Total Behavior Problems Research Articles

Temporal relationships among role stress, staff burnout, and residents' behavioral problems: A 2-year longitudinal study in child care homes in Hong Kong.

Young residents in care homes experience psychological distress arising from their complex family backgrounds. Residential care workers face job demands and are prone to burnout due to the role stress of balancing enormous workloads with residents' emotional needs. This 2-year study examined the changes in role stress, burnout, and residents' behavioral problems, and their temporal relationships in a sample of 381 young residents and 76 workers from residential care homes in Hong Kong. The workers completed the Role Questionnaire and Copenhagen Burnout Inventory and evaluated the residents' behavioral problems using the Child Behavior Checklist every 3 months. Latent growth modeling was used to analyze the temporal changes, and multilevel regression analysis was used to evaluate the associations between role stress and residents' behavioral problems. The workers displayed stable trends in role stress and burnout with significant inter-individual variations in temporal changes. The residents' total behavioral problems displayed piecewise decreasing trajectories with significant declines over the first 9 months. Controlling for baseline levels, changes in role stress showed significant and positive associations with changes in work burnout and total behavioral problems over the first 9 months. The findings provide support for the temporal relationships among role stress, work burnout, and residents' behavioral problems in a residential care setting.

Developmental trajectories of toddler sleep problems: can a person-centered approach help identify children at risk?

Previous research examining toddler sleep problems has relied almost exclusively on variable-centered statistical approaches to analyze these data, which provide helpful information about the development of the average child. The current study examined whether person-centered trajectory analysis, a statistical technique that can identify subgroups of children who differ in their initial level and/or trajectory of sleep problems, has the potential to inform our understanding of toddler sleep problems and their development. Families (N = 185) were assessed at 12, 24, 30, and 36 months of child age. Latent class growth analysis was used to test for subgroups that differed in their 24-36 month sleep problems. Subgroups were compared on child 36-month externalizing, internalizing, and total problem behaviors, and on 12 month maternal mental health, inter-parental conflict, and maternal parenting behaviors. Results support a four-class solution, with "low, stable," "low, increasing," "high, increasing," and "high decreasing" classes. The classes whose sleep problems persisted or worsened over time had worse behavioral problems than those whose symptoms improved or remained stably low. Additionally, 12 month maternal depression and global symptom severity, intimate partner violence, and maternal harsh-intrusive parenting behaviors discriminated between the classes that had similar levels of 24 month sleep disturbance but who had diverging trajectories over time. This statistical approach appears to have the potential to increase understanding of sleep problem trajectories in the early years of life. Maternal mental health, intimate partner violence, and parenting behaviors may be clinically useful markers of risk for the persistence or development of toddler sleep problems.

Sleep disturbances and behavior in Smith-Magenis syndrome

BackgroundThe Smith-Magenis syndrome (SMS) shows a collection of neurodevelopmental problems including mild to moderate intellectual disability, change-related anxiety, impulsivity, speech delay, Attention-Deficit/Hyperactivity Disorder (ADH) and sleep disturbances. Sleep disorders, when present, have been treated in several populations with consecutive improvements in cognitive and behavioral aspects. AimsTo better understand the existing relationships between sleep disturbances and behavioral problems in SMS syndrome this study describes the sleep and behavior problems in the SMS and explores the possible relation between both. Methods and procedures17 individuals with SMS (50% males; 11.2 ± 4.9 years old) and 12 individuals with typical development (50% male; 11.1 ± 4.4 years old) were investigated using the Sleep Disturbance Scale for Children and the Child Behavior Checklist. ResultsA high percentage (60%) of individuals with SMS have an indication of sleep disorders, being the most frequent disorders the sleep-wake transition disorders, and disorders of initiating and maintaining sleep with sleep latency higher than acceptable and total sleep time below acceptable. More than 94% of the SMS group presented clinical or borderline scores on the total behavioral problems scale. The most common behavioral problems were Externalizing Problems, Thought and Attention, ADH and Aggressive problems. There was a positive correlation between disorders of initiating and maintaining sleep, sleep-wake transition disorders, disorders of arousal, disorders of excessive somnolence and behavioral problems. Conclusions and implicationsThe worse the sleep disturbances investigated, the more severe the behavioral problems characteristics reinforcing the importance to address the sleep problems in the treatment of SMS individuals.

Children with Congenital Heart Disease Show Increased Behavioral Problems Compared to Healthy Peers: A Systematic Review and Meta-Analysis.

Millions of children and adults are living with congenital heart disease (CHD). Their risk for behavioral problems has not been the subject of a meta-analysis. We performed a systematic review and meta-analysis of measures of behavioral problems in people born with CHD compared to peers without CHD. We searched Pubmed, CINAHL, Embase, PsycInfo, and the Cochrane Library from January 1, 1986 to November 15, 2021. We included studies that reported a measure of behavioral problems in patients with CHD in children and adults older than 3years of age. We screened 26,343 search results, and 24 studies met inclusion criteria. The quality of evidence was generally low. Subjects with CHD had a small increase in internalizing problems [standardized mean difference (SMD): 0.198, p = 0.02] and total behavior problems (SMD: 0.287, p = 0.013), but no difference in externalizing behavioral problems. There was significant heterogeneity in all three domains of behavior problems analyzed, and it could not be explained by variables such as age, severity, assessor, or assessment tool. There are small increases in parent- and self-reported overall behavioral problems and internalizing problems in patients with CHD compared to healthy controls. Wide confidence intervals in the meta-analyses leave open the possibility that certain factors may increase the risk of behavioral problems in this group, and future studies with important attention paid to potential confounders may help identify risk factors.

Association of Antenatal Micronutrient Supplementation With Adolescent Emotional and Behavioral Health: A 14-Year Follow-Up of a Double-Blind Randomized Controlled Trial

Abstract Objectives To examine the impact of antenatal micronutrient supplementation on adolescent emotional and behavioral health, and to identify the modifying effect of household wealth. Methods We conducted a double-blind cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2008. Pregnant women in every village were randomized to daily take one capsule of folic acid (as control), folic acid plus 60 mg iron (IFA), and multiple micronutrients (MMNs) including 30 mg iron. Singleton births were prospectively followed at early adolescence in 2016. Adolescents actively completed the localized and qualified Youth Self-Report. Scores of Internalizing Behavior Problems (constituting by Anxious/Depressed, Withdrawn and Somatic Complaints), Externalizing Behavior Problems (constituting by Delinquent/Rule-Breaking Behavior and Aggressive Behavior) and Total Behavior Problems, were derived. As priorly specified, we examined the modifying effect of household wealth on the response to antenatal IFA and MMNs vs. folic acid supplementation on adolescent emotional and behavioral health. Results Of 1920 adolescents included in the final analysis, 1130 (58.9%) were male, with a mean (SD) age of 11.8 (0.78) years. As compared to folic acid, adolescents born to mothers who consumed IFA had lower scores of total behavioral problems, externalizing, rule-breaking and aggressive behavior. The adjusted mean differences were −2.94 (95% CI −5.78, −0.11), −1.00 (95% CI −1.82, −0.18), −0.39 (95% CI −0.73, −0.05) and −0.61 (95% CI −1.15, −0.07), respectively. Similar associations were observed among medium-wealth households, while null associations in low-wealth households (all interaction P values < 0.05). Further, among high-wealth households, MMNs show benefits on reducing the risk of adolescent behavioral problems as compared to IFA or folic acid. Conclusions Sufficient iron intake in pregnancy has long-term benefits on reducing the risk of adolescent behavioral problems. Multiple micronutrients including 60 mg iron are recommended in rural areas with micronutrients deficiencies widely prevalent given the benefits of MMNs on improving birth outcomes. Funding Sources National Natural Science Foundation of China and China Postdoctoral Science Foundation.

Screening of behavioral disorders in children with hemophilia

To screen types of behavioral problems among children with hemophilia and their relation to the disease parameters. Fifty boys, 6-18 years old, with moderate and sever hemophilia were subjected to: history taking, joint evaluation using the Hemophilia Joint Health Score, and behavioral assessment using the Child Behavioral Check List. Patients experienced different patterns of behavior disorder. Patients' age significantly correlated with anxious/depressed behavior, somatic complaints, social problems, aggressive behavior, internalizing behavior, and total behavior problems. Hemophilia severity significantly correlated with social problems, thought problems, aggressive behavior, internalizing behavior, externalizing behavior, and total behavior disorders. Affected joint number significantly correlated with withdrawn/depressed behavior, social problems, thought problems, aggressive behavior, internalizing behavior, and total behavior disorders. A high Hemophilia Joint Health Score of the target joints was significantly correlated with social problems, rule-breaking behavior, aggressive behavior, externalizing behavior, and total behavior disorders. Hemophilic arthropathy duration significantly correlated with somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing behavior, externalizing behavior, and total behavior problems. Children with hemophilia had behavioral disorders. The most affected scale was aggressive behavior. The least affected scale was attention problems. Behavioral disorders in children with hemophilia are influenced by the age of the patient, the severity of the disease, the number of joints affected, the duration of hemophilic arthropathy, and the score of joint affected by Hemophilia Joint Health Score.

0496 Sleep and Behavior Problems in Children with Overweight and Obesity

Abstract Introduction Limited studies have examined sleep variability in children with overweight and obesity, nor do studies focused on its relation with behavior outcomes in this high risk pediatric population. The purpose of this study was to examine sleep duration and its variability in relation to behavior outcomes in school-age children with overweight and obesity. Methods Sleep in 246 children aged 6-9 years with overweight and obesity was assessed using actigraphy for 7 days and through the parent-report Children’s Sleep Habits Questionnaire (CSHQ). Children’s behaviors were assessed using parental responses on the Behavior Assessment for Children. Children were categorized into 4 groups based on the median split of the average daily sleep duration and its variability: sufficient-stable, sufficient-variable, insufficient-stable, and insufficient-variable. General linear model (GLM) analyses were performed with the 4 sleep groups as the primary predictor variable and child behavior outcomes as the dependent variable. Results Average daily sleep duration by actigraphy was 7.52 hours, with 84.6% of the children having clinically significant CSHQ sleep disturbance scores and 68.3% having a total behavior problem score in the clinical range. In the unadjusted and adjusted GLM analysis, children in the insufficient-stable sleep duration category had significantly higher emotion problem (p < 0.05), self-control problem (p < 0.01), and total behavior problem scores (p < 0.01) when compared with those in the sufficient-stable sleep duration (reference) category. Children in the insufficient-variable sleep duration category had significantly higher self-control problem scores when compared with those in the reference category (p < 0.05). Conclusion School-age children with overweight and obesity coexist with sleep and behavior problems, with those who have persistent short sleep at the greatest risk for the worst behavior outcomes. Support (If Any) This work was supported by Ministry of Science and Technology, Taiwan, MOST 107 - 2314 - B - 002 - 025 - MY3.

Review: Which components of behavioral parent and teacher training work for children with ADHD? - a metaregression analysis on child behavioral outcomes.

This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes. We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness. Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms. This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.

It's not always binary: Connecting the continuum of caregiver depression with child adjustment in children who are high risk for maltreatment

BackgroundYoung children living with a depressed parent are at risk for developing social, behavioral, and emotional problems. The purpose of this study was to evaluate whether an increase in subclinical caregiver depression scores was associated with increases in internalizing and externalizing behavior in children who are at high risk for maltreatment. MethodsThe 1019 U.S.-based dyads consisted of predominantly single (45.53%) and Black/African American (53.29%) caregivers and high-risk 4-year-olds from the LONGSCAN study. Multivariate regression analyzes were used to evaluate the relationship between caregiver Center for Epidemiological Studies-Depression (CES-D) scores, above and below the at-risk for depression CES-D score, and preschooler internalizing, externalizing, and total problem behaviors, measured with the Child Behavior Checklist (CBCL). ResultsCaregiver CES-D score increases, above and below the at-risk for depression score, were significantly associated (p < 0.05) with increased child internalizing, externalizing, and total problem behaviors. After adjusting for covariates, among dyads whose caregivers had subclinical (CES-D < 16) scores, a one-unit score increase was significantly associated with a 0.43 increase (p = 0.00) in children's CBCL internalizing score. LimitationsThese findings are restricted to preschool children who are at risk for maltreatment, limiting generalizability. ConclusionsLow and moderate levels of caregiver depressive symptomatology were associated with a negative influence on preschoolers' adjustment. Practitioners should consider that the link between caregiver depression and child wellbeing may lie on a continuum. With consideration of the full continuum of symptoms, early intervention and anticipatory guidance may decrease the impact of depression on the caregiver, child, and system.

Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission

The pediatric intensive care unit (PICU) exposes children to stressful experiences with potential long-term psychological repercussions. However, current understanding of post-PICU psychological outcomes is incomplete. To systematically review and evaluate reported long-term psychological outcomes among children previously admitted to the PICU. A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE (PubMed), and PsycINFO was conducted from database inception to June 2021. Search terms included phrases related to intensive care (eg, intensive care units and critical care) and terms for psychological disorders (eg, posttraumatic stress disorder, depressive disorder, conduct disorder, and neurodevelopmental disorder) limited to the pediatric population. This systematic review and meta-analysis included randomized clinical trials and observational studies reporting psychological disorders among children younger than 18 years who were admitted to the PICU with follow-up for at least 3 months. Psychological disorders were defined using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Children were excluded if they were admitted to the PICU for primary brain conditions (eg, traumatic brain injury, meningoencephalitis, and brain tumors) or discharged to the home for palliative care. Titles and abstracts were independently screened by 2 reviewers, with data extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using a random-effects model during meta-analysis. Age-corrected IQ scores and long-term psychological outcomes measured by scales such as the Child Behavior Checklist (higher scores indicate more behavioral problems) among children admitted to the PICU. Of 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, 6.2-8.4 years]; 4267 boys [54.8%]; race and ethnicity were not reported by all studies) admitted to the PICU were included. Overall, 1 of 19 children (5.3%) to 14 of 16 children (88.0%) previously admitted to the PICU were reported to have at least 1 psychological disorder. Studies that examined posttraumatic stress disorder reported that 6 of 60 children (10.0%) to 31 of 102 children (30.4%) met the diagnostic criteria for the disorder at 3 to 6 months of follow-up. Compared with healthy children, those admitted to the PICU had lower IQ scores at 1 to 2 years of follow-up (mean, 89.40 points [95% CI, 88.33-90.47 points] vs 100.70 points [95% CI, 99.43-101.97 points]; P < .001) and 3 to 5 years of follow-up (mean, 88.54 points [95% CI, 83.92-93.16 points] vs 103.18 [95% CI, 100.36-105.99 points]; P < .001) and greater total emotional and behavioral problems at 4 years of follow-up (mean, 51.69 points [95% CI, 50.37-53.01 points] vs 46.66 points [95% CI, 45.20-48.13 points]; P < .001). This systematic review and meta-analysis found a high burden of psychological sequelae among children previously admitted to the PICU, suggesting that risk stratification and early interventions are needed for high-risk groups.

Child‐centered play therapy and adverse childhood experiences: A randomized controlled trial

AbstractThere is a preponderance of evidence that adverse childhood experiences (ACEs) result in harmful physical, learning, social, emotional, and behavioral health outcomes during childhood, with far reaching effects lasting across the lifespan. The cumulative effect of childhood adversity and its relationship to childhood trauma represent an urgent call to action among stakeholders, yet treatment studies are rare. The purpose of this randomized controlled trial was to explore the impact of child‐centered play therapy (CCPT) among children with two or more ACEs on improvement of social and emotional assets and behavioral problems. Results of a repeated measures linear mixed model demonstrated statistically significant increases in social‐emotional competencies including empathy, social competence, and self‐regulation/responsibility and decreases in total behavior problems among children who participated in CCPT. Results of this study support the effectiveness of CCPT among children who have experienced ACEs and at risk for complex trauma.

Sex moderated and RSA mediated effects of prenatal cocaine exposure on behavior problems at age 7

This study was designed to assess whether prenatal cocaine exposure (PCE) is associated with sex differences in behavior problems in middle childhood and whether there are sex differences in the way in which parasympathetic functioning mediates the relations between PCE and behavior problems within a diverse low-income sample. Participants included 164 high risk mother-child dyads including 89 PC exposed children and 75 control children participating in an ongoing longitudinal study. Respiratory sinus arrhythmia (RSA) was measured to assess parasympathetic functioning at 13 months of age and maternal reports of child behavior problems were collected at 7 years of age. Results revealed no significant association between PCE and behavior problems for the full sample. A 2 × 2 Anova revealed a significant interaction between PCE and child sex on internalizing, externalizing, and total behavior problems (F (3, 160) = 13.45, p < .001) with cocaine exposed females averaging the highest behavior problem scores. Results also revealed a statistically significant indirect effect linking cocaine exposure to lower externalizing problems via lower baseline RSA among males. Findings indicate that cocaine exposed females may be more vulnerable to developing behavior problems than cocaine exposed males and that high baseline RSA may present a sex specific risk factor for externalizing problems among exposed males.

Pre-pregnancy body mass index and parent and teacher-reported behavioral outcomes among offspring in childhood

ObjectivePre-pregnancy obesity has been linked to childhood neurodevelopmental outcomes, including autism and attention-deficit hyperactivity disorder. The aim of our study was to examine the association between pre-pregnancy body mass index (BMI) and scores on behavioral scales according to both mother and teacher report. MethodsWe conducted a longitudinal study of 469 mother-child pairs. Information on pre-pregnancy body mass index (BMI) was collected from standardized maternal interviews conducted after delivery and assessment of childhood behavioral problems was measured at 5–12 years of age according to maternal-report using the Child Behavior Checklist (CBCL) and teacher-report using the Teacher Report Form (TRF). Using normal pre-pregnancy BMI (18.5–24.9 kg/m2) as the reference (n = 305), we calculated adjusted mean differences (MD) for t-scores on broadband and syndrome scales of behavior for children of mothers with pre-pregnancy overweight (n = 101) or obese (n = 63) BMI. We also examined associations with scores in the clinical range using risk ratios (RR) and compared results across informants. To account for loss to follow-up between the initial interview and the childhood behavioral assessment, we weighted models using stabilized inverse probability weights. ResultsPre-pregnancy obesity was associated with a mean increase in child's total behavior problem t-scores according to both mother and teacher report, after adjustment for confounders and weighted for loss to follow-up (MD: 0.7, 95% CI: −2.2, 3.6 on CBCL; MD: 3.1, 95% CI: 0.5, 5.7 on TRF), indicating poorer behavioral outcomes. Comparing the magnitude of associations between mother and teacher-report, mean differences for pre-pregnancy obesity and most behavioral problem scales were larger for teacher-reported outcomes than mother-reported outcomes. Pre-pregnancy obesity was associated with increased risks of externalizing behaviors in the clinical range regardless of informant (CBCL RR: 1.6, 95% CI: 0.8, 3.2 and TRF RR: 1.7, 95% CI: 0.8, 3.5). Pre-pregnancy obesity was also associated with increased risks of internalizing behaviors according to teacher-report (TRF RR: 2.6, 95% CI:1.5, 4.6). ConclusionsPre-pregnancy obesity, compared to pre-pregnancy normal weight, is associated with generally higher scores on both mother and teacher reported childhood behavioral assessments, indicating an increased likelihood of behavioral problems.

Parental Preconception and Prenatal Environmental Exposures and Child Neurobehavioral Outcomes

BACKGROUND AND AIM: There are limited studies quantifying the effects of paternal and maternal preconception environmental exposures on children’s health. The Preconception Environmental exposure And Childhood health Effects (PEACE) Study includes children (age 6-13 years) who were born to couples in the Environment and Reproductive Health (EARTH) Study and aims to determine the extent to which maternal and paternal preconception phthalate exposures are associated with neurobehavioral outcomes. METHODS: The PEACE study began in 2019 and is ongoing. A total of 478 eligible children (includes multiples) were born to 451 mothers who participated in the EARTH study (2005-2017). Study staff collected multiple maternal and paternal preconception urine samples before pregnancy and prenatal maternal urine samples during each trimester of pregnancy. We quantified 10 urinary phthalate metabolites in these samples. Children’s behavior, executive function, and reciprocal social behaviors are being assessed via parent-report using the Behavior Assessment System for Children-3 (BASC-3), Behavior Rating Inventory of Executive Function (BRIEF), and Social Responsiveness Scale-2 (SRS-2), respectively. Trained staff collected additional information about diet, sleep, physical activity, product use, and COVID-19 stress. RESULTS:As of March 2021, we enrolled 95 mothers, 57 fathers, and 120 children in the PEACE Study who completed visits either in person or virtually. Of children who completed the study, 64 (53%) were boys and 97 (81%) were White. Mean BASC-3 total behavior problem scores were 48.7 (SD: 7.6). Ten percent of children had scores indicative of being at-risk for behavioral problems (T-score60). Average BRIEF and SRS-2 scores were 48.2 (SD: 9.5) and 46.9 (SD:6.1), respectively. CONCLUSIONS:The PEACE Study will provide new information about the potential impact of parental preconception environmental chemical exposures on children’s health. In addition, the PEACE study will be able to leverage the rich data repository that includes parental chemical, built environment, and dietary exposures. KEYWORDS: Children's environmental health, Neurodevelopmental outcomes, Phthalates, Male, Chemical exposures, Endocrine disrupting chemicals, Female

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.

Association of exposure to organophosphate flame retardants and children's behavior at a median age of 18 months

Exposure to polybrominated diphenyl ether (PBDE) flame retardants (FRs) could have adverse effects on neurodevelopment in children. Some organophosphate (OPFRs) are used as alternatives for the phased-out decabromodiphenylether such as resorcinol bis(diphenyl phosphate (PBDPP) and bisphenol A bis(diphenyl phosphate (BPA-BDPP). This study aims to investigate the relationship between indoor OPFR exposure and neurodevelopmental behavior in children. OPFRs were measured in house dust and hand wipes from 42 children, aged 8-16 months, from the LInking maternal Nutrition to Child health (LINC) study. At the median age of 18 months, the children's behavior was assessed with the Child Behavior Checklist, using three composite behavior scales: externalizing problems, internalizing problems, and total problems. Linear regression analysis was performed, adjusting for maternal education and smoking by the partner. Children with higher BPA-BDPP, PBDPP, and tris(chloroethyl) phosphate (TCEP) house dust concentrations were found to have higher scores on the behavioral problems scales. A 10-fold increase in BPA-BDPP and PBDPP concentration was associated with a 4.1 and 2.6 point increase on the internalizing problems scale (respectively p=0.004 and p=0.042). Increased BPA-BDPP concentrations were associated with elevated scores on the externalizing problems scale and total behavioral problems scale (respectively 7.6 and 16 points increase per 10-fold BPA-BDPP concentration increase, p=0.015 and p=0.007). TCEP dust concentrations were associated with the externalizing problems scale (13 point increase per 10-fold TCEP concentration increase, p=0.043). This study showed the importance of investigating the health effects of exposure to organophosphate flame retardants. Further research on neurodevelopmental health effects of OPFR exposure is warranted.

Peningkatan Trend Screentime selama Pandemi Covid 19 dan Efeknya pada Perilaku Anak

Background. One of the policies carried out by WHO and the Indonesian government in increasing and handling Covid-19 is physical activity savings. This policy requires all people to stay at home more. Along with this, children's activities outside the home are also the foundation. Goal. To see the increase in screen time in children aged 4-12 years during the COVID-19 Pandemic and its effects on children's behavior problems. Method. This research with cross sectional design was conducted by using questionnaires to parents who have children aged 4-12 years. Questionnaire was distributed using Google Forms for 4 weeks via social media such as WhatsApp, Instagram, and Facebook. Questionnaire used in this study was the Strength and Difficulty Questionnaire (SDQ) questionnaire. Result. During 4 weeks, 74 respondents were obtained. The duration of screen time has a significant relationship with the total behavior problems in children (p = 0.024). Conclusion. Increasing the screen time beyond the recommended duration can cause various behavioral problems in children such as emotional problems, behavior and hyperactivity.

A Yoga Intervention for Young Children: Self-Regulation and Emotion Regulation.

Yoga-based interventions have been implemented in schools and demonstrated promising results on students’ self-regulation outcomes. Nevertheless, there is limited literature on the effects that yoga may have for children in the early primary grades, despite the evidence demonstrating that this is an opportune period in development for early self-regulation. Few studies have focused on young children living in the context of economic difficulty, which can hinder children’s development of self-regulatory skills and educational trajectories. The effects of an eight-week yoga intervention on economically disadvantaged pre-kindergarten and kindergarten children’s self-regulation and emotion regulation were examined via a paired within-subjects comparison study. Nine classrooms were assigned to the yoga intervention (Treatment First, TxFirst; n = 90) or a wait-list control group (Treatment Second, TxSecond; n = 64). All children were assessed at pre-intervention (Time 1), post-intervention assessment for TxFirst (Time 2), and post-intervention assessment for TxSecond (Time 3). Children demonstrated significant predicted gains on a behavioral task of self-regulation and declines in teacher-rated submissive venting and total behavior problems. Implications for future research are discussed, with a focus on including follow-up assessments and multiple dimensions of fidelity of implementation.

Analysis of behavioral problems in children with sleep-disordered breathing and decreased REM sleep

ObjectiveREM sleep is known to be closely associated with behavioral problems in children. Our previous study showed that children with decreased REM sleep (REM < 10%) suffered from severe sleep-disordered breathing (SDB). In this study we explored the characteristics of behavioral problems in children with SDB and decreased REM sleep. MethodsA total of 223 children were enrolled in the study. Sleep was evaluated by Polysomnography (PSG). Behavioral problems were assessed by a Chinese version of Child Behavior Checklist (parent-reported). Parameters of SDB and behavioral problem scores (internalizing, externalizing, and total scores) were compared between the children with decreased REM (REM < 10%) and those with REM ≥ 10% before and after controlling overweight/obesity and obstructive sleep apnea hypopnea syndrome (OSAHS). Parameters of SDB were also compared between the normal behavior group and the abnormal behavior group. The correlation between the behavioral problems and the sleep parameters was analyzed. ResultsThe children with decreased REM sleep (<10%) had more severe externalizing and total behavioral problems, even when controlled for overweight/obesity. The abnormal behavior group had significantly shorter total sleep time and REM sleep compared to the normal behavior group. ConclusionChildren with SDB and decreased REM sleep showed more severe behavioral problems, especially the externalizing behavioral problems. The behavioral problems can be aggravated by insufficient total sleep. Decreased REM sleep in children may be an independent parameter that is associated with the behavioral problems in children with SDB.

Measuring the Impact of Trauma-Focused, Cognitive Behavioral Group Therapy with Middle School Students

This study examines differential effects of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program on behavioral and academic outcomes of middle school students. Researchers administered screenings to grade 6 students to assess traumatic stress and then randomized those with elevated levels to the CBITS treatment (n = 150; 47% female) or comparison group (n = 143; 53% female). Analyses examined the overall impact of CBITS and differential effects among subpopulations of students who reported clinically significant externalizing (n = 75; 67% female) or internalizing behavior (n = 185; 53% female) at baseline. Overall, students who received CBITS reported significantly reduced post-traumatic stress symptoms and marginally significant improvements in internalizing symptoms. Relative to counterparts in the comparison group, students exhibiting externalizing behaviors in the CBITS group reported significantly reduced post-traumatic stress, dissociation, anger, internalizing and total behavior problems, and also significantly improved scores on a standardized literacy assessment at posttest and follow-up. Students with internalizing behavior problems showed differential academic effects at 1-year follow-up; those in CBITS did significantly better on standardized math tests.