Evaluation of dental behavior, anxiety, fear, and its correlation with trait emotional intelligence in 8-12-year-old children: Exploring a new frontier in behavior modification.

BACKGROUND: Children's fear and distress in dental settings often lead to anxiety and behavior issues. This study delves into why some children experience dental anxiety, whereas others do not, attributing differences to child-rearing and personality traits. Emotional intelligence (EQ), the ability to comprehend, generate, and manage emotions, is explored as a factor influencing a child's dental experience. This novel intelligence theory accommodates the intricacies of human-environment interactions. AIM: The study aimed to investigate the relationship between EQ and a child's dental anxiety, fear, and behavior in children aged 8-12 years. MATERIALS AND METHODS: The Trait Emotional Intelligence Questionnaire-Child Short Form, specifically developed for children aged between 8 and 12 years, was used among 100 participants reporting to the department outpatient department. The Frankl's Behavior Rating Scale, Modified Child Dental Anxiety Scale, and Children's Fear Survey Schedule-Dental Subscale were used to evaluate behavior, anxiety, and fear, respectively. RESULTS: Results show a positive correlation between EQ and dental behavior (P = 0.002) whereas a negative correlation between EQ and dental anxiety and fear (P < 0.001). CONCLUSION: This study sheds light on the intricate interplay between emotional intelligence, dental behavior, anxiety, and fear among children. By recognizing the impact of EQ, dental practitioners could adopt personalized strategies to alleviate anxiety and enhance cooperation, improving overall dental experiences for young patients.

No "Top of the triangle kids": Toward conceptual clarity of students, behavior, and tiers in MTSS to advance social justice.

Schools have increasingly adopted multitier systems of support to address a variety of educational aims. Despite their grounding in behavioral science and the public health model of prevention, in many settings there has been a shift from a foundational focus on behavioral principles to emphasize categorization and treatment of "top of the triangle" or "Tier 3" students. Herein, we first discuss how such emphasis on situating individuals, rather than behaviors, within the continuum of supports is counter to the principles and goals of MTSS, as well as undermining efforts to support prevention and social justice. Next, we apply a critical lens to review the related literature on problem-solving, labeling, marginalization of disabled students, and discipline disparities to provide a rationale for equity-centered MTSS with corresponding recommendations for practice.

Food Neophobia in Children Aged 1-6 Years-Between Disorder and Autonomy: Assessment of Food Preferences and Eating Patterns.

Food neophobia, defined as fear or aversion to eating new or unfamiliar foods, is a significant challenge, especially in the context of preschool children. In the scientific literature, this phenomenon is often described as a natural developmental stage, but its severity and impact on preferences and eating patterns still raise many questions. The purpose of the present study was to assess the prevalence of food neophobia in children aged 1 to 6 years and to analyze its relationship with eating habits, preferences, and eating patterns. The study was conducted using a proprietary questionnaire and validated research tools such as the Child Feeding Scale (MCH-FS) and Food Neophobia Scale (FNS). The study included 345 children, of whom 59.1% were observed to be at significant risk for food neophobia. The results of the study suggest that food neophobia is not a common phenomenon in children aged 1-2 years but becomes more pronounced later in childhood. Another important finding was that food neophobia shows a stronger association with established eating patterns than with individual taste preferences. Considering these results, this phenomenon should be considered not only as a natural part of child development, but also as a potential indicator of eating disorders that may require intervention. These findings underscore the need for further research that could deepen the understanding of the mechanisms governing food neophobia and its long-term consequences for child health.

Evaluating Emotional Eating in Children from the Perspective of Parents: Psychometric Properties of the Parent Version of the Emotional Eating Scale Adapted for Children and Adolescents.

BACKGROUND: Emotional eating is associated with adverse health outcomes in children, including elevated weight status. Currently, there is not a well-validated parent-report measure of emotional eating for young children. This study assessed the reliability and validity of the 10-item parent version of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) Short-Form. METHODS: The participants were 207 parents and 144 children from the southern United States. They completed the parent- and child-report EES-C Short-Form and responded to measures related to child eating behaviors, mood, and gratitude. RESULTS: The parent-report EES-C Short-Form demonstrated good internal consistency reliability (Cronbach's alpha = 0.94). Test-retest reliability was also supported, as evidenced by a medium correlation (ICC = 0.56, p < 0.001) between parent-rated emotional eating across two time points. Additionally, the measure demonstrated a significant correlation with a scale of emotional overeating (r = 0.25, p < 0.001)-a theoretically related construct. Supporting discriminant validity, the measure was not significantly related to a measure of parent-reported gratitude (r = 0.07, p = 0.30). A unidimensional model provided good fit for the data (CFI = 0.997, SRMR = 0.046). CONCLUSIONS: The results from the current study provide preliminary evidence supporting the reliability and validity of the parent version of the EES-C Short-Form. For the purpose of screening children in school or primary care settings, the EES-C Short-Form may be practical and helpful in identifying children who may be at risk of developing adverse health outcomes or more-severe eating disorder pathology.

The relationship between children's emotional development tasks fulfilment and Strength and Difficulties Rutter Questionnaire assessment on elementary school-aged children's mental health.

OBJECTIVE: To assess the emotional development of school-aged children. METHODS: The descriptive, analytical study was carried out on children of elementary schools in the Semarang City area in January 2022. Included were children aged 6-12 years with active elementary school status. Data was collected using the 25-item Strength and Difficulties Rutter Questionnaire. The questionnaire was filled manually by the subject along with the guardian or teacher. Data was analysed using SPSS 20. RESULTS: Of the 326 children, 174(53.21%) were girls and 153(46.79%) were boys. Overall, 171(52.3%) subjects were aged <10 years, while 156(47.7%) were aged 10-12 years. There were 295(90.21%) children with normal prosocial behaviour, 206(63%) with normal emotional status, 264(80.73%) with normal conduct, 133(40.67%) with normal hyperactivity level, and 91(27.83%) with normal equation with peers. CONCLUSIONS: Different domains of the Strength and Difficulties Questionnaire showed varying degrees of pro-social behaviour, emotional status, conduct, hyperactivity level and peer interaction among the subjects.

Food neophobia scores at 8 Years and associations with nutrition-related behaviors at home in early life: Findings from a New Zealand contemporary birth cohort.

Food neophobia (FN) reduces nutritional adequacy and variety which poses a significant concern for children's health and well-being We described the FN scores among 8-year-olds and examined its associations with nutrition-related behaviors at 45 months within the Growing Up in New Zealand cohort (n = 4621). FN was estimated using the Food Neophobia Scale (FNS). Mean FNS scores between variable categories were compared using t-tests for independent samples and ANOVA. Associations between FNS scores at 8 years and nutrition-related behaviors at 45-months were examined using multivariate linear regression. The mean (standard deviation) FN score was 46.2 (15.2) with statistically significant differences by sex (boys = 47.6 (15.7), girls = 43.8 (14.2), p=<0.001). For all children, in models adjusted by breastfeeding duration and sociodemographic characteristics: children who sometimes and never/almost never ate the same foods as their parents, scored, on average, 5.8 and 11 points higher in the FNS (versus those who did always/almost always); children who occasionally/never found mealtimes enjoyable scored on average 3.6 points lower in the FNS (versus mostly/quite often); children who always/almost always had the television on during mealtimes scored on average 2.7 higher in the FNS (versus never/almost never). In comparison to children who mostly/quite often had time to talk to others during mealtimes, those who never/occasionally did it scored on average higher points in the FNS overall (1.46 points higher) and within girls (1.73 points higher). These findings support the eating behavior statements in the National Children's Food and Nutrition Guidelines, which emphasize early exposure to food variety, limiting mealtime distractions, and acknowledge that parental role modeling shapes children's nutrition-related behaviors. Early adoption of preventative interventions for reducing FN in early and middle childhood are needed.

Individual characteristics and environmental factors influencing preschoolers' emotional eating.

Emotional eating, which refers to eating in response to emotional states, is prevalent in early childhood. Executive function (EF) and sleep problems are related to preschoolers' self-regulatory abilities during the day and night and have been reported to be associated with their emotional eating. These associations can be stronger in emotionally stressful situations, such as controlling feeding practices. This study explored the role of preschoolers' EF and sleep problems as child characteristics, as well as maternal feeding practices as environmental factors influencing emotional eating during the preschool period. Participants included 363 Korean mothers with preschoolers aged 3- to 5-years old (190 boys, 173 girls). Mothers reported on their own feeding practices, and preschoolers' EF, sleep problems, and emotional eating. Results indicated that preschoolers' EF was negatively associated with emotional over- and undereating, and this association was stronger when mothers applied more pressure to eat. Maternal monitoring had a similar effect, with emotional overeating exerting a greater impact with low levels of maternal monitoring. Finally, maternal pressure to eat moderated the influence of preschoolers' sleep problems on emotional overeating, with higher pressure to eat predicting a stronger relationship between sleep problems and emotional overeating. These findings suggest that maternal feeding practices, which are relatively modifiable, should be considered an important element in intervention programs aimed at preventing emotional eating in preschool children.

Associations between child eating behaviors with eating patterns and diet quality in preschool-aged children.

Childhood eating behaviors are associated with weight status and laboratory assessments of dietary intake. However, little is known about how eating behaviors relate to the eating patterns and diet quality of children from marginalized populations when assessed in their natural environments. Therefore, we examined the association of food avoidant (e.g., food fussiness and satiety responsiveness) and food approach (e.g., food responsiveness and enjoyment of food) eating behaviors with children's meal size, eating frequency, and diet quality. We analyzed data from 61 predominately low-income Hispanic/Latinx preschool-aged children. Caregivers completed the Childhood Eating Behavior Questionnaire and two 24-h dietary recalls. From the recalls, we calculated meal size, eating frequency, and modified Diet Quality Index Scores (DQIS), and evaluated associations with eating behaviors using multivariable linear models. We also explored the relationship between eating behaviors and DQIS components. Food-avoidant subscales were associated with smaller meals and satiety responsiveness were associated with decreased snack frequency. Food approach subscales were not associated with meal size or eating frequency. Both food-avoidant and food-approach behaviors were associated with components of diet quality and caloric beverages outside of meal and snacks. These findings can inform future research on the relationship between child eating behaviors and dietary intake so that we can develop more tailored and effective interventions to promote healthy eating habits for low-income, Hispanic/Latinx preschool-aged children.

The Effect of Prebedtime Behaviors on Sleep Duration and Quality in Children: Protocol for a Randomized Crossover Trial.

BACKGROUND: It is recommended that children should avoid eating dinner, being physically active, or using screens in the hour before bed to ensure good sleep health. However, the evidence base behind these guidelines is weak and limited to cross-sectional studies using questionnaires. OBJECTIVE: The aim of this randomized crossover trial was to use objective measures to experimentally determine whether recommendations to improve sleep by banning electronic media, physical activity, or food intake in the hour before bed, impact sleep quantity and quality in the youth. METHODS: After a baseline week to assess usual behavior, 72 children (10-14.9 years old) will be randomized to four conditions, which are (1) avoid all 3 behaviors, (2) use screens for at least 30 minutes, (3) be physically active for at least 30 minutes, and (4) eat a large meal, during the hour before bed on days 5 to 7 of weeks 2 to 5. Families can choose which days of the week they undertake the intervention, but they must be the same days for each intervention week. Guidance on how to undertake each intervention will be provided. Interventions will only be undertaken during the school term to avoid known changes in sleep during school holidays. Intervention adherence and shuteye latency (time from getting into bed until attempting sleep) will be measured by wearable and stationary PatrolEyes video cameras (StuntCams). Sleep (total sleep time, sleep onset, and wake after sleep onset) will be measured using actigraphy (baseline, days 5 to 7 of each intervention week). Mixed effects regression models with a random effect for participants will be used to estimate mean differences (95% CI) for conditions 2 to 4 compared with condition 1. RESULTS: Recruitment started in March 2024, and is anticipated to finish in April 2025. Following data analysis, we expect that results will be available later in 2026. CONCLUSIONS: Using objective measures, we will be able to establish if causal relationships exist between prebedtime behaviors and sleep in children. Such information is critical to ensure appropriate and achievable sleep guidelines. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12624000206527; https://tinyurl.com/3kcjmfnj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63692.

Cross-cultural adaptation and psychometric properties of the Malay version of parenting and child tooth brushing assessment (M-PACTA).

BACKGROUND: Malaysian preschool children continue to exhibit a high prevalence of dental caries and poor oral hygiene. There is a need to gain an in-depth understanding of oral hygiene habits and design suitable interventions to improve oral hygiene in early childhood. OBJECTIVE: To cross-culturally adapt and determine the psychometric properties of the Malay-translated Parenting and Child Tooth Brushing Assessment questionnaire (M-PACTA). METHODOLOGY: This cross-sectional study involved face and content validation, and forward and back-translation of PACTA. The M-PACTA was then tested for reliability and construct validity on 150 Malaysian parents of children aged 5 to 6 years old. RESULTS: Face validity indicated that the M-PACTA items were clear and easy to understand. For content validity, some words had to be modified in accordance with the recommendations of the expert committees to make it more coherent to Malaysians. Some statements in the parental knowledge scales were modified according to the guidelines applicable in Malaysia. The content comparison of the back translation with the adapted PACTA revealed that all items were semantic and linguistically equivalent. Exploratory factor analyses of M-PACTA suggested a two-factor structure for three scales including child behaviour scale ('non-compliance' and 'avoidance behaviour'), parental attitudes ('lack of concern' and 'attitude of care'), and parental knowledge ('general tooth brushing knowledge' and 'awareness of tooth brushing care') while for the parental strategy scale, three-factor structure was extracted including 'routine positive methods', 'uncommon positive methods', and 'negative methods'. Internal consistencies for all scales were good (α > 0.9). CONCLUSION: M-PACTA did not replicate the construct of the original PACTA. Nonetheless, M-PACTA demonstrated good construct validity, internal consistency reliability, and test-retest reliability within Malaysian context.

Developmental patterns and computational mechanisms of school-aged children's fairness-related decision making under social comparison.

The developmental patterns and computational mechanisms underlying the impact of unfair offers and social comparisons on school-aged children's fairness-related decision making remain unclear. To address this, we recruited 190 children aged 8 to 12 years (52.1% female) in a multi-responder ultimatum game. Results revealed an age-related decline in children's tendency to reject unfair offers, partially mediated by emotions, alongside a slight increase in rejecting inferior social comparisons. Computational modeling identified two distinct motivations guiding children's rejection behavior: inequity aversion and inferior social comparison avoidance. Furthermore, there was significant variability in responses to superior social comparisons, with some children displaying aversion and others seeking. Our refined model enhances the explanatory power of inequity aversion theory in complex multi-player social scenarios, validating and refining existing theories. In addition, the exploration of superior social comparison tendencies reveals individual heterogeneity, enriching our understanding of children's social comparisons. These findings contribute to elucidating the developmental patterns and internal mechanisms of children's socialization processes, offering implications for promoting their social adaptation and mental health.

Comparing upward: How parental social comparisons shape children's self-concept and mastery motivation in China.

The prevalence of Chinese parents using upward social comparisons to influence their children's behavior is well-documented. However, the lack of reliable tools for measuring parental social comparisons, combined with a limited understanding of their association with preschoolers' mastery motivation, highlights a significant gap in research. To bridge this gap, we undertook a comprehensive investigation. Study 1 involved the development of the Parental Social Comparison Scale. Study 2 and Study 3 explored the association between parental social comparisons and children's mastery motivation, considering perspectives from parents (N = 194; Mage = 33.72 years, SD = 4.97) and children (N = 102; Mage = 5.14 years, SD = 3.78). We found that parental social comparisons were positively associated with children's mastery motivation according to parents' perceptions but were negatively associated with mastery motivation through children's self-concept from children's perspectives.

Effects of praise and "easy" feedback on children's persistence and self-evaluations.

Praise is thought to affect children's responses to failure, yet other potentially impactful messages about effort have been rarely studied. We experimentally investigated the effects of praise and "easy" feedback after success on children's persistence and self-evaluations after failure. Children (N = 150; Mage = 7.97 years, SD = 0.58) from the mid-Atlantic region of the United States (73 girls; 79% White) heard one of five types of feedback from an experimenter after success on online tangram puzzles: process praise ("You must have worked hard on that puzzle"), person praise ("You must be good at puzzles"), process-easy feedback ("It must have been easy to rotate and fit those pieces together"), person-easy feedback ("It must have been an easy puzzle for you"), or a control. Next, children failed to complete a harder tangram puzzle. Preregistered primary analyses revealed no differences in persistence and self-evaluation between person and process praise or between person-easy and process-easy feedback. Exploratory analyses showed that hearing process praise led to greater persistence after failure than the control condition (d = .61) and that process-easy feedback led to greater strategy generation than the control condition. The effects of adult feedback after success may be more context dependent than previously thought.

Siblings at home: Moderating influence of sibling presence and composition on the relation between problem behaviors and Theory of Mind in early childhood.

Despite the prevalence of internalizing and externalizing difficulties in children, the impact of these problem behaviors on the development of important social cognitive skills, such as Theory of Mind (ToM), is not well-understood. Indeed, many studies that have explored relations between problem behaviors and ToM report inconsistent findings. A possible reason for these disparities may be a lack of accounting for social protective factors within the home, such as the presence and number of siblings. Here, we explored the moderating influence of sibling presence and number on the relation between problem behaviors (i.e., internalizing and externalizing) and ToM. A total of 184 children (88 boys; Mage = 64.6 months, SD = 10.39) completed six well-validated ToM tasks while mothers reported on their children's externalizing and internalizing behaviors. Children who had siblings living in the same home exhibited higher ToM than children without siblings. In addition, both sibling presence and number of siblings moderated the relation between children's externalizing behaviors and ToM, such that in children without siblings externalizing behaviors were negatively associated with ToM. In contrast, children with siblings had similar ToM regardless of externalizing behaviors. As well, children with relatively fewer siblings and higher externalizing behaviors displayed lower ToM than children with relatively more siblings and higher externalizing behaviors. We did not detect a moderating effect of sibling presence or number on the relation between internalizing behaviors and ToM. These findings provide support for siblings' protective utility within the context of children's social cognition.

Differences in parental behaviour, emotions, and cognitions between children's eating profiles.

A variety of parent psychological characteristics (e.g., wellbeing) have been related to children's eating behaviour. However, parent-child feeding interactions are reciprocal and complex, including relationships between parental cognitions, emotions, as well as the influence of children's varying appetitive traits. Using a person-centred approach, children's appetitive traits can be clustered into meaningful eating profiles. To date, no research has examined whether parental behaviours, emotions, and cognitions differ depending on a child's eating profile. Hence, this study recruited parents/primary caregivers from the APPETItE project, whose child had previously been identified as having an avoidant, typical, happy, or avid eating profile. Parents/primary caregivers of children (3-6 years; N = 632) completed online questionnaires examining broader parenting behaviour (parenting styles), parental emotions (stress, wellbeing), and parental cognitions (goals, self-efficacy, time and energy for meal planning and preparation, and perceptions about children's body size). Findings showed significant differences in parent responses to the questionnaires based on children's eating profiles. Parents of children with a happy eating profile reported better psychological wellbeing and greater parenting time and energy for meal planning and preparation, as well as being less likely to report goals of avoiding mealtime stress and conflict. In contrast, parents of children with an avoidant eating profile reported poorer psychological wellbeing. Children with an avid eating profile were perceived by parents as having a higher body weight, whereas children with an avoidant eating profile were perceived as having a lower body weight. Overall, these findings demonstrate that differences in parental characteristics and perceptions exist between children's eating profiles and thus should be considered in the development of tailored interventions to support children's healthy eating.

Facial impressions of niceness influence children's interpretations of peers' ambiguous behavior.

Children infer personality traits from faces when they are asked explicitly which face appears nice or mean. Less is known about how children use face-trait information implicitly to make behavioral evaluations. We used the Ambiguous Situations Protocol to explore how children use face-trait information to form interpretations of ambiguous situations when the behavior or intention of the target child was unclear. On each trial, children (N = 144, age range = 4-11.95 years; 74 girls, 67 boys, 3 gender not specified; 70% White, 10% other or mixed race, 5% Asian, 4% Black, 1% Indigenous, 9% not specified) viewed a child's face (previously rated high or low in niceness) before seeing the child's face embedded within an ambiguous scene (Scene Task) or hearing a vignette about a misbehavior done by that child (Misbehavior Task). Children described what was happening in each scene and indicated whether each misbehavior was done on purpose or by accident. Children also rated the behavior of each child and indicated whether the child would be a good friend. Facial niceness influenced children's interpretations of ambiguous behavior (Scene Task) by 4 years of age, and ambiguous intentions (Misbehavior Task) by 6 years. Our results suggest that the use of face-trait cues to form interpretations of ambiguous behavior emerges early in childhood, a bias that may lead to differential treatment for peers perceived with a high-nice face versus a low-nice face.

Advanced theory of mind and children's prosocial lie-telling in middle childhood: A training study.

Children's advanced theory of mind (AToM) is concurrently associated with their prosocial lie-telling. However, the causal link between AToM and prosocial lie-telling has not yet been demonstrated. To address this gap, the current study adopted a training paradigm and investigated the role of AToM in children's prosocial lie-telling in middle childhood. A total of 66 9- and 10-year-old children who did not demonstrate any prosocial lie-telling in a disappointment gift paradigm at the baseline were recruited and randomly assigned to either the experimental group (n = 32) or an active control group (n = 34). The experimental group underwent a conversation-based training program of four sessions. The results showed significantly greater gains in AToM at the posttest for the experimental group children compared with the control group children, controlling for family socioeconomic status, children's literacy score, working memory, and inhibition. More important, the experimental group children were more likely to tell prosocial lies than the control group, even after controlling for the pretest AToM and other covariates. However, the training effects faded at the 6-month follow-up test after the training's completion. These findings provide the first evidence for the causal role of AToM in the development of prosocial lie-telling in middle childhood. The fade-out effect is discussed in the context of educational interventions.

Facility dogs during police investigative interviews: Does it decrease children's reluctance?

BACKGROUND: Using facility dogs during police investigative interviews is a recent practice in Canada. While the common use of this intervention is decidedly an indicator of sympathy capital, its utility in this context is relatively unknown and no study has specifically evaluated the effect of using facility dogs on children's collaboration during investigative interviews. OBJECTIVE: This study compares police investigative interviews conducted in the presence of a service dog (n = 46) to those without (n = 45) to examine the effects of the presence of and interactions with a dog on children's reluctance. PARTICIPANTS, SETTING AND METHODS: The interviews were done with children aged 3 to 15 years and were coded for children's reluctance, their physical interactions with and comments about the dog, as well as for investigator's verbal support. RESULTS: No significant group differences were found in terms of children's overall reluctance (p = 0.700), though the children accompanied by a dog showed significantly more digression (p = 0.008). Among the children who were accompanied by a dog, those who interacted with the dog more frequently (p = 0.035) and who made more comments about the dog (p < 0.001) showed more signs of reluctance, even after accounting for child age and investigator support. No association was observed between children's reluctance and the total duration of dog-child physical interactions (p = 0.097). CONCLUSIONS: This study contributes to an enhanced understanding of the usefulness of facility dogs and the factors that influence children's reluctance during investigative interviews.

The longitudinal relationship between prenatal maternal cortisol and preschool internalising problems.

INTRO: Prenatal exposure to synthetic glucocorticoids may increase the risk of emotional symptoms in childhood partly by reducing fetal growth. We explored if physiological levels of prenatal maternal cortisol were associated with internalising problems in boys and girls and if this was mediated by birth weight. METHODS: Mother-child dyads from the prospective Odense Child Cohort (n=1162) were included if maternal serum cortisol (3rd trimester), offspring birth weight, and Child Behaviour Checklist (CBCL) assessments in preschool age were available. Crude and adjusted associations between cortisol and internalising problems were determined in linear mixed models stratified by offspring sex. Covariates included parental psychiatric history, parity, maternal age, education, smoking during pregnancy, and gestational age at birth. In the presence of significant associations, we evaluated the potential mediating role of birth weight. RESULTS: The study sample included 601 boys and 561 girls and internalising problems were assessed at mean ages 2.3 (±0.4) and 5 (±0.5) years. In the crude analysis, cortisol was positively associated with internalising problems in boys (p-value 0.017) and in girls (p-value < 0.0001). In the adjusted analyses, there was no statistically significant association between cortisol and offspring internalising problems in boys or girls (all p-values > 0.15). There was no mediation by birth weight. DISCUSSION: Maternal serum cortisol was positively associated with offspring internalising problems in boys and girls, but there was no association following adjustment for potential confounders and no mediation through birth weight. Maternal third-trimester cortisol levels do not predict preschool offspring internalising problems in our study.