Physical Discipline, Deprivation, and Differential Risk of Developmental Delay Across 17 Countries

Cognitive deficits and enhancements in youth from adverse conditions: An integrative assessment using Drift Diffusion Modeling in the ABCD study

Childhood adversity can lead to cognitive deficits or enhancements, depending on many factors. Though progress has been made, two challenges prevent us from integrating and better understanding these patterns. First, studies commonly use and interpret raw performance differences, such as response times, which conflate different stages of cognitive processing. Second, most studies either isolate or aggregate abilities, obscuring the degree to which individual differences reflect task-general (shared) or task-specific (unique) processes. We addressed these challenges using Drift Diffusion Modeling (DDM) and structural equation modeling (SEM). Leveraging a large, representative sample of 9-10 year-olds from the Adolescent Brain Cognitive Development (ABCD) study, we examined how two forms of adversity-material deprivation and household threat-were associated with performance on tasks measuring processing speed, inhibition, attention shifting, and mental rotation. Using DDM, we decomposed performance on each task into three distinct stages of processing: speed of information uptake, response caution, and stimulus encoding/response execution. Using SEM, we isolated task-general and task-specific variances in each processing stage and estimated their associations with the two forms of adversity. Youth with more exposure to household threat (but not material deprivation) showed slower task-general processing speed, but showed intact task-specific abilities. In addition, youth with more exposure to household threat tended to respond more cautiously in general. These findings suggest that traditional assessments might overestimate the extent to which childhood adversity reduces specific abilities. By combining DDM and SEM approaches, we can develop a more nuanced understanding of how adversity affects different aspects of youth's cognitive performance. RESEARCH HIGHLIGHT: To understand how childhood adversity shapes cognitive abilities, the field needs analytical approaches that can jointly document and explain patterns of lowered and enhanced performance. Using Drift Diffusion Modeling and Structural Equation Modeling, we analyzed associations between adversity and processing speed, inhibition, attention shifting, and mental rotation. Household threat, but not material deprivation, was mostly associated with slower task-general processing speed and more response caution. In contrast, task-specific abilities were largely intact. Researchers might overestimate the impact of childhood adversity on specific abilities and underestimate the impact on general processing speed and response caution using traditional measures.

Developmental delay and its demographic and social predictors among preschool-age children in Palestine

PURPOSE

This study was designed to assess the developmental outcomes among preschool-aged children and its associated factors in Palestine.

METHODS

A cross-sectional, descriptive-correlational design involved a representative sample of preschool-aged children from kindergarten in Ramallah governorate. Data were collected using the Ages and Stages Questionnaire, Arabic version-3. Associations between developmental delay (DD), parent, child and family characteristics were analyzed utilizing SPSS-25 version.

RESULTS

A total of 249 preschoolers participated in the study. The overall rate of children with Global Developmental Delay (GDD) was 23.7%. The most prevalent DD were in gross motor, personal social, and fine motor skills (25.3%, 17.7%, and 16.5%, respectively). Binary logistic regression analysis revealed that the male gender of a child (OR = 2.66, 95% CI [1.37, 5.19]), the mother's part-time work (OR = 6.01, 95% CI [1.68, 21.52]), low family income (OR = 3.67, 95% CI [1.05, 12.73]), and families with three or more children (OR = 1.43, 95% CI [1.15, 1.781]) were statistically significant independent predictors of GDD.

CONCLUSION

The study findings revealed higher rate of DD among preschoolers in Palestine than regional areas, especially in gross motor, fine motor, and personal social skills, which has consequences for both national and global health. According to the results, factors related to the child, the mother and the family are associated with the cumulative risk of preschoolers having DD.

IMPLICATIONS

It is a crucial role for pediatric nurses to detect DD early and its related risk factors through screening programs to limit the burden of problems in childhood and later adulthood.

Corporal Punishment and Child Development in Low- and- Middle-Income Countries: Progress, Challenges, and Directions

Most studies and reviews of studies on the developmental consequences of corporal punishment have focused on samples from the U.S. and other high-income countries. This study conducted a rapid review of the literature on the associations between corporal punishment and children's cognitive and social-emotional development in low- and- middle-income countries (LMICs). Information from more than 42 studies of children younger than 18 years living in 64 LMICs was reviewed. Overall, the reviewed studies show associations between corporal punishment and negative cognitive and social-emotional outcomes, and there is no evidence that corporal punishment may relate to any positive developmental outcome in LMICs. Yet, issues of internal and external validity are common in the literature. The current evidence indicates that corporal punishment might increase the risk of detrimental child outcomes in LMICs, but further research with stronger methodological designs including samples from multiple settings is warranted.

How can early life adversity still exert an effect decades later? A question of timing, tissues and mechanisms

Exposure to any number of stressors during the first 1000 days from conception to age 2 years is important in shaping an individual's life trajectory of health and disease. Despite the expanding range of stressors as well as later-life phenotypes and outcomes, the underlying molecular mechanisms remain unclear. Our previous data strongly suggests that early-life exposure to a stressor reduces the capacity of the immune system to generate subsequent generations of naïve cells, while others have shown that, early life stress impairs the capacity of neuronal stem cells to proliferate as they age. This leads us to the "stem cell hypothesis" whereby exposure to adversity during a sensitive period acts through a common mechanism in all the cell types by programming the tissue resident progenitor cells. Furthermore, we review the mechanistic differences observed in fully differentiated cells and suggest that early life adversity (ELA) may alter mitochondria in stem cells. This may consequently alter the destiny of these cells, producing the lifelong "supply" of functionally altered fully differentiated cells.

Prevalence and risk factors of developmental disabilities among preschool children in the Arab world: a narrative literature review

PURPOSE

Developmental disabilities (DDs) are a global childhood problem whose prevalence is rising, with a disproportionate impact on individuals in low-and middle-income countries. However, data on the prevalence of DDs in the Arab world are limited. This review highlights what is currently known about the prevalence and risk factors of DDs in preschool children in the Arab world.

METHODS

PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar were searched for publications on DDs among preschool children in the Arab world. Only 14 studies were identified in the literature, from 12 Arab countries.

RESULTS

The overall estimated prevalence of DDs among preschool children in the Arab world is 27.5%. An analysis of risk factors for DDs showed that child-related, maternal, and family-related factors account for a significant cumulative risk of developing DDs in preschool children. Maternal factors, such as antenatal and perinatal complications, were the most common risk factors.

CONCLUSION

The prevalence of DDs among preschoolers is significantly high in the Arab world, which emphasizes the importance of the early detection and diagnosis of DD, as well as its associated risk factors.

Preventing Punitive Violence: Implementing Positive Discipline in Everyday Parenting (PDEP) with Marginalized Populations in Bangladesh

Physical and other types of punishment remain common in Bangladesh, despite overwhelming evidence of their harm and worldwide efforts to decrease their use. One of the strategic priorities of Save the Children in Bangladesh's Child Protection Program is to protect children from physical and humiliating punishment in homes, schools, and other settings. Save the Children in Bangladesh selected the Positive Discipline in Everyday Parenting (PDEP) Program to provide parents with alternatives to physical punishment that comply with human rights standards while strengthening relationships and understanding of child development. High-risk communities where children are particularly vulnerable were selected for this project. The PDEP program was delivered to 857 parents living in lower socioeconomic areas of Bangladesh, including ethnic minority groups, and parents living in urban slums of Dhaka and rural brothel areas. Due to the low levels of education of the participants (almost two-thirds of participants had not completed elementary school), simplified pre and posttests were utilized. Following program completion, parents' approval of both physical punishment and punishment in general declined; they were less likely to view typical parent-child conflicts as intentional misbehavior and were less reactive to frustration. In addition, parents indicated an increased understanding of the positive discipline and more confidence in their parenting skills. Before taking PDEP, 64% of the parents often felt like they just did not know what to do as a parent, compared to 34% following program completion. PDEP demonstrated the potential to decrease the use of physical and humiliating punishments by parents living in high-risk communities in Bangladesh.

Measuring early life adversity: A dimensional approach

Exposure to adversity in childhood is associated with elevations in numerous physical and mental health outcomes across the life course. The biological embedding of early experience during periods of developmental plasticity is one pathway that contributes to these associations. Dimensional models specify mechanistic pathways linking different dimensions of adversity to health and well-being outcomes later in life. While findings from existing studies testing these dimensions have provided promising preliminary support for these models, less agreement exists about how to measure the experiences that comprise each dimension. Here, we review existing approaches to measuring two dimensions of adversity: threat and deprivation. We recommend specific measures for measuring these constructs and, when possible, document when the same measure can be used by different reporters and across the lifespan to maximize the utility with which these recommendations can be applied. Through this approach, we hope to stimulate progress in understanding how particular dimensions of early environmental experience contribute to lifelong health.

What is the expected human childhood? Insights from evolutionary anthropology

In psychological research, there are often assumptions about the conditions that children expect to encounter during their development. These assumptions shape prevailing ideas about the experiences that children are capable of adjusting to, and whether their responses are viewed as impairments or adaptations. Specifically, the expected childhood is often depicted as nurturing and safe, and characterized by high levels of caregiver investment. Here, we synthesize evidence from history, anthropology, and primatology to challenge this view. We integrate the findings of systematic reviews, meta-analyses, and cross-cultural investigations on three forms of threat (infanticide, violent conflict, and predation) and three forms of deprivation (social, cognitive, and nutritional) that children have faced throughout human evolution. Our results show that mean levels of threat and deprivation were higher than is typical in industrialized societies, and that our species has experienced much variation in the levels of these adversities across space and time. These conditions likely favored a high degree of phenotypic plasticity, or the ability to tailor development to different conditions. This body of evidence has implications for recognizing developmental adaptations to adversity, for cultural variation in responses to adverse experiences, and for definitions of adversity and deprivation as deviation from the expected human childhood.

Housing environment and early childhood development in sub-Saharan Africa: A cross-sectional analysis

BACKGROUND

The influence of the safety and security of environments on early childhood development (ECD) has been under-explored. Although housing might be linked to ECD by affecting a child's health and a parent's ability to provide adequate care, only a few studies have examined this factor. We hypothesized that housing environment is associated with ECD in sub-Saharan Africa (SSA).

METHODS AND FINDINGS

From 92,433 children aged 36 to 59 months who participated in Multiple Indicator Cluster Survey (MICS) in 20 SSA countries, 88,271 were tested for cognitive and social-emotional development using the Early Childhood Development Index (ECDI) questionnaire and were thus included in this cross-sectional analysis. Children's mean age was 47.2 months, and 49.8% were girls. Children were considered developmentally on track in a certain domain if they failed no more than 1 ECDI item in that domain. In each country, we used conditional logistic regression models to estimate the association between improved housing (housing with finished building materials, improved drinking water, improved sanitation facilities, and sufficient living area) and children's cognitive and social-emotional development, accounting for contextual effects and socioeconomic factors. Estimates from each country were pooled using random-effects meta-analyses. Subgroup analyses were conducted by the child's gender, maternal education, and household wealth quintiles. On-track cognitive development was associated with improved housing (odds ratio [OR] = 1.15, 95% CI 1.06 to 1.24, p < 0.001), improved drinking water (OR = 1.07, 95% CI 1.00 to 1.14, p = 0.046), improved sanitation facilities (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.014), and sufficient living area (OR = 1.06, 95% CI 1.01 to 1.10, p = 0.018). On-track social-emotional development was associated with improved housing only in girls (OR = 1.14, 95% CI 1.04 to 1.25, p = 0.006). The main limitations of this study included the cross-sectional nature of the datasets and the use of the ECDI, which lacks sensitivity to measure ECD outcomes.

CONCLUSIONS

In this study, we observed that improved housing was associated with on-track cognitive development and with on-track social-emotional development in girls. These findings suggest that housing improvement in SSA may be associated not only with benefits for children's physical health but also with broader aspects of healthy child development.

Association between Household Crowding and Violent Discipline and Neglect of Children: Analysis of Multiple Indicator Cluster Surveys in 26 Low- and Middle-Income Countries

The influence of household crowding on physical and mental health has been well documented. However, research on the influence of household crowding on violent discipline and neglect of children is scarce. Therefore, we aimed to investigate whether household crowding was associated with violent discipline and neglect of children in low- and- middle-income countries (LMICs). Cross-sectional data for 280,005 and 73,030 children in 26 LMICs surveyed using the Multiple Indicator Cluster Survey were analyzed for (1) violent discipline and (2) neglect, respectively. In each country, we used logistic regression models to estimate the effects of household crowding on multiple forms of violent discipline and stimulation activities (as a proxy of the level of child neglect). Estimates were pooled using random effects meta-analyses. After adjusting for confounding variables, household crowding was associated with higher odds of any violent discipline (odds ratio (OR) = 1.09, 95% CI 1.03 to 1.15, p = 0.002) and lower odds of engaging in four or more stimulation activities (OR = 0.88, 95% CI 0.83 to 0.94, p < 0.001). The associations were stronger for urban children and children living in low- and lower-middle-income countries. The findings suggest that screenings and interventions aimed at reducing the effects of household crowding might be effective in preventing and controlling violent discipline and neglect of children in LMICs.

Editorial: Sharpening Our Focus on Early Adversity, Development, and Resilience Through Cross-National Research

The impacts of the Adverse Childhood Experiences (ACEs) Study continue to reverberate across medicine, influencing clinical practice, research, and public policy, prompting reexamination of the original ACEs research, and generating a range of new research questions that are critical for understanding health and development across the lifespan.^1,2 Within child and adolescent psychiatry, this explosion of interest in childhood trauma and its consequences is generating rich new areas of inquiry: how does adversity become biologically embedded in brain structure and functioning? What familial, environmental, and genetic factors influence resilience and risk? How should we update and adapt the original ACEs framework to account for cultural, ethnic, and geographic differences across populations with various exposures during childhood and distinct ways of experiencing and understanding these exposures? What positive experiences during childhood might have equally profound lifelong health impacts? In this issue of the Journal, Salhi et al.³ present findings from a large cross-national survey of parents of young children to examine their hypotheses that particular household exposures, physical discipline, and lack of cognitive stimulation represent adverse experiences associated with specific developmental outcomes in young children. Like much related research emerging in this area, the present study may provoke more new questions than it answers, and the article sharpens our focus to better understand the developmental science of early adversity and its implications for mental health promotion and clinical care.