Developmental Pathways among Adaptive Functioning and Externalizing and Internalizing Behavioral Problems: Cascades from Childhood into Adolescence

Mothers' and their children's emotional and behavioral symptom trajectories and subsequent maternal adjustment: Twenty-seven years of motherhood

BACKGROUND

This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems).

METHODS

The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers.

RESULTS

We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning.

LIMITATIONS

Maternal and child measures were based on maternal reports only.

CONCLUSIONS

The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children.

Infants of mothers with early remitted clinical depression and mothers with no postpartum depression: Adaptive functioning in the second year of life

Whether and how remitted clinical depression in postpartum motherhood contributes to poor infant adaptive functioning is inconclusive. The present longitudinal study examines adaptive functioning in infants of mothers diagnosed as clinically depressed at 5 months but remitted at 15 and 24 months. Fifty-five U. S. mothers with early, remitted clinical depression and 132 mothers without postpartum depression completed the Vineland Adaptive Behavior Scales about their infants at 15 and 24 months. Between groups, mothers were equivalent in age, ethnicity, marital status, and receptive vocabulary (a proxy for verbal intelligence), and infants were equivalent in age and distribution of gender. Controlling for maternal education and parity, mothers with early, remitted clinical depression and mothers with no postpartum depression rated their infants similarly on communication, daily living skills, and socialization. Mothers with early, remitted clinical depression rated their infants poorer in motor skills. Girls were rated more advanced than boys in communication at 24 months and daily living skills at 15 and 24 months. Rated infant adaptive behavior skills increased from 15 to 24 months. With exceptions, adaptive functioning in infants may be robust to early, remitted maternal depression, and adaptive functioning presents a domain to promote positive development in this otherwise vulnerable population.

The role of social cognition in mental health trajectories from childhood to adolescence

We investigated the association between an aspect of Theory of Mind in childhood, false-belief understanding, and trajectories of internalising (emotional and peer) and externalising (conduct and hyperactivity) problems in childhood and adolescence. The sample was 8408 children from the UK's Millennium Cohort Study, followed at ages 5, 7, 11, 14, and 17 years. Social cognitive abilities were measured at 5 and 7 years through a vignette version of the Sally-Anne task administered by an unfamiliar assessor in a socially demanding dyadic interaction. Internalising and externalising problems were measured via the Strengths and Difficulties Questionnaire at 7-17 years. Using latent growth modelling, and after controlling for sex, ethnicity, maternal education, verbal ability, and time-varying family income, we found that superior social cognitive abilities predicted a decrease in emotional problems over time. In sex-stratified analyses, they predicted decreasing conduct problem trajectories in females and lower levels of conduct problems at baseline in males.

Longitudinal association of nighttime sleep duration with emotional and behavioral problems among rural preschool children

This study aimed to examine the association between nighttime sleep duration and emotional and behavioral problems (EBPs) among rural preschool children. This longitudinal study including 1595 preschool children aged 3-6 years from 26 kindergartens in four counties was conducted in Anhui Province rural areas. Cross-lagged panel models and multivariable logistic regressions were performed to examine the bidirectional association between nighttime sleep duration and EBPs and further explore the predictive effect of nighttime sleep duration on EBPs. Compared to baseline, preschool children at follow-up had significantly more nighttime sleep duration (10.01 ± 0.68 vs. 10.15 ± 0.69) and lower EBPs (total difficulties: 15.8% vs. 11.2%; prosocial behavior problems: 12.4% vs. 7.0%). Results of cross-lagged panel models indicated that nighttime sleep duration was a predictor for EBPs, but not vice versa. Results of logistic regression analysis showed that each 1-h increase in nighttime sleep duration at T1 was associated with a 0.77-fold reduction in the risk of total difficulties at T2 (the most adjusted OR = 0.774, 95% CI 0.607-0.988, P = 0.040), but not with the prosocial behavior. Interestingly, the predictive effect of nighttime sleep duration at T1 on EBPs at T2 was only found in girls, children aged 3 years and children with lower maternal education. The decreased nighttime sleep duration may predict future EBPs, especially in girls, younger preschool children and children with lower maternal education. Extending sleep duration may improve EBPs in preschool children.

Gene-by-Environment Interaction Effects of Social Adversity on Externalizing Behavior in ABCD Youth

This study tested whether multiple domains of social adversity, including neighborhood opportunity/deprivation and life stress, moderate genetic (A), common environmental (C), and unique environmental (E) influences on externalizing behaviors in 760 same-sex twin pairs (332 monozygotic; 428 dizygotic) ages 10-11 from the ABCD Study. Proportion of C influences on externalizing behavior increased at higher neighborhood adversity (lower overall opportunity). A decreased and C and E increased at lower levels of educational opportunity. A increased at lower health-environment and social-economic opportunity levels. For life stress, A decreased and E increased with number of experienced events. Results for educational opportunity and stressful life experiences suggest a bioecological gene-environment interaction pattern such that environmental influences predominate at higher levels of adversity, whereas limited access to healthcare, housing, and employment stability may potentiate genetic liability for externalizing behavior via a diathesis-stress mechanism. More detailed operationalization of social adversity in gene-environment interaction studies is needed.

Protective Role of Self-Regulatory Efficacy: A Moderated Mediation Model on the Influence of Impulsivity on Cyberbullying through Moral Disengagement

During online interactions, adolescents are often exposed to deviant opportunities. In this context, the capacity to regulate one's behavior is essential to prevent cyberbullying. Among adolescents, this online aggressive behavior is a growing phenomenon, and its deleterious effects on teenagers' mental health are well known. The present work argues the importance of self-regulatory capabilities under deviant peer pressure in preventing cyberbullying. In particular, focusing on two relevant risk factors, i.e., impulsivity and moral disengagement, we examine (1) the mediation role of moral disengagement in the process leading to cyberbullying from impulsivity; (2) the buffering effect of the perceived self-regulatory capability to resist deviant peer pressure in mitigating the effect of these impulsive and social-cognitive dimensions on cyberbullying. Moderated mediation analysis was performed on a sample of 856 adolescents; the results confirm that the perceived self-regulatory capability to resist peer pressure effectively mitigates the indirect effect of impulsivity through moral disengagement on cyberbullying. The practical implications of designing interventions to make adolescents more aware and self-regulated in their online social lives to counter cyberbullying are discussed.

Parental suicide attempts and offspring mental health problems in childhood and adolescence

BACKGROUND

The relationship between parental suicide attempts and offspring suicide risk has been established. However, the impact of parental suicide attempts on mental health problems in offspring as youth remains unexplored. This study examined the prospective association between parental suicide attempts and offspring internalizing, externalizing, and attention/hyperactivity problems in childhood and adolescence. We also examined how offspring mental health problems in childhood mediated the association between parental suicide attempts and offspring mental health problems in adolescence.

METHODS

A subsample of 6,381 (48.4% female) cohort members with complete data on mental health problems in childhood and adolescence was extracted from the Northern Finland Birth Cohort 1986 Study. Offspring mental health problems were assessed via teacher's Rutter B2 scale during the childhood assessment (child's age of 8) and the Youth Self-Report scale (child's age of 15/16). Information about first parental suicide attempts was collected using ICD codes from hospital discharge records.

RESULTS

Lifetime parental suicide attempts during the study period (N = 95) were associated with offspring internalizing, externalizing, and attention/hyperactivity problems in adolescence. Parental suicide attempts before the childhood assessment (N = 55) were associated with offspring behavioral problems in childhood [B (95% CI) = .64 (0.08-1.28)]. In the mediation models, parental suicide attempts before the childhood assessment had a significant indirect effect on offspring externalizing [B (95% CI) = .03 (0.01-0.05)] and attention/hyperactivity problems [B (95% CI) = .02 (0.01-0.04)] in adolescence via offspring behavioral problems in childhood.

CONCLUSIONS

Our findings highlight the importance of assessing and monitoring mental health problems in offspring whose parents have been hospitalized for attempting suicide. Among children with behavioral problems, clinicians should inquire about parental history of suicide attempts, as children with familial vulnerability to suicide may develop externalizing and attention/hyperactivity problems in adolescence.

Mental Health and Well-Being among Children of Public Safety Personnel in Canada

Public safety personnel (PSP) often experience stress due to their occupational demands that affect the family environment (e.g., work-family conflict, marital breakdown, disruption to home routines, and holidays). A substantial base of research has focused on the impact of PSP work on the marital relationship, but fewer studies have focused specifically on children's functioning within PSP families. The current study investigated mental health, well-being, and functioning among children of PSP in Canada, as reported by PSP. Data were collected between 2016 and 2017 as part of a large pan-Canadian study of PSP. Participants (n = 2092; 72.5% women) were PSP parents who responded to questions about their 4- to 17-year-old children. Overall, a substantial proportion of PSP parents reported their children have at least some difficulties with sadness (15.4%), worries and fear (22.0%), disobedience or anger (22.0%), attention (21.0%), and friendships (11.4%). Firefighters reported the fewest problems among their children compared to other PSP groups. Almost 40% of participants indicated that their child's problems were related to their work as a PSP. The results highlight the need to find ways to identify children that are struggling and provide support to those families. Organizations and PSP leadership should develop and prioritize efforts to support families of PSP members, with the likely outcome of enhancing PSP member well-being.

Sleep disturbance is a common feature of Kabuki syndrome

Kabuki syndrome (KS) is a rare epigenetic disorder caused by heterozygous loss of function variants in either KMT2D (90%) or KDM6A (10%), both involved in regulation of histone methylation. While sleep disturbance in other Mendelian disorders of the epigenetic machinery has been reported, no study has been conducted on sleep in KS. This study assessed sleep in 59 participants with KS using a validated sleep questionnaire. Participants ranged in age from 4 to 43 years old with 86% of participants having a pathogenic variant in KMT2D. In addition, data on adaptive function, behavior, anxiety, and quality of life were collected using their respective questionnaires. Some form of sleep issue was present in 71% of participants, with night-waking, daytime sleepiness, and sleep onset delay being the most prevalent. Sleep dysfunction was positively correlated with maladaptive behaviors, anxiety levels, and decreasing quality of life. Sleep issues were not correlated with adaptive function. This study establishes sleep disturbance as a common feature of KS. Quantitative sleep measures may be a useful outcome measure for clinical trials in KS. Further, clinicians caring for those with KS should consider sleep dysfunction as an important feature that impacts overall health and well being in these patients.

Differential DNA methylation by early versus late parenteral nutrition in the PICU: a biological basis for its impact on emotional and behavioral problems documented 4 years later

Background

The PEPaNIC multicenter randomized controlled trial (RCT) has shown that early administration of supplemental parenteral nutrition (early-PN) as compared with withholding PN for 1 week (late-PN) induced long-term internalizing, externalizing and total emotional/behavioral problems in critically ill children, as observed 4 years later. Early-PN was further shown to alter the methylation status of 37 CpG-sites in leukocyte DNA between admission and discharge from the pediatric intensive care unit (PICU). In a preplanned subanalysis of the PEPaNIC trial, we now investigated whether the altered methylation of these CpG-sites could statistically explain the negative impact of early-PN on emotion/behavior documented 4 years after PICU admission.

Results

The combination of DNA methylation data and data on behavior 4 years after PICU admission was available for 403 of the 1440 patients (aged 0–17 years at PICU admission) who were included in the PEPaNIC RCT (192 early-PN and 211 late-PN patients). Mediation analyses with use of bootstrapped multivariable non-linear regression analyses adjusted for baseline risk factors revealed that the adverse alterations by early-PN in methylation of the 37 CpG-sites together statistically explained its harmful impact on internalizing, externalizing and total emotional/behavioral problems. When adding the methylation status of the 37 CpG-sites to the models, the explanatory power improved with a 1.710 to 1.851-fold increase, and the impact of the altered methylation status of the CpG-sites explained the impact of the randomization to early-PN versus late-PN.

Conclusions

Abnormal DNA methylation induced by the early use of PN in the PICU provides a biological basis for its long-term harmful effect on emotion/behavior of critically ill children 4 years after PICU admission.

Trial Registration ClinicalTrials.gov NCT01536275, registered February 17, 2012, https://clinicaltrials.gov/ct2/show/NCT01536275.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13148-021-01124-3.

Sleep, Behavior, and Adaptive Function in KAT6A Syndrome

KAT6A syndrome is a Mendelian Disorder of the Epigenetic Machinery characterized by intellectual disability and profound expressive language impairment. This study aimed to further characterize behavior and sleep in this syndrome. 26 participants between the ages of 3 and 35 years with KAT6A syndrome were assessed via parental informant using the Adaptive Behavior Assessment System version 3 (ABAS-3), Achenbach Child or Adult Behavior Checklist (CBCL/ABCL), and a Modified Simonds and Parraga Sleep Questionnaire (MSPSQ). The ABAS reports conceptual, social, and practical domains of adaptive function as well as a general composite score for adaptive function. The CBCL/ABCL is an inventory that measures internalizing, externalizing, and DSM-oriented problem domains. The MSPSQ is a mix of qualitative and quantitative sleep information that includes behavioral and medical sleep problems. Mean values for all domains of the ABAS-3 were in the extremely low range. Additionally, sleep was very dysfunctional in this cohort. Sixty percent of respondents reported feeling there was a sleep problem, 64% take medication for sleep, and 68% have sought treatment or advice for sleep. Only 12% of these participants have sleep apnea suggesting that sleep problems in this disorder are unrelated to sleep-disordered breathing. Interestingly, there were extremely low rates of all types of behaviors reported among participants on the CBCL/ABCL. No significant differences were seen based on genotype grouping in adaptive function, sleep, or behavior. This study further delineates the phenotype of the KAT6A syndrome and emphasizes the need for supports for adaptive functioning as well as detailed attention to the behavioral aspects of sleep in this condition.

Efficacy of the parenting support program on child behavior problems

The study aimed to examine the efficacy of the Parenting Support Program (PSP) for reducing problem behaviors and increasing adaptive behaviors in young children aged 3 to 6. The PSP focuses on effective parenting skills and building positive interactions between parents and their children. Parents of children (n = 18 mothers and 11 fathers) were randomly assigned to an experiment group (EG) and a wait-list (WL) group. The EG attended a total of 12 individually delivered sessions. Data was gathered via parent and teacher report measures, observation and semi-structured interviews. The PSP was effective in increasing adaptive behaviors and decreasing behavior problems in children. The change in the children's score which fulfills the Reliable Change Index criteria in the EG was found to be higher than the WL group. However, fathers reported fewer improvements than mothers in the EG. Qualitative data supported the experimental study results demonstrating the efficacy of the PSP, and met the expectations of parents. Consequently, the PSP could be used as an intervention tool to decrease behavior problems and increase adaptive behaviors in young children.

Long-term developmental effect of withholding parenteral nutrition in paediatric intensive care units: a 4-year follow-up of the PEPaNIC randomised controlled trial

BACKGROUND

The PEPaNIC randomised controlled trial, which recruited 1440 critically ill infants and children in 2012-15, showed that withholding parenteral nutrition for 1 week (late-parenteral nutrition), compared with early supplementation within 24 h of admission to the paediatric intensive care unit (early-parenteral nutrition), prevented infections, accelerated recovery, and improved neurocognitive development assessed 2 years later. Because several neurocognitive domains can only be thoroughly assessed from age 4 years onwards, we aimed to determine the effect of late-parenteral nutrition versus early-parenteral nutrition on physical, neurocognitive, and emotional and behavioural development 4 years after randomisation.

METHODS

This is a preplanned, blinded, 4-year follow-up study of participants included in the PEPaNIC trial (done at University Hospitals Leuven, Belgium; Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands; and Stollery Children's Hospital, Edmonton, AB, Canada) and of matched healthy children. Studied outcomes were anthropometrics; health status; parent-reported or caregiver-reported executive functions, and emotional and behavioural problems; and clinical tests for intelligence, visual-motor integration, alertness, motor coordination, and memory. Through multivariable linear and logistic regression analyses, after imputation for missing values (≤30%) and adjustment for risk factors, we investigated the effect of early-parenteral nutrition versus late-parenteral nutrition. This trial is registered with ClinicalTrials.gov, NCT01536275.

FINDINGS

Between March 8, 2016, and Nov 8, 2019, 684 children from the original PEPaNIC trial (356 from the late-parenteral nutrition group and 328 from the early-parenteral nutrition group) were assessed for neurocognitive development at 4-years follow-up. Compared with the control group (369 healthy children), children who had critical illness had lower height (β-estimate -2·11 [95% CI -3·15 to -1·06]; p<0·0001) and head circumference (-0·42 [-0·67 to -0·18]; p=0.00077); and worse health status (eg, hospital admission odds ratio 4·27 [95% CI 3·12 to 5·84]; p<0·0001), neurocognitive (eg, parent-reported or caregiver-reported total executive functioning β-estimate 3·57 [95% CI 1·95 to 5·18], p<0·0001; total intelligence quotient -7·35 [-9·31 to -5·39], p<0·0001), and parent-reported or caregiver-reported emotional and behavioural developmental outcomes (internalising 2·73 [1·19 to 4·28], p=0·00055; externalising 1·63 [0·19 to 3·08], p=0·027; and total behavioural problems 2·95 [1·44 to 4·46], p=0·00013), adjusted for risk factors. Outcomes were never worse in the late-parenteral nutrition group compared with the early-parenteral nutrition group, but patients in the late-parenteral nutrition group had fewer parent-reported or caregiver-reported internalising (β-estimate -1·88 [95% CI -3·69 to -0·07]; p=0·042), externalising (-1·73 [-3·43 to -0·03]; p=0·046), and total emotional and behavioural problems (-2·44 [-4·22 to -0·67]; p=0·0070) than patients who had received early-parenteral nutrition, after adjusting for risk factors, and were no longer different from healthy controls for these outcomes.

INTERPRETATION

Omitting early parenteral nutrition use for critically ill children did not adversely affect long-term outcomes 4 years after randomisation and protected against emotional and behavioural problems, further supporting the deimplementation of early parenteral nutrition.

FUNDING

European Research Council, Methusalem, Flanders Institute for Science and Technology, Research Foundation Flanders, Sophia Foundation, Stichting Agis Zorginnovatie, Erasmus Trustfonds, and the European Society for Clinical Nutrition and Metabolism.

Demographic, Social, and Economic Factors of Internalizing Problems in Referred and Non-Referred Adolescents

Depressive symptoms and suicidal ideation are common internalizing problems during adolescence. Numerous studies have explored the role of certain demographic, social, and economic factors in their development in referred or non-referred adolescents, but not simultaneously in both groups. In this study, we examined the association between age, gender, parents’ educational level, and socioeconomic status (SES) and depressive symptoms and suicidal ideation in a referred group (n = 211) and a non-referred (n = 1401) group of adolescents. We also examined the moderating role that these factors play in the relationships between both internalizing problems. The results showed: higher levels of depressive symptoms and suicidal ideation in the referred group; an increase in both problems during early-to-middle adolescence in the non-referred group; an association between low SES and suicidal ideation in both groups; an association between low father’s education level and depressive symptoms in the non-referred group; and no gender differences in either of these two internalizing problems. The moderation analyses showed that age, in referred adolescents, and SES, in non-referred adolescents, moderated the relationship between depressive symptoms and suicidal ideation. This study contributes to the identification of groups of vulnerable adolescents that could constitute the target populations of preventive programs.

Externalizing Behavior Problems in Offspring of Teen Mothers: A Meta-Analysis

Young maternal age at birth has been consistently recognized as a factor contributing to externalizing behavior. However, estimates of the magnitude of this association across existing studies are inconsistent. Such inconsistencies cloud the interpretation of the literature and highlight the need for a systematic synthesis of existing empirical evidence. Further, the roles of possible moderators in the association remain to be revealed. Moderation analyses will enhance the field's capacity to evaluate needs and locate a subgroup of children born to teen mothers with particularly heightened vulnerabilities. To address these gaps, the present study had two primary aims. First, a meta-analysis was conducted to quantify the magnitude of the association between being born to young mothers and children's externalizing behavior across existing studies. Second, moderation meta-analyses were conducted to evaluate whether the influence of being born to teen mothers on children's externalizing behavior is stronger during specific developmental periods, for a specific gender, for a specific race, or across contexts with varying teen pregnancy rates at a societal level. The current study followed the PRISMA guidelines. The search utilized multiple electronic databases including Web of Science, ProQuest, PubMed, and Ovid MEDLINE through July 2019. Standardized mean difference, Cohen's d, was used as a summary estimate of effect size. A random-effects model was conducted. Moderating effects were evaluated. Twenty-one effect sizes from 18 independent samples (n = 133,585) were included in the meta-analysis. The main meta-analysis and sensitivity analysis suggested a small yet robust association between teenage motherhood and children's externalizing behavior problems. The relevant moderation analyses detected no statistically significant moderating effect for a specific gender, for racial and ethnic minority groups, during a specific developmental period, or across varying contexts. The current meta-analysis findings suggest that the impact of young maternal age on children's externalizing behavior is small, yet independent. Further, such impacts of young maternal age were similar for girls and boys, in different racial and ethnic groups, across developmental periods, and across different contexts with varying teen pregnancy rates. Prevention efforts seeking to curb the emergence of youth's externalizing behavior should focus on parenting teens, regardless of their child's gender, race, age, or contexts. Further, the current findings suggest that prevention strategies for this specific group may benefit from a hybrid approach that combines universal, selective, and indicated prevention strategies.

Developmental Trajectories of Adaptive Behavior From Toddlerhood to Middle Childhood in Autism Spectrum Disorder

Longitudinal growth modeling was utilized to examine adaptive behavior over eight years across the three time points (i.e., ages 2-10). Seventy-six parents completed the Vineland Adaptive Behavior Scales interviews of adaptive behavior. Child participants completed standardized developmental testing and an executive function task in toddlerhood and the Autism Diagnostic Observation Schedule across all time points. Growth models were specified for communication, daily living skills, and socialization domains of adaptive behavior. Mental age in toddlerhood was a significant predictor of trajectories of communication, daily living skills, and socialization. Executive function and autism severity were significant predictors of socialization. Findings suggest executive function as a potential target for promoting the growth of adaptive behavior skills in addition to autism symptomology.

Investigating multilevel pathways of developmental consequences of maltreatment

The impact of maltreatment spreads across many developmental domains and extends across the entire life span. Identifying unidirectional or bidirectional drivers of developmental cascades of the effects of maltreatment experiences is critical to efficiently employing interventions to promote resilient development in maltreated children. This 1-year longitudinal study utilized a multiple-levels approach, investigating "bottom-up" and "top-down" cascades using structural equation modeling between cortisol regulation, externalizing behavior, and peer aggression. Neither a bottom-up model driven by cortisol regulation nor a top-down model driven by peer aggression fit the data well. Instead, lower rates of externalizing behavior at Year 1 most strongly predicted improvements at all levels of analysis (reduced cortisol, externalizing behavior, and peer aggression) at Year 2. These results provide initial indication of a mechanism through which interventions for maltreated children may be most effective and result in the most substantial positive changes across developmental domains.

Latent national subpopulations of early education classroom disengagement of children from underresourced families

This research examined the latent developmental patterns for early classroom disengagement among children from some of the most underresourced families in the nation. Based on standardized teacher observations from the Head Start Impact Study, a nationally representative sample of children (N=1377) was assessed for manifestations of reticent/withdrawn and low energy behavior over four years spanning prekindergarten through first grade. For each form of disengagement, latent growth mixture modeling revealed three distinct subpopulations of change patterns featuring a dominant class associated with generally good classroom adjustment, a medial class that varied close to the population average over time, and a more extreme class (about 10% of the population) whose adjustment was relatively marginal and sometimes reached problematic levels. Whereas reticent/withdrawn behavior ordinarily subsided over time, low energy behavior increased. More extreme low energy behaviors tended to dissipate through schooling and extreme reticence/withdrawal became more accentuated, with both types associated with later academic and social problems. Attendant risk and protective factors are identified and mitigating assessment and prevention measures are discussed.

Longitudinal pathways between mental health difficulties and academic performance during middle childhood and early adolescence

There is a growing appreciation that child functioning in different domains, levels, or systems are interrelated over time. Here, we investigate links between internalizing symptoms, externalizing problems, and academic attainment during middle childhood and early adolescence, drawing on two large data sets (child: mean age 8.7 at enrolment, n = 5,878; adolescent: mean age 11.7, n = 6,388). Using a 2-year cross-lag design, we test three hypotheses - adjustment erosion, academic incompetence, and shared risk - while also examining the moderating influence of gender. Multilevel structural equation models provided consistent evidence of the deleterious effect of externalizing problems on later academic achievement in both cohorts, supporting the adjustment-erosion hypothesis. Evidence supporting the academic-incompetence hypothesis was restricted to the middle childhood cohort, revealing links between early academic failure and later internalizing symptoms. In both cohorts, inclusion of shared-risk variables improved model fit and rendered some previously established cross-lag pathways non-significant. Implications of these findings are discussed, and study strengths and limitations noted. Statement of contribution What is already known on this subject? Longitudinal research and in particular developmental cascades literature make the case for weaker associations between internalizing symptoms and academic performance than between externalizing problems and academic performance. Findings vary in terms of the magnitude and inferred direction of effects. Inconsistencies may be explained by different age ranges, prevalence of small-to-modest sample sizes, and large time lags between measurement points. Gender differences remain underexamined. What does this study add? The present study used cross-lagged models to examine longitudinal associations in age groups (middle child and adolescence) in a large-scale British sample. The large sample size not only allows for improvements on previous measurement models (e.g., allowing the analysis to account for nesting, and estimation of latent variables) but also allows for examination of gender differences. The findings clarify the role of shared-risk factors in accounting for associations between internalizing, externalizing, and academic performance, by demonstrating that shared-risk factors do not fully account for relationships between internalizing, externalizing, and academic achievement. Specifically, some pathways between mental health and academic attainment consistently remain, even after shared-risk variables have been accounted for. Findings also present consistent support for the potential impact of behavioural problems on children's academic attainment. The negative relationship between low academic attainment and subsequent internalizing symptoms for younger children is also noteworthy.

Cognitive Abilities, Social Adaptation, and Externalizing Behavior Problems in Childhood and Adolescence: Specific Cascade Effects Across Development

Children's and adolescents' cognitive abilities, social adaptation, and externalizing behaviors are broadly associated with each other at the bivariate level; however, the direction, ordering, and uniqueness of these associations have yet to be identified. Developmental cascade models are particularly well-suited to (1) discern unique pathways among psychological domains and (2) model stability in and covariation among constructs, allowing for conservative tests of longitudinal associations. The current study aimed to identify specific cascade effects among children's cognitive abilities, social adaptation, and externalizing behaviors, beginning in preschool and extending through adolescence. Children (46.2 % female) and mothers (N = 351 families) provided data when children were 4, 10, and 14 years old. Cascade effects highlighted significant stability in these domains. Unique longitudinal associations were identified between (1) age-10 cognitive abilities and age-14 social adaptation, (2) age-4 social adaptation and age-10 externalizing behavior, and (3) age-10 externalizing behavior and age-14 social adaptation. These findings suggest that children's social adaptation in preschool and externalizing behavior in middle childhood may be ideal intervention targets to enhance adolescent well-being.

Mental health difficulties and academic attainment: Evidence for gender-specific developmental cascades in middle childhood

We present a developmental cascade model of the longitudinal relationships between internalizing symptoms, externalizing problems, and academic performance in middle childhood, utilizing a large sample (N = 1,771) from the United Kingdom in a 3-year, cross-lag design. Three hypotheses were tested: adjustment erosion, academic incompetence, and (cumulative) shared risk. In addition, we sought to examine whether developmental cascade pathways varied across gender, while also statistically exploring indirect, mediation pathways. Structural equation models that accounted for within-time covariance, data nesting, and temporal stability provided evidence of gender-specific effects as follows: externalizing-attainment adjustment erosion pathways were found only in boys, while attainment-internalizing/externalizing academic incompetence pathways were found only in girls. Analysis of mediation pathways provided further support for these gender-specific longitudinal profiles. Protective longitudinal internalizing-externalizing and externalizing-internalizing pathways were found for both boys and girls. Finally, while it improved model fit for both genders, the influence of cumulative shared risk on the aforementioned pathways was relatively meager, substantively affecting only one (externalizing-attainment adjustment erosion pathway in boys). The implications of these findings are discussed, and study limitations noted.

Child Temperamental Flexibility Moderates the Relation between Positive Parenting and Adolescent Adjustment

Temperamental flexibility and lower positive parenting are associated with internalizing and externalizing problems; however, youth varying in flexibility may be differentially affected by positive parenting in the prediction of symptoms. We examined whether children's flexibility moderated prospective relations between maternal and paternal positive parenting and youth internalizing and externalizing symptoms during adolescence. Participants (N =775, 71% male) and their caregivers completed measures when youth were 10-12 and 12-14 years old. Father positive parenting interacted with child flexibility to predict father-reported internalizing and externalizing problems. Consistent with the diathesis-stress model, children lower in flexibility experienced greater symptoms than children higher in flexibility in lower positive parenting contexts. Among children lower in flexibility, lower paternal positive parenting was associated with greater internalizing and externalizing symptoms compared to higher paternal positive parenting. However, among youth higher in flexibility, symptom levels were similar regardless of whether youth experienced lower or higher paternal positive parenting.

Grouping Youth With Similar Symptoms: A Person-Centered Approach to Transdiagnostic Subgroups

OBJECTIVES

The present study extracted symptom profiles based on parent and youth report on a broad symptom checklist. Profiles based on parent-reported symptoms were compared to those based on adolescent self-report to clarify discrepancies.

METHOD

The current study used archival data from 1,269 youth and parent dyads whose youth received services at a community mental health center. The mean age of the sample was 14.31 years (standard deviation = 1.98), and the youth sample was half male (50.1%) and primarily Caucasian (86.8%). Latent profile analysis was used to extract models based on parent and self-reported emotional and behavioral problems.

RESULTS

Results indicated that a 5-class solution was the best fitting model for youth-reported symptoms and an adequate fit for parent-reported symptoms. For 46.5% of the sample, class membership matched for both parent and youth.

CONCLUSION

Latent profile analysis provides an alternative method for exploring transdiagnostic subgroups within clinic-referred samples.