Prevalence and Factors Associated with Behavioral Problems in 5-Year-Old Children Born with Cleft Lip and/or Palate from the Cleft Collective

OBJECTIVES

To determine the UK prevalence of behavioral problems in 5-year-old children born with isolated or syndromic cleft lip and/or palate (CL/P) compared to the general population and identify potentially associated factors.

DESIGN

Observational study using questionnaire data from the Cleft Collective 5-Year-Old Cohort study and three general population samples.

MAIN OUTCOME MEASURE

The Strengths and Difficulties Questionnaire (SDQ).

PARTICIPANTS

Mothers of children (age: 4.9-6.8 years) born with CL/P (n  =  325). UK general population cohorts for SDQ scores were: Millennium Cohort Study (MCS) (n  =  12  511), Office of National Statistics (ONS) normative school-age SDQ data (n  =  5855), and Avon Longitudinal Study of Parents and Children (ALSPAC) (n  =  9386).

RESULTS

By maternal report, 14.2% of children born with CL/P were above clinical cut-off for behavioral problems, which was more likely than in general population samples: 7.5% of MCS (OR  =  2.05 [1.49-2.82], P < 0.001), 9.8% of ONS (OR  =  1.52 [1.10-2.09], P  =  0.008), and 6.6% of ALSPAC (OR  =  2.34 [1.70-3.24], P < 0.001). Children in the Cleft Collective had higher odds for hyperactivity, emotional and peer problems, and less prosocial behaviors. Maternal stress, lower maternal health-related quality of life and family functioning, receiving government income support, and maternal smoking showed evidence of association (OR range: 4.41-10.13) with behavioral problems, along with maternal relationship status, younger age, and lower education (OR range: 2.34-3.73).

CONCLUSIONS

Findings suggest elevated levels of behavioral problems in children born with CL/P compared to the general population with several associated maternal factors similar to the general population.

PEERS® for Preschoolers preliminary outcomes and predictors of treatment response

PEERS® for Preschoolers (P4P) is a social skills group program for young autistic children and their caregivers, which provides everyday tools for interacting and communicating with others. Twenty-two caregiver-child dyads participated and completed pre-treatment, post-treatment, and follow-up measures (4-16 weeks after). Using single-subject analyses to examine social skills, 60% demonstrated post-treatment improvement, and 53.85% demonstrated follow-up improvement. Regarding a secondary outcome of behavioral difficulties, 33.33% demonstrated post-treatment reduction, and 7.69% demonstrated follow-up reduction. Using regressions, autistic traits predicted outcomes; fewer social communication difficulties predicted both greater social skills and fewer behavioral difficulties at post-treatment, while fewer repetitive behaviors predicted fewer post-treatment and follow-up behavioral difficulties. These results preliminarily demonstrate the benefits of P4P and how autistic traits may impact P4P outcomes.

Facing Pediatric Rheumatic Diseases: The Role of Disease Activity and Parental Emotion Regulation Strategy in Parents' and Children's Psychological Adjustment

BACKGROUND

Pediatric rheumatic diseases (PRDs) are a group of chronic disorders that start in childhood and are characterized by periodic exacerbations and remissions of symptoms, with limitations in family, school, and social activities. The aim of this study was to detect differences in parents' psychological adjustment and emotion regulation strategies, and parent-reported children's adjustments in families of children with active and inactive PRDs.

METHODS

Fifty-four parents (38 mothers and 16 fathers) of children with PRD were recruited from a pediatric unit. Disease activity was evaluated by their pediatric rheumatologist, while parents' depressive and anxiety symptoms, emotion regulation strategies, and children's emotional difficulties and hyperactivity-inattention symptoms were assessed through a web-based survey.

RESULTS

Parents of children with active PRDs reported higher levels of their child's emotional difficulties and hyperactivity-inattention symptoms. Linear regression analysis demonstrated that having a child in the active phases of PRD and lower use of cognitive reappraisal lead to higher children's emotional symptoms, while active disease, low use of cognitive reappraisal, and greater expressive suppression were associated with higher hyperactivity-inattention symptoms. Our study highlights that children with PRDs and their parents may be at increased risk for psychological problems, especially during the active disease phase, highlighting the importance of a multidisciplinary approach.

Re-engagement of Early Adolescents with Severe School Issues in School/Professional Project Reduces School-Behavior-Health Problems

BACKGROUND

In France, 3.2 million middle-school students have serious/persistent school difficulties and are re-engaged in adapted-general/vocational-education class (AGVEC), created to early re-engage them in school/professional projects. We assessed the AGVEC's benefits for school-behavior-health-related difficulties (SBHDs).

METHODS

This population-based study compared 83 AGVEC students (mean age = 14.4 ± 1.1) with 1559 regular-class students (mean age = 13.5 ± 1.3) from north-eastern France. They completed a questionnaire collecting socioeconomic features and SBHDs. The data were analyzed using logistic regression models and Kaplan-Meier estimates.

RESULTS

The AGVEC students had similar academic performance but fewer school absences due to health problems, less sleep difficulty, fewer depressive symptoms, and more social support as compared with regular-class students: sex-age-class-level-adjusted odds ratio (saclOR) 0.31-0.56 (p < 0.05/0.001). The AGVEC students had fewer skipping school, better health status, less sleep difficulty, fewer depressive symptoms, fewer suicide ideation/attempt, and more social support as compared with regular-class students with low academic performance: saclOR 0.22-0.52 (most with p < 0.01). Socioeconomic features played modest roles. The benefits for depressive symptoms and suicide attempt increased with age since age 10.

CONCLUSIONS

Re-engagement in the AGVEC is particularly effective in reducing SBHDs.

Examining clinical characteristics of autism and links with parent perceptions of sibling relationship quality

LAY ABSTRACT

Sibling relationship quality is important for the well-being of children on the autism spectrum and their siblings. Little is known, however, about how varied behavior and abilities of children on the autism spectrum may be associated with parent perceptions of domains of sibling relationship quality. We drew data from a subsample of 119 children on the autism spectrum (ages 10-11 years), participating in an ongoing longitudinal study. We looked at how three clinical characteristics (autism symptoms, behavioral difficulties, and communication ability) related to four areas of parent-reported sibling relationship quality (warmth/closeness, conflict, relative status/power, and rivalry). We also examined whether the strength of the association between behavioral difficulties and parent-reported sibling relationship quality was influenced by communication ability. We found that more severe autism symptoms were associated with less conflict and rivalry, and higher communication ability was associated with more relative status/power. We also found that children on the autism spectrum with more behavioral difficulties and weaker communication ability had less warmth/closeness in their sibling relationships. Our findings highlight that it is important to consider autism symptoms, behavioral difficulties, and communication ability, as well as multiple domains of relationship quality, to better understand how parents view the relationships between autistic children and their siblings. Clinically, methods for improving sibling relationships may include teaching conflict resolution strategies to children on the autism spectrum with stronger communication abilities and their siblings, and fostering sibling connection for those with lower communication abilities.

The Emergence of 5-Year-Olds' Behavioral Difficulties: Analyzing Risk and Protective Pathways in the United Kingdom and Germany

This study aimed to advance our understanding of 5-year-olds' behavioral difficulties by modeling and testing both mediational protective and risk pathways simultaneously. Drawing on two national samples from different Western European countries-the United Kingdom (13,053) and Germany (2,022), the proposed model considered observed sensitive parental interactive behaviors and tested child vocabulary as protective pathways connecting parental education with children's behavioral outcomes; the risk pathways focused on negative parental disciplinary practices linking (low) parental education, parental distress, and children's difficult temperament to children's behavioral difficulties. Further, the tested model controlled for families' income as well as children's sex and formal child care attendance. Children with comparatively higher educated parents experienced more sensitive interactive behavior, had more advanced vocabulary, and exhibited fewer behavioral difficulties. Children with a comparatively higher level of difficult temperament or with parents who suffered from distress tended to experience more negative disciplinary behavior and exhibited more behavioral difficulties. Additionally, children's vocabulary skills served as a mechanism mediating the association between parental education and children's behavioral difficulties. Overall, we found similar patterns of results across the United Kingdom and Germany with both protective and risk pathways contributing simultaneously to children's behavioral development. The findings suggest that promoting parents' sensitive interactive behaviors, favorable disciplinary practices, and child's vocabulary skills have potential for preventing early behavioral difficulties.

Understanding Behavior in Phelan-McDermid Syndrome

BACKGROUND

Phelan-McDermid syndrome (PMS) or 22q13.3 deletion syndrome is a rare genetic disorder characterized by developmental delay, hypotonia and severely delayed speech. Behavioral difficulties are often reported in PMS, although knowledge of behavioral profiles and the interpretation of reported behavior remains limited. Understanding the meaning of behavior requires considering the context as well as other domains of functioning, for example the individual's level of cognitive, social and emotional development. Combining structured direct in-person neurodevelopmental assessments with contextual assessments to enable meaningful interpretations of reported behavior on functional dimensions across multiple units of analysis, as proposed by the RDoc framework, is essential.

METHODS

In this article we present a structured multidisciplinary method of assessment through direct in-person neurodevelopmental assessments and assessment of contextual factors. Our study sample includes data of 33 children with an average age of 6.2 years (range 1.1 to 15.7) with PMS, obtained through individual in-person assessments in combination with parent informed questionnaires. We assessed developmental age using the Bayley-III, adaptive behavior was assessed with the Vineland screener, social-emotional development with the ESSEON-R and behavior by using the CBCL.

RESULTS

Our results show a great deal of variability in phenotypic presentation with regard to behavior, symptom expression and symptom severity in individuals with PMS. The data on behavior is interpreted in the context of the individual's level of cognitive, adaptive development and the (genetic) context. Behavioral data showed high levels of withdrawn behavior and attention problems. More than half of the children showed borderline or clinical symptoms related to Autism Spectrum Disorder (ASD).

CONCLUSIONS

The interpretation of the meaning of certain behavior in PMS is often based on questionnaires and descriptions without taking the specific context of development into account. Combining questionnaires with direct in-person assessments measuring different domains of functioning should be considered a more accurate method to interpret the meaning of findings in order to understand behavior in rare genetic disorders associated with developmental delay such as PMS. Direct in-person assessment provides valuable and specific information relevant to understanding individual behavior and inform treatment as well as increase knowledge of the neurodevelopmental phenotype in individuals with PMS. More specific application of the proposed frameworks on behavior in PMS is desirable in making useful interpretations.

Longitudinal Association Between Participation in Organized Sport and Psychosocial Development in Early Childhood

OBJECTIVE

To explore whether the associations between developmental delays in the first year of life and psychosocial outcomes in preschool children are affected by participation in organized sport.

STUDY DESIGN

Data were obtained from the infant cohort of the Growing Up in Ireland project. Parents reported on child development (Ages and Stages Questionnaire) at age 1 year, psychosocial characteristics (Strengths and Difficulties Questionnaire) at ages 3 and 5 years, and engagement in organized sport at age 5 years. Data were analyzed using mixed models.

RESULTS

At age 1 year, 15% of the cohort was classified as having developmental delays. These children exhibited more behavioral difficulties (0.55, ±0.27; mean difference, ±95% confidence limits [CL]) (P < .0001) and fewer prosocial behaviors (-0.54, ±0.11) (P < .0001) at age 3 years. For boys in this group, engagement in sport was associated with a significant decrease in behavioral difficulties between ages 3 and 5 years (-0.44, ±0.39) (P = .03). Compared with those classified as lacking regular engagement (ie, never engaging, or engaging <1 hour/week), the relative effect of sport on changes in behavioral difficulties for boys with developmental delays was statistically significant (0.70, ±0.59) (P = .02). Participation in sport was not associated with significant changes in behavioral difficulties for girls, or a significant change in prosocial behaviors for boys or girls.

CONCLUSIONS

Regular participation in sport by boys could attenuate some of the behavioral difficulties associated with early development. Lack of opportunities for engaging in sport could negatively affect boys' behavioral regulation in the preschool period.

An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial

Background

Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs.

Objective

The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people.

Methods

The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up.

Results

There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone.

Conclusions

It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted.

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.7019

Media Use of Mothers, Media Use of Children, and Parent-Child Interaction Are Related to Behavioral Difficulties and Strengths of Children

The present study investigated the associations of media use of children, media use of mothers, and parent-child interactions with behavioral strengths and difficulties in children. Screen time of 553 2- to 9-year-old children and their mothers were indicated by the daily durations of their TV/games console/computer/mobile phone use. The amount of parent–child interaction was indicated by the frequencies of shared activities at home. Behavioral strengths and difficulties of children were investigated using the Strengths and Difficulties Questionnaire. Children whose mothers reported high screen times (>/= 5 h/day) were significantly more likely to show high screen times (>/= 2 h/day). High screen time of children was associated with more conduct problems, more symptoms of hyperactivity/inattention and less prosocial behavior. High screen time of mothers was associated with emotional problems, conduct problems, and symptoms of hyperactivity/inattention. In contrast, a higher frequency of parent–child interactions was associated with fewer conduct problems, fewer peer-relationship problems, and more prosocial behavior of children. Children might use the media behavior of their mothers as a role model for their own media use. Furthermore, the findings suggest that media use of children and mothers and parent–child interaction contribute independently to behavioral strengths and difficulties of children.

The Effect of Hypertensive Disorders of Pregnancy on the Risk of ADHD in the Offspring

OBJECTIVE

Evidence suggests that perinatal factors may contribute to the development of ADHD. Our objective was to examine the association between hypertensive disorders of pregnancy (HDP) and ADHD, and behavioral difficulties among 7-year-old children.

METHOD

The study cohort consisted of 13,192 children (weighted = 13,500) who participated in the Millennium Cohort Study (MCS) at age 7. HDP (raised blood pressure, preeclampsia, eclampsia, and toxemia) were reported by mothers 9 months postdelivery. ADHD was reported by parents at age 7 years. Weighted logistic regression models were used to assess the association.

RESULTS

In all, 1,069 (7.9%) women reported HDP and 166 (1.2%) children had an ADHD diagnosis. There was a significant association between HDP and ADHD (adjusted odds ratio [OR] = 1.78, 95% confidence interval [CI] = [1.03, 3.07]).

CONCLUSION

These findings suggest that HDP is associated with an increased risk of ADHD. It is important to confirm this in larger cohorts and to understand the biological basis of this association.

Reciprocal Associations between Electronic Media Use and Behavioral Difficulties in Preschoolers

The use of electronic media has increased substantially and is already observable in young children. The present study explored associations of preschoolers’ use of electronic media with age, gender, and socio-economic status, investigated time trends, and examined reciprocal longitudinal relations between children’s use of electronic media and their behavioral difficulties. The study participants included 527 German two- to six-year-old children whose parents had provided information on their use of electronic media and their behavioral difficulties at two time points, with approximately 12 months between baseline and follow-up. The analyses revealed that older vs. younger children, as well as children from families with a lower vs. higher socio-economic status, were more often reported to use electronic media. Furthermore, the usage of mobile phones increased significantly between 2011 and 2016. Most interestingly, baseline usage of computer/Internet predicted more emotional and conduct problems at follow-up, and baseline usage of mobile phones was associated with more conduct problems and hyperactivity or inattention at follow-up. Peer relationship problems at baseline, on the other hand, increased the likelihood of using computer/Internet and mobile phones at follow-up. The findings indicate that preschoolers’ use of electronic media, especially newer media such as computer/Internet and mobile phones, and their behavioral difficulties are mutually related over time.

Rock drumming enhances motor and psychosocial skills of children with emotional and behavioral difficulties

Objectives: Drumming may have therapeutic and learning benefits but there exists little causal evidence regarding the benefits for children with emotional and behavioral difficulties (EBD) such as Autistic Spectrum Disorder. Methods: Six EBD pupils (EBD Drum) and six peers (Peer Drum) were given 2, 30-min rock drumming lessons per week, over 5 weeks. Six matched individuals received no drumming instruction (3 = EBD Control; 3 = Peer Control). An exploratory, mixed-methods analysis was used to explore quantitative changes in skills and qualitative perspectives of the teaching staff. All pupils were tested two times (pretest and posttest) on drumming ability and Motor skills (Movement Assessment Battery for Children, version 2). Teacher's rating of social behavior (Strength and Difficulties Questionnaire; SDQ) was tested two times (pretest and retention). Results: Significant differences in total SDQ difficulties between the four groups (χ2(3) = 8.210, p = 0.042) and the hyperactivity subscale (χ2(3) = 10.641, p = 0.014) were observed. The EBD Drum group had greater reductions in total difficulties compared to the Peer Drum (p = 0.009) group and specifically greater reductions in hyperactivity compared to Peer Drum (p = 0.046) and the EBD Control (p = 0.006) group. In follow-up interviews, staff spoke positively about changes in pupil's attitudes toward learning and social confidence. Conclusions: The positive changes to social and behavioral skills reported in this pilot study are similar to those recorded for other music modalities.

An App to Help Young People Self-Manage When Feeling Overwhelmed (ReZone): Protocol of a Cluster Randomized Controlled Trial

BACKGROUND

The association between behavioral difficulties and academic attainment is well established. Recent policy advising schools on managing behavior has promoted the early identification of behavioral difficulties. There is also increasing research into mHealth interventions to provide support for emotional and behavioral difficulties for young people.

OBJECTIVE

The primary aim of the proposed research is to examine the effectiveness of an mHealth intervention, ReZone, in reducing emotional and behavioral difficulties in young people.

METHODS

The protocol is a cluster trial of 12 classes with N=120 students with classes randomized to ReZone or management as usual. Multilevel modeling will be used to compare ReZone versus management as usual accounting for classroom-level variation.

RESULTS

Baseline data collection started in February 2017 and ended in April 2017. Follow-up data collection started in April 2017 and ended in June 2017.

CONCLUSIONS

The proposed research will provide evidence as to whether ReZone is effective at helping young people to self-manage when feeling overwhelmed.

TRIAL REGISTRATION

ISRCTN 13425994; http://www.isrctn.com/ISRCTN13425994 (Archived by WebCite at http://www.webcitation.org/6tePwwiHk).

[Relationship between Machiavellianism and emotional and behavioral difficulties in adolescence]

INTRODUCTION

Machiavellianism is a personality trait that is characterized by intense interpersonal manipulation in order to achieve personal material goals. Previous studies revealed a relationship between Machiavellianism and diverse forms of psychological difficulties in adults.

AIM

Studies also revealed such relationships in adolescents as well, but studies investigating the relationship between Machiavellianism and psychological difficulties in adolescents are still absent in Hungary.

METHOD

In this study 502 secondary school students (356 girls) filled out questionnaires that measured Machiavellianism and psychological and behavioral difficulties.

RESULTS

Machiavellianism was associated with higher total problem score. This resulted mainly from higher scores on scales measuring emotional and behavioral problems. Moreover, hyperactivity and lack of prosocial behavior were also associated with Machiavellianism. At the same time, Machiavellian adolescents did not differ in self-reported loneliness from their peers.

CONCLUSIONS

The author discusses the results in the light of previous research and from the perspective of emotion and behavior regulation. Practical aspects of the results are also discussed in the context of prevention.

Classroom peer relationships and behavioral engagement in elementary school: the role of social network equity

Applying social capital and systems theories of social processes, we examine the role of the classroom peer context in the behavioral engagement of low-income students (N = 80) in urban elementary school classrooms (N = 22). Systematic child observations were conducted to assess behavioral engagement among second to fifth graders in the fall and spring of the same school year. Classroom observations, teacher and child questionnaires, and social network data were collected in the fall. Confirming prior research, results from multilevel models indicate that students with more behavioral difficulties or less academic motivation in the fall were less behaviorally engaged in the spring. Extending prior research, classrooms with more equitably distributed and interconnected social ties-social network equity-had more behaviorally engaged students in the spring, especially in classrooms with higher levels of observed organization (i.e., effective management of behavior, time, and attention). Moreover, social network equity attenuated the negative relation between student behavioral difficulties and behavioral engagement, suggesting that students with behavioral difficulties were less disengaged in classrooms with more equitably distributed and interconnected social ties. Findings illuminate the need to consider classroom peer contexts in future research and intervention focused on the behavioral engagement of students in urban elementary schools.

Reading, Mathematics, and Behavioral Difficulties Interrelate: Evidence from a Cross-lagged Panel Design and Population-based Sample

We examined three questions. First, do reading difficulties increase children's risk of behavior difficulties? Second, do behavioral difficulties increase children's risk of reading difficulties? Third, do mathematics difficulties increase children's risk of reading or behavioral difficulties? We investigated these questions using a sample of 9,324 children followed from third to fifth grade as they participated in a nationally representative dataset, conducting multilevel logistic regression modeling and including statistical control for many potential confounds. Results indicated that poor readers in third grade were significantly more likely to display poor task management, poor self-control, poor interpersonal skills, internalizing behavior problems, and externalizing behavior problems in fifth grade (odds ratio [OR] range = 1.30 - 1.57). Statistically controlling for a prior history of reading difficulties, children with poor mathematics skills in third grade were also significantly more likely to display poor task management, poor interpersonal skills, internalizing behavior problems, and reading difficulties in fifth grade (OR range = 1.38 - 5.14). In contrast, only those children exhibiting poor task management, but not other types of problem behaviors, in third grade were more likely to be poor readers in fifth grade (OR = 1.49).