Predicting internalizing and externalizing problems at five years by child and parental factors in infancy and toddlerhood

Auditory Risk Factors at Birth and Language Development at 2 Years of Age: A Longitudinal Analysis

Aim. To analyze the relationship between auditory risk factors at birth and subsequent language development in toddlerhood. Methods. Participants are 136 children from a longitudinal birth cohort follow-up at age 2 years. They were divided into 2 groups: One comprising 105 children without hearing risk factors at birth and another comprising 31 children with auditory risk factors at birth but normal hearing. Results. In children with and without risk factors, the combination of socio-emotional, socio-economic, and auditory risk factors at birth significantly predicted language development at age 2 years. Family socio-economic status had a significant impact on overall child development, even after controlling for socio-emotional development and the presence of risk factors. Conclusions. The study was conducted in an upper-middle income country with a socialized health care system. It underscores the importance of a holistic approach to early childhood language development, taking into account biological, socioeconomic, and emotional factors.

Executive Functions and Social-Emotional Problems in Toddlerhood: Nature, Persistence, and Direction of Associations

Social-emotional problems can emerge as early as the first years of life and are associated with a broad range of negative outcomes throughout the lifespan. There is convincing evidence that poorer executive functions (EF) are associated with more social-emotional problems during childhood and adolescence. However, the nature, persistence, and direction of the associations between different components of EF and social-emotional problems in toddlerhood remain unclear. Using two complementary statistical approaches, the present study aimed to (a) identify the role of EF components (inhibitory control, cognitive flexibility, and working memory) in the emergence and maintenance of social-emotional problems during toddlerhood, and (b) explore potential bidirectional associations between toddlers' EF and social-emotional problems. EF and social-emotional problems were assessed around 13, 19, and 28 months of age in a sample of 133 typically developing toddlers (51% boys) from mostly White middle-class families. At each time point, EF were measured with three behavioral tasks and social-emotional problems with a well-validated questionnaire completed by mothers. Multilevel growth models revealed a significant increase in social-emotional problems across toddlerhood and a negative association between inhibitory control and social-emotional problems that persisted across time. Controlling for stability across time, cross-lagged panel models indicated that child inhibitory control at 19 months negatively predicted child social-emotional problems at 28 months, but not the reverse. This study highlights that toddlerhood is a period of significant increase in social-emotional problems and provides evidence for the protective role of early inhibitory control skills against the development of social-emotional problems during toddlerhood.

The Coronavirus Pandemic and Mental Health Presentations of Young Children

Children under the age of four are emotionally vulnerable to global disasters, such as the COVID-19 pandemic given the lack of socialization opportunities and coping mechanisms, and susceptibility to heightened caregiver stress. Currently, the extent to which the pandemic impacted the mental health of clinically referred young children is unknown. To evaluate how children's mental health outcomes were impacted during the pandemic, interRAI Early Years assessments (N = 1343) were obtained from 11 agencies across the Province of Ontario, during pre-pandemic and pandemic timepoints. Findings demonstrated that the number of completed assessments declined during the pandemic. Further, children's emotional concerns differed before and during the pandemic, whereby children exhibited greater emotional dysregulation during the pandemic. However, there were no significant differences when examining caregiver distress, parenting strengths, child distractibility/inattention or behavioural issues. Implications for young children and their families, clinicians, and policy makers are discussed.

Paternal and Maternal Depressive Symptoms and Sensitivity: Links with Trajectories of Socioemotional Problems in Toddlerhood

Parental depressive symptoms and sensitivity have well-documented consequences for children; however, studies considering both parents are still scarce. This longitudinal study aimed to investigate the respective roles of paternal and maternal depressive symptoms and sensitivity in predicting the development of child socioemotional problems during toddlerhood. We also investigated the buffering role of each parent's sensitivity in the associations between the other parent's depressive symptoms and toddlers' socioemotional problems. The sample consisted of 140 Canadian families who were visited in their homes when children were around 13 (T1), 19 (T2), and 27 (T3) months of age. At T1, both parents' sensitivity was assessed from observations of parent-child interactions at home and each parent reported on his or her own depressive symptoms. At T1, T2, and T3, maternal and paternal perceptions of their toddler's socioemotional problems were assessed and aggregated. Growth curve analyses revealed that paternal and maternal depressive symptoms as well as paternal sensitivity were unique and persistent predictors of child socioemotional problems and that sensitive fathering acted as a buffer in the context of maternal depressive symptoms. This study highlights the importance of considering both parents when studying risk and protective factors for young children's socioemotional problems.

Maternal alcohol dependence symptoms, maternal insensitivity to children's distress, and young children's blunted emotional reactivity

Maternal insensitivity to children's emotional distress (e.g., expressions of sadness or fearfulness) is one mechanism through which maternal alcohol dependence may increase children's risk for psychopathology. Although emotion dysregulation is consistently associated with psychopathology, it remains unclear how or why alcohol dependence's effects on caregiving responses to children's distress may impact children's emotion regulation over time, particularly in ways that may engender risks for psychopathology. This study examined longitudinal associations between lifetime maternal alcohol dependence symptoms, mothers' insensitivity to children's emotional distress cues, and children's emotional reactivity among 201 mother-child dyads (Mchild age = 2.14 years; 56% Black; 11% Latino). Structural equation modeling analyses revealed a significant mediational pathway such that maternal alcohol dependence predicted increases in mothers' insensitivity to children's emotional distress across a one-year period (β = .16, p = .013), which subsequently predicted decreases in children's emotional reactivity one year later (β = -.29, p = .009). Results suggest that mothers with alcohol dependence symptoms may struggle to sensitively respond to children's emotional distress, which may prompt children to suppress or hide their emotions as an adaptive, protective strategy. The potential developmental benefits and consequences of early, protective expressive suppression strategies are discussed via developmental psychopathology frameworks.

Future-oriented cognition: links to mental health problems and mental wellbeing in preschool-aged and primary-school-aged children

Future-oriented cognition plays a manifold role for adults' mental health. The present study aimed to investigate the relationship between future-oriented cognition and mental health in N = 191 children aged between 3 and 7 years. Parents completed an online-questionnaire including children's future-oriented cognition (e.g., episodic foresight; Children Future Thinking Questionnaire; CFTQ), children's mental health problems (Strengths and Difficulties Questionnaire; SDQ), and wellbeing (Parent-rated Life Orientation Test of children; PLOT and Positive-Mental-Health Scale; PMH). More externalizing problems (especially hyperactivity) related to lower future-oriented cognition. For mental wellbeing, higher levels of optimism were associated with higher episodic foresight. Future-oriented cognition increased with age cross-sectionally. This increase was flatter at higher levels of wellbeing (indicated by lower pessimism). Results are discussed considering findings on the role of future-oriented cognition for mental health in adults and adolescents. Suggestions for future work are presented regarding the direction of the observed links and underlying mechanisms.

Conditions of Birth and Early Childhood Developmental Risk for Mental Disorders

Distinct classes of children in the general population are at increased odds of later mental illness and other adverse outcomes according to patterns of early childhood developmental vulnerability. If certain risk factors known at the time of birth are reliably associated with membership in early childhood risk classes, then preventative interventions could be initiated in the earliest years of life. Associations between 14 factors known at the time of birth and membership in early childhood risk classes were examined in 66,464 children. Risk class membership was associated with maternal mental illness, parental criminal charges and being male; distinct patterns of association were shown for some conditions, for example, prenatal child protection notification was uniquely associated with misconduct risk'. These findings suggest that risk factors known at the time of birth could assist in very early detection of children who may benefit from early intervention in the first 2000 days.

Building Emotional Awareness and Mental Health (BEAM): an open-pilot and feasibility study of a digital mental health and parenting intervention for mothers of infants

BACKGROUND

Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care.

METHODS

To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6-17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys.

RESULTS

The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen's d = .93).

DISCUSSION

This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants.

TRIAL REGISTRATION

NCT04772677 . Registered on February 26 2021.

Social, Community, and Cultural Factors Associated with Parental Stress in Fathers and Mothers

Parenting stress is a key factor in predicting the quality of parent−child relationships and child development outcomes. Previous research tends to focus on examining individual factors contributing to parental stress, with minimal attention to other important contextual factors that may affect parenting. This study examines the issue from a broader ecological perspective by investigating social, cultural, and community factors associated with parental stress in a community sample of economically active fathers and mothers in Hong Kong. A secondary analysis was conducted using the data from the 2017 Family Survey, a territory-wide household survey conducted in Hong Kong. The data of the current study included a sub-sample of 736 working-class parents (48.4% males and 51.6% females). The mean age of fathers and mothers was 50.99 (SD = 11.2) and 48.68 (SD = 10.34) years, respectively. Mothers reported significantly higher levels of parental stress than fathers, t = −4.241, p < 0.001. Different social, cultural, and community factors were associated with parental stress for fathers and mothers. Strong endorsement of traditional family values (B = −0.23, p = 0.032) and frequent practice of filial piety (B = −0.005, p = 0.019) reduced parental stress in fathers. Additionally, fathers who perceived formal support as effective scored higher levels of parental stress, B = 0.20, p < 0.001. For mothers, informal social support from family members was the only social predictor for reduced parental stress (B = −0.14, p < 0.001) among all the other contextual variables. Community support to reduce parental stress in working parents should address the respective risk factors for fathers and mothers.

Couple's Relationship during the Transition to Parenthood and Toddler's Emotional and Behavioral Problems

The literature has mainly focused on the impact of the negative aspects of the couple's relationship on the toddler's internalizing and externalizing problems. This study explored the impact of the positive and negative dimensions of the couple's relationship during the transition to parenthood on toddlers' psychological adjustment, considering the concurrent impact of the couple's relationship at 30 months postpartum. The sample comprised 115 mothers and fathers (N = 230) recruited during the 1st trimester of pregnancy. The mothers and fathers individually completed a measure of the couple's relationship (Relationship Questionnaire) during the first trimester of pregnancy, at 3 and 30 months postpartum, and the Child Behavior Checklist 1.5-5 at 30 months postpartum. Multiple linear regressions, cluster analyses, and univariate and multivariate analyses of variance were conducted. The positive dimension at the 1st trimester of pregnancy and the negative dimension of the couple's relationship at 3 months postpartum were the strongest predictors of the toddler's internalizing problems, while the negative dimension at 3 months postpartum and the positive dimension of the couple's relationship at 30 months postpartum were the strongest predictors of the toddler's externalizing problems. Two patterns of the couple's relationship (adjusted vs. non-adjusted) during the transition to parenthood were identified. Higher levels of internalizing and externalizing problems were found in toddlers from couples with a non-adjusted couple's relationship. Findings suggested the impact of both positive and negative dimensions of the couple's relationship during the transition to parenthood on the toddler's emotional and behavioral problems. Promoting the couple's relationship adjustment during the transition to parenthood can help to prevent toddlers' emotional and behavioral problems.

Paternal mind-mindedness and infant-toddler social-emotional problems

A growing body of evidence suggests that paternal behaviors are influential in child development. However, few studies have focused on paternal mind-mindedness, that is, the tendency of fathers to view their child as having mental agency, which is manifested as a propensity to name the child's mental states while they are interacting with the child. The purpose of this study was to better understand the role of paternal mind-mindedness in the development of social-emotional problems during infancy. 131 families (father-mother-child) were recruited from the community and assessed when children were 6, 12, and 18 months old. Paternal and maternal mind-mindedness was assessed through observation of father-child and mother-child dyads at 6 months. Children's social-emotional problems were measured with a questionnaire completed by both parents at 12 and 18 months. Results indicate that maternal mind-mindedness at 6 months predicts fewer social-emotional problems at 12 months, while fathers' mind-mindedness at 6 months predicts fewer social-emotional problems at 18 months. This study highlights the unique contribution of paternal mind-mindedness to children's early social-emotional development.

Cumulative risk, infant sleep, and infant social-emotional development

The effect of cumulative biological, psychosocial, and demographic risk and infant sleep on infant social-emotional functioning in 12-month-old infants (46% female) was examined in data from racially (30% Black, 60% White, 10% multiracial/other) and socioeconomically (41% below median income) diverse caregivers (N = 468, M = 30.42 years old, SD = 5.65) recruited from two midwestern states in 2019-2020. Due to the major changes in sleep patterns during infancy and the reported association between sleep and social-emotional functioning, this study also examined whether sleep moderates the association between risk and infant social-emotional functioning and potentially promotes healthy social-emotional functioning despite risk. Greater cumulative risk was associated with poorer sleep efficiency and more social-emotional problems, but was not associated with the general acquisition of social-emotional milestones. Results also suggested that poorer sleep efficiency was associated with more social-emotional problems and poorer social-emotional milestone acquisition. No significant interaction effects were found between cumulative risk and infant sleep. Risk and sleep appear to have unique associations with infant social-emotional problems and development; thus both could be targeted in early intervention to promote social-emotional functioning during infancy and early childhood.

Assisted Conception Socialization Self-Efficacy Among Israeli Lesbian, Gay, and Heterosexual Parent Families and its Association with Child Externalizing Problems

This questionnaire-based study compared 36 Israeli lesbian mother families (n = 72 lesbian mothers) formed by donor insemination, 39 Israeli gay father families (n = 78 gay fathers) formed by gestational surrogacy, and 36 Israeli heterosexual parent families (n = 72 heterosexual parents) formed by assisted reproduction (without donated gametes), all with a target child aged 3-10 years. The families were examined for parents' assisted conception socialization self-efficacy, depression, negative and positive affect, life satisfaction, positivity, resilience, social support, and child externalizing problems. Multiple factors associated with child externalizing problems were also examined. Multilevel modeling analyses indicated that parents' assisted conception socialization self-efficacy did not differ between family groups; however, lesbian mothers and gay fathers reported fewer child externalizing problems and greater social support, relative to heterosexual parents. Also, lesbian mothers-but not gay fathers-reported lower levels of depression, greater life satisfaction, and more positivity than did heterosexual parents. Finally, irrespective of family type, greater assisted conception socialization self-efficacy was associated with fewer parent-reported child externalizing problems. Findings are interpreted in light of the cultural socialization framework and Israel's familistic and pronatalist environment. Implications for health professionals, educators, and policymakers working with diverse family forms are discussed.

Progression of externalizing disorders into anxiety disorders: Longitudinal transitions in the first three decades of life

BACKGROUND

There is a notable comorbidity between externalizing disorders and anxiety disorders, which may be explained by the co-occurrence of two prevalent early-onset disorders, by shared vulnerability and risk factors, or as evidence that one disorder group might be causally related to the other.

AIM

To investigate the longitudinal trajectories of externalizing disorders, their interplay with anxiety disorders, and putative predictors for symptom progression in youth.

METHODS

1053 adolescents (14-17 years) from the general population were assessed at baseline and prospectively at 2, 4, and 10-year follow-up using a standardized interview of mental disorders (DIA-X/M-CIDI) to assess "early" (oppositional-defiant disorder, conduct disorder, ADHD) and "late" (antisocial behavior, substance use disorders) externalizing disorders as well as anxiety disorders. Longitudinal associations and predictors for symptom progression were examined using Kaplan-Meier-analyses.

RESULTS

Lifetime prevalence of early externalizing disorders were 9.1% and 6.4% among those with and without any anxiety disorder. A late externalizing disorder was reported by 50.3% of those with an early externalizing disorder and in 26.6% of those with any anxiety disorder. Both early (HR: 1.5, 95%CI: 1.0-2.3) and late externalizing disorders (HR: 2.1, 95%CI: 1.7-2.6) were associated with incident anxiety disorders. Higher parental rejection, lower volitional inhibition, and higher volitional avoidance predicted incident anxiety disorders among those with early externalizing disorders.

DISCUSSION

Early externalizing disorders likely follow a homotypic continuity (to late externalizing disorders) and/or a heterotypic continuity to anxiety disorders, and thus appear as a useful target for prevention and early intervention.

Parenting Stress and Child Externalizing and Internalizing Problems Among Low-Income Families: Exploring Transactional Associations

Although the association between parenting stress and child behavioral outcomes is well established (Deater-Deckard, Clin Psychol 5:314-332, 1998), longitudinal research examining the direction of these effects is limited. This study examined transactional associations between parenting stress and child externalizing and internalizing behaviors among 1209 low-income female caregivers (M_age = 34.51) with children in early childhood or early adolescence (i.e., either 2- to 5-years-olds or 9- to 15-year-olds at Time 1) across a 6 year time span using three time points. Parent-driven associations between parenting stress and child internalizing problems for the early childhood group were found. In the early adolescent group, transactional and child-driven associations were found between parenting stress and child externalizing problems, but only child-driven associations for internalizing problems. Thus, transactional associations were only supported for the early adolescent group. These findings suggest developmental differences in how parenting stress and child behavioral problems are linked among low-income families. Clinical implications are discussed.

Adverse childhood experiences predict neurite density differences in young children with and without attention deficit hyperactivity disorder

Adverse childhood experiences (ACEs) put millions of children at risk for later health problems. As childhood represents a critical developmental period, it is important to understand how ACEs impact brain development in young children. In addition, children with attention-deficit/hyperactivity disorder (ADHD) are more likely than typically developing (TD) peers to experience ACEs. Therefore, the current study examined the impact of ACEs on early brain development, using a cumulative risk approach, in a large sample of children with and without ADHD. We examined 198 young children (M_age  = 5.45, 82.3% Hispanic/Latino; 52.5% ADHD) across measures of brain volume, cortical thickness, neurite density index (NDI), and orientation dispersion index (ODI). For the NDI measure, there was a significant interaction between group and cumulative risk (ß = .18, p = .048), such that for children with ADHD, but not TD children, greater cumulate risk was associated with increased NDI in corpus callosum. No other interactions were detected. Additionally, when examining across groups, greater cumulative risk was associated with reduced ODI and volume in the cerebellum, although these findings did not survive a correction for multiple comparisons. Our results highlight the role early cumulative ACEs play in brain development across TD and children with ADHD.

Parenting Stress and Related Factors of Parents in Self-Support Groups

Objectives: The aim of this study was to evaluate the relationship between positive and negative effects of participating in self support group, attitudes towards self support group, parenting efficacy, and parenting stress among parents with preschool children by using structural equation modeling.Methods: The participants in this study were parents in Gyeonggido with at least one preschool child who participated in self-support groups. The number of participants was 495. The data were collected using an online survey, and structural equation modeling was employed to investigate significant factors related to parenting stress among parents in self-support groups. IBM SPSS 25.0 and AMOS 21.0 were used in this study to conduct statistical analysis.Results: First, attitudes toward self-support group had no direct effect on parenting efficacy and parenting stress. Second, negative effects of self-support group had a significant direct effect on parenting stress. Parenting efficacy had also a direct effect on parenting stress. Finally, through parenting efficacy, the positive effects of self-support group had both direct and indirect effects on parenting stress. Parents who perceived the self-support group as having a higher level of positive impact reported higher parenting efficacy and they were less likely to experience parenting stress.Conclusion: This study examined the mediation effect of parenting efficacy in relations between related factors of self support group(parents’ attitudes and perceived effects) and parenting stress. Individuals’ perceptions of the positive and negative effects of participating in self-support groups, rather than the circumstances of group activities, are highlighted in this study.

A brief video-coaching intervention buffers young children's vulnerability to the impact of caregivers’ depressive symptoms: Examination of differential susceptibility

Informed by the National Institute of Mental Health's Research Domain Criteria (RDoC) and developmental psychopathology frameworks, the current study used cortisol area under the curve with respect to ground (AUCg) as an index of differential sensitivity to context, which was expected to predispose young children with elevated vulnerability to adverse caregiving experiences and adaptive sensitivity to intervention effects. Particularly, the study aimed to determine whether improving caregivers’ responsive parenting through the Filming Interactions to Nurture Development (FIND) intervention would buffer children's biologically embedded vulnerability to caregivers’ depressive symptoms. Data were derived from a randomized controlled trial using pretest–posttest design with low-income families of children aged 4 to 36 months (N = 91). Young children's differential sensitivity was measured using cortisol AUCg during a structured stress paradigm. As hypothesized, children whose cortisol AUCg indicated greater sensitivity to social context exhibited more internalizing and externalizing behaviors in relation to caregivers’ elevated depressive symptoms. Critically, the intervention program was effective in attenuating psychopathology symptoms among the more biologically sensitive children. As proven by rigorous statistical tests, the findings of this study partially supported the differential susceptibility hypotheses, indicating both greater vulnerability to adverse conditions and responsiveness to intervention among children with high levels of cortisol AUCg.

Interplay between Prepregnancy Body Mass Index, Early Childhood Negative Temperament, and Slowness in Eating on Early Childhood Rapid Weight Gain

Background: Early childhood eating behaviors and temperament have been linked to excess weight gain in separate lines of research. However, the interplay among these variables along with maternal prepregnancy body mass index (BMI) in predicting rapid weight gain is poorly understood. Methods: This observational study tested superfactors of early childhood temperament using the Infant Behavior Questionnaire-Revised, and their relationships with eating behavior using the Baby Eating Behavior Questionnaire on rapid weight gain among 9-18 months children (n = 283). The bivariate relationships were evaluated using Pearson correlations. Two-way interactions assessed whether childhood temperament moderated the relationship between childhood eating behaviors and rapid weight gain, with prepregnancy BMI as a higher order moderator. Results: Food responsiveness positively correlated with Negativity [r = 0.256, adjusted (adj) p < 0.001] and inversely with Regulation (r = -0.203, adj p = 0.006). Slowness in eating positively correlated with Negativity (r = 0.196, p = 0.006) and inversely with Surgency (r = -0.188, adj p = 0.008) and Regulation (r = -0.181, p = 0.007). Slowness in eating was significantly correlated with rapid weight gain (r = -0.168, p = 0.005). Prepregnancy BMI was a moderator of slowness in eating and Negativity such that children of mothers with high prepregnancy BMI in conjunction with high Negativity and low in slowness in eating experienced the greatest rapid weight gain, whereas children of mothers with low prepregnancy BMI in conjunction with low Negativity and high in slowness in eating experienced the least rapid weight gain. Conclusions: Assessing early childhood temperament may bolster health care and parenting interventions to increase early eating regulation and to promote healthier weight trajectories.

Longitudinal transactional relationships between caregiver and child mental health during the COVID-19 global pandemic

BACKGROUND

Emerging work examining the psychological impact of COVID-19 on children and families suggests that the relationship between pandemic-related stress, child psychosocial functioning, and caregiver mental health are interrelated. However, much of this research is unidirectional and thus little is known about the bidirectional cascading effects children and caregivers may experience. The current study examined the transactional relationships between caregiver and child mental health over time during the COVID-19 pandemic.

METHODS

Linguistically, racially, and ethnically diverse caregivers (N = 286) of young children completed measures of caregiver mental health, caregiver pandemic-related stress, and child mental health (i.e., externalizing, internalizing, prosocial behavior) across three time points in the spring of 2020.

RESULTS

Using autoregressive cross-lagged analyses, impaired caregiver mental health at Time 1 (April 2020) predicted increased caregiver pandemic-related stress at Time 2 (May 2020). Caregiver pandemic-related stress at Time 1 predicted increased child internalizing symptoms at Time 2 which, in turn, predicted increased caregiver pandemic-related stress at Time 3 (July 2020). Lastly, impaired caregiver mental health at Time 2 (May 2020) predicted increased child externalizing symptoms at Time 3 (July 2020).

CONCLUSIONS

Assessing transactional relationships between child and caregiver mental health during the COVID-19 pandemic is important to inform models of risk and resilience. Interventions at the level of the caregiver, the child, and/or the family should be considered as a way to interrupt potential negative developmental cascades.

Communication skills predict social-emotional competencies

INTRODUCTION

Studies have shown that many children with early language difficulties also have delays in social-emotional competencies as well as social-emotional and behavioral problems. It is unclear if these conditions are causally related, if they share a common underlying etiology, or if there are bidirectional effects. Studies investigating these associations have mostly involved children who are already using words to communicate, but it is important to know whether delays in preverbal communication and language development have any effects on these associations. The aim of the present study was to examine associations between preverbal communication and early verbal skills in infancy and subsequent social-emotional competencies and ensuing social-emotional and behavioral problems in early toddlerhood. The role of background factors known to influence early language development was also examined.

METHODS

The sample consisted of 395 children (51.6% boys) from the Finnish Steps Study cohort. Language was assessed at age 13 months (+ 1 month) with the MacArthur Communicative Development Inventory for Infants (CDI-I), and the social-emotional domain was assessed at age < 17 months with the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

RESULTS

Infants with lower preverbal gestural communication and receptive language skills had a higher risk of delays in social-emotional competencies in toddlerhood than children with better communication skills, but not of elevated social-emotional and behavioral problems.

CONCLUSIONS

The results indicate that lower early communication skills can predict delays in the development of social-emotional competencies, which has been found to be a risk factor for later development of social-emotional and behavioral problems. It is important to monitor early communication skills to provide guidance to parents in supporting early pragmatic communication and language development in infancy, if needed.

Cultural contributors to negative emotionality: A multilevel analysis from the Joint Effort Toddler Temperament Consortium

This study advances the cross-cultural temperament literature by comparing temperament ratings of toddlers from 14 nations. Multilevel modeling (MLM) procedures were utilized to regress negative emotionality (NE) and component subscales on Hofstede’s cultural value dimensions while controlling for age and gender. More individualistic values were associated with lower NE, and component discomfort, fear, motor activity, perceptual sensitivity, and soothability scales. The discomfort subscale was negatively associated with power distance and positively associated with masculine cultural values. Higher ratings of shyness were related to a more long-term cultural orientation. Results illustrate the feasibility of an MLM approach to cross-cultural research and provide a new perspective on the intersection of culture and temperament development. Limitations and future implications are discussed.

Parenting Stress and its Associated Components Prior to an Autism Spectrum Disorder (ASD) Diagnostic Evaluation

Parents of children with autism spectrum disorder (ASD) show increased levels of parenting stress, but only one study has examined this association before a diagnostic evaluation. We conducted a cross-sectional study of parenting stress in 317 low SES parents with children at-risk for ASD before a diagnostic evaluation. Multiple regression modeling evaluated the associations between parenting stress and parent and child factors. Parenting stress was negatively associated with social support and positively associated with active avoidance coping and parental worry. However, parenting stress was not associated with the child's ASD symptom severity or adaptive functioning, except for self-direction. Findings suggest parenting stress among parents of children at risk of ASD should be assessed prior to diagnosis.

iCCareD: The Development of an Algorithm to Identify Factors Associated With Distress Among Caregivers of Children and Youth Referred for Mental Health Services

Caregiver well-being plays an important role in children's development and a number of factors have been found to impact distress levels among caregivers of children and youth referred for mental health services. Further, caregiver distress impacts youth psychopathology, its acuity as well as related mental health interventions. The purpose of this study was to develop and validate an algorithm for identifying caregivers who are at greatest risk of experiencing caregiver distress. This algorithm was derived from, and will be embedded in, existing comprehensive interRAI child and youth instruments. Ontario data based on the interRAI Child and Youth Mental Health assessment instruments (ChYMH and ChYMH-DD) were analyzed to identify predictors of distress among caregivers of children and youth ages 4-18 years. Starting with proactive aggression, the algorithm uses 40 assessment items to assign one of 30 nodes that are grouped into five levels of risk. The interRAI ChYMH Caregiver Distress (iCCareD) algorithm was validated using longitudinal data from mental health agencies across Ontario and was found to be a good predictor among this sample with a c-statistic of 0.71 for predicting new or ongoing caregiver distress and 65% for both sensitivity and specificity using algorithm values of 3 or greater. This algorithm provides an evidence-based decision-support tool embedded within a comprehensive assessment tool that may be used by clinicians to inform their selection of supports and services for families.

Understanding pathways to inequalities in child mental health: a counterfactual mediation analysis in two national birth cohorts in the UK and Denmark

OBJECTIVES

We assessed social inequalities in child mental health problems (MHPs) and how they are mediated by perinatal factors, childhood illness and maternal mental health in two national birth cohorts.

DESIGN

Longitudinal cohort study SETTING: We used data from the UK Millennium Cohort Study and the Danish National Birth Cohort.

PRIMARY AND SECONDARY OUTCOME MEASURES

We applied causal mediation analysis to longitudinal cohort data. Socioeconomic conditions (SECs) at birth were measured by maternal education. Our outcome was child MHPs measured by the Strength and Difficulty Questionnaire at age 11. We estimated natural direct, indirect and total effects (TEs) of SECs on MHPs. We calculated the proportion mediated (PM) via three blocks of mediators-perinatal factors (smoking/alcohol use during pregnancy, birth weight and gestational age), childhood illness and maternal mental health.

RESULTS

At age 11 years, 9% of children in the UK and 3.8% in Denmark had MHPs. Compared with high SECs, children in low SECs had a higher risk of MHPs (relative risk (RR)=4.3, 95% CI 3.3 to 5.5 in the UK, n=13 112; and RR=6.2, 95% CI 4.9 to 7.8 in Denmark, n=35 764). In the UK, perinatal factors mediated 10.2% (95% CI 4.5 to 15.9) of the TE, and adding maternal mental health tripled the PM to 32.2% (95% CI 25.4 to 39.1). In Denmark, perinatal factors mediated 16.5% (95% CI 11.9 to 21.1) of the TE, and including maternal mental health increased the PM to 16.9% (95% CI 11.2 to 22.6). Adding childhood illness made little difference in either country.

CONCLUSION

Social inequalities in child mental health are partially explained by perinatal factors in the UK and Denmark. Maternal mental health partially explained inequalities in the UK but not in Denmark.

Testing the Effects of COVID-19 Confinement in Spanish Children: The Role of Parents' Distress, Emotional Problems and Specific Parenting

The present study aimed to examine the effects of the Spanish confinement derived from the COVID-19 crisis on children and their families, accounting for child's age. A range of child negative (e.g., conduct problems) and positive outcomes (e.g., routine maintenance) were examined, along with a set of parent-related variables, including resilience, perceived distress, emotional problems, parenting distress and specific parenting practices (e.g., structured or avoidant parenting), which were modeled through path analysis to better understand child adjustment. Data were collected in April 2020, with information for the present study provided by 940 (89.6%) mothers, 102 (9.7%) fathers and 7 (0.7%) different caregivers, who informed on 1049 Spanish children (50.4% girls) aged 3 to 12 years (M_age = 7.29; SD = 2.39). The results suggested that, according to parents' information, most children did not show important changes in behavior, although some increasing rates were observed for both negative and positive outcomes. Child adjustment was influenced by a chain of effects, derived from parents' perceived distress and emotional response to the COVID-19 crisis, via parenting distress and specific parenting practices. While parenting distress in particular triggered child negative outcomes, specific parenting practices were more closely related to child positive outcomes. These findings may help to better inform, for potential future outbreaks, effective guidelines and prevention programs aimed at promoting the child's well-being in the family.

Testing the Effects of COVID-19 Confinement in Spanish Children: The Role of Parents' Distress, Emotional Problems and Specific Parenting

The present study aimed to examine the effects of the Spanish confinement derived from the COVID-19 crisis on children and their families, accounting for child's age. A range of child negative (e.g., conduct problems) and positive outcomes (e.g., routine maintenance) were examined, along with a set of parent-related variables, including resilience, perceived distress, emotional problems, parenting distress and specific parenting practices (e.g., structured or avoidant parenting), which were modeled through path analysis to better understand child adjustment. Data were collected in April 2020, with information for the present study provided by 940 (89.6%) mothers, 102 (9.7%) fathers and 7 (0.7%) different caregivers, who informed on 1049 Spanish children (50.4% girls) aged 3 to 12 years (Mage = 7.29; SD = 2.39). The results suggested that, according to parents' information, most children did not show important changes in behavior, although some increasing rates were observed for both negative and positive outcomes. Child adjustment was influenced by a chain of effects, derived from parents' perceived distress and emotional response to the COVID-19 crisis, via parenting distress and specific parenting practices. While parenting distress in particular triggered child negative outcomes, specific parenting practices were more closely related to child positive outcomes. These findings may help to better inform, for potential future outbreaks, effective guidelines and prevention programs aimed at promoting the child's well-being in the family.

Ecological contributions to maternal-infant functioning: Differences between rural and urban family contexts

AIMS

This study considered urban-rural differences in maternal-infant interactions (sensitivity/responsiveness and synchrony/reciprocity), infant temperament, and parenting stress, for samples similar in socioeconomic and racial composition. Higher sensitivity/responsiveness and synchrony/reciprocity were hypothesized for urban dyads, with more challenging temperament profiles predicted for rural infants. Rural mothers were expected to report more parenting-role stress.

METHODS

Urban (n = 68; San Francisco Bay) and rural (n = 120; inland Pacific Northwest) mothers of infants provided ratings of temperament and parenting stress. Parental sensitivity/responsiveness and synchrony/reciprocity were coded from mother-infant play observations. Groups were compared via analyses of covariance.

RESULTS

Urban mothers demonstrated significantly more sensitivity/responsiveness and synchrony/reciprocity compared to their rural counterparts. Rural mothers rated their infants significantly higher in negative affectivity and distress in response to limitations.

CONCLUSION

Although socioeconomic status is traditionally implicated in rural and urban population differences, our results suggest other factors (e.g., isolation, access to resources) warrant further exploration. Rural ecology appears to present risk that should be examined more closely in maternal-infant interactions and child social-emotional development. The variability of risk within urban and rural classifications (e.g., suburban, inner-city) also requires consideration.

[Influence of genetic and environment factors on aggressive behavior in twin children]

OBJECTIVE

To investigate the influence of genetic and environmental factors on aggressive behavior in twin children, and to provide clues for further exploring the causal relationship between such factors and aggressive behavior.

METHODS

A questionnaire was used to investigate aggressive behavior, temperament type and parenting style among 261 twin children aged 4-12.8 years. The Holzinger method and the maximum likelihood method were used to construct a structural equation model for the estimation of heritability. Binary logistic regression analysis, multivariate linear regression analysis and general linear model analysis were used to analyze the association between aggressive behavior and environmental factors in twin children.

RESULTS

The heritability of aggressive behavior was 44.4% in twin children and the score of aggressive behavior showed moderate heritability (60.9% in boys and 65.6% in girls). The multivariate analysis showed that the score of aggressive behavior in twin children was affected by the mother's emotional warmth/understanding, the mother's punishment/severity and the father's overprotection (P<0.05). There was an interaction between the mother's emotional warmth/understanding and the father's overprotection (P<0.05).

CONCLUSIONS

Both genetic and environmental factors have influence on children's aggressive behavior, and parenting style is the main environmental factor affecting the aggressive behavior of twin children.

How do early-life factors explain social inequalities in adolescent mental health? Findings from the UK Millennium Cohort Study

BACKGROUND

Reducing inequalities in adolescent mental health is a public health priority, yet the pathways that link social conditions to mental health outcomes in the early years are unclear. We aimed to evaluate the extent to which early years risk factors explain social inequalities in adolescent mental health in the UK.

METHODS

We analysed data from 6509 children captured in the UK Millennium Cohort Study. Mental health was assessed through the socioemotional behavioural problems at age 14 (Strengths and Difficulties Questionnaire). The main exposure was maternal education at birth, used as a measure of childhood socioeconomic conditions (SECs), and used to calculate the relative index of inequality. Using causal mediation analysis, we assessed how perinatal, individual child, family, peer relation and neighbourhood-level factors measured up to age 3-mediated the total effect (TE) of SECs on adolescent socioemotional behavioural problems, estimating the proportion mediated and natural indirect effect (NIE) via each block of mediators, and all mediators together.

RESULTS

Children of mothers with no qualification were almost four times as likely to have socioemotional behavioural problems compared with degree plus level (relative risk (RR) 3.82, 95% CI 2.48 to 5.88). Overall, 63.9% (95% CI 50.2% to 77.6%) (NIE RR 1.97, 95% CI 1.63 to 2.37) of the TE (RR 4.40, 95% CI 3.18 to 6.07) of social inequalities on risk of adolescent socioemotional behavioural problems was mediated by early-life factors.

CONCLUSIONS

About two-thirds of the social inequality in adolescent mental health was explained by early risk factors measured by age 3, highlighting the importance of public health interventions in this period.

How does perinatal maternal mental health explain early social inequalities in child behavioural and emotional problems? Findings from the Wirral Child Health and Development Study

BACKGROUND

This study aimed to assess how maternal mental health mediates the association between childhood socio-economic conditions at birth and subsequent child behavioural and emotional problem scores.

METHODS

Analysis of the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological longitudinal study of the early origins of child mental health (n = 664). Household income at 20-weeks gestation, a measure of socio-economic conditions (SECs) in pregnancy, was the main exposure. The outcome measure was externalising and internalising problems, as measured by the Child Behaviour Checklist at 5 years. We assessed the association of household income with child behavioural outcomes in sequential linear models adjusting for maternal mental health in the pre- and post- natal period.

RESULTS

Children of mothers in more disadvantaged households had higher scores for externalising behaviour with a difference of 3.6 points comparing the most affluent to the most disadvantaged families (the socio-economic (SEC) gap). In our regression model adjusting for baseline confounders, comparing children of mothers in the most disadvantaged households to the least disadvantaged, we found that most disadvantaged children scored 45 percentage points (95% CI 9, 93) higher for externalising problems, and 42% of this difference was explained in the fully adjusted model. Adjusting for prenatal maternal depressive symptomology attenuated the SEC gap in externalising problems by about a third, rendering the association non-significant, whilst adjusting for pre- and post-natal maternal mental health attenuated the SEC gap by 42%. There was no significant relationship between household income and internalising problems.

CONCLUSION

Social disadvantage is associated with higher child externalising behaviour problems score at age 5, and about 40% of this was explained by maternal perinatal mental health. Policies supporting maternal mental health in pregnancy are important to address the early emergence of inequalities in child mental health.

Maternal depression: A major risk factor for psychosocial wellbeing among preschoolers

This study aims to determine the prevalence of behavioural problems among preschoolers and their association with maternal depression. A cross-sectional study was carried out in three districts of Sindh province of Pakistan. Mothers were interviewed by using a structured questionnaire during household survey. Total 1566 children were assessed on Strength and Difficulty Questionnaire while mother was inquired about her mental health by using Aga Khan Anxiety and Depression Scale (AKUADS). Almost 23% children were rated as abnormal and 23.5% as borderline by their mother on SDQ scale. 21.5% mothers were found depressed. Maternal depression was found to be highly significant association with childhood behavioural problems (OR for borderline behavioural problems = 1.30, CI: 0.96-1.76; OR for abnormal behaviour = 2.04, CI: 1.53-2.71). The OR did not change significantly when adjusted for child's gender or age or both. Maternal depression was found to be a significant risk factor for childhood psychosocial wellbeing and behavioural problems.

Family and Environmental Influences on Child Behavioral Health: The Role of Neighborhood Disorder and Adverse Childhood Experiences

OBJECTIVE

The Adverse Childhood Experiences study suggests childhood adversity is a "root" origin for health and human development. Newer research is examining the more immediate impact of adverse childhood experiences (ACEs) on child development and the impact of neighborhood environment on the likelihood of and prevention ACEs. The extent to which all of these aspects of the child context fit together remains unclear. The current study seeks to fill this gap examining the precursors for ACEs and the multitude of ways in which a child's home life can impact his or her development.

METHODS

Using data from 3001 mothers of children in the Fragile Families and Child Wellbeing Study, this study investigates the relationship between neighborhood disorder, ACEs, and child behavioral health. Using a path analysis, the direct and indirect relations between neighborhood disorder and child behavioral health are estimated, with ACEs as the key mediator.

RESULTS

The most common ACE in our study was intimate partner violence (IPV), followed by child emotional abuse. Neighborhood disorder is associated with higher levels of ACEs and is both directly and indirectly (through its relation with ACEs) negatively related to child behavioral health.

CONCLUSION

Screening for ACEs for children living in disordered neighborhoods may help reduce those experiences and their impacts in this high-risk population. Preventive interventions related to IPV and child emotional abuse may be especially helpful.

Examining pathways linking maternal depressive symptoms in infancy to children's behavior problems: The role of maternal unresponsiveness and negative behaviors

The extent to which maternal depressive symptoms in the first 6 months of life is linked with internalizing and externalizing behaviors in childhood through specific insensitive maternal behaviors (unresponsive and overtly negative behaviors) was examined in a sample of 259 mother-infant dyads. In addition, the extent to which these paths were moderated by infant negative emotionality was also examined. Maternal depressive symptoms were assessed prenatally and when infants were 6 months and 2 years old. Maternal unresponsive and overtly negative behaviors and infant negative emotionality were observed when infants were 6 months old. Mothers reported on infant's internalizing and externalizing behaviors when infants were 2 years old. Maternal depressive symptoms were directly associated with higher internalizing behaviors; this path was not mediated by maternal behaviors. Depressive symptoms were unrelated to externalizing symptoms. Infant negative emotionality did not moderate these effects, but was related positively to overtly negative maternal behaviors, and temperament interacted with maternal depressive symptoms to predict unresponsive maternal behaviors. Results suggest that early maternal depressive symptoms, infant negative emotionality, and negative maternal behavior pose risk for infants' later internalizing behaviors, but the proposed moderated mediation model was not supported.

Behavioral Risk Assessment From Newborn to Preschool: The Value of Older Siblings

OBJECTIVES

The aim of this study was to examine the plausibility of a risk prediction tool in infancy for school-entry emotional and behavioral problems. Familial aggregation has been operationalized previously as maternal psychopathology. The hypothesis was tested that older sibling (OS) psychopathology, as an indicator of familial aggregation, would enable a fair level of risk prediction compared with previous research, when combined with traditional risk factors.

METHODS

By using a longitudinal design, data on child and family risk factors were collected on 323 infants (M = 2.00 months), all of whom had OSs. Infants were followed up 4.5 years later when both parents provided ratings of emotional and behavioral problems. Multiple regression and receiver operating characteristic curve analyses were conducted for emotional, conduct, and attention problems separately.

RESULTS

The emotional and behavioral problems of OSs at infancy were the strongest predictors of the same problems in target children 4.5 years later. Other risk factors, including maternal depression and socioeconomic status provided extra, but weak, significant prediction. The area under the receiver operating characteristic curve for emotional and conduct problems yielded a fair prediction.

CONCLUSIONS

This study is the first to offer a fair degree of prediction from risk factors at birth to school-entry emotional and behavioral problems. This degree of prediction was achieved with the inclusion of the emotional and behavioral problems of OSs (thus limiting generalizability to children with OSs). The inclusion of OS psychopathology raises risk prediction to a fair level.

Do child healthcare professionals and parents recognize social-emotional and behavioral problems in 1-year-old infants?

Growing evidence supports the existence of clinically significant social-emotional/behavioral (SEB) problems among as young as 1-year-old infants. However, a substantial proportion of early SEB problems remain unidentified during contacts with child healthcare professionals. In this study, child healthcare nurse (CHCN; N = 1008) and parental (N = 518) reports about SEB worries were gathered, along with the maternal and paternal Brief Infant-Toddler Social and Emotional Assessment (BITSEA) ratings, for 12-month-old infants randomly recruited through Finnish child health centers. Only 1.4-1.8 % of CHCNs, 3.9 % of mothers, and 3.2 % of fathers reported of being worried about the assessed child's SEB development. When the CHCNs' and parental reports were combined, 7.7 % (33/428) of the infants assessed each by all three adults had one (7.0 %), two (0.7 %) or three (0 %) worry reports. Even the combination of the CHCN's and parental worry reports identified only 7.0-13.8 % of the infants with the maternal and/or paternal BITSEA Problem or Competence rating in the of-concern range. Identified associations across the three informants' worry reports, parental BITSEA ratings and sociodemographic factors are discussed in the paper. Routine and frequent use of developmentally appropriate screening measures, such as the BITSEA, might enhance identification and intervening of early SEB problems in preventive child healthcare by guiding both professionals and parents to pay more attention to substantial aspects of young children's SEB development and encouraging them to discuss possible problems and worries.

Temperament in infancy and behavioral and emotional problems at age 5.5: The EDEN mother-child cohort

OBJECTIVE

Early temperamental characteristics may influence children's developmental pathways and predict future psychopathology. However, the environmental context may also shape or interact with infant temperament and indirectly contribute to increased vulnerability to adverse developmental outcomes. The aim of the present study is to explore the long-term contribution of temperamental traits at twelve months of age to the presence of emotional and behavioral problems later in childhood, and whether this association varies with the child's sex, parental separation, family socioeconomic status and maternal depression.

METHOD

1184 mother-child pairs from the EDEN mother-child birth cohort study based in France (2003-2011), were followed from 24-28 weeks of pregnancy to the child's fifth birthday. Infant temperament at 12 months was assessed with the Emotionality Activity and Sociability (EAS) questionnaire and behavior at 5.5 years was assessed with the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

Emotional temperament in infancy predicts children's overall behavioral scores (β = 1.16, p<0.001), emotional difficulties (β = 0.30, p<0.001), conduct problems (β = 0.51, p<0.001) and symptoms of hyperactivity/inattention (β = 0.31, p = 0.01) at 5.5 years. Infants' active temperament predicts later conduct problems (β = 0.30, p = 0.02), while shyness predicts later emotional problems (β = 0.22, p = 0.04). The association between the child's temperament in infancy and later behavior did not vary with children's own or family characteristics.

CONCLUSION

An emotional temperament in infancy is associated with higher levels of emotional and behavioral difficulties at the age of 5.5 years. Children who show high emotionality early on may require early prevention and intervention efforts to divert possible adverse developmental pathways.

The Protective Role of Childcare Quality for Behavioral Adjustment in 3- to 5-Year-Old Children

Abstract. This study examined the role of childcare process quality regarding the relation between family risks and preschoolers’ social–emotional problems. The study included 24 childcare centers with 42 groups in the German-speaking part of Switzerland. The 162 children in the sample were aged 3 – 5 years. Parents and teachers completed the Strengths and Difficulties Questionnaire (SDQ-Deu). Eight family risk factors were subsumed into a cumulative risk index. Childcare process quality was assessed by various observation instruments, for example, the Infant/Toddler Environment Rating Scale-Revised (ITERS-R) and the Early Childhood Environment Rating Scale-Revised (ECERS–R). The calculated structural equation models show that high-quality teaching and interaction, and provisions for learning, can mitigate the negative effects of family risks on children’s internalizing problems. High process quality can provide the chance of considerable attention, encouragement, and new learning opportunities for children at risk; these high-quality centers thereby contribute to protective processes.

Early development in children that are later diagnosed with disorders of attention and activity: a longitudinal study in the Danish National Birth Cohort

Not much is known about the early development in children that are later diagnosed with disorders of attention and activity (ADHD). Using prospective information collected from mothers in the Danish National Birth Cohort (DNBC), we investigated if developmental deviations in the first years of life are associated with later ADHD. In the DNBC 76,286 mothers were interviewed about their child's development and behaviour at age 6 and 18 months. At the end of follow-up, when the children were 8-14 years of age, 2034 were registered in Danish health registers with a clinical diagnosis of ADHD. The Hazard Ratio of ADHD was estimated using Cox regression model. At 6 months of age deviations in development showed associations with the child later being diagnosed with ADHD such as duration of breastfeeding, motor functioning, and incessant crying. At 18 months, many observations clearly associated with ADHD as for example the child not being able to fetch things on request [HR 3.0 (95 % CI 2.4; 3.7)], or the child being significantly more active than average [HR 2.0 (95 % CI 1.8; 2.2)]. An association to ADHD was shown, especially at 18 months, if the mother found it difficult to handle the child [HR 2.9 (95 % CI 2.4-3.5)]. However, it goes for all observations that the positive predictive values were low. Many children with ADHD showed signs of developmental deviations during the first years of their life. In general, however, ADHD cannot be identified solely on basis of the questions in DNBC.

Trajectories and the influencing factors of behavior problems in preschool children: a longitudinal study in Guangzhou, China

BACKGROUND

Since child mental health problem was a global health issue, many researchers in western countries has focused on the trajectory of it to provide evidence for prevention programs. We designed this study to determine the trajectories of children's behavior problems, and to explore the effect of parent predictors on children's behavior problems in Guangzhou, China.

METHODS

Children (N = 1480) for this longitudinal, population-based survey, were recruited from eight regular kindergartens (October, 2010) across four districts in Guangzhou. Repeated measurement design analysis was used to compare the variation in behavioral problems by gender, only child status, and temperament. Logistic regression was applied to analyze the effect of parents' risks (maternal depression, parenting style) on the change in child problem behaviors.

RESULTS

The scores of behavior problems (externalizing, emotional, social communication problems) were stable during the entire preschool period by gender and child number. Children with difficult temperament exhibited more problem behaviors than children with easy temperament in the early years, and the misbehaviors declined significantly over time. Moreover, maternal depression and the increase in excessive interference/over protective or punishing parenting strategies resulted in an increase in child behavior problems.

CONCLUSION

There was no difference between the only-child status and child with siblings in the trajectory of problem behaviors. Parent factors were significant predictions of trajectory of child behavior problem during preschool age.

Factors Associated With Whether Pediatricians Inquire About Parents' Adverse Childhood Experiences

OBJECTIVE

Cumulative adverse childhood experiences (ACE) can have profound and lasting effects on parenting. Parents with a history of multiple ACE have greater challenges modulating their own stress responses and helping their children adapt to life stressors. We examined pediatric practice in inquiring about parents' childhood adversities as of 2013.

METHODS

Using data from the 85th Periodic Survey of the American Academy of Pediatrics (AAP), we restricted analyses to the 302 pediatricians exclusively practicing general pediatrics who answered questions regarding their beliefs about childhood stressors, their role in advising parents, and whether they asked about parents' ACEs. Weighted descriptive and logistic regression analyses were conducted.

RESULTS

Despite endorsing the influence of positive parenting on a child's life-course trajectory (96%), that their advice can impact parenting skills (79%), and that screening for social-emotional risks is within their scope of practice (81%), most pediatricians (61%) did not inquire about parents' ACE. Pediatricians who believed that their advice influences positive parenting skills inquired about more parents' ACE.

CONCLUSIONS

As of 2013, few pediatricians inquired about parents' ACEs despite recognizing their negative impact on parenting behaviors and child development. Research is needed regarding the best approaches to the prevention and amelioration of ACEs and the promotion of family and child resilience. Pediatricians need resources and education about the AAP's proposed dyadic approach to assessing family and child risk factors and strengths and to providing guidance and management.

The Co-Development of Parenting Stress and Childhood Internalizing and Externalizing Problems

Although the detrimental influence of parenting stress on child problem behavior is well established, it remains unknown how these constructs affect each other over time. In accordance with a transactional model, this study investigates how the development of internalizing and externalizing problems is related to the development of parenting stress in children aged 4-9. Mothers of 1582 children participated in three one-year interval data waves. Internalizing and externalizing problems as well as parenting stress were assessed by maternal self-report. Interrelated development of parenting with internalizing and externalizing problems was examined using Latent Growth Modeling. Directionality of effects was further investigated by using cross-lagged models. Parenting stress and externalizing problems showed a decrease over time, whereas internalizing problems remained stable. Initial levels of parenting stress were related to initial levels of both internalizing and externalizing problems. Decreases in parenting stress were related to larger decreases in externalizing problems and to the (stable) course of internalizing problems. Some evidence for reciprocity was found such that externalizing problems were associated with parenting stress and vice versa over time, specifically for boys. Our findings support the transactional model in explaining psychopathology.

Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers

Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver–child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach.

Maternal Depression Trajectories and Children's Behavior at Age 5 Years

OBJECTIVE

To assess the relationship between trajectories of maternal depression from pregnancy to the child's age of 5 years and children's emotional and behavioral difficulties at age 5 years.

STUDY DESIGN

Mother-child pairs (n = 1183) from the EDEN mother-child birth cohort study based in France were followed from 24 to 28 weeks of pregnancy to the child's fifth birthday. Children's behavior at age 5 years was assessed with the Strengths and Difficulties Questionnaire. Maternal depression was assessed repeatedly with the Center for Epidemiological Studies Depression questionnaire (pregnancy, 3, and 5 years of age) and the Edinburgh Postnatal Depression Scale (4, 8, and 12 months postpartum). Homogeneous latent trajectory groups of maternal depression were identified within the study population and correlated with Strengths and Difficulties Questionnaire scores by the use of multivariate linear regression analyzes.

RESULTS

Five trajectories of maternal symptoms of depression were identified: no symptoms (62.0%); persistent intermediate-level depressive symptoms (25.3%); persistent high depressive symptoms (4.6%); high symptoms in pregnancy only (3.6%); and high symptoms in the child's preschool period only (4.6%). Children whose mothers had persistent depressive symptoms--either intermediate or high--had the greatest levels of emotional and behavioral difficulties at age 5 years. In addition, compared with children whose mothers were never depressed, those whose mothers had high symptoms in the preschool period also had increased levels of emotional symptoms, conduct problems, and peer problems.

CONCLUSIONS

Maternal depression symptoms are related to children's emotional and behavioral problems, particularly if they are persistent (29.9%) or occur during early childhood (4.6%).

Developmental trajectories of young children with neurofibromatosis type 1: a longitudinal study from 21 to 40 months of age

OBJECTIVE

To establish the developmental trajectory of young children with neurofibromatosis type 1 (NF1) during the first 4 years of life.

STUDY DESIGN

In this longitudinal study, 39 children with NF1 and 39 controls were assessed with the Bayley Scales of Infant Development, Second Edition at 21 (time point 1, or T1) and 30 months (T2) of age, and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition at 40 months (T3). Language was also assessed at T2 and T3. Parents rated their child's productive vocabulary at T1 and T2, and behavior at each time point. Linear mixed models were performed to examine cognitive development and behavior over time. Linear regressions were conducted to determine whether mental development and productive vocabulary at T1 or T2 predicted intellectual and language outcomes at T3.

RESULTS

Over time, the NF1 group had significantly lower cognitive scores than controls. Parent ratings indicated no group differences in behavior at each time point. Earlier mental function significantly predicted later general intelligence. Earlier productive vocabulary was a significant predictor of later language skills.

CONCLUSIONS

There are consistent differences over time in cognitive performance between children with NF1 and unaffected peers during the early childhood period. Earlier mental function and productive vocabulary are significant predictors of subsequent general intelligence and performance on language measures in NF1. This provides an opportunity for early identification and treatment for young children with NF1 who may show signs of impairments in these developmental domains.

Shared pleasure in early mother-infant interaction: predicting lower levels of emotional and behavioral problems in the child and protecting against the influence of parental psychopathology

Shared pleasure (SP) was analyzed in fifty-eight 2-month-old infants and their mothers in face-to-face interaction (T1, at 2 months). The association of SP with child's emotional and behavioral outcome at 2 years (T2) was examined. SP as a possible protecting factor in the presence of parental psychopathology also was studied. Mean duration of SP moments (SP-MD) was related to subsequent socioemotional outcome of the child: Infants of dyads with longer SP-MD showed fewer internalizing and externalizing problems 2 years later. In hierarchical linear regressions, SP-MD uniquely and significantly contributed to internalizing problems after adjusting for infant and maternal factors and mother's interactive behavior. SP protected the child against the influence of parental psychopathology. Father's mental health problems during the follow-up increased the child's risk for higher externalizing and internalizing problems, but only among children with short SP-MD at T1. Internalizing symptoms at T2 increased when moving from the category "no mental health problems" to "mental health problems in one parent" and further to "mental health problems in both parents," but this increase was found only among those with short SP-MD at T1. SP in parent-child interaction is an important feature that fosters positive psychological development and moderates the health effects of other risks such as parental psychopathology.