Internalizing Behavior Problems Research Articles

Association of Neonatal Pain-Related Stress and Parent Interaction With Internalizing Behaviors Across 1.5, 3.0, 4.5, and 8.0 Years in Children Born Very Preterm

Internalizing (anxiety and/or depressive) behaviors are prevalent in children born very preterm (24-32 weeks' gestation). Procedural pain-related stress in the neonatal intensive care unit (NICU) is associated with long-term internalizing problems in this population; however, whether positive parenting during toddlerhood attenuates development of internalizing behaviors across childhood is unknown. To investigate whether neonatal pain-related stress is associated with trajectories of internalizing behaviors across 1.5, 3.0, 4.5, and 8.0 years, and whether supportive parenting behaviors and lower parenting stress at 1.5 and 3.0 years attenuate this association. In this prospective longitudinal cohort study, preterm neonates (born at 24-32 weeks' gestation) were recruited from August 16, 2006, to September 9, 2013, with follow-up visits at ages 1.5, 3.0, 4.5, and 8.0 years. The study was conducted at BC Women's Hospital, Vancouver, Canada, with recruitment from a level III neonatal intensive care unit and sequential developmental assessments performed in a Neonatal Follow-up Program. Data analysis was performed from August to December 2021. Parental report of child internalizing behaviors on the Child Behavior Checklist at 1.5, 3.0, 4.5, and 8.0 years. A total of 234 neonates were recruited, and 186 children (101 boys [54%]) were included in the current study across ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years. After accounting for clinical factors associated with prematurity, greater neonatal pain-related stress was associated with more internalizing behaviors across ages (B = 4.95; 95% CI, 0.76 to 9.14). Higher parenting stress at age 1.5 years (B = 0.17; 95% CI, 0.11 to 0.23) and a less supportive parent environment (less sensitivity, structure, nonintrusiveness, nonhostility, and higher parenting stress; B = -5.47; 95% CI, -9.44 to -1.51) at 3.0 years were associated with greater internalizing problems across development to age 8.0 years. In this cohort study of children born very preterm, exposure to repetitive neonatal pain-related stress was associated with persistent internalizing behavior problems across toddlerhood to age 8.0 years. Supportive parenting behaviors during early childhood were associated with better long-term behavioral outcomes, whereas elevated parenting stress was associated with more child anxiety and/or depressive behaviors in this population. These findings reinforce the need to prevent pain in preterm neonates and inform future development of targeted parent-led behavioral interventions.

Child Internalizing Problems in Ukraine: The Role of Prosocial and Antisocial Friends and Generalized Self-Efficacy

The current study examines the association between peer behaviors, self-efficacy, and internalizing symptoms in a sample of 1545 children aged 11 to 13 years old who attended middle schools in eastern Ukraine. We used structural equation modeling (SEM) to examine the role of self-efficacy in the relationship between child internalizing behaviors (anxiety, depression, and somatic complaints) and exposure to prosocial and antisocial friends among girls and boys. Higher self-efficacy was linked with fewer internalizing symptoms for girls and boys. For both boys and girls, exposure to prosocial friends was not statistically associated with changes in internalizing behaviors. However, girls and boys who reported having more antisocial friends had significantly more internalizing symptoms. For girls, association with a greater number of prosocial friends and fewer antisocial friends has been linked with higher self-efficacy and fewer internalizing symptoms. For boys, having more prosocial friends was also linked with higher self-efficacy and fewer internalizing symptoms; however, there was no statistically significant association between having more antisocial friends and self-efficacy. The study discusses the cultural and gender aspects of child socialization in the context of antisocial and prosocial friends, and the development of internalizing behavior problems.

Perceived Social Support and Alcohol Consumption during Adolescence: A Path-Analysis with Internalizing and Externalizing Behaviour Problems

ABSTRACT The aim of the current study was to investigate the relationship between adolescents’ social support, their internalising and externalising behaviour problems, and their alcohol consumption. Adolescents attending Grade 7–10 (N = 329), answered questionnaires regarding their perceived social support (from parents, teachers, classmates, and friends), internalising (emotional and peer problems) and externalising behaviour problems (hyperactivity and conduct problems), and alcohol consumption (monthly frequency of consumption, beverage consumption on the weekend, and problematic consumption). Building a structural equation model, we found negative associations between parent support and all internalising and externalising behaviour problem scales. Furthermore, social support from classmates was negatively associated with the internalising behaviour problem scales. In turn, peer problems were negatively associated with alcohol consumption, and conduct problems were positively associated with alcohol consumption. Both parent and teacher support had a direct effect on alcohol consumption, and parent support also had an indirect effect via behaviour problems. The findings highlight the importance of parents and teachers for alcohol consumption during adolescence.

Insecure attachment and internalizing behavior problems in growth discordant identical twins

BackgroundPsychosocial development in monochorionic (MC) twins born after selective fetal growth restriction (sFGR) has been unreported to date, despite its importance for daily functioning and future relationships. AimsTo investigate psychosocial development, attachment and school functioning in MC twins with sFGR and compare outcomes with the general population and between smaller and larger twins. Study designObservational cohort study. SubjectsMC twins with sFGR (defined as a birth weight discordance ≥20 %) born between 2002 and 2017 and aged 3–17 years. Outcome measuresMultiple parent report questionnaires: the Child Behavior Checklist (social-emotional development and behavior), the (Early) Childhood Behavior Questionnaire Very Short Form (temperament), the Attachment Insecurity Screening Inventory (attachment) and a school functioning questionnaire. ResultsMedian age for the 48 twin pairs was 11 (interquartile range (IQR) 8–13) years. Attachment insecurity for both twins was higher than in the general population for ambivalence/resistance (34 % (21/62) vs. 16 %, p = 0.024) and total attachment insecurity (35 % (22/62) vs. 16 %, p = 0.016). Smaller twins had more internalizing behavioral problems, i.e. negative emotions and behaviors turned inwards (22 % (10/46) vs. 11 % (5/46), p = 0.021) and a higher negative affect, i.e. more likely to experience negative emotions (3.2 (2.9–3.7) vs. 2.9 (2.2–3.2), p = 0.009) than larger twins, as well as a lower secondary school level (p = 0.031). ConclusionMC twins with sFGR have more ambivalent/resistant attachment insecurity following the complicated pregnancy course. Smaller twins have a tendency towards negative emotions and internalizing behaviors compared to larger twins, indicating an increased sensitivity for depression and anxiety.

Association between Maternal Anxiety and Children's Problem Behaviors: A Systematic Review and Meta-Analysis.

Although numerous studies have found that maternal anxiety is a risk factor for the development of children’s problem behaviors, and there is a possible role of genes in the association between the two. And anxious mothers caring for their children can also affect the development of children’s problem behaviors. However, there is also considerable evidence from studies that refute this view. This study used a meta-analysis to explore the relationship between maternal anxiety and preschool children’s problem behaviors. Through literature retrieval and selection, in terms of the criteria for inclusion in the meta-analysis, 88 independent effect sizes (34 studies, 295,032 participants) were picked out as meta-analysis units. The test for heterogeneity illustrated that there was significant heterogeneity in 88 independent effect sizes, while the random effects model was an appropriate model for the subsequent meta-analysis. The publication bias test indicated that the impact of publication bias was modest but the major findings remained valid. In addition, in terms of the tentative review analysis and research hypotheses, the random effects model was used as a meta-analysis model. The research revealed that maternal anxiety was significantly positively correlated with preschool children’s internalizing problem behaviors, externalizing problem behaviors, and overall problem behaviors. The moderating effect analysis showed that region and gender of the child affected the relationship between maternal anxiety and children’s internalizing problem behaviors and externalizing problem behaviors, and region, child’s age and gender, mother’s age, and education level affected maternal anxiety and preschool children’s problems behavioral relationship. Hence, these results affirmed the role of maternal anxiety and emphasized the need to pay attention to the demographic characteristics and cultural background of the subjects during the research process and consider the generalizability of the conclusions under different circumstances.

Follow-up of infants with colic into childhood: Do they develop behavioural problems?

To assess whether infants with colic (IC) demonstrate persisting developmental dysregulation into childhood, manifested as behavioural problems, and to determine if these behavioural problems are associated with parenting factors. Preschool children with a history of IC at the age of 0-3 months, as defined by the Wessel criteria, were invited to participate in an observational follow-up study, in which their caregivers completed the Child Behaviour Checklist (CBCL). Raw scores and clinical-range scores on the internalising, externalising and total behavioural problems scales were compared with a Dutch normative sample using independent t-tests and Chi-square tests. For the clinical-range scores, multivariable logistic regressions (odds ratios [99% confidence interval, CI]) were used to adjust for confounders and to identify variables associated with behavioural problems. Two hundred and fifty-eight children with a history of IC (median age 5.1 (interquartile range, IQR 4.6-5.5) years, 51.9% boys) were included. The cases had a significantly higher adjusted risk (adjusted odds ratios (aORs) [99% CI]) of scoring in the clinical range of the emotionally reactive, internalising and total problems scale (2.96 [1.24-7.06]; 2.50 [1.35-4.62]; 2.98 [1.46-6.07], respectively). Internalising (P< 0.001), externalising (P< 0.001) and total (P< 0.001) behavioural problems in children with a history of IC were associated with higher parenting stress scores. Children with a history of IC demonstrated significantly more internalising behavioural problems at preschool age compared to the norm sample. Specific advice and support need to be available for parents to understand and regulate the behaviour of their child, from infancy to childhood.

Maternal-fetal attachment, parenting stress during infancy, and child outcomes at age 3years.

Maternal-fetal attachment (MFA), a woman's relationship with and affiliative behaviors toward her unborn child, has been linked to near-term infant physical and developmental outcomes. However, further longitudinal research is needed to understand whether the impact of MFA extends past the earliest years of life. The current study explored relationships between MFA and child socioemotional competence and behavior problems at age 3 and whether parenting stress mediated the association between MFA and child outcomes. Data were collected from 221 primarily Black/African-American mothers who completed a scale of MFA during pregnancy. Mothers reported on parenting stress at infant age 7 months and reported on child socioemotional competence and problem behaviors at child age 3 years. In path analyses, MFA was directly associated with child socioemotional competence at age 3 years, but an indirect association between MFA and socioemotional competence via parenting stress was not significant. We also observed a significant indirect association between lower MFA and child internalizing behavior problems via parenting stress that was related to maternal dissatisfaction regarding interactions with her child. Findings suggest that assessing MFA may serve as a means to identify dyads who would benefit from support to promote individual health outcomes.

Transactions between Problem Behaviors and Academic Performance in Early Childhood.

This study aimed to further the understanding of transactional relationships that exist between problem behaviors and academic performance in early childhood. Early academic and behavior difficulties increase the risk of school disengagement, academic failure, and dropout. Although children’s academic and behavioral difficulties have been shown to be intercorrelated, little research has focused on how the relationship reciprocates and progresses in early childhood. This study investigated how problem behaviors (i.e., externalizing and internalizing) influence and are influenced by academic performance (i.e., poor reading and math) from kindergarten to third grade. Participants included 18,135 students (51.22% boys) derived from a nationally representative sample in the Early Childhood Longitudinal Study, Kindergarten Class of 2011 (ECLS-K: 2011). Teacher ratings of children’s internalizing (low self-esteem, anxiety, loneliness, or sadness) and externalizing (fighting, arguing, showing anger, impulsively acting, and disruptive behaviors) problem behaviors, as well as direct assessments of children’s academic performance (reading and math), were collected yearly. Cross-lagged panel modeling (CLPM) was employed to examine reciprocal relationships between problem behaviors and academic performance over time from kindergarten to third grade. The results supported the transactional relationships in early childhood, with higher externalizing as well as internalizing problem behaviors predicting lower academic performance and lower academic performance predicting higher externalizing and internalizing problem behaviors. The implications for research, prevention, and early intervention regarding the progression of academic and behavioral problems are discussed.

Addressing Adolescent Stress in School: Perceptions of a High School Wellness Center.

Adolescents are often burdened with academic, home, and peer stressors. With adolescent mental health issues and suicide on the rise, administrators have worked with nonprofit organizations and the community to address stress and internalized behavior problems. School-based wellness centers are tranquil rooms with various sensory activities, calming nature scenes, and sounds for relaxation purposes. School-based wellness centers may have behavioral effects by reducing exposure to aversive events and increasing access to positive and negative reinforcers. There has not yet been a formal study of school-based wellness centers published in the literature. In the present study, we used questionnaires to examine the perceptions of 752 students, 124 parents, and 69 school staff of their high school wellness center. Results indicated that stakeholders had positive perceptions of the wellness center. In particular, results implied that stakeholders believed the wellness center contributed to students’ academic success, elevation of mood, confidence, and coping skills. Results also suggested that attendance at the wellness center was associated with a decrease in student stress and anxiety, though recommendations for improvements were noted. Implications and limitations of this study are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43494-022-00079-1.

Family processes and structure: Longitudinal influences on adolescent disruptive and internalizing behaviors.

The present study revisits the assumption in American culture, based in "family privilege," that children fare better in two-parent households by longitudinally examining associations between family structure, process, and adolescent behavior. Societal assumptions and cross-sectional research suggest that there is a difference in child adjustment across varying family structures. Relatedly, the family process literature emphasizes the importance of parent-child relationship quality in addition to family structure on child adjustment. We utilized a longitudinal, prospective design that assessed family structures on nine occasions covering a 12-year period beginning when the target child was 2 years of age for a large (N=714), ethnically and racially diverse sample of low-income families. We examined the relation between self-reported, teacher-reported, and primary caregiver-reported adolescent disruptive and internalizing problem behavior across family structures and parent-child relationship quality. Across seven identified family structures, adolescent behavior did not differ after accounting for middle-childhood adjustment and relevant contextual factors. However, consistent with family process models of child adjustment, positive parent-child relationship quality predicted lower rates of adolescent maladaptive behavior. These findings serve to combat stigma related to family structures that deviate from married parents raising their children and highlight the need for interventions designed to foster positive parent-child relationships. Policy makers and practitioners should aim to support efforts to foster positive parent-child relationships across types of family structures and refrain from promoting or discouraging the formations of specific family structure types.

유아기 자녀의 문제행동, 어머니 원가족 건강성, 자기분화, 부부갈등 간 구조적 관계

Objectives The purpose of this study is to reveal the structure and influence between the mother's role in the family-of-origin health, mother's differentiation of self, marital conflict, and problem behavior of early childhood. Methods For this purpose, a questionnaire was distributed to 435 children attending early childhood education institutions located in S and G to measure the variables of childhood child problem behavior, mother's family-of-Origin health, mother's differentiation of self, and marital conflict. In the structural equation model, the independent variable was the mother's family-of-Origin health as the mediating variable, differentiation of self and marital conflict dependent variables were selected as the externalization problem behavior and internalization problem behavior of early children. Results Mothers’ family-of-Origin health had a positive effect on the level of mother’s differentiation of self, and mother’s differentiation of self had a negative effect on children’s externalizing and internalizing problem behaviors. Couple conflict had a positive effect on the externalization and internalization problem behaviors of children in early childhood. Mothers' family-of-Origin health fully mediated the level of mother's differentiation of self in the externalizing and internalizing problem behaviors of children in early childhood. In addition, it was found that marital conflict and mother differentiation of self between the and the externalization and internalization problem behaviors of the infant children had an indirect effect on the externalization and internalization problem behavior of early childhood. Conclusions For this reason, it was verified that differentiation of self in the mother is an important factor in preventing and reducing problem behavior of early childhood, Based on the results of this study, various measures were sought to prevent and reduce problem behavior of early childhood.

유아기 자녀의 문제행동, 어머니 원가족 건강성, 자기분화, 부부갈등 간 구조적 관계

Objectives The purpose of this study is to reveal the structure and influence between the mother's role in the family-of-origin health, mother's differentiation of self, marital conflict, and problem behavior of early childhood. Methods For this purpose, a questionnaire was distributed to 435 children attending early childhood education institutions located in S and G to measure the variables of childhood child problem behavior, mother's family-of-Origin health, mother's differentiation of self, and marital conflict. In the structural equation model, the independent variable was the mother's family-of-Origin health as the mediating variable, differentiation of self and marital conflict dependent variables were selected as the externalization problem behavior and internalization problem behavior of early children. Results Mothers’ family-of-Origin health had a positive effect on the level of mother’s differentiation of self, and mother’s differentiation of self had a negative effect on children’s externalizing and internalizing problem behaviors. Couple conflict had a positive effect on the externalization and internalization problem behaviors of children in early childhood. Mothers' family-of-Origin health fully mediated the level of mother's differentiation of self in the externalizing and internalizing problem behaviors of children in early childhood. In addition, it was found that marital conflict and mother differentiation of self between the and the externalization and internalization problem behaviors of the infant children had an indirect effect on the externalization and internalization problem behavior of early childhood. Conclusions For this reason, it was verified that differentiation of self in the mother is an important factor in preventing and reducing problem behavior of early childhood, Based on the results of this study, various measures were sought to prevent and reduce problem behavior of early childhood.

Family Socioeconomic Status and Internalizing Problem Behavior Among Chinese Adolescents: The Chain Mediation Effect of Academic Performance and Peer Conflict.

This study aims to provide a new perspective on the relationship between family socioeconomic status (SES) and internalizing problem behavior (IPB) among adolescents. Many studies have focused on the relationship between family SES and IPB among adolescents; however, research on the underlying mechanism is still insufficient, and peer conflict has been ignored as a crucial social relationship factor for adolescents. This study identifies two new mediating variables and a chain mediating mechanism model between them. Using national longitudinal data from 2,467 adolescents aged 10–15 published in the China Family Panel Studies of wave 2018, this study found the following: (1) higher family SES can significantly reduce peer conflict and IPB among adolescents; (2) adolescents with better academic performance were less likely to be involved in peer conflict; (3) peer conflict mediated 30.41% of the relationship between family SES and adolescent’s IPB; and (4) there was a chain mediating mechanism, and the mediating effect of peer conflict was much stronger than the mediating effect of both academic performance and the chain mediation pathways. This is the first study to develop a chain mediation model to examine the roles of academic achievement and peer conflict in the relationship between family SES and IPB. These findings are significant in that they highlight the importance of providing adolescents with proper emotional de-escalation and peer conflict resolution strategies, contributing to the management of adolescent mental health in urban governance and rural development.

My Child Likes to be with People: Sociability Trajectories from age 2 to age 4 and Behavior Problems at First Grade

ABSTRACT This study aims to identify early childhood sociability trajectories and examine their longitudinal associations with behavior problems. Using a population-based data set presented by the Panel Study on Korean Children, sociability trajectories from age 2 to age 4 were identified by latent class growth analysis. Associations between sociability trajectories and behavior problems at first grade were examined with binary logistical regressions. Research Findings: Korean children developed one of the three sociability patterns: low (10.059%), moderate (66.185%), or high (23.756%). Children’s behavior problems at first grade differed according to their early sociability trajectories. First graders with the low sociability trajectory in early childhood were vulnerable to internalizing problems, such as affective or anxiety problems. Practice and Policy: A persistent low preference for being with others observed in early childhood can be a meaningful marker in predicting later internalizing behavior problems.

Impact of COVID-19-related Stress on Preschool Children's Internalizing and Externalizing Problem Behaviors: The Indirect Effect of Mother's Depression and Parenting Behavior.

The COVID-19 pandemic is affecting families and children worldwide. Experiencing the pandemic leads to stress in families resulting from fear of infection and social isolation derived from social distancing. For families raising preschoolers, the prolonged closure of childcare centers puts additional childcare burden on family members, especially mothers. Due to the limited research exploring the impact of COVID-19 on preschool children’s problem behaviors, this study examines the association between stress due to COVID-19 and preschool children’s internalizing and externalizing problem behaviors related to mother’s depression and parenting behavior. The study sample included data collected from 316 South Korean mothers raising preschool-aged children aged 3 to 5. The study findings suggest that mother’s COVID-19 stress was indirectly associated with preschool children’s internalizing and externalizing problem behaviors resulting from the mother’s depression and parenting behaviors, although the direct effect of COVID-19 stress on preschool children’s outcomes was not statistically significant. Increase in mother’s COVID-19 stress was associated with increase in depression, and sequentially decreased positive parenting behaviors, which in turn resulted in preschool children’s internalizing and externalizing problem behaviors. The study findings highlight the need to focus on enhancing mental health of mothers and preschool children’s adjustment by implementing supportive interventions to reduce the adverse impacts of the prolonged COVID-19 pandemic.

Effectiveness of psychosocial intervention for internalizing behavior problems among children of parents with alcohol dependence: Randomized controlled trial.

BACKGROUNDParental drinking has a direct bearing on children. Behavioral problems such as anxiety and depression are common problems among children whose parents drink heavily. Psychosocial interventions have shown promising results for anxiety and depression among children; however, few studies have been conducted in the context of children of parents with alcohol dependence in India.AIMTo evaluate the efficacy of psychosocial intervention for internalizing behavioral problems among children of parents with alcohol dependence.METHODSA randomized controlled trial with a 2 × 4 factorial design was adopted with longitudinal measurement of outcomes for 6 mo. Two-hundred and eleven children who met the eligibility criteria (at least one parent with alcohol dependence) at government high schools in Bangalore, India, were randomized to the experimental (n = 97) or control group (n = 98). The psychosocial intervention was administered to the experimental group in eight sessions (biweekly) over 4 wk after baseline assessment. The intervention focused on identifying and modifying negative thoughts, replacing thinking errors with realistic alternatives, modification of maladaptive behavior, developing adaptive coping skills and building self-esteem. The data was collected pre-intervention and at 1, 3 and 6 mo after the intervention. Data were analyzed using SPSS 28.0 version. RESULTSMean age of the children was 14.68 ± 0.58 years, 60.5% were male, 56% were studying in 9th standard, 70.75% were from nuclear families, and mean family monthly income was 9588.1 ± 3135.2 INR. Mean duration of parental alcohol dependence was 7.52 ± 2.94 years and the father was the alcohol-consuming parent. The findings showed that there were significant psychosocial intervention effects in terms of decreasing anxiety and depression scores, and increasing self-esteem level among experimental group subjects over the 6-mo interval, when compared with the control group (P < 0.001). CONCLUSIONThe present study demonstrated that the psychosocial intervention was effective in reducing anxiety and depression, and increasing self-esteem among children of parents with alcohol dependence. The study recommends the need for ongoing psychosocial intervention for these children.

Intergenerational Continuity of Risk: Examining Pathways From Parental Mental Health to Children’s Behavioral Health Problems Among Families Investigated for Maltreatment

Objective: Children exposed to maltreatment are a vulnerable population with disproportionately high rates of adverse outcomes, including internalizing and externalizing behavior problems. Parental risk characteristics, such as poor mental health, may help to explain the health and developmental trajectories of children who have experienced maltreatment. This study examined the hypothesis that specific parenting behaviors mediate the association between parental mental health and children’s behavioral health outcomes among families investigated for maltreatment. Method: We used data from parent interviews from Waves 1 and 3 of the National Survey of Child and Adolescent Well-Being II (N = 1,192) to measure parenting behavior pathways from parental mental health to children’s behavioral health. Results: Path analyses indicated statistically significant direct effects of poor parental mental health on neglectful, psychologically aggressive, and physically assaultive parenting and on children’s internalizing and externalizing behavior problems. We found statistically significant indirect effects from poor parental mental health to internalizing behavior problems through neglectful and psychologically aggressive parenting, and from poor parental mental health to externalizing behavior problems through psychologically aggressive parenting. Conclusion: Results suggest that specific parenting behaviors partially mediate the relationship between parental mental health and children’s behavioral health outcomes. Findings suggest the need to target specific parenting behaviors to reduce children’s internalizing and externalizing behavior problems and promote health and development across generations.

Association of Antenatal Micronutrient Supplementation With Adolescent Emotional and Behavioral Health: A 14-Year Follow-Up of a Double-Blind Randomized Controlled Trial

Abstract Objectives To examine the impact of antenatal micronutrient supplementation on adolescent emotional and behavioral health, and to identify the modifying effect of household wealth. Methods We conducted a double-blind cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2008. Pregnant women in every village were randomized to daily take one capsule of folic acid (as control), folic acid plus 60 mg iron (IFA), and multiple micronutrients (MMNs) including 30 mg iron. Singleton births were prospectively followed at early adolescence in 2016. Adolescents actively completed the localized and qualified Youth Self-Report. Scores of Internalizing Behavior Problems (constituting by Anxious/Depressed, Withdrawn and Somatic Complaints), Externalizing Behavior Problems (constituting by Delinquent/Rule-Breaking Behavior and Aggressive Behavior) and Total Behavior Problems, were derived. As priorly specified, we examined the modifying effect of household wealth on the response to antenatal IFA and MMNs vs. folic acid supplementation on adolescent emotional and behavioral health. Results Of 1920 adolescents included in the final analysis, 1130 (58.9%) were male, with a mean (SD) age of 11.8 (0.78) years. As compared to folic acid, adolescents born to mothers who consumed IFA had lower scores of total behavioral problems, externalizing, rule-breaking and aggressive behavior. The adjusted mean differences were −2.94 (95% CI −5.78, −0.11), −1.00 (95% CI −1.82, −0.18), −0.39 (95% CI −0.73, −0.05) and −0.61 (95% CI −1.15, −0.07), respectively. Similar associations were observed among medium-wealth households, while null associations in low-wealth households (all interaction P values &amp;lt; 0.05). Further, among high-wealth households, MMNs show benefits on reducing the risk of adolescent behavioral problems as compared to IFA or folic acid. Conclusions Sufficient iron intake in pregnancy has long-term benefits on reducing the risk of adolescent behavioral problems. Multiple micronutrients including 60 mg iron are recommended in rural areas with micronutrients deficiencies widely prevalent given the benefits of MMNs on improving birth outcomes. Funding Sources National Natural Science Foundation of China and China Postdoctoral Science Foundation.

Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020

Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020 Abstract. Objective: Studies show a high prevalence of mental health problems in children and adolescents in youth-welfare facilities compared to the general population. However, to date, studies on this development over time are lacking. The present study examines the development of mental health problems and psychosocial functioning in the years 2008 to 2020. Method: Mental health problems were assessed with the CBCL, psychosocial functioning with Axis VI of the MAS. In total, data from 3,269 children and adolescents from residential-care facilities located throughout Germany were included in the analysis. Results: a decrease in externalizing behaviour was observed regarding the frequency of mental health problem in children and adolescents in youth-welfare facilities from 2008 to 2020. Particularly boys aged 12 and older show less deviant behavior. Older girls show high internalizing behavior problem scores over time, but there is no consistent trend. More than a quarter of the institutionalized children in youth-welfare institutions show severely impaired psychosocial functioning at a consistent level over time. Conclusions: In light of the age and gender effects associated with the development of mental health problems over time, there is a need to regard the care situation in youth-welfare institutions.

Maternal use of corporal punishment and behavior problems in early childhood: A sibling comparison analysis

BackgroundPrevious research demonstrates that there are environmental and genetic factors associated with the use of corporal punishment (CP) and children's behavior problems. Thus, it is difficult to disentangle whether CP has a causal effect on children's developmental outcomes. ObjectiveThis study explored the relationship between maternal use of CP at ages 3–4 years and symptoms of internalizing and externalizing behavior problems between the ages of 6 and 9 years using a sibling comparison design. In doing so, we were able to control for shared environmental factors and partially control for genetic factors that could explain the relationship between CP and behavior problems. MethodsThis study analyzed data from 11,506 children from the United States. We used generalized linear models to assess the relationship between the use of CP and behavior problems among biological siblings raised in the same home. ResultsAt the population level, CP was significantly associated with the development of internalizing behavior problems (β = 0.134, SE = 0.03, p < .001). When comparing siblings, this relationship was no longer significant. In contrast, CP was significantly associated with externalizing behavior problems at both the population (β = 0.233, SE = 0.02, p < .001) and sibling comparison level (β = 0.107, SE = 0.03, p < .001). ConclusionWe did not find evidence to suggest that the association between CP and externalizing behavior problems is due to environmental and genetic factors exclusively. Corroborating previous research, these results suggest that CP may increase the likelihood of externalizing behavior problems.