Oppositional Defiant Problems Research Articles

Predictive associations of executive functions and oppositional defiant problems and obsessive-compulsive problems in preschoolers

ABSTRACT Oppositional defiant problems (ODP) and obsessive-compulsive problems (OCP) may co-occur in children, though the way they interact is not known. The aim of the study was to examine longitudinal associations between executive functions at age 3 and ODP, ODP dimensions, and OCP at age 6. The sample consisted of 622 preschoolers (50% were boys) from the general population. Executive functions were assessed by teachers using the Behavior Rating Inventory of Executive Functioning – Preschool version questionnaire when children were 3 years old, and ODP and OCP were informed by parents and teachers at the age of 6 years. Multiple linear regression analyses indicated that higher Inhibit and Emotional Control and lower Shift deficits were associated with higher ODP reported by teachers, while higher Shift but lower Inhibit deficits were related to higher OCP. Moreover, ODP and OCP shared difficulties on the Flexibility Index, which means that the capacity to modulate emotions and behavior according to contextual and environmental demands is compromised in both disorders. The findings inform etiology and prevention, pointing out not only the executive function specificities related to each problem, but also common cognitive challenges related to Flexibility. Young children could benefit from training and programs designed to improve executive function processes at an early age to prevent later behavioral difficulties.

Adherence to the Mediterranean diet during pregnancy and behavioural problems at 4 years of age.

There is an increasing prevalence of psychological issues in childhood. Lifestyle factors during pregnancy, including maternal nutrition, have been linked to children's behavioural development. This study aims to assess the impact of adherence to the Mediterranean diet during pregnancy on the behavioural problems of children at the age of 4. A total of 231 mother-child pairs were assessed. Maternal adherence to the Mediterranean diet during pregnancy was estimated using a relative Mediterranean Diet Score (rMED). Behavioural outcomes were evaluated through the Child Behaviour Checklist 1½--5, Teacher's Report Form 1½-5, and Behaviour Rating Inventory of Executive Function-Preschool Version questionnaires. The results indicated that a higher rMED score during pregnancy was associated with a reduced probability of obtaining a clinical score for total problems (OR = 0.42; 95%IC from 0.21 to 0.85), including externalising (OR = 0.29; 95%IC from 0.14 to 0.62), attention problems (OR = 0.32; 95%IC from 0.15 to 0.70), attention-deficit/hyperactivity problems (OR = 0.36; 95%IC from 0.15 to 0.87), oppositional defiant problems (OR = 0.06; 95%IC from 0.06 to 0.75), and depressive problems (OR = 0.38; 95%IC from 0.15 to 0.96). This study highlights the importance of maternal diet, especially Mediterranean diet, during gestation for proper child development.

Parental psychological control and children’s self-esteem: A longitudinal investigation in children with and without oppositional defiant problems

Oppositional defiant problems are among the most prevalent psychological problems among children and adolescents from China and across the world. Still little is understood about how self-esteem, in conjunction with parenting experiences, develops in children with oppositional defiant problems. We addressed this gap of knowledge in a two-year longitudinal study. Specifically, we explored how parental psychological control predicts children’s self-esteem levels over time, and in turn, how children’s self-esteem levels predict parental psychological control. We collected data in Chinese children (ages 8 to 13 at T1) with (N = 224) and without (N = 217) oppositional defiant problems, and tested three-wave cross-lagged panel models. Multigroup analyses showed that the associations between parental psychological control and children’s self-esteem were the same for children with and without oppositional defiant problems. Results for the total sample revealed bi-directional associations between maternal psychological control and children’s self-esteem. Children who perceived more psychological control from their mothers were likely to exhibit lower self-esteem over time, and vice versa, children with lower self-esteem were likely to perceive more maternal psychological control over time. Conversely, a unidirectional paternal effect was observed in father-child dyads. Our findings help understand the parent–child dynamics that shape the psychological development of children with oppositional defiant problems.

Utility of Multiple Specifiers for Subtyping Oppositional Defiant Problems: Investigating Multiple Psychopathy Dimensions as Specifiers.

Past research has speculated that using grandiose-manipulative (GM) and daring-impulsive (DI) traits, rather than solely callous-unemotional (CU) traits, could better inform subtyping youths with behavioral problems. However, this approach remains largely untested. To further enhance our understanding of this matter, the current study utilized self-report (n = 2,381) and parent-report (n = 1,846) data to examine the utility of three psychopathic dimensions as specifiers for oppositional defiant problems (ODP). Findings showed that ODP was a significant predictor of negative outcomes, while the GM, CU, and DI traits emerged as significant predictors of theoretically and clinically relevant external variables (e.g., conduct problems and proactive aggression), independent of ODP (and age, gender, and socioeconomic status), forming the potential foundation for the development of specifiers for ODP. Furthermore, children presenting ODP alongside heightened levels of the three psychopathic traits demonstrated notably higher scores in important external variables compared to other groups, including but not confined to the subgroup of children with ODP and high CU trait levels. Findings provide preliminary support for employing GM and DI traits as specifiers for ODP. However, more comprehensive evaluations of these specifiers' utility would help inform ongoing discussions before definitively concluding they should be included in diagnostic manuals.

Behavioral and Emotional Problems in Children and Adolescents with Obesity: A Preliminary Report.

Parent-child agreement regarding emotional and behavioral problems in adolescents with obesity was measured. One hundred Italian adolescents with obesity (36 males, 64 females, mean age ± SD: 15.3 ± 1.61 years, mean body mass index, BMI: 37.9 ± 5.48 kg/m2), hospitalized for a 3-week multidisciplinary body weight reduction program at Istituto Auxologico Italiano, Piancavallo-Verbania, Italy, and one of their parents (n = 100, 40 fathers, 60 mothers) participated in the study. Achenbach's Child Behavior Checklist (CBCL) for parents and the Youth Self Report (YSR) for teens were administered. Most of the CBCL and YSR scores were normal, with more borderline and clinical scores being found in CBCL (29% of borderline scores in attention problems, 28% in affective problems, and 26% in ADHD; 32% of clinical scores in affective problems, 23% in withdrawn/depressed, and 22% in anxiety problems and somatic complains subscales) than in YSR (19% of borderline scores in affective behaviors and 17% in somatic complains; 15% of clinical scores in anxiety problems and 17% in withdrawn/depressed subscale). Young females reported greater anxiety problems (p = 0.009), oppositional defiant problems (p = 0.029), anxiety/depressed (p = 0.030), and internalizing problems (p = 0.045) than males. Pearson's coefficients ranged between 0.273 to 0.517. This study provides information on the cross-informant evaluation of psychological profiles with CBCL and YSR in a clinical sample of adolescents with obesity and their parents.

Parents’ mental health state and self perceived difficulties of their children

Abstract Past research shows that parents’ mental health is highly associated with children's emotional and behavioural state. The study aimed to explore and verify the hypothesis that high self perceived parental depression and anxiety levels increase observed emotional/behavioural problems in their children. The sample included 53 parent-child pairs, residents of Crete, Greece where the average age of parents (88.7% females) was 42.30 yrs (SD = 5.41) and with mean child (54.7% males) age of 9.16 (SD = 1.36), who presented for learning difficulties assessment at a community Mobile Unit. Among them, 64.2% had university degree while 24.5% had secondary education. The tools used were Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to assess depression and anxiety symptoms in parents and Child Behaviour CheckList (CBCL /6-18 DSM-oriented scales) to assess observed emotional/behavioural problems of their children (Emotional and Somatic Problems, Anxiety, Attention Deficit, Oppositional Defiant Problems, Conduct Problems). The study found a significant positive correlation (r=.400; p=.011) between BAI (M = 11.89, SD = 8.48) and Anxiety Problems in the CBCL (M = 2.93; SD = 2.11). Additionally, there was a significant positive correlation between BDI (M = 11.44, SD = 10.63) and Emotional Problems (M = 4.22, SD = 3.34), with r = 0.427 (p=.006) as well as with Anxiety Problems (r=.427; p=.006). These results indicate a link between parents’ self perceived anxiety with the anxiety they observe in their children and parents’ self perceived depression levels with the emotional and anxiety problems they identify in their children. It seems that anxious and depressed parents tend to highly identify same characteristics in their children. For the future it is recommended to test a bigger sample and also evaluate children's own beliefs. Nevertheless, the study confirms the connection between parental and child mental health which cannot be ignored when designing family based interventions. Key messages • Understanding parents’ mental health issues could improve children’s lives and inform health policy planning. • Validated tools need to be introduced in community health setting to early detect parent mental health issues.

Sensory processing abilities and their impact on disease severity in children with attention-deficit hyperactivity disorder.

Although several studies have shown sensory processing abnormalities in pediatric subjects with attention-deficit hyperactivity disorder (ADHD), there is significant heterogeneity among their results. This study was performed to compare the sensory processing abilities of children and adolescents with and without ADHD aged 6-15 years and to correlate the sensory processing problems in these patients, with the symptom profile and severity of ADHD. While child sensory profile-2 (SP-2) was used to assess, the sensory processing abilities of ADHD patients, revised Connor's parent rating scale revised, Malin's intelligence scale for Indian children, grade level assessment device, and child behavior checklist were used to assess ADHD symptom severity, intelligence, learning, and behavioral problems, respectively. A total of 66 ADHD patients enrolled (60 boys), 22 (28%), 7 (9%), and 49 (63%) cases were the ADHD-hyperactive-impulsive (ADHD-HI), ADHD-inattentive, and ADHD-combined (ADHD-C) types, respectively, and 33 typically developing controls. The ADHD patients had a significantly low raw score on most of the factors, sections, and response patterns of SP-2 (P < 0.05), but only four and one ADHD patients had auditory and visual processing scores outside the normal clinical range. There was a trend toward higher scores in the children with ADHD-C and ADHD-HI subtypes. There was a moderate negative correlation between hyperactivity/impulsivity T-score and auditory processing scores in the SP (P < 0.05, r = -0.43). We observed a negative correlation, although weak, between visual processing scores and hyperactivity/impulsivity and a positive correlation between the severity of conduct disorder-related problems, oppositional defiant problems, anxiety problems, and auditory as well as tactile processing scores (P < 0.05). In the quadrant score summary, the scores for all four types, that is, sensory sensitivity, low registration, sensation avoiding, and sensation seeking, were significantly more in the ADHD group, as compared to healthy controls. Sensory processing abilities in ADHD children differ from that of typically developing children when objectively assessed, although most of the ADHD children had scores in the clinically normal range. The sensory processing profile also has an impact on the severity and comorbidity profile of ADHD patients.

The Effect of Hormonal Therapy on the Behavioral Outcomes in 47,XXY (Klinefelter Syndrome) between 7 and 12 Years of Age.

47,XXY, also known as Klinefelter syndrome, is the most commonly occurring sex chromosomal aneuploidy (SCA). Hormonal replacement therapy (HRT) has been associated with improved neurodevelopmental capabilities in boys with 47,XXY, although studies investigating HRT's possible positive effect on behavioral outcomes are scarce. This study explores the association between behavioral outcomes and HRT in boys ages 7-12. Patients were divided into 4 groups based on HRT status: untreated, early hormonal treatment (EHT), hormonal booster therapy (HBT), and both EHT and HBT. Analysis of Variance (ANOVA) and Kruskal-Wallis tests were conducted to determine group differences on the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF). The treated groups were found to have better scores in emotional control, initiative, organization of materials, behavioral rating index, metacognition index, and global executive composite than the untreated group on the BRIEF. On the CBCL, the treated groups presented better scores for somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing problems, total problems, affective problems, somatic problems, ADHD problems, oppositional defiant problems, and sluggish problems in comparison to the untreated group. These results offer evidence that HRT, specifically the combination of both EHT and HBT, may be successful in mitigating some undesirable behavioral outcomes. Further research is necessary to determine the efficacy of the combination of EHT and HBT regarding dosage, specific ages, and long-term benefits.

Wild and Willful Kids: Can We Help Parents? The Effectiveness of a Group Parent Training Program Without a Psychiatric Label.

Many children with a classification of attention-deficit/hyperactivity disorder exhibit mild-to-moderate problem behavior. For these children, a stepped diagnosis and stepped care approach has been proposed. Although a psychiatric classification may bring support to families, it may also have negative consequences. Therefore, in this preliminary study, the effect of a group parent training program without child-bound classifications (named Wild & Willful, Druk & Dwars in Dutch) was investigated. In 7 sessions, groups of parents (experimental, n=63; waiting list control, n=38) learned strategies to deal with wild and willful behavior in their children. Outcome variables were assessed by questionnaires. Multilevel analyses showed that, compared with the control group, the intervention group had significantly lower scores on parental stress and communication problems (Cohen d=0.47 and 0.52, respectively), but not on attention and hyperactivity problems, oppositional defiant problems, and responsivity. Zooming in on the course of outcome variables over time in the intervention group, improvements on all variables were seen, with small to moderate effect sizes (Cohen d=0.30 to 0.52). Overall, the group parent training program without the need for a classification for children seemed beneficial. The training is low cost, brings together parents who are facing similar problems in rearing their children, and may help to reduce overdiagnosis of mild and moderate problems, without risking undertreatment of severe difficulties.

COVID-19 Pandemic: 1-Year Follow-Up in Children and Adolescents with Neuropsychiatric Disorders

Few studies have focused on the long-term effects of the COVID-19 pandemic on mental health. The objective of our work was to evaluate the changes in emotional and behavioral symptoms in patients with neuropsychiatric disorders and the impact on parenting stress 1 year after the first national lockdown. We enrolled 369 patients aged 1.5-18 years of age referred to the Child and Adolescent Neuropsychiatry Unit of the University Hospital of Salerno (Italy) by their parents. We asked their parents to complete two standardized questionnaires for the assessment of emotional/behavioral symptoms (Child Behavior CheckList, CBCL) and parental stress (Parenting Stress Index, PSI) prior to the pandemic (Time 0), during the first national lockdown (Time 1) and after 1 year (Time 2), and we monitored the changes in symptoms over time. After 1 year from the start of the first national lockdown, we found a significant increase of internalizing problems, anxiety, depression, somatization, and social and oppositional-defiant problems in older children (6-18 years), and a significant increase of somatization, anxiety problems, and sleep problems in younger children (1.5-5 years). We also observed a significant relationship between emotional/behavioral symptoms and parental stress. Our study showed that parental stress levels increased compared to the pre-pandemic months and continues to persist over time, while internalizing symptoms of children and adolescents showed a significant worsening during 1 year follow-up from the first COVID-19 lockdown.

Children's behavioral and emotional problems and peer relationships across elementary school: Associations with individual- and school-level parental education

This study examined (a) whether growing up with lower-educated parents and attending lower parental education schools associated with children's problem development within the behavioral, emotional, and peer relationship domains; and (b) whether the association of lower individual-level parental education with children's development within these three domains depended upon school-level parental education. To this end, 698 children (Mage = 7.08 in first grade) from 31 mainstream elementary schools were annually followed from first grade to sixth grade. Problems within the behavioral domain included conduct problems, oppositional defiant problems, attention-deficit and hyperactivity problems, and aggression. Problems within the emotional domain included depression and anxiety symptoms. Problems within the peer relationship domain included physical victimization, relational victimization, and peer dislike. Results from multi-level latent growth models showed that, as compared to children of higher-educated parents, children of lower-educated parents generally had higher levels of problems within all three domains in first grade and exhibited a faster growth rate of problems within the behavioral domain from first to sixth grade. Furthermore, as compared to children attending higher parental education schools, children attending lower parental education schools generally had higher levels of problems within the behavioral and emotional domains in first grade and showed a faster growth rate of peer dislike over time. In addition, cross-level interaction analyses showed that in higher parental education schools, children of lower-educated parents showed a faster growth rate of depression symptom levels than children of higher-educated parents. In lower parental education schools, the growth rate of depression symptom levels did not differ between children of higher- and lower-educated parents. Results highlight that addressing the needs of lower parental education schools and children growing up with lower-educated parents may be of primary importance.

Defense-Oriented Psychoanalytic Psychotherapy as a Tailored Treatment for Boys: Neurobiological Underpinnings to Male-Specific Response Tested in Regulation-Focused Psychotherapy for Children.

This paper presents defense-oriented psychoanalytic psychotherapy as a tailored treatment for boys through a neurophysiological hypothesis. Male central nervous system development is reviewed, with a focus on the development of the emotion regulation system. The organizational effects of pre- and post-natal androgens delay central nervous system development in males relative to females, following a caudal to rostral phylogenetic framework. Ventromedial prefrontal structures mature at an earlier developmental age than dorsolateral prefrontal structures, creating less of a gender gap in the available underlying neural architecture for responsivity to targeted therapeutic intervention. The hypothesized operation of defense analysis upon ventromedial prefrontal cortical structures and corticolimbic connectivity therefore positions boys to benefit from psychotherapy equally as girls. In this study, we explored gender differences in presentation and response to a short-term, manualized defense-oriented psychoanalytic psychotherapy named regulation-focused psychotherapy for children. In a sample size of 43 school-aged children, consisting of 32 boys and 11 girls, with oppositional defiant disorder, we found no statistically significant differences in participant characteristics upon entry nor in treatment response, as measured by changes in scores on the Oppositional Defiant Disorder Rating Scale, the oppositional defiant problems subscale of the Child Behavior Checklist, the suppression and reappraisal subscales of the Emotion Regulation Questionnaire for Children and Adolescents, and the lability and negativity subscale of the Emotion Regulation Checklist. The findings were comparable with the gendered findings of preexisting studies of play therapy, where boys and girls improve equally, but not of behaviorally predominant psychotherapy, where girls appear to have superior responses. Our findings suggest that the treatment as a general play therapy, but with a focus on the implicit emotion regulation system, was successful in meeting boys’ gendered treatment needs. Conclusions are drawn with implications for further study.

Age and sex-specific cutoff scores for the teacher-report inventory of callous-unemotional traits on children.

This longitudinal study aims to provide meaningful cutoff scores for total score of the teacher-rated Inventory of Callous-Unemotional Traits (ICU) from the preschool age until early adolescence, separately by age and sex. The ICU cutoff scores were determined by using low/high trajectories of oppositional defiant problems (ODP) and conduct problems in a Spanish community sample of 620 children that were followed up between the ages of 3 and 13. Receiver operating characteristic (ROC) curves with the two trajectories as criteria and ICU total score at each age as a predictor were estimated by sex separately, and the area under the ROC curve (AUC) was obtained. Average ICU cutoff scores of 26 for boys and 22 for girls were found to be of moderate utility for the prediction of high trajectories of each of ODP and conduct problems. They identified cases with an average sensitivity of 66% and specificity of 70% for boys and an average sensitivity of 69% and specificity of 72% for girls. The obtained cutoff scores might help clinical practitioners in their decision-making process when identifying low and high-risk groups of children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effect of COVID-19 infection on psychological aspects of pre-schooler children: a cross-sectional study

BackgroundCoronavirus disease 2019 (COVID-19) had a tremendous effect on individual’s lives worldwide. The pandemic’s significant socioecological impact is one of the many burdens children confront in the current crises. As a result, this study was designed to determine the psychological impacts of the COVID-19 pandemic on preschoolers, particularly the consequences of COVID-19 infection. This study involved 138 children aged 2–5.11 years old who were classified into two groups based on their COVID-19 infection history, which was documented via a PCR test. All participants were assessed by the Socioeconomic Scale and The Children’s Behavior Checklist (CBCL).ResultsCOVID-19 infection was found in 21.7% of the children who participated in this study. Furthermore, children with COVID-19 had a higher percentage of clinical rating on the CBCL Profile of DSM-5 scales for affective problems (13.3 vs. 7.4%), anxiety problems (13.3 vs. 9.3%), pervasive developmental problems (20 vs. 13%), and oppositional defiant problems (6.7 vs. 5.6%) than children without COVID-19. Anxiety and somatic problems had a positive correlation with the impact of the COVID-19 pandemic on the lives of children.ConclusionsChildren infected with COVID-19 were more likely to have psychological issues, such as affective disorders, anxiety problems, pervasive developmental problems, and oppositional defiant problems. These psychological issues had a relationship with the impact of the COVID-19 pandemic on the lives of children.

Reciprocal relations between dimensions of Oppositional defiant problems and callous-unemotional traits

Although irritability, headstrong/defiant behavior, and callous-unemotional traits (CU traits) often co-occur, the prospective associations between them are not well known. A general population sample of 622 children was followed up yearly from ages 3 to 12 years and assessed using dimensional measures of irritability, headstrong/defiant, and CU traits with teacher provided information. A random intercept cross-lagged panel model, accounting for all unmeasured time-invariant confounding using the children as their own controls, revealed cross-lagged reciprocal associations between increased headstrong/defiant and increased CU traits at all ages and a unidirectional association from headstrong/defiant to irritability. The findings are consistent with headstrong/defiant behavior and CU traits mutually influencing each other over time and headstrong/defiant behavior enhancing irritability. School-based intervention and prevention programs should take these findings into consideration. They also suggest that irritability acts as a distinct developmental dimension of headstrong/defiant and callous-unemotional behaviors and needs to be addressed independently.

A longitudinal study of mental health in at-risk adolescents before and during the COVID-19 pandemic.

Although cross-sectional studies have shown that the COVID-19 pandemic has negatively affected the mental health of adolescents, the effect of the pandemic on adolescents with pre-pandemic symptoms is unclear. We, therefore, tested the hypothesis that adolescents had increased emotional and behavioral problems during the lockdowns imposed during the pandemic.This study included three measurements in a prospective cohort of 1022 adolescents who were oversampled based on their high risk of developing psychopathology. Before the pandemic, we assessed depressive, anxiety, stress, oppositional defiant problems, psychotic experiences and suicidality, using the Youth Self-Report; 445 and 333 of these 1,022 adolescents subsequently completed the online questionnaire in the first lockdown (in April 2020) and in the second lockdown (in January 2021), respectively. Multilevel random intercept regression models were used to determine the change in psychiatric symptoms, including an interaction term to assess whether these changes differed based on the severity of symptoms prior to the pandemic. Throughout the pandemic, the majority of the participating adolescents reported having emotional and behavioral symptoms that were within the normal range. Moreover, the mean symptom scores for all six outcomes decreased significantly among adolescents with high clinical severity prior to the pandemic.In contrast to our original hypothesis, the effects of the COVID-19 pandemic may not necessarily be detrimental, at least among a specific subgroup of adolescents with pre-existing mental health problems. Moreover, our finding that most adolescents in this at-risk sample did not report experiencing clinically relevant symptoms during the pandemic reflects their resilience during the pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-021-01935-y.

Meta-analysis of the Efficacy and Effectiveness of Parent Child Interaction Therapy (PCIT) for Child Behaviour Problems.

Parent-Child Interaction Therapy (PCIT) is a well-established treatment for behavioural, hyperactivity and oppositional-defiant problems in children. Previous meta-analyses are scarce, and they have tended to mix problems and measures. A meta-analysis study was conducted with all available studies on PCIT (1980 to 2020) to determine its specific efficacy and effectiveness for child behavioural problems. Selection from databases collected a total of 100 studies. The inclusion criteria were to compare PCIT in children with behavioural problems between 2 and 12 years of age; comparing groups and using standardized instruments. PCIT exhibited a significant mean effect size ( d = -0.87 [95% CI: -1.10, -0.63] versus control and/or treatment-as-usual groups, but the effect size was smaller and not significant in follow-ups ( d = -0.23 [95% CI: -0.49, 0.04]). The within-group studies, comparing versions of PCIT, also demonstrated a significant effect size ( d = -0.26 (95% CI: -0.43, -0.08), and in pre-post comparisons this effect was greater ( d = -1.40 [95% CI: -1.69, -1.10]). PCIT is an effective intervention for treating child behaviour problems such as disruptive, hyperactive, negative, and externalizing problems. It is supported by 40 years of experimental and clinical studies, and also by this meta-analysis.

Factors Related to Caregiver Intentions to Vaccinate Their Children with Attention-Deficit/Hyperactivity Disorder against COVID-19 in Taiwan.

The aims of this study were to examine the proportion of caregivers who were hesitant to vaccinate their children with attention-deficit/hyperactivity disorder (ADHD) against coronavirus disease 2019 (COVID-19) and the factors related to caregiver intentions to vaccinate their children against COVID-19. In total, 161 caregivers of children with ADHD were recruited in this study. The caregivers completed an online questionnaire to provide data regarding their intention to vaccinate their children against COVID-19, concerns about the effectiveness and safety of vaccines, unfavorable family attitudes toward vaccines, and children’s medication use for ADHD and comorbid psychopathology. The factors related to caregiver intentions to vaccinate their child were examined using linear regression analysis. The results indicated that 25.5% of caregivers were hesitant to vaccinate their children with ADHD, and 11.8% refused to vaccinate their children against COVID-19. The caregivers’ concerns about the safety of vaccines and children’s regular use of medication for ADHD were negatively associated with caregiver intentions to vaccinate, whereas the children’s comorbid conduct or oppositional defiant problems were positively associated with the caregiver intentions to vaccinate. An intervention that enhances caregiver intentions to vaccinate their children with ADHD against COVID-19 by addressing the related factors found in this study is warranted.

Association between humidifier disinfectant exposure during infancy and subsequent neuropsychiatric outcomes during childhood: a nation-wide cross-sectional study

BackgroundThe purpose was to determine the association between infant exposure to humidifier disinfectant (HD) with neuropsychiatric problems in pre-school children.MethodsA total of 2,150 children (age 4–11 months) were enrolled in the Panel Study of Korean Children (PSKC) study. The Korean version of the Child Behavior Checklist (CBCL) was used for assessments of neuropsychiatric problems. 1,113 children who participated in all the first to third PSKC studies and answered a question about HD exposure were finally enrolled.ResultsThere were 717 (64.5%) children in non-HD group who were not exposed to HD and 396 (35.5%) in HD group with former exposure to HD. Exposure to HD was associated with total neuropsychiatric problems (adjusted odds ratio, aOR = 1.54, 95% CI = 1.15–2.06), being emotionally reactive (aOR = 1.55, 95% CI = 1.00–2.39), having attention problems (aOR = 1.96, 95% CI = 1.10–3.47), having oppositional defiant problems (aOR = 1.70, 95% CI = 1.07–2.71), and having attention deficit/hyperactivity problems (aOR = 11.57, 95% CI = 1.03–2.38). The risks for neuropsychiatric problems were clearly increased in boy, firstborn, and secondary smoker.ConclusionsExposure to HD during early childhood had a potential association with subsequent behavioral abnormalities.

Psychologist attitudes, self-reported competence and practices associated with the use of dietary interventions for children presenting for psychological treatment

ABSTRACT Objective Despite limited evidence, children with neurodevelopmental and psychological disorders may be having dietary interventions incorporated into treatment. Little is known about psychologists’ role in influencing these decisions. Method Australian psychologists working with children (N=60) completed the Nutritional Competence Tool, and questions exploring psychologist attitudes, self-reported competence and practices associated with the use of dietary interventions for children presenting for psychological treatment of psychological disorders. Results Most respondents reported positive attitudes towards dietary interventions. Incorporating dietary interventions into clinical practice was common, with 56.7% reporting they would be likely to recommend one or more dietary interventions pre-specified for one of the conditions explored. Participants were most likely to endorse the use of dietary interventions for children presenting with oppositional defiant disorder, conduct disorder or other behavioural problems. Conclusion Despite training in evidence-based practice, some registered psychologists have positive attitudes towards dietary modifications in the treatment of children with psychological conditions, and may be susceptible to recommending dietary interventions, regardless of the limited evidence base. The conditions for which recommendations were most likely, as well as diets most commonly recommended had hallmark features of “fads”, raising several ethical concerns. Further research should determine how widespread this practise is. Key Points What is already known about this topic: Dietary interventions do not have a robust evidence-base in treating psychological and neurodevelopmental disorders. Children often receive dietary modification to aid the amelioration of symptoms of psychological and neurodevelopmental disorders. Limited research suggests that psychologists may be contributing to the use of complementary and alternative treatments. What this paper adds: Some psychologists have positive attitudes towards dietary interventions for a range of psychological disorders in childhood. Some psychologists report that they are likely to recommend dietary interventions for children presenting for psychological treatment. Oppositional defiant disorder and conduct disorder were the conditions most likely elicit information about dietary interventions or recommendations to consider a dietary interventions.