Future Behavior Problems Research Articles

Intolerance of uncertainty and internet addiction among college students in China post-pandemic era: the mediating role of future anxiety

Due to the repeated changes in the COVID-19 pandemic, we live in an era of various uncertainties that raise future anxiety and behavioral addiction problems. According to the Protection Motivation Theory (PMT), the present study attempted to explore the impact of COVID-19 intolerance of uncertainty (COVID-19 IU) on internet addiction (IA) among college students and the mediating role of future anxiety (FA) by constructing a mediating model. A questionnaire survey was conducted on 679 Chinese college students and PROCESS 3.5 was utilized to test the hypotheses. The results indicated that the COVID-19 IU was significantly positively correlated with IA and FA, and FA was significantly positively correlated with IA. COVID-19 IU had a significant positive predictive effect on IA; FA played a complementary partial mediating role between COVID-19 IU and IA. The results supported the PMT, which not only enriched our understanding of FA under uncertain life circumstances, but also deepened our understanding of the potential mechanisms of the effects of IA. Finally, discussions and suggestions were presented based on the results.

Supporting Children Transitioning to Secondary School: A Qualitative Investigation into Families’ Experiences of a Novel Online Intervention

ABSTRACT Supporting children to successfully transition from primary to secondary school is of utmost importance for several reasons, including to prevent future emotional and behavioural problems. Level Up is a novel, UK-based intervention consisting of five online group sessions, straddling the summer holidays, and providing at-risk children and their parents/carers with skills to manage their behaviour, emotions, and relationships to support their transition to secondary school. A prior evaluation of Level Up reported a need to better describe the mechanisms of change. This study therefore evaluated the experiences of children and their parents/carers regarding the facilitators and barriers to engagement and change, and the perceived impact. Fourteen children and 17 parents/carers were interviewed. Identified barriers and facilitators were: (1) Having a safe, supportive, and fun space, (2) Learning through connection, (3) A family approach, (4) Problematic group dynamics, and (5) Connecting through video calls. Perceived impact was described as: (1) Empowering children, (2) Supporting children socially, (3) Supporting parents and carers in their parenting role, and (4) Supporting a successful transition to secondary school. Another theme (5) describes some families’ experiences of limited impact. These findings can be used to better understand how to support children in their school transition.

Early Infant Prefrontal Cortical Microstructure Predicts Present and Future Emotionality

BackgroundHigh levels of infant negative emotionality (NE) and low positive emotionality (PE) predict future emotional and behavioral problems. The prefrontal cortex (PFC) supports emotional regulation, with each PFC subregion specializing in specific emotional processes. Neurite orientation dispersion and density imaging estimates microstructural integrity and myelination via the neurite density index (NDI) and dispersion via the orientation dispersion index (ODI), with potential to more accurately evaluate microstructural alterations in the developing brain. Yet, no study has used these indices to examine associations between PFC microstructure and concurrent or developing infant emotionality. MethodsWe modeled PFC subregional NDI and ODI at 3 months with caregiver-reported infant NE and PE at 3 months (n = 61) and at 9 months (n = 50), using multivariable and subsequent bivariate regression models. ResultsThe most robust statistically significant findings were positive associations among 3-month rostral anterior cingulate cortex (ACC) ODI and caudal ACC NDI and concurrent NE, a positive association between 3-month lateral orbitofrontal cortex ODI and prospective NE, and a negative association between 3-month dorsolateral PFC ODI and concurrent PE. Multivariate models also revealed that other PFC subregional microstructure measures, as well as infant and caregiver sociodemographic and clinical factors, predicted infant 3- and 9-month NE and PE. ConclusionsGreater NDI and ODI, reflecting greater microstructural complexity, in PFC regions supporting salience perception (rostral ACC), decision making (lateral orbitofrontal cortex), action selection (caudal ACC), and attentional processes (dorsolateral PFC) might result in greater integration of these subregions with other neural networks and greater attention to salient negative external cues, thus higher NE and/or lower PE. These findings provide potential infant cortical markers of future psychopathology risk.

Gender Differences in Internet Addiction and Its Impact on Exposure to Pornography and Internet Gaming Disorder

Various studies have shown that internet addiction and its impact can vary by gender. Previous research has shown that excessive internet use in men is associated with addiction to video games, while in women it is linked to social media addiction. There is still little research on internet addiction that inferentially inferences its impact on gender differences. The study aims to test gender differences in internet addiction and its impact on exposure to pornography and Internet Gaming Disorder (IGD) among adolescents. The data was collected through a survey of 242 students at one of the state high schools in Jakarta. The results of the study showed no gender differences in internet addiction, but there were gender differences in terms of the impact of Internet addiction on pornography exposure and IGD. MANOVA's results showed an association between internet addictions and pornographic exposure, and IGD. Male adolescents tend to be more exposed to pornography and experience IGD compared to female adolescents. This research brings early warning about the impact of excessive internet use on future online behavioural problems. Although the impact of internet addiction on adolescents is not at its highest level, we need to be careful about this. In the future, access to the Internet is becoming easier and cheaper, plus the world's educational pressure on adolescents students is increasing, fearing that adolescents will seek escape through excessive use of the Internet.

Neural Network Functional Interactions Mediate or Suppress White Matter–Emotional Behavior Relationships in Infants

BackgroundElucidating the neural basis of infant positive emotionality and negative emotionality can identify biomarkers of pathophysiological risk. Our goal was to determine how functional interactions among large-scale networks supporting emotional regulation influence white matter (WM) microstructural–emotional behavior relationships in 3-month-old infants. We hypothesized that microstructural–emotional behavior relationships would be differentially mediated or suppressed by underlying resting-state functional connectivity (rsFC), particularly between default mode network and central executive network structures. MethodsThe analytic sample comprised primary caregiver–infant dyads (52 infants [42% female, mean age at scan = 15.10 weeks]), with infant neuroimaging and emotional behavior assessments conducted at 3 months. Infant WM and rsFC were assessed by diffusion-weighted imaging/tractography and resting-state magnetic resonance imaging during natural, nonsedated sleep. The Infant Behavior Questionnaire-Revised provided measures of infant positive emotionality and negative emotionality. ResultsAfter significant WM–emotional behavior relationships were observed, multimodal analyses were performed using whole-brain voxelwise mediation. Results revealed that greater cingulum bundle volume was significantly associated with lower infant positive emotionality (β = −0.263, p = .031); however, a pattern of lower rsFC between central executive network and default mode network structures suppressed this otherwise negative relationship. Greater uncinate fasciculus volume was significantly associated with lower infant negative emotionality (β = −0.296, p = .022); however, lower orbitofrontal cortex–amygdala rsFC suppressed this otherwise negative relationship, while greater orbitofrontal cortex–central executive network rsFC mediated this relationship. ConclusionsFunctional interactions among neural networks have an important influence on WM microstructural–emotional behavior relationships in infancy. These relationships can elucidate neural mechanisms that contribute to future behavioral and emotional problems in childhood.

Predictors of externalizing behavior outcomes following pediatric stroke

ABSTRACT Children who experience pediatric stroke are at higher risk for future behavioral problems in childhood. We examined the prevalence of parent reported externalizing behaviors and executive function problems in children following stroke and neurological predictors. This study included 210 children with pediatric ischemic stroke (mean age 9.18 years (SD = 3.95)). The parent form of the Behavioral Assessment System for Children-Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF) were used to evaluate externalizing behavior and executive function. No externalizing behavior or executive function differences were found between perinatal (n = 94) or childhood (n = 116) stoke, except for the shift subscale which had higher T-scores among the perinatal group (M = 55.83) than childhood group (M = 50.40). When examined together, 10% of children had clinically elevated hyperactivity T-scores as opposed to the expected 2%. Parents endorsed higher ratings of concern on the behavior regulation and metacognition indices of the BRIEF. Externalizing behaviors were correlated moderately to strongly with executive functions (r = 0.42 to 0.74). When examining neurological and clinical predictors of externalizing behaviors, only female gender was predictive of increased hyperactivity (p = .004). However, there were no significant gender differences in diagnosis of attention deficit hyperactivity disorder (ADHD). In summary, in this cohort, children with perinatal and childhood stroke did not differ on parent reported externalizing behavior or executive function outcomes. However, compared to normative data, children with perinatal or childhood stroke are significantly more likely to experience clinically elevated levels of hyperactivity.

Bereavement as suffering: a must priority in public health.

In a recent article, the author emphasized how the coronavirus 2019 (COVID-19) pandemic brought many forms of suffering, tormenting people from all walks of life. Using the theologian Soelle’s ‘solidarity’ concept, the role of an individual/community in solidarity with the sufferer to overcome suffering is highlighted.1 I firmly affirm this and want to flesh out this claim in the context of ‘bereavement’, which is one of the most common sources of suffering, and apply concrete ways using my experience as a professor to validate the essential role of ‘solidarity’. Bereavement is the state of having experienced the loss of a person dear to someone. The death of a significant person can shake the foundations of our assumptive and relational world and lead to anguished attempts to find meaning in the loss and our lives in its aftermath.2 I lost both of my parents due to illness many years ago. I could imagine the struggle faced by some of my students who experienced the same loss during this health crisis. The death of a parent or sibling during childhood is an adverse experience that increases the risk for future behavioral health, academic and relational problems, as well as earlier mortality.3 I could recall a few of them sending me messages in the wee hours of the morning concerning how can they handle the pain and continue living. Their reflection papers in class express relational and financial burdens, hopelessness and alarming depressive symptoms.

Unsupervised Machine Learning to Identify Depressive Subtypes.

ObjectivesThis study evaluated an unsupervised machine learning method, latent Dirichlet allocation (LDA), as a method for identifying subtypes of depression within symptom data.MethodsData from 18,314 depressed patients were used to create LDA models. The outcomes included future emergency presentations, crisis events, and behavioral problems. One model was chosen for further analysis based upon its potential as a clinically meaningful construct. The associations between patient groups created with the final LDA model and outcomes were tested. These steps were repeated with a commonly-used latent variable model to provide additional context to the LDA results.ResultsFive subtypes were identified using the final LDA model. Prior to the outcome analysis, the subtypes were labeled based upon the symptom distributions they produced: psychotic, severe, mild, agitated, and anergic-apathetic. The patient groups largely aligned with the outcome data. For example, the psychotic and severe subgroups were more likely to have emergency presentations (odds ratio [OR] = 1.29; 95% confidence interval [CI], 1.17–1.43 and OR = 1.16; 95% CI, 1.05–1.29, respectively), whereas these outcomes were less likely in the mild subgroup (OR = 0.86; 95% CI, 0.78–0.94). We found that the LDA subtypes were characterized by clusters of unique symptoms. This contrasted with the latent variable model subtypes, which were largely stratified by severity.ConclusionsThis study suggests that LDA can surface clinically meaningful, qualitative subtypes. Future work could be incorporated into studies concerning the biological bases of depression, thereby contributing to the development of new psychiatric therapeutics.

The role of inflammation and cortisol in the relationship between social cognition abilities and later emotional or behavioural problems: evidence from a UK birth cohort

IntroductionDeficits in social cognition have been associated with the onset of emotional and behavioural problems, but the biological mechanisms underlying this relationship remain unclear.ObjectivesThis study examined whether diurnal cortisol patterns, systemic inflammation, or both, explained the association between social cognition difficulties and subsequent emotional and behavioural symptoms.MethodsThe sample consisted of 714 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC) with valid data on cortisol measures (age 15 years) and emotional or behavioural problems (age 17 years). Social cognition abilities were measured at 8, 11, and 14 years old. Inflammation was measured using serum levels of interleukin 6 (IL-6, age 9 years) and C-reactive protein (CRP, age 9 and 16 years). Bayesian structural equation modelling was used to investigate the mediating effect of cortisol or inflammation on the association between social cognitive difficulties and emotional or behavioural problems.ResultsChildren with social cognition difficulties were associated with later emotional and behavioural problems. Flattened diurnal cortisol slope was associated with the hyperactivity/inattention problem two years later. Mediation analyses revealed that lower morning cortisol significantly mediated the associations between social communication difficulties at 8 years with hyperactivity/inattention and conduct problems in adolescence, with the adjustment of inflammation and all covariates. Systemic inflammation was not related to social cognitive difficulties or future emotional and behavioural problems.ConclusionsThe finding suggests that social cognition is related to cortisol activities longitudinally. It also expands the evidence that adolescents with behavioural problems are characterised by hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis.DisclosureNo significant relationships.

Relationship between Neonatal MRI Findings and Emotional/Behavioral Evaluation in Early Childhood for Extremely Low-Birth-Weight Infants.

The aim of this study is to investigate whether it is possible to detect future behavioral and emotional problems in extremely low-birth-weight infants by evaluating the neonatal head magnetic resonance imaging (MRI) using a scoring system. This study included 62 extremely low-birth-weight infants born between April 2015 and March 2017 and those who had undergone MRI at 36 to 42 weeks of gestation. These subjects were administered with the Strength and Difficulties Questionnaire (SDQ) at age 4–5, and the patients who responded to the questionnaire were included in the study. A positive correlation was observed between the Global Brain Abnormality Score and Total Difficulties Score of the SDQ (r = 0.26, p = 0.038). However, no significant difference was observed between the median Global Brain Abnormality Score of the normal and borderline-range group and the Total Difficulties Score of the clinical-range group (p = 0.51). This study demonstrated the relationship between the MRI findings in the newborn period and the emotional and behavioral problems in early childhood, but it is not clinically useful as a predictive marker.

Health Equity and Enrollment in Preventive Parenting Programs: A Qualitative Study of Filipino Parents

ABSTRACT This qualitative study identified the parent health beliefs and normative beliefs related to child behavioral and mental health problems and examined the benefits and barriers of enrolling in an evidence-based parenting intervention among Filipino parents of school-aged children. A secondary aim was to also use the results to inform the development of a theory-based video intervention to increase enrollment in parenting interventions. Semi-structured interviews were conducted with fifteen parents who had or had not participated in the Incredible Years® parenting program, an evidence-based parenting intervention. Interviews were recorded and transcribed verbatim. Using a “Coding Consensus, Co-occurrence, and Comparison” methodology, emergent themes were mapped into a matrix against a priori-coded health belief model (HBM) and Theory of Planned Behavior (TPB) constructs. Parents believed that perceived susceptibility could be influenced by including knowledge of health disparities affecting Filipino youth in the U.S. Perceived severity was related to behavioral and mental health concerns about school, family dynamics, bullying and parent coping strategies. Perceived benefits included strengthening parent-child relationships, creating support systems, and learning positive parenting skills. Perceived barriers included logistics, stigma, and the perception of the relevance of the program, cultural factors such as generational differences about parenting, and family issues. Social norms and subjective norms related to parent participation were also discussed. Applying the HBM and TPB to enrollment in parenting interventions may explain low enrollment rates. Future interventions need to target perceived susceptibility to future behavioral health problems, barriers, and benefits to enrollment, and influence subjective and social norms.

Prevention of child mental health problems through parenting interventions in Southeastern Europe (RISE): study protocol for a multi-site randomised controlled trial

BackgroundChildhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children’s future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting programmes are an effective way to alleviate them, although their outreach and scalability is still limited in LMICs.Methods/designA multi-site randomised controlled trial will be conducted in North Macedonia, Republic of Moldova and Romania to test the efficacy and cost-effectiveness of an optimised version of the promising Parenting for Lifelong Health Programme for Young Children (PLH-YC, 5 sessions), against a standard lecture on parenting issues (control group, 1 session). At least 864 participants who report having children between 2 and 9 years old who display elevated levels of behavioural difficulties will be randomised on a 1:1 basis to the intervention and control groups. The primary outcome will consist of parent report of child oppositional aggressive behaviour. Post-test (four months) and follow-up (12 months) assessments will provide information on short- and longer-term effects of PLH-YC compared to the parenting lecture in the control group.DiscussionThis randomised trial will test the efficacy of PLH-YC in alleviating child behavioural problems and assess the cost-effectiveness, transportability across three different cultural contexts, and potential for scalability of the programme.Trial registrationClinicalTrials.gov., Registration number: NCT04721730 (https://clinicaltrials.gov/ct2/show/NCT04721730). Registered 13.01.2021

P036 Trajectories of emotional and behavioural problems in Aboriginal and Torres Strait Islander children: Role of sleep and cultural attachment

Abstract Purpose This study explored the link between sleep and emotional and behavioural problems and assessed whether cultural attachment reduces the risk of emotional and behavioural problems in Aboriginal and Torres Strait Islander (Indigenous) children. Methods The data from wave 5 to wave 10 of the Footprints in Time cohort were used. Multi-trajectory modelling was used to identify sleep trajectories using weekday sleep duration, weekday bedtimes, wake times, and sleep problems (waves 5, 7 & 10). Trajectories of emotional and behavioural problems were derived from the Strengths and Difficulties Questionnaire (SDQ) data (waves 6, 8 & 10). Cultural attachment assessment included the knowledge of Indigenous language, clan, people, family stories/history and other cultural practice. Multivariable logistic regression models were used to assess the link between sleep and emotional and behavioural problems. Results Analysis of sleep data from 1270 Indigenous children (50.6% females, mean age 6.3 years (±1.5)) identified four distinct trajectories: early sleepers/early risers (19.3%); early/long sleepers (22.1%), normative sleepers (47.8%), and late sleepers (10.8%). Three emotional and behavioural problem trajectories emerged: low stable (49.1%), high decreasing (40.5%), and high stable (10.4%). Early sleepers//early risers (OR: 0.48, 95% CI: 0.28–0.82) and children with strong cultural attachment (OR: 0.47, 95% CI: 0.27–0.82) had lower odds of being in the high emotional and behavioural problem trajectory group. Conclusions Early bedtime in children may reduce the risk of future emotional and behavioural problems. The protective effect of cultural attachment further highlights the need for strengths-based approaches to reduce mental health issues in Indigenous children.

Paternal depression and attachment levels of first-time fathers in Turkey.

Paternal depression and inadequate attachment experienced in the postpartum period may be associated with future emotional and behavioural problems of children. This study aimed to investigate the paternal depression and attachment levels of first-time fathers. The sample of this descriptive study consisted of 175 fathers with 3-6 months old babies whose wives applied to the polyclinic for check-up. When the cut-off point of the scale was evaluated at 13 and above in this study, the risk of depression was found to be 14.2%. The level of attachment decreases as fathers' risk of depression increases (p < 0.05). There is a risk of depression in fathers in the postpartum period. The level of attachment decreases as fathers' risk of depression increases.

Changes in the social-emotional functioning of young children with a significant cognitive and motor developmental delay across a two-year period

Children with a significant cognitive and motor developmental delay (SDD) are vulnerable for the development of (future) behavioral and mental health problems. To support children within this target group, knowledge on their social-emotional development is necessary. Therefore, in this paper, an explorative assessment of the changes in the social-emotional functioning of children with SDD over a two-year period was done. Yearly semi-structured interviews with one or more primary caregiver(s) of 25 children were conducted and analyzed on 13 domains of social-emotional functioning, according to an adapted version of the Scale for Emotional Development - Revised (SED-R). This study showed a lot of variation in individual and group patterns of change across the two-year period. Charting the social-emotional development in this target group is challenging and requires further in-depth analysis of individual trajectories as well as more fine-grained and long-term data collection.

Using social and emotional learning paradigms to inform a therapeutic intervention for preschool-aged children and their parents

ABSTRACT Early intervention for young children who struggle with emotional dysregulation can prevent future social, emotional, and behavioural problems and promote healthier trajectories. Although existing interventions address these areas, there are few that focus explicitly on the acquisition of targeted social and emotional skills within a developmentally appropriate framework. To address this gap, a novel social and emotional learning intervention (SEL-I) for children identified with mental health concerns and their parents is introduced. An overview of the intervention theory, structure, and initial pilot implementation with five children, aged four to six, is provided. Participants in this phase had high rates of session attendance, treatment satisfaction, and SEL-I skill use. Initial results indicate good adherence and behavioural outcomes and improved social and emotional skill attainment. This suggests the need for the additional study and development of SEL-informed therapy interventions to prevent and reduce impairing social and emotional development, especially for young children with additional risk factors.

The social-emotional functioning of young children with a significant cognitive and motor developmental delay

Children with a significant cognitive and motor developmental delay (SDD) are vulnerable for the development of (future) behavioral and mental health problems. This paper aims to assess the social-emotional functioning of these children, both globally and in various domains. Semi-structured interviews with one or more primary caregiver(s) of 45 children were conducted and analyzed on 13 domains of social-emotional functioning, according to the Scale for Emotional Development - Revised (SED-R). The SED-R scoring system was slightly adapted in the current study in order to elucidate more subtle differences between children. A general delayed social-emotional development was found, with children functioning within different phases across domains and certain domains generally showing higher or lower scores. To capture the emotional needs of children with SDD, a more disaggregated scoring system seems valuable so that both the global level and the level per domain can be taken in consideration in designing interventions.

Physical Activity, Sleep, Body Mass Index, and Associated Risk of Behavioral and Emotional Problems in Childhood.

Cross-sectional data indicate that physical activity, longer sleep duration, and normal body weight are associated with better mental health in childhood. It is less clear whether these factors protect against future emotional and behavioral problems. We investigated whether physical activity, sleep duration, and body mass index (BMI) at the age of 7 years are associated with emotional and behavioral problems at the age of 11 years. Children born to European mothers enrolled in the prospective longitudinal Auckland Birthweight Collaborative Study (N = 871) were assessed at birth and ages 7 and 11 years. Physical activity and sleep duration were measured using accelerometer. BMI was calculated from height and weight measurement. Outcome variables assessed at the age of 11 years were parent and child self-report Strengths and Difficulties Questionnaire and parent and teacher Conners' Rating Scale scores. Physical activity, sleep duration, and BMI at the age of 7 years were not significantly associated with emotional and behavioral problems at the age of 11 years. In cross-sectional analysis at the age of 11 years, there was no significant association between physical activity or sleep duration and emotional and behavioral problems. Children with a BMI in the overweight or obese range were significantly more likely to have teacher-rated behavior problems and parent-rated emotional or behavioral problems after adjustment for potential confounders. Although physical activity and sleep have physical health benefits, they may not be protective against future emotional and behavioral problems in childhood in the general population. BMI in the obese or overweight range was significantly associated with current emotional and behavioral problems at the age of 11 years.

SUN-072 Emotional Disorders in Pediatric Renal Transplant Recipients: A Comparative Study

Kidney transplantation is recognized as the optimal therapy for children with ESRD. We performed this study to compare the children’s behavioral problems and their parents’ function in pediatric patients with Kidney transplantation in Arak Amir Kabir Hospital. To perform this case-control study, we recruited 29 children with renal transplantation and compared them with 29 healthy children aged 5-14 years old. The Child Behavior Checklist (CBCL4/18) was used for the assessment of the children’s behavioral problems and Global Assessment of functioning (GAF) was employed for the evaluation of their parents’ behaviors. Among 29 patients with RTR, anxiety/depression, somatic complaints, social problems, and attention problem were demonstrated in 65.5%, 55.1%, 51.7%, and 76%, respectively. We found out a significant difference between cases and controls. Delinquent and aggressive behavior was not seen in two groups. As a significant difference, the parents’ mean stress and behavior score in case and control groups was 22.4% and 63.1%, respectively. The higher prevalence of behavioral problems in the renal transplant recipients and their parent’s functional impairment highlights the importance of early parental intervention for early prevention of future behavioral problems in their siblings.

Childhood bereavement: Understanding prevalence and related adversity in the United States.

The death of a parent or sibling during childhood is an adverse experience that increases risk for future behavioral health, academic, and relational problems, as well as earlier mortality. Efforts to estimate childhood bereavement prevalence rates have been hampered by methodological, reporting, and data source limitations. In the absence of national tracking systems in the United States, a quantitative statistical model has been introduced with the aim of estimating the prevalence of this public health issue to aid in needs assessment and service provision. A hybrid of binomial probability and life table methods was applied to develop the Childhood Bereavement Estimation Model (CBEM), which utilizes U.S. vital statistics data to generate current and projected estimates of the number of youth impacted by the death of a parent or sibling. National and state CBEM estimates are reported. Notable differences among geographies and associated public health implications are discussed, contextualizing childhood bereavement among other social determinants of health and calling for a more comprehensive approach to this underresourced issue. Nationally, CBEM Projected Estimates reveal that 6.99% of children-nearly 5.0 million-have or will have experienced the death of a parent or sibling by age 18. For youth under 25, this estimate more than doubles to almost 12.9 million. The CBEM offers social service professionals a tool for raising awareness about the magnitude of childhood bereavement and assessing the need for grief services within specific localities to ultimately equip communities in developing effective preventive interventions that are inclusive and accessible. (PsycInfo Database Record (c) 2020 APA, all rights reserved).