Associations between Adolescents' Interpersonal Relationships, School Well-being, and Academic Achievement during Educational Transitions.

A youth's ability to adapt during educational transitions has long-term, positive impacts on their academic achievement and mental health. Although supportive relationships with parents, peers, and teachers are protective factors associated with successful educational transitions, little is known about the reciprocal link between the quality of these interpersonal relationships and school well-being, with even less known about how these two constructs affect academic achievement. This longitudinal study examined how the quality of interpersonal relationships and school well-being worked together to affect academic achievement during the transition from primary school to lower secondary school. Data were collected from 848 Finnish adolescents (54% girls, mean age at the outset 12.3 years) over the course of sixth and seventh grade. The results support a transactional model illustrating the reciprocal associations between the quality of interpersonal relationships and school well-being during the transition to lower secondary school. As such, the presence of high quality interpersonal relationships promoted higher academic achievement through increased school well-being, whereas high school well-being promoted higher subsequent academic achievement through increased quality of interpersonal relationships. Overall, the results suggest that promoting learning outcomes and helping adolescents with challenges during educational transitions is a critical part of supporting school well-being and the formation of high-quality interpersonal relationships.

Resolving reading disability-Childhood predictors and adult-age outcomes.

We examined frequency of adult-age reading disability (RD) and its childhood predictors among 48 adults (20 to 39 years) with documented childhood RD, and contrasted their cognitive skills, education, and employment with 37 matched controls. Among individuals with childhood RD, more than half had improved in their reading fluency to the level where the set criterion for adult-age RD was not met anymore. More fluent rapid naming, less severe childhood RD, and multiple support providers in childhood together predicted improvement of reading fluency. More fluent naming differentiated the childhood RD participants whose reading fluency had improved by adult-age from those participants whose RD persisted to adult-age. All the individuals with childhood RD performed weaker than the controls in adult-age working memory, processing speed, and verbal skills. Educational level among both RD groups was lower than that among the controls. Unemployment of individuals with persistent adult-age RD (31.6%) was higher than that of individuals with improved adult-age RD (13.8%) or that of the controls (8.1%). According to our findings, rapid naming is one evident factor differentiating individuals with persisted RD from those with ameliorated reading fluency. Also, better adult-age reading fluency has significance for adult-age employment among individuals with childhood RD.

Reducing Stress and Enhancing Academic Buoyancy among Adolescents Using a Brief Web-based Program Based on Acceptance and Commitment Therapy: A Randomized Controlled Trial.

Acceptance and commitment therapy programs have rarely been used as preventive tools for alleviating stress and enhancing coping skills among adolescents. This randomized controlled trial examined the efficacy of a novel Finnish web- and mobile-delivered five-week intervention program called Youth COMPASS among a general sample of ninth-grade adolescents (n= 249, 49% females). The intervention group showed a small but significant decrease in overall stress (between-group Cohen's d = 0.22) and an increase in academic buoyancy (d= 0.27). Academic skills did not influence the intervention gains, but the intervention gains were largest among high-stressed participants. The results suggest that the acceptance and commitment based Youth COMPASS program may be well suited for promoting adolescents' well-being in the school context.

Mediating effects of motor performance, cardiorespiratory fitness, physical activity, and sedentary behaviour on the associations of adiposity and other cardiometabolic risk factors with academic achievement in children.

We investigated the associations of cardiometabolic risk factors with academic achievement and whether motor performance, cardiorespiratory fitness, physical activity, or sedentary behaviour mediated these associations. Altogether 175 children 6-8 years-of-age participated in the study. We assessed body fat percentage (BF%), waist circumference, insulin, glucose, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure, leptin, alanine aminotransferase, and gamma-glutamyltransferase (GGT). Reading fluency, reading comprehension, and arithmetic skills were assessed using standardized tests. Speed/agility, balance, and manual dexterity test results were used to calculate motor performance score and physical activity was assessed by combined heart rate and movement sensor and cardiorespiratory fitness by maximal cycle ergometer test. In boys, BF% was inversely associated with reading fluency (ß = -0.262, P = 0.007) and reading comprehension (ß = -0.216, P = 0.025). Motor performance mediated these associations. Leptin was inversely related to reading fluency (ß = -0.272, P = 0.006) and reading comprehension (ß = -0.287, P = 0.003). The inverse association of leptin with reading fluency was mediated by motor performance. In girls, GGT was inversely associated with reading fluency independent of confounders (ß = -0.325, P = 0.007). The inverse association of BF% with academic achievement among boys was largely explained by motor performance. Leptin in boys and GGT in girls were inversely associated with academic achievement independent of confounding factors.

Diet quality and academic achievement: a prospective study among primary school children.

PURPOSE: Poor diet quality may impair academic achievement in children, but such evidence is limited. Therefore, we investigated the associations of healthy diet in Grade 1 assessed by Mediterranean Diet Score (MDS), Baltic Sea Diet Score (BSDS), and Finnish Children Healthy Eating Index (FCHEI) with academic achievement in Grades 1-3 in children. METHODS: The participants were 161 Finnish children who were 6-8 years old in Grade 1 and attended in a large ongoing physical activity and dietary intervention study. Dietary factors were assessed using 4-day food records, and MDS, BSDS, and FCHEI were calculated. Academic achievement was assessed by reading fluency, reading comprehension, and arithmetic skill tests. The data were analyzed using linear regression analysis and analysis of covariance adjusted for age, sex, parental education, household income, body fat percentage, physical activity, the PANIC Study group, and total energy intake. RESULTS: MDS was positively associated with reading comprehension in Grade 3 (standardized regression coefficient ß = 0.167, P = 0.032). BSDS was positively associated with reading fluency in Grades 2-3 and reading comprehension in Grades 1-3 (ß = 0.161-0.274, P < 0.05). FCHEI was positively related to reading fluency in Grades 1-2 and reading comprehension in Grades 1-3 (ß = 0.190-0.344, P < 0.05). Children in the highest third of BSDS and FCHEI had better reading fluency and reading comprehension in Grades 1-3 than children in the lowest third (P < 0.05). None of the diet scores was associated with arithmetic skills. CONCLUSIONS: Healthier diet assessed by BSDS or FCHEI in Grade 1 was associated with better reading skills, but not with arithmetic skills, among children in Grades 1-3. Long-term intervention studies are needed to investigate the effects of improvements in diet quality on academic achievement among children. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01803776.

Physical activity and obesity mediate the association between childhood motor function and adolescents' academic achievement.

The global epidemic of obesity and physical inactivity may have detrimental implications for young people's cognitive function and academic achievement. This prospective study investigated whether childhood motor function predicts later academic achievement via physical activity, fitness, and obesity. The study sample included 8,061 children from the Northern Finland Birth Cohort 1986, which contains data about parent-reported motor function at age 8 y and self-reported physical activity, predicted cardiorespiratory fitness (cycle ergometer test), obesity (body weight and height), and academic achievement (grades) at age 16 y. Structural equation models with unstandardized (B) and standardized (ß) coefficients were used to test whether, and to what extent, physical activity, cardiorespiratory fitness, and obesity at age 16 mediated the association between childhood motor function and adolescents' academic achievement. Physical activity was associated with a higher grade-point average, and obesity was associated with a lower grade-point average in adolescence. Furthermore, compromised motor function in childhood had a negative indirect effect on adolescents' academic achievement via physical inactivity (B = -0.023, 95% confidence interval = -0.031, -0.015) and obesity (B = -0.025, 95% confidence interval = -0.039, -0.011), but not via cardiorespiratory fitness. These results suggest that physical activity and obesity may mediate the association between childhood motor function and adolescents' academic achievement. Compromised motor function in childhood may represent an important factor driving the effects of obesity and physical inactivity on academic underachievement.

Psychological distress of children with early-onset type 1 diabetes and their mothers' well-being.

AIM: Few studies have focused on the psychological adjustment of pre-adolescent children with type 1 diabetes. This study examined psychosocial functioning in nine- and 10-year-old children with early-onset type 1 diabetes, and their mothers, and associations between psychosocial functioning and diabetes management. METHODS: The mothers of 63 children with early-onset diabetes and 86 healthy children evaluated their own psychosocial functioning, and their child's, with standardised rating scales. We used general linear models to analyse the children's behaviour problems and the mothers' well-being. Associations between the children's behaviour problems, diabetes-related measures and the mothers' well-being were studied with partial correlations. RESULTS: Children with diabetes had more internalising problems than the controls (p = 0.001), and these were associated with poor glycaemic control at the early stage of the illness (p = 0.033) and the use of insulin pumps in girls (p = 0.004). Mothers in the diabetes group had more child-related stress than the controls (p < 0.001), and poorer well-being was associated with the children's behavioural problems (p < 0.024). CONCLUSION: Children with early-onset diabetes faced an increased risk of internalising problems in middle childhood. The mothers' psychological distress was associated with children's behaviour problems rather than their diabetes.

Social withdrawal in children moderates the association between parenting styles and the children's own socioemotional development.

BACKGROUND: Social withdrawal in early childhood is a risk factor for later socioemotional difficulties. This study examined the joint effects of children's social withdrawal and mothers' and fathers' parenting styles on children's socioemotional development. Based on diatheses-stress, vantage sensitivity, and differential susceptibility models, socially withdrawn children were assumed to be more prone to parental influences than others. METHODS: Teachers rated 314 children on prosocial skills, and internalizing and externalizing behaviors at three points in time between grades 1-3. Mothers (n = 279) and fathers (n = 182) filled in questionnaires measuring their affection, and their behavioral and psychological control at the same points in time. Teacher reports on children's level of social withdrawal were obtained at the end of kindergarten. RESULTS: Panel analysis showed that particularly those children who showed signs of social withdrawal were vulnerable to the negative effects of low maternal affection in terms of externalizing behavior. Moreover, among these children, mothers' and fathers' psychological control predicted high levels of internalizing problem but, at the same time, mothers' psychological control predicted also a high level of prosocial behavior and low levels of externalizing problem. CONCLUSIONS: The results supported the diathesis-stress model more than the differential susceptibility model. For example, socially withdrawn children were found to be particularly vulnerable to the negative effects of low maternal affection. Although maternal psychological control had positive effects on the prosocial skills of socially withdrawn children, and reduced the amount of externalizing problems, it was at the same time associated with an increase in their internalizing problems. In this way, socially withdrawn children seem to be at risk of pleasing their mothers at the cost of their own well-being.

Academic skills in children with early-onset type 1 diabetes: the effects of diabetes-related risk factors.

AIM: The study aimed to assess the effects of diabetes-related risk factors, especially severe hypoglycaemia,on the academic skills of children with early-onset type 1 diabetes mellitus (T1DM). METHOD: The study comprised 63 children with T1DM (31 females, 32 males; mean age 9 y 11 mo,SD 4 mo) and 92 comparison children without diabetes (40 females, 52 males;mean age 9 y 9 mo,SD 3 mo). Children were included if T1DM had been diagnosed before the age of 5 years and if they were aged between 9 and 10 years at the time of study. Children were not included if their native language was not Finnish and if they had a diagnosed neurological disorder that affected their cognitive development. Among the T1DM group, 37 had and 26 had not experienced severe hypoglycaemia and 26 had avoided severe hypoglycaemia. Severe hypoglycaemia, diabetic ketoacidosis(DKA), and glycaemic control were used as T1DM-related factors. Task performance in reading, spelling, and mathematics was compared among the three groups, and the effects of the T1DM-related factors were analysed with general linear models. RESULTS: The groups with (p<0.001) and without (p=0.001) severe hypoglycaemia demonstrated a poorer performance than the comparison group in spelling, and the group without severe hypoglycaemia showed a poorer performance than the comparison group in mathematics (p=0.003).Severe hypoglycaemia, DKA, and recent glycaemic control were not associated with poorer skills,but poorer first-year glycaemic control was associated with poorer spelling (p=0.013). INTERPRETATION: An early onset of T1DM can increase the risk of learning problems, independently of the history of severe hypoglycaemia or DKA. Poorer glycaemic control after the first year of T1DM is associated with a poorer acquisition of academic skills indicating the effect of the timing of metabolic aberrations on cognitive development.

Learning Disabilities Elevate Children's Risk for Behavioral-Emotional Problems: Differences Between LD Types, Genders, and Contexts.

Our purpose was to study the frequency of behavioral-emotional problems among children identified with a learning disability (LD). The data were obtained for 579 Finnish children (8-15 years) with reading disability (RD-only), math disability (MD-only), or both (RDMD) assessed at a specialized clinic between 1985 and 2017. We analyzed percentages of children with behavioral-emotional symptoms reaching clinical range (i.e., z score ≥1.5 SDs) and the effects of the LD type, gender, and context (home vs. school) on them. Furthermore, we analyzed the effect of the severity of LD and gender on the amount of behavioral-emotional symptoms reported by teachers and parents. Alarmingly high percentages of children, irrespective of LD type, demonstrated behavioral-emotional problems: more than 37% in Affective, Anxiety, and Attention-Deficit/Hyperactivity Disorder (ADHD) problems. Contextual variation was large, as more problems were reported by teachers than by mothers. The unique effects of gender and LD type were rare, but the results raised concern for those with MD-only, especially boys. The results underscore the need to draw attention to the importance of assessing children with LD for behavioral-emotional problems and emphasize the importance of teachers' awareness of behavioral-emotional problems among students with LD and cooperation among child, teacher, and parents in assessment and support planning.

Longitudinal and situational associations between math anxiety and performance among early adolescents.

Studies have found math anxiety and achievement to be related from the beginning of formal schooling, but the knowledge regarding the direction of the relationship is vague. The purpose of the present study was to study this relationship. We investigated math anxiety from two points of view: trait and state anxiety. In the first substudy, we investigated the longitudinal relationship between math anxiety and performance from sixth to seventh grade (n = 848) with cross-lagged modeling. In the second substudy, we investigated the situational relationship of anxiety and performance by giving the participants (n = 149) challenging and nonchallenging math tasks adapted to their skill level, and then examining the association between anxiety and the performance. The results suggest that math anxiety has a small longitudinal effect on performance: High anxiety in sixth grade predicted low performance in seventh grade. Anxiety also had a situational association with performance: when anxiety was aroused, the participants performed more poorly compared to their skill level. The results adduce the two-fold effect of anxiety on achievement: math anxiety seems to have both a real-time association with performance and a long-term effect on the development of basic arithmetic skills.

Are balance problems connected to reading speed or the familial risk of dyslexia?

AIM: The aim of this study was to examine the connection between balance problems and reading speed in children with and without a familial risk of dyslexia by controlling for the effects of attention, hyperactivity, and cognitive and motor functioning. METHOD: The prevalence of balance problems was studied in 94 children (48 females, 46 males) with a familial risk of dyslexia (at-risk group) and 85 children (38 females, 47 males) without a risk of dyslexia (comparison group). Further, the relationships between balance problems (at age 8y 6mo), reading proficiency (at age 9y), attention-deficit-hyperactivity disorder (at age 8y), and cognitive (at age 8y 6mo) and motor functioning (at age 6y 6mo) were examined. Inclusion criteria for the at-risk group were that at least one parent had a confirmed reading problem and one or more of the parents' close relatives also had a reading problem. The Good Balance System was used to assess static standing balance, word-list and text reading tasks were used to measure reading proficiency. The Behavioural Assessment System for Children - Parent Rating Scale was used to assess attention-deficit-hyperactivity disorder, the Wechsler Intelligence Scale for Children was used to assess cognitive functioning, and the Movement Assessment Battery for Children was used to measure motor functioning. RESULTS: Balance (F((1,177)) =4.82; p=0.029; =0.027) and reading (F((1,176)) =11.95; p=0.001; =0.064) problems were more common in the at-risk group than in the comparison group. Furthermore, attention, hyperactivity, IQ, and motor functioning were not related to balance problems. However, attention (F((1,154)) =10.80; p=0.001; =0.066) and IQ (F((1,170)) =22.08; p<0.001; =0.115) were individually connected to reading speed. INTERPRETATION: Balance problems alone could not produce any differences in reading skills. Instead, both balance problems and reduced reading skills were mainly associated separately with a familial risk of dyslexia. This indicates that there may be a shared genetic mechanism between balance and reading problems.

Computer-assisted remedial reading intervention for school beginners at risk for reading disability.

The aim of the longitudinal study was to investigate whether a computer application designed for remedial reading training can enhance letter knowledge, reading accuracy, fluency, and spelling of at-risk children. The participants, 7-year-old Finnish school beginners (N=166), were assigned to 1 of 3 groups: (a) regular remedial reading intervention (n=25), (b) computer-assessed reading intervention (n=25), and (c) mainstream reading instruction (n=116). Based on the results, computer-assisted remedial reading intervention was highly beneficial, whereas regular type of intervention was less successful. The results indicated that at-risk children require computer-based letter-name and letter-sound training to acquire adequate decoding and spelling skills, and to reach the level of their non-at-risk peers.

Validity of the Play Assessment for Group Settings: an evaluation of differential item functioning between children with specific language impairment and typically developing peers.

AIM: The purpose of this study was to evaluate the validity evidence based on internal structure of the Play Assessment for Group Settings (PAGS). METHODS: The study was conducted in day care centres by comparing observations of the free play performance of two groups of children: those with specific language impairments (SLIs) (n=55) and those with typical language development (n=55). The participating children were 3 to 6.5 years of age. Data were subjected to many-faceted Rasch analyses and differential item functioning analysis was conducted to identify possible group-specific items in the PAGS. The effect of differentially functioning items on mean play performance measurements between two subgroups of children was controlled with two different independent samples t-tests. RESULTS: According to the results, 80% of the test items were stable across the groups of children. Four items were harder for children with SLI, and clearly required language skills. Two items were relatively speaking easier for children with SLI, and reflected explorative functioning. The differential functioning items did not affect the ability of the PAGS to separate the children with SLI in mean play performance from their typically developing peers. CONCLUSION: We concluded that the PAGS is a valid tool for identifying children who have challenges in their play performance and can be used for clinical purposes. However, the slight variability supports the fact that differential item functioning should be controlled in research when using the PAGS for comparison of different subgroups in play performance.

Unveiling the Mysteries of Dyslexia-Lessons Learned from the Prospective Jyväskylä Longitudinal Study of Dyslexia.

This paper reviews the observations of the Jyväskylä Longitudinal Study of Dyslexia (JLD). The JLD is a prospective family risk study in which the development of children with familial risk for dyslexia (N = 108) due to parental dyslexia and controls without dyslexia risk (N = 92) were followed from birth to adulthood. The JLD revealed that the likelihood of at-risk children performing poorly in reading and spelling tasks was fourfold compared to the controls. Auditory insensitivity of newborns observed during the first week of life using brain event-related potentials (ERPs) was shown to be the first precursor of dyslexia. ERPs measured at six months of age related to phoneme length identification differentiated the family risk group from the control group and predicted reading speed until the age of 14 years. Early oral language skills, phonological processing skills, rapid automatized naming, and letter knowledge differentiated the groups from ages 2.5-3.5 years onwards and predicted dyslexia and reading development, including reading comprehension, until adolescence. The home environment, a child's interest in reading, and task avoidance were not different in the risk group but were found to be additional predictors of reading development. Based on the JLD findings, preventive and intervention methods utilizing the association learning approach have been developed.

Verbal and academic skills in children with early-onset type 1 diabetes.

AIM: Basic verbal and academic skills can be adversely affected by early-onset diabetes, although these skills have been studied less than other cognitive functions. This study aimed to explore the mechanism of learning deficits in children with diabetes by assessing basic verbal and academic skills in children with early-onset diabetes and in comparison children. In addition, the incidence of dyslexia (< or =10th centile in reading speed or reading-spelling accuracy) was studied. METHOD: The performance of 51 children with early-onset diabetes (25 females, 26 males; mean age 9y 11mo, SD 4mo; range 9-10y) was compared with that of 92 children without diabetes (40 females, 52 males; mean age 9y 10mo, SD 3mo; range 9-10y) in the tasks of phonological processing, short-term memory, rapid automatized naming, reading, spelling, and mathematics. RESULTS: The performance of children with diabetes was poorer than that of the comparison children in phonological processing (p=0.001), spelling accuracy (p<0.001), and mathematics (p=0.024). They learned to read later (p=0.013), but reading performance and the incidence of dyslexia in the third grade (aged 9-10y) were similar in the two groups. INTERPRETATION: Children with early-onset diabetes are prone to minor learning difficulties in their early school years as a result of deficits in phonological processing.

Neuropsychological subgroups of adolescents with conduct disorder.

In group-level studies adolescents with conduct disorder (CD) have been found to have deficiencies in verbal and executive functions. Teichner and Golden (2000) addressed the neuropsychological heterogeneity of CD, and hypothesized the existence of six neuropsychologically different subgroups. We used that theoretical basis to identify subgroups among 77 adolescents with CD and 48 controls. Among subjects with CD we identified subjects with no, diffuse, verbal and executive function deficits, but none with specific memory or visuo-spatial deficits. In total, neuropsychological deficits altogether were more common among subjects with CD relative to controls, as were specific verbal deficits. Subgroups did not differ in gender distribution, comorbidity of psychiatric disorders, type or severity of CD, or number of psychosocial risk factors. Among subjects with CD, learning disabilities were common. CD is neuropsychologically a heterogeneous disorder, and neuropsychological deficits should be taken into account in assessing and planning interventions for adolescents with CD.

The role of academic buoyancy and emotions in students' learning-related expectations and behaviours in primary school.

BACKGROUND: Academic buoyancy refers to students' ability to come through ordinary challenges they face in the academic context, and it can positively contribute to students' beliefs and behaviours in learning situations. Although buoyancy has been found to be related to positive academic outcomes, previous studies have not examined how buoyancy influences academic emotions in learning situations and how these emotions further affect students' learning-related expectations and behaviours. AIMS: This study investigated to what extent academic buoyancy predicts students' failure expectations, avoidance behaviour, and task-oriented planning in learning situations, and to what extent academic emotions mediate the effect of academic buoyancy on these expectations and behaviours. SAMPLE: A total of 845 Finnish students in the sixth grade of primary school. METHODS: Self-report data for academic buoyancy and academic emotions in the autumn semester and learning-related expectations and behaviours in the spring semester were analysed using structural equation modelling, controlling for gender, grade point average, and previous levels of learning-related expectations and behaviours. RESULTS: The findings showed that high academic buoyancy indirectly predicted lower avoidance behaviour, fewer failure expectations, and higher task-oriented planning via academic emotions. High academic buoyancy was related to high enjoyment and hope as well as low boredom and hopelessness, which further predicted low failure expectations. High hope and low boredom also predicted low avoidance behaviour, and high hope was associated with high task-oriented planning. CONCLUSIONS: The findings suggest that academic buoyancy supports positive expectations and adaptive behaviours in learning situations through the regulation of emotions.

How does early developmental assessment predict academic and attentional-behavioural skills at group and individual levels?

The main aim of the study was to explore the ability of a brief developmental assessment to predict teacher-rated learning and attentional and behavioural skills in the first grade of school at both the group and individual levels. A sample of 394 children (181 males, 213 females) aged 4 years were followed to the age of 6 years, and 283 of the children (145 males, 138 females; mean age 7 y 11 mo) were followed further to the first grade (age 7 y) at school. The children were administered a brief but comprehensive developmental assessment (Lene - a neurodevelopmental screening method) at their local child health-care centres at ages 4 and 6 years. In the first grade, teachers completed a detailed questionnaire (JLD Teacher Questionnaire) on the children's (mean age 7 y 11 mo, SD 3.1 mo, range 7 y 3 mo-8 y 4 mo) performance and behaviour. Structural equation modelling showed that no single developmental area predicted development during the follow-up. Instead, a comprehensive developmental outcome at age 4 years significantly predicted skills in the first grade at the group level. Developmental status at age 4 and 6 years together explained 66% of the variance of academic skills and 40% of the variance of attentional and behavioural skills in the first grade. Age-specific logistic regression analyses were constructed to produce the risk indices. At the individual level it was possible to reach acceptable levels of sensitivity and specificity for academic skills at age 4 and age 6 years. Identification of attentional and behavioural problems at the individual level was possible at age 6 years, but the number of false positives was high.

Effects of multidomain risk accumulation on cognitive, academic, and behavioural outcomes.

This longitudinal study examined the predictive associations between cumulative multidomain risk factors and cognitive (IQ), academic (reading fluency), and social adaptive outcomes at 8 to 9 years among 190 children with or without familial risk for dyslexia. Other risk factors included parental and neurocognitive risks assessed when the children were 1 to 6 years of age. Risks accumulated more among children with familial risk for dyslexia than among children without familial risk. A higher number of risks was associated with poorer performance in all outcome measures as postulated by the cumulative risk model. However, when the effects of individual risk variables were controlled for at the outset, the cumulative risk indices did not have incremental effects beyond those of individual risks. This suggests that the detrimental effect of several risks was due to the content-specific effect of individual risks. Children with familial risk were not differentially affected by the number of risks.