Green Space and Internalizing or Externalizing Symptoms Among Children

Importance

Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare.

Objective

To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms.

Design, Setting, and Participants

Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included.

Exposures

Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment.

Main Outcome and Measures

Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples.

Results

Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood.

Conclusions and Relevance

In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.

Airborne Lead Exposure and Childhood Cognition: The Environmental Influences on Child Health Outcomes (ECHO) Cohort (2003-2022)

Objectives. To examine whether a previously reported association between airborne lead exposure and children's cognitive function replicates across a geographically diverse sample of the United States. Methods. Residential addresses of children (< 5 years) were spatially joined to the Risk-Screening Environmental Indicators model of relative airborne lead toxicity. Cognitive outcomes for children younger than 8 years were available for 1629 children with IQ data and 1476 with measures of executive function (EF; inhibitory control, cognitive flexibility). We used generalized linear models using generalized estimating equations to examine the associations of lead, scaled by interquartile range (IQR), accounting for individual- and area-level confounders. Results. An IQR increase in airborne lead was associated with a 0.74-point lower mean IQ score (b = -0.74; 95% confidence interval = -1.00, -0.48). The association between lead and EF was nonlinear and was modeled with a knot at the 97.5th percentile of lead in our sample. Lead was significantly associated with lower mean inhibitory control but not with cognitive flexibility. This effect was stronger among males for both IQ and inhibitory control. Conclusions. Early-life exposure to airborne lead is associated with lower cognitive functioning. (Am J Public Health. 2024;114(3):309-318. https://doi.org/10.2105/AJPH.2023.307519).

Sex differences in acute health service contact after release from prison in Australia: a data linkage study

OBJECTIVES

Women released from prison typically experience worse health outcomes than their male counterparts. We examined sex differences in the patterns, characteristics, and predictors of acute health service contact (AHSC) (i.e. ambulance and/or emergency department use) after release from prison.

STUDY DESIGN

Data linkage study.

METHODS

Baseline survey data from 1307 adults (21% women) within six weeks of expected release from prisons in Queensland, Australia (2008-2010) were linked prospectively with state-wide ambulance and emergency department, correctional, mental health, and death records. Crude and adjusted incidence rates and incidence rate ratios of AHSC were calculated overall and by sex. An Andersen-Gill model was fit to examine whether sex predicted AHSC. The interaction effect between sex and each model covariate was tested.

RESULTS

The crude incidence rates of AHSC after release from prison were 1.4 (95% confidence interval [CI]: 1.3-1.5) and 1·1 (95%CI: 1.1-1.2) per person-year for women and men, respectively. The relationship between perceived physical health-related functioning at the baseline and AHSC was modified by sex (P = 0·039). The relationship between perceived health-related functioning and AHSC also differed among women. Compared to women who perceived their physical health as fair or good at the baseline, women who perceived their physical health as poor were at greater risk of AHSC (hazard ratio = 2.4, 95%CI: 1.4-3·9, P = 0.001) after release from prison.

CONCLUSIONS

Among people released from prison, women's and men's AHSC differs depending on how they perceive their own physical health. The specific needs of women and men must be considered in transitional support policy and planning to improve their health outcomes.

Early maternal language input and classroom instructional quality in relation to children's literacy trajectories from pre-kindergarten through fifth grade

Both early childhood maternal language input and the quality of classroom instruction in elementary school have been shown to be important environmental supports in predicting children's literacy skill development. However, no studies have simultaneously examined these two environmental supports in relation to children's early language skills and later literacy skills across elementary school. The current study examined how multiple years of early maternal language input from 6 to 36 months and later classroom instructional quality from pre-kindergarten (pre-K) through fifth grade were related to children's early language at 36 months and later literacy trajectories in word recognition and reading comprehension across elementary school. The study included a diverse, population-representative sample of 1,292 children who were born in low-wealth rural communities and followed through fifth grade. Video recordings and subsequent transcripts of mother-child shared picture book tasks in the home at four timepoints during early childhood were used to assess maternal diversity of vocabulary, utterance complexity, and engagement (wh-questions) during book sharing. The quality of instruction in elementary school was assessed using classroom observations from pre-K through fifth grade. Maternal complexity and engagement were indirectly related to children's literacy trajectories across pre-K to fifth grade through effects on early child language at 36 months. Higher-quality classroom instruction was not reliably related to concurrent literacy skills in pre-K through fifth grade. Findings suggested the enduring importance of early maternal language input in predicting children's early language and later literacy skill development during elementary school. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Improvements in motor competence skills are associated with improvements in executive function and math problem-solving skills in early childhood

Efforts to increase moderate-to-vigorous physical activity (MVPA) in school-age children are associated with improved health, cognitive, and academic outcomes. However, questions remain about whether similar benefits are observed in early childhood. We hypothesized that motor competence, not MVPA, would be related to improved cognitive and academic skill development in early childhood. For this study, 283 children were recruited from 13 community-based preschools (55% female; M = 4.2 years old, SD = .6; 41% non-Hispanic White, 37% non-Hispanic Black; 10% Hispanic, 10% mixed race, 2% Asian, 1% American Indian). Children's physical activity, motor competence, executive function (EF), and math problem-solving skills were measured using the same protocol in three assessments in a single academic year (i.e., fall, winter, spring). Although motor competence was strongly correlated with contemporaneous measures of EF and math problem-solving skills (rs = .51-.63), MVPA was weakly correlated with EF and math problem-solving skills (rs = .03-.18). Mixed linear models demonstrated that improvements in children's motor competence were related to improvements in their EF and math problem-solving skills (ps < .001), their improvements in MVPA were not statistically significant related to any of the outcomes. These within-child associations provide a stronger basis of inference by controlling for all time-invariant confounders. The results of this study suggest that efforts to improve motor competence skills in young children may improve EF and math problem-solving skills, though experimental studies are required to rigorously test this idea. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Proximity to sources of airborne lead is associated with reductions in Children's executive function in the first four years of life

Although policies to remove lead from gasoline have resulted in a substantial reduction in airborne lead, multiple industries are known to generate lead that is released in the air. The present study examines the extent to which residential proximity to a documented source of airborne lead is associated with intellectual and executive function in children. Data were available for n = 849 children from the Family Life Project. Geolocation for children's residences between birth and 36 months were referenced against the Environmental Protection Agency's Risk Screening Environmental Indicators (RSEI) database, which estimates exposure for each ½ mile grid in the contiguous United States. Instrumental variable models were employed to estimate causal associations between exposure and cognitive outcomes measured at 36, 48, and 60 months, using census-documented density of manufacturing employment as the instrument. Models of continuous lead dosage indicated small negative effects for both child IQ and executive function (EF). These results indicate that RSEI estimates of airborne lead exposure are meaningfully associated with decrements in cognitive development.

Infant and Toddler Child-Care Quality and Stability in Relation to Proximal and Distal Academic and Social Outcomes

This study considered the quality and stability of infant and toddler nonparental child care from 6 to 36 months in relation to language, social, and academic skills measured proximally at 36 months and distally at kindergarten. Quality was measured separately as caregiver-child verbal interactions and caregiver sensitivity, and stability was measured as having fewer sequential child-care caregivers. This longitudinal examination involved a subsample (N = 1,055) from the Family Life Project, a representative sample of families living in rural counties in the United States. Structural equation modeling revealed that children who experienced more positive caregiver-child verbal interactions had higher 36-month language skills, which indirectly led to higher kindergarten academic and social skills. Children who experienced more caregiver stability had higher kindergarten social skills.

The Mortality After Release from Incarceration Consortium (MARIC): Protocol for a multi-national, individual participant data meta-analysis

INTRODUCTION

More than 30 million adults are released from incarceration globally each year. Many experience complex physical and mental health problems, and are at markedly increased risk of preventable mortality. Despite this, evidence regarding the global epidemiology of mortality following release from incarceration is insufficient to inform the development of targeted, evidence-based responses. Many previous studies have suffered from inadequate power and poor precision, and even large studies have limited capacity to disaggregate data by specific causes of death, sub-populations or time since release to answer questions of clinical and public health relevance.

OBJECTIVES

To comprehensively document the incidence, timing, causes and risk factors for mortality in adults released from prison.

METHODS

We created the Mortality After Release from Incarceration Consortium (MARIC), a multi-disciplinary collaboration representing 29 cohorts of adults who have experienced incarceration from 11 countries. Findings across cohorts will be analysed using a two-step, individual participant data meta-analysis methodology.

RESULTS

The combined sample includes 1,337,993 individuals (89% male), with 75,795 deaths recorded over 9,191,393 person-years of follow-up.

CONCLUSIONS

The consortium represents an important advancement in the field, bringing international attention to this problem. It will provide internationally relevant evidence to guide policymakers and clinicians in reducing preventable deaths in this marginalized population.

KEY WORDS

Mortality; incarceration; prison; release; individual participant data meta-analysis; consortium; cohort.

Between- and within-person contributions of simple reaction time to executive function skills in early childhood

This study tested whether the bivariate association between simple reaction time (SRT) and executive function (EF) performance that has been observed in early childhood represented a between- and/or within-person association. Up to three repeated assessments (i.e., fall, winter, and spring assessments from September to May) were available for 282 preschool-aged children (M_age = 4.2 years; 54% female) who participated in the Kids Activity and Learning Study. A series of three-level hierarchical linear models (repeated measures nested in child; child nested in classroom) was used to disaggregate the observed variation in EF and SRT into between-classroom, between-person, and within-person components. EF composite scores were regressed on two indicators of SRT, which reflected between- and within-child sources of variation, along with demographic covariates (child age, gender, and parental education). Both between-person (b = -21.2, p < 0.001) and within-person (b = -13.2, p < 0.001) sources of SRT variation were uniquely related to EF performance. These results are discussed with respect to interest in using SRT as a proxy for foundational cognitive processes that contribute to EF task performance in early childhood, including the appropriateness of using SRT to refine EF task scores.

How Early Maternal Language Input Varies by Race and Education and Predicts Later Child Language

The maternal language input literature suggests that mothers with more education use a greater quantity and complexity of language with their young children compared to mothers with less education although race and socioeconomic status have been confounded in most studies because of small sample sizes. The current Family Life study included a representative sample of 1,292 children, oversampling for poverty and African American, followed from birth. This study found no race differences within maternal education levels on five measures of maternal language input from 6 to 36 months. Maternal language input variables of number of different words, mean length of utterance and number of wh-questions were partial mediators of the relationship between maternal education and later child language at school age.

Maternal sensitivity and adrenocortical functioning across infancy and toddlerhood: Physiological adaptation to context?

Theory suggests that early experiences may calibrate the "threshold activity" of the hypothalamus-pituitary-adrenal axis in childhood. Particularly challenging or particularly supportive environments are posited to manifest in heightened physiological sensitivity to context. Using longitudinal data from the Family Life Project (N = 1,292), we tested whether links between maternal sensitivity and hypothalamus-pituitary-adrenal axis activity aligned with these predictions. Specifically, we tested whether the magnitude of the within-person relation between maternal sensitivity and children's cortisol levels, a proxy for physiological sensitivity to context, was especially pronounced for children who typically experienced particularly low or high levels of maternal sensitivity over time. Our results were consistent with these hypotheses. Between children, lower levels of mean maternal sensitivity (7-24 months) were associated with higher mean cortisol levels across this period (measured as a basal sample collected at each visit). However, the magnitude and direction of the within-person relation was contingent on children's average levels of maternal sensitivity over time. Increases in maternal sensitivity were associated with contemporaneous cortisol decreases for children with typically low-sensitive mothers, whereas sensitivity increases were associated with cortisol increases for children with typically high-sensitive mothers. No within-child effects were evident at moderate levels of maternal sensitivity.

Infant attachment disorganization and moderation pathways to level and change in externalizing behavior during preschool ages

This research examined the child, parent, and family conditions under which attachment disorganization was related to both level and change in externalizing behavior during preschool among a community sample. Using the ordinary least squares regression, we found that attachment disorganization at 12 months significantly predicted children's externalizing behavior at 36 months and this prediction was not contingent on any other factors tested. For predicting changes in externalizing behavior from 36 to 60 months, we found a significant main effect of family cumulative risk and an interaction effect between attachment disorganization at 12 months and maternal sensitivity at 24 months. Specifically, high disorganization was related to a significant decrease in externalizing behavior from 36 to 60 months when maternal sensitivity at 24 months was high. Our main-effect findings replicated the significant effect of attachment disorganization and cumulative risk on externalizing behavior with preschool-aged children. Our interaction finding provided support for understanding the parenting conditions under which infant attachment disorganization may be related to change in externalizing behavior during preschool ages. Implications of the findings were discussed.

The role of household chaos in understanding relations between early poverty and children's academic achievement

The following prospective longitudinal study used an epidemiological sample (N = 1,236) to consider the potential mediating role of early cumulative household chaos (6-58 months) on associations between early family income poverty (6 months) and children's academic achievement in kindergarten. Two dimensions of household chaos, disorganization and instability, were examined as mediators. Results revealed that, in the presence of household disorganization (but not instability) and relevant covariates, income poverty was no longer directly related to academic achievement. Income poverty was, however, positively related to household disorganization, which was, in turn, associated with lower academic achievement. Study results are consistent with previous research indicating that household chaos conveys some of the adverse longitudinal effects of income poverty on children's outcomes and extend previous findings specifically to academic achievement in early childhood.

Predictors of behavioral regulation in kindergarten: Household chaos, parenting, and early executive functions

Behavioral regulation is an important school readiness skill that has been linked to early executive function (EF) and later success in learning and school achievement. Although poverty and related risks, as well as negative parenting, have been associated with poorer EF and behavioral regulation, chaotic home environments may also play a role in understanding both early EF and later behavioral regulation at school age. To explore these relationships, a unique longitudinal and representative sample was used of 1,292 children born to mothers who lived in low-wealth rural America who were followed from birth into early elementary school. This study examined whether household chaos, which was measured across the first 3 years of life, predicted behavioral regulation in kindergarten above and beyond poverty-related variables. In addition, this study tested whether parent responsivity and acceptance behaviors, measured during the first 3 years of life, as well as EF skills, which were measured when children were 3 to 5 years of age, mediated the relationship between early household chaos and kindergarten behavioral regulation. Results suggested that household chaos disorganization indirectly predicted kindergarten behavioral regulation through intermediate impacts on parenting behaviors and children's early EF skills. These findings suggest the importance of early household chaos disorganization, the parenting environment, and early EF skills in understanding behavioral regulation above and beyond poverty-related risks.

Household Chaos and Children's Cognitive and Socio-Emotional Development in Early Childhood: Does Childcare Play a Buffering Role?

Evidence suggests that household chaos is associated with less optimal child outcomes. Yet, there is an increasing indication that children's experiences in childcare may buffer them against the detrimental effects of such environments. Our study aims were to test: (1) whether children's experiences in childcare mitigated relations between household chaos and children's cognitive and social development, and (2) whether these (conditional) chaos effects were mediated by links between chaos and executive functioning. Using data from The Family Life Project (n = 1,235)-a population-based sample of families from low-income, rural contexts-our findings indicated that household disorganization in early childhood was predictive of worse cognitive and social outcomes at approximately age five. However, these relations were substantially attenuated for children attending greater childcare hours. Subsequent models indicated that the conditional associations between household disorganization and less optimal outcomes at age five were mediated by conditional links between disorganization and less optimal executive functioning.

Catechol-O-methyltransferase Val158met polymorphism interacts with early experience to predict executive functions in early childhood

Numerous studies demonstrate that the Methionine variant of the catechol-O-methyltransferase Val158Met polymorphism, which confers less efficient catabolism of catecholamines, is associated with increased focal activation of prefrontal cortex (PFC) and higher levels of executive function abilities. By and large, however, studies of COMT Val158Met have been conducted with adult samples and do not account for the context in which development is occurring. Effects of early adversity on stress response physiology and the inverted U shape relating catecholamine levels to neural activity in PFC indicate the need to take into account early experience when considering relations between genes such as COMT and executive cognitive ability. Consistent with this neurobiology, we find in a prospective longitudinal sample of children and families (N = 1292) that COMT Val158Met interacts with early experience to predict executive function abilities in early childhood. Specifically, the Valine variant of the COMT Val158Met polymorphism, which confers more rather than less efficient catabolism of catecholamines is associated with higher executive function abilities at child ages 48 and 60 months and with faster growth of executive function for children experiencing early adversity, as indexed by cumulative risk factors in the home at child ages 7, 15, 24, and 36 months. Findings indicate the importance of the early environment for the relation between catecholamine genes and developmental outcomes and demonstrate that the genetic moderation of environmental risk is detectable in early childhood.

Fathers' sensitive parenting and the development of early executive functioning

Using data from a diverse sample of 620 families residing in rural, predominately low-income communities, this study examined longitudinal links between fathers' sensitive parenting in infancy and toddlerhood and children's early executive functioning, as well as the contribution of maternal sensitive parenting. After accounting for the quality of concurrent and prior parental care, children's early cognitive ability, and other child and family factors, fathers' and mothers' sensitive and supportive parenting during play at 24 months predicted children's executive functioning at 3 years of age. In contrast, paternal parenting quality during play at 7 months did not make an independent contribution above that of maternal care, but the links between maternal sensitive and supportive parenting and executive functioning seemed to operate in similar ways during infancy and toddlerhood. These findings add to prior work on early experience and children's executive functioning, suggesting that both fathers and mothers play a distinct and complementary role in the development of these self-regulatory skills.

A randomized, controlled trial of Social Cognition and Interaction Training (SCIT) for outpatients with schizophrenia spectrum disorders

OBJECTIVES

In schizophrenia, the ability to adaptively infer the thoughts and feelings of others (i.e., social cognition) is strongly associated with community functioning. Researchers have designed psychosocial interventions to improve social cognition with the aim of improving downstream social functioning. Social Cognition and Interaction Training (SCIT) is one such intervention. Previous research on SCIT has been promising, but has consisted largely of smaller trials with insufficient experimental control.

DESIGN

Randomized, controlled trial.

METHODS

The current article reports on a controlled trial of 66 adults with schizophrenia randomized to receive either SCIT (n = 33), delivered in weekly group sessions, or treatment as usual (n = 33) for 6 months. Participants completed assessments of social cognition, social functioning, neurocognition and symptoms at baseline, post-treatment, and 3-month follow-up.

RESULTS

Primary analyses suggest that SCIT may improve social functioning, negative symptoms, and possibly hostile attributional bias. Post-hoc analyses suggest a dose-response effect.

CONCLUSIONS

Findings are discussed in the context of continuing to refine and improve social cognitive interventions for schizophrenia.

PRACTITIONER POINTS

Social cognitive intervention is a feasible and promising approach to improving social functioning among individuals with schizophrenia-spectrum disorders. Dose-response findings suggest that delivering social cognitive interventions with greater frequency may maximize their benefit to patients. Research on social cognitive interventions is still young and effects from well-controlled trials have been inconsistent. It is not yet clear which components of social cognitive training may be the key active ingredients.

Child care and cortisol across early childhood: context matters

A considerable body of literature suggests that children's child-care experiences may impact adrenocortical functioning in early childhood. Yet emerging findings also suggest that the magnitude and sometimes the direction of child-care effects on development may be markedly different for children from higher risk contexts. Using data from a large population-based sample of families from predominantly low-income backgrounds in rural communities, we tested the degree to which links between children's child-care experiences (at 7-36 months) and their subsequent cortisol levels (at 48 months) were moderated by their level of cumulative environmental risk. Our results provided evidence of a crossover interaction between cumulative risk and child-care quantity. For children from low-risk contexts, greater weekly hours in child care were predictive of higher cortisol levels. In contrast, for children facing several cumulative risk factors, greater hours in child care per week were predictive of lower cortisol levels. These effects were robust after adjusting for several controls, including children's cortisol levels in early infancy. Child-care quality and type were not predictive of children's cortisol levels, and neither mitigated the conditional effect of child-care quantity on cortisol. These findings suggest that links between child care and children's development may differ as a function of children's broader ecologies.

Salivary alpha-amylase and cortisol in infancy and toddlerhood: direct and indirect relations with executive functioning and academic ability in childhood

Using data from a predominantly low-income, population-based prospective longitudinal sample of 1292 children followed from birth, indicators of children's autonomic (salivary alpha-amylase; sAA) and hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol) activity at 7, 15, and 24 months of age were found to predict executive functioning at 36-months and academic achievement in pre-kindergarten. The findings suggested that the respective cortisol and sAA effects on executive functioning and academic achievement were interactive. Optimal developmental outcomes were associated with asymmetrical cortisol/sAA profiles. Higher cortisol levels were predictive of lower executive functioning and academic abilities, but only for those with concurrently moderate to high levels of sAA. In contrast, higher sAA concentrations were predictive of better executive functioning and academic abilities, but only for those with concurrently moderate to low levels of cortisol. These relations were statistically identical across infancy and toddlerhood. The conditional effects of cortisol and sAA on pre-kindergarten academic achievement were mediated fully by links between these early physiological indicators and executive functioning.

Poverty as a predictor of 4-year-olds' executive function: new perspectives on models of differential susceptibility

In a predominantly low-income, population-based longitudinal sample of 1,259 children followed from birth, results suggest that chronic exposure to poverty and the strains of financial hardship were each uniquely predictive of young children's performance on measures of executive functioning. Results suggest that temperament-based vulnerability serves as a statistical moderator of the link between poverty-related risk and children's executive functioning. Implications for models of ecology and biology in shaping the development of children's self-regulation are discussed.

Suffering: etiology and treatment

Suffering comes in many forms. Certain psychological therapies rooted in the work of Victor Frankl have been shown to alleviate suffering at the end of life. Frankl asserted, with subsequent agreement from secular and religious authors, that it is important to include the transcendent when working with those who suffer. This article explores some of the causes for and treatments of suffering. It briefly argues for the importance of addressing and even embracing the transcendent.

Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood

In a predominantly low-income population-based longitudinal sample of 1,292 children followed from birth, higher level of salivary cortisol assessed at ages 7, 15, and 24 months was uniquely associated with lower executive function ability and to a lesser extent IQ at age 3 years. Measures of positive and negative aspects of parenting and household risk were also uniquely related to both executive functions and IQ. The effect of positive parenting on executive functions was partially mediated through cortisol. Typical or resting level of cortisol was increased in African American relative to White participants. In combination with positive and negative parenting and household risk, cortisol mediated effects of income-to-need, maternal education, and African American ethnicity on child cognitive ability.

Test-retest reliability of a new executive function battery for use in early childhood

This study reported test-retest reliability for a newly developed executive function battery designed for use in early childhood. A total of 140 predominantly low-income children (M = 48.1 months; 51% male; 43% African American) completed up to six tasks on two occasions an average of 18 (Mdn = 16) days apart. Pearson correlations between individual task scores indicated moderate retest reliability (mean r = .60; range = .52-.66) similar to that observed in other retest studies of executive function in preschool, school-aged, and adult samples. In contrast, confirmatory factor analyses of performance on the task battery across time indicated high retest reliability (ϕ = .95) that was identical to that observed in a recent study that used an identical method involving a sample of older adults. The short-term test-retest reliability of executive function in early childhood is comparable to that observed in childhood and adult samples. The retest reliability of children's performance on batteries of executive function tasks is appreciably stronger than the retest reliability of their performance on individual tasks. Studies that focus on inter- and intraindividual differences in executive function would be better served by using scores that are derived from task batteries than those derived from individual tasks.

Contributions of hot and cool self-regulation to preschool disruptive behavior and academic achievement

The construct of self-regulation can be meaningfully distinguished into hot and cool components. The current study investigated self-regulation in a sample of 926 children aged 3-5 years old. Children's performance on self-regulatory tasks was best described by two latent factors representing hot and cool regulation. When considered alone, hot and cool regulation were both significantly correlated with disruptive behavior and academic achievement. When considered together, cool regulation was uniquely associated with academic achievement, while hot regulation was uniquely associated with inattentive-overactive behaviors. Results are discussed with respect to treatment studies that directly target improvement in children's self-regulation.

Interdependence of parenting of mothers and fathers of infants

This study examined the relations among parenting behaviors of 97 coresident mothers and fathers of infants during a dyadic free-play setting. The authors examined the extent to which observed sensitive and intrusive parenting behaviors in mother-child and father-child dyads were related and how perceived marital quality may be associated with the similarity between maternal and paternal parenting behaviors. The authors found support for interdependence of parenting by mothers and fathers. High perceived marital quality was associated with interdependence of sensitive parenting behaviors in mother-infant and father-infant interactions. Negative parenting behaviors by mothers and fathers were interrelated regardless of marital quality. The findings highlight the importance of studying parenting by mothers and fathers as embedded within particular family systems.

Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach

OBJECTIVE

To determine factors associated with breastfeeding in rural communities.

METHODS

We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N=1292) of infants born September 2003-2004 and (2) a parallel ethnographic study (N=30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding.

RESULTS

Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance.

CONCLUSIONS

Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative.

Parenting quality, DRD4, and the prediction of externalizing and internalizing behaviors in early childhood

Recent research has found that the dopamine D4 receptor (DRD4) gene and maternal insensitivity may interact to predict externalizing behavior in preschoolers. The current study attempted to replicate and extend this finding in a sample of 18-30-month-old children. The current study examined two distinct dimensions of parenting (warm-responsive and negative-intrusive) as predictors of childhood externalizing and internalizing behavior. Further, race was investigated as a moderator of gene-environment relationships. Results revealed that high warm-responsive parenting was associated with decreased externalizing behavior only for African American children possessing the short polymorphism of DRD4. The data indicate that children may be differentially susceptible to different aspects of parenting depending on their genotype, and it is important to consider differences in racial composition when studying these relationships.

Paths to child social adjustment: parenting quality and children's processing of social information

BACKGROUND

The purpose of this research was to examine the manner in which multiple influences on child social adjustment operated together to predict differential outcomes for young children. Specifically, this study was designed to (i) examine the role of social cognitive and emotional factors in parents' observed and self-reported behaviour towards their children, and (ii) investigate the impact of parenting and children's social information processing (SIP) patterns on children's subsequent social adjustment in the school setting.

METHODS

A model of children's peer social adjustment was evaluated using a group of 166 children, over-sampled for history of physical child abuse. Assessment of constructs was multi-method, including parent and child self-reports as well as teacher reports of child adjustment and observations of parent-child and child-peer interactions.

RESULTS

Using structural equation modelling, support was found for our theoretical model. Specifically, parents' negative child-related beliefs and clinical elevations in emotional distress were predictors of harsh, insensitive parenting, which in turn predicted children's SIP operations and social maladjustment 6 months later. However, children's SIP did not significantly predict their social adjustment above and beyond the impact of parenting.

CONCLUSIONS

Results indicated that the quality of parenting that children received was more central to subsequent adjustment in peer interactions than were children's SIP operations. Furthermore, the quality of parenting children experienced was closely linked to parents' beliefs about their children and parents' mental health status. Directions for future research and potential implications for clinical practice are discussed.

Maternal Sensitivity Is Related to Hypothalamic-Pituitary-Adrenal Axis Stress Reactivity and Regulation in Response to Emotion Challenge in 6-Month-Old Infants

This study examined relations between maternal sensitivity as observed in a free play interaction and changes in levels of the glucocorticoid hormone cortisol in response to procedures designed to elicit negative affect in 6-month old infants. The sample included 1,292 families in predominantly rural and low-income communities in Pennsylvania and North Carolina. Results indicated that infants of more sensitive mothers had lower levels of cortisol at baseline and increased cortisol reactivity and regulation in response to the emotion procedures. Maternal negativity was unrelated to infant cortisol. Findings highlight the need for further research on variation in early caregiving and the development of the stress response in young children.

The role of children's ethnicity in the relationship between teacher ratings of attention-deficit/hyperactivity disorder and observed classroom behavior

Significant ethnic differences have been consistently documented on attention-deficit/hyperactivity disorder (ADHD) teacher rating scales. Whether these ethnic differences result from a teacher rating bias or reflect actual classroom behavior patterns is unknown. Ethnic differences between Caucasian and African American (AA) elementary schoolchildren on teacher ratings and codings of observed classroom behavior were examined with latent variables. In structural equation models, correlations between teacher ratings and observed classroom behavior suggested nonbiased teacher ratings of AA schoolchildren with diagnosed ADHD. Ethnic differences were documented for both teacher ratings of ADHD and classroom behavior. Differences in classroom behavior were attenuated when the behavior of an average child in the classroom was taken into account. Multiple explanations for this pattern of results are discussed.

Managing acute cardiac patients in and out of the hospital setting

The National Service Framework (NSF) for Coronary Heart Disease (CHD) (Department of Health, 2003) sets the standard of treating eligible acute myocardial infarction (AMI) patients within 60minutes of a call for help in order to improve survival rates and long-term quality-of-life for heart-attack patients.

Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial

OBJECTIVES

To assess the effectiveness of continuous PC6 acupressure as an adjunct to antiemetic drug therapy in the prevention and control of nausea and vomiting in the first 24h after myocardial infarction (MI).

DESIGN

Partially randomised, partially blinded placebo-controlled, exploratory clinical study.

SETTING

Coronary Care Unit, Torbay Hospital, Torquay, Devon.

PARTICIPANTS

A total of 301 consecutive patients (205 males, 96 females) admitted following acute MI.

INTERVENTION

The first 125 patients recruited received no additional intervention. Subsequent patients were randomised to receive either continuous PC6 acupressure or placebo acupressure.

OUTCOME MEASURES

(1) Incidence of post-MI nausea and/or vomiting, (2) severity of symptoms, (3) use of antiemetic drugs, over 24h.

RESULTS

There were no significant differences between the groups for the whole 24-h treatment period. However, the PC6 acupressure group experienced significantly lower incidence of nausea and/or vomiting during the last 20h (18%), compared with the placebo (32%) or control (43%) groups (P<0.05). The severity of symptoms and the need for antiemetic drugs were also reduced in the acupressure group, but these differences were not statistically significant.

CONCLUSIONS

Continuous 24-h PC6 acupressure therapy as an adjunct to standard antiemetic medication for post-MI nausea and vomiting is feasible and is well accepted and tolerated by patients. In view of its benefits, further studies are worthwhile using earlier onset of treatment.

Overt and covert dimensions of antisocial behavior in early childhood

The present study was designed to assess both the prevalence and structure of antisocial behavior in a normative sample of preschoolers. Prevalence estimates suggested that 40% of preschoolers exhibit at least one antisocial behavior each day. Furthermore, 10% of preschoolers exhibit six or more antisocial behaviors each day. Consistent with research based on older children, factor analyses provided support for conceptualizing antisocial behavior in early childhood as consisting of both overt and covert dimensions. While both overt and covert behaviors had acceptable test-retest reliability, only overt behaviors had acceptable interrater reliability. Finally both overt and covert dimensions of antisocial behavior were uniquely related to general measures of conduct problems, hyperactivity, and adult and peer conflict in the classroom setting. Findings are discussed with regard to early assessment and the developmental course of antisocial behavior.

Bone marrow leukemic progenitor cell content in pediatric T-lineage acute lymphoblastic leukemia patients with an isolated extramedullary first relapse

Isolated extramedullary relapse in childhood acute lymphoblastic leukemia (ALL) is associated frequently with the T-lineage immunophenotype and may be accompanied by occult bone marrow disease. We employed highly sensitive multiparameter flow cytometry and blast colony assays to quantify the leukemic progenitor cell (LPC) burden in the pretreatment bone marrows of 15 pediatric T-lineage ALL patients with an isolated extramedullary first relapse. Sites of extramedullary relapse were CNS (11 patients), testes (3 patients), and both CNS and testes (1 patient). Bone marrow LPC were detectable in 8 patients (53%) and undetectable in 7 patients (47%) at day 0 of post-relapse induction therapy, with LPC counts ranging from 0/10(6) mononuclear cells (MNC) to 518/10(6) MNC (mean +/- SEM, 50+/-34/10(6) MNC). Five of 9 patients with an early relapse (< 18 months after achieving a first complete remission [CR1]) and 3 of 6 patients with a late relapse (> or = 18 months from CR1) had detectable bone marrow LPC at day 0. Five of 8 patients with NCI-defined poor risk ALL and 3 of 7 patients with NCI-defined standard risk ALL had detectable LPC at day 0. Following post-relapse induction chemotherapy. LPC counts were detectable in bone marrows of 4 of 6 evaluated patients. Thus, approximately half of the extramedullary relapse T-lineage ALL patients studied had substantial occult involvement of the bone marrow. These findings may partly explain the previously observed poor prognosis of T-lineage patients following a CNS relapse.

High-dose carmustine, thiotepa and etoposide followed by autologous bone marrow rescue for the treatment of high risk central nervous system tumors

Forty-two patients (29 newly diagnosed) with high grade gliomas (n = 37), medulloblastoma (n = 2) or non-biopsied tumors (n = 3) with supratentorial (n = 24), brain stem (n = 11), posterior fossa (n = 5) or spinal (n = 2) location were eligible for this study with adequate organ function and no bone marrow tumor infiltration. Median patient age was 12.2 years (range, 0.7-46.8). A total of 600 mg/m2 BCNU, 900 mg/m2 thiotepa and 1500 or 750 mg/m2 etoposide (VP-16) was administered followed by autologous bone marrow reinfusion (ABMR). Twenty-one newly diagnosed patients received local irradiation (RT) post ABMR. Nine early deaths were observed (21%), as well as one secondary graft failure. Half of the patients aged 18 years or older experienced toxic deaths, whereas only 15% of patients younger than 18 years experienced toxic death (P = 0.05). Of 25 evaluable newly diagnosed patients, 20% achieved complete remission (CR) and 4% partial remission (PR), while 28% remained in continuing complete remission (CCR) and 44% remained with stable disease prior to RT. Of eight evaluable patients with recurrent disease, one achieved CR and two PR, while one remained in CCR and four with stable disease for 1 to 110.2 months. Overall survival was 36%, 24% and 17% at 1, 2 and 3 years following ABMR, with three newly diagnosed patients and one patient treated for recurrent disease being alive, without disease progression 64.4, 67.0, 86.3 and 110.2 months after ABMR, respectively. The combination of high-dose BCNU/ thiotepa/VP-16 has substantial toxicity but definite activity for high risk CNS tumors. Similar protocols with lower toxicity merit further evaluation in both newly diagnosed and recurrent CNS tumors.

Paucity of leukemic progenitor cells in the bone marrow of pediatric B-lineage acute lymphoblastic leukemia patients with an isolated extramedullary first relapse

Isolated extramedullary relapse in childhood acute lymphoblastic leukemia (ALL) may be accompanied by occult bone marrow disease. We used a highly sensitive assay to quantify leukemic progenitor cells (LPCs) in the bone marrow of such patients. Multiparameter flow cytometry and blast colony assays were used to detect LPCs in the bone marrow of 31 pediatric B-lineage ALL patients with an isolated extramedullary first relapse. Sites of relapse were central nervous system (22 patients), testes (7 patients), and eye (2 patients). Bone marrow (BM) LPC counts ranged from 0/10(6) mononuclear cells (MNCs) to 356/10(6) MNCs (mean +/- SE, 27.8+/-13.1/10(6) MNCs). LPCs were undetectable in 19 patients (61%). The BM LPC burden at the time of extramedullary relapse was similar, regardless of site (Wilcoxon P = 0.77) or time of relapse (Wilcoxon P = 0.80). Compared with higher risk, standard risk at initial diagnosis showed a trend for increased BM LPC burden (mean +/- SE, 44.6+/-17.1 versus 7.5+/-3.3; Wilcoxon P = 0.22). After successful postrelapse induction chemotherapy, LPC counts in 21 evaluated patients ranged from 0/10(6) to 175/10(6) MNCs (mean +/- SE, 15.9+/-9.6/10(6) MNCs). By comparison, LPC burden was higher after successful induction chemotherapy among children with an early BM relapse (range, 0 to 3262/ 106 MNC; mean +/- SE, 166+/-107; Wilcoxon P = 0.11). Thus, not all patients with an extramedullary relapse have occult systemic failure with substantial involvement of the bone marrow, and after reinduction therapy, LPC counts were lower in these patients than in patients treated for an overt BM first relapse.