Developmental Outcomes Research Articles

A lifespan perspective on fetal alcohol syndrome: Developmental challenges and outcomes

Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD) result from alcohol exposure during the intrauterine life of the fetus and are the most common nonheritable, avoidable causes of intellectual disability and a wide range of neurobehavioral outcomes. Alcohol causes neurotoxicity in the developing brain. Children with FASD experience behavioral issues from an early age and progress to adulthood. The prevalence of alcohol consumption among women is increasing. Clinically, symptoms in children with FAS manifest in a wide range of ways, probably as a result of the quantity and timing of alcohol exposure, as well as maternal and genetic effects. All of these elements contribute to the mechanisms through which alcohol harms a growing brain, the specifics of which are still largely unknown. Neuroimaging reveals alterations in the structure of the brain, white matter structure, cortical development, and functional connections. However, recent advancements and ongoing research have yielded encouraging findings that could result in the use of FAS screening tools and therapy for individuals. Intervention aims to enhance development, address behavioural challenges, and ensure suitable educational programming. Prioritizing early childhood intervention is crucial to prevent secondary disabilities that may arise from delays in obtaining a definitive diagnosis of Fetal Alcohol Syndrome. Effective nutritional therapies as well as cognitive rehabilitation are now being tested. This disorder represents the intersection of complicated societal, community, family, and biological circumstances that increase the risk for intergenerational suffering, health disparity, and social injustice. This paper aims to guide healthcare professionals and policymaker in enhancing the quality of life for individuals with FAS through effective strategies.

Routine third-trimester ultrasonography and child neurodevelopmental outcomes: a follow-up of a pragmatic cluster-randomised controlled trial

ABSTRACT Aims/Background Routine third-trimester ultrasonography is increasingly conducted to screen for foetal growth restriction (FGR) and reduce adverse perinatal and child neurodevelopmental outcomes using timely obstetric management. While it did not reduce adverse perinatal outcomes in previous trials, evidence regarding its association with child neurodevelopmental outcome is absent. We examined whether routine third-trimester ultrasonography is positively associated with child developmental and behavioural/emotional outcomes compared to usual care. Design/Methods Dutch mothers with a low-risk pregnancy participating in a subsample (n = 1070) of a nationwide cluster-randomised trial reported infant (age 6 months) and toddler (age 28 months) developmental milestones (Ages and Stages Questionnaire) and toddlers’ internalising and externalising problems (Child Behavior Checklist). Usual care (n = 380) comprised selective ultrasonography. The intervention strategy (n = 690) included two routine third-trimester ultrasounds next to usual care. Both strategies applied the same interdisciplinary protocol for FGR detection and management. Results Adjusted linear mixed-level regressions revealed that routine third-trimester ultrasonography was positively but modestly related to z-standardised infant developmental milestones at 6-month follow-up, B = 0.20, 95%CI [0.07; 0.32], p = 0.003, compared to usual care. At 28-month follow-up, these strategies did not differ in child developmental outcome and internalising and externalising problems. Conclusion Routine third-trimester ultrasonography was positively but modestly associated with infant development. In toddlerhood, routine ultrasonography was not related to child developmental and behavioural/emotional outcomes. Overall, these findings do not support the implementation of routine third-trimester ultrasonography for low-risk pregnant women for reasons concerning children’s early neurodevelopmental outcomes.

The apple does not fall far: stable predictive relationships between parents’ ratings of their own and their children’s self-regulatory abilities

Having control over your own behavior and impulses is a critical skill that influences children’s academic, social, and emotional development. This study investigates the stability and predictive relationships between parents’ ratings of their own and their children’s executive function and delay aversion. Using data from approximately 1700 families collected during the COVID-19 pandemic, we employed hierarchical structural equation models and cross-lagged panel models to analyze the temporal stability and directional influences of executive function and delay aversion assessments.Our analysis revealed a substantial latent correlation (r = 0.48, p < 0.001) between parents’ and children’s executive function problems, indicating a shared variance of approximately 23%. Significant cross-lagged effects were found, with parental executive functions at T1 predicting child executive functions at T2 (β = 0.16, p = 0.005). For delay aversion, we found a latent correlation of r = 0.53 (p < 0.001) and significant within-timepoint and temporal stability, but no cross-lagged effects.These findings suggest that higher levels of executive function problems reported by parents at T1 correspond to an increased perception of similar problems in their children at T2. This highlights the importance of parental self-perception in assessing children’s abilities. Our results highlight the importance of incorporating family dynamics into interventions targeting executive function difficulties and delay aversion in children, and understanding this interplay enables the development of more effective, individualized approaches to support positive developmental outcomes.

Sex differences in DNA methylation variations according to ART conception-evidence from the Norwegian mother, father, and child cohort study

Previous studies have shown cord-blood DNA methylation differences in newborns conceived using assisted reproductive technologies (ART) compared to those conceived naturally. However, whether these ART-related DNA methylation differences vary with children’s sex is unknown. We hypothesize that the DNA methylation differences in cord blood between ART-conceived and naturally conceived newborns also varies by the sex of the child, with distinct patterns of differential methylation present in males and females. We investigated sex differences in cord-blood DNA methylation variation according to conception by ART using the Illumina MethylationEPIC platform, comparing 456 ART-conceived versus 507 naturally-conceived girls, and 503 ART-conceived and 473 naturally-conceived boys. We identified 37 differentially methylated CpGs according to ART-conception among girls, and 70 differentially methylated CpGs according to ART-conception among boys, when we used a 1% false discovery rate to account for multiple testing. Ten CpGs were differentially methylated according to conception by ART in both sexes. Among the genes that were associated with these CpGs, we found the BRCA1; NBR2 gene (two CpGs) was hypermethylated in girls while the APC2 (two CpGs) and NECAB3;ACTL10, (four CpGs) related to cellular signaling were hypomethylated in boys. These findings confirm the presence of sex-specific epigenetic differences, illustrating the nuanced impact of ART on the fetal epigenome. There is a need for further explorations into the implications for sex-specific developmental trajectories and health outcomes in ART-conceived children.

Assessing the safety and pharmacokinetics of casirivimab and imdevimab (CAS+IMD) in a cohort of pregnant outpatients with COVID-19: results from an adaptive, multicentre, randomised, double-blind, phase 1/2/3 study

ObjectivePregnant women with COVID-19 are at elevated risk for severe outcomes, but clinical data on management of these patients are limited. Monoclonal antibodies, such as casirivimab plus imdevimab (CAS+IMD), have...

Examining the School Climate Influence on Jamaican Secondary School Students: A Comprehensive Literature Review

This article synthesises the literature on the socioecological factors within the school climate - quality and character of school life (Cohen, 2009) influencing adolescents’ resilience. The review focuses on social relationships and the mechanisms used for teaching and learning practices. Resilience is a positive development outcome resulting from a triadic interactive process between the adolescent, the internal capacity, and the socioecological factors within the environment (Ungar, 2008). Changes imposed by COVID-19 on teaching and learning practices assumedly altered the school climate and are known to impact adolescents’ psychosocial well-being. Transforming the school climate at its minimum will require improving social relationships, communicating expectations, and creating a school environment where students will feel safe. Giving students autonomy through active and productive engagement in decisions that affect their developmental outcomes is critical for success. Expansion of this study requires applying a methodological approach that allows for students’ perspectives of the school climate, careful measurement of their resilience levels and lived experiences of students and other school personnel.

Maternal perceived safety and parenting practices with young children: a cross-sectional analysis from 15 low-income and middle-income countries

IntroductionSocial environments can influence parents’ caregiving capacities and the quality of nurturing care provided to children. These links, in turn, can shape children’s developmental outcomes over the life course. We...

Preschool quality and developmental outcomes of preschool children in rural China: Evidence from longitudinal and subgroup analyses

Using a longitudinal data set developed from surveys of 1,285 children (and their families), as well as 683 preschools teachers in 382 preschools in rural western China, we examined the association between preschool quality and the development (cognitive and social-emotional skills) of preschool children. The findings showed that 55 % of the sample children were cognitively delayed, and 49 % of the children were social-emotionally delayed at age 3. The rates of delay decreased to less than 40 % when the children were at preschool age. Although other factors were associated with the decline in development delays, according to the findings, preschool attendance respectively led to an improvement of 0.47 SD (p = 0.001) in child cognitive development (i.e., the fall in delays). More specifically, the global quality and the structural quality of preschools improved child cognitive development by 0.11 SD (p = 0.001) and 0.09 SD (p = 0.004), respectively. The findings of the subgroup analyses suggested that children from disadvantaged backgrounds benefited more from being able to attend quality preschools. Preschool quality also helped to improve developmental outcomes (cognitive abilities and social-emotional skills): for children that were developmentally delayed before age 3, but not for those children that were not delayed when they were 3 years old; for children with lower educated parents, but not for those with more highly educated parents; for children that were from relatively poor families, but not for those that were from relatively rich families; and for children that were attending preschools in rural areas, but not for those who were attending a preschool in an urban area.

Exploring the use of tummy time guidelines to improve infant development in rural primary care

BackgroundTummy time enhances motor development, improves mobility, strength, and head clearance, reduces cranial asymmetry, and decreases the risk of childhood obesity. The American Academy of Pediatrics (AAP) advises all infants, beginning at birth, partake in supervised daily tummy time during awake periods. Since 1994, when the AAP initiated the “Back to Sleep” campaign, the number of infants participating in daily tummy time has significantly declined, leading to an increase in adverse outcomes. MethodsUsing a quasi-experimental design, tummy time guidelines were implemented in a rural family primary care practice to support infant development. This three-phase intervention included educating providers, developing a smart phrase, and posting visual reminders. A convenience sample of infants who presented for well-visits at a rural family practice in southwestern Washington were included in this project. The Survey of Wellbeing of Young Children measurement tool was used to collect infant developmental outcome data. FindingsFollowing the intervention, infant developmental outcomes improved. There was a 10% reduction at two months of age and a 7% reduction at four months of age in the number of infants with below average developmental scores. DiscussionThis project demonstrates that increased provider awareness and implementation of tummy time clinical practice guidelines can benefit infant development in primary care, especially in rural populations. Application to practiceViable strategies for incorporating clinical practice guidelines into primary care are presented.

A Review of Interleukin-23/Interleukin-17 Inhibitor Exposure during Pregnancy in Patients with Psoriasis

Psoriasis is an immune cell-mediated chronic relapsing inflammatory skin disease that often develops during the reproductive years of women. The treatment of psoriasis during pregnancy is challenging as remarkable changes occur in the maternal body, and it requires the selection of therapy which is safe for both mother and fetus. The use of interleukin-23 (IL-23)/IL-17 inhibitors has been growing in psoriasis disease management and so the risk of their exposure during pregnancy is increasing too. However, human safety data in pregnancy are limited. This article aims to review pregnancy outcomes associated with IL-23/IL-17 inhibitor exposure in psoriasis patients and to see possible therapeutic options for psoriasis treatment during pregnancy. A search of the PubMed database up to June 2023 for articles was performed. The search strategy included a combination of terms as (pregnancy) AND (psoriasis) AND (Ustekinumab)/(Secukinumab)/(ixekizumab)/(brodalumab)/(guselkumab)/(tildrakizumab)/(risankizumab)/IL-23 inhibitors/IL-17 inhibitors. Resulted articles were reviewed manually for case reports, exposures from registries, and clinical trials. Most of the exposures to IL-23/IL-17 inhibitors were inadvertent, and therapy was suspended upon the detection of pregnancy. No signals on miscarriages, spontaneous abortions, and adverse developmental outcomes have been reported with first-trimester exposures to IL-23/IL-17 inhibitors. However, benefit–risk profile cannot be extrapolated based on first-trimester exposure as the transfer of these biologics across the placenta occurs in the later stage of pregnancy. More safety data from large cohorts of full-term exposure are required for IL-23/IL-17 inhibitors to consider them safe therapeutic options during pregnancy.

Questions and controversies in the management of hypotension in preterm infants

Hypotension is a frequent condition that affects preterm infants during the first days of life, within the transition period to an extra uterine environment, or associated with neonatal pathology. Persistent hypotension in the neonatal period is associated with increased neonatal morbidity and mortality. Understanding neonatal hemodynamics is the first step in approaching hypotensive neonatal patients. Treating hypotension should be to restore impaired blood flow and maintain cellular metabolism. Neonatologists should look beyond values of blood pressure and check for markers of low systemic blood flow and inadequate organ perfusion. There are many anti-hypotensive agents, but choosing the most appropriate intervention should take into consideration the underlying pathophysiologic process, the effectiveness versus side effects of the drug, and medium and long-term developmental outcomes. This article intends to review the therapeutic options for neonatal hypotension to offer the clinicians support for an evidence-based choice.

INSIGHT responsive parenting intervention effects on child self-regulation at ages 3 and 6 years.

Self-regulation encompasses the ability to modulate behavior, cognition, and emotions. Parents can promote child self-regulation with responsive parenting (RP). RP shapes various components of self-regulation and is associated with numerous developmental outcomes. Here, we examine long-term effects of an early-life RP intervention designed for obesity prevention on later child self-regulation and temperament. Participants were from a randomized clinical trial comparing the RP intervention against a safety control (n = 279). RP intervention content in the domains of feeding, sleep, emotion regulation, and interactive play was delivered to primiparous mothers and infants at four home visits during the first year after birth, followed by clinical research center visits at ages 1 and 2 years and phone calls at 1.5 and 2.5 years. Child self-regulation and temperament were assessed with behavioral tasks and the Children's Behavior Questionnaire at child ages 3 and 6 years. A path model tested whether the RP intervention affected child self-regulation in comparison to the control group. At 6 years, children in the RP group had lower parent-reported negative affect (b = -0.34, SE = 0.15, p = .023) and better observed emotion regulation (b = 0.45, SE = 0.16, p = .007). Findings indicate that an RP intervention designed for early obesity prevention promoted emotional aspects of self-regulation in middle childhood, highlighting RP as a strategy for promoting healthy behavior across multiple domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Risk of Developmental Delay in Infants Born to Perinatal COVID-19-Positive Mothers at a Tertiary Care Hospital: A Cross-Sectional Study

Purpose: Prenatal and perinatal experiences of the mother are known to influence infant development. Maternal exposure to coronavirus disease 2019 (COVID-19) during pregnancy has been associated with increased morbidity and mother-baby separation. However, the developmental outcomes of infants born to COVID-19-positive mothers remain unclear. This study represents an initial exploratory effort to assess the developmental risks faced by infants born to mothers who tested positive for COVID-19. Methods: This cross-sectional study involved telephonic interviews and developmental screenings of 45 infants, aged 9 to 15 months, who were born to perinatal COVID-19-positive mothers between July 2020 and May 2021. The Ages &amp; Stages Questionnaire was used for the developmental assessment. The impacts of maternal, infant and separation-related factors on development were analyzed. Results: Within the study population, 28.8% (13 of 45 infants) presented with a risk of developmental delay. The gross motor and problem-solving domains were the most frequently impacted. Among the factors studied, prolonged separation period (exceeding 7 days), advanced maternal age, and gestational age (preterm birth) were associated with higher proportions of infants at risk of developmental delay; however, these associations were not statistically significant.Conclusion: This study suggests that infants born to mothers who tested positive for COVID-19 during the perinatal period face a risk of developmental delay. Factors such as maternal age, gestational age at birth, metabolic disease during pregnancy, and infant-mother separation could exacerbate this risk. Future research should prioritize objective assessments of development and long-term follow-up to monitor developmental outcomes in this population.

Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study.

Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child's birth. The majority of women (n=282-315, 82%-92%) "strongly agreed or agreed" that receiving information from CFHN via technology would be acceptable, and most (n=308) women "strongly agreed or agreed" with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days.

Daylight duration and time allocation of children and adolescents

This study explores the allocation of time, particularly to sleep, among children and adolescents in response to daily daylight variation. Utilising a dataset of over 50,000 time-use diaries from two Australian cohorts spanning 16 years and employing an individual fixed effects estimator, we uncover a substantial causal impact of daily daylight duration on sleep patterns. Our findings reveal that days with longer daylight hours are associated with a decrease in total sleep duration, primarily driven by a later sleep onset time. Additionally, longer daylight hours correspond to reduced time spent on personal care and media activities, with increased dedication to school and physical activities. Furthermore, we identify socio-demographic factors moderating these effects, such as older age and weekend days exerting a stronger influence on sleep duration, while females and children of unemployed mothers exhibit a subtle impact. These insights contribute to our understanding of how environmental factors shape daily routines and offer implications for designing schedules that promote positive developmental outcomes in young individuals.

Don't skip class: A new conceptual model for examining classism among adolescents and families

AbstractThis article introduces a new conceptual model for examining classism among adolescents and families. Classism refers to the discrimination that individuals experience because of their social class. For adolescents, social class refers to their family's social class and includes income, education, occupation, and position in society. Despite extensive research that has shown how social class is associated with adolescent development, there remains a gap in the knowledge about how classism might explain this association. To advance scholarship about classism among adolescents and families, I present a new model. This model integrates theories on (a) classism among adults, (b) discrimination among adolescents, (c) family science, (d) social class, and (e) intersectionality. I include hypotheses about the associations between classism and adolescent developmental outcomes and conclude with directions for future research.

Strengths and limitations of the worm development and activity test (wDAT) as a chemical screening tool for developmental hazards

The worm Development and Activity Test (wDAT) measures C. elegans developmental milestone acquisition timing and stage-specific spontaneous locomotor activity (SLA). Previously, the wDAT identified developmental delays and SLA level changes in C. elegans with mammalian developmental toxicants arsenic, lead, and mercury. 5-fluorouracil (5FU), cyclophosphamide (CP), hydroxyurea (HU), and ribavirin (RV) are teratogens that also induce growth retardation in developing mammals. In at least some studies on each of these chemicals, fetal weight reductions were seen at mammalian exposures below those that had teratogenic effects, suggesting that screening for developmental delay in a small alternative whole-animal model could act as a general toxicity endpoint to identify chemicals for further testing for more specific adverse developmental outcomes. Consistent with mammalian developmental effects, 5FU, HU, and RV were associated with developmental delays with the wDAT. Exposures associated with developmental delay induced hypoactivity with 5FU and HU, but slight hyperactivity with RV. CP is a prodrug that requires bioactivation by cytochrome P450s for both therapeutic and toxic effects. CP tests as a false negative in several in vitro assays, and it was also a false negative with the wDAT. These results suggest that the wDAT has the potential to identify some developmental toxicants, and that a positive wDAT result with an unknown may warrant further testing in mammals. Further assessment with larger panels of positive and negative controls will help qualify the applicability and utility of this C. elegans wDAT assay within toxicity test batteries or weight of evidence approaches for developmental toxicity assessment.

An explainable map of human gastruloid morphospace reveals gastrulation failure modes and predicts teratogens.

Human gastrulation is a critical stage of development where many pregnancies fail due to poorly understood mechanisms. Using the 2D gastruloid, a stem cell model of human gastrulation, we combined high-throughput drug perturbations and mathematical modelling to create an explainable map of gastruloid morphospace. This map outlines patterning outcomes in response to diverse perturbations and identifies variations in canonical patterning and failure modes. We modeled morphogen dynamics to embed simulated gastruloids into experimentally-determined morphospace to explain how developmental parameters drive patterning. Our model predicted and validated the two greatest sources of patterning variance: cell density-based modulations in Wnt signaling and SOX2 stability. Assigning these parameters as axes of morphospace imparted interpretability. To demonstrate its utility, we predicted novel teratogens that we validated in zebrafish. Overall, we show how stem cell models of development can be used to build a comprehensive and interpretable understanding of the set of developmental outcomes.

Beyond the Spectrum: Subtype-Specific Molecular Insights into Autism Spectrum Disorder Via Multimodal Data Integration.

Some toddlers with autism spectrum disorder (ASD) have mild social symptoms and developmental improvement in skills, but for others, symptoms and abilities are moderately or even severely affected. Those with profound autism have the most severe social, language, and cognitive symptoms and are at the greatest risk of having a poor developmental outcome. The little that is known about the underlying biology of this important profound autism subtype, points clearly to embryonic dysregulation of proliferation, differentiation and neurogenesis. Because it is essential to gain foundational knowledge of the molecular biology associated with profound, moderate, and mild autism clinical subtypes, we used well-validated, data-driven patient subtyping methods to integrate clinical and molecular data at 1 to 3 years of age in a cohort of 363 ASD and controls representative of the general pediatric population in San Diego County. Clinical data were diagnostic, language, cognitive and adaptive ability scores. Molecular measures were 50 MSigDB Hallmark gene pathway activity scores derived from RNAseq gene expression. Subtyping identified four ASD, typical and mixed diagnostic clusters. 93% of subjects in one cluster were profound autism and 93% in a different cluster were control toddlers; a third cluster was 76% moderate ability ASD; and the last cluster was a mix of mild ASD and control toddlers. Among the four clusters, the profound autism subtype had the most severe social symptoms, language, cognitive, adaptive, social attention eye tracking, social fMRI activation, and age-related decline in abilities, while mild autism toddlers mixed within typical and delayed clusters had mild social symptoms, and neurotypical language, cognitive and adaptive scores that improved with age compared with profound and moderate autism toddlers in other clusters. In profound autism, 7 subtype-specific dysregulated gene pathways were found; they control embryonic proliferation, differentiation, neurogenesis, and DNA repair. To find subtype-common dysregulated pathways, we compared all ASD vs TD and found 17 ASD subtype-common dysregulated pathways. These common pathways showed a severity gradient with the greatest dysregulation in profound and least in mild. Collectively, results raise the new hypothesis that the continuum of ASD heterogeneity is moderated by subtype-common pathways and the distinctive nature of profound autism is driven by the differentially added profound subtype-specific embryonic pathways.

Pathways of Socioeconomic Disadvantage and Peer Bullying in Children and Youth: A Scoping Review

Growing up in socioeconomic disadvantage increases risk of peer bullying at school. Both socioeconomic status and involvement in bullying are predictive of a range of adverse developmental outcomes. However, neither (a) the mechanisms whereby disadvantage increases bullying risk nor (b) the developmental outcomes for which bullying may mediate disadvantage are clear. This review scoped the literature on the relationships between socioeconomic disadvantage, bullying, and health and developmental outcomes for school-aged children and adolescents. Four databases were searched up to June 3, 2023 with 565 studies retrieved, of which 17 met criteria. Most studies were cross-sectional, and studies varied greatly in their definition and measurement of both bullying involvement and disadvantage. No intervention studies were found. Mediators of the disadvantage-bullying association ranged from individual level (e.g., depression) to the national level (e.g., homicide rate); only two studies examined bully–victim status. Of studies where bullying was a mediator, none examined bullying perpetration; the range of outcomes examined was narrowly focused on mental health, failing to capture the full range of developmental outcomes associated with either socioeconomic disadvantage or bullying involvement. This review highlights that future research is needed on identifying and understanding the mediators of the association between disadvantage and bullying victimization, and on the developmental outcomes mediated by bullying perpetration for disadvantaged children. These insights are critical to increase the effectiveness of community- and school-based bullying prevention, particularly in communities with high proportions of socioeconomically disadvantaged families.