Child Behavioral Outcomes Research Articles

Helping the Noncompliant Child and Child Behavior Outcomes: An Exploratory Examination of Financial Strain.

Theoretical models and empirical research have highlighted the impact of economic disadvantage on children's psychosocial development broadly and the onset, maintenance, and treatment of early-onset (3-8 years) behavior disorders (BDs) more specifically. In the context of intervention, evidence suggests that economic disadvantage may pose risk for diminished parent-mediated treatment efficacy (e.g., Behavioral Parent Training [BPT]) given its impact on salient factors in the family system. Though, studies have shown significant variability in BPT outcomes within families experiencing economic disadvantage, suggesting that additional influences may further contribute to disparities in the trajectory of treatment and maintenance of treatment gains for this population. To address this gap in existing knowledge, financial strain, or the inability to meet financial needs, was examined in families (N = 54) of young children (3-8 years old) with low-income and clinically elevated behavior problems participating in one BPT program, Helping the Noncompliant Child (HNC). Results demonstrated that families who experienced greater levels of financial strain prior to engaging in HNC exhibited diminished maintenance of parent reported child behavior gains following treatment. Financial strain did not significantly influence rate of change or maintenance of treatment gains for HNC clinician-coded child compliance. Clinical implications and directions for future research are discussed. ClinicalTrials.gov Identifier: NCT02191956, registered on 6/18/2014.

Associations Between Sleep Health and Child Behavior at Age 6 Years in the INSIGHT Study.

Suboptimal sleep is associated with disruptive behaviors in childhood. We evaluate associations of mean and variability (SD) of sleep duration, quality, and timing with emotion regulation, impulsivity, and prosocial and antisocial behavior in children. Intervention Nurses Start Infants Growing on Healthy Trajectories, a randomized controlled trial designed for obesity prevention, compared a responsive parenting intervention delivered in the first 2.5 years after birth with a home safety control group. At age 6 years, children wore an actigraphy device for 7 days and participated in behavioral tasks evaluating behavioral control, emotion regulation, and prosocial and antisocial behaviors. Separate linear regression models examined associations between sleep and behavioral variables, adjusting for study group, child sex, and household income. Moderation analysis investigated whether the study group moderated relationships between sleep and positive age-appropriate behavior. Children (N = 143, age 6.7 ± 0.3 years) were predominantly non-Hispanic White (95%). Mean actigraphic sleep duration, quality, and timing were not associated with behavioral variables. By contrast, greater variability in sleep onset timing was associated with greater impulsivity (B = 0.85, p = 0.004) and poorer emotion regulation (B = -0.65, p = 0.01). Greater variability in sleep midpoint timing was associated with greater impulsivity (B = 0.80, p = 0.03). The study group moderated the effect of sleep onset variability on behavior; only the home safety control group exhibited a significant negative relationship between variability in sleep onset timing and emotion regulation (B = -1.28, p = 0.0002). Findings support the importance of consistency in sleep timing and how this may play a greater role in children's behavioral and emotional outcomes than mean actigraphic sleep duration and quality.

Maternal support in preschool and child behavior problems: The mediating role of childhood emotion knowledge.

Children's emotion knowledge encompasses abilities to recognize and label emotions in the service of positive adaptation. Drawing on a sociodemographically diverse sample of 250 children (50% female sex assigned at birth; Mage_W1 = 49.02 months, SD = 2.99) and their maternal caregivers (55.6% Latina; 37.6% poverty), this study evaluated a multiple mediation model to integrate heretofore distinct bodies of research examining (a) parenting effects on the development of emotion knowledge and (b) emotion knowledge effects on socioemotional adaptation. Observations of maternal supportive presence at age 4 predicted increases in children's emotion recognition and labeling from ages 4 to 8. However, only emotion labeling skills explained children's behavioral adjustment outcomes with a significant pathway from supportive parenting at age 4 to fewer externalizing and internalizing behavior problems at age 10 via improved emotion labeling skills. These findings suggest that emotion knowledge, particularly labeling skills, partially explains the protective impact of supportive parenting on behavioral adaptation across childhood. Prevention and intervention efforts should target both supportive parenting practices and emotion knowledge skill development to support children's socioemotional functioning and reduce behavior problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Father-child attachment on children’s screen time: mediating role of ego resilience

BackgroundChildren spend a significant amount of time engaging in sedentary behaviors, defined as activities that do not increase energy expenditure significantly above resting levels, such as watching TV and playing PC/video games. Increased screen time is a significant public health concern because children are in a developmental stage where lifestyle behaviors predict various health outcomes in adulthood and beyond. This study explores the links between parent-child attachment, ego resilience, and children’s screen time.MethodsThis cross-sectional correlation study uses 1,163 parents and their children data from the 12th Panel Survey of Korean Children. The study instruments were a modified Armsden and Greenberg scale of parent-child attachment and modified the children’s ego resilience scale of the Block and Kremen. Children’s screen time was classified as more than 2 h per day spent watching television, playing on computers, or playing video games in their leisure time.ResultsStudy results show a negative association between father-child attachment and children’s screen time (ß = -0.43, p < .001) and a positive association between father-child attachment and ego resilience (ß = 0.24, p < .001). Ego resilience showed a negative link to children’s screen time after adjusting for parental attachment (ß =- 0.03, p = .009). Father-child attachment link to children’s screen time (ß = -0.36, p < .001) continued even though the association was slightly reduced in magnitude after adjusting for ego resilience.ConclusionsOur findings show the mediating role of ego resilience on a negative path of father-child attachment to children’s screen time. This finding emphasizes the importance of fostering solid father-child relationships and enhancing children’s psychological resilience as critical strategies for reducing excessive screen time. By addressing emotional support and resilience-building, interventions can more effectively promote healthier behavioral outcomes in children.

Socioeconomic status, linguistic skills and language background differentially relate to preschoolers' emotional and behavioural profile.

Proximal and distal factors interact to shape children's development and well-being. The present study aimed to examine socioeconomic status (SES), linguistic skills, and language background as concurrent predictors of socio-emotional and behavioural outcomes in heritage bilingual and monolingual children attending preschool. Parents of 1810 children (mean age = 63.42 months ± 7.36), attending preschool in Italy, completed the Four Factor Index of SES and the Strengths and Difficulties Questionnaire (SDQ). Teachers (n = 99) completed a questionnaire on children's linguistic skills and emotional and behavioural profiles. A subsample of 995 children was administered an expressive vocabulary task in Italian. Regression analyses showed that linguistic skills were the only concurrent predictor of conduct problems, as well as the dominant predictor of hyperactivity/impulsivity, peer problems, and better prosocial behaviour. SES was negatively related to ADHD traits, peer problems, and prosocial behaviour. Finally, heritage bilingualism background was associated, although not as a primary predictor, with increased emotional problems, peer relationship problems, and lower teacher-rated emotional and behavioural skills. However, it was the main factor positively associated with prosocial behaviour. The implications of these findings for research in this area and for educational policy are discussed, highlighting the need for a multidimensional perspective that includes linguistic skills and SES in the assessment of children's emotional and behavioural outcomes.

Latino Family Engagement and Student Outcomes in Early Elementary School: Evidence from Two National Datasets

ABSTRACT Family engagement in children’s schooling is important. Research indicates that Latino families often utilize home-based practices (e.g. reading, telling stories, singing, counting) over school-based involvement (e.g. participating in school events and committees, volunteering in the classroom). Using an assets-based approach, the present study considers both school- and home-based forms of engagement for Latino families. Drawing upon data from two large, nationally representative datasets, the Early Childhood Longitudinal Study, Kindergarten Class of 2010–11 (ECLS-K:2011; N = 4,590) and the Head Start Impact Study (HSIS; N = 1,670), this study seeks to examine national patterns of Latino family school- and home-based engagement in kindergarten, and how such engagement relates to child academic, cognitive, and behavioral outcomes in early elementary school. Descriptive findings show high levels of Latino family participation in a variety of both home-based academic activities and school-based activities. Regression analyses indicate an association between Latino family engagement and child outcomes, most evident in school-based engagement. Implications for educators, schools, and research are discussed.

Study Of Psychological And Behavioral Outcomes In Children Admitted In PICU

Study Of Psychological And Behavioral Outcomes In Children Admitted In PICU

Maternal Nutrition during Pregnancy and Offspring Brain Development: Insights from Neuroimaging.

Maternal nutrition during pregnancy is known to be important for offspring growth and health and has also been increasingly recognized for shaping offspring brain development. On the other hand, recent advancements in brain imaging technology have provided unprecedented insights into fetal, neonatal, and pediatric brain morphometry and function. This review synthesizes the current literature regarding the impact of maternal nutrition on offspring brain development, with a specific focus on findings from neuroimaging studies. The diverse effects of maternal nutrients intake or status during pregnancy on neurodevelopmental outcomes in children are discussed. Neuroimaging evidence showed associations between maternal nutrition such as food categories, macronutrients, and micronutrients including vitamins and minerals during pregnancy and child brain imaging features measured using imaging techniques such as ultrasound, magnetic resonance imaging (MRI), electroencephalography (EEG), and magnetoencephalography (MEG). This review demonstrates the capability of neuroimaging in characterizing how maternal nutrition during pregnancy impacts structure and function of the developing brain that may further influence long-term neuropsychological, cognitive, and behavioral outcomes in children. It aims to inspire future research utilizing neuroimaging to deepen our understanding of the critical impacts of maternal nutrition during pregnancy on offspring brain development.

Transgenerational impact of maternal adverse childhood experiences on children's mental health among families experiencing homelessness

BackgroundAdverse childhood experiences (ACEs) threaten the livelihood of individuals and their families. This may be particularly detrimental for mothers facing homelessness and their children's behavioral adjustment. ObjectiveThis study compared two models to examine the impact of maternal ACEs on children's internalizing and externalizing symptoms. Rather than using the cumulative approach to conceptualize ACEs, we analyzed a model that assessed the effect of each maternal ACE individually (i.e., specificity model) and another model that categorized them into two subtypes of maltreatment and household dysfunction (i.e., dimensional model). Participants and settingWe evaluated a sample of 164 children and their mothers in a residential vocational training program in Northern California. MethodsACEs for both mother and children and children's behavioral outcomes were collected via questionnaires completed by the mothers with the assistance of trained researchers. Additional demographic data was collected via trained case managers at the residential facility. Two models (i.e., specificity model; dimensional model) were utilized to better understand how to best assess adversity in settings with limited resources. ResultsResults of the specificity ACE model identified maternal childhood physical abuse and parental incarceration as predictors of internalizing problems and parental substance problems as a predictor of externalizing behaviors. The dimensional ACE model indicated that only the broad category of maltreatment predicted internalizing behavioral difficulties. The individual ACE model demonstrated a better fit for the data and highlighted specific events relevant to children's outcomes. ConclusionsThese results suggest that programs focusing on ending generational trauma may benefit from screening participants for individual ACE and tailoring services for mothers and children accordingly.

Interpregnancy intervals and behavioural outcomes in children: A population-based longitudinal study

BackgroundWhile the physical health consequence of short interpregnancy intervals (IPIs) is well documented, its mental health impact is not well explored. This study aimed to examine the associations between IPIs and behavioural outcomes in children born following the interval at four developmental time points between ages 7 and 16. MethodsOur study sample comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, an ongoing population-based longitudinal birth cohort in Bristol, Avon, United Kingdom. Behavioural problems, including total behavioural difficulties, hyperactivity, emotional symptoms, conduct problems, peer-problems, and problems of pro-social behaviour, were assessed using the Strengths and Difficulties Questionnaire (SDQ). Over 2300 mothers and their singleton children were included in this study. Generalized Estimating Equations (GEE) were used to estimate odds ratios for the associations. ResultsChildren born to mothers with short IPI (<6 months) were 1.54 (95%CI: 1.12–2.11), 1.42 (95% CI: 1.12–1.81) and 1.37 (95%CI: 1.04–1.79) times more likely to have total behavioural difficulties, conduct problems and hyperactivity/inattention problems across the child's age, respectively, compared with children of mothers with IPIs of 18–23 months. We found no evidence of associations between short IPI (<6 months) and emotional symptoms, peer-relationship problems and pro-social behaviour problems. ConclusionShort IPI (<6 months) was associated with externalising (conduct and hyperactivity/inattention) but not internalising (emotional and peer-relationship problems) problems. Further studies are needed to confirm this association and elucidate the underlying mechanisms.

The Role of Physical Activity in the Rehabilitation of Children with Fetal Alcohol Syndrome: Why It Should Be Considered a Vital Part of Treatment

This literature review examines the pivotal role of physical activity in the treatment and rehabilitation of children with Fetal Alcohol Syndrome (FAS). By analysing a range of research studies, this review identifies the beneficial impact of structured physical activity programmes on motor skills, cognitive functions, and behavioural outcomes in children with FAS. Furthermore, it proposes educational recommendations for integrating physical activity into therapeutic interventions.

Child maltreatment and behavioral health outcomes in child welfare: Exploring the roles of severity and polyvictimization

BackgroundChild maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample. Participants and settingMedical records of children with child welfare involvement with at least one behavioral health condition (i.e., mental, behavioral or neurodevelopmental disorder, ICD-10 F01-F99) between 1/1/2018–12/31/2021 were extracted from a large, academic hospital system. MethodsBehavioral health complexity was categorized as non-chronic, non-complex chronic, or complex chronic using the Pediatric Medical Complexity Algorithm. Partial proportional logistic regression models adjusted for age, sex, race/ethnicity, caregiver type, and physical health complexity generated odds of behavioral health complexity by maltreatment type (physical abuse, sexual abuse, neglect) and maltreatment combinations. ResultsThe analytic sample included 3992 participants (mean age 7.6 (Standard Deviation, 5.0) 44 % female, 29 % white, 32 % black, 22 % Hispanic). Participants who experienced physical abuse (Odds Ratio [OR]: 1.79, 95 % Confidence Interval [CI]: 1.10–2.91), or neglect (OR: 1.69, 95 % CI: 1.38–2.07) were more likely to have increasing behavioral health complexity versus those without maltreatment. Participants with both physical abuse and neglect were over twice as likely (OR: 2.44, 95 % CI: 1.88–3.16) to have increasing behavioral health complexity versus those who did not experience maltreatment. ConclusionResults emphasize the differential impacts of maltreatment and polyvictimization exposures on behavioral health complexity among children with child welfare involvement that can guide risk assessment and clinical care.

Prenatal Wildfire Smoke Exposure and Child Neurodevelopmental and Behavioral Outcomes

Prenatal Wildfire Smoke Exposure and Child Neurodevelopmental and Behavioral Outcomes

Adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in children and adolescents: A longitudinal study

BackgroundAdverse childhood experiences (ACEs) have a profound impact on individuals, shaping their long-term health and life opportunities. This study delves into the complex ties between ACEs and the socioemotional development of Australian children and youth by examining the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors. MethodsThis study utilized data from the Longitudinal Study of Australian Children and employed the generalized estimating equation method to investigate the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in Australian children and adolescents. ResultsAdverse childhood experiences such as physical punishment, hostile parenting, parental conflicts, separation, financial strain, and parental mental health issues increased the risk of externalizing and internalizing behaviors while reducing prosocial behaviors. The risk increases with the number of ACEs, as evidenced by the incidence ratio (IR); for example, for externalizing behaviors, an ACEs score of one leads to IR = 1.69, while an ACEs score of 4 results in IR = 3.34. Similar trends were observed for internalizing and prosocial behaviors. LimitationsThe presence of imbalanced longitudinal data, arising from variations in the number of observations across different time points, challenges robust inferences. Furthermore, this study investigates the relationship between ACEs and behavioral problems, without establishing causality. Consequently, the results should be interpreted with caution. ConclusionsThe findings of this study highlight that adverse childhood experiences significantly influence behavioral outcomes in children and adolescents. These findings underscore the critical need for early detection and intervention to mitigate the consequences of traumatic childhood experiences.

Family and Peer Social Capital and Child Behavioral Outcomes in Japan.

Child problem behaviors have been linked to immediate and long-term negative outcomes. Research has found that family and peer social capital have a strong influence on child behavioral outcomes. However, most research about social capital and child behavior problems has been conducted in Western contexts. Social capital may influence child behavior problems differently in non-Western sociocultural environments due to different family and peer dynamics. Using a sample from the Japan Household Panel Survey and Japan Child Panel Survey (N = 182), we expand this literature on various forms of social capital to the Japanese context with data that were collected between 2009 and 2014. We examine the relationship of family and peer social capital with children internalizing and externalizing problem behaviors using OLS linear regression. Our results differ from what is commonly found in Western contexts. Whereas family and peer social capital are typically associated with both internalizing and externalizing problem behaviors in Western countries, we find that greater family social capital is associated with decreased externalizing problem behaviors but not internalizing problem behaviors in Japan, and peer social capital has no association on either type of problem behaviors. Our findings emphasize the importance of considering social and cultural contexts when exploring how social capital might encourage prosocial child outcomes.

The Lifelines Cohort Study: Prevalence of Tinnitus Associated Suffering and Behavioral Outcomes in Children and Adolescents.

Tinnitus in children and adolescents is relatively unexplored territory. The available literature is limited and the reported prevalence of tinnitus suffering varies widely due to the absence of a definition for pediatric tinnitus. The impact on daily life seems to be lower than in the adult population. It is unclear if children who suffer from tinnitus, like adults, also experience psychological distress like anxiety or depressive symptoms. A better understanding of tinnitus in children and its impact on daily life could provide more insight into the actual size of the problem and could give direction for future studies to investigate the cause of progression of tinnitus. A cross-sectional study was performed using the Dutch Lifelines population-based cohort of people living in the north of the Netherlands. A total of 4964 children (4 to 12 years of age) and 2506 adolescents (13 to 17 years of age) were included. The presence of tinnitus suffering and behavioral outcomes were assessed with a single-item question and the Child Behavioral Checklist or the Youth Self Report questionnaire respectively. The associations of behavioral outcomes and tinnitus suffering were analyzed using univariate binary regressions. The prevalence of tinnitus suffering in children was 3.3 and 12.8% in adolescents. Additionally, 0.3% of the children and 1.9% of the adolescents suffered a lot or extremely of their tinnitus. Externalizing and internalizing problems were associated with tinnitus in adolescents. Internalizing problems were associated with tinnitus in children. The prevalence of tinnitus suffering in this sample of the general population is comparable to other population-based studies. A low percentage of children (0.3%) or adolescents (1.9%) suffered a lot or extremely of their tinnitus. Tinnitus suffering is associated with all behavioral outcome subscales in adolescents and with internalizing problems in children, although the effect sizes were very small. Future research should focus on achieving a consensus for the definition of pediatric tinnitus and on the development of a validated outcome measure.

The shadow of the past: How paternal traumatic experiences shape early parent-child interactions and offspring's emotional development

Introduction and AimsEarly childhood is crucial for the development of social and emotional competencies, significantly influenced by parental interactions. While the impact of maternal psychopathology has been extensively studied, less is known about the effect of paternal trauma on parenting behaviors and subsequent child development. This study examines the effects of fathers' traumatic experiences on their psychopathology, quality of feeding interactions, and children's emotional and behavioral functioning. MethodsA sample of 100 fathers and their two-year-old children participated in this cross-sectional study. Paternal psychopathology was assessed using the Symptom Checklist-90-Revised (SCL-90-R), and trauma exposure was measured with the Traumatic Experience Checklist (TEC). Parent-child feeding interactions were evaluated using the Scala di Valutazione delle Interazioni Alimentari (SVIA), and children's emotional and behavioral outcomes were assessed using the Child Behavior Checklist (CBCL 1,5-5). ResultsFathers with past trauma displayed significantly higher levels of psychopathological symptoms and engaged in poorer quality feeding interactions compared to controls. These paternal characteristics were associated with higher scores on maladaptive outcomes in children's CBCL, indicating worse emotional and behavioral functioning. ConclusionsThe findings suggest that paternal trauma is linked to increased psychopathological risks and negatively affects the quality of paternal feeding interactions, which in turnith children's emotional and behavioral development. These results underscore the importance of integrating paternal trauma into clinical assessments and interventions to support family dynamics and promote healthier developmental outcomes in children.

Associations between prenatal caffeine exposure and child development: Longitudinal results from the Adolescent Brain Cognitive Development (ABCD) Study.

Though caffeine use during pregnancy is common, its longitudinal associations with child behavioral and physical health outcomes remain poorly understood. Here, we estimated associations between prenatal caffeine exposure, body mass index (BMI), and behavior as children enter adolescence. Longitudinal data and caregiver-reported prenatal caffeine exposure were obtained from the ongoing Adolescent Brain and Cognitive Development (ABCD) SM Study, which recruited 11,875 children aged 9-11 years at baseline from 21 sites across the United States starting June 1, 2016. Prenatal caffeine exposure was analyzed as a 4-level categorical variable, and further group contrasts were used to characterize "any exposure" and "daily exposure" groups. Outcomes included psychopathology characteristics in children, sleep problems, and BMI. Potentially confounding covariates included familial (e.g., income, familial psychopathology), pregnancy (e.g., prenatal substance exposure), and child (e.g., caffeine use) variables. Among 10,873 children (5,686 boys [52.3%]; mean [SD] age, 9.9 [0.6] years) with nonmissing prenatal caffeine exposure data, 6,560 (60%) were exposed to caffeine prenatally. Relative to no exposure, daily caffeine exposure was associated with higher child BMI (β=0.08; FDR-corrected p=0.02), but was not associated with child behavior. Those exposed to two or more cups of caffeine daily (n=1,028) had greater sleep problems than those with lower/no exposure (β>0.92; FDR-corrected p<0.04). Daily prenatal caffeine exposure is associated with heightened childhood BMI, and when used multiple times a day greater sleep problems even after accounting for potential confounds. Whether this relationship is a consequence of prenatal caffeine exposure or its correlated factors remains unknown.

Postnatal maternal care moderates the effects of prenatal bisphenol exposure on offspring neurodevelopmental, behavioral, and transcriptomic outcomes.

Bisphenols (BP), including BPA and "BPA-free" structural analogs, are commonly used plasticizers that are present in many plastics and are known endocrine disrupting chemicals. Prenatal exposure to BPA has been associated with negative neurodevelopmental and behavioral outcomes in children and in rodent models. Prenatal BPA exposure has also been shown to impair postnatal maternal care provisioning, which can also affect offspring neurodevelopment and behavior. However, there is limited knowledge regarding the biological effects of prenatal exposure to bisphenols other than BPA and the interplay between prenatal bisphenol exposure and postnatal maternal care on adult behavior. The purpose of the current study was to determine the interactive impact of prenatal bisphenol exposure and postnatal maternal care on neurodevelopment and behavior in rats. Our findings suggest that the effects of prenatal bisphenol exposure on eye-opening, adult attentional set shifting and anxiety-like behavior in the open field are dependent on maternal care in the first five days of life. Interestingly, maternal care might also attenuate the effects of prenatal bisphenol exposure on eye opening and adult attentional set shifting. Finally, transcriptomic profiles in male and female medial prefrontal cortex and amygdala suggest that the interactive effects of prenatal bisphenol exposure and postnatal maternal care converge on estrogen receptor signaling and are involved in biological processes related to gene expression and protein translation and synthesis. Overall, these findings indicate that postnatal maternal care plays a critical role in the expression of the effects of prenatal bisphenol exposure on neurodevelopment and adult behavior. Understanding the underlying biological mechanisms involved might allow us to identify potential avenues to mitigate the adverse effects of prenatal bisphenol exposure and improve health and well-being in human populations.

The Effects of Breastfeeding on Childhood Behavioral and Emotional Development: A Prospective Cohort Study in China.

Breastfeeding could improve a child's health early on, but its long-term effects on childhood behavioral and emotional development remain inconclusive. We aimed to estimate the associations of feeding practice with childhood behavioral and emotional development. In this population-based birth cohort study, data on feeding patterns for the first 6 mo of life, the duration of breastfeeding, and children's emotional and behavioral outcomes were prospectively collected from 2489 mother-child dyads. Feeding patterns for the first 6 mo included exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF, including mixed feeding or formula feeding), and the duration of breastfeeding (EBF or mixed feeding) was categorized into ≤6 mo, 7-12 mo, 13-18 mo, and >18 mo. Externalizing problems and internalizing problems were assessed with the Child Behavior Checklist (CBCL) and operationalized according to recommended clinical cutoffs, corresponding to T scores ≥64. Multivariable linear regression and logistic regression were used to evaluate the association of feeding practice with CBCL outcomes. The median (interquartile range) age of children at the outcome measurement was 32.0 (17.0) mo. Compared with non-EBF for the first 6 mo, EBF was associated with a lower T score of internalizing problems [adjusted mean difference (aMD): -1.31; 95% confidence interval (95% CI): -2.53, -0.10], and it was marginally associated with T scores of externalizing problems (aMD: -0.88; 95% CI: -1.92, 0.15). When dichotomized, EBF versus non-EBF was associated with a lower risk of externalizing problems (aOR: 0.54, 95% CI: 0.34, 0.87), and it was marginally associated with internalizing problems (aOR: 0.75, 95% CI: 0.54, 1.06). Regarding the duration of breastfeeding, breastfeeding for 13-18 mo versus ≤6 mo was associated with lower T scores of internalizing problems (aMD: -2.50; 95% CI: -4.43, -0.56) and externalizing problems (aMD: -2.75; 95% CI: -4.40, -1.10), and breastfeeding for >18 mo versus ≤6 mo was associated with lower T scores of externalizing problems (aMD: -1.88; 95% CI: -3.68, -0.08). When dichotomized, breastfeeding for periods of 7-12 mo, 13-18 mo, and >18 mo was associated with lower risks of externalizing problems [aOR (95% CI): 0.96 (0.92, 0.99), 0.94 (0.91, 0.98), 0.96 (0.92, 0.99), respectively]. Exclusive breastfeeding for the first 6 mo and a longer duration of breastfeeding, exclusively or partially, are beneficial for childhood behavioral and emotional development.