Young children's self-reported emotional, behavioral, and peer problems: the Berkeley Puppet Interview

Adult observers are typically the only informants on emotional and behavioral problems in young children. Although additional information can be provided by child self-report, few validated, structured instruments are available to obtain self-report from young children. The Berkeley Puppet Interview (BPI) has been developed to obtain structured self-reports on multiple domains of mental health and social well-being. This study was the 1st to evaluate the psychometric properties of the BPI in a large sample. We studied 8 a priori scales of the interview in a Dutch community sample of 6,375 children ages 5-7 years. Using confirmatory factor analysis, we demonstrated adequate fit (Tucker-Lewis index = .90; comparative fit index = .90; root-mean-square error of approximation = .03) of a multidimensional model with 50 items loading on 8 latent factors (Depression, Separation Anxiety, Overanxious, Oppositional Defiant, Overt Hostility, Conduct Problems, Bullied by Peers, and Peer Acceptance/Rejection). This model was invariant across gender. Children reported anxiety-related problems more frequently than depressive problems, behavioral problems, or difficulties in peer relations. Reliability analyses showed that 3 broadband scales designated as Internalizing, Externalizing, and Peer Relations were homogeneous constructs (αs = .68-.79). Higher scores on most BPI scales were associated with lower maternal education, lower family income, and non-Western ethnicity. Boys reported more behavioral and peer relation problems, whereas girls reported more emotional problems. The findings indicate that young children from socioeconomically and demographically diverse backgrounds are capable of providing valid, multidimensional information on their emotional, behavioral, and peer relation problems using the BPI. Young children's self-report is a promising addition to existing assessment tools.

The dysregulation profile in young children: empirically defined classes in the Generation R study

OBJECTIVE

Children with co-occurring internalizing and externalizing problems have higher levels of impairment and worse outcomes later in life, but it is unclear whether these children can be distinguished validly from children who have problems in a single domain. We used a person-centered statistical approach to examine whether a group of children with co-occurring internalizing and externalizing problems can be identified in a general-population sample of young children.

METHOD

This study included a population-based sample of 6,131 children, aged 5 through 7 years. Mothers (92.6%) reported emotional and behavioral problems using the Child Behavior Checklist/1.5-5 (CBCL). A latent profile analysis was performed on the CBCL syndrome scales. Identified classes were compared on early socioeconomic and parental risk factors using multinomial logistic regression.

RESULTS

We identified 4 classes, as follows: a class scoring high on all internalizing and externalizing scales (1.8%); a class with internalizing problems (5.3%); a class with externalizing problems and emotional reactivity (7.3%); and a class without problems (85.6%). The first class, with co-occurring problems, was associated with higher levels of maternal and paternal affective symptoms and hostility than the other 3 classes.

CONCLUSIONS

The class with co-occurring internalizing and externalizing problems appears to be highly similar to the CBCL Dysregulation Profile described in older children. This empirically based dysregulation profile offers a promise to the study of the development of poor self-regulation.

Cortisol in the morning and dimensions of anxiety, depression, and aggression in children from a general population and clinic-referred cohort: An integrated analysis. The TRAILS study

Anxiety and depressive problems have often been related to higher hypothalamic-pituitary-adrenal (HPA)-axis activity (basal morning cortisol levels and cortisol awakening response [CAR]) and externalizing problems to lower HPA-axis activity. However, associations appear weaker and more inconsistent than initially assumed. Previous studies from the Tracking Adolescents Individual Lives Study (TRAILS) suggested sex-differences in these relationships and differential associations with specific dimensions of depressive problems in a general population sample of children (10-12 years). Using the TRAILS population sample (n=1604), we tested hypotheses on the association between single day cortisol (basal morning levels and CAR) and specifically constructed dimensions of anxiety (cognitive versus somatic), depressive (cognitive-affective versus somatic), and externalizing problems (reactive versus proactive aggression), and explored the modifying role of sex. Moreover, we repeated analyses in an independent same-aged clinic-referred sample (n=357). Structural Equation Modeling was used to investigate the association between cortisol and higher- and lower-order (thus, broad and specific) problem dimensions based on self-reports in an integrated model. Overall, findings were consistent across the population and clinic-referred samples, as well as with the existing literature. Most support was found for higher cortisol (mainly CAR) in relation to depressive problems. However, in general, associations were weak in both samples. Therefore, the present results shed doubt on the relevance of single day cortisol measurements for problem behaviors in the milder range. Associations may be stronger in more severe or persistent psychopathology.

Parental depressive and anxiety symptoms during pregnancy and attention problems in children: a cross-cohort consistency study

BACKGROUND

Maternal depression and anxiety during pregnancy have been associated with offspring-attention deficit problems.

AIM

We explored possible intrauterine effects by comparing maternal and paternal symptoms during pregnancy, by investigating cross-cohort consistency, and by investigating whether parental symptoms in early childhood may explain any observed intrauterine effect.

METHODS

This study was conducted in two cohorts (Generation R, n = 2,280 and ALSPAC, n = 3,442). Pregnant women and their partners completed questionnaires to assess symptoms of depression and anxiety. Child attention problems were measured in Generation R at age 3 with the Child Behavior Checklist, and in ALSPAC at age 4 with the Strengths and Difficulties Questionnaire.

RESULTS

In both cohorts, antenatal maternal symptoms of depression (Generation R: OR 1.23, 95% CI 1.05-1.43; ALSPAC: OR 1.33, 95% CI 1.19-1.48) and anxiety (Generation R: OR 1.24, 95% CI 1.06-1.46; ALSPAC: OR 1.32, 95% CI 1.19-1.47) were associated with a higher risk of child attention problems. In ALSPAC, paternal depression was also associated with a higher risk of child attention problems (OR 1.11, 95% CI 1.00-1.24). After adjusting for maternal symptoms after giving birth, antenatal maternal depression and anxiety were no longer associated with child attention problems in Generation R. Moreover, there was little statistical evidence that antenatal maternal and paternal depression and anxiety had a substantially different effect on attention problems of the child.

CONCLUSIONS

The apparent intrauterine effect of maternal depression and anxiety on offspring-behavioural problems may be partly explained by residual confounding. There was little evidence of a difference between the strength of associations of maternal and paternal symptoms during pregnancy with offspring-attention problems. That maternal symptoms after childbirth were also associated with offspring-behavioural problems may indicate a contribution of genetic influences to the association.

Blunted HPA axis response to stress is related to a persistent Dysregulation Profile in youth

The Child Behavior Checklist Dysregulation Profile (DP) in youth has been shown to be a predictor of psychopathology later in life. We examined the activity of the hypothalamic pituitary adrenal (HPA) axis in youth with remitted, new, persistent, and no DP. Data from 489 youth (47% boys) participating in a Dutch longitudinal general population study were included (Wave 1 mean age=11.5, Wave 2=14.2). Wave 2 diurnal cortisol patterns and levels in response to a laboratory stress paradigm were compared in youth with DP at Wave 1 only, Wave 2 only, both Waves, and neither Wave. Youth with the DP at Wave 2 only or at both time points showed blunted cortisol responses to stress relative to the other two groups. There were no group or sex differences in diurnal cortisol activity. More research is needed to determine how the association between DP symptoms and HPA axis functioning changes over time.

Longitudinal associations between depressive problems, academic performance, and social functioning in adolescent boys and girls

Depressive problems and academic performance, social well-being, and social problems in adolescents are strongly associated. However, longitudinal and bidirectional relations between the two remain unclear, as well as the role of gender. Consequently, this study focuses on the relation between depressive problems and three types of functioning in adolescents while testing gender differences. Depressive problems and functioning of 2,230 children were measured with structured questionnaires. The measurements took place biennially over 3 waves, from late childhood into adolescence (age range = 10-18 years). To examine the longitudinal relation between depression and functioning, path analyses with cross-lagged effects were conducted with structural equation modeling. Multigroup analyses were used to test for gender differences, which were only observed for academic performance. Other findings indicated substantial stability in depressive problems and functioning over time and within-wave correlations between depression and the 3 types of functioning. Poor social well-being was predicted by depressive problems but not the other way around. The relation between depressive and social problems was bidirectional, that is, they predicted each other. Finally, depressive problems and academic performance were bidirectionally related as well but only in girls.

Cannabis use and vulnerability for psychosis in early adolescence--a TRAILS study

AIMS

To examine the direction of the longitudinal association between vulnerability for psychosis and cannabis use throughout adolescence.

DESIGN

Cross-lagged path analysis was used to identify the temporal order of vulnerability for psychosis and cannabis use, while controlling for gender, family psychopathology, alcohol use and tobacco use.

SETTING

A large prospective population study of Dutch adolescents [the TRacking Adolescents' Individual Lives Survey (TRAILS) study].

PARTICIPANTS

A total of 2120 adolescents with assessments at (mean) age 13.6, age 16.3 and age 19.1.

MEASUREMENTS

Vulnerability for psychosis at the three assessment points was represented by latent factors derived from scores on three scales of the Youth Self-Report and the Adult Self-Report, i.e. thought problems, social problems and attention problems. Participants self-reported on cannabis use during the past year at all three waves.

FINDINGS

Significant associations (r = 0.12-0.23) were observed between psychosis vulnerability and cannabis use at all assessments. Also, cannabis use at age 16 predicted psychosis vulnerability at age 19 (Z = 2.6, P < 0.05). Furthermore, psychosis vulnerability at ages 13 (Z = 2.0, P < 0.05) and 16 (Z = 3.0, P < 0.05) predicted cannabis use at, respectively, ages 16 and 19.

CONCLUSIONS

Cannabis use predicts psychosis vulnerability in adolescents and vice versa, which suggests that there is a bidirectional causal association between the two.

Early vocabulary delay and behavioral/emotional problems in early childhood: the generation R study

PURPOSE

The authors tested associations between (a) parent-reported temporary vs. persistent vocabulary delay and (b) parent-reported behavioral/emotional problems in a sample of 5,497 young Dutch children participating in a prospective population-based study.

METHOD

Mothers completed the MacArthur Communicative Development Inventory-Netherlands (Zink & Lejaegere, 2003) at age 18 months and the Language Development Survey (Rescorla, 1989) at age 30 months, with expressive vocabulary delay defined as scores in the lowest 15th age- and gender-specific percentiles. The Child Behavior Checklist (Achenbach & Rescorla, 2000) was completed by mothers when their children were age 18 months and by both parents when their children were age 36 months, from which Internalizing Problems and Externalizing Problems scores were analyzed.

RESULTS

All analyses were adjusted for covariates. Expressive vocabulary delay at age 18 months was weakly related to Internalizing Problems scores at age 18 months as well as mother-reported Externalizing and Internalizing Problems scores at age 36 months (the latter for boys only). Expressive vocabulary delay at age 30 months was weakly associated with mother-reported Externalizing and Internalizing Problems scores (the latter for boys only) and father-reported Internalizing Problems scores. Persistent expressive vocabulary delay predicted the highest risk of mother-reported internalizing and externalizing problems at age 36 months.

CONCLUSION

This population-based study showed modest associations between vocabulary delay and behavioral/emotional problems detectable from 18 months onward.

Maternal dietary patterns during pregnancy and child internalising and externalising problems. The Generation R Study

BACKGROUND & AIMS

Maternal nutritional factors during pregnancy have been linked to foetal brain development and subsequent offspring behaviour. Less is known about associations between maternal dietary patterns and offspring behaviour.

METHODS

Within a population-based cohort, we assessed maternal diet using a food frequency questionnaire. Three dietary patterns were derived by means of Principal Component Analysis. Child internalising (emotionally reactive, anxious/depressed or withdrawn, having somatic complaints) and externalising problems (inattention, aggression) were assessed with the Child Behaviour Checklist at 1.5, 3 and 6 years in 3104 children. We assessed the association of maternal Mediterranean, Traditionally Dutch and Confectionary dietary pattern during pregnancy with child internalising and externalising problems.

RESULTS

After adjustment, the Mediterranean diet was negatively associated (ORper SD in Mediterranean score = 0.90, 95% CI: 0.83-0.97) and the Traditionally Dutch diet was positively associated with child externalising problems (ORper SD in Traditionally Dutch score = 1.11, 95% CI: 1.03-1.21). Neither diet was associated with internalising problems.

CONCLUSIONS

Both low adherence to the Mediterranean diet and high adherence to the Traditionally Dutch diet during pregnancy are associated with an increased risk of child externalising problems. Further research is needed to unravel the effects of nutrient interplay during and after pregnancy on child behavioural development.

Does the Revised Child Anxiety and Depression Scale (RCADS) measure anxiety symptoms consistently across adolescence? The TRAILS study

We assessed if the Revised Child Anxiety and Depression Scale (RCADS) measures anxiety symptoms similarly across age groups within adolescence. This is crucial for valid comparison of anxiety levels between different age groups. Anxiety symptoms were assessed biennially in a representative population sample (n = 2226) at three time points (age range 10-17 years) using the RCADS anxiety subscales (generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD], panic disorder [PD], separation anxiety [SA], social phobia [SP]). We examined longitudinal measurement invariance of the RCADS, using longitudinal confirmatory factor analysis, by examining the factor structure (configural invariance), factor loadings (metric invariance) and thresholds (strong invariance). We found that all anxiety subtypes were configural invariant. Metric invariance held for items on the GAD, OCD, PD and SA subscales; yet, for the SP subscale three items showed modest longitudinal variation at age 10-12. Model fit decreased modestly when enforcing additional constraints across time; however, model fit for these models was still adequate to excellent. We conclude that the RCADS measures anxiety symptoms similarly across time in a general population sample of adolescents; hence, measured changes in anxiety symptoms very likely reflect true changes in anxiety levels. We consider the instrument suitable to assess anxiety levels across adolescence.

Attachment insecurity predicts child active resistance to parental requests in a compliance task

AIM

We studied the effects of early mother-child relationship quality and child temperament on the development of child compliance and active resistance in a large population-based cohort study (n = 534).

BACKGROUND

Parenting and the quality of the parent-child relationship can either hamper or support the development of child compliance directly or in interplay with child temperament.

METHODS

Mother-infant dyads were observed at 14 and 36 months and maternal and child behaviours were independently coded. The quality of compliance was assessed at 36 months in a clean-up task. Child behaviour was coded using a system differentiating between two dimensions: Compliance and Active Resistance.

RESULTS

Controlling for concurrent maternal sensitivity, child temperament, and gender children with a more insecure attachment relationship showed higher levels of active resistance during Clean-Up than more securely attached children. The effect was stronger for boys than for girls and mainly driven by attachment avoidance.

CONCLUSIONS

Early attachment is an important contributor to child socialization of moral behaviour.

Assessing expressed emotion during pregnancy

We assessed expressed emotion (EE) with an adapted version of the five-minute speech sample in 847 pregnant women. The prevalence of high EE was 6%. High EE was significantly associated with having a first child, low income, maternal childhood trauma and lack of parental emotional warmth during childhood.

Early childhood assessments of community pediatric professionals predict autism spectrum and attention deficit hyperactivity problems

For clinically referred children with Autism Spectrum Disorder (ASD) or Attention Deficit/Hyperactivity Disorder (ADHD) several early indicators have been described. However, knowledge is lacking on early markers of less severe variants of ASD and ADHD from the general population. The aim of the present study is to identify early indicators of high risk groups for ASD and ADHD problems based on routine data from community pediatric services between infancy and age four. Data are from 1,816 participants who take part in Tracking Adolescents’ Individual Lives Survey (TRAILS), a longitudinal study. Information on early developmental factors was extracted from charts of routine Preventive Child Healthcare (PCH) visits. To assess ASD and ADHD problems, respectively, we used the Children’s Social Behavior Questionnaire (CSBQ) and the Child Behavior Checklist (CBCL), filled out by parents three times between the ages of 11 and 17. Note that these are parent ratings and not diagnostic instruments performed by trained clinicians. Male gender, low birth weight, low level of education of the mother, social, behavioral, language, psychomotor and eating problems significantly predicted ASD problems (odds ratios (OR) between 1.34 and 2.41). ADHD problems were also predicted by male gender and low level of education of the mother and by maternal smoking during pregnancy, good gross motor skills in first year, early attention and hyperactivity problems, and absence of parent-reported positive behavior (ORs between 1.36 and 1.74). Routine data on early childhood from PCH services are predictive for ASD and ADHD problems in adolescents in the general population. The PCH services are a useful setting to identify high risk groups, and to monitor them subsequently.

Diurnal cortisol rhythm and cognitive functioning in toddlers: the Generation R Study

Little is known about the relationship between diurnal cortisol secretion patterns and cognitive function early in life. This population-based study examined whether diurnal cortisol rhythms and cognitive functioning in toddlers are related. Within the Generation R Study, parents of 364 infants (median age: 14.2 months) collected saliva samples at five moments during one day. We assessed the diurnal cortisol rhythm by calculating the area under the curve (AUC), the cortisol awakening response (CAR), and the diurnal slope. Verbal cognitive functioning and fine motor development was determined at age 18 months. Nonverbal cognitive functioning was assessed at age 30 months. A more positive CAR was associated with a lower risk of delay in language comprehension (OR per 1-SD CAR: 0.62, 95%CI: 0.40-0.98, p = .04), a lower risk of nonoptimal fine motor development (OR per 1-SD slope: 0.74, 95%CI: 0.57-0.96, p = .03), and a lower risk of delay in nonverbal cognitive development (OR per 1-SD CAR: 0.58, 95%CI: 0.38-0.90, p = .02). Also, children with flatter slopes had a lower risk of delay in nonverbal cognitive development (OR per 1-SD slope: 0.51, 95%CI: 0.34-0.76, p = .001). Higher AUC levels were associated with a higher risk of delay in language production. These results show that variations in diurnal cortisol rhythms are already associated with variations in cognitive functioning at a young age. Infants with a diurnal cortisol pattern indicative of less stress and more cortisol reactivity, that is, lower AUC levels and a more positive CAR, show a lower risk of delay in cognitive functioning as toddlers.

Gender-Specific Developmental Trajectories of Anxiety during Adolescence: Determinants and Outcomes. The TRAILS Study

OBJECTIVE

To identify developmental trajectories of anxiety symptoms for adolescent girls and boys. Trajectories were compared with regard to early-adolescent risk factors and psychiatric outcomes during adolescence and in young adulthood.

METHOD

A community sample of 2,230 adolescents was assessed three times across a six-year interval (10-17 years). Symptom scores of anxiety were analyzed with growth mixture models, stratified by gender.

RESULTS

Three gender-specific anxiety trajectories were identified for both girls (93.3% low, 4.1% mid-adolescence limited, 2.6% mid-adolescence increasing) and boys (84.4% low, 9.5% mid-adolescence limited, 6.1% early-adolescence decreasing). Child, family and peer factors at baseline predicted group membership of the mid-adolescence limited anxiety trajectory and the early-adolescence decreasing anxiety trajectory in boys. Parental emotional problems predicted the early-adolescence anxiety increase trajectory in girls. Prevalence of anxiety disorders and depression during adolescence and in early adulthood was higher in both the mid-adolescence limited and the mid-adolescence anxiety increase trajectory.

CONCLUSIONS

The longitudinal course of anxiety symptoms during adolescence was characterized by three distinct gender-specific developmental trajectories. The most at-risk trajectory in girls was the mid-adolescence anxiety increase trajectory, and in boys the mid-adolescence limited trajectory. None of the environmental (i.e., child, family and peer) factors distinguished the at-risk trajectories from the other trajectories.

The impact of parenting styles on adolescent alcohol use: the TRAILS study

AIMS

To investigate the influence of parenting styles (overprotection, emotional warmth, and rejection) in early adolescence on regular alcohol use in late adolescence.

METHODS

We analyzed data from the first three waves (mean ages: 11.09, 13.56, and 16.27 years, respectively) of a population-based prospective cohort study of 2,230 adolescents, conducted between 2001 and 2007. Adolescents reported on parental overprotection, emotional warmth, and rejection (T1). Regular alcohol use was defined as six and seven glasses or more a week for girls and boys, respectively. We further assessed family socioeconomic status, parental divorce, parental alcohol use, educational level of the adolescent, and alcohol use at baseline.

RESULTS

Parental overprotection had the strongest relationship to regular alcohol use: adolescents who perceived more parental overprotection were at increased risk of developing regular alcohol use, even after adjustment for several confounders. Rejection was not related to adolescents' alcohol use and, after adjustment for the other variables, neither was emotional warmth.

CONCLUSION

Overprotective parenting is a determinant of future regular adolescent alcohol use and therefore health professionals should pay particular attention to those adolescents who have overprotective parents. The role of adolescent characteristics in the relationship between overprotection and alcohol use deserves further study.

Trajectories of maternal depressive symptoms predict child problem behaviour: the Generation R study

BACKGROUND

It is unclear how the course of maternal depressive symptoms affects child development. We modelled trajectories of maternal depressive symptoms from mid-pregnancy to 3 years after childbirth to better determine their associations with child problem behaviour.

METHOD

Mother-child dyads (n = 4167) participated in a population-based prospective cohort in The Netherlands. Depressive symptoms were assessed with the Brief Symptom Inventory during pregnancy and at 2, 6 and 36 months postnatally. When children were 3 years old, problem behaviour was assessed with the Child Behaviour Checklist completed by each parent. A group-based modelling technique was used to model trajectories of maternal depressive symptoms and to examine their association with child problem behaviour. The added value of trajectory modelling was determined with successive linear regressions.

RESULTS

We identified four trajectories of maternal depressive symptoms; 'no' (34%), 'low' (54%), 'moderate' (11%) and 'high' (1.5%). Child problem behaviour varied as a function of maternal trajectory membership. Whether rated by mother or father, children of mothers assigned to higher trajectories had significantly more problem behaviours than children of mothers assigned to lower trajectories. The model including trajectories had additive predictive value over a model relying only on a summed repeated measure of severity and a predefined chronicity variable.

CONCLUSIONS

Depending on their course, maternal depressive symptoms have different effects on child problem behaviour. More information is gained by studying trajectories of symptoms, than only predefined measures of severity and chronicity. Moreover, trajectories can help identifying clinically depressed mothers who are possible candidates for early interventions.

Infant brain structures, executive function, and attention deficit/hyperactivity problems at preschool age. A prospective study

BACKGROUND

Neuroimaging findings have provided evidence for a relation between variations in brain structures and attention deficit/hyperactivity disorder (ADHD). However, longitudinal neuroimaging studies are typically confined to children who have already been diagnosed with ADHD. In a population-based study, we aimed to characterize the prospective association between brain structures measured during infancy and executive function and attention deficit/hyperactivity problems assessed at preschool age.

METHODS

In the Generation R Study, the corpus callosum length, the gangliothalamic ovoid diameter (encompassing the basal ganglia and thalamus), and the ventricular volume were measured in 784 6-week-old children using cranial postnatal ultrasounds. Parents rated executive functioning at 4 years using the behavior rating inventory of executive function-preschool version in five dimensions: inhibition, shifting, emotional control, working memory, and planning/organizing. Attention deficit/hyperactivity problems were assessed at ages 3 and 5 years using the child behavior checklist.

RESULTS

A smaller corpus callosum length during infancy was associated with greater deficits in executive functioning at 4 years. This was accounted for by higher problem scores on inhibition and emotional control. The corpus callosum length during infancy did not predict attention deficit/hyperactivity problem at 3 and 5 years, when controlling for the confounders. We did not find any relation between gangliothalamic ovoid diameter and executive function or Attention deficit/hyperactivity problem.

CONCLUSIONS

Variations in brain structures detectible in infants predicted subtle impairments in inhibition and emotional control. However, in this population-based study, we could not demonstrate that early structural brain variations precede symptoms of ADHD.

Structured shared decision-making using dialogue and visualization: a randomized controlled trial

OBJECTIVE

The aim of this study is to evaluate a method, "Counseling in Dialogue" (CD), developed to increase the quality of counseling in youth mental health. Decisional conflict was used as indicator of the quality of counseling and shared decision-making.

METHODS

94 children aged 2-12 years were randomized into a CD group and a care as usual (CU) group. In a before-and-after design decisional conflict was measured using the decisional conflict scale (DCS) for parents (N=133) and the Provider Decision Process Assessment Instrument for therapists (PDPAI, N=20). 81 children had follow-up data.

RESULTS

Compared with parents of the CU group, parents of the CD group reported significantly less decisional conflict after counseling (difference mothers: -0.38 (95%CI -0.56; -0.19), p<.001; fathers: -0.22 (95%CI -0.44; -0.01), p=.045). 98% of the mothers and 96% of the fathers in the CD group accepted the recommended treatment, compared to 71% (fathers) and 77% (mothers) in the CU group, p<0.05. Decisional conflict of the therapists was low in both groups after counseling (difference: -0.03 (95%CI -0.19; 0.14), p=.741).

CONCLUSION

The counseling procedure significantly lowered decisional conflict of the parents and promoted the acceptance of the recommended treatment.

Heart rate and antisocial behavior: mediation and moderation by affiliation with bullies. the TRAILS Study

PURPOSE

Low heart rate (HR) has been linked to antisocial behavior (ASB). However, the effect of low HR may be mediated by affiliation with bullies. We hypothesized that individuals with low HR are more likely to affiliate with bullies and in turn are influenced by these peers.

METHODS

Data come from two waves of a subsample of the TRAILS study (N = 809; 44.0% boys; mean age of 11.0 years at T1 and 13.5 years at T2). ASB was measured using the Antisocial Behavior Questionnaire at both waves. HR was assessed during rest at T1. Affiliation with bullies was assessed via peer nominations at T1. Possible gender differences were taken into account, and all analyses were adjusted for family context (i.e., family breakup and socioeconomic status).

RESULTS

Regression analyses showed that lower HR was only associated with ASB in (pre)adolescents who affiliated with bullies. Moreover, the effect of lower HR on boys' ASB was partly mediated by affiliation with bullies.

CONCLUSIONS

Our findings show that (pre)adolescents, and in particular boys, seem to be in environments that match their biological disposition and in turn are shaped by this environment.

Attachment disorganization moderates the effect of maternal postnatal depressive symptoms on infant autonomic functioning

We examined associations of disorganized attachment and maternal depressive symptoms with infant autonomic functioning in 450 infant-mother dyads enrolled in the Generation R study. Maternal depressive symptoms were measured 2 months postpartum with the Brief Symptom Inventory. At 14 months, we assessed infant attachment with a slightly shortened Strange Situation and measured infant resting heart rate. Respiratory sinus arrhythmia (RSA) was calculated using spectral analysis. Higher levels of maternal postnatal depressive symptoms predicted lower resting RSA in disorganized infants (B = -0.31, SE = 0.15, p = .04, R(2)  = .05) but not in nondisorganized infants (B = 0.05, SE = 0.06, p = .36). This effect was buffered in disorganized infants with a secondary secure attachment classification. Disorganized infants were more vulnerable to the effect of maternal postnatal depressive symptoms on the physiological stress systems.

Childhood internalizing and externalizing problems predict the onset of clinical panic attacks over adolescence: the TRAILS study

BACKGROUND

Panic attacks are a source of individual suffering and are an independent risk factor for later psychopathology. However, much less is known about risk factors for the development of panic attacks, particularly during adolescence when the incidence of panic attacks increases dramatically. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence.

METHOD

This study is part of the TRacking Adolescents' Individual Lives Survey (TRAILS), a Dutch longitudinal population cohort study (N = 1,584). Internalizing and Externalizing Problems were collected using the Youth Self-Report (YSR) and the parent-report Child Behavior Checklist (CBCL) at baseline (age 10-12). At age 18-20, DSM-IV defined panic attacks since baseline were assessed with the Composite International Diagnostic Interview (CIDI). We investigated whether early adolescent Internalizing and Externalizing Problems predicted panic attacks between ages 10-20 years, using survival analysis in univariate and multivariate models.

RESULTS

There were N = 314 (19.8%) cases who experienced at least one DSM-IV defined panic attack during adolescence and N = 18 (1.2%) who developed panic disorder during adolescence. In univariate analyses, CBCL Total Problems, Internalizing Problems and three of the eight syndrome scales predicted panic attack onset, while on the YSR all broad-band problem scales and each narrow-band syndrome scale predicted panic attack onset. In multivariate analyses, CBCL Social Problems (HR 1.19, p<.05), and YSR Thought Problems (HR 1.15, p<.05) and Social Problems (HR 1.26, p<.01) predicted panic attack onset.

CONCLUSION

Risk indicators of panic attack include the wide range of internalizing and externalizing problems. Yet, when adjusted for co-occurring problem behaviors, Social Problems were the most consistent risk factor for panic attack onsets in adolescence.

Low urinary iodine excretion during early pregnancy is associated with alterations in executive functioning in children

The rare but deleterious effects of severe iodine deficiency during pregnancy on cognitive functioning of children are well known. Reports on possible associations between mild-to-moderate maternal iodine deficiency and child development, however, are scarce. In a population-based cohort we examined the association between maternal urinary iodine during early pregnancy and executive functioning in children at 4 y of age. In addition, we investigated the modification of this association by maternal diet and thyroid function. During pregnancy, we measured urinary iodine and thyroid hormone concentrations in 1156 women. In 692 of their children impairment of executive functioning was assessed by the Behavior Rating Inventory of Executive Function. Five hundred mothers of Dutch national origin completed an FFQ. Analyses were performed by using regression models. The children of mothers with low urinary iodine showed higher scores on the problem scales of inhibition [β = 0.05 (95% CI: 0.01, 0.10), P = 0.03] and working memory [β = 0.07 (95% CI: 0.02, 0.12), P = 0.003]. Although maternal dietary intake and thyroid hormone concentration did not significantly modify these associations, the associations between urinary iodine and problems of inhibition were attenuated after adjustment for maternal psychological symptoms. In addition, the consumption of bread [β = 0.61 (95% CI: 0.27, 0.95), P < 0.001] and eggs (β = 1.87 (95% CI: 0.13, 3.62), P = 0.04] was associated with higher urinary iodine. Thus, low maternal urinary iodine during pregnancy is associated with impaired executive functioning in children. Because these symptoms were subclinical and occurred at an early age, future studies are needed to show whether these children are more vulnerable to develop later clinical disorders.