Psychosocial Functioning Of Children Research Articles

Family Functioning in Pediatric Functional Gastrointestinal Disorders: A Systematic Review.

Children with some chronic health conditions experience family functioning difficulties. However, research examining family functioning in youth with functional gastrointestinal disorders (FGIDs) has produced mixed results. Therefore, the current review critically synthesized the literature on family functioning among youth with FGIDs. A systematic search using pediatric, family functioning, and FGID search terms was conducted in PubMed, PsycInfo, and ProQuest. Out of the 586 articles initially identified, 17 studies met inclusion criteria. Studies were included if they presented original research in English, assessed family functioning, and the study sample consisted of children (0-18 years) diagnosed with a FGID. Quality assessment ratings were conducted for each included study based on a previously developed scientific merit 3-point rating system. The majority of studies (n = 13) examined family functioning between youth with FGIDs and comparison groups. The remaining studies explored associations between family functioning and study variables (e.g., child psychosocial functioning and sociodemographic factors) and examined family functioning clusters among children with FGIDs. In general, children with FGIDs demonstrated poorer family functioning compared to healthy counterparts. Findings also suggested that child psychosocial functioning, disease characteristics, and sociodemographic factors were related to family functioning among youth with FGIDs. The average quality of studies was moderate (M = 2.3). Maintaining healthy family functioning appears to be challenging for some families of children with FGIDs. Future research should explore the directionality of the relationship between family functioning and child physical and psychosocial outcomes to advance the understanding and treatment of pediatric FGIDs.

Family Talk versus usual services in improving child and family psychosocial functioning in families with parental mental illness (PRIMERA\u2014Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children): study protocol for a randomised controlled trial

BackgroundParental mental illness is common and can lead to dependent children incurring a high risk of developing mental disorders, physical illness, and impaired educational and occupational outcomes. Family Talk is one of the better known interventions designed to prevent the intergenerational transmission of mental illness. However, its evidence base is small, with few robust independent randomised controlled trials, and no associated process or cost evaluations. The PRIMERA (Promoting Research and Innovation in Mental hEalth seRvices for fAmilies and children) research programme involves a mixed method evaluation of Family Talk which is being delivered in mental health settings in Ireland to improve child and family psychosocial functioning in families with parental mental illness.MethodsThe study comprises a multi-centre, randomised controlled trial (RCT), with nested economic and process evaluations, to assess the clinical and cost-effectiveness and implementation mechanisms of Family Talk compared to usual services. The study is being conducted in 15 adult and child mental health settings in Ireland. Families with a parent with mental illness, and children aged 5–18 years (n = 144 families) will be randomised to either the 7-session Family Talk programme (n = 96) or to standard care (n = 48) using a 2:1 allocation ratio. The primary outcomes are child psychosocial functioning and family functioning. Secondary outcomes are as follows: understanding and experience of parental mental illness, parental mental health, child and parental resilience, partner wellbeing and service utilisation. Blind assessments will take place at pre-intervention and at 6- and 12-month follow-up.DiscussionGiven the prevalence and burden of intergenerational mental illness, it is imperative that prevention through evidence-based interventions becomes a public health priority. The current study will provide an important contribution to the international evidence base for Family Talk whilst also helping to identify key implementation lessons in the scaling up of Family Talk, and other similar interventions, within routine mental health settings.Trial registrationISRCTN Registry, ISRCTN13365858. Registered 5th February 2019.

Psychometric properties of the Chinese version of the Multidimensional Assessment of Parenting Scale.

Parenting practices have been linked to a wide range of issues related to children's psychological adjustment; however, more research is warranted to further understand not only cultural variations of parenting norms, but also how such variations might differentially influence child outcomes. The current study examined the psychometric properties of a Chinese translation of the Multidimensional Assessment of Parenting Scale (MAPS) in order to: (a) assess both positive and negative dimensions of parenting in Chinese-speaking societies and (b) to explore the association between these practices and children's psychopathological symptoms. A total of 2,237 parents with children between 6 and 12 years old completed the MAPS, Interpersonal Mindfulness in Parenting Scale (IM-P), adapted Parental Bonding Instrument (PBI), and other measures related to children's psychosocial functioning. Exploratory and confirmatory factor analyses (CFA) revealed a clear six-factor structure. Strong to strict measurement invariance for child gender, parent gender, and child age were found. The results demonstrated adequate psychometric properties in terms of internal consistency and test-retest reliability. MAPS subscales also showed concurrent and convergent validity with mindful parenting, parent-child bonding, and children's psychopathology outcomes. The Chinese version of the MAPS will help facilitate multidimensional parenting research in Chinese-speaking societies and promote future cross-cultural studies examining the effect of positive and negative parenting on children's psychopathological adjustment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Influence of Early Childhood Temperament on Later Social-Emotional Functioning in Youth with Cancer.

One of the peak incidences of childhood cancer is during the early childhood years. This is also an important time for psychosocial and personality development, and it is well known that early childhood temperament influences later psychosocial functioning. However, this association has not been examined in young children with cancer. Parents of children with cancer (N = 39) and healthy comparisons (N = 35) completed an indicator of temperament (Children's Behavior Questionnaire) when children were young (Mage=4.99 ± 1.05 years). Five years later, parents and youth completed measures of psychosocial functioning (Mage=10.15 ± 1.10 years; Behavior Assessment Scale for Children, 2nd edition and Social Emotional Assets and Resilience Scale). Parents of healthy comparisons reported that their children demonstrated greater surgency than youth with cancer; there were no differences in negative affect or effortful control. Children with cancer and healthy comparisons were rated similarly on measures of psychosocial functioning. Health status was not a significant predictor of later functioning, but socioeconomic status and temperament were. The influence of temperament was stronger for strengths-based functioning (e.g., social competence, adaptive functioning) versus distress (internalizing and externalizing problems). Early childhood temperament is a strong predictor of later psychosocial functioning, regardless of health status. Findings highlight the need to consider temperament in the clinical assessment of psychosocial functioning in children with cancer. Additional research is needed to specifically assess how a diagnosis of cancer in early childhood influences temperament over time.

Trauma-focused cognitive behavioral therapy for children and youth in low and middle-income countries: A systematic review.

Trauma-focused cognitive behavioral therapy (TF-CBT) has been identified as a gold standard treatment for childhood posttraumatic stress disorder (PTSD) in Western countries. More recently, TF-CBT has emerged in the literature as an area of interest for children and youth affected by conflict and war in low- and middle-income countries (LMIC). The present systematic review assesses the current evidence base of TF-CBT for children and youth in LMIC, with a focus on conflict-affected countries. A total of 143 articles were identified, of which 11 articles, representing 1,354 participants, met the proposed inclusion criteria. Results showed that the majority of the studies identified were conducted in low-resource community settings in East or Central Africa (n = 8). It was also found that cultural considerations were taken into account in TF-CBT delivery to meet the needs of local populations. Additionally, measures were translated and validated for local use. Findings of outcome data indicated that TF-CBT was effective in treating trauma-related symptoms and improving psychosocial functioning in children and adolescents in LMICs. Given the limited number of published literature available in this area, further studies are needed to conclude when and for whom trauma-focused interventions are most relevant.

A Longitudinal Assessment of Parenting Stress in Parents of Children with New-Onset Epilepsy.

Parents of children with newly diagnosed epilepsy may experience elevated parenting stress. The present study examined trajectories of parenting stress over time and identified modifiable predictors of these trajectories. Parents of youth with epilepsy (N = 102; 2-12 years old) completed questionnaires 1, 4, 13, 19, and 25-months post-diagnosis, including measures of parenting stress, family functioning, child psychosocial functioning, sociodemographics, and perceived stigma. Latent growth curve models (LGCM) were used to examine domains of parenting stress over time. At baseline, 25-48% of parents reported elevated parenting stress. LGCMs revealed that the parent and child domains of parenting stress were generally stable across time. However, life stress was more variable across time, and parents with higher initial life stress had a greater reduction in life stress over time. Socioeconomic status was identified as a non-modifiable predictor of life stress. Family functioning was associated with greater parenting stress in the parent domain. Child psychosocial functioning was associated with greater parenting stress in the parent and child domains. Parenting stress was elevated for a subset of families and appeared to be relatively stable over time, with the exception of life stress, which was more variable. With early screening, child factors and parent appraisals of epilepsy may be valuable targets for clinical intervention with families of children with epilepsy.

Psychosocial Functioning in Children with Dyslexia: Perspectives from Parents, Counsellors and Teachers

Purpose: The study aimed to understand the issues and challenges encountered by various stakeholders (teachers, parents and counsellors) working with children with dyslexia in the inclusive school context. Method: Using purposive and snowball sampling, 20 teachers, 20 counsellors and 20 parents (mothers) of children with specific learning disability (dyslexia) were selected from 8 inclusive schools in Delhi. A qualitative approach was adopted, with a semi-structured interview schedule to elicit responses. Qualitative thematic analysis was used as a framework for data analysis. Results: Parents experienced negative feelings due to lack of awareness and acceptance of dyslexia. Counsellers felt parental ignorance led to delay in assessment and remediation. Parents and counsellors perceived lack of support from schools and lack of empathy among teachers. Teachers confessed they lacked training to deal with dyslexic learners, were unaware of policies and concessions for them, and were currently overburdened with their workload. Conclusion: There is a need to hold psycho-educational workshops for parents in order to increase their awareness, and conduct training workshops (pre-service and in-service) for teachers to increase awareness and build empathy. Schools should provide in-house assistive services such as assessment and remediation, and redefine the goals of education to focus on the holistic skills of children.

Effect of Parental English Proficiency on Psychosocial Functioning in Children with Craniofacial Anomalies.

Psychosocial distress in children with craniofacial anomalies is multifactorial. A known cause of childhood psychosocial distress is parental limited English proficiency; however, its role as a psychosocial stressor in the craniofacial anomaly population remains unknown. The current study aimed to understand the potential influence of parental English proficiency in children with craniofacial anomalies. Two hundred ninety-six children were prospectively evaluated at the University of California, Los Angels and the Orthopaedic Institute for Children using the Pediatric Patient-Reported Outcomes Measurement Information System to assess anger, anxiety, depression, and peer relationships. Children were grouped by parental English proficiency based on the requirement or lack thereof for interpreting services during clinic appointments. Independent t tests, analyses of variance, and linear regressions were performed to compare groups and identify predictors for psychosocial functioning. Although comparison children did not exhibit any differences in psychosocial scores with respect to parental English proficiency, craniofacial anomaly children with parents who have limited English proficiency demonstrated higher anger, anxiety, depression, and lower peer relationships compared with those with parents who are English proficient. Linear regression analyses demonstrated that limited English proficiency in parents was a significant predictor for anger (p = 0.005), anxiety (p = 0.002), depression (p < 0.001), and poor peer relationships (p < 0.001) in children with craniofacial anomalies. Parental English proficiency is associated with increased psychosocial distress in children with craniofacial anomalies. Future efforts toward identification of and assistance for parents with limited English proficiency to address barriers to care may improve psychosocial function in children with craniofacial anomalies. Risk, II.

Polymorbidity of developmental disabilities: Additive effects on child psychosocial functioning and parental distress

BackgroundWhile parents of children with developmental disabilities show greater parenting burden and distress compared with their counterparts, little is known about to what extent developmental polymorbidity in children escalates and magnifies the risk of parental distress. AimsThis study investigated the co-occurrence of developmental disabilities among a sample of elementary school children and examined its additive effects on child psychosocial functioning and parental distress. Methods and proceduresA cross-sectional survey among 710 parents of elementary school children in Hong Kong included measures of child psychosocial functioning and parental stress. Structural equation modeling was used to test a hypothesized model in which child psychosocial functioning mediates the effect of developmental polymorbidity on parental distress. Outcomes and resultsAbout one-fourth of the participants reported their children having two or more developmental disabilities. The number of developmental disabilities was positively related to the severity of emotional and behavioral problems in children, which in turn explained general and parenting distress in parents. Conclusions and implicationsGiven the heightened vulnerability to distress among parents of children with multiple developmental disabilities, psychological care should particularly target this population. Early identification and intervention strategies are also needed to detect children with multiple co-occurring developmental disabilities, which could potentially alleviate their emotional and behavioral problems and lessen the parenting burden.

Parental Perception of Changes in Basic Life Needs of Children with Disabilities after Six Months of Therapeutic Horseback Riding: A Qualitative Study

Therapeutic horseback riding (THR) has a positive effect on the physical, cognitive, and psychosocial functioning of children with disabilities. Parents’ reports of the effects of THR on their children support professionals in individualizing the THR program. With this qualitative study, we aimed to explore parents’ perceptions of changes in the basic life needs of their children with disabilities after six months of THR lessons and to survey parents’ explanations for the causes of these changes. The study involved parents of 13 children with disabilities who were enrolled in a six-month THR program. Parents continuously monitored their children and wrote a report on possible changes in their child’s needs according to Virginia Henderson’s need theory. Qualitative content analysis of parents’ reports indicated only positive changes in 11 children. Most codes were identified in categories “relationships and communication with other people” and “movement and posturing”. Other categories identified codes such as easier breathing, a better quality of sleep, better appetite, better elimination of stool and urine, more independence in clothing and maintaining personal hygiene, and greater interest in play and learning. Parents’ reports are further supported by the assessments of professionals. Most parents think THR is responsible for the noticeable improvements in their children’s quality of life.

Health literacy and attitudes of caregivers of intellectually disabled children towards eye care

Background: The development of visual impairment in young children can negatively impact visual, motor, and cognitive function, and subsequently, affect the child's psychosocial functioning. Objective: The objective of this study is to assess the eye care status among children with intellectual disabilities (IDs). Methodology: A questionnaire was designed to explore the attitudes of parents toward eye care for their intellectually disabled children aged 3–17 years and possible barriers to accessing eye care between April 2018 and April 2019. Results: A total of 198 completed questionnaires were analyzed (19.3% response rate). Sixty-four caregivers (32.3%) believed in the importance of eye examinations for children with ID. Although 72 participants (36.4%) believed their children had visual impairment, 95 (47.9%) reported that their children had never received an eye examination in their lifetime. Only 80 caregivers (40%) had sought ophthalmological care for their children within the last 24 months. Having had a previous eye examination was not significantly associated with any sociodemographic factors. Among the caregivers' major reasons for not seeking eye care was the belief that their children did not need an eye check-up (68.9%), followed by prioritizing other medical issues (11.7%), transportation barrier/financial burden (5.8%), and lack of social support (4.9%). Conclusion: The vision care status among students with ID in special needs schools in Jeddah is poor, highlighting the necessity of establishing routine vision screening check-ups coupled with multidisciplinary health assessments.

Psychosocial functioning in children with phenylketonuria: Relationships between quality of life and parenting indicators.

This study aimed to assess the impact of phenylketonuria (PKU) and its treatment on parent and child health-related quality of life (HRQoL) and to identify the parenting-related correlates of parent and child HRQoL, as well as metabolic control. Eighteen mothers of 2- to 12-year-old children with PKU participated and completed a series of self-report questionnaires including the PKU Impact and Treatment Quality of Life Questionnaire (PKU-QOL). Mothers reported that the most significant impact of PKU on HRQoL was in relation to the impact of their child's anxiety during blood tests on their own HRQoL and guilt related to poor adherence to dietary restrictions and supplementation regimens. Higher reported intensity of child emotional and behavioural difficulties and parenting stress were associated with higher scores for PKU symptoms on the PKU-QOL, higher scores for emotional, social, and overall impact of PKU, and higher scores for the impact of dietary restriction. Where mothers reported greater use of overreactivity as a parenting strategy, children tended to have better lifetime phenylalanine levels; however, the overall impact of PKU and the impact of supplement administration on mothers' HRQoL were worse for these families. These findings have implications for a holistic family-centred approach to the care of children with PKU and their families.

Motor problems in children with severe emotional and behavioural difficulties.

There is growing evidence that children with motor difficulties are at risk of psychosocial problems and vice versa. However, it is not clear how far different aspects of motor function are predictive of psychosocial well-being in the context of other powerful factors, such as family upset, that are known to affect psychosocial development. To investigate the role of basic motor skills and primary reflex persistence in young children with severe emotional and behavioural difficulties (EBD). From a total sample of 225 children, three groups were selected: children excluded from school (severe EBD) (n=29), a male comparison group (n=38), and a female comparison group (n=45). The groups were matched (at group level) on age, IQ, and level of social disadvantage. All of the selected children completed a range of standardized motor, cognitive, social, and behavioural measures, as well as a clinical protocol for primary reflex persistence. Children with severe EBD had significant levels of motor difficulties, primary reflex persistence, and family upset, as well as significant literacy problems, attention deficits, and raised levels of hyperactivity/impulsivity relative to the comparison groups. A hierarchical multiple regression analysis revealed that basic motor skills, primary reflex persistence, family upset, hyperactivity, and literacy were all significant predictors of psychosocial functioning. The findings suggest that motor difficulties and primary reflex persistence may act as independent stressors of psychosocial functioning in children with EBD. We suggest that specific movement interventions should be adopted to complement existing provision for children at risk of psychosocial problems.

Early Emotional, Behavioural and Social Development of Infants and Young Children with Congenital Heart Disease: A Systematic Review.

The experiences of diagnosis of congenital heart disease (CHD), cardiac surgery and hospitalisation(s) are distressing and represent a significant stressor for a child and family, which may impact psychosocial development. This systematic review provides a synthesis of psychosocial outcomes of infants and young children with congenital heart disease who had cardiac surgery early in life. Twenty-eight studies related to infant and young children's psychosocial development, specifically emotional, social and behavioural functioning were identified. Variability was related to methodological factors including differences in study design, varying measurement tools and heterogeneous samples. Despite these limitations, the majority of studies were of high quality. The most common finding was a high prevalence of low-severity emotional and behavioural dysregulation. Young children with severe CHD or comorbid conditions experienced greater impairment, with higher rates of externalising behaviour problems, although internalising behaviour problems were also evident. This review integrates findings from literature in the past 28years on the psychosocial well-being of infants and young children with CHD and demonstrates a risk for emotional, social and behavioural development difficulty, and, importantly, that symptoms of psychosocial impairment are detectable very early in infancy. We advocate for assessment and monitoring of emotional and behavioural regulation and social development to be routinely conducted from infancy to enable prevention and early intervention.

How Much Is Too Much? Examining the Relationship Between Digital Screen Engagement and Psychosocial Functioning in a Confirmatory Cohort Study

Previous studies have offered mixed results regarding the link between digital screen engagement and the psychosocial functioning of young people. In this study, we aimed to determine the magnitude of this relation, to inform the discussion regarding whether amount of digital screen time has a subjectively significant impact on the psychosocial functioning of children and adolescents. We analyzed data from primary caregivers participating in the National Survey of Children's Health (NSCH), an annual nationally representative survey fielded by the US Census Bureau between June 2016 and February 2017. NSCH uses an address-based sampling frame and both Web- and paper-based data collection instruments to measure psychosocial functioning and digital engagement, including a modified version of the Strengths and Difficulties questionnaire and caregiver estimates of daily television- and device-based engagement, respectively. The expected parabolic inverted-U-shaped relationship linking digital screen engagement to psychosocial functioning was found. These results replicated past findings suggesting that moderate levels of screen time (1-2 hours a day) were associated with slightly higher levels of psychosocial functioning compared to lower or higher levels of engagement. Furthermore, it indicated that children and adolescents would require 4 hours 40 minutes of television-based engagement and 5 hours 8 minutes of daily device-based engagement before caregivers would be able to notice subjectively significant variations in psychosocial functioning. The possible influence of digital screen engagement is likely smaller and more nuanced than we might expect. These findings do not rule out the possibility that parents might only notice very high levels of screen time when their child manifests pronounced psychosocial difficulties. Future work should be guided by transparent and confirmatory programs of research.

2282-PUB: Differences in Child Psychosocial Functioning According to Diabetes and Weight Status

Children with diabetes may be expected to experience greater psychosocial difficulty than children without chronic diseases, however less is known about how this varies according to weight status. Purpose: The purpose of this study was to evaluate differences in child psychosocial functioning among children with type 1 diabetes (T1D) in comparison to children with overweight and obesity. Methods: Parents of children age 2-17 years were invited to participate in this online survey study. Parents reported child demographics, chronic disease diagnoses, body size, and completed the parent version of the 35-item Pediatric Symptom Checklist (PSC). Children were classified into 4 groups based on diagnosis of T1D, and then according to BMI percentile. ANOVA was used to compare PSC total score and internalizing, externalizing, and attention subscales between groups. Multiple regression was used to examine the contribution of T1D diagnosis, age, gender, and BMI percentile to PSC total score. Results: A total of 133 children were included in the analysis (mean age 9.7 + 3.1 years, 48.9% girls). PSC total score was highest among children with T1D (54.25 + 17.9) followed by children with obesity (48.1 + 16.6), comparison (46.6 + 12.4), and overweight children (43.8 + 14.0); however, these differences did not reach statistical significance. Comparison children demonstrated higher externalizing and internalizing subscale scores than did overweight children, while the highest attention subscale score was found among children with obesity. The strongest predictor of PSC total score was T1D (unstandardized B = 9.4; p=0.03). Discussion: No differences were found in psychosocial functioning among this sample. Trends in the data suggest that the presence of T1D, and potentially obesity, may be associated with worse psychosocial functioning among children. However, additional studies are needed to confirm. Disclosure E.H. Guseman: None. M.K. Englert: None. J. Whipps: None. M. Schulze: None. E.A. Beverly: None.

Relationship between parent mood and resilience and child health outcomes in pediatric asthma.

Asthma is the most common pediatric chronic disease and disproportionately affects urban, minority, and disadvantaged youth. This study explored the relationship between parent and child psychosocial functioning and asthma-related health outcomes in a sample of at-risk children with asthma. We hypothesized that greater parent resilience would be associated with better parent mood, more symptom-free days (SFDs), better child mood, and less child anxiety. Further, we hypothesized that parent resilience would moderate the relationship between parent mood and SFDs. We performed a secondary analysis of baseline cross-sectional enrollment data. Parents of African American children on Medicaid with persistent asthma reported their children's asthma SFDs and their own measures of parent quality of life, mood, and resilience, and child mood and anxiety. Baseline data from 217 parents (92.2% female, Mage = 33.8 years ± 9.5) of children (Mage = 6.6 years ± 2.3) were available. Parent resilience was significantly associated with parent mood. Better parent-reported quality of life (QOL) and mood were significantly associated with more child asthma SFDs. In contrast to our hypothesis, parent resilience did not moderate the relationship between parent mood and SFDs. Higher parent-reported QOL and mood were significantly associated with better parent report of child asthma SFDs. Although parent resilience was associated with parent mood, it did not moderate the relationship to child SFDs. Future research is warranted to better understand the unique contribution of resilience in families with children with asthma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Military Life Stressors, Family Communication and Satisfaction: Associations with Children's Psychosocial Outcomes.

Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.

Association of anthropometric status and residential locality factors with cognitive scores of 4–6-year-old children in Kwazulu-Natal, South Africa

Background: The Asenze study has the long-term goal of promoting better physical, cognitive and psychosocial functioning of children in a rural area in KwaZulu-Natal, 50 km from Durban, with a view to planning interventions to promote growth and development for very young children. The specific objective in this paper was to provide information for the Child Health and Development project of the Valley Trust to assist with intervention planning. The broader goal was to assess developmental delays in communities ravaged by the HIV epidemic. The Asenze study was designed in two phases from 2008 and 2012. The current paper reports on 1 581 4–6-year-old children in the baseline phase (2008–2010) in the five adjacent tribal areas in the study area. Method: The participants included all the 4–6-year-olds whose parents had consented to inclusion in the project and their caregivers. Data were derived from a brief questionnaire administered in the homes of participants, and subsequently from medical and psychological assessments of the children and their caregivers at the Asenze clinic. The association between child factors and other factors (geographic area, socioeconomic status (SES), parental level of education, the child’s preschool education) on the one hand, and the child’s cognitive performance (as measured by the Grover Counter and subtests of the KABC-11) were analysed. Linear regression models were employed to determine which predictor variables of interest in a model were associated with the children’s cognitive scores as the dependent variables. Results: Based on the data, the principal factors associated with children’s cognitive outcomes were height-for-age z-score (HAZ), preschool education and the area of residence. Generally children who had low cognitive scores were more often stunted (as defined by the WHO anthropometric tables), had not had preschool education, and came from areas less favourable in terms of local infrastructure and access to employment opportunities and arable land. Conclusion: The finding from this cross-sectional analysis of baseline data showed that in addition to height for age and preschool education, which are commonly thought to impact on cognition, the local authority area where the children lived was associated with their scores on cognitive tests. This has implications for intervention planning. The functioning of local government in promoting the type of community development that will protect the rights of children should be taken into account.

Psychosocial Burden of Undiagnosed Persistent ADHD Symptoms in 12-Year-Old Children: A Population-Based Birth Cohort Study

Objective: To describe the psychosocial functioning in children with undiagnosed persistent ADHD symptoms. Method: A prospective, population-based birth cohort study was conducted among 2,945 children and their primary caregivers who lived in Tokyo, Japan, and were followed up at the age of 10 years and 12 years. Parents reported a history of ADHD diagnosis and completed the Strengths and Difficulties Questionnaire. Results: Overall, 91 participants had persistent ADHD symptoms; however, 76 (83.5%) had no history of an ADHD diagnosis. The presence of undiagnosed ADHD symptoms was significantly associated with worse psychosocial functioning for most continuous outcomes when compared with the absence of ADHD symptoms and diagnosis, including lower self-esteem (standardized mean difference [SMD] = −0.31) and higher depression (SMD = 0.36), emotional symptoms (SMD = 0.69), conduct problems (SMD = 1.26), and peer relationship problems (SMD = 0.98). Conclusion: Our findings suggest the importance of paying more attention to the possible underdiagnosis of ADHD in children.