Effortful control, positive emotional expression, and behavior problems in children born preterm

Emotional problems and peer victimization in adolescents born very preterm and full-term: Role of self-control skills in childhood

The aim of the current study was to examine whether self-control skills in childhood moderate the association between very preterm birth (<32 weeks of gestational age) and emotional problems and peer victimization in adolescence. We used data from four prospective cohort studies, which included 29,378 participants in total (N = 645 very preterm; N = 28,733 full-term). Self-control was mother-reported in childhood at 5-11 years whereas emotional problems and peer victimization were both self- and mother-reported at 12-17 years of age. Findings of individual participant data meta-analysis showed that self-control skills in childhood do not moderate the association between very preterm birth and adolescence emotional problems and peer victimization. It was shown that higher self-control skills in childhood predict lower emotional problems and peer victimization in adolescence similarly in very preterm and full-term borns.

Self-regulation facets differentially predict internalizing symptom trajectories from middle childhood to early adolescence: a longitudinal multimethod study

BACKGROUND

Internalizing symptoms are among the most common psychological symptoms in childhood and adolescence, are highly stable and can cause severe impairment. Current research discusses lower capacities of self-regulation (SR) as risk factors for the development of internalizing symptoms. The present study identifies trajectories of internalizing symptoms in the transition phase from middle childhood to adolescence and examines multiple SR facets as predictors of potentially unfavorable trajectories, also in the presence of other established risk factors.

METHODS

The study utilized a community sample of N = 1453 (52.2% female) German children, who provided data at up to three measurement points (t1: 6-11 years, t2: 7-11 years, t3: 9-13 years). Trajectories of internalizing symptoms were based on parents' ratings of the emotional problems scale of the Strengths and Difficulties Questionnaire. SR facets were assessed using multiple methods and informants. Two multinomial regression analyses were conducted to predict class membership by (1) SR facets and gender and (2) SR facets, gender, and other established risk factors (education status, family adversity, peer problems).

RESULTS

Using growth mixture modelling, we identified three trajectory classes with stable low (n = 1200), increasing (n = 124), and early high decreasing internalizing symptoms (n = 129). In the regression analysis controlling for risk factors, membership in the increasing trajectory was significantly predicted by higher emotional reactivity (OR = 2.65, p < .001), higher cognitive flexibility/set-shifting (OR = 1.48, p = .032), and higher family adversity (OR = 1.38, p = .046). Membership in the early high decreasing trajectory was significantly predicted by higher emotional reactivity (OR = 4.15, p < .001), higher inhibitory control (OR = 1.47, p = .045), lower working-memory updating (OR = 0.69, p = .016), lower delay of gratification (OR = 0.75, p = .028), and higher family adversity (OR = 1.63, p = .001).

CONCLUSIONS

SR facets incrementally and differentially predict potentially unfavorable trajectories of internalizing symptoms from age 6 to 13, surpassing the predictive value of gender or education status. Higher emotional reactivity emerged as the most influential factor, which could therefore be addressed in future prevention and intervention efforts.

Diathesis-stress or differential susceptibility? Comparing the theories when determining the outcomes for children born before 33 weeks' gestation

Infants born preterm (less than 37 weeks completed gestation) have a higher risk of suboptimal cognitive and behavioral outcomes when compared with their term-born counterparts. The risk and severity of poor outcome increases as gestational age at birth decreases; however, not all children born preterm will develop deficits, and environmental influences post birth may have a role in shaping developmental outcomes. Whilst early preterm birth is not preventable, it may be possible to intervene after birth via the environment in order to improve outcomes. The diathesis-stress theory hypothesizes that vulnerable individuals will have worse outcomes after a negative environmental exposure, whereas the differential susceptibility theory posits that vulnerable (or plastic) individuals can be both adversely and positively affected by environmental factors. These two theories were compared in 535 children born <33 weeks' gestation. The interaction between the degree of prematurity and the home environment (as measured by the Home Screening Questionnaire) at 18 months on cognition (Intelligence Quotient from the Wechsler Abbreviated Scale of Intelligence) and behavior (Total Difficulties Score from the Strengths and Difficulties Questionnaire) at 7 years was explored. Evidence was not found for either theory, although a supportive/stimulating home environment appeared to contribute to a decrease in the risk or severity of suboptimal scores. Future research is needed to establish stronger evidence in order to inform interventions to improve the home environment of children born preterm.

Digital Phenotype for Childhood Internalizing Disorders: Less Positive Play and Promise for a Brief Assessment Battery

Childhood internalizing disorders, like anxiety and depression, are common, impairing, and difficult to detect. Universal childhood mental health screening has been recommended, but new technologies are needed to provide objective detection. Instrumented mood induction tasks, designed to press children for specific behavioral responses, have emerged as means for detecting childhood internalizing psychopathology. In our previous work, we leveraged machine learning to identify digital phenotypes of childhood internalizing psychopathology from movement and voice data collected during negative valence tasks (pressing for anxiety and fear). In this work, we develop a digital phenotype for childhood internalizing disorders based on wearable inertial sensor data recorded from a Positive Valence task during which a child plays with bubbles. We find that a phenotype derived from features that capture reward responsiveness is able to accurately detect children with underlying internalizing psychopathology (AUC = 0.81). In so doing, we explore the impact of a variety of feature sets computed from wearable sensors deployed to two body locations on phenotype performance across two phases of the task. We further consider this novel digital phenotype in the context of our previous Negative Valence digital phenotypes and find that each task brings unique information to the problem of detecting childhood internalizing psychopathology, capturing different problems and disorder subtypes. Collectively, these results provide preliminary evidence for a mood induction task battery to develop a novel diagnostic for childhood internalizing disorders.

Curvilinear Relations Between Preschool-Aged Children's Effortful Control and Socioemotional Problems: Racial-Ethnic Differences in Functional Form

The majority of studies of preschool-aged children's self-regulation presume that their higher levels of self-regulation are concurrently and prospectively associated with fewer externalizing and internalizing problems. This assumes their relations are only linear in form and negative, but studies with community samples of mostly non-Hispanic White children have found curvilinear or positive relations between self-regulation and socioemotional problems in early childhood. This cross-sectional study tests linear and quadratic relations between children's behavioral battery assessed effortful control and parent rated externalizing and internalizing problems, and whether their functional forms differ across racial-ethnic groups in a diverse sample of 2.5- to 3.5-years-olds (N = 72) from highly educated two-parent households. Child effortful control was negatively related to externalizing, quadratically related to internalizing (albeit marginally), and an interaction between effortful control and race-ethnicity indicated opposite linear relations between effortful control and internalizing problems for different racial-ethnic groups. By integrating tests of curvilinearity and interactions, this study builds on theoretical and empirical work indicating complex relations between the development of self-regulation and psychopathology.

Negative affectivity moderated by preterm birth predicted toddlers' behavior problems

OBJECTIVE

The present study aimed to examine the predictive effect of temperament moderated by preterm childbirth on behavioral problems in toddlerhood.

METHOD

The sample comprised 100 toddlers of 18-36 months of chronological age and their mothers. They were divided into two groups: 50 toddlers born preterm and admitted to the Neonatal Intensive Care Unit (PT group), and 50 toddlers born full-term (FT group) and recruited from day-care centers. Mothers completed questionnaires about toddlers' temperament and behavior. The Early Childhood Behavior Questionnaire was used to assess temperament, and the Child Behavior Checklist (CBCL 1¹/²-5) to evaluate the total, internalizing, and externalizing behavior problems. Multiple regression analysis was performed to examine the moderation effects of preterm childbirth and temperament factors after controlling for toddlers' age and socioeconomic level.

RESULTS

There was a moderation effect between preterm childbirth and temperament. Temperament with more Negative Affectivity, moderated by preterm birth, and less Effortful Control explained the total, internalizing, and externalizing behavior problems.

CONCLUSION

The findings contribute to a better understanding of the impact of preterm childbirth and the dispositional traits of temperament on behavioral problems of toddlers born preterm.

Effects of Neonatal Pain and Temperament on Attention Problems in Toddlers Born Preterm

Objective

To examine the effects of individual characteristics of neonates and neonatal pain-related stress on attention problems and externalizing behavior problems of toddlers born preterm, analyzing the moderating effects of the dispositional traits of temperament.

Methods

The sample included 62 toddlers aged 18-36 months and their mothers. The mothers were interviewed using the Child Behavior Checklist 1.5-5 for toddlers' attention and externalizing behavior problems assessment, the Early Childhood Behavior Questionnaire for toddlers' temperament assessment, and the Adult Temperament Questionnaire for their temperament assessment. The Neonatal Infant Stressor Scale analyzed the number of pain-related stress events during neonatal intensive care unit (NICU) hospitalization recorded in the medical charts. Statistical descriptive, correlation, and multiple linear regression analyses were performed.

Results

High neonatal pain-related stress total index, associated with toddler's temperament with less Effortful Control, and mother's temperament with high Surgency explained 23% variability of the attention problems. Otherwise, the externalizing behavior problems were explained by temperament, but not by neonatal pain-related stress.

Conclusions

The findings support the impact of neonatal pain experiences, and current toddlers' and mothers' temperament characterized by poorer self-regulation on attention problems in toddlers born preterm. Developmental care in the NICU and follow-up programs after discharge are recommended to promote regulated temperament of the mother-child dyads, aiming to prevent attentional problems in toddlers born preterm.

Temperament moderated by neonatal factors predicted behavioral problems in childhood: A prospective longitudinal study

OBJECTIVE

The present study aimed to examine the predictor effects of neonatal, sociodemographic characteristics, and temperament assessed at 18-36 months of age on behavioral problems in 4- to 5-year-old children born preterm.

METHODS

The sample comprised 70 children born preterm. The amount and the intensity of stress procedures during a stay in the neonatal intensive care unit were evaluated using the Neonatal Infant Stressor Scale. Temperament was assessed using the Early Childhood Behavior Questionnaire, and behavioral problems were assessed using the Child Behavior Checklist 1^1/2-5. Multiple linear regression analysis was performed.

RESULTS

Total behavioral problems were predicted by a child temperament of more negative affectivity and less effortful control, moderated by gestational age. Internalizing behavioral problems was predicted by more negative affectivity and less effortful control moderated by male sex and associated with lower gestational age. Externalizing behavior problems was predicted by less effortful control.

CONCLUSIONS

The main findings of the present study showed that the high immaturity at the birth of preterm infants, associated with temperament traits of more negative affectivity and less effortful control, increase the risk for future behavioral problems.

Converging function, structure, and behavioural features of emotion regulation in very preterm children

Children born very preterm (VPT; <32 weeks' gestational age) are at high risk for emotional regulation and social communication impairments. However, the underlying neurobiological correlates of these difficulties remain poorly understood. Using a multimodal approach, including both magnetoencephalographic and structural magnetic resonance imaging, we investigated the functional, structural, and behavioural characteristics of socio-emotional processing in 19 school-age children born VPT and 21 age-matched term-born (TB) children (7-13 years). Structural MRI analyses were conducted on a subset of these groups (16 VPT and 21 age-matched TB). Results showed that the inhibition of aversive socio-emotional stimuli was associated with a sustained reduction of right frontoparietal functional brain activity in children born VPT children. Moreover, whole brain structural analyses showed that reductions of cortical thickness or volume in these regions were associated with poor socio-emotional performance in children born VPT. Hence, our results suggest that functional and structural alterations encompassing the frontoparietal areas might be a biological marker of less efficient emotion regulation processes/performance in school-age children born VPT. These findings open up novel avenues to investigate the potential impact of such atypicalities, and in particular, those related to the atypical maturation of the medial prefrontal regions, on the frequent development of psychiatric disorders in this vulnerable population.

Temperament and behavior in toddlers born preterm with related clinical problems

OBJECTIVE

The aim of this study was to compare temperament and behavior profiles among groups of preterm toddlers differentiated by level of prematurity and the presence of bronchopulmonary dysplasia (BPD) or retinopathy of prematurity (ROP), controlling for neonatal clinical conditions and chronological age.

METHOD

The sample comprised 100 preterm toddlers segregated according to level of prematurity (75 very preterm and 25 moderate/late preterm) and presence of BPD (n=36) and ROP (n=63). Temperament was assessed by the Early Childhood Behavior Questionnaire and behavior by the Child Behavior Checklist. The MANOVA was performed with a post-hoc univariate test.

RESULTS

The level of prematurity and the presence of BPD and ROP did not affect temperament and behavioral problems in toddlers born preterm. However, the covariates age and length of stay in NICU (Neonatal Intensive Care Unit) affected temperament and behavioral problems, respectively. The older toddlers showed higher inhibitory control and lower activity levels than younger toddlers (range of 18-36months-old). Additionally, toddlers who stayed in the NICU longer showed more pervasive development and emotionally reactive problems than toddlers who stayed in NICU for less time.

CONCLUSION

The level of prematurity and the presence of bronchopulmonary dysplasia and retinopathy of prematurity did not affect temperament and behavioral problems in toddlers born preterm. However, a longer stay in the NICU increased the risk for behavioral problems, and age enhanced the regulation of temperament at toddlerhood.

Impact of neonatal risk and temperament on behavioral problems in toddlers born preterm

Children born preterm are at risk for later developmental disorders. The present study examined the predictive effects of neonatal, sociodemographic, and temperament characteristics on behavioral outcomes at toddlerhood, in children born preterm. The sample included 100 toddlers born preterm and with very-low-birth-weight, and their mothers. Neonatal characteristics were evaluated using medical records. The mothers were interviewed using the Early Childhood Behavior Questionnaire for temperament assessment, and the Child Behavior Checklist for behavioral assessment. Multiple linear regression analyses were performed. Predictors of 39% of the variability of the total behavioral problems in toddlers born prematurely were: temperament with more Negative Affectivity and less Effortful Control, lower family socioeconomic status, and younger mothers at childbirth. Temperament with more Negative Affectivity and less Effortful Control and lower family socioeconomic status were predictors of 23% of the variability of internalizing behavioral problems. Additionally, 37% of the variability of externalizing behavioral problems was explained by temperament with more Negative Affectivity and less Effortful Control, and younger mothers at childbirth. The neonatal characteristics and stressful events in the neonatal intensive care unit did not predict behavioral problems at toddlerhood. However, temperament was a consistent predictor of behavioral problems in toddlers born preterm. Preventive follow-up programs could assess dispositional traits of temperament to provide early identification of preterm infants at high-risk for behavioral problems.

Emotional and effortful control abilities in 42-month-old very preterm and full-term children

BACKGROUND

Very preterm (VP) infants are at greater risk for cognitive difficulties that may persist during school-age, adolescence and adulthood. Behavioral assessments report either effortful control (part of executive functions) or emotional reactivity/regulation impairments.

AIMS

The aim of this study is to examine whether emotional recognition, reactivity, and regulation, as well as effortful control abilities are impaired in very preterm children at 42 months of age, compared with their full-term peers, and to what extent emotional and effortful control difficulties are linked.

STUDY DESIGN

Children born very preterm (VP; < 29 weeks gestational age, n=41) and full-term (FT) aged-matched children (n=47) participated in a series of specific neuropsychological tests assessing their level of emotional understanding, reactivity and regulation, as well as their attentional and effortful control abilities.

RESULTS

VP children exhibited higher scores of frustration and fear, and were less accurate in naming facial expressions of emotions than their aged-matched peers. However, VP children and FT children equally performed when asked to choose emotional facial expression in social context, and when we assessed their selective attention skills. VP performed significantly lower than full terms on two tasks of inhibition when correcting for verbal skills. Moreover, significant correlations between cognitive capacities (effortful control) and emotional abilities were evidenced.

CONCLUSIONS

Compared to their FT peers, 42 month-olds who were born very preterm are at higher risk of exhibiting specific emotional and effortful control difficulties. The results suggest that these difficulties are linked. Ongoing behavioral and emotional impairments starting at an early age in preterms highlight the need for early interventions based on a better understanding of the relationship between emotional and cognitive difficulties.