Using the child behavior checklist to determine associations between psychosocial aspects and TMD-related pain in children and adolescents

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed.

OBJECTIVE

To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings.

METHODS

International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents.

RESULTS

The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Maternal psychosocial stress during pregnancy and offspring neurobehavioral outcomes during early childhood in the Healthy Start Study

PURPOSE

We evaluate singular and combined effects of prenatal maternal depression and stress on early childhood neurobehavioral outcomes among 536 mother-child pairs.

METHODS

First, we used multivariable linear regression to investigate associations of women's Edinburgh Postnatal Depression Scale (EPDS) score and Perceived Stress Scale (PSS) score, separately, with offspring Child Behavior Checklist score. Next, to assess the combined effect of EPDS and PSS, we dichotomized each score at the fourth versus first to third quartiles and created a four-level variable comprising combinations of high and low depression and stress. Across all models, we accounted for household chaos, hubbub, and order scale (CHAOS) score, an indicator of the household environment associated with offspring behavioral outcomes.

RESULTS

Each one-unit increment in maternal EPDS and PSS scores corresponded with 0.75 (95% CI: 0.53, 0.96) and 0.72 (95% CI: 0.48, 0.95) units higher offspring total problems T-score, respectively. Children of women with high EPDS and PSS had highest T-scores for total problems. All associations remained materially unchanged after adjustment for CHAOS score.

CONCLUSIONS

Prenatal maternal depression and stress is associated with worse neurobehavioral outcomes among offspring, with the most unfavorable outcomes among children whose mothers had high scores for both EPDS and PSS.

Temporomandibular disorders in children and adolescents: A review

BACKGROUND

Temporomandibular disorders (TMD) are generally observed in individuals between the ages of 20 and 40 years. TMD have also been described in children and adolescents but are still not widely detected and treated in routine practice. Through a literature review, this work aims to improve the diagnosis and management of TMD in children and adolescents by dentists.

METHODS

This literature review was performed by a computerized search of the database PubMed for published articles on TMD in children and adolescents. Articles evaluating the prevalence, etiologies and risk factors, diagnosis, signs, and symptoms as well as the comorbidities of TMD, published between 2001 and 2022, were included in this review.

RESULTS

A total of 51 articles were included. Most of studies reported a prevalence of over 20%, with a higher prevalence in females. The two most common diagnoses were myofascial pain and disk displacement with reduction. Headaches were often associated with the condition. The management of TMD in children and adolescents has been poorly studied.

CONCLUSION

TMD frequently affect children and adolescents. Therefore, for prevention purposes, an examination of the masticatory system should be included in the dental check-up. Early diagnosis is essential in order to limit effects on their growth, development, and quality of life. TMD management is not currently validated for children and adolescents. Noninvasive and reversible care should be preferred.

The Association Between Psychological Symptoms and Self-Reported Temporomandibular Disorders Pain Symptoms in Children and Adolescents

Background: Several studies have reported an association between temporomandibular disorder pain (TMD-P) and emotional disorders in children and adolescents. However, no studies have reported if self-reported TMD-P in Saudi Arabia is associated with psychosocial symptoms. Therefore, the current study aimed to evaluate the association between self-reported TMD-P with depression, anxiety and somatic problems in children and adolescents in Saudi Arabia. The hypothesis was that there is an association between self-reported TMD-P and psychological symptoms among children and adolescents.

Materials and Methods: The included participants were randomly selected boys and girls aged between 10 and 18 years, with a mean (SD) age of 14.0 (2.3) years. Out of 633 children and adolescents that were invited to participate, 509 voluntarily agreed to participate, and 466 completed all questionnaires. The questionnaires included items retrieved from the Youth Self Report (YSR) and Axis II of the Research Diagnostic Criteria for TMD (RDC/TMD) besides demographic data, medical history, and presence of oral parafunctions. To assess the presence of self-reported TMD-Pain, each participant was verbally asked two validated questions regarding the presence of TMD-P and dysfunction (2Q-TMD).

Results: Self-reported TMD-P in children and adolescents was significantly associated with anxiety, depression, somatic symptoms, and social problems (P < 0.0001). Further, the frequencies of anxiety, depression, and somatic disorders were more evident among children and adolescents who suffered from TMD-P (P < 0.0001). The odds of reporting TMD-P in children and adolescents was 1.4 times for border line and clinical diagnosis scores for anxiety and withdrawal depression domains, and 2.6 times for the somatic symptoms' domains. However, in the multiple regression model after controlling for possible confounders, only somatic symptoms and social scores were significant. Moreover, self-reported TMD-P was twice as prevalent among girls compared to boys.

Conclusion: This study reports a significant association between psychosocial burden and presence of self-reported TMD-Pain, with a stronger impact on girls than boys. There were significantly higher number of participants with self-reported TMD-P reporting a poor oral and general health. In addition, self-reported TMD-P was higher among those with borderline and clinically diagnosed anxiety/depression scores. Based on this finding, the current study supports that an early approach and recognition of children and adolescents with anxiety, depression, somatic symptoms, and TMD problems. This could result in a lesser burden for these children and adolescents both in regard to pain and psychosocial implications with increased quality of life.

Diagnostic criteria for temporomandibular disorders (DC/TMD) in children and adolescents: an international Delphi study-Part 2-Development of Axis II

BACKGROUND

Unlike the psychosocial assessment established for adults in the diagnostic criteria for temporomandibular disorders (DC/TMD), a standardized psychosocial assessment for children and adolescents with TMD complaints has not yet been established.

OBJECTIVES

To develop a new standardized instrument set to assess the psychosocial functioning in children and adolescents by adapting the psychosocial status and pain-related disability (Axis II) of the adult DC/TMD and by including new instruments.

METHODS

A modified Delphi method was used to survey 23 international TMD experts and four international experts in pain-related psychological factors for consensus regarding assessment tools for psychosocial functioning and pain-related disability in children and adolescents. The TMD experts reviewed 29 Axis II statements at round 1, 13 at round 2, and 2 at round 3. Agreement was set at 80% for first-round consensus level and 70% for each of the second and third rounds. The psychological experts completed a complementary Delphi survey to reach a consensus on tools to use to assess more complex psychological domains in children and adolescents. For the psychological experts, the first round included 10 open-ended questions on preferred screening tools for depression, anxiety, catastrophizing, sleep problems, and stress in children (ages 6-9 years old) and adolescents (ages 10-19 years old) as well as on other domains suggested for investigation. In the second round, the psychological experts received a 9-item questionnaire to prioritize the suggested instruments from most to least recommended.

RESULTS

The TMD experts, after three Delphi rounds, reached consensus on the changes of DC/TMD to create a form to evaluate Axis II in children and adolescents with TMD complaints. The psychological experts added tools to assess depression and anxiety, sleep disorders, catastrophizing, stress, and resilience.

CONCLUSION

Through international expert consensus, this study adapted Axis II of the adult DC/TMD to assess psychosocial functioning and pain-related disability in children and adolescents. The adapted Axis II protocols will be validated in the target populations.

Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort

Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.

Prevalence of self-reported pain-related temporomandibular disorders and association with psychological distress in a dental clinic setting

Objectives

To investigate the prevalence of self-reported pain-related temporomandibular disorders (TMDs) and its association with psychological status in a dental clinic setting.

Methods

In this cross-sectional study, patients were asked to complete a TMD pain screener and the Patient Health Questionnaire-4 (PHQ-4). Correlations between symptoms of pain-related TMDs and PHQ-4 scores were analysed using Spearman’s correlation test. Symptoms of pain-related TMDs were compared between four groups of participants with different psychological profiles using the Kruskal–Wallis test followed by multiple comparisons. The level of significance was adjusted using the Dunn–Bonferroni test.

Results

The prevalence of self-reported pain-related TMDs was 22.2%. TMD pain score was positively correlated with PHQ-4 score. The high anxiety and the comorbidity groups had significantly higher TMD pain scores than the controls.

Conclusion

There was a high prevalence of self-reported pain-related TMDs, which was correlated with scores on all psychological assessment scales. Symptoms of pain-related TMDs were significantly greater in patients with high anxiety scores, regardless of depression level.

Household Income and Children's Depressive Symptoms: Immigrants' Diminished Returns

Introduction

Relative to socially privileged groups, socially marginalized people experience weaker health effects of household income and other economic resources, a pattern known as Minorities' Diminished Returns (MDRs). These MDRs are frequently seen in racial and ethnic minorities, but less is known about the relevance of such MDRs in immigrant families. To investigate the MDRs of household income on children's depression as a function of immigration, we compared non-immigrant and immigrant children for the effect of household income on children's depressive symptoms.

Methods

This cross-sectional study was conducted across multiple cities in the United States. Baseline data from the Adolescent Brain Cognitive Development (ABCD) study collected in 2018 was used. A total of 6,412 children between the ages of 9-10-year-old were included. The predictor variable was household income. The primary outcome was children's depression measured by the Child Behavior Checklist (CBCL). Race, ethnicity, age, sex, parental marital status, parental employment, and financial difficulties were the covariates. Immigration status was the effect modifier.

Results

Overall, high household income was associated with lower children's depressive symptoms. Immigration status showed a statistically significant interaction with household income on children's depression. This interaction term suggested that high household income has a smaller protective effect against depression for immigrant children than non-immigrant children.

Conclusion

The protective effect of household income against children's depression is diminished for immigrant than non-immigrant children.

Youth Social, Emotional, and Behavioral Problems in the ABCD Study: Minorities' Diminished Returns of Family Income

BACKGROUND

To investigate ethnic differences in the protective effects of family income against youth social, emotional, and behavioral problems in the US. As proposed by the Marginalization-related Diminished Returns (MDRs), family income may generate fewer tangible outcomes for ethnic minority compared to NHW families. Our existing knowledge is minimal about diminished returns of family income on parental reports of youth social, emotional, and behavioral outcomes.

AIM

To compare ethnic groups for the effects of family income on parental reports of youth social, emotional, and behavioral problems.

MATERIALS AND METHODS

In this cross-sectional study, data from wave 1 of the Adolescent Brain Cognitive Development (ABCD) study were included. The ABCD, an ongoing national cohort of American youth brain development, included 10,762 American youth between ages 8 and 11 years old. The independent variable was family income. The primary outcomes were 1) anxious and depressed mood, 2) withdrawn and depressed affect, 3) somatic complaints, 4) social and interpersonal problems, 5) thought problems, 6) rule-breaking behaviors, 7) attention problems, and 8) violent and aggressive behaviors. These outcomes were generated based on parent-reported behavioral problems measured using the Child Behavior Checklist (CBCL).

RESULTS

Overall, high family income was associated with lower levels of parental reports of youth social, emotional, and behavioral problems across all domains (p <0.05 for all beta coefficients across multivariable regression models). Ethnicity showed statistically significant interactions with family income on youth fewer social, emotional, and behavioral problems (all domains), net of all confounders (p <0.05 for all beta coefficients that reflected interaction terms across multivariable regression models), indicating smaller tangible gains from their family income for NHB and HW compared to NHW youth.

CONCLUSION

The protective effects of family income against behavioral problems are systematically diminished for HW and NHB youth compared to NHW youth. To minimize the ethnic gap in youth social, behavioral, and emotional problems, diminished returns of family income should be addressed. There is a need for programs and interventions that equalize not only SES but also the marginal returns of SES for ethnic groups. Such efforts require addressing structural and societal barriers that hinder HW and NHB families from translating their SES resources into tangible outcomes. There is a need for studies that can minimize MDRs for NHB and HW families. Thus, SES can similarly secure tangible outcomes in the presence of SES resources.

Family Income Mediates the Effect of Parental Education on Adolescents' Hippocampus Activation During an N-Back Memory Task

Introduction: Hippocampus, a medial temporal lobe structure, has significant implications in memory formation and learning. Although hippocampus activity is believed to be affected by socioeconomic status (SES), limited knowledge exists on which SES indicators influence hippocampus function. Purpose: This study explored the separate and combined effects of three SES indicators, namely parental education, family income, and neighborhood income, on adolescents’ hippocampus activation during an N-Back memory task. As some of the effects of parental education may be through income, we also tested if the effect of parental education on hippocampus activation during our N-Back memory task is mediated by family or neighborhood income. Methods: The Adolescent Brain Cognitive Development (ABCD) study is a national multi-center investigation of American adolescents’ brain development. Functional magnetic resonance imaging (fMRI) data of a total sample of 3067 9–10-year-old adolescents were used. The primary outcome was left- hippocampus activation during the N-Back memory task (mean beta weight for N-Back run 1 2 back versus 0 back contrast in left hippocampus). The independent variable was parental education. Family income and neighborhood income were two possible mediators. Age, sex, and marital status were the covariates. To test mediation, we used hierarchical linear regression models first without and then with our mediators. Full mediation was defined according to Kenny. The Sobel test was used to confirm statistical mediation. Results: In the absence of family and neighborhood income in the model, higher parental educational attainment was associated with lower level of left hippocampus activation during the N-Back memory task. This effect was significant while age, sex, and marital status were controlled. The association between parental educational attainment and hippocampus activation during the N-Back memory task was no more significant when we controlled for family and neighborhood income. Instead, family income was associated with hippocampus activation during the N-Back memory task. These findings suggested that family income fully mediates the effect of parental educational attainment on left hippocampus activation during the N-Back memory task. Conclusions: The effect of parental educational attainment on adolescents’ hippocampus activation during an N-Back memory task is fully explained by family income. That means low family income is why adolescents with low-educated parents show highlighted hippocampus activation during an N-Back memory task. Given the central role of the hippocampus in learning and memory and as income is a modifiable factor by tax and economic policies, income-redistribution policies, fair taxation, and higher minimum wage may have implications for promotion of adolescent equality and social justice. There is a need to focus on family-level economic needs across all levels of neighborhood income.