Child Behavior Checklist Total Score Research Articles

Autistic traits, emotional recognition and empathy in adolescents with gender dysphoria

Objective: Gender dysphoria (GD) is defined as an apparent incongruence between the sex assigned at birth and the experienced gender. The aim of this study is to evaluate the basic milestones of autistic symptoms in adolescents diagnosed with GD and to compare them with the control group. Method: The Sociodemographic Information Form, the Reading the Mind in the Eyes Test (RMET) and DANVA (Non-Verbal Diagnostic Accuracy Test), the Ka-Si Empathy Scale, and the Social Response Scale (SRS) were used. The psychiatric symptoms were evaluated using the Child Behavior Checklist (CBCL). Results: A total of 36 adolescents, diagnosed with GD (n=17) and a control group (n=19), included to the study. The GD group and control group were similar in terms of mean age. Of the GD group, 29.4% had a CBCL total score, 35.3% had a CBCL internalization score and 11.8% had a CBCL externalization score above their respective cut-off points. The GD group had significantly higher scores in the SRS social subscale than the control group (t=2.227, p=0.033). SRS social score was found to be predicted by group and gender variables (df=3, F=5.064). Conclusion: Having male biological sex and having GD increased the SRS social subscale score. It was found that internalizing problems such as depression and anxiety were common in adolescents with GD and their social skills were impaired compared to the control group.

Second generation of the 1993 birth cohort, Pelotas (Brazil): Aims, design, preliminary results.

Background and AimsLongitudinal cohort studies examining different generations can explain how health problems can be transmitted through genetic and environmental mechanisms and their effects on the health of offspring. This study aimed to present the design and to describe the characteristics of the baseline sample of a second generation cohort.MethodsThe 93Cohort‐II is a dynamic prospective cohort composed of a second generation from the original 1993 Pelotas Birth Cohort (offspring), whose parents had their last follow‐up at 22 years old. Biological parents were asked to answer questions addressing the type of birth, general health status, family composition, dietary habits, breastfeeding habits, and child‐caregiver(s), among others, and the children's anthropometric measurements were evaluated.ResultsOf 1650 children identified, 1212 were evaluated (response rate, 73.4%), and 21 died before the baseline assessment. The age of the offspring ranged from 0 to 10 years (mean [±SD], 2.9 ± 2.1 years); most children (65.6%) lived with both parents and were born to young mothers and poor families. One‐third of the children were breastfed until 6 months of age, one‐half were born by cesarean section, 63.9% had used medication in the previous 15 days, 26.4% experienced hospitalization at least once since birth, and 14% had no updated vaccination; asthma/bronchitis (20.4%) and bronchiolitis (13.4%) were the most frequently reported diseases. More than 60% consumed ultra‐processed foods, and the prevalence of overweight among those <5 and ≥6 years of age was 10.2% and 18.9%, respectively. The mean total Child Behavior Checklist score was 44.1 ± 23.61 (≥16 months), and the mean intellectual quotient score in children ≥6 years of age was 97.9 ± 15.4.ConclusionDespite the difficulties in conducting intergenerational cohort studies, the results of the present investigation provide evidence supporting the feasibility of performing these types of studies in middle‐income countries.

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems

Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively. A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F). N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29months (SD 5.3) and C-TRF (N = 989) at 32.6months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026). Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.

Behavioral comorbidity, overweight, and obesity in children with incontinence: An analysis of 1638 cases.

Children with nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are at risk for behavioral problems, overweight, and obesity. The aim of this study was to analyze the specific behavioral and weight comorbidity in subtypes of incontinence. A total of 1638 consecutive patients presented to a tertiary incontinence clinic from 2012 to 2018 was examined prospectively according to ICCS criteria. Behavioral symptoms were measured with the Child Behavior Checklist (CBCL). Psychiatric disorders were diagnosed according to ICD-10 criteria. Weight categories were calculated according to WHO recommendations. The mean age was 7.8 years, 67% of patients were male. Fifty-seven percent had NE (n = 934), 33% DUI (n = 547), and 40% FI (n = 656). Boys had significantly higher rates of NE and FI than girls. Of all children, 39.2% (n = 539) had a clinically relevant CBCL total score. A total of 28.3% (n = 463) had an ICD-10 psychiatric diagnosis, mainly ODD and ADHD, and 28.6% (n = 463) were overweight or obese. Boys were more often affected by behavioral symptoms, psychiatric disorders, and overweight/obesity. Children with NE had the highest rate of overweight/obesity. Except for primary nonmonosymptomatic NE, subtypes of incontinence did not differ regarding behavioral symptoms and weight categories. However, overweight/obesity was significantly associated with behavioral and psychiatric parameters. Behavioral symptoms and psychiatric disorders, as well as overweight/obesity are important risk factors associated with incontinence, but the interaction between these factors is complex. In clinical settings, all children with incontinence should be screened with behavioral questionnaires. Also, weight should be measured, and overweight/obesity should be addressed.

Maternal immune-related conditions during pregnancy may be a risk factor for neuropsychiatric problems in offspring throughout childhood and adolescence.

Emerging research suggests that maternal immune activation (MIA) may be associated with an increased risk of adverse neurodevelopmental and mental health outcomes in offspring. Using data from the Raine Study, we investigated whether MIA during pregnancy was associated with increased behavioral and emotional problems in offspring longitudinally across development. Mothers (Generation 1; N = 1905) were classified into the following categories: AAAE (Asthma/Allergy/Atopy/Eczema; N = 1267); infection (during pregnancy; N = 1082); no AAAE or infection (N = 301). The Child Behavior Checklist (CBCL) was administered for offspring at ages 5, 8, 10, 14, and 17. Generalized estimating equations were used to investigate the effect of maternal immune status on CBCL scores. AAAE conditions were associated with significant increases in CBCL Total (β 2.49; CI 1.98-3.00), Externalizing (β 1.54; CI 1.05-2.03), and Internalizing (β 2.28; CI 1.80-2.76) scores. Infection conditions were also associated with increased Total (β 1.27; CI 0.77-1.78), Externalizing (β 1.18; CI 0.70-1.66), and Internalizing (β 0.76; CI 0.28-1.24) scores. Exposure to more than one AAAE and/or infection condition was associated with a greater elevation in CBCL scores than single exposures in males and females. Females showed greater increases on the Internalizing scale from MIA, while males showed similar increases on both Internalizing and Externalizing scales. MIA was associated with increased behavioral and emotional problems in offspring throughout childhood and adolescence. This highlights the need to understand the relationship between MIA, fetal development, and long-term outcomes, with the potential to advance early identification and intervention strategies.

Sleep disturbances in Italian children and adolescents with epilepsy: A questionnaire study

Sleep and epilepsy interact with each other in a complex bidirectional way.The main objective of this study was to characterize and determine the prevalence of sleep and behavioral disorders among Italian children and adolescents with epilepsy.We asked 84 consecutive parents/caregivers of patients with epilepsy aged between 6 and 17 years old to fill out the Sleep Disturbances Scale for Children (SDSC) and Child Behavior Checklist (CBCL).An abnormal total sleep score was found in 20 subjects with epilepsy (23.8%), compared with 4 (4.4%) of control group (P < .001). Forty-eight patients (57.1%) had an abnormal score in at least one SDSC factor: disorders in initiating and maintaining sleep (DIMS; 13.1%), sleep breathing disorders (SBD; 13.1%), disorders of arousal (DA; 5.9%), sleep–wake transition disorders (SWTD; 15.5%), disorders of excessive somnolence (DOES; 20.2%), and sleep hyperhidrosis (SHY; 5.9%). Patients with epilepsy showed higher prevalence of behavioral/emotional disturbances in all CBCL domains but one compared with patients without epilepsy. The SDSC and CBCL total scores showed a significant correlation (R-square = 0.256; P < .001).Sleep and behavioral/emotional disorders are common in epilepsy during childhood and adolescence. The SDSC could be a valid tool to screen sleep disturbances in this group of patients.

Psychological Distress in Early Childhood and the Risk of Adolescent Spinal Pain with Impact: A Longitudinal Cohort Study

Background: Spinal pain (SP), including neck and back pain, is common and often associated with substantial functional interference (e.g. school absenteeism), poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests stronger influence of psychological rather than other factors. We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence. Methods: 1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalising and externalising symptoms) were converted to age-standardized scores and dichotomized according to t-scores (>60 = high distress). Spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models. Sex was tested as a moderator and confounders were: child sex, age, body mass index, physical activity, sedentary behaviour, family pain history, income and maternal education. Findings: The prevalence of adolescent SP with impact and greater impact were 49% and 14%, respectively. Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (adjusted OR 1.33; 95% CI 1.01 to 1.76). We found similar, significant associations for internalizing and externalizing symptoms after adjusting for a range of potential child and family confounders. Interpretation: Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target. Funding Statement: The core management of the Raine Study is funded by The University of Western Australia (UWA), Raine Medical Research Foundation; Telethon Kids Institute; Women and Infants Research Foundation; Curtin University; Murdoch University, The University of Notre Dame Australia and Edith Cowan University. The 17 year Raine Study follow up was funded by the National and Medical Research Council (NHMRC) programme grant 353514 and NMHRC project grant 323200. Declaration of Interests: The authors stated: None. Ethics Approval Statement: The authors obtained ethics approval for this study from the Curtin University Human Research Ethics Committee and the Princess Margaret Hospital Human Research Ethics Committee (HR84/2005). Consent was gained from the participants’ guardians.

Tuberous Sclerosis Complex Associated Neuropsychiatric Disorders and Parental Stress: Findings from a National, Prospective TSC Surveillance Study.

To assess the role of the TAND (tuberous sclerosis complex [TSC] associated neuropsychiatric disorders) checklist as a screening tool for neuropsychiatric pathology, to evaluate behavioral and psychiatric symptoms and related parental stress in children with TSC, and to analyze associations between parental stress, TAND findings, and TSC pathology. This is a prospective cohort study including 22 individuals from a national TSC surveillance study in Germany using demographic and clinical data, the TAND checklist, the Child Behavior Checklist (CBCL), and the Parenting Stress Index (PSI). Mean (standard deviation) age at follow-up was 4 years (3 years 9 months), and 13/22 of patients were male. Seventeen children had epilepsy (focal: 9; generalized: 4; infantile spasms: 4). Developmental delay was diagnosed in 12/22 patients. The most prevalent TAND items were anxiety and mood swings in 10/22 children. At least one TAND item was reported by 17/22 patients, internalizing symptoms by 10/22, and externalizing symptoms by 11/22. In contrast, only one patient had a clinically relevant score in the CBCL scales. Of 22 parents, 12 reported clinically relevant parental stress due to both child and parenting factors. Higher total parental stress was associated with a higher TAND externalizing score (r = 0.49; p = 0.028) and TAND total score (r = 0.51; p = 0.016), a higher CBCL total score (r = 0.59; p = 0.005), and the number of antiepileptic drugs (r = 0.50; p = 0.017). Developmental delay was correlated with child stress factors (r = 0.48; p = 0.023). The TAND checklist appears to be a promising screening tool for neuropsychiatric problems in very young children with TSC. Parental stress in children with TSC is modified by TSC-related pathology, both neuropsychiatric and neurological.

Community greenness and neurobehavioral health in children and adolescents

BackgroundNeighborhood greenness appears to be beneficial to human health. However, there are few studies on the relationship between greenness of children's residential communities and their neurobehavioral health. ObjectiveIn this cross-sectional study, we examined the association between neighborhood greenness of children's residential area and their neurobehavioral health. MethodsWe used a population-representative sample of school children (n = 1817) from 2012 and 2013 in South Korea. Parents or guardians of children completed the Child Behavior Checklist (CBCL) to assess their children's neurobehavioral health. As a measurement for greenness, the modified soil-adjusted vegetation index (MSAVI) at a 30-m resolution was retrieved from the Landsat satellite data operated by NASA. The MSAVI values were categorized into tertiles (low, moderate, high greenness) and each child was assigned the mean MSAVI within a 1.6-km radius of residence. We applied survey regressions of the CBCL transformed scores on the 3 levels of greenness, controlling for age, sex, physical activity, monthly family income, exposure to second-hand smoke, exposure to NO2, and blood lead level. ResultsHigh greenness was associated with a lower Total CBCL score compared to low greenness (−2.33, 95% CI, −4.10 to −0.56). Externalizing Behavior showed a slightly stronger association with greenness than did Internalizing Behavior. The inverse relationship with greenness was strongest for Attention Problems (−1.32; 95% CI: -2.58, −0.06). The magnitudes of the association were strongest when the buffer distance was 1600 m. ConclusionsGreenness of residential neighborhood was associated with lower problematic behavior scores in children, especially aggressive behaviors and attention problems.

Antenatal Vitamin D Status Is Not Associated with Standard Neurodevelopmental Assessments at Age 5 Years in a Well-Characterized Prospective Maternal-Infant Cohort

Although animal studies show evidence for a role of vitamin D during brain development, data from human studies show conflicting signals. We aimed to explore associations between maternal and neonatal vitamin D status with childhood neurodevelopmental outcomes. Comprehensive clinical, demographic, and lifestyle data were collected prospectively in 734 maternal-infant dyads from the Cork BASELINE Birth Cohort Study. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were quantified at 15 weeks of gestation and in umbilical cord sera at birth via a CDC-accredited liquid chromatography-tandem mass spectrometry method. Children were assessed at age 5 y through the use of the Kaufman Brief Intelligence Test (2nd Edition, KBIT-2) and the Child Behaviour Checklist (CBCL). Linear regression was used to explore associations between 25(OH)D and neurodevelopmental outcomes. 25(OH)D concentrations were <30 nmol/L in 15% of maternal and 45% of umbilical cord sera and <50 nmol/L in 42% of mothers and 80% of cords. At age 5 y, the mean±SD KBIT-2 intelligence quotient (IQ) composite score was 104.6±8.6; scores were 107.2±10.0 in verbal and 99.8±8.8 in nonverbal tasks. Developmental delay (scores <85) was seen in <3% of children across all domains. The mean±SD CBCL total problem score was 21.3±17.5; scores in the abnormal/clinical range for internal, external, and total problem scales were present in 12%, 4%, and 6% of participants, respectively. KBIT-2 and CBCL subscale scores at 5 y were not different between children exposed to low antenatal vitamin D status, either at 30 or 50 nmol/L 25(OH)D thresholds. Neither maternal nor cord 25(OH)D (per 10 nmol/L) were associated with KBIT-2 IQ composite scores [adjusted β (95% CI): maternal -0.01 (-0.03, 0.02); cord 0.01 (-0.03, 0.04] or CBCL total problem scores [maternal 0.01 (-0.04, 0.05); cord 0.01 (-0.07, 0.09)]. In this well-characterized prospective maternal-infant cohort, we found no evidence that antenatal 25(OH)D concentrations are associated with neurodevelopmental outcomes at 5 y. The BASELINE Study was registered at www.clinicaltrials.gov as NCT01498965; the SCOPE Study was registered at http://www.anzctr.org.au as ACTRN12607000551493.

Airborne manganese exposure and neurobehavior in school-aged children living near a ferro-manganese alloy plant

Excessive exposure to Mn can lead to its accumulation in the brain with neurotoxic consequences. In children, elevated Mn has been associated with deficits in certain neuropsychological domains such as cognition, motor function, memory and attention, and in some instances, hyperactivity and behavioral problems. The aim of this study was to evaluate behavioral effects in school-aged children living near a ferro-manganese alloy plant and examine their association with Mn exposure. Occipital hair, toenails and blood samples were collected from 225 children (7–12 years old) enrolled in four elementary schools with different levels of exposure to Mn, based on dust Mn deposition rates. Full data set collection was completed and run from 165 children. Mn in hair (MnH), toenails (MnTn), blood (MnB) and blood lead levels (PbB) were determined by graphite furnace atomic absorption spectrometry. Children's behavior was assessed with the Child Behavior Check List (CBCL) reported by parents. Median levels and range of MnH, MnT and MnB were, respectively, 0.73 µg/g (0.16–8.79), 0.84 µg/g (0.15–9.29) and 8.98 μg/L (1.51–40.43). Median and range of PbB were 1.2 µg/dL (0.2–15.6). MnH and MnB were not associated with any scale of the CBCL behavior scores. We found a positive association between logMnTn and raw total CBCL score (β = 10.17, p = 0.034), adjusting for sex, age, maternal IQ and logPbB. Analyses using Generalized Additive Model showed non-linear associations between MnTn and externalizing behavior (p = 0.035), as well as with the related subscales: aggressive behavior (p = 0.045) and rule-breaking behavior (p = 0.024). Further positive associations were observed between MnTn and thought problems (p = 0.031) and social problems (p = 0.027). These findings corroborate previous studies showing an association between Mn exposures and externalizing behavior. Our results suggest that toenail Mn, as a biomarker of environmental exposure, is associated with disruptive behavior in children living near a ferro-manganese alloy plant.

Religion and mental health among Nepal earthquake survivors in temporary tent villages

ABSTRACTThe aim of this study was to explore the relationship between mental health and the perceived importance of religion and the frequency of prayer among 200 children ages 10–18 years who lived in temporary camps for earthquake survivors in Nepal. The participants were examined using the Child Behavior Checklist (CBCL) 6–18 and were asked about the importance of religion in their lives. In contrast to expectation that high perceived importance of religion and prayer frequency have positive impacts on mental health after earthquakes, the results indicated significantly higher levels of withdrawal/depression. The group that prayed less frequently after the earthquakes had significantly higher scores for somatic symptoms, withdrawal/depression, anxiety/depression, social immaturity, internalising problems, and total CBCL scores. However, the clinical risk group (T score of 65 or higher in the CBCL total score), no significant difference according to the importance of religion showed and frequency of daily prayer.

Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study.

Few studies have examined the effectiveness of outpatient cognitive-behavioral therapy (CBT) delivered in routine care settings for children and adolescents with mental disorders. This observational study examined changes in behavioral and emotional problems of adolescents with mental disorders during routine outpatient CBT delivered at a university outpatient clinic and compared them with a historical control group of youths who received academic tutoring of comparable length and intensity. Assessments were made at the start and end of treatment (pre- and post-assessment) using parent ratings of the German versions of the Child Behavior Checklist (CBCL) and self-ratings of the Youth Self-Report (YSR) scale. For the main analysis, 677 adolescents aged 11‒21years had complete data. Changes from pre- to post-assessment showed significant reductions in mental health problems on both parent- and self-ratings. Pre- to post-effect sizes (Cohen's d) were small-to-medium for the total sample (d=0.23 to d=0.62) and medium-to-large for those adolescents rated in the clinical range on each (sub)scale at the start of treatment (d=0.65 to d=1.48). We obtained medium net effect sizes (d=0.69) for the CBCL and YSR total scores when patients in the clinical range were compared to historical controls. However, a substantial part of the sample remained in the clinical range at treatment end. The results suggest that CBT is effective for adolescents with mental disorders when administered under routine care conditions but must be interpreted conservatively due to the lack of a direct control condition.

Serum copeptin in children exposed to maltreatment

Childhood maltreatment (CM) has been related to a persistent reprograming of stress-response. Copeptin is a marker of hypothalamic-pituitary-adrenal axis activation; however, few studies have examined copeptin levels in children exposed to CM. The aim of this study was to compare serum copeptin levels in children reporting child abuse and/or neglect and children with no history of CM. This study included 65 children with a positive history of moderate to severe CM, as reported by themselves and their parent(s) during a clinical interview, and 71 children with no history of CM as a comparison group. CM was considered moderate to severe based on the child-reported frequency of being exposed to events related to sexual abuse, physical abuse, emotional abuse, emotional neglect, and/or physical neglect. Child psychopathology symptoms were assessed using the Child Behavior Checklist (CBCL). We measured serum copeptin concentration using enzyme-linked immunosorbent assay. Children exposed to CM exhibited higher levels of serum copeptin compared to children without CM when controlling for sex, age, and psychiatric morbidity. The CBCL total score, including internalizing and externalizing symptoms, was higher in children with CM. We found no correlation between copeptin and CBCL scores for internalizing symptoms and externalizing symptoms. CM is associated with copeptin serum levels independently of age, sex, and symptom severity. Copeptin is a promising new biomarker for children with a history of abuse and/or neglect.

Correlates of emotional and behavioural problems in children with perinatally acquired HIV in Cape Town, South Africa

ABSTRACTIn the antiretroviral era, youth perinatally infected with HIV (PHIV+) are surviving into adulthood and are at risk for emotional and behavioural problems. Few studies of these problems have been conducted in low- and middle-income countries and even fewer in sub-Saharan Africa. The aims of this study were to provide a quantitative description of emotional and behavioural problems in a group of PHIV+ youth (n = 78) in South Africa compared with a group of demographically matched HIV-negative controls (n = 30) and to identify correlates of emotional and behavioural problems. A cross-sectional study was conducted employing participants from community and hospital-based clinics. Emotional and behavioural problems were assessed using the Child Behaviour Checklist (CBCL). Several measures were used to assess demographic, biological, cognitive and contextual correlates of problem behaviours. Youth were compared by HIV status on demographic, cognitive and contextual variables as well as the Total Problems and subscale scores of the CBCL. Multivariate comparisons of the influence of contextual and cognitive variables on CBCL Total Problems scores were performed using a stepwise linear regression analytic procedure. In this study, there were no significant differences in between-group comparisons for the prevalence of Internalizing, Externalizing and Total Problems in the PHIV+ youth and control group at the clinical and borderline cut-off ranges of the CBCL. Caregiver depression was the only significant predictor of greater Total Problems scores in the full model, after controlling for age and gender (F = 8.57, df = 5.102, P < .01). An interaction between HIV status and caregiver depression was observed (t = −2.20, P = .03), with follow-up within-group analyses confirming that caregiver depression predicted greater Total Problems scores both in HIV-negative youth (β = 0.61, P < .001), and to a lesser extent, in HIV-positive youth (β = 0.25, P < .001). This study highlights the need for adequate screening of depression in the caregivers of HIV-infected youth.

Screening for psychopathology in a national cohort of 8- to 15-year-old children with cerebral palsy

Cerebral palsy (CP) is often accompanied by psychopathology and learning disability. Aims(1) to evaluate the prevalence of psychopathology as estimated by the Child Behavior Checklist (CBCL) parental questionnaire in 8- to 15-year-old Danish children with CP and to analyze its association with cognitive ability and families’ social characteristics; (2) to examine to what extent children with CP had been evaluated by a child psychiatrist and/or psychologist. MethodThe parents of 462 children with CP answered a questionnaire about their child's treatment and the family's characteristics and 446 the CBCL. The cutoff for psychopathology was the Total CBCL score or DSM-oriented scores above the 93rd percentile in an age- and gender-stratified population. ResultsThe psychopathology screening was positive in 46.2% (CI 41.6–50.8%) against 15.1% in general population. Cognitive disability was associated with an increased prevalence of psychopathology (odds ratio (OR) 2.6, CI 1.4–4.6, for Developmental Quotient of cognitive function (DQ) 50–85 and OR 3.0, CI 1.3–7.0, for DQ<50). Children with CP and a single parent showed increased odds for a positive CBCL screening compared to children living with two parents (OR 2.1, 95% CI 1.1–4.0). Children with DQ 50–85 more often had a psychological evaluation. A positive CBCL screening was strongly associated with a psychiatric assessment (21% vs. 7%, p<0.01). ConclusionThe high prevalence of emotional and behavioral problems indicates that screening for psychopathology should be a part of multidisciplinary follow-up of CP. The CBCL can be used as a screening instrument in children with CP without severe motor and cognitive disability.

Pre-adoption adversity and behavior problems in adopted Chinese children: A longitudinal study

In this paper, we report (1) trajectories in adopted Chinese children's behavior problems over six years, (2) how pre-adoption adversity predicted Wave 1 behavior problems and the rate of behavioral change in subsequent Waves, and (3) the predictive importance of age at adoption relative to four psychosocial measures of pre-adoption adversity. Four waves (across six years) of data on 1285 adopted children (Mage at adoption=16.40months, SD=15.40; Mage=4.89years, SD=2.96 at Wave 1) were collected from adoptive mothers with the Child Behavior Checklist (CBCL). At Wave 1, data on age at adoption, and four psychosocial measures of pre-adoption adversity were collected: physical signs/symptoms (e.g., sores) of deprivation, developmental delays at arrival, refusal/avoidance behaviors, and crying/clinging behaviors during the first three weeks of adoption. Multilevel modeling yielded three key findings: First, the adopted Chinese children's CBCL scores increased over time. Second, signs/symptoms, refusal/avoidance and crying/clinging behavior predicted differences in the adopted children's Internalizing, Externalizing and Total CBCL scores at study entry; developmental delays at arrival predicted differences in Internalizing and Total CBCL scores at study entry. Crying/clinging scores also predicted rates of change in Internalizing and Total CBCL scores. Refusal/avoidance scores also predicted rates of change in Internalizing, Externalizing and Total CBCL scores. Finally, the four psychosocial measures of pre-adoption adversity outperformed age at adoption as predictors of CBCL scores at study entry and the rate of change in CBCL scores in subsequent Waves.

The impact of life skills training on behavior problems in left-behind children in rural China: A pilot study

A randomized controlled experimental pilot study was conducted in order to investigate the effect of life skills training on behavior problems in left-behind children (LBC) in rural China. Sixty-eight LBC were recruited from a middle school in rural China. The intervention group took a ten-week-long life skills training course. The Child Behavior Checklist (CBCL) and Teacher’s Report Form (TRF) were used to evaluate the behavioral problems of the children at three separate intervals: Prior to the intervention, the first week following the intervention, and three months after the intervention. Children in the intervention group showed significant improvement both in the CBCL and the TRF compared to children in the control group. Significant improvements were found in the CBCL total scores, internalizing behavior, externalizing behavior and seven subscales scores ( p &gt; 0.05). In TRF, similar significant improvements were found, except in internalizing behavior and the subscale of thought problems ( p &gt; 0.05). The effect of intervention remained the same three months after the intervention. As a pilot study, the life skill training was found to be effective in improving behavior problems in the LBC in rural China, with the exception of thought problems.

Inflammation, neurotrophism and oxidative stress and childhood psychopathology in a large community sample.

To investigate the association between peripheral biomarkers and child psychopathology in a large community sample. A total of 625 aged 6- to 13-year old subjects were recruited from a community school-based study. Psychopathology was assessed using the Child Behaviour Checklist (CBCL). Psychiatric diagnosis was evaluated using the Development and Well-Being Assessment. The following biomarkers were examined in peripheral blood: brain-derived neurotrophic factor, cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, IFN-g, and TNF-α), chemokines (eotaxin/CCL11, IP-10, MCP-1), cytokine receptors (sTNFR1 and sTNFR2), and the oxidative stress marker TBARS. We found significant associations between sTNFR2, eotaxin/CCL11 and CBCL total score, as well as with specific dimensions of psychopathology. There were different patterns of association between these biomarkers and psychological and behavioural symptoms in children with and without a mental disorder. TBARS, IL-6 and MCP-1 were more specific to some clusters of symptoms in children with a psychiatric diagnosis. Our data support the potential use of biomarkers, especially those involved in immune-inflammatory pathways, in investigating neurodevelopmental psychopathology. Their association with different dimensions of symptoms might be of useful when analyzing illness severity and clusters of symptoms within specific disorders.

Specific behavioral comorbidity in a large sample of children with functional incontinence: Report of 1,001 cases.

Psychological comorbidity among children with functional incontinence is high: 20-30% of children with nocturnal enuresis (NE), 20-40% of those with daytime urinary incontinence (DUI) and 30-50% of those with fecal incontinence (FI) have clinically relevant comorbid disorders. The aim of this study was to analyze specific comorbid behavioral symptoms for different subtypes of incontinence in a large group of children. All 1,001 consecutive children and adolescents (67.5% boys) with a mean age of 8.5 years presented at a tertiary outpatient department between 2004 and 2011 were examined with a full pediatric and child psychiatric assessment. Prevalence of different subforms of incontinence and associated behavioral symptoms were analyzed. The internalizing, externalizing, and total problem scores of the Child Behavior Checklist (CBCL) were evaluated. Of all children, 70.1% (702 children) had NE, 36.1% (361 children) had DUI, and 36.8% (368 children) were affected by FI. More than 43% of all children had clinically relevant psychological symptoms (CBCL total score, cut-off at 90th percentile). Children with non-retentive FI had highest rates of clinically relevant psychological symptoms (58.8%). Children with combined subtypes of incontinence (any combination of NE, DUI, and FI) were more affected by psychological comorbidities than children with isolated subtypes (NE or DUI or FI). Children with incontinence have high rates of comorbid behavioral symptoms-three to six times higher than norms. Especially children with FI and combined subtypes of incontinence were affected. As behavioral symptoms and disorders will interfere with incontinence treatment, a general screening is recommended.