Behavioral Problems In School-aged Children Research Articles

Long-term health-related quality of life and psychological adjustment in children after haemolytic-uraemic syndrome.

In children after haemolytic-uraemic syndrome (HUS), little is known about long-term health-related quality of life (HRQoL) and psychological adjustment as defined by behavioural problems, depressive symptoms and post-traumatic stress symptoms. Sixty-two paediatric patients with a history of HUS were included in this study. Medical data of the acute HUS episode were retrieved retrospectively from hospital records. Data on the clinical course at study investigation were assessed by clinical examination and laboratory evaluation. HRQoL and psychological adjustment data were measured by standardised, parent- and self-reported questionnaires. Haemolytic-uraemic syndrome was diagnosed at a mean of 6.5years before the initiation of the study (standard deviation 2.9, range 0.1-15.7) years. Among the preschool children, parents reported that their child was less lively and energetic (HRQoL emotional dimension), while no increased behavioural problems were reported. In the school-age children, self- and proxy-reported HRQoL was well within or even above the norms, while increased total behavioural problems were found. The school-age children reported no increased depression scores. Also none of the children met the criteria for full or partial HUS-associated posttraumatic stress disorder. Healthcare providers should be particularly alert to behavioural problems in school-age children with a history of HUS and to lower HRQoL in preschool children.

Psychometric Testing of Behavior Assessment for Children

The purpose of this study was to test the reliability and validity of the Behavior Assessment for Children (BAC) in a community of school-aged children in Taiwan. A school-based sample comprising third grade and fourth grade students was recruited from Taichung City in Taiwan. The parents (n = 248) and teachers (n = 15) of these students completed structured questionnaires, including the Child Behavior Checklist (CBCL) and the proposed BAC. Content validity, concurrent validity, construct validity, internal consistency, and inter-rater reliability of the BAC were assessed. The BAC comprised three subscales (attention, emotion, and self-control) that included 17 items. The content validity index (CVI) score was 0.98. The result of the confirmatory factor analysis (goodness of fit = .90, root mean square of residual = .03, root mean square error of approximation = .06, and comparative fit index = .94) supported the construct validity of the three BAC subscales. The concurrent validity of the BAC subscales significantly correlated with the compatible CBCL subscales (r = .59-.78, p < .001). Cronbach α of the subscales of the BAC ranged from .78 to .92. The intraclass correlation coefficient between the parents and teachers ranged from .31 to .44, and the joint probability of agreement ranged from 31.4% to 92.2%. The BAC is a valid and reliable instrument for evaluating behavioral problems in school-aged children.

Postnatal Environmental Tobacco Smoke Exposure Related to Behavioral Problems in Children.

ObjectiveThe purpose of this study was to examine the association between pre and post environmental tobacco smoke (ETS) exposure and behavioral problems in schoolchildren.MethodsIn the cross-sectional 6 cities Study conducted in France, 5221 primary school children were investigated. Pre- and postnatal exposure to secondhand tobacco smoke at home was assessed using a parent questionnaire. Child’s behavioral outcomes (emotional symptoms and conduct problems) were evaluated by the Strengths and Difficulties Questionnaire (SDQ) completed by the parents.ResultsETS exposure during the postnatal period and during both pre- and postnatal periods was associated with behavioral problems in children. Abnormal emotional symptoms (internalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.72 (95% Confidence Interval (CI)= 1.36-2.17), whereas the OR was estimated to be 1.38 (95% CI= 1.12-1.69) in the case of postnatal exposure only. Abnormal conduct problems (externalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.94 (95% CI= 1.51-2.50), whereas the OR was estimated to be 1.47 (95% CI=1.17-1.84) in the case of postnatal exposure only. Effect estimates were adjusted for gender, study center, ethnic origin, child age, low parental education, current physician diagnosed asthma, siblings, preterm birth and single parenthood.ConclusionPostnatal ETS exposure, alone or in association with prenatal exposure, increases the risk of behavioral problems in school-age children.

Immunological correlates of behavioral problems in school-aged children living with HIV in Kayunga, Uganda

HIV can affect the neuropsychological function of children, including their behavior. We aim to identify immunological correlates of behavioral problems among children living with HIV in Uganda. Children participating in a parent randomized control trial in Kayunga, Uganda were assessed with the Behavior Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL). We constructed simple and multiple linear regression models to identify immunological correlates of behavioral problems. A total of 144 children living with HIV (50% male) with a mean age of 8.9 years [Standard Deviation (s.d.)=1.9] were included in the analysis. Eighty-two children were on antiretroviral therapy. Mean CD4 cell count % was 35.1 cells/μl (s.d.=15.0), mean CD4 cell activation 5.7% (s.d.=5.1), mean CD8 cell activation was 17.5% (s.d.=11.2) and 60 children (41.7%) had a viral load of <4000copies/ml. In the adjusted models for the BRIEF, higher scores were associated with higher viral loads (aβ=16.7×10-6, 95% CI -5.00×10-6 to 28.4×10-6), specifically on the behavioral regulation index. Higher mean CD8 activation % was associated with higher scores on the Externalizing Problems and Total Problems scales of the CBCL (aβ=0.17, 95% CI 0.04-0.31 and aβ=0.15, 95% CI 0.00-0.28, respectively). Poorer behavioral outcomes were associated with higher viral loads while higher CD8 activation was associated with poorer emotional and behavioral outcomes. Complete immunological assessments for children living with HIV could include commonly used viral and immunological parameters to identify those at higher risk of having negative behavior outcomes and who would benefit the most from behavioral interventions.

Associations between prenatal cigarette smoke exposure and externalized behaviors at school age among Inuit children exposed to environmental contaminants

BackgroundSmoking during pregnancy is common among Inuit women from the Canadian Arctic. Yet prenatal cigarette smoke exposure (PCSE) is seen as a major risk factor for childhood behavior problems. Recent data also suggest that co-exposure to neurotoxic environmental contaminants can exacerbate the effects of PCSE on behavior. This study examined the association between PCSE and behavior at school age in a sample of Inuit children from Nunavik, Québec, where co-exposure to environmental contaminants is also an important issue. Interactions with lead (Pb) and mercury (Hg), two contaminants associated with behavioral problems, were also explored. MethodsParticipants were 271 children (mean age=11.3years) involved in a prospective birth-cohort study. PCSE was assessed through maternal recall. Assessment of child behavior was obtained from the child's classroom teacher on the Teacher Report Form (TRF) and the Disruptive Behavior Disorders Rating Scale (DBD). Exposure to contaminants was assessed from umbilical cord and child blood samples. Other confounders were documented by maternal interview. ResultsAfter control for contaminants and confounders, PCSE was associated with increased externalizing behaviors and attention problems on the TRF and higher prevalence of attention deficit hyperactivity disorder (ADHD) assessed on the DBD. No interactions were found with contaminants. InterpretationThis study extends the existing empirical evidence linking PCSE to behavioral problems in school-aged children by reporting these effects in a population where tobacco use is normative rather than marginal. Co-exposure to Pb and Hg do not appear to exacerbate tobacco effects, suggesting that these substances act independently.

Family matters: Parental-acquired brain injury and child functioning

To relate illness related to and family factors to emotional and behavioural problems in school-age children (7-14 years old) of parents with acquired brain injury and their healthy spouses. Members of 35 families in which a parent had been diagnosed with acquired brain injury participated. Family and brain injury characteristics were reported by the ill and healthy parents. Children self-reported post-traumatic stress symptoms (PSS) using the Child Impact of Events revised (CRIES). Emotional and behavioural problems among the children were also identified by the parents using the Achenbach's Child Behaviour Checklist (CBCL). The family stress variables relating to the healthy spouse in all six comparisons were significant (p <= 0.05) or nearly so (p = 0.07) in each case showing higher scores for spouses to be associated with higher CRIES and CBCL total scores for the children. For the adjusted associations, we again found the family stress variables in the healthy spouse to be related to the risk of emotional and behavioral problems in the children. The present results suggest that in ABI families, the children's emotional functioning depends upon family factors and primarily on the level of parental stress in the healthy parent.

Resilience as a protective factor for the behavioral problems in school-aged children with atopic dermatitis

This study investigates the relationships between resilience and behavioral problems in school-aged children with atopic dermatitis (AD) and identifies factors associated with these behavioral problems. A total of 102 school-aged children suffering from chronic AD were administered a self-report questionnaire on resilience, and the Korean version of the Child Behavior Checklist, to measure their internalizing/externalizing behavioral problems. The means of the internalizing and externalizing behavioral problems of children with AD were 6.58 and 7.26, respectively. Both resilience and economic status were negatively correlated with the internalizing, r = -0.262, p < 0.05, and externalizing, r = -0.248, p < 0.05, behaviors in children. The higher the children's school achievements, the less externalizing behavioral problems were reported, r = -0.327, p < 0.05. Resilience was identified as the single potent variable affecting children's behavioral problems. The higher the children's resilience scores, the lower was the chance of both internalizing, β = -1.648, p = 0.034, and externalizing behavioral problems, β = -1.382, p = 0.041. To prevent possible behavioral problems in children with chronic AD, a care plan enhancing their resilience (i.e. promoting parenting skills and social supports for children) should be developed.

Peer problems mediate the relationship between developmental coordination disorder and behavioral problems in school-aged children

The aim of this study was to gain insights into the relationship between developmental coordination disorder, peer problems, and behavioral problems in school-aged children where both internalizing and externalizing behavioral problems were considered. We assumed that the relationship between developmental coordination disorder and internalizing/externalizing problems in school-aged children is mediated by peer problems and tested the hypothesis that a greater degree of motor impairment causes a greater degree of peer problems and thus a greater degree of internalizing or externalizing problems. Seventy boys and girls aged between 5 and 11 years were examined using the Movement Assessment Battery for Children 2 and the Intelligence and Developmental Scales. The results of path analysis showed that the relationship between developmental coordination disorder and internalizing/externalizing problems in school-aged children is mediated at least in part by peer problems. However, the cross-sectional design of the study does not provide conclusive evidence for a cause-effect relationship and only allows for the conservative prognosis that a greater degree of motor impairment may cause a greater degree of peer problems and thus a greater degree of internalizing/externalizing problems. Nevertheless, the results of this study emphasize the importance of being well-integrated in their peer group especially for children with developmental coordination disorder.

Sleep, cognition, and behavioral problems in school-age children: A century of research meta-analyzed.

Clear associations of sleep, cognitive performance, and behavioral problems have been demonstrated in meta-analyses of studies in adults. This meta-analysis is the first to systematically summarize all relevant studies reporting on sleep, cognition, and behavioral problems in healthy school-age children (5-12 years old) and incorporates 86 studies on 35,936 children. Sleep duration shows a significant positive relation with cognitive performance (r = .08, confidence interval [CI] [.06, .10]). Subsequent analyses on cognitive subdomains indicate specific associations of sleep duration with executive functioning (r = .07, CI [.02, .13]), with performance on tasks that address multiple cognitive domains (r = .10, CI = [.05, .16]), and with school performance (r = .09, CI [.06, .12]), but not with intelligence. Quite unlike typical findings in adults, sleep duration was not associated with sustained attention and memory. Methodological issues and brain developmental immaturities are proposed to underlie the marked differences. Shorter sleep duration is associated with more behavioral problems (r = .09, CI [.07, .11]). Subsequent analyses on subdomains of behavioral problems showed that the relation holds for both internalizing (r = .09, CI [.06, .12]) and externalizing behavioral problems (r = .08, CI [.06, .11]). Ancillary moderator analyses identified practices recommended to increase sensitivity of assessments and designs in future studies. In practical terms, the findings suggest that insufficient sleep in children is associated with deficits in higher-order and complex cognitive functions and an increase in behavioral problems. This is particularly relevant given society's tendency towards sleep curtailment.

P-281 - Prolonged non-nutritive suckling habits are associated with emotional and behavioral problems in school-age children

Prolonged non-nutritive suckling habits (finger and pacifier) (PNNSH) can indicate children's emotional and behavioral difficulties. Our aim was to evaluate the association of such habits with emotional and behavioral problems in schoolchildren, taking also into account birth and school age conditions. Data were collected at birth and school age from children of two Brazilian cities, São Luís (SL) and Ribeirão Preto (RP). The Strength and Difficulties Questionnaire (SDQ) was applied to 790 schoolchildren in RP and 673 in SL to identify Emotional Symptoms, Conduct Problems, Hyperactivity and Peer Problems. The children were classified as “normal” and “abnormal” depending on the score for each scale. PNNSH were considered to be prolonged when they lasted 36 months or more. Crude and adjusted prevalence ratios (PR) were calculated by Poisson regression. The overall proportion of PNNSH was 47.6% and 19.6%, and of the proportion of symptoms was 38.2% and 34.7% in RP and SL, respectively. Abnormal symptoms were: Emotional Symptoms, RP = 54.0%, SL = 57.4%; Conduct Problems, RP = 34.7%, SL = 48.0%; Hyperactivity, RP = 26.4%, SL = 32.5%; Peer Problems, RP = 27.2%, SL = 26.5%. After adjustment for socio-demographic factors, PNNSH was a risk factor for emotional symptoms (PR = 1.17), conduct problems (PR = 1.43) and hyperactivity (PR = 1.55) in RP and marginally for peer problems (PR = 1.33, 95%CI 1.00–1.77) in SL. Girls were protected against conduct problems and hyperactivity in both cities. PNNSH were associated with behavioral and emotional symptoms at school age in RP children and borderline associated with peer problems in SL. Girls were protected from behavioral problems in both cities

Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent behavioral problems in school-age children. Although the etiology remains unclear, the involvement of the dopaminergic system has been suggested by genetic studies that report an overexpression of the dopamine transporter (DAT) gene. In spite of these abnormalities being directly related to the decrease of dopamine (DA) in the striatum (STR), abnormalities in brain perfusion have also been observed in cortical-subcortical structures. Functional neuroimaging studies have suggested that the DA concentration may cause changes in the cerebral blood flow (CBF). The objective of our study was to evaluate the relationship between DAT density in STR and cortical-subcortical impairment in CBF. Based on the hypothesis that there is a correlation between DA availability and brain perfusion, we postulated that individuals with ADHD, with a higher DAT density in the basal ganglia, will have lower perfusion in the fronto-striatal-cerebellar networks. We used Tc-99m TRODAT-1 SPECT to measure DAT density and Tc-99m ECD SPECT to assess brain perfusion. Ten adolescents diagnosed with ADHD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were investigated. Analysis with Statistical Parametric Mapping 5 corrected for multiple comparisons, using small volume correction, showed a significant negative correlation between the DAT density in the STR and CBF in the cingulate gyrus, frontal lobe, temporal lobe, and cerebellum (pFDR <0.01). Our findings suggest that higher DAT density in the STR was associated with a decrease in the regional CBF in the cortical and subcortical attention network.

Behavioral Consequences of Pediatric Traumatic Brain Injury

Behavioral problems are common after pediatric traumatic brain injury (TBI), but poorly understood. In this article we review ten common behavioral problems observed in children after TBI and consider the factors that appear to contribute to their expression. Both neurological and non-neurological variables can interact in a complicated way to produce behavioral problems in school-age children following TBI. We conclude with suggestions for the management and treatment of these behavioral problems in a manner that hopefully will reduce parental distress and disruptive behaviors of the child in school.

Counseling children at risk in a resilient contextual perspective: a paradigmatic shift of school psychologists’ role in inclusive education

Existing evidence shows an increasing number of learning, emotional, interpersonal, and behavioural problems in school-age children that affect their academic and social development. If not treated in a holistic and effective manner, these difficulties may increase the probability of more serious psychosocial and academic problems during adolescence. The purpose of this paper is to describe a school-based counseling intervention model aiming at supporting vulnerable children (children with various forms of disabilities) and families at risk based on a resilient and eco-systemic perspective. This implies a considerable and paradigmatic shift in school goals, in the role of educational staff and school psychologists as well as the establishment of a holistic and comprehensive intervention model within schools; a model which will refer to a meaningful and systemic conception of academic and mental health problems in childhood.

Prenatal and Postnatal Tobacco Exposure and Behavioral Problems in 10-Year-Old Children: Results from the GINI-plus Prospective Birth Cohort Study

BackgroundPrenatal and postnatal tobacco exposure have been reported to be associated with behavioral problems. However, the magnitude of the association with tobacco exposure at specific periods of exposure is unclear.ObjectiveWe assessed the relative risk of behavioral problems in children who had been exposed to tobacco smoke in utero and postnatally.MethodsWe analyzed data from a prospective birth cohort study in two cities in Germany: the German Infant Nutrition Intervention. Our sample included 5,991 children born between 1995 and 1998 as well as their parents. We measured behavioral problems using the Strength and Difficulties Questionnaire (SDQ) at follow-up 10 years after birth. According to prespecified SDQ cutoff values, children were classified as “normal,” “borderline,” or “abnormal” according to the subscales “emotional symptoms,” “conduct problems,” “hyperactivity/inattention,” “peer-relationship problems,” and a total difficulties score. Smoke exposure and further covariates were assessed using parent questionnaires.ResultsCompared with children not exposed to tobacco smoke, children exposed both pre- and postnatally to tobacco smoke had twice the estimated risk [95% confidence interval (CI), 1.4–3.1] of being classified as abnormal according to the total difficulties score of the SDQ at 10 years of age. Children who were only prenatally exposed had a 90% higher relative risk (95% CI, 0.9–4.0), whereas children who were only postnatally exposed had a 30% higher relative risk (95% CI, 0.9–1.9). These results could not be explained by confounding by parental education, father’s employment, child’s time spent in front of computer or television screen, being a single father or mother, or mother’s age.ConclusionsPrenatal exposure to tobacco smoke is associated with behavioral problems in school-age children. Although our findings do not preclude the influence of postnatal exposure, prenatal exposure seems to be more important.

Prenatal cocaine exposure: An examination of childhood externalizing and internalizing behavior problems at age 7 years

This study examines the relationship between prenatal cocaine exposure and parent-reported child behavior problems at age 7 years. Data are from 407 African-American children (210 cocaine-exposed, 197 non-cocaine-exposed) enrolled prospectively at birth in a longitudinal study on the neurodevelopmental consequences of in utero exposure to cocaine. Prenatal cocaine exposure was assessed at delivery through maternal self-report and bioassays (maternal and infant urine and infant meconium). The Achenbach Child Behavior Checklist (CBCL), a measure of childhood externalizing and internalizing behavior problems, was completed by the child's current primary caregiver during an assessment visit scheduled when the child was seven years old. Structural equation and GLM/GEE models disclosed no association linking prenatal cocaine exposure status or level of cocaine exposure to child behavior (CBCL Externalizing and Internalizing scores or the eight CBCL subscale scores). This evidence, based on standardized ratings by the current primary caregiver, fails to support hypothesized cocaine-associated behavioral problems in school-aged children with in utero cocaine exposure. A next step in this line of research is to secure standardized ratings from other informants (e.g., teachers, youth self-report).

Behavioral Problems in School-Aged Children of Mothers with HIV/AIDS

This study examined the relationships between selected risk and resistance factors and maternal reports of child behavior problems on the Child Behavior Checklist (CBCL) in families affected by maternal HIV/AIDS. Data were obtained from 193 mothers with late-stage HIV/AIDS who were included in a sample consecutively recruited from the New York City Division of AIDS Services Income Support to participate in Project Care, a randomized trial of a permanency planning intervention. Each mother reported on one HIV negative index child 5–12 years of age. Child behavior problems were related significantly to the mother’s psychological distress and marginally to her having illness-related activity restrictions, but not to other measures of maternal physical health, stigma or disclosure of her HIV to the child. Two child dispositional factors, productivity and independence, and two family factors, adaptability and a good parent–child relationship, were related to better child functioning, but family cohesion was a risk factor for poorer adjustment in this sample. These are likely to be key target variables useful to policy makers in planning programs to assist these children in coping successfully with their mother’s illness.