Behavioural and emotional disorders in childhood: A brief overview for paediatricians

Differences in cortical morphology and child internalizing or externalizing problems: Accounting for the co-occurrence

Background

Childhood internalizing and externalizing problems frequently co-occur. Many studies report neural correlates of either internalizing or externalizing problems, but few account for their co-occurrence. We aimed to assess specific cortical substrates of these psychiatric problems.

Methods

We used data from 9635 children aged 9-11 years in the baseline Adolescent Brain Cognitive Development Study. Internalizing and externalizing problem composite scales scores were derived from the Child Behavior Checklist. We standardized FreeSurfer-derived volumes of 68 cortical regions. We examined internalizing and externalizing problems separately and jointly (covariate-adjustment) in relation to cortical volumes, with and without adjusting for total brain volume (TBV) in multivariate linear regressions adjusted for demographics and multiple comparisons. We fit bifactor models to confirm the consistency of patterns exploring specific internalizing and specific externalizing problems. Sensitivity analyses included a vertex-wide analysis and a replication in another large population-based study.

Results

In separate TBV-unadjusted analyses, externalizing and internalizing problems were associated with smaller cortical volumes. If adjusted for externalizing behavior, however, larger cortical volumes were associated with internalizing problems, while smaller cortical volumes remained associated with externalizing problems after adjustment for internalizing problems. The bifactor model produced similar results, which were consistently replicated in another pre-adolescent neuroimaging sample. These associations likely represent global effects: adjusting for TBV rendered most associations non-significant. Vertex-wise analyses confirmed global patterns.

Conclusion

Our results suggest that internalizing and externalizing problems have globally opposing, and non-specific associations with cortical morphology in childhood, which are only apparent if analyses account for their co-occurrence.

A scoping review of gamification for mental health in children: Uncovering its key features and impact

Mental health conditions in children and adolescents have wide-ranging effects, limiting opportunities for future productive lives. While there has been an upsurge of interest in using games for learning, gamification to optimize health outcomes is worth reviewing when this approach to address mental health conditions is in its infancy. A literature search was conducted with two hundred and fifteen articles involving participants up to 19 years of age with diagnosable mental health conditions, involving the concept of game design elements to motivate health in the context of comparing gamification and non-gamification approaches were retrieved after employing Boolean operators and pre-determined search strategies. Literature of participants with addiction to alcohol or substance use and organic brain issues were excluded as their mental health recovery differed regardless of gamification impact. Findings, extracted from 8 included articles following rigorous screening and critical appraisal, showed that gamification to relieve mental health symptoms were conducted via mobile devices or computers. Key features of the games involved applications or video where players with mental health conditions took on roles in a virtual world with narratives. Real-life knowledge and skills to manage the symptoms of mental health conditions were learned in the process as players leveled up in the game. Only one study utilized gamification platforms that could detect breathing changes but it was shown to be only helpful towards relief of anxiety symptoms. Nevertheless, the potential for gamification for mental health outcomes remains promising.

The Use of Psychotropic Medication in Pediatric Oncology for Acute Psychological and Psychiatric Problems: Balancing Risks and Benefits

Severe acute behavioral and emotional problems represent one of the most serious treatment-related adverse effects for children and adolescents who have cancer. The critical and severe nature of these symptoms often makes necessary the use of psychotropic drugs. A working group composed of experts in multiple disciplines had the task of creating an agreement regarding a management plan for severe acute behavioral and emotional problems (SABEPs) in children and adolescents treated for cancer. To obtain global information on the use of psychotropic drugs in pediatric oncology, the working group first developed and mailed a 15-item questionnaire to many Italian pediatric oncology centers. Overall, an evident lack of knowledge and education regarding the use of psychotropic medications for the treatment of SABEPs was found. Thus, by referring to an adapted version of the Delphi method of consensus and standard methods for the elaboration of clinical questions (PICOs), the working group elaborated evidence-based recommendations for psychotropic drugs in the pediatric oncology setting. Furthermore, based on a thorough multivariate analysis of needs and difficulties, a comprehensive management flow was developed to optimize therapeutic interventions, which allows more accurate and efficient matching of the acute needs of patients while guiding treatment options.

Review of the Current Knowledge of Reactive Attachment Disorder

Reactive attachment disorder (RAD), classified under Trauma and Stressor Related Disorders in the DSM-5 manual, is a childhood psychiatric illness due to familial or social neglect or due to maltreatment. It is characterized by an inhibited and withdrawn social and emotional behavior toward an adult caregiver, typically before the age of 5. Neurobiological changes in patients with RAD have been shown to be substantially significant with features such as loss of grey matter volume and neurotransmitter deficiencies that not only impact the ability to form healthy attachments but also increase the risk of comorbidities such as depression and anxiety. Different theories, including the current mediation hypothesis and learning theory of attachment, showed childhood maltreatment from caregivers and desensitization toward deficiencies in social development in children from special education teachers to be key components in the development of RAD. Patients with RAD had an increased risk of developing psychiatric comorbidities, including learning disabilities and mood disorders. Institutionalized care and childhood maltreatment have a significant impact on the development of RAD. RAD is an underdiagnosed and underreported condition with significant repercussions that can severely impact the development of a child. By being able to raise awareness and promote further research into refining the diagnostic methodology, treatment protocols, and long-term follow-up, children afflicted with this condition may be able to develop better socio-emotional bonds and reduce the incidence of comorbidities such as depression and attention deficit hyperactivity disorder.

The Impact of Parent Child Interaction Therapy on Temper Tantrums in Pre-school

Temper tantrum behavior is a child's emotional behavior which is shown by explosive anger and some parents consider this behavior to be bad behavior. Temper tantrums can occur in children aged 3-6 years or more. This literature review aims to determine the impact of PCIT (Parent Child Interaction Therapy) on temper tantrums in preschool. In finding this literature review used four databases (ProQuest, Scopus, Pubmed, and Sains Direct) for the design of the study used cross sectional, True Experimental, Observational and Systematic Reviews published in the last five years. The protocol and evaluation of the literature review used the PRISMA checklist to determine the selection of studies that were found and adapted to the objectives of the literature review. The results of literature review analysis of several parents in group and individual PCIT reported that the application of parent-child-based interventions was proven to be effective and has the potential to bring significant and lasting changes in increasing positive behavior in children with external behavior problems. The frequency of problematic child relationship behavior significantly decreased with increasing age of the child.  In addition, assessing both positive and negative child relationship behavior could assist parents in understanding the relevance of different aspects for the development of parent-child relationships.

Exposure to road traffic noise and behavioral problems in Chinese schoolchildren: A cross-sectional study

BACKGROUND

Transportation noise is second only to air pollution as an environmental contributor to adverse health outcomes in Western countries. However, no studies investigated the association between road traffic noise and behavioral problems among schoolchildren in China.

OBJECTIVE

To investigate the association between exposure to road traffic noise at home and behavioral problems in Chinese schoolchildren.

METHODS

From January to June 2017, we screened 3236 children aged 7-13 years in Guangzhou (Guangdong, China) from the first investigation of an ongoing school-based cohort study with complete information on behavioral problems and residential geolocation. Residential road traffic noise exposure levels were assessed using a validated modeling method in different periods of the day, including daytime (L_day), nighttime (L_night), and weighted 24-hr (L_dn). The annual mean concentration of nitrogen dioxide was also modeled in our study. Behavioral problems were assessed by the parent-rated Strengths and Difficulties Questionnaire (SDQ). Generalized linear mixed models were utilized to estimate the associations between road traffic noise and behavioral problems.

RESULTS

In the main adjusted model, a 10-dB increase in L_dn was associated with 0.33 (95% CI: 0.08, 0.59), 0.08 (95% CI: -0.01, 0.17), and 0.09 (95% CI: 0.01, 0.16) increases in three subscales score for total difficulties score, emotional problems, and conduct problems, respectively. The same increase in L_dn was also associated with the abnormal total difficulties score (OR = 1.25, 95%CI: 1.01, 1.55), emotional problems (OR = 1.19, 95%CI: 0.98, 1.44), and conduct problems (OR = 1.28, 95%CI:1.02, 1.63). Externalising behavior appears more susceptible to traffic noise than internalising behavior. NO₂ had a small impact on the associations between L_dn and behavioral problems. Our estimates were generally robust in several sensitivity analyses.

CONCLUSION

Residential road traffic noise exposure might be related to increased behavioral problems in Chinese schoolchildren, such as emotional symptoms and conduct problems.

Revealing Differences in Brand Loyalty and Brand Engagement of Single or no Parented Young Adults

The present study reveals differences in brand engagement, brand loyalty and brand evangelism among single or no parented young adults. It was found that persons who were raised without one or both parents for at least three years show higher emotional connectivity to brands compared to their counterparts from a control group. A widely recognized structural equation modelling technique—partial least squares method—has been applied in order to test the research hypotheses. Two Baltic States, namely, Lithuania and Latvia, served as an empirical basis of the study. The results of the research are relevant not only to business related disciplines, such as marketing and management, but also to other social sciences fields presuming the existence of more psychology-related differences among single or no parented persons.

Infant inflammation predicts childhood emotional and behavioral problems and partially mediates socioeconomic disadvantage

BACKGROUND

Emotional and behavioral problems (EBP) are common in children. Environmental factors like socioeconomic disadvantage influence EBP pathogenesis and can trigger inflammation. However, the link between early inflammation-EBP in children is unclear. We investigated the associations between i) infant inflammatory biomarkers and subsequent EBP and ii) early life environmental factors and EBP and assessed whether infant inflammation mediated these associations.

METHODS

Inflammatory biomarkers glycoprotein acetyls (GlycA) and high-sensitivity C-reactive protein (hsCRP) were quantified at birth and 12 months in a population-derived birth cohort, the Barwon Infant Study. Early life factors including demographic, prenatal, and perinatal factors were collected from antenatal to the two-year period. Internalizing and externalizing problems at age two were measured by the Child Behavior Checklist. Prospective associations were examined by multivariable regression analyses adjusted for potential confounders. Indirect effects of early life factors on EBP through inflammation were identified using mediation analyses.

RESULTS

Elevated GlycA levels at birth (GlycAbirth) were associated with greater internalizing problems at age two (β = 1.32 per SD increase in GlycA; P = 0.001). Inflammation at birth had a stronger magnitude of effect with later EBP than at 12 months. GlycAbirth partially mediated the associations between lower household income (6%), multiparity (12%) and greater number of older siblings (13%) and EBP. Patterns were less evident for hsCRP or externalizing problems.

CONCLUSIONS

GlycAbirth was positively associated with EBP at age two and partially mediated the association between several indicators of socioeconomic disadvantage and EBP. Prenatal and perinatal inflammation may be relevant to early neurodevelopment and emotional health.

Self-Reported Psychosomatic Complaints and Conduct Problems in Swedish Adolescents

Physical conditions in children and adolescents are often under reported during mainstream school years and may underlie mental health disorders. Additionally, comparisons between younger and older schoolchildren may shed light on developmental differences regarding the way in which physical conditions translate into conduct problems. The aim of the current study was to examine the incidence of psychosomatic complaints (PSC) in young and older adolescent boys and girls who also report conduct problems. A total of 3132 Swedish adolescents (age range 15-18 years, 47% boys) completed the Uppsala Life and Health Cross-Sectional Survey (LHS) at school. The LHS question scores were categorised by two researchers who independently identified questions that aligned with DSM-5 conduct disorder (CD) criteria and PSC. MANOVA assessed the effects of PSC, age, and gender on scores that aligned with the DSM criteria for CD. The main effects of gender, age, and PSC on the conduct problem scores were observed. Adolescents with higher PSC scores had higher conduct problem scores. Boys had higher serious violation of rules scores than girls, particularly older boys with higher PSC scores. Psychosomatic complaints could be a useful objective identifier for children and adolescents at risk of developing conduct disorders. This may be especially relevant when a reliance on a child's self-reporting of their behavior may not help to prevent a long-term disturbance to their quality of life.

A Narrative Review on Prevention and Early Intervention of Challenging Behaviors in Children with a Special Emphasis on COVID-19 Times

Background

COVID-19 and the measures stemming from efforts to control it have affected the psychosocial wellbeing of children and adolescents. The increasing trend of challenging behavior has exerted further pressure on parents and schools. Understanding socioemotional development and interrelating triggers is the key to management. Early interventions prevent the future threat of mental illness and risky acts. Effective strategies are ones that primarily focus on strengthening parent-child interactions.

Aim

The purpose of this paper is to review the literature on the (i) psychosocial and behavioral impacts of COVID-19 on children/adolescents and (ii) approaches to identify determinants of challenging behaviors as a principal guide to effective interventional strategies for children and their families.

Methodology

Electronic database searches of PubMed, ScienceDirect, Medline, and Scopus were conducted to identify studies meeting the inclusion criteria that address the impact of COVID-19 on behaviors, contributing factors, and management in the context of families/schools. The content of the selected articles was themed under five categories, namely the developmental milestones, the Pyramid Model, the Positive Behavioral Support, the management strategies, and the impact of COVID-19 on children/adolescents' behavior.

Results

The present review demonstrates considerable influence of COVID-19 on children and adolescents' behavior and mental wellbeing. It stresses the importance of early family-based interventions focusing on the triggers of challenging behavior. Functional Behavioral Assessment and Behavioral Intervention Plan provide a systematic analysis with a strategic plan that support children's self-regulation and socioemotional intelligence. Regular behavioral screening is vital to promote prevention and early management.

Conclusion

Managing behavioral difficulties remains an area of deficit for parents, teachers, and health care providers. With a quality support, parents and schools will be able to clearly characterize the challenging behavior, understand the causes, reinforce parent-child interactions, and consequently, gain the strategic skills required to apply it within natural settings. Timely interventions will limit the risk of future misconduct and mental disorders.

The role of child diets in the association between pre-pregnancy diets and childhood behavioural problems: a mediation analysis

OBJECTIVE

To quantify the mediating role of childhood diets in the relationship between maternal diets prior to pregnancy and childhood behavioural disorders.

DESIGN

The Healthy Eating Index score was constructed using a semi-quantitative and validated 101-item FFQ. We assessed childhood behavioural disorders using the Strengths and Difficulties Questionnaire. Three dietary patterns were identified using principal component analysis to explore childhood dietary patterns (high fats and sugar; prudent diets; and diary). A causal inference framework for mediation analysis was used to quantify the mediating role of childhood diets in the association between pre-pregnancy diets and the risk of offspring behavioural problems.

SETTING

This is a national representative population-based survey which covers all Australian citizens and permanent residents in Australia.

PARTICIPANTS

We included 1448 mother-child pairs from the Australian Longitudinal Study on Women's Health and its sub-study mothers and their children's health.

RESULTS

We found a 20 % of the total effect of the poor adherence to pre-pregnancy diet quality on the risk of offspring behavioural problems was mediated through childhood high consumptions of fats and sugar. No clear mediating effect through prudent and diary childhood diets was observed.

CONCLUSION

This study suggests that childhood high fats and sugar consumption may contribute to the total effects of the pre-pregnancy diets on the risk of childhood behavioural problems.

Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy

BACKGROUND

Treatment efficacy for attention-deficit/hyperactivity disorder (ADHD) is reported to be poor, possibly due to heterogeneity of ADHD symptoms. Little is known about poor treatment efficacy owing to ADHD heterogeneity.

AIM

To use generalized structural equation modeling (GSEM) to show how the heterogeneous nature of hyperactivity/impulsivity (H/I) symptoms in ADHD, irritable oppositional defiant disorder (ODD), and the presentation of aggression in children interferes with treatment responses in ADHD.

METHODS

A total of 231 children and adolescents completed ADHD inattention and H/I tests. ODD scores from the Swanson, Nolan, and Pelham, version IV scale were obtained. The child behavior checklist (CBCL) and parent’s satisfaction questionnaire were completed. The relationships were analyzed by GSEM.

RESULTS

GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD, ODD symptoms, and childhood aggressive behavior. ODD directly mediated ADHD symptom severity. The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494% [= exp (2.602)] in children with comorbid ADHD and ODD [odds ratio (OR) = 2.602, 95% confidence interval (CI): 1.832-3.373, P = 0.000] after adjusting for the effects of other factors. Childhood aggression mediated ODD symptom severity. The chance of reaching remission based on ODD symptoms was lowered by 11.000% [= 1 - exp (-0.117)] in children with more severe baseline symptoms of aggression based on the CBCL score at study entry [OR = -0.117, 95%CI: (-0.190)-(-0.044), P = 0.002].

CONCLUSION

Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity. More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment, e.g., symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.

Screen Time and Mental Health Among Adolescents: Implications of the Rise in Digital Environment in South Africa

The rise in use of digital technology among adolescents is unquestionable, with few studies having explored the effect of screen time on mental or behavior challenges in sub-Saharan Africa. We investigated the extent of screen time and its associations with mental/behavior challenges in South Africa. A multisite study was conducted among adolescents aged 15 to 17 years from three government schools in KwaZulu-Natal Province, South Africa. Measures included depressive symptoms (using Patient Health Questionnaire-9), behavioral problems (using Strengths and Difficulties Questionnaire), and screen time (using Children's Leisure Activities Study Survey). The prevalence of severe depressive symptoms, conduct features, and negative prosocial behavior was 11.2% (n = 20), 13.6% (n = 25), and 4.9% (n = 9), respectively. The mean screen time was 2.1 h/d (SD = 2.4) during weekday and 4.7 h/d (SD = 5.5) during weekend. Weekend screen time was significantly associated with a greater likelihood of severe depression and conduct challenges, based on multivariable regression. We also found that greater weekend cell phone use was significantly associated with lower prosocial behavior. No role of weekday screen time was detected in this study. Parents or legal guardians need to be aware of their children's weekend screen time, including cell phones, as access to digital devices becomes more ubiquitous in resource-limited settings.

One Child's Struggle in School: A Case Report of a Diagnosis of Seizures

Some children diagnosed with epilepsy also have attention deficit hyperactivity disorder. Parents, teachers, and health care professionals may be the first to notice and recognize symptoms of a seizure in a child. In this case report, a patient's journey to a diagnosis of benign rolandic epilepsy will be reviewed.

The 25-Item Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B): Test-Retest Reliability and Construct Validity When Used as Categorical Measures

OBJECTIVE

Child and youth mental health problems are often assessed by parent self-completed checklists that produce dimensional scale scores. When converted to binary ratings of disorder, little is known about their psychometric properties in relation to classifications based on lay-administered structured diagnostic interviews. In addition to estimating agreement, our objective is to test for statistical equivalence in the test-retest reliability and construct validity of two instruments used to classify child emotional, behavioural, and attentional disorders: the 25-item, parent completed Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) and the Mini International Neuropsychiatric Interview for Children and Adolescents-parent version (MINI-KID-P).

METHODS

This study draws on independent samples (n = 452) and uses the confidence interval approach to test for statistical equivalence. Reliability is based on kappa (κ). Construct validity is based on standardized beta coefficients (β) estimated in structural equation models.

RESULTS

The average differences between the MINI-KID-P and OCHS-EBS-B in κ and β were -0.022 and -0.020, respectively. However, in both instances, criteria for statistical equivalence were met in only 5 of 12 comparisons. Based on κ, between-instrument agreement on the classifications of disorder went from 0.481 (attentional disorder) to 0.721 (emotional disorder) but were substantially higher (0.731 to 0.895, respectively) when corrected for attenuation due to measurement error.

CONCLUSIONS

Although falling short of equivalence, the results suggest on balance that the reliability and validity of the two instruments for classifying child psychiatric disorder assessed by parents are highly comparable. This conclusion is supported by the high levels of agreement between the instruments after correcting for attenuation due to measurement error.

Association between plasma proteome and childhood neurodevelopmental disorders: A two-sample Mendelian randomization analysis

Background

Childhood neurodevelopmental disorders, including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS), comprise a major cause of health-related disabilities in children. However, biomarkers towards pathogenesis or novel drug targets are still limited. Our study aims to provide a comprehensive investigation of the causal effects of the plasma proteome on ASD, ADHD, and TS using the two-sample Mendelian Randomization (MR) approach.

Methods

Genetic associations with 2994 plasma proteins were selected as exposures and genome-wide association data of ASD, ADHD, TS were utilized as outcomes. MR analyses were carried out using the inverse-variance weighted method, and the MR-Egger and weighted median methods were used for sensitivity analysis.

Findings

Using single-nucleotide polymorphisms as instruments, the study suggested increased levels of MAPKAPK3 (OR: 1.09; 95% CI: 1.05–1.13; P = 1.43 × 10⁻⁶) and MRPL33 (OR: 1.07; 95% CI: 1.04–1.11; P = 5.37 × 10⁻⁶) were causally associated with a higher risk of ASD, and increased MANBA level was associated with a lower risk of ADHD (OR: 0.91; 95% CI: 0.88–0.95; P = 8.97 × 10⁻⁶). The causal associations were robust in sensitivity analysis, leave-one-out analysis and Multivariable MR, and no pleiotropy was observed. No significant risk protein was identified for TS.

Interpretation

The study findings support the idea that the MAPK/ERK signaling pathway and mitochondrial dysfunction are involved in the pathogenesis of ASD, while a deficiency in beta-mannosidase might play a role in the development of ADHD.

A network perspective on abnormal child behavior in primary school students

Abnormal child behavior is a complex entity including among others disorders such as ADHD, a neuropsychiatric disorder interfering with the normal development of the child, and combining many comorbidities. There are no specific tools designed to assess abnormal child behavior, although well-known ADHD screening tools such as the CTRS-R:S go beyond the disorder itself and cover the wider construct. This can be understood as the complex system of mutually influencing entities, that is why the aim of this study was to investigate the items of the CTRS-R:S as a psychological network. We analyzed a data set of 525 children in French-speaking primary schools from Belgium, and estimated a Bayesian Gaussian Graphical Model with a Bayes Factor of 30. We identified highly connected nodes from each community of the CTRS-R:S to build an additional network of communities. In the domain network, Oppositional and Cognitive skills share the strongest connection in the network. The 28-item network was overall positively connected albeit the presence of some negative connections. The spinglass algorithm identified eight domains in the CTRS-R:S network that causally influence each other. The network approach is a useful framework to investigate the domains of abnormal child behavior as well as the interplay between individual symptoms.

Classification, prevalence and integrated care for neurodevelopmental and child mental health disorders: A brief overview for paediatricians

'Neurodevelopmental disorders' comprise a group of congenital or acquired long-term conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations, including autism spectrum disorder, attention deficit/ hyperactivity disorder, tic disorder/ Tourette's syndrome, developmental language disorders and intellectual disability. Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability. Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm. Together these are referred to as neurodevelopmental, emotional, behavioural, and intellectual disorders (NDEBIDs) in this paper. Varying prevalence rates for NDEBID have been reported in developed countries, up to 15%, based on varying methodologies and definitions. NDEBIDs are commonly managed by either child health paediatricians or child/ adolescent mental health (CAMH) professionals, working within multidisciplinary teams alongside social care, education, allied healthcare practitioners and voluntary sector. Fragmented services are common problems for children and young people with multi-morbidity, and often complicated by sub-threshold diagnoses. Despite repeated reviews, limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research. The recently developed "Mental, Behavioural and Neurodevelopmental disorder" chapter of the International Classification of Diseases-11 offers a way forward. In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID, enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

A rapid review of emergency department interventions for children and young people presenting with suicidal ideation

BACKGROUND

Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care.

AIMS

This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation.

METHOD

Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies.

RESULTS

Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms.

CONCLUSIONS

Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.

Parental self-efficacy and satisfaction with parenting as mediators of the association between children’s noncompliance and marital satisfaction

Parents of young children who exhibit behavioral problems often experience lower marital satisfaction. In the present study we aimed to explore the association between preschool children's noncompliant behavior and marital satisfaction, and to explain it through the mediating role of parental self-efficacy and satisfaction with parenting. Participants were 188 married Israeli couples with a typically developing child aged 3 to 6, selected in a convenience sample. Mothers and fathers independently completed measures of child’s behavior, marital satisfaction, parental self-efficacy, and satisfaction with parenting. Data were collected between September 2019 and February 2020 and were analyzed using the common fate model (CFM). Results indicate a direct, negative association between child's noncompliant behavior and marital satisfaction, which was fully explained by parental self-efficacy and satisfaction with parenting. The study suggests that both parents are affected by their young child’s noncompliance, with a spillover effect from the parent–child relationship into the marital relationship. The findings highlight the importance of early treatment of children's noncompliance and indicate that interventions aimed at enhancing parents’ self-efficacy and satisfaction, as well as the inclusion of both parents in treatment, may be beneficial.

Integrating self-efficacy in the cyclical process of paediatric asthma management: a new perspective

Asthma management consists of a cyclical process based on clinical assessment of the patient, the implementation of therapeutic adjustments, and evaluation of the patient's response. Self-efficacy is the person's confidence in his or her ability to successfully perform a behaviour and guides the patient's decisions for producing healthy behaviours.Studies have shown that asthma management is related to self-efficacy, which in turn can be influenced by various psychosocial factors. A literature search on the relationship between asthma and self-efficacy in paediatric age, has allowed us to hypothesize that adequate levels of self-efficacy might be achieved through a cyclical process, 'the self-efficacy cycle', taking into account assessment, identification of modifiable risk factors and patient's response. This would make it easier to identify the personal and social aspects on which to intervene to promote a proper management of the disease.

Decreased Balance Function in School-Aged Children with Behavioral Problems

Children with behavioral problems have a high risk of impaired motor performance. However, the characteristics of balance functions and their associations with behavioral traits are unclear in this population. This study aimed to evaluate balance functions and their relationships with the degree of behavioral problems in school-aged children. A total of 209 children, aged 6–10 years, were divided into two groups, those with and those without behavioral problems, using the Strengths and Difficulties Questionnaire (SDQ). Physical assessments included the one-leg standing test (OLST), the two-step test, and the five-times-sit-to-stand test. We compared the data between groups and assessed for correlations in terms of total difficulties and the SDQ subscale scores. Children with behavioral problems showed significantly reduced the OLST results (p < 0.001) and the two-step test results (p = 0.008). The five-times-sit-to-stand test results did not show significant differences between groups. The OLST results were significantly correlated with emotional symptoms (r = −0.22, p < 0.001), hyperactivity/inattention (r = −0.29, p < 0.001), peer relationship problems (r = −0.22, p < 0.001), and total difficulties (r = −0.32, p < 0.001). Meanwhile, the two-step test results showed no significant correlation with the SDQ scores. Children with behavioral problems have poor balance function, thereby increasing the risk for instability. This suggests that the balance function of children with behavioral problems needs to be considered.

Troublesome behaviour and traumatic dental injuries during adolescence

BACKGROUND/AIM

Troublesome behaviour can lead to bodily injuries among young people, although a link with traumatic dental injuries (TDIs) remains unclear. The aim of this study was to evaluate the longitudinal association between troublesome behaviour and TDIs during adolescence.

METHODS

This study analysed data from phases 2 and 3 of the Research with East London Adolescents Community Health Survey (RELACHS), a longitudinal study of public secondary schools in East London. Troublesome behaviour in the past 12 months was measured with 8 items (told lies to get things from others, started fight, bullied or threatened people, stayed late outside, stole valuable things, ran away from home, played truant from school and intentionally destroyed someone else's property) from the Development and Well-Being Assessment (DAWBA), when participants were 13-14 years old (Phase 2). Adolescents were dentally examined for TDIs when they were 15-16 years old (Phase 3). The association between troublesome behaviour and TDIs was tested in logistic regression models adjusting for socio-demographic characteristics and oral clinical factors.

RESULTS

Forty-three per cent of adolescents reported one or more troublesome behaviours at age 13-14 years, and 16% had evidence of TDIs by age 15-16 years. Adolescents who answered 'perhaps' and 'definitely' to any troublesome behaviour item had, respectively, 1.37 (95% CI: 0.62-3.00) and 1.50 (95% CI: 0.69-3.30) greater odds of having TDIs than those who answered 'no' after adjustment for confounders. Of the 8 behaviours assessed, having run away from home, bullied or threatened people, often told lies, and stolen valuable things were associated with having TDIs.

CONCLUSION

This study among adolescents shows that reporting troublesome behaviour was associated with TDIs two years later. Given the wide confidence intervals for these associations, the present findings require confirmation from further longitudinal studies.

Long-Term Mental Health and Quality of Life Outcomes of Neonatal Insults in Kilifi, Kenya

We examined the mental health and quality of life (QoL) outcomes and their correlates of school-aged survivors of neonatal jaundice (NNJ), hypoxic-ischemic encephalopathy (HIE), and a comparison group. The Child Behavior Checklist and the Pediatric Quality of Life Inventory were administered to assess the mental health and QoL of 375 children (134 with NNJ, 107 with HIE, and 134 comparison group) aged 6 to 12 years [Median age 9 (interquartile range 7 to 11)]. The results showed that survivors of NNJ and HIE have mental health problems and QoL similar to the comparison group. Maternal mental health was the predominant covariate of mental health and QoL in survivors of NNJ and HIE. This result could indicate that mothers with mental health problems are more likely to have children with mental health issues, but also that caring for children with these adversities may affect mental health well-being of the caregivers. There is a need for early mental health screening and psychosocial intervention for caregivers and their children to enhance both their mental health and QoL.

Obstetrical mode of delivery and behavioural outcomes in childhood and adolescence: findings from the Millennium Cohort Study

PURPOSE

To examine the association between mode of delivery (in particular caesarean section) and behavioural outcomes in offspring at six time-points between age 3 and 17 years.

METHODS

Similar to previous work examining the association between mode of delivery and behavioural outcomes in offspring at age 7, we used maternal-reported data from the Millennium Cohort Study. Data on mode of delivery were collected when children were 9 months and categorised as spontaneous vaginal delivery, assisted vaginal delivery, induced vaginal delivery, emergency caesarean section, planned caesarean section and caesarean section after induction of labor. Data on behavioural outcomes were collected at ages 3, 5, 7, 11, 14 and 17 years using the Strengths and Difficulties Questionnaire (SDQ). Crude and adjusted logistic regression examined mode of delivery-behavioural difficulties relationship, using validated SDQ cut-off points (total SDQ ≥ 17, emotional ≥ 5, conduct ≥ 4, hyperactivity ≥ 7, peer problems ≥ 4 and prosocial behaviour ≤ 4). Multilevel models with linear splines examined the association between mode of delivery and repeated measures of SDQ.

RESULTS

There were 18,213 singleton mother-child pairs included at baseline, 13,600 at age 3; 13,831 at age 5; 12,687 at age 7; 11,055 at age 11; 10,745 at age 14 and 8839 at age 17. Adjusted logistic regression suggested few associations between mode of delivery and behavioural outcomes at ages 3, 5, 11, 14 and 17 years using validated SDQ cut-off points. After correction for multiple testing, only the protective association between planned caesarean section-Conduct difficulties at age 5 years (OR 0.63, 95% CI 0.46, 0.85) and positive association between caesarean section after induction-Emotional difficulties at age 11 years (OR 1.57, 95% CI 1.19, 2.07) remained statistically significant. Multilevel modelling suggested mean SDQ scores were similar in each mode of delivery group at each time point.

CONCLUSIONS

Results of this study indicate that mode of delivery is unlikely to have a major impact on behavioural outcomes.

Therapeutic applications of transcutaneous auricular vagus nerve stimulation with potential for application in neurodevelopmental or other pediatric disorders

Non-invasive transcutaneous auricular vagus nerve stimulation (taVNS) as a newly developed technique involves stimulating the cutaneous receptive field formed by the auricular branch of the vagus nerve in the outer ear, with resulting activation of vagal connections to central and peripheral nervous systems. Increasing evidence indicates that maladaptive neural plasticity may underlie the pathology of several pediatric neurodevelopmental and psychiatric disorders, such as autism spectrum disorder, attention deficit hyperactivity disorder, disruptive behavioral disorder and stress-related disorder. Vagal stimulation may therefore provide a useful intervention for treating maladaptive neural plasticity. In the current review we summarize the current literature primarily on therapeutic use in adults and discuss the prospects of applying taVNS as a therapeutic intervention in specific pediatric neurodevelopmental and other psychiatric disorders. Furthermore, we also briefly discuss factors that would help optimize taVNS protocols in future clinical applications. We conclude from these initial findings that taVNS may be a promising alternative treatment for pediatric disorders which do not respond to other interventions.

Occupational Therapy Theory and School-Based Filial Therapy: Intervention Rationale and Formulation : Théorie de l'ergothérapie et thérapie filiale en milieu scolaire : formulation et logique de l'intervention

Background: Emotional-behavioural problems in children present a barrier to engagement and participation in school occupations. Applying practice theory is an essential process to explore the impact of clinical problems and to orient clinical thinking to the domain of occupation. Purpose: Occupational therapy practice theory and frameworks are applied to the formulation of School-Based Filial Therapy, a viable treatment response to emotional-behavioural problems in children. Key issues: Bowen family systems theory, the Occupational Therapy Practice Framework IV and the Canadian Model of Occupational Performance and Engagement are applied to intervention formulation. Implications: School-Based Filial Therapy engages the dynamic interaction of the person, the occupations he/she engages in and the environment via therapeutic medium of play. It is consistent with the Occupational Therapy Practice Framework IV and the Canadian Model of Occupational Performance and Engagement and provides new possibilities as an intervention for occupational therapists working in children's mental health.

Parental mental illness and their offspring's mental health in Rwanda: neuropsychiatric hospital of Rwanda

BACKGROUND

Offspring of the parents with mental disorders are at higher risk to have the mental diseases throughout the world. This study examined the association between psychopathology of parents and the mental health of their offspring in Neuropsychiatric Hospital of Rwanda, Butare Branch.

METHODS

A cross-sectional study made up of case and control offspring was conducted on the case group made up of 80 offspring born to parents with mental diseases and a control group of 80 offspring from parents without mental disease. Hamilton Rating Scale for Depression (HRSD, α = 0.82), Posttraumatic stress disorders scale (PTSD, α = 0.73) and the Test of Psychological Problems (TPP, α = 0.93) were used. STATISTICA version 8 was used for statistical analysis.

RESULTS

Results indicated a significance difference between the two groups on depressive symptoms, psychological problems and PTSD symptomatology. The case group seemed to experience high level symptoms than the control group. Results indicated that, among the offspring born to parents with mental disease, there was a significant correlation between anxiety and depression symptoms (r = 0.71, p < .001), PTSD and eating disorder (r = 0.75, p < .001), domestic violence and PTSD (r = 0.78, p < .001), aggressive behavior and PTSD (r = 0.79, p < .001), somatoform disorders and PTSD (r = 0.98, p < .001). No significant association between the low self-esteem, depression, anxiety, mental disorders induced drug abuse and PTSD was found.

CONCLUSION

Offspring of the parents with mental disorders had higher risk to develop mental diseases than the offspring born to the parents without mental diseases. Taking into account the assessment of parents' mental illness when taking care of the offspring's psychological disorders is needed in the neuropsychiatric hospital.

Self-management, self-care, and self-help in adolescents with emotional problems: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to clarify the ways in which the concepts of self-management, self-care, and self-help are defined in the literature in the context of adolescents with emotional problems, as well as to identify the strategies or techniques that have been proposed to facilitate self-management, self-care, and self-help for this group.

INTRODUCTION

There is evidence that emotional problems are rising amongst adolescents, yet timely access to specialist mental health treatment is limited to adolescents with greater severity of mental health difficulties. Nonetheless, self-management, self-care, and self-help strategies may be used by adolescents. Given the overlap in existing definitions and the lack of clarity around these concepts in a youth mental health context, a scoping review of the literature is warranted.

INCLUSION CRITERIA

The review will consider studies that involve adolescents aged 10 to 19 years with symptoms of emotional problems. These problems do not require a formal diagnosis and may be based on self-reporting. Studies that reference self-management, self-care, or self-help in this population, in any setting, will be included. Strategies may be provided by a mental health professional or discovered by the adolescent on their own. Quantitative, qualitative, economic, and mixed methods studies, as well as systematic, scoping, and literature reviews, are eligible for inclusion.

METHODS

MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, Google Scholar, and MedNar will be searched for English-language texts from the year 2000 onward. A map or typology of definitions will be presented alongside a narrative summary of the results.

Social-Emotional Difficulties in Irish Children Aged Five and Nine Years: A National, Longitudinal Study

A small proportion of children experience social-emotional difficulties from early childhood onwards. Longitudinal studies with nationally representative samples are needed to identify the prevalence and the characteristics of children and families persistently experiencing these difficulties. Secondary analysis of data collected on over 7500 Irish children and with the Strengths and Difficulties Questionnaire as the primary indicator, found that 6% of children when they were five year olds and 8% when they were nine-years, had above threshold scores that warranted further investigation. A smaller proportion-2.9% had elevated scores at both ages. Logistic regression analyses found that children with one or more developmental disabilities were up to six times more likely to have sustained difficulties. There were also significant associations with the lower education attainment of primary caregivers and the socio-economic deprivation of families. Primary caregivers and teachers reported higher conflict in their relationships with these children. Although the number of Irish children presenting with continuing social-emotional difficulties is small, they can present an ongoing and future societal cost in terms of the impact on family relations and demands placed on educational, health and social services. This study identified the children and families who are at greatest risk and for whom targeted early intervention services could be provided.

Internet gaming disorder and its relationship with behavioral disorder and mother's parenting styles in primary school students according to gender in Iran

BACKGROUND

The problem of students' gaming addiction has been related to the individual student's characteristics and the influence of family environment. Researchers aimed to investigate if and how internet gaming disorder (IGD) of the elementary school boys and girls is related to behavioral disorder and their mother's parenting style in Iran.

METHODS

This is a descriptive correlational study, involving 657 fifth and sixth-grade elementary school students in 2019. Researchers used a multistage stratified random sampling of students, their parents and their teachers. Data were collected using internet gaming disorder questionnaire (IGD 20), Rutter teacher behavioral disorder questionnaire and Baumrind Parenting Styles questionnaire (PSI). Obtained data were analyzed using SPSS version16 for descriptive statistics and Pearson correlation coefficient test.

RESULTS

Findings showed that IGD prevalence was 5.9% among primary school students with significant relationship between IGD and behavioral disorder among all participants (r = 0.23, p = 0.04); although it was insignificant among boys (r = 0.13, p = 0.11). Also the relationship between IGD and mother's parenting style was significant in the total sample (r = 0.12, p = 0.03), in particular for girls and their mothers (r = 0.2, p = 0.001).

CONCLUSIONS

The results of this study indicate the importance of family and parental involvement in prevention and management of IGD chiefly among girls. Healthcare professionals will benefit from knowing the problematic consequences of online gaming among school-age children and try to promote safe and healthy online behavior supported by a supervised family environment.

Assessment of Temper Tantrums Behaviour Among Preschool Children in Jordan

PURPOSE

A good understanding of children's emotions, activities, and needs should be promoted. This study assessed temper tantrum behaviour, including frequency, severity, duration, common behaviours, reasons, locations, contexts, and parent's strategies, among Jordanian children aged 24-48 months.

DESIGN AND METHODS

A cross-sectional design was used to conduct this study. A non-probability convenience sample was adopted to recruit 213 parents of children aged between 24 months to 48 months. All parents completed the Parents' Experience of Temper Tantrums in Children's questionnaire.

RESULTS

Findings showed that about half of the children experienced weekly tantrums, however, half of the parents reported that mild tantrums were exhibited by their youngsters, with an average duration of minutes. The most frequently reported tantrum behaviour was 'screaming or shouting'. "Seeking attention" was the most frequent reason and most tantrums occurred when visiting someone else's home. Unfamiliar situations were the most commonly associated with tantrum episodes. The main strategies used by parents to lessen their child's tantrums were first, stating a consequence (e.g., timeout), and secondly, ignoring the behaviour.

CONCLUSIONS

The results draw attention to significant aspects of tantrums, such as the duration, where children managed to maintain a tantrum episode for more than seven minutes on average. Tantrum behaviours, reasons, locations, context, and parents' strategies to control tantrums were significant in developing proper interv entions.

PRACTICE IMPLICATIONS

The findings of this study are of practical use in equipping parents and caregivers with the appropriate strategies to enable them to halt tantrums among children.

Maternal pregnancy diet, postnatal home environment and executive function and behavior in 3- to 4-y-olds

BACKGROUND

Optimal maternal nutrition during pregnancy has been linked to better cognitive and behavioral development in children. However, its influence on the effects of suboptimal postnatal exposures like reduced stimulation and support in the home is not known.

OBJECTIVES

To examine the effect of maternal pregnancy diet on executive function and/or behavioral development in children raised in suboptimal home environments.

METHODS

Data were provided by 808 mother-infant dyads from the Canadian Maternal-Infant Research on Environmental Chemicals-Child Development study. Maternal pregnancy diet was self-reported using the Healthy Eating Index 2010 questionnaire. Stimulation and support in the home was assessed using the Home Observation for Measurement of the Environment (HOME) when children were 3-4 y old. Child executive function was reported by mothers at this age using the Behavior Rating Inventory of Executive Functioning-Preschool Edition, and child behavior was assessed using the Behavior Assessment System for Children-2nd Edition. We examined the interaction of maternal pregnancy diet and postnatal HOME scores on child executive function and behavior using linear regression adjusted for maternal education, postpartum depression, prepregnancy BMI, and smoking.

RESULTS

Maternal pregnancy diet was associated with an increasingly positive association with child working memory (β: 0.21; 95% CI: 0.82, 3.41; P = 0.001), planning (β: 0.17; 95% CI: 0.38, 2.84; P = 0.007), and adaptability (β: -0.13; 95% CI: -1.72, -0.08; P = 0.032) as levels of postnatal stimulation decreased.

CONCLUSIONS

The positive association of maternal pregnancy diet quality and executive function and adaptability in 3- to 4-y-olds appeared to increase with decreasing levels of postnatal stimulation and support. These results suggest that overall maternal pregnancy diet could be linked to better child neurodevelopment in families experiencing barriers to providing stimulation and support to children in their home.

Associations between Adolescents' Social Leisure Activities and the Onset of Mental Disorders in Young Adulthood

The association of leisure time activities with specific mental disorders has mainly remained unclear because of lack of such research. This study analyzed the association of different levels of social leisure time activity during adolescence (ages 15–16 years) with the incidence of mental disorders during adolescence and young adulthood between the ages of 16–33 years. The study population consisted of 6838 (females 51.5%) participants from the longitudinal follow-up study, the Northern Finland Birth Cohort 1986, covering 72% of the total 1986 birth cohort. Psychiatric morbidity of the participants was followed through nationwide health registers until the end of the year 2018 when the participants were 33 years old. High social leisure time activity in adolescence associated with lower incidence of psychiatric disorders in general, and specifically, with affective, anxiety, and substance use disorders. Low social leisure time activity was related to increased incidence of any psychiatric disorder in general, and particularly to anxiety and behavioral disorders. In terms of prevention of mental disorders, these study findings encourage families, schools and other communities to continue to enhance and develop community-based social leisure time activities for children and adolescents.

Genetic variations influence brain changes in patients with attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is a neurological and neurodevelopmental childhood-onset disorder characterized by a persistent pattern of inattentiveness, impulsiveness, restlessness, and hyperactivity. These symptoms may continue in 55-66% of cases from childhood into adulthood. Even though the precise etiology of ADHD is not fully understood, it is considered as a multifactorial and heterogeneous disorder with several contributing factors such as heritability, auxiliary to neurodevelopmental issues, severe brain injuries, neuroinflammation, consanguineous marriages, premature birth, and exposure to environmental toxins. Neuroimaging and neurodevelopmental assessments may help to explore the possible role of genetic variations on ADHD neuropsychobiology. Multiple genetic studies have observed a strong genetic association with various aspects of neuropsychobiological functions, including neural abnormalities and delayed neurodevelopment in ADHD. The advancement in neuroimaging and molecular genomics offers the opportunity to analyze the impact of genetic variations alongside its dysregulated pathways on structural and functional derived brain imaging phenotypes in various neurological and psychiatric disorders, including ADHD. Recently, neuroimaging genomic studies observed a significant association of brain imaging phenotypes with genetic susceptibility in ADHD. Integrating the neuroimaging-derived phenotypes with genomics deciphers various neurobiological pathways that can be leveraged for the development of novel clinical biomarkers, new treatment modalities as well as therapeutic interventions for ADHD patients. In this review, we discuss the neurobiology of ADHD with particular emphasis on structural and functional changes in the ADHD brain and their interactions with complex genomic variations utilizing imaging genetics methodologies. We also highlight the genetic variants supposedly allied with the development of ADHD and how these, in turn, may affect the brain circuit function and related behaviors. In addition to reviewing imaging genetic studies, we also examine the need for complementary approaches at various levels of biological complexity and emphasize the importance of combining and integrating results to explore biological pathways involved in ADHD disorder. These approaches include animal models, computational biology, bioinformatics analyses, and multimodal imaging genetics studies.

Risk of conduct and oppositional defiant disorder symptoms in offspring of parents with mental health problems: Findings from the Raine Study

BACKGROUND

Epidemiological data indicate that paternal and maternal mental health difficulties are predictors of conduct disorder (CD) and oppositional defiant disorder (ODD) in offspring. We tested the association between maternal anxiety and depressive symptoms and paternal emotional problems with CD and ODD symptoms in adolescent offspring aged 17.

METHODS

Data was from the Raine Study, a birth cohort study based in Western Australia. Offspring CD and ODD symptoms at age 17 years were measured using the DSM-oriented scales of the Child Behavior Checklist (CBCL). Depression, Anxiety, and Stress Scale (DASS) was used to assess maternal depressive and anxiety symptoms, and a self-reported questionnaire measured paternal emotional problems when the offspring was 10 years. Negative binomial regression model was used to explore associations.

RESULTS

Adjusting for potential confounding factors, we found an increased risk of CD symptoms in the offspring of mothers with anxiety [RR = 1.76 (95%CI; 1.08-2.86)], depressive [RR = 1.40 (95%CI; 1.01-1.95)], and comorbid anxiety and depressive symptoms [RR = 2.24 (95%CI 1.35-3.72)]. We also found an increased risk of ODD symptoms in offspring of mothers with depressive [RR = 1.24 (95%CI 1.02-1.52)], but not anxiety symptoms [RR = 1.23 (95%CI 0.92-1.67)]. No associations were seen with paternal emotional problems.

CONCLUSION

Our study showed that adolescents whose mothers reported anxiety, depressive, and comorbid anxiety and depressive symptoms had a higher risk of CD and ODD symptoms at age 17. The findings have implications for preventive strategies.

Adiposity, psychomotor and behaviour outcomes of children born after maternal bariatric surgery

BACKGROUND

Bariatric surgery before pregnancy can result in improved maternal fertility. However, long-term data on the consequences at childhood age are currently lacking.

METHODS

EFFECTOR is a prospective cohort study of children (aged 4 to 11 years) born to mothers who underwent bariatric surgery (BS) before pregnancy (n = 36), controls with overweight/obesity (OW/OB) matched on pre-pregnancy BMI (n = 36) and normal weight controls (NL) (n = 35). We performed prospective collection of anthropometric data, data on psychomotor development, school functioning and behaviour (Strengths and Difficulties Questionnaire (SDQ), Child Behaviour Checklist (CBCL)).

RESULTS

The children born after bariatric surgery (BS) presented with the highest body-weight SDS (0.70 vs 0.14 in OW/OB and -0.09 in NL; P = .006) and BMI SDS (0.47 vs -0.02 in OW/OB and -0.42 in NL; P = .01). A higher excess in body fat percentage and waist circumference SDS were found in the BS group (5.7 vs 1.4 in OW/OB and -0.1 in NL; P < .001 and 0.61 vs 0.16 in OW/OB and -0.15 in NL; P = .04). The SDQ questionnaires revealed a higher amount of overall problems in the BS offspring (11.1 vs 7.5 in OW/OB and 8.1 in NL; P = .03), with a higher externalizing score at the CBCL (52.0 vs 44.2 in OW/OB and 47.0 in NL; P = .03).

CONCLUSION

Maternal bariatric surgery does not appear to protect the offspring for childhood overweight and obesity. Parents reported more behaviour problems in these children, especially externally of nature.

Adaptation and Implementation of the Multiple-Family Group Intervention in Ghana

BACKGROUND

The health system in Ghana is severely underequipped to meet the needs of children with behavioral health problems. A substantial treatment gap exists among individuals with behavioral challenges, necessitating the implementation of an evidence-based intervention to address child behavioral challenges in Ghana. This article presents learning opportunities from the adaptation and initiation process of an evidence-based approach, the multiple-family group (MFG) intervention, aimed at addressing child behavioral challenges in northern Ghana.

METHODS

The MFG intervention will be tested and implemented in three schools selected through a clustered randomization process, with 60 child-caregiver dyads per school. Each school will be assigned to MFG delivery by parent peers, MFG delivery by School Health Education Program (SHEP) coordinators, or an intervention where students are supplied only with mental health wellness materials and educational supports. The providers will be assessed on a fidelity measure.

RESULTS

The approach of engaging stakeholders in Ghana is anticipated to prove challenging because multiple partners are involved in MFG implementation. Participants are expected to actively participate, however, given some changes to the protocol to adapt it to the Ghanaian context, including the types of MFG facilitators and sample size. Other anticipated challenges include obtaining permission from key partners such as the education authorities, timing of the study within the academic calendar in Ghana, and meeting the high expectations of school authorities for the study.

NEXT STEPS

The MFG intervention will be delivered by parent peers and SHEP coordinators at the selected schools.

24-Hour Movement Behaviors and Internalizing and Externalizing Behaviors Among Youth

PURPOSE

The Canadian 24-Hour Movement Guidelines for Children and Youth (≥60 minutes of moderate-to-vigorous physical activity per day, ≤2 hours of recreational screen time per day, and 9-11 hours of sleep per night for 5-13 years old) are associated with better physical health, but less is known about how these behaviors are related to mental health. This study examined the association of meeting these guideline recommendations with internalizing and externalizing behaviors among youth.

METHODS

A large and broadly representative cross-sectional sample of 9- to 11-year-old U.S. youth (N = 11,875) from the Adolescent Brain and Cognitive Development study was analyzed. Internalizing and externalizing behaviors were measured using the Child Behaviour Checklist. Associations were examined using negative binomial regression adjusted for several confounders.

RESULTS

Compared to meeting none of the recommendations, meeting recommendations for screen time and sleep but not physical activity was associated with a lower prevalence ratio of total, internalizing, and externalizing behaviors. Meeting two or all three recommendations was more strongly associated with these outcomes than meeting one recommendation or none. The prevalence ratio of the group meeting all three recommendations was .77 (95% confidence interval [CI]: .68-.86) for total problem scores, .78 (95% CI: .68-.89) for internalizing problem scores, and .79 (95% CI: .68-.91) for externalizing problem scores.

CONCLUSIONS

Meeting the 24-hour movement guidelines was associated with a lower risk of internalizing and externalizing behaviors in youth. These associations were mainly explained by meeting the screen time and sleep duration recommendations.

Genodermatoses with behavioural sequelae

Children with genodermatoses are at an increased risk of developing behavioural disorders which may impart lasting damage on the individual and their family members. As such, early recognition of childhood mental health disorders via meticulous history taking, thorough physical examination, and disorder-specific testing is of paramount importance for timely and effective intervention. If carried out properly, prompt psychiatric screening and intervention can effectively mitigate, prevent or even reverse, the psychiatric sequela in question. To that end, this review aims to inform the concerned physician of the manifestations and treatment strategies relevant to the psychological sequelae of genodermatoses.

Longitudinal association of nighttime sleep duration with emotional and behavioral problems in early childhood: results from the Danish Healthy Start Study

STUDY OBJECTIVES

To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among preschool children.

METHODS

Data of children aged 2 to 6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores.

RESULTS

With adjustment for child, family factors, and parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (p = 0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β = -1.28, p = 0.02) compared with those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations.

CONCLUSIONS

Among preschool children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood.Clinical trials: The Healthy Start Study: https://clinicaltrials.gov/ct2/show/NCT01583335Trial registration: ID NCT01583335.

Impact of attention deficit hyperactivity disorder and gender differences on academic and social difficulties among adolescents in Qatari Schools

Background: To evaluate the social and academic impact of adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and gender differences compared with their non-ADHD peers.

Methods: A cross-sectional descriptive study using a standardized rating scale of teacher observations was conducted in the schools of Qatar from 7^th to 12^th grades. Teachers completed Swanson, Nolan, and Pelham (SNAP-IV) rating scale questionnaires for the ADHD core symptoms together with nine questions to evaluate the academic and social difficulties in all participants.

Results: A total of 1775 students (mean age: 15 ± 1.5 years; boys/girls: 717/1058) were included in this study. Based on the SNAP-IV rating scale, 150 students were showing core symptoms of ADHD and classified as having ADHD (8.5%; boys/girls; 93/57) and 1625 students as non-ADHD peers (91.5%; boys/girls; 624/1001). Prevalence of ADHD among adolescent students is 8.5%, and it varied significantly between genders with 13% of boys and 5.4% of girls affected by this disorder. Adolescents with ADHD had more academic and social difficulties than their non-ADHD peers, the boys more so than the girls. Boys with inattentive subtype of ADHD had more academic difficulties than girls, while girls had more social difficulties than boys.

Conclusion: The results of this study revealed that ADHD among adolescents is substantially associated with academic and social difficulties in the school environment. Gender differences among students with ADHD should be considered in the school and clinical environment.

Improvement of brain functional connectivity in autism spectrum disorder: an exploratory study on the potential use of virtual reality

Patients with Autism Spectrum Disorder (ASD) need to be provided with behavioral, psychological, educational, or skill-building interventions as early as possible. Cognitive Behavior Therapy has proven useful to manage such problems. There is also growing evidence on the usefulness of Virtual Reality Therapy (VRT) in treating various functional deficits in ASD. This exploratory study is aimed at assessing the changes in cognitive functions in children with ASD, and the putative subtending neurophysiological mechanisms, following the provision of rehab training using an innovative VRT system. Twenty patients with ASD, aged 6-15 years, were provided with 24 sessions of VRT by using the pediatric module of the BTS NIRVANA System. Neuropsychological and EEG evaluations were carried out before and at the end of the training. After VRT, all patients showed a significant improvement in their cognitive-behavioral problems concerning attention processes, visuospatial cognition, and anxiety. These findings were paralleled by an evident reshape of frontoparietal connectivity in the alpha and theta frequency range. Our study suggests that VRT could be a useful and promising tool to improve ASD neurorehabilitation outcomes. This improvement is likely to occur through changes in frontoparietal network connectivity following VRT.

A longitudinal study of adolescents engaged in Non-Suicidal Self Injury (NSSI): clinical follow-up from adolescence to young adulthood

The main aim of the current study is to examine the demographic and clinical factors that predict a continuity of the use of Mental Health Services (MHS) in adulthood by subjects who have engaged in non-suicidal-self-injury behaviors (NSSI) and have been followed in MHS in their teen years. A cohort of 147 participants was selected from an original sample of 267 adolescent patients recruited from the Child and Adolescent Outpatient Psychiatric Services. Patients were divided into two groups: those who had engaged in NSSI (NSSI-group), and those who had not (non-NSSI-group). Rate of use of MHS in adulthood was calculated for both groups and univariate analyses and binary logistic regression analysis were applied. In the NSSI-group, two factors appeared to influence a continuity of the use of MHS in adulthood. Prosocial behavior was associated with a greater use of MHS in adulthood whereas behavioral problems were associated with less use. Only prosocial behavior was maintained in the regression model as a predictor. Our findings could have implications for clinical practice with NSSI patients and highlight the importance of working on specific areas that could prevent treatment abandonment in the transition from adolescence to adulthood.

Factors Associated with Mental Health Problems among Malaysian Children: A Large Population-Based Study

Mental health problems are a major public health issue, particularly among children. They impair children’s development, academic achievement, and ability to live a productive life. The present study aimed to determine the prevalence and factors associated with mental health problems among children aged 5 to 15 years old in Malaysia. Data from the National Health and Morbidity Survey (NHMS) 2015 were analyzed. A validated Strengths and Difficulties Questionnaire (SDQ) was used. The overall prevalence of mental health problems among children in Malaysia was 11.1%. Multiple logistic regression analysis revealed that for every year increment in age, mental health problems decreased by 5%. Further analysis found that children who had fathers with a non-formal education and worked in the private sector, had parents who were widowed or divorced, and had either parent with mental health problems were more likely to have mental health problems themselves. Children from the lower socioeconomic group and who had either parent with mental health problems had higher odds of having mental health problems in Malaysia.