Higher Total Difficulties Scores Research Articles

Prenatal particulate matter exposure is linked with neurobehavioral development in early life

Abstract Background Particulate matter (PM) is a major environmental health concern and there is growing evidence that early exposure to PM can have adverse effects on neurobehavioral development in children, including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). In this study, we hypothesized that prenatal PM2.5 exposure is linked with changes in neurobehavioral development in early life. Methods This study was part of the prospective ENVIRONAGE birth cohort and included 85 mother-newborn pairs. The Neonatal Behavioral Assessment Scale (NBAS) was administered to 1-2-month-olds to evaluate newborn's behavior. In addition, 392 children aged 4-6 years of the ENVIRONAGE cohort were included. The Strengths and Difficulties Questionnaire (SDQ) was used to assess the child's behavior. PM2.5 concentrations were determined by a high-resolution spatial-temporal method based on the maternal residential address. Multiple linear and multinomial logistic regression models were used to link prenatal PM2.5 exposure and neurobehavioral development in newborns and children, respectively. Results A 5 µg/m3 increase in PM2.5 concentration in early pregnancy was linked with lower scores for the NBAS range of state cluster (-0.22; 95% CI: -0.42 to -0.02; p = 0.03) in newborns aged 1-2 months old, as well as with higher odds of a child having peer problems (OR 3.90; 95% CI: 1.39 to 10.88; p = 0.01), higher total difficulties scores (OR 1.67; 95% CI: 1.01 to 2.78; p = 0.047), and abnormal prosocial behavior (OR 0.49; 95% CI: 0.25 to 0.98; p = 0.04) at age 4-6 years. Conclusions This study provides indications that prenatal PM2.5 exposure influences neurobehavioral development, both in newborns and in early childhood. This evidence suggests that reducing exposure to PM2.5 during pregnancy may be an important public health strategy for promoting optimal neurodevelopment in early life. Key messages • In utero PM2.5 exposure is related to changes in neurobehavior in newborns. • Prenatal PM2.5 exposure is linked with higher chances of abnormal behavior in children aged 4-6 years old.

Influence of sleep fragmentation in infancy and toddler period on emotional and behavioral problem at the age of 6 years: a birth cohort study

Objective: To investigate the influence of sleep fragmentation in infancy and toddler period on emotional and behavioral problems at the age of 6 years. Methods: Using a prospective cohort design, 262 children were extracted from mother-child birth cohort recruited from May 2012 to July 2013 in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Children's sleep and physical activities were assessed using actigraphy at 6, 12, 18, 24, and 36 months of age, from which the sleep fragmentation index (FI) at each follow-up point was calculated. Children's emotional and behavioral problems at 6 years of age were assessed using the strengths and difficulties questionnaire. Group-based trajectory model was applied to determine sleep FI in infancy and toddler period trajectory groups with Bayesian information criteria being used to determine the best fitting model. Children's emotional and behavioral problems between groups were examined with independent t test and linear regression models, etc. Results: A total of 177 children, with 91 boys and 86 girls, were included in the final analysis and were divided into 2 groups: high FI group (n=30) and low FI group (n=147). Compared with children in the low FI group, those in the high FI group presents with higher total difficulties score and higher hyperactivity or inattention score ((11.0±4.9) vs. (8.9±4.1), (4.9±2.7) vs. (3.7±2.3) scores, t=2.17, 2.23, both P<0.05, respectively), with the differences remaining significant after adjusting for covariates (t=2.08, 2.09, both P<0.05 respectively). Conclusion: High sleep fragmentation in infancy and toddler period is associated with more emotional and behavioral problems, especially hyperactivity or inattention problems, at 6 years of age.

Mapping Geographic Trends in Early Childhood Social, Emotional, and Behavioural Difficulties in Glasgow: 2010-2017.

Measuring variation in childhood mental health supports the development of local early intervention strategies. The methodological approach used to investigate mental health trends (often determined by the availability of individual level data) can affect decision making. We apply two approaches to identify geographic trends in childhood social, emotional, and behavioural difficulties using the Strengths and Difficulties Questionnaire (SDQ). SDQ forms were analysed for 35,171 children aged 4–6 years old across 180 preschools in Glasgow, UK, between 2010 and 2017 as part of routine monitoring. The number of children in each electoral ward and year with a high SDQ total difficulties score (≥15), indicating a high risk of psychopathology, was modelled using a disease mapping model. The total difficulties score for an individual child nested in their preschool and electoral ward was modelled using a multilevel model. For each approach, linear time trends and unstructured spatial random effects were estimated. The disease mapping model estimated a yearly rise in the relative rate (RR) of high scores of 1.5–5.0%. The multilevel model estimated an RR increase of 0.3–1.2% in average total scores across the years, with higher variation between preschools than between electoral wards. Rising temporal trends may indicate worsening social, emotional, and behavioural difficulties over time, with a faster rate for the proportion with high scores than for the average total scores. Preschool and ward variation, although minimal, highlight potential priority areas for local service provision. Both methodological approaches have utility in estimating and predicting children’s difficulties and local areas requiring greater intervention.

Green space quality and adolescent mental health: do personality traits matter?

IntroductionAdolescents, especially females, tend to experience poorer mental health if they are higher in introversion and neuroticism. As a result, they also may have more to gain from having quality green space (e.g. parks) nearby to enable restoration, but this remains tested. MethodCross-sectional data on 2946 adolescents aged 16-17y were extracted from the Longitudinal Study of Australian Children. Multilevel linear regressions assessed association between parent/caregiver green space quality perception with self-reported Strengths and Difficulties Questionnaire Total Difficulties Scores (TDS) and internalising (e.g. anxiety) and externalising (e.g. fidgetiness) subscales. Models were weighted for representativeness, accounted for spatial clustering within postcodes, and adjusted for geographic stratum and socioeconomic confounders. This was followed by adjustment for introversion and neuroticism, and then three-way interaction terms between each trait, green space quality and sex to assess for potential effect modification. ResultsQuality green spaces was associated with higher TDS (β = 1.506; SE = 0.371), internalising (β = 0.982; SE = 0.220) and externalising (β = 0.518; SE = 0.234) scores (i.e. poorer mental health). Introversion was associated with higher TDS (β = 1.416; SE = 0.089), higher internalising (β = 1.233; SE = 0.050) and higher externalising scores (β = 0.181; SE = 0.056). Similar associations were observed for neuroticism and TDS (β = 2.283; SE = 0.084), internalising (β = 1.627; SE = 0.046) and externalising scores (β = 0.656; SE = 0.056). Mean levels of introversion were similar for girls and boys (1.73 vs 1.76, p = 0.6573), but mean levels of neuroticism were notably higher in girls than boys (2.42 and 1.67, p < 0.0001). Likelihood ratio tests indicated three-way interactions improved models analysing the internalising subscale outcome only. Green space quality made no difference to associations between introversion or neuroticism and internalising scores in males. Quality green space was associated with 3.2 and 2.1 reductions in mean internalising scores among females with the highest levels of introversion or neuroticism, respectively. ConclusionsIndividual differences in psychological traits may predispose some adolescents, and females especially, to restoration from green space.

Impact of COVID-19 Related Knowledge and Precautions on Emotional and Behavioral Problems Among Children During the Post-pandemic in China: The Explanatory Value of Emotional Problems Among Caregivers.

To investigate the prevalence of emotional and behavioral problems (EBPs) among children during the COVID-19 post-pandemic in China; examine associations between COVID-19-related knowledge and precautions and problems in children, and explore the potential explanatory value of the mental health status of caregivers on any associations observed. Based on a cross-sectional design, caregivers of 6,017 children from 12 primary schools in Shanghai and Taizhou, China, were invited to complete an online survey from June 26 to July 6, 2020. EBPs of the children were assessed using the Strengths and Difficulties Questionnaire (SDQ), while the emotional problems of caregivers were assessed using the Depression Anxiety Stress Scales-21 (DASS-21). Structural equation modeling was employed to estimate the direct and indirect associations (explained by the emotional problems of caregivers) between COVID-19-related knowledge and precautions and the EBPs among children. The overall prevalence of EBPs in the sample was 12.5%, and 5.3% of them had a high or very high SDQ total difficulties score during the COVID-19 post-pandemic. After adjustment for covariates, higher COVID-19-related knowledge (β = −0.83; P < 0.001) and precautions (β = −0.80; P < 0.001) were significantly associated with lower SDQ total difficulties score among children. There was an explanatory effect of emotional problems of caregivers on the aforementioned associations, which explained 31% and 41% of the total effect, respectively. Higher levels of knowledge and precautions of COVID-19 were associated with lower EBPs among children, and the relationship was partially explained by the emotional problems in caregivers. It may be beneficial to improve pandemic-related prevention education and adopt psychological interventions toward the emotional status of caregivers for the psychological health of children.

Nutritional status indicator and its correlation with mental health score among adolescents in Islamic boarding schools

Background: It has been estimated that about 10–20% of adolescents worldwide had experiences of mental health problems. Malnutrition, including overweight and obese, is one of the risk factors for mental health in adolescents. There is a knowledge gap regarding the nutritional status and its correlation with mental health among adolescents who live in boarding schools. This study aimed to determine nutritional status and its correlation with mental health among adolescents in Islamic boarding schools.Methods: A cross-sectional approach was used in this study in which two schools in South Tangerang City of Banten Province were purposively selected and 302 of students aged 15–18 years were completed this study. BMI-for-age Z-scores (BAZ) was used as the nutritional status indicator, and the Strengths and Difficulties Questionnaire (SDQ) was used to determine mental health of the subjects. Spearman correlation was used to determine the correlation between nutritional status indicator and mental health score.Results: Nearly 30% of the subjects were overweight and obese, and almost 20% had result of mental health score in categories “borderline” and “abnormal”. There was a significant correlation between nutritional status indicator and mental health score among adolescents in Islamic boarding schools (r=0.157, P=0.006).Conclusion: Adolescents who had higher BAZ, had higher total difficulties scores. The schools and policy makers should give attention to nutritional status of the students since it is correlated with mental health.

Emotional and Behavioral Trajectories of 2 to 9 Years Old Children Born to Opioid-Dependent Mothers

Maternal opioid use in pregnancy has increased dramatically. Knowledge about children’s longer-term emotional and behavioral development after prenatal opioid exposure is scarce. A regional sample of 89 opioid-exposed and 104 non-exposed comparison children were studied prospectively at ages 2, 4.5, and 9 years using the Strengths and Difficulties Questionnaire (SDQ) completed by primary caregivers. Across all childhood assessments, opioid-exposed children obtained significantly higher total difficulties scores than non-exposed comparison children. Growth curve modeling revealed that, relative to their same age peers, opioid-exposed children’s emotional and behavioral difficulties significantly worsened over time. Moreover, fixed effects estimates showed that total difficulties trajectories were poorer for children subject to higher prenatal risk (Est = 1.78, 95% CI = [0.46, 3.09]) who were born to mothers with high levels of social adversity (1.11 [0.51, 1.71]), and were then raised in families characterized by high levels of psychosocial risk (1.94 [0.90, 2.98]) and unstable caregiving (1.91 [0.33, 3.48]). A complex set of pre- and postnatal processes contribute to opioid-exposed children’s emotional and behavioral development. Efforts to mitigate the long-term consequences of opioid use in pregnancy need to consider both children’s and their caregivers’ biopsychosocial risks.

Migration as a Determinant in the Development of Children Emotional and Behavior Problems: A Quantitative Study for Lisbon Region, Portugal.

The role of migration as a determinant in child mental health has been demonstrated in a number of studies. However, results are not always consistent, and the research continues to be scarce, especially in Portugal. We examined the association between sociodemographic profiles and the chance for the development of emotional and behavioral difficulties in a group of 420 children, immigrant (n = 217) and born in Portugal to Portuguese born parents (n = 203). We used a structured questionnaire to obtain sociodemographic information and the Strength and Difficulties Questionnaire (SDQ). Descriptive statistics were used to characterize children and their families; variables were compared between groups using the Chi-squared, Fisher’s Exact Test, or the Mann–Whitney U test and logistic regression was used to analyze the association between socio-demographic factors and emotional and behavioral difficulties. Results showed a pattern of social and mental health inequalities with immigrant children at a disadvantage: they are more often part of families with low income and where parents had low skilled jobs. Internalizing behaviors are more frequent in immigrants than in children born in Portugal to Portuguese-born parents (p = 0.001) whereas a high total SDQ difficulties score (p = 0.039) and externalizing behaviors were more frequent in 1st generation immigrant children (p = 0.009). A low family income (aOR 4.5; 95% CI: 1.43–13.95), low parental education level (aOR 2.5; 95% CI: 1.11–5.16), and being a first-generation immigrant child (aOR 2.2; 95% CI: 1.06–4.76) increased significantly the chance of developing emotional and behavioral difficulties. This study contributes to the identification of children vulnerable to mental health problems who can benefit from monitoring, early detection and preventive interventions in order to mitigate possible negative outcomes in the future.

Psychiatric comorbidities of children with elimination disorders

Enuresis and encopresis can be stressful for children and parents. We investigated the comorbid psychiatric disorders and the emotional and behavioral symptoms associated with elimination disorders. A total of 97 children and adolescents (aged 4–17 years) with an elimination disorder participated in this study. The elimination disorder group consisted of three subgroups: 50 subjects with enuresis nocturna, 26 with encopresis, and 21 subjects with enuresis+encopresis. The control group with no elimination disorder comprised 50 healthy subjects. All children were interviewed by a child and adolescent psychiatrist. Comorbid psychiatric disorders were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Strengths and Difficulties Questionnaire. The most common diagnosis was attention-deficit/hyperactivity disorder, followed by oppositional defiant disorder. The highest rate of psychiatric comorbidity was observed in the enuresis+encopresis subgroup, followed by the enuresis nocturna and encopresis subgroups. All the subgroups had higher total difficulties scores than the control group. Screening for psychiatric disorders should be performed for all children with incontinence.

Emotional/Behavioural Problems and Functional Impairment in Children with Attention-Deficit/Hyperactivity Disorder.

This study aimed to compare the emotional/behavioural problems and functional impairment between early school-age children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls. Factors associated with behavioural problem scores were also evaluated. Children aged 6 to 10 years who were diagnosed with ADHD based on the Swanson, Nolan and Pelham version IV Scale (SNAP-IV) and the DSM-5 criteria for ADHD were compared with age-and sex-matched controls with negative SNAP-IV results in terms of emotional/behavioural problems (as assessed by the Child Behavioural Checklist) and functional impairment (as assessed by the Strength and Difficulties Questionnaire). 40 children with ADHD and 40 non-ADHD controls with a mean age of 8.40 ± 1.44 years were included. The ADHD group scored significantly higher than controls in terms of all eight subscales of emotional/behavioural problems (p<0.001 to p<0.01). Regarding functional impairment, the ADHD group reported significantly higher scores than controls in terms of total difficulties, conduct problems, and hyperactivity (all p<0.01); and significantly lower prosocial scores (p<0.03). In the multiple linear regression analysis, among the ADHD group, comorbid medical disorders were associated with higher total problem score, internalising behaviour problems score, and externalising behaviour problems score; whereas combined subtype ADHD was associated with higher total difficulties score. Early school-age children with ADHD have more emotional/behavioural problems and functional impairment than non-ADHD controls, and they need further evaluation and intervention for psychosocial functioning, particularly those with comorbid medical disorder or combined subtype ADHD.

Clinical characteristics of boys with comorbid autism spectrum disorder and attention deficit/hyperactivity disorder.

Autism spectrum disorder (ASD) and attention deficit / hyperactivity disorder (ADHD) are frequently comorbid and, as both are defined as neurodevelopmental disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, simultaneous diagnosis is possible. However, despite the frequency of this comorbid state, its endophenotypic features remain unclear. This study thus aimed to describe the behavioral and emotional problems in boys with comorbid ASD and ADHD using the Strengths and Difficulties Questionnaire (SDQ). In total, 102 boys (age, 6-12years) diagnosed with one or both disorders were divided into three groups according to their clinical diagnosis: ASD+ADHD (N=39), ASD (N=37), and ADHD (N=25). Symptoms and related behaviors were compared among the groups using parents' ratings of the autism spectrum quotient, ADHD rating scale-IV, and SDQ. In the ASD+ADHD group, the proportion of "clinical-range" cases was as high as 76.9% for the SDQ total difficulties score (TDS). The ASD+ADHD and ADHD groups had significantly higher TDS as well as behavioral problems and hyperactivity subscale scores than did the ASD group; however, the ASD+ADHD group did not have significantly different scores on any subscale compared with the other two groups. The ASD+ADHD and ASD groups also had significantly lower prosocial behavior scores than the ADHD group. When using the SDQ as a screening tool for neurodevelopmental disorders, a high TDS, conduct problems, hyperactivity, and low prosocial behavior can be considered characteristic of ASD and ADHD comorbidity in 6- to 12-year-old boys.

Mental health status compared among rural-to-urban migrant, urban and rural school-age children in Guangdong Province, China

BackgroundPrevious research has documented mental health status among rural-to-urban migrant children (labeled as “migrant children” henceforth) and urban children. However, the findings remain unclear. In addition, far less attention has been paid to rural children’s psychological outcomes. The purpose of this study was to compare mental health status among migrant, urban and rural school-age children in Guangdong Province, China.MethodsThis was a cross-sectional study involving 372 migrant, 254 urban and 268 rural children selected respectively from 3 private schools, 4 public schools and 2 village schools in Guangdong Province, China. Participants provided their socio-demographic information and completed the Strengths and Difficulties Questionnaire (SDQ) to assess mental health. One-way analyses of variance (ANOVAs) and Bonferroni post hoc test were used to evaluate SDQ scores differences. A multiple linear regression analysis was conducted to measure mental health differences among children after controlling for socio-demographics. Chi-square analyses were used to assess differences in the prevalence of mental health problems among children.ResultsBonferroni post hoc test showed that migrant and rural children reported significantly higher scores than urban peers in emotional symptoms, hyperactivity/inattention and total difficulties score (p < 0.01). In addition, migrant children reported a higher peer problems score compared to urban children (p < 0.001). In multiple linear regression analysis, rural and migrant children reported significantly a higher total difficulties score than urban children (p = 0.046 and 0.024, respectively). Additionally, female gender, having insurance, seldom communicating with parents, and higher monthly household income were negatively associated with a higher total difficulties score. Conversely, children’s father with secondary education was positively associated with a higher total difficulties score. The prevalence of mental health problems among rural, migrant and urban children were 26.5, 18.8 and 15.0% (χ2 = 11.41, p = 0.003), respectively.ConclusionsRural and migrant children reported poorer mental health than urban children. Female gender, having insurance, seldom communicating with parents, and higher monthly household income were associated with better mental health of children. However, children’s father with secondary education was associated with poorer mental health of children. Given the different effects of socio-demographics, further support might be provided accordingly to improve the mental health of school-age children.

Mental health and risk behaviors of children in rural China with different patterns of parental migration: a cross-sectional study

BackgroundOne in seven members of China’s population are migrants. There are an estimated 41 million children left behind in rural areas who are living without one or both of their parents. The impact of two- and single-parent migration on child mental health and risk behaviors is unclear. The aim of this study was to compare the mental health and risk behaviors among children whose parents are either both migrating (B-LBC), have one parent migrating (O-LBC) or those whose parents do not migrate (N-LBC).MethodsThis study was a cross-sectional survey using a self-administered questionnaire conducted in rural areas with high proportions of left behind children (LBC) in Anhui Province, southeast China. The tools used were the Strength and Difficulties Questionnaires, Youth Risk Behavior Survey and the Young’s Internet Addiction Test for Chinese.ResultsFull data were available for 699 B-LBC, 552 O-LBC and 741 N-LBC. After adjusting for gender, age, grade, number of siblings and self-rated socio-economic status, B-LBC were significantly more likely to have higher emotional symptoms scores (B(SE) = 0.36(0.11), p < 0.01), higher hyperactivity scores (B(SE) = 0.22(0.11), p < 0.01) and higher total difficulties scores (B(SE) = 0.79(0.29), p < 0.01) than N-LBC. B-LBC were also more likely to be an addicted internet user (OR(95%CI) = 1.91(1.33, 2.76), p < 0.01) compared to N-LBC. However, there were no identified differences between O-LBC and N-LBC or between O-LBC and B-LBC in any measures.ConclusionsOur findings found that living with one parent or both parents was associated with better mental health and fewer risk behaviors than was being separated from both parents. Future research is needed to consider the implications of these findings for policies and programs to protect LBC, especially for those with two migrating parents.

Phthalate exposure and neurodevelopmental outcomes in early school age children from Poland

Some phthalates are known endocrine disrupting chemicals (EDC). They are widely present in the environment thus their impact on children’s health is of particular scientific interest. The aim of the study was to evaluate the association between phthalate exposure and neurodevelopmental outcomes, in particular behavioral, cognitive and psychomotor development, in 250 early school age children from the Polish Mother and Child Cohort (REPRO_PL). Urine samples were collected at the time of children’s neurodevelopmental assessment and were analysed for 21 metabolites of 11 parent phthalates. Behavioral and emotional problems were assessed by the Strengths and Difficulties Questionnaire (SDQ) filled in by the mothers. To assess children’s cognitive and psychomotor development, Polish adaptation of the Intelligence and Development Scales (IDS) was administered. The examination was performed by trained psychologists. Dimethyl phthalate (DMP) and di-n-butyl phthalate (DnBP) were the two phthalates showing the highest statistically significant associations, with higher total difficulties scores (β = 1.5, 95% CI 0.17; 2.7; β = 1.5, 95% CI 0.25; 2.8, respectively) as well as emotional symptoms and hyperactivity/inattention problems for DnBP (β = 0.46, 95% CI -0.024; 0.94; β = 0.72, 95% CI 0.065; 1.4, respectively), and peer relationships problems for DMP (β = 0.37, 95% CI -0.013; 0.76). In addition, DnBP and DMP have been found to be negatively associated with fluid IQ (β = −0.14, 95% CI -0.29; 0.0041) and crystallized IQ (β = −0.16, 95% CI -0.29; −0.025), respectively. In the case of mathematical skills, three phthalates, namely DMP (β = −0.17, 95% CI -0.31; −0.033), DEP (β = −0.16, 95% CI -0.29; −0.018) and DnBP (β = −0.14, 95% CI -0.28; 0.0012), have also shown statistically significant associations. This study indicates that exposure to some phthalates seems to be associated with adverse effects on behavioral and cognitive development of early school age children. Further action including legislation, educational and interventional activities to protect this vulnerable population is still needed.

Objectively measured physical activity and psychosocial functioning in young children: The GECKO Drenthe cohort

ABSTRACTThe global trend in inactivity in children may be related to psychosocial problems. We investigated the cross-sectional association between physical activity (PA) levels and psychosocial functioning in 3.4–7.3-year-old children. Children from the Dutch GECKO birth cohort (N = 898; 51.6% boys) had PA levels assessed objectively by accelerometry (ActiGraph GT3X) for at least three days. Linear regression analysis was used for associations with psychosocial functioning (parent report of the Strengths and Difficulties Questionnaire), controlling for gender, age and socio-economic status. Higher total and moderate-to-vigorous PA levels (MVPA) were associated with higher Total Difficulty scores, and sedentary time to lower Total Difficulty scores. More time spent in MVPA was significantly associated to “hyperactivity/inattention” in both boys (Standardized BBOYS = 0.192) and girls (Std.BGIRLS = 0.139) whereas for the time in sedentary behaviour, a reverse association was found only in boys (Std.BBOYS = −0.230). In boys only, more time in MVPA (Std.BBOYS = 0.154) and less time in sedentary behaviour (Std.BBOYS = −0.147), were significant determinants for ‘behavioural problems’. When using objectively measured PA, parents report more hyperactivity/inattention and behavioural problems in the more active children, and less in the more sedentary children, most clearly for boys. High levels of PA might be an indicator of psychosocial problems in young children.

Prenatal alcohol consumption and infant and child behavior: Evidence from the Growing Up in New Zealand Cohort

BackgroundHigh levels of alcohol exposure during pregnancy can damage developing brains and influence child behavior and learning. AimTo examine the effects of lower levels of alcohol and very early exposure to alcohol on infant temperament and child behavior. Study design, subjects, and outcome measuresThe Growing Up in New Zealand study involves a prospective birth cohort of 6822 pregnant women of whom 6156 provided information on their child's temperament using the Infant Behavior Questionnaire-Revised (IBQ-R VSF) at 9 months and their child's behavior using the Strengths and Difficulties Questionnaire at 2 years. ResultsA series of adjusted linear regression models controlling for socio-demographic factors found alcohol consumption during pregnancy was most consistently related to Lower Positive Affect, Affiliation/Regulation, and Orienting Capacity temperament scores. Mothers who stopped drinking after becoming aware of their pregnancy, but had an unplanned pregnancy (hence may have a baby exposed to alcohol for longer), also reported infants with lower Orienting Capacity, Affiliation/Regulation, and Fear temperament scores compared to those that did not drink. Children whose mothers drank four or more drinks per week during pregnancy were more likely to report their child as having conduct problems, with higher total difficulties scores at age 2. ConclusionsAlcohol consumption during pregnancy has a negative effect especially on infant temperament, even if small amounts of alcohol are consumed. Our findings have implications for men and women who drink, medical professionals, and for the availability of contraception to those who drink, but do not plan to get pregnant.

Examining the psychological and social impact of relative age in primary school children: a cross-sectional survey.

A number of studies demonstrate that children who are younger within their school year have poorer academic attainment and are more likely to have special educational needs. Few, however, have considered the impact relative age may have on child mental health, behaviour and happiness in school. This paper utilized data from the Supporting Teachers and Children in Schools study (2075 pupils aged 5 to 9years from 80 primary schools) to explore the relationship among relative age, behaviour and happiness in school. Behavioural and emotional development was assessed by using the teacher-reported and parent-reported Strengths and Difficulties Questionnaire and the Pupil Behaviour Questionnaire. Children's happiness within school was assessed by using the How I Feel About My School Questionnaire. Relatively younger children had higher Total Difficulties scores on the Strengths and Difficulties Questionnaire than their peers. There was a mean increase per 30-day decrease in relative age of 0.09 (95% CI: 0.03 to 0.16; p=0.007) in teacher-reported and 0.08 (0.001 to 0.16; p=0.05) in parent-reported scores. There was little evidence of a relationship between relative age and children's behaviour and happiness in school. For children with complex difficulties, being relatively young for their school year may be an additional stressor that may undermine mental health.

Associations between children’s behavioural and emotional development and objectively measured physical activity and sedentary time: Findings from the UK Millennium Cohort Study

Physical activity (PA) can have a positive influence on mental health. Less is known about the influence of mental health on recent and later PA and sedentariness in childhood. This study investigated cross-sectional and distal associations between behavioural and emotional development, and objectively-measured moderate-to-vigorous PA (MVPA) and sedentary time, in seven-year-old children participating in the Millennium Cohort Study ( n = 6497). Markers of behavioural/emotional development (scores for total difficulties, internalising and externalising problems) were obtained using the Strengths and Difficulties Questionnaire at ages three, five and seven years. Associations between sedentary time or MVPA (outcomes) and behavioural/emotional development (exposures) were analysed using median regressions, stratified by sex. In cross-sectional analyses, boys’ sedentary time decreased with higher total difficulties scores (-1.1 minutes/day per score unit), boys’ and girls’ sedentary time decreased with higher externalising scores (-2.3 minutes/day per unit), and girls with higher internalising scores were more sedentary (1.4 minutes/day per unit). In analyses of MVPA, boys and girls were marginally more active with higher externalising scores (0.4 and 0.5 minutes/day per unit), and boys were less active for higher internalising scores (-0.7 minutes/day per unit). Distal associations showed similar patterns: children with increasing total difficulty and externalising scores at all ages were less sedentary at age seven; girls with increasing internalising scores more so. Boys and girls with increasing externalising scores were more active at age seven, whilst increasing internalising problems reduced MVPA for boys. In conclusion, behavioural behavioural/emotional development is associated with mid-childhood sedentary time and, more weakly, MVPA.

Reported alcohol drinking and mental health problems in Hong Kong Chinese adolescents

ObjectiveTo investigate the association between reported alcohol drinking and mental health problems in Hong Kong adolescents. MethodsIn a school-based questionnaire survey in 2012-13 on 4620 Secondary one (US Grade seven) to six students (mean age 14.5, SD 1.6 years; 53.4% boys), alcohol drinking was classified as never drinking (reference), experimental, former, less-than-weekly and weekly drinking. Binge drinking was defined as drinking at least five drinks on one occasion. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) with five subscales (emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial activity) and the total difficulties score (sum of the first four subscales). Multilevel regression was used to analyse the associations of mental health problems with drinking frequency and binge drinking, adjusting for potential confounders. ResultsCompared with never drinking, higher total difficulties scores were associated with less-than-weekly drinking (adjusted odds ratio AOR 1.39, 95% CI 1.01–1.91), weekly drinking (AOR 3.21, 95% CI 2.18–4.70), and binge drinking (AOR 2.18, 95% CI 1.42–3.32). Weekly drinking was most strongly associated with hyperactivity (AOR 6.27, 95% CI 1.42–3.32) among all subscales. Girls were more likely than boys to report emotional problems (AOR 3.36 vs 1.47) and hyperactivity (AOR 19.2 vs 2.31) related to weekly alcohol drinking (both P for interaction <0.05). ConclusionsIn Hong Kong adolescents, less-than-weekly, weekly, and binge drinking are associated with higher risks of mental health problems based on self-reported data. Prospective studies are warranted to explore the causality between alcohol drinking and mental health problems.

Mental health and associated risk factors of Dutch school aged foster children placed in long-term foster care

More than 20,000 children in the Netherlands live in foster families. The majority are in long-term foster family placements, which are intended to provide a stable rearing environment until the children reach adulthood. International studies have shown, however, that compared to children in the general population, foster children have more mental health problems and more negative developmental outcomes in their later life. Less is known about Dutch foster children, however. To fill this knowledge gap, the present study focused on the mental health of 239 foster children (aged 4–12) living in long-term placements in the Netherlands. Their behavior was assessed with the Strengths and Difficulties Questionnaire, which was completed by their foster parents. The results revealed a wide range of problem behavior (ranging from none to very serious problem behavior), and showed that a third of the children have total difficulty scores (TDS) in the clinical range. Higher TDS appear to have a positive univariate association with age of the foster child, age upon entering the current foster family, number of prior foster placements, non-kinship placement, and fostering experience of the foster parents. The more risk factors, the higher the TDS. These findings suggest the importance of the early detection of problems and potential risk factors in foster families, and the need to support a substantial number of foster children and foster families.