Total Behavior Problems Research Articles

Neuropsychiatric symptoms in Tanzanian HIV-infected children receiving long-term efavirenz treatment: a multicentre, cross-sectional, observational study

Efavirenz is commonly prescribed for children with HIV infection, yet little is known about risks of neuropsychiatric side-effects. We aimed to compare competence (social involvement, activities, and school performance) and psychopathology (internalising and externalising problems), cognitive performance (intelligence and working memory), and adherence in Tanzanian children on an efavirenz-based versus a non-efavirenz-based regimen. In this multicentre, cross-sectional, observational study, we included consecutive children (aged 6-12 years) with HIV infection, on combination antiretroviral therapy (cART) for at least 6 months, and with viral loads of less than 1000 copies per mL from HIV care clinics of three primary health facilities and three referral hospitals in Moshi, Kilimanjaro, Tanzania. Children with acute illnesses, medication switch in the 6 months before the study visit, and any history of brain injury or developmental delay before cART initiation were excluded. All interviews and assessments were done by trained local research nurses under the supervision of a medical doctor. The primary outcomes, competence and psychopathology, were measured with the Child Behavior Checklist. We used ANCOVA to assess differences between groups. This study is registered with ClinicalTrials.gov, number NCT03227653. Between June 19, 2017, and Dec 14, 2017, 141 children were analysed, of whom 72 (51%) used efavirenz-based cART and 69 (49%) used non-efavirenz-based cART. After controlling for age, sex, and clinical and demographic confounders, we observed lower competence (adjusted mean difference -2·43 [95% CI -4·19 to -0·67], p=0·0071), largely driven by lower school performance scores (adjusted mean difference -0·91 [-1·42 to -0·40], p=0·00055), in the efavirenz group than in the non-efavirenz group. More total (adjusted mean difference 5·96 [95% CI -1·12 to 13·04], p=0·098) and internalising (adjusted mean difference 2·00 [-0·29 to 4·29], p=0·086) behavioural problems were seen in the efavirenz group than in the non-efavirenz group, although these findings were non-significant. No differences were found in externalising problems (adjusted mean difference 0·78 [95% CI -1·55 to 3·11], p=0·51). Our results suggest that treatment with efavirenz in children is associated with a mild increase in neuropsychiatric symptoms, especially in children who receive doses higher than or equal to the WHO recommended doses for efavirenz. Clinical awareness and adequate follow-up of neuropsychiatric symptoms in efavirenz in children remain warranted. Aidsfonds, Radboud University Medical Center.

Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

Mechanisms of Early Adversity Associated Increases In Risk For Psychiatric Disorders

Overall Abstract Early adverse exposures, such as maternal stress or toxins during pregnancy and childhood adversity are thought to result in long-lasting consequences on many systems, including the brain and ultimately in an increased risk for psychiatric disorders. The impact of these environmental risk factors is moderated by genetic variation. The biological mechanisms underlying this increased risk are still unclear. This symposium will focus on potential mechanisms mediating these lasting effects and their moderation by genetic variation, with epigenetics, specifically DNA methylation as main candidate. The developing brain is highly sensitive to environmental exposures during the in utero period and three of the presentations will focus on how environmental factors during pregnancy alter risk for psychiatric symptoms as well as brain structure and function and have lasting influences on the epigenome at birth. Prenatal exposures such as cigarette smoke, heavy metals, and folic acid are associated with changes in DNA methylation measured in infants at birth Kelly Bakulski (University of Michigan) will report on data generated in an autism enriched-risk birth cohort that examines the sensitivity of DNA methylation at birth, measured in placental tissue and cord blood, to in utero environmental exposures and the development of autism spectrum disorder or related traits by age three. Margit Burmeister (University of Michigan) will present a study of iron deficiency in newborns in China, demonstrating the detrimental effects of pre-and postnatal iron deficiency with regards to brain structure and function. This is complemented by genome-wide epigenetic analyses that investigate the impact of iron deficiency in the presence of lead exposure and pesticides. Another set of pregnancy-related risk factors associated with increased risk for emotional and behavioral problems in children are stress and depression during pregnancy. Katri Raikkonen (University of Helsinki, Finland) will present data from a large prospective study of pregnancy risk factors and their effects on cord blood DNA methylation and child behavior up to 3.5 years of age. Maternal depression during pregnancy was related to significant changes in a recently established epigenetic predictors of gestational age, with increasing depression, associated with more “immature” epigenetic age. This epigenetic marker was then in turn predicting total behavioral, emotionally reactive, and withdrawn problems in boys. Finally, risk for psychiatric symptoms following exposure to childhood adversity is moderated by genetic variation. Understanding the mechanisms of this moderation may help in targeting specific treatments to children with combined genetic and environmental risk. Sara Jaffee (University of Pennsylvania) showed that 8- to 11-year-old children from the UK who carried two copies of the serotonin transporter polymorphism had elevated levels of internalizing and externalizing problems following exposure to adverse life events because of their coping strategies. Influencing the coping styles of these children may be an effective treatment strategy in this subgroup of children. At the end of the symposium, Elisabeth Binder (MPI of Psychiatry, Munich) will comment of common mechanisms emerging from the data presented in the individuals talk and how a better understanding of these factors will aid biology-based diagnoses of psychiatric disorders and individualized treatment approaches.

The Epigenetic Clock At Birth: Associations With Maternal Antenatal Depression And Child Psychiatric Problems

BackgroundMaternal antenatal depression may compromise the fetal developmental milieu and contribute to individual differences in aging and disease trajectories in later life. We evaluated the association between maternal antenatal depression and a novel biomarker of aging at birth, namely epigenetic gestational age (GA) that was based on fetal cord blood methylation data. We also examined if this biomarker could prospectively predict early childhood psychiatric problems. Methods700 mothers from the PREDO Study reported if they had had/not had past or present physician-diagnosed depression in early pregnancy. Of these, 584 completed the Center for Epidemiological Studies Depression Scale biweekly throughout pregnancy, and 407 filled in the Child Behavior Checklist at child’s age 3.7 (SD=0.75) years. DNA methylation (DNAm) GA of fetal cord blood DNA was based on the methylation profile of 148 selected CpGs. Epigenetic GA was calculated as the arithmetic difference between DNAm GA and chronological GA and adjusted for chronological GA in linear regression models. ResultsMaternal past or present physician-diagnosed depression (Mean difference=-0.24 SD units, 95%CI -0.45;-0.03, p=0.02) and greater depressive symptoms throughout pregnancy (-0.08 SD unit per SD unit, 95%CI -0.16;-0.01, p=0.04) were associated with child’s epigenetic GA deceleration (GAD) (lower epigenetic GA than chronological GA). Child epigenetic GAD, in turn, prospectively predicted total behavioral, emotionally reactive, and withdrawn problems only in boys. ConclusionsMaternal antenatal depression is associated with epigenetic GA immaturity in offspring. Epigenetic GA immaturity seems to be developmentally disadvantageous for boys, who in early childhood show greater psychiatric problems in maternal reports.

Therapeutic itinerary of children living with epilepsy in Kinshasa: Features, determinants, and relationships with behavioral problems and cognitive impairment

BackgroundEpilepsy mostly affects children in sub-Saharan Africa. However, little is known about the therapeutic itinerary of these children living with epilepsy (CWE). This study aimed to describe the therapeutic itinerary of CWE in Kinshasa and to analyze its relationships with clinical features, behavioral problems, and cognitive impairment. MethodsThis hospital-based study has included 104 CWE aged 6 to 17 years. The features of their therapeutic itinerary and their relationship with clinical features, behavioral problems, and cognitive impairment were analyzed. ResultsThe vast majority of CWE (87%) has started their therapeutic itinerary by the Western medicine. The first source of information about epilepsy as well as the type of antiepileptic treatment varied with the socioeconomic status of families of CWE. The total duration of the therapeutic itinerary was shorter for the CWE who were living with both their parents (P = .038), who had generalized seizures (P = .0073) or who had no family history of epileptic seizures (P = .019). The CWE who had total behavioral problem, compared with the others, were putting more time (P = .021) to reach the Centre de Santé Mentale Telema (CSMT) after the suspicion or the diagnostic of epilepsy. The total duration of CWE who had cognitive impairment (P = .021) was longer than that of CWE who had not cognitive impairment. ConclusionThe therapeutic itinerary of CWE in Kinshasa began with Western medicine. The remainder of this therapeutic itinerary looks like what is described in sub-Saharan literature with the majority of CWE seeking the healing based on beliefs. This study also shows that the therapeutic itinerary of CWE was associated with socioeconomic conditions, clinical features, behavioral problems, and cognitive impairment.

Behavior problems and health-related quality of life in Dravet syndrome

ObjectiveBehavior problems in Dravet syndrome (DS) are common and can impact the lives of patients tremendously. The current study aimed to give more insight into (1) the prevalence of a wide range of specific behavior difficulties and aspects of health-related quality of life (HRQoL) in patients with DS compared with the general population (gp) and patients with epilepsy without DS, (2) the relations between these behavior problems and different aspects of HRQoL, and (3) the associations between seizure frequency, cognitive impairment (CI), behavior problems, and HRQoL, based on a conceptual model. MethodsOne hundred and sixteen patients (aged between 2 and 67 years), affected by SCN1A-related seizures, were included in the study. Eighty-five were patients with DS, 31 were patients with epilepsy without DS. Behavior problems were measured using the Child/Adult Behavior Checklist (C/ABCL), HRQoL was measured using the Pediatric Quality of Life Inventory (PedsQL) Measurement Model. Other characteristics were obtained by clinical assessments, medical records, and semi-structured telephone interviews with parents. Comparisons between patients with DS, patients without DS, and the gp were calculated by the exact goodness of fit χ2 analyses, relations between subscales were analyzed using Pearson's correlations, and the conceptual model was tested in a path analysis. Results(1) Patients with DS show significantly more behavior problems compared with the gp and patients with epilepsy without DS. A total of 56.5% of patients with DS scored in the borderline and clinical ranges for total behavior problems. Problems with attention were most prevalent; 62.3% of patients with DS scored in the borderline and clinical ranges. Health-related quality of life was significantly lower for patients with DS compared with the gp and patients without DS. Physical and social functioning scores were especially low and decreased even more in the older age categories. (2) Problems with attention, aggression, and withdrawn behavior were most related to social functioning. Somatic problems and anxiety/depression were most related to emotional functioning. (3) Cognitive impairment and behavior problems were both independent predictors of poorer HRQoL in patients with DS, with behavior problems being the strongest predictor. Seizure frequency was only indirectly related to HRQoL, mediated by cognitive impairment. ImplicationsThe high prevalence of behavior problems in DS and the significant impact on quality of life (QoL), independent of epilepsy-related factors, emphasize the need for active management and treatment of these problems and should be considered as part of the management plan.

Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study.

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

Household Food Insecurity in Early Adolescence and Risk of Subsequent Behavior Problems: Does a Connection Persist Over Time?

Household food insecurity is common among U.S. families, and adolescents are almost twice as likely as school-aged children to be food insecure. However, little is known about how household food insecurity relates to adolescent behavioral outcomes over time. The purpose of this study was to examine whether food security status in early adolescence is associated with behavioral problems over a 6-year period in an ethnically diverse sample of teenagers from low-income households. The study examined longitudinal data from the Welfare, Children, and Families: A Three-City Study. A total of 1,049 primary caregivers completed measures of child/adolescent behavioral problems and household food insecurity during the past year. Data were collected across three waves, when focal children were between 10 and 14 years old, 11 and 16 years old, and 16 and 18 years old, respectively. Generalized estimating equations were used to assess initial household food insecurity as a time-invariant effect on adolescent behavioral problems over time. Baseline household food insecurity in pre- or early adolescence was significantly associated with greater internalizing problems and total behavioral problems over time. These findings indicate that household food insecurity is associated with behavioral problems throughout adolescence. This suggests the need for health providers to screen for household food insecurity during scheduled health visits and highlight the need for integration of psychosocial services into pediatric care and expansions in current federal assistance programs.

Infant regulatory behavior problems during first month of life and neurobehavioral outcomes in early childhood

Whether infant regulatory behavior problems already in the first month of life indicate an increased risk of childhood neurobehavioral problems, and whether maternal depression in the postpartum and early childhood underpins these associations remain unclear. Altogether, 2049–2364 mothers from the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study completed the Neonatal Perception Inventory on regulatory behavior problems at the infant’s age of 15.6 days (SD 3.2, range 1–30), the Infant Behavior Questionnaire-Revised on temperament at 6.5 months (SD 0.9, range 4.2–12.4), and the Ages and Stages Questionnaire-3 on developmental milestones and the Child Behavior Checklist on behavioral problems at 3.5 years (SD 0.7, range 1.9–6.0). Maternal depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (infancy follow-ups) and Beck Depression Inventory-II (childhood follow-up). Father-rated infant temperament and paternal depressive symptoms were also available (n = 1474). Higher levels of infant regulatory behavior problems predicted higher levels of mother- and father-rated negative affectivity temperament (0.13 SD units per SD unit, 95% confidence interval 0.09–0.17; and 0.09, 0.04–0.14, respectively), lower levels of mother-rated orienting/regulation temperament (− 0.09, − 0.13 to − 0.05) and problem-solving skills (− 0.12, − 0.21 to − 0.04), and higher levels of Externalizing (0.07, 0.03–0.11) and Total behavioral problems (0.07, 0.03–0.11). Regulatory behaviors partially mediated the effect of maternal depressive symptoms. Regulatory behavior problems already during the first month of life predict neurobehavioral outcomes, and partially mediate the effect of maternal depressive symptoms. Our study may inform design of interventions aimed at timely prevention in children at risk.

The cognitive and socio-emotional development of 5-year-old children born after PGD.

Does PGD increase the risk on adverse cognitive and socio-emotional development? The cognitive and socio-emotional development in children born after PGD seems to be normal when compared to control groups. A limited number of studies with small sample sizes indicate that the cognitive and socio-emotional development of (pre)school-aged children born after either PGD or PGS seem to be comparable to those of children born after IVF/ICSI and to naturally conceived (NC) children from the general population. For this study we invited 72 5-year-old PGD children, 128 5-year-old IVF/ICSI children and 108 5-year-old NC children from families with a genetic disorder. All children were invited between January 2014 and July 2016. In total, 51 PGD children, 52 IVF/ICSI children and 35 NC children underwent neuropsychological testing (WPPSI-III-NL and AWMA). The children's parent(s) and teachers filled in questionnaires evaluating children's executive functioning (Behaviour Rating Inventory of Executive Functions; BRIEF) and socio-emotional development (Child Behaviour Checklist; CBCL and Caregiver-Teacher Report Form; C-TRF). The mean full-scale intelligence quotient scores (P = 0.426) and performance on the AWMA Listening Span task (P = 0.873) and Spatial Span task (P = 0.458) were comparable between the three groups. Regarding socio-emotional development, the teachers' scores revealed more externalizing (P = 0.011) and total problem (P = 0.019) behaviour in PGD children than for IVF/ICSI children; both groups did not differ significantly from the NC children (P = 0.11). More children (13%) with an affected first-degree family member (mostly parent) were included in the PGD group than in the NC group. Scores in all groups fell within the normal population range and should be considered normal. The number of NC children from families with a genetic disorder was relatively small. Furthermore, the fathers' CBCL results were based on small samples. PGD children show levels of cognitive and socio-emotional development at 5 years that are within the normal range, despite the biopsy involved in PGD and the potential extra psychological burden associated with the presence of a genetic disorder in the family. This study was funded by ZonMw (70-71300-98-106). None of the authors have any competing interests to declare. NCT02149485.

Behavioral disorders and impairment of quality of life in children and adolescents with lower urinary tract dysfunction

Lower urinary tract dysfunction (LUTD) is a broad term describing the full spectrum of disorders in any of the stages of bladder function-storage or voiding LUTD is a clinical condition associated with emotional and behavioral disorders in children. This cross-sectional study aimed to investigate the association of emotional and behavioral symptoms and their impact on the quality of life (QoL) in children and adolescents with LUTD. Eighty-eight patients and their parents enrolled in an interdisciplinary program for children and adolescents with LUTD were included in the analysis. Child Behavior Checklist (CBCL) was used to estimate the prevalence of behavioral and emotional problems through the assessment of 14 items. Pediatric Quality of Life Inventory (versions for parents and children) was applied in the versions for parents and children to evaluate the QoL. The Pediatric Quality of Life Inventory-PedsQL, version 4.0-was applied separately for parents and patients. The association of clinical variables and aspects related to QoL of patients were evaluated through non-parametric correlations (Spearman) and multiple linear regression analysis. According to CBCL's clinical scores, 56% of the patients showed total behavioral problems, 55% internalizing, and 38% externalizing. When comparing the conditions of LUTD and the CBCL scores, patients with voiding postponement had the lowest rates of total problems (P=0.036). Children and adolescents with LUTD who also had enuresis showed a higher frequency of externalizing problems (P=0.001), especially aggressive behavior (P=0.013). Scores of patients with LUTD were significantly lower in all domains of QoL than normative data. Presence of behavioral problems was associated with worse QoL in all evaluated aspects. The total QoL was most influenced by the CBCL school competence scale according to the regression model analysis. The study findings suggest the relevance of evaluation of behavioral and social repercussions of LUTD to improve the multidisciplinary approach for this condition in pediatric population.

Behavioral and psychological features in girls and women with triple-X syndrome.

Triple-X syndrome is a common sex chromosome aneuploidy, which appears in 1 out of 1,000 females. The aim of our study was to describe the behavioral features of a large group of girls and women with triple-X in comparison to a control group. A total of 72 subjects with triple-X and 69 subjects of an age-matched control group were included. Psychological and behavioral questionnaires were allocated to three age groups, representing a range of ages from young childhood to adulthood. Regarding the females between 4 and 7 years of age, we found significant differences for social problems, attention problems, and school performance. For the age group 8-17 years, we found larger significant differences for the majority of the scales listed in the child behavior checklist. The most significant differences (p < .001) were from total behavior problems, internalizing problems, and four other scales. Young females with triple-X have significantly lower general self-esteem, especially concerning school and family. In the adults, there were significant differences concerning psychological symptoms and distress, with higher scores in the triple-X subjects. Regardless, their mean scores were still in the normal range. We did not find clinical evidence for more than 50% of the triple-X females in any age group, indicating that approximately half of them do not have behavioral problems, and that more than 60% do not differ in their competence from the control group. However, our findings suggest that triple-X influences mental health and the overall well-being of the individuals across their whole life spans.

Play Therapy and Psychoeducational School-Based Group Interventions: A Comparison of Treatment Effectiveness

This study focused on using a single case research design (SCRD) to compare the effectiveness of a child-centered group play therapy intervention to a psychoeducational group intervention (skillstreaming), and a group that received no intervention for 6 weeks. A group of 10 young children (kindergarten and Grade 1) were randomly assigned to 1 of the 3 groups. We found that children participating in the CCGPT intervention were 4.18 times more likely to have a decrease in total problem behavior across the 6-week period compared to children in the skillstreaming group, and 1.61 times more likely than children in the wait-list group.

Effects of maternal (pre)pregnancy lifestyle interventions in obese women on child neurobehavioral development: Follow-up of two RCT studies

Background Obesity is a major public health problem. The prevalence of obesity in women of reproductive age ranges from 7 to 25% in European countries. Children of women who were obese before or during pregnancy are at increased risk for neurodevelopmental delay and behavioral problems. Improving the lifestyle of obese women before and during pregnancy may have a great potential to optimize child neurobehavioral development, but no previous study has assessed this however. We examined the effects of two maternal lifestyle interventions before and during pregnancy in obese women on child neurobehavioral development. Methods This study concerns the follow-up of two randomized controlled trials that were successful in reducing maternal weight or gestational weight gain: the Finnish RADIEL and the Dutch LIFEstyle trial. Women with a pre-pregnancy BMI ≥ 29 kg/m2 wishing to conceive or who were already pregnant ( Results We had data of 161 (40%) RADIEL and 96 (32%) LIFEstyle children. In both studies, child total neurodevelopmental score (B = −0.17, 95% confidence interval (−0.51 to 0.16) and B = 0.06 (−0.38 to 0.51) respectively) and total behavioral problem score (B = −0.06 (−0.38 to 0.27) and B = 0.01 (−0.47 to 0.48) respectively) did not differ between children of the intervention and the control group. Children of the intervention and the control group also did not differ in neurodevelopmental domain scores and specific behavioral problem scores. Also, when comparing children of the mothers of the intervention group who attained the lifestyle intervention goal with children of mothers of the control group, no differences in neurobehavioral development were found. Conclusion Although previous findings of neurobehavioral problems in children of obese mothers give reason to suggest maternal (pre-) pregnancy lifestyle intervention to be preventive, this follow-up of two randomized controlled trials is the first to show that lifestyle interventions before and during pregnancy in obese women do not affect child neurobehavioral development at age 3–5 years.

Risk for Childhood Internalizing and Externalizing Behavior Problems in the Context of Prenatal Alcohol Exposure: A Meta-Analysis and Comprehensive Examination of Moderators.

Prenatal alcohol exposure (PAE) is associated with a constellation of physical, neurocognitive, and behavioral abnormalities in offspring. The presence of internalizing (e.g., anxiety, mood disorders) and externalizing (e.g., oppositional defiant and conduct disorders) behavior problems has devastating and often long-lasting impacts on children, adolescents, and their families. The present meta-analysis explored the strength of the association between PAE and behavior problems, as well as factors that increase or mitigate risk. The current meta-analysis included 65 studies comparing children and adolescents with PAE to non- or light-exposed controls and attention-deficit/hyperactivity disorder (ADHD) samples, on a variety of internalizing and externalizing behavior outcomes. Results indicated that individuals with PAE are at increased risk for internalizing (d=0.71, medium effect) and externalizing (d=0.90, large effect) problems compared to control samples. The occurrence of total behavior problems was similar to that seen in ADHD samples. The strength of the association between internalizing and externalizing behavior problems and PAE was significantly moderated by several distinct sample characteristics, such as sample age, socioeconomic status, severity of exposure, and type of behavior problem. These findings further our understanding of the behavior problems experienced by children and adolescents with PAE.

Protective Role of Parenting Attitude on the Behavioral and Neurocognitive Development of the Children from Economically Disadvantaged Families.

Objective Association between home environment and the behavioral and neurocognitive development of children from a community childcare center for low-income families was examined (aged 6 to 12 years, n=155). Methods The parents performed a questionnaire on home environment (K-HOME-Q) to assess home environment including parenting attitude and the Child Behavior Checklist (K-CBCL). The children performed the Wechsler Intelligence (IQ) Scale, Stroop interference test (Stroop), word fluency test (WF), and design fluency test (DF) to assess their neurocognitive development. Results ‘Nurturing of Development’ and ‘Variety of Language Interaction’ scores from the K-HOME-Q, were inversely associated with total behavior problems, externalization, rule-breaking, and aggressive behavior subscales of K-CBCL, and ‘Emotional atmosphere’ and ‘Tolerance toward the child’ scores showed inverse associations with the total behavior problems, rule-breaking, aggressive behavior, and withdrawn/depressed subscales. Despite economic hardship, the mean scores of the neurocognitive tests were comparable to the average level of Korean children’s normative sample. However, ‘Nurturing of Development’ and ‘Tolerance toward the Child’ score of K-HOME-Q were associated with better executive function (IQ, WF, DF). Conclusion These results suggest that parental stimulation of development and tolerant parenting attitude may offer protection against the negative effects of suboptimal economic environment on children’s behavior and neurocognitive development.

Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm

There are concerns that apparently healthy extremely preterm children face a risk of developing motor impairments, such as developmental coordination disorder. To evaluate the prevalence of developmental coordination disorder and associated comorbidities in a national cohort of apparently healthy children born at 22 to 26 gestational weeks, compared alongside term-born peers. This prospective, population-based cohort study included all children who were consecutively born at 22 to 26 gestational weeks in Sweden from April 1, 2004, through March 31, 2007. At 6.5 years, 441 preterm children were evaluated alongside 371 controls. A total of 275 preterm children (62.4%) and 359 term-born children (96.8%) did not have neurodevelopmental disabilities. Motor assessments were completed for 229 of 275 preterm children (83.3%) and 344 of 359 (95.8%) term-born children, who composed the final study sample. Developmental coordination disorder was defined as a score of the fifth percentile or lower on the Movement Assessment Battery for Children-Second Edition scale, using control group scores. Assessment tools included the Wechsler Intelligence Scale for Children-Fourth Edition, the Brown Attention-Deficit Disorder Scales, the Five to Fifteen questionnaire, and the Strengths and Difficulties questionnaire. Of the 229 extremely preterm children and 344 term-born controls who underwent motor assessments, 115 (50.2%) and 194 (56.4%) were boys, respectively. Developmental coordination disorder was present in 85 of 229 (37.1%) preterm children and in 19 of 344 controls (5.5%) (adjusted odds ratio [OR], 7.92; 99% CI, 3.69-17.20). When preterm children with developmental coordination disorder were compared with term-born peers, the risk was increased for total behavioral problems, internalizing, externalizing, attentional problems, hyperactivity, perceptual problems, executive dysfunction, and poor social skills, with adjusted ORs varying from 2.66 (99% CI, 1.09-6.48) for time concepts to 9.06 (99% CI, 3.60-22.8) for attentional problems (all P < .01). When preterm children with and without developmental coordination disorder were compared, preterm children with developmental coordination disorder had more behavioral problems; the adjusted OR for total behavioral problems was 2.71 (99% CI, 1.15-6.37); for externalizing problems, 2.80 (99% CI, 1.10-7.12); for inattention, 3.38 (99% CI, 1.39-8.18); and for combined attention/hyperactivity problems, 3.68 (99% CI, 1.47-9.16) (all P < .01). Parents underestimated the children's motor problems and only a few of the children had received psychological care or physiotherapy. Children who were born extremely preterm faced a high risk for developmental coordination disorder with associated comorbidities. Our findings support the importance of a structured follow-up of motor function, behavior, and cognition.

The association between pre-pregnancy overweight/obesity and offspring's behavioral problems and executive functioning

The prevalence of obesity among women of childbearing age has been rising dramatically over the last decades. Pre-pregnancy obesity may have negative neurodevelopmental consequences for the offspring. The present study examined the association of maternal pre-pregnancy overweight and obesity with child behavior problems and executive functioning at age 5 years. Data of 4094 mother-child pairs of the Amsterdam Born Children and their Development birth cohort study was used. Child behavioral problems were assessed with the maternal and teacher version of the Strengths and Difficulties Questionnaire. Two executive functioning constructs, inhibitory control and cognitive flexibility, were measured with the Response Organization Objects task of the Amsterdam Neuropsychological Tasks test battery. Increased maternal pre-pregnancy BMI was associated with an increase in children's behavioral problems (OR total behavioral problems reported by mothers pre-pregnancy obesity versus normal weight: 1.78 [95% CI 1.17 to 2.69] and reported by teachers for pre-pregnancy overweight versus normal weight: 1.32 [1.00 to 1.74]). Maternal pre-pregnancy obesity was associated with an increase in peer relationship problems reported by teachers (OR: 1.77 [1.18 to 2.64]). It was also associated with a small decrease in cognitive flexibility (increased Reaction Time in ms: B = 67.59 [5.88 to 129.30] and Within Subject Standard Deviation in ms: B = 76.46 [32.00 to 120.92]), but not with inhibitory control. Cognitive flexibility did not mediate the association between maternal pre-pregnancy BMI and children's behavioral problems.

Effect of socioeconomic status on behavioral problems from preschool to early elementary school - A Japanese longitudinal study.

PurposeSocial inequalities are widely accepted to have a deleterious effect on children’s mental health, and those with lower socioeconomic status generally experience more mental health issues. In this study, we examine the impact of socioeconomic situations of children’s families during their early childhood on the children’s social adaptation in Japanese elementary school.MethodsThe current investigation consisted of two sets of data relating to two separate years (with a one-year interval). The participants included preschoolers aged five years at Time 1 (the first year) and first graders aged six years at Time 2 (the second year); 1,712 met the inclusion criteria for both years. Parents of the participants completed a self-reported questionnaire regarding their SES (i.e., family economy and mother’s education) and their children’s mental health. Mental health was assessed using the Child Behavior Checklist/4–18, Parent Report.ResultsFor each SES indicator, we found an inverse relationship across all the symptom dimensions. Specifically, bivariate analyses revealed that lower family income, maternal education level, and paternal education level predict all three domains of behavioral problems (i.e., internalized problems, externalized problems, and total behavioral problems). Further, multivariate analyses revealed that lower family income consistently predicts all domains of behavioral problems, lower maternal education level predicted externalized problems and total behavioral problems, and paternal education level did not predict any clinically significant behavioral problems.ConclusionIn this sample, we found that, for children, family income and parental education when entering preschool were significant predictors of mental health problems after elementary school enrollment; in particular, low income and low maternal educational achievement predicted a high probability of the development of a psychiatric disorder. A greater understanding of the mechanisms of these associations could contribute to improvements in interventions aimed at preventing child maladjustment.

Immediate and Long-Term Effectiveness of Disciplinary Tactics by Type of Toddler Noncompliance

SYNOPSISObjective. To clarify when the disciplinary recommendations of positive parenting and behavioral parent training apply, this study investigated how the effectiveness of seven disciplinary tactics varies by type of toddler noncompliance, using methods to improve the validity of causal inferences. Design. Multilevel modeling and hierarchical longitudinal regression are used to test immediate and long-term effectiveness of disciplinary tactics in a convenience sample of 102 mother–toddler pairs, using coded information from detailed descriptions of a sample of five discipline episodes along with survey measures. Results. Offering alternatives is the most effective disciplinary tactic for reducing noncompliance severity immediately regardless of the type of noncompliance. Reasoning is the second best tactic for immediately reducing noncompliance severity when responding to parent-oriented noncompliance (negotiating and whining), whereas power assertive and punishment tactics are least effective, but the immediate effectiveness of those tactics reverses when responding to parent-opposing noncompliance (defiance and hitting). Long-term outcomes also differ for toddlers whose predominant noncompliance is parent-oriented or parent-opposing. For parent-oriented toddlers, frequently offering alternatives leads to reduced externalizing problems, whereas punishments increase their behavior problems. For oppositional toddlers, offering alternatives too frequently increases externalizing problems, whereas moderate use of punishments (<16% of the time) decreases total behavior problems. Frequent reasoning also reduces subsequent externalizing problems for oppositional toddlers, despite being the least effective disciplinary response for de-escalating parent-opposing noncompliance immediately. Conclusions. Parenting advice should move beyond universal disciplinary recommendations to help parents match their disciplinary tactics to their child’s type of noncompliance.