The Strengths and Difficulties Questionnaire Predicts Concurrent Mental Health Difficulties in a Transdiagnostic Sample of Struggling Learners

The assessment of transdiagnostic dimensions of emotional disorders: Validation of the Multidimensional Emotional Disorders Inventory (MEDI) in adolescents with subthreshold anxiety and depression

BACKGROUND

The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. The Multidimensional Emotional Disorders Inventory (MEDI) is a specifically designed self-report to measure the transdiagnostic dimensions proposed by Brown and Barlow (2009). This study aims to analyse the psychometric properties of the MEDI scores in adolescents with subthreshold anxiety and depression.

METHOD

The sample consisted of a total of 476 students. The mean age was 13.77 years (SD = 1.43) (range 10 to 18 years), 73.9 % were females. Several questionnaires assessing positive affect, negative affect, mental health difficulties, and quality of life were used.

RESULTS

The original 9-factor structure of the MEDI was confirmed with good fit indices. Satisfactory levels of internal consistency were observed in most of the MEDI scores using McDonald's Omega, ranging from 0.58 to 0.87. The MEDI dimensions were associated with psychopathology, positive affect, negative affect, and quality of life.

LIMITATIONS

Reliance on self-reported data, a cross-sectional design limiting temporal assessment, and a 73.9 % female gender imbalance.

CONCLUSION

The MEDI scores showed adequate psychometric properties among adolescents with subclinical emotional symptoms. The results found might have potential clinical implications for conceptualization, assessment, intervention, and prevention of emotional disorders at both clinical and research levels.

A psychometric investigation of health-related quality of life measures for paediatric neurodevelopment assessment: Reliability and concurrent validity of the PEDS-QL, CHU-9D, and the EQ-5D-Y

There is a need for tools that can provide a brief assessment of functioning for children with neurodevelopmental conditions, including health-related quality of life (HR-QoL). This study evaluated the psychometric properties of three commonly used and well known HR-QoL measures in a cohort of children presenting to clinical developmental assessment services. The most common diagnoses received in these assessment services were autism spectrum disorders. Findings showed good internal consistency for the PedsQL and the CHU-9D, but not the EQ-5D-Y. This research also found that the CHU-9D, EQ-5D-Y, and PedsQL correlated with relevant functioning domains assessed by the VABS-III. Overall, the measures showed that children with neurodevelopmental conditions experienced poor HR-QoL. The majority of children (>86%) met cut-off criteria for significant health concerns on the PedsQL. On the EQ-5D-Y and CHU-9D, they showed reduced HR-QoL particularly on domains relating to school and homework, being able to join in activities, looking after self, and doing usual activities. This study supports the use of the CHU-9D and PedsQL in this population to assess and potentially track HR-QoL in a broad neurodevelopment paediatric population.

Socioeconomic inequalities in child and adolescent mental health in Australia: the role of parenting style and parents' relationships

BACKGROUND

Socioeconomic inequalities in health and their determinants have been studied extensively over the past few decades. However, the role of parenting style and parents' couple relationships in explaining mental health inequalities is limited. Therefore, this study aims to investigate the distributional impact of parenting style (angry parenting, consistent parenting, and inductive parenting) and parents' couple relationships (e.g., argumentative, happy relationships) on socioeconomic inequalities and by extension on mental health status of Australian children and adolescents.

METHODS

This study utilized data from the Longitudinal Study of Australian Children (Waves 1-7), specifically focusing on intact biological parent families, while excluding single-parent and blended-family households. We applied the decomposition index and the Blinder Oaxaca method to investigate the extent of the contribution and temporal impact of parenting style and parents' couple relationships on the mental health status of Australian children and adolescents.

RESULTS

This study revealed that poor parenting style is the single most important factor that leads to developing mental health difficulties in children and adolescents, especially from low socioeconomic status, and it contributes almost 52% to socioeconomic inequalities in mental health status. Conversely, household income, maternal education, employment status, and parents' couple relationships contributed 28.04%, 10.67%, 9.28%, and 3.34%, respectively, to mental health inequalities in children and adolescents.

CONCLUSION

Overall, this study underscores the importance of parenting style and parents' couple relationships as significant predictors of mental health outcomes in children and adolescents. These results highlight the need for targeted interventions to support families from low socioeconomic backgrounds to address the significant mental health inequalities observed in the study population.

What is the role of screening instruments in the management of psychiatric comorbidities in epilepsy? Tools and practical tips for the most common comorbidities: Depression and anxiety

Depression and anxiety are the most common psychiatric comorbidities in epilepsy and are known to increase healthcare utilization, the risk of refractory epilepsy, and anti-seizure medication intolerability. Despite this, depression and anxiety continue to be underrecognized and undertreated in people with epilepsy (PWE). Several barriers to the identification of depression and anxiety in PWE exist, including reliance on unstructured interviews rather than standardized, validated instruments. Moreover, there is a dearth of behavioral health providers to manage these comorbidities once identified. The use of validated screening instruments in epilepsy clinics can assist with both the identification of psychiatric symptoms and monitoring of treatment response by the epilepsy clinician for PWE with comorbid depression and/or anxiety. While screening instruments can identify psychiatric symptoms occurring within a specified time, they are not definitively diagnostic. Screeners can be time efficient tools to identify patients requiring further evaluation for diagnostic confirmation. This article reviews recent literature on the utility of depression and anxiety screening instruments in epilepsy care, including commonly used screening instruments, and provides solutions for potential barriers to clinical implementation. Validated depression and anxiety screening instruments can increase identification of depression and anxiety and guide epilepsy clinician management of these comorbidities which has the potential to positively impact patient care.

Relationship between physical activity and behaviour challenges of adolescents in South Africa

Background

Four out of five adolescents worldwide are physically inactive based on recommended standards.

Aim

We determined whether physical activity is associated with lower behavioural challenges in adolescents to promote buy-in from stakeholders.

Setting

KwaZulu-Natal province, South Africa, from January 2020 to March 2020.

Methods

A cross-sectional study was conducted among 187 adolescent learners (12-18 years) from three government schools in KwaZulu-Natal Province, South Africa, from January to March 2020. We fitted linear regression models between the Strengths and Difficulties Questionnaire scores (total, internalising, externalising, and prosocial) and hours of physical activity exposure, adjusting for demographic covariates, and depression history.

Results

The median age was 14.4 years (interquartile range = 1.36) and 75.9% of the participants were females. Overall average and weekday physical activity were each associated with lower total and externalising but higher pro-social scores. Depression was associated with higher inactivity scores (total, internalising and externalising).

Conclusions

The article shows that physical activity can reduce the behavioural and emotional problems in adolescents.

Contribution

Physical activity is critical for a healthy adolescent hood and needs to be actively included in childhood development.

Harsh Parenting and Trajectories of Emotional and Behavioural Difficulties in Autistic Children

Autistic children show higher rates of co-occurring emotional and behavioural difficulties compared to other children in the general population. However, the environmental factors which contribute to the development of emotional (internalising) and behavioural (externalising) difficulties in autistic individuals are poorly understood. This study sought to investigate the association between harsh parenting (smacking, shouting, telling off) and the trajectories of emotional and behavioural difficulties in autistic children from ages 3 to 7. A sample comprising of 349 autistic children participated from the UK's Millennium Cohort Study. Associations between harsh parenting and child emotional and behavioural difficulties were modelled using multilevel growth curve models. In autistic children, harsh parenting was associated with total emotional and behavioural difficulties and behavioural (but not emotional) problems concurrently. Moreover, harsh parenting was not associated with changes in emotional and behavioural difficulties over time. Harsh parenting may have an important role in externalising problems in young autistic children indicating the need for public health strategies which educate parents on its effects.

Analysis of Protective Factors in Schoolchildren in England Using the Dual-factor Model of Mental Health

The dual-factor approach to mental health was employed to explore levels and interrelations of protective factors associated with resilience in a dataset of 30,841 schoolchildren aged 11-14 in England. ANOVA was used to contrast levels of protective factors between groups (combinations of higher/lower psychopathology and higher/lower wellbeing) and network analysis to explore protective factor interrelations. Levels of protective factors tended to be highest for those who had higher wellbeing and lower psychopathology (termed 'complete mental health'). Those with lower levels of protective factors were split between two subpopulations: having lower wellbeing and higher psychopathology (termed 'troubled'), and having lower wellbeing and lower psychopathology (termed 'vulnerable'). Analysis of the protective factor networks revealed that the four subpopulations of the model were distinguished by both their overall structure and individual node connectivity (the 'complete mental health' subpopulation demonstrated the greatest connectivity), though two were similar: those with higher wellbeing and higher psychopathology (termed 'symptomatic but content') and lower wellbeing and higher psychopathology ('troubled'). The results indicate that while 'vulnerable' and 'symptomatic but content' may be hard to discriminate conceptually, the former may reflect a lower capacity to cope during periods of adversity (i.e., show resilience). Overall, the results encourage a holistic approach to mental health screening, particularly as children with lower wellbeing had lower levels of the protective factors, regardless of their level of psychopathology. Moreover, interventions to improve protective factors associated with positive development in stressed environments may therefore have a greater impact on improving wellbeing than decreasing symptoms of psychopathology.

Maternal psychological functioning mediates the association between infant behavior and subsequent child psychological functioning

Symptoms of psychopathology that onset during childhood are often more severe, chronic, and difficult to treat than symptoms that first appear later in life. Maternal psychological symptoms are associated with the development of psychological symptoms in children. However, less research focuses on whether children's behaviors may presage maternal psychological difficulties that, in turn, contribute to the child's own psychological functioning. Identifying psychological difficulties in families and intervening in early life may lower risk for intergenerational transmission of subsequent psychological symptoms. Even at non-clinical or normative levels, exploring transactional models of parent-child behavior and psychological functioning may provide insight into the development of later psychological difficulties or symptoms within families. Thus, the current study examined whether difficult infant behavior (e.g., fussiness, unpredictability) is associated with future maternal psychological difficulties and subsequently, the child's own psychological functioning in early childhood. The current sample includes 847 dyads from a multi-wave birth cohort in England ('Born in Bradford'), who identified as predominantly non-White (62.2%) and socioeconomically diverse. Mothers reported on their child's behaviors at 6 months, their own psychological functioning during pregnancy and at 18 months postpartum, and their child's psychological functioning at age 3. Results of a mediation model revealed that the association between infant behavior at 6 months and child psychological functioning at 3 years is partially explained by maternal psychological functioning at 18 months, even after accounting for psychological difficulties during pregnancy, maternal age at birth, child sex, family income, and ethnicity. Post-hoc exploratory analyses revealed that the association between infant behavior, maternal psychological functioning, and subsequent child psychological functioning was significant for Pakistani British families but not White British families. These findings provide preliminary evidence that infant behaviors (e.g., temperament) may presage future maternal psychological difficulties and subsequent child psychological functioning, above and beyond previous maternal psychological functioning. Importantly, these results highlight infant behavior as a potential catalyst for later psychological difficulties within families.

Parental Supervision and Its Relation With Emotional and Behavioral Problems in Secondary School Children

Background Emotional and behavioral problems of children are a common concern for parents and mental health stakeholders alike. Poor parenting is a well-known factor associated with behavioral problems in children. There is unanimity regarding the correlation between parental supervision and emotional and behavioral problems. This present study aimed to establish a relationship between parental supervision and emotional and behavioral problems, as it could make way for further research based on the concept of parental supervision, which parents can quickly adopt as an intervention strategy for children with behavioral and emotional problems. Aim We aim to assess parental supervision and its relation with emotional and behavioral problems in secondary school children. Method This is a community-based cross-sectional observational study among 770 parents of children from schools in Dibrugarh, Assam, over a period of one year. Multistage random sampling was applied to obtain the sample size. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children's emotional and behavioral problems, the Alabama Parenting Questionnaire (APQ) was used to assess parental supervision, and sociodemographic proforma was used to study various demographic variables. The observed data were analyzed using the computer program Statistical Package for the Social Sciences for Macintosh version 24.0 (IBM SPSS Statistics, Armonk, NY, USA). Results The study revealed that participants' poor supervision had a positive correlation with emotional and behavioral problems. Poor monitoring/supervision had a positive correlation with total difficulty score levels, and positive parenting practices such as involvement and positive parenting had a negative correlation with emotional and behavioral problems. There was a statistically significant association between behavioral problems and selected demographic variables such as parents' education, socioeconomic status, and family type. The study also found that there was a significant statistical association between sociodemographic variables such as age and negative parenting practices such as poor monitoring/supervision, inconsistent discipline, and corporal punishment. Conclusion It was found that factors such as inconsistent discipline and poor supervision had a significant impact on emotional and behavioral problems in children. In future monitoring research, one can adopt a constructional approach, where the goal should be to explain and distinguish good parental supervision behaviors from poor supervision. This knowledge can be used to develop good intervention strategies to halt such emotional and behavioral problems.

Restricted and repetitive behaviors and their developmental and demographic correlates in 4-8-year-old children: A transdiagnostic approach

Background: Restricted and repetitive behaviors (RRBs) are a broad class of behaviors characterized by frequent action repetition and intense preference for sameness. Research has predominantly focused on RRBs in diagnosed clinical groups, particularly in autism spectrum disorder and genetic disorders. Using a transdiagnostic approach, the current study examined RRBs in a diverse sample of children in relation to developmental and demographic correlates (age, language, non-verbal ability, child anxiety, sex, and socioeconomic status). Separate analyses examined two RRB subtypes; repetitive sensory and motor behaviors (RSMB) and insistence on sameness (IS). Method: Children (N = 260, age 4-8 years, 174 male, 86 female) in mainstream schools identified by teachers as having behavioral, emotional, and/or cognitive difficulties, were assessed using the Repetitive Behavior Questionnaire-2 (RBQ-2), the British Picture Vocabulary Scale (BPVS), Lucid Ability Scale, the Welsh Index of Multiple Deprivation (WIMD) and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Recruitment excluded diagnosed clinical conditions. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children's difficulties. Results: RRB scores were of high frequency and the scores for the IS were higher than for RSMB. The severity of anxiety symptoms and male sex were significantly associated with both RRB subtypes, and younger age and SES scores were associated with IS. Elevated RRB total and subtype scores were significantly related to SDQ scores for emotion, conduct, hyperactivity, and peer-relations. Discussion: The study provides the first evidence of RRBs in a diverse sample of young children with emerging difficulties in behavior, cognition, and/or emotion. The results contribute to proposals about psychological development in RRB and indicate that RRBs are best represented on a continuum of severity found across children in the early school years. The results support previous findings of a relation between RRB and anxiety reported in clinical samples and importantly, they indicate that it is time to move beyond the study of categorically defined groups and consider correlates of RRBs that include broad indices of mental health and well-being.

Inconsistencies between Subjective Reports of Cognitive Difficulties and Performance on Cognitive Tests are Associated with Elevated Internalising and Externalising Symptoms in Children with Learning-related Problems

Children with learning difficulties are commonly assumed to have underlying cognitive deficits by health and educational professionals. However, not all children referred for psycho-educational assessment will be found to have deficits when their abilities are measured by performance on cognitive tasks. The primary aim of this study was to estimate the prevalence of this inconsistent cognitive profile (ICP) in a transdiagnostic sample of children referred by health and education service providers for problems related to attention, learning and memory (N = 715). A second aim was to explore whether elevated mental health problems were associated with ICPs. Findings suggest that approximately half of this sample could be characterised as having an ICP. Cognitive difficulties, whether identified by parent ratings or task performance, were associated with elevated internalising and externalising difficulties. Crucially, a larger discrepancy between a parent's actual ratings of a child's cognitive difficulties and the ratings that would be predicted based on the child's performance on cognitive tasks was associated greater internalising and externalising difficulties for measures of working memory, and greater externalising difficulties for measures of attention. These findings suggest that subjective cognitive difficulties occurring in the absence of any task-based performance deficits may be a functional problem arising from mental health problems.

The Quality of Everyday Eye Contact in Williams Syndrome: Insights From Cross-Syndrome Comparisons

Past research shows that individuals with Williams syndrome (WS) have heightened and prolonged eye contact. Using parent report measures, we examined not only the presence of eye contact but also its qualitative features. Study 1 included individuals with WS (n = 22, ages 6.0-36.3). Study 2 included children with different neurodevelopmental (ND) conditions (WS, autism spectrum condition, fragile X syndrome, attention-deficit/hyperactivity disorder) and children with neurotypical development (NT; n = 262, ages 4.0-17.11). Unusual eye contact features, including staring, were found in approximately half of the WS samples. However, other features such as brief glances were frequently found in WS and in all ND conditions, but not NT. Future research in ND conditions should focus on qualitative as well as quantitative features of eye contact.

Behavioral aspects and learning motivation: a study of middle school adolescents

PURPOSE

To analyze the association between behavioral aspects and learning motivation according to age, sex, and grade in school in middle school students.

METHODS

Observational, analytical, and cross-sectional study with 11- to 14-year-old adolescents, who answered the participant characterization questionnaire, the Strengths and Difficulties Questionnaire - SDQ-Por, and the Learning Motivation Evaluation Scale - EMAPRE. Descriptive and bivariate statistical analyses were conducted.

RESULTS

In the sample researched, there was a statistically significant association between the Strengths and Difficulties Questionnaire domains and the learning motivation goals. It demonstrated that the students with higher means and medians for higher quality motivations had normal results in the SDQ conduct problems, whereas those with a greater tendency to a more extrinsic motivation had an abnormal result in peer relationship problems. In the total classification, the sample students with higher mean and median for the learning goal (which refers to a greater academic commitment) had a normal result, whereas those more prone to the performance-avoidance goal had more abnormal results. The learning motivation did not vary according to age and grade in school, and the adolescents had a greater tendency to the learning goal than to the other two.

CONCLUSION

The association between the behavioral aspects and the learning motivation in the sample assessed was present in the abnormal SDQ-Por scores in relation to the performance-avoidance goal, and in the normal SDQ-Por scores in relation to the learning goal.

Supporting the mental health of children with speech, language and communication needs: The views and experiences of parents

BACKGROUND AND AIMS

A high rate of children in mental health services have poor language skills, but little evidence exists on how mental health support is delivered to and received by children with language needs. This study looked at parental experiences, asking parents of children with speech, language and communication needs (SLCN) about their experiences seeking help for their children's mental health. We were particularly interested on the experiences of parents of children with Developmental Language Disorder (DLD), a specific SLCN that remains relatively unknown to the general public.

METHODS

We conducted an online survey of 74 parents of children with speech, language and communication needs (SLCN). Survey respondents included parents of children with a range of difficulties, including DLD, autism, verbal dyspraxia, global intellectual delay, a history of hearing problems, and SLCN without a primary diagnosis. Survey respondents were asked what sources of support they had accessed for their child's mental health and to provide comments on what was good and what was not good about this support. We then conducted 9 semi-structured interviews of parents of children with DLD about their experiences. These were parents of children with DLD aged 7 to 17 years, from across a range of educational settings, and with a range of present mental health concerns.

RESULTS

Content analyses of the survey responses from parents of children with SLCN highlighted three broad factors of importance to parents' experiences: relational aspects of care, organisational aspects of care, and professionals' knowledge. Thematic analyses of the interviews of parents of children with DLD identified 5 themes: the effects of language problems on the presentation of distress; the role of the school environment; the role of key professionals; standard approaches to mental health support might not be appropriate; and the role and impact on parents. Parents expressed concerns that their children's mental health problems and need for support would not be recognised, and felt interventions were not accessible, or delivered in a manner that was not comfortable for their children due to high reliance on oral language skills. Some parents were left feeling that there was no provision suitable for their children.

CONCLUSIONS

Parents of children with SLCN face barriers accessing support for their children's mental health, including a lack of professional knowledge about their children's language needs. Parents argued that language and communication needs can significantly affect the delivery and success of psychological therapies and interventions. Systematic research is needed to understand how to successfully adapt services to make them accessible to children and young people with language needs, and to ensure that mental health problems are detected in children with language difficulties. Increased knowledge about language disorders such as DLD, and access to speech and language therapy expertise, is needed amongst professionals who work to support children's mental health.

Higher-order dimensions of psychopathology in a neurodevelopmental transdiagnostic sample

Hierarchical dimensional models of psychopathology derived for adult and child community populations offer more informative and efficient methods for assessing and treating symptoms of mental ill health than traditional diagnostic approaches. It is not yet clear how many dimensions should be included in models for youth with neurodevelopmental conditions. The aim of this study was to delineate the hierarchical dimensional structure of psychopathology in a transdiagnostic sample of children and adolescents with learning-related problems, and to test the concurrent predictive value of the model for clinically, socially, and educationally relevant outcomes. A sample of N = 403 participants from the Centre for Attention Learning and Memory (CALM) cohort were included. Hierarchical factor analysis delineated dimensions of psychopathology from ratings on the Conner's Parent Rating Short Form, the Revised Children's Anxiety and Depression Scale, and the Strengths and Difficulties Questionnaire. A hierarchical structure with a general p factor at the apex, broad internalizing and broad externalizing spectra below, and three more specific factors (specific internalizing, social maladjustment, and neurodevelopmental) emerged. The p factor predicted all concurrently measured social, clinical, and educational outcomes, but the other dimensions provided incremental predictive value. The neurodevelopmental dimension, which captured symptoms of inattention, hyperactivity, and executive function and emerged from the higher-order externalizing factor, was the strongest predictor of learning. This suggests that in struggling learners, cognitive and affective behaviors may interact to influence learning outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).