Total Behavioral Difficulties Research Articles

Interpregnancy intervals and behavioural outcomes in children: A population-based longitudinal study

BackgroundWhile the physical health consequence of short interpregnancy intervals (IPIs) is well documented, its mental health impact is not well explored. This study aimed to examine the associations between IPIs and behavioural outcomes in children born following the interval at four developmental time points between ages 7 and 16. MethodsOur study sample comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, an ongoing population-based longitudinal birth cohort in Bristol, Avon, United Kingdom. Behavioural problems, including total behavioural difficulties, hyperactivity, emotional symptoms, conduct problems, peer-problems, and problems of pro-social behaviour, were assessed using the Strengths and Difficulties Questionnaire (SDQ). Over 2300 mothers and their singleton children were included in this study. Generalized Estimating Equations (GEE) were used to estimate odds ratios for the associations. ResultsChildren born to mothers with short IPI (<6 months) were 1.54 (95%CI: 1.12–2.11), 1.42 (95% CI: 1.12–1.81) and 1.37 (95%CI: 1.04–1.79) times more likely to have total behavioural difficulties, conduct problems and hyperactivity/inattention problems across the child's age, respectively, compared with children of mothers with IPIs of 18–23 months. We found no evidence of associations between short IPI (<6 months) and emotional symptoms, peer-relationship problems and pro-social behaviour problems. ConclusionShort IPI (<6 months) was associated with externalising (conduct and hyperactivity/inattention) but not internalising (emotional and peer-relationship problems) problems. Further studies are needed to confirm this association and elucidate the underlying mechanisms.

Screen Media Use and Mental Health of Children and Adolescents

Excessive screen media use has been associated with poorer mental health among children and adolescents in several observational studies. However, experimental evidence supporting this hypothesis is lacking. To investigate the effects of a 2-week screen media reduction intervention on children's and adolescents' mental health. This prespecified secondary analysis of a cluster randomized clinical trial with a 2-week follow-up included 89 families (with 181 children and adolescents) from 10 Danish municipalities in the region of Southern Denmark. All study procedures were carried out in the home of the participants. Enrollment began on June 6, 2019, and ended on March 30, 2021. This analysis was conducted between January 1 and November 30, 2023. Families were randomly allocated to a screen media reduction group or a control group. The 2-week screen media reduction intervention was designed to ensure a high level of compliance to the reduction in leisure-time screen media use. Participants allocated to the intervention group had to reduce their leisure-time screen media use to 3 hours per week or less per person and hand over smartphones and tablets. The main outcome was the between-group mean difference in change in total behavioral difficulties, measured by the Strengths and Difficulties Questionnaire at 2-week follow-up. Results were estimated using mixed-effects tobit regression models. Analyses were carried out as both intention to treat and complete case. In the sample of 89 families including 181 children and adolescents (intervention group [45 families]: 86 children; mean [SD] age, 8.6 [2.7] years; 42 girls [49%]; control group [44 families]: 95 children; mean [SD] age, 9.5 [2.5] years; 57 girls [60%]), there was a statistically significant between-group mean difference in the total difficulties score, favoring the screen media reduction intervention (-1.67; 95% CI, -2.68 to -0.67; Cohen d, 0.53). The greatest improvements were observed for internalizing symptoms (emotional symptoms and peer problems; between-group mean difference, -1.03; 95% CI, -1.76 to -0.29) and prosocial behavior (between-group mean difference, 0.84; 95% CI, 0.39-1.30). This secondary analysis of a randomized clinical trial found that a short-term reduction in leisure-time screen media use within families positively affected psychological symptoms of children and adolescents, particularly by mitigating internalizing behavioral issues and enhancing prosocial behavior. More research is needed to confirm whether these effects are sustainable in the long term. ClinicalTrials.gov Identifier: NCT04098913.

Maternal Pregnancy and Pre-Pregnancy Weight and Behavioural Outcomes in Children.

Reported associations of pre-pregnancy weight and/or gestational weight gain with offspring behavioural outcomes are inconsistent. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to examine these associations at five developmental stages between the ages of 3 and 16. Over 6800 mother-offspring pairs at age 3 and 3925 pairs at age 16 were included. Pre-pregnancy underweight was associated with a 22% increased risk of total behavioural difficulties (OR = 1.22, 95% CI 1.02-1.45). In separate analyses using the SDQ subscales, pre-pregnancy underweight was linked to a 37% (OR = 1.37, 95% CI 1.14-1.65) and 33% (OR = 1.33, 95% CI 1.01-1.76) increased risk of emotional symptoms and prosocial behaviour problems over time, respectively. While pre-pregnancy overweight was associated with an 11% (OR = 1.11, 95% CI 1.03-1.20) and 18% (OR = 1.18, 95% CI 1.03-1.36) increased risk of conduct and peer relationship problems, respectively, pregnancy obesity was associated with a 43% increased risk of emotional problems (OR = 1.43, 95% CI 1.16-1.77). We found no evidence of associations between gestational weight gain and child behaviour except for a reduced risk in prosocial behaviour problems (OR = 0.82, 95% CI 0.70-0.96). Our findings provide insights into the link between preconception BMI and child behaviour, underscoring the necessity for further research to validate these associations and elucidate underlying mechanisms.

Harsh Parenting and Trajectories of Emotional and Behavioural Difficulties in Autistic Children

Autistic children show higher rates of co-occurring emotional and behavioural difficulties compared to other children in the general population. However, the environmental factors which contribute to the development of emotional (internalising) and behavioural (externalising) difficulties in autistic individuals are poorly understood. This study sought to investigate the association between harsh parenting (smacking, shouting, telling off) and the trajectories of emotional and behavioural difficulties in autistic children from ages 3 to 7. A sample comprising of 349 autistic children participated from the UK’s Millennium Cohort Study. Associations between harsh parenting and child emotional and behavioural difficulties were modelled using multilevel growth curve models. In autistic children, harsh parenting was associated with total emotional and behavioural difficulties and behavioural (but not emotional) problems concurrently. Moreover, harsh parenting was not associated with changes in emotional and behavioural difficulties over time. Harsh parenting may have an important role in externalising problems in young autistic children indicating the need for public health strategies which educate parents on its effects.

Parental Recreational Screen Media Practices and Behavioral Difficulties Among Danish 7-Year-Old Children.

This study aimed to investigate the association of parental recreational screen media practices, including time use and level of smartphone addiction, with behavioral difficulties in 7-year-old children. The study was based on cross-sectional data from the Odense Child Cohort, a community-based birth-cohort study. A total of 1152 parent-child dyads with complete data were included based on data from the 7-year examination conducted in 2018-21. Parental recreational screen use was self-reported as hours/day using the SCREENS-questionnaire, and their smartphone addiction was self-reported using the Smartphone Addiction Scale Short Version. Child behavioral difficulties were assessed by the parent-reported version of the Strengths and Difficulties Questionnaire (SDQ). Parental recreational screen time was not consistently associated with behavioral difficulty SDQ subscales and total difficulty scores when adjusted for other determinants of child mental well-being such as sociodemographic factors, parental well-being, and number of siblings. Children had higher total behavioral difficulty scores (adjusted mean difference 2.12 (95% CI, 1.19-3.05)) when comparing fourth quartile versus first quartile of maternal smartphone addiction score. Also, higher maternal smartphone addiction scores were associated with more externalizing and internalizing behavioral problems of their child (adjusted mean difference 1.61 points (95% CI, 0.95-2.27), and 0.81 points (95% CI, 0.19-1.43)) for fourth quartile versus first quartile, respectively. No cross-sectional association was found between total parental recreational screen use and behavioral difficulties in their 7-year-old children, but an association between maternal obsessive smartphone use and behavioral difficulties of their children was found.

The effect of maternal pre-pregnancy body mass index and gestational weight gain on behavioural outcomes in term normal birth weight children: UK birth cohort study

IntroductionExisting evidence in the association between maternal pregnancy and pre-pregnancy weight and behavioural outcomes in children.ObjectivesThis study aimed to examine these associations at six developmental time-points between ages 3 and 16.MethodsWe used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), an ongoing population-based longitudinal pregnancy cohort study in Bristol, United Kingdom (UK). Data on behavioural outcomes were measured at ages 3.5, 7, 9, 11 and 16 years using the Strengths and Difficulties Questionnaire (SDQ). Over 7960 (at 3.5 years of age) and 4400 (at 16 years of age) mother-child pairs were included in the final analysis. Logistic regression analyses were used to examine the associations.ResultsPre-pregnancy BMI and gestational weight gain were associated with total behavioural difficulties in children across all age groups. In separate analyses using each SDQ subscale, however, we found that pre-pregnancy underweight was associated with emotional problems at ages 7 (OR = 1.66, 95% CI; 1.20 – 2.29), 11 (OR = 1.49, 95% CI; 1.02 – 2.18) and 16 (OR = 1.74, 95% CI; 1.16 – 2.60) years and hyperactivity/inattention problems at age 16 (OR = 1.96, 95% CI; 1.27 – 3.05). We also found an association between guideline-discordant gestational weight gain and peer relationship problems at age 9 and pro-social behaviour at ages 9 and 11.ConclusionsOur findings highlight that pre-pregnancy underweight than overweight, obesity or gestational weight gain may influence the emotional health of children and adolescents.Disclosure of InterestNone Declared

Sleep problems in adolescents with epilepsy and their caregivers: associations with behavioural difficulties.

The aim of this study was to investigate the frequency of sleep problems in adolescents with epilepsy and their caregivers. We also examined the behavioural difficulties in adolescents with epilepsy and compared these behaviors with healthy controls. This observational case-control study included 37 adolescents with epilepsy and their caregivers, and 43 healthy age-matched adolescents and their caregivers. The Children`s Sleep Habits Questionnaire (CSHQ), DSM-5 Level 2 Sleep Disorders Scale for Children, and Strengths & Difficulties Questionnaire (SDQ) were used to evaluate sleep habits, sleep problems, and behavioural difficulties in adolescents. The DSM-5 sleep disorder scale for adults was used to evaluate the caregivers` sleep problems. Adolescents with epilepsy had higher sleep problem scores such as daytime sleepiness and overall sleep problems compared with healthy controls. The psychopathological symptoms such as conduct problems, hyperactivity/inattention, and total behavior were also more frequent in adolescents with epilepsy. There was a nonsignificant increase in DSM-5 sleep disturbance score in caregivers of adolescents with epilepsy. Sleep onset delay had a significant negative correlation with total behavioral difficulties (r = -0.44, p < 0.01), and emotional problems (r = -0.47, p < 0.05) in adolescents with epilepsy. Sleep duration was negatively correlated with conduct problems (r = -0.33, p < 0.05), but positively correlated with prosocial score (r = 0.46, p < 0.01) in adolescents with epilepsy. Night waking was positively correlated with total behavioral difficulties (r = 0.35, p < 0.05) and hyperactivity score (r = 0.38, p < 0.05) in adolescents with epilepsy. Adolescents with epilepsy have more frequent sleep disturbances and maladaptive behaviors such as hyperactivity/inattention, and conduct problems compared with healthy controls, and their caregivers are more vulnerable to sleep problems. Moreover, we also demonstrated a strong association between sleep disturbances and behavioral problems in adolescents with epilepsy.

Educational achievement and bullying: The mediating role of psychological difficulties.

Bullying has a profound and enduring impact on academic achievement. However, there is a lack of clarity surrounding the specific mechanisms of this relationship. This study examined the link between bullying at age 9 and Numeracy/Literacy achievement at age 15 to determine if this relationship is partially or fully explained by psychological difficulties at age 13. Secondary data analysis was completed on waves 1, 2 and 3 of child cohort (Cohort'98) of the Growing Up in Ireland (GUI) study, respectively, at 9years (N=8568), 13years (N=7527) and 15years of age (N=6216). Longitudinal path mediation model was conducted with bullying at age 9 as the predictor, total (emotional and behavioural) difficulties at age 13 as the mediator and Numeracy/Literacy scores at age 15 as outcomes revealing significant indirect effects of bullying on achievement, via psychological difficulties. We discuss the impact of bullying on the student's psychological well-being, the relationship between bullying and academic attainment and how this may be tackled to avoid consequences throughout education and later in life. This study emphasizes the need for schools to address the emotional and behavioural difficulties occurring as a result of bullying in order to improve the overall educational experience of a child. Existing interventions can be built upon by focusing on the continuous remediation of such psychological difficulties.

Remote and Hybrid Schooling During COVID-19: Associations with Child Behavior and Sleep.

The purpose of this study was to assess the prevalence of child behavior, academic and sleep concerns, and parent stress and depression symptoms during COVID-19; to test associations of parent-child well-being with child school format; and to examine effect moderation by child race/ethnicity and material hardship. A total of 305 English-speaking parents of elementary school-age children completed online surveys regarding demographics, child school format, behavior, learning-related experiences, sleep, and parent stress and depression symptoms. Multivariable linear and logistic regression analyses examined associations of school format with child and parent outcomes. Children were aged 5.00 to 10.99 years, with 27.8% underrepresented minority race/ethnicity. Per parental report, 27.7% attended school in-person, 12.8% hybrid, and 59.5% remote. In multivariable models, compared with children receiving in-person instruction, children receiving remote instruction exhibited more hyperactivity (β 0.94 [95% confidence interval, 0.18-1.70]), peer problems (β 0.71 [0.17-1.25]), and total behavioral difficulties (β 2.82 [1.11-4.53]); were less likely to show academic motivation (odds ratio [OR] 0.47 [0.26-0.85]) and social engagement (OR 0.13 [0.06-0.25]); were more likely to show schoolwork defiance (OR 2.91 [1.56-5.40]); and had a later sleep midpoint (β 0.37 [0.18-0.56]) and higher odds of cosleeping (OR 1.89 [1.06-3.37]). Associations of remote learning with behavior difficulties were stronger for children without material hardships. Children receiving remote and hybrid instruction were reported to have more difficulties compared with children receiving in-person instruction. Children with material hardships showed more behavior challenges overall but less associated with school format. Therefore, planning for a return to in-person learning should also include consideration of family supports.

Lifestyle changes, mental health, and health-related quality of life in children aged 6\u20137\xa0years before and during the COVID-19 pandemic in South Germany

BackgroundThe measures against the COVID-19 pandemic are challenging for children and parents, and detrimental effects on child health are suggested especially from lock-down measures and school closings.MethodsWe conducted a cross-sectional analysis using a population based longitudinal (birth-) cohort study (SPATZ study) conducted in the South of Germany. Data included all 6 or 7 year old children for whom a questionnaire was completed during first grade of school. Consequently, we were able to analyze children being in first grade before the first lockdown in Germany (≤ 15th March 2020), as well as children being in first grade during the pandemic (> 15th March 2020). We conducted descriptive statistics and estimated the associations between the two time periods, before and during the pandemic, and various outcomes of child health using multivariable adjusted linear or logistic regression modeling. The analysis was stratified by gender.ResultsResults among n = 362 children aged six or seven years showed substantially lower mean scores of health-related quality of life (difference in means: − 5.5, 95% confidence interval (CI) − 9.0, − 2.0), and higher mean scores in total emotional and behavioral difficulties (difference in means: 2.0, 95% CI 0.2, 3.8) in girls during vs. before the COVID-19 pandemic using multivariable linear regression modeling. In addition, weekly screen-time was increased in boys by 3.5 h (95% CI 0.6, 6.4). We did not find substantial differences in sleep quality, physical activity, and time spent with books, neither in boys nor in girls, however, the limited sample size has to be considered.ConclusionChild health (and behavior) of first grade school children is possibly impacted by the COVID-19 pandemic with adverse consequences possibly differing by gender.

Supporting Children Who Experience Domestic Violence: Evaluating the Child Witness to Domestic Violence Program.

Impacting 1 in 4 children in the United States, childhood exposure to domestic violence predicts myriad negative sequelae. Intervening post exposure is critical to help children and their protective parent heal and avoid long-term negative consequences. Children aged 2-17 and their mothers who were victims of domestic violence participated in a 12-week group program delivered by domestic violence agency staff that provides psychoeducation on the impact of trauma and domestic violence and aims to improve parent and child well-being. The impact of the Child Witness to Domestic Violence (CWDV) program was tested in an intervention group (n = 69 children, 33 mothers) who participated in CWDV and control group (n = 80 children, 39 mothers) consisting of children whose mothers received adult-focused domestic violence services but were not enrolled in CWDV or other child-focused services. Multiple regression analyses controlling for child gender, child age, mother's age, and the outcome of interest at time 1 found that participation in CWDV program significantly predicted better child functioning as indicated by less hyperactivity (B = -.85, p = .06), fewer negative emotional symptoms (B = -1.14, p = .01), and fewer total behavioral difficulties (B = -2.48, p = .02) as well as higher maternal hope (B = .57, p = .03). These data provide promising evidence of the impact of a brief, replicable group intervention that promotes healing and well-being among children and parents exposed to domestic violence. Limitations include a quasi-experimental design and reliance on maternal report.

Parent and Teacher-Reported Child Outcomes Seven Years After Mild Traumatic Brain Injury: A Nested Case Control Study.

Background: Increasing evidence suggests potential lifetime effects following mild traumatic brain injury (TBI) in childhood. Few studies have examined medium-term outcomes among hospitalized and non-hospitalized samples. Study aims were to describe children's behavioral and emotional adjustment, executive function (EF), quality of life, and participation at 7-years following mild TBI using parents' and teachers' reports.Methods: Nested case control study of 86 children (68% male, mean age at assessment = 11.27 years; range 7–17 years) who sustained a mild TBI 7-years previously, identified from a prospective, population-based study. They were compared to 69 children free from TBI (61% male, mean age at assessment = 11.12 years; range 5–17 years). In addition to parent-reported socio-demographic details, parents (mild TBI n = 86, non-TBI n = 69) completed age-appropriate standardized questionnaires about children's health-related quality of life, behavioral and emotional adjustment, EF, and social participation. Parents own mood was assessed using the Hospital Anxiety and Depression Scale. Teachers (mild TBI n = 53, non-TBI n = 42) completed questionnaires about children's behavioral and emotional adjustment, and EF.Results: Parent reports showed median group-level scores for cases were statistically significantly greater than controls for emotional symptoms, conduct problems, hyperactivity/inattention, total behavioral difficulties, inhibitory control, shifting, planning/organizing, and Global Executive Composite (total) EF difficulties (p-values 0.001–0.029). Parent reports of child quality of life and social participation were similar, as were teacher reports of child behavioral and emotional adjustment, and EF (p > 0.05). When examining clinical cut-offs, compared to controls, cases had a higher risk of parent-reported total EF difficulties (odds ratio = 3.00) and, to a lesser extent, total behavior problems (odds ratio = 2.51).Conclusions: As a group, children with a history of mild TBI may be at elevated risk for clinically significant everyday EF difficulties in the medium-term compared to non-TBI controls, as judged by their parents. Further multi-informant longitudinal research is required, following larger samples. Aspects requiring particular attention include pre-injury characteristics, such as sleep disturbances and comorbidities (e.g., headaches), that may act as potential confounders influencing the association between mild TBI and child behavioral problems.

Adverse childhood experiences and its association with emotional and behavioral problems in U.S. children of Latino immigrants

BackgroundResearch has long shown that Adverse Childhood Experiences (ACEs) are correlated with major risk factors for several of the leading causes of death in adults. However, only recently have studies begun to measure the impact of ACEs during childhood and on underserved populations. ObjectiveThis study assessed the prevalence of 8 ACEs, including physical, emotional, and sexual abuse, among rural U.S. Latino children of immigrant parents. We examined the association of those adversities with several factors including emotional and behavioral difficulties, health problems and healthcare utilization. Participants and settingA total of 100 Latino subjects (ages 8–17) were recruited from a community health center in Southwest Florida. MethodsParents and children were asked to complete the Child Trust Events Survey to measure child ACEs; Parents were asked to complete the Strengths and Difficulties Questionnaire to measure child emotional and behavioral problems. ResultsChild ACEs ranged from 1.38 (parent-report) to 1.56 (child self-report) with emotional abuse, incarceration, and loss/separation from a caregiver being the most common. ACEs were correlated with emotional symptoms (p = .038 for child-report; p = .043 for parent-report), hyperactivity/inattention problems (p = .011 for parent-report), and with total behavioral difficulties (p = .021 for parent-report). There was a negative correlation between ACES and child chronic health diagnosis (p = .038 for parent-report; p = .010 for child-report) and total health problems (p = .021). There was no significant relationship between ACEs and healthcare utilization. ConclusionsACEs appear to be more prevalent among rural Latino youth in immigrant families and may be associated with emotional and behavioral problems during childhood.

The Father I Knew: Early Paternal Engagement Moderates the Long-term Relationship between Paternal Accessibility and Childhood Behavioral Difficulties

The long-term impact of a father’s involvement in offspring development is understudied. The current study investigated the relations between early paternal engagement (i.e., the amount of time fathers engaged in one-to-one activity with their child), paternal accessibility (i.e., fathers’ physical proximity to their children) and later child behavioral difficulties. Data were obtained from five phases of the Auckland Birthweight Collaborative (ABC) longitudinal cohort study: at the study children’s birth; at 12 months; 3.5 years; 7 years; and 11 years of age. Moderated linear regression analyses revealed that there was a negative, long-term effect of paternal departure from the family household (i.e., reduced paternal accessibility) by 3.5 years of age on children’s total behavioral difficulties and conduct problems scores, but only if departed fathers had been highly engaged during the child’s first year of life. These findings suggest that the relationship between paternal accessibility and paternal engagement is potentially more nuanced than previously thought.

Pre-Pregnancy Diet Quality and Its Association with Offspring Behavioral Problems

Abstract Objectives To examine the relationship between pre-pregnancy diet quality and offspring behavioral problems among children aged 5–12 years. Methods 1554 mother-child dyads with mothers from the Australian longitudinal study on women's health (ALSWH) and children from the mothers and their children's health Study (MatCH). The healthy eating index (HEI-2015) score was used to explore maternal diet quality before pregnancy. Childhood total behavioral difficulties, internalizing (emotional and peer) and externalizing problems (hyperactivity and conduct) were assessed using the strengths and difficulties questionnaire (SDQ). Multivariable logistic regression analyses were used to examine the association between maternal diet quality and offspring behavioral problems. Results 211 children experienced a greater score on total behavioral difficulties (13.6%) among the 1554 children. Better pre-pregnancy diet quality was associated with lower odds of offspring total behavioral difficulties after adjustment for potential confounders, highest vs lowest tertile (AOR = 0.52, 95% CI: 0.32, 0.85) at P = 0.009. Greater adherence to the HEI-2015 score before pregnancy was also inversely associated with odds of offspring externalizing problems (AOR = 0.64, 95% CI: 0.43, 0.94). Among the four subscales, hyperactivity and peer problems were negatively associated with better diet quality, (AOR = 0.67, 95% CI: 0.47, 0.96) and (AOR = 0.63, 95% CI: 0.42, 0.96), respectively. Conclusions We found that mothers who recorded the better quality of diets before pregnancy had children with a lower risk of behavioral disorders in childhood. Further well-powered prospective studies are warranted to confirm the findings. Funding Sources The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women's Health by the University of Queensland and The University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. Gete is supported by the UQ Research Training Scholarship. Mishra holds the Australian Health and Medical Research Council Principal Research Fellowship APP1121844.

Pre-pregnancy diet quality and its association with offspring behavioral problems.

The maternal diet has a critical role in epigenetic changes in the fetus, which has been associated with fetal brain tissue development and later onset of behavioral disorder. However, pre-pregnancy diet quality has not been examined in relation to offspring behavioral problems. 1554 mother-child dyads with mothers from the Australian longitudinal study on women's health (ALSWH) and children from the mothers and their children's health Study (MatCH). The healthy eating index (HEI-2015) score was used to explore maternal diet quality before pregnancy. Childhood total behavioral difficulties, internalizing (emotional and peer) and externalizing problems (hyperactivity and conduct) were assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariable logistic regression was used. 211 children experienced a greater SDQ-score on total behavioral difficulties (13.6%) among the 1554 children. Better pre-pregnancy diet quality was associated with lower odds of offspring total behavioral difficulties after adjustment for potential confounders, highest vs lowest tertile (AOR = 0.52, 95% CI 0.32, 0.85) at p = 0.009. Greater adherence to the HEI-2015 score before pregnancy was also inversely associated with lower odds of offspring externalizing problems (AOR = 0.64, 95% CI 0.43, 0.94). Among the four subscales, hyperactivity and peer problems were negatively associated with better diet quality, (AOR = 0.67, 95% CI 0.47, 0.96) and (AOR = 0.63, 95% CI 0.42, 0.96), respectively. We found that adherence to a diet of better quality in pre-pregnancy was associated with a lower risk of behavioral disorders in the offspring. Large prospective studies are warranted to confirm the findings.

Hypertensive disorders of pregnancy and emotional and behavioural problems in children: a longitudinal population-based study.

There is evidence that offspring of mothers who have hypertensive disorders of pregnancy (HDP) are at increased risk of adverse health outcomes. This study aims to examine the association between maternal HDP and emotional- and behavioural problems in offspring at age 11years as reported by teachers and parents. The current study is based on the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective, population-based study that has followed a cohort of offspring since their mothers were pregnant. Childhood emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ), completed by parents (n = 7196) and the child's teacher (n = 7411). Maternal preeclampsia, but not gestational hypertension, was associated with teacher-reported total behavioural difficulties (RR = 1.62; 95% CI 1.03-2.52) and internalising problems in children [peer problems (RR = 1.48; 95% CI 1.06-2.08) and emotional problems (RR = 1.68; 95% CI 1.13-2.51)]. No associations between preeclampsia and/or gestational hypertension and parent-reported emotional- and behaviour problems were observed. Our study showed that children exposed to preeclampsia had higher risk of teacher-reported total behavioural difficulties and internalising problems compared with unexposed children. The findings suggest emotional- and behavioural difficulties may not be evident in all settings, hence the importance of collecting evidence from multiple informants.

Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children

BackgroundRacism is a pervasive experience in the life of Aboriginal Australians that begins in childhood. As a psychosocial stressor, racism compromises wellbeing and impacts developmental trajectories. The purpose of the present study was to estimate the effect of racism on indicators of Australian Aboriginal child socio-emotional wellbeing (SEWB) at one to two years after exposure. Age-related differences in the onset of symptoms were explored.MethodsData from the B- and K-cohorts of the Longitudinal Study of Indigenous Children were used (aged 6 to 12 years). Racism, confounding variables, and the Strengths and Difficulties Questionnaire (a measure of SEWB) were collected by questionnaires and guided interviews with each child’s main caregiver. Adjusted Poisson regression was used to estimate the relative risk (RRa) effects of racism on SEWB for both cohorts separately. RRa were pooled in a random effects meta-analysis.ResultsExposure to racism was associated with an adjusted point estimate indicating a 41% increased risk for total emotional and behavioural difficulties, although the confidence intervals were wide (pooled RRa 1.41, 95% CI 0.75, 2.07). Analyses by cohort showed younger children had higher RRa for total difficulties (RRa 1.72, 95% CI 1.16, 2.54), whilst older children had higher RRa for hyperactive behaviour (RRa 1.66, 95% CI 1.01, 2.73).ConclusionsThe effects observed contributes to our understanding of the impact of racism on Aboriginal Australian children. Support for emotional and behavioural difficulties, and hyperactive behaviour, for Aboriginal children might help counteract the effects of racism. Future longitudinal research and policies aimed at reducing racism in Australian society are necessary.

School-age outcomes of children without cerebral palsy cooled for neonatal hypoxic–ischaemic encephalopathy in 2008–2010

ObjectiveSince therapeutic hypothermia became standard care for neonatal hypoxic–ischaemic encephalopathy (HIE), even fewer infants die or have disability at 18-month assessment than in the clinical trials. However, longer term follow-up...

Outdoor air pollution pregnancy exposures are associated with behavioral problems in China's preschoolers.

There are mounting evidences indicated that maternal exposure to outdoor air pollutants in pregnancy affects children's neural development, but the researches on children's behavioral difficulties are seldom. We explored the association between maternal exposure to outdoor air pollution during different trimesters of pregnancy and the prevalence of behavioral difficulties among 657 preschool children aged 3-4 from three kindergartens in Wuhan, China. This is a cross-sectional study. Children's behavioral difficulties were assessed by the Strengths and Difficulties Questionnaire (SDQ) (reported by parents). Maternal exposure to outdoor air pollutants during pregnancy were estimated based on the daily average measured concentration levels from ground monitoring stations. Potential confounding factors including children-related, maternal, and socio-economic status (SES) were adjusted in the study. We calculated the prevalence of each type of behavioral difficulties and used binary logistic regression method to estimate the crude odds ratio (cOR), adjusted odds ratio (aOR), and corresponding 95% confidence intervals (95% CIs) for 1μg/m3 increase in each air pollutant during every exposure window in single- and two-pollutant models. The prevalence of participants' total behavioral difficulties was 9.6%. In single-pollutant models, during full gestation, positive associations were observed between exposure to NO2 (aOR = 1.204, 95% CI 1.042, 1.392), particle matter (PM)10 (aOR = 1.070, 95% CI 1.018, 1.125), PM2.5 (aOR = 1.095, 95% CI 1.021, 1.176) and total difficulties, exposure to PM10 (aOR = 1.040, 95% CI 1.001, 1.081), PM2.5 (aOR = 1.053, 95% CI 1.000, 1.109) and prosocial behavior, respectively. In the first trimester, exposure to SO2 (aOR = 1.047, 95% CI 1.009, 1.086), NO2 (aOR = 1.039, 95% CI 1.013, 1.066), PM10 (aOR = 1.013, 95% CI 1.004, 1.023), and PM2.5 (aOR = 1.016, 95% CI 1.004, 1.028) were all positively associated with total difficulties. The associations between second and third trimesters' exposure to all pollutants and outcomes were not statistically significant. However, in the two-pollutant models, second trimester exposure to PM2.5 (aOR = 1.078, 95%CI 1.023, 1.137) was positively associated with total behavioral difficulties after adjusting for PM10. Exposure to outdoor air pollutants SO2, NO2, PM10, and PM2.5 during pregnancy may be associated with behavioral difficulties, especially in the first trimester.