Parent-reported Child Research Articles

Effects of an Online Emotion Socialization Intervention for Parents of At-Risk Preschoolers Enrolled in Head Start During a Global Pandemic

Children from low-income families experience greater developmental risk factors, suggesting the need for evidence-based social-emotional interventions to support children and their families. This study explored the engagement, effectiveness, and acceptability of an unstudied online version of an evidence-based emotion-focused intervention – Tuning in to Kids Online (TIKOL). This pilot study within a small Head Start sample demonstrated that parents watched, on average, 97% of the ten modules across the program duration, and all reported using “quite a few” of the parenting skills taught. Outcome data revealed significant improvements in employing an emotion coaching parenting style. Distressing reactions and parent-reported child conduct problems both decreased. There were no significant reductions in emotion dismissing beliefs. High levels of treatment acceptability were reported. Treatment engagement, effectiveness, and acceptability findings from this pilot TIKOL intervention study support the need to study this accessible, online version of a well-supported parenting program approach.

Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships.

Children and adolescents with externalizing disorders are at risk for suicidal ideation or behavior. Factors that put them at risk could be symptoms related or facilitated by their environment. We evaluated the links of symptoms profiles with suicidality, and the effects of family relationship characteristics on these links. Latent profile analysis was used to subgroup participants referred for ADHD assessment (n = 1249, aged 6-17) based on their externalizing and internalizing symptoms. Self- and parent-reported child suicidal ideation (S-SI, P-SI), and parent-reported self-harm behavior (P-SHB) were compared across profiles. The moderating effects of parent-reported marital conflict and parenting practices were examined. A four-profile model showed optimal fit. Participants of the Low Symptoms profile followed by the Inattentive-Hyperactive/Impulsive profile showed lower P-SI compared to those of the Irritable-Defiant and the Conduct Problems profiles. Low Symptoms participants also reported lower S-SI compared to those of the Inattentive-Hyperactive/Impulsive and the Irritable-Defiant profiles. Participants of the Irritable-Defiant and the Conduct Problems profiles had higher P-SHB compared to the Low Symptoms and the Inattentive-Hyperactive/Impulsive participants. Dysregulated marital conflict practices were associated with greater increase in P-SI in all profiles compared to the Low Symptoms profile. Aggressive marital conflict practices were associated with increased P-SHB in the Conduct Problems profile compared to the Inattentive-Hyperactive/Impulsive profile. Children and adolescents with irritability and defiance symptoms with or without conduct problems show higher risk for suicidal ideation and behavior compared to those with ADHD symptoms alone. Dysregulated and aggressive marital conflict practices might pose additional suicidality risk in children and adolescents with disruptive behavior.

Relationships Between Parental Anxiety and Child Quality of Life in Advanced Childhood Cancer.

Background: Family factors, such as household income and parental psychosocial distress, have been associated with quality of life in children with cancer. However, relationships between parent anxiety and child health-related quality of life (HRQoL) have not been evaluated in children with advanced cancer. Objective: To examine relationships between parent anxiety and both parent-reported and child self-reported HRQoL for children with advanced cancer. Method: Children (aged 5-17 years) with relapsed or refractory cancer and their parents participated in this single-institution cross-sectional study. Parents completed measures of their own baseline anxiety (State-Trait Anxiety Inventory-Trait [STAI-T] form) and their ill child's HRQoL (PedsQL Generic and PedsQL Cancer, parent report). Children completed age-specific PedsQL Generic and PedsQL Cancer, child report. Spearman's rho coefficients assessed correlations between total parent STAI-T score and both parent-reported and child-reported HRQoL scales. Results: Twenty children (Mage = 9.5 years, 50% female) and their 20 parents (90% mothers) participated. The strongest and statistically significant (p < .05) correlations were inverse associations between parental trait anxiety and parent-reported child psychosocial HRQoL (rs = -.54), emotional functioning (rs = -.49), school functioning (rs = -.45), and child pain and hurt (rs = -.45). Correlations of parental anxiety with all dimensions of child-reported HRQoL were generally smaller (rs < .40), positive, and not statistically significant (p > .05). Discussion: Given the inverse correlations between parental anxiety and child psychosocial HRQoL, assessment of parent mental health needs and access to interventions should be provided routinely for parents of children with advanced cancer.

Associations of Changes in Sleep and Emotional and Behavioral Problems From Late Childhood to Early Adolescence

Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear. To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence. This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022. Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC). Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist. A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P < .001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P < .001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P < .001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P < .001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P < .001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P < .001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa. There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.

Early childhood parent-reported speech problems in small and large for gestational age term-born and preterm-born infants: a cohort study

Objective(1) To assess if preterm and term small for gestational age (SGA) or large for gestational age (LGA) infants have more parent-reported speech problems in early childhood compared with infants...

354 Unitary neural correlates of executive control in pediatric transdiagnostic psychopathology

OBJECTIVES/GOALS: Childhood psychiatric symptoms are highly comorbid. Their co-occurrence and association with negative life outcomes is partially explained by deficits in executive control, or processes enabling self-regulation. Here, we test a novel executive neural target in three fMRI tasks and its relevance to shared psychopathology. METHODS/STUDY POPULATION: We studied 60 children [15 F/45 M; mean age (SD)=11.6 years (1.62)] with diverse diagnoses including attention deficit disorder (n=26) and autism spectrum disorder (n=22). We extracted a latent general factor of psychopathology using principal component analyses applied to parent-report Child Behavior Checklist syndrome scores. Subjects completed 3 executive control fMRI probes, tapping adaptive control, working memory, and inhibition. Correlational psychophysiological interaction (cPPI) analysis measured correlations between executive control-related modulations of activity in 414 network-affiliated parcels. We selected parcels exhibiting control-related cross-network correlations as well as control-related activity across all tasks and tested them for association with psychopathology. RESULTS/ANTICIPATED RESULTS: cPPI connectivity matrices were thresholded and graphs were identified using the Network-Based Statistic toolbox (p90th percentile PC) as well as control-related activation (&gt;10% activated voxels; p DISCUSSION/SIGNIFICANCE: Our results examine cross-network interactions between brain regions during 3 fMRI tasks and their role in explaining individual variation in psychopathology. As executive control links to both comorbidity and life outcomes, identifying the clinically-relevant neural correlates of controlled behavior may lead to transdiagnostic treatments.

Economic and health impacts of the Change4Life Food Scanner app: Findings from a randomized pilot and feasibility study.

The UK Government developed the Change4Life Food Scanner app to provide families with engaging feedback on the nutritional content of packaged foods. There is a lack of research exploring the cost-effectiveness of dietary health promotion apps. Through stakeholder engagement, a conceptual model was developed, outlining the pathway by which the Food Scanner app leads to proximal and distal outcomes. The conceptual model informed the development of a pilot randomized controlled trial which investigated the feasibility and acceptability of evaluating clinical outcomes in children and economic effectiveness of the Food Scanner app through a cost-consequence analysis. Parents of 4-11 years-olds (n = 126) were randomized into an app exposure condition (n = 62), or no intervention control (n = 64). Parent-reported Child Health Utility 9 Dimension (CHU9D) outcomes were collected alongside child healthcare resource use and associated costs, school absenteeism and parent productivity losses at baseline and 3 months follow up. Results for the CHU9D were converted into utility scores based on UK adult preference weights. Sensitivity analysis accounted for outliers and multiple imputation methods were adopted for the handling of missing data. 64 participants (51%) completed the study (intervention: n = 29; control: n = 35). There was a mean reduction in quality adjusted life years between groups over the trial period of -0.004 (SD = 0.024, 95% CI: -0.005; 0.012). There was a mean reduction in healthcare costs of -£30.77 (SD = 230.97; 95% CI: -£113.80; £52.26) and a mean reduction in workplace productivity losses of -£64.24 (SD = 241.66, 95% CI: -£147.54; £19.07) within the intervention arm, compared to the control arm, over the data collection period. Similar findings were apparent after multiple imputation. Modest mean differences between study arms may have been due to the exploration of distal outcomes over a short follow-up period. The study was also disrupted due to the coronavirus pandemic, which may have confounded healthcare resource data. Although measures adopted were deemed feasible, the study highlighted difficulties in obtaining data on app development and maintenance costs, as well as the importance of economic modeling to predict long-term outcomes that may not be reliably captured over the short-term. https://osf.io/, identifier 62hzt.

Efficacy of a Primary Care eHealth Obesity Treatment Pilot Intervention Developed for Vulnerable Pediatric Patients.

Background: Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI. Methods: In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6-12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links to internet resources. Parents completed an online survey before and after 3 months. Pre-post changes in family nutrition and physical activity (FNPA) scores, clinic-measured child %BMIp95, and self-reported parent BMI were assessed using mixed-effects linear regression modeling. Results: A total of 73 families (mean child age = 9.3 years; 87% Hispanic, 12% non-Hispanic Black, and 77% Spanish-speaking families) completed the baseline survey (participants) and 46 (63%) used the DK site (users). Among users, pre-post changes (mean [standard deviation]) showed an increase in FNPA scores (3.0 [6.3], p = 0.01); decrease in child %BMIp95 (-1.03% [5.79], p = 0.22); and decrease in parent BMI (-0.69 [1.76], p = 0.04). Adjusted models showed -0.02% [95% confidence interval: -0.03 to -0.01] change in child %BMIp95 for each minute spent on the DK website. Conclusions: DK demonstrated a significant increase in parent FNPA scores and decrease in self-reported parent BMI. e-Health interventions may overcome barriers and require a lower dosage than in-person interventions.

The longitudinal relationship between dissociative symptoms and self-harm in adolescents: a population-based cohort study.

Previous studies have reported that dissociative symptoms (DIS) are associated with self-harm (SH) in adolescents. However, most of these studies were cross-sectional, which limits the understanding of their theoretical relationship. We aimed to investigate the longitudinal relationship between DIS and SH in the general adolescent population. We used data from the Tokyo Teen Cohort study (N = 3007). DIS and SH were assessed at times 1 and 2 (T1 and T2) (12years of age and 14years of age, respectively). DIS were assessed using the parent-report Child Behavior Checklist (CBCL), and severe dissociative symptoms (SDIS) were defined as a score above the top 10th percentile. The experience of SH within 1year was assessed by a self-report questionnaire. The longitudinal relationship between DIS and SH was examined using regression analyses. Using logistic regression analyses, we further investigated the risk for SH at T2 due to persistent SDIS and vice versa. DIS at T1 tended to predict SH at T2 (odds ratio (OR) 1.11, 95% CI 0.99 to 1.25, p = 0.08), while SH at T1 did not predict DIS at T2 (B = -0.03, 95% CI -0.26 to 0.20, p = 0.81). Compared with adolescents without SDIS, those with persistent SDIS had an increased risk of SH at T2 (OR 2.61, 95% CI 1.28 to 5.33, p = 0.01). DIS tended to predict future SH, but SH did not predict future DIS. DIS may be a target to prevent SH in adolescents. Intensive attention should be given to adolescents with SDIS due to their increased risk of SH.

Emotional Experience, Physiological Reactivity, and Psychological Difficulties during middle childhood: a pilot study

Introduction Many studies linked expression and regulation of emotions as transdiagnostic variables involved in the emergence of psychopathological disorders. However, few studies investigated such processes during middle childhood, a critical period of life defined by significant psychological, physical, and social changes.ObjectivesExplore the relationship between child’s emotion regulation – both emotional subjective experience and physiological reactivity – and child’s psychological difficulties.Methods 20 children (Mage=10.7, SD=1.25; 65% males) and their mothers were recruited from general population. Emotion regulation was assessed with (1) How I Feel (HIF) and Positive and Negative Affect questionnaires (PANAS) and (2) Heart Rate (i.e., Beats Per Minute, BPM) and Heart Rate Variability (i.e., High Frequency and Low Frequency ratio, LF/HF). Child’s psychological difficulties were measured with the parent report Child Behavioral Checklist 6-18 (CBCL-6/18).ResultsStatistically significant correlations emerged between the HIF-Positive emotions scale and both externalizing (rs = -.51) and internalizing (rs = -.46) difficulties; the HIF-Negative emotions scale and internalizing difficulties (rs = .49); LF/HF and internalizing difficulties (rs = -.58). Finally, a non-significant but moderate effect was found between the HIF-Negative emotions scale and externalizing difficulties (rs = .33).Conclusions Although the limited number of participants, data suggest an interesting role played by both child’s emotional experience and physiological reactivity on internalizing and externalizing difficulties as reported by mothers. More specifically, child’s experience of positive emotions is associated with fewer internalizing and externalizing difficulties, while child’s experience of negative emotions illustrates an opposite relationship, implying the relevance of looking at child’s emotional subjective experience in understanding psychological difficulties. Moreover, LF/HF ratio – labeled as the child’s sympathovagal balance – seems like it might be higher in children with less internalizing difficulties. Although doubts about LF/HF interpretation, several studies share this view showing a decrease in autonomic reactivity in internalizing problems, such as depression, in adults. Overall, our preliminary results underline the importance of studying the emergence of psychopathological outcomes in middle childhood connected to both psychological and physiological emotional processes.Disclosure of InterestNone Declared

Physical Activity Trajectories in Early Childhood: Investigating Personal, Environmental, and Participation Factors.

To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years. Two hundred seventy-nine children (4.5 ± 0.9 yr, 52% boys) were included in this study. Physical activity was collected via accelerometry at six different timepoints over 6.3 ± 0.6 yr. Time-stable variables were collected at baseline and included child's sex and ethnicity. Time-dependent variables were collected at six timepoints (age, years) and included household income (CAD), parental total PA, parental influence on PA, and parent-reported child's quality of life, child's sleep, and child's amount of weekend outdoor PA. Group-based trajectory modeling was applied to identify trajectories of moderate-to-vigorous PA (MVPA) and total PA (TPA). Multivariable regression analysis identified personal, environmental, and participation factors associated with trajectory membership. Three trajectories were identified for each of MVPA and TPA. Group 3 in MVPA and TPA expressed the most PA over time, with increased activity from timepoints 1 to 3, and then declining from timepoints 4 to 6. For the group 3 MVPA trajectory, male sex (β estimate, 3.437; P = 0.001) and quality of life (β estimate, 0.513; P < 0.001) were the only significant correlates for group membership. For the group 3 TPA trajectory, male sex (β estimate, 1.970; P = 0.035), greater household income (β estimate, 94.615; P < 0.001), and greater parental total PA (β estimate, 0.574; P = 0.023) increased the probability of belonging to this trajectory group. These findings suggest a need for interventions and public health campaigns to increase opportunities for PA engagement in girls starting in the early years. Policies and programs to address financial inequities, positive parental modeling, and improving quality of life are also warranted.

Exploration of parental rewards in incentivizing children's physical activity.

The purpose of this study was to explore the prevalence, varieties, and motivations behind parent-selected incentivization for children's physical activity (PA). Parents (n=90; 30.0±8.5 years) of children (8.7±2.1 years) completed a web-based survey that included items regarding the use of PA rewards, children's moderate-to-vigorous PA (MVPA, min·week-1), access to electronic devices, and demographic characteristics. Open-ended questions were used to determine the type of activity rewarded, type of reward given, and parents' reasoning for not using PA rewards. Independent sample t-tests were used to determine differences between reward groups (reward and no reward) and parent-reported children's MVPA. Open-ended responses underwent thematic analysis. Over half (55%) of the respondents provided PA rewards. There was no difference between reward groups for MVPA. Parents reported their children having access to various technology modes, including TV, tablets, video game systems, computers, and cellphones. Most of the parents (78.2%) reported restricting their child's technology time in some capacity. Rewarded PAs were thematized as "children responsibilities", "non-sport activity", and "sport". Two themes regarding types of rewards included "tangible" and "nontangible". Two underlying themes as to why parents did not give rewards were deemed "built-in-habit" and "enjoyment". Rewarding children's PA is prevalent among this sample of parents. Substantial variety exists regarding the type of PA incentivized and the type of reward provided. Future studies should explore whether parents use reward structures and how they conceptualize nontangible, electronics-based rewards versus tangible rewards to incentivize children's PA to promote lifelong behavior.

The association of prenatal phthalates, organophosphorous pesticides, and organophosphate esters with early child language ability in Norway

BackgroundPrenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides have been associated with neurodevelopmental deficits including language ability, however, few studies consider the effect of exposure mixtures and the potential longitudinal detriments over time. ObjectiveThis study examines the influence of prenatal exposure to phthalates, organophosphate esters, and organophosphorous pesticides, on children's language ability from toddlerhood to the preschool period. MethodsThis study includes 299 mother-child dyads from Norway in the Norwegian Mother, Father and Child Cohort Study (MoBa). Prenatal exposure to chemicals were assessed at 17 weeks’ gestation, and child language skills were assessed at 18 months using the Ages and Stages Questionnaire communication subscale and at preschool age using the Child Development Inventory. We ran two structural equation models to examine the simultaneous influences of chemical exposures on parent-reported and teacher-reported child language ability. ResultsPrenatal organophosphorous pesticides were negatively associated with preschool language ability through language ability at 18 months. Additionally, there was a negative association between low molecular weight phthalates and teacher-reported preschool language ability. There was no effect of prenatal organophosphate esters on child language ability at either 18 months or preschool age. ConclusionsThis study adds to the literature on prenatal exposure to chemicals and neurodevelopment and highlights the importance of developmental pathways in early childhood.

A Comparison of Child-Reported and Parent-Reported Interoceptive Awareness in Typically Developing School-Aged Children

ABSTRACT Interoceptive awareness refers to the way in which we perceive and interpret our body signals. It has links to sensory processing and how we understand and respond to emotion. Current research lacks evidence as to whether gender influences interoceptive awareness in children. In occupational therapy practice, clinicians use a family-centered approach to understand both child and parent perspectives to support participation, yet there is a gap in the literature that speaks to any differences in child- and parent-reports of child interoceptive awareness. This exploratory study investigated comparisons of gender and child- and parent-reported child interoceptive awareness. Twenty-seven pairs of typically developing school-aged Australian children, and one of their parents participated in the study by completing the Multidimensional Assessment of Interoceptive Awareness – Youth (MAIA-y). Independent-samples t-tests revealed no statistically significant differences in child interoceptive awareness between boys and girls. Comparing child-report (M = 3.837, SD = 0.509) and parent-report (M = 3.326, SD = 0.785) of child interoceptive awareness elicited one statistically significant difference on the MAIA-y Emotional Awareness subscale (t(52) = −2.840, p = 0.006). This exploratory study provides preliminary evidence relating to gender differences regarding interoceptive awareness in children and for using both a child- and family-centered practice approach in pediatric occupational therapy practice.

The Impact of the Early COVID-19 Global Pandemic on Children Undergoing Active Cancer Treatment and Their Parents.

(1) Background: The COVID-19 global pandemic has impacted people worldwide with unique implications for vulnerable groups. In this cross-sectional study, we examined the impact of the early pandemic on children undergoing active cancer treatment and their parents. (2) Methods: In May 2020, 30 parents of children undergoing active cancer treatment completed an online survey regarding the impact of COVID-19 on their child's cancer care, perceived utility of telemedicine, and child and parent mental health status. (3) Results: Most participants (87%) reported that they did not experience any changes to major cancer treatments. Among those who reported using telemedicine, 78% reported this to be beneficial. Over half of the participants reported that their child's mental health status was worse now than prior to the COVID-19 global pandemic. Parent-reported child anxiety scores were significantly higher for those who reported changes to mental health care for their child compared to those who did not report the same, t(25.99) = -3.04, p = 0.005. (4) Conclusion: Child and parent mental health status were affected when compared to pre-pandemic. Telemedicine appears to be a promising complement to face-to-face meetings for some families and warrants further exploration.

Child posttraumatic stress symptoms in an acute injury sample: Patterns of associations among child report, parent report, and child heart rate parameters.

Parent-child agreement on measures of child posttraumatic stress disorder (PTSD) is moderate at best, and understanding of this discrepancy is limited. To address this, we conducted an item-level investigation of parent-child symptom agreement to examine the potential influence of parental posttraumatic stress symptoms (PTSS) on parents' reports of their child's PTSS. We also examined heart rate (HR) indices as possible independent indicators of child PTSD, examining patterns of association with parent versus child report. Parent-child dyads (N = 132, child age: 6-13 years, 91.7% White) were recruited after the child's hospital admission following an acute, single-incident traumatic event. At 1-month posttrauma, questionnaires assessing children's PTSS (self- and parental reports) and parental PTSS were administered. For a subset of participants (n = 70), children's HR recordings were obtained during a trauma narrative task and analyzed. Parent and child reports of child PTSS were weakly positively correlated, r = .25. Parental PTSS were found to be stronger positive predictors of parental reports of child PTSS than the children's own symptom reports, β = 0.60 vs. β = 0.14, and were associated with higher parent-reported child PTSS relative to child reports. Finally, children's self-reported PTSS were associated with HR indices, whereas parent reports were not, βs = -.33-.30 vs. βs = -.15-.01. Taken together, children's self-reported PTSS could be a more accurate reflection of their posttrauma physiological distress than parent reports. The potential influence of parental PTSS on their perceptions of their child's symptoms warrants further consideration.

Tap water natural fluoride and parent-reported experience of child dental caries in Japan: Evidence from a nationwide birth cohort survey.

Water fluoridation is an effective measure to prevent dental caries. In Japan, artificial water fluoridation is not implemented, and tap water natural fluoride concentration geographically differs because of various soil natures. This study aimed to examine the association between tap water natural fluoride and parent-reported experience of dental caries in children. Data from the Longitudinal Survey of Newborns in the twenty-first century, a national birth cohort study following all infants born between January 10-17 and July 10-17, 2001, were analysed. Caregivers answered the child's caries treatment history, a proxy for dental caries, yearly from 5.5 to 12 years of age (N=202 517 observations from 34 998 children). The annual data on tap water natural fluoride concentration in the municipality of residence were obtained from the national statistics. Cross-classified multilevel Poisson regression models were fitted, adjusting for child, household and municipality characteristics, including average income and dental clinic density. The average tap water natural fluoride concentration across municipalities was 0.0887ppm (SD=0.0422). The proportion of parent-reported experience of child dental caries treatment ranged from 24.9% (at 12 years) to 40.3% (at 7 years) and was lower among children living in municipalities with high natural fluoride concentrations, which were 35.0%, 35.4%, 33.4% and 32.3% for <0.10, 0.10-0.19, 0.20-0.29 and ≥0.30ppm respectively. A 0.1 ppm increment in tap water natural fluoride after controlling for all covariates was significantly associated with a lower prevalence of parent-reported child dental caries treatment by 3.3% (prevalence ratio=0.967, 95% credible interval: 0.939, 0.996). Natural fluoride in tap water showed a protective effect for the parent-reported experience of child dental caries in Japan.

Appetite hormone dysregulation, body mass index, and emotional dysregulation in nonobese adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder: a cross-sectional association study.

Evidence has suggested that emotional dysregulation is a transdiagnostic feature in schizophrenia and major affective disorders. However, the relationship between emotional dysregulation and appetite hormone disturbance remains unknown in nonobese adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder. In total, 22 adolescents with schizophrenia; 31 with bipolar disorder; 33 with major depressive disorder; and 41 healthy age-, sex-, and body mass index (BMI)/BMI percentile-matched controls were enrolled for assessing levels of appetite hormones, namely leptin, ghrelin, insulin, and adiponectin. Emotional regulation symptoms were measured using the parent-reported Child Behavior Checklist-Dysregulation Profile. Adolescents with first-episode schizophrenia, bipolar disorder, and major depressive disorder exhibited greater emotional dysregulation symptoms than the control group (P=.037). Adolescents with bipolar disorder demonstrated higher log-transformed levels of insulin (P=.029) and lower log-transformed levels of leptin (P=.018) compared with the control group. BMI (P<.05) and log-transformed ghrelin levels (P=.028) were positively correlated with emotional dysregulation symptoms. Emotional dysregulation and appetite hormone disturbance may occur in the early stage of severe mental disorders. Further studies are required to clarify the unidirectional or bidirectional association of emotional dysregulation with BMI/BMI percentile and appetite hormones among patients with severe mental disorder.

Effects of a Parenting Intervention for Emotional and Behavioral Problems in Young Autistic Children Under Conditions of Enhanced Uncertainty: Two-Year Follow-up of a Pilot Randomized Controlled Trial Cohort (ASTAR) During the United Kingdom COVID-19 Pandemic

Most young autistic children display emotional and behavioral problems (EBPs). There is evidence that behavioral parenting interventions (BPIs) reduce these. The COVID-19 pandemic and associated lockdowns can be seen as a natural experiment to test the longer-term effect of BPIs under conditions of increased uncertainty. Opportunistic follow-up (n= 49) of a pilot randomized controlled trial (RCT) cohort (n= 62 autistic children aged 6-11 years; originally randomized to a 12-week group BPI [Predictive Parenting; n= 31] or an attention control [Psychoeducation; n= 31]) was conducted during COVID-19-related lockdowns. Measures of parent-reported child irritability and parenting stress were collected at 3 time points (baseline: mean age= 6.7 years; primary endpoint: mean age= 7.1 years, ∼5 months after randomization; and COVID-19 follow-up: mean age= 8.8 years, ∼2 years after randomization). We tested the magnitude of intervention effects using point estimates of differences in child irritability and parenting stress between arms at primary endpoint and COVID-19 follow-up, covarying for baseline scores. We used area under the curve (AUC) analyses to obtain overall estimates of the average intervention effect across all 3 timepoints. Semi-structured qualitative interviews were conducted with a subsample of parents (n= 18). A small but significant intervention effect was found from baseline to COVID-19 follow-up in favor of Predictive Parenting on parent-reported child irritability (d=-0.33, 95% CI=-0.65,-0.01) and parenting stress (d=-0.31, 95% CI=-0.59,-0.03). No overall mean intervention effect for these measures as estimated by the AUC analyses (which takes into account the nonsignificant effect at primary endpoint) was found. Interview feedback on the both interventions was positive, and parents reported using strategies from Predictive Parenting during COVID-19-related restrictions. This opportunistic follow-up study at a time of stress indicates the need for careful consideration of how and when to measure the effects of BPIs in autistic child populations. Future trials should consider both the most appropriate endpoint and in what context effects may be more likely to be seen. Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com;91411078.

Evaluation of a Parenting Program for Disadvantaged Families in the Czech Republic

Purpose: This impact evaluation report describes the effects of the “Parenting Program for Disadvantaged Families” in the Czech Republic. We provide a detailed look at the quantitative data on treatment and control families in a program delivered by social workers to reduce the risk of children's misconduct. Method: The study specifies the results of two waves of quantitative research based on Parenting Young Children (PARYC), Strengths and Difficulties Questionnaire (SDQ), and items measuring parents’ attitudes toward punishment of their children. Results: The results of parental self-reported competencies and parent-reported children's behavior indicate that there was a statistically significant impact of the intervention. Discussion: There was a large effect on Supporting Positive Behavior (PARYC), and Prosocial Behavior and Peer Relationship dimensions of the SDQ. Parental practices and attitudes toward punishment are further explored, although the conclusions remain ambiguous.