Child Mental Health Symptoms Research Articles

Mental health concerns in children with neurodevelopmental conditions attending a developmental assessment service

Children with neurodevelopmental conditions (NDCs), such as autism and attention-deficit/hyperactivity disorder (ADHD), frequently experience co-occurring mental health concerns. Little research has examined mental health symptoms in children attending developmental assessment services. This study profiled mental health symptoms in children with NDCs attending a hospital-based diagnostic service for their first diagnostic and developmental assessment. Participants were 232 children aged 1.96–17.51 years. Mental health concerns were assessed using the Child Behavior Checklist (CBCL), a caregiver-rated, questionnaire-based assessment of behavioural and emotional difficulties. Subclinical or clinically elevated internalising, externalising and total scores on the CBCL were reported in approximately 48% of preschool and 61% of school-age children. These increased prevalence rates, using the same cutoff scores, remained after excluding items specifically relating to neurodevelopmental concerns (36% preschool; 37% school-age children). More school-aged females reported elevated internalising problems, relative to males (67 % vs 48 %). The number of diagnoses impacted symptoms, with children who received two or more DSM-5 diagnoses showing a greater rate of subclinical or clinically elevated scores, relative to children who received one DSM-5 diagnosis. Our findings demonstrate that children attending developmental assessment services have considerable mental health needs. It is critical that mental health concerns are identified and addressed in children when they first present to developmental assessment services, and that service providers are equipped to provide appropriate resources and pathways to ongoing care.

The role of language in mental health during the transition from primary to secondary education.

We report a preregistered analysis to test whether children meeting diagnostic criteria for language disorder (LD) have higher self-reported and/or parent-reported mental health symptoms during the transition from primary to secondary education. Data are from a UK-based longitudinal cohort study, The Surrey Communication and Language in Education Study (SCALES). SCALES oversampled children at risk of LD at school entry. Language was measured using a battery of standardised assessments in Year 1 (age 5-6 years, n = 529), and mental health symptoms were measured using self and parent report in Year 6 (age 10-11 years, n = 384) and Year 8 (age 12-13 years, n = 246). Social experiences were also measured using self-report measures in Year 6. Mental health symptoms were stable during the transition from primary to secondary school. Symptom rates did not differ between children with and without LD based on self-report, but children with LD had higher parent-reported mental health symptoms than their peers with typical language. Similarly, early language was negatively associated with parent-reported but not self-reported mental health symptoms. Early language was associated with fewer child-reported positive social experiences in Year 6, but social experiences did not mediate the association between language and mental health. We found poor agreement between parent and self-reported child mental health symptoms across language groups. Future studies should aim to determine sources of disagreement between parent and child report, particularly for children with communication difficulties who may struggle to accurately self-report mental health symptoms.

Autistic characteristics and mental health symptoms in autistic youth during the first COVID-19 wave in Canada.

Autistic youth are at heightened risk for mental health issues, and pandemic-related stressors may exacerbate this risk. This study (1) described caregiver-reported youth mental health prior to and during the pandemic; and (2) explored individual, caregiver, and environmental factors associated with changes in autistic characteristics, social-emotional symptoms, and overall mental health. 582 caregivers of autistic children (2-18 years old) completed an online survey between June and July 2020 in which they provided demographic information, their child's pre-COVID and current mental health, autistic characteristics, and social-emotional symptoms. Caregivers also rated their own perceived stress, and COVID-related household and service disruption. According to caregivers, youth experienced more autistic characteristics and social-emotional concerns during the pandemic. Autistic youth were also reported to experience poorer overall mental health during the pandemic than before the pandemic. Older youth whose caregiver's indicatedhigher perceived stress and greater household disruption were reported to experience more autistic traits during pandemic. Caregiver-reported increases in youth social-emotional symptoms (i.e., behavior problems, anxiety, and low mood) was associated with being older, the presence of a pre-existing mental health condition, higher caregiver stress, and greater household and service disruption. Finally, experiencing less household financial hardship prior to COVID-19, absence of a pre-existing psychiatric condition, less caregiver stress, and less service disruption were associated with better youth pandemic mental health. Strategies to support the autistic community during and following the pandemic need to be developed. The developmental-ecological factors identified in this study could help target support strategies to those autistic youth who are most vulnerable to mental health problems.

The impact of the initial COVID-19 lockdown on the mental health and lifestyle of children in Turkey

The COVID-19 lockdown and subsequent school closures increased children’s mental health difficulties and associated risk of school exclusion. The present study examined the changes in children’s daily habits, and emotional and behavioral symptoms during the first national lockdown in 2020 as compared to before. A total of 854 caregivers living in Turkey with children aged 5 to 12 years completed a survey. The results showed that children spent significantly more time using screens, and less time engaging in physical activity during the lockdown compared to before. Additionally, one in three children were reported as feeling bored. Approximately half of the children were reported to show signs of nervousness, anger, anxiety, worry, restlessness, irritability, argumentativeness, and fear of infection. The children whose caregivers reported more family coexistence difficulty, higher risk of COVID-19 infection, poorer mental health, and high parenting role stress experienced higher levels of emotional and behavioral difficulties during the lockdown as compared to before. Children’s pandemic-related emotional symptoms increased with age. Our findings suggested that the COVID-19 lockdown in Turkey had a negative impact on children’s socioemotional and behavioral wellbeing with pre-adolescents being at higher risk of emotional change during the lockdown. These findings can guide early prevention and intervention programs to address child mental health symptoms in Turkey

Exploring the relationship between parent mental health and parent–child emotion reminiscing

ABSTRACT This study examines how parents’ mental health symptoms, emotion regulation and mindfulness relate to parent–child reminiscing conversations about past emotional events. Fifty-four children aged 8–12 years and their parents were recruited from a child psychology clinic (n = 28) and local schools (n = 26). Dyad’s reminiscing conversations were recorded, transcribed, and coded for elaboration style, emotion content and emotion closure. Child language ability and mental health symptoms were measured, as was parent mindfulness, emotion regulation and mental health symptoms. Mindfulness acting with awareness was a unique predictor of dyad emotion closure. Depression, anxiety, and stress symptoms were not directly related to elaborative reminiscing, however, moderation by clinical status revealed a negative relationship for the community children only. These findings suggest a more complex relationship at play between parent and child mental health in reminiscing within clinical populations. Implications of these findings for a growing body of reminiscing interventions are discussed.

Mental Health Trajectories of Latinx Female Caregivers and Young Children During COVID-19: A Longitudinal Analysis.

Studies of the impact of COVID-19 on mental health symptoms suggest that there may be a unique impact of COVID-19 on minoritized individuals, young children (children five and younger), and their caregivers. Longitudinal studies with representative samples including minoritized populations are needed to accurately reflect the experience of families during COVID-19. The current study used a longitudinal design to assess trajectories of mental health among Latinx female caregivers and their young children over time, beginning prior to the onset of the COVID-19 pandemic and over the course of 12 months. In fall of 2019, Latinx female caregivers (N = 213; 93.0% biological mother) of young children (M age = 5.38, SD = 0.34) reported on their own and their child's (52.6% female) mental health symptoms, as well as parenting stress, at three time points through Fall of 2020. Growth curve models showed that self-report of caregiver global mental health worsened over time, though caregiver depression and parenting stress did not change significantly, nor did caregiver-report of their children's mental health. Results suggest that while female caregiver well-being was adversely affected by COVID-19, caregivers showed resilience in the face of this pandemic, which in turn may have buffered the impact of the pandemic on Latinx child mental health. Methodological and contextual implications of these results are considered.

Population heterogeneity in developmental trajectories of internalising and externalising mental health symptoms in childhood: differential effects of parenting styles.

Multiple studies have connected parenting styles to children's internalising and externalising mental health symptoms (MHS). However, it is not clear how different parenting styles are jointly influencing the development of children's MHS over the course of childhood. Hence, the differential effects of parenting style on population heterogeneity in the joint developmental trajectories of children's internalising and externalising MHS were examined. A community sample of 7507 young children (ages 3, 5 and 9) from the Growing Up in Ireland cohort study was derived for further analyses. Parallel-process linear growth curve and latent growth mixture modelling were deployed. The results indicated that the linear growth model was a good approximation of children's MHS development (CFI = 0.99, RMSEA = 0.03). The growth mixture modelling revealed three classes of joint internalising and externalising MHS trajectories (VLMR = 92.51, p < 0.01; LMR = 682.19, p < 0.01; E = 0.86). The majority of the children (83.49%) belonged to a low-risk class best described by a decreasing trajectory of externalising symptoms and a flat low trajectory of internalising MHS. In total, 10.07% of the children belonged to a high-risk class described by high internalising and externalising MHS trajectories, whereas 6.43% of the children were probable members of a mild-risk class with slightly improving yet still elevated trajectories of MHS. Adjusting for socio-demographics, child and parental health, multinomial logistic regressions indicated that hostile parenting was a risk factor for membership in the high-risk (OR = 1.47, 95% CI 1.18-1.85) and mild-risk (OR = 1.57, 95% CI 1.21-2.04) classes. Consistent (OR = 0.75, 95% CI 0.62-0.90) parenting style was a protective factor only against membership in the mild-risk class. In short, the findings suggest that a non-negligible proportion of the child population is susceptible to being at high risk for developing MHS. Moreover, a smaller proportion of children was improving but still displayed high symptoms of MHS (mild-risk). Furthermore, hostile parenting style is a substantial risk factor for increments in child MHS, whereas consistent parenting can serve as a protective factor in cases of mild-risk. Evidence-based parent training/management programmes may be needed to reduce the risk of developing MHS.

Urban factors and mental health symptoms in children of the Tokyo Early Adolescence Survey; impact of proximity to railway stations

IntroductionThere is an evolving literature on the association of the proximity of place of residence to specific urban features with mental health symptoms or diagnoses, although few studies have examined these associations in children. This study tested the hypothesis that proximity of home to railway stations is a positive predictor of mental health at age 10 years. MethodsWe used data from a large population-based survey conducted in three municipalities in Tokyo, Japan, the Tokyo Early Adolescence Survey. We examined relationships between distance from home to the nearest railway station and Strengths and Difficulties Questionnaire (SDQ) scores for hyperactivity/inattention, prosocial behaviour and emotional symptoms. We undertook unadjusted analyses and then adjusted for urban, child and parental co-variates. Analyses were performed both in the whole sample and after stratification by child gender. Multiple Imputation with Chained Equations was used for missing data analyses. ResultsGreater distance to the nearest railway station was associated with higher SDQ-derived hyperactivity/inattention scores (i.e. more symptoms) in the unadjusted analysis across all 4052 analyzable children (β = 0.144, 95% C.I. 0.013 to 0.276, p = 0.031), and in the fully adjusted analysis in boys (β = 0.186, 95% C.I. 0.001 to 0.372, p = 0.049) but not in girls (β = 0.020, 95% C.I. −0.146 to 0.185, p = 0.817). There were no associations with the other SDQ-based outcomes of prosocial behaviour and emotional symptoms. ConclusionsThese findings suggest that access to high-frequency rail transit may be associated with improved hyperactivity/inattention outcomes in children living in urban environments, raising the possibility that an additional benefit of transit-oriented developments in urban settings may be a positive impact on this important aspect of children's mental health.

Disruption to Education During COVID-19: School Nonacademic Factors Are Associated with Children's Mental Health.

Few studies have examined aspects of the school environment, beyond modality, as contributors to child and youth mental health during the coronavirus pandemic. We investigated associations between nonacademic school experiences and children's mental health. Parents of children ages 6 to 18 years completed online surveys about school experiences (November 2020) and mental health (February/March 2021). Parent-reported and child-reported school experiences (i.e., nonacademic factors) included school importance, adapting to public health measures, and school connectedness. Children's mental health symptoms of depression, anxiety, inattention, and hyperactivity were collected using standardized parent-reported measures. Children's (N = 1052) self-reported and parent-reported nonacademic factors were associated with mental health outcomes, after adjusting for demographics and previous mental health. Lower importance, worse adapting to school changes, and less school connectedness were associated with greater depressive symptoms ( B = -4.68, CI [-6.04, -3.67] to - 8.73 CI [-11.47, 5.99]). Lower importance and worse adapting were associated with greater anxiety symptoms ( B = - 0.83 , CI [-1.62, -0.04] to -1.04 CI [-1.60, -0.48]). Lower importance was associated with greater inattention (B = -4.75, CI [-6.60, -2.90] to -6.37, CI [-11.08, -7.50]). Lower importance and worse adapting were associated with greater hyperactivity (B = -1.86, CI [-2.96, -0.77] to -4.71, CI [-5.95, -3.01]). Schools offer learning opportunities that extend beyond curriculum content and are a primary environment where children and youth develop connections with others. These aspects of school, beyond academics, should be recognized as key correlates of child and youth mental health.

Social Disparities in Mental Health Service Use Among Children and Youth in Ontario: Evidence From a General, Population-Based Survey.

To examine differences in mental health-related service contacts between immigrant, refugee, racial and ethnic minoritized children and youth, and the extent to which social, and economic characteristics account for group differences. The sample for analyses includes 10,441 children and youth aged 4-17 years participating in the 2014 Ontario Child Health Study. The primary caregiver completed assessments of their child's mental health symptoms, perceptions of need for professional help, mental health-related service contacts, experiences of discrimination and sociodemographic and economic characteristics. Adjusting for mental health symptoms and perceptions of need for professional help, children and youth from immigrant, refugee and racial and ethnic minoritized backgrounds were less likely to have mental health-related service contacts (adjusted odds ratios ranged from 0.54 to 0.79), compared to their non-immigrant peers and those who identified as White. Group differences generally remained the same or widened after adjusting for social and economic characteristics. Large differences in levels of perceived need were evident across non-migrant and migrant children and youth. Lower estimates of mental health-related service contacts among immigrant, refugee and racial and ethnic minoritized children and youth underscore the importance and urgency of addressing barriers to recognition and treatment of mental ill-health among children and youth from minoritized backgrounds.

Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial.

Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms. This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors. Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022. The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety. ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933. DERR1-10.2196/40707.

1.60 School Professional and Caregiver Understanding of Causes of Mental Health Concerns in Rural Darjeeling, India

1.60 School Professional and Caregiver Understanding of Causes of Mental Health Concerns in Rural Darjeeling, India

Participating in extracurricular activities and school sports during the COVID-19 pandemic: Associations with child and youth mental health.

In Ontario, Canada, school extracurricular activities and sports were modified or canceled for a prolonged period due to public health restrictions resulting from the COVID-19 pandemic. The present study aims to examine the association of changes to extracurricular and sport participation and child and youth mental health. Data were collected on child and youth mental health symptoms (n = 908) and participation in extracurricular activities and sports in the 2019–2020 and 2020–2021 academic years. Results indicated that pre-COVID (2019–2020) participation in either extracurricular activities or sports was associated with reduced anxiety, inattention, and hyperactivity during the pandemic (β range −0.08 to −0.11, p < 0.05). Participation in either extracurricular activities or sports during-COVID (2020–2021) was associated with lower depressive symptoms (β range −0.09 to −0.10, p < 0.05). Findings suggest that participation in extracurricular activities and/or school sports both before or during the COVID-19 pandemic were associated with better mental health outcomes in children and youth. Implications of this work consider future situations where restrictions on extracurricular and sport participation are reinstated and the impact of child and youth mental health.

Children and Adolescents' Mental Health Following COVID-19: The Possible Role of Difficulty in Emotional Regulation.

The COVID-19 pandemic has shattered routines throughout the world, creating closures and social isolation. Preliminary studies conducted during the pandemic have shown that children and adolescents are mainly affected by social distancing and the lack of a supportive framework. The purpose of the present study was to compare mental health symptoms of 430 children and adolescents who sought mental health services in the community before vs. during the pandemic. The study examined children's perceived burden of the pandemic, reports of emotional and behavioral problems (SDQ) anxiety (SCARED), depressed moods (SMFQ-C), and difficulty in emotional regulation (DERS), as well as intervening variables such as age and gender. Furthermore, the effect of difficulty in emotional regulation on children's mental health symptoms was explored. Findings indicate an increase in all mental health symptoms excluding anxiety, during the pandemic. Boys reported more difficulty in emotional regulation during the pandemic than before, and girls reported more emotional and behavioral problems. Children reported an increase in emotional and behavioral problems and adolescents in peer relationship problems. Difficulty in emotional regulation predicted all mental health symptoms in both samples, more so in girls and adolescents. These initial findings support the need for further studies to examine the long-term mental health effects of COVID-19 pandemic on children and adolescents.

Parental surveillance of OCD and mental health symptoms during COVID-19: A longitudinal study of Australian children, adolescents and families

To ensure the needs of children and families are met for the remainder of the COVID-19 situation and beyond there is a demand for a specific response strategy. This longitudinal study will investigate the impact of COVID-19 on Australian parental and childhood mental health symptoms, particularly OCD symptoms, examining the stability of this relationship over time and the needs and preferences for mental health support in response to child symptoms. A total of 141 parents completed a questionnaire during the lockdown period in Australia (June–September 2020). Thirty-five of them completed a follow-up questionnaire during the post-lockdown period (November 2020–January 2021). The questionnaire assessed COVID-19 experiences/worries/knowledge, child OCD, and child/parental anxiety and depression. Sub-samples of youth were determined based on parent-report of an existing diagnosis of any mental health (n = 24), of OCD (n = 22), or no mental health diagnosis (i.e., healthy, n = 81). Results: Parents reported a significant positive association between increased parental worries regarding COVID-19, and their own as well as their child's mental health symptoms. The current sample of children experienced elevated symptom severity for OCD symptoms during COVID-19. The OCD group reported significant reductions in child OCD symptoms at post-lockdown. The any mental health diagnosed children are at greater risk of developing OCD symptoms and reported strong preferences for increased support as a result. The exploratory nature of this study adds further insight into the impact of the COVID-19 pandemic on child OCD and parent mental health symptoms and the stability of symptoms over time.

A multi-group confirmatory factor analysis of the revised children's anxiety and depression scale (RCADS) in Spain, Chile and Sweden

BackgroundThere is a need for a measure that can be used across countries and cultures to advance cross-cultural research about internalizing mental health symptoms in children and adolescents. The Revised Children's Anxiety and Depression Scale (RCADS) is a potential candidate, but no study has examined whether its scales are measured similarly in youth populations from different countries. MethodsIn this study, we use confirmatory factor analysis (CFA) and multi-group CFA to examine the cross-cultural properties of a short and free to use 30-item version of RCADS that assesses social, generalized, panic, and separation anxiety alongside depression and obsessive-compulsive symptoms. We tested the factor structure of RCADS in children and adolescents from Chile, Spain, and Sweden, recruited using different research designs (i.e., school-based studies and an anonymous web survey), and whether the factor structure showed measurement invariance across the three countries. ResultsThe proposed factor structure of RCADS showed good model/data fit in all three countries and was superior to a unidimensional model in which correlations among scale items were explained by a single broad internalizing factor. Each RCADS subscale showed adequate to excellent internal consistency in all three countries and multi-group CFA supported scalar invariance across the three countries. LimitationsNo clinical sample was included. ConclusionsThis study provides an important first step in supporting the use of RCADS in cross-cultural research on depression, anxiety and obsessive-compulsive symptoms in children and adolescents, but more work on validity aspects of the scale across cultures is needed.

Mental health symptoms in children and adolescents during COVID-19 in Australia.

COVID-19 has led to disruptions to the lives of Australian families through social distancing, school closures, a temporary move to home-based online learning, and effective lockdown. Understanding the effects on child and adolescent mental health is important to inform policies to support communities as they continue to face the pandemic and future crises. This paper sought to report on mental health symptoms in Australian children and adolescents during the initial stages of the pandemic (May to November 2020) and to examine their association with child/family characteristics and exposure to the broad COVID-19 environment. An online baseline survey was completed by 1327 parents and carers of Australian children aged 4 to 17 years. Parents/carers reported on their child's mental health using five measures, including emotional symptoms, conduct problems, hyperactivity/inattention, anxiety symptoms and depressive symptoms. Child/family characteristics and COVID-related variables were measured. Overall, 30.5%, 26.3% and 9.5% of our sample scored in the high to very high range for emotional symptoms, conduct problems and hyperactivity/inattention, respectively. Similarly, 20.2% and 20.4% of our sample scored in the clinical range for anxiety symptoms and depressive symptoms, respectively. A child's pre-existing mental health diagnosis, neurodevelopmental condition and chronic illness significantly predicted parent-reported child and adolescent mental health symptoms. Parental mental health symptoms, having a close contact with COVID-19 and applying for government financial assistance during COVID-19, were significantly associated with child and adolescent mental health symptoms. Our findings show that Australian children and adolescents experienced considerable levels of mental health symptoms during the initial phase of COVID-19. This highlights the need for targeted and effective support for affected youth, particularly for those with pre-existing vulnerabilities.

Exploring Mental Health and Academic Outcomes of Children Receiving Non-manualized, Transdiagnostic, Task-Shifted Mental Health Care From Their Teachers in a Low-and-Middle Income Country

A majority of children worldwide who face mental health difficulties, especially in low-and-middle income countries, remain undiagnosed and untreated. This deficit roots in part from a lack of trained professionals qualified to provide care. Task-shifting the provision of treatment to teachers, individuals with consistent access to children, can reduce the care gap. The current study investigated whether the implementation of a pilot trial of Tealeaf-Mansik Swastha (Teachers Leading the Frontlines—Mental Health; “Tealeaf”) was associated with improvements in child mental health and academic outcomes. Tealeaf is a transdiagnostic, non-manualized, task-shifting intervention in which teachers identify students in need of mental health care and then provide task-shifted care for them using an emerging, novel therapy modality, “education as mental health therapy” (Ed-MH). Pre-post standardized quantitative measures focused on child mental health status and academics. The measures were completed by multiple raters and compared to determine whether changes occurred. Results indicated that primary teacher raters observed significant improvements in child mental health symptoms overall, while secondary teacher raters and caregivers noted improvement for certain diagnostic categories. Caregivers observed on average a decreased impact of their children's mental health symptoms on their children's lives. Academically, math scores significantly improved while reading trended toward significance. Preliminary evidence overall supports the viability of Tealeaf and Ed-MH for positively impacting child mental health and academics. Future directions include the implementation of a formalized, randomized-controlled trial to strengthen preliminary outcomes.

The relationship between physical and mental health multimorbidity and children’s health-related quality of life

PurposeTo examine the relationships between physical health problems, and borderline or clinical levels of mental health symptoms and children’s health-related quality of life (HRQoL).MethodsData were from the Longitudinal Study of Australian Children (2004–2018). Parents reported on their child’s HRQoL (PedsQL), physical health problems and mental health symptoms (Strengths and Difficulties Questionnaire, SDQ). A pooled cross-sectional analysis using linear regressions examined the relationships between physical health and clinical/borderline mental health symptoms, individually and when multi-morbid, and children’s HRQoL, and whether these relationships vary by a range of child, family and social factors.ResultsThe sample comprised 47,567 observations of children aged 4–17 years. Borderline and clinical levels of mental health symptoms were associated with significantly lower HRQoL, equal to more than two-times (10.5 points) and more than three-times (16.8 points) the clinically meaningful difference, respectively. This was a larger difference than that associated with physical health problems (4.4 points). We found a significant interaction effect between physical health problems and clinical mental health symptoms which was associated with even poorer HRQoL after accounting for the individual relationships of both problems. Mental health problems were associated with poorer HRQoL for older versus younger children; and the interaction effect was significant for boys but not girls.ConclusionFindings highlight the importance of identifying and addressing mental health symptoms in children of all ages, even if these problems do not meet formal clinical criteria. Particular attention should be paid to the mental health and HRQoL of children with physical–mental multimorbidity, who are at risk of disproportionately poorer HRQoL.

Developmental pathways from toddler difficult temperament to child generalized psychopathology and adult functioning

BackgroundEarly difficult temperament and child mental health problems are consistently associated with impaired functioning in adulthood. We examined three potential pathways between difficult temperament in toddlerhood (age 2) and depressive symptoms (ages 21–23) and well-being (age 23): i) direct – early difficult temperament directly associates with these outcomes, ii) mediated – these direct effects are also mediated by a general psychopathology factor in late childhood/early adolescence (GPF; ages 7, 10,and 13), and iii) moderated-mediated – these mediated effects are also moderated by negative (age 42 months) and positive (age 33 months) parenting behaviors. MethodsThe analytic sample included 1892 mother-child dyads (33.4% male children) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Mothers reported on their child's difficult temperament, negative parenting, positive parenting, and child's mental health symptoms. In adulthood, participants reported their own depressive symptoms and well-being (i.e. mental well-being, life satisfaction, happiness). ResultsFirst, early difficult temperament associated directly and positively with depressive symptoms, but negatively with well-being in adulthood. Second, the GPF in late childhood/early adolescence mediated these direct associations. Third, the mediated pathways were not moderated by negative or positive parenting. Limitationsi) low risk community sample, ii) early risks are based on maternal reports. ConclusionsTemperament is a risk factor for impaired psychosocial functioning in adulthood, manifested through increased susceptibility to psychopathology in childhood/adolescence. Although more research is needed to test their generalizability, these findings suggest that targeting early difficult temperament may alleviate the risk for later mental health difficulties and may increase general well-being.