Internalizing Symptoms and Their Impact on Patient-Reported Health-Related Quality of Life and Fatigue among Patients with Craniopharyngioma During Proton Radiation Therapy.

OBJECTIVE: The aim of this study was to describe fatigue, health-related quality of life (HRQOL) and brain tumor-associated symptoms after surgical resection and during proton radiotherapy, using latent class analysis (LCA), and to determine if there is class membership change among pediatric patients with craniopharyngioma. METHODS: For all patients (n = 92), demographic and disease-related/clinical variables were attained, and patient reported outcomes were collected prior to proton therapy, at week three, and at the completion of proton therapy. The mean scores for fatigue, HRQOL, and brain tumor symptoms were compared over time and profiles were identified. Factors that influenced profile status and transition probability were examined. RESULTS: Fatigue, HRQOL, and brain tumor symptoms improved over time during proton therapy; however, a subset remained in the lower profile, profile 1, associated with increased internalizing behaviors, compared to profile 2. CONCLUSIONS: Future study should explore the bidirectional relationship of sleep, worry and anxiety in the context of ongoing radiotherapy.

Siblings at home: Moderating influence of sibling presence and composition on the relation between problem behaviors and Theory of Mind in early childhood.

Despite the prevalence of internalizing and externalizing difficulties in children, the impact of these problem behaviors on the development of important social cognitive skills, such as Theory of Mind (ToM), is not well-understood. Indeed, many studies that have explored relations between problem behaviors and ToM report inconsistent findings. A possible reason for these disparities may be a lack of accounting for social protective factors within the home, such as the presence and number of siblings. Here, we explored the moderating influence of sibling presence and number on the relation between problem behaviors (i.e., internalizing and externalizing) and ToM. A total of 184 children (88 boys; Mage = 64.6 months, SD = 10.39) completed six well-validated ToM tasks while mothers reported on their children's externalizing and internalizing behaviors. Children who had siblings living in the same home exhibited higher ToM than children without siblings. In addition, both sibling presence and number of siblings moderated the relation between children's externalizing behaviors and ToM, such that in children without siblings externalizing behaviors were negatively associated with ToM. In contrast, children with siblings had similar ToM regardless of externalizing behaviors. As well, children with relatively fewer siblings and higher externalizing behaviors displayed lower ToM than children with relatively more siblings and higher externalizing behaviors. We did not detect a moderating effect of sibling presence or number on the relation between internalizing behaviors and ToM. These findings provide support for siblings' protective utility within the context of children's social cognition.

Psychosocial Difficulties Profiles Among Youth with Intellectual Disabilities.

This study sought to identify the various configurations, or profiles, of internalizing and externalizing behaviors found among a sample of youth with intellectual disabilities (ID). These behaviors were assessed twice over one year, using self, parental, and teacher reports. Six variables were hypothesized to predict profile membership: Parent-child relationship (i.e., warmth and conflict), student-teacher relationship (i.e., warmth and conflict), peer acceptance, and peer victimization. To this end, we conducted Latent Profile Analysis among a sample of 393 youth with ID (aged 11-22 years old) recruited in Canada (French-speaking; n = 142; 49.30% boys) and Australia (English-speaking; n = 251; 67.30% boys). Our results revealed five profiles: (1) Adjusted (13.48%), (2) Mild School-related Difficulties (34.38%), (3) Underestimation of Mild Difficulties (12.40%), (4) High Difficulties (19.45%), and (5) Internalizing Difficulties Unobserved at School (20.19%). These profiles, as well as profile membership, remained stable over time. Lower levels of student-teacher warmth, lower levels of peer acceptance, and higher levels of peer victimization were associated with a higher likelihood of membership into profiles characterized by above-average levels of psychosocial difficulties, especially self-reported. Based on these findings, future interventions addressing internalizing and externalizing behaviors could benefit from focusing on the school environment, notably peer acceptance and student-teacher warmth.

Direct and Indirect Longitudinal Associations of Mother and Father Engagement in Middle Childhood on Adolescent Externalizing and Internalizing Behaviors.

Parent engagement is an important aspect of parenting during childhood. However, little is known about the unique longitudinal associations of mother and father engagement with adolescents' externalizing and internalizing problem behaviors. This study uses Future of Families and Child Wellbeing Study data to examine the potential direct and indirect associations of parent engagement at age 9 on adolescent externalizing and internalizing behaviors at age 15. The analytic sample size is 1349, and at age 9, the mean age of children was 9.40 years (SD = 0.37). Forty-eight percent of children were female and 68% of them were from the married families. The results show that while controlling for mother engagement, higher father engagement at age 9 was directly associated with fewer adolescent internalizing behaviors, only among adolescent boys and in married families. In addition, among adolescent boys, father engagement had an indirect association with externalizing behaviors through father-child closeness. Mother engagement, however, is only found to have an indirect association with adolescents' externalizing and internalizing behaviors through maternal hostility (while controlling for father engagement). The results for mother engagement held for boys and in married families only. The findings indicate that both mother and father engagement during childhood is important and helpful to prevent adolescent problem behaviors directly or indirectly via parent-child relationship.

Predictors of Adolescent Internalizing and Externalizing Mental Health Symptoms: A School-Based Study in Southern India.

INTRODUCTION: Mental illnesses are one of the major contributors to the overall burden of disease among the young. We investigated the predictors of emotional and behavioral problems among in-school adolescents in the Indian context. METHODS: Using stratified sampling, 1441 adolescents were recruited to participate in the study in Udupi taluk. The study instruments included a socio-demographic pro forma and the adolescent self-reporting version of the Strengths and Difficulties Questionnaire (SDQ) to assess the emotional and behavioral problems among them. We explored the predictors of total difficulties, as well as externalizing and internalizing problems and gender differences. SPSS version 25 was used to analyze the data. Descriptive statistics, a Chi-square test for associations, an independent t-test to explore the gender differences, correlation analysis, and backward stepwise logistic regression for the predictors were used. RESULTS: The mean age of the participants was 15.31 ± 0.76. An almost equal percentage of male (49.6%) and female (50.4%) participants provided data. Abnormal scores were highest under conduct problems (8.5%), and the total difficulties reached 5.1%. The male participants had higher levels of conduct, hyperactivity, peer relationship, and externalizing problems the while the female participants experienced higher levels of emotional and internalizing problems. It was observed that there was a significant positive relationship between age and emotional problems, conduct problems, hyperactivity, peer problems, and total SDQ score. An older age predicted an abnormal total difficulties score and externalizing and internalizing behaviors, while the type of school predicted the total difficulties and internalizing behaviors. CONCLUSION: The age of the adolescent, their gender, and the type of school they attended emerged as predictors of the emotional and behavioral problems among them.

Gestational PBDE concentrations, persistent externalizing, and emerging internalizing behaviors in adolescents: The HOME study.

BACKGROUND: Polybrominated diphenyl ethers (PBDEs) are ubiquitous environmental chemicals used as flame retardants in commercial and consumer products. Gestational PBDE concentrations are associated with adverse behaviors in children; however, the persistence of these associations into adolescence remains understudied. OBJECTIVE: We estimated the association of gestational PBDE serum concentrations with early adolescent self- and caregiver-reported behaviors at age 12 years and determined the consistency with previously observed associations in childhood with caregiver-reported behaviors in a prospective pregnancy and birth cohort. METHODS: We measured maternal serum concentrations of five individual PBDE congeners and created a summary exposure variable (∑5BDE: 28, -47, -99, -100 and -153) during pregnancy. At age 12 years, we assessed behaviors for 237 adolescents using self- and caregiver-reports with the Behavioral Assessment System for Children-3 (BASC3). We used multivariable linear regression models to estimate covariate-adjusted associations of lipid standardized, log10-transformed gestational PBDE concentrations with BASC3 scores. We obtained estimates and 95% confidence intervals through a bootstrapping approach. We evaluated potential effect measure modification (EMM) of adolescent sex by examining sex-stratified regression models and estimating the EMM p-values. RESULTS: Gestational PBDE concentrations were positively associated with adolescent-reported BASC3 composite indices for inattention & hyperactivity (BDE-28, -47, -99, -100, ∑5BDE), internalizing problems (BDE-28, -47, -99), functional impairment (BDE-28, ∑5BDE), and emotional symptoms (BDE-28). Gestational PBDE concentrations were positively associated with caregiver-reported BASC3 composite indices for externalizing problems (BDE-28, -47, -99, -100, -153, ∑5BDE) and behavioral symptoms (BDE-99). For caregiver reported behaviors, we observed stronger associations with gestational BDE concentrations among males, especially for executive functioning (BDE-28, -47, -99, -100, ∑5BDE). DISCUSSION: Gestational PBDE serum concentrations were associated with self-reported internalizing and externalizing behavior problems in early adolescence. Caregiver-reported externalizing behaviors recognized during childhood remain associated with gestational PBDE concentrations and persist into early adolescence. Internalizing behaviors were less recognized by caregivers.

Contamination bias in the estimation of child maltreatment causal effects on adolescent internalizing and externalizing behavior problems.

BACKGROUND: When unaddressed, contamination in child maltreatment research, in which some proportion of children recruited for a nonmaltreated comparison group are exposed to maltreatment, downwardly biases the significance and magnitude of effect size estimates. This study extends previous contamination research by investigating how a dual-measurement strategy of detecting and controlling contamination impacts causal effect size estimates of child behavior problems. METHODS: This study included 634 children from the LONGSCAN study with 63 cases of confirmed child maltreatment after age 8 and 571 cases without confirmed child maltreatment. Confirmed child maltreatment and internalizing and externalizing behaviors were recorded every 2 years between ages 4 and 16. Contamination in the nonmaltreated comparison group was identified and controlled by either a prospective self-report assessment at ages 12, 14, and 16 or by a one-time retrospective self-report assessment at age 18. Synthetic control methods were used to establish causal effects and quantify the impact of contamination when it was not controlled, when it was controlled for by prospective self-reports, and when it was controlled for by retrospective self-reports. RESULTS: Rates of contamination ranged from 62% to 67%. Without controlling for contamination, causal effect size estimates for internalizing behaviors were not statistically significant. Causal effects only became statistically significant after controlling contamination identified from either prospective or retrospective reports and effect sizes increased by between 17% and 54%. Controlling contamination had a smaller impact on effect size increases for externalizing behaviors but did produce a statistically significant overall effect, relative to the model ignoring contamination, when prospective methods were used. CONCLUSIONS: The presence of contamination in a nonmaltreated comparison group can underestimate the magnitude and statistical significance of causal effect size estimates, especially when investigating internalizing behavior problems. Addressing contamination can facilitate the replication of results across studies.

Comparing two measures of neighborhood quality and internalizing and externalizing behaviors in the adolescent brain cognitive development study.

PURPOSE: There is widespread recognition of the importance and complexity of measuring neighborhood contexts within research on child psychopathology. In this study, we assessed the cross-sectional associations between two measures of neighborhood quality and internalizing and externalizing behaviors in preadolescence. METHODS: Drawing on baseline data from the Adolescent Brain Cognitive Development Study (n = 10,577 preadolescents), we examined two multi-component assessments of neighborhood quality in relation to children's internalizing and externalizing symptoms: the Area Deprivation Index (ADI), which measures socioeconomic adversity, and the Child Opportunity Index 2.0 (COI), which measures economic, educational, and environmental opportunity. Both measures were categorized into quintiles. We then used mixed-effects linear regression models to examine bivariate and adjusted associations. RESULTS: The bivariate associations displayed strong inverse associations between the COI and ADI and externalizing symptoms, with a graded pattern of fewer externalizing behaviors with increasing neighborhood quality. Only the ADI was associated with externalizing behaviors in models adjusted for child and family characteristics. We did not observe a clear association between either measure of neighborhood quality and internalizing behaviors in bivariate or adjusted models. CONCLUSIONS: Neighborhood quality, as measured by the COI and ADI, was associated with externalizing behaviors in preadolescent children. The association using the ADI persisted after adjustment for family-level characteristics, including financial strain. Our results indicate that different assessments of neighborhood quality display distinct associations with preadolescent behavioral health. Future research is needed to assess the association between neighborhood quality and behavior trajectories and to identify place-based intervention strategies.

Across ages and places: Unpredictability of maternal sensory signals and child internalizing behaviors.

BACKGROUND: Patterns of sensory inputs early in life play an integral role in shaping the maturation of neural circuits, including those implicated in emotion and cognition. In both experimental animal models and observational human research, unpredictable sensory signals have been linked to aberrant developmental outcomes, including poor memory and effortful control. These findings suggest that sensitivity to unpredictable sensory signals is conserved across species and sculpts the developing brain. The current study provides a novel investigation of unpredictable maternal sensory signals in early life and child internalizing behaviors. We tested these associations in three independent cohorts to probe the generalizability of associations across continents and cultures. METHOD: The three prospective longitudinal cohorts were based in Orange, USA (n = 163, 47.2 % female, Mage = 1 year); Turku, Finland (n = 239, 44.8 % female, Mage = 5 years); and Irvine, USA (n = 129, 43.4 % female, Mage = 9.6 years). Unpredictability of maternal sensory signals was quantified during free-play interactions. Child internalizing behaviors were measured via parent report (Orange & Turku) and child self-report (Irvine). RESULTS: Early life exposure to unpredictable maternal sensory signals was associated with greater child fearfulness/anxiety in all three cohorts, above and beyond maternal sensitivity and sociodemographic factors. The association between unpredictable maternal sensory signals and child sadness/depression was relatively weaker and did not reach traditional thresholds for statistical significance. LIMITATIONS: The correlational design limits our ability to make causal inferences. CONCLUSIONS: Findings across the three diverse cohorts suggest that unpredictable maternal signals early in life shape the development of internalizing behaviors, particularly fearfulness and anxiety.

Mediating Effect of Life Satisfaction on the Relationship between Hope and Internalizing/Externalizing Behaviors among Chinese Adolescents.

This study aimed to examine the mediating effect of life satisfaction in the relationship between hope and internalizing/externalizing behaviors among a sample of 1170 Chinese adolescents (mean age = 14.80 ± 1.76 years, 46.24% boys). Through the use of structural equation modeling (SEM), the study revealed a negative association between hope and internalizing/externalizing behaviors. Furthermore, the findings indicated that life satisfaction partially mediated the relationship between hope and internalizing/externalizing behaviors. The findings highlight the significance of hope and life satisfaction as protective factors in reducing internalizing/externalizing behaviors among adolescents. These results also contribute to the existing research on the role of hope and emphasize the importance of fostering hope and enhancing life satisfaction in prevention and intervention programs targeting adolescent internalizing/externalizing behaviors.

Prenatal cocaine exposure and self-reported behavioral adjustments from ages 12 to 21: environmental pathways.

BACKGROUND: In a birth-cohort study, we followed offspring with prenatal cocaine exposure (PCE) to investigate longitudinal associations of PCE with self-reported behavioral adjustment from early adolescence to emerging adulthood (EA). Environmental pathways (family functioning, non-kinship care, maltreatment) were specified as potential mediators of PCE. METHODS: Participants were 372 (190 PCE; 47% male), primarily Black, low socioeconomic status, enrolled at birth. Internalizing and externalizing behaviors were assessed using Youth Self-Report at ages 12 and 15 and Adult Self-Report at age 21. Extended random-intercept cross-lagged panel modeling was used to account for potential bidirectional relationships between internalizing and externalizing behaviors over time, examining potential mediators. RESULTS: Adjusting for covariates, significant indirect effects were found for each mediator at different ages. For family functioning, these were both internalizing (ß = 0.83, p = 0.04) and externalizing behaviors (ß = 1.58, p = 0.02) at age 12 and externalizing behaviors at age 15 (ß = 0.51, p = 0.03); for non-kinship care, externalizing behaviors at ages 12 (ß = 0.63, p = 0.02) and 15 (ß = 0.20, p = 0.03); and for maltreatment, both internalizing and externalizing behaviors at ages 15 (ß = 0.64, p = 0.02 for internalizing; ß = 0.50, p = 0.03 for externalizing) and 21 (ß = 1.39, p = 0.01 for internalizing; ß = 1.11, p = 0.01 for externalizing). Direct associations of PCE with internalizing and externalizing behaviors were not observed, nor cross-lagged relationships between internalizing and externalizing behaviors. CONCLUSIONS: Negative associations of PCE with behavioral adjustment persist into EA via environmental pathways, specifying intervention points to disrupt adverse pathways toward healthy development.

Risk of suicidal behavior as a function of alcohol use disorder typologies: A Swedish population-based study.

BACKGROUND AND AIMS: Alcohol use disorder (AUD) is one of the strongest predictors of suicidal behavior. Here, we measured risk of suicide attempt and death as a function of AUD typologies. DESIGN: We used AUD typologies from previous latent class analysis: (i) externalizing subtype (characterized by externalizing symptomatology and early age of onset; individuals in this group have lower education and higher familial/social difficulties); (ii) subtype described by minimal psychopathology; and (iii) internalizing subtype (characterized by internalizing symptomatology and later age of onset; individuals in this group have higher education). We used class membership to predict distal outcomes (attempt and death) and performed regressions to evaluate whether differences in suicidal behavior were explained by the group characteristics (sex, age of onset, number and type of AUD registrations, familial/genetic risk for AUD, externalizing and internalizing behaviors, socio-economic indicators, marital status and childhood family status). We also evaluated the effect of suicide attempt prior to AUD. SETTING AND PARTICIPANTS: Based on longitudinal Swedish registry data, we included 217 074 individuals with AUD born 1950-80. MEASUREMENTS: Suicide attempts were identified using medical registers and deaths using the mortality register. FINDINGS: Individuals with the externalizing subtype had higher risks of suicidal behavior than other groups [attempt: externalizing versus minimal psychopathology: odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.35, 1.35; externalizing versus internalizing: OR = 1.47, 95% CI = 1.46, 1.48; death: externalizing versus minimal psychopathology: OR = 1.57, 95% CI = 1.57, 1.58; externalizing versus internalizing: OR = 1.99, 95% CI = 1.93, 2.06]. Individuals with minimal psychopathology had higher risks than those with internalizing symptomatology (attempt: OR = 1.09, 95% CI = 1.08, 1.10, death: OR = 1.26, 95% CI = 1.23, 1.30). These differences were explained by age at registration and were related to the number of registrations, sex, education, family disruption and suicide attempt prior to AUD. CONCLUSIONS: Among people in Sweden, considering alcohol use disorder (AUD) heterogeneity appears to be a meaningful way to evaluate suicide risk. The highest risk of suicide attempt and death occurs in the externalizing subtype of AUD, followed by the minimal psychopathology subtype, and then the internalizing subtype.

Assessing the benefits of the "Intergalactic World" social emotional learning program for 8-12-year-old children in Portugal: perspectives from teachers and caregivers.

Introduction: "Intergalactic World" is a new social-emotional program designed to reduce psychopathological symptoms and improve social and emotional skills in children aged 8-12. This study aims to evaluate the program's benefits from teachers' and caregivers' perspectives, focusing on internalizing and externalizing behaviors. Methods: The findings were obtained through self-reported measures using a pretest-posttest design with a follow-up period, but with no control group. One hundred fifty-four children (M age = 9.66, SD = 0.78) participated in this intervention study. Eleven teachers completed the Teacher's Report Form (TRF) for these children, and 133 caregivers completed the Child Behavior Checklist (CBCL). Participants without caregivers' reports were excluded from the analysis. Data were collected at three-time points: before the intervention (T1), immediately after (T2), and 6 months after the implementation of the program (T3). Results: Results (n = 133) showed an effect of time on the Internalization scores (at T3 for teachers and T2 and T3 for caregivers) with no gender effect and a decrease in the perception of externalizing behaviors with a gender effect: Boys were perceived as exhibiting more externalizing behaviors than girls. However, these behaviors significantly decrease at T3 for teachers and at T2 and T3 for caregivers. Discussion: Despite its limitations, this study highlights the benefits of employing social-emotional programs to help reduce children's internalizing and externalizing behaviors. A multi-informant approach enables a comprehensive analysis and provides insights into the child's significant contexts and interactions with adults.

COVID-19 Pandemic and Changes in Children's Behavioral Problems: The Mediating Role of Maternal Depressive Symptoms.

The COVID-19 pandemic has been linked to a range of behavioral problems in children. To date, however, longitudinal studies with data prior to the pandemic are rare, and moreover, few studies have examined the family context. This is notable as evidence suggests that mothers were highly vulnerable to the effects of the pandemic, and stress proliferation models would argue that children's wellbeing are undoubtedly affected by maternal wellbeing. In the current investigation, we examine changes in maternal depressive symptoms and children's behavioral problems from prior to the pandemic to the first few months of COVID-19 in the U.S. The results suggest a significant increase in children's internalizing problems and maternal depressive symptoms. Consistent with stress proliferation models, the relationship between COVID-19-related stressors and children's behavioral problems were mediated by maternal mental health.

Conductas internalizantes y externalizantes en jóvenes universitarios peruanos afectados por violencia familiar / Internalizing and externalizing behaviors in young peruvian university students affected by family violence / Comportamentos internalizando e externalizando em jovens universitários peruanos afetados pela violência familiar

Debido al aislamiento social que se vivió gracias a la pandemia por Covid-19, las horas de convivencia familiar aumentaron en cada hogar, convirtiéndose en un potencial peligro cuando el entorno familiar más cercano está lleno de violencia; esto puede traer diversos problemas a la salud física, psicológica y emocional. Por ello, se buscó identificar los principales tipos de violencia familiar que han experimentado los jóvenes universitarios, distinguir entre las conductas externalizantes e internalizantes como consecuencia de estos eventos adversos, así como conocer la relación estadística entre las variables de estudio. La investigación tuvo un enfoque cuantitativo, alcance correlacional y con diseño no experimental transversal; la muestra final estuvo constituida por 374 estudiantes de tres universidades de Lima, Perú. Según los hallazgos, la violencia psicológica es la que se presenta con mayor frecuencia, la ansiedad-depresión y el retraimiento son las dos conductas más comunes y los índices de correlación entre las variables son positivos y significativos. Las mujeres presentan más puntaje en las conductas internalizantes, mientras que los varones en las externalizantes; así mismo, se encontró que los más jóvenes presentan más conductas externalizantes. Finalmente, se evidenció la existencia de violencia familiar en los hogares de los jóvenes universitarios, lo cual se ha traducido en diversos tipos de conducta que podrían afectar su salud y también su rendimiento académico.

Due to the social isolation that was experienced thanks to the Covid-19 pandemic, the hours of family life increased in each home, becoming a potential danger when the closest family environment is full of violence; this can bring various problems to physical, psychological and emotional health. Therefore, we sought to identify the main types of family violence that university students have experienced, distinguish between externalizing and internalizing behaviors as a consequence of these adverse events, as well as knowing the statistical relationship between the study variables. The research was a quantitative, correlational and a non-experimental cross-sectional design; the sample consisted of 374 students from three universities in Lima, Peru. According to the findings, psychological violence is the one that occurs most frequently, anxiety-depression and withdrawal are the two most common behaviors and the correlation rates between the variables are positive and significant. Women present higher scores in internalizing behaviors, while men in externalizing ones; Likewise, it was found that the youngest present more externalizing behaviors. The existence of family violence in the homes of university students was evidenced, which has resulted in various types of behavior that could affect their health and also their academic performance.

Pathways to Children's Behavioral Problems during the COVID-19 Pandemic: Fathers' Parenting Stress and Parenting Approaches.

Although the family stress model theoretically focuses on the roles of both mothers and fathers as predictors of children's outcomes, studies generally have focused on mothers. The pandemic has brought additional burdens to parents' daily functioning, including fathers' involvement in childcare. The current study aimed to examine the contributions of fathers' parenting stress and parenting approaches to their children's behavior problems during the COVID-19 pandemic. Particularly, we examined the indirect effects of parenting stress on children's behavior problems via parenting practices. The participants were 155 fathers (Mage = 36.87, SD = 5.11) and their children (71 girls, 84 boys; Mage = 59.52, SD = 14.98) from Turkish contexts. The fathers reported their parenting stress, approaches, and children's behavioral problems. The results from the path analysis showed that parenting stress predicted children's internalizing and externalizing behaviors. Parenting stress also predicted severe punishment and obedience as parts of the parenting approach. Finally, parenting stress was indirectly related to children's externalizing behaviors via the punishment-based parenting approach of fathers. The findings of the current study highlighted the importance of examining the roles of fathers during the COVID-19 pandemic. Intervention programs targeting reducing fathers' parenting stress and negative parenting approaches would also be beneficial for reducing children's behavioral problems.

Greater Gestational Vitamin D Status is Associated with Reduced Childhood Behavioral Problems in the Environmental Influences on Child Health Outcomes Program.

BACKGROUND: Vitamin D deficiency is common in pregnancy. Vitamin D plays an important role in the developing brain, and deficiency may impair childhood behavioral development. OBJECTIVES: This study examined the relationship between gestational 25(OH)D concentrations and childhood behavior in the Environmental influences on Child Health Outcomes (ECHO) Program. METHODS: Mother-child dyads from ECHO cohorts with data available on prenatal (first trimester through delivery) or cord blood 25(OH)D and childhood behavioral outcomes were included. Behavior was assessed using the Strengths and Difficulties Questionnaire or the Child Behavior Checklist, and data were harmonized using a crosswalk conversion. Linear mixed-effects models examined associations of 25(OH)D with total, internalizing, and externalizing problem scores while adjusting for important confounders, including age, sex, and socioeconomic and lifestyle factors. The effect modification by maternal race was also assessed. RESULTS: Early (1.5-5 y) and middle childhood (6-13 y) outcomes were examined in 1688 and 1480 dyads, respectively. Approximately 45% were vitamin D deficient [25(OH)D < 20 ng/mL], with Black women overrepresented in this group. In fully adjusted models, 25(OH)D concentrations in prenatal or cord blood were negatively associated with externalizing behavior T-scores in middle childhood [-0.73 (95% CI: -1.36, -0.10) per 10 ng/mL increase in gestational 25(OH)D]. We found no evidence of effect modification by race. In a sensitivity analysis restricted to those with 25(OH)D assessed in prenatal maternal samples, 25(OH)D was negatively associated with externalizing and total behavioral problems in early childhood. CONCLUSIONS: This study confirmed a high prevalence of vitamin D deficiency in pregnancy, particularly among Black women, and revealed evidence of an association between lower gestational 25(OH)D and childhood behavioral problems. Associations were more apparent in analyses restricted to prenatal rather than cord blood samples. Interventions to correct vitamin D deficiency during pregnancy should be explored as a strategy to improve childhood behavioral outcomes.

Children's internalizing behavior development is heterogeneously associated with the pace of epigenetic aging.

BACKGROUND: Internalizing behaviors are an indicator of children's psychological and emotional development, predicting future mental disorders. Recent studies have identified associations between DNA methylation (DNAm) and internalizing behaviors. This prospective study aimed at exploring the associations between pace of biological aging and the developmental trajectories of internalizing behaviors. METHODS: Participants were children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (N = 974). Measures of DNA methylation were collected at birth, age 7 and ages 15-17. The pace of aging was estimated using the DunedinPoAm algorithm (PoAm). Internalizing behaviors reported by caregivers between ages 4 and 16 using the Strengths and Difficulties Questionnaire. To explore heterogeneity in the association between PoAm and internalizing behaviors we use Poisson quantile regression in cross-section heterogeneity and longitudinal latent class analysis over the childhood and adolescence. RESULTS: Internalizing behavior trajectories were identified: low-risk, childhood limited, late onset and early onset (persistent). Accelerated aging at birth was negatively associated with internalizing behaviors in early childhood but positively correlated during adolescence. Higher PoAm at birth increased chance of low-risk profile, while decreasing likelihood of childhood limited trajectory. PoAm at age 15 was negatively associated with childhood limited profile and positively linked to late onset trajectories. Associations were larger at higher values of internalizing symptoms. CONCLUSIONS: The heterogeneity in the association between biological age acceleration and internalizing behaviors suggests a complex dynamic relationship, particularly in children with high or increased risk of adverse mental health outcomes.

Child Behavior Problems and Parenting Stress in Underserved Families of Children with ASD: Investigation of Family Resources and Parenting Self-efficacy.

Behavior problems in children with autism spectrum disorder (ASD) may exacerbate parenting stress. Parenting self-efficacy and family resources may influence this association. We examined cross-sectional statistical mediation effects of parenting self-efficacy on the relationship between child behavior problems and parenting stress and hypothesized that family-level resources moderated this indirect effect. Participants included 132 underserved (Medicaid-eligible) children with ASD (ages 3-13) with racial/ethnic diversity; many (63%) had intellectual disability. Greater externalizing problems were linked with lower parenting self-efficacy, which in turn was associated with increased parenting stress. A larger mediation effect was observed for families with fewer resources. A plausible alternative model (parenting stress mediating parenting self-efficacy) exhibited poorer fit. Implications for family supports and benefits of longitudinal follow-up are discussed.

A path model examination: maternal anxiety and parenting mediate the association between maternal adverse childhood experiences and children's internalizing behaviors.

BACKGROUND: Children of mothers with adverse childhood experiences (ACEs) are at increased risk for developmental problems. However, the mechanisms through which a mother's experience of ACEs are transmitted to her offspring are understudied. The current study investigates potential modifiable mediators (maternal psychopathology and parenting) of the association between maternal ACEs and children's behavioral problems. METHODS: We utilized data from a pregnancy cohort study (N = 1030; CANDLE study) to investigate longitudinal associations between maternal ACEs, postpartum anxiety, observed parenting behavior, and child internalizing behaviors (meanage = 4.31 years, s.d. age = 0.38) in a racially diverse (67% Black; 33% White/Other) sample. We used structural equation modeling to test for direct associations between maternal ACEs and children's internalizing behaviors, as well as indirect associations via two simple mediations (maternal anxiety and parenting), and one serial mediation (sequence of maternal anxiety to parenting). RESULTS: Simple mediation results indicated that maternal anxiety and cognitive growth fostering behaviors independently mediated the association between maternal ACEs and child internalizing. We observed no evidence of a serial mediation from ACEs to internalizing via the effects of maternal anxiety on parenting. CONCLUSIONS: This study supports and refines extant literature by confirming the intergenerational association between maternal ACEs and child internalizing behaviors in a large, diverse sample, and identifies potential modifiable mediators: maternal anxiety and parenting behaviors related to fostering cognitive development. Findings may inform interventions targeting mothers who have experienced ACEs and suggest that providing support around specific parenting behaviors and addressing maternal anxiety may reduce internalizing behaviors in children.