Behavioural and emotional disorders in childhood: A brief overview for paediatricians

Influence of lifestyle and family environment factors on mental health problems in Hong Kong preschoolers

BACKGROUND AND AIMS

Existing studies that simultaneously consider the effects of lifestyle and family environment factors on mental health problems (MHPs), particularly in preschoolers, are limited. This study aims to explore lifestyle and family environment factors associated with MHPs, externalising problems (EPs) and internalising problems (IPs) in preschoolers.

METHODS

This territory-wide, school-based study conducted from 2020 to 2022 involved 1926 preschoolers. MHPs, EPs, and IPs and factors such as sleep duration, sleep latency, entertainment screen time, educational screen time, parent-child recreation and learning activities were assessed. Linear and logistic regression analyses were used to explore the relationships between these factors and MHPs, EPs, and IPs.

RESULTS

The average sleep duration was 9.94 h per day, average screen time of 2.53 h per day, and 42.6 % experienced sleep latency exceeding 20 min per day among preschoolers (mean age: 4.39 years, 49.1 % female). Adjusted analyses showed that decreased parent-child recreation activities, prolonged sleep latency and excessive entertainment screen time were associated with increased MHPs, EPs, and IPs (β: 0.05 to 0.20, all p < 0.05). Weekend sleep duration of <10 h per day, sleep latency of >20 min per day, and educational screen time of >30 min per day were identified as risk factors for MHPs, EPs, and IPs, with an adjusted odds ratio ranging from 1.32 to 2.32 (all p < 0.05).

CONCLUSIONS

Preschoolers' lifestyle and family environment factors are associated with MHPs, EPs, and IPs respectively. Ensuring adequate sleep duration, avoiding sleep latency exceeding 20 min per day, reducing entertainment screen time, limiting educational screen time to 30 min per day, and increasing parent-child interactions may help to minimise mental health problems.

Socioeconomic inequalities in mental health difficulties over childhood: a longitudinal sex-stratified analysis using the UK Millennium Cohort Study

Stark socioeconomic inequalities in childhood mental health have been widely reported. Understanding whether they vary with age, by type of difficulty or sex can inform public health policies to tackle socioeconomic inequalities. We investigated the effects of early life childhood socioeconomic circumstances (SECs) (maternal education and household income) on developmental trajectories of externalising and internalising difficulties in childhood and adolescence, in males and females from the UK-representative Millennium Cohort Study (N = 15383). We estimated the Slope Index of Inequality (SII) (absolute difference between the most versus least advantaged) using linear mixed-effects regression models, on parent-reported Strengths and Difficulties Questionnaire externalising and internalising difficulties score, at 5, 7, 11, 14, and 17 years(y). The mean externalising score was high at 5y (4.8 [95 %CI: 4.7, 4.9]) and decreased slightly, while mean internalising score increased over childhood, reaching 3.9 [3.8, 4.1] by 17y, with a steeper trend for females in adolescence. Lower maternal education was associated with greater externalising scores at 5y (SII, Male: 3.0 [2.7 to 3.3]; Female: 2.7 [2.4, 3.0]) with inequalities decreasing slightly up to 17y (SII Male: 2.4 [2.0 to 2.7], Female: 2.5 [2.1, 2.8]). Inequalities in internalising scores increased slightly over childhood (SII Female 5y: 1.3 [1.1, 1.6]; 17y: 1.9 [1.5, 2.3]; SII Male 5y = 1.6 [1.3, 1.8], 17y = 1.8 [1.5, 2.2]). Patterns were similar using household income. Disadvantaged SECs are associated with persistently higher levels of parent-reported mental health difficulties up to 17y, with larger effects on externalising than internalising difficulties, but little differences by sex or socioeconomic measure.

Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders

BACKGROUND

Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.

AIM

To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.

METHODS

A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.

RESULTS

The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children's vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.

CONCLUSION

Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.

Reducing childhood externalizing behavior: A feasibility RCT of the being a Parent program

OBJECTIVE

Rising rates of childhood behavioral problems are a global concern and in Portugal cases of behavioral problems in youth have been following international trends. Parenting interventions are widely regarded as one of the most effective ways to address externalizing behaviors early on, and thus their dissemination is crucial. This paper presents a feasibility randomized controlled trial (RCT) conducted in Portugal to evaluate the effectiveness of a parenting intervention for childhood behavioral problems. Our goals were threefold: a) assess feasibility parameters; b) evaluate program fidelity and acceptability; and c) examine the program's potential impact on child behavior, parenting skills, parental concern, and parental competence.

METHOD

A double-blinded, two-arm design was employed. Fifty-five families of children aged 2-11 years old who reported difficulties managing their child's behavior were included. Parents were randomly assigned to either the intervention group or a waitlist control group, and the intervention group participated in the eight-week "Being a Parent" program (Portuguese version: Ser Pai & Ser Mãe). Data were collected at two time points (pre- and post-intervention) using quantitative measures.

RESULTS

Findings confirmed the program's successful implementation in Portugal and demonstrated significant positive effects, particularly in reducing externalizing behavior, as well as aggressive behavior, and increasing parental competence, more specifically parental satisfaction.

CONCLUSIONS

This study represents the first trial of the Being a Parent program conducted outside the UK, and highlights its potential for broader international application. Key challenges and clinical implications are also addressed.

TRIAL REGISTRATION

ClinicalTrials.gov (nº NCT05626244).

Children and Adolescents with Severe Tyrannical Behaviour: Profile of Youth and Their Parents

This study focused on a subtype of child-to-parent violence, severe tyrannical behaviour (STB). The aim was to examine the clinical characteristics of children and adolescents who physically and/or verbally abuse their parents and the sociodemographic characteristics and generalities of those families. Clinical and sociodemographic data from 73 children and adolescents with STB and their parents have been collected from a randomized control trial. Results showed a specific profile of youth with tyrannical behaviour (aggressive behaviour only in-home settings, only-child, previously mental health care), as well as differential characteristics of these families (late parenthood, high socio-economic status and conjugal family). Children with tyrannical behaviour frequently had psychiatric conditions, such as attention deficit hyperactivity disorder, separation anxiety, sleeping disorders and severe irritability was frequently described. These clinical patterns of combined neurodevelopmental, externalized and internalized symptoms suggest that the combination of individual characteristics, parenting style and parent-child relationship play essential roles in children's STB development.

Bidirectional and longitudinal relationship between nature contact and children's problem behavior: The mediating role of prosocial behavior

Previous studies have suggested that nature contact is a protective factor for problem behavior in children. However, there remains a significant gap in research exploring the reciprocal relationship between nature contact and children's problem behavior, as well as the underlying mechanisms driving this relationship. This study employed a longitudinal three-wave design involving 516 children in China (268 girls, Mage = 10.88 ± 0.66 years old at Time 3). Cross-lagged analyses indicated that nature contact and problem behavior negatively predicted each other over time, and prosocial behavior bidirectionally mediated the relationship between nature contact and problem behavior. These results provided evidence for the relationships among nature interaction, social development, and behavioral development in children. These findings suggested that promoting prosocial behavior could reduce problem behavior and enhance nature engagement, potentially serving as a strategy to foster comprehensive development in children.

A Systematic Review of Guided, Parent-Led Digital Interventions for Preadolescent Children with Emotional and Behavioural Problems

Emotional and behavioural problems (EBP) are prevalent amongst children, and guided, parent-led digital interventions offer one method of improving access to effective treatments. This systematic review (PROSPERO: CRD42023484098) aimed to examine the evidence base for, and characteristics of, these types of interventions through a narrative synthesis. Systematic searches were conducted using Medline, EMBASE, PsycINFO, Scopus and Web of Science in January 2024 and February 2025, supplemented with hand searching in March/April 2024 and February 2025. Studies were eligible if they reported outcomes related to preadolescent EBP from a guided, fully parent-led, fully digital intervention. Thirteen studies were eligible, including 2643 children and covering eight interventions (addressing anxiety problems, comorbid anxiety and depression, attention deficit hyperactivity disorder, conduct disorder and disruptive behaviour). Studies included randomised controlled trials and pre-post studies. The QualSyst checklist was used to assess study quality; all studies were rated as good quality. All studies showed statistically significant improvements in the child's symptoms or interference levels, with small to very large effect sizes immediately post-treatment, and at least medium effect sizes by follow-up, suggesting a promising evidence base. A wide range of intervention characteristics were identified, forming a basis for future intervention development for childhood EBP. However, there was a lack of consistency in how information was reported across studies (such as completion rates) and studies lacked information on parent demographics and key intervention details. Further high quality randomised controlled trials for a wider range of EBP are needed to continue building the evidence base.

Associations between air pollution and surrounding greenness with internalizing and externalizing behaviors among schoolchildren

BACKGROUND

Air pollution and greenness are emerging as modifiable risk and protective factors, respectively, in child psychopathology. However, research shows inconsistencies. Here, we examined associations between air pollution and surrounding greenness with internalizing and externalizing behaviors. In addition, the potential modifying role of the genetic susceptibility for these traits and socioeconomic status (SES) was explored.

METHODS

This population-based study included 4485 schoolchildren aged 5-18 years from Spain. Internalizing and externalizing behaviors were assessed using the Child Behavior Checklist (CBCL). Average air pollution (NO2, PM2.5, PM10, PMcoarse, and PM2.5 absorbance) and surrounding greenness (NDVI within 100-m, 300-m, and 500-m buffers) school exposure were estimated for 12 months before outcome assessment. Genetic liability was assessed by computing polygenic risk scores (PRS) and SES was calculated using the Hollingshead Four-Factor Index. Associations were analyzed using negative binomial mixed-effects models.

RESULTS

Although no associations survived multiple testing, we found that increases of 5.48 μg/m3 in PM10 and 2.93 μg/m3 in PMcoarse were associated with a 6% (Mean Ratio (MR) = 1.06; 95% CI: 1.01-1.12) and a 4% (MR = 1.04; 95% CI: 1.00-1.09) increase in internalizing behavior scores. A 0.1 increase in NDVI within a 100-m buffer was associated with a 6% decrease in externalizing behavior (MR = 0.94; 95% CI: 0.89-0.99). Neither differences by sex or age, or moderation effects by PRS or SES, were observed.

CONCLUSIONS

We found preliminary evidence of detrimental effects of air pollution on internalizing behavior and protective effects of greenness on externalizing behavior, which were not modified by sex, age, SES, or genetic liability. If confirmed, these results reinforce the need for improving air quality, especially around schools, as part of preventive strategies focused on childhood psychopathology.

Life skills among school-going adolescents in South India: A gender comparison

BACKGROUND

The stress faced by adolescents in the current situation is enormous. Research studies show that various psychosocial factors and life skills deficits are the mediating factors resulting in behavioral, psychological, and health-related problems among adolescents. The present study aims to study and compare the life skills among 8th- and 9th-grade male and female students attending the schools of Udupi, Karnataka, India.

MATERIAL AND METHODS

A descriptive research design was considered for the present study. The study was conducted in two settings, that is, rural and urban areas of Udupi District, of Karnataka. In the study, 8th- and 9th-grade students attending two urban schools and eight rural schools of Udupi District were considered as the study population for the current study. A total sample of 594 students equally representing two schools in urban and eight schools in rural based on male and female ratio and medium of instruction were drawn from the study population. The schools were selected based on the willingness of the school administration. The schools were selected based on the medium of instruction with equal representation of gender. A stratified random sampling technique was adopted to draw the sample, giving equal representation to domicile, gender, and medium of instruction. A semi structured data sheet and Life Skills Scale were administered. Written informed consent was taken from all participants and parents. Participants were assured of confidentiality and anonymity. Participants were informed that they had the option of withdrawing from the study at any point in time.

RESULTS

The present results reveal that 48% of the adolescents had a moderate level of life skills; 29% of them had a high level of life skills, and the remaining 23% of them had a low level of life skills. Female students had better overall life skills, social skills, and emotional skills compared to male students, whereas male students had better thinking skills than females had. Female students tend to cope with stress better than males [p=<.001]. Male students had better interpersonal relationships and critical thinking life skills compared to female students (P = .001).

CONCLUSION

Female students tend to cope with stress better than male students. Strengthening life skills among school students can be a popular approach for prevention and health promotion in schools. Identification of life skills at an early stage can be effective in providing life skills training for the promotion of mental health among school children. Schools should incorporate life skills in their course and curriculum to support and promote mental health.

Symptoms of attention deficit hyperactivity disorder and emotional behavioral problems: The mediating effect of executive function

The aim was to investigate the symptoms of attention deficit hyperactivity disorder (ADHD) and emotional behavioral problems, with focus on studying the mediating effect of executive function. A total of 240 children with ADHD aged 6-10 years old participated. They all met the diagnostic criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. SPSS 26.0 was used for statistical analysis. Mean interpolation was used to interpolate missing values of a small number of questionnaire items. One-way analysis of variance was used for comparison between multiple groups. Pearson correlation analysis was used for correlation between variables. The results of this study showed that inattention and hyperactivity-impulsivity scores of children with ADHD were positively correlated with the scores of emotional and behavioral problems (EBPs), that is, the more severe the attention deficit and hyperactivity-impulsivity symptoms were, the more severe the EBPs were. The hyperactivity-impulsivity score of children with ADHD positively predicted their behavioral regulation index (BMI) and metacognition index (MI) scores. The BMI score positively predicted the emotional and behavioral problem scores of children with ADHD, while the MI score had no statistically significant predictive effect on the emotional and behavioral problem scores of children with ADHD. These findings suggest that interventions targeting executive function-particularly behavioral regulation-may help mitigate emotional and behavioral difficulties in children with ADHD.

OsLdh7 Overexpression in Rice Confers Submergence Tolerance by Regulating Key Metabolic Pathways: Anaerobic Glycolysis, Ethanolic Fermentation and Amino Acid Metabolism

Lactate dehydrogenase plays a key role in alleviating hypoxia during prolonged submergence. To explore the function of the OsLdh7 gene in enhancing submergence tolerance, we overexpressed this gene in rice (Oryza sativa cv. IR64) and subjected the transgenic lines to complete inundation. The overexpression lines showed enhanced viability, chlorophyll content and photosystem II (PSII) efficiency compared to wild-type (WT) plants under stress and recovery conditions. Additionally, these lines exhibited better starch accumulation and reduced reactive oxygen species (ROS) accumulation. Protein-protein interaction studies revealed that OsLdh7 interacts with OsLos2, OsPdc2, OsAlaAT2 and OsAsp2. Under submergence, enhanced enzyme activities of OsLdh7, OsAsp2 and OsAdh1 led to higher NAD+ levels, sustaining anaerobic glycolytic flux and increasing pyruvate, a critical carbon source for amino acid metabolism as well as anaerobic fermentation pathways. Elevated l-lactate levels resulted in increased activity of OsPdc2, which eventually led to enhanced ethanol production. The overexpression lines also accumulated higher levels of aspartate, glutamate and alanine, crucial for ROS reduction and energy production during recovery. These findings suggest that OsLdh7 overexpression confers tolerance to submergence stress by regulating the important metabolic pathways- anaerobic glycolysis, ethanolic fermentation and amino acid metabolism in rice.

Relationship of maternal childhood maltreatment and children's emotional-behavioral problems: parental reflection functioning and social support's role

Childhood maltreatment has profound and long-lasting effects, not only on the victims but also on their offspring when they become parents later in life. This study aimed to investigate the role of two key mediating factors-parental reflective functioning and perceived social support-in the relationship between maternal childhood maltreatment and children's emotional and behavioral problems. We conducted a cross-sectional study in Iran from March to June 2024. Mothers of preschool children (4-6 years old) with emotional or behavioral problems (N = 222; Mean age = 34.06 ± 4.2 years) completed measures of Childhood maltreatment Questionnaire (CTQ), Parental Reflective Functioning Questionnaire (PRFQ), Perceived Social Support (PSS), and children's emotional and behavioral outcomes, as assessed using the Strengths and Difficulties Questionnaire (SDQ). The SDQ includes subscales for emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Structural equation modeling (SEM) was used to assess the conceptual model. The results revealed that childhood maltreatment had no direct association with children's emotional and behavioral problems. However, childhood maltreatment was positively and indirectly related to children's emotional and behavioral problems (including emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems) and negatively and indirectly related to children's prosocial behavior. These associations were mediated through pre-mentalizing modes of parental reflective functioning. Additionally, the analysis revealed no significant mediating role of perceived social support in this relationship. The findings highlight the significant indirect association between childhood maltreatment and various aspects of children's emotional and behavioral problems through pre-mentalizing modes of parental reflective functioning. This underscores the critical role of enhancing parental reflective abilities to mitigate the adverse outcomes of childhood maltreatment on children's emotional regulation and behavioral adjustment.

Cross-sectional comparison of risk factors associated with mental illness and learning difficulties in kindergarten and elementary, middle, and high school children in the United States: a socio-ecological resilience framework

Aim

Mental illness and learning difficulties in children can be explained using the socio-ecological resilience (SER) model, which states that personal characteristics and an individual’s social relationships coupled with environmental factors of adverse life events influence mental health. We aimed to identify factors associated with anxiety, depression, and learning difficulties in kindergarten and elementary, middle, and high school children.

Subject and methods

This study utilized data collected from the 2019 National Health Interview Survey (NHIS) questionnaire administered across the United States. Children aged 4 to 17 were included. Risk factors were categorized into personal characteristics, lack of peer support, adverse family events, and socioeconomic status (SES). Logistic regression was used to estimate the risk for each risk factor and SER layers for anxiety, depression, and learning difficulties.

Results

In relation to the SER model, factors from personal, relational, and structural layers all influenced the likelihood of anxiety, depression, and learning difficulties in children across all ages. Negative personal characteristics of emotional dysregulation were the most significant risk factor associated with anxiety and depression. For children in kindergarten, relational factors of poor peer relations were more significant in influencing learning difficulties, while behavioural dysregulation measured by hyperactivity had a greater influence on learning difficulties for older children in elementary, middle, and high school. Having experienced adverse family events was significantly associated with worse mental health, while low SES was associated with worse depression and learning difficulties.

Conclusion

Comprehensive interventions that strengthen personal characteristics, peer interactions, and environmental stressors are needed to address mental illness in children.

The relationship between below average cognitive ability at age 5 years and the child's experience of school at age 9

Background

At age 5, while only embarking on their educational journey, substantial differences in children's cognitive ability will already exist. The aim of this study was to examine the causal association between below average cognitive ability at age 5 years and child-reported experience of school and self-concept, and teacher-reported class engagement and emotional-behavioural function at age 9 years.

Methods

This longitudinal cohort study used data from 7,392 children in the Growing Up in Ireland Infant Cohort, who had completed the Picture Similarities and Naming Vocabulary subtests of the British Abilities Scales at age 5. Principal components analysis was used to produce a composite general cognitive ability score for each child. Children with a general cognitive ability score more than 1 standard deviation (SD) below the mean at age 5 were categorised as 'Below Average Cognitive Ability' (BACA), and those scoring above this as 'Typical Cognitive Development' (TCD). The outcomes of interest, measured at age 9, were child-reported experience of school, child's self-concept, teacher-reported class engagement, and teacher-reported emotional behavioural function. Binary and multinomial logistic regression models were used to examine the association between BACA and these outcomes.

Results

Compared to those with TCD, those with BACA had significantly higher odds of never liking school [Adjusted odds ratio (AOR) 1.82, 95% CI 1.37-2.43, p < 0.001], of being picked on (AOR 1.27, 95% CI 1.09-1.48) and of picking on others (AOR 1.53, 95% CI 1.27-1.84). They had significantly higher odds of experiencing low self-concept (AOR 1.20, 95% CI 1.02-1.42) and emotional-behavioural difficulties (AOR 1.34, 95% CI 1.10-1.63, p = 0.003). Compared to those with TCD, children with BACA had significantly higher odds of hardly ever or never being interested, motivated and excited to learn (AOR 2.29, 95% CI 1.70-3.10).

Conclusion

Children with BACA at school-entry had significantly higher odds of reporting a negative school experience and low self-concept at age 9. They had significantly higher odds of having teacher-reported poor class engagement and problematic emotional-behavioural function at age 9. The findings of this study suggest BACA has a causal role in these adverse outcomes. Early childhood policy and intervention design should be cognisant of the important role of cognitive ability in school and childhood outcomes.

Implementation of an Anxiety Management Process in Pediatric Primary Care: An Evidence-Based Practice Quality Improvement Initiative

INTRODUCTION

Pediatric anxiety is rapidly increasing, and in 2022, the US Preventive Services Task Force recommended universal anxiety screening using a validated tool for children 8-18 years.

METHOD

This evidence-based practice quality improvement initiative integrated an educational process, a validated anxiety screening tool, and a Caregiver Satisfaction Survey into all primary care wellness visits for patients aged 8-18 years.

RESULTS

Significant increases in screening and referrals for mental healthcare were observed postinitiative implementation, especially in ages 8-11 years. Anxiety diagnosis and referral for treatment increased from 6.1% to 21.3%, demonstrating the importance of screening and early action at a younger age than previously recommended. However, many telephone follow-ups to caregivers for mental health referrals were unanswered.

DISCUSSION

Integrating mental health services within pediatric primary care settings is recommended to increase timely treatment accessibility. Results from this initiative may be transferable to other primary care practices.

The Impact of Positive Childhood Experiences: A Systematic Review Focused on Children and Adolescents

Childhood and adolescence are crucial stages of life, characterized by significant changes that profoundly influence overall development. While positive childhood experiences (PCEs) can help mitigate the effects of adverse events during these formative years, they have not been as thoroughly researched. Then, this systematic review aims to address this gap by organizing the existing literature on PCEs and examining their impact on both positive and negative outcomes in children and adolescents. A search through databases such as B-On, PsycINFO, PubMed, SCOPUS, and Scielo, as well as supplementary searches, identified 30 studies that met the inclusion criteria. The results indicate that most studies were published in the last 4 years, primarily in the USA, and focused on community populations with mixed samples. In addition, the results reveal that among children and adolescents, higher levels of PCEs were associated with better mental health outcomes (e.g., reduced depressive symptoms, anxiety, self-harm, substance use, and suicidal ideation), improved psychosocial outcomes (e.g., enhanced adult functioning and future orientation), better academic achievement (e.g., reduced absenteeism and fewer academic difficulties), and some improvements in physical health (e.g., reduced chronic pain). However, the relationship between PCEs and behavioral outcomes showed mixed results. Strengthening efforts to promote PCEs and resources that support child and adolescent resilience is crucial. Further research involving diverse samples is needed to gain a deeper understanding of the role of PCEs.

Phytoconstituents of Hericium erinaceus Exert Benefits for ADHD Conditions by Targeting SLC6A4: Extraction, Spectroscopic Characterization, Phytochemical Screening, In Vitro, and Computational Perspectives

Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder. Despite pharmacological interventions, there is a need for effective lead molecules and therapeutic targets. Recently, Hericium erinaceus (HE) has been traditionally reported to treat various diseases. Herein, we aimed to explore the noncytotoxic properties, phytochemical composition, and spectroscopic characterization of HE aqueous extract. Additionally, we used computational workflows to identify key therapeutic targets for ADHD and assess HE extract phytoconstituents for potential targeting. Initially, the HE aqueous extract was obtained using Soxhlet extraction, and its cytotoxicity was assessed on SH-SY5Y cells using MTT assays. FTIR spectroscopy characterized the extract's functional groups, while biochemical methods and GC-MS identified its phytochemical constituents. A protein-protein interaction network identified ADHD targets, and molecular docking, dynamics, and QM/MM calculations were used to find potential drug candidates from the HE extract. As a result, the HE extract exhibited no cytotoxicity in SH-SY5Y cells across concentrations (0.625 to 10 μg/mL) after 24 h. FTIR spectroscopic analysis detected 13 different functional groups that hold diverse biological importance. Qualitative phytochemical screening revealed the presence of carbohydrates, flavonoids, anthocyanins, tannins, alkaloids, saponins, steroids, and phenolic compounds. GC-MS profiling identified 17 diverse metabolites. Simultaneously, ADHD-related genes and known therapeutic protein targets were integrated into a network, identifying SLC6A4 as a hub target. Molecular docking of HE extract compounds showed myo-inositol's high binding efficiency (-6.53 kcal/mol). Dynamic simulations demonstrated stable interactions, and QM/MM analysis confirmed myo-inositol's ability to transfer electrons, reinforcing its interaction potential. Overall, the HE aqueous extract shows a potent nontoxic profile and contains phytoconstituents like myo-inositol, offering promising therapeutic potential by targeting SLC6A4 for ADHD.

Family correlates of behavioral problems among adolescents in Rwanda

BACKGROUND

Globally, 20% of adolescents exhibit behavioral problems. Behavioral problems are associated with individual and environmental factors. However, little is known about the contribution of the nuclear family to the development of behavioral problems in adolescents from sub-Saharan Africa. This study aimed to explore family-based correlates influencing behavioral problems among adolescents in Rwanda.

METHODS

With an institutional-based cross-sectional study design, a convenience sample of 158 participants {107 males and 51 females; Mean age (M) = 16.96, Standard Deviation (SD) = 1.86; age ranging from 13 to 23 years} was selected in secondary schools in the Nyarugenge district. Participants filled out Behavioral Problems Scale (BPS), Child and Adolescent Trauma Screen (CATS), University of California, Los Angeles Loneliness Scale (UCLA Loneliness Scale), Multidimensionality of Perceived Social Support Scale (MSPSS), Multidimensional Neglectful Behavior Scale (MNBS), and Paediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) to record pertinent scores. Socio-demographic information was also collected. SPSS version 24 was used for statistical analysis.

RESULTS

Females exhibited more behavioral problems than males. Child and adolescent trauma (β = 0.705, t = 8.21, p < .001) and neglect (β = 0.147 t = 2.15, p < .05) were two significant family correlates in our sample. Poor quality of life enjoyment and satisfaction, loneliness, and poor parental perceived social support were not identified as family-based factors that influence behavioral problems in our sample.

CONCLUSIONS

Results highlighted the importance of implementing family and community-based interventions to sustain family well-being, change parenting behaviors, and help children and adolescents adopt positive behaviors.

The prevalence of and the effect of global stressors on eating disorders among medical students

Background

Eating disorders (EDs) are among the most serious forms of psychiatric illness, potentially leading to multi-systemic complications. Owing to their high stress levels, medical students are more likely to experience mental health difficulties that predispose them to developing EDs. Societal stigmatization and misinformation, especially in a middle eastern context, contribute to the underreporting and challenges in seeking the appropriate treatment at an early stage, increasing the risk of complications and mortality. EDs remain an under-studied phenomena in the middle east, limiting understanding and treatment options.

Objective

The objectives of the current study were to assess the prevalence of EDs, potential contributing factors, and the impact of the COVID-19 pandemic as an independent global stressor among medical students at the Arabian Gulf University.

Methods

This cross-sectional study consisted of a three-part self-administered questionnaire comprising of demographic data, the Eating Attitudes-26 (EAT-26) test, and COVID-19 associated stressors. The study was conducted on medical students at the AGU in the preparatory year up to Year 6. Data was collected from September 2022 to February 2023.

Results

Three hundred and ninety-seven students were recruited in the present study. 32.1% of the tested students demonstrated an elevated risk for developing EDs. Living situation, earlier years of study, and mental health status were significantly associated with increased risk. Response to global stressors such as COVID-19 pandemic was significantly correlated to worsening EDs status in high-risk individuals.

Conclusion

Eating disorders have been discovered to be highly prevalent among medical students, which brings to light an undervalued health concern. This warrants both awareness programs on campus, and the development of individual-tailored eating disorder treatment programs to halt progression and increase overall quality of life and education.

Health-related quality of life association with sociodemographic characteristics among children under-five with Down syndrome in Western Region Secondary Care Hospitals, Saudi Arabia

Background

The Health-Related Quality of Life (HRQoL) of children with Down syndrome (DS) can be significantly affected by various physical, social, and cognitive elements. There is a scarcity of research on the HRQoL of Saudi children and its correlation with sociodemographic factors. Therefore, our objective was to evaluate the HRQoL of children under the age of 5 years with DS in the Western Region of Saudi Arabia.

Methods

The study included children under 5 years with DS who were receiving care at secondary care hospitals in Taif, Mecca, and Jeddah. The children were accompanied by their parents or caregivers, who provided sociodemographic and child-specific data as well as medical information. They completed a validated TNO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire. The association between HRQoL and respondents' characteristics was assessed using independent samples t-test, ANOVA, Mann-Whitney, and Kruskal-Wallis tests. A multivariate linear regression analysis was conducted to examine the association between the TAPQOL scores and sociodemographic characteristics in children under the age of 5 years children with DS.

Results

A total of 460 responded to the questionnaire. The overall HRQoL score was high. The scores for physical functioning were relatively high, particularly for motor functioning (mean = 86.64) and skin health (mean = 85.68). In addition, social functioning exhibited a lower level, with a significant difference (mean = 25.29). The cognitive functioning scores exhibited variability, with communication scoring relatively high (mean = 76.68), while positive mood (mean = 19.51) and liveliness (mean = 21.25) were significantly low. There was a significant correlation between the educational level and occupation of both fathers and mothers and their HRQoL. Specifically, individuals with higher education and stable employment had better HRQoL scores. Parents' health also has an impact on HRQoL, with children of parents without comorbidities scoring higher. Furthermore, there was a significant association between higher sociodemographic levels of parents and improved HRQoL of the patients.

Conclusions

The level of HRQoL among children with DS was high, particularly in the physical and cognitive domains. The sociodemographic factors of parents, specifically the level of education and occupation of fathers, have been identified as essential factors influencing HRQoL. Providing increased economic and educational support for families has a significant positive impact on the quality of life for these children.

Is maternal diabetes during pregnancy associated with neurodevelopmental, cognitive and behavioural outcomes in children? Insights from individual participant data meta-analysis in ten birth cohorts

BACKGROUND

Growing evidence shows that dysregulated metabolic intrauterine environments can affect offspring's neurodevelopment and behaviour. However, the results of individual cohort studies have been inconsistent. We aimed to investigate the association between maternal diabetes before pregnancy and gestational diabetes mellitus (GDM) with neurodevelopmental, cognitive and behavioural outcomes in children.

METHODS

Harmonised data from > 200 000 mother-child pairs across ten birth cohorts in Europe and Australia were available. Mother-child pairs were included for analysis to determine whether GDM was recorded (yes or no) and whether at least one neurodevelopmental, cognitive and behavioural outcome was available in children aged 3 to 13 years. Confounder-adjusted regression models were used to estimate associations between maternal diabetes and child outcomes using two-stage individual participant data (IPD) meta-analysis. Model 1 included a crude estimate. The full adjustment model (model 2) included adjustment for child sex, maternal age, pre-pregnancy BMI, pregnancy weight gain, maternal smoking during pregnancy, plurality, parity and maternal education.

RESULTS

Children (aged 7-10 years) born to mothers with GDM had higher attention-deficient hyperactive disorder (ADHD) symptoms compared to non-exposed controls (model 2, regression coefficient (β) 3.67 (95% CI 1.13, 6.20), P = 0.001). Moreover, children (aged 4-6 years) born to mothers with GDM exhibited more externalising problems than those born to mothers without GDM (model 2, β 2.77 (95% CI 0.52, 5.02), P = 0.01). A pre-existing maternal history of type 1 and type 2 diabetes mellitus was associated with ADHD symptoms at 4-6 years (model 1, β 8.82 (95% CI 2.21, 15.45, P = 0.009) and β 7.90 (95% CI 0.82, 14.98, P = 0.02), respectively). The association was no longer apparent in further adjustments.

CONCLUSIONS

This study found that children between 4 - 6 and 7-10 years of age born to mothers with GDM have a greater likelihood of developing externalising problems and ADHD symptoms, respectively. Externalising problems often co-exist with ADHD symptoms and precede formal ADHD diagnosis. Overall, this large-scale multi-cohort study suggested that a dysregulated metabolic environment during pregnancy may contribute to ADHD symptoms and externalising problems in young children.

Executive function is associated with behaviour problems in children and adolescents with cerebral palsy and intellectual disability

BACKGROUND

Children and adolescents with cerebral palsy (CP) commonly have behaviour problems. The present study aimed to determine which of the most common clinical features experienced by children and adolescents with CP and intellectual disability are associated with behaviour problems.

METHOD

We investigated 11 possible associated variables including epilepsy, visual and hearing impairments, motor difficulties, communication and speech difficulties, pain, sleep disturbance, executive function (EF) deficits, type of CP, and parent stress. Thirty-eight parents or guardians of children aged 6 to 17 years with CP and intellectual disability (parent informed) completed proxy and self-report standardised questionnaires.

RESULTS

EF deficits and parent stress were significantly associated with behavioural problems.

CONCLUSION

For children and adolescents with CP and intellectual disability, the present study suggests close attention should be placed on specific clinical features including EF deficits and parent stress when considering variables associated with behaviour problems.

Gender differences in behavioral and emotional problems among school children and adolescents in China: National survey findings from a comparative network perspective

BACKGROUND

Behavioral and emotional problems are common and often co-occur during childhood and adolescence. The aim of this study was to assess gender differences in the network structures of behavioral and emotional problems of children and adolescents in China based on a national survey.

METHODS

The Parent version of Achenbach' s Child Behavior Checklist (CBCL) was used to assess behavioral and emotional problems. To account for potential confounding factors in comparisons between boys and girls, propensity score matching was utilized. Network model differences were assessed using Network Comparison Test (NCT).

RESULTS

Data from 60,715 children and adolescents were included for analyses. Boys exhibited more severe total behavioral and emotional problems compared to girls. While several edges showed significant differences between boys and girls, the strongest association was consistently found between "Attention problems" (CBCL6) and "Aggressive behavior"(CBCL8) in both boys and girls, regardless of age. Network centrality was higher among adolescents compared to children. The most central problems commonly found across different genders and age groups were "Aggressive behavior" (CBCL8) (centrality values were 1.142 for boys aged 6-11 years, 1.051 for boys aged 12-16 years, 1.148 for girls aged 6-11 years, and 1.028 for girls aged 12-16 years), "Anxious/depressed" (CBCL1) (centrality values of 0.892 for boys aged between 6 and 11 years, 1.031 for boys aged 12-16 years, 0.951 for girls aged 6-11 years, and 1.099 for girls aged 12-16 years) and "Social problems" (CBCL4) (centrality values of 1.080 for boys aged 6-11 years, 0.978 for boys aged 12-16 years, 1.086 for girls aged between 6 and 11 years, and 0.929 for girls aged 12-16 years).

CONCLUSION

Testing effective interventions that address aggressive behavior, anxiety/depression, and social problems may be beneficial for reducing risk of psychopathology among children and adolescents.

Emotional and Behavioural Problems of HIV-infected Children: Findings from a Southeastern Nigeria Tertiary Healthcare Facility

Background

In children, HIV infection presents with grave consequences, including a predisposition to emotional and behavioural problems (EBP). These are mental health problems affecting thoughts, emotions, behaviours and relationships, and may be categorised into emotional problems (EP) and behavioural problems (BP). Studies have shown a high burden of EBP in children; however, knowledge gaps still exist regarding the burden of EBP on HIV-infected children. Our study seeks to address these gaps by determining the prevalence and type of EBP among HIV-infected children.

Methodology

This cross-sectional and comparative study enrolled 386 participants (193 subjects and 193 controls). The subjects were HIV-infected children aged 2-15 years attending the Paediatric HIV Clinic of Federal Medical Centre, Umuahia. The controls were age and sex-matched HIV-negative children attending primary or secondary schools in Umuahia. Sociodemographic characteristics were assessed, and EBP was determined using the strengths and difficulties questionnaire.

Results

Sixty-one subjects (31.6%) had EBP compared to 15 controls (7.8%) and this difference was significant (p<0.001). The subjects were three times more likely to have EBP than the controls (aOR=3.03; CI=1.17-7.82). The EBP type showed that, while there was no significant difference in the multivariate analysis of the behavioural problems, emotional problems were significantly higher in the subjects than in the controls (p = 0.001). The subjects were six times more likely to have emotional problems than the controls (aOR=6.26; CI=2.80-13.97).

Conclusion

There is a high burden of EBP among HIV-infected children in Umuahia with emotional problems as the common type.

The Association Between In Utero Exposure to Painkillers and Trajectories of Hyperactivity and Emotional Problems in Children with Autism Compared with Neurotypical Peers

Background/Objectives: In utero exposure to painkillers has raised concerns regarding its potential impact on neurodevelopmental disorders, such as autism spectrum disorder (ASD). This study investigates the association between in utero exposure to painkillers and trajectories of hyperactivity and emotional problems in children with and without ASD, separately. Methods: Data were drawn from 5107 participants enrolled in the Longitudinal Study of Australian Children. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire at ages 4, 6, and 8 years. ASD diagnosis was determined based on parental self-report by age 12. To examine the association between the exposure and the outcomes, mixed linear models were applied to assess the impact of in utero exposure to painkillers on hyperactivity and emotional problems, controlling for sex, time, and other perinatal risk factors. The interaction term between exposure and time was included to evaluate the effect of exposure on the trajectory over time. Results: In utero exposure to painkillers did not significantly affect hyperactivity or emotional problem trajectories in children with ASD. However, in non-ASD children, painkiller exposure was associated with worsening emotional problems by age 8, with males being affected to a greater extent than females. Further, emotional problem scores increased over time by gender, reflecting developmental challenges in early childhood. Conclusions: These findings indicate that prenatal painkiller exposure is unlikely to be a major determinant of the severity of neurodevelopmental outcomes in autistic children, but its role in neurodevelopmental outcomes among neurotypical children warrants further investigation. Future research should prioritize precise exposure assessments and integrate multi-environment interactions to further elucidate the long-term impacts of prenatal painkiller use.

Care providers' view of the barriers in providing care for adolescents with emotional and behavioral problems

Objectives

Emotional and behavioral problems (EBP) during adolescence are a major public health issue due to its high prevalence and long-lasting consequences. The knowledge of the barriers in providing psychosocial care can be a starting point for subsequent efficiency improvement. Therefore, the aim of this study is to assess which barriers do care providers experience while providing psychosocial care for adolescents with EBP.

Methods

We performed a qualitative assessment that was embedded in the Slovak Care4Youth study mapping the system of care provided for adolescents with EBP. We conducted 25 semi-structured individual and group interviews with a total of 49 care providers from 17 institutions that provided preventive counselling, social, and mental healthcare for adolescents with EBP. We focused on the care provider's perception of barriers in providing care for these adolescents. The interviews were audiotaped and transcribed verbatim. We coded the data using the consensual qualitative research approach in combination with conventional content analysis.

Results

We found that care providers experienced several barriers in providing care for adolescents with EBP which relate to six themes-legislative framework and legislative changes; financing of the care system; coordination of care; workforce development, education, methodical guidance and supervision; personnel and institutional capacities; and administrative burden.

Conclusion

Addressing these barriers within the care system from the "front line" perspective provides clues to efficiently improve the psychosocial care for adolescents with EBP. According to the care providers, the organization and financing of the care system requires adaptation; the burden of the care providers should be reduced; and care providers require quality practical education, training, and methodological guidance.

Behavioral problems in children with unoperated rheumatic heart disease at national referral hospital in Ethiopia: an observational study

BACKGROUND

The behavioral disorder is characterized by a profound abnormality in an individual's cognition, emotion or behavior that reflects in psychological, biological or developmental dysfunction. Rheumatic heart disease (RHD) is a long-term sequel of single or recurrent acute rheumatic fever. Children with RHD are thought to be at increased risk for behavioral problems due to autoimmunity seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Behavior disorder is not well studied among children with RHD. Hence, this study aimed to assess the pattern and predictors of behavioral problems among children with RHD enrolled in chronic care at a national cardiac referral Hospital.

METHODS

This cross-sectional study used a validated parental-reported Amharic Strengths and Difficulties Questionnaire (SDQ) to assess behavior problems. Children with RHD aged 6-17 years on chronic outpatient cardiac care at Tikur Anbessa Specialized Hospital, Ethiopia between February and May 2023 were included. Factors associated with behavior problems were assessed using logistic regression models.

RESULTS

The study included 166 children with a median age of 15 years [Interquartile range (IQR):13-17 years]. One-fourth of children, 24.7% (95% CI: 18.34-31.98), had behavioral problems. Of these, 46.4% (77) emotional, 35.5% (59) peer, 18.1% (30) conduct and 6.6% (11) hyperactivity problems were documented. Children who had good medication adherence, adjusted odds ratio AOR 0.29(95% CI: 0.09-0.94, P 0.040) and on New York Health Association (NYHA) class I, AOR 0.28(95% CI: 0.11-0.79, P 0.016) had lower odds for behavioral problems.

CONCLUSION

One-fourth of children with RHD had behavioral abnormalities. Medication adherence and NYHA predicted behavioral abnormality. Better physical symptom control was associated with fewer behavioral problems. Behavioral abnormalities should be considered and assessed among children with RHD. Further multi-center mixed studies are recommended to uncover the unseen behavioral problem and guide health policy action on modalities of integration of behavioral problems assessment tools in clinical care.

Childhood trauma distribution and behavioural problems among Pakistani adolescents

BACKGROUND

Childhood trauma adversely impacts adolescents, and consequently, they develop behavioural problems. Understanding the distribution of childhood traumas and their association with behavioural problems among adolescents is paramount for the preventive efforts.

AIM/OBJECTIVE

The present research aimed to investigate this association among adolescents.

METHODS

This association was investigated among adolescents (N = 200) between 12 and 18 years. Childhood Trauma Questionnaire and Strength and Difficulty Questionnaire was used to assess the distribution of trauma and internalizing and externalizing behavioural problems among adolescents through purposive and convenience sampling technique.

RESULTS

The findings across trauma distribution indicated higher distribution of childhood abuse and neglect across males as compared to females. Males further significantly scored higher on sexual abuse and emotional neglect. Apparently, a large number of adolescents experienced all five sub types of childhood traumas (sexual abuse, emotional abuse, physical abuse, emotional and physical neglect). Additionally, across the severity continuum of childhood traumas, male scored higher on the severe to extreme continuum for all subtypes except physical abuse, where females scored higher. Lastly, logistic regression analysis indicated higher peer problems among those adolescents who have experienced all types of childhood traumas.

CONCLUSION

These findings could be beneficial for intervention-based programs and policies to help trauma-exposed adolescents cope with their lives.

Prevalence and risk factors associated with psychological distress among children in Penang, Malaysia: A stratified multistage cluster study

Mental health is a state of mind influences one thinking, feeling and acting from inside and outside that are vital for children's normal growth and development. Psychological distress may results in serious mental health problem if left untreated. Hence, early diagnosis can largely improve the condition from being deteriorating. This study determined the prevalence of psychological distress and its associated risk factors among children in Penang, Malaysia. The study applied stratified multistage cluster sampling for the recruitment of children, and their socio-demographics background, health and lifestyle practices, and the prevalence and risk factors of psychological distress were succinctly studied. The study provides a fundamental platform for informing parents and policy makers about psychological distress, and the need to strategize potential health intervention for achieving optimum human well-being.•Stratified multistage cluster sampling was useful to study the prevalence and risk factors of psychological distress in a children population.•DASS-Y is robust for brief dimensional measure of depression, anxiety and stress among children.

Karate Kata training: A promising intervention for behavioral problems in elementary school children

Behavioral issues frequently arise in primary school children, affecting their academic performance, social interactions, and general welfare. These concerns encompass challenges related to attention, concentration, aggression, oppositional behavior, and social maladaptation. The purpose of the current study was to examine the impacts of karate Kata training on extrinsic behavioral problems of elementary school students. The Achenbach Child Behavior Checklist (CBCL) questionnaire was given to all fourth- to sixth-grade students from a male elementary school, totaling 241 students, in Mashhad, Iran. A total of 76 eligible school-aged children with a total score of 65 and above in attention, aggression, oppositional defiance, and social maladaptation issues were selected and randomly assigned to an exercise group (n = 38) or a no-exercise control group (n = 38). Participants in the exercise group were instructed to engage in Kata training, which consists of a series of choreographed movements designed to enhance physical and mental discipline, for a duration of 12 60-min sessions, whereas the participants in the control group followed their daily activities. The CBCL from the Achenbach System of Empirically Based Assessment was used to assess dependent variables such as attention and concentration, aggression, oppositional defiance, and social maladaptation at baseline and post-intervention. The repeated-measures analysis of variance indicated that Kata training results in significant improvements in attention and concentration and significant reductions in aggression, oppositional defiance, and social maladaptation among elementary school students (all ps < .001). These results highlight the potential benefits of incorporating Kata training into interventions aimed at improving the behavioral outcomes of children.

A feasibility study on the virtual adaptation of Child Adult Relationship Enhancement in Primary Care

Childhood behavioral problems are common; despite evidence that parenting interventions improve outcomes, the use of these programs is limited. Virtual delivery may ameliorate attendance barriers, but little is known on the acceptability and feasibility of virtual group parenting interventions. This mixed-methods study explored the feasibility, acceptability, and appropriateness of the virtual delivery of a parenting intervention, Child Adult Relationship Enhancement in Primary Care (PriCARE) among 18 caregivers and 8 facilitators. Subjects completed survey instruments assessing acceptability, appropriateness, feasibility, and telehealth usability and participated in semi-structured interviews exploring these constructs. Directed content analysis of interview transcripts identified themes. Most participants were female with a mean age of 35 years among caregivers and 37 years among facilitators. Slightly less than half of caregivers were Black (44%), with the remaining White. The majority of facilitators were White (88%). Over half (56%) of families received government assistance. Surveys indicated high acceptability, appropriateness, feasibility, and telehealth usability. We identified five overarching themes from qualitative analysis: nuances of feasibility, high acceptability, balancing skills and group dynamics, flexibility within fidelity, and multiple perspectives of disparities. Within these themes, reduced logistical barriers and the normalization of virtual meetings were contrasted with virtual burnout and distractions in the home. The majority of participants expressed that they learned helpful parenting skills, even in the setting of the suboptimal group dynamic of the virtual format. While disparities in technology and support systems were identified, the participation of caregivers who would not have attended in person was highlighted.

The Role of Emotionality Stigma in Adolescent Mental Health: Measure Development and Call for Systems-Level Change

Youth mental health concerns, including substance abuse, continue to rise. With high co-morbidity rates and a marked lack of representation from diverse groups in study conceptualization, measurement, and implementation, efforts to understand factors impacting youth mental health from a cultural lens are needed. The theory of emotionality stigma posits that many mental health concerns can be understood based on one's endorsement of emotionality stigma-the experience of stigma around emotions-which manifests within one's context. Informed by this theory, the current study aimed to adapt and test a measure of emotionality stigma for diverse youth in combined mental health and substance use treatment. Targeted youth focus groups informed the adaptation of the pre-existing Emotionality Stigma Scale for implementation with diverse youth. Using a mixed methods approach, this measure was then tested for relevance, reliability, and validity in an outpatient youth clinic. Patients (N = 58, aged 13 to 21) reported their emotionality stigma, values, and attachment as part of routine monitoring. Based on qualitative feedback and quantitative analysis, our results illustrate the reliability and validity of the adapted Emotionality Stigma Scale and the relevance of this new measure for assessing youth mental health concerns and treatment outcomes. Areas for continued research are identified, and recommendations for implementation in conceptualization and treatment are provided.

The path of depression in rural children: A fuzzy-set qualitative comparative analysis across multiple provinces in China

OBJECTIVES

This study explores the combinations of conditional variables contributing to depressive symptoms in rural children.

METHODS

We analyzed data from 715 children from a rural mental health database, conducting detailed follow-up investigations on 129 children in Zhejiang and Henan provinces. We used fuzzy set Qualitative Comparative Analysis (fsQCA) and regression analysis to identify causal pathways leading to depression.

RESULTS

The results indicate that depression in rural children does not stem from a single, necessary condition but arises from multiple factors. Our findings highlight significant contributions from both maternal and paternal involvement. Specifically, maternal involvement, combined synergistically with peer support and problematic behaviors, as well as paternal involvement, together with peer support and anxiety, significantly affects depressive outcomes. Additionally, anxiety and strong peer relationships independently have a substantial impact on these outcomes. Effective mitigation strategies involve active parental engagement and robust peer support, reducing the influence of risk factors such as problematic behaviors and anxiety.

LIMITATIONS

The generalizability of the results is limited by cultural and geographical variations. The study also does not account for all potential factors influencing depression in rural children.

CONCLUSION

Depression in rural children results from multiple interacting factors. Tailored interventions addressing these specific combinations are recommended.

Mitochondrial related Mendelian randomization identifies causal associations between metabolic disorders and childhood neurodevelopmental disorders

Childhood neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder, and Tourette syndrome, are a predominant cause of health-related disabilities in children and adolescents. Nevertheless, disease biomarkers are still limited. The aim of this study was to evaluate the potential, causal relationship between mitochondrial DNA copy number (mtDNA-CN), metabolic disorders, and childhood NDDs using the two-sample Mendelian randomization (MR) method. Genetic associations with mtDNA-CN, disorders of lipoprotein metabolism, and disorders of iron metabolism were selected as exposures, and genome-wide association data from ASD, attention-deficit hyperactivity disorder, and Tourette syndrome were utilized as outcomes. Results of the study suggested that a high degree of disordered lipoprotein metabolism related increases in ASD risk result from a decrease in mtDNA-CN (disordered lipoprotein metabolism-mtDNA: inverse variance weighting β: -0.03, 95% confidence interval: -0.05 to -0.02, P = 2.08 × 10-5; mtDNA-CN-ASD: inverse variance weighting odds ratio: 0.83, 95% confidence interval: 0.69-0.99, P = .034). The research findings implied that mtDNA-CN can mediate disorders of lipoprotein metabolism, potentially influencing the development of ASD. The potential impact of the results of this study for the prevention and treatment of childhood NDDs warrants validation in robust randomized clinical trials.

Trends in Childhood Behavioral, Mental, and Developmental Problems (2019-2022) Using the National Survey of Children's Health

BACKGROUND

This study examines nationwide prevalence of US childhood behavioral, mental, and developmental problems in the 6-11 age group category between 2019 and 2022, and several key metrics related to caregiver social determinants of health.

METHODS

We used NSCH data for 6-11-year-old children for the years 2019-2022. Summary statistics for the selected sample were generated and binary logistic regressions were conducted for each severity level binary variable for each study year with caregiver mental or emotional health as a covariate.

RESULTS

Our study found significant associations between severe childhood anxiety and "fair" or "poor" caregiver rankings of mental and emotional health for both the 2020 and 2022 survey years. Our study also found that caregiver mental and emotional health may play a role in childhood ADD and ADHD prevalence rates as caregivers who ranked their mental health as "fair" or "good" had significantly higher odds of having a child with severe ADD or ADHD than caregivers who reported "excellent" mental and emotional health.

CONCLUSION

These findings support prospects of an increase in the need for developmental health services, thus necessitating efforts towards effective allocation and focus of developmental treatment programs tailored to children and pediatric population groups.

EEG activation in preschool children: Characteristics and predictive value for current and future mental health status

BACKGROUND

Previous research has characterised EEG changes associated with resting activation in primary school children and adults, while task-related activation has only been considered in adults. The current study characterises physiological activation in preschool children and examines the potential value of activation indices for predicting mental health status at two time points.

AIMS

To investigate how resting activation and task-related activation are represented in 4- to 5-year-old preschool children and examine if these activation indices can predict current and future mental health status.

METHODS AND PROCEDURES

Frontal EEG was recorded from 81 preschool children during eyes-closed resting, eyes-open resting, and an inhibitory control task to allow calculation of activation indices. The Child Behaviour Checklist was completed by the child's parent at this time, and again 6-8 months later after the child's transition to kindergarten.

OUTCOMES AND RESULTS

Resting activation was represented by reductions in frontal delta, theta, and alpha power in the eyes-open compared to eyes-closed condition, and an increase in frontal beta power. Task-related activation was represented by increases in frontal delta, theta, and alpha power and a decrease in beta power. Frontal delta and theta task-related activation significantly predicted externalising behaviours in both preschool and kindergarten, with stronger prediction in kindergarten.

CONCLUSIONS AND IMPLICATIONS

This study characterised resting and task-related activation in preschool children, and reported similar effects to those found in older children and adults for resting activation, with novel effects for task-related activation. As task-related activation indices were predictive of externalising behaviours in both preschool and kindergarten, these results have implications for early identification of children who experience externalising behavioural problems across the transition to school period. WHAT DOES THIS STUDY ADD?: This study provides new data on how the fundamental physiological processes of resting and task-related activation, both of which are theorised to contribute to "upstream" processes such as executive functions and broader behaviour, are represented in the frontal EEG of preschool aged children. We also learn that the top-down task-related activation indices for delta and theta activity were predictive of current mental health status and future status after the transition to kindergarten, while the bottom-up resting activation indices were not.

Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial

BACKGROUND

A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors.

OBJECTIVE

This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up.

METHODS

This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms.

RESULTS

Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=-0.41, 95% CI -0.82 to 0.0004; P=.05) or significant (T3: B=-0.76, 95% CI -1.22 to -0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems.

CONCLUSIONS

This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.

Prevalence and repercussions of stress and mental health issues on primary and middle school students: a bibliometric analysis

Objective

This study analyzes the presence and reverberations of stress, anxiety, and other mental health issues on primary and middle school students using bibliometric analysis. The aim of this study is to map the research landscape by statistically analyzing existing literature and identifying key themes, trends, and research hotspots in the domain of stress in students. This study also presents analysis related to top contributing countries, journals, authors, citations, and collaboration networks.

Method

A total of 1,335 publications from 1962 to 10 September 2023 were included in this study using the Web of Science, PubMed, and Scopus databases. The steps involved in the bibliometric study included data collection, cleaning, and various analyses such as performance analysis, citation analysis, and network analysis. Biblioshiny by RStudio and Microsoft Excel were used for bibliometric analysis to determine the collaboration between countries and authors and to explore keyword analysis and thematic evolution.

Results

The findings show that China and USA have contributed the highest number of publications. Frontiers in Psychology with 50 publications turns out to be the most prominent journal. The study presents the thematic evolution and the trend topics in this research domain. Some of the trend topics are stress, test anxiety, bullying, depression, cyberbullying, virtual reality, mathematics anxiety, childhood maltreatment and self-compassion, primary school, and middle school. The paper also highlights the prominent authors and their collaboration network.

Discussion

The study has highlighted the various reasons for stress and its potential repercussions on students. This information can be used to help parents, teachers, and the school administration to spot the most susceptible group of students who need immediate intervention to address various mental health issues. We see a gradual progress in the research areas being covered under this domain. More relevant areas of concern related to stress are being explored with time. With the technological advancement and the vast unmonitored internet usage (especially for primary and middle school students), the stress caused by cyberbullying and peer victimization has also become an important topic of research in later years.

Assessment of the Quality of Life and Family Function in Attention Deficit Hyperactivity Disorder Caregivers in Al-Ahsa, Saudi Arabia

Background Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurobehavioral disorder in children and teenagers. The condition is debilitating, affecting numerous cognitive and behavioral processes and leading to substantial long-term consequences. Affected individuals, their families, and society as a whole bear a heavy functional, psychological, and financial cost. Aim The objective of this study was to evaluate the quality of life (QOL) among parents of children with ADHD diagnoses, as well as the burden and level of dysfunction in the family. Additionally, to ascertain the sociodemographic factors that influence these issues. Methods This cross-sectional study used an online survey to collect data from caregivers of children with a confirmed diagnosis of any type of ADHD who were exhibiting symptoms before the age of seven, speaking Arabic fluently and consented to take part in the study. The Arabic version questionnaire of the World Health Organization Quality of Life instrument (WHOQOL-BREF) was used to assess the QOL, and the Zarit Burden Interview questionnaire was employed to assess the degree of the experienced burden. Participants were recruited by a systematic random sampling method. Results A total of 103 ADHD caregivers were included in the study. A total of 89 out of 103 (86.4%) participants reported having various degrees of burden. There was a significant relation between the marital status of the caregiver and the degree of burden (p=0.024). Divorced caregivers were (4, 57.1%) severely burdened. Ninety out of 103 participants (87.4%) reported having dysfunctional families, and the majority of them (60, 60.1%) reported moderate family dysfunction. All quality-of-life domains were negatively impacted, with the environmental domain experiencing the most disruption. The overall four subdomains of QOL did not differ significantly with various sociodemographic characteristics. Conclusion There was a high prevalence of burden and family dysfunction among caregivers of ADHD children. Marital status was associated with a significant impact on the level of burden. In addition, there was a detrimental influence on every aspect of quality of life, with the environmental domain suffering the most. It is important to take into account family therapy and other interventions that strengthen caregivers' and families' relationships.

Self-management, self-care, and self-help in adolescents with emotional problems: a scoping review

This study aimed to review the existing published and grey literature describing the concepts of self-management, self-care, and self-help, and to capture strategies or techniques related to these concepts, for adolescents with emotional problems. Emotional problems are rising amongst adolescents, yet timely access to specialist mental health treatment is limited to those with greater severity of mental health difficulties. Self-management, self-care, and self-help strategies may be used by adolescents with emotional problems both in terms of those waiting for treatment and to prevent relapse. Given the overlap in existing definitions and the lack of clarity around these concepts in an adolescent mental health context, a scoping review of the literature is warranted to provide clarity. Eligible studies were those involving adolescents aged 10 to 19 years with symptoms of emotional problems. Studies referenced self-management, self-care, or self-help, not involving a professional, in this population. Quantitative, qualitative, economic, and mixed methods studies, as well as systematic, scoping, and literature reviews, from 2000 onwards and in the English language, were eligible for inclusion. A systematic search was conducted of both published and grey literature. Databases searched included PsycINFO, Medline, Embase, Web of Science, and CINAHL Plus. Mednar was also searched for unpublished studies and grey literature. Tables  of themes, terms, and associated strategies are presented alongside a thematic analysis of the results. 62 articles were included. These were 20 quantitative studies, 14 systematic reviews, 10 qualitative studies, five review papers, four book chapters, four mixed methods studies, two dissertations, two meta-analyses and one scoping review and systematic review. Most of the included articles referenced self-help (n = 51), followed by self-management (n = 17) and self-care (n = 6). A total of 12 themes were identified from a reflexive thematic analysis of descriptions (and associated strategies) of self-management, self-help, or self-care in included texts. This scoping review provides clarity on the similarities and differences between how these concepts are discussed, and the strategies which are associated with each of these concepts in the relevant literature. Implications for policy and intervention development for adolescents' self-management, self-help, and self-care of their mental health are discussed. There is considerable overlap in both the ways in which these concepts are described, and the strategies or approaches proposed in relation to them, supporting previous research suggesting these strategies should be grouped under a single term, such as "self or community approaches." More research is needed for self-management, self-help, and self-care amongst marginalized groups as these adolescents may have the highest unmet need for mental health support.

Patterns of maternal adverse childhood experiences and the intergenerational association of preschool children's emotional and behavioral problems

Introduction

Children of whose mothers exposed to adverse childhood experiences (ACEs) are at increased risk for developmental problems. This study aims to investigate the relationship between types and patterns of maternal ACEs and preschool children's emotional and behavioral problems (EBPs) in China, and to explore gender differences associated with these problems.

Methods

In this cross-sectional study, we selected 9,647 children from 36 preschools in three cities of Anhui province, China. Questionnaires were used to report the details of maternal ACEs and children's EBPs. We used the latent class analysis (LCA) to identify "patterns" in the types of maternal ACEs. Binomial logistic regressions was performed to examine the relationship between types and patterns of maternal ACEs and preschoolers' EBPs.

Results

Latent class analysis (LCA) revealed four different classes of maternal ACEs. Logistic regression analysis showed that compared with the low ACEs class, children of mothers in the high abuse and neglect class had the highest risk of developing EBPs (OR = 5.93, 95%CI: 4.70-7.49), followed by moderate ACEs class (OR = 2.44, 95%CI: 1.98-3.00), and high household dysfunction class (OR = 2.16, 95%CI: 1.19-3.90). We found gender differences in the effects of high abuse and neglect/moderate ACEs class and maternal childhood physical abuse/neglect on children's EBPs, which had a stronger impact on EBPs in boys than girls (P<0.05).

Discussion

This study supports and refines existing research that confirms an intergenerational association between types and patterns of maternal ACEs and children's EBPs in a large Chinese sample, so as to provide references for the early prevention and control of children's EBPs.

Global research in schizophrenia and serotonin: a bibliometric analysis

Background

Schizophrenia is a chronic mental illness that affects millions of individuals worldwide. The etiological origin of schizophrenia is heterogeneous, but it has been shown to be associated with dysfunction in serotonin activity, serotonin receptors, and serotonin metabolism in the brain. Bibliometric analysis is a tool used to scrutinise and analyse research activities and evidence in a specific research area. No existing bibliometric analyses have considered both serotonin and schizophrenia.

Methods

We conducted a bibliometric analysis including 12,027 studies related to the schizophrenia-serotonin link published from the inception of the study to 2023 and available in the Scopus database. We used VOSviewer software to identify global trends, analyse the author and editors keywords, the most cited articles and author, as well as the most productive institutes and journals publishing research on schizophrenia-serotonin link.

Results

Most publications related to the link between schizophrenia and serotonin are focused on adult humans and examine topics such as antipsychotic agents, depression, and serotonin uptake inhibitors. The Journal of Clinical Psychiatry has published the most papers on the schizophrenia-serotonin relationship. Among nations, the United States is the leader in publications. King's College London is the institution with the highest number of publications, and H. Y. Meltzer is the most influential author. Growing trends in schizophrenia-serotonin research are personalised medicine, alternative medicine, transcranial magnetic stimulation, artificial intelligence, nervous system inflammation, brain-gut axis, and the gut microbiome.

Conclusion

Since 1950, there have been several fluctuations in the number of published studies related to schizophrenia and serotonin. We believe that the development of novel medications and treatments for schizophrenia will be increased in the future, as well as research into genetic risks, psychological factors, and cranial neuroimaging components. Future schizophrenia and serotonin research is likely to focus on personalised medicine, alternative therapies, novel pathogenesis of schizophrenia, and the use of emerging technologies such as artificial intelligence.

Psychosocial and emotional well-being of Syrian refugee children and adolescents in Jordan: In-camp versus out-of-camp comparative analysis

There is a notable gap in understanding how different living arrangements influence the psychosocial and emotional well-being of Syrian refugee children and adolescents. Moreover, limited literature exists on the comparison between in-camp and out-of-camp living situations. The aim of this study was to compare the psychosocial and emotional status between camp and non-camp Syrian refugee children and adolescents living in Jordan. A nationwide school survey was conducted in Jordan from December 2022 to April 2023 and targeted children (8-11 years) and adolescents (12-18 years), encompassing Jordanians, Syrians, and Palestinians, both in camps (camp refugees) and urban areas (urban refugees). In this paper, the analysis was limited to Syrian refugees. A total of 1,420 children and 1,249 adolescents were included. Children in camps had higher rates of hyperactivity (12.7% vs 8.3%) and total difficulties (19.3% vs 13.9%) compared to urban dwellers. However, they had lower rates of bedtime problems (12.8% vs 17.0%) and problematic internet use (19.9% vs 34.8%). Camp adolescents had higher rates of separation anxiety disorder (44.0% vs 37.8%) and conduct problems (22.2% vs 15.0%), but lower rates of poor physical functioning (43.3% vs 52.3%) compared to urban adolescents. Adjusted analysis showed lower odds of generalized anxiety disorder (OR=0.59), problematic internet use (OR=0.39), and bedtime problems (OR=0.67) for camp children. However, they had higher odds of emotional symptoms (OR=1.47), hyperactivity (OR=2.08), and overall difficulties (OR=1.50). Camp adolescents had higher odds of overall difficulties (OR=1.49) but lower odds of poor physical functioning (OR=0.67) compared to urban adolescents. In conclusion, children in refugee camps had lower rates of problematic internet use and bedtime issues but higher rates of hyperactivity and overall difficulties than urban children. Similarly, camp adolescents faced more total difficulties but reported better physical functioning than their urban peers. The complex interplay between living conditions and well-being underscores the need for tailored mental health interventions for displaced populations.

Examining Patient- and Community-Level Factors Associated with Pediatric Mental Healthcare Access Within a Patient Navigation Program

In 2021, national leaders in the United States declared a "national youth mental health crisis." Still, only 1-in-4 children receive adequate mental healthcare access. Patient Navigator Programs (PNPs) can improve children's referral-to-connection to mental health services. We examined patient- and community-level factors associated with pediatric mental healthcare access. Pediatric Support Services (PSS) is a PNP that triages mental and behavioral health referrals within a large health system in a southeastern state. This study analyzes PSS data from September 2017-March 2023 and Child Opportunity Index 2.0 state-normed zip-code level data to assess social drivers of health estimates. Structural equation modeling was conducted between patient- and community-level factors and connection to mental health services. Overall, 62.7% of children connected to mental health services since PSS' inception. Regardless of SDOH, as children get older, they are more likely to connect with mental health services (β = .053, SE = .010, p < .001). Children with greater number of referral needs are more likely to connect with mental health services (β = .034, SE = .011, p = .002). Further, children who live in communities with higher opportunity levels are more likely to connect with mental health services (β = .016, SE = .008, p = .040), suggesting that children who live in low-income communities experience more barriers to mental healthcare. Social drivers may inform referral practices and tiered navigation support for optimal mental healthcare access among children. Further research should demonstrate the effectiveness of PNPs integrated within healthcare and community-based settings.

Cool and hot executive function problems in young children: linking self-regulation processes to emerging clinical symptoms

Self-regulation (SR) difficulties are implicated in a wide range of disorders which develop in childhood, including attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), anxiety and depression. However, the integration of the existing research evidence is challenging because of varying terminology and the wide range of tasks used, as well as the heterogeneity and comorbidity within and across diagnostic categories. The current study used the Research Domain Criteria (RDoC) framework to guide the examination of different SR processes in young children showing a wide range of symptomatology. Children (aged 4-8) referred by teachers for moderate-to-high conduct, hyperactivity and/or emotional problems at school (assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales; n = 212), and children in SDQ typical ranges (n = 30) completed computerised cognitive control and decision-making tasks. Parents completed questionnaires to assess ADHD, ODD, anxiety and depression symptoms (n = 191). Compared to children with no teacher-reported difficulties, those with moderate-to-high problems showed poorer visuomotor control and decision-making. A factor analysis revealed that task variables adhered to RDoC dimensions and predicted variance in specific disorders: difficulties in cognitive control predicted ADHD symptoms, low reward-seeking was associated with depression and high reward-seeking was associated with ODD. This study highlights how the assessment of cognitive processes positioned within the RDoC framework can inform our understanding of disorder-specific and transdiagnostic difficulties in SR which are associated with diverse clinical symptoms in children.

Investigating war trauma, its effects, and associated risk factors on anxiety among high school students in Woldia town, northeast Ethiopia, 2022

Background

Anxiety symptoms are the most frequent mental health problems in the world, and it is a serious public health concern, especially among adolescents, because if left untreated, adolescent anxiety can have a number of detrimental effects, including lower academic performance, strained relationships with friends and family, substance addiction, thoughts of suicide and homicide, and trouble finding work. While this vulnerability is concerning in all situations, it is particularly critical in armed conflict areas. Ethiopia is one of the most recent war-affected countries, but to the best of our knowledge, limited studies focused on adolescents in this context. Therefore, this study assessed the experience of war trauma and its effects on anxiety symptoms among high school students in Woldia town, Ethiopia.

Objective

We assessed the experience of war trauma and its effects on anxiety among high school students, as well as associated risk factors, in war-affected areas in Woldia town, northeast Ethiopia.

Methods

A cross-sectional study design was conducted from May 23 to June 08 2022. Data were collected from high school students in Woldia town. Bivariable and multivariable logistic regression analyses were used to identify independent factors associated with anxiety.

Results

A total of 624 out of 660 students participated in the study (94.5% response rate). The prevalence of anxiety among high school students in Woldia town was 39.7%. In the multivariable analysis, having depression (AOR = 9.24, 95% CI: 6.27, 13.64), witnessing the murder of family/friends (AOR = 1.93, 95% CI: 1.05, 3.57), being of female sex (AOR=1.59, 95% CI: 1.08, 2.36), and having a family history of mental illness (AOR=1.69, 95% CI: 1.00, 2.85) were factors significantly associated with anxiety.

Conclusions and recommendations

The prevalence of anxiety in this study was approximately two in five high school students. Therefore, we recommend that the Ministry of Education collaborate with the Ministry of Health to expand and implement mental health services in high schools to promote the wellbeing of students for the prevention of anxiety.

The effect of drama on psychosocial problems and emotional states of hospitalized children with cancer

BACKGROUND AND PURPOSE

Hospitalization is a traumatic experience for children. Especially in the case of childhood cancers that require long-term hospitalization, children need psychosocial support. The study aimed to examine the effectiveness of drama in reducing psychosocial problems in hospitalized paediatric children diagnosed with cancer.

METHODS

The study used a mixed method approach, combining both qualitative and quantitative methods with a single group. Drama sessions prepared according to the Tasks and Skills Model were used to support their psychosocial conditions. The Facial Expression Form, The Assessment Scale for Psychosocial Symptoms in Hospitalized Children, and the Drawing and Writing Technique were used before and after the drama sessions.

RESULTS

This study differs from others in its use of drama intervention to reduce psychosocial problems in children undergoing cancer treatment. As a result of the study, it was found that there was a decrease in anxiety, hopelessness, anger-aggression and communication difficulties among psychosocial problems and a change in mood towards feeling happy. The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients.

CONCLUSION

The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients.

PRACTICE IMPLICATIONS

Applying drama to children undergoing long-term hospital treatment can help alleviate psychosocial problems by reducing stress, emotional suppression, and compensating for trauma.

The unique role of adolescent internalizing and externalizing problems, and maternal-adolescent communication in their association with attachment in early adulthood

Attachment styles influence mental health and relationships through life. Few studies examine the adolescent factors associated with adult attachment styles. This paper examines the association between adolescent emotional and behavioral problems and maternal-adolescent communication with attachment style in early adulthood. Data from 3423 participants in a birth cohort study were examined. At 14-years, participants' mothers completed the Parent-Adolescent Communication Scale. Participants completed the Youth Self-Report at 14-years which measures internalizing and externalizing symptoms, and the Attachment Style Questionnaire (ASQ) at 21-years. The ASQ comprises five domains of internal working models of interpersonal relationships and attachment style: confidence (security), discomfort with closeness and relationships as secondary (avoidance), need for approval and preoccupation with relationships (anxiety). Associations were examined using general linear models. After adjustments, internalizing symptoms score was associated with all domains of attachment and externalizing symptoms score was associated with four domains of attachment insecurity, but not attachment security. Low openness in maternal-adolescent communication was most strongly associated with decreased confidence and high problem maternal-adolescent communication was associated with viewing relationships as secondary. Adolescents with emotional and behavioral problems and maternal-adolescent communication may benefit from attachment-based interventions to support the development of healthy relationships and attachments in young adulthood.

Severe malaria-related disability in Ethiopian children from the perspectives of caregivers: an interpretive description study

PURPOSE

This study explored severe malaria-related disability in children from the perspectives of their caregivers.

MATERIALS AND METHODS

The interpretive description qualitative approach was employed. The participants were selected using the purposive sampling technique considering the child's history of severe malaria, age (0-10 years), and location (urban/rural). Data were collected through face-to-face interviews with sixteen caregivers. Reflexive thematic data analysis was utilized. Through prolonged engagement, reflective journaling, an audit trail, and co-authors' review, trustworthiness was enhanced.

RESULTS

The study generated five themes from the interviews: mitigators of disability, contributors of disability, impact on body function, impact on activities and participation, and uncertainties about future well-being. The findings revealed previously unstudied social components of disability and environmental factors. Furthermore, the research uncovered health-related quality of life aspects that are out of the scope of the current comprehensive disability framework.

CONCLUSIONS

The study contributes to a deeper understanding of severe malaria-related disability in children from the biopsychosocial perspective. The findings could help policymakers, researchers, and clinicians who want to design rehabilitation interventions for the affected children or examine the components of disability on a large scale using quantitative methods.IMPLICATIONS FOR REHABILITATIONVarious contextual factors interacted with severe malaria and influenced functioning either as facilitators or barriers, implying disability related to malaria can be prevented or created.The long-term impacts of severe malaria are not limited to functioning and disability but also affect the health-related quality of life of children who survive severe malaria.Rehabilitation professionals should consider applying comprehensive functioning and disability frameworks such as the ICF when designing (or applying) screening tools, planning interventions, and evaluating the outcomes of intervention for children with severe malaria-related disability.Rehabilitation interventions for children with severe malaria-related disability should consider patient- or caregiver-reported outcomes (components of disability).