Early-life Problems Research Articles

Associations of Internalizing and Externalizing Problems in Childhood and Adolescence With Adult Labor Market Marginalization

Mental health problems in early life are associated with labor market marginalization, especially in youths with persistent internalizing and externalizing problems. However, previous research has not adjusted for familial (genetic and shared environmental) factors. To examine associations of early-life internalizing and externalizing problems with adulthood unemployment and work disability, adjusting for familial factors. This population-based prospective cohort study included Swedish twins who were born in 1985-1986 and surveyed at 4 consecutive waves across childhood and adolescence until 2005. Through linkage to nationwide registries, participants were followed up from 2006 to 2018. Data analyses were conducted between September 2022 and April 2023. Internalizing and externalizing problems, assessed with the Child Behavior Checklist. Participants were differentiated regarding duration of internalizing and externalizing problems (persistent, episodic, and noncases). Unemployment (180 days or more of being unemployed) and work disability (60 days or more of being sickness absent or disability pensioned) during follow-up. Cox proportional hazards regression models were calculated to obtain cause-specific hazard ratios (HRs) with 95% CIs in the whole cohort and exposure-discordant twin pairs. Of 2845 participants, 1464 (51.5%) were female. Incident unemployment was experienced by 944 (33.2%) and incident work disability by 522 (18.3%) participants. Compared with noncases, persistent internalizing problems were associated with unemployment (HR, 1.56; 95% CI, 1.27-1.92) and work disability (HR, 2.32; 95% CI, 1.80-2.99). Similarly, compared with noncases, persistent externalizing problems were associated with unemployment (HR, 1.87; 95% CI, 1.55-2.26) and work disability (HR, 2.38; 95% CI, 1.87-3.03). Persistent cases had overall higher risks of adverse outcomes than episodic cases. After adjustment for familial factors, associations with unemployment were no longer statistically significant, whereas associations with work disability remained or were only slightly reduced. In this cohort study of young Swedish twins, familial factors explained the associations between early-life persistent internalizing and externalizing problems and unemployment; such factors were comparatively less important for the association with work disability. This suggests nonshared environmental factors may be important for the risk of future work disability among young individuals with persistent internalizing and externalizing problems.

Oral health inequalities and disability: Closing the gap.

The social determinants of health impact disproportionately on disabled people creating a cumulative risk of unequal oral health outcomes, compounded by impairment. Problems in early life, education and employment, poor social status and support, social exclusion, poverty and stress characterize the life course of many disabled people. Ableism and exclusion combine to ensure that disabled voices are rarely heard, ignorance and indifference lead to prejudice in policy-making and enforcement and negative media attitudes fuelled by political austerity lead to stigmatization. Yet, the health disparities experienced by disabled people are still perceived as being uniquely caused by a medical condition or impaired body function, excluding disabled people from the inequalities discourse. In parallel, the influence of medical conditions within other marginalized groups are minimized (e.g. mental health), leading to the underestimation of the impact of disability on oral health generally. The common ground between all groups subject to oral health inequalities can be conceptualized using the WHO International Classification of Functioning. Outcomes for all might be improved by emphasizing this common ground; by considering disability as a primary variable, such as gender or age; by identifying disabled people within existing inequalities research; and by explicitly including disabled people in future research.

Internalizing behavior problems in early life are associated with the risk of childhood asthma: The COCOA study

Previous clinical studies suggest the relationship between children’s behavior problems and asthma. This study aimed to investigate children’s behavior problems in early life and subsequent development of childhood asthma through longitudinal birth cohort study in Korea.

Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8\u201316\u2009years

BackgroundKnowledge about the occurrence and distribution of musculoskeletal problems in early life is needed. The objectives were to group children aged 8 to 16 according to their distribution of pain in the spine, lower- and upper extremity, determine the proportion of children in each subgroup, and describe these in relation to sex, age, number- and length of episodes with pain.MethodData on musculoskeletal pain from about 1,000 Danish schoolchildren was collected over 3 school years (2011 to 2014) using weekly mobile phone text message responses from parents, indicating whether their child had pain in the spine, lower extremity and/or upper extremity. Result are presented for each school year individually.ResultsWhen pain was defined as at least 1 week with pain during a school year, Danish schoolchildren could be divided into three almost equally large groups for all three school years: Around 30% reporting no pain, around 40% reporting pain in one region, and around 30% reporting pain in two or three regions. Most commonly children experienced pain from the lower extremities (~ 60%), followed by the spine (~ 30%) and the upper extremities (~ 23%). Twice as many girls reported pain in all three sites compared to boys (10% vs. 5%) with no other statistically significant sex or age differences observed. When pain was defined as at least 3 weeks with pain during a schoolyear, 40% reported pain with similar patterns to those for the more lenient pain definition of 1 week.ConclusionDanish schoolchildren often experienced pain at more than one pain site during a schoolyear, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes.

Functional Activation During a Cognitive Control Task in Healthy Youth Specific to Externalizing or Internalizing Behaviors

BackgroundExternalizing behaviors are negative behaviors expressed outwardly, including rule breaking, aggression, and risk taking; internalizing behaviors are expressed inwardly, including depression, withdrawal, and anxiety. Such behavior can cause problems in early life and predict difficulties across the lifespan. There is evidence for a relationship between executive function and both externalizing and internalizing. However, although these behaviors occur along a spectrum, there is little neuroimaging research on this relationship in typically developing youth. MethodsWe assessed 41 youth (10–19 years of age) using the Multi-Source Interference Task during functional magnetic resonance imaging and related the findings to self-reported externalizing and internalizing scores as measured by the Youth Self-Report. We performed a general linear model using FSL software; externalizing, internalizing, age, and sex were included in the model. ResultsCompared to the control condition, the more difficult Multi-Source Interference Task interference condition was associated with greater engagement of the frontoparietal cognitive control system and decreased engagement of regions in the default mode network, based on a cluster threshold of Z > 3.1 (p = .01). When we examined regions uniquely associated with either internalizing or externalizing, we found that within the same group of subjects, higher externalizing behavior was associated with hyperactivity in the parietal lobe; in contrast, higher internalizing behavior was associated with increased activation in the medial prefrontal cortex. ConclusionsThese findings suggest that externalizing and internalizing may be associated with altered, but different, patterns of activation during cognitive control. This has implications for our understanding of the relationship between cognitive control and behavioral problems in youth.

The relationship between maternal emotional symptoms during pregnancy and emotional and behavioral problems in preschool children: a birth cohort study

To investigate the related influencing factors of preschool children's emotional and behavioral problems in early life and explore the associations between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children. Based on the Ma'anshan Birth Cohort Study of the China-Anhui Birth Cohort Study (C-ABCS), women were recruited at their first clinical visit between October 2008 and October 2010 in four municipal medical and health institutions of Ma'anshan City, a total of 5 084 pregnant women and 4 669 singletons live births were included in the birth cohort. Women completed measures of depressive (Self-Rating Anxiety scale) and anxious (Center for Epidemiologic Studies Depression) symptoms in pregnancy. By the age of 3-6 follow-up, 3 653 children were followed with completed information between April 2014 and April 2015, strengths and difficulties questionnaires were used to assessed offspring emotional and behavioral problems. Logistics regression was used to investigate the relationship between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children. The detected rates of emotional symptoms, conduct problems, hyperactivity and peer problems in preschool children were 6.3% (229/3 653), 7.5% (274/3 653), 7.6% (278/3 653) and 2.8% (103/3 653), while 7.6% (277/3 653) for total difficulties, 10.9%(398/3 653) for prosocial behavior and 27.4%(981/3 557) for impact respectively. Prevalence of anxiety and depression in the first trimester was 2.7%(100/3 653) and 4.7%(171/3 653) respectively, and in the second trimester was 2.0%(66/3 375) and 3.6%(122/3 375) respectively. After we controlled the confoundings of gestation age, place of residence, family income, maternal education, paternal education, premature birth and folic acid supplement before pregnancy, multinomial logistic regression analysis showed that the risk of children's emotional symptoms in maternal anxiety in both first-trimester and second-trimester group was higher than the group of no depression and anxiety symptoms, and OR(95%CI) was 5.90(2.00-17.48). Compared with whose mother no depression in both first-trimester and second-trimester, the risk of children's emotional symptoms in maternal depression in both first-trimester and second-trimester group was higher, and OR(95% CI) was 3.07 (1.30-7.28). And the risk of children's total difficulties of maternal anxiety in second-trimester was 2.27 (95%CI: 1.10-4.71) times of no anxiety in second-trimester. While the risk of children's total difficulties of maternal depression in second-trimester was 2.20 (95%CI: 1.24-3.93) times of no depression in second-trimester. Maternal emotional symptoms were not significant associations with conduct problems, hyperactivity, peer problems and prosocial behaviors (P> 0.05). There was a negative impact of maternal anxiety and depression symptoms during pregnancy on emotional and behavioral problems in preschool children. These findings highlight the need for additional clinical and research attention to both maternal depression and anxiety in pregnancy, which may be helpful to reduce the incidence of children's emotional and behavioral problems and act as an important measure in prevention.

The co-occurrence of chronic pain and psychological distress and its associations with salient socio-demographic characteristics among long-term social assistance recipients in Norway

BackgroundWhile lower socioeconomic status increases individual's risk for chronic conditions, little is known about how long-term social assistance recipients (LTRs) with multiple chronic health problems experience chronic pain and/or psychological distress. Social assistance is the last safety net in the Norwegian welfare system and individuals have a legal right to economic assistance if they are unable to support themselves or are entitled to other types of benefits. The purposes of this study were to determine the co-occurrence of both chronic pain and psychological distress and to evaluate for differences in demographic and social characteristics, as well as health-related quality of life, among LTRs. MethodsThis descriptive, cross-sectional study surveyed people receiving long-term social assistance in Norway about their health and social functioning from January-November 2005. The social welfare authority offices in each of 14 municipalities in Norway were responsible to locate the LTRs who met the study's inclusion criteria. The selected municipalities provided geographic variability including both rural and urban municipalities in different parts of the country. LTRs were included in this study if they: had received social assistance as their main source of income for at least 6 of the last 12 months; were between 18 and 60 years of age; and were able to complete the study questionnaire. In this study, 405 LTRs were divided into four groups based on the presence or absence of chronic pain and/or psychological distress. (1) Neither chronic pain nor psychological distress (32%, n=119), (2) only chronic pain (12%, n=44), (3) only psychological distress and (24%, n=87), (4) both chronic pain and psychological distress (32%, n=119). ResultsExcept for age and marital status, no differences were found between groups in demographic characteristics. Significant differences were found among the four groups on all of the items related to childhood difficulties before the age of 16, except the item on sexual abuse. LTRs with both chronic pain and psychological distress were more likely to have experienced economic problems in their childhood home; other types of abuse than sexual abuse; long-term bullying; and had more often dropped out of school than LTRs with neither chronic pain nor psychological distress. LTRs with both chronic pain and psychological distress, reported more alcohol and substance use/illicit drug use, more feelings of loneliness and a lower mental score on SF-12 than LTRs with only chronic pain. Conclusions and implicationsCo-occurrence of chronic pain and psychological distress is common in LTRs and problems in early life are associated with the co-occurrence of chronic pain and psychological distress in adult life. Although this study cannot assign a clear direction or causality to the association between social and demographic characteristics and chronic pain and psychological distress, the findings when examining LTRs’ problems in childhood before the age of 16, indicated that incidents in early life create a probability of chronic pain and psychological distress in the adult life of the individuals. Further studies should use life course studies and longitudinal data in to investigate these important questions in LTRs.

Conduct problem trajectories and alcohol use and misuse in mid to late adolescence

BackgroundWe consider the strength of the relationship between types of conduct problems in early life and pattern of alcohol use during adolescence. MethodsChildren from the Avon Longitudinal Study of Parents and Children, a UK birth-cohort, had their level of conduct problems assessed repeatedly from 4 to 13 years using the maternal report Strengths and Difficulties Questionnaire. Developmental trajectories derived from these data were subsequently related to (i) patterns of alcohol use from 13 to 15 years, and (ii) hazardous alcohol used at age 16. ResultsBoys with ‘Adolescent Onset’ or ‘Early Onset Persistent’ conduct problems were much more likely to be high frequency drinkers between 13 and 15 years (OR 5.00 95% CI=[2.4, 10.6] and 3.9 95% CI=[2.1, 7.3] respectively) compared with those with Low or ‘Childhood Limited’ conduct. Adolescent Onset/Early Onset Persistent girls also had greater odds of this high-alcohol frequency drinking pattern (2.67 [1.4, 5.0] and 2.14 [1.2, 4.0] respectively). Associations were more moderate for risk of hazardous alcohol use at age 16. Compared to 32% among those with low conduct problems, over 40% of young people classified as showing Adolescent Onset/Early Onset Persistent conduct problems were drinking hazardously (OR 1.52 [1.09, 2.11] and 1.63 [1.22, 2.18] respectively). ConclusionsWhilst persistent conduct problems greatly increase the risk of adolescent alcohol problems, the majority of adolescents reporting hazardous use at age 16 lack such a history. It is important, therefore, to undertake alcohol prevention among all young people as a priority, as well as target people with manifest conduct problems.

Early life conditions and financial risk-taking in older age

Abstract Using life-history survey data from 11 European countries, we investigate whether childhood conditions – such as socioeconomic status, cognitive abilities and health problems – influence portfolio choice, including homeownership, and risk attitudes later in life. After accounting for the corresponding conditions in adulthood, we find that both higher childhood socioeconomic status and cognition (especially mathematical ability) are strongly and positively associated with owning risky financial assets, a house, as well as with one’s willingness to take financial risks. In stark contrast, having had health problems in early life negatively affects only homeownership in older age. Finally, favorable childhood conditions are also positively associated with the transition in and out of risky asset ownership several decades later, both by facilitating investing and making divesting less likely.

Behavior Problems Antecede the Development of Wheeze in Childhood

It is not clear to what extent behavior problems observed in children with asthma antecede asthma development, or are a consequence of the disease. We investigated psychologic factors at age 3 years and subsequent development of wheeze by age 5 in an unselected birth cohort study. Children were recruited prenatally, followed prospectively, and reviewed at age 3 and 5 years. The rate of significant behavior problems at age 3 (above the clinically relevant cut-off on the Eyberg Child Behavior Inventory) was compared between children who had never wheezed (n = 397) and those developing late-onset wheezing (after age 3 years; n = 39). Late-onset wheezers were more likely to be above cut-offs for behavior problems at 3 years (before wheeze onset), compared with children who never wheezed, on Intensity (23.1% vs. 6.0%, p < 0.001) and Problem scores (10.8% vs. 1.3%, p < 0.001). Families of late-onset wheezers had poorer scores on family functioning variables, but we found no evidence of increased anxiety or depression scores in parents. In the multivariate analysis, significant and independent associates of late-onset wheeze were as follows: maternal asthma (odds ratio [OR] 5.4, 95% confidence intervals [CI] 2.1-13.8, p < 0.001), maternal smoking when child was 3 years (OR 3.3, CI 1.2-8.7, p = 0.02), expressiveness (OR 0.71, CI 0.55-0.9, p = 0.005), and significant behavior problems at age 3 years (OR 3.5, CI 1.2-9.9, p = 0.02). Behavior problems in early life are associated with increased risk of subsequent development of wheeze.

A CLINICAL PERSPECTIVE IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE

The pediatric clinician enjoys a responsible position in the evaluation and management of cardiac problems in early life. The diagnosis of congenital heart disease is facilitated by an understanding of the functional meaning of cyanosis, the physical work of the heart and its chambers, and the significance of the pulmonary vascular bed. Medical history and physical findings may be interpreted to suggest the presence or absense of a shunt, its predominant direction and gross magnitude, and its effect on volume flow and pressure in the pulmonary circulation. Similarly, many obstructive lesions and anomalous vascular arrangements may be identified, localized and their severity grossly evaluated from historic and physical observations. A malformation is significant to the extent that circulatory function is disturbed. The resulting stresses are manifest as clinical abnormality. Clinical evaluation incorporating appreciation of abnormal function leads logically to differential identification of anatomic alternatives. Innocent murmurs, commonly a cause of needless parental anxiety and iatrogenic cardiac disability, may be confidently identified in large majority by their own physical characteristics. Electrocardiographic and roentgenographic study are essential for complete evaluation. Complex and severe cases may require the skill of a consultant and the assistance of definitive investigative procedures, particularly if the differential diagnosis includes an operable malformation. Indications for cardiac catheterization and angiographic study may vary, but indiscriminate use at any age is discouraged. Even when such methods are necessary, searching clinical appraisal is required in order to define the most profitable direction and optimum time for study. For simpler problems, such procedures may be unnecessary and even misleading as well as significantly hazardous and expensive. Diagnosis is often most difficult and most critical in early infancy, partly because of characteristics of circulatory function peculiar to this period, partly because of the larger number of bizarre, complex and lethal malformations encountered.