Child Behavior Research Articles

Functional network disruptions in youth with concussion using the Adolescent Brain Cognitive Development study

ABSTRACT Objective This study aimed to compare psychosocial outcomes and functional neuroimaging among youth with concussion, youth with anxiety, and age- and sex-matched controls. Methods Using archival data from the Adolescent Brain Cognitive DevelopmentSM Study, we analyzed between-group differences in psychosocial outcomes measured by the Child Behavior Checklist’s internalizing and externalizing problem scales, and assessed brain function using resting-state fMRI network-region connectivity (specifically frontoparietal network (FPN) and default mode network (DMN) connectivity with the amygdala). Results Significant differences in psychosocial outcomes were found across all groups, with the anxiety group reporting the most internalizing problems, followed by the concussion group which significantly differed from controls. Additionally, FPN-amygdala connectivity was significantly reduced in the concussion group only; this reduced connectivity did not predict psychosocial outcomes across groups. Conclusion This study provided preliminary findings that brain connectivity is reduced exclusively in individuals with concussion. Although disruptions were observed in the concussion group, further investigation is warranted to understand how disruptions may be associated with concussion symptoms. Studies that utilize well-defined control and study groups, and comprehensive cognitive and mental health measures will offer a deeper understanding of the relationship between brain function and psychosocial outcomes.

A Comparative Analysis of Parent–Child Interaction Therapy Procedures Used to Facilitate Verbalizations by Children with Autism

AbstractThe current study conducted a comparative analysis of the effects of select components of Parent–Child Interaction Therapy, labeled praise, behavior descriptions, and reflections on child vocalizations in two children with autism spectrum disorder and accompanying language delays using a concurrent multiple baseline across participants design. The frequency of verbalizations, the frequency of different verbalizations, and the mean length of utterance of words (MLUw) were measured during a baseline condition followed sequentially by two experimental conditions during a free play environment. The total number of therapist–child interactions remained consistent across all experimental conditions such that only the topography of the interactions varied across conditions. During the first experimental condition the clinician used labeled praise and behavior descriptions during child play. After establishing stability of changes under these conditions, the therapist systematically added reflections of child vocalizations in the second experimental condition. Total verbalizations, different verbalizations, and MLUw increased following the introduction of labeled praise and behavior descriptions. Total verbalizations and different verbalizations increased and the frequencies accelerated following the systematic introduction of reflections. The study showed the relative value of reflections of child verbalizations as a powerful component of Parent–Child Interaction Therapy procedures to facilitate verbalizations by children with autism.

The modular approach to therapy for youths with anxiety, depression, trauma, and conduct problems (MATCH): results from the Norwegian randomized-controlled trial

BackgroundA randomized controlled trial was conducted to examine the effectiveness of the Modular Approach to Therapy for Youths with Anxiety, Depression, Trauma, and Conduct Problems (MATCH) for Norwegian youths referred to seven Child and Adolescent Psychiatric Outpatient Clinics. MATCH addresses comorbid problems that are common in children and youth, and its transdiagnostic design may therefore be more effective compared to standard treatments that often address single problems. MATCH has, however, never been evaluated in a Nordic context, and the present study aimed to fill this gap.MethodsA sample of 121 Norwegian youths (Mage = 9.83, 58.7% boys) was randomly assigned to MATCH (n = 73) or treatment as usual (TAU, n = 48). Primary treatment outcomes were youths’ externalizing and internalizing problems as reported by parents, using the Child Behavior Checklist, the Behavior and Feelings Survey. In addition, the study included assessments of parent-reported Top Problems.ResultsOverall, youths showed significant improvements in both externalizing and internalizing problems from intake to post-test. Results did not provide evidence that MATCH reduces symptoms of these problems compared to TAU.ConclusionsThe findings were inconclusive regarding whether MATCH was more effective than TAU in reducing youth internalizing and externalizing problems.Trial Registration IdentifierISRCTN24029895. Registration date: 8/8/2016.

Sensory processing, executive function, and behavior in children with ADHD

ABSTRACT The relationship between sensory processing, executive function, and behavior in children with Attention Deficit/Hyperactivity Disorder (ADHD) is far from clear. The aim of this study was to examine the mediating role of executive function in the relationship between sensory processing and behavior in ADHD. Sixty-three children (51 boys), aged between 7 and 14 years participated in this study. Caregivers completed the Sensory Profile 2 (SP-2), the Behavior Rating Inventory of Executive Function 2 (BRIEF-2), and the Child Behavior Checklist (CBCL) to assess sensory processing, executive function, and behavior, respectively. Positive and significant associations were found between sensory processing, executive function, and behavioral problems. In addition, positive indirect effects between sensory processing and behavior were mediated by executive function. These findings add to other evidence on neurodevelopmental disorders, suggesting that sensory processing may be a foundational aspect related to executive function, which in turn affects behavior in ADHD.

Manajemen pembelajaran siswa dengan Autism Spectrum Disorder (ASD) di SLB Samara Bunda Yogyakarta

This study aims to determine the implementation of learning management students who have autistic disorders that include planning, organizing, implementing and evaluating for children with autistic disorders in Samara Bunda SLB Yogyakarta. Supporting factors and inhibitors in the implementation of learning for students who experience autistic disorders in Samara Bunda SLB Yogyakarta. The results of the ability of students who experience autism disorders after getting learning at Samara Bunda Yogyakarta SLB, this study uses a qualitative approach, the data sources in this study include the principal, vice principal of the affairs of Curriculum, Studentism, Advice and Infrastructure, class teacher, school committee, people old students, and documents, the main instrument in this study is the researcher. Learning management for students with autistic disorders consists of 1). Learning planning, 2). Organizing learning, 3). Implementation of learning, 4). Evaluation of learning. Students' ability as a result of participating in learning programs at Samara Bunda SLB is that students become emotionally stable, independent, confident, concentrated, child behavior becomes more controlled, social communication skills are increased, skilled and capable. Factors that support the learning of students with autistic disorders in Samara Bunda SLB are good and directed student abilities, good cooperation between the school and parents / guardians, good cooperation between schools, the government, stakeholders and observers of education in students with autism disorders , availability of facilities and infrastructure, adequate funding, and experts. The inhibiting factors in achieving learning goals are the students' initial abilities that have not been good, not directed, and behaviors that cannot be controlled, the absence of continuity between teachers and parents

Parents' online coaching in the early intervention home program for toddlers with autism spectrum disorder during the COVID-19 pandemic: Manual development and feasibility study.

Early intervention improves the developmental progress among toddlers with ASD. Family involvement enhances the intervention outcome. This study aimed to develop and test the feasibility of an early intervention home program manual for toddlers with ASD. Method: This study involved three phases: (I) formulation of manual concept and content design (II) manual development through focus group discussion (n = 10) and content validation by experts (n = 9); (III) cognitive interview (n = 6) and feasibility study (n = 8). Result: Content Validity Index (I-CVI) for the developed manual ranged from .78-1.0, S-CVI/Ave .96, and S-CVI/UA .79. Cognitive interview among six parents reported that the manual was easy to understand. The feasibility study reported all eight parents benefitted from coaching sessions. Approximately 87.5% of the respondents found the program benefited their children and could easily implement the activities in their daily routines. Approximately 75% of respondents reported having greater confidence in managing their child's behaviors at home. Parent coaching using the developed home program is feasible and accepted by parents of a toddler with ASD. Further study should be developed to explore the effectiveness of parent coaching using the manual.

Evidence-Based Psychosocial Treatments for Disruptive Behaviors in Children: Update.

We reviewed the available evidence on psychosocial treatments for disruptive behaviors in children, as an update to Kaminski and Claussen (2017), focusing on children up to age 12 years. Search strategies, study inclusion, and treatment classification followed the procedures developed by Southam-Gerow and Prinstein (2014). Of the 44 included studies from 2016 to 2021, only 9 impacted previous results, either by increasing the level of evidence (for two treatment families) or documenting evidence for a new treatment family (four new treatment families). All three treatment families classified as Level 1: Well Established are parent-focused and now include Group parent behavior therapy + group child behavior therapy (previously classified as Probably Efficacious), in addition to Group parent behavior therapy and Individual parent behavior therapy with child participation (already classified as Well Established). Fifteen treatment families were classified as Level 2: Probably Efficacious, eight were classified as Level 3: Possibly Efficacious. Given the variability of programs in each treatment family, the evidence is for the overall treatment approach and may not apply to each program with those characteristics. Data were insufficient to examine outcomes in relation to participant characteristics. The information can be used to improve dissemination, implementation, and uptake of effective treatment, and inform research on improving access barriers.

Developmental trajectories in infants and pre-school children with Neurofibromatosis 1

BackgroundChildren with Neurofibromatosis 1 (NF1) show cognitive, behavioural and social differences compared to their peers. However, the age and sequence at which these differences begin to emerge is not fully understood. This prospective cohort study examines the cognitive, behavioural, ADHD trait and autism symptom development in infant and pre-school children with NF1 compared with typically developing (TD) children without a family history of neurodevelopmental conditions.MethodsData from standardised tests was gathered at 5, 10, 14, 24 and 36 months of age (NF1 n = 35, TD n = 29). Developmental trajectories of cognitive (Mullen Scales of Early Learning, MSEL) and adaptive behavioural (Vineland Adaptive Behavior Scales, VABS) development from 5 to 36 months were analysed using linear mixed modelling. Measures of ADHD (Child Behavior Checklist) and autism traits (ADOS-2, BOSA-MV and ADI-R) were assessed at 24 and 36 months.ResultsThe developmental trajectory of cognitive skills (all domains of the MSEL) and behavioural skills (four domains of the VABS) differed significantly between NF1 and TD groups. Post-hoc tests demonstrated that the NF1 participants scored significantly lower than TD participants at 24 months on all MSEL and VABS domains. The NF1 cohort demonstrated higher mean autism and ADHD traits at 24 months and 14% of the NF1 cohort met a research diagnostic classification for autism at 36 months.LimitationsThe study has a relatively small sample size due to variable retention and rolling recruitment. Due to limitations imposed by the COVID-19 pandemic, we utilised the Brief Observation of Symptoms of Autism for Minimally Verbal children (BOSA-MV) for some participants, which was administered online and may not gather as accurate a picture of traits as ADOS-2. The BOSA-MV was utilised for 41% of participants with NF1 at 36 months compared to 11% at 24 months. This may explain the reduction in the percentage of children with NF1 that met autism criteria at 36 months.ConclusionsBy 24 months of age, the NF1 cohort show lower cognitive skills and adaptive behaviour and higher levels of autism and ADHD traits as compared to TD children. This has implications for developmental monitoring and referral for early interventions.Trial registrationNot applicable.

Online Parenting Programs for Children's Behavioral and Emotional Problems: a Network Meta-Analysis.

Online parenting programs to support parents of children with behavioral problems and emotional problems have become widely available in recent years. Research has consistently shown their positive effects on child development, parents' adaptive parenting practices, and parents' mental health. However, knowledge is lacking on which type of content is more suitable to be delivered online. Our work addresses this knowledge gap by conducting traditional and network meta-analyses to improve our understanding of (1) how effective online parenting programs are to improve children's behavior and emotional problems, and (2) what clusters of components are most likely to yield the strongest effects. Following the PROSPERO preregistration, we systematically searched PsycINFO, MEDLINE, Web of Science, and Cochrane. Of the 8292 records retrieved, 28 records on 27 randomized controlled trials (N = 5,312) met the inclusion criteria. Results show moderate effect sizes of online parenting programs on reduced child behavioral and emotional problems, parents' ineffective parenting practices, and parents' mental health problems. Online programs adopting a learning theory perspective, either with or without additional parental self-care and parents as therapist approaches, are most likely to yield the strongest effects on child behavioral problems. Online programs adopting a learning theory perspective, parental self-care and parents as therapist approaches, with or without additional relationship perspectives, are most likely to yield the strongest effects on child emotional problems. Online parenting programs seem promising tools for improving child behavioral and emotional problems. Future research should identify the circumstances that allow parents and children to benefit more from specific components in these programs.

Early Socio-Emotional Difficulty as a Childhood Barrier to the Expected Benefits of Active Play: Associated Risks for School Engagement in Adolescence.

Active play allows children to develop social and cognitive skills, which could lead to higher school engagement. Little is known about the role of child socioemotional difficulty in these associations. This study aims to examine the interaction between active play and socioemotional difficulty in childhood and their prospective association with academic engagement in adolescence. The participants were 4537 children (51.1% boys) who were longitudinally followed, between ages 6 and 14 years, from the National Longitudinal Study on Children and Youth (NLSCY), Canada. Active play (weekly organized sport and unstructured physical activity outside of school hours) and child behavior (hyperactivity, anxiety, and relational difficulties) were reported by mothers for their children at age 6 years. Academic engagement was self-reported at age 14 years. Unstructured physical activity predicted lower subsequent school engagement for boys (β = -0.057, p < 0.05). Boys with high anxiety symptoms and high relational aggression who participated in more unstructured physical activity in childhood were subsequently less engaged in school (respectively, β = -0.066, p < 0.05 and β = -0.062, p < 0.05). Girls who partook in more organized sports showed lower school engagement in adolescence when they had high anxiety symptoms (β = -0.067, p < 0.05). Although past studies have highlighted the contribution of active play to school engagement, certain socioemotional difficulties could impede the child's ability to reap its benefits.

The mediating role of marital quality in parenting intervention: Effects on preschoolers' conduct problems and effortful control.

This study explores whether marital quality mediates the effects of a parenting intervention on preschoolers' conduct problems and effortful control. Using data from 209 children in a two-wave randomized controlled trial of the Hitkashrut program, participants were assigned to either a 14-session co-parent training group or a minimal intervention control group. Intent-to-treat analysis revealed that improvements in marital quality significantly mediated the intervention's impact on both conduct problems and effortful control. An alternative model, which hypothesized that changes in child behavior would lead to improvements in marital quality, was not supported, reinforcing the importance of targeting marital dynamics to achieve better child outcomes. These findings highlight the potential of marital-focused strategies within parenting interventions to foster healthier family environments and improve long-term developmental trajectories in children.

Family Factors of Conduct Problems in Children and their Genetic Aspects: Review of Empirical Research

The analysis of empirical studies and reviews was conducted to highlight the influence of four family factors: socio-economic status, family structure, parental stress (symptoms of anxiety and depression in mothers), and inconsistent discipline on children’s behavioral problems. Studies that assess heredity’s contribution to each factor were also examined. Known and hypothesized mechanisms that negatively affect child behavior are described. The importance of changing the proximal environment for correcting behavior problems, particularly inconsistent discipline, is emphasized.

An open pilot of GROW, a responsive parenting intervention for young children with brain injuries: preliminary efficacy

Purpose Families experience stress and burden following their child’s traumatic brain injury (TBI). Parenting styles are related to parent stress and child behavior problems and executive dysfunction. Parent-child interactions are shown to be a promising intervention target. We aimed to examine the preliminary efficacy of Gaining Real life skills Over the Web (GROW) in improving responsive parenting and reducing parent stress and depression in parents of children ages 0-4 who experienced TBI. Method Participants (n = 11) were parents of children four years old or younger, at the time of enrollment, and previously hospitalized overnight for TBI. Parent-reported measures included the Center for Epidemiologic Studies Depression Scale, Parenting Stress Inventory—Short Form, and Patient-Reported Outcomes Measurement Information System. Recordings of parent-child interactions were coded using the Play and Learning Strategies coding scheme. Study hypotheses were analyzed using independent samples t-tests, chi square analyses, and linear mixed models. Results Parental warmth (t=-3.64, p = 0.001, d=.97), responsiveness (t=-2.09, p = 0.047, d = 0.70), and verbal stimulation (t=-2.30, p = 0.029, d = 0.75) increased significantly from pretreatment to posttreatment. Improvements in parental warmth were maintained 3 months posttreatment (t=-3.15, p = 0.004, d = 1.16). There were no significant changes in depression, parental stress, or quality of life. Conclusions Results provide preliminary support for the efficacy of GROW in improving responsive parenting for children following early TBI. Future directions include tailoring GROW to better fit the needs of families and testing the utility through a randomized control trial.

Thumbtack needle at front-mu points for abnormal behavior in children with autism spectrum disorders

To compare the clinical effect of thumbtack needle at front-mu points combined with conventional rehabilitation training and simple conventional rehabilitation training in the treatment of autism spectrum disorders (ASD). A total of 40 children with ASD were randomly divided into a combination group (20 cases, 3 cases dropped out) and a conventional rehabilitation group (20 cases, 3 cases dropped out). Conventional rehabilitation training i.e. language-cognition training and comprehensive education training was adopted in the conventional rehabilitation group, once a day, 5 days a week. On the basis of the treatment in the conventional rehabilitation group, thumbtack needle was applied at Zhongwan (CV 12), bilateral Tianshu (ST 25) and Guanyuan (CV 4) in the combination group, the needles were retained for 3 days each time, 3-day interval was taken between each treatment, for 5 times per month. One-month treatment was as one course and a total of 3 courses were required in both groups, with 10-day break between each course. Before and after treatment, the scores of autism behavior checklist (ABC), childhood autism rating scale (CARS), TCM spleen-stomach symptoms and Achenbach child behavior checklist (CBCL) were observed, and the serum ratio of glutamate and gamma-aminobutyric acid (Glu/GABA) was measured. After treatment, the scores of ABC, CARS and CBCL were decreased compared with those before treatment (P<0.05, P<0.01) in both groups, the TCM spleen-stomach symptoms score was decreased compared with that before treatment (P<0.05) in the combination group; the changes in the scores of ABC, CARS, TCM spleen-stomach symptoms and CBCL, as well as the serum Glu/GABA in the combination group were lager than those in the conventional rehabilitation group (P<0.05, P<0.01). Both thumbtack needle at front-mu points combined with conventional rehabilitation training and simple conventional rehabilitation training can effectively treat ASD, the combination treatment has superior effect on improving the abnormal behavior, spleen-stomach symptoms and balance of nerve impulse and inhibition.

Association between maternal stress and child sleep quality: a nationwide ECHO prospective cohort study.

Childhood sleep quality is associated with physical, cognitive, and behavioral health and predicts later sleep quality; it has many determinants, including developmental exposures. To examine associations between maternal stress during pregnancy and childhood sleep quality and determine whether postnatal stress mediates the association. Data from the Environmental Influences on Child Health Outcomes cohort were used. Perceived Stress Scale (PSS) T-scores were the exposure measure. Outcome measures were preschool Child Behavior Checklist (CBCL) sleep syndrome scale and Patient-Reported Outcomes Measurement Information System Sleep Disturbance Parent Proxy short form 4a (PSD4a) T-scores at ages 4-8 years. Linear mixed-effects regression modeling was performed for each sleep outcome, adjusting for maternal age at delivery and education and child sex, gestational age at birth, and age at outcome ascertainment, with random intercepts for cohorts. Prenatal PSS score was associated with both CBCL (B = 0.09, 95% confidence interval [CI]: 0.06, 0.11; p < 0.01) and PSD4a (B = 0.07, 95% CI: 0.03, 0.12; p < 0.01) scores. Postnatal perceived stress mediated a proportion of the total effect of prenatal stress in both CBCL (66.3%) and PSD4a (95.9%) samples. Both pre- and postnatal maternal perceived stress appear to influence sleep quality during early life. Prenatal stress significantly associates with child sleep problems and disturbances at ages 4-8 years; postnatal maternal stress is a significant mediator of these associations. Research suggests a range of prenatal affective/distress exposures associated with child sleep problems, but the conclusions remain in doubt due to the mixture of exposures and outcomes employed. Ours is the first US-based effort to explore associations between perceived maternal stress during pregnancy and child sleep problems and disturbance in early and middle childhood. Even a small effect of a prevalent issue like psychosocial stress may have important public health implications at the population level.

Revisiting the 8-syndrome of the Child Behavior Checklist (CBCL) in 67257 Chinese school students

ABSTRACT The 8-Syndrome structure of the Child Behavior Checklist (CBCL) has been well supported globally, but its validity in the Chinese sample remains untested. A total of 67,257 school students aged 6–16 were included. The Chinese version of the CBCL consists of 118 specific behavioral and emotional items, with two open-ended screening items. Confirmatory factor analysis (CFA), cluster analysis, and network analysis were employed to test the 8-Syndrome structure in the Chinese CBCL. The Chinese CBCL showed a comparative fit index (CFI) of 0.734, indicating poor fit in the Chinese sample. Cluster and network analyses suggested that Anxious/Depressed (AD), Withdrawn/Depressed (WD), and Thought Problems (TP) might form internalizing factors (representing emotional or thought problems), whereas Aggressive Behavior (AB), Rule-Breaking Behavior (RBB), and Attention Problems (AP) might comprise externalizing factors (representing behavioral problems). Age emerged as a significant factor influencing emotional and behavioral problems in the Chinese sample (p < 0.05). The 8-Syndrome structure of the Chinese CBCL did not fit well, prompting the need for further exploration and possible restructuring across different samples. Definitions of Internalizing and Externalizing factors may require refinement and age considerations should be integrated into future revisions of the CBCL structure.

Promoting social competence and social inclusion in the preschool: a peer-based relational intervention

ABSTRACT Reviews concerning the enhancement of preschool children’s social competencies reveal areas within which teacher approach, definitions of social competence and methods of study can be enhanced. In response, teachers and researchers co-developed and introduced a peer-based relational intervention to support children’s communication, empathic response and non-homophilic choice of friendship/work mates. Within this design-based approach, a three-phase comparison was made in 14 English preschool classrooms. Results identified changes attributed to the intervention regarding: teacher behaviour (movement from giving directions to observation and support); child behaviour (enhanced reciprocal communication, empathic response to others and engagement in cognitively challenging activities) and an expansion of socially inclusive play/work mates. Not all teachers/classes responded to the relational approach in the same manner: those that engaged actively in the approach encouraged more social competence enhancements amongst children; those with lower engagement identified support/implementation problems and children showed less social competence advances.

Caregivers on point: a randomized treatment–control prevention trial for foster and kinship caregivers to reduce behavior challenges among children in foster care

BackgroundChildren in foster care who are newly placed with licensed or kinship caregivers are often vulnerable to increased behavior problems associated with trauma and social disruptions. When those issues are not addressed, children are susceptible to placement disruptions that exacerbate behavior problems. Few preventive interventions are available for foster and kinship caregivers, and none are designed to be delivered at the time of a child’s placement into the home. This study aims to examine the impact of the Chicago Parent Program adapted and customized for foster and kinship caregivers (CPP-FC), locally branded as Caregivers on Point, on caregiver stress, parenting confidence and strategies, children’s behaviors, and placement stability.MethodsCaregivers (N = 300) are being recruited from a specialized foster care clinic that sees children and caregivers within five business days of a new placement. Upon completing baseline surveys and behavioral observation, caregiver-child dyads are randomized to receive CPP-FC (n = 150) or usual care (n = 150). Those in the treatment condition will complete 11 weekly sessions addressing child behavior management and caregiving approaches. A booster session will occur one month after the weekly sessions conclude. A mid-point assessment and behavioral observation will be collected four months after the baseline assessment for all participants, coinciding with the completion of the CPP-FC programming. At 6 months post-baseline, an end-of-study assessment will be collected. Administrative data will be extracted from the child welfare record to determine placement stability for the 12 months following enrolment. The primary outcome of interest is child behavior, indicated by changes in caregiver reports and objective ratings of behavior from observations, where raters are blinded to the treatment arm and timing of data collection. Secondary outcomes include placement stability and changes in caregiver stress and confidence in managing children’s behavior.DiscussionIf found to be effective, CPP-FC would be helpful for families involved with child welfare. It could be delivered by child welfare agencies, licensing and kinship navigator agencies, and foster care clinics and may be eligible for government reimbursement as a preventive intervention for children in foster care.Trial registrationThis study was prospectively registered with ClinicalTrials.gov, NCT06170047.

Identifying the Types of Trajectories for Each of the Five Child Behavior Checklist Sub-Concepts

Identifying the Types of Trajectories for Each of the Five Child Behavior Checklist Sub-Concepts

Childhood psychosocial adjustment and midlife obesity, diabetes and hypertension: prospective study from two birth cohorts.

Understanding how childhood psychosocial adjustment (CPA) influences later life health outcomes is crucial for developing interventions to mitigate the long-term risk of cardiometabolic diseases (CMDs). To investigate the association between CPA and incident CMDs in mid-life, and the mediating roles of educational attainment, smoking habits and depression during young adulthood. A prospective cohort study utilised data from the 1958 National Child Development Study (NCDS; 1958-2013) and the 1970 British Cohort Study (BCS70; 1970-2018), encompassing 22 012 participants assessed for CPA in childhood, who were subsequently evaluated for educational attainment, smoking habits and depression in young adulthood, followed by assessments for CMDs in mid-life. CPA was assessed using the Bristol Social Adjustment Guides in the NCDS and the Rutter Child Behaviour Scale in the BCS70, with higher scores indicating poorer psychosocial adjustment. The primary outcomes were the mid-life incidences of hypertension, diabetes and obesity. Compared with children in the lowest tertile for CPA scores, those in the middle tertile had an adjusted odds ratio for hypertension of 0.98 (95% CI 0.90-1.06), whereas those in the highest tertile had an odds ratio of 1.17 (95% CI 1.08-1.26). For diabetes, the corresponding odds ratios (95% CI) were 1.15 (0.98-1.35) and 1.39 (1.19-1.62). For obesity, the corresponding odds ratios (95% CI) were 1.08 (1.00-1.16) and 1.18 (1.09-1.27). These associations were partially mediated by educational attainment (2.4-13.9%) and depression during young adulthood (2.5-14.9%). Poorer CPA is correlated with the development of hypertension, diabetes and obesity in mid-life. Interventions aimed at improving CPA may help in reducing the burden of these diseases in later life.