Prenatal maternal infections and early childhood developmental outcomes: analysis of linked administrative health data for Greater Glasgow & Clyde, Scotland.

BACKGROUND: Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self-reported survey data, or data on hospital-recorded infections only, resulting in gaps in data collection. METHODS: This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011-2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6-8 week or 27-30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention and speech-language-communication) and (b) the trimester(s) in which infections occurred. RESULTS: After confounder/covariate adjustment, hospital-diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19-1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), that is the trimesters in which foetal brain myelination occurs. Infection-related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of concerns specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development. CONCLUSIONS: Prenatal infections, particularly those which are hospital-diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.

Recruitment and retention of adolescents for an ecological momentary assessment measurement burst mental health study: The MHIM engagement strategy.

INTRODUCTION: Recruitment and long-term retention of adolescent participants in longitudinal research are challenging and may be especially so in studies involving remote measurement and biosampling components. The ability to effectively recruit and retain participants can be supported by the use of specific evidence-based engagement strategies that are built in from the earliest stages. METHODS: Informed by a review of the evidence on effective engagement strategies and consultations with adolescents (via two Young Person Advisory Groups [YPAGs]; ages 11-13 and 14-17), the current protocol describes the planned participant engagement strategy for the Mental Health in the Moment Study: a multimodal measurement burst study of adolescent mental health across ages 11-19. RESULTS: The protocol incorporates engagement strategies in four key domains: consultations/co-design with the target population, incentives, relationship-building and burden/barrier reduction. In addition to describing general engagement strategies in longitudinal studies, we also discuss specific concerns regarding engagement in data collection methods such as biosampling and ecological momentary assessment where a paucity of evidence exists. CONCLUSION: Engagement strategies for adolescent mental health studies should be based on existing evidence and consultations with adolescents. We present our approach in developing the planned engagement strategies and also discuss limitations and future directions in engaging adolescents in longitudinal research. PATIENT OR PUBLIC CONTRIBUTION: The study design for this project places a strong emphasis on the active engagement of adolescents throughout its development. Specifically, the feedback and suggestions provided by the YPAGs have been instrumental in refining our strategies for maximising the recruitment and retention of participants.

Late adolescent outcomes of different developmental trajectories of ADHD symptoms in a large longitudinal study.

There exists substantial heterogeneity in the developmental trajectories of ADHD symptoms, with distinctions often made between persistent versus remittent, and early- versus late-onset. However, how these trajectories relate to late adolescent functioning and whether, in particular, later onset trajectories mark a milder subtype remains unclear. Building on earlier work that has examined early life predictors of ADHD symptom trajectories up to age 14, we applied latent class growth analysis to data from the UK Millennium Cohort Study (N = 10,262) to evaluate whether developmental trajectories of ADHD symptoms up to age 17 (from age 3) were similar to those identified up to age 14 and associated with differing levels of impairment in peer victimisation, mental health, substance use, and delinquency outcomes at age 17. Our optimal model included five trajectory groups, labelled unaffected (37.6%), mildly affected (34.8%), subclinical remitting (14.4%), adolescent onset (7.6%), and stable high (5.6%). Adolescent onset and stable high trajectories were similarly impaired across all outcomes, other than substance use. Subclinical remitting individuals were impaired on self-esteem and well-being compared to unaffected individuals. By the end of mid-adolescence, those with a later onset have similar impairments to those following an early onset/persistent trajectory. Residual impairment may remain for those on a remitting trajectory.

Investigating Moderation Effects at the Within-Person Level Using Intensive Longitudinal Data: A Two-Level Dynamic Structural Equation Modelling Approach in Mplus.

Recent technological advances have provided new opportunities for the collection of intensive longitudinal data. Using methods such as dynamic structural equation modeling, these data can provide new insights into moment-to-moment dynamics of psychological and behavioral processes. In intensive longitudinal data (t > 20), researchers often have theories that imply that factors that change from moment to moment within individuals act as moderators. For instance, a person's level of sleep deprivation may affect how much an external stressor affects mood. Here, we describe how researchers can implement, test, and interpret dynamically changing within-person moderation effects using two-level dynamic structural equation modeling as implemented in the structural equation modeling software Mplus. We illustrate the analysis of within-person moderation effects using an empirical example investigating whether changes in spending time online using social media affect the moment-to-moment effect of loneliness on depressive symptoms, and highlight avenues for future methodological development. We provide annotated Mplus code, enabling researchers to better isolate, estimate, and interpret the complexities of within-person interaction effects.

The characteristics of users of an online screening tool for children and adolescents with intellectual disability and of those being screened.

Screening tools can help with the identification of intellectual disability, but little is known about who uses them. This study analysed anonymous information from 2691 users of an evidence-based, online, intellectual disability screening questionnaire for children and adolescents (CAIDS-Q) to explore the characteristics of the users and of those being screened. The users were split almost equally between parents/family members (48.6%) and professionals (49.9%), with the majority (63.8%) of the latter group being health staff. Significant differences in the characteristics of the children being screened were found, according to whether the user was a parent/family member or a professional, with the overall pattern suggesting that professionals screened children with greater complexity of needs, but about whom less was known. The screened children had a range of areas of difficulties that are common to those with intellectual disability. Implications for practice are discussed.

Maternal metabolic syndrome in pregnancy and child development at age 5: exploring mediating mechanisms using cord blood markers.

BACKGROUND: There is limited evidence on how the classification of maternal metabolic syndrome during pregnancy affects children's developmental outcomes and the possible mediators of this association. This study uses a cohort sample of 12,644 to 13,832 mother-child pairs from the UK Born in Bradford Study to examine the associations between maternal metabolic syndrome classification (MetS) and child development outcomes at age 5, using cord blood markers as candidate mediators. METHODS: Maternal cardiometabolic markers included diabetes, obesity, triglycerides, high-density lipoprotein cholesterol, blood pressure, hypertension, and fasting glucose during pregnancy. Cord blood markers of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, leptin, and adiponectin were used as child mediators. Child outcomes included two starting school variables: British Picture Vocabulary Scale (BPVS) and the Letter Identification Assessment (LID), and five developmental milestone domains from a national UK framework: (1) communication and language (COM); (2) personal, social, and emotional (PSE); (3) physical development (PHY); (4) literacy (LIT); and (5) mathematics (MAT). Mediation models were used to examine the associations between the classification of maternal metabolic syndrome and child developmental milestones. Models were adjusted for potential maternal, socioeconomic, and child confounders such as maternal education, deprivation, and gestational age. RESULTS: In mediation models, significant total effects were found for MetS associations with children's development in the LIT domain at age 5. MetS predicted individual cord blood mediators of lower HDL and increased leptin levels in both adjusted and unadjusted models. Total indirect effects (effects of all mediators combined) for MetS on a child's COM and PSE domain were significant, through all child cord blood mediators of LDL, HDL, triglycerides, adiponectin, and leptin for adjusted models. CONCLUSIONS: The results support the hypothesis that maternal metabolic syndrome classification during pregnancy is associated with some child developmental outcomes at age 5. After adjusting for maternal, child, and environmental covariates, maternal metabolic syndrome classification during pregnancy was associated with children's LIT domain through direct effects of maternal metabolic health and indirect effects of cord blood markers (total effects), and COM and PSE domains via changes only in a child's cord blood markers (total indirect effects).

Development of the item pool for the 'WHO-ageism scale': conceptualisation, item generation and content validity assessment.

OBJECTIVES: ageism harms individuals' health and wellbeing and can be costly to societies. Reliable and valid measures that can quantify ageism are critical for achieving accurate data on its global prevalence, determinants and impacts, and to evaluate the effectiveness of interventions to reduce it. Ageism scales exist; however, none have been demonstrated to validly measure ageism in a manner consistent with consensus definitions of the concept (i.e. as manifested in all of stereotypes, prejudices and discrimination), whilst also quantifying ageism against all groups, from a target and perpetrator perspective, and across diverse country settings. Our objective was to develop an item pool to meet this need. METHODS: we completed the conceptualisation, item generation and content validity assessment phases of a new World Health Organisation (WHO) WHO-ageism item pool that aims to measure the multi-dimensional nature of ageism. These phases drew on a review of available evidence, an experts' workshop and structured content validity reviews conducted by experts in scale development and ageism drawn from every world region defined by WHO. RESULTS: our resulting item pool is designed to provide a multi-dimensional measure of ageism against all ages measured from both a perpetration and experienced perspective and that can produce valid and reliable scores within diverse country contexts and comparable scores across these contexts. CONCLUSIONS: our item pool is the first major step in providing a global and comprehensive measure of ageism. Future phases of research will refine the item pool and establish the statistical psychometric properties of the final tool.

Social expectations as a possible mechanism for adult personality change: Limited empirical evidence for the social investment principle.

OBJECTIVE: Personality traits change in both mean levels and variance across the life span but the mechanisms underlying these developmental trends remain unclear. Social Investment Principle (SIP) suggests that social expectations drive personality changes in adulthood. Accordingly, we tested whether differences between personality traits in social expectations for them can explain their different change trajectories in young adulthood. METHODS: A pool of 257 personality items was used to measure personality traits' means and variances (N = 1096), and levels expected by friends, partners and bosses/supervisors (N = 121). RESULTS: Raters were consistent in their expectations for how young adults should think, feel and behave. Traits under stronger expectations had higher mean levels and lower variances than traits under lower expectations; trait means and variances increased with age, but inconsistently with the SIP, these increases were unrelated to the traits' expected levels. CONCLUSION: Our results are only partially consistent with the SIP.

Social expectations and abilities to meet them as possible mechanisms of youth personality development.

OBJECTIVE: Personality traits change from childhood through late-adolescence, however the effects of social expectations and self-regulatory efforts remain unknown. This study aims to explore mechanisms underlying personality development by assessing mean levels personality traits from childhood to late-adolescence. METHOD: We used Common-Language California Child Q-Set to measure youths' (N = 11,000) mean personality trait levels; social expectations for these traits as perceived by parents (N = 47), teachers (N = 42) and students (N = 120); and self-regulatory efforts required for achieving the desired levels in these traits as perceived by parents (N = 27), teachers (N = 26), and students (N = 54). RESULTS: Expectations for youths' traits were consistent, regardless of raters' or youths' age. In our unique between-trait study design, traits' mean levels were positively associated with expectations for them, but age differences minimally tracked these expectations. Traits' required self-regulatory efforts were not associated with their developmental trends. CONCLUSIONS: Results were only partially consistent with existing developmental theories of personality development.

Predicting Participation Willingness in Ecological Momentary Assessment of General Population Health and Behavior: Machine Learning Study.

BACKGROUND: Ecological momentary assessment (EMA) is widely used in health research to capture individuals' experiences in the flow of daily life. The majority of EMA studies, however, rely on nonprobability sampling approaches, leaving open the possibility of nonrandom participation concerning the individual characteristics of interest in EMA research. Knowledge of the factors that predict participation in EMA research is required to evaluate this possibility and can also inform optimal recruitment strategies. OBJECTIVE: This study aimed to examine the extent to which being willing to participate in EMA research is related to respondent characteristics and to identify the most critical predictors of participation. METHODS: We leveraged the availability of comprehensive data on a general young adult population pool of potential EMA participants and used and compared logistic regression, classification and regression trees, and random forest approaches to evaluate respondents' characteristic predictors of willingness to participate in the Decades-to-Minutes EMA study. RESULTS: In unadjusted logistic regression models, gender, migration background, anxiety, attention deficit hyperactivity disorder symptoms, stress, and prosociality were significant predictors of participation willingness; in logistic regression models, mutually adjusting for all predictors, migration background, tobacco use, and social exclusion were significant predictors. Tree-based approaches also identified migration status, tobacco use, and prosociality as prominent predictors. However, overall, willingness to participate in the Decades-to-Minutes EMA study was only weakly predictable from respondent characteristics. Cross-validation areas under the curve for the best models were only in the range of 0.56 to 0.57. CONCLUSIONS: Results suggest that migration background is the single most promising target for improving EMA participation and sample representativeness; however, more research is needed to improve prediction of participation in EMA studies in health.

The role of student-teacher relationships in the association between negative parenting practices and emotion dynamics - Combining longitudinal and ecological momentary assessment data.

Emotion dysregulation is increasingly implicated as a transdiagnostic risk factor in the etiology of mental health problems. This project aimed to explore the links between emotion regulation, negative parenting and student-teacher relationships using longitudinal and ecologically valid data. A sample of n = 209 young people enrolled in the 'Decades-to-Minutes' (D2M) study, based in Zurich, Switzerland, provided data from the ages of 7-20 via parent- and self-report questionnaires and ecological momentary assessment. Data were analyzed using Dynamic Structural Equation Modeling (DSEM). Worse student-teacher relationships predicted increased negative affectivity and emotional lability. Negative parenting practices predicted emotional lability only via their impact on student-teacher relationships. The findings point to worse student-teacher relationships as risk factors in the socioemotional development of children and young people.

Exploring the effect of ADHD traits on the moment-to-moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling.

The relation between attention deficit hyperactivity disorder (ADHD) symptoms and aggression is well documented; however, the processes that account for higher levels of aggression associated with ADHD in the course of daily life are little understood. The current study used ecological momentary assessment to explore how ADHD traits relate to individual differences in perceiving provocation from others and the resultant aggressive behaviors; and the strengths of the links between provocation and aggression in the flow of daily life. A dynamic structural equation model was fit using data from a subpopulation of young adults involved in the longitudinal z-proso study (n = 259, median-age 20). Data on provocation and aggression was collected at four quasi-random time periods per day over a 14-day period. Individuals with higher ADHD trait levels reported higher instances of provocation and aggression, with ADHD traits significantly moderating aggression inertia such that those with higher levels of ADHD traits showed greater persistence of aggressive behavior over time. However, ADHD trait levels did not significantly moderate any of the observed cross-lagged effects. Our findings suggest that individuals with higher levels of ADHD traits are at greater risk of exposure to interpersonal interactions involving interpersonal provocation, show higher levels of aggressive behavior in daily life, and find it more difficult to reduce their aggression once triggered. These findings support the importance of targeting factors such as social skills and emotion regulation that may underpin the increased difficulties in interpersonal interactions often experienced by individuals with high levels of ADHD symptoms.

Trajectories of Screen Time across Adolescence and Their Associations with Adulthood Mental Health and Behavioral Outcomes.

Excessive screen time among adolescents is discussed as a significant public health concern. Identifying adolescent longitudinal patterns of time spent on regularly-used media screens and understanding their young adulthood mental health and behavioral issue correlates may help inform strategies for improving these outcomes. This study aimed to characterize joint developmental patterns of time spent on videogames, surfing/chatting the Internet, and TV/DVDs during adolescence (at ages 11, 13, 15, 17) and their associations with mental health (i.e., depression, anxiety, suicidal ideation, and self-injury) and behavioral issues (i.e., substance use, delinquency, aggression) in early adulthood (at age 20). A parallel-process latent class growth analysis was used to model data from a diverse community-ascertained sample of youth in Zurich, Switzerland (n = 1521; 51.7% males). Results suggested that a five-class model best fitted the data: (1) low-screen use, 37.6%; (2) increasing chatting/surfing, 24.0%; (3) moderate-screen use, 18.6%; (4) early-adolescence screen use, 9.9%; and (5) increasing videogame and chatting/surfing, 9.9%. After adjusting for baseline levels of outcomes (primarily at age 11), the trajectory groups differed in their associations with adulthood outcomes of mental health and behavioral problems, indicating the importance of problematic screen usage patterns in predicting these outcomes. Future research to test the directionality of these associations will be important. These findings suggest which patterns of screen use may be a marker for later mental health and behavioral issues in different domains.

Teacher-Student Relationships in Childhood as a Protective Factor against Adolescent Delinquency up to Age 17: A Propensity Score Matching Approach.

In this paper we examined the impact of the quality of teacher-student relationships at age 10 on young people's delinquency at ages 13, 15, and 17 utilizing propensity-score matching. The young people were matched based on 105 characteristics, measured at ages 7 to 10. The sample comprised 1483 (49.4% female) adolescents representing around 80 different countries of origin, residing in Zurich, Switzerland. We found that young people who reported a better relationship with their teacher at age 10, engaged in fewer delinquent acts at ages 13, 15, and 17. These findings suggest that when young people perceive a better relationship with their teachers this serves as a protective factor against their engagement in delinquency up to 7 years later.

Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a 'perfect storm' for increases in emotional distress. Such increases can only be identified by studies that use data collected before and during the pandemic. Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for. METHODS: Data came from a cohort study (N = 768). Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22. Previous distress and stressors were measured before COVID-19 (at age 20). RESULTS: On average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before. Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (e.g. bullying victimization and stressful life events). Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models. Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing. CONCLUSIONS: In our community sample, pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures.

Within-family relations of mental health problems across childhood and adolescence.

BACKGROUND: While transactional models suggest that parent and child mental health reciprocally influence one another over development, research has largely focused on parent-to-child effects. Additionally, it is not known whether observed associations hold when appropriate statistical tools are used to operationalise within-family dynamics. METHODS: We investigated within-family mental health dynamics using autoregressive latent trajectory models with structured residuals, stratified by child gender. Parental psychological distress was assessed using the Kessler (K6) scale, and children's internalising and externalising problems were assessed using the Strengths and Difficulties Questionnaire. Both measures were administered at the age 3, 5, 7, 11, 14 and 17 waves of the Millennium Cohort Study (N = 10,746, ~50% female). RESULTS: Maternal psychological distress was positively associated with subsequent internalising and externalising problems for girls but only with internalising problems for boys. Paternal psychological distress was associated with boys' later internalising and externalising problems during early adolescence. Among boys, internalising problems were associated with later maternal psychological distress, while externalising problems were associated with later paternal psychological distress. Among girls, internalising problems were associated with subsequent paternal psychological distress, while externalising problems were associated with later maternal psychological distress. Finally, maternal and paternal psychological distress showed negative bidirectional associations in early childhood but positive associations in middle childhood and early adolescence. CONCLUSIONS: Findings support a transactional model of family mental health, with both child-to-parent and parent-to-child effects playing a role in the development of mental health difficulties. Mental health intervention efforts should, therefore, target the whole family system.

Developmental associations between bullying victimization and suicidal ideation and direct self-injurious behavior in adolescence and emerging adulthood.

BACKGROUND: Bullying, suicide, and self-injury are significant issues among young people. Extensive research has documented bullying victimization associations with suicidal ideation and self-injury; however, the modeling approaches used have mostly not addressed the relations between these constructs at the within-person level, and it is these links that are critical for testing developmental theories and guiding intervention efforts. This examined the within-person, bidirectional relations between these constructs in adolescence and emerging adulthood. METHODS: Participants were from the Zurich Project on Social Development from Childhood to Adulthood (z-proso). Random intercept cross-lagged panel models (RI-CLPMs) were fit to general and sexual bullying victimization and suicidal ideation data at ages 15, 17, and 20 (n = 1465), and general and sexual victimization and direct self-injurious behavior data at ages 13, 15, 17, and 20 (n = 1482). RESULTS: There was a positive within-person effect of age 15 general bullying victimization on age 17 suicidal ideation (ß = .10) and age 17 suicidal ideation on age 20 general bullying victimization (ß = .14). CONCLUSIONS: General bullying victimization and suicidal ideation may have detrimental effects on each other over development but at different stages.

Does emotion dysregulation mediate the association between ADHD symptoms and internalizing problems? A longitudinal within-person analysis in a large population-representative study.

BACKGROUND: Previous research has suggested that children with attention-deficit/hyperactivity disorder (ADHD) symptoms commonly show emotion dysregulation difficulties. These difficulties may partly explain the strong tendency for internalizing problems such as anxiety and depression to co-occur with ADHD symptoms. However, no study has yet provided a longitudinal analysis of the within-person links between ADHD symptoms, emotion dysregulation, and internalizing problems necessary to examine this hypothesis from a developmental perspective. METHODS: We used data from the age 3, 5, and 7 waves of the large UK population-representative Millennium Cohort Study (n = 9,619, 4,885 males) and fit gender-stratified autoregressive latent trajectory models with structured residuals (ALT-SR) to disaggregate within- and between-person relations between ADHD symptom, emotion dysregulation, and internalizing problem symptoms. RESULTS: We found that emotion dysregulation significantly mediated the longitudinal within-person association between ADHD symptoms and internalizing problems. CONCLUSIONS: Results underline the promise of targeting emotion dysregulation as a means of preventing internalizing problems co-occurring with ADHD symptoms.

A symptom level perspective on reactive and proactive aggressive behaviours and ADHD symptoms in childhood.

OBJECTIVE: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent childhood disorders, affecting around 3.4% of children worldwide. A common and impairing correlate of ADHD is aggressive behaviour. ADHD symptoms and aggression are both heterogeneous and it has been speculated that certain symptoms of ADHD might be more important in aggressive behaviours of different types than others. This study uses a symptom-level analysis to investigate the concurrent and temporal links between ADHD symptoms and aggressive behaviours. METHODS: Using Gaussian Graphical Models and Graphical Vector Autoregression Models, longitudinal and cross-sectional networks of ADHD symptoms and aggressive behaviours, measured using parent-reported Social Behaviour Questionnaires, were estimated. Participants included 1,246 children taking part in the longitudinal Swiss z-proso cohort study at ages 7, 9 and 11. RESULTS: The longitudinal network highlighted that ADHD symptoms and aggressive behaviours share a multitude of reciprocal temporal relations, with inattentive ADHD symptoms preceding both reactive and proactive aggression. Cross-sectional networks suggested that hyperactive/impulsive symptoms were predominantly connected to reactive aggressive behaviours but also to a form of proactive aggression, namely dominating other children. CONCLUSION: Findings provide preliminary evidence which specific symptoms are the most promising targets for reducing aggressive behaviours in children with ADHD. They also highlight the potential importance of targeting feedback loops resulting from aggressive behaviours. Future research is needed to better understand the mechanisms through which ADHD and aggressive behaviours become linked.

Polygenic risks for joint developmental trajectories of internalizing and externalizing problems: findings from the ALSPAC cohort.

BACKGROUND: Joint developmental trajectories of internalizing and externalizing problems show considerable heterogeneity; however, this can be parsed into a small number of meaningful subgroups. Doing so offered insights into risk factors that lead to different patterns of internalizing/externalizing trajectories. However, despite both domains of problems showing strong heritability, no study has yet considered genetic risks as predictors of joint internalizing/externalizing problem trajectories. METHODS: Using parallel process latent class growth analysis, we estimated joint developmental trajectories of internalizing and externalizing difficulties assessed across ages 4 to 16 using the Strengths and Difficulties Questionnaire. Multinomial logistic regression was used to evaluate a range of demographic, perinatal, maternal mental health, and child and maternal polygenic predictors of group membership. Participants included 11,049 children taking part in the Avon Longitudinal Study of Parents and Children. Polygenic data were available for 7,127 children and 6,836 mothers. RESULTS: A 5-class model was judged optimal: Unaffected, Moderate Externalizing Symptoms, High Externalizing Symptoms, Moderate Internalizing and Externalizing Symptoms and High Internalizing and Externalizing Symptoms. Male sex, lower maternal age, maternal mental health problems, maternal smoking during pregnancy, higher child polygenic risk scores for ADHD and lower polygenic scores for IQ distinguished affected classes from the unaffected class. CONCLUSIONS: While affected classes could be relatively well separated from the unaffected class, phenotypic and polygenic predictors were limited in their ability to distinguish between different affected classes. Results thus add to existing evidence that internalizing and externalizing problems have mostly shared risk factors.