The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort.

The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-Wide Cohort Data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7-11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in 5 main outcome areas: pre-, peri-, and postnatal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include factors at the level of place (e.g., air pollution, neighborhood socioeconomic status), family (e.g., parental mental health), and individuals (e.g., diet, genomics).

Green Space and Internalizing or Externalizing Symptoms Among Children.

Importance: Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare. Objective: To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms. Design, Setting, and Participants: Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included. Exposures: Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment. Main Outcome and Measures: Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples. Results: Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood. Conclusions and Relevance: In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.

Interparental aggression and infant patterns of adrenocortical and behavioral stress responses.

Drawing on emotional security theory, this study examined linkages between interparental aggression, infant self-regulatory behaviors, and patterns of physiological and behavioral stress responses in a diverse sample of 735 infants residing in predominately low-income, non-metropolitan communities. Latent profile analysis revealed four classes of adrenocortical and behavioral stress-response patterns at 7 months of age, using assessments of behavioral and cortisol reactivity to an emotion eliciting challenge, as well as global ratings of the child's negative affect and basal cortisol levels. The addition of covariates within the latent profile model suggested that children with more violence in the home and children who used less caregiver-oriented regulation strategies were more likely to exhibit a pattern of high cortisol reactivity with moderate signs of distress rather than the average stress response, suggesting possible patterns of adaptation in violent households.

Profiles of family-based social experiences in the first 3 years predict early cognitive, behavioral, and socioemotional competencies.

This study utilized latent profile analyses to identify unique configurations of children's family-based social experiences during the first 3 years of life and examine differences across profiles with respect to developmental outcomes at 36 and 48 months of age. Seven family process variables were used: maternal emotional functioning, maternal sensitivity, negative controlling parenting, cognitive stimulation, corporal punishment, adult-adult aggression, and household disorganization. Data were collected by the Family Life Project (N = 1,087), a longitudinal study of families living in low-wealth, nonurban areas, for whom the biological mother was the child's primary caregiver from 6 to 36 months of age. On average, mothers were 26 years of age at 2 months of child age. Approximately 36% of the families lived below the federal poverty limit, and 41% identified as Black; 49% of children were female. Latent profile analyses identified four groups: (a) positive exposure (b) average exposure, (c) problematic adult functioning, and (d) problematic parenting . Comparisons indicate that children in the positive exposure profile had the highest levels of socioemotional and cognitive outcomes compared to overall profiles. Children in the problematic adult functioning and problematic parenting profiles had the most problematic child outcomes, with children in the problematic parenting profile scoring lowest overall. Results indicate that there is configural heterogeneity in family-based social experiences at the highest levels of risk and that exposures to problematic parenting may be more consequential for later child outcomes than exposures to problematic adult functioning in the absence of compromised caregiving. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Interparental aggression, attention skills, and early childhood behavior problems.

The current study explored longitudinal associations between interparental aggression, the development of child attention skills, and early childhood behavior problems in a diverse sample of 636 families living in predominately low-income, nonmetropolitan communities. The results of latent-variable, cross-lagged longitudinal models revealed that maternal-reported interparental aggression in infancy predicted reduced observed attention skills in toddlerhood; no association was observed, however, between attention in infancy and interparental aggression during the toddler years. Further, reduced toddler attention and high interparental aggression were both associated with increased risk for attention-deficit/hyperactivity disorder symptoms and conduct problems at 3 years of age. Processes largely operated in similar ways regardless of child gender or low-income status, although a few differences were observed. Overall, the results suggest that interparental aggression undermines attention development, putting children's early behavioral adjustment at risk.

Poverty, Caregiving, and HPA-Axis Activity in Early Childhood.

The association between poverty and the activity of the hypothalamic pituitary adrenal (HPA) axis in early childhood is well established. Both ecological and transactional theories suggest that one way in which poverty may influence children's HPA-axis activity is through its effects on parents' behaviors, and over the past three decades a substantial literature has accumulated indicating that variations in these behaviors are associated with individual differences in young children's HPA-axis activity. More recent research suggests that non-parental caregiving behaviors are associated with HPA-axis activity in early childhood as well. Here we systematically review the literature on the association between both parental and non-parental caregiving behaviors in the context of poverty and the activity of the HPA-axis in early childhood. We conclude by noting commonalities across these two literatures and their implications for future research.

Differences in saliva collection location and disparities in baseline and diurnal rhythms of alpha-amylase: a preliminary note of caution.

Identified in the early 1980s as a surrogate marker of the sympathetic nervous system component of the stress response, there has been renewed interest in measuring salivary alpha-amylase (sAA) to test biosocial models of stress vulnerability. This brief report presents studies that document that oral fluids from the parotid and submandibular gland areas had higher sAA values than did whole saliva specimens, and sAA values in whole saliva were higher than levels measured in oral fluids from the sublingual gland area. sAA in oral fluids from the parotid and submandibular gland areas showed the highest and more pronounced diurnal variation than levels in whole saliva, and sAA in sublingual saliva showed the lowest and shallowest diurnal variation. When this source of inherent variability in sAA activity levels is not controlled for by collecting oral fluids consistently from specific gland areas, the detection of individual differences, associations between sAA and "behavioral" variables, and intra-individual change in sAA levels may be compromised. Awareness, and management, of this ubiquitous source of measurement error in sAA are essential to ensure the success of future research on the correlates and concomitants of sAA levels, stress-related reactivity and recovery, and diurnal variation.

Power assertive discipline, maternal emotional involvement, and child adjustment.

Despite long-standing research, the relations between power assertive discipline and child adjustment continue to be debated. Disentangling disciplinary practices from the parent-child emotional climate may aid understanding of how such parenting practices impact child adjustment. This study explored longitudinal relations between maternal emotional involvement, power assertive discipline, and child adjustment in a sample of 35 mothers of infant, toddler, and preschool-age children. Results indicate that power assertive discipline may differentially impact child adjustment, depending on levels of maternal emotional involvement.

Agree or Agree to Disagree? Assessing the Convergence between Parents and Observers on Infant Temperament.

The assessment of infant temperament has been typically accomplished with parent questionnaires. When compared with temperament behaviours observed in the laboratory, parents and observers generally do not agree, leading some researchers to question the validity of parent report. This paper reports on a representative sample of infants whose families resided in non-metropolitan counties and whose temperament was measured in three ways: (1) standard parent report (Infant Behavior Questionnaire); (2) observer ratings across two lengthy home visits; and (3) observer coding of second-by-second reactions to specific emotion-eliciting tasks. In order to account for both trait and method variance, structural equation modelling was applied to a sample of 955 infants (M age = 7.3 months) using variables from the three methods that reflected the dimensions of positivity and negativity. Although models based solely on method factors and trait factors fit the data well, results indicated that a model that included method and trait factors provided the best fit. Results also indicated that parents and observers (either across the home visit or to specific tasks) converge, to a degree, on ratings of the positivity dimension but diverge on the negativity dimension.

Perceived family impact of preschool anxiety disorders.

OBJECTIVE: We examined the perceived impact of child anxiety disorders on family functioning, because such impact is a key predictor of mental health service receipt. In addition, we examined the relative impact of preschool anxiety compared to that of other early childhood disorders, and whether this impact persisted after accounting for the effects of comorbidity, or varied by child age and sex. METHOD: Drawing from a pediatric primary-care clinic and oversampling for children at risk for anxiety, 917 parents of preschoolers (aged 2-5 years) completed a diagnostic interview and reported on child psychiatric symptom impact on family finances, relationships, activities, and well-being. RESULTS: After accounting for comorbid disorders, families of children with anxiety were 3.5 times more likely to report a negative impact of their child's behavior on the family relative to nondisordered children. Generalized and separation anxiety had an impact on family functioning similar to that of attention-deficit/hyperactivity disorder and disruptive disorders. There was a significant family impact for girls with social phobia, whereas there was no impact for boys. CONCLUSIONS: Preschool anxiety has a significant, unique impact on family functioning, particularly parental adjustment, highlighting the family impairment linked with early anxiety, and the need for further research on barriers to care for these disorders.

Fathers' sensitive parenting and the development of early executive functioning.

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

Family Violence and Children's Behavior Problems: Independent Contributions of Intimate Partner and Child-Directed Physical Aggression.

Using data from a diverse sample of 581 families living in predominantly low-income, rural communities, the current study sought to investigate the longitudinal associations among father-perpetrated intimate partner violence (IPV) and child-directed physical aggression perpetrated by the mother. The unique contributions of each of these types of family violence on children's behavioral problems at school entry were also examined. Results confirm bidirectional associations between father-perpetrated IPV and maternal physical aggression directed toward the child, and indicate that both types of physical aggression contribute to child behavior problems at school entry.

Preschool anxiety disorders in pediatric primary care: prevalence and comorbidity.

OBJECTIVE: We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety disorder, separation anxiety disorder, and social phobia in preschool-aged children. METHOD: The Duke Preschool Anxiety Study, a screen-stratified, cross-sectional study, drew from pediatric primary care and oversampled for children at risk for anxiety. A total of 917 parents of preschool children (aged 2-5 years) completed the Preschool Age Psychiatric Assessment. RESULTS: Generalized anxiety disorder, separation anxiety disorder, and social phobia are common in preschool-aged children attending pediatric primary care. Three-fourths of preschoolers with an anxiety disorder only had a single anxiety disorder. Generalized anxiety disorder displayed the greatest degree of comorbidity: with separation anxiety disorder (odds ratio [OR] = 4.1, 95% CI = 2.0-8.5), social phobia (OR = 6.4, 95% CI = 3.1-13.4), disruptive behavior disorders (OR = 5.1, 95% CI = 1.6-15.8), and depression (OR = 3.7, 95% CI = 1.1-12.4). CONCLUSIONS: The weakness of association between generalized anxiety disorder and depression stands in contrast to substantial associations between these 2 disorders reported in older individuals. Attenuated associations in preschool-aged children could translate into clinical opportunities for targeted early interventions, aimed at modifying the developmental trajectory of anxiety disorders.