Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study.

Childhood bullying behaviors (bullying and victimization) were studied as risk factors for substance use among Finnish males. The study design was a nationwide prospective general population study, where information was collected in 1989 and 1999. Bullying behaviors and childhood psychopathology at age eight were collected from teachers, parents and boys themselves. At age 18, self-reports of frequent drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or more per day), and illicit drug use during the past six months were obtained from 78% of the boys attending the study at age eight (n=2946). Being frequently victimized at age eight predicted daily heavy smoking, and this was evident even after adjusting for childhood family background, psychopathology at age eight and at age 18, and other forms of substance use. In multivariate analysis, bullying others frequently predicted illicit drug use, while being a victim of bullying associated with a lower occurrence of illicit drug use. Bullying behaviors had no association with frequent drunkenness independent of other factors. Accordingly, being a victim of bullying predisposes in particular to subsequent smoking. Bullying others in childhood can be regarded as an early indicator to illicit drug use later in life. The screening and intervention possibilities in order to recognize the risk group for later health compromising behaviors are emphasized.

Do mental health problems in childhood predict chronic physical conditions among males in early adulthood? Evidence from a community-based prospective study.

BACKGROUND: Previous studies have documented associations between mental and physical health problems in cross-sectional studies, yet little is known about these relationships over time or the specificity of these associations. The aim of the current study was to examine the relationship between mental health problems in childhood at age 8 years and physical disorders in adulthood at ages 18-23 years. METHOD: Multiple logistic regression analyses were used to examine the relationship between childhood mental health problems, reported by child, parent and teacher, and physical disorders diagnosed by a physician in early adulthood. RESULTS: Significant linkages emerged between childhood mental health problems and obesity, atopic eczema, epilepsy and asthma in early adulthood. Specifically, conduct problems in childhood were associated with a significantly increased likelihood of obesity and atopic eczema; emotional problems were associated with an increased likelihood of epilepsy and asthma; and depression symptoms at age 8 were associated with an increased risk of asthma in early adulthood. CONCLUSIONS: Our findings provide the first evidence of an association between mental health problems during childhood and increased risk of specific physical health problems, mainly asthma and obesity, during early adulthood, in a representative sample of males over time. These data suggest that behavioral and emotional problems in childhood may signal vulnerability to chronic physical health problems during early adulthood.

The persistence of psychiatric deviance from the age of 8 to the age of 15 years.

BACKGROUND: Earlier research has shown that psychiatric problems in children tend to persist over years. This investigation assessed the persistence of psychiatric deviance among children over a 7-year period from the age of 8 to the age of 15 years. We also explored the relationship between problems leading to special attention at the well-baby clinics before school age and future psychiatric deviance. METHODS: The study material consisted of three questionnaires filled out by the parents, teachers and children themselves (N = 1268) at three time points, together with data concerning the children gathered from the records of well-baby clinics. RESULTS: At the age of 15 years, girls scored higher than boys on the parental scale and on the Beck's Depression Inventory (BDI), while boys scored higher than girls on the teachers' scale. Parental ratings had a high correlation over 3 years and a moderate correlation over 7 years. Teachers' and children's ratings correlated moderately over 3 years, but did not correlate significantly over 7 years. The probability of being deviant at the age of 15 years was elevated if the child scored high on the parents' or teachers' scale at the age of 8 or 12 years, or on the Children's Depression Inventory (CDI) at the age of 12 years. Problems noted by health professionals (problems in growth, somatic diseases, emotional/behavioural problems of the child, psychosocial problems of the family) before school age were related to future deviance on the parental scale. Emotional/behavioural problems before school age elevated the probability of scoring high on the teachers' scale at the age of 15, and problems in psychomotor development elevated the probability of scoring high on the BDI. CONCLUSIONS: Psychiatric deviance is persistent over several years in children. Primary health care professionals can identify children who are at risk for future psychiatric problems.

Children involved in bullying at elementary school age: their psychiatric symptoms and deviance in adolescence. An epidemiological sample.

OBJECTIVE: This study investigated psychiatric symptoms and deviance at the age of 15 years among children involved in bullying at the age of 8 years or at the age of 12 years. Furthermore, the relationships between involvement in bullying at the age of 8 years, concurrent psychiatric deviance, and later psychiatric deviance were studied. METHOD: Questionnaires filled in by the parents, teachers and children themselves were used to reveal psychiatric symptoms and deviance. RESULTS: Children involved in bullying, in particular those who were bully-victims at early elementary school age and those who were victims in their early teens, had more psychiatric symptoms at the age of 15 years. The probability of being deviant at the age of 15 years was higher among children involved in bullying at the age of 8 or 12 years than among non-involved children. When concurrent psychiatric deviance was taken into account, involvement in bullying increased the probability of teacher-defined deviance at the age of 15 years. CONCLUSION: Bullying experiences are connected not only to concurrent psychiatric symptoms but also to future psychiatric symptoms. Furthermore, the probability of being deviant in adolescence is increased if the child has been involved in bullying at elementary school age.

Psychiatric symptoms and deviance in early adolescence predict heavy alcohol use 3 years later.

OBJECTIVE: The aim of this study was to discover whether the heavy use of alcohol in adolescence is associated with earlier psychiatric symptoms and deviance, gender, family structure and socio-economic situation of the family (SES). METHODS: Questionnaires designed to reveal psychiatric symptoms and deviance were filled in by parents (Rutter A2 Scale), teachers (Rutter B2 Scale) and the children themselves (CDI) at the age of 12 years. The Rutter scales are behaviourally orientated questionnaires, and the CDI is a self-report of depression. Information concerning alcohol use was obtained from the children at the age of 15 years. RESULTS: Both male and female heavy users of alcohol had more commonly displayed externalizing behaviour and hyperactivity at school 3 years earlier than had their same-sex peers. Furthermore, female heavy users in particular had displayed hyperactivity at home. The probability that a boy who used alcohol excessively at the age of 15 years had already been deviant 3 years earlier was increased on the teachers' scale, and that of a girl was increased on the CDI. Logistic regression analysis using parent-assessed symptoms and self-reported depressive symptoms showed that externalizing behaviours and depression were the factors predicting the heavy use of alcohol in adolescence when gender, SES and family structure were controlled. When teacher-assessed symptoms and self-reported symptoms were used, externalizing behaviour predicted heavy alcohol use at the age of 15 years when gender, SES and family structure were controlled. CONCLUSIONS: Children with behavioural deviance and depression are at risk of later excessive alcohol use. Further research is warranted to determine whether psychiatric treatment could reduce the risk of future heavy alcohol use.

Children involved in bullying: psychological disturbance and the persistence of the involvement.

OBJECTIVE: This follow-up investigation studied the extent of bullying among children aged 8 (Study 1) and 12 (Study 2), and measured the persistence of this behaviour. The relationship between bullying and psychological disturbance at these two time points was also studied. Furthermore, the relationships between bullying and some background factors were investigated. METHOD: 1268 children were studied at two time points using three different questionnaires. Parents filled out the Rutter A2 Scale, teachers the Rutter B2 Scale and children themselves the Children's Depression Inventory (CDI). RESULTS: Males outnumbered females at both time points among bullies, bully-victims (children who both bully and are victims) and victims. There was a clear difference between the genders among bullies and bully-victims, but the difference was quite minimal among victims. The number of children involved in bullying declined somewhat during the 4-year follow-up period, and a substantial number of children changed status, bullies became bully-victims for example. Nearly half the children involved in bullying in Study 2 had been involved 4 years earlier. Those children who were bully-victims in Study 1 were most commonly found to be still involved in bullying 4 years later. At both time points, children involved in bullying were found to have significantly more psychiatric symptoms than other children, and to be psychologically disturbed. Males and children from low SES families were more prone to continue to be involved in bullying over a 4-year period. CONCLUSIONS: Bullying is common among children, and in many cases lasts for years. Bully-victims are particularly at risk of remaining involved in bullying over longer periods. Also, children involved in bullying often have psychiatric problems and are disturbed.

Design and subjects of a Finnish epidemiological study on psychiatric disorders in childhood.

In an epidemiological multi-centre study, parents filled in the Rutter Parent Questionnaire (RA2) and teachers filled in the Rutter Teacher Questionnaire (RB2) for almost 6000 children. The children filled in the Children's Depression Inventory (CDI). The subjects well represented the entire population of 8-9-year-old children in Finland. The material and design of the study as well as the basic demographic characteristics are presented.

Behavioural and emotional symptoms in 8-9-year-old children.

We present epidemiological data from a multi-centre study on psychiatric symptoms among 6017 8-9-year-old children representing a total annual birth cohort (N = 60007) in Finland. The results are based on three questionnaires: the Rutter Parent Scale (RA2), the Rutter Teacher Scale (RB2), the Children's Depression Inventory (CDI). The proportion of children that scored above the cutoff points, indicating probable psychiatric disturbance, were 11.2% for the RA2, 13.9% for the RB2 and 6.9% for the CDI. Twenty-four percent of the subjects scored above the cutoff point on at least one of the questionnaires. Low family social status and disrupted family relations correlated strongly with high rates of symptoms in the children.

Emotional and behavioural symptoms in 8-9-year-old children in relation to family structure.

The association between family structure and behavioural and emotional symptoms in prepubertal children was studied in an epidemiological survey conducted in Finland. Five thousand eight hundred thirteen children aged 8 and 9 years were screened using the Rutter Parent Questionnaire (RA2) for parents and the Rutter Teacher Questionnaire (RB2) for teachers. Information concerning family type, birth order and sibship size were obtained from the parents. The majority of the children (84%) in the sample lived with both their biological parents, 10% with a single parent, and around 5% with a biological parent and a stepparent. Around 1% of the children lived outside their original home. The prevalence of behavioural and emotional symptoms was lowest in children living with both their biological parents and highest among children living outside their original home according to both parents' and teachers' reports. Children living with a parent and a stepparent had problems more often at home, but less often at school than children living with a single parent. Living with a single father was associated with having more externalizing, school-related problems, while living with a stepfather was associated with having more internalizing, home related problems. Having younger siblings seemed to be associated with fewer problems at school, and being the youngest child with having less problems both at home and at school.

Children's behavioural/emotional problems: a comparison of parents' and teachers' reports for elementary school-aged children.

This study assessed the agreement between parents and teachers concerning behavioural/emotional symptoms of children. 5671 children born in 1981 (mean age 8.5 years at the time of study) were studied using the Rutter Parent Questionnaire (RA2) and the Rutter Teacher Questionnaire (RB2). Boys had more behavioural symptoms on both scales, 3.6% of the boys and 2.3% of the girls were deviant on both scales. Agreement between parents and teachers on single behaviours was better for deviant girls than for deviant boys. The factors constructed from the Rutter scale items (separately of each scale) represented externalizing, internalizing and hyperactivity behaviours. For all children, moderate correlations between parents' and teachers' ratings were found in externalizing behaviour and hyperactivity. Correlations of the factors were clearly higher for deviant girls than for deviant boys. Scoring high on one of the scales increased the probability of scoring high on the second scale. The discussion focuses on factors that may affect agreement between parents and teachers when behavioural symptoms are assessed.

Psychiatric disorders in 8-9-year-old children based on a diagnostic interview with the parents.

Using three questionnaires, the Rutter Parent Questionnaire (RA2), The Rutter Teacher Questionnaire (RB2) and the Children's Depression Inventory (CDI), we screened 8-9-year-old children representing a total annual birth cohort (N = 60007) in Finland. In a second stage we interviewed the parents of 119 screen negative, and 316 screen positive children by using a structured parent interview. At the population level the overall prevalence rate for psychiatric disturbance was 21.8%, higher among boys (29.8%) than among girls (12.8%). Nine percent of the children were in urgent need of treatment and, in addition, 25% were in need of assessment. The prevalence of different levels of disturbance was: reactive 9.5%; neurotic 18.4%; borderline 3.1%; and other severe disorders 2.3%. The prevalence of different diagnostic groups were: anxiety disorder 5.2%; depressive disorder 6.2%; specific fears 2.4%; defiant and conduct disorder 4.7%; and attention-deficit hyperactivity-disorder 7.1%. The prevalence for the most common single first Axis-I DSM-III-R diagnoses were: attention-deficit hyperactivity-disorder 7%; dysthymia 4.6%; adjustment disorder with mixed disturbance of emotion and conduct 3.4%; oppositional defiant disorder 2.7%; specific fear 1.7%; anxiety disorder 1.5%; enuresis nocturnal 1.5%; and depression 1.4%. Only 3.1% of the children had visited health professionals for psychiatric problems during the previous three months. Only a minority of the children with psychiatric disturbances had ever consulted health professionals for their problems. Of all the children, 7.5% had a severe psychiatric disturbance that had lasted for more than 3 years.

Psychiatric disorders, performance level at school and special education at early elementary school age.

We assessed the relationship between psychological deviance and performance level at school among 8-year-old children. The use of special education among children with psychiatric disorders was also studied. In Stage 1, 5813 children were studied using the Rutter Parent Questionnaire (RA2), the Rutter Teacher Questionnaire (RB2) and the Children's Depression Inventory (CDI). In Stage 2, a subsample (n = 424) of these children were interviewed, using the Isle of Wight Interview. In Stage 1, more children defined as low achievers (LAs) came from low SES families than did average (NAs) and high achievers (HAs). They also had more psychiatric symptoms, and they scored above the cutoff (13 points on the RA2, nine points on the RB2 and 17 points on the CDI) more commonly than other children. In Stage 2, two thirds of children who received special education had some psychiatric disorder. The probability of a child with psychiatric disorder obtaining some extra tutoring or special education was 3.1-fold when compared with children without psychiatric disorders. Depressive children and children with attention deficit disorders most commonly had extra tutoring (4.8-fold) when compared with children without psychiatric disorders. The probability of getting special education was highest for attention deficit disorders (6.2-fold), thereafter for anxiety (3.1-fold), and for oppositional/conduct disorders (2.8-fold).

Smoking and drinking habits in adolescence--links with psychiatric disturbance at the age of 8 years.

Smoking and drinking habits were studied among 1098 14-15-year-old adolescents using a mailed questionnaire. The subjects were drawn from a representative population of 5813 randomly selected 8-year-old children previously studied in the National Epidemiological Child Psychiatry Study in Finland in 1989. The questionnaire included items on the adolescents' smoking habits and alcohol consumption. Regular smoking was more common among boys (and girls) who, in childhood, had been rated by their parents (Rutter Parent Questionnaire) (RA2) as disturbed, 14.6% (30.3%), than among the nondisturbed, 6.6% (8.4%). Similarly, more of the previously disturbed (according to the RA2) adolescent boys drank alcohol regularly, 19.7%, as compared to the nondisturbed boys, 9.3%. Among girls, regular alcohol consumption was more common among those who previously had behavioural or mixed type problems (according to the RA2), 70.7%, as compared to those who previously had emotional or no problems, 12.2%. More of the previously depressed girls smoked regularly, 45.1%, than those who had not been depressed, 7.9%. Behavioural and emotional problems in childhood seemed to predispose to smoking and drinking in adolescence. The parents were more sensitive than the teachers in recognising the long-lasting problems of their children.

Are twins' behavioural/emotional problems different from singletons'?

We compared twins with singletons in the National Epidemiological Child Psychiatric Study, which included 122 twins and 5455 singletons, born in 1981 and selected at random. Behavioural and emotional symptoms were assessed in 1989 on the basis of questionnaires filled in by the parents (Rutter Parent Questionnaire) (RA2), teachers (Rutter Teacher Questionnaire) (RB2) and the children themselves (Children's Depression Inventory) (CDI). Parents' reported proportions of probable behavioural/emotional disorders did not differ between the twin and singleton girls, but among the twin boys there was a nonsignificant trend of being more often probably disturbed. Twins were reported to be less disturbed than singletons according to the teachers' assessments. No difference was found between twins and singletons in their self-reports. When analysing parents' reported values of various sum scores, the twin boys obtained slightly higher scores than singletons, while twin girls scored significantly lower on total and emotional disturbances. Twin boys obtained lower mean scores than singletons for probable disorder in the teachers' evaluations, the differences arising mostly in the emotional area. The same type of trend, however nonsignificant, was found among the teachers' evaluations of girls. No significant difference was found in the mean scores for hyperactivity. This large population-based sample suggests that twins may have a lower rate of behavioural problems in childhood than singletons, a finding that has to be taken into account in behavioural genetic studies.

Psychiatric symptoms in children with intellectual disability.

In a sample of almost 6000 8-year-old children, we found that 1.5% attended special schools for the educationally subnormal, or training schools. Psychiatric symptoms were studied by means of three screening instruments: the Rutter Parent Questionnaire (RA2) for the parents, the Rutter Teacher Questionnaire (RB2) for the teachers, and the Children's Depression Inventory (CDI) for the children. The prevalence rate of children identified as possibly suffering from a psychiatric disturbance was 32.2% according to the RA2. The corresponding prevalence rate for the RB2 was 34.2%. According to the CDI 11.0% had depressive disturbance. All types of disturbances were more frequent among the intellectually disabled children as compared to the nondisabled children. The differences were statistically significant for emotional and mixed types of disturbance on the RA2, and for emotional and conduct types of disturbance on the RB2.

Psychiatric disturbances among prepubertal children in southern Finland.

The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studied in a two-stage epidemiological survey. In the first stage of the study 3397 children aged 8 or 9 were screened with the Rutter A2 scale for parents, Rutter B2 scale for teachers and Children's Depression Inventory (CDI). In the second stage a random sample of the children screened was drawn for more detailed assessment. Altogether 279 children were interviewed with the Finnish version of the Diagnostic Interview Schedule for Children (DISC), and their parents with the Isle of Wight Interview Schedule. In the parental interview the prevalence of psychiatric disturbance among children was 15.1%. The rate was higher for boys (23.7%) than for girls (5.3%). The prevalence of psychiatric disturbance verified with the child interview was 14.9%. The prevalence of psychiatric disturbance in boys based on the child interview was 20.5%. For girls the prevalence of psychiatric disturbance based on the child interview was 8.7%. The spectrum of psychiatric disturbance differed in the two interviews. Attention deficit disorder, depression and conduct disorder were the most common diagnoses in the parent interview, while anxiety disorder and depression were most common according to the child interview. In only 24% of the cases both the parent and child interview gave the same diagnosis.

Bullying and psychiatric symptoms among elementary school-age children.

OBJECTIVE: The aim of this study was to assess bullying and psychological disturbance among 5,813 elementary school-aged children. METHOD: The data consisted of information given by the parents, teachers, and children themselves (Rutter A2 Scale, Rutter B2 Scale and Children's Depression Inventory). Children involved in bullying (as bullies, bully-victims, and victims) were compared to other children. RESULTS: More boys than girls were found to be involved in bullying. Bully-victims scored highest in externalizing behaviour and hyperactivity, and they themselves reported feelings of ineffectiveness and interpersonal problems. Victims scored highest in internalizing behavior and also psychosomatic symptoms, and they themselves reported anhedonia. Some gender differences in psychiatric symptomatology were also found. Children involved in bullying, especially children who both bullied and were bullied themselves, were psychologically disturbed. More children involved in bullying than others were referred for psychiatric consultation. The probability of being referred was highest among bully-victims (6.5 fold for males and 9.9 for females when compared to children not involved in bullying). CONCLUSIONS: The findings indicate that bullying is a common phenomenon among children who are psychologically disturbed. Bullying also elevates the probability of being referred for psychiatric consultation.

Selective mutism among second-graders in elementary school.

OBJECTIVE: This study assessed the prevalence of selective mutism among second graders in elementary school, and examined related issues such as the situations in which the children refuse to speak, their performance level at school, and some temperamental/behavioural characteristics of these children. METHOD: A definition of selective mutism (according to the DSM-IIIR) was sent to all second grade teachers in the study area, asking them if there were any children with these symptoms in their class. If a positive answer, the teacher was asked to fill in a questionnaire concerning the child. RESULTS: The prevalence rate for selective mutism was found to be 2%, with girls outnumbering boys. Selective mutism had been in progress more than a year in most cases. Most often, the children refused to speak to the teacher (58%), and one-fifth spoke to nobody at school. One-third of the mute children were performing at a lower level than average. Fewer of these children were reluctant to speak to the teacher than were mute children with an average or higher than average performance level. The children were characterized as shy, withdrawn and serious, with only some being hyperactive or aggressive. About one third of the children had had contact with health services.

Children with symptoms of depression--what do the adults see?

In order to find out whether parents and teachers report depressive symptoms in children with self-reported depression and which features are connected with sought psychiatric care, a sample of 5682 prepubertal children was assessed with the Children's Depression Inventory (CDI), the Rutter A2 scale (RA) and Rutter B2 scale (RB). In stepwise regression analysis of parent report, depressed mood, unpopularity, social withdrawal, disobedience, inattentiveness, and stealing were associated with high CDI scores. The items of the teacher report associated with high CDI scores included poor school performance, restlessness, somatic complaints, unresponsiveness, being bullied, and absenteeism from school. Although the parents and teachers readily saw and reported depressive symptoms in children, only for a small minority of children with multiple depressive symptoms had psychiatric care been sought or even considered. The symptoms associated with sought psychiatric care for depressed children were somatic (soiling, asthma) and behavioural (disobedient, restless). The results indicate that a large number of children with multiple depressive symptoms are left without necessary psychiatric assessment and help.

The persistence of teacher-reported behavioral problems among children aged 8 to 12.

This investigation assessed psychiatric symptoms in children reported by teachers at two points of time, and the persistence of symptom groups over an interval of four years. 1128 children born in 1981 (mean age 8.5 yr in Study 1 and 12.5 yr in Study 2) were studied, using the Rutter Scale B2 questionnaires in both studies. The frequencies of teacher-reported problems generally decreased over an interval of four years. Hyperkinetic symptoms were the most prevalent at both occasions. Gender differences were seen in both studies, boys outnumbering girls on most items. Symptoms were classified into five groups representing hyperactivity, internalizing and externalizing behaviour, relationship difficulties, and habits. The correlations of these different groups in Study 1 with those in Study 2 were moderate. Among deviant girls, correlations were high or moderate for externalizing, hyperactivity and internalizing behavior between the two studies. For deviant boys, high correlations between the studies were found for hyperactivity and habits. Externalizing behavior was also highly correlated with relationship difficulties among deviant boys. Two symptom groups (hyperactivity and relationship difficulties) and low performance level in Study 1 increased the probability of being deviant in Study 2 among boys, and four interactional terms (hyperactivity by relationship difficulties, hyperactivity by performance level, internalizing by performance level, and externalizing by relationship difficulties) also had an effect. Among girls, the probability of being deviant in Study 2 was increased if they were hyperactive or had relationship difficulties in Study 1. Furthermore, one interactional term (hyperactivity by performance level) had an impact on deviance among girls.