Early life stress and child temperament style as predictors of childhood anxiety and depressive symptoms: findings from the longitudinal study of Australian children

Early childhood anxiety disorders: continuity and predictors in adolescence

Anxiety disorders are among the most common disorders in early childhood. Although many older children and adolescents with anxiety disorders recover and remain well, little is known about the continuity of early childhood anxiety and the factors that predict persistence/recurrence in later childhood and adolescence. We followed 129 children who met anxiety disorder criteria at age 3 and/or 6 and determined how many continued to experience an anxiety disorder between age 7 and 15, as well as the continuity of specific anxiety disorders. We explored whether biological sex, number of anxiety disorders, early childhood persistence (i.e., anxiety diagnosis at both age 3 and 6), childhood comorbidities, temperamental behavioral inhibition, a maternal history of anxiety, and authoritarian and overprotective parenting predicted persistence/recurrence of an anxiety disorder from age 7 to 15. Sixty-five (50.4%) of the adolescents with an early childhood anxiety disorder met anxiety disorder criteria during the age 7-15 interval. Homotypic continuity from early childhood to school-age/mid-adolescence was observed for social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). Early childhood agoraphobia predicted school-age/mid-adolescent GAD and early childhood GAD predicted school-age/mid-adolescent specific phobia. In bivariate analyses, number of anxiety disorders, persistence of anxiety from age 3 to 6, and having a mother with a history of anxiety predicted the persistence/recurrence of anxiety disorders from age 7 to 15. Only early childhood persistence of anxiety uniquely predicted the persistence/recurrence of an anxiety disorder over and above the other predictors. Early intervention efforts should focus on identifying and intervening with young children who demonstrate a protracted course of anxiety.

Adjustment and homesickness in hospitalised children: A systematic review

Children can experience significant distress during hospitalisation, as a result of the treatment process and due to psychosocial factors impacting their adjustment to the hospital environment. Such factors can contribute to negative outcomes for the child. Despite this, limited research focus has been placed on understanding the psychosocial factors that contribute to a child's distress to inform support strategies that can improve the experience of hospitalisation across paediatric conditions. The objectives of this review were to synthesise the qualitative and quantitative literature on psychosocial factors associated with hospital adjustment and to identify risk and protective factors that influence the adjustment process. The literature search (1980 to February 2024: CINAHL / Embase / Medline / PsychINFO and Web of Science databases) identified thirty-four studies. Poor hospital adjustment, anxiety, depression and homesickness, were reported by the majority of hospitalised children. Several demographic and psychosocial factors were identified in the quantitative synthesis to contribute to poor adjustment. Child age, temperament, attachment style, past negative hospital experiences, homesickness and fear cognitions, were all associated with adjustment to the hospital environment. Homesickness was identified as a particularly understudied and important construct. Theoretical and methodological considerations are discussed, and recommendations made for future research that can further support inpatient children and their families.

Difficult Toddler Temperament - Prevalence and Associated Factors at 18-Month Follow-Up of a Birth Cohort

Purpose

Difficult temperament coupled with other risk factors may lead to mental health problems in childhood and have long-lasting effects in adolescence and adulthood. This study aimed to investigate the prevalence of parental perception of difficult temperament in toddlers and identify significant factors associated with individual and family-level sociodemographic risk factors.

Patients and Methods

The prevalence of parental perception of difficult temperament was derived from items in the 18-month follow-up questionnaire within the Watch Me Grow (WMG) longitudinal birth cohort study in a multicultural and socioeconomically disadvantaged community in Sydney, Australia. Data was available for 500 children and their parents. Descriptive analysis was used to calculate the participant characteristics and the prevalence of parental perception of difficult temperament, whereas multivariable logistic regression analysis was used to assess significant risk factors associated with a difficult temperament.

Results

Parental perception of difficult temperament in the cohort was 7.3% (n = 492). Findings of the multivariable logistic regression showed that screen time >2 hours a day (AOR 2.43, 95% CI: 1.2, 4.9), child not being read to (AOR 3.92, 95% CI: 1.8, 8.5), and family history of mental health problems (AOR 2.69, 95% CI: 1.1, 6.5) significantly increased the odds of having a difficult temperament.

Conclusion

Toddlers with difficult temperament were less likely to have received stimulatory experiences, and their families were more likely to be under greater stress. The findings emphasize the importance of parental support and anticipatory guidance in promoting nurturing care to facilitate child health and development, particularly in disadvantaged communities.

Influence of Child's Temperament on Behaviour Management Problems in the Dental Office: A Literature Review

BACKGROUND

A child's temperament could have an influence on his/her behaviour in the dental environment. This review aims to present the main temperament surveys and their clinical use and to discuss the relationship between certain temperament dimensions and Dental Behaviour Management Problems (DBMP).

METHODS

A literature search was conducted in Medline/PubMed, ScienceDirect, Wiley Online Library and Cochrane library electronic databases for publications, up to June 2022, investigating the link between child's temperament and DBMP.

RESULTS

From 733 potentially eligible studies, 12 were included in qualitative synthesis.

CONCLUSION

According to studies using the Child Behaviour Questionnaire (CBQ) scale, the most impactful dimensions are activity, extraversion and surgency, high-intensity pleasure and attention control. For those using the Emotionality-Activity-Sociability (EAS) scale, emotionality and shyness have a statistically significant positive linear correlation with dental anxiety and DBMP. It has yet to be determined whether the use and interpretation of these questionnaires can be carried out in a daily clinical situation as an aid to sharpen the indications for the several levels of sedation.

The Development of Shyness from Late Childhood to Adolescence: A Longitudinal Study of Mexican-origin Youth

Shyness, the tendency to be inhibited and uncomfortable in novel social situations, is a consequential personality trait, especially during adolescence. The present study examined the development of shyness from late childhood (age 10) through adolescence (age 16) using data from a large, longitudinal study of Mexican-origin youth (N = 674). Using both self- and mother-reports of shyness assessed via the Early Adolescent Temperament Questionnaire-Revised, we found moderate to high rank-order stabilities across two-year intervals and a mean-level decrease in shyness from age 10 to 16. Anxiety and depression were associated with higher initial levels of shyness, and anxiety was associated with greater decreases in shyness from age 10 to 16. Contrary to predictions, neither nativity (country of birth) nor language proficiency (English, Spanish) was associated with the development of shyness across adolescence. Thus, youth generally decline in shyness during adolescence, although there is substantial individual variability in shyness trajectories.

The perinatal origins of childhood anxiety disorders and the role of early-life maternal predictors

BACKGROUND

The development of childhood anxiety disorders (CADs) is likely to depend on pathways that can be programmed by early-life risk factors. We test the hypothesis that early-life maternal factors can predict this programming effect on CAD.

METHODS

Data were obtained from 198 women and children from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy, postpartum and until 4 years of age. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV), together with antenatal hair cortisol concentrations, maternal childhood trauma and parenting stress at 6 months postpartum. CAD was assessed with the Preschool Age Psychiatric Assessment and the Child Behaviour Checklist.

RESULTS

Antenatal depression, a history of maternal childhood trauma and lower gestational age at birth were each associated with anxiety disorders at 4 years of age in their children. A multivariate binary logistic model with these early predictors explained approximately 9% of variance in CAD outcome at 4 years of age; however, only maternal trauma and gestational age were significant predictors in the model. The effect of early parenting stress on CAD was found to vary by the concentration of maternal antenatal hair cortisol, whereby postpartum parenting stress was associated with CAD only when there were higher maternal antenatal cortisol levels.

CONCLUSIONS

This study suggests the importance of maternal factors pre-conception, pregnancy and in the postnatal period, which predict CADs and this is consistent with a developmental programming hypothesis for CAD.

Prospective Association between Childhood Behavioral Inhibition and Anxiety: a Meta-Analysis

Behavioral inhibition (BI) is a risk factor for anxiety. However, the estimates of the strength of this association vary widely. In addition, while BI is a strong predictor of social anxiety disorder (SAD), its association with other anxiety disorders is unclear. The current study sought to establish the relationship between BI and anxiety and to quantify this association for a range of anxiety disorders. We searched PsycInfo, PubMed and Embase for articles published before May 18th, 2019 using search terms for BI, anxiety and prospective study design. We selected articles which assessed the prospective relationship between BI in childhood and anxiety. Using random-effects meta-analysis with robust variance estimation, which allowed for the inclusion of multiple follow-ups of the same sample, we established the association between BI and any anxiety. We also explored the association between BI and individual anxiety disorders. Data from 27 studies consisting of 35 follow-ups of 20 unique samples indicated that BI prospectively increases the odds of anxiety (OR = 2.80, 95% CI 2.03 to 3.86, p < 0.001). There was also a positive association between BI and all individual anxiety disorders, with effect sizes ranging from small in the case of specific phobia (OR = 1.49, 95% CI 1.03 to 2.14, p = 0.03) to large in the case of SAD (OR = 5.84, 95% CI 3.38 to 10.09, p < 0.001). BI in early childhood is a strong risk factor for anxiety. Targeting BI may help reduce the number of children who will develop anxiety disorders.

Parent-reported childhood temperament and adolescent self-reported substance use initiation

Children differ in their general temperament and these differences predict consequential outcomes, including mental health, peer relations, and academic performance. In adults, there is strong evidence that personality correlates with substance use, but the temporal direction of the relation is unclear, as substance use may alter personality. The present research uses data from the Longitudinal Study of Australian Children (N = 5,362) to examine whether temperament assessed by parents in early childhood is associated with adolescent self-reported initiation of alcohol, cigarette, marijuana, or other drug use. Children rated higher on sociability at 4-5 years old were at higher risk of initiation for all types of substances in adolescence (age 12 to 17), controlling for SES, single-parent household, parent substance use, and other demographic variables. Additionally, children rated higher on reactivity were at higher risk of cigarette or marijuana use initiation, and children rated higher on persistence had a lower risk of cigarette use initiation. This multi-informant prospective study demonstrates that early individual differences in psychological functioning predict risk of future substance use initiation and highlights the importance of considering temperament and personality when assessing risk of future substance use initiation.

The Prevention of Anxiety and Depression in Early Childhood

Recent statistics suggest that anxiety and depressive symptoms and disorders can occur earlier in life than previously thought, and appear to be on the increase. The burden that is associated with internalizing symptoms is large, with children's social, emotional, and cognitive development negatively impacted. Research suggests that early intervention and prevention is vital for adaptive development, and this review set out to explore the literature regarding social-emotional learning programs for children of preschool age that aim to prevent and reduce symptoms of anxiety and depression. The review focused on interventions that could be delivered universally in the school context to children aged 4-6 years or their parents. Only six programs were identified that met these criteria. The results of this review suggest that intervention and prevention efforts in early childhood are needed and can be effective in terms of reducing the burden associated with internalizing symptoms in childhood, at least in the short term. This appears to be the case particularly when parents are actively involved in the intervention, too. However, more rigorous research is needed that involves larger randomized controlled trials with multiple reporters and consistent administration of assessments across the samples.

Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Proximal and distal predictors of self-regulatory change in children aged 4 to 7 years

Background

Growth in early self-regulation skills has been linked to positive health, wellbeing, and achievement trajectories across the lifespan. While individual studies have documented specific influences on self-regulation competencies in early childhood, few have modelled a comprehensive range of predictors of self-regulation change across health, development, and environment simultaneously. This study aimed to examine the concurrent associations among a range of proximal and distal influences on change in children’s self-regulation skills over 2 years from age 4–5 years.

Methods

Data from the Longitudinal Study of Australian Children (N = 4983) were used in a structural equation model, predicting a multi-source composite measure of self-regulation at each of 4–5 years and 6–7 years. By controlling for earlier self-regulation and covariates, the model examined the relative contributions of a comprehensive range of variables to self-regulation change including health, development, educational, home environment, time-use, and neighbourhood characteristics.

Results

The significant predictors of children’s self-regulation growth across 4 to 7 years were fewer behavioural sleep problems, higher gross motor and pre-academic skills, lower levels of maternal and paternal angry parenting, and lower levels of financial hardship. There were also marginal effects for high-quality home learning environments and child-educator relationships.

Conclusion

Findings suggest that if we are to successfully foster children’s self-regulation skills, interventionists would do well to operate not only on children’s current capacities but also key aspects of their surrounding context.

Family and neighborhood socioeconomic status and temperament development from childhood to adolescence

OBJECTIVE

Children differ in their temperament and these differences predict consequential outcomes, including mental health, peer relations, substance use, academic performance, and adult personality. Additionally, children's temperament develops over time in response to environmental factors, such as the socioeconomic status (SES) of their family and the neighborhood in which they are raised. However, there has been lack on research on the relation between neighborhood SES and the development of temperament or personality.

METHOD

Using data from two cohorts of the Longitudinal Study of Australian Children (LSAC; N = 9,217) that followed children from 4 to 15 years old, the present analyses examined whether parent income, parent education, and neighborhood disadvantage were associated with three child temperament traits that are precursors to Five-Factor Model (FFM) adult personality traits.

RESULTS

Longitudinal hierarchical linear models (HLM) generally found that children with lower neighborhood SES or family SES tended to have lower sociability, higher reactivity, and lower persistence and these associations did not decrease over time.

CONCLUSIONS

This research demonstrates that both the neighborhood and the family SES in childhood are important for the development of temperament across childhood and adolescence.

Review: Longitudinal trajectories of child and adolescent depressive symptoms and their predictors - a systematic review and meta-analysis

BACKGROUND

With depression predicted to contribute to an increased disease burden in coming decades, prevention efforts have become increasingly important. In order to prevent depression it is valuable to identify and classify longitudinal patterns of depressive symptoms across development, ideally beginning early in childhood. To achieve this, longitudinal studies are increasingly using person-centered data-analytic methods to model subgroups with similar developmental patterns (trajectories) of depressive symptoms.

METHOD

A search was completed for English language studies that longitudinally modeled depressive symptom trajectories in nonclinical populations with a baseline age of <19 years. Study characteristics were extracted, prevalence rates and risk factors were summarized, a random-effect meta-analysis was undertaken, and risk of bias analysis completed.

RESULTS

Twenty studies published between 2002 and 2015 were included. Participants were recruited at ages 4 through 17 (average age 12.34) and followed longitudinally for an average of 7.45 years. Between 3 and 11 trajectory subgroups were identified. A random pooled effect estimate identified 56% [95% Confidence Interval (CI) 46-65%] of the sampled study populations (N = 41,236) on 'No or low' depressive symptom trajectories and 26% (CI 14-40%) on a 'Moderate' trajectory. 'High', 'Increasing', and 'Decreasing' depressive symptom subgroups were evident for 12% (CI 8-17%). Moderate symptoms were associated with poorer adjustment and outcomes relative to low symptom groups. 'High' or 'Increasing' trajectories were predominantly predicted by: female gender, low socioeconomic status, higher stress reactivity; conduct issues; substance misuse, and problems in peer and parental relationships.

CONCLUSIONS

The review highlighted consistent evidence of subgroups of children and adolescents who differ in their depressive symptom development over time. The findings suggest preventative interventions should evaluate the longer term benefits of increasing membership in low and moderate trajectories, while also targeting reductions in high-risk subgroups. Considerable between-study method and measurement variation indicate the need for future trajectory studies to use standardized methods.

Adolescent depressive symptoms in India, Australia and USA: Exploratory Structural Equation Modelling of cross-national invariance and predictions by gender and age

BACKGROUND

The present study compares depressive symptoms in adolescents from three countries: Mumbai, India; Seattle, United States; and Melbourne, Australia measured using the Short Moods and Feelings Questionnaire (SMFQ). The study cross nationally compares SMFQ depressive symptom responses by age and gender.

METHODS

Data from a cross-nationally matched survey were used to compare factorial and measurement characteristics from samples of students from Grade 7 and 9 in Mumbai, India (n=3268) with the equivalent cohorts in the Washington State, USA (n=1907) and Victoria, Australia (n=1900). Exploratory Structural Equation Modelling (ESEM) was used to cross-nationally examine factor structure and measurement invariance.

RESULTS

A number of reports suggesting that SMFQ is uni-dimensional were not supported in findings from any country. A model with two factors was a better fit and suggested a first factor clustering symptoms that were affective and physiologically based symptoms and a second factor of self-critical, cognitive symptoms. The two-factor model showed convincing cross national configural invariance and acceptable measurement invariance. The present findings revealed that adolescents in Mumbai, India, reported substantially higher depressive symptoms in both factors, but particularly for the self-critical dimension, as compared to their peers in Australia and the USA and that males in Mumbai report high levels of depressive symptoms than females in Mumbai.

LIMITATIONS

the cross sectional study collected data for adolescents in Melbourne and Seattle in 2002 and the data for adolescents in Mumbai was obtained in 2010-2011 CONCLUSIONS: These findings suggest that previous findings in developed nations of higher depressive symptoms amongst females compared to males may have an important cultural component and cannot be generalised as a universal feature of adolescent development.

Temperament in infancy and behavioral and emotional problems at age 5.5: The EDEN mother-child cohort

OBJECTIVE

Early temperamental characteristics may influence children's developmental pathways and predict future psychopathology. However, the environmental context may also shape or interact with infant temperament and indirectly contribute to increased vulnerability to adverse developmental outcomes. The aim of the present study is to explore the long-term contribution of temperamental traits at twelve months of age to the presence of emotional and behavioral problems later in childhood, and whether this association varies with the child's sex, parental separation, family socioeconomic status and maternal depression.

METHOD

1184 mother-child pairs from the EDEN mother-child birth cohort study based in France (2003-2011), were followed from 24-28 weeks of pregnancy to the child's fifth birthday. Infant temperament at 12 months was assessed with the Emotionality Activity and Sociability (EAS) questionnaire and behavior at 5.5 years was assessed with the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

Emotional temperament in infancy predicts children's overall behavioral scores (β = 1.16, p<0.001), emotional difficulties (β = 0.30, p<0.001), conduct problems (β = 0.51, p<0.001) and symptoms of hyperactivity/inattention (β = 0.31, p = 0.01) at 5.5 years. Infants' active temperament predicts later conduct problems (β = 0.30, p = 0.02), while shyness predicts later emotional problems (β = 0.22, p = 0.04). The association between the child's temperament in infancy and later behavior did not vary with children's own or family characteristics.

CONCLUSION

An emotional temperament in infancy is associated with higher levels of emotional and behavioral difficulties at the age of 5.5 years. Children who show high emotionality early on may require early prevention and intervention efforts to divert possible adverse developmental pathways.

Child regulative temperament as a mediator of parenting in the development of depressive symptoms: a longitudinal study from early childhood to preadolescence

Child temperament as well as parenting behaviors have been linked to adolescent depression. Beyond their main effects, the interplay between these factors is of interest. For example, in an interactive model, a differential susceptibility of temperamental variants to parenting has been suggested. However, so far, the differential susceptibility hypothesis has mostly been studied with a focus on externalizing disorders. On the other hand, parenting may shape the child's temperament and vice versa in a transactional process. In a prospective, longitudinal at-risk sample (163 boys, 176 girls), we assessed emotional (easy-difficult) and regulative (self-control) temperament at ages 4.5, and 8 years, respectively, as well as parenting quality at age 4.5 years using the HOME inventory. Hierarchical linear regression analysis was used to investigate the prediction of depressive symptoms at age 11, measured by the Child Depression Inventory, including interaction terms between the temperament variable and parenting. We additionally tested whether parenting was mediated by child temperament. As previously reported, both self-control and parenting were longitudinally associated with preadolescent depressive symptoms. There were no interactive effects between temperament and parenting. However, the effects of parenting were partly mediated by self-control. Our data do not support a differential susceptibility of temperamental variants in the development of preadolescent depression. However, our results are in line with the assumption that parenting may shape young children's temperament, with positive parenting in the early childhood fostering the development of regulative temperament.

Perinatal Maternal Mental Health, Fetal Programming and Child Development

Maternal mental disorders over pregnancy show a clear influence on child development. This review is focused on the possible mechanisms by which maternal mental disorders influence fetal development via programming effects. This field is complex since mental health symptoms during pregnancy vary in type, timing and severity and maternal psychological distress is often accompanied by higher rates of smoking, alcohol use, poor diet and lifestyle. Studies are now beginning to examine fetal programming mechanisms, originally identified within the DOHaD framework, to examine how maternal mental disorders impact fetal development. Such mechanisms include hormonal priming effects such as elevated maternal glucocorticoids, alteration of placental function and perfusion, and epigenetic mechanisms. To date, mostly high prevalence mental disorders such as depression and anxiety have been investigated, but few studies employ diagnostic measures, and there is very little research examining the impact of maternal mental disorders such as schizophrenia, bipolar disorder, eating disorders and personality disorders on fetal development. The next wave of longitudinal studies need to focus on specific hypotheses driven by plausible biological mechanisms for fetal programming and follow children for a sufficient period in order to examine the early manifestations of developmental vulnerability. Intervention studies can then be targeted to altering these mechanisms of intergenerational transmission once identified.

How many infants are temperamentally difficult? Comparing norms from the Revised Infant Temperament Questionnaire to a population sample of UK infants

The original norms for the Revised Infant Temperament Questionnaire (RITQ) were published in 1978 and were based on a small sample from the US. The aim of this study is to compare temperament scores from the original RITQ against scores from a large population-based cohort of infants from the UK. This study consists of 10,937 infants from the Avon Longitudinal Study of Parents and Children (ALSPAC) born between April 1991 and December 1992 in the southwest of England. Infant temperament at 6 months of age was reported by parents using the adapted RITQ. Responses were scored according to the RITQ manual and then categorized into temperament groups (easy, intermediate low, intermediate high, and difficult) using either the RITQ norms or norms derived from the data. The scores for each temperament subscale and the proportion of children in each temperament group were compared across the two methods. Subscale scores for the ALSPAC sample were higher (more "difficult") than the RITQ norms for rhythmicity, approach, adaptability, intensity, and distractibility. When RITQ norms were applied, 24% infants were categorized as difficult and 25% as easy, compared with 15% difficult and 38% easy when ALSPAC norms were used. There are discrepancies between RITQ norms and the ALSPAC norms which resulted in differences in the distribution of temperament groups. There is a need to re-examine RITQ norms and categorization for use in primary care practice and contemporary population-based studies.

Depression and suicidal behavior in adolescents: a multi-informant and multi-methods approach to diagnostic classification

BACKGROUND

Informant discrepancies have been reported between parent and adolescent measures of depressive disorders and suicidality. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification.

METHOD

Within the context of assessment of eligibility for a randomized clinical trial, 50 parent-adolescent pairs (mean age of adolescents = 15.0 years) were interviewed separately with a structured diagnostic interview for depression, the KID-SCID. Adolescent self-report and parent-report versions of the Strengths and Difficulties Questionnaire, the Short Mood and Feelings Questionnaire and the Depressive Experiences Questionnaire were also administered. We examined the diagnostic concordance rates of the parent vs. adolescent structured interview methods and the prediction of adolescent diagnosis via questionnaire methods.

RESULTS

Parent proxy reporting of adolescent depression and suicidal thoughts and behavior is not strongly concordant with adolescent report. Adolescent self-reported symptoms on depression scales provide a more accurate report of diagnosable adolescent depression than parent proxy reports of adolescent depressive symptoms. Adolescent self-report measures can be combined to improve the accuracy of classification. Parents tend to over report their adolescent's depressive symptoms while under reporting their suicidal thoughts and behavior.

CONCLUSION

Parent proxy report is clearly less reliable than the adolescent's own report of their symptoms and subjective experiences, and could be considered inaccurate for research purposes. While parent report would still be sought clinically where an adolescent refuses to provide information, our findings suggest that parent reporting of adolescent suicidality should be interpreted with caution.

Early life programming as a target for prevention of child and adolescent mental disorders

This paper concerns future policy development and programs of research for the prevention of mental disorders based on research emerging from fetal and early life programming. The current review offers an overview of findings on pregnancy exposures such as maternal mental health, lifestyle factors, and potential teratogenic and neurotoxic exposures on child outcomes. Outcomes of interest are common child and adolescent mental disorders including hyperactive, behavioral and emotional disorders. This literature suggests that the preconception and perinatal periods offer important opportunities for the prevention of deleterious fetal exposures. As such, the perinatal period is a critical period where future mental health prevention efforts should be focused and prevention models developed. Interventions grounded in evidence-based recommendations for the perinatal period could take the form of public health, universal and more targeted interventions. If successful, such interventions are likely to have lifelong effects on (mental) health.