Family poverty, neighbourhood greenspace and perinatal outcomes.

OBJECTIVE: The relationship between low income and adverse perinatal outcomes, such as low birth weight and developmental delays, is well established making the search for protective factors important. One such factor may be neighbourhood greenspace. This study elucidates the role of urban neighbourhood greenspace in the relationship between income and perinatal outcomes in a nationally representative birth cohort from the UK. METHODS: Data on 14 050 infants participating in the initial wave at age 9 months of the Millennium Cohort Study were used (51% male, 20% non-white, 52% living in disadvantaged areas). We tested whether the association between income and perinatal outcomes is moderated by urban greenspace (measured in deciles) before and after adjustments for confounding. The perinatal outcomes included birth weight, gestational age (in days), communication and motor delays. The models were adjusted for the infant's sex and ethnicity, mother's age, education, substance use and mental health as well as area disadvantage and air pollution. RESULTS: Neighbourhood greenspace moderated the association between income and gestational age, even after adjustment for all confounders, b=0.37, 95% CI (0.01, 0.72). For births in low-income households, in particular, it was associated with an increase in gestational age by an average of approximately 3 days. However, after adjustment, greenspace was not found to influence birth weight, communication or motor delays at age 9 months. CONCLUSION: The biophilic design of urban environments is a modifiable factor for improving perinatal outcomes in the UK as urban greenspaces appear to be mitigating the risk of preterm birth associated with family poverty.

Paternal and maternal psychological distress and adolescent health risk behaviors: The role of sensitive periods.

INTRODUCTION: Adolescent health risk behaviors are linked to poor physical and mental health outcomes. While past research shows that maternal psychological distress predicts those behaviors, we know less about the role of paternal psychological distress and the role of sensitive periods. METHODS: Using 11,128 data from families (50.5% female children) from the UK's Millennium Cohort Study, we examined the role of timing of exposure to paternal and maternal psychological distress in engagement in health risk behaviors (smoking, alcohol use, binge drinking, and sexual activity) at age 14. Paternal and maternal psychological distress, measured with the Kessler-6 scale, were assessed at child ages 3, 7, and 11. We performed path analysis, adjusting for key covariates, modeling maternal distress parallel to paternal, and allowing for autoregressive paths. RESULTS: Paternal distress experienced at age 11 predicted a higher likelihood of smoking at age 14. Maternal distress at age 7 also predicted a higher likelihood of smoking, alcohol use, and binge drinking, but only for boys. Moreover, maternal distress at age 3 was associated with a lower risk for alcohol use. Effects were not replicated in the sensitivity analysis we performed, including only families with resident biological fathers across the study period. Instead, maternal and paternal distress at age 11 raised girls' risk for binge drinking and sexual activity, respectively. CONCLUSIONS: Parental distress in early childhood does not predict adolescent health risk behaviors. In late childhood, however, both paternal and maternal distress seem to influence the likelihood of engagement in such behaviors.

The relationship between mental health and risky decision-making in children and adolescents: a scoping review.

BACKGROUND: Evidence from studies on adult participants and clinical samples of children suggest an association between risky decision-making and mental health problems. However, the extent and nature of this association in the general youth population remains unknown. Therefore, this scoping review explores the current evidence on the relationship between mental health (internalising and externalising symptoms) and risky decision-making in the general youth population. METHODS: A three-step search strategy was followed and applied to four databases. Selection criteria included participants < 18 years representative of the general population, and information on both risky decision-making (assessed using gambling tasks) and internalising /externalising symptoms. Data were extracted and synthesised for study and participant characteristics, aspects and measures for the main variables, and key findings. RESULTS: Following screening, twenty-one studies were retrieved. Non-significant associations were more frequent than significant associations for both internalising and externalising symptoms, particularly for social difficulties and broad externalising symptoms. Among the significant associations, hyperactivity/inattention and conduct problems appeared to be positively associated with risk-taking and negatively associated with quality of decision-making. However, patterns were less clear for links between risky decision-making and internalising symptoms, especially between risk-taking and anxiety symptoms. CONCLUSIONS: The present review suggests predominantly a lack of relationship between risky decision-making and mental health problems, and outlines several possible reasons for it. However, when specificity is considered carefully there seems to be a link between risk-taking and specific externalising problems. Future research should employ study designs aimed at disentangling the direction of this relationship and identifying specific aspects of mental health and risky decision-making that could be eventually addressed by tailored interventions.

A scoping review on self-regulation and reward processing measured with gambling tasks: Evidence from the general youth population.

Aberrant reward processing and poor self-regulation have a crucial role in the development of several adverse outcomes in youth, including mental health disorders and risky behaviours. This scoping review aims to map and summarise the evidence for links between aspects and measures of reward processing and self-regulation among children and adolescents in the general population. Specifically, it examined the direct associations between self-regulation (emotional or cognitive regulation) and reward processing. Studies were included if participants were <18 years and representative of the general population. Quantitative measures were used for self-regulation, and gambling tasks were used for reward processing. Of the eighteen studies included only two were longitudinal. Overall, the direction of the significant relationships identified depended on the gambling task used and the self-regulation aspect explored. Emotional regulation was measured with self-report questionnaires only, and was the aspect with the most significant associations. Conversely, cognitive regulation was mainly assessed with cognitive assessments, and most associations with reward processing were non-significant, particularly when the cognitive regulation aspects included planning and organisational skills. Nonetheless, there was some evidence of associations with attention, cognitive control, and overall executive functioning. More longitudinal research is needed to draw accurate conclusions on the direction of the association between self-regulation and reward processing.

Sibling effects on problem and prosocial behavior in childhood: Patterns of intrafamilial "contagion" by birth order.

We investigated longitudinal relations between siblings' problem and prosocial behavior, measured by the Strengths and Difficulties Questionnaire, among different sibship sizes in the UK's Millennium Cohort Study. We identified 3436 families with two children and 1188 families with three children. All children (cohort members and their older sibling [OS]) had valid data on behavior at two time points (in 2004 and 2006). Using structural equation model, we found that for internalizing and externalizing problems, OSs (MOS1 = 6.3 years, MOS2 = 9.1 years at T1) exerted a dominant effect on younger siblings (Mage = 3.12 years at T1; 49.7% boys) across sibship sizes. For prosocial behavior, there was OS dominance in two-child families and youngest sibling dominance in three-child families.

Changes in Early Childhood Irritability and Its Association With Depressive Symptoms and Self-Harm During Adolescence in a Nationally Representative United Kingdom Birth Cohort.

OBJECTIVE: This study aimed to investigate longitudinal associations between changes in early childhood irritability, and depressive symptoms and self-harm at 14 years. METHOD: We used data from 7,225 children in a UK-based general population birth cohort. Childhood irritability was measured at 3, 5, and 7 years using 4 items from 2 questionnaires (the Children's Social Behaviour Questionnaire [CSBQ] and the Strengths and Difficulties Questionnaire [SDQ]). Participants reported depressive symptoms via the short Mood and Feelings Questionnaire (sMFQ) and self-harm via a single-item question, at 14 years. We used multilevel models to calculate within-child change in irritability between 3 and 7 years and examined associations between irritability, and depressive symptoms and self-harm at 14 years using linear and logistic regression models, respectively. We adjusted for child and family sociodemographic/economic characteristics, mental health difficulties, and child cognitive development. RESULTS: Irritability at ages 5 and 7 years was positively associated with depressive symptoms and self-harm at age 14 years. Irritability that remained high between 3 and 7 years was associated with depressive symptoms and self-harm at 14 years in unadjusted (depressive symptoms: ß coefficient = 0.22, 95 % CI = 0.08-0.37, p = .003; self-harm: odds ratio = 1.09, 95 % CI = 1.01-1.16, p = .019) and adjusted models (depressive symptoms: ß coefficient = 0.31, 95 % CI = 0.17-0.45, p < .001; self-harm: odds ratio = 1.12, 95 % CI = 1.0.4-1.19, p = .004). Results were similar in imputed samples. CONCLUSION: Children with irritability that remains high between 3 and 7 years are more likely to report higher depressive symptoms and self-harm during adolescence. These findings support early intervention for children with high irritability and universal interventions in managing irritability for parents of preschool-aged children.

The role of social cognition in mental health trajectories from childhood to adolescence.

We investigated the association between an aspect of Theory of Mind in childhood, false-belief understanding, and trajectories of internalising (emotional and peer) and externalising (conduct and hyperactivity) problems in childhood and adolescence. The sample was 8408 children from the UK's Millennium Cohort Study, followed at ages 5, 7, 11, 14, and 17 years. Social cognitive abilities were measured at 5 and 7 years through a vignette version of the Sally-Anne task administered by an unfamiliar assessor in a socially demanding dyadic interaction. Internalising and externalising problems were measured via the Strengths and Difficulties Questionnaire at 7-17 years. Using latent growth modelling, and after controlling for sex, ethnicity, maternal education, verbal ability, and time-varying family income, we found that superior social cognitive abilities predicted a decrease in emotional problems over time. In sex-stratified analyses, they predicted decreasing conduct problem trajectories in females and lower levels of conduct problems at baseline in males.

The role of inflammation in the effects of peer victimisation and stressful life events on mental health in childhood.

Background: Peer victimisation represents a salient stressor during childhood. However, studies investigating the mechanism of its impact on children's mental health typically examine socio-cognitive factors as mediators. The current study sought to provide novel insight through testing a potential biological mechanism, inflammation. It also tested for pathway-specific effects by comparing how inflammation may mediate the effect of peer victimisation and that of another important stressor in childhood: adverse life events. Method: Data from 4,583 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) were used. Path analysis was carried out to investigate whether inflammation (IL-6 and CRP) at age 9 years mediates the effect of peer victimisation and stressful life events at age 8 years on internalising (peer and emotional) or externalising (hyperactivity and conduct) problems (measured at age 11 years), both before and after adjustment for potential confounders. Results: IL-6 partially mediated the effect of peer victimisation on peer problems, even after adjustment for potential confounders. Inflammation did not mediate the effect of stressful life events on either type of internalising problems. Neither stressor predicted externalising problems via inflammation. Conclusion: We did not find evidence that inflammation mediates the effect of stressful life events on mental health in childhood when they are considered alongside experiences of peer victimisation. Inflammation may already represent a form of biological embedding of peer victimisation in the early years.

The role of mild stressors in children's cognition and inflammation: positive and negative impacts depend on timing of exposure.

Although the impact of stressful life events (SLEs) on mental health is well-established, the research on the impact of such stressors on cognitive outcomes has produced mixed results. Arguably, the timing and severity of exposure may play a key role. In this study, we shed light on the relationship between timing of exposure to relatively minor SLEs and cognitive ability in children, while taking into account the role of a plausible biological mediator: inflammation. Using data from the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we explored the role of relatively minor SLEs, experienced during two crucial developmental stages: up to transition to school (1-4.5 years) and up to transition to puberty (5.5-8.5 years). We then tested if they may impact differently on inflammatory markers (serum C-reactive protein [CRP] and interleukin 6 [IL-6]) at age 9 and general intelligence, measured with the Wechsler Abbreviated Scale of Intelligence at age 15. Data (n = 4,525) were analyzed using path analysis while controlling for covariates. We found that when relatively minor stressful events were experienced up to transition to school they were significantly associated with higher IQ at age 15, whereas when experienced up to transition to puberty they were significantly associated with higher levels of IL-6 at age 9. Results were robust to adjustment for relevant covariates, including IQ at age 8. Mild stressors in childhood may result in positive (i.e., improved cognition) or negative (i.e., inflammation) outcomes depending on the timing of exposure.

The relationship between diurnal cortisol slope and cognitive development among children maltreated as infants.

Little is known about the role of hypothalamic-pituitary-adrenal (HPA) axis functioning for children's cognitive development, especially among vulnerable groups. The current study explores the relationship between diurnal cortisol slope and cognitive outcomes among children at the ages of 5 and 6 who have been maltreated as infants and involved with child protective services, using data from the National Survey of Child and Adolescent Well-Being (NSCAW) I (N=158). Multiple regression analyses showed that a greater decline in salivary cortisol from morning to evening was positively associated with scores on applied problems and expressive communication, even after adjustment for confounding. It was also associated with lower odds of cognitive disability. There were null associations with letter-word identification, passage comprehension, auditory comprehension, matrices, and vocabulary. Results suggest that children involved with child protective services as infants, and thus exposed early to likely 'toxic' levels of stressors, may face dysregulation of the HPA axis and particular difficulties in some aspects of cognitive function. Potential explanations and implications for policy are discussed.

The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review.

The physical environment is of critical importance to child development. Understanding how exposure to physical environmental domains such as greenspace, urbanicity, air pollution or noise affects aggressive behaviours in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review, we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of aggressive behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0-18 years. We used the GRADE system to appraise the evidence. Searches were performed in eight databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and interior home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of aggressive behaviour. Most of the studies were rated as having low or unclear risk of bias. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of aggressive behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of aggressive behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and aggression problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the underlying aetiological mechanisms for environmental influences on aggression, the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people.

The Relationship Between Bullying Victimization and Perpetration and Non-suicidal Self-injury: A Systematic Review.

Experience of bullying may be a significant risk factor for non-suicidal self-injury (NSSI). This study had three aims: to systematically investigate the association between bullying and NSSI, analyze the possible mechanisms underlying the two phenomena, and evaluate any differences between bullying victimization and bullying perpetration with respect to NSSI. A systematic search about the association between bullying victimization and perpetration and NSSI was conducted using specific databases (PubMed, Scopus, Science Direct). The following keywords were used in all database searches: "bullying" AND "NSSI" OR "peer victimization" and NSSI. The searches in PubMed, Scopus and Science Direct revealed a total of 88 articles about bullying or peer victimization and NSSI. However, only 29 met our inclusion criteria and were used for the present review. Overall, all studies examined victimization; four studies also evaluated the effects of perpetration and one included bully-victims. According to the main findings, both being a victim of bullying and perpetrating bullying may increase the risk of adverse psychological outcomes in terms of NSSI and suicidality in the short and the long run. To the best of our knowledge, this is the first review to systematically evaluate the relation between bullying victimization/perpetration and NSSI. The main results support a positive association. Future research should evaluate the possible role of specific mediators/moderators of the association between experience of bullying and NSSI.

Decision-making difficulties mediate the association between poor emotion regulation and eating disorder symptoms in adolescence.

BACKGROUND: The emergence of eating problems during childhood increases the risk for eating disorders (EDs) during young adulthood. Previous studies highlight a relationship between poor self-regulation and onset of eating pathology. In this study, we investigated whether this association is mediated by decision-making difficulties. METHODS: To test this hypothesis, we used data from the Millennium Cohort Study. Decision-making performance was assessed with the Cambridge Gambling Task at age 11. Principal components analysis was used to derive an index of ED symptoms at age 14. The trajectories of scores of two subscales of the Child Social Behaviour Questionnaire, Independence and Self-Regulation (ISR) and Emotional Dysregulation (EmotDy), were modelled from ages 3 to 7 years in a latent growth curve analysis. The individual predicted values of the intercept (set at baseline, 3 years) and the slope (rate of annual change) were then used in the mediation analysis. RESULTS: In our sample of 11 303 individuals, there was evidence for mediation by three measures of decision-making at age 11 (poor quality of decision-making, delay aversion and low risk-adjustment) in the association between EmotDy across ages 3-7 and ED symptoms at age 14 even after the adjustment for relevant covariates. We found no evidence of association between ISR and ED symptoms. CONCLUSION: Our findings suggest that emotion regulation processes during childhood may be relevant for the future onset of ED symptoms via their association with decision-making skills. These findings, obtained from a large, representative, sample, shed light on the relationship between self-regulation, decision-making and symptoms of EDs.

Reciprocal associations between affective decision-making and mental health in adolescence.

Poor affective decision-making has been shown to associate cross-sectionally with poor mental health in clinical populations. However, evidence from general population samples is scarce. Moreover, whether decision-making is prospectively linked to mental health in youth in the general population and whether such associations are reciprocal have yet to be examined. The present study examined bidirectional associations between various aspects of affective decision-making and emotional and behavioural problems at ages 11 and 14 years in 13,366 members of the Millennium Cohort Study. Decision-making (delay aversion, deliberation time, quality of decision-making, risk adjustment, risk-taking) and emotional (emotional symptoms, peer problems) and behavioural (conduct problems, hyperactivity/inattention) problems were measured using the Cambridge Gambling Task and the Strengths and Difficulties Questionnaire, respectively. Results of cross-lagged panel models adjusted for confounding revealed a negative reciprocal association between hyperactivity and quality of decision-making but also positive reciprocal associations between conduct problems and delay aversion, and between peer problems and deliberation time. Emotional problems and peer problems predicted a decrease in risk-taking, conduct problems predicted an increase in risk-taking, and hyperactivity predicted an increase in delay aversion and deliberation time. Furthermore, hyperactivity and conduct problems predicted less risk adjustment, and risk adjustment predicted fewer peer problems. The results suggest that behavioural problems are prospectively linked to greater risk-taking and lower risk adjustment in adolescence. Moreover, adolescents with behavioural problems tend to make poorer decisions and be more delay-averse, but also poorer quality of decision-making and increased delay aversion are associated with more behavioural problems over time.

Does decision-making at age 11 predict prodromal eating pathology at ages 14 and 17? A prospective, observational, UK population-based cohort study.

OBJECTIVES: We examined whether decision-making at age 11 and 14 is associated with prodromal eating pathology at age 14 and whether it would persist across adolescence and also be present at age 17. DESIGN: This prospective, observational, population-based cohort study used a longitudinal design. SETTING: Data from the Millennium Cohort Study (MCS), a UK longitudinal cohort study involving 19 244 families from England, Scotland, Wales and Northern Ireland, were analysed. PARTICIPANTS: We modelled data from 8922 boys and girls aged 11, 14 and 17 (MCS sweeps 5, 6 and 7). PRIMARY AND SECONDARY OUTCOMES: We investigated decision-making using the risk-taking, quality of decision-making, deliberation time, delay aversion and risk adjustment subscales of the Cambridge Gambling Task and prodromal eating pathology through binary response items measuring: body dissatisfaction (whether the participant perceived their body as being too overweight); intention to lose weight (whether participants reported a strong desire to lose weight); dietary restriction (whether participants reported actively eating less to influence their shape/weight) and excessive exercise (whether participants reported exercising in a driven way in order to influence weight/shape). Data were analysed using latent class analysis and logistic regression. RESULTS: Lower scores on quality of decision-making (OR=0.46) and deliberation time (OR=0.99) at age 14 were associated with prodromal eating pathology at both ages 14 and 17 (all p<0.05), indicating an association between less frequently opting to bet on the most likely outcome and taking less time to decide on which bet to choose and the persistence of prodromal eating pathology over adolescence. Lower deliberation time (OR=0.99) and delay aversion (OR=0.62) at 11 and lower risk-taking scores at 14 (OR=0.43) were associated with the absence of prodromal eating pathology at 14 and 17 (all p<0.05), indicating that a moderate approach under conditions of risk in childhood and mid-adolescence is associated with reduced eating pathology across adolescence. CONCLUSIONS: Training advantageous decision-making might protect from later prodromal eating pathology.

The role of inflammatory markers and cortisol in the association between early social cognition abilities and later internalising or externalising problems: Evidence from a UK birth cohort.

OBJECTIVE: Deficits in social cognition are associated with internalising (emotional and peer problems) and externalising (conduct problems and hyperactivity/inattention) symptoms in youth. It has been suggested that stress may be one of the mechanisms underlying these associations. However, no empirical studies have investigated if physiological stress can explain the prospective associations between social cognition deficits and internalising and externalising symptoms in the general youth population. This study addressed this question and focused on two indicators of physiological stress, dysregulated diurnal cortisol patterns and systemic inflammation. METHOD: Participants were 714 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort. Bayesian structural equation modelling was used to investigate a) the associations of social cognition abilities at ages 8, 11, and 14 years with internalising and externalising problems at age 17 years and b) the potential mediating effects of cortisol parameters at age 15 years and inflammatory markers [interleukin 6 (IL-6) and C-reactive protein (CRP)] at ages 9 and 16 years. RESULTS: We found that social cognition difficulties were associated with later internalising and externalising problems. Flattened diurnal cortisol slope was associated with hyperactivity/inattention problems two years later. Lower morning cortisol partially mediated the direct association between social communication deficits at 8 years and hyperactivity/inattention and conduct problems at 17 years, even after adjustments for inflammation and confounders (for hyperactivity/inattention: indirect effect = 0.07, 95% CI [0.00, 0.18], p = .042; for conduct problems: indirect effect = 0.04, 95% CI [0.00, 0.11], p = .040). We did not find a significant association between systemic inflammation and social cognition difficulties, internalising problems, or externalising problems. CONCLUSION: Our findings suggest that part of the effect of social communication difficulties in childhood on externalising problems in adolescence was mediated by lower morning cortisol. Hence, our study indicates that the hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis may be one of the physiological mechanisms linking some social cognition deficits to externalising problems.

Types of Eating Disorder Prodrome in Adolescence: The Role of Decision Making in Childhood.

Psychiatric disorders like eating disorders (EDs) might be underpinned by differences in decision making. However, little previous research has investigated this potential relationship using longitudinal data. This study aimed to understand how components of decision making (delay aversion, risk adjustment, risk taking, quality of decision making and deliberation time) measured by the Cambridge Gambling Task in the United Kingdom's Millennium Cohort Study (MCS; n = 11,303; female = 50.17%) at age 11 might explain clusters/types of ED prodrome involving body dissatisfaction, intention to lose weight, dietary restraint, excessive exercise and significant under/overweight measured in the MCS at age 14. Latent class analysis revealed two groups within the cohort: a non-prodromal eating pathology group, who were more likely to be of "average" weight, according to the UK90, with minimal disordered attitudes and behaviors in relation to eating and weight; and a second group with prodromal eating pathology, who had more body dissatisfaction, a desire to lose weight, were using dietary restriction and exercise to influence weight and were more likely to be "overweight" according to the UK90. Logistic regression showed that, after adjustment for confounding, higher risk-taking scores were associated with a 60% greater probability of being in the prodromal eating pathology group (b = 0.47, OR = 1.60, p < 0.01), and higher scores on quality of decision making were associated with a 30% lower probability of being in the prodromal eating pathology group (b = -0.34, OR = 0.70, p < 0.05). Helping young people to engage in moderate risk taking and improving decision making might reduce the later presence of ED prodromes.

Decision-Making in Childhood Predicts Prodromal Eating Pathology in Adolescence.

OBJECTIVE: Differences in decision-making under conditions of risk have been observed cross-sectionally in clinical groups of people with eating disorders but have never been studied longitudinally or in large cohorts. We investigated whether responses on the Cambridge Gambling Task (CGT), measured in the Millennium Cohort Study in childhood, would predict prodromal eating pathology in adolescence. METHOD: Regression models were built to explore relationships between CGT variables at age 11 years and prodromal eating pathology (body dissatisfaction, intention to lose weight, dietary restriction, significant under/overweight, and excessive exercise) at 14 years. RESULTS: In 11,303 boys and girls, those with better quality decision-making were 34% less likely to show an intention to lose weight (b = -0.40, odds ratio [OR] = 0.66, p < 0.05) and 34% less likely to be overweight (b = -0.41, relative risk ratio [RRR] = 0.66, p < 0.05). Those with higher risk-taking were 58% more likely to report dietary restriction (b = 0.45, OR = 1.58, p < 0.05) and 46% more likely to report excessive exercise (b = 0.38, OR = 1.46, p < 0.05). In the complete-cases sample, higher risk-adjustment scores were associated with a 47% increased risk of underweight (b = 0.39, RRR = 1.47, p < 0.05), and better quality of decision-making was associated with a 46% lower risk of overweight (b = -0.60, RRR = 0.54, p < 0.05). CONCLUSION: Disadvantageous decision-making in childhood may predict prodromal eating pathology in adolescence and might represent a prevention target.

The role of physical environmental characteristics and intellectual disability in conduct problem trajectories across childhood: A population-based Cohort study.

BACKGROUND: The paucity of research investigating the role of the physical environment in the developmental progression of conduct problems and the potential moderating effects of intellectual disability (ID) is surprising, given the clinical relevance of elucidating environmental determinants of disruptive behaviours. AIMS: To use data from a large UK cohort study to assess associations between physical environmental exposures, ID, and conduct problem trajectories. METHOD: The sample included 8168 Millennium Cohort Study children (1.9% with ID). Multilevel growth curve modelling was used to examine the role of physical environment characteristics in the developmental trajectories of conduct problems after adjustments for ID status. RESULTS: Exposure to external environmental domains was not associated with differences in children's conduct problems across development. Alternatively, internal aspects of the household environment: spatial density (b = 0.40, p < .001) and damp problems (b = 0.14, p < .001) were both significantly associated with increased trajectories. Various individual and familial covariates were positively associated with conduct problems over time, including: presence of ID (b = 0.96, p < .001), autism spectrum disorder (b = 1.18, p < .001), male sex (b = 0.26, p < .001), poverty (b = 0.19, p < .001), maternal depression (b = 0.65, p < .001), and non-nuclear family structure (b = 0.35, p < .001). Positive ID status appeared to moderate the effects of internal household spatial density, reporting a non-linear negative association with spatial density and conduct problems across development (b = -1.08, p < .01). CONCLUSIONS: Our findings highlight the potential harmful consequences of poor internal residential conditions on children's development of disruptive behaviours.

Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence.

BACKGROUND: Autism can be diagnosed from 2 years of age, although most autistic people receive their diagnosis later than this after they have started education. Research is required to understand why some autistic children are diagnosed late, and the level and nature of unmet need prior to diagnosis for late-diagnosed children. METHODS: We examined trajectories of emotional, behavioural and social difficulties (EBSDs) across childhood and adolescence, comparing 'earlier-diagnosed' (diagnosed 7 years or younger) with 'late-diagnosed' (diagnosed between 8 and 14 years) autistic children. Data were from the Millennium Cohort Study, a population-based UK birth cohort. EBSDs were measured using the parent-report Strengths and Difficulties Questionnaire, at 3, 5, 7, 11 and 14 years. We used Growth Curve Modelling to investigate levels and rates of change in these difficulties, and to compare earlier- (n = 146) and late-diagnosed (n = 284) autistic children. RESULTS: Aged 5, earlier-diagnosed autistic children had more emotional (i.e., internalising), conduct, hyperactivity and social difficulties; although clinical difficulties in these areas were nevertheless common in late-diagnosed children. There was a faster annual increase in scores for all domains for late-diagnosed children, and by age 14 years, they had higher levels of EBSDs. These results persisted when we ran adjusted models, to account for the late-diagnosed group having higher rates of late-diagnosed attention deficit/hyperactivity disorder, higher IQ, a higher proportion of females and older and more educated mothers. CONCLUSIONS: Emotional, behavioural and social difficulties are associated with, and may influence, the timing of autism diagnosis. Late-diagnosed autistic children often have high levels of mental health and social difficulties prior to their autism diagnosis, and tend to develop even more severe problems as they enter adolescence.