Behavioral Difficulties Research Articles

Sleep correlates of behavior functioning in Cornelia de Lange syndrome.

Pathogenic variants in the cohesin genes, NIPBL and SMC1A, both cause Cornelia de Lange syndrome (CdLS), a rare genetic disorder associated with developmental delay and intellectual disability. This study aimed to compare sleep behaviors across individuals with CdLS caused by a variant in NIPBL or SMC1A, and identify relationships between sleep and behavior functioning. A total of 31 caregivers of individuals with a variant in NIPBL (N = 22) or SMC1A (N = 9) completed questionnaires regarding their child's sleep behaviors, behavior regulation, attention, and autistic features (repetitive behaviors and social communication difficulties) as part of the Coordination of Rare Diseases (CoRDS) registry. Findings showed a trend of increased behavior regulation difficulties and repetitive behaviors in the NIPBL compared to the SMC1A participants. Both groups presented with a similar degree of attention, social communication, and sleep challenges. In the whole sample, sleep disturbance was strongly correlated with more behavior regulation difficulties, a relationship that was more robust in the NIPBL sample. In brief, study results support our prior observations of greater behavior difficulties among those with a variant in NIPBL as compared to SMC1A. Preliminary findings point to unique associations between sleep and behavior regulation in the NIPBL group, suggesting sleep interventions may yield differential effects on behavior management across variants.

Socio-emotional behavior, learning, and the distinct contributions of Executive Functions in primary graders

Socio-emotional school behavior and learning are both fundamental aspects of children’s development influenced by cognitive control processes named Executive Functions (EF). Yet, research on school-age children has often focused on the relationship between EF and learning skills overlooking that of EF and school behavior, which has usually been examined among preschoolers. The current study investigated the contribution of EF in both school behavior and learning in school-age children. One hundred forty-six III–V graders were assessed using text comprehension and EF tasks and evaluated by teachers-rated inventories on behavioral difficulties and EF within the school context. The results suggested a different involvement of direct and indirect EF measures in the two domains considered: controlling for socioeconomic level and age, an EF direct measure, predicted reading comprehension whereas teacher-reported EF related to both behavior and text comprehension. The results contribute to defining the role of cognitive control processes on school behavior and learning in school-age children.

Radiographic severity is associated with worse executive function in metopic craniosynostosis.

Children with metopic synostosis have been found to have more neurocognitive and behavioral difficulties. The variables that may affect future neurodevelopmental outcomes, including presenting morphologic severity, have not been fully studied. In the largest study to date, we aimed to assess what portends worse neurocognitive and behavioral outcomes at school age. Children 6-18 years old with surgically corrected metopic nonsyndromic craniosynostosis underwent neurocognitive testing. Parents completed behavior rating surveys about their child: Conners-3 (ADHD), Social Responsiveness Scale-2 (autism spectrum disorder), Behavior Rating Inventory of Executive Function-2 (BRIEF-2: executive function), and Child's Behavior Checklist (overall behavior). The endocranial bifrontal angle (EBA), adjusted EBA (aEBA), frontal angle (FA), and AI-derived metopic severity score (MSS) were determined on pre-operative CT images. Multivariate linear regressions were used to evaluate the association of age at surgery and severity. There were 87 children who underwent neurocognitive testing (average age 10.9 ± 3.3 years) of whom 67 also completed behavioral assessments. Greater phenotypical severity of metopic synostosis (lower FA, aEBA, and EBA) was associated with worse scores on the subscales of the BRIEF-2 (executive function) and executive subscale of the Conners-3. Increasing age at surgery was associated with worse executive function subscale scores of the Conners-3 when controlling for each severity measurement and sociodemographic risk. Children with greater phenotypic severity of metopic synostosis have worse executive function at school age. The majority of children with metopic synostosis have signs of ADHD. Later surgeries (greater than 12months) may impact executive functioning, regardless of the degree of severity. Future research should aim at identifying the direct structural changes to the brain.

Doxapram for apnoea of prematurity and neurodevelopmental outcomes at age 5–6 years

ObjectiveTo assess the long-term neurodevelopmental impact of doxapram for treating apnoea of prematurity.DesignSecondary analysis of the French national cohort study EPIPAGE-2. Recruitment took place in 2011. A standardised neurodevelopmental assessment...

Investigate the Processability of Biobased Thermoplastics Used in Nonwoven Fabrics.

The Covid-19 pandemic increased enormously the manufacturing and usage of face masks and other personal protective equipment (PPE), resulting in accumulation of plastic waste and, thus, causing universal environmental concerns. In addressing the issue of waste reduction and finding alternatives for fossil-based products, investigation of different biobased and biodegradable polymers plays a crucial role. This study examines the processability characteristics of three commonly used biobased polymers available in the market: biobased poly(lactic acid) (PLA), partly biobased and biodegradable poly(butylene succinate) (PBS), and biobased high-density poly(ethylene) (BioHDPE). The investigation combines substantial polymer analysis with subsequent processability trials in two different spunmelt processes, namely, meltblow (MB) and the Nanoval technology, aiming to reveal the differences and difficulties in the processing behavior and pointing out advantages and/or disadvantages of the respective polymer/technology combination. In general, the observed processability behavior and outcomes indicate that within the used processes PLA exhibits superior processability compared to PBS and BioHDPE. Both the meltblow and Nanoval processing of PLA demonstrated a consistent production of fibers and efficient uptake without any compromise on the throughput. In contrast, the processing of PBS using Nanoval required the utilization of significantly elevated temperatures, as indicated by a rheological study. Furthermore, the rheological evaluation revealed that the viscosity of BioHDPE was excessively elevated, rendering it unsuitable for effective processing by the Nanoval method. The microfibers in the PLA-based meltblown fabric had a higher surface area, explaining why the PLA fibers were able to function as a barrier and, thus, contribute to the mitigation of air permeability adjustable between 500 and 1000 l·s-1·m-2 and thus competitive or even superior to PP nonwovens of the same fiber diameter and base weight (1480 l·s-1·m-2). Overall, these results showed that PLA can be an alternative raw material for fossil-based nonwovens of PPE applying, especially, the meltblown technique.

“Let's keep calm and breathe”—A mindfulness meditation program in school and its effects on children's behavior and emotional awareness: An Australian pilot study

AbstractThis study aimed to understand how mindfulness meditation affects young people by examining its impact on self‐regulation, happiness, emotional awareness, and school performance among two groups of school children. A 10‐week mindfulness program was conducted by a meditation expert for 552 children aged 4–8 (Group 1) and 287 children aged 9–11 (Group 2). Results for the 4–8 years group (Group 1) showed meditation predicted an increase in happiness (R2 = .003, p < .001) and self‐reported school performance (R2 = .005, p < .001) and a decrease in emotional (R2 = .017, p < .001) and behavioral difficulties (R2 = .009, p < .001); however, the effect sizes were small. In the 9–11 years group (Group 2), meditation predicted an increase in emotional awareness (R2 = .02, p < .001), and a decrease in emotional (R2 = .014, p < .001) and behavioral difficulties (R2 = .009, p < .001) as measured by scores from baseline to postintervention. For Group 2, there was no significant change in happiness over the 10 weeks. The findings support incorporating mindfulness meditation in schools, noting significant enhancements in self‐regulation with just 5 min of daily practice.

Sleep disturbance in children with attention-deficit hyperactivity disorder: relationship with melatonin and behavior

ABSTRACT Aim To evaluate the prevalence and types of sleep problems and their correlations with melatonin content and behavior in Attention-Deficit Hyperactivity Disorder (ADHD) children. Method Sleep in ADHD children and typically developing children (TD) aged 6–14 was assessed by the Sleep Disorders Scale for Children (SDSC) and actigraphy, salivary melatonin quantified by ELISA, and behavior was analyzed using the Strengths and Difficulties Questionnaire. Results ADHD children showed a higher frequency of sleep disturbances, higher sleep latency, and lower sleep efficiency than in the TD group. The ADHD group presented lower melatonin nocturnal content compared to the TD group. Disorders of Initiating and Maintaining Sleep (DIMS) was moderately associated with nocturnal melatonin. The total behavior difficulties were correlated with Disorders of Initiating and Maintaining Sleep (DIMS), Sleep/Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DES), Sleep Hyperhidrosis (SHY) and Total SDSC Score. The behavior was the only determinant of the total SDSC score (R2 = 0.499; p < 0.002). Conclusion This study provides, for the first time, evidence that among the frequent sleep disturbances in ADHD, the disorders in initiating and maintaining sleep are associated with the low levels of melatonin found in this population. Additionally, these, along with other sleep disturbances, are linked to behavioral problems in ADHD.

Body image, eating distress and emotional-behavioral difficulties among adolescents in Mbarara, Southwestern Uganda

BackgroundAdolescents frequently have emotional and behavioral difficulties as they struggle with the challenges of transition from childhood to adulthood. Many struggle with issues of body image and eating distress as they deal with the difficult and frequently perplexing changes that occur with puberty. Yet there is surprisingly little research on the emotional and behavioral challenges, as well as body image and eating distress among this sizable population in Uganda. This study sought to assess attitudes and behaviors related to body image and eating distress, as well as emotional and behavioral difficulties among adolescents in Mbarara, Southwestern Uganda.MethodsThis was a cross-sectional study among 788 adolescents aged 13 to 19 years in secondary schools in Mbarara city and Mbarara district in south-western Uganda. The study employed the Body Image and Eating Distress scale to assess attitudes and behaviors about dieting and body shape and the extended version of the Strengths and Difficulties Questionnaire (SDQ) to assess for perceived emotional and behavioral difficulties. Logistic regression was used to identify the association between body image and eating distress and perceived difficulties.ResultsThe prevalence of high body image and eating distress was 10.8% while that of perceived emotional and behavioral difficulties was 45.8%. Some of the adolescents (16.1%) were dissatisfied with their body shape, 24.6% exercised a lot to avoid gaining weight, 15.0% were terrified to gain even a little weight, and 12.1% could not control their eating. More males reported eating large amounts of food at one time (p = < 0.001). Having emotional and behavioral difficulties (aOR: 1.89; 95% CI: 1.18 – 3.02; p = 0.019) and coming from a two-parent household (aOR: 1.79; 95% CI: 1.10 – 2.92; p = 0.019) increased the odds of high body image and eating distress.ConclusionHigh levels of body image and eating distress are linked to behavioral and emotional problems and adolescent’s family structure. Clinicians who treat adolescents should use a holistic care strategy and be aware of the high prevalence and close association between emotional and behavioral difficulties, concerns about weight, and dieting. It is important to encourage parental involvement and support in providing information about mental health issues among adolescents.

Integrating a Self-Regulation Intervention Within a Tier-2 Academic Intervention

Behavior and academic outcomes in school are interrelated; students who struggle with academics are likelier to exhibit troublesome behavior and students who struggle with behavior tend to fall behind academically. Multitiered systems of support (MTSS) offer frameworks for providing increasingly intensive support for students with academic and behavioral difficulties, but it can be challenging to efficiently integrate academic and behavioral supports rather than implementing separate resource-intensive systems. This article describes how behavior support can be integrated within Tier-2 interventions for reading and mathematics. A strategy that included four evidence-based elements—teaching expectations, self-monitoring, self-evaluation, and mystery match—was embedded within academic intervention lessons to target students’ academic engagement, respectful behavior, and effort. In this article, we describe our approach as one way that academic and behavioral supports might be integrated within a tiered intervention system.

Family engagement in a behavioral parenting intervention: A randomized comparison of telehealth versus office-based treatment formats.

Despite effective treatment options, many families-especially those from marginalized backgrounds-lack access to quality care for their children's behavioral difficulties. Since the COVID-19 pandemic, telehealth has become a prominent format for the delivery of outpatient services, with potential to increase access to quality care. Although telehealth-delivered parenting interventions are associated with positive clinical outcomes, limited research has examined whether telehealth formats improve treatment engagement relative to office-based care. The present study is the first controlled comparison of engagement across office-based parent-child interaction therapy (PCIT) and internet-delivered PCIT (iPCIT). Children ages 3-5 years, and their caregiver(s) (N = 40) participated in a randomized trial comparing iPCIT to office-based PCIT in the treatment of behavioral problems. Analyses examined the effects of treatment format on engagement (i.e., missed sessions, premature treatment discontinuation, homework completion, therapeutic alliance, and treatment satisfaction). Logistic and linear regressions further explored whether treatment format moderated the effects of common predictors of treatment engagement (i.e., family economic means, racial/ethnic background, caregiver stress). iPCIT improved attendance rates relative to office-based PCIT, especially for families from minoritized racial/ethnic backgrounds. At the same time, among families with relatively higher levels of caregiver stress, office-based PCIT was associated with lower dropout rates and improved treatment alliance and satisfaction, relative to iPCIT. This study provides the first experimental support that telehealth formats can improve treatment attendance in behavioral parenting interventions. Findings highlight nuances in treatment engagement across treatment formats that reveal limits to the extent telehealth transcends engagement concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Increased Hyperactivity with Decreased Parental Perceived Social Support Among Turkish Children with Autism Spectrum Disorder during Coronavirus Disease 2019 Pandemic.

The aim of the present study is to investigate the change in emotional/behavioral problems of children with autism spectrum disorder (ASD) and the perceived social support of parents during the coronavirus disease 2019 (COVID-19) pandemic. A total of 51 children with ASD aged between 6 and 18 years took part in the study. The Aberrant Behavior Checklist (ABC), the Strengths and Difficulties Questionnaire (SDQ), and the Multidimensional Scale of Perceived Social Support (MSPSS) were used to evaluate ASD symptoms, emotional/behavioral problems, and perceived social support, respectively. The cases were assessed before and 6 months after the pandemic. Our findings indicated that after the onset of the pandemic hyperactivity scores of children with ASD increased, whereas perceived social support of their parents decreased, compared to their pre-pandemic levels (P-value < .05). The increase in hyperactivity and irritability levels among children were positively associated with the presence of a chronic illness in the family and medication discontinuation (P-value < .05). Quarantine in the COVID-19 pandemic may cause or worsen behavioral problems among children with ASD possibly due to problems related to poor medication adherence and lowered perceived social support among their parents. Clinicians working with children with special needs may be pro-active to assess and manage emotional/behavioral problems among this special population particularly during difficult times such as pandemic.

The role of adolescents' mental health and well-being in predicting their smoking status

ObjectivesThis study aims to examine the relationship between adolescent's mental health, well-being and their tobacco use. MethodsThe study employed a relational survey model. The sample consisted of 691 adolescents aged between 12 and 15. This study deployed “Decisional Balance Scale” to predict and define the adolescents' tobacco use, and the “Me and My Feelings Scale” to evaluate mental health and well-being. Multiple linear regression analysis was used during data analysis. ResultThe results revealed that the emotional difficulties dimension of Me and My Feelings Scale had a statistically significant effect on the Decisional Balance Scale. However, the behavioral difficulties dimension did not have a statistically significant impact on the Decisional Balance Scale. ConclusionsAdolescents' mental health affects their tobacco use at the level of 2.3 %. A significant relationship was noted across the adolescents' mental health and their perceptions towards smoking.

Relationships between cognitive flexibility performance and adaptive behavior outcomes in survivors of pediatric brain tumor

Objective: Survivors of pediatric brain tumors are at increased risk of executive function (EF) and adaptive behavior difficulties. While previous research suggests that executive dysfunction impacts suboptimal adaptive outcomes, the specific elements of EF influencing this relationship remain unexplored. This study examines the relationship between cognitive flexibility and adaptive behavior in survivors compared to healthy controls. Methods: 86 survivors (M age(SD)=23.41(4.24), 44 females) and 86 controls (M age(SD)=23.09(4.50), 44 females) completed the Delis-Kaplan Executive Function System Trail Making Test (TMT) and Verbal Fluency Test (VFT). The Letter-Number Sequencing (LNS) and Category Switching (CS) conditions were isolated as measures of cognitive flexibility. Informants provided responses to obtain adaptive behavior ratings using the Scales of Independent Behavior-Revised (SIB-R). Linear regressions explored relationships between cognitive flexibility and SIB-R scores in survivors compared to controls. Results: For both TMT and VFT, the relationship between cognitive flexibility and adaptive behavior was significantly different between survivors and controls for SIB-R scores in Social Communication, Community Living, and Personal Living Skills (p<.0125). Survivors’ better LNS performance predicted greater SIB-R scores across the same 3 domains (all p= <.001, r 2semipartial=.08). Similarly, survivors’ better CS performance predicted greater SIB-R scores across the same 3 domains (p = 0.002 to .02, r 2semipartial =.03 to .04). No significant relationships were found in controls (all p >.05). After adjusting for working memory and inhibitory control, most relationships remained significant in survivors (p= <.001 to .046, r 2semipartial=.02 to .08). Conclusion: These findings reveal a robust, positive relationship between cognitive flexibility performance and adaptive behaviors specific to survivors.

The prevalence of comorbid mental health difficulties in young people with chronic skin conditions: A systematic review and meta-analysis.

Chronic skin conditions can have psychosocial and somatic implications, influencing well-being and quality of life. This systematic review and meta-analysis aimed to synthesise evidence on the prevalence of comorbid mental health difficulties in 0-25-year-olds with chronic skin conditions. A secondary aim included identifying factors associated with resilience. The narrative synthesis included 45 studies. Four meta-analyses were performed with moderate-high quality studies, one for each outcome: diagnosed mental disorders; mental health symptoms; suicidal behaviour; socio-emotional and behavioural difficulties. The pooled prevalence of diagnosed mental disorders was 1.2% (95% CI = 0.2-6.1); of mental health symptoms was 22.6% (95% CI = 18.9-26.7); of suicidal behaviour was 7.8% (95% CI = 1.4-3.1); of socio-emotional and behavioural difficulties was 20.9% (95% CI = 14.7-28.8). Findings demonstrate the pooled prevalence of comorbid mental health difficulties in youth with chronic skin conditions.

Complimentary vertebrate Wac models exhibit phenotypes relevant to DeSanto-Shinawi Syndrome.

Monogenic syndromes are associated with neurodevelopmental changes that result in cognitive impairments, neurobehavioral phenotypes including autism and attention deficit hyperactivity disorder (ADHD), and seizures. Limited studies and resources are available to make meaningful headway into the underlying molecular mechanisms that result in these symptoms. One such example is DeSanto-Shinawi Syndrome (DESSH), a rare disorder caused by pathogenic variants in the WAC gene. Individuals with DESSH syndrome exhibit a recognizable craniofacial gestalt, developmental delay/intellectual disability, neurobehavioral symptoms that include autism, ADHD, behavioral difficulties and seizures. However, no thorough studies from a vertebrate model exist to understand how these changes occur. To overcome this, we developed both murine and zebrafish Wac/wac deletion mutants and studied whether their phenotypes recapitulate those described in individuals with DESSH syndrome. We show that the two Wac models exhibit craniofacial and behavioral changes, reminiscent of abnormalities found in DESSH syndrome. In addition, each model revealed impacts to GABAergic neurons and further studies showed that the mouse mutants are susceptible to seizures, changes in brain volumes that are different between sexes and relevant behaviors. Finally, we uncovered transcriptional impacts of Wac loss of function that will pave the way for future molecular studies into DESSH. These studies begin to uncover some biological underpinnings of DESSH syndrome and elucidate the biology of Wac, with advantages in each model.

Resilience in residential care: A qualitative study based on the voices of adolescents

Young people placed in residential care are at an increased risk of a wide range of emotional and behavioral difficulties. Some of them deteriorate in psychological outcomes, some show no changes, and some show healthy psychological outcomes. Recent research has identified protective factors of adolescents’ psychological health outcomes in residential care, framed on the Resilience Portfolio Model. However, to the best of our knowledge, studies using qualitative designs are scarce.This qualitative study aimed to identify adolescents’ perspectives on the concept of resilience and identify their perspectives on protective factors for psychological health. Nineteen adolescents (12–17 years old;M = 14.21; 57.9 % male) from three non-specialized residential care settings in Portugal participated in this study, answering to a semi-structured interview. Data were analyzed using content analysis, and the results revealed that our participants identified specific factors in residential care (e.g., staff and peer support) and out-of-care (e.g., family) contexts that are relevant to their resilience outcomes. The childcare system should consider adolescents’ resilience portfolios by fostering individual assets and contextual protective factors to promote positive outcomes.

Comparison of Serum Neurofilament Light Chain and Tau Protein Levels in Cases with Autism Spectrum Disorder and Their Healthy Siblings and Healthy Controls.

: There is a growing interest among clinicians and researchers in identifying potential biomarkers associated with autism. Neurofilament light chain (NfL) and Tau protein, which are proteins associated with neurodegeneration and neuroaxonal degeneration, are particularly promising potential biomarker candidates in this field. : In this study, we compared serum NfL (sNfL) and serum Tau (sTau) levels in Autism spectrum disorder (ASD) patients, their healthy siblings (HS), and healthy controls (HC), aimed to investigate their relationship with ASD severity. Our study included 43 ASD-diagnosed participants, 43 HS participants and 42 HC participants. Clinical characteristics of the participants were assesed by Kiddie Schedule for Affective Disorders and Schizophrenia, Childhood Autism Rating Scale, Aberrant Behavior Checklist, and Strengths and Difficulties Questionnaire. Serum samples were subjected to analysis via enzyme-linked immunosorbent assay to quantitatively measure the levels of NfL and Tau protein. : sNfL levels in the ASD group were significantly higher than both of the control groups. Regarding sTau levels, no significant difference was found between study and control groups. In addition, NfL and Tau levels were not significantly correlated with ASD symptom severity. : Our findings may indicate that the sNfl levels associated with neuroaxonal damage may constitue a potential clinical biomarker rather than being an endophenotype phenomena.

Machine learning-based health environmental-clinical risk scores in European children

BackgroundEarly life environmental stressors play an important role in the development of multiple chronic disorders. Previous studies that used environmental risk scores (ERS) to assess the cumulative impact of environmental exposures on health are limited by the diversity of exposures included, especially for early life determinants. We used machine learning methods to build early life exposome risk scores for three health outcomes using environmental, molecular, and clinical data.MethodsIn this study, we analyzed data from 1622 mother-child pairs from the HELIX European birth cohorts, using over 300 environmental, 100 child peripheral, and 18 mother-child clinical markers to compute environmental-clinical risk scores (ECRS) for child behavioral difficulties, metabolic syndrome, and lung function. ECRS were computed using LASSO, Random Forest and XGBoost. XGBoost ECRS were selected to extract local feature contributions using Shapley values and derive feature importance and interactions.ResultsECRS captured 13%, 50% and 4% of the variance in mental, cardiometabolic, and respiratory health, respectively. We observed no significant differences in predictive performances between the above-mentioned methods.The most important predictive features were maternal stress, noise, and lifestyle exposures for mental health; proteome (mainly IL1B) and metabolome features for cardiometabolic health; child BMI and urine metabolites for respiratory health.ConclusionsBesides their usefulness for epidemiological research, our risk scores show great potential to capture holistic individual level non-hereditary risk associations that can inform practitioners about actionable factors of high-risk children. As in the post-genetic era personalized prevention medicine will focus more and more on modifiable factors, we believe that such integrative approaches will be instrumental in shaping future healthcare paradigms.

Linking child adjustment difficulties with mother's maladaptive parental behavior: The mediating roles of parental cognitions and parenting stress.

Child abuse is prevalent worldwide, with most of the burden in developing countries. To reduce and prevent child abuse occurrence, many efforts are directed toward reducing maladaptive parental behaviors (MPBs), a predictor of parents' risk of engaging in child abusive behaviors. MPBs have been associated with child (e.g., behavioral difficulties) and parent characteristics (e.g., parenting stress and parental cognitions), although little research tested for mediational pathways. This study aimed to test the pathways through which child and parent characteristics are linked to MPB. Consistent with the social information processing model of parenting, we hypothesized that child behavioral difficulties would exert an indirect influence on MPB through parenting stress and that parenting stress will exert a direct and indirect effect on MPB through parental cognitions (i.e., expectations, attitudes, and attributions). This study used data from 243 mothers of children aged between 2 and 9 years in Romania. Two-stage structural equation modeling was employed to test the hypothesized model. Results support the role of child behavior, parenting stress, and parental cognitions in predicting MPB (R2 = 0.69). Significant indirect effects were found from child behavior to MPB via parenting stress and parental cognitions. Direct effects from parenting stress and parental cognitions to MPB were significant. Findings show that parenting stress and parental cognitions are important mechanisms through which child behavioral difficulties influence maladaptive parental behavior, underscoring the need to focus on these mechanisms when assessing or intervening with families at risk for child abuse.

Manifold child, family and social variables are associated with injury among New Zealand preschool children

AimApproaches to understanding child injury tend to focus on short-term proximal influences. Previous analyses have found higher rates of injury among Māori and Pacific children in Aotearoa New Zealand (NZ)....