Childhood behavior problems and academic outcomes in adolescence: longitudinal population-based study

Evaluation of Virtual Enhanced Child Adult Relationship Enhancement in Primary Care Intervention

OBJECTIVE

Because of COVID-19 pandemic social distancing requirements, the in-person Child Adult Relationship Enhancement in Primary Care (PriCARE) positive parenting intervention was adapted for virtual delivery. Objective was to evaluate the efficacy of the virtual PriCARE program to improve parenting capacity, decrease child behavioral problems, and decrease child maltreatment risk.

METHODS

Caregivers of children 2 to 6 years old recruited from pediatric primary care were randomized to PriCARE (n = 92) or waitlist control (n = 90). Dysfunctional parenting, positive parenting skills, child behaviors, and child maltreatment risk were measured at baseline and 2 to 3 months after intervention using the Parenting Scale (PS), Dyadic Parent-Child Interaction Coding System (DPICS), Eyberg Child Behavior Inventory (ECBI), and Child Abuse Potential Inventory (CAPI). Kruskal-Wallis test compared median change scores from baseline to follow-up by treatment arm.

RESULTS

Of 182 enrolled caregivers, 92% (168) were mothers and 67% (122) completed study measures at baseline and follow-up. The median decrease (improvement) in total PS score was greater in the PriCARE group compared with the control group (-0.3 [IQR 0.69] vs -0.1 [IQR 0.56], p = 0.028) as was the median decrease (improvement) in ECBI problem score (-3 [IQR 9] vs -1 [IQR 7], p = 0.045) and ECBI intensity score (-9 [IQR 21] vs 0 [IQR 25], p = 0.006). Improvements in 4 positive parenting skills measured by DPICS were greater in the PriCARE group compared with the control group (all p< 0.003). Median decrease in CAPI abuse score did not differ significantly by study arm (p = 0.055).

CONCLUSION

The PriCARE virtual adaptation demonstrated promise in promoting positive parenting and decreasing child behavior problems.

The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016-2022)

Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33-41; Research in Nursing and Health, 2016, 39(4), 229-243). Yet, there is limited research on the impact of evidence-based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa-Uganda study (2016-2022), a cluster randomized clinical trial testing an evidence-based family-strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8-13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post-intervention completion. The intervention effectiveness was evaluated via a three-level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent-peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.

Is Attention-Deficit/Hyperactivity Disorder (ADHD) a Dimension or a Category? What Does the Relationship Between ADHD Traits and Psychosocial Quality of Life Tell Us?

OBJECTIVE

The question of whether attention-deficit/hyperactivity disorder (ADHD) is a discrete category or a continuous dimension remains clinically relevant. We report the first examination of this question from the viewpoint of the relationship between ADHD traits and psychosocial quality of life (QoL), and whether the level of QoL declines markedly around a certain high ADHD trait range suggestive of a categorical boundary.

METHODS

Parents/caregivers of 1,967 schoolchildren aged 6 to 11 from the general population completed the Pediatric Quality of Life Inventory and the ADHD-Rating Scale IV. Piecewise linear and non-linear regression analyses were performed.

RESULTS

No evidence for a non-linear association or an abrupt change in the rate of decrease in QoL was observed in the high end of the ADHD traits continuum. Instead, the relationship was consistent with linearity.

CONCLUSION

Psychosocial QoL gradually declines in a linear manner as ADHD trait levels increase providing further support for a dimensional model.

The Engaged Learners Program: Effects on Student Engagement During Small Group Reading Instruction

In this study we tested the usability, feasibility, social validity, and effectiveness of Engaged Learners, a behavior support program designed to be integrated into small group reading interventions. Participants included eight Grade 3 to 5 students with co-occurring reading difficulties and inattention. A concurrent multiple-baseline design was utilized to test the effects of Engaged Learners on engagement outcomes. Visual analysis and effect sizes indicated an improvement in engagement for seven students. Interventionists and students viewed the Engaged Learners program to be effective and socially valid. Limitations included lower than expected levels of fidelity for one interventionist and high student absenteeism. More research is needed to identify the extent to which Engaged Learners can support reading outcomes. Educators seeking an effective behavior support program that requires minimal training and coaching may consider integrating Engaged Learners into their small group reading instruction.

Association between adverse childhood experiences and sleep quality, emotional and behavioral problems and academic achievement of children and adolescents

The impact of adverse childhood experiences (ACEs) on adult health has been extensively examined, but the association between ACEs and sleep, emotion, behavior and academic outcomes of children and adolescents is not well known. A total of 6363 primary and middle school students were included to examine the effect of ACEs on sleep quality, emotional and behavioral problems and academic achievement and further explore the mediation role of sleep quality and emotional and behavioral problems. Children and adolescents with ACE exposure had 1.37 times risk of poor sleep quality (adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI]: 1.21-1.55), 1.91 times risk of emotional and behavioral problems (adjusted OR = 1.91, 95%CI: 1.69-2.15) and 1.21 times risk of self-reported lower academic achievement (adjusted OR = 1.21, 95%CI: 1.08-1.36). Most types of ACEs were significantly associated with poor sleep quality, emotional and behavioral problems and lower academic achievement. There were dose-response relationships between cumulative ACE exposure and risk of poor sleep quality, emotional and behavioral problems, and lower academic achievement. Sleep quality and emotional and behavioral performance mediated 45.9% of the effect of ACEs exposure on math scores and 15.2% of the effect of ACEs exposure on English scores. Early detection and prevention of ACEs among children and adolescents are urgent and essential, and targeted interventions for sleep and emotional and behavioral performance as well as early educational interventions are recommended for children with ACEs exposure.

Long-Term Follow-Up of Daily Life Functioning After Pediatric Intensive Care Unit Admission

OBJECTIVE

To investigate the long-term impact of pediatric intensive care unit (PICU) admission on daily life functioning while exploring the potential mediating role of neurocognitive outcome.

STUDY DESIGN

This cross-sectional observational study compared children aged 6-12 years with previous PICU admission (age ≤1 year) for bronchiolitis requiring mechanical ventilation ("patient group," n = 65) to demographically comparable healthy peers ("control group," n = 76). The patient group was selected because bronchiolitis is not expected to affect neurocognitive functioning in itself. Assessed daily life outcome domains were behavioral and emotional functioning, academic performance, and health-related quality of life (QoL). The role of neurocognitive outcomes in the relationship between PICU admission and daily life functioning was assessed by mediation analysis.

RESULTS

The patient group did not differ from the control group regarding behavioral and emotional functioning but performed poorer on academic performance and school-related QoL (Ps ≤ .04, d = -0.48 to -0.26). Within the patient group, lower full-scale IQ (FSIQ) was associated with poorer academic performance and school-related QoL (Ps ≤ .02). Poorer verbal memory was associated with poorer spelling performance (P = .002). FSIQ mediated the observed effects of PICU admission on reading comprehension and arithmetic performance.

CONCLUSIONS

Children admitted to the PICU are at risk for long-term adverse daily life outcomes in terms of academic performance and school-related QoL. Findings suggest that lower intelligence may contribute to academic difficulties after PICU admission. Findings underline the importance of monitoring daily life and neurocognitive functioning after PICU admission.

Impulsiveness among Undergraduates from the United Arab Emirates and Jordan: Role of Socio-demographic Variables

BACKGROUND

Some undergraduate students may appear impulsive in their behavior without taking enough time to think, and impulsiveness may vary according to gender, academic specialization, and academic level.

OBJECTIVE

This study investigated the differences in impulsiveness between undergraduates of different gender, academic specializations, and academic years at three private universities in the United Arab Emirates and Jordan.

METHOD

The research design of the study was a survey in nature. The researchers collected data online using a translated Arabic version of the Barratt Impulsiveness Scale (BIS-11) as described in Patton et al..1 A sample of 334 undergraduates was selected using the convenient non-probability sample technique.

RESULTS

To analyze data, the researchers deployed descriptive and inferential statistics and found no significant differences between the students in the subscales of motor impulsiveness, non-planning, attentional impulsiveness, and the total scale score according to gender, academic specializations, and academic years variables.

CONCLUSION

The researchers concluded that undergraduates have a moderate level of impulsiveness; except for attentional impulsiveness, the results indicated that the average student's score on the subscale was low. Motor impulsiveness, non-planning impulsiveness, and attentional impulsiveness were not significantly different between males and females, academic specialization, academic year variables, and their interaction. The limitations and implications of these findings are discussed.

Vicious cycle of emotion regulation and ODD symptoms among Chinese school-age children with ODD: a random intercept cross-lagged panel model

A strong link between children's emotion regulation and oppositional defiant disorder (ODD) symptoms has been documented; however, the within-person mechanisms remain unclear. Based on the self-control theory and self-regulation theory, our study investigated the longitudinal, bidirectional relationship between emotion regulation and ODD symptoms in school-age children with ODD using parent- and teacher-reported data, respectively. A total of 256 Chinese elementary school students participated in a three-wave longitudinal study spanning two years. We used the random intercept cross-lagged panel model (RI-CLPM) to investigate the concurrent and longitudinal associations between emotion regulation and ODD symptoms. Results from the RI-CLPMs revealed that ODD symptoms were negatively correlated with emotion regulation and positively correlated with emotion lability/negativity at both the between-person and within-person levels across settings. Additionally, in the school setting, emotion regulation negatively predicted subsequent ODD symptoms but not vice versa, whereas emotion lability/negativity was bidirectionally associated with ODD symptoms over time. The longitudinal associations of ODD symptoms with emotion regulation and lability/negativity were not observed in the home setting. These findings suggest a circular mechanism between children's emotion regulation and ODD symptoms and support the view that emotion regulation, particularly emotion lability/negativity, plays an important role in the development of ODD symptoms.

Association of emotional and behavioral problems with sleep disturbance among Chinese adolescents: The moderation effect of academic performance

BACKGROUND

This study aimed to explore the association of emotional and behavioral problems with sleep disturbance among Chinese adolescents, and to test whether these associations vary with adolescents' academic performance.

METHODS

Data were from the 2021 School-based Chinese Adolescents Health Survey using a multistage, stratified-cluster, and random-sampling method to collect information from 22,684 middle school students in Guangdong Province, China.

RESULTS

Emotional problems (aOR = 1.34, 95 % CI = 1.32-1.36), conduct problems (aOR = 1.19, 95 % CI = 1.16-1.21), hyperactivity (aOR = 1.35, 95 % CI = 1.33-1.37), and peer problems (aOR = 1.06, 95 % CI = 1.04-1.09) were significantly associated with the increased risk of sleep disturbance among middle school students in Guangdong Province. The prevalence of sleep disturbance among adolescents was 29.4 %. There were significant interactions of emotional problems/conduct problems/peer problems/prosocial behavior with academic performance on sleep disturbance. Further stratification analyses by academic performance showed that adolescents with self-reported good academic performance had a higher risk of sleep disturbance than those students with self-reported average or poor academic performance.

LIMITATIONS

This study only included school students and used the cross-sectional design to preclude causality determination.

CONCLUSIONS

Our findings suggest that emotional and behavioral problems elevate the risk of sleep disturbance in adolescents. Adolescent academic performance plays a modulating role in these above-mentioned significant associations for sleep disturbance.

The impact of attention-deficit/hyperactivity disorder and specific learning disorders on academic performance in Spanish children from a low-middle- and a high-income population

Introduction

Past research has demonstrated that attention-deficit/hyperactivity disorder (ADHD), specific learning disorders (SLD), and socioeconomic status (SES) affect a host of educational outcomes. However, there are no studies examining whether SES moderates the association between these neurodevelopmental disorders (ND) and the academic achievement of children and adolescents. The present investigation examined the impact of ADHD and SLD on academic performance in 1,287 Spanish students aged 5-17 from a low-middle (LM)- and a high-income population, when adjusted for comorbidity and demographic factors that may influence educational functioning.

Methods

Parents completed a questionnaire regarding demographic data along with the Strengths and Difficulties Questionnaire. Additionally, teachers provided information on learning difficulties trough the Protocol for Detection and Management of Dyslexia. Teacher's Version. Academic performance across multiple domains (i.e., first language, foreign language, mathematics) was obtained from school records. ND were determined using standardized diagnostic methods based on the Diagnostic and Statistical Manual of Mental Disorders criteria. To examine the effects of ADHD and SLD on academic achievement and the potential moderating role of SES, a series of ordinal logistic regressions were conducted.

Results

Emotional/behavioral problems, learning difficulties, and ND were more frequent among individuals from the LM-income population. After controlling for gender, age, parental divorce/separation, grade retention, frequency of screen use, and daily meals, both ADHD and SLD were associated with worse educational outcomes. Lower SES also increased the risk for academic impairment, although the interactions with ADHD or SLD were not significant.

Conclusion

These findings indicate that ADHD and SLD exert a pervasive impact on academic performance across different socioeconomic backgrounds. Therefore, early detection and effective intervention strategies aimed at students with these ND are crucial to improve their educational functioning and mitigate the negative consequences related to academic problems.

The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on oppositional defiant disorder and impaired functioning among children in Uganda: analysis of a cluster randomized trial from the SMART Africa-Uganda scale-up study (2016-2022)

BACKGROUND

Oppositional Defiant Disorders (ODDs) and other Disruptive Behavior Disorders (DBDs) are common among children and adolescents in poverty-impacted communities in sub-Saharan Africa. Without early intervention, its progression into adulthood can result in dire consequences. We examined the impact of a manualized family strengthening intervention called Amaka Amasanyufu designed to reduce ODDs and other DBDs among school-going children residing in low-resource communities in Uganda.

METHODS

We used longitudinal data from the SMART Africa-Uganda study (2016-2022). Public primary schools were randomized to: (1) Control condition (receiving usual care comprising generalized psychosocial functioning literature), 10 schools; (2) intervention delivered via parent peers (Amaka-parents), 8 schools or; (3) intervention delivered via community healthcare workers (Amaka-community), 8 schools. All the participants were blinded. At baseline, 8- and 16-weeks postintervention initiation, caregivers completed the Iowa Conners Scale, which measured Oppositional Defiant Disorder (ODD) and Impairment Rating Scale to evaluate children's overall impairment and impaired functioning with peers, siblings, and parents; impaired academic progress, self-esteem, and family functioning. Three-level linear mixed-effects models were fitted to each outcome. Pairwise comparisons of postbaseline group means within each time point were performed using Sidak's adjustment for multiple comparisons. Only children positive for ODD and other DBDs were analyzed.

RESULTS

Six hundred and thirty-six children screened positive for ODDs and other DBDs (Controls: n = 243; Amaka-parents: n = 194; Amaka-community: n = 199). At 8 weeks, Amaka-parents' children had significantly lower mean scores for overall impairment compared to controls, (mean difference: -0.71, p = .001), while Amaka-community children performed better on ODD (mean difference: -0.84, p = .016). At 16 weeks, children in both groups were performing better on ODD and IRS than controls, and there were no significant differences between the two intervention groups.

CONCLUSIONS

The Amaka Amasanyufu intervention was efficacious in reducing ODD and impaired functioning relative to usual care. Hence, the Amaka Amasanyufu intervention delivered either by Amaka-community or Amaka-parents has the potential to reduce negative behavioral health outcomes among young people in resource-limited settings and improve family functioning.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017.

School-based group intervention in attention and executive functions: Intervention response and moderators

Objective

This study investigated the effects of a school-based skill-training intervention in attention control and executive functions for pupils with hyperactivity-impulsivity (H-I) and cognitive control (CC) deficits. The main aim was to examine whether the intervention differently influenced H-I and CC, and whether cognitive abilities or conduct problems moderated response to the intervention.

Method

Elementary school pupils from 41 schools participated the study and were divided into an intervention group (n = 71) and a waitlist control group (n = 77). Intervention outcomes were assessed with an inventory assessing executive function difficulties (including H-I and CC) completed by classroom teachers.

Results

Significant intervention effects and positive changes were detected in CC but not in H-I. Significant intervention effects were found mainly among pupils with low levels of conduct problems.

Conclusions

The results suggest that a skill-training intervention has specific positive effects on CC, but conduct problems may diminish response to intervention.

Examining the Effects of Integrating Anxiety Management Instruction Within a Reading Intervention for Upper Elementary Students With Reading Difficulties

We present findings from the first cohort of third- and fourth-grade students with reading difficulties (128 students from 31 classrooms) who participated in a 2-year intervention examining the effects of a reading intervention with and without anxiety management. Using a randomized controlled trial, students were assigned to one of three conditions: (a) small-group reading intervention with anxiety management instruction (RANX), (b) small-group reading intervention with math fact practice (RMATH), and (c) business-as-usual (BAU) comparison condition (no researcher provided treatment). Personnel from the research team provided participants in the RANX and RMATH the same reading intervention with the variation in the two treatments being whether the same amount of time per lesson was allocated to anxiety management (RANX) or practicing math facts (RMATH). Students in the RANX significantly outperformed students in the BAU on reading comprehension (effect size [ES] = 1.22) and students in the RMATH outperformed BAU on reading comprehension (ES = 0.77). Groups did not differ significantly on other reading outcomes. Reading anxiety moderated the main effect of the RANX intervention on the Test of Word Reading Efficiency (TOWRE) word reading when contrasted against the BAU group, indicating a significant difference favoring RANX where treatment's effect decreased by 0.94 units (about 1 point on the outcome) on word reading for each additional point increase in reading anxiety.

A preliminary investigation of psychometric properties of the youth-reported Pediatric Symptom Checklist (PSC-Y) in Chinese elementary, middle, and high schools

The current study validated the youth-reported Pediatric Symptom Checklist-Youth (PSC-Y) using a Chinese youth sample (N = 20,996). The factor structure, measurement invariance, and criterion validity were examined. First, factor analysis documented that the correlated three-factor structure, including externalizing problems, internalizing problems, and attention problems fit the data best, which aligns with the prior factor structure of the PSC-Y in other settings (e.g., teacher ratings). In addition, measurement invariance was established across gender and age groups. The latent mean differences revealed that middle and high school students and females reported more internalizing and attention problems than elementary students and males. Additionally, high school students and females were less likely to report externalizing problems than elementary students and males. Finally, the criterion validity of the PSC-Y was established using external scales assessing subjective wellbeing and prosocial behavior. Teachers, school administrators, and school psychologists can utilize the results of this study to more precisely identify youth at risk for psychosocial problems.

The Contributions of Cognitive Abilities to the Relationship between ADHD Symptoms and Academic Achievement

The main objective of this study was to examine whether increased levels of inattentive (INA) and hyperactive/impulsive (H/I) behaviours were associated with lower scores on standardized tests of achievement in basic reading, spelling, and math skills, after accounting for certain known background risk factors and cognitive processes. Clinical assessment data from a rigorously diagnosed, stimulant-medication-naïve sample of 354 elementary school-aged children experiencing academic difficulties and behavioural symptoms of inattention and/or hyperactivity/impulsivity were analyzed. Although higher scores of INA were significantly associated with lower scores in reading, spelling, and math, these associations did not persist when cognitive variables were added to the models. H/I was associated with math achievement, along with cognitive and background variables. Overall, cognitive variables accounted for the majority of the variance across basic reading, spelling, and math skills. Additionally, the only background demographic variables associated with academic achievement were age and sex for spelling and math. This finding highlights the importance of looking beyond observable INA and H/I behaviours to determine the underlying factors influencing academic achievement. Accurate identification of deficits in specific academic skills and the underlying factors influencing achievement in these skills are essential components in determining appropriate recommendations and targeted interventions.

Validation of brief screening instruments for internalizing and externalizing disorders in Mozambican adolescents

BACKGROUND

Mental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa.

METHODS

We selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12-19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents.

RESULTS

Participants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test-retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test-retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden's index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity.

CONCLUSIONS

Our data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives.

Criando Niños Con Cariño : Primary Care-Based Group Parenting Program Adaptation and Pilot

OBJECTIVE

This study culturally adapted and piloted a primary care-based group parenting program (Child-Adult Relationship Enhancement in Primary Care, PriCARE) for Spanish-speaking, Hispanic parents of 2- to 6-year-old children.

METHODS

The process was informed by the cultural adaptation literature, expert consultation, and focus group data from 18 previous PriCARE, eligible Cariño , and initial Cariño test participants. As adaptations were made, an implementation framework was applied to systematically record all changes. Finally, parents of children aged 2 to 6 years participated in the Cariño pilot study (n = 32). Enrollment and attendance data were used to examine feasibility, and the Therapy Attitude Inventory (TAI) was administered postintervention to measure acceptability.

RESULTS

Most adaptations were minor changes to make the adapted program, Criando Niños con Cariño , more appropriate, applicable, or acceptable. Some changes required reframing Cariño concepts (e.g., child-led play) or incorporating new concepts (e.g., respeto , armonía , and educación ) to better align Cariño goals with parents' values. Among the 121 dyads invited to participate in the Cariño pilot study, 52 (43%) enrolled. Among the 52 enrolled, 32 (62%) attended at least 4 of the 6 sessions and reported high satisfaction on the TAI (mean 47/50, range 33-50).

CONCLUSION

Cariño is the result of a rigorous adaption process and incorporates multiple changes to ensure the translation reflects the intended meaning and to reframe the program goals and concepts in a culturally congruent manner. Pilot data suggest Cariño is feasible and acceptable to parents.

Home learning environment and out-of-home activities: their relations to prosocial behaviour and peer relationships in primary school children

There is consensus that child socio-emotional development is influenced by various contexts, such as the family one. Research on influencing factors on child socio-emotional skills mainly investigated the effects of home learning environment, whereas the effects of out-of-home activities were often analysed mainly in samples of adolescents. The present study aimed to shed light on effects of preschool home learning environment and out-of-home activities on two facets of socio-emotional skills at the beginning of primary school: Prosocial behaviour and peer relationships. The information on the child prosocial behaviour and peer relationships at preschool age was included with the aim to control for most of the differences across children. Using data from a large sample of children (N = 1,818; M age = 7.08 years, SD = 0.15; 49.9% girls), results of regression analyses show significant effects of out-of-home activities on prosocial behaviour after controlling a range of child- and family-related influencing factors on prosocial behaviour as well as prosocial behaviour at preschool age. The effects of home learning environment were significant after controlling a range of child- and family-related influencing factors on both facets of socio-emotional skills but became nonsignificant after taking into account respective behaviour at preschool age. The results of the present study suggest that fostering participation in out-of-home activities might contribute to an increase of prosocial behaviour in primary school children.

Evaluating Measures of Externalizing Personality Pathology Traits in Black and White American Adolescents in a Program for at-Risk Youths

Adolescent personality assessment measures can aid in the identification of traits that are associated with various types of maladjustment. Externalizing personality pathology traits (e.g., antisocial, borderline, and narcissistic personality disorder features) are particularly relevant for many problematic outcomes, yet measures that assess these traits have not been validated extensively in diverse samples. The present study aimed to examine the properties of measures of externalizing personality pathology traits in a sample of White (n = 184) and Black (n = 99) adolescents participating in a residential program for at-risk youth. The fit of the proposed structure for these measures was tested in the sample as a whole and in each racial group separately. Associations between these measures and the count of disciplinary infractions received while in the program were also tested. Measures were found to have less than optimal fit in this sample, especially among Black adolescents. Suggestions for future research and clinical use of these measures are discussed.

Developing and applying synergistic multilevel implementation strategies to promote reach of an evidence-based parenting intervention in primary care

Background: This practical implementation report describes a primary care-based group parenting intervention—Child–Adult Relationship Enhancement in Primary Care (PriCARE)—and the approach taken to understand and strengthen the referral process for PriCARE within a pediatric primary care clinic through the deployment of synergistic implementation strategies to promote physician referrals. PriCARE has evidence of effectiveness for reducing child behavior problems, harsh and permissive parenting, and parent stress from three randomized controlled trials (RCTs). The integration of evidence-based parenting interventions into pediatric primary care is a promising means for widespread dissemination. Yet, even when integrated into this setting, the true reach will depend on parents knowing about and attending the intervention. A key factor in this process is the endorsement of and referral to the intervention by the child's pediatrician. Therefore, identifying strategies to improve physician referrals to parenting interventions embedded in primary care is worthy of investigation. Method: Through lessons learned from the RCTs and key informant interviews with stakeholders, we identified barriers and facilitators to physician referrals of eligible parent–child dyads to PriCARE. Based on this data, we selected and implemented five strategies to increase the PriCARE referral rate. We outline the selection process, the postulated synergistic interactions, and the results of these efforts. Conclusions: The following five discrete strategies were implemented: physician reminders, direct advertising to patients, incentives/public recognition, interpersonal patient narratives, and audit and feedback. These discrete strategies were synergistically combined to create a multifaceted approach to improve physician referrals. Following implementation, referrals increased from 13% to 55%. Continued development, application, and evaluation of implementation strategies to promote the uptake of evidence-based parenting interventions into general use in the primary care setting are discussed.

Plain Language Summary

There is strong evidence that parenting interventions are effective at improving child behavioral health outcomes when delivered in coordination with pediatric primary care. However, there is a lack of focus on the implementation, including the screening and referral process, of parenting interventions in the primary care setting. This is contributing to the delay in the scale-up of parenting interventions and to achieving public health impact. To address this gap, we identified barriers and facilitators to physician screening and referrals to a primary care-based parenting intervention, and selected and piloted five synergistic strategies to improve this critical process. This effort successfully increased physician referrals of eligible patients to the intervention from 13% to 55%. This demonstration project may help advance the implementation of evidence-based interventions by providing an example of how to develop and execute multilevel strategies to improve intervention referrals in a local context.

Inattentive and hyperactive traits differentially associate with inter-individual functional synchrony during video viewing in young children without ADHD

Inattention and hyperactivity present on a spectrum and may influence the way children perceive and interact with the world. We investigated whether normative variation in inattentive and hyperactive traits was associated with differences in brain function, while children watched clips from an age-appropriate television program. Functional magnetic resonance imaging (fMRI) data and parent reports of inattention and hyperactivity traits were collected from 81 children 4–7 years of age with no parent-reported diagnoses. Data were analyzed using intersubject correlations (ISCs) in mixed effects models to determine if inattentive and hyperactive traits were associated with idiosyncrasy of fMRI response to the video. We hypothesized that pairs of children with higher average inattention and hyperactivity scores would show less interindividual brain synchrony to one another than pairs with lower average scores on these traits. Video watching engaged widespread visual, auditory, default mode and dorsal prefrontal regions. Inattention and hyperactivity were separably associated with ISC in many of these regions. Our findings suggest that the spectrum of inattention and hyperactivity traits in children without ADHD are differentially associated with neural processing of naturalistic video stimuli, which may have implications for understanding how children with different levels of these traits process audiovisual information in unconstrained conditions.

Effectiveness of Child-Focused Interventions for Externalizing Behavior: a Rapid Evidence Review

Parent behavior management training (BMT) is well established as an effective, evidence-based treatment for children with externalizing behavior. Despite the wealth of data supporting BMT, many community providers use a variety of child-focused and non-directive interventions to target behavior problems. There is lack of clarity as to whether the evidence supporting child-focused externalizing treatments is sufficiently compelling to support offering these treatments rather than or in addition to BMT. This rapid evidence review compares the effectiveness of BMT with several common child-focused interventions for externalizing behavior including cognitive behavioral (CBT), social skill (SS), and play/dynamic (PT) approaches. PubMed, PsychINFO, and Web of Science were searched for English-language articles from year 2000 onwards for each intervention type. Inclusion criteria were child age (12 and under), presence of a child-focused behavioral treatment condition, and externalizing behavior as an outcome variable. A total of 30 studies met inclusion criteria and were coded (13 CBT, 10 SS, 7 PT). Results supported social skills interventions with accompanying BMT as effective in improving externalizing problems, with generally moderate effect sizes. Individual social skills interventions were promising but needing further evaluation compared to treatment as usual. CBT treatments with and without accompanying BMT showed moderate effects over waitlist but produced less consistently significant effects compared to more robust controls. Play therapy approaches showed inconsistent effects and require further evaluation. This review supports social skills plus BMT treatments as a child-focused intervention with probable efficacy for child externalizing problems. Implications for policy and community practice are discussed.

Symptomatology of attention deficit, hyperactivity and defiant behavior as predictors of academic achievement

BACKGROUND

It is essential to understand the factors that affect the academic achievement of schoolchildren, both in general and in terms of the major subsectors of each grade. Although symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Negative Defiant Disorder (NDD-which are commonly recognized as externalizing problems in childhood and adolescence-have been associated with lower academic achievement in the international literature, few studies have addressed this problem in Latin America. This study aimed to analyze the possible predictive relationship of attention problems, hyperactivity, and defiant behavior on academic achievement.

METHODS

We recruited a sample of 4580 schoolchildren (50.9% female, 1754 belonging to primary school, and 2826 to secondary school, ranging from 9 to 18 years old). This cross-sectional study used the scales pertaining to attention problems, hyperactivity, and challenging behavior from the Child and Adolescent Evaluation System.

RESULTS

The analysis showed that attention problems significantly affected all academic achievement areas, while hyperactivity and challenging behavior affected only some of them. The regression models explained 24% of the variability in overall academic achievement in primary school and 17% in secondary school. Other predictors included sex, age, socioeconomic level, and school attendance.

CONCLUSIONS

It is important to consider this symptomatology in the design of educational interventions.

Cultural Adaptation of Group Parenting Programs: Review of the Literature and Recommendations for Best Practices

Group parenting programs based on cognitive-behavioral and social learning principles are effective in improving child behavior problems and positive parenting. However, most programs target non-Hispanic, White, English-speaking families and are largely inaccessible to a growing Hispanic and non-White population in the United States. We sought to examine the extent to which researchers have culturally adapted group parenting programs by conducting a systematic review of the literature. We identified 41 articles on 23 distinct culturally adapted programs. Most cultural adaptations focused on language translation and staffing, with less focus on modification of concepts and methods, and on optimizing the fit between the target cultural group and the program goals. Only one of the adapted programs engaged a framework to systematically record and publish the adaptation process. Fewer than half of the culturally adapted programs were rigorously evaluated. Additional investment in cultural adaptation and subsequent evaluation of parenting programs is critical to meet the needs of all US families.

The role of school enjoyment and connectedness in the association between depressive and externalising symptoms and academic attainment: Findings from a UK prospective cohort study

BACKGROUND

Previous research on the relationship between children's depressive and externalising symptoms, experience of school, and academic attainment is inconclusive. The aims of this study were (i) to test bidirectional associations between children's school experience and depressive and externalising symptoms at age 10-11 and 13-14, (ii) to ascertain whether school experience age 13-14 is associated with academic attainment age 16, and (iii) to test whether school experience mediates the relationship between depressive or externalising symptoms and attainment.

METHODS

Data was used from the Avon Longitudinal Study of Parents and Children (n=6,409). A cross-lagged model was used to investigate bidirectional associations between school experience (enjoyment and connectedness) and depression and externalising at age 10-11 and 13-14. The same framework was used to test if school experience aged 13-14 mediated associations of depressive and externalising symptoms with later attainment.

RESULTS

Depressive and externalising symptoms at 10-11 were negatively associated with school connectedness (depressive: standardised β=-0.06, CI: -0.11, 0.01; externalizing: β=-0.13, CI: -0.17, -0.08), and school enjoyment at 13-14 (depressive β=-0.04, -0.08, 0.03; externalising: β=-0.08, CI: -0.13, -0.03). School enjoyment at 13-14 was positively associated with attainment at 16 (β=0.10, CI: 0.04, 0.15), and partially mediated associations between depressive and externalising symptoms at 10-11 and attainment at 16 (depressive: proportion mediated 2.2%, CI: -1.5, 5.9; externalising: proportion mediated; 4.7%, CI: 0.7, 10.1,).

LIMITATIONS

Results may be subject to residual confounding.

CONCLUSIONS

School enjoyment is a potentially modifiable risk factor that may affect educational attainment of adolescents with depressive or externalising symptoms.

Influence of Physical Fitness and Attention Level on Academic Achievements of Female and Male Military Academy Cadets in Poland

A professional soldier should be characterized not only by high physical fitness but also by high intellectual and cognitive skills. Therefore, it is important to focus on the future commanding cadre-cadets that are educated in military academies. The aim of the study was to look for correlations between the level of physical fitness and attention and academic achievements (AA) in different subjects among cadets studying at military academies. The research group consisted of students of a military academy in Poland, i.e., 228 cadets, including 31 women and 197 men. Correlations between explained and explanatory variables were assessed using Pearson’s correlation. Correlations between AA and somatic parameters and motor components were analysed using optimal regression, using the best subset method. A statistical difference was found between men and women in terms of the level of somatic and motor development; men also performed significantly better in practical military subjects. In the female group, dominant hand strength is a significant determinant of AA in civilian and theoretical military subjects. The findings suggest the need for specialized training aimed at bridging the major differences in physical fitness between men and women by placing greater emphasis on muscle strength development.

Exploring predictors at toddler age of distinct profiles of attentional functioning in 6-year-old children born moderate-to-late preterm and full term

Objective

Examining relationships of toddler abilities in attention, cognitive, motor, and language development, and behavioral problems, with distinct attention profiles at 6 years of age in children born moderate-to-late preterm and full term.

Method

Longitudinal study with a cohort of 88 moderate-to-late preterm and 83 full term born children. At 18 months attention abilities were assessed. At 24 months cognitive, motor, and language development was examined and behavioral problems were screened. At 6 years ten measures of attention were administered, which were used to classify children in one of four attentional functioning profiles (normal attention, overall poorer attention, poorer cognitive attention, and behavioral attention problems). Performance at 18 and 24 months was examined in relation to these four distinct attention profiles, as well as in relation to normal (first profile) versus subaverage attention (second, third, and fourth profiles) using multinomial logistic regressions.

Results

Orienting and alerting attention, and receptive language were related to distinct attention profiles. Specifically, children with an overall poorer attention profile at 6 years were differentiated by lower orienting attention and receptive language scores at toddler age, while those with a poorer cognitive attention profile showed lower early alerting attention at 18 months. Children with a behavioral attention problems profile at 6 years were differentiated by lower orienting attention but higher alerting attention scores at toddler age. Orienting attention and receptive language, but not alerting attention, at toddler age were related to normal versus subaverage attention, with lower scores predicting subaverage attention.

Conclusions

Children at risk of poorer attentional functioning at school-age, expressed in distinct attention profiles, already showed differentiated functioning in attention abilities and in language comprehension as toddlers. Distinguishing distinct attention profiles could be important for future research and clinical practice, as is early monitoring of attention and language abilities in children at risk.

Effect of Parent Training on Health-Related Quality of Life in Preschool Children With Attention-Deficit/Hyperactivity Disorder: A Secondary Analysis of Data From a Randomized Controlled Trial

OBJECTIVE

School-age children with attention-deficit/hyperactivity disorder (ADHD) have reduced health-related quality of life (HRQoL), but it is unclear whether this is also true for preschool children. It is unknown whether parent training (PT) improves HRQoL. This study compared HRQoL in preschool children with ADHD with age-matched children from the general population; examined whether PT improves HRQoL; and tested if treatment-related changes in HRQoL were mediated by improvements in ADHD, parent efficacy, and family stress.

METHOD

Parents of 164 children age 3-7 years with an ADHD diagnosis participated in a randomized controlled trial comparing the New Forest Parenting Programme and treatment as usual. Measures of HRQoL, ADHD, parent efficacy, and family stress were completed at baseline, posttreatment, and 36-week follow-up. Child baseline HRQoL was compared with 2 general population-based reference groups. PT effects were analyzed using linear models and mediation analyses.

RESULTS

Preschoolers with ADHD had lower HRQoL than the reference groups. The New Forest Parenting Programme, but not treatment as usual, was associated with improvement in psychosocial HRQoL at posttreatment (change 2.28, 95% CI [0.78, 3.77]) and at 36-week follow-up (change 2.05, 95% CI [0.56, 3.54]). This difference between treatment arms was not statistically significant. Parent efficacy and family stress scores at posttreatment significantly mediated improvements in HRQoL at 36-week follow-up; ADHD scores at posttreatment did not.

CONCLUSION

ADHD negatively impacts HRQoL in early childhood. PT for ADHD has the potential to improve HRQoL independently of its effects on ADHD symptoms.

CLINICAL TRIAL REGISTRATION INFORMATION

A Controlled Study of Parent Training in the Treatment of ADHD in Young Children (D'SNAPP); http://clinicaltrial.gov/; NCT01684644.

Is concentration an indirect link between social anxiety and educational achievement in adolescents?

Social anxiety is associated with reduced educational achievement. Given that concentration is a predictor of educational achievement, and social anxiety symptoms are associated with reduced concentration in class, this prospective study examined the possibility that social anxiety may impair educational achievement through reduced classroom concentration. A sample of 509 participants (53.8% female; M age: 12.77 years [SD = 0.81]) recruited from secondary schools completed questionnaires assessing social anxiety symptoms, depressive symptoms, and concentration in class. Educational achievement was assessed by internal grades within schools. An indirect effect of social anxiety on later educational achievement via concentration was observed, over and above baseline achievement and depression symptoms; adolescents with higher levels of social anxiety tend to have more difficulties concentrating in class, which in turn is associated with poorer academic outcomes. Findings underscore the challenges socially anxious adolescents will face trying to learn in school, and the need for education providers and clinicians to consider the effect of social anxiety symptoms on concentration and learning.

Improving Child Behaviors and Parental Stress: A Randomized Trial of Child Adult Relationship Enhancement in Primary Care

BACKGROUND

Prior single-site evaluations of Child Adult Relationship Enhancement in Primary Care (PriCARE), a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes.

OBJECTIVE

To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study.

METHODS

Caregivers of children 2- to 6-year-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1 to PriCARE intervention (n = 119) or waitlist control (n = 55). Seventy-nine percent of caregivers identified as Black and 59% had annual household incomes under $22,000. Child behavior, parenting stress, and parenting attitudes were measured at baseline and 2 to 3 months after intervention using the Eyberg Child Behavior Inventory, Parenting Stress Index, and Adult-Adolescent Parenting Inventory-2. Marginal standardization implemented in a linear regression compared mean change scores from baseline to follow-up by treatment arm while accounting for clustering by site.

RESULTS

Mean change scores from baseline to follow-up demonstrated greater improvements (decreases) in Eyberg Child Behavior Inventory problem scores but not intensity scores in the PriCARE arm compared to control, (problem: -4.4 [-7.5, -1.2] vs -1.8 [-4.1, 0.4], P= .004; intensity: -17.6 [-28.3, -6.9] vs -10.4 [-18.1, -2.6], P= .255). Decreases in parenting stress were greater in the PriCARE arm compared to control (-3.3 [-4.3, -2.3] vs 0 [-2.5, 2.5], P= .025). Parenting attitudes showed no significant changes (all P> .10).

CONCLUSIONS

PriCARE showed promise in improving parental perceptions of the severity of child behaviors and decreasing parenting stress but did not have an observed impact on parenting attitudes.

Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review

IMPORTANCE

Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services.

OBJECTIVE

To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions.

EVIDENCE REVIEW

This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality.

FINDINGS

Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms.

CONCLUSIONS AND RELEVANCE

This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.

Trajectories of Emotional and Conduct Problems and Their Association With Early High School Achievement and Engagement for Adolescents With ADHD

Objective: This study aimed to (a) identify longitudinal trajectories of emotional and conduct problems from middle childhood to early adolescence in a sample of 130 adolescents diagnosed with ADHD and (b) examine trajectories in relation to early adolescent academic achievement and engagement. Method: Group-based trajectory models (GBTMs) were constructed from the parent-rated strengths and difficulties questionnaire (SDQ) subscales of emotional and conduct problems at three time points, mean ages 10.7 years, 11.6 years, and 13.7 years. Associations between trajectories and adolescent academic achievement and engagement were examined using multivariate regression. Results: Four distinct trajectories were identified within each domain. High-persistent problem trajectories in each domain were associated with poorer achievement and lower school engagement compared with adolescents following persistent-low problem trajectories. Conclusion: Findings highlight the importance of early assessment and management of comorbid emotional and conduct problems for children with ADHD as they predict school difficulties during early high school. (J. of Att. Dis. XXXX; XX(X) XX-XX).

Is Japan's child allowance effective for the well-being of children? A statistical evaluation using data from K-CHILD study

Background

Child allowance payment is one form of social security policy that aims to mitigate the child poverty gap by providing financial support to families. This study aimed to explore the impact of the child allowance on children’s physical and mental health (BMI, problem behavior, depression, and self-rated health), and parental investment in child health (children’s material goods, family events, extracurricular activities, interaction with children, and involvement in child maltreatment).

Methods

We used cross-sectional data from the 2016 Kochi Child Health Impact of Living Difficulty (K-CHILD) study. Participants were 1st, 5th and 8th grade children living in Kochi prefecture in Japan (N = 8207). Caregivers reported children’s child allowance status, BMI and behavior problems, while children filled out a self-assessment on depression and health condition. Propensity score matching analysis regarding potential confounders was used.

Results

We found that children in families that received child allowance showed a smaller total difficulties score by 1.29 points (95% CI: − 2.32 to − 0.25) and a lower risk of overweight (OR: 0.51, 95% CI: 0.29 to 0.91) although there is no association with underweight, prosocial behavior, depressive symptoms and self-rated health. Parental investment did not differ by child allowance status (p > 0.05).

Conclusions

Child allowance was found to be potentially beneficial in decreasing behavior problems and reducing child overweight. Further longitudinal studies are needed to elucidate how child allowance is used by family members and associated with children’s well-being.

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Association of Mental Disorder in Childhood and Adolescence With Subsequent Educational Achievement

IMPORTANCE

Onset of mental disorders during childhood or adolescence has been associated with underperformance in school and impairment in social and occupational life in adulthood, which has important implications for the affected individuals and society.

OBJECTIVE

To compare the educational achievements at the final examination of compulsory schooling in Denmark between individuals with and those without a mental disorder.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study was conducted in Denmark and obtained data from the Danish Civil Registration System and other nationwide registers. The 2 cohorts studied were (1) all children who were born in Denmark between January 1, 1988, and July 1, 1999, and were alive at age 17 years (n = 629 622) and (2) all children who took the final examination at the end of ninth grade in both Danish and mathematics subjects between January 1, 2002, and December 31, 2016 (n = 542 500). Data analysis was conducted from March 1, 2018, to March 1, 2019.

EXPOSURES

Clinical diagnosis by a psychiatrist of any mental disorder or 1 of 29 specific mental disorders before age 16 years.

MAIN OUTCOMES AND MEASURES

Taking the final examination at the end of ninth grade and mean examination grades standardized as z scores with differences measured in SDs (standardized mean grade difference).

RESULTS

Of the total study population (n = 629 622; 306 209 female and 323 413 male), 523 312 individuals (83%) took the final examination before 17 years of age and 38 001 (6%) had a mental disorder before that age. Among the 542 500 individuals (274 332 female and 268 168 male), the mean (SD) age was 16.1 (0.33) years for the females and 16.2 (0.34) years for the males. Among the 15 843 female and 22 158 male students with a mental disorder, a lower proportion took the final examination (0.52; 95% CI, 0.52-0.53) compared with individuals without a mental disorder (0.88; 95% CI, 0.88-0.88). Mental disorders affected the grades of male individuals (standardized mean grade difference, -0.30; 95% CI, -0.32 to -0.28) more than the grades of their female peers (standardized mean grade difference, -0.24; 95% CI, -0.25 to -0.22) when compared with same-sex individuals without mental disorders. Most specific mental disorders were associated with statistically significantly lower mean grades, with intellectual disability associated with the lowest grade in female and male students (standardized mean grade difference, -1.07 [95% CI, -1.23 to -0.91] and -1.03 [95% CI, -1.17 to -0.89]; P = .76 for sex differences in the mean grades). Female and male students with anorexia nervosa achieved statistically significantly higher grades on the final examination (standardized mean grade difference, 0.38 [95% CI, 0.32-0.44] and 0.31 [95% CI, 0.11-0.52]; P = .54 for sex differences in the mean grades) compared with their peers without this disorder. For those with anxiety, attachment, attention-deficit/hyperactivity, and other developmental disorders, female individuals attained relatively lower standardized mean grades compared with their male counterparts.

CONCLUSIONS AND RELEVANCE

Results of this study suggest that, in Denmark, almost all mental disorders in childhood or adolescence may be associated with a lower likelihood of taking the final examination at the end of ninth grade; those with specific disorders tended to achieve lower mean grades on the examination; and female, compared with male, individuals with certain mental disorders appeared to have relatively more impairment. These findings appear to emphasize the need to provide educational support to young people with mental disorders.

Many Kinds of Poverty: Three Dimensions of Economic Hardship, Their Combinations, and Children's Behavior Problems

Income poverty, material deprivation, and subjective financial stress are three distinct dimensions of economic hardship. The majority of the theoretical and empirical literature on the effects of economic hardship on children has treated material deprivation and subjective financial stress as only mediators of the effects of income poverty, not considering the independent effects of each dimension or the effects of their combinations. Using nationally representative, longitudinal data from the Millennium Cohort Study on more than 18,000 families in the United Kingdom, we propose seven distinct experiences of economic hardship, based on the possible combinations of income poverty, material deprivation, and subjective financial stress. We use mixed- and fixed-effects linear regression models to identify whether these different economic hardship combinations are differentially associated with children's behavior problems between ages 3 and 7. We find that all economic hardship combinations, including those without income poverty, are associated with higher levels of children's behavior problems. The combination of material deprivation and subjective financial stress and the combination of all three dimensions of economic hardship are associated with the highest levels of behavior problems. Based on these findings, we argue that income poverty is an important but insufficient measure of economic hardship for children and that theory and research on the effects of economic hardship on children should consider the multidimensional nature of economic stressors for families.

Improving multicultural parenting program for children with emotional and behavioral problems: An integrated review

Children with emotional and behavioral problems are often managed using medications or behavioral therapy, but in some countries, there is no structured parenting intervention to equip parents from different cultural backgrounds with adequate parenting skills to help these children. This paper aims to synthesize key findings from previous research on multicultural parenting programs and produce a comprehensive integrated view by looking into three separate themes: effective multicultural parenting programs, ethnocultural groups and cultural adaptation process. Literature search through Scopus and Google Scholar from 1999 to 2019 was conducted using the terms "effective parenting program", "effective parenting intervention", "effective multicultural parenting program", "effective multicultural parenting intervention", "multicultural parenting program", "multicultural parenting intervention", "parenting program and ethnic groups", "parenting intervention and ethnic groups", "adapted parenting program", "adapted parenting intervention", "cultural adaptation of parenting program'' and "cultural adaptation of parenting intervention". By applying the "Literature Review Synthesis Process", authors conducted cross-analysis, integrated possibilities, and prioritized the synthesized information gearing towards highly probable solutions for improving multicultural parenting programs to manage emotional and behavioral problems in children better. Development of a culturally fit parenting intervention and its implications on existing parenting programs are also discussed. The findings highlight the need 1) to engage with ethnocultural groups of parents during development of a new multicultural parenting program, and 2) to incorporate specific measures for engaging with parents during multicultural parenting program implementation. This paper contributes in acknowledging cultural components in future parenting intervention programs. Finally, recommendations are made for future directions of research.

Child-Adult Relationship Enhancement in Primary Care: A Randomized Trial of a Skill-Based Parent Training with Parent Mentor Adaptation

INTRODUCTION

Child-Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group training designed to teach positive parenting skills. Parent engagement in such programs is a common implementation barrier. Our objectives were to (1) examine the impact of a peer mentor on attendance and stigma and (2) replicate a previous study by measuring PriCARE's impact on child behavior and parenting practices.

METHOD

Parents of 2- to -6-year-old children without specific behavior problems were randomized to mentored PriCARE (n = 50), PriCARE (n = 50), or control (n = 50). Stigma was measured at 10 weeks. Child behavior and parenting practices were measured at baseline and 10 weeks using the Eyberg Child Behavior Inventory (ECBI) and Parenting Scale (PS). Analysis of variance models were used to examine differences across groups.

RESULTS

There was no significant difference in attendance between mentored PriCARE and PriCARE arms (mean 3.80 vs 3.36 sessions, p = 0.35). Parents randomized to the mentor reported lower stigma (3.75 vs 5.04, p = 0.02). Decreases in the mean ECBI scores between 0 and 10 weeks were greater in the PriCARE arms (n = 100) compared with the control arm (n = 50), reflecting larger improvements in behavior [intensity: -7 (-2 to -13) vs 4 (-3 to 12) to p = 0.014; problem: -3 (-1 to -4) vs 1 (-1 to 3) to p = 0.007]. Scores on all PS subscales reflected greater improvements in parenting behaviors in PriCARE arms compared with control (all p < 0.04).

CONCLUSION

Adapting PriCARE with a peer mentor may decrease stigma but does not improve program attendance. PriCARE shows promise in improving behavior in preschool-aged children and increasing positive parenting practices.

Starting School: a large-scale start of school assessment within the ‘Born in Bradford’ longitudinal cohort

The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort.

Incidence Rates and Cumulative Incidences of the Full Spectrum of Diagnosed Mental Disorders in Childhood and Adolescence

IMPORTANCE

Knowledge about the epidemiology of mental disorders in children and adolescents is essential for research and planning of health services. Surveys can provide prevalence rates, whereas population-based registers are instrumental to obtain precise estimates of incidence rates and risks.

OBJECTIVE

To estimate age- and sex-specific incidence rates and risks of being diagnosed with any mental disorder during childhood and adolescence.

DESIGN

This cohort study included all individuals born in Denmark from January 1, 1995, through December 31, 2016 (1.3 million), and followed up from birth until December 31, 2016, or the date of death, emigration, disappearance, or diagnosis of 1 of the mental disorders examined (14.4 million person-years of follow-up). Data were analyzed from September 14, 2018, through June 11, 2019.

EXPOSURES

Age and sex.

MAIN OUTCOMES AND MEASURES

Incidence rates and cumulative incidences of all mental disorders according to the ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research, diagnosed before 18 years of age during the study period.

RESULTS

A total of 99 926 individuals (15.01%; 95% CI, 14.98%-15.17%), including 41 350 girls (14.63%; 95% CI, 14.48%-14.77%) and 58 576 boys (15.51%; 95% CI, 15.18%-15.84%), were diagnosed with a mental disorder before 18 years of age. Anxiety disorder was the most common diagnosis in girls (7.85%; 95% CI, 7.74%-7.97%); attention-deficit/hyperactivity disorder (ADHD) was the most common in boys (5.90%; 95% CI, 5.76%-6.03%). Girls had a higher risk than boys of schizophrenia (0.76% [95% CI, 0.72%-0.80%] vs 0.48% [95% CI, 0.39%-0.59%]), obsessive-compulsive disorder (0.96% [95% CI, 0.92%-1.00%] vs 0.63% [95% CI, 0.56%-0.72%]), and mood disorders (2.54% [95% CI, 2.47%-2.61%] vs 1.10% [95% CI, 0.84%-1.21%]). Incidence peaked earlier in boys than girls in ADHD (8 vs 17 years of age), intellectual disability (5 vs 14 years of age), and other developmental disorders (5 vs 16 years of age). The overall risk of being diagnosed with a mental disorder before 6 years of age was 2.13% (95% CI, 2.11%-2.16%) and was higher in boys (2.78% [95% CI, 2.44%-3.15%]) than in girls (1.45% [95% CI, 1.42%-1.49%]).

CONCLUSIONS AND RELEVANCE

This nationwide population-based cohort study provides a first comprehensive assessment of the incidence and risks of mental disorders in childhood and adolescence. By 18 years of age, 15.01% of children and adolescents in this study were diagnosed with a mental disorder. The incidence of several neurodevelopmental disorders peaked in late adolescence in girls, suggesting possible delayed detection. The distinct signatures of the different mental disorders with respect to sex and age may have important implications for service planning and etiological research.

Pathways Between a Polygenic Score for Educational Attainment and Higher Educational Attainment in an African American Sample

We investigated the extent to which performance on standardized achievement tests, executive function (EF), and aggression in childhood and adolescence accounted for the relationship between a polygenic score for educational attainment (EA PGS) and years of education in a community sample of African Americans. Participants (N = 402; 49.9% female) were initially recruited for an elementary school-based prevention trial in a Mid-Atlantic city and followed into adulthood. In first and twelfth grade, participants completed math and reading standardized tests and teachers reported on participants' aggression and EF, specifically impulsivity and concentration problems. At age 20, participants reported on their years of education and post-secondary degrees attained and their genotype was assayed from blood or buccal swabs. An EA PGS was created using results from a large-scale GWAS on EA. A higher EA PGS was associated with higher education indirectly via adolescent achievement. No other mediating mechanisms were significant. Adolescent academic achievement is thus one mechanism through which polygenic propensity for EA influences post-secondary education among urban, African American youth.

Association of emotional and behavioral problems with single and multiple suicide attempts among Chinese adolescents: Modulated by academic performance

BACKGROUND

There were differences in the characteristics and prevalence rates between individuals with a history of one suicide attempt and those with multiple suicide attempts. This large-scale study was conducted to test, among Chinese adolescents, the associations of emotional and behavioral problems with single and multiple suicide attempts and whether these associations vary with adolescents' academic performance.

METHODS

Data were drawn from the 2019 School-based Chinese Adolescents Health Survey (n = 20,702). Information about emotional and behavioral problems, suicide attempts, suicidal ideation, academic performance, and sleep duration was gathered. Multinomial logistic regression models using Firth penalized likelihood approach and appropriate sampling weights were performed.

RESULTS

Compared with no suicide attempt, peer problems, emotional problems, conduct problems, and hyperactivity were associated with an elevated risk of both a single suicide attempt and multiple suicide attempts, respectively (P < 0.05); the magnitudes of these associations in multiple suicide attempters were higher than those in single suicide attempters. Further stratification analyses by academic performance showed a greater association of the four difficulties with multiple suicide attempts in adolescents reporting poor academic performance than in those with good or average academic performance.

LIMITATIONS

The school-based study sample only included students, and causal inference could not be delineated due to the cross-sectional design.

CONCLUSIONS

Emotional and behavioral problems are associated with an elevated risk of single and multiple suicide attempts with differences between multiple suicide attempters and single suicide attempters. Adolescent academic performance plays a modulating role in these associations for multiple suicide attempts.

Using drift diffusion modeling to understand inattentive behavior in preterm and term-born children

Objective: Children born very preterm are at increased risk of inattention, but it remains unclear whether the underlying processes are the same as in their term-born peers. Drift diffusion modeling (DDM) may better characterize the cognitive processes underlying inattention than standard reaction time (RT) measures. This study used DDM to compare the processes related to inattentive behavior in preterm and term-born children. Method: Performance on a cued continuous performance task was compared between 33 children born very preterm (VP; ≤32 weeks’ gestation) and 32 term-born peers (≥37 weeks’ gestation), aged 8–11 years. Both groups included children with a wide spectrum of parent-rated inattention (above average attention to severe inattention). Performance was defined using standard measures (RT, RT variability and accuracy) and modeled using a DDM. A hierarchical regression assessed the extent to which standard or DDM measures explained variance in parent-rated inattention and whether these relationships differed between VP and term-born children. Results: There were no group differences in performance on standard or DDM measures of task performance. Parent-rated inattention correlated significantly with hit rate, RT variability, and drift rate (a DDM estimate of processing efficiency) in one or both groups. Regression analysis revealed that drift rate was the best predictor of parent-rated inattention. This relationship did not differ significantly between groups. Conclusions: Findings suggest that less efficient information processing is a common mechanism underlying inattention in both VP and term-born children. This study demonstrates the benefits of using DDM to better characterize atypical cognitive processing in clinical samples.

Less efficient information processing during a sustained attention task explained individual differences in inattentive behavior. This was true both in 8- to 11-year-olds born very preterm and their term-born peers. Drift diffusion modeling provides a way to help us better characterize the processes that underlie task performance. This is valuable for understanding processing differences that affect clinical groups.

Examining ODD/ADHD Symptom Dimensions as Predictors of Social, Emotional, and Academic Trajectories in Middle Childhood

The goal of this article is to investigate the symptom dimensions of oppositional defiant disorder (ODD; irritability, defiance) and attention deficit/hyperactivity disorder (ADHD; inattention, hyperactivity-impulsivity) as predictors of academic performance, depressive symptoms, and peer functioning in middle childhood. Children (N = 346; 51% female) were assessed via teacher-report on measures of ODD/ADHD symptoms at baseline (Grades K-2) and academic performance, depressive symptoms, peer rejection, and victimization on 7 occasions over 4 school years (K-2 through 3-5). Self-report and grade point average data collected in Grades 3-5 served as converging outcome measures. Latent growth curve and multiple regression models were estimated using a hierarchical/sensitivity approach to assess robustness and specificity of effects. Irritability predicted higher baseline depressive symptoms, peer rejection, and victimization, whereas defiance predicted higher baseline peer rejection; however, none of these ODD-related effects persisted 3 years later to Grades 3-5. In contrast, inattention predicted persistently poorer academic performance, persistently higher depressive symptoms, and higher baseline victimization; hyperactivity-impulsivity predicted subsequent peer rejection and victimization in Grades 3-5. In converging models, only inattention emerged as a robust predictor of 3-year outcomes (viz., grade point average, depressive symptoms, peer rejection, and relational victimization). Broadly, ODD dimensions-particularly irritability-may be linked to acute disturbances in social-emotional functioning in school-age children, whereas ADHD dimensions may predict more persistent patterns of peer, affective, and academic problems. By examining all 4 ODD/ADHD symptom dimensions simultaneously, the present analyses offer clarity and specificity regarding which dimensions affect what outcomes, and when. Findings underscore the importance of multidimensional approaches to research, assessment, and intervention.

Attention deficit/hyperactivity disorder and future expectations in Russian adolescents

In recent years, there has been an increasing focus on the role of future expectations-the extent to which a future outcome is deemed likely-in the health and well-being of adolescents, with research linking future expectations to outcomes such as an increased likelihood of engaging in risky health behaviors. As yet, however, there has been no research on future expectations and attention deficit/hyperactivity disorder (ADHD) in adolescence. To address this research gap, the current study examined the association between ADHD symptoms/possible ADHD status and future expectations in a school-based sample of adolescents. Data were analyzed from 537 Russian adolescents (aged 12-17) with teacher-reported ADHD symptoms and self-reported future expectations. Logistic regression analysis was used to examine associations. In fully adjusted analyses, inattention symptoms/possible ADHD inattentive status was associated with lower future educational expectations, while a possible ADHD hyperactivity status was associated with increased odds for negative future expectations relating to work, family and succeeding in what is most important. The findings of this study suggest that greater ADHD symptoms/possible ADHD status in adolescence may be linked to an increased risk for negative future expectations across a variety of different life domains.

Training teachers in classroom management to improve mental health in primary school children: the STARS cluster RCT

Background

Poor mental health in childhood is common, persistent and associated with a range of adverse outcomes that include persistent psychopathology, as well as risk-taking behaviour, criminality and educational failure, all of which may also compromise health. There is a growing policy focus on children’s mental health and the role of schools in particular in addressing this.

Objectives

To evaluate whether or not the Incredible Years®(IY) Teacher Classroom Management (TCM) training improved children’s mental health, behaviour, educational attainment and enjoyment of school, improved teachers’ mental health and relationship with work, and was cost-effective in relation to potential improvements.

Design

A two-arm, pragmatic, parallel-group, superiority, cluster randomised controlled trial.

Setting

A total of 80 UK schools (clusters) were recruited in three distinct cohorts between 2012 and 2014 and randomised to TCM (intervention) or teaching as usual [(TAU) control] with follow-ups at 9, 18 and 30 months. Schools and teachers were not masked to allocation.

Participants

Eighty schools (n = 2075 children) were randomised: 40 (n = 1037 children) to TCM and 40 (n = 1038 children) to TAU.

Interventions

TCM was delivered to teachers in six whole-day sessions, spread over 6 months. The explicit goals of TCM are to enhance classroom management skills and improve teacher–student relationships.

Main outcome measures

The primary planned outcome was the teacher-reported Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score. Random-effects linear regression and marginal logistic regression models using generalized estimating equations were used to analyse outcomes.

Results

The intervention reduced the SDQ-TD score at 9 months [adjusted mean difference (AMD) –1.0, 95% confidence interval (CI) –1.9 to –0.1;p = 0.03] but there was little evidence of effects at 18 months (AMD –0.1, 95% CI –1.5 to 1.2;p = 0.85) and 30 months (AMD –0.7, 95% CI –1.9 to 0.4;p = 0.23). Planned subgroup analyses suggested that TCM is more effective than TAU for children with poor mental health. Cost-effectiveness analysis using the SDQ-TD suggested that the probability of TCM being cost-effective compared with TAU was associated with some uncertainty (range of 40% to 80% depending on the willingness to pay for a unit improvement in SDQ-TD score). In terms of quality-adjusted life-years (QALYs), there was evidence to suggest that TCM was cost-effective compared with TAU at the National Institute for Health and Care Excellence thresholds of £20,000–30,000 per QALY at 9- and 18-month follow-up, but not at 30-month follow-up. There was evidence of reduced disruptive behaviour (p = 0.04) and reductions in inattention and overactivity (p = 0.02) at the 30-month follow-up. Despite no main effect on educational attainment, subgroup analysis indicated that the intervention’s effect differed between those who did and those who did not have poor mental health for both literacy (interactionp = 0.04) and numeracy (interactionp = 0.03). Independent blind observations and qualitative feedback from teachers suggested that teachers’ behaviour in the classroom changed as a result of attending TCM training.

Limitations

Teachers were not masked to allocation and attrition was marked for parent-reported data.

Conclusions

Our findings provide tentative evidence that TCM may be an effective universal child mental health intervention in the short term, particularly for primary school children who are identified as struggling, and it may be a cost-effective intervention in the short term.

Future work

Further research should explore TCM as a whole-school approach by training all school staff and should evaluate the impact of TCM on academic progress in a more thorough and systematic manner.

Trial registration

Current Controlled Trials ISRCTN84130388.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 6. See the NIHR Journals Library website for further project information. Funding was also provided by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula).

Adult outcomes of childhood disruptive disorders in offspring of depressed and healthy parents

BACKGROUND

Longitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders.

METHOD

Offspring (N = 267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested.

RESULTS

Eighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AOR = 3.42, p < 0.0001), bipolar disorder (AOR = 3.10, p = 0.03), and substance use disorders (AOR = 5.69, p < 0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HR = 3.25, p < 0.0001; SUD, HR = 2.52, p < 0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group.

LIMITATIONS

Associations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began.

CONCLUSION

If there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity.

The impact of health on economic and social outcomes in the United Kingdom: A scoping literature review

This is the first review of the evidence, based on longitudinal studies in the United Kingdom, on the association of ill health at any life stage and later social and economic outcomes. The review included a wide range of physical and mental health exposures, both self-reported and objectively measured, as well as social (e.g. life satisfaction) and economic (e.g. employment) outcomes. We searched the Web of Science, key longitudinal datasets based in the UK, major economic journals, Google Scholar and reference lists of relevant publications. The review includes 80 studies. There was strong evidence for the association between early mental health, mainly attention deficit hyperactivity disorder, and lifetime educational, occupational and various social outcomes. Also, both poor physical and mental health in early and middle adulthood, tended to be associated with unemployment and lower socioeconomic status. Among older adults, the evidence quite consistently indicated an association between mental health, chronic conditions, disability/functional limitations, self-rated general health and quality of life, life satisfaction and early retirement. Overall, mental health was consistently found to be associated with a range of social and economic outcomes throughout the lifespan. The evidence for the association between physical health and later outcomes is more inconsistent. A number of methodological challenges need to be addressed, particularly related to causal inference, to produce robust evidence with potential to inform public health policy.