Higher Problem Scores Research Articles

Paternal depression at kindergarten entry and teacher-reported behavior at age 9.

The study investigated associations between paternal depression when children were age 5 and teacher-reported behavioral problems at age 9. 1,422 children in a U.S. cohort study of mostly non-marital births were studied. Data collection, which is ongoing, began in 1998-2000. Behavioral outcomes were measured in 2009-2010, when the children transitioned to middle school. Analysis was conducted in 2023-2024. Negative binomial regression models of associations between paternal depression and children's behavior and social skill scores and logistic regression models of associations between paternal depression and high (≥1 standard deviation (SD) above mean) or low (≥1 SD below mean) scores were estimated. Adjusting for child/paternal/family characteristics and maternal depression, paternal depression was associated with a 36% higher oppositional score (IRR 1.36; 95% CI: 1.02-1.82), 37% higher hyperactive score (IRR: 1.37; 95% CI: 1.11-1.69) and 25% higher ADHD score (IRR: 1.25; 95% CI: 1.08-1.46) but not associated with cognitive problem/inattention score. A similar pattern was apparent for high behavior problem scores, with AORs from 1.78-1.85. Paternal depression was associated with an 11% lower positive social skills score and a 25% higher problematic behavior score with similar associations across subscales. Similar patterns were apparent for some high problematic and low positive social skills. Paternal depression when children transitioned to kindergarten was associated with poorer teacher ratings of behaviors and social skills at age 9. These findings suggest a need for interventions that identify and support fathers with depressive symptoms and their children.

Maternal concentrations of environmental phenols during early pregnancy and behavioral problems in children aged 4 years from the Shanghai Birth Cohort

BackgroundPrenatal exposure to environmental phenols such as bisphenol (BPs), paraben (PBs), benzophenone (BzPs), and triclosan (TCS) is ubiquitous and occurs in mixtures. Although some of them have been suspected to impact child behavioral development, evidence is still insufficient, and their mixed effects remain unclear. ObjectivesTo explore the association of prenatal exposure to multiple phenols with child behavioral problems. MethodIn a sample of 600 mother–child pairs from the Shanghai Birth Cohort, we quantified 18 phenols (6 PBs, 7 BPs, 4 BzPs, and TCS) in urine samples collected during early pregnancy. Parent-reported Strengths and Difficulties Questionnaires were utilized to evaluate child behavioral difficulties across four subscales, namely conduct, hyperactivity/inattention, emotion, and peer relationship problems, at 4 years of age. Multivariable linear regression was conducted to estimate the relationships between single phenolic compounds and behavioral problems. Additionally, weighted quantile sum (WQS) regression was employed to examine the overall effects of the phenol mixture. Sex-stratified analyses were also performed. ResultsOur population was extensively exposed to 10 phenols (direction rates >50 %), with low median concentrations (1.00 × 10−3–6.89 ng/mL). Among them, single chemical analyses revealed that 2,4-dihydroxy benzophenone (BP1), TCS, and methyl 4-hydroxybenzoate (MeP) were associated with increased behavior problems, including hyperactivity/inattention (BP1: β = 0.16; 95 % confidence interval [CI]: 0.04, 0.30), emotional problems (BP1: β = 0.11; 95 % CI: 0.02, 0.20; TCS: β = 0.08; 95 % CI: 0.02, 0.14), and peer problems (MeP: β = 0.10; 95 % CI: 0.02, 0.18); however, we did not identify any significant association with conduct problems. Further phenol mixture analyses in the WQS model yielded similar results. Stratification for child sex showed stronger positive associations in boys. ConclusionOur findings indicated that maternal phenol levels during early pregnancy, specifically BP1, TCS, and MeP, are associated with high behavioral problem scores in 4-year-old children.

Using machine learning to predict individual patient toxicities from cancer treatments

PurposeMachine learning (ML) is a powerful tool for interrogating datasets and learning relationships between multiple variables. We utilized a ML model to identify those early breast cancer (EBC) patients at highest risk of developing severe vasomotor symptoms (VMS).MethodsA gradient boosted decision model utilizing cross-sectional survey data from 360 EBC patients was created. Seventeen patient- and treatment-specific variables were considered in the model. The outcome variable was based on the Hot Flush Night Sweats (HFNS) Problem Rating Score, and individual scores were dichotomized around the median to indicate individuals with high and low problem scores. Model accuracy was assessed using the area under the receiver operating curve, and conditional partial dependence plots were constructed to illustrate relationships between variables and the outcome of interest.ResultsThe model area under the ROC curve was 0.731 (SD 0.074). The most important variables in the model were as follows: the number of hot flashes per week, age, the prescription, or use of drug interventions to manage VMS, whether patients were asked about VMS in routine follow-up visits, and the presence or absence of changes to breast cancer treatments due to VMS. A threshold of 17 hot flashes per week was identified as being more predictive of severe VMS. Patients between the ages of 49 and 63 were more likely to report severe symptoms.ConclusionMachine learning is a unique tool for predicting severe VMS. The use of ML to assess other treatment-related toxicities and their management requires further study.

Prevalence of emotional and behavioral problems and subthreshold psychiatric disorders in Austrian adolescents and the need for prevention

PurposeEpidemiological data are crucial to plan adequate prevention strategies. Thus, this study aims at obtaining the prevalence of mental health problems (MHP) and subthreshold psychiatric disorders based on a representative sample of Austrian adolescents.MethodsAdolescents aged 10–18 were recruited from Austrian schools. Emotional and behavioral problems were determined using the Youth Self-Report (YSR); the point prevalence of subthreshold psychiatric disorders was assessed using structured diagnostic interviews. Sociodemographic variables including socioeconomic background, migration status, family structure, and place of residence were obtained. In addition, a non-school sample (unemployed adolescents, and child and adolescent psychiatry patients) was included to enhance representativeness and generalizability.Results3446 students, 37 unemployed adolescents, and 125 child and adolescent psychiatric patients provided analyzable YSR data sets. In the school sample, 16.5% scored in the clinically relevant range, while internalizing problems were more prevalent (17.8%) than externalizing problems (7.4%). These prevalences increased by 0.7–2.0% when the non-school sample was taken into account. A low socioeconomic status (SES) and living in single parent families were associated with higher problem scores. Regarding the interviewed sample (377 students and 407 parents), subthreshold psychiatric disorders were observed in 12.7% of students. 92.5% of them have not yet received any kind of help.ConclusionsA significant proportion of Austrian adolescents are at risk for MHP. A non-responder analysis indicates that the observed prevalence may be even underestimated. These findings emphasize the urgent need for targeted prevention, especially for reducing anxiety and depressive symptoms and for adolescents in disadvantaged families.

Gestational cytokine concentrations and neurocognitive development at 7 years

Gestational inflammation may contribute to brain abnormalities associated with childhood neuropsychiatric disorders. Limited knowledge exists regarding the associations of maternal cytokine levels during pregnancy with offspring neurocognitive development. We assayed the concentrations of five cytokines (interleukin (IL)-6, IL-1β, IL-8, tumor necrosis factor alpha (TNF-α), and IL-10) up to four times in the 2nd and 3rd trimesters of pregnancy using stored prenatal sera from 1366 participants in the New England Family Study (enrollment 1959–1966). Intelligence (IQ), academic achievement, and neuropsychological functioning of singleton offspring were assessed at age 7 years using standardized tests. We used linear mixed models with random effects to estimate the cumulative exposure to each cytokine during 2nd and 3rd trimesters, and then related cumulative cytokine exposure to a wide range of offspring neurocognitive outcomes. We found that children of women with higher levels of the pro-inflammatory cytokine, TNF-α, in the 2nd and 3rd trimesters had lower IQ (B = −2.51, 99% CI: −4.84,−0.18), higher problem scores in visual-motor maturity (B = 0.12, 99% CI: 0.001,0.24), and lower Draw-a-Person test scores (B = −1.28, 99% CI: −2.49,−0.07). Higher gestational levels of IL-8, another pro-inflammatory molecule, were associated with better Draw-a-Person test scores and tactile finger recognition scores. Other cytokines were not associated with our outcome of interest. The opposing directions of associations observed between TNF-α and IL-8 with childhood outcomes suggest pleiotropic effects of gestational inflammation across the domains of neurocognitive functioning. Although the path to psychopathological disturbances in children is no doubt multifactorial, our findings point to a potential role for immune processes in the neurocognitive development of children.

Study of the profile of behavioral problems and quality of life indexes in a pediatric cohort of monosymptomatic enuresis

ObjectiveTo evaluate and correlate, before and after the therapeutic intervention, the behavioral problem scores evaluated by the CBCL/6-18 questionnaire and the quality of life indexes evaluated by the PedsQL™ 4.0 in patients with monosymptomatic nocturnal enuresis. MethodAfter the initial evaluation and completion of the CBCL/6-18 questionnaire, a multidisciplinary evaluation and completion of the PedsQL™ 4.0 questionnaire was performed. Of the initially evaluated 140 children and adolescents aged 6–16 years, 58 were excluded due to non-monosymptomatic enuresis or associated comorbidities. Of the initially included 82 patients, who were randomized to three treatment groups, 59 completed the CBCL/6-18 and PedsQL™ 4.0 questionnaires at the end of the treatment and were included in this study. The α error was set at 5% for ruling out the null hypothesis. ResultsOf the total of 59 participants, 45.8% responded with total success, 23.7% were partially successful, 23.7% did not reach the improvement criteria, and 6.8% gave up the treatment. There was a significant increase in quality of life indexes and a reduction of post-intervention behavioral problem scores, in the three proposed modalities, in patients who had a total or partial response to treatment. There was no correlation between higher scores of pre-treatment behavior problems and therapeutic failure. ConclusionsOnly the participants who successfully responded to interventions showed improvement in quality of life and behavioral problems, which indicates that enuresis is a primary problem that has a negative impact on these parameters. The authors suggest that it is possible to achieve success in the treatment of monosymptomatic enuresis, even in patients with high pre-intervention behavioral problem scores.

Predictive validity of a service-setting-based measure to identify infancy mental health problems: a population-based cohort study.

Measures to identify infancy mental health problems are essential to guide interventions and reduce the risk of developmental psychopathology in early years. We investigated a new service-setting-based measure the Copenhagen Infant Mental Health Screening (CIMHS) within the general child health surveillance by community health nurses (CHN). The study population of 2973 infants was assessed by CIMHS at age 9-10months. A subsample of 416 children was examined at age 1½ years, using parent interviews including the Child Behavior Checklist (CBCL 1½-5), Check List of Autism and Toddlers (CHAT), Infant-Toddler Symptom Checklist (ITSCL), and the Bayley Scales of Infant and Toddler Development (BSID) and observations of behavior, communication, and interaction. Child mental disorders were diagnosed according to ICD-10 and parent-child relationship disorders according to DC:0-3R. Statistical analyses included logistic regression analyses adjusted and weighted to adjust for sampling and bias. CIMHS problems of sleep, feeding and eating, emotions, attention, communication, and language were associated with an up to fivefold increased risk of child mental disorders across the diagnostic spectrum of ICD-10 diagnoses. Homo-type continuity was seen in problems of sleep and feeding and eating being associated with a threefold increased risk of disorders within the same area, OR 3.0 (95% CI 1.6-5.4) and OR 2.7 (95% CI 1.7-4.2), respectively. The sensitivity at high CIMHS problem scores was 32% and specificity 86%. In summary, CIMHS identify a broad range of infants' mental health problems that are amenable to guide intervention within the general child health surveillance.

Family Disruption and Social, Emotional and Behavioral Functioning in Middle Childhood

The association between family disruption and child socio-emotional and behavioral development is a relatively well-examined but as yet unresolved issue, and the conclusions of previous research have been ambiguous. Further, some studies have indicated that associations may depend on other risk factors, yet the question of heterogeneity has been relatively little discussed. The purpose of this cross-sectional study was to assess associations between family disruption on the one hand and teacher-rated and self-reported outcomes on subscales from the Behavior Assessment System for Children, 2nd edition (BASC-2) and the Behavior and Emotional Screening System (BESS) on the other, among a Danish sample of 817 normally developing schoolchildren. Specifically, we assessed (a) the extent to which background factors explained unadjusted associations and (b) whether associations were heterogeneous across the distribution of outcome measures. Results from ordinary least squares (OLS) models showed that relative to children from intact families, children from disrupted families had higher problem scores on BASC-2 subscales Externalizing Problems, Study Skills and School Problems even after controlling for a wide range of background factors. Quantile regression (QR) models showed that associations with Externalizing Problems and Study Skills were stronger among children with higher problem scores. Certain behavioral problems may therefore indicate increased vulnerability towards adverse events, such as family disruption. General screening for such problems could provide an opportunity to identify children in need of special attention and support against the potentially negative outcomes of family disruption for their school experience.

A preliminary study of emotional and behavioral problems among Bedouin children living in ‘unrecognized villages’ in Southern Israel

AimsThis study presents data on the emotional and behavioral problems of Bedouin children, the most underserved citizens of Israel. Methods458 children aged 4 – 10 were rated by their mothers with the Strengths and Difficulties Questionnaire. Socio-demographic traits and children’s exposure to traumatic events were recorded. Bedouin children were compared with independent samples of American, Chinese and Australian children. ResultsBoys had higher problems scores than girls. Bedouin children had higher problem scores than other children. ConclusionsThe higher problems scores of Bedouin children can be partly explained by their poverty, dire living conditions and consequent maternal distress.

New patient-reported experience measure for children with allergic disease: development, validation and results from integrated care

ObjectivesTo develop and validate a new allergy-specific patient-reported experience measure (PREM) for children and their parents, and to collect feedback in an integrated care setting.DesignTwo allergy-specific PREMs were produced using...

Problems and Adaptive Functioning Reported by Adults in 17 Societies

This study tested for similarities and differences across societies in self-ratings of problems, personal strengths, and aspects of adaptive functioning on the Adult Self-Report (ASR) for nonclinical samples of adults ages 18 to 59 in 17 societies ( N = 10,197). Results indicated considerable consistency across societies regarding mean ratings on the ASR problem items. Most effect sizes (ESs) for societal differences in problem scales were small (2–5%). Hierarchical linear modeling (HLM) analyses indicated that culture clusters and society accounted for small percentages of variance in Internalizing, Externalizing, and Total Problems scores, with most of the variation accounted for by individual differences within societies. In contrast to the small effects of society on problem scores, for the ASR Personal Strengths scale the societal ES was 34% and culture cluster accounted for 12% of the variance. Worse reported relations with spouse/partner were associated with higher problem scores. Overall, findings indicated considerable similarity but also some important differences in self-reported problems and adaptive functioning across 17 societies.

Cystic fibrosis (CF) care through the patients' eyes – A nationwide survey on experience and satisfaction with services using a disease-specific questionnaire

The patients' perspective is an important aspect of quality management. A newly developed disease-specific questionnaire was used to assess the patients' experiences with care provided in specialised cystic fibrosis (CF) care centres. 90 CF centres in Germany were invited to participate. Centre staff collected patient consent forms and sent the patients' addresses to the study centre. The questionnaires for adults and parents had 100 and 104 items respectively, with 3-6 response categories each. Items were dichotomised into "problem scores" (PS), indicating the presence or absence (PS 0%) of a reported problem. 56 CF centres took part in the survey and recruited 1642 adults with CF and 1205 parents. The response rates were 74% in each group, with 1221 completed questionnaires from adults and 891 from parents. Participants reported good experiences with care. Factor analysis revealed 10 factors covering 70 items. Participants reported the best results for the factors "Physiotherapists" (PS 6%) and "Physician-Patient Relationship" (PS 9%). Factors with the highest problem scores were inpatient and outpatient "Facilities, Hygiene and Services". CF centres received reports of their own results and mean problem scores of all participating institutions. The problem scores differed considerably between CF centres. The nation-wide CF-specific patient experience survey identified specific shortcomings which were mainly related to communication, centre organisation, and facilities. Centre staff can use the results to improve the quality of care. We suggest that patients' views should become an integral component of efforts to promote patient-centred care.

Parental reports of behavioural outcome among paediatric leukaemia survivors in Malaysia: a single institution experience.

To determine the behavioural impact of chemotherapy in survivors of acute lymphoblastic leukaemia (ALL) treated with chemotherapy only and to identify treatment-related or sociodemography-related factors that might be associated with behavioural outcome. We examined 57 survivors of childhood ALL, who were off treatment for at least 2 years and were in remission, aged 4-18 years, and 221 unrelated healthy controls. The Child Behaviour Checklist (CBCL) parent report was used either in English or in Bahasa Malaysia (the national language of Malaysia) to assess the behavioural outcome. Childhood ALL survivors had significantly higher scores on externalising behaviour on the CBCL parent report than did controls. Higher problem scores were found in ALL survivors with single parents on 'total problems' (P = 0.03) and subscales 'withdrawn' (P = 0.03), 'social problems' (P < 0.01) and 'delinquent behaviour' (P = 0.03) than in survivors with married parents. Significant associations were seen between a lower education level of the father and the variables representing internalising (withdrawn, anxious/depressed) and externalising (aggressive behaviour). We observed trends on higher scores in all scales in ALL survivors with single parents than in controls with single parents or with fathers with low education level, especially primary education only. Malaysian childhood ALL survivors had a significantly increased risk for externalising behavioural problems, and there was a trend towards increased risk of problems in many other behavioural scales. Understanding the sociocultural dimension of patients' health is important to be able to design the most appropriate remedy for problem behaviours detected in this multi-ethnic population.

Clinical, psychological and maternal characteristics in early functional constipation

This cross-sectional study investigated the clinical features of functional constipation (FC) at preschool age, as well as emotional and behavioral characteristics of the children, psychological symptom level and parental attitudes of the mothers, and compared these with that of non-referred typically developing controls with normal intestinal habits. Participants included 65 children with FC (mean age, 43.6 ± 15.4 months; range, 25-72 months), 59 healthy controls (mean age, 46.9 ± 14.5 months; range, 25-72 months) and the mothers of the children. The Childhood Behavior Checklist, Symptom Checklist 90 and Parental Attitude Research Instrument were filled in by the mothers. Participants with FC had higher problem scores than the comparison children in a variety of emotional and behavioral parameters. Approximately half exhibited internalizing and one-third had externalizing problems in the clinical range. The mothers of the patient group had higher levels of psychological distress, overprotective parenting and strict discipline. On multiple logistic regression analysis child psychopathology, maternal education level and maternal distress were independently associated with FC. Behavior problems are common in children with FC from an early age. Low level of education and high psychological distress of the mothers seem to be important risk factors for constipation and should be assessed carefully in the management of these cases.

A community study on psychosocial functioning of overweight and obese pre-school children in Germany.

While evidence exists that some aspects of psychopathology may be associated with overweight (including obesity) in older children and adults, this association has less empirical support in younger children. Beyond this, little is known about the influence of parental psychopathology on young overweight children. The aim of this study was to examine psychosocial functioning in non-clinical overweight pre-schoolers considering maternal mental health (MMH). Nationally representative data on a subset of 449 mother-child-dyads from the German Socio-Economic Panel Study (SOEP) were analysed cross-sectionally. Mothers provided data on children’s psychosocial functioning (Strengths and Difficulties Questionnaire, SDQ), and their own mental health (SF12v2). Weight status was calculated on parent-reported weight and height. Multivariate logistic and linear regression analyses were performed. Using body-mass index (BMI) percentiles for age and sex based on the German reference data, 4.6% of the children were considered overweight (p90 < p97), 7.4% were obese (⩾p97). Although overweight children had higher problem scores than nonoverweight children, differences between groups were small and substantially reduced when analyses controlled for sociodemographic characteristics. Lower MMH was independently associated with higher problem scores on three SDQ scales (odds ratio, OR 2.6–2.8) as compared to average MMH. Between-group analyses revealed that MMH predicted children’s psychosocial functioning on all SDQ scales in nonoverweight children, but predicted only hyperactivity symptoms in obese, not overweight children. The results suggest that child overweight made no independent contribution to child psychosocial functioning, while MMH was a significant predictor.

Problem Behavior of Individuals with Down Syndrome in a Nationwide Cohort Assessed in Late Adolescence

To assess problem behavior in adolescents with Down syndrome and examine the association with sex and severity of intellectual disability. Cross-sectional data of a Dutch nationwide cohort of Down syndrome children aged 16-19 years were collected using a written parental questionnaire. Problem behavior was measured using the Child Behavior Checklist and compared with normative data. The degree of intellectual disability was determined using the Dutch Social competence rating scale. The response rate was 62.8% (322/513), and the mean age 18.3 years (SD ± 0.8). The total score for problem behavior was higher in adolescents with Down syndrome than in adolescents without Down syndrome (26.8 vs 16.5; P < .001). Overall, 51% of adolescents with Down syndrome had problem scores in the clinical or borderline range on 1 or more Child Behavior Checklist subscales; this is more than twice as high as adolescents without Down syndrome. Adolescents with Down syndrome had more internalizing problems than their counterparts without Down syndrome (14% and 9%, respectively, in the clinical range); the percentages for externalizing problems were almost equal (7% and 9%, respectively, in the clinical range). The highest problem scores in adolescents with Down syndrome were observed on the social problems and thought problems subscales (large to very large standardized differences). Male sex and/or more severe mental disabilities were associated with more behavioral problems. Serious problem behavior is more prevalent in adolescents with Down syndrome. This demonstrates the need for a focus on general behavior improvement and on the detection and treatment of specific psychopathology in individuals with Down syndrome.

WS6.5 Experience and satisfaction of patients and parents with CF services – A nationwide survey in Germany

Objectives: To assess the patients’ experiences with care provided by staff in CF centres, we developed a CF-specific questionnaire in 2009 [1]. After a pilot study [2], the revised form was used for a nationwide survey. Methods: 90 CF centres in Germany were invited to participate. Centre staff collected patient consent forms and sent the patients’ addresses to the Picker Institute Germany. The 110 items had 3 to 6 response categories, which were dichotomised to “problem scores” (PS). The ideal score is 0%, indicating no problem. Results: 56 CF centres took part in the survey and recruited 1642 adults with CF and 1205 parents. The response rates were 74% in each group. Factor analysis revealed 10 different factors covering 70 of the 110 items. Participants reported the best results for the factors “physiotherapists” (PS 6%) and “physician-patient relationship” (PS 9%). Factors with the highest problem scores were inpatient and outpatient “facilities and services”. Items with high PS were “not enough information on possible side effects of drugs” (PS 49%) and “inadequate support to meet other patients/families” (PS 46%). For each item and factor, the institutions received reports of their own results and the mean PS of all participating centres. The problem scores differed considerably between CF centres. Conclusion: The CF-specific patient experience survey identified areas with higher and lower patient satisfaction. Centre staff can use the results to augment the quality of care. Supported by an educational grant from Mukoviszidose e.V., the German CF Association.

Infant brain structures, executive function, and attention deficit/hyperactivity problems at preschool age. A prospective study

Neuroimaging findings have provided evidence for a relation between variations in brain structures and attention deficit/hyperactivity disorder (ADHD). However, longitudinal neuroimaging studies are typically confined to children who have already been diagnosed with ADHD. In a population-based study, we aimed to characterize the prospective association between brain structures measured during infancy and executive function and attention deficit/hyperactivity problems assessed at preschool age. In the Generation R Study, the corpus callosum length, the gangliothalamic ovoid diameter (encompassing the basal ganglia and thalamus), and the ventricular volume were measured in 784 6-week-old children using cranial postnatal ultrasounds. Parents rated executive functioning at 4 years using the behavior rating inventory of executive function-preschool version in five dimensions: inhibition, shifting, emotional control, working memory, and planning/organizing. Attention deficit/hyperactivity problems were assessed at ages 3 and 5 years using the child behavior checklist. A smaller corpus callosum length during infancy was associated with greater deficits in executive functioning at 4 years. This was accounted for by higher problem scores on inhibition and emotional control. The corpus callosum length during infancy did not predict attention deficit/hyperactivity problem at 3 and 5 years, when controlling for the confounders. We did not find any relation between gangliothalamic ovoid diameter and executive function or Attention deficit/hyperactivity problem. Variations in brain structures detectible in infants predicted subtle impairments in inhibition and emotional control. However, in this population-based study, we could not demonstrate that early structural brain variations precede symptoms of ADHD.

Children's mental health and collective violence: a binational study on the United States-Mexico border

To investigate the risk effects of poverty and exposure to collective violence attributed to organized crime on the mental health of children living on the United States-Mexico border. A repeated, cross-sectional study measured risk effects by comparing scores of psychosocial and behavioral problems among children and adolescents living on the border in the United States or Mexico in 2007 and 2010. Patients living in poverty who responded once to the Pictorial Child Behavior Checklist (P+CBCL) in Spanish were randomly selected from clinics in El Paso, Texas, United States (poverty alone group), and Ciudad Juarez, Chihuahua, Mexico (poverty plus violence group). Only children of Hispanic origin (Mexican-American or Mexican) living below the poverty level and presenting at the clinic for nonemergency visits with no history of diagnosed mental, neurological, or life-threatening disease or disability were included. Exposure to collective violence and poverty seemed to have an additive effect on children's mental health. Children exposed to both poverty and collective violence had higher problem scores, as measured by the P+CBCL, than those exposed to poverty alone. It is important to consider that children and adolescents exposed to collective violence and poverty also have fewer chances to receive treatment. Untreated mental health problems predict violence, antisocial behaviors, and delinquency and affect families, communities, and individuals. It is crucial to address the mental health of children on the border to counteract the devastating effects this setting will have in the short term and the near future.

Improving Self-Efficacy in Statistics: Role of Self-Explanation & Feedback

Novice problem solvers often fail to recognize structural similarities between problems they know and a new problem because they are more concerned with the surface features rather than the structural features of the problem. The surface features are the story line of the problem whereas the structural features involve the relationships between objects in the problem. We used an online technology to investigate whether students' self-explanations and reception of feedback influenced recognition of similarities between surface features and structural features of statistical problems. On average students in our experimental group gave 12 comments in the form of self-explanation and peer feedback. Students in this Feedback group showed statistically significantly higher problem scores over the No-Feedback group; however, the mean self-efficacy scores were lower for both groups after the problem solving experiment. The incongruence in problem scores with self-efficacy scores was attributed to students' over-rating of their abilities prior to actually performing the tasks. This process of calibration was identified as an explanation for the statistically significant positive correlation between problem solving scores and post self efficacy scores for the Feedback group (p < .01).