The Healthy Brains and Behavior Study: objectives, design, recruitment, and population coverage

Machine learning approach to investigate pregnancy and childbirth risk factors of sleep problems in early adolescence: Evidence from two cohort studies

BACKGROUND

This study aimed to predict early adolescent sleep problems using pregnancy and childbirth risk factors through machine learning algorithms, and to evaluate model performance internally and externally.

METHODS

Data from the China Jintan Child Cohort study (CJCC; n=848) for model development and the US Healthy Brain and Behavior Study (HBBS; n=454) for external validation were employed. Maternal pregnancy histories, obstetric data, and adolescent sleep problems were collected. Several machine learning techniques were employed, including least absolute shrinkage and selection operator, logistic regression, random forest, naïve bayes, extreme gradient boosting, decision tree, and neural network. The area under the receiver operating characteristic curve, sensitivity, specificity, accuracy, and root mean square of residuals were used to evaluate model performance.

RESULTS

Key predictors for CJCC adolescents' sleep problems include gestational age, birthweight, duration of delivery, and maternal happiness during pregnancy. In HBBS adolescents, the duration of postnatal depressive emotions was the primary perinatal predictor. The prediction models developed in the CJCC had good-to-excellent internal validation performance but poor performance in predicting the sleep problems in HBBS adolescents.

CONCLUSION

The identification of specific perinatal risk factors associated with adolescent sleep problems can inform targeted interventions during and after pregnancy to mitigate these risks. Health providers should consider integrating these predictive factors into routine pre- and postnatal assessments to identify at-risk populations. The variability in model performance across different cohorts highlights the need for context-specific models and the cautious application of predictive analytics across diverse populations. Future research should focus on refining predictive models to account for such variations, potentially through the incorporation of additional socio-cultural factors and genetic markers. This study emphasizes the importance of personalized and culturally sensitive approaches in the prediction and management of adolescent sleep problems, leveraging advanced computational methods to enhance maternal and child health outcomes.

Omega-3 Supplementation Reduces Schizotypal Personality in Children: A Randomized Controlled Trial

BACKGROUND AND HYPOTHESIS

Based on a childhood intervention from ages 3 to 5 years that included additional fish consumption and which resulted in reduced schizotypal personality at age 23, we had previously hypothesized that omega-3 could reduce schizotypy. The current study tests the hypothesis that omega-3 supplementation reduces schizotypy in children.

STUDY DESIGN

In this intention-to-treat, randomized, single-blind, stratified, factorial trial, a community sample of 290 children aged 11-12 years were randomized into Omega-3 Only, Cognitive Behavioral Therapy (CBT) Only, Omega-3 + CBT, and Control groups. Schizotypy was assessed using the SPQ-C (Schizotypal Personality Questionnaire for Children) at 0 months (baseline), 3 months (end of treatment), 6 months (3 months post-treatment), and 12 months (9 months post-treatment).

STUDY RESULTS

A significant group × time interaction (P = .013) indicated that, compared with Controls, total schizotypy scores were reduced in both Omega-3 Only and Omega-3 + CBT groups immediately post-treatment (d = 0.56 and 0.47, respectively), and also 3 months after supplementation terminated (d = 0.49, d = 0.70). Stronger findings were observed for the interpersonal schizotypy factor, with both omega-3 groups showing reductions 9 months post-treatment compared with the CBT Only group. Schizotypy reductions were significantly stronger for those with higher dietary intake of omega-3 at intake. Sensitivity analyses confirmed findings.

CONCLUSIONS

Results are unique in the field and suggest that omega-3 can help reduce schizotypal personality in community-residing children. From an epidemiological standpoint, if replicated and extended, these findings could have implications for early prevention of more significant schizotypal features developing later in adolescence.

CLINICAL TRIAL REGISTRATION

"Healthy Brains & Behavior: Understanding and Treating Youth Aggression (HBB)." ClinicalTrials.gov Identifier: NCT00842439, https://clinicaltrials.gov/ct2/show/NCT00842439.

Lower dietary intake of magnesium is associated with more callous-unemotional traits in children

BACKGROUND

Although researchers increasingly recognize the role of nutrition in mental health, little research has examined specific micronutrient intake in relation to antisocial behavior and callous-unemotional (CU) traits in children. Vitamin B6 and magnesium are involved in neurochemical processes implicated in modulating antisocial behavior and CU traits. The current study examined dietary intakes of magnesium and vitamin B6 in relation to antisocial behavior and CU traits.

METHOD

: We enrolled 11-12 year old children (n = 446, mean age = 11.9 years) participating in the Healthy Brains and Behavior Study. Magnesium and vitamin B6 dietary intake were assessed with three 24-hour dietary recall interviews in children. CU traits and antisocial behavior were assessed by caregiver-reported questionnaires. We controlled for age, sex, race, total energy intake, body mass index, social adversity, ADHD or learning disability diagnosis, and internalizing behavior in all regression analyses.

RESULTS

Children with lower magnesium intake had higher levels of CU traits, controlling for covariates (β = -0.18, B = -0.0066, SE = 0.0027, p < 0.05). Vitamin B6 intake was not significantly associated with CU traits (β = 0.061, B = 0.19, SE = 0.20, p > 0.05). Neither magnesium (β = 0.014, B = 0.0020, SE = 0.0093, p > 0.05) nor vitamin B6 (β = 0.025, B = 0.33, SE = 0.70, p > 0.05) were significantly associated with antisocial behavior.

CONCLUSIONS

Findings suggest that low dietary intake of magnesium may play a role in the etiology of CU traits but not general antisocial behavior. More studies are needed to determine if magnesium supplementation or diets higher in magnesium could improve CU traits in children.

The conduct and oppositional defiant disorder scales (CODDS) for disruptive behaviour disorders

This study evaluates the clinical validity of a five-minute instrument, the Conduct and Oppositional Defiant Disorder Scales (CODDS), for assessing oppositional defiant disorder (ODD) and conduct disorder (CD). Children (N = 428) aged 11-12 years and their caregiver were administered the NIMH DISC-IV (Diagnostic Interview Schedule for Children), the CODDS, and validity measures. A second sample (N = 671) was utilized to develop a brief measure of limited prosocial emotions based on DSM 5. Receiver operating characteristic (ROC) curves documented good sensitivity and specificity for CODDS scales in predicting DISC-IV clinical diagnoses of ODD (85%, 72% respectively) and CD (85%, 88%) diagnoses. Baseline CODDS provided added value over and above baseline clinical DISC- diagnoses in predicting future DISC ODD and CD diagnoses 12 months later, as well as in predicting social and school functioning. Study 2 further established psychometric properties of the CODDS, with brief measures of CODDS limited prosocial emotions (LPE) having a good fit to the hypothesized DSM 5 four-factor structure of LPE. Findings indicates that the CODDS has utility as a five-minute proxy for diagnoses of ODD and CD in clinical research and potentially practice where time and resources are limited.

Blood lead levels mediate the relationship between social adversity and child externalizing behavior

BACKGROUND/AIMS

The association between social adversity and externalizing behavioral problems in children is well-documented. What is much less researched are biological mechanisms that may mediate such relationships. This study examines the hypothesis that low blood lead mediates the relationship between social adversity and child externalizing behavior problems.

METHODS

In this cross-sectional study, participants were 131 children aged 11-12 years (mean = 11.90) from Philadelphia, US. A venous fasting blood sample was taken and analyzed for blood lead levels. A social adversity index was calculated based on 10 total indicators derived from a psychosocial interview of the parent and official neighborhood data, while child behavior outcomes (internalizing and externalizing behavior) were assessed using both parent-report and child self-report.

RESULTS

The mean blood lead level was 2.20 μg/dL. Both relatively higher blood lead levels and higher social adversity scores were associated with higher levels of parent-reported and child self-reported externalizing behaviors. Additionally, blood lead mediated the relationship between social adversity and child-reported externalizing behavior (Indirect effect: B = 0.03, 95% CI: 0.004, 0.09) and partially mediated the relationship between social adversity and parent-reported externalizing behavior (Indirect Effect: B = 0.03, 95% CI: 0.01, 0.07).

CONCLUSION

To our knowledge, this study is the first to suggest that blood lead levels play a mediating role in the relationship between externalizing behavior problems and social adversity. Findings have potentially important implications for public health and environmental regulation as well as understanding biological mechanisms that link social inequality with health outcomes, especially in youth from low-income, urban areas.

Vitamin D sufficiency attenuates the effect of early social adversity on child antisocial behavior

BACKGROUND

Vitamin D insufficiency and child antisocial behavior are public health concerns. It is unknown whether vitamin D plays a role in antisocial outcomes. This study examines whether higher levels of vitamin D can act as a protective factor against antisocial behavior for children who are exposed to early social adversity.

METHODS

In a community sample of 300 children aged 11-12 years (151 females, 149 males), serum concentrations of 25-hydroxyvitamin D [25(OH)D] were assessed alongside early social adversity, and both parent and child-reported antisocial behavior.

RESULTS

Vitamin D moderated the association between early social adversity and multiple antisocial outcomes. Higher social adversity was associated with greater antisocial behavior among vitamin D-insufficient [25(OH)D < 30 ng/mL], but not vitamin D-sufficient children [25(OH)D ⩾ 30 ng/mL], after adjusting for other variables. Results from child reports of antisocial behavior were replicated with parent reports, providing support for the robustness of the findings. At serum 25(OH)D concentrations above 27.16-30.69 ng/mL (close to 30 ng/mL, the recommended optimal vitamin D level for pediatric populations), the effect of social adversity on antisocial behavior outcomes was nullified.

CONCLUSIONS

To our knowledge, this study is the first to document that a nutritional factor, vitamin D, can potentially confer resilience to antisocial behavior. Our findings in a pediatric population suggest a possible role of vitamin D supplementation in interventions to reduce antisocial behavior, which may be further investigated in future randomized controlled trials.

The Schizotypal Personality Questionnaire for Children (SPQ-C): Factor Structure, Child Abuse, and Family History of Schizotypy

There is a relative dearth of research on features of schizotypal personality in children, in part due to lack of instrumentation. This study tests 5 competing models of the factor structure of the self-report Schizotypal Personality Questionnaire for Children (SPQ-C) and examines its relationship with a family history of schizotypal personality disorder (SPD), child abuse, and stability over time. Hypotheses were tested on 454 11- to 12-year-old schoolchildren and their caregivers. Confirmatory factor analyses supported a 3-factor structure of the SPQ-C (cognitive-perceptual, interpersonal, and disorganized). Test-retest stability was relatively robust over 3 months (r = .67), 6 months (r = .64), and 12 months (r = .55), with acceptable internal reliabilities (r = .84 to .91). Regarding construct validity, children with a biological family history of SPD had higher scores on all 3 factors (d =.51). Abused children had higher schizotypy scores (d = .55). A genetic × environment interaction was observed, with schizotypy highest in those with both a family history of schizotypy and also child abuse. Findings are the first in the child schizotypy field to document a gene × environment interaction and the independence of child abuse from confounding genetic influences. Results support the utility of the SPQ-C in future family and clinical studies of schizotypal personality and provide an avenue for much-needed and neglected research into the early antecedents of child schizotypal personality.

Reduced Electrodermal Fear Conditioning and Child Callous-Unemotional Traits

Diminished fear conditioning is a well-replicated finding in adult psychopathy. In contrast, there is virtually no research on fear conditioning and callous-unemotional (CU) traits in children. This study aimed to fill in this knowledge gap using a sample of predominantly African American children. The sample comprised 446 community-recruited children (mean age = 11.93 years; 52% boys; 82% African Americans). Skin conductance was recorded during a fear conditioning task and a resting task. CU traits were assessed using the Antisocial Processes Screening Device completed by children and their parents, while aggression was measured with the Buss-Perry Aggression Questionnaire-Short Form. Self-report, but not parent-report CU traits were inversely associated with fear conditioning skin conductance response. CU traits from either report source were not associated with skin conductance responding to the aversive stimulus, or with resting skin conductance level. This is the first study documenting an association between CU traits in children and reduced electrodermal fear conditioning. Findings highlight the importance of conditioned negative emotional arousability in CU traits, and lend support to the developmental psychopathology hypothesis that CU traits may result from impaired conscience development. Electrodermal fear conditioning has the potential to be incorporated into treatment protocols for screening and evaluation purpose.

The within-person coordination of HPA and ANS activity in stress response: Relation with behavior problems

This study tests the within-person coordination of HPA and ANS activity in response to stress and examines for the first time the association between such coordination and behavior problems in minority urban children. Participants, ages 11-12 (N = 419; 50 % male; 80 % African American) completed the Youth Self Report for externalizing and internalizing problems and a modified Trier Social Stress Task (mTSST). They also provided saliva samples for cortisol and alpha-amylase (AA) prior to and 5, 20 and 40 min post-mTSST. Analyses revealed a positive cortisol-sAA coordination, with a 1% increase in cortisol corresponding to a 0.20 % average increase in sAA in response to stress. Higher degrees of within-person cortisol-sAA coordination predicted more behavior problems. The cortisol-sAA coordination explained 28 % and 10 % of the variance in externalizing and internalizing problems, much larger than when stress dynamics of single systems or the interaction of cortisol (AUCi) and sAA (AUCi) were predictors. Findings highlight the importance of multisystem interplay in stress responding in understanding behavior problems. Individuals with more behavior problems may have difficulty turning off their "fight or flight" ANS response, with this system remaining active to the stimulating influence of cortisol even when cortisol's stimulating effects should have dissipated.

Testosterone and Proactive-Reactive Aggression in Youth: the Moderating Role of Harsh Discipline

This study tests a biosocial model of the link between testosterone and proactive-reactive aggression in youth at varying levels of harsh discipline. Given that proactive aggression is used to gain power and status and the importance of social learning in its formation, we hypothesized that testosterone would be associated with proactive aggression at higher levels of harsh discipline, and that this relationship would be more pronounced in boys than girls. Participants (n = 445; 50% male; M age = 11.92 years; 80% African-American) and their caregivers completed questionnaires including demographics, conflict tactics, and proactive-reactive aggression. Youth also provided a saliva sample for testosterone. Analyses revealed an interaction between testosterone and harsh discipline on proactive aggression in both boys and girls, and an interaction between testosterone and harsh discipline on reactive aggression in boys only. For those experiencing high levels of harsh discipline, testosterone was positively associated with proactive aggression, with the magnitude of the association increasing as harsh discipline increased. For below average levels of harsh discipline, there were protective effects of high testosterone for boy's reactive aggression and for girl's proactive aggression. The findings support basic tenets of the biosocial model which suggest that links between testosterone and aggressive behavior are dependent on contextual forces, highlighting the complex relationship between hormones, social context, and aggression. Novel findings include protective effects of high testosterone for those exposed to low levels of harsh discipline. Findings are discussed in light of the context-contingency effect and also within the differential susceptibility framework.

Effects of harsh parenting and positive parenting practices on youth aggressive behavior: The moderating role of early pubertal timing

Prior research indicates that early pubertal timing is associated with aggressive behavior, particularly in the context of adversity as postulated in the contextual amplification hypothesis. However, few studies have examined harsh parenting as the context for the effect of early pubertal timing. Even fewer studies have tested the interactive effect of early pubertal timing and positive parenting on aggressive behavior. In this study, we tested the proposition that early pubertal timing, contrary to the general conception of it as a vulnerability, indexed susceptibility, and thus early maturing individuals were affected more by their environment in a "for better and for worse" manner. The sample consisted of 411 community-recruited youth aged 11-12 years (51% boys, 80% African Americans). Participants reported Tanner Stages of pubertal development, aggressive behavior and harsh parenting practice of their parents. Puberty scores were standardized with groups of the same age, sex, and ethnicity, and those that scored the top one-third were defined as early maturing individuals. Parents reported youth's aggressive behavior and their parenting practices towards the youth, including harsh parenting and positive parenting. Early pubertal timing significantly moderated the relationship between harsh/positive parenting and aggressive behavior. Specifically, harsh parenting was positively associated with aggressive behavior to a larger degree among early maturing individuals than among on-time/late-maturing individuals. Positive parenting was inversely associated with aggressive behavior but only among early maturing individuals. This study is the first to document support for early pubertal timing as susceptibility to the environmental influences in relation to aggressive behavior. Theoretical and intervention implications are discussed.

Nutritional supplementation to reduce child aggression: a randomized, stratified, single-blind, factorial trial

BACKGROUND

While some studies suggest that nutritional supplementation may reduce aggressive behavior in children, they have not examined whether its efficacy may be enhanced in conjunction with other treatment approaches. This study tests the hypothesis that a nutritional supplementation of omega-3, multivitamins, and minerals over 3 months, combined with cognitive behavior therapy, will reduce childhood aggression.

METHODS

In this randomized, single-blind, stratified, factorial trial, a high-risk community sample of 290 children aged 11-12 years were randomized into Nutrition only, cognitive behavioral therapy (CBT) only, Nutrition + CBT, and Control groups. The primary outcome measures of child- and parent-reported aggressive and antisocial behavior were collected at 0 months (baseline), 3 months (end of treatment), 6 months (3 months posttreatment), and 12 months (9 months posttreatment). The trial ('Healthy Brains & Behavior: Understanding and Treating Youth Aggression (HBB)' was registered at ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT00842439 RESULTS: For child self-reports, children in the Nutrition only group showed reduced externalizing behavior compared to Controls at 3 months. At 6 months, the Nutrition + CBT group scored lower on externalizing behavior compared to both CBT only and Control groups. Findings were more in evidence for an Aggressive-Reactive form of antisocial behavior than for a Callous-Proactive form. Effect sizes were in the small-to-medium range (d = -.33 to -.37). Group differences were not sustained 9 months posttreatment, and no other effects were significant.

CONCLUSIONS

Findings provide some limited support for the efficacy of omega-3, vitamin, and mineral supplementation in reducing aggressive behavior in children, and represent the first evaluation of nutritional supplements in conjunction with CBT.

Digit ratio (2D:4D) moderates the relationship between cortisol reactivity and self-reported externalizing behavior in young adolescent males

Although reduced cortisol reactivity to stress and increased circulating testosterone level are hypothesized to be associated with higher levels of externalizing behavior, empirical findings are inconsistent. One factor that may account for the heterogeneity in these relationships is prenatal testosterone exposure. This study examined whether the second-to-fourth digit ratio (2D:4D), a putative marker of prenatal testosterone exposure, moderates the relationships of testosterone and cortisol reactivity with externalizing behavior. Left and right hand 2D:4D and self-reported externalizing behavior were measured in a sample of 353 young adolescents (M age=11.92 years; 178 females; 79.7% African American). Saliva samples were collected before and after a stress task and later assayed for cortisol. Testosterone levels were determined from an AM saliva sample. 2D:4D interacted with cortisol reactivity to predict externalizing behavior in males, but not females. In males, low cortisol reactivity was associated with higher levels of aggression and rule-breaking behavior, but only among subjects with low 2D:4D (i.e., high prenatal testosterone). Findings suggest the importance of a multi-systems approach in which interactions between multiple hormones are taken into account. Furthermore, results demonstrate the importance of considering the organizational influence of prenatal testosterone in order to understand the activational influence of circulating hormones during adolescence.

Interaction of adrenocortical activity and autonomic arousal on children's externalizing and internalizing behavior problems

The psychobiology of stress involves two major components, the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS). Research has revealed the association between behavior problems and the psychobiology of stress, yet findings are inconsistent and few studies have addressed the moderate correlations between behavior problems. This study examines the individual and interactive effects of HPA and ANS on child behavior problems while taking into account the comorbidity of externalizing and internalizing problems. Four saliva samples were collected from each participant in a community sample (N = 429; aged 11-12 years; 50.49 % male), which were assayed for cortisol (HPA) and alpha-amylase, sAA (ANS). Children's behavior problems were assessed using parent-report and self-report versions of the Child Behavior Checklist. Latent variables were constructed to represent trait-like individual differences in cortisol and sAA. Low levels of HPA axis activity were associated with higher levels of both externalizing and internalizing problems, but only among children with low ANS arousal. The association between externalizing and internalizing problems diminished to non-significant after taking into account the influence of HPA axis activity and ANS arousal, which suggests that the psychobiology of stress explains a fair proportion of comorbidity of behavior problems. The findings support that interaction between HPA axis and ANS functioning has potential to clarify prior mixed findings and advance our understanding of the child behavior problems.

Tactics for modeling multiple salivary analyte data in relation to behavior problems: Additive, ratio, and interaction effects

Individual differences in the psychobiology of the stress response have been linked to behavior problems in youth yet most research has focused on single signaling molecules released by either the hypothalamic-pituitary-adrenal axis or the autonomic nervous system. As our understanding about biobehavioral relationships develops it is clear that multiple signals from the biological stress systems work in coordination to affect behavior problems. Questions are raised as to whether coordinated effects should be statistically represented as ratio or interactive terms. We address this knowledge gap by providing a theoretical overview of the concepts and rationales, and illustrating the analytical tactics. Salivary samples collected from 446 youth aged 11-12 were assayed for salivary alpha-amylase (sAA), dehydroepiandrosterone-sulfate (DHEA-s) and cortisol. Coordinated effect of DHEA-s and cortisol, and coordinated effect of sAA and cortisol on externalizing and internalizing problems (Child Behavior Checklist) were tested with the ratio and the interaction approaches using multi-group path analysis. Findings consistent with previous studies include a positive association between cortisol/DHEA-s ratio and internalizing problems; and a negative association between cortisol and externalizing problems conditional on low levels of sAA. This study highlights the importance of matching analytical strategy with research hypothesis when integrating salivary bioscience into research in behavior problems. Recommendations are made for investigating multiple salivary analytes in relation to behavior problems.