Strengths And Difficulties Questionnaire Total Score Research Articles

Emotional status and problem behavior of pre-school children according to the pandemic period and occupational status of the mother

ABSTRACT The aim was to compare the emotional status and problem behavior of pre-school children according to their mother’s occupational status in two groups before the pandemic and during the pandemic period. Mothers were asked to fill out a survey form containing sociodemographic characteristics, the Emotion Regulation Checklist (ERC) and the Strengths and Difficulties Questionnaire (SDQ) . Total ERC and Emotion Regulation Subscale scores were significantly higher and Lability-Negativity Subscale scores, conduct problems, peer relationship problems, internalising scores and total SDQ scores were significantly lower in the pandemic period group than in the pre-pandemic group. The occupational status of mothers in the PanP and Pre-Pan groups did not significantly differ in ERC scores, peer relationship problems scores, and prosocial behavior, whereas, internalization was lower during PanP and was associated with the mother’s occupational status.

The effect of personality traits and parental attitudes on treatment in children and adolescents: a 6-month follow-up study

Objectives: This study aims to examine the effects of personality traits and parental attitudes on the change of emotional and behavioral problems in children and adolescents with mental disorders receiving outpatient treatment during the six months. Methods: In the study, 233 individuals between the ages of 7-17 who applied to the Child Psychiatry Outpatient Clinic of a private hospital in Istanbul between September 2015 and September 2017 and who had psychiatric disorders regarding DSM-V diagnostic criteria were evaluated before treatment with the Sociodemographic Data Form, Strengths and Difficulties Questionnaire (SDQ), Quick Big Five Personality Test (QBFPT), and Parental Attitude Scale (PAS). Emotional and behavioral problems of children and adolescents who were followed up for psychiatric treatment were evaluated by SDQ at the first, third, and sixth months. Results: According to the Pearson Correlation Analysis, it was found that the SDQ total scores of children and adolescents in the pre-treatment period were statistically significantly positively correlated with the Democratic Attitude subscale scores (r = 0.129, p = 0.049). Considering the QBFPT and PAS sub-dimension scores in ANCOVA analyzes, the change in the SDQ total scores before and after treatment was statistically significant (p < 0.05), and Democratic Attitude subscale scores (F = 2.70, p = 0.048) and Emotional Stability subscale scores (F = 3.27, p = 0.023) had statistically significant effects on this change. Conclusions: In children and adolescents with mental disorders, focusing on democratic attitudes and personality traits associated with emotional stability may help reduce emotional and behavioral problems during treatment.

Impact of school closures during the pandemic on screen time and behavior of children: Evidence from a developing country

IntroductionSerious concerns regarding the indirect physical and mental health impact of the extended school closure measure to control the spread of the pandemic have been raised, however, the extent of the problem remains unquantified in India.ObjectivesTo examine the impact of school closures on recreational screen time, emotional, and behavioral functioning of school-going children during the pandemic.MethodsThe survey utilized a Google form that was sent to parents of children (6-14 years) through emails and social media platforms. Parents were asked to report on the child’s duration of recreational screen time and whether the child’s overall behavioral functioning had changed since the school closures. The child’s emotional and behavioral functioning was assessed by the Strength and Difficulties Questionnaire (SDQ). The study was cleared by the Ethics committee.ResultsA total of 160 parents were recruited for the study. Overall, a little more one-fourth (28.1%) of the children’s behavior was reported to have worsened. The mean recreational screen time was 2.65 hours (SD=1.89). A significantly higher proportion of children whose behavior worsened after school closures, relative to those whose behavior improved or remained same, had scores in the abnormal range of functioning on three of the subscales of SDQ. Stepwise multiple regression analysis indicated that recreational screen time explained 2% of the variance in the total SDQ score (F=4.18. P=.04).ConclusionsIncrease in psychological services supporting healthy behaviors and anticipatory telehealth consultations for high-risk children and families is the need of the hour to foster psychological wellbeing during the pandemic.DisclosureNo significant relationships.

Development and validation of a multidimensional, culturally and socially inclusive Child Resilience Questionnaire (parent/caregiver report) to measure factors that support resilience: a community-based participatory research and psychometric testing study in Australia

ObjectiveDevelop a comprehensive socially inclusive measure to assess child resilience factors.DesignA socioecological model of resilience, community-based participatory research methods and two rounds of psychometric testing created the Child Resilience Questionnaire...

Psychological problems in tunisian children during the covid-19 pandemic

IntroductionThe Covid-19 outbreak and the subsequent lockdown have profoundly impacted families’ daily life. Children may be among the most exposed to the psychosocial consequences of the pandemic.ObjectivesTo assess the psychological well-being of children during the COVID-19 pandemic.MethodsThis was a descriptive study shared on social media during the period from 8 to 20 April 2021, targeting mothers of children aged 2 to 18 years. The first part included socio-demographic data of mothers and children. Then, to assess the behavior and coping skills of children and adolescents, we administered the Strengths and Difficulties Questionnaire (SDQ).ResultsOur study included 65 middle-aged moms = 35.28 years. Among mothers, 1.5% reported having at least one child with a psychiatric, medical or genetic illness. The average age of the children was 8.54 years, the sex ratio was 1.03 and they were in primary school in 52.3%. Moms had talked to their child about COVID in 93.8%, using scientific data in 69.4% of cases. The total average SDQ score was 10.82; and overall mental health was at risk in 15.4% of the children. They had risky emotional symptoms in 9.2%, risky aggressive behaviors in 12.3%, risky hyperactivity-inattention symptoms in 16.9%, relationship behaviors with at-risk pairs in 24.6%, and risky prosocial behavior in 9.2% of cases.ConclusionsResearchers and government officials should be more concerned about the mental health of children who are often neglected as a result of the pandemic due to their comparatively lower mortality than older adults.DisclosureNo significant relationships.

Testing the psychometric quality of screening tools for the well-being of children and caregivers in alternative care-settings: a multi-informant study with families in Tanzania

ABSTRACT Given the lack of validated screening tools for the well-being of children and caregivers in family-based care in low-income settings, the present study aimed to test the psychometric quality of two newly developed tools: Scorecard A as a screener for children’s emotional and behavioral problems and Scorecard B as a screener for caregivers’ well-being and resources. The study was conducted within the framework of an ongoing caregiver training program in Dar es Salaam, Tanzania, and included a sample of 124 caregivers and 99 children (57 girls, M age = 9.30, SD = 4.65, range 3–17) divided in three equally sized age groups of preschool (3 to 5 years), primary school (6 to 12 years) and secondary school age (13 to 17 years). Caregivers reported on children’s emotional and behavioral problems using Scorecard A and the Strengths and Difficulties Questionnaire (SDQ) administered as a structured interview. A sub-sample (n = 78) of caregivers participated in another structured interview on various aspects of their well-being and caregiving resources, based on which interviewers rated Scorecard B. Additionally, caregivers completed Scorecard B and measures of their well-being and resources administered as self-report questionnaires. All assessments were conducted twice with an interval of 1 week. Scorecard A showed good internal consistency and test-retest-reliability across age groups and significant associations with the SDQ total score and subscales indicate convergent validity, particularly among preschool-aged children. The internal consistency of Scorecard B was acceptable in the questionnaire and good in the interviewer rating, while re-test-reliability in both modes and inter-rater reliability between interviewer and caregiver rating were moderate. Associations with established measures of well-being and resources provided evidence for convergent validity of Scorecard B. The Scorecards hold promise as brief screening tools to identify children and caregivers with difficulties and evaluate intervention programs in low-resource contexts.

The relationship between online courses and mental health among Chinese children

BackgroundPrevious studies on the association of online courses and mental health were mainly conducted in universities, and no study investigated the relationship between characteristics of online courses and children’s mental health in primary and secondary school. This study aimed to explore the association of online courses and children’s mental health in primary and secondary school.MethodsA cross-sectional study was conducted through an online survey among 540 primary and secondary school students and their parents in the eastern, central and western region of China from April to May in 2020. Children’s mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ). Borderline mental health problems (SDQ total difficulties score ≥ 16) and mental health problems (SDQ total difficulties score ≥ 20) were defined according to Goodman’s standard. Multivariable linear and logistic regression models were used to examine the association between online courses and children’s mental health.ResultsCompared with those who did not have problems of online courses, children having the difficulty in understanding the content of online courses had a higher SDQ total difficulties score [β = 1.80, 95% confidence interval (CI): 0.89, 2.71] and a higher risk of borderline mental health problems [odds ratio (OR) = 1.93, 95%CI: 1.07, 3.49], while device or internet connection problems were not significantly associated with children’s mental health. Compared with children who had live courses, those having video-recorded courses had a higher SDQ total difficulties score (β = 0.90, 95%CI: 0.01, 1.80). Children who spent more than 4 h on online courses had a higher SDQ total difficulties score than those of less than or equal to 4 h (β = 0.95, 95%CI: 0.09, 1.81).ConclusionWe found that online courses with inappropriate characteristics were associated with children’s mental health. The findings called for the efforts to optimize the online courses and improve children’s mental health.

Park access and mental health among parents and children during the COVID-19 pandemic

BackgroundTime spent outdoors and in nature has been associated with numerous benefits to health and well-being. We examined relationships between park access and mental health for children and parents during the COVID-19 pandemic. We also explored associations between park access and co-participation of parent and child in time outdoors, and child and parent physical activity.MethodsWe used data from 1,000 respondents to a nationally representative U.S. survey of parent–child dyads during October–November 2020. Park access was defined as an affirmative response to: “do you have a park that you can safely walk to within 10 min of your home?” Child mental health was operationalized as the Strengths and Difficulties Questionnaire (SDQ) total difficulties score. The Patient Health Questionnaire-4 (PHQ-4) total score assessed parent mental health and the International Physical Activity Questionnaire (IPAQ) assessed parent physical activity. Child physical activity and co-participation in outdoor activity were reported as number of days in the prior week. Linear regression was used to examine relationships between park access and health outcomes in models adjusted for child and parent characteristics and COVID-19 impact.ResultsOur sample included 500 parents of children ages 6–10 years, and 500 parent–child dyads of children ages 11–17 years. Park access was associated with a lower SDQ total score among children (β: -1.26, 95% CI: -2.25, -0.27) and a lower PHQ-4 total score among parents (β: -0.89, 95% CI: -1.39, -0.40). In models stratified by child age, these associations were observed for SDQ scores among adolescents ages 11–17 and for PHQ-4 scores among parents of children ages 6–10 years. Park access was also associated with 0.50 more days/week of co-participation in outdoor time (95% CI: 0.16, 0.84), and higher levels of parent physical activity (β: 1009 MET-min/week, 95% CI: 301, 1717), but not child physical activity (β: 0.31 days/week, 95% CI: -0.03, 0.66).ConclusionsPark access was associated with better mental health among children and parents, and more parent physical activity and parent–child co-participation in outdooractivity during the COVID-19 pandemic. Access to nearby parks may be an important resource to promote health and well-being, for both individuals and families.

Emotional and Behavioural Changes in Children and Adolescents and Their Association With Parental Depression During COVID-19 Pandemic: a Pilot Study in Bangladesh.

The COVID-19 pandemic has affected the mental health of children, adolescents, and their parents. This study aimed to assess the emotional and behavioural changes in children and adolescents and their association with parental depression during the COVID-19 pandemic in Bangladesh. On 7 May 2020 during COVID-19 lockdown, an online questionnaire was distributed through social media and made available for 10 days. Data were collected from parents of children aged 4 to 17 years. The Bangla version of the parent-rated version of the Strengths and Difficulties Questionnaire (SDQ) was used to determine the behavioural and emotional disturbances of the children and adolescents. The Bangla version of the Patient Health Questionnaire (PHQ-9) was used to assess the depression status of parents. There were 512 participants. 21.5% of children and adolescents had emotional and behavioural problems. More boys than girls had abnormal peer relationship problems (21.1% vs 15.4%, p = 0.03). Of the parents, 16.2% had moderate depression, 5.5% moderately severe depression, and 2.9% severe depression. 8.2% and 2.9% of parents reported that it was very difficult and extremely difficult, respectively, to do work, take care of things at home, or get along with other people; the proportion was higher in mothers than fathers (χ2 = 11.4, df = 3, p = 0.01). The PHQ-9 total score of parents mildly correlated with the SDQ score of children and adolescents (r = 0.51, p = 0.01). In multiple linear regression, a combination of parent sex (β = 0.08, p < 0.001), child's history of developmental/psychiatric problems (β = 0.02, p = 0.67), and the SDQ total score of children and adolescents (β = 0.52, p = 0.03) accounted for 27% of the variability in PHQ total score of parents. During lockdown, the prevalence of psychiatric disorder among children and adolescents and their parents increased. The depression status of parents mildly correlated with the behavioural and emotional disturbances of children and adolescents. We recommend opening the schools as soon as the situation improves and developing interventions such as virtual mental health assessment for children and adolescents and their parents.

The Strengths and Difficulties Questionnaire self-report-, parent-, and teacher version in children with intellectual and developmental disabilities

BackgroundThe Strengths and Difficulties Questionnaire (SDQ) is a frequently used behavioral screening instrument. However, its psychometric properties have been rarely examined among children with intellectual and developmental disabilities (IDD). AimsThe main aims of this study were to examine the internal consistency (i.e., McDonald’s Omega), the convergent validity (by correlating the Total difficulties score with the Aberrant Behavior Checklist [ABC]), the divergent validity (by correlating the Total difficulties score with the Vineland Adaptive Behavior Composite; VABS-II Total) and the factorial validity (by the means of confirmatory factor analyses [CFA]) of the SDQ self-report-, parent-, and teacher version in a sample of children with IDD. MethodParticipants were 365 children and adolescents (males n = 238; 65 %) aged 4–18 years (M = 10.11, SD = 3.82) referred for a developmental/neurological assessment to the neuropediatric outpatient clinics in the specialist health services. The SDQ was filled inn by 115 children, 337 parents, and 248 teachers. ResultsMcDonald’s Omega was overall lowest for the self-report version. Correlations of the SDQ Total difficulties score and the ABC subscales were strongest for the parent version. The results of the CFA indicated best model fit for the six-factor model that included a method factor for all three versions of the SDQ, however, model fit was overall not good. ConclusionsFurther research that examines the psychometric properties of the SDQ among multiple informants in large samples of children with IDD is needed.

The effect of school summer holidays on inequalities in children and young\xa0people\u2019s mental health and cognitive ability in the UK using data from the millennium cohort study

BackgroundSummer learning loss has been the subject of longstanding concern among researchers, the public and policy makers. The aim of the current research was to investigate inequality changes in children’s mental health and cognitive ability across the summer holidays.MethodsWe conducted linear and logistic regression analysis of mental health (borderline-abnormal total difficulty and prosocial scores on the strengths and difficulties questionnaire (SDQ)) and verbal cognitive ability (reading, verbal reasoning or vocabulary) at ages 7, 11 and 14, comparing UK Millennium Cohort Study members who were interviewed before and after the school summer holidays. Inequalities were assessed by including interaction terms in the outcome models between a discrete binary variable with values representing time periods and maternal academic qualifications. Coefficients of the interaction terms were interpreted as changes from the pre- to post-holiday period in the extent of inequality in the outcome between participants whose mothers had high or low educational qualifications. Separate models were fitted for each age group and outcome. We used inverse probability weights to allow for differences in the characteristics of cohort members assessed before and after the summer holidays.ResultsMental health (borderline/abnormal SDQ total and prosocial scores) at ages 7 and 14 worsened and verbal cognitive ability scores at age 7 were lower among those surveyed after the summer holidays. Mental health inequalities were larger after the holidays at age 7 ([OR = 1.4; 95%CI (0.6, 3.2) and 14: [OR = 1.5; 95%CI (0.7, 3.2)], but changed little at age 11 (OR = 0.9; 95%CI (0.4, 2.6)]. There were differences in pro-social behaviours among those surveyed before/after the school holidays at age 14 [OR = 1.2; 95%CI (0.5, 3.5)] but not at age 7 or 11. There was little change in inequalities in verbal cognitive ability scores over the school holidays [Age 7: b = 1.3; 95%CI (− 3.3, 6.0); Age 11: b = − 0.7; 95%CI (− 4.3, 2.8); Age 14: b = − 0.3; 95%CI (− 1.0, 0.4)].ConclusionWe found inequalities in mental health and cognitive ability according to maternal education, and some evidence or worsening mental health and mental health inequalities across school summer holidays. We found little evidence of widening inequalities in verbal cognitive ability. Widespread school closures during the COVID-19 restrictions have prompted concerns that prolonged closures may widen health and educational inequalities. Management of school closures should focus on preventing or mitigating inequalities that may arise from differences in the support for mental health and learning provided during closures by schools serving more or less disadvantaged children.

Association between community noise and children’s cognitive and behavioral development: A prospective cohort study

BackgroundNoise exposure has been associated with adverse cognitive and behavioral outcomes in children, but evidence on longitudinal associations between community noise and child development in low- and middle-income countries is rare. We investigated associations between community noise and behavioral and cognitive development in preschool children in São Paulo. MethodsWe linked child development data from the São Paulo Western Region Birth Cohort with average (Lden) and night-time (Lnight) community noise exposure at children's home, estimated by means of a land use regression model using various predictors (roads, schools, greenness, residential and informal settlements). Outcomes were the Strengths and Difficulties Questionnaire (SDQ) and Regional Project on Child Development Indicators (PRIDI) at 3 years of age and the Child Behavior Checklist (CBCL) and International Development and Early Learning Assessment (IDELA) at 6 years of age. We investigated the relationship between noise exposure and development using cross-sectional and longitudinal regression models. ResultsData from 3385 children at 3 years of age and 1546 children at 6 years of age were analysed. Mean Lden and Lnight levels were 70.3 dB and 61.2 dB, respectively. In cross-sectional analyses a 10 dB increase of Lden above 70 dB was associated with a 32% increase in the odds of borderline or abnormal SDQ total difficulties score (OR = 1.32, 95% CI: 1.04; 1.68) and 0.72 standard deviation (SD) increase in the CBCL total problems z-score (95% CI: 0.55; 0.88). No cross-sectional association was found for cognitive development. In longitudinal analyses, each 10 dB increase was associated with a 0.52 SD increase in behavioral problems (95% CI: 0.28; 0.77) and a 0.27 SD decrease in cognition (95%-CI: 0.55; 0.00). Results for Lnight above 60 dB were similar. DiscussionOur findings suggest that community noise exposure above Lden of 70 dB and Lnight of 60 dB may impair behavioral and cognitive development of preschool children.

Impact of psychosocial stressors on emotional and behavioral problems in Chinese adolescents during the COVID-19 period: the explanatory value of loneliness.

BackgroundChinese adolescents experienced a variety of stressors during the COVID-19 home confinement period. This study aimed to investigate the prevalence of emotional and behavioral problems (EBPs) among adolescents during the COVID-19 period. The study also examined the relationships between psychosocial stressors and adolescents’ EBPs, and explored the potential explanatory value of loneliness for any associations observed.MethodsWe conducted a cross-sectional study which included 6,587 adolescents in Taizhou, China between April 16 and May 14, 2020. Adolescents’ EBPs were assessed by the Strengths and Difficulties Questionnaire (SDQ), while subjective feelings of loneliness were assessed using one item from the Children’s Depression Inventory. We applied structural equation modelling to assess direct and indirect associations (explained by loneliness) between psychosocial stressors (study problems, parent-child relationship, and family or friends with COVID-19) and the total difficulties and prosocial scores.ResultsThe prevalence of EBPs in the sample was 31.6% for total difficulties and 37.5% for prosocial problems. After adjustment for a range of covariates, the presence of study problems, poor parent-child relationship and family or friends with COVID-19 were significantly associated with a higher SDQ total difficulties score (β=6.20, 21.46, 5.21; P<0.01) and a lower prosocial score (β=−0.79, −4.35, −1.65; P<0.01). There was an explanatory effect of loneliness on these associations, which explained 27–37% of the total effect on the total difficulties score and 11–37% on the prosocial score.ConclusionsThe presence of psychosocial stressors during the home confinement period was related to higher EBPs in adolescents, and the relationship was partially explained by loneliness. Targeted psychosocial interventions towards loneliness and COVID-19 related stressors may improve adolescents’ psychological health.

Early cognitive ability and emotional-behavioural development in childhood

Abstract Background Children with below average cognitive ability represent a substantial yet under-researched population for whom cognitive and social demands, which increase in complexity year by year, may pose significant challenge. This study compares trajectories in emotional-behavioural development for children with and without below average cognitive ability and examines the independent association between cognitive ability and clinically significant emotional-behavioural difficulty (EBD) in childhood. Methods Participants consist of 7,000 children and caregivers from the Growing Up in Ireland survey. Cognitive ability was measured at age 3 using the Picture Similarities Scale. A t-score 1-2 standard deviations below the mean was categorised as below average cognitive ability (n = 767), and scores above this as average/above (n = 6418). EBD was measured using the Strengths and Difficulties Questionnaire (SDQ) at age 3,5 and 9 years. A generalised linear mixed model with repeated measures was used to examine the relationship between cognitive ability and SDQ. Logistic regression examined the independent association between cognitive ability and clinically significant EBDs between age 3-9 years. Results The change in mean total SDQ score over time differed significantly between the cognitive ability groups (F(2)=8·817, p &amp;lt; 0·001). Between 5-9 years, there was no change in SDQ for those with average/above cognitive ability. For those with below average ability there was a significant increase of 0·48 points (95% CI 0·34 - 0·62, p &amp;lt; 0·001). After adjustment, the odds of a clinically significant EBD between age 3-9 were 1.4 times higher for those with below average cognitive ability (AOR 1.39, 95% CI 1.17-1.66, p &amp;lt; 0.001). Conclusions Children with below average cognitive ability are at higher risk of EBD in childhood. A scalable method of early identification should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes. Key messages Children with below average cognitive ability experience higher mean emotional-behavioural difficulty scores throughout childhood compared to those with average or above cognitive ability. Early life is a critical period for cognitive development. Public health research must focus on the early identification of at risk children to enable cognitive and adaptive functioning interventions.

Impact of COVID-19 Related Knowledge and Precautions on Emotional and Behavioral Problems Among Children During the Post-pandemic in China: The Explanatory Value of Emotional Problems Among Caregivers.

To investigate the prevalence of emotional and behavioral problems (EBPs) among children during the COVID-19 post-pandemic in China; examine associations between COVID-19-related knowledge and precautions and problems in children, and explore the potential explanatory value of the mental health status of caregivers on any associations observed. Based on a cross-sectional design, caregivers of 6,017 children from 12 primary schools in Shanghai and Taizhou, China, were invited to complete an online survey from June 26 to July 6, 2020. EBPs of the children were assessed using the Strengths and Difficulties Questionnaire (SDQ), while the emotional problems of caregivers were assessed using the Depression Anxiety Stress Scales-21 (DASS-21). Structural equation modeling was employed to estimate the direct and indirect associations (explained by the emotional problems of caregivers) between COVID-19-related knowledge and precautions and the EBPs among children. The overall prevalence of EBPs in the sample was 12.5%, and 5.3% of them had a high or very high SDQ total difficulties score during the COVID-19 post-pandemic. After adjustment for covariates, higher COVID-19-related knowledge (β = −0.83; P < 0.001) and precautions (β = −0.80; P < 0.001) were significantly associated with lower SDQ total difficulties score among children. There was an explanatory effect of emotional problems of caregivers on the aforementioned associations, which explained 31% and 41% of the total effect, respectively. Higher levels of knowledge and precautions of COVID-19 were associated with lower EBPs among children, and the relationship was partially explained by the emotional problems in caregivers. It may be beneficial to improve pandemic-related prevention education and adopt psychological interventions toward the emotional status of caregivers for the psychological health of children.

Association between psychosocial functioning, health status and healthcare access of asylum seekers and refugee children: a population-based cross-sectional study in a German federal state

BackgroundThe mental health condition and healthcare needs of asylum seeking and refugee (ASR) children may go unrecognized if barriers to healthcare access exist accompanied by exclusive focus on somatic illness. We analysed the relationship between psychosocial functioning, health status and healthcare access of ASR children.MethodsDuring 2018, 560 ASR adults in 58 collective accommodations in Germany’s 3rd largest federal state were randomly sampled and assessed. The parent-reported Strengths and Difficulties Questionnaire (SDQ) was used to assess child psychosocial functioning. SDQ dimensions (Emotional, Conduct, Peer, Hyperactivity, Prosocial, Total) were compared by demographics (sex, age, region of origin, time since arrival, subjective social status), health status (long-lasting illness, physical limitation, pain) and healthcare access (utilization: paediatrician, specialist, dentist, psychologist, hospital/emergency department, prescribed medicines; and unmet needs: for paediatrician/specialist, reduced spending to cover healthcare cost). Age and sex-adjusted odds ratios (AOR, 95%CI-Confidence Intervals) for scoring in borderline/abnormal ranges in SDQ dimensions were estimated through logistic regression depending on children’ health status and healthcare access.ResultsWe analysed parents’ answers pertaining to 90 children aged 1–17 years old, 57% of which were girls and 58% with (Eastern or Western) Asian nationality. Scoring in the borderline/abnormal range of the SDQ Total Difficulties score was associated with feeling bodily pain (compared to no pain, AOR, 95%CI = 3.14, 1.21–8.10) and with an unmet need for a specialist during the previous year (4.57, 1.09–19.16). Borderline/abnormal SDQ Emotional scores were positively associated with a long-lasting illness (5.25, 1.57–17.55), physical limitation (4.28, 1.49–12.27) and bodily pain (3.00, 1.10–8.22), and negatively associated with visiting a paediatrician (0.23, 0.07–0.78), specialist (0.16, 0.04–0.69), and the emergency department (0.27, 0.08–0.96).ConclusionPoor psychosocial functioning among ASR children is associated with somatic problems, unmet medical needs, and lower healthcare utilisation. Somatic clinical encounters with ASR should include children’ mental health symptomatology assessment, especially in those with worst physical health conditions.

29.3 Ghosts in the Nursery: Burden of Adverse Childhood Experiences in Mothers of Children Presenting to a Tertiary Care Hospital in Pakistan and Its Lifelong and Intergenerational Impact

The study aims to investigate the prevalence of adverse childhood experiences (ACEs) in mothers and their impact on the psychosocial health of the mothers as well as their children. Following ethical approval and written consent, we obtained retrospective information on ACEs self-reported by 212 mothers of children presenting to a tertiary care hospital setting and their current mental health using the Agha Khan University Anxiety and Depression Scale (AKU-ADS). Mothers’ report of their children’s emotional and behavioral problems was also assessed using the Strengths and Difficulties Questionnaire (SDQ). The mean age of the mothers was 32.6 ± 6.0 years. The majority of the participants were housewives (N = 188; 88.7%) and belonged to a very low socioeconomic status (N = 147; 69.3%). Among mothers, 45.7% (N = 97) reported one or more ACEs in their childhood. Emotional abuse (N = 38; 17.9%), physical neglect (N = 37; 17.5%), physical abuse (N = 35; 16.5%), and emotional neglect (N = 33; 15.6%) were the most frequently reported ACEs. Household incarceration (N = 9; 4.2%) and sexual abuse (N = 8; 3.8%) were the least prevalent ACEs. The prevalence of depression and anxiety in mothers was 45.8% (N = 97). The mean AKU-ADS score was 21.84 ± 14.05. Having 4 or more ACEs was associated with high mean scores of anxiety and depression in mothers (p < 0.01). Children’s SDQ mean score was 17.08 ± 6.06. An increasing number of maternal ACEs was associated with higher total SDQ scores as well as with higher emotional, conduct, and hyperactivity subscale scores in children (p < 0.01). The intergenerational consequences of ACEs cannot be overlooked. The impact of ACEs not only encompasses the entire lifetime of the mothers as psychosocial problems but also transmits to the next generation as emotional and behavioral problems. Therefore, it is extremely important to devise strategies to alleviate the implications of ACEs in mothers and subsequent generations.

Study protocol: DexaDays-2, hydrocortisone for treatment of dexamethasone-induced neurobehavioral side effects in pediatric leukemia patients: a double-blind placebo controlled randomized intervention study with cross-over design

BackgroundDexamethasone, a highly effective drug in treating pediatric acute lymphoblastic leukemia (ALL), can induce serious neurobehavioral side effects. These side effects are experienced by patients and parents as detrimental with respect to health related quality of life (HRQoL). Based on previous studies, it has been suggested that neurobehavioral side effects are associated to cortisol depletion of the mineralocorticoid receptor in the brain. Our previously reported randomized controlled trial, the Dexadagen study (NTR3280), suggests that physiological hydrocortisone addition during dexamethasone treatment may overcome clinically relevant neurobehavioral problems in patients who experience these problems during dexamethasone treatment. With our current study, we aim to replicate these results in a targeted larger sample before further implementing this intervention into standard of care.MethodsIn a national center setting, pediatric ALL patients between 3 and 18 years are enrolled in an Identification study, which identifies patients with clinically relevant dexamethasone-induced neurobehavioral side effects using the Strengths and Difficulties Questionnaire (SDQ). Contributing factors, such as genetic susceptibility, dexamethasone pharmacokinetics as well as psychosocial and family factors are studied to determine their influence in the inter-patient variability for developing dexamethasone-induced neurobehavioral side effects.Patients with clinically relevant problems (i.e. a rise of ≥ 5 points on the SDQ Total Difficulties Score after 5 days of dexamethasone) are subsequently included in a randomized double-blind placebo-controlled trial with a cross-over design. They receive two courses placebo followed by two courses hydrocortisone during dexamethasone treatment, or vice versa, each time at least 16 days without study medication in between. The primary endpoint is change in SDQ score. The secondary endpoints are sleep (measured with actigraphy and the Sleep Disturbance Scale for Children) and HRQoL (Pediatric Quality of Life Questionnaire).DiscussionThe results of our current study may contribute to the management of future ALL patients who experience dexamethasone-induced neuropsychological problems as it may improve HRQoL for patients who suffer most from dexamethasone-induced neurobehavioral side effects. Furthermore, by investigating multiple risk factors that could be related to inter-patient variability in developing these side effects, we might be able to identify and treat patients who are at risk earlier during treatment.Trial registrationMedical Ethical Committee approval number: NL62388.078.17. Affiliation: Erasmus Medical Centre. Netherlands Trial Register: NL6507 (NTR6695). Registered 5 September 2017

At-risk early adolescents profiles in the community: A cluster analysis using the strengths and difficulties questionnaire

Early adolescence, with its several changes and demands, represents a delicate period of life. Several studies highlighted that during early adolescence, emotional and behavioral problems tend to increase. Using a person-centered approach, the present study explored the emotional and behavioral functioning profiles in a sample of Italian preadolescent students. Participants were 2959 youths (1533 males and 1426 females; age 10–14 years); they completed the Strengths and Difficulties Questionnaire (SDQ) and the Inventory of Callous Unemotional traits (ICU). Findings revealed four different profiles: "no psychopathology" (41.5%), "low psychopathology with sub-threshold hyperactivity" (33%), "predominantly internalizing" (19%), and "predominantly externalizing" (6.5%). The two latter clusters are characterized by high levels of SDQ Total Score. The “predominantly internalizing” is distinguished by a higher prevalence of females, and the “predominantly externalizing” by a higher prevalence of males and higher CU traits. A person-oriented approach allowed for identifying subgroups of early adolescents who may significantly vary in their configuration of internalizing and externalizing problems. Such subgroups may reflect youths for whom the creation of prevention and intervention programs could be more tailored.

Mental health and school absenteeism in children with long-term physical conditions: A secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007.

Children and young people (CYP) with long-term physical conditions (LTCs) are more likely to have poorer mental health and more school absenteeism compared with CYP with no LTCs. However, there is limited longitudinal research, and the extent to which these difficulties persist in CYP with LTCs is unknown. Furthermore, little is known about the relative impact of different types of LTC on mental health and absenteeism. We investigated cross-sectional and longitudinal associations of different LTCs with mental health and school absenteeism in a large (N=7977) nationally representative survey of CYP in Great Britain and its 3-year follow-up. Psychopathology was assessed using the parent-reported Strengths and Difficulties Questionnaire (SDQ), and diagnosis of any psychiatric disorder using the Development and Wellbeing Assessment (DAWBA). Days absent and persistent absence (missing 10% or more of school days) were reported by parents. Compared with those with no LTCs, CYP with any LTC had higher SDQ total difficulties scores at baseline (adjusted mean difference 1.4, 1.1-1.6) and follow-up (1.1, 0.8-1.4) and were more likely to have a psychiatric disorder at baseline (adjusted odds ratio [aOR] 1.59, 1.34-1.89) and follow-up (1.75, 1.44-2.12). Children with any LTC also missed more days of school at baseline (adjusted incidence rate ratio 1.47, 1.31-1.64) and follow-up (1.17, 1.00-1.36) and were more likely to be persistently absent (aOR baseline 1.78, 1.48-2.14; follow-up 1.27, 1.00-1.61). Neurodevelopmental disorders, migraines and atopic conditions were particularly strongly associated with both mental health and absenteeism. Children with LTCs had poorer mental health and more school absence than those with no LTCs. Clinicians should routinely enquire about mental health and school attendance in CYP with LTCs and should collaborate with families and schools to ensure these children are provided with sufficient mental health and educational support.