's well-being.

Relative contribution of maternal adverse childhood experiences to understanding children's externalizing and internalizing behaviours at age 5: findings from the All Our Families cohort.

The negative effect of adverse childhood experiences (ACEs) on physical and mental health has led to calls for routine screening for ACEs in primary care settings. We aimed to examine the association between maternal ACEs and children's behaviour problems (externalizing and internalizing) at age 5 in the context of other known predictors. We analyzed data from mother-and-child dyads participating in the All Our Families cohort in Calgary, Canada, between 2011 and 2017. Data were collected for factors related to the individual child (sex, age, temperament and behaviour), the mother (adverse childhood experiences, mental health, personality and parenting) and sociodemographic characteristics (family income, ethnicity and family structure) when the children were 3 and 5 years of age. We used logistic regression models to estimate crude and adjusted associations between maternal ACEs and children's externalizing (hyperactivity and aggression) and internalizing (anxiety, depression and somatization) behaviours. Data were available for 1688 mother-and-child dyads. In the crude models, the presence of 4 or more maternal ACEs was associated with children's externalizing and internalizing behaviours at age 5. However, these associations were attenuated with adjustment. Persistent maternal mental health symptoms were associated with both externalizing and internalizing behaviours at age 5 (adjusted odds ratio [OR] 4.20, 95% confidence interval [CI] 2.50-7.05, and adjusted OR 2.52, 95% CI 1.66-3.81, respectively). High levels of ineffective parenting behaviours were also associated with both externalizing and internalizing behaviours at age 5 (adjusted OR 6.27, 95% CI 4.30-9.14, and adjusted OR 1.43, 95% CI 1.03-1.99, respectively). The association between maternal ACEs and children's behaviour at age 5 was weakened in the presence of other maternal and family-level factors. Assessments of maternal mental health and parenting behaviours may be better targets for identifying children at risk of behavioural problems.

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3-5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (β = .037, p < .001) and internalizing (β = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (β = .071, p < .01) and internalizing (β = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.

Parental preconception and prenatal urinary bisphenol A and paraben concentrations and child behavior.

The Environment and Reproductive Health (EARTH) Study is a prospective cohort of couples from a fertility clinic at Massachusetts General Hospital. The Centers for Disease Control and Prevention (CDC) quantified BPA, butylparaben, ethylparaben, methylparaben, and propylparaben concentrations in multiple urine samples collected before conception and during pregnancy. From the eligible parents (N = 220), we enrolled 158 children between 2 and 9 years of age. The parents completed the Behavior-Assessment-System-for-Children-2 (BASC-2). We estimated covariate-adjusted associations of average parental preconception and prenatal ln-transformed urinary BPA and sum of paraben concentrations (∑paraben) with BASC-2 scores using linear regression with generalized estimating equations. Median urinary BPA and Σparaben concentrations were 1.2 and 189 μg/L in mothers preconception and 1.7 and 25 μg/L in fathers preconception, respectively. Among all children, parental BPA and ∑paraben concentrations were not associated with BASC-2 behavioral symptoms index, internalizing, or externalizing problems scores. Point estimates ranged from -1.5 to 1.4 with wide 95% confidence intervals that included the null value. In this fertility clinic cohort, parental preconception and maternal prenatal BPA and paraben concentrations were not associated with problem behaviors among children. However, our small sample sizes reduced the precision of our results.

Supplemental Material for Language Ability in the Development of Externalizing Behavior Problems in Childhood

Supplemental Material for Language Ability in the Development of Externalizing Behavior Problems in Childhood

Latent class analysis of early onset of behavior problems: relevance for predicting offending across the life-course

ABSTRACT Research has demonstrated the importance of early-life behavioral issues for predicting risk for offending throughout the life-course. However, there has yet to be any study that has examined how early behavior problems may cluster together and how these clusters predict offending across the life-course. Latent class analysis was used to identify behavior classes comprising the onset of the childhood behavior problems: cheating, disrupting class, being drunk/stoned, stealing, and fighting. Analysis of variance was used to identify between-class differences in risk/protective factors. Age–crime curves were identified for groups to measure offending throughout the life-course. Results indicated that a three-class model best fits the data (Low EOBP, FDC, DCSF). Groups differed in risk/protective factor profiles. Age–crime curves indicated that participants assigned to the DCSF group demonstrated more serious offending in adolescence and that the FDC and DCSF groups demonstrated more serious offending in early adulthood. Identification of individuals reporting disturbing class, fighting, and stealing in childhood may be at elevated risk for more serious offending in adolescence. This may place them at risk for encountering snares in the life-course.

Attachment quality assessed from children’s family drawings links to child conduct problems and callous-unemotional behaviors

ABSTRACT Objective: Recently, there has been considerable research on the origins of childhood conduct problems (CP) and callous-unemotional (CU) behaviors. This study examined associations between children’s attachment representations and CP and CU behaviors during middle childhood. Method: At 1st grade, 1,292 children (57% European American, 42.5% African American, 0.5% other race; 50.9% girls) completed a drawing of their family, which was coded by trained raters to assess attachment representations. Primary caregivers reported on children’s CP and CU behaviors. Results: Children with disorganized representations showed more CP and CU behaviors than children with secure and resistant representations. They were also more likely than those with secure representations to show elevated CP without CU behaviors, CU behaviors only, and co-occurring CP and CU behaviors. Conclusion: These findings provide support for attachment disorganization as a correlate of CP and CU behaviors and suggest that attachment representations are likely important proximal influences on children’s behavior.

Infant-directed language following a brief behavioral parenting intervention: The importance of language quality

Behavioral parenting interventions decrease early childhood behavior problems and increase positive parenting skills. However, few studies have examined the impact of low intensity interventions for infants at risk for behavior problems on changes in parent language. This study examined the effect of a brief parenting intervention, the Infant Behavior Program, on changes in parent linguistic input and its influence on infant language. Participants were 58 mothers and their12- to 15-month-olds, with elevated levels of behavioral problems. Mothers and their infants were from primarily Hispanic and low-income backgrounds. Mother-infant dyads were randomly assigned to receive the Infant Behavior Program or standard pediatric primary care. Mothers receiving the Infant Behavior Program provided more linguistic input, which indirectly influenced infant language, and suggest targeting infants at risk for behavior problems can have a broader impact on language development.

Combining Economic Strengthening and Parenting Programmes to Reduce Violence Against Children in Rural Tanzania: A Cluster Randomised Controlled Trial

Background: Parenting programmes may reduce risk of violence against children and improve child wellbeing. However, additional economic support may be necessary in highly-deprived low-income countries. Methods: A parallel cluster randomised controlled trial examined the combined and separate effects of parenting and economic strengthening on reducing violence against children ages 0 to 18 years in impoverished farming communities in Tanzania (N =248 families). Eight villages were randomly assigned to four conditions (2:2:2:2 ratio): 1) 12-session parenting programme (N =60); 2) agribusiness training (N =56); 3) parenting and agribusiness combined (N =72); 4) control (N =60). Parent-report, child-report, and early childhood observation assessments were conducted at baseline, mid-treatment, and post-treatment. Primary outcomes included child maltreatment, parenting behaviour, and corporal punishment endorsement. Secondary outcomes included parenting stress, parent/child depression, child behaviour, economic wellbeing, and child development (ClinicalTrials.gov: NCT02633319). Assessors were blind to allocation status at baseline; the data analyst was also blind to allocation until after initial intention-to-treat analyses. Findings: At post-treatment, parents and children receiving the combined interventions reported less maltreatment (parents: IRR=0.40, 95%CI [0.24,0.65]; children: IRR=0.40, 95%CI [0.17,0.92]). Parents also reported reduced endorsement of corporal punishment (Dw =-0.43, 95%CI [-0.79,0.07]), and less child behaviour problems (Dw =-0.41, 95%CI [-0.77,-0.05]). Parents in parenting-only villages reported less abuse (IRR=0.36, 95%CI [0.21,0.63]) and less child behaviour problems (Dw =-0.47, 95%CI [-0.84,-0.11]). Parents in agribusiness-only villages reported less child behaviour problems (Dw =-0.43, 95%CI [-0.77,-0.08]) and greater household wealth (Dw =0.57, 95%CI [0.08,1.06]). However, children in agribusiness-only villages reported increased physical abuse (IRR=2.26, 95%CI [1.00,5.12]) and less positive parenting (Dw =-0.50, 95%CI [-0.91,-0.10]). There were no other adverse effects. Interpretation: Results suggest that the parenting component may be the active ingredient in reducing maltreatment, and that agribusiness training programmes may have unintended negative consequences on children when delivered alone. Trial Registration: (ClinicalTrials.gov: NCT02633319; Pan African Clinical Trials: PACTR201610001267268). Funding Statement: The Skilful Parenting and Agribusiness Child Abuse Prevention Study (SPACAPS) was supported by the UBS Optimus Foundation (Grant: 7849.09), the Netherlands Ministry of Foreign Affairs, and the Complexity in Health Improvement Programme of the Medical Research Council MRC UK (Grant: MC_UU_12017/14). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approval was received from the Tanzania Lake Zone Institutional Review Board (03.09.2015) and the University of Oxford Social Sciences and Humanities Interdivisional Research Ethics Committee (SSD/CUREC1A/14-SSH_C2_15_023).

Family social support buffers the intergenerational association of maternal adverse childhood experiences and preschoolers’ externalizing behavior.

Despite previous work demonstrating that an accumulation of maternal adverse childhood experiences (ACEs) is associated with negative health outcomes across generations, few studies have investigated protective factors beyond the parent-child dyad in the intergenerational transmission of adversity. The current study extends previous findings by examining maternal family social support as a culturally relevant buffer in the association between mothers' ACEs and her children's behavior problems in early childhood. Participants included 121 African American mothers and their preschool-aged children experiencing high sociodemographic risk. Mothers completed questionnaires on ACEs, perceived family social support, children's violence exposure and behavior problems as well as relevant demographics. Maternal family social support moderated the relation between maternal ACEs and children's externalizing behaviors (b = -.14, p < .01), such that children of mothers who reported high ACEs and also moderate to high family social support did not show elevated externalizing behaviors; this pattern was not observed for internalizing behaviors (b = -.06, p = .06). Additionally, the intergenerational buffering effects of family social support were observed above and beyond mothers' psychopathology and children's exposure to violence. These results have implications for culturally relevant prevention and intervention efforts supporting African American mothers with young children that reflect resiliency in the face of disparities across generations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Medicaid Instability and Mental Health of Teen Parent Families.

This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.

White matter microstructure mediates the association between prenatal exposure to phthalates and behavior problems in preschool children

BackgroundPrevious research reports associations between prenatal exposure to phthalates and childhood behavior problems; however, the neural mechanisms that may underlie these associations are relatively unexplored. ObjectiveThis study examined microstructural white matter as a possible mediator of the associations between prenatal phthalate exposure and behavior problems in preschool-aged children. MethodsData are from a subsample of a prospective pregnancy cohort, the Alberta Pregnancy Outcomes and Nutrition (APrON) study (n = 76). Mother-child pairs were included if mothers provided a second trimester urine sample, if the child completed a successful magnetic resonance imaging (MRI) scan at age 3–5 years, and if the Child Behavior Checklist was completed within 6 months of the MRI scan. Molar sums of high (HMWP) and low molecular weight phthalates (LMWP) were calculated from levels in urine samples. Associations between prenatal phthalate concentrations, fractional anisotropy (FA) and mean diffusivity (MD) in 10 major white matter tracts, and preschool behavior problems were investigated. ResultsMaternal prenatal phthalate concentrations were associated with MD of the right inferior fronto-occipital fasciculus (IFO), right pyramidal fibers, left and right uncinate fasciculus (UF), and FA of the left inferior longitudinal fasciculus (ILF). Mediation analyses showed that prenatal exposure to HMWP was indirectly associated with Internalizing (path ab = 0.09, CI.95 = 0.02, 0.20) and Externalizing Problems (path ab = 0.09, CI.95 = 0.01, 0.19) through MD of the right IFO, and to Internalizing Problems (path ab = 0.11, CI.95 = 0.01, 0.23) through MD of the right pyramidal fibers. DiscussionThis study provides the first evidence of childhood neural correlates of prenatal phthalate exposure. Results suggest that prenatal phthalate exposure may be related to microstructural white matter in the IFO, pyramidal fibers, UF, and ILF. Further, MD of the right IFO and pyramidal fibers may transmit childhood risk for behavioral problems.

Impact of the United States federal child tax credit on childhood injuries and behavior problems

Children who grow up in poverty are at risk for various poor outcomes. Socioeconomic policies can shape the conditions in which families are raising children and may be effective at reducing financial strain and helping families obtain economic sufficiency, thereby reducing risk for poor health outcomes. This study used data from two surveys conducted in the US, the National Longitudinal Survey of Youth 1979 (NLSY79) and the NLSY79 Young Adult survey to determine whether the U.S. Federal Child Tax Credit (CTC), a socioeconomic policy that provides tax relief to low- and middle-income families to offset the costs of raising children, is associated with child well-being, as indicated by whether the child had injuries requiring medical attention and behavioral problems. Fixed-effects models, accounting for year and state of residence, detected a lower likelihood of injuries requiring medical attention (OR = 0.58, 95% CI [0.40, 0.86]) and significantly fewer behavior problems (b = −2.07, 95% CI [−4.06, −0.08]) among children with mothers eligible to receive a CTC, but only when it was partially refundable (i.e., mothers could receive a tax refund for a portion of the CTC that exceeds their tax liability) for families making as little as $3000 a year. Tax credits like the CTC have the potential to alleviate financial strain among families, and consequently, may have impacts on injury and behavior problems.

Birth children of foster carers: How do they experience the foster care placement

Foster care is an important concept in our society and is preferred over other institutional care. However, including a foster child in the family, brings consequences to the whole family, including the birth children. Fostering is known to come with both positive as negative effects for birth children and parental concerns for the wellbeing of birth children often contribute to foster care breakdown. The aim of this study is to explore foster child characteristics and the acceptance of foster children, by birth children and to compare mothers’ perceptions to birth children’s own perceptions. 139 Belgian birth children and their mothers were questioned with a self-assembled questionnaire. Regarding foster child characteristics, foster mothers and birth children reported that 20–21% of the foster children presented emotional problems, 14.5–20.5% behaviour problems and 25.2–33.1% signs of hyperactivity. Foster mothers seem to overestimate the problems of their foster children compared to the problems of their birth children. Subsequently, even though they both mostly reported average levels of cohesion and adaptation, foster mothers gave higher scores on cohesion in the family and significantly lower scores on the adaptation fostering asks, compared to the scores of their birth children. Regarding acceptation, most birth children indicate that they have a positive attitude towards the foster child and would have difficulties with an ending of the foster care placement. However, both foster mothers as birth children mostly report low levels of acceptation. Two backward linear regressions were done to become a predictive model of the acceptation of the foster child by the birth child. Results indicate that it is important to involve birth children in the recruitment and to support them throughout the whole foster experience. Behaviour problems of foster children should be screened earlier and more effective interventions to lower problem behaviour should be researched and deployed.

Direct and indirect contributions of child difficult temperament and power assertive parental discipline to Turkish children’s behaviour problems

ABSTRACT The purpose of the current study was to examine power assertive parental discipline and child difficult temperament as predictors of children’s behaviour problems (internalizing, externalizing, and total behaviour problems) as well as mediating role of difficult temperament between power assertive parental discipline and children’s behaviour problems. Participants were 118 children (53 boys) and their parents for the current study. Children’s age ranged from 16 months to 36 months (M = 27.91, SD = 5.67). Mothers reported on their power assertive parental discipline, child temperament, and behaviour problems of children. Results from regression analysis showed that: (1) there was a positive association between parents’ power assertive discipline and child behaviour problems. (2) Child difficult temperament was positively associated with children’s internalizing, externalizing and total behaviour problems. (3) Children’s difficult temperament mediated the association between power assertive discipline and child behaviour problems. Limitations and future directions of the current study are discussed.

Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children.

BackgroundBehavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.MethodsA decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5–12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.ResultsIntervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.ConclusionsParenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.

Maternal Anxiety, Parenting Stress, and Preschoolers' Behavior Problems: The Role of Child Self-Regulation.

Maternal anxiety is a well-known risk factor for early childhood behavior problems. In this study, we explore (1) whether parenting stress mediates this relation and also (2) whether child factors, namely self-regulation, modify the influence of maternal well-being on child externalizing and internalizing problems at 4 years of age. Mothers taking part in the Growing Up in Singapore Towards Healthy Outcomes cohort completed the Spielberger State-Trait Anxiety Inventory when their children were 24 months of age. At 42 months of age, children performed a self-regulation task (n = 391), and mothers completed the Parenting Stress Index. When children were 48 months old, both parents completed the Child Behavior Checklist. As predicted, parenting stress mediated the relation between maternal trait anxiety and child externalizing and internalizing problems. This mediating effect was further moderated by child self-regulation. The indirect effect of maternal trait anxiety through parenting stress on child externalizing problems was stronger among children with low self-regulation. Parenting stress is an additional pathway connecting maternal trait anxiety and children's externalizing and internalizing behavior problems. The risk for child externalizing problems conveyed by elevated maternal trait anxiety and parenting stress may be buffered by better self-regulation in 4-year-olds. These results suggest that interventions that include decreasing parenting stress and enhancing child self-regulation may be important to limiting the transgenerational impact of maternal trait anxiety.

Recurrent depression in childhood and adolescence and low childhood socioeconomic status predict low cardiorespiratory fitness in early adulthood

Cardiorespiratory fitness (CRF) strongly influences health, but very little is known about the childhood determinants of adult CRF. Our longitudinal study investigated whether childhood psychopathology and socioeconomic status (SES) were related to adult CRF in 1647 Finnish male military conscripts. Childhood psychopathology was assessed at the age of eight using the Rutter and Children's Depression Inventory questionnaires. Parental education and family structure were used to assess childhood SES. In late adolescence, depressive symptoms were assessed with the Beck Depression Inventory and smoking with a questionnaire. CRF in early adulthood was examined with the Cooper's 12-minute run test. General linear models showed that low parental education (p=0.001), depressive symptoms in childhood (p=0.035) and late adolescence, smoking, underweight, and overweight/obesity (all p<0.001) independently predicted lower CRF. The interaction between depressive symptoms in childhood and adolescence was significant (p=0.003). In adolescents with depressive symptoms, childhood depressive symptoms (p=0.001) and overweight/obesity (p<0.001) predicted lower CRF. In adolescents without depressive symptoms, conduct problems in childhood predicted lower CRF in the initial models, but the effect disappeared after taking into account smoking and body mass index. Mediational analysis confirmed these results. We lacked data on physical activity and only studied males at three time-points. Recurrent depression in childhood and adolescence and low SES in childhood predict lower adult CRF. Conduct problems in childhood predict lower CRF, but the effect is mediated by overweight/obesity and smoking. Psychiatric treatment for children and adolescents should promote physical activity, particularly for children with low SES.

Maternal acetaminophen use during pregnancy and childhood behavioural problems: Discrepancies between mother- and teacher-reported outcomes.

Maternal acetaminophen use during pregnancy is common and has been associated with childhood behavioural problems among offspring, specifically hyperactivity and conduct problems. Assessments of child behaviour in many previous studies have relied on maternal or parent report. Acknowledging that results of behavioural assessments vary between informants, we examined the association between maternal acetaminophen use during pregnancy and behaviour problems in childhood based on mother- and teacher-report. A longitudinal study of 560 mother-child pairs with data on illnesses and medication use during pregnancy and neurodevelopmental assessments during childhood was conducted. Acetaminophen use during pregnancy was captured using a standardised maternal interview, completed 1year after delivery on average. Measures of childhood (6-12years of age) behaviour were obtained via mother- and teacher-report, using the Child Behaviour Checklist and Teacher Report Form. Linear and log-binomial models were used to calculate adjusted mean differences (MD) and risk ratios (RR), respectively and 95% confidence intervals (CI) for internalising, externalising, and total behaviour problems comparing acetaminophen users to non-users. Stabilized inverse probability weights were used to account for loss to follow-up, and adjustments for indication were made. Approximately 60% (n=354) of women reported use of acetaminophen during pregnancy. Acetaminophen use during pregnancy was associated with an increase in total behaviour problem score and risk of clinical behaviour problems according to mother report (MD 2.2, 95% CI 0.3, 4.1 and RR 1.93, 95% CI 0.99, 3.76) but not according to teacher report. Weighting to account for participation did not alter results, while adjustment for indications of acetaminophen use greatly attenuated the associations with mother-reported total behaviour problem score and risk of clinical behaviour problems (MD 0.1, 95% CI -2.1, 2.3 and RR 1.31, 95% CI 0.67, 2.58). Acetaminophen use during pregnancy was weakly associated with mother-reported behaviour problems and not associated with teacher-reported problems.