Early childcare arrangements and children's internalizing and externalizing symptoms: an individual participant data meta-analysis of six prospective birth cohorts in Europe.

Background: Early childcare attendance may be related to children's internalizing and externalizing symptoms throughout childhood and young adolescence, however evidence from Europe is limited. We aimed to assess this association across multiple population-based birth cohorts of children recruited in different European countries. Methods: Data come from six parent-offspring prospective birth cohort studies across five European countries within the EU Child Cohort Network. A total of 87,208 parent-child dyads were included in the study. To test associations between childcare attendance (centre-based or informal) anytime between ages 0 and 4 years and children's internalizing and externalizing symptoms in middle childhood and young adolescence (measured at: 5-6 years, 7-9 years, and 10-13 years) a two-stage individual participant data meta-analysis was implemented. Linear regression models were performed in each cohort separately; combined random-effects meta-analysis was then used to obtain overall association estimates. In secondary analyses, we tested interactions between childcare attendance and mother's post-partum depression, low education status, and the child's sex. Findings: Compared to children who were exclusively cared for by their parents prior to school entry, those who attended centre-based childcare had lower levels of internalizing symptoms in all age groups [5-6 years: ß: -1.78 (95% CI: -3.39, -0.16); 7-9 years: ß: -0.55 (95% CI: -0.88, -0.73); 10-13 years: ß: -0.76 (95% CI: -1.15, -0.37)]. Children who attended informal childcare appeared to have elevated levels of internalizing symptoms between 7-9 and 10-13 years, respectively [ß: 1.65 (95% CI: 1.25, 2.06); ß: 1.25 (95% CI: 0.96, 1.54)]. Informal childcare attendance was also associated with increased levels of children's externalizing symptoms between 7-9 and 10-13 years, respectively [ß: 2.84 (95% CI: 1.41, 4.26); ß: 2.19 (95% CI: 0.54, 3.84)]. Interpretation: Early centre-based childcare is associated with decreased levels of children's internalizing symptoms compared to exclusive parental care. For informal childcare, opposite associations were observed. Overall, our results suggest that centre-based childcare attendance may be associated with slight positive impacts on children's emotional development and should be encouraged by public policies. In addition, children from socioeconomically disadvantaged families require special attention, as they may not sufficiently benefit from universal early childhood education and care (ECEC). Funding: This research was funded by the ERC Consolidator grant RESEDA (Horizon Europe, 101001420).

Mothers' Adverse Childhood Experiences Moderate the Association between Maternal Anger and Children's Externalizing Symptoms.

BACKGROUND/OBJECTIVES: This study examined the association between maternal anger, children's externalizing symptoms, and the moderating impact of maternal adverse childhood experiences (ACEs) in the context of intimate partner violence (IPV). The primary objective was to investigate whether maternal ACEs alter the link between maternal anger and children's externalizing symptoms, guided by theoretical frameworks such as the stress sensitization and stress steeling models. METHODS: A sample of 159 Portuguese mothers exposed to IPV participated in the study, completing a protocol of self-report measures. Measured variables included maternal anger, ACEs, children's externalizing symptoms, and IPV. RESULTS: Results indicate a significant moderation effect of ACEs on the association between maternal anger and externalizing symptoms at low levels of ACEs. Conversely, at moderate and high ACEs levels, no statistically significant association exists between maternal anger and children's externalizing symptoms. CONCLUSIONS: Clinical implications emphasize the importance of tailored parenting interventions to prevent externalizing symptoms in children, integrating diverse emotion regulation strategies while considering the impact of maternal ACEs.

Early risk for child externalising symptoms: Examining genetic, prenatal, temperamental and parental influences.

This study utilized the Early Growth and Development Study (N = 561 adoptive children; 57.2% male, 55.3% White), a study of children adopted at birth, to examine heritable (birth parent psychopathology) and prenatal risk (prenatal maternal distress and smoking during pregnancy), infant negative affectivity, adoptive parent over-reactivity and warmth as independent predictors of childhood externalizing symptoms. The current study evaluated if: (1) infant negative affectivity and over-reactive parenting are candidate mediators for the effects of heritable and prenatal risk on externalizing symptoms and (2) parental warmth weakens the influence of heritable risk, prenatal risk, negative affectivity, and over-reactive parenting on externalizing symptoms. There were main effects of heritable risk, infant negative affectivity, and over-reactive parenting on child externalizing symptoms. The study found no support for the hypothesized mediation and moderation effects, suggesting that targeting parental over-reactivity rather than warmth would be more effective in reducing risk for childhood externalizing symptoms.

Trajectories of sleep problems and the longitudinal associations with mental health difficulties among Chinese adolescents.

OBJECTIVE: Growing research highlights the negative impact of sleep problems on adolescent mental health. However, the developmental trajectory of sleep problems during adolescence and their relationship with mental health difficulties, including both internalizing and externalizing symptoms, remain unclear. Additionally, the direction of the effects between sleep problems and mental health difficulties is not well established. This study aims to identify the developmental trajectories of sleep problems and examine their association with mental health difficulties in both internalizing and externalizing domains. METHOD: The study involved 1,281 Chinese middle school students (645 males, mean age at initial assessment = 12.73, SD = 0.68). Data were collected at four time points (T1, T2, T3, T4) over approximately 6-month intervals, spanning from the first semester of seventh grade to the second semester of 8th grade. RESULTS: Latent growth modeling revealed an overall increasing trend in sleep problems. Parallel latent growth modeling indicated that trajectories of sleep problems were positively related to the developmental trends of mental health difficulties, as shown by intercept-intercept and slope-slope associations. The cross-lagged panel model demonstrated significant bidirectional associations between sleep problems and internalizing symptoms. In contrast, we observed unidirectional associations between sleep problems and externalizing symptoms. Hence, sleep problems were a significant predictor of subsequent externalizing symptoms, with no significant reverse effect observed. CONCLUSION: These findings suggest that future research should explore whether interventions targeting sleep problems can reduce the incidence of both internalizing and externalizing symptoms. Additionally, interventions aimed at internalizing symptoms may potentially improve adolescent sleep, while those targeting externalizing symptoms may not have the same effect.

A semi-structured interview for the dimensional assessment of internalizing and externalizing symptoms in children and adolescents: Interview Version of the Symptoms and Functioning Severity Scale (SFSS-I).

BACKGROUND: This study evaluates the psychometric properties of the newly developed semi-structured interview, Interview Version of the Symptoms and Functioning Severity Scale (SFSS-I), which is designed to provide a dimensional assessment of internalizing and externalizing symptoms. METHODS: Multi-informant baseline data from the OPTIE study was used, involving 358 children and adolescents aged 6 to 17 years (M = 11.54, SD = 3.4, n = 140 [39.1%] were female). Participants were screened for internalizing and externalizing symptoms. For validity analyses, caregiver (Child Behavior Checklist), youth (Youth Self Report), and teacher ratings (Teacher Report Form) were used. We performed Receiver Operating Characteristic (ROC) analyses to evaluate the effectiveness of the SFSS-I subscales in distinguishing between children and adolescents diagnosed with internalizing and externalizing disorders, as determined by clinical judgement in routine care. RESULTS: Confirmatory factor analyses supported a correlated two-factor model for internalizing and externalizing symptoms. Acceptable to good internal consistencies (α = 0.76 to 0.89; ω = 0.76 to 0.90) and excellent interrater reliability on the scale level (ICC ≥ 0.91) was found. The ROC analyses showed an acceptable accuracy in identifying internalizing diagnoses (AUC = 0.76) and excellent accuracy for externalizing diagnoses (AUC = 0.84). CONCLUSION: The SFSS-I demonstrates potential as a clinically-rated instrument for screening and routine outcome monitoring, offering utility in both clinical practice and research settings for the dimensional assessment of broad psychopathological dimensions. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00016737 ( https://www.drks.de/DRKS00016737 ). Registered 17 September, 2019.

Mechanisms in the intergenerational effect of maternal childhood maltreatment on offspring externalizing symptoms: The role of maternal and paternal parenting.

BACKGROUND: Although maternal childhood maltreatment has been associated with offspring externalizing symptoms, little is known about the potential mechanisms that contribute to breaking the intergenerational effect of maternal childhood maltreatment. OBJECTIVE: The current study aimed to (a) investigate the intergenerational effect between maternal childhood maltreatment and offspring externalizing symptoms in the Chinese family; (b) examine maternal supportive and harsh parenting as potential mediators of this intergenerational effect; and (c) explore the moderating roles of paternal support parenting, as well as paternal harsh parenting, in this mediation process of maternal supportive and harsh parenting. PARTICIPANTS AND SETTING: The sample consisted of 1111 mother-father-child triads from Beijing, recruited when the children were one and three years old. METHODS: Mothers completed the Childhood Trauma Questionnaire, and both parents completed the Infant-Toddler Social and Emotional Assessment and Comprehensive Early Childhood Parenting Scale. RESULTS: Our results showed that maternal childhood maltreatment was a risk factor for offspring externalizing symptoms at T2 (ß = 0.24, t = 6.51, p < .001), and this effect was mediated by maternal supportive (indirect effect = 0.03, 95%CI = [0.02, 0.05]) and harsh parenting (indirect effect = 0.03, 95%CI = [0.02, 0.07]) at T1. Furthermore, paternal harsh parenting moderated the indirect effect of maternal childhood maltreatment on child externalizing symptoms through maternal supportive parenting. CONCLUSIONS: These findings contribute to our understanding and provide valuable information for disrupting the intergenerational effect of maternal childhood maltreatment.

Emotion dysregulation mediates the relationship between sleep problems and externalizing symptoms in early adolescents: A four-wave longitudinal study.

BACKGROUND: Despite the growing body of longitudinal research linking sleep problems and externalizing symptoms, regarding the direction of the effects of both variables, the results have been inconsistent. Given the mixed findings and inconsistent results in the literature, we propose that emotion dysregulation may link sleep problems and externalizing symptoms. METHODS: The participants (N = 1281, 49.65 % female; M = 12.73 years at time 1, SD = 0.68) were middle school students who completed assessments for sleep problems, externalizing symptoms, and emotion dysregulation. The interval between each wave was six months, for two consecutive years. Autoregressive mediation models using longitudinal data and cross-sectional mediation models using baseline data were evaluated and compared through structural equation modeling. RESULTS: The results revealed that severe sleep problems (at T1, T2, or T3) were associated with higher levels of externalizing symptoms later in adolescence (at T2, T3, or T4), but not vice versa. In addition, analyses of indirect effects indicated that emotion dysregulation mediated this link, such that greater sleep problems led to more emotion dysregulation, which, in turn, led to more externalizing symptoms. CONCLUSION: The findings highlight the critical role that emotional regulation plays in the link between sleep problems and externalizing symptoms and emphasize the need for students as well as middle school administration to pay close attention to both the sleep and externalizing symptoms of early adolescents.

Caregiving stress and maternal mental health during the COVID-19 pandemic.

It has now been extensively documented that parental mental health has deteriorated since the beginning of the COVID-19 pandemic. Although pandemic-related stress has been widespread, parents faced the unique challenge of navigating remote schooling. Parental oversight of children's education, loss of access to school supportive resources, and the challenges of remote learning may have been most problematic for parents of children with or at elevated risk for mental health difficulties. In the current study, we examined interactive effects of parent-reported pandemic-related caregiving stress and child internalizing and externalizing problems on parental depressive symptoms in a community-based cohort (N = 115) in the Northeast of the United States. Results indicated that parents experiencing higher levels of pandemic-related caregiving stress whose children exhibited elevated externalizing behaviors reported heightened levels of depressive symptoms. Greater child internalizing problems were associated with higher parental depressive symptoms independent of caregiving stress. These findings point to conditions that might heighten risk for parent mental health challenges in the context of ongoing remote or hybrid learning and pandemic-associated restrictions. Further, the findings point to conditions and characteristics that may be screened to identify and intervene with vulnerable families to mitigate mental health problems.

Longitudinal links from attachment with mothers and fathers to adolescent substance use: Internalizing and externalizing pathways.

The present study examined whether internalizing and externalizing symptoms may mediate the association between adolescent-mother and adolescent-father attachment and substance use. The sample included 167 adolescents (47% girls) who were assessed at five time points with approximately 1 year between each assessment, beginning in middle adolescence (Mage = 14.07) and ending in the transition to young adulthood (Mage = 18.39). The adolescents reported their perceived attachment with both their mother and father during middle adolescence (Times 1 and 2), their internalizing and externalizing symptoms during late adolescence (Times 3 and 4), and their alcohol use during the transition to young adulthood (Time 5). The results showed that less secure adolescent-father attachment, but not adolescent-mother attachment, was predictive of heightened externalizing and internalizing symptoms. In turn, heightened externalizing symptoms were predictive of heightened alcohol use. Despite the nonsignificant direct association between adolescent-father attachment and alcohol use, less secure adolescent-father attachment was indirectly predictive of greater alcohol use, mediated through heightened externalizing symptoms. The findings highlight the importance of close and trusting father-adolescent relationships in the development of psychopathology and substance use behaviors. The developmental cascade from a less secure adolescent-father attachment to greater externalizing symptoms and heightened substance use, as well as implications for prevention and intervention of young adult substance use, are discussed. RESEARCH HIGHLIGHTS: The differential pathways from adolescent-mother and adolescent-father attachment to substance use during the transition to young adulthood are not well known. Longitudinal data were used to test whether internalizing and externalizing symptoms may mediate the association between adolescent-mother and adolescent-father attachment and substance use. Less secure adolescent-father attachment predicted heightened internalizing and externalizing symptoms, and less secure adolescent-father attachment predicted greater alcohol use, mediated through heightened externalizing symptoms. The findings suggest that addressing insecure attachment with fathers during adolescence may reduce unhealthy substance use during the transition to young adulthood.

Early cognitive development and psychopathology in children at familial high risk for schizophrenia.

Schizophrenia is a neurodevelopmental disorder associated with deficits in cognitive development and childhood psychopathology. Previous studies have focused on older children and the few studies of early childhood have yielded inconsistent findings. We studied cognitive development and psychopathology in children at familial high risk (FHR) of schizophrenia and matched controls from 1 to 6 years and hypothesized that FHR children would show consistent deficits across cognitive and behavioral measures in early childhood. STUDY DESIGN: Cognitive development in children at high familial risk for schizophrenia or schizoaffective disorder (n = 33) and matched healthy controls (n = 66) was assessed at 1 and 2 years with the Mullen Scales of Early Learning, and at 4 and 6 years with the Stanford Binet Intelligence Scales, BRIEF-P/BRIEF and CANTAB. Psychopathology was assessed at 4 and 6 years with the BASC-2. General linear models were used to examine differences on outcome scores, and chi-square analyses were used to explore differences in the proportion of "at risk" or "below average" score profiles. STUDY RESULTS: FHR children scored significantly lower than controls on Mullen Composite at age 2, and demonstrated broad deficits in IQ, executive function and working memory and 4 and 6 years. FHR children were also rated as significantly worse on most items of the BASC-2 at ages 4 and 6. CONCLUSIONS: Children at FHR for schizophrenia demonstrate abnormal cognitive development and psychopathology at younger ages than previously detected, suggesting that early detection and intervention needs to be targeted to very early childhood.

Evolution of Child and Youth Mental Health in the Context of the COVID-19 Pandemic: A Longitudinal Analysis.

BACKGROUND: The COVID-19 pandemic generated uncertainty and disruption among the child and adolescent population. Multiple studies have documented a worsening of mental health following the pandemic. The main objective of this longitudinal study is to analyze the short-, medium-, and long-term evolution of the overall functioning of children and adolescents treated by a child and adolescent mental health team in the context of the COVID-19 pandemic. METHODS: 420 patients aged 3 to 18 were assessed using the Global Assessment of Functioning (GAF) scale at three time points: during the lockdown, three months later, and three years later. Differences based on gender, diagnosis, and time were analyzed. RESULTS: A significant improvement was observed in the short-term (three months) and long-term (three years) compared to the lockdown period. This improvement was maintained in all diagnostic subgroups except for mixed cases (severe mental pathology), which showed the least improvement. No significant differences were found between males and females. CONCLUSIONS: The child and adolescent population showed a greater capacity for adaptation to the lockdown than expected. Family support, decreased stress, and therapeutic intervention appear to have played an important role in improving mental health.

Pre-existing parental stress and youth internalizing symptoms predict parent-reported COVID-related stress in military families.

Understanding the extent to which youth and families experienced COVID-related stress requires accounting for prior levels of stress and other associated factors. This is especially important for military families, which experience unique stressors and may be reluctant to seek outside help. In this prospective study, we examined the role of pre-pandemic family factors in predicting parent and youth stress during the COVID-19 pandemic. Participants were 234 families with at least one active-duty parent and a 3rd or 5th-grade child. Findings revealed that preexisting factors predicted youth and family COVID-related stress. Specifically, heightened pre-pandemic parental stress and youth internalizing symptoms were significant predictors of COVID-related stress. Implications for mental health professionals and other organizations supporting military parents and families during the COVID-19 pandemic as well as other times of upheaval are discussed.

Association between Body Mass Index and Externalizing and Internalizing Symptoms among Chinese Adolescents: Mediating Role of Traditional Bullying and Cyberbullying Victimization.

BACKGROUND: Externalizing problems, internalizing problems, and obesity are among the greatest challenges to adolescent health. However, the moderating and mediating mechanisms that underlie this association remain predominantly unexplored. OBJECTIVES: In this study, we examined the association between body mass index (BMI) and externalizing and internalizing scores in adolescents, tested whether traditional bullying and cyberbullying mediated the association, and explored the moderated role of sex. METHODS: The data came from 1486 adolescents from grade 7, 8, and 10 living in Shantou, China. Information on BMI, traditional bullying, and cyberbullying victimization was obtained through a self-administered questionnaire. The students' externalizing and internalizing scores were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Furthermore, we built two parallel mediation models with sex as a moderating variable. RESULTS: Compared to their peers with normal weight, adolescents with increased BMI reported higher externalizing and internalizing scores. Traditional bullying and cyberbullying were both significant mediators in the two relationships. Sex moderated the pathway from BMI to cyberbullying. But sex did not moderate the relationship between BMI and traditional bullying. CONCLUSIONS: The results highlight that it is imperative for educators to identify students who are subjected to weight-based bullying and provide them with recommendations for effective coping strategies. Meanwhile, both victims of traditional bullying and those affected by cyberbullying should be the focus of prevention and intervention efforts when developing a strategy to improve levels of internalizing and externalizing symptoms among adolescents with increased BMI.

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.

Trajectories of actigraphy-derived sleep duration, quality, and variability from childhood to adolescence: downstream effects on mental health.

STUDY OBJECTIVES: We examined growth trajectories of four actigraphy-derived sleep parameters (sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency across a week of assessments) across childhood and adolescence and examined individual differences in trajectories according to participants' race/ethnicity and sex. We also assessed the predictive effect of growth trajectories of sleep parameters on growth trajectories of mental health outcomes and moderation by race and sex. METHOD: Youth (N = 199, 49% female, 65% white, 32% black, 3% biracial) and their parents participated in five waves of data (M ages were 9, 10, 11, 17, and 18 across waves). Participants were from a diverse range of socioeconomic backgrounds. RESULTS: Across participants, sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency demonstrated significant linear change across childhood and adolescence. Whereas sleep duration shortened over time, sleep efficiency improved. Youth exhibited increases in night-to-night variability in sleep minutes and reductions in night-to-night variability in sleep efficiency. Highlighting the importance of individual differences, some race- and sex-related effects emerged. Black youth and male youth experienced steeper declines in their sleep duration across development relative to their respective counterparts. Black youth also demonstrated smaller improvements in sleep efficiency and greater variability in sleep efficiency compared to white youth. Finally, trajectories of sleep efficiency and variability in sleep minutes predicted trajectories of internalizing symptoms and externalizing behaviors. CONCLUSIONS: Findings showed significant changes in developmental trajectories of four sleep parameters across childhood and adolescence. We discuss the empirical and translational implications of the findings.

Sex Differences in Youth with Chronic Tic Disorder and Tourette Syndrome: Evaluation of Tic Severity, Psychological Profiles, and Quality of Life.

Background: Tourette syndrome (TS) and Chronic Tic Disorder (CT) are neurodevelopmental conditions involving motor and/or phonic tics. Youth with tics may encounter feelings of isolation, diminished self-esteem and quality of life, and academic difficulties. A growing body of scientific literature suggests sex differences in youth with tics, but findings have been mixed so far. Because symptom severity peaks around puberty, understanding sex differences in tic manifestations and associated symptoms during this critical period is essential. Therefore, we aimed to assess sex differences related to tic symptoms, action planning styles, quality of life, and externalizing/internalizing symptoms in youth with tics. Methods: Our sample consisted of 66 youths with tics (19 girls) aged 7-14 (mean = 10 years). Youths were assessed with clinical interviews, as well as self- and parent-reported inventories evaluating tic symptoms, psychological profiles, and quality of life. Results: While no differences in tic symptoms were found, girls exhibited lower functional inflexibility, reduced overall functional planning effectiveness, and higher impairment in the psychological well-being subscale than boys. Additionally, girls had reduced general life satisfaction and social self-esteem. Boys reported more explosive outbursts, higher levels of hyperactivity, and more difficulties with self-concept. Conclusions: Our analyses suggested differences in several manifestations associated with tics. This introduces new perspectives that refine our understanding of sex differences. A better understanding of sex differences in tic disorders may eventually improve outcomes for all individuals living with these conditions.

The role of cumulative risk and armed conflict exposure in adolescent psychological symptoms in Turkey.

Exposure to risk factors and adversity may cause immediate, and sometimes prolonged, psychological symptoms in adolescents. Identifying universal and specific risk factors in a particular context and examining their cumulative effects is crucial for understanding the mechanisms underlying psychological symptoms and informing about strategies for intervention. Using concurrent measures, the current study aimed to examine the role of armed conflict experiences and cumulation of other risk factors (e.g., maternal psychological symptoms, socioeconomic indicators) in predicting adolescent psychological symptoms in an underresearched community. The sample included 161 adolescents (54.7% female) aged 11-14 years (M = 12.36, SD = 1.27) and their mothers living in the east of Turkey. The cumulative risk index was calculated by summing the standardized scores of the corresponding factors. Hierarchical multiple regression analyses were conducted to predict internalizing and externalizing symptoms among adolescents by introducing demographic variables (age, gender) in the first step, armed conflict experiences and cumulative risk in the second step, and their interaction in the final step. Results showed that the levels of internalizing and externalizing symptoms were predicted by gender, armed conflict experience and cumulative risk. Being a girl was associated with higher levels of internalizing symptoms and lower levels of externalizing symptoms. Higher levels of internalizing and externalizing symptoms were predicted by exposure to armed and cumulative risk. After controlling for other factors, the interaction of armed conflict experience and cumulative risk significantly predicted externalizing, but not internalizing symptoms. These findings suggested that cumulative risk was a stronger predictor of psychological symptoms, and further amplified the strength of the association between armed conflict experiences and externalizing symptoms. These findings can be used in the formulation of intervention strategies and policies to promote psychological well-being in adolescents living in armed conflict zones under multiple risks.

Exploring the association of Indigeneity, social adversity status and externalizing symptoms in children and adolescents.

OBJECTIVE: The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people. METHODS: A total of 132 Indigenous and 247 non-Indigenous young people aged 6-16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms. RESULTS: The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms. CONCLUSIONS: High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don't necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity.

Acceptance and utilization of web-based self-help for caregivers of children with externalizing disorders.

BACKGROUND: Web-based self-help interventions for parents of children with ADHD and other externalizing disorders have been proven to be effective. In order to recommend individualized and optimized interventions, a better understanding of the acceptance and utilization of this innovative treatment approach is needed. Previous research has frequently employed subjective reports of utilization, but the validity of these studies may be limited. METHODS: Data from the German WASH study were used. Participants (n = 276) were randomly assigned to the intervention condition (a) web-based self-help or (b) web-based self-help with optional telephone-based support calls. Data collection took place at baseline (T1) and 12 weeks later (T2). Utilization data were tracked using a log file generated for each participant at T2. Prediction models were calculated using CART (Classification and Regression Trees), a method known mostly from the field of machine learning. RESULTS: Acceptance, of the intervention as defined in this paper was very high on objective (89.4% have taken up the intervention) and subjective measures (91.4% reported having used the intervention and 95.3% reported they would recommend the intervention to a friend). The average number of logins corresponded to recommendations. Predictors of acceptance and predictors of utilization were similar and included, e.g., child's externalizing symptoms, parental psychopathology, and above all additional telephone-based support by counselors. CONCLUSIONS: Through a detailed identification of acceptance and utilization, and the predictors thereof, we were able to gain a better understanding of the acceptance and utilization of web-assisted self-help for a parent management intervention in the treatment of children with ADHD and ODD. These findings can be used to recommend web-based interventions to particularly suitable families. It should be noted that some form of support is required for an intensive engagement with the content of the program. TRIAL REGISTRATION: The protocol of the study (German Clinical Trials Register DRKS00013456 conducted on January 3rd, 2018) was approved by the Ethics Committee of the University Hospital, Cologne.

Sex-specific associations between co-exposure to multiple metals and externalizing symptoms in adolescence and young adulthood.

Externalizing disorders, such as attention-deficit/hyperactivity disorder (ADHD), account for the majority of the child/adolescent referrals to mental health services and increase risk for later-life psychopathology. Although the expression of externalizing disorders is more common among males, few studies have addressed how sex modifies associations between metal exposure and adolescent externalizing symptoms. This study aimed to examine sex-specific associations between co-exposure to multiple metals and externalizing symptoms in adolescence and young adulthood. Among 150 adolescents and young adults (55% female, ages: 15-25 years) enrolled in the Public Health Impact of Metals Exposure (PHIME) study in Brescia, Italy, we measured five metals (manganese (Mn), lead (Pb), copper (Cu), chromium (Cr), nickel (Ni)) in four biological matrices (blood, urine, hair, and saliva). Externalizing symptoms were assessed using the Achenbach System of Empirically Based Assessment (ASEBA) Youth Self-Report (YSR) or Adult Self Report (ASR). Using generalized weighted quantile sum (WQS) regression, we investigated the moderating effect of sex (i.e., assigned at birth) on associations between the joint effect of exposure to the metal mixture and externalizing symptoms, adjusting for age and socioeconomic status. We observed that metal mixture exposure was differentially associated with aggressive behavior in males compared to females (ß = -0.058, 95% CI [-0.126, -0.009]). In males, exposure was significantly associated with more externalizing problems, and aggressive and intrusive behaviors, driven by Pb, Cu and Cr. In females, exposure was not significantly associated with any externalizing symptoms. These findings suggest that the effect of metal exposure on externalizing symptoms differs in magnitude between the sexes, with males being more vulnerable to increased externalizing symptoms following metal exposure. Furthermore, our findings support the hypothesis that sex-specific vulnerabilities to mixed metal exposure during adolescence/young adulthood may play a role in sex disparities observed in mental health disorders, particularly those characterized by externalizing symptoms.