Total Behavior Problems Research Articles

Feasibility of a Home-Based Developmental Behavioral Intervention for Children With Autism Spectrum Disorder in Underserved Taiwanese Families

Purpose: This study aims to investigate the feasibility of the home-based parent- mediated intervention Naturalistic developmental behavioral intervention (HB-NDBI) in underserved Taiwanese families of children with Autism spectrum disorder (ASD) and explore its effects on children’s developmental skills and parents’ parenting stress. Method: 24 underserved Taiwanese families of children with ASD (mean age = 46.5 months) received 12-week HB-NDBI programs. Social Responsiveness Scale, Second Edition (SRS-2), Mullen Scales of Early Learning (MSEL), Child Behavior Checklist (CBCL/1.5-5), and Parenting Stress Index (PSI) were administered before and after the HB-NDBI programs. Results: Following the HB-NDBI programs, significant improvements in social cognition, social communication subscales, receptive language subscale, internalizing, externalizing, and total behavioral problems scales of children, and release of parenting stress were observed. Conclusion: This study demonstrated the feasibility of home-based parent-mediated intervention for underserved families in Taiwan. These promising results might facilitate the development of such interventions for underserved families.

Are early emotional and behavioral problems related to subsequent asthma in preschool children?

Abstract Background The most common mental health problems in preschool children are emotional and behavioral problems, and one of the most common chronic inflammatory diseases in children is asthma. Most research on the relationship between emotional and behavioral problems and asthma includes school-aged children. The current study aimed to explore the association between emotional and behavioral problems during preschool years and the risk of asthma in a Swedish context. Methods The study was a longitudinal cohort study, with 6954 children aged 3-5 years for which data on emotional and behavioral problems through the Strengths and Difficulties Questionnaire were collected in Uppsala Region, Sweden, between 2013 and 2017. The cohort was followed with data from the National Patient Register from 2013 to 2022. Asthma was defined as having at least three diagnoses (ICD-10 codes: J45-J46) during follow-up. Unadjusted and adjusted cox regression models were used to analyze data. Results A total of 269 children (3.9%) had diagnosed asthma during follow-up. Preliminary results show that children with emotional symptoms, rated separately by mothers (HR: 1.62, 95% CI: 1.20-2.20), fathers (HR: 1.49, 95% CI: 1.10-2.03), and preschool teachers (HR: 1.53, 95% CI: 1.08-2.16) had increased risk of being diagnosed with asthma according to unadjusted cox-regression models. In addition, children with total emotional and behavioural problems, rated by fathers (HR: 1.51 95% CI: 1.10-2.07) were also at higher risk of being diagnosed with asthma. These associations remained significant when adjusting for background and sociodemographic factors. Conclusions Our findings point to the significance of a clinical awareness of the relation between emotional and behavioral problems and asthma in young children. Our findings highlight the importance of also considering somatic problems, including asthma, in children with early signs of emotional and behavioral problems. Key messages • Emotional and behavioral problems in preschool children is related to being diagnosed with asthma. • Somatic problems, as asthma, needs to be considered in children with emotional and behavioral problems.

Associations of fetal and infant growth patterns with behavior and cognitive outcomes in early adolescence

AbstractBackgroundFetal life and infancy might be critical periods for brain development leading to increased risks of neurocognitive disorders and psychopathology later in life. We examined the associations of fetal and infant weight growth patterns and birth characteristics with behavior and cognitive outcomes at the age of 13 years.MethodsPopulation‐based prospective cohort study from fetal life until adolescence. Pregnant women with a delivery date between April 2002 and January 2006 were eligible. Follow‐up measurements were available for 4716 children. Fetal weight was estimated in the second and third trimesters of pregnancy by ultrasonography. Infant weight was measured at birth and at 6, 12, and 24 months. Fetal and infant weight acceleration or deceleration were defined as a change in SD greater than 0.67 between time points. Total, internalizing and externalizing problems and attention‐deficit hyperactivity disorder (ADHD) symptoms were measured using Child Behavior Checklist (CBCL/6–18), autistic traits by the Social Responsiveness Scale (SRS) and intelligence quotient (IQ) by the Wechsler Intelligence Scale for Children‐Fifth Edition (WISC‐V).ResultsOne week longer gestational age at birth was associated with a −0.03 SDS (95% Confidence Interval (CI): −0.04, −0.01) lower total behavior problems score, a −0.02 SDS (95% CI: −0.04, −0.01) lower ADHD symptoms score. Also an increase in birth weight of 500 g was associated with a lower odds of having high externalizing problems (OR 0.92 (95% CI: 0.86, 0.98) and of having a low IQ score (OR 0.79 (95% CI: 0.71, 0.88). Compared to children with normal fetal and infant growth, those with accelerated fetal and infant growth had a 0.27 SDS higher IQ (95% Confidence Interval 0.11, 0.44).ConclusionsBoth fetal and infant weight development are associated with behavioral and cognitive outcomes in early adolescence. Follow‐up studies are needed to assess whether these associations link to later life mental health outcomes.

Adaptive changes in multiple aspects of emotion regulation in the offspring of pregnant persons receiving a diet-and-exercise intervention relative to usual pregnancy care: A randomized controlled trial

BackgroundHuman studies examining the influence of prenatal diet and/or exercise interventions on offspring neurodevelopment are mixed. Interventions that include the provision of whole foods, nutritional counselling, address exercise behaviors, and that utilize multimethod assessments of offspring emotion regulation may better reveal the impact of these interventions on neurodevelopment. ObjectiveTo explore whether the Be Healthy in Pregnancy (BHIP) prenatal diet-and-exercise intervention improves emotion regulation (ER) in 22-month-old offspring. MethodsPregnant persons (>18 years, singleton pregnancy) were recruited between 12-17 weeks gestation and randomized to the intervention [high protein energy-controlled diet via the provision of cottage cheese, Greek yogurt, low-fat milk, individualized biweekly nutritional counselling, a controlled walking program, and usual pregnancy care (UPC)] or control (UPC alone) groups. ER in offspring (mage=22.2(SD=4.04); 50.9% female; intervention: n=29, control: n=28) was assessed using reports from pregnant persons and their partners on the Child Behavior Checklist, and the Behavior Rating Inventory of Executive Function-Preschool Version, laboratory observational tasks examining inhibitory control, attention, and empathy, and high frequency heart rate variability (HF-HRV). ResultsChildren exposed to the BHIP intervention exhibited medium to large effect size reductions in pregnant person and partner reported externalizing (effect size ƞ2pmother=0.08, 95% CI of the difference[0.05,7.14]; ƞ2ppartner=0.17[1.68,9.65]), internalizing ƞ2pmother=0.08[0.09,5.32]; ƞ2ppartner=0.13[0.84,8.88]) and total behavior problems ƞ2pmother=0.09[0.72,11.87];; ƞ2ppartner=0.17 [3.17,17.88]) relative to control participants’ children. Pregnant persons, but not partners, reported fewer problems with inhibitory control (ƞ2p=0.13[1.40,8.55]), cognitive flexibility (ƞ2p=0.08[0.18,4.85]), emergent metacognition (ƞ2p=0.14[2.00,11.59]), and global executive function (ƞ2p=0.14[3.37,20.12]). Intervention children displayed fewer impulsive behaviors (ƞ2p=0.11[0.16,1.77]) and a longer attention span (ƞ2p=0.08[0.30,13.34]). Finally, intervention children exhibited greater baseline HF-HRV (ƞ2p=0.10[0.16,2.01]), and adaptive HF-HRV reactivity during the impulsivity (ƞ2p=0.12[0.20,2.19]) and attention tasks (ƞ2p=0.21[0.74,2.77]). ConclusionsThis intervention was associated with medium/large effect size improvements in offspring ER. Larger trials are needed to confirm the potential of these interventions on offspring neurodevelopment. Clinical Trial RegistryNCT01689961, Sept 21, 2012

Gender differences in behavioral and emotional problems among school children and adolescents in China: National survey findings from a comparative network perspective

BackgroundBehavioral and emotional problems are common and often co-occur during childhood and adolescence. The aim of this study was to assess gender differences in the network structures of behavioral and emotional problems of children and adolescents in China based on a national survey. MethodsThe Parent version of Achenbach' s Child Behavior Checklist (CBCL) was used to assess behavioral and emotional problems. To account for potential confounding factors in comparisons between boys and girls, propensity score matching was utilized. Network model differences were assessed using Network Comparison Test (NCT). ResultsData from 60,715 children and adolescents were included for analyses. Boys exhibited more severe total behavioral and emotional problems compared to girls. While several edges showed significant differences between boys and girls, the strongest association was consistently found between “Attention problems” (CBCL6) and “Aggressive behavior”(CBCL8) in both boys and girls, regardless of age. Network centrality was higher among adolescents compared to children. The most central problems commonly found across different genders and age groups were “Aggressive behavior” (CBCL8) (centrality values were 1.142 for boys aged 6–11 years, 1.051 for boys aged 12–16 years, 1.148 for girls aged 6–11 years, and 1.028 for girls aged 12–16 years), “Anxious/depressed” (CBCL1) (centrality values of 0.892 for boys aged between 6 and 11 years, 1.031 for boys aged 12–16 years, 0.951 for girls aged 6–11 years, and 1.099 for girls aged 12–16 years) and “Social problems” (CBCL4) (centrality values of 1.080 for boys aged 6–11 years, 0.978 for boys aged 12–16 years, 1.086 for girls aged between 6 and 11 years, and 0.929 for girls aged 12–16 years). ConclusionTesting effective interventions that address aggressive behavior, anxiety/depression, and social problems may be beneficial for reducing risk of psychopathology among children and adolescents.

Sleep problems in preschool mediate the association between chronotype and socioemotional problems at school-age

ObjectivesEvening-chronotype is associated with increased socioemotional problems among school-aged children. Inadequate sleep and increased sleep problems are also prevalent among evening-chronotype children and may underlie the relationship between chronotype and socioemotional problems. However, it is unclear whether the association between chronotype and socioemotional problems at school-age may be mediated by poorer sleep during late preschool. MethodsOur study utilized cross-sectional data to examine the relations between chronotype, sleep duration, sleep problems and socioemotional problems in preschoolers. We subsequently performed longitudinal mediation analyses to examine how the association between chronotype at preschool-age and later socioemotional problems at school-age may be mediated by sleep problems and sleep duration during late preschool. 399 children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study were included for analyses. Children's chronotype were identified with the Children's Chronotype Questionnaire at 4.5 years old. Sleep duration and problems were measured with the Children's Sleep Habits Questionnaire at 4.5 and 6 years old. Socioemotional problems were evaluated using the Child Behavioral Checklist at 4 and 7 years of age. All questionnaires were caregiver-reported. ResultsLinear regressions demonstrated that eveningness was associated with concurrent sleep problems and internalizing, externalizing and total behavioral problems at 4–4.5 years old, but not sleep duration. Mediation analyses supported that sleep problems (and not sleep duration) at 6 years old mediated the relationship between chronotype and socioemotional problems at 7 years old. ConclusionsOur findings suggest addressing sleep problems during early development may reduce socioemotional problems at school-age, especially among evening-chronotype children.

Examining emotional and behavioural trajectories in siblings of children with life-limiting conditions

BackgroundHealthy siblings of children with life-limiting conditions often experience emotional and behavioural struggles over the course of the ill child’s condition(s). Resources to support these siblings are limited due to a lack of understanding about their needs. Therefore, this study was designed to characterize the emotional and behavioural trajectories among siblings of children with progressive, life-limiting genetic, metabolic, or neurological conditions over a 12-month observation period.MethodsSeventy siblings were recruited from a large-survey based study (Charting the Territory) that examined the bio-psychosocial health outcomes of parents and siblings. Linear mixed effect models were used to assess the association between siblings’ emotions and behaviour trajectories and selected demographic variables. Siblings’ emotions and behaviour were measured with Child Behaviour Checklist (CBCL).ResultsSiblings’ mean age was 11.2 years at baseline and Internalizing, Externalizing, and Total Behaviour Problems mean scores were within normal ranges across time. However, 7–25% of siblings had scores within the clinical range. Brothers had higher levels of Internalizing Problems than sisters, whereas sisters had higher levels of Externalizing Problems than brothers. When treatment was first sought for the ill child less than a year prior to study participation, siblings had higher levels of Internalizing and Externalizing Problems compared with siblings who participated more than one year after treatment was sought.ConclusionHealthy siblings experience emotional and behavioural problems early in the child’s disease trajectory. Although these problems improve with time, our findings show that brothers and sisters experience different types of challenges. Therefore, timely support for siblings is important as they navigate through the uncertainties and challenges.

Pathways linking greenspace to behavioural problems in Polish children

BackgroundPrevious cross-sectional studies have found a beneficial relationship between greenspace and children's behaviour. Nevertheless, evidence on the mechanisms underlying this association remains scant. We examined whether the availability of greenspace was related to fewer behavioural problems in Polish children and investigated potential mechanisms. MethodsData were obtained from the case-control NeuroSmog study, in which children with and without attention deficit hyperactivity disorder (ADHD) were tested from October 2020 to September 2022. The analytic sample comprised 679 children aged 10–13 years. Parents reported internalizing, externalizing, and total behavioural problems using the Child Behaviour Check List (CBCL), as well as information about the presence of a domestic garden and potential mediators: greenspace perception, neighbourhood social cohesion, and physical activity. Tree and grass covers were extracted in 500 m and 1 km buffers around lifelong residences. Structural equation modelling (SEM) was used to examine the psychosocial pathways linking the greenspace metrics to behavioural problems. ResultsGreenspace was only indirectly related to fewer behavioural problems. Specifically, tree cover was related to greater levels of physical activity which, in turn, was related to fewer internalizing and total behavioural problems. Tree cover and presence of garden were related to greenspace perception which, in turn, was associated with higher neighbourhood social cohesion which, in turn, was linked to fewer behavioural problems. The patterns of associations in children without ADHD were very similar to those in the full sample except that the associations from garden to greenspace perception and from physical activity to total behavioural problems were no longer significant. The only association persisted among girls was from neighbourhood social cohesion to behavioural problems and among boys were from tree cover to physical activity and tree cover and garden to greenspace perception. ConclusionTrees and garden, but not grass, are linked to fewer behavioural problems through greenspace perception, neighbourhood social cohesion, and physical activity in Polish children.

Behavior problems 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de L'Enfant study.

To investigate the occurrence of behavioral problems 7 years after severe pediatric traumatic brain injury (TBI), and their evolution from 3 months to 7 years postinjury. Thirty-four participants, 38% girls, M (SD) age at injury 7.6 (4.7) years, age at assessment 15 (4.6) years, underwent comprehensive assessments 7 years after severe TBI from March 2014 to March 2016 and were matched to a control group by age, gender, and parental education. A subgroup of 20 participants had available behavioral assessments at 3, 12, and 24 months postinjury. Internalizing, externalizing, and total behavioral problems were assessed with self- and parent reports of the Achenbach's Behavioral Checklist. Additional data included sociodemographic background, initial injury severity, and specific outcomes assessed concurrently 7 years postinjury. Compared to controls: (a) a significant proportion of participants with severe TBI fell above the clinical cutoff for self- (42%) and parent-reported (36%) externalizing problems, but not for self- (33%) or parent-reported (45%) internalizing problems; (b) withdrawn/depressed, intrusive behavior, and somatic complaints were significantly higher in self-reports; and (c) rule-breaking behavior, attention, and social problems were significantly higher in parent reports. Parent-reported internalizing problems were associated with older age at injury, whereas externalizing problems correlated with greater injury severity and concurrent levels of greater overall disability, lower intellectual ability, and poorer family functioning. In multiple hierarchical regression analyses, overall disability and worse family functioning significantly predicted externalizing problems. Parent-reported internalizing and externalizing problems persisted over time. These results highlight the importance of long-term follow-up and individualized behavioral interventions for children who sustained severe TBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Finding the balance: The influence of movement behaviours on childhood behaviour problems

Background and aimsThe Canadian 24-h movement guidelines have led to an increased focus on movement behaviours (sleep, screen, sedentary, and physical activity) throughout the day. MethodsWe examined the cross-sectional and longitudinal associations between 24-h movement behaviours and parent-reported levels of internalizing, externalizing, and total behaviour problems in a subset of the CHILD birth cohort study at ages 3 (N Age 3 = 541, 48.1% girls) through 5 (N Age 5 = 575, 49.6% girls). Physical activity, sedentary time, and sleep were measured using an accelerometer worn on the non-dominant wrist for seven days following a 24-h protocol. Screen time was measured via parent-report and date-matched to daily accelerometer recordings. Compositional isotemporal substitution models predicted change in behaviour problems with reallocating time between movement behaviours. ResultsCross-sectional analysis indicated that screen time relative to other movement behaviours was associated with greater externalizing behaviours at age 3 and greater internalizing and total problem behaviours at ages 3 and 5. This was supported in the longitudinal analysis, where increased screen time at 3 was associated with increased internalizing, externalizing, and total problem behaviours at 5. Cross-sectional reallocation from screen to non-screen sedentary time was associated with reductions in internalizing and total behaviour problems at 3 and 5 years and reductions in externalizing at 3. Contrary to previous findings, cross-sectional proportional increases in moderate-to-vigorous-intensity physical activity were associated with increased externalizing and total problem behaviours at 5. ConclusionsClinicians should prioritize supporting families to find a balanced approach rather than promoting specific movement behaviours.

Exploring the Relationship Between Age at Nap Cessation and Social-Emotional Functioning in Children.

The objective of this study was to examine variations in age at nap cessation and identify whether there is an association with social-emotional functioning (SEF) as measured by internalizing/externalizing behavior, child temperament, and social skills in a sample of early childhood education and care-attending children. The sample comprised 1117 children from the Australian Effectiveness Early Educational Experiences for Children longitudinal early childhood study. We used children's age at nap cessation as retrospectively recalled by caregivers in 2011 or 2013 when children were between ages 2 and 7 years. Each child's SEF was reported by a caregiver using the Strengths and Difficulties Questionnaire, the Short Temperament Scale for Children, and the Social Skills Inventory Scale. Associations between children's age of nap cessation and SEF were tested using linear regressions. The children's age at nap cessation ranged from 6 months to 6 years. For each additional year of napping, children's total , conduct , externalizing , and peer behavior problems decreased by 0.39 (95% confidence interval [CI], -0.70 to -0.09), 0.11 (95% CI, -0.21 to -0.01), 0.11 (95% CI, -0.51 to -0.06), and 0.11 (95% CI, -0.20 to -0.02) units on the Strengths and Difficulties Questionnaire scale, respectively. No further significant associations were found. This is the first study reporting the age range of nap cessation and its associations with social-emotional functioning. Our findings demonstrate earlier cessation ages in Australian children attending Early Childhood Education and Care programs than previously reported and a small association with externalizing and peer problems.

Neurodevelopmental outcomes at 18 months of children diagnosed with CHD compared to children born very preterm.

To compare neurodevelopmental outcomes and parent behaviour ratings of children born term with CHD to children born very preterm. A clinical research sample of 181 children (CHD [n = 81]; very preterm [≤32 weeks; n = 100]) was assessed at 18 months. Children with CHD and born very preterm did not differ on Bayley-III cognitive, language, or motor composite scores, or on expressive or receptive language, or on fine motor scaled scores. Children with CHD had lower ross motor scaled scores compared to children born very preterm (p = 0.047). More children with CHD had impaired scores (<70 SS) on language composite (17%), expressive language (16%), and gross motor (14%) indices compared to children born very preterm (6%; 7%; 3%; ps < 0.05). No group differences were found on behaviours rated by parents on the Child Behaviour Checklist (1.5-5 years) or the proportion of children with scores above the clinical cutoff. English as a first language was associated with higher cognitive (p = 0.004) and language composite scores (p < 0.001). Lower median household income and English as a second language were associated with higher total behaviour problems (ps < 0.05). Children with CHD were more likely to display language and motor impairment compared to children born very preterm at 18 months. Outcomes were associated with language spoken in the home and household income.

Behavior problems in foster care, systematic review of associated factors

Every year, a significant number of children are placed in family foster care. Although foster children are at risk of behavioral problems, it is not yet clear which factors contribute to this. The methodology of this review was based on the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The electronic databases PubMed, Web of Science, ProQuest, and Google Scholar were systematically searched. Reference lists from the articles retrieved were hand searched. Studies were included in this scoping review if they: (1) were published between January 2010 and August 2020, (2) were primary research including at least two quantitative variables (one of them being the behavioral problems of the foster child and/or the evolution of these behavioral problems), (3) included a sample of foster children who were under 18 years old, and (4) published in English or Dutch. This review provides an overview of the associated characteristics with internalizing, externalizing and total behavior problems and changes over time in these behavior problems. The results mainly point out the importance of foster family factors in the context of behavioral problems. The results point into the direction of a positive association between foster parental stress and (an increase in) behavioral problems in foster children and the association of parenting behavior and (changes in) behavioral problems. Monitoring parenting stress and the implementation of interventions aiming at optimalisation of parenting behavior can be used to help foster parents in raising foster children with behavioral problems.

Psychological aftereffects experienced by sexually abused children: Psychopathological characteristics revealed by the K-CBCL.

Children who have been sexually abused may experience various short- and long-term psychological sequelae and behavioral problems. This study assessed the mental health of sexually abused children using the Korean-Child Behavior Checklist (K-CBCL) and examined differences from a control group. The participants were 97 children who had been sexually abused and who visited a local Sunflower Center, and 178 control participants. Data were collected via the K-CBCL and analyzed using SPSS version 25.0. T-tests, cross-tabulation, and logistic regression analyses were performed. Scores from the K-CBCL Problem Behavior Syndrome scale were compared between sexually abused children and the control participants. Significant differences were observed between the 2 groups in all the subscales. Compared to the control group, children who were sexually abused showed statistically significant differences in the total problem behavior, internalization, anxiety/depression, withdrawal/depression (withdrawn), somatic symptoms, externalization, rule-breaking behavior (delinquency), aggressive behavior, social immaturity, thought problems, attention problems, and other subscale scores. Sexual violence hurts the overall mental health of children who are abused, including their emotional, behavioral, and social factors. Our findings suggest that multidisciplinary assessment and treatment are required for children who have experienced sexual abuse.

Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review

BackgroundThe mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people’s Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years.MethodsFor the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics.ResultsIn total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people’s skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes.ConclusionsFuture intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base.Systematic review registrationPROSPERO CRD42020177478.

Testing the temporal precedence of family functioning and child psychopathology in the LONGSCAN sample.

Family functioning may serve as protective or risk factors in the development of youth psychopathology. However, few studies have examined the potentially reciprocal relation between child psychopathology and family functioning. To fill this gap in the literature, this study tested for time-ordered associations between measures of family functioning (e.g., cohesion, conflict, and emotional expressiveness) and child psychopathology (e.g., total behavior problems, externalizing, and internalizing problems) using data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN; N = 1143, 52.3% female, Nwaves = 5). We used a random-intercept cross-lagged panel model to identify whether child psychopathology preceded and predicted family functioning, the reverse, or both processes occurred simultaneously. At the between-person level, families who tended to have more cohesion, who lacked conflict, and who expressed their emotions had lower levels of child psychopathology. At the within-person level in childhood, we found minimal evidence for time-ordered associations. In adolescence, however, a clear pattern whereby early psychopathology consistently predicted subsequent family functioning emerged, and the reverse direction was rarely found. Results indicate a complex dynamic relation between the family unit and child that have important implications for developmental models that contextualize risk and resilience within the family unit.

Evaluation of multidimensional pediatric-psychosomatic inpatient therapy: a pilot study comparing two treatment modalities.

Multidimensional pediatric-psychosomatic inpatient treatment should be considered a highly relevant concept in the German healthcare system. This treatment concept has been successfully integrated to support youth with mental disorders and patients with chronic somatic conditions. Studies on treatment impact and empirical evidence of pediatric-psychosomatic inpatient therapies are rare, despite their clinical significance. Therefore, the study aims to provide initial indications of what constitutes to enhanced treatment effectiveness by comparing two different pediatric-psychosomatic inpatient treatment concepts. The clinics are comparable regarding the treated disorders, which include: dissociative, mood, and somatoform disorders, and psychological factors associated with chronic somatic conditions. Multidimensional treatment in both clinics include components of individual and family therapy, along with group-, art-, music-, creative-, and physio-therapy. Both clinics differed regarding their treatment philosophy in which; Clinic A practiced psychodynamic behavioral elements more strongly, while Clinic B rooted itself more strongly with psychoanalysis and family-dynamic practices. Each clinic recruited 25 patients for the study. They completed two questionnaires both at admission and discharge, which measured general behavioral and emotional problems (YSR); and, respectively, difficulties in emotion perception and processing (TAS-26). The effectiveness of the treatment was examined by conducting one-sample t-test and effect sizes for each clinic. To obtain information on differentiating treatment effects, mixed ANOVAs were calculated. For estimating its influence, the treatment duration was taken into account as a covariate calculating an ANCOVA. In both settings, treatment effects can be observed regarding internalizing problems. For alexithymia, no effects were seen in Clinic B, while in Clinic A, there was a significant reduction. When comparing both clinics, the ANOVAs showed significant interaction effects displaying advantages for Clinic A in the reduction of internalizing, total behavioral problems and alexithymia. Taking into account the treatment duration as a covariate, those effects level out. Significant differences between the clinics were no longer statistically detectable. The present study provides substantial preliminary indications on the effectiveness of multidimensional pediatric-psychosomatic inpatient therapy, which seems suitable for alleviating the general symptom burden and problems by identifying and processing emotions. Furthermore, the results indicate that an extended treatment duration may contribute to more pronounced effects.

Effectiveness of a Training Program for Parents of Toddlers with or at Risk of Autism Spectrum Disorder

Purpose: This study aimed to evaluate a hospital-provided hybrid parental support program designed to help parents implement routine interventions for their toddlers under 34 months, with or at risk of autism spectrum disorder (ASD).Methods: An experimental group including 15 pairs of toddlers and their parents received eight weekly sessions, while a control group including nine pairs received no sessions. Toddlers’ joint attention, autism-related behaviors, and adaptive behaviors, as well as parenting stress and parenting efficacy, were compared between baseline and 8 weeks later. Results: The toddlers in the experimental group showed significant improvement in their joint attention scores on the Early Social Communication Scales (&lt;i&gt;P&lt;/i&gt;&lt;0.01) and the Korean-Childhood Autism Rating Scale scores (&lt;i&gt;P&lt;/i&gt;&lt;0.01). However, statistically significant differences were not found in the adaptive behavior composite scores of the Korean Vineland Adaptive Behavior Scales-II and total behavior problem scores of the Korean version of the Child Behavior Checklist. Parenting efficacy in the experimental group showed significant improvement (&lt;i&gt;P&lt;/i&gt;&lt;0.05). Parenting stress increased in the experimental group, but the difference was not significant. Additionally, parents showed a statistically significant between-group difference in parenting efficacy (&lt;i&gt;P&lt;/i&gt;&lt;0.05). Conclusion: A hospital-provided hybrid program affected the development of toddlers with ASD and parents’ implementation of interventions. It is significant that an online platform was used to provide individualized support for families to continue practicing the interventions and that the effectiveness of this program was demonstrated. This intervention can be considered as an efficient and sustainable alternative system to support toddlers with ASD and their families.

Greater Gestational Vitamin D Status is Associated with Reduced Childhood Behavioral Problems in the Environmental Influences on Child Health Outcomes Program

BackgroundVitamin D deficiency is common in pregnancy. Vitamin D plays an important role in the developing brain, and deficiency may impair childhood behavioral development. ObjectivesThis study examined the relationship between gestational 25(OH)D concentrations and childhood behavior in the Environmental influences on Child Health Outcomes (ECHO) Program. MethodsMother-child dyads from ECHO cohorts with data available on prenatal (first trimester through delivery) or cord blood 25(OH)D and childhood behavioral outcomes were included. Behavior was assessed using the Strengths and Difficulties Questionnaire or the Child Behavior Checklist, and data were harmonized using a crosswalk conversion. Linear mixed-effects models examined associations of 25(OH)D with total, internalizing, and externalizing problem scores while adjusting for important confounders, including age, sex, and socioeconomic and lifestyle factors. The effect modification by maternal race was also assessed. ResultsEarly (1.5–5 y) and middle childhood (6–13 y) outcomes were examined in 1688 and 1480 dyads, respectively. Approximately 45% were vitamin D deficient [25(OH)D < 20 ng/mL], with Black women overrepresented in this group. In fully adjusted models, 25(OH)D concentrations in prenatal or cord blood were negatively associated with externalizing behavior T-scores in middle childhood [−0.73 (95% CI: −1.36, −0.10) per 10 ng/mL increase in gestational 25(OH)D]. We found no evidence of effect modification by race. In a sensitivity analysis restricted to those with 25(OH)D assessed in prenatal maternal samples, 25(OH)D was negatively associated with externalizing and total behavioral problems in early childhood. ConclusionsThis study confirmed a high prevalence of vitamin D deficiency in pregnancy, particularly among Black women, and revealed evidence of an association between lower gestational 25(OH)D and childhood behavioral problems. Associations were more apparent in analyses restricted to prenatal rather than cord blood samples. Interventions to correct vitamin D deficiency during pregnancy should be explored as a strategy to improve childhood behavioral outcomes.

Sleep and its variability in relation to behavioral outcomes in school-age children with overweight and obesity.

This was a cross-sectional study to examine sleep and its variability in relation to behavioral outcomes in school-age children with overweight and obesity. A total of 246 school-age children with overweight or obesity were recruited between 2019 and 2021 from 10 public elementary schools in Northern Taiwan. Parents completed sleep and behavior questionnaires, with children wearing an actigraphy monitor for 7 days. Average daily sleep duration by actigraphy was 7.52 h, with 84.6% of the children having clinically significant sleep disturbance scores and 68.3% having a total behavior problem score in the clinical range. Children were categorized by median split for sleep duration and sleep duration variability. Multivariate regression analyses showed that children in the insufficient (duration)-stable (variability) sleep category had significantly higher scores for emotion problems (B = 0.94, p = 0.01), self-control problems (B = 1.61, p < 0.01), and total behavior problems (B = 3.38, p < 0.01) compared to children in the sufficient-stable sleep (reference) category. Children in the insufficient-variable sleep category had significantly higher self-control problem scores compared to children in the reference category (B = 1.03, p < 0.05). Findings from our study suggest that school-age children with overweight and obesity coexist with sleep and behavioral problems, and those who have consistently insufficient sleep are at the greatest risk for the worst behavioral outcomes. Screening for sleep habits and behavioral problems should be considered a standard practice in pediatric overweight and obesity.