Latent Class Analysis of the CBCL Dysregulation Profile for 6- to 16-Year-Olds in 29 Societies

The Effects of Breastfeeding on Childhood Behavioral and Emotional Development: A Prospective Cohort Study in China

BACKGROUND

Breastfeeding could improve a child's health early on, but its long-term effects on childhood behavioral and emotional development remain inconclusive. We aimed to estimate the associations of feeding practice with childhood behavioral and emotional development.

METHODS

In this population-based birth cohort study, data on feeding patterns for the first 6 mo of life, the duration of breastfeeding, and children's emotional and behavioral outcomes were prospectively collected from 2489 mother-child dyads. Feeding patterns for the first 6 mo included exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF, including mixed feeding or formula feeding), and the duration of breastfeeding (EBF or mixed feeding) was categorized into ≤6 mo, 7-12 mo, 13-18 mo, and >18 mo. Externalizing problems and internalizing problems were assessed with the Child Behavior Checklist (CBCL) and operationalized according to recommended clinical cutoffs, corresponding to T scores ≥64. Multivariable linear regression and logistic regression were used to evaluate the association of feeding practice with CBCL outcomes.

RESULTS

The median (interquartile range) age of children at the outcome measurement was 32.0 (17.0) mo. Compared with non-EBF for the first 6 mo, EBF was associated with a lower T score of internalizing problems [adjusted mean difference (aMD): -1.31; 95% confidence interval (95% CI): -2.53, -0.10], and it was marginally associated with T scores of externalizing problems (aMD: -0.88; 95% CI: -1.92, 0.15). When dichotomized, EBF versus non-EBF was associated with a lower risk of externalizing problems (aOR: 0.54, 95% CI: 0.34, 0.87), and it was marginally associated with internalizing problems (aOR: 0.75, 95% CI: 0.54, 1.06). Regarding the duration of breastfeeding, breastfeeding for 13-18 mo versus ≤6 mo was associated with lower T scores of internalizing problems (aMD: -2.50; 95% CI: -4.43, -0.56) and externalizing problems (aMD: -2.75; 95% CI: -4.40, -1.10), and breastfeeding for >18 mo versus ≤6 mo was associated with lower T scores of externalizing problems (aMD: -1.88; 95% CI: -3.68, -0.08). When dichotomized, breastfeeding for periods of 7-12 mo, 13-18 mo, and >18 mo was associated with lower risks of externalizing problems [aOR (95% CI): 0.96 (0.92, 0.99), 0.94 (0.91, 0.98), 0.96 (0.92, 0.99), respectively].

CONCLUSIONS

Exclusive breastfeeding for the first 6 mo and a longer duration of breastfeeding, exclusively or partially, are beneficial for childhood behavioral and emotional development.

Dysregulation profile in children of ethnoracially diverse at-risk families: Factor structure and longitudinal correlates

The present work sought to confirm the factor structure and examine longitudinal strengths-based and mental health correlates of the dysregulation profile (DP) in children of at-risk fragile families of diverse ethnoracial backgrounds. The data came from the Fragile Families and Child Wellbeing Study (N = 2125 families). Mothers (Mage = 25.3) were mostly unmarried (74.6%), and children (51.4% boys) were identified as Black (47.0%), Hispanic (21.4%), White (16.7%), or multiracial or other backgrounds. Childhood DP was constructed using mother reports of the Child Behavior Checklist at age 9. Mothers' in-home parent-child interactions and depressive symptoms were assessed at child age 5. At age 15, children responded about their own mental health, social skills, and other strengths-focused outcomes. A bifactor DP structure fit well to the data, with the DP factor representing difficulties in self-regulation. Using SEM, we found that mothers who were more depressed and used less warm parenting at child age 5 had children who presented with higher DP at age 9. DP was in turn associated with less social skills, perseverance, optimism, and more anxiety, depression, and impulsivity at adolescence. Childhood DP appears to be relevant and applicable for at-risk, diverse families, and may also impede on children's future positive functioning.

Effects of Helicopter Parenting, Tiger Parenting and Inhibitory Control on the Development of Children's Anxiety and Depressive Symptoms

Helicopter parenting and tiger parenting may increase the risks of anxiety and depression in children. However, it is unclear how these parenting styles affect the developmental outcomes and trajectories of anxiety and depressive symptoms, and how children's internal inhibitory control (IC) moderates such effects. The present study aimed to examine this issue. A sample of 172 typically developing children (77 girls; Mage = 7.14, SDage = 0.33) and their parents participated in the study. Parents reported children's anxiety and depressive symptoms using the Child Behavior Checklist each year from the first measurement (T1) to the third measurement (T3) and reported their helicopter parenting and tiger parenting at T1. Children completed the Go/No-go task at T1 to measure their IC. Higher T1 helicopter parenting impeded the declines in anxiety and depression over time, and higher T1 tiger parenting predicted more anxiety and depressive symptoms at T3. However, such effects were only observed in children with low IC, and higher IC buffered the adverse impacts of both helicopter parenting and tiger parenting on children's anxiety and depressive symptoms. These findings revealed that helicopter parenting and tiger parenting had negative impacts on the developmental trajectories and outcomes of anxiety and depression in children and suggest that IC plays an important role in alleviating the risks of anxiety and depression among children in adverse environments.

Aggressive behaviors predict greater intraindividual reaction time variability in children: Evidence from cross-lagged panel models

Deficits in attentional control or inhibitory control are distinct features of childhood aggressive behaviors. Lower attentional control or inhibitory control is considered to predict more aggressive behaviors, while few studies have documented the possible predictive effects of aggressive behaviors on attentional control or inhibitory control. The present study examined the bidirectional relations between aggressive behaviors and both inhibitory control and attentional control in 169 Chinese primary school children (75 girls, Mage  = 7.15, SDage  = 0.33), annually for 3 years starting at age 7. The No-go accuracy on a Go/No-go task was used as the index of inhibitory control, and the intraindividual reaction time variability (IIRTV) of correct Go trials indicated attentional control. The aggressive behaviors subscale of the child behavior checklist-Chinese version was used to assess the children's aggressive behaviors. The results demonstrated a significant and stable predictive effect of previous aggressive behaviors on subsequent attentional control, with more aggressive behaviors predicting greater IIRTV at both the between-child and within-child levels. No significant effects of inhibitory control or attentional control on aggressive behaviors or sex-specific patterns were found. The findings suggest the negative impact of childhood aggressive behaviors on attentional control and underscore the importance of early prevention and intervention for childhood aggressive behaviors.

Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence

OBJECTIVE

This cohort study assessed perinatal factors known to be related to maternal and neonatal inflammation and hypothesized that several would be associated with emotional, cognitive, and behavioral dysregulation in youth.

METHOD

The Environmental influences on Child Health Outcomes (ECHO) is a research consortium of 69 pediatric longitudinal cohorts. A subset of 18 cohorts that had both Child Behavior Checklist (CBCL) data on children (6-18 years) and information on perinatal exposures including maternal prenatal infections was used. Children were classified as having the CBCL-Dysregulation Profile (CBCL-DP) if the sum of their T scores for 3 CBCL subscales (attention, anxious/depressed, and aggression) was ≥180. Primary exposures were perinatal factors associated with maternal and/or neonatal inflammation, and associations between these and outcome were assessed.

RESULTS

Approximately 13.4% of 4,595 youth met criteria for CBCL-DP. Boys were affected more than girls (15.1% vs 11.5%). More youth with CBCL-DP (35%) were born to mothers with prenatal infections compared with 28% of youth without CBCL-DP. Adjusted odds ratios indicated the following were significantly associated with dysregulation: having a first-degree relative with a psychiatric disorder; being born to a mother with lower educational attainment, who was obese, had any prenatal infection, and/or who smoked tobacco during pregnancy.

CONCLUSION

In this large study, a few modifiable maternal risk factors with established roles in inflammation (maternal lower education, obesity, prenatal infections, and smoking) were strongly associated with CBCL-DP and could be targets for interventions to improve behavioral outcomes of offspring.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

A latent class approach to understanding patterns of emotional and behavioral problems among early adolescents across four low- and middle-income countries

Early adolescents (ages 10-14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (51% female) living in the Democratic Republic of Congo (DRC), Malawi, Indonesia, and China, and explore the extent to which these patterns varied by country and sex. LCA was used to identify and classify patterns of emotional and behavioral problems separately by country. Within each country, measurement invariance by sex was evaluated. LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into the following subgroups: Well-Adjusted (40-62%), Emotional Problems (14-29%), Behavioral Problems (15-22%; not present in China), and Maladjusted (4-15%). Despite the consistency of these patterns, there were notable contextual differences. Further, tests of measurement invariance indicated that the prevalence and nature of these classes differed by sex. Findings can be used to support the tailoring of interventions targeting psychosocial adjustment, and suggest that such programs may have utility across diverse cross-national settings.

Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age

Importance

Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children.

Objective

To characterize children's emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood.

Design, Setting, and Participants

This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022.

Exposures

Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities.

Main Outcomes and Measures

Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression).

Results

The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks' gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005).

Conclusions and Relevance

In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.

Prevalence of affective disorders in Chinese school-attending children and adolescents aged 6-16 based on a national survey by MINI-Kid

BACKGROUND

Major depressive disorder (MDD), dysthymia disorder (DD) and bipolar disorder (BD) are the most prevalent affective disorders. A nationwide epidemiological investigation of MDD, DD and BP in school-attending children and adolescents was carried out, taking the effect of age, gender and comorbidity into consideration.

METHODS

A two-stage nationwide epidemiological study of point prevalence was conducted. Using a multistage cluster stratified random sampling strategy. The sample distribution was described, and the point prevalence of affective disorders was estimated. Chi-squared tests were used to compare disease prevalence based on sex and age. Comorbid ratios for MDD, DD and BP were calculated.

RESULTS

The total number of cases in Stage 1 was 72,107 (aged 6-16 years). The point prevalence of MDD, DD and BP were 2.004 % (95 % CI: 1.902 to 2.106), 0.352 % (95 % CI: 0.309 to 0.395) and 0.856 % (95 % CI: 0.788 to 0.923), respectively. The total prevalence of affective disorder was 3.212 % (95 % CI: 3.079 to 3.338). The total prevalence of affective disorders between sexes (female: 3.834 % versus male: 2.587 %, χ² = 90.155, p < 0.001) was consistent with the gender difference in MDD, DD and MD. The total prevalence of affective disorders in adolescents was higher than that in children (adolescents: 5.024 % versus children: 1.863 %, χ² = 566.841, p < 0.001).

CONCLUSIONS

Our study is the first nationwide survey on the prevalence of affective disorders among school-attending children and adolescents aged 6-16 in China. Our results also highlighted the importance of addressing comorbidities in future studies of affective disorders.

The Prevalence and Comorbidity of Tic Disorders and Obsessive-Compulsive Disorder in Chinese School Students Aged 6-16: A National Survey

Background: Obsessive-compulsive disorder (OCD) and tic disorders (TDs) are closely related and considered to etiologically overlap. Both disorders are characterized by repetitive behaviors. TD and OCD often co-occur. The high comorbidity between OCD and TD individuals suggests that we also need to pay more attention to the homogeneity and heterogeneity between TS and OCD. To date, there has been no systematic nationwide epidemiological survey of the mental health (including tic disorders and obsessive-compulsive disorder) of children and adolescents in China. Methods: A two-stage epidemiological study of psychiatric point prevalence was conducted. We used the multistage cluster stratified random sampling strategy to assess five provinces of China. The Child Behavior Checklist was used to identify behavioral problems among the enrolled students in the first stage. The results from the Mini-International Neuropsychiatric Interview for Children and Adolescents and evaluations from two psychiatrists based on the Diagnostic and Statistical Manual-IV were used to make a diagnosis. Point weighted prevalence for TD and OCD was estimated. We adjusted prevalence estimates with the product of sampling weights and poststratification weights. Standard error values and 95% confidential intervals were generated with Taylor series linearization. Rao−Scott adjusted chi-square (χ2) tests were employed to compare the prevalence estimates of different age and sex groups. Results: In the first stage, 73,992 participants aged 6−16 years old were selected. The prevalence rates of OCD and TDs were 1.37% (95% CI: 1.28−1.45) and 2.46% (95% CI: 2.35−2.57), respectively. The prevalence of OCD was found to be higher in girls (p < 0.001) and higher in boys with transient tic disorder (TTD) (p < 0.001) and Tourette’s syndrome (TS) (p < 0.001). The most common comorbidity of TS was OCD (40.73%), and for OCD, it was TS (11.36%). Conclusions: Our study is the first nationwide survey on the prevalence of TD (2.46%) and OCD (1.37%) in school students aged 6−16 years old in China. The high comorbidity between OCD and TD individuals suggested overlap based on the prevalence dimensions, which might be influenced by age and sex. This result suggested that we also need to pay more attention to the homogeneity and heterogeneity between TS and OCD.

Stability and Change of Psychopathology Symptoms Throughout Childhood and Adolescence

Assessing stability and change of children's psychopathology symptoms can help elucidate whether specific behaviors are transient developmental variations or indicate persistent psychopathology. This study included 6930 children across early childhood (T1), late childhood (T2) and early adolescence (T3), from the general population. Latent profile analysis identified psychopathology subgroups and latent transition analysis quantified the probability that children remained within, or transitioned across psychopathology subgroups. We identified four psychopathology subgroups; no problems (T1: 85.9%, T2: 79.0%, T3: 78.0%), internalizing (T1: 5.1%, T2: 9.2%, T3: 9.0%), externalizing (T1: 7.3%, T2: 8.3%, T3: 10.2%) and the dysregulation profile (DP) (T1: 1.7%, T2: 3.5%, T3: 2.8%). From T1 to T2, 44.7% of the children remained in the DP. Between T2 and T3, 33.6% remained in the DP; however, 91.4% were classified in one of the psychopathology subgroups. Our findings suggest that for many children, internalizing or externalizing symptoms encompass a transient phase within development. Contrary, the DP resembles a severe at-risk state in which the predictive value for being in one of the psychopathology subgroups increases over time.