Parent Report Research Articles

Assessment of sleep bruxism and its association with sleep quality, stress levels, and dental health in pediatric population: a multifactorial analysis.

Bruxism is defined as the recurring muscular activity of the jaw, which is distinguished by the unconscious grinding or clenching of teeth or pushing and forcing of the lower jaw. The present study was conducted to assess sleep bruxism and its association with sleep quality, stress levels, and dental health in the paediatric population. 384 children aged 6-12years were recruited for the study. Ethical approval from the institutional ethical committee and informed consent from parents and guardians were obtained. Children with systemic diseases, mental or developmental disorders, CNS-affecting medications, or those whose parents did not provide consent were not included. Bruxism was identified using the American Academy of Sleep Medicine (AASM) criteria through parental reports. Sleep quality and stress levels were assessed using AASM guidelines and the Perceived Stress Scale for Children (PSS-C). A chi-square test was applied to assess association, with a p value < 0.05 considered to be significant. The number of siblings and the mother's education level were also significantly associated. It was found that sleep bruxism is significantly associated with all parameters of sleep quality except the usage of pillows. When stress levels among children were assessed, it was found that 60 (15.6%) children had very low stress, 131 (34.1%) children had low stress, 95 (24.7%) children had average stress, 92 (24%) children had high stress, and 6 (1.6%) children had a very high level of stress. A statistically highly significant (p = 0.001) association was found between bruxism and stress levels among children. The results of the present study concluded that sleep bruxism was significantly linked with sleep quality and stress levels among children, which ultimately affect dental health.

Analysis of urban–rural differences in the relationship between grandparenting and the nutrition and health status of children aged 0–3 in China

BackgroundThe practice of grandparents taking on the role of primary caregivers for their grandchildren is widespread across both urban and rural regions in China. Yet, the existing body of research offered limited clarity on how grandparenting associated with nutrition as well as health of children aged 0–3 years, particularly in terms of potential differences between urban and rural areas in China. Therefore, this study aims to delve into the association between grandparenting and nutrition as well as health status of children aged 0–3 and its urban–rural differences in China.MethodsThis study draws on data from 1,028 children aged 0 to 3 years and their families, collected through the China Family Panel Studies (CFPS) in 2020. Nutrition and health status of children aged 0–3 was assessed based on the indicators of malnutrition, medical consultations due to illness and developmental delay. Parental reports were used to determine the extent of grandparenting, which any caregiving arrangement involving grandparents, whether during daytime, nighttime, or both, were categorized as grandparenting. Multivariate regression analyses were conducted to explore the association between grandparenting and nutrition as well as health outcomes of children aged 0–3.ResultsRegression analysis results indicated that grandparenting is positively associated with malnutrition (OR 1.323; 95% CI 1.008, 1.735), medical consultation for illness (OR 1.382; 95% CI 1.058, 1.804), and developmental delay (OR 1.502; 95% CI 1.508, 2.134) in children aged 0–3 years. The above association has been proven to be evident in rural settings, whereas it was not significant in urban environments.ConclusionGrandparenting exhibits a negative association with nutrition and health status of children aged 0–3. It is imperative for parents to consider their children’s caregiving arrangements carefully, and foster nutrition and health status of children from birth to 3 years old actively.

Barriers to Physical Activity Participation in Children and Adolescents with Autism Spectrum Disorder

Background: Children and adolescents with autism spectrum disorders tend to participate in less physical activity. The purpose of this study was to identify barriers to physical activity participation in children and adolescents with autism spectrum disorder (ASD) based on parental reports. Methods: The sample comprised 370 children and adolescents with ASD, aged 8–20 years. Simple random sampling was selected. We designed a questionnaire and used the survey method for data collection. Data were analyzed using descriptive and inferential statistics. Results: The results revealed several barriers to physical activity participation: interpersonal barriers were the top priority, followed by friends and peers as well as psychological factors as the second and third priorities. Additionally, family, cognition, management and planning, social and cultural factors, and skills were identified as the fourth through eighth barriers, respectively. Conclusions: Understanding these barriers is crucial for developing effective school- and community-based strategies to promote physical activity participation.

Socialization of adolescent emotion regulation through interparental conflict: Adolescent versus parent report

Socialization of adolescent emotion regulation through interparental conflict: Adolescent versus parent report

Concurrent and prospective associations of social media usage with binge eating symptoms in early adolescence.

This study investigated longitudinal relationships between social media usage and binge eating (BE) in early adolescence and explored potential moderating effects of sex and BMI. Data from the Adolescent Brain Cognitive Development (ABCD) Study, including 1940 participants aged 11 to 12 years at Wave 1, were analyzed over three annual waves. Social media addiction (SMA) scores and time spent on social media were calculated from self-report questionnaires. BE symptoms were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) through self-reports and parent reports. Modified Poisson regression was used to estimate associations, adjusting for demographic and behavioral covariates. SMA symptoms, but not time on social media, were cross-sectionally and prospectively associated with BE. Prospective associations were stronger in male adolescents and differed by baseline body weight. The consistently high SMA group showed the strongest association with follow-up BE compared with the consistently low SMA group, whereas decreased and increased SMA groups showed similarly positive associations. SMA scores predict BE in early adolescence, with differentiation in the relationship by sex and weight status. Further observational and interventional research could illuminate underlying mechanisms and test the value of targeting social media-addictive behaviors to mitigate the risk of disordered eating.

The discrepancies in parent and teacher reports of children’s behavioral inhibition provide domain-specific information about psychopathology and parenting

IntroductionBehavioral inhibition is a temperamental factor that increases the risk of internalizing disorders. Therefore, the identification of highly inhibited children is of great importance. However, informant discrepancies make this process difficult. In a cluster analytic approach, we aimed to use both parent and teacher reports of behavioral inhibition in order to gain a more detailed picture about children’s behavioral inhibition in different contexts and to characterize highly inhibited children.MethodsParents and teachers of 318 preschool children completed a questionnaire, which included the Behavioral Inhibition Questionnaire (BIQ) and the Strengths and Difficulties Questionnaire (SDQ). Parents also reported their parenting behavior on the Multidimensional Assessment of Parenting Questionnaire (MAPS). A two-step cluster analysis was conducted on BIQ parent and teacher reports, and the resulting clusters were compared on the SDQ externalizing and internalizing subscales. Multinomial logistic regression analyses were conducted separately for girls and boys to predict cluster membership based on the MAPS hostility, lax control and physical control subscales.ResultsFour clusters were identified, labelled as medium-low (ML), low-elevated (LE), elevated-elevated (EE) and high-high (HH), based on the levels of BIQ parent and teacher reports, respectively. In the HH cluster, mean scores of the SDQ internalizing subscales as reported by parents and teachers were significantly higher, and in boys but not in girls, mean scores of the SDQ externalizing subscale as reported by teachers were lower than in the other clusters. High levels of hostility predicted group membership of HH compared to LE and EE in both genders. Furthermore, in boys, lax control and physical control were also found to be significant when comparing HH to EE and LE, respectively.DiscussionOur results suggest that the joint use of parent and teacher reports on behavioral inhibition may increase the ability to identify highly inhibited children at risk of developing internalizing disorders and add to our understanding of the underpinnings of children’s inhibited behavior in different contexts.

Parental depressiveness and children’s emotional problems

This study used panel data to examine the longitudinal effect of maternal and paternal depressiveness on children’s emotional difficulties in two-parent families in Germany. The main purpose was to examine whether the strength of this association differs depending on whether parents or children themselves assessed children’s emotional difficulties. Based on data from 1,586 children from the German Family Panel (pairfam), our findings show much stronger associations between parental depressiveness and children’s emotional difficulties when using parent-reported measures than when using child-reported measures, which indicates a negative mood bias in parent reports. The findings emphasise the importance of taking children’s self-reports into account when studying child wellbeing.

Pathways to health: A longitudinal examination of protective factors in children with and without preschool anxiety.

Preschool anxiety is highly prevalent and well known to predict risk for future psychopathology. The present study explores whether a diagnosis of an anxiety disorder in preschool interacts with (a) social skills and (b) cognitive ability to longitudinally predict psychopathology, two well-known protective factors, among a sample of 207 children measured at preschool (Mage = 4.34 years) and early childhood (Mage = 6.61 years). To assess social skills and cognitive ability, we utilized the Social Skills Rating Scale and the Differential Abilities Scale, respectively. To assess psychopathology, we utilized the parent report of the Preschool Age Psychiatric Assessment. Hierarchical linear regression models revealed significant interactions between both social skills and cognitive ability with preschool anxiety. We observed that social skills protected against emergent psychopathology for both children with and without anxiety, although this association was stronger for children with preschool anxiety. Contrastingly, cognitive ability served as a protective factor against future psychopathology primarily among children without preschool anxiety. Results from this study identify targets for future intervention and inform our understanding of how preschool anxiety, a common disorder among young children, shapes future psychopathology risk in childhood.

Long-term quality of life and surgical outcome of female congenital adrenal hyperplasia patients.

To investigate the long-term quality of life and surgical outcome of female patients with congenital adrenal hyperplasia (CAH). Questionnaires for health-related quality of life (HRQoL) outcome (WHO-5, SF-36), lower urinary tract symptoms (ICIQ-FLUTS) and sexual outcome (ICIQ-FLUTSsex) were administered to adult CAH patients. Paediatric CAH patients and their parents were invited to complete WHO-5, PedsQL-4.0-SF15-Generic Core Scales and ICIQ-CLUTS. Six (46%) adults and 7 (54%) children with 21-hydroxylase-deficiency (age ranged from 8 years to 53 years) were recruited. Eleven (85%) had undergone a feminising genitoplasty. In the adult group, no statistically significant difference was identified in the HRQoL and ICIQ-FLUTS scores. Mean overall score of ICIQ-FLUTSsex was lower but not significantly in adult patients compared to controls (7.3 ± 2.9 vs. 2.9 ± 3.4, P = 0.06). A statistically significant negative correlation (r = -0.98, P = 0.02) was found between age at first operation and role limitations due to emotional problems in SF-36. No statistically significant difference was identified in the self-reported HRQoL and ICIQ-CLUTS scores in the paediatric group compared to controls. However, parent's report showed a statistically significant difference in school functioning (73.8 ± 18.9 vs. 91.2 ± 18.7, P = 0.02) and emotional functioning (80.3 ± 15.9 vs. 94.7 ± 12.7, P = 0.007). Our data did not show an impaired HRQoL nor long-term lower urinary tract symptoms in CAH patients' self-reports. Healthcare team should pay more attention to adult patient's sexual function.

Household chaos, emotion regulation and social adjustment in preschool children

Social adjustment is critical to preschool children’s overall development and well-being. Household chaos and emotion regulation are important influencing factors that affect young children’s social adjustment. Our study examines the interplay between household chaos and social adjustment among preschool children and investigates the mediating function of emotion regulation. Three parent report scales with sufficient reliability and validity were completed by parents from six kindergartens: the Confusion, Hubbub and Order Scale (CHAOS), Emotion Regulation Checklist (ERC), and Social Competence and Behavior Evaluation (SCBE-30). The results showed that household chaos can directly and indirectly predict social adjustment via the intermediary effect of emotion regulation. Understanding and addressing household chaos, as well as supporting children in developing emotion regulation skills, can play a significant role in promoting social adjustment and mental health in preschool children.

Social-Emotional Functioning of Children With Different Hearing Status and Diverse Cultural Background.

The study investigated the social-emotional functioning of children with typical hearing and deaf and hard of hearing (D/HH) children from diverse cultural backgrounds in Israel through parental reports. A total of 242 parents from both Arabic and Jewish communities participated: 130 were parents of D/HH children and 112 were parents of children with typical hearing. The Strengths and Difficulties Questionnaire and a background questionnaire were used. Results revealed increased total difficulties, emotional symptoms, and peer problems as reported by parents of D/HH children. Jewish parents of D/HH children reported greater total difficulties, conduct problems, and peer problems than Arab parents. Significant gender differences were found, with parents of boys reporting higher levels of hyperactivity/inattention and lower prosocial behavior. Among D/HH children, Arab parents reported higher peer problems among hearing aid users compared to cochlear implant users, whereas Jewish parents reported the opposite trend. These findings highlight the significant social-emotional challenges faced by D/HH children, particularly in peer interactions, and underscore the need for tailored interventions that consider cultural differences.

Oral health manifestations and the perceived quality of life among Saudi children: a cross-sectional study.

This cross-sectional study addresses scarcity of evidence on oral health issues among Saudi children and their impact on quality of life (OHRQL). We aimed to investigate parental reports of oral health problems in children and their effect on their OHQRL. Parents of children aged 2-11-years from Five-Saudi regions participated from February 2021 to July 2021 by completing an electronic, self-administered questionnaire structured according to World Health Organization-Oral Health Questionnaire for children. It comprises questions on children experiencing oral pain/discomfort, oral lesions/manifestations and reduction in their OHRQL. Among 1,516 responders, 1,107 (73.0%) reported that their children experienced toothache/discomfort. The possibility of parents reporting toothache/discomfort or oral manifestations decreased with younger children. For children aged 2-5 years, the odds ratio (AOR) was 0.18 (95% CI [0.13-0.24], P < 0.001) for toothache and 0.58 (95% CI [0.45-0.74], P < 0.001) for oral manifestations. For children aged 6-8 years, the AOR was 0.57 (95% CI [0.4-0.81], P = 0.002) for toothache. Additionally, parents of younger children less frequently reported reduced OHRQL with AORs of 0.58 (95% CI [0.45-0.73], P < 0.001) for children aged 2-5 years and 0.64 (95% CI [0.49-0.83], P < 0.001) for those aged 6-8 years. Lower parental education increased AORs, with values of 1.575 (95% CI [1.196-2.074], P = 0.001) and 1.505 (95% CI [1.208-1.876], P < 0.001) for younger and 6-8-year-old children, respectively. Results revealed notable prevalence of toothache/discomfort and oral manifestations in children reported by parents, which was related to age and parental education; ultimately leading to reduction in their OHRQL.

Non-Nutritive Suck and Parent Report of Feeding Skills in Infants Born With Cleft Lip and/or Palate

Objective To compare non-nutritive sucking (NNS) and caregiver-reported feeding skills in infants with cleft lip and/or palate (CL/P) to a control group of typically developing infants without CL/P. To examine differences in NNS patterns and feeding behavior between cleft phenotypes. Design Prospective, cross-sectional study comparing infants born with CL/P to an age-matched control group with no congenital anomalies. Setting Urban, academic, tertiary care children's hospital and academic department of speech-language pathology. Patients, Participants Forty-two infants (21 with CL/P; 21 without CL/P), 6 months of age and younger were included. Infants with syndromes or who underwent cleft repair were excluded. Main Outcome Measures A 5min NNS sample was collected from the infant sucking on the lab's custom research pacifier. The infant's caregiver completed the Neonatal Eating Assessment Tool (NeoEAT) bottle-feeding section about their infant's feeding behaviors. Results Infants with CL/P demonstrated slower NNS frequency ( P = .04) and reduced suck amplitude ( P = .04) compared to the control group. Caregivers of infants with CL/P reported a higher incidence of gastrointestinal symptoms ( P = .04) and overall feeding difficulties ( P = .03) relative to the control group. There were no significant differences between CL/P phenotypes for NNS or caregiver reported outcomes. Conclusions Infants with CL/P demonstrate differences in NNS physiology and caregiver report measures of feeding compared to age-matched controls. These findings support the need for interventions to optimize sucking and feeding skill development in infants with CL/P.

The patient and the family: investigating parental mental health problems, family functioning, and parent involvement in child and adolescent mental health services (CAMHS)

AbstractParental mental health problems can impact child mental health, as well as treatment of child mental health problems. The aim of this study was to investigate self-reported mental health problems in parents of children referred to outpatient child and adolescent mental health services (CAMHS) and to compare child mental health problems, family variables, treatment received and parent participation in treatment planning between parents above and below the cut-off for elevated mental health problems. The sample included N = 111 parents of N = 98 children. Parental reports covering their own and their children’s mental health problems, family functioning, adult relationship satisfaction, and previous treatment for mental health problems were collected at the time of the child’s intake appointment. Questions concerning contact with CAMHS were completed one year later. At the time of the intake appointment, 44% of the children had a parent who reported elevated mental health problems. In these families, children reportedly had significantly more mental health problems and problematic family functioning was more common than in families where parent mental health problems were not elevated. Parents with elevated mental health problems received group-based parent support/education to a greater extent during the first year of contact with CAHMS and reported less participation in treatment planning compared to parents without elevated mental health problems. To conclude, findings indicate that co-occurring mental health problems are common in parents when their child is referred to CAMHS, and in these families, it is reported that children have more symptoms, and more families experience problematic functioning. These factors merit consideration in assessment and treatment planning, indicating increased treatment needs in this group of families.

Development of inattention and executive dysfunction in youth with spina bifida: condition severity variables as predictors

ABSTRACT Youth with spina bifida (SB) are at increased risk for inattention and executive dysfunction challenges. This study aimed to characterize the development of inattention and executive dysfunction in SB and examine the relationship between condition severity (i.e. lesion level, shunt status, and shunt revisions) and inattention and executive dysfunction at age 11.5 and longitudinally. Participants included 140 youth with SB. Condition severity was collected via parent reports and chart review. Parents and teachers reported on youth’s inattention and executive dysfunction using informant-based measures across five time points. Parents and teachers both reported linear decreases in inhibition and working memory problems. Development of inattention and shifting problems varied by reporter. At 11.5 years, shunt status predicted worse parent- and teacher-reported inattention and executive dysfunction, while shunt revisions predicted worse parent-reported working memory alone. Higher lesion level predicted fewer parent-reported inhibition problems at 11.5 years. Over time, more shunt revisions and higher lesion level predicted worse parent-reported inattention and inhibition, respectively. Findings suggest that inattention and executive dysfunction may significantly change over time in youth with SB, related to condition severity and reporter. Early deficit identification and intervention implementation, particularly for youth with greater SB severity, may result in better longitudinal outcomes.

Predicting Syndromic Status Based on Longitudinal Data from Parental Reports of the Presence of Additional Structural and Functional Anomalies in Children Born with an Orofacial Cleft.

Background: Orofacial clefts are the most common craniofacial congenital malformation in humans. Approximately 30% of clefts arise as part of a syndrome or sequence, characterised by co-existing structural and functional anomalies. Many syndromes are thought to be undiagnosed, although the presence of multiple anomalies may indicate the presence of a syndrome or sequence. Aim: To determine the extent to which the presence of additional structural and functional anomalies can help to identify those children with an undiagnosed syndrome. Methods: Secondary data analysis was performed using data from 1701 children born with an orofacial cleft, collected as part of a longitudinal cohort study, the Cleft Collective. Data were collected between 2013 and 2023 across the United Kingdom. The prevalence of structural and functional anomalies and syndromes were explored using descriptive statistics. Logistic regression was used to determine the extent to which anomalies can predict syndromic status. Results: A syndrome and/or sequence was reported in 20.5% children. Among children who reported five or more anomalies, the prevalence of a diagnosed syndrome was 81.5%. When adjusting for cleft subtype and sex, in 27 out of 32 anomalies tested, strong evidence was found to suggest increased odds of having a syndrome if the specific anomaly was present compared to if the anomaly was absent (p-values ranged between 1.4 × 10-30 and 0.002). Conclusions: Children born with a cleft who present with two or more anomalies are much more likely to have a syndrome than those with fewer anomalies and should be prioritised for genetic screening and counselling.

Assessing Whether Negative Parenting Cognitions Bias Parent Report of Preschoolers' Externalizing Symptoms: A Regularized Moderated Non-Linear Factor Analysis Approach.

Parent report is frequently used to assess children's psychopathology, however, researchers have expressed concerns about the validity of parent reports. Some parental characteristics, attitudes, or beliefs may systematically bias a parent's report of their child's behaviors and functioning. Informed by social information processing models of parenting risk, parents with more difficulties reflecting on and interpreting their children's behavior may be at risk for less accurate reports. The present study conducted two regularized moderated non-linear factor analyses with LONGSCAN data to examine how parents' self-reported negative parenting cognitions were associated with structural parameters of parent-reported child aggression and attention problems. While differential item functioning (DIF) was present on the aggression and attention problems subscales as a function of negative parenting cognitions, the DIF was small in magnitude, inconsistent in directionality and did not significantly alter factor-level parameters. Negative parenting cognitions did demonstrate a small but significant negative impact on all latent externalizing factors (aggression and attention problems), such that caregivers with fewer negative parenting cognitions endorsed fewer items, and this was associated with a lower mean of each latent variable. Given that accounting for DIF did not contribute to meaningful differences in impact parameters or improve criterion validity, findings suggest that the aggression and attention subscales are functionally invariant to negative parenting cognitions, suggesting that externalizing symptoms can be reliability compared across parents of varying parenting cognitions.

Modeling longitudinal change patterns of self-regulation from early to middle childhood: Methodological innovations and individual differences.

Patterns of change in self-regulation from the ages of 2.5 to 12 years were modeled using repeated measures of self-regulation for a sample of 399 African American (n = 180, 45%) and Latinx (n = 219, 55%) children from families experiencing low income. Measures included both direct assessment and parent report. Results confirmed four components of self-regulation: working memory, inhibitory control, complex response inhibition, and set shifting. Furthermore, these components of self-regulation were more differentiated at younger ages but grew increasingly integrated as children developed. During early childhood, Latinx children displayed greater levels of working memory and higher levels of inhibitory control, and African American children displayed greater complex response inhibition and set shifting, but these ethnic differences reversed by early elementary school. By late middle childhood, ethnic differences in self-regulation had virtually disappeared altogether. Few differences by child gender or family poverty status were identified. Recommendations are provided to facilitate the modeling of self-regulation over extended periods of development including (a) utilizing measures that overlap time points, (b) standardizing the measurement scales, and (c) utilizing a flexible latent variable model. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Multi-Informant Universal Mental Health Screening for Preschool-Aged Children by Parents and Educators: A PRISMA Systematic Review.

Children develop rapidly in the preschool period, making accurate appraisals of mental health (MH) difficult. The preschool years are a key period for early identification of MH concerns and could benefit from multi-informant, universal MH screening (UMHS). This systematic review aimed to identify multi-informant UMHS measures for preschool-aged children, and to examine their clinical utility, effectiveness, and acceptability. Studies reporting the predictive and incremental validity, effectiveness or acceptability of parent and educator-report UMHS measures for children aged 3-5years were identified through CINAHL, Embase, ERIC, Medline, PsycINFO, Scopus and Web of Science. Studies were excluded if screening was not the primary focus, not universal, single informant, or primarily focussed on Autism Spectrum Disorder. A total of 11 studies using 10 measures was identified. Ten studies screened for broad MH difficulties. Three educator-report and one parent- and educator-report measures had acceptable predictive validity. One study reporting incremental validity found that adding educator-report to parent ratings significantly improved the identification of MH concerns. No studies reported on effectiveness. Three studies that explored acceptability reported strong support for either UMHS in general or specific measures. There are promising results that UMHS can accurately identify child MH concerns in the preschool period using parent and educator reports. However, with few of the examined measures reaching the benchmark standards for predictive validity and only one study examining incremental validity, further research is needed to establish clinical utility. UMHS with preschool populations appears to be acceptable; future studies should further examine multi-informant screening in preschool populations. This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; https://www.crd.york.ac.uk/prospero ; registration number: CRD 42022383426).

A Multicomponent Preventive Intervention in the Early Elementary Years: A Look at Academic and Social Adjustment Outcomes.

Cogent indicated prevention with young children at risk for early onset conduct problems needs to address multiple domains of influence in school and home settings. A multicontextual preventive intervention (MPI) spanning grades one and two was conducted in schools serving economically disadvantaged communities and evaluated separately for boys and girls. The cluster randomized design evaluated children nested within schools receiving either the MPI (6 schools), which consisted of after-school reading-mentoring, home-based family, peer coping-skills, and classroom components, or a control condition (6 schools) involving a school-wide conflict management program without targeted intervention. Drawn at the end of kindergarten based on elevated behavioral difficulties and first-grade attendance at one of the 12 schools, the two subsamples consisted of 193 boys and 171 girls (63% in households with annual income < $15,000; 95% Black children). Extensive fidelity data indicated that the MPI components were well implemented. The two post-intervention third-grade outcomes in this report are academic performance and social/behavioral adjustment. The analyses involved a linear mixed effects model controlling for school. The key finding for the male subsample was that the MPI produced greater overall and language-arts/reading achievement, measured by report cards for the entire third-grade school year, compared with the control group. MPI-control differences did not emerge for externalizing problems and social competence assessed via teacher and parent report. In the face of elevated risk and poverty, the study underscored the importance of contributions from community-based reading-mentors, positive and inclusive classrooms, and nurturing family contexts in achieving academic gains.