The Influence of Social Disadvantage on Children's Emotional and Behavioral Difficulties at Age 4-7 Years

Preschool-level socio-economic deprivation in relation to emotional and behavioural problems among preschool children in Sweden

AIMS

The aim of this study was to explore the association between preschool-level socio-economic deprivation and emotional and behavioural problems among preschool children in Sweden using a multilevel approach.

METHODS

In this cross-sectional study, we used data on 2267 children whose parents and preschool teachers had responded to items measuring individual-level socio-economic deprivation and the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems. Further, the Socioeconomic Structure Compensation Index (SSCI), collected from Uppsala municipality, was used to assess preschool-level socio-economic deprivation. Unadjusted and adjusted multilevel logistic regression models were used to explore the relations between preschool-level socio-economic deprivation and emotional and behavioural problems.

RESULTS

In unadjusted models, children who attended preschools classified as highly deprived had elevated odds for emotional symptoms (odds ratio (OR) 1.71) as rated by parents. However, this association did not remain significant after adjusting for individual-level socio-economic deprivation factors. In both unadjusted and adjusted models, children who attended preschools classified as moderately deprived had elevated odds for peer-relationship problems as rated by parents (OR 1.63; adjusted OR 1.48). There were no significant associations between preschool deprivation and emotional and behavioural problems as rated by preschool teachers.

CONCLUSIONS

Swedish preschools may have a compensatory capacity in addressing children's emotional and behavioural problems, whereas preschool-level deprivation remained significantly associated with peer-relationship problems after controlling for individual-level socio-economic deprivation factors. This implies that peer-relationship problems in deprived preschools need to be addressed in a broader community context.

Birth order and socioeconomic disadvantage predict behavioural and emotional problems at age 3 years

AIM

The aim of this study was to describe sociodemographic and family predictors for behavioural and emotional problems in pre-schoolers.

METHODS

This was a cross-sectional study including 30,795 children in the Stockholm region whose parents had completed the Strength and Difficulties Questionnaire (SDQ) prior to a routine visit to a well-baby clinic at age 3 years. Multivariate logistic regression was used to analyse predictors for having a high total SDQ difficulties score.

RESULTS

Young parental age and a low level of parental education predicted high total SDQ score in a stepwise pattern. Being a first-born child was associated with a high SDQ score with an adjusted odds ratio of 2.10 (95% C.I. 1.84-2.41), compared with having older siblings. A sole physical custody arrangement predicted a high total SDQ score after parental separation. The percentage of children with a high total SDQ score increased with the Care Need Index (CNI) of the well-baby clinic.

CONCLUSIONS

This study identified socioeconomic disadvantage and being the first-born child as the main predictors of poor mental health at age 3 years. Well-baby clinics with socioeconomically disadvantaged catchment areas should be provided with adequate resources and methods for equitable prevention.

Pregnancy and Infant Development (PRIDE)-a preliminary observational study of maternal adversity and infant development

Background

Children from socioeconomically disadvantaged families have a markedly elevated risk for impaired cognitive and social-emotional development. Children in poverty experience have a high risk for developmental delays. Poverty engenders disproportionate exposure to psychological adversity which may contribute to impaired offspring development; however the effect may be mitigated by social support and other aspects of resilience. Our objective was to determine the association between maternal stress, adversity and social support and early infant neurobehavior and child behavior at two and three years.

Methods

We conducted a longitudinal mother-infant cohort study nested within a regional home visiting program in Cincinnati, Ohio. Four home study visits were completed to collect measures of maternal stress, adversity and social support and infant and child behavior. A measure of infant neurobehavior (‘high-arousal’ infant) was derived from the NICU Network Neurobehavioral Scale (NNNS) at 1 month and externalizing and internalizing symptoms were measured by the Child Behavior Checklist (CBCL) at 24 and 36 months. Linear and logistic regression identified associations between maternal risk/protective factors and infant and child behavioral measures. We used stratification and multiplicative interaction terms to examine potential interactions.

Results

We enrolled n = 55 pregnant mothers and follow 53 mother–offspring dyads at 1 month, 40 dyads at 24 months and 27 dyads at 36 months. Maternal adversity and protective factors were not associated with neurobehavior at one month. However, maternal depression and measures of distress in pregnancy were significantly associated with internalizing and externalizing symptoms at 24 and 36 months.

Conclusions

This pilot study established the feasibility of conducting longitudinal research within a community intervention program. In addition, although there were no statistically significant associations between maternal psychosocial factors in pregnancy and infant neurobehavior, there were several associations at 24 months, primarily internalizing symptoms, which persisted through 36 months. Future work will replicate findings within a larger study as well as explore mediators and modifiers of these associations.

Social determinants of psychological wellness for children and adolescents in rural NSW

Background

The mental wellness of children and adolescents in rural Australia is under researched and key to understanding the long-term mental health outcomes for rural communities. This analysis used data from the Australian Rural Mental Health Study (ARMHS), particularly the parent report Strengths and Difficulties Questionnaire (SDQ) measure for children under 18 years old and their reporting parent’s demographic information to compare this sample’s mental wellness scores to the Australian norms and to identify what personal, family, community and rurality factors contribute to child mental wellness as pertaining to the SDQ total and subdomain scores.

Method

Five hundred thirty-nine children from 294 families from rural NSW were included. SDQ scores for each child as well as personal factors (sex and age), family factors (employment status, household income and sense of community of responding parent), community SES (IRSAD) and rurality (ASCG) were examined.

Results

Children and adolescents from rural areas had poorer mental wellness when compared to a normative Australian sample. Further, personal and family factors were significant predictors of the psychological wellness of children and adolescents, while after controlling for other factors, community SES and level of rurality did not contribute significantly.

Conclusions

Early intervention for children and families living in rural and remote communities is warranted particularly for low income families. There is a growing need for affordable, universal and accessible services provided in a timely way to balance the discrepancy of mental wellness scores between rural and urban communities.

Neonatal NR3C1 Methylation and Social-Emotional Development at 6 and 18 Months of Age

The variation in childhood social-emotional development within at-risk populations may be attributed in part to epigenetic mechanisms such as DNA methylation (DNAm) that respond to environmental stressors. These mechanisms may partially underlie the degree of vulnerability (and resilience) to negative social-emotional development within adverse psychosocial environments. Extensive research supports an association between maternal adversity and offspring DNAm of the NR3C1 gene, which encodes the glucocorticoid receptor (GR). A gap in knowledge remains regarding the relationship between NR3C1 DNAm, measured in neonatal (1-month of age) buccal cells, and subsequent social-emotional development during infancy and early childhood. We conducted a longitudinal cohort study of n = 53 mother-child dyads (n = 30 with developmental outcomes formed the basis of current study) who were enrolled in a home visiting (HV) program. Higher mean DNAm of the NR3C1 exon 1_F promoter was significantly associated with lower 6-month Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) scores—more positive infant social-emotional functioning. A similar trend was observed at 18-months of age in a smaller sample (n = 12). The findings of this pilot study indicate that in a diverse and disadvantaged population, the level of neonatal NR3C1 DNAm is related to later social-emotional development. Limitations and implications for future research are discussed.

Maternal distress and hair cortisol in pregnancy among women with elevated adverse childhood experiences

Life-course exposure to stress is associated with a wide-range of health outcomes. Early childhood adversity may affect an individual's future response to stress. This is of particular concern during pregnancy as early maternal stress may impact the stress response in pregnancy, altering fetal exposure. We therefore hypothesized maternal childhood adversity may interact with distress experienced in pregnancy affecting maternal cortisol accumulation in pregnancy. Analyses were conducted within the PRegnancy and Infant Development (PRIDE) Study, a cohort of mother-infant pairs participating in Every Child Succeeds, a home visiting program in Cincinnati, Ohio. Thirty (of 53) healthy pregnant mothers contributed a hair sample and completed a battery of psychologic and stress measures including the Adverse Childhood Experiences (ACE) Scale. We used linear models to estimate the association between symptoms of depression, anxiety, somatization, both pregnancy and perceived stress and cortisol deposition; we generated multiplicative interaction terms generated and models stratified by the dose of ACEs (≥2/<2). Although overall the associations between maternal psychological distress were not associated with hair cortisol, among women who experienced ≥2 ACEs, depressive, somatic, and anxiety symptoms and perceived stress during pregnancy were positively (and significantly for depressive and somatic) correlated with cortisol accumulation. Pregnancy-specific stress was inversely associated with cortisol and also varied by ACEs. Interactions were non-significant (p values 0.11-0.51). We identified an association between measures of distress in pregnancy and hair cortisol only among mothers who experienced high levels of childhood adversity demonstrating importance of recognizing life-course stress.

Cumulative adversity, childhood behavioral problems, and educational mobility in China's poorest rural communities

Behavioral problems are recognized as playing a potentially important role in educational attainment, but their function in contexts of extreme poverty is not well understood. In such settings, other factors might swamp any effects of children's behavioral problems. Further, the interpretation of behavioral problems in circumstances of deep poverty is not clear: problematic behaviors might be in part a direct function of adverse experiences in childhood. In this paper, we focus on the case of 2000 rural youth sampled in the year 2000 from 100 villages in Gansu, one of China's poorest provinces, and followed up through 2015. We investigate whether behavioral problems-internalizing problems, externalizing problems, and teacher-reported behavior problems-predict subsequent educational attainment among the rural poor, and consider the contributions of cumulative adversity to behavioral problems. Results in a high-poverty context where promotion decisions are closely tied to performance show that behavioral factors are linked to long-term educational outcomes. These results are robust to adjustment for a host of individual, family, and community context variables. There is some evidence that children in higher socioeconomic status families and in more developed communities are less vulnerable to behavioral problems. While girls are slightly less vulnerable to teacher-reported behavior problems than boys, there is no gender difference in the implications of behavioral problems for educational attainment. Finally, behavioral problems do not appear to operate simply as a proxy for measured family adversity.

Risk and protective factors for mental health problems in preschool-aged children: cross-sectional results of the BELLA preschool study

BACKGROUND

Mental health problems (MHPs) in preschoolers are precursors of mental disorders which have shown to be associated with suffering, functional impairment, exposure to stigma and discrimination, as well as enhanced risk of premature death. A better understanding of factors associated with MHPs in preschoolers can facilitate early identification of children at risk and inform prevention programs. This cross-sectional study investigated the association of risk and protective factors with MHPs within a German representative community sample.

METHODS

MHPs were assessed in a sample of 391 preschoolers aged 3-6 years using the Strength and Difficulties Questionnaire (SDQ). The effects of parental MHPs, children's temperament, parental socioeconomic status (SES), social support and perceived self-competence on MHPs were assessed using bivariate and multivariate logistic regression analyses that controlled for sociodemographic characteristics.

RESULTS

Overall, 18.2% of preschoolers were classified as 'borderline or abnormal' on the total difficulties score of the SDQ. Bivariate analyses showed that parental MHPs, children's difficult temperament, and parental low SES increased the likelihood, whereas high perceived parental competence decreased the likelihood of preschool MHPs. In the multivariate analyses, only difficult child temperament remained significantly associated with preschool MHPs when other variables were controlled.

CONCLUSIONS

The results underline the importance of children's difficult temperamental characteristics as a risk factor for mental health in preschoolers and suggest that these may also be an appropriate target for prevention of preschool MHPs. More research on specific aspects of preschool children's temperament, the socioeconomic environment and longitudinal studies on the effects of these in the development of preschool MHPs is needed.