Identifying and addressing unmet clinical needs in primary cutaneous B-cell lymphoma: A consensus-based paper from an ad-hoc international panel.

Primary cutaneous B-cell lymphomas (PCBCLs) are lymphoproliferative disorders that appear on the skin without evidence of extracutaneous manifestations at the time of diagnosis. There is a lack of evidence-based guidelines for their clinical management due to the availability of very few large scale studies and controlled clinical trials. Here we present and discuss a series of major unmet clinical needs (UCNs) in the management of PCBCLs by a panel of 16 experts involved in research and clinical practice of PCBCL. The Panel produced recommendations on the appropriateness of the clinical decisions concerning the identified clinical needs and proposed research for improving the knowledge needed to solve them. Recommendations and proposals were achieved by multiple-step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. Recommendations and proposals lay in the domain of classification uncertainties of PCBCL, optimization of diagnosis, optimization of prognosis, optimization of staging and critical issues on therapeutic strategies with particular focus on new treatments. These recommendations are intended for use not only by experts but above all by dermatologists and hematologists with limited experience in the field of PCBCLs as well as general practitioners.

Long-term efficacy, safety, and tolerability, including behavior and executive functioning, during adjunctive lacosamide treatment in pediatric patients with uncontrolled epilepsy.

OBJECTIVES: To evaluate long-term efficacy, safety, and tolerability, including behavior and executive functioning, during adjunctive lacosamide (LCM) treatment in pediatric patients (≥1 month to <18 years of age) with focal-onset or generalized seizures enrolled in 2 open-label, long-term follow-up trials. METHODS: Two open-label extension trials (SP848: NCT00938912; EP0034: NCT01964560) were conducted in pediatric patients who had participated in previous trials of adjunctive LCM (SP0847/NCT00938431; SP0966/NCT01969851; EP0060/NCT02710890; SP0967/NCT02477839; SP0969/NCT01921205); SP848 also directly enrolled eligible pediatric patients who had not previously participated in a clinical trial of LCM. Outcomes included retention, efficacy, and safety/tolerability. Patient improvement was assessed with Clinician's and Caregiver's Global Impression of Change scale. Behavior and emotional function was assessed with Achenbach Child Behavior Checklist (CBCL) and executive functioning was assessed with Behavior Rating Inventory of Executive Function® (BRIEF). RESULTS: The pooled dataset from both trials included 905 patients (851 in the focal-onset seizure population and 47 in the generalized seizure population). In the overall population, Kaplan-Meier-estimated 1-year retention was 80 %. From baseline to the end of the treatment period, patients in the focal-onset seizure population had a median percent reduction in focal-onset seizure frequency per 28 days of 60.4 %, 55.4 % of patients were 50 % responders, and 40.8 % of patients were 75 % responders. In patients with ≥12 months of LCM treatment, ≥12 month seizure freedom during the LCM treatment period was achieved by 29.9 % of patients in the focal-onset seizure population (median duration of first ≥12-month seizure-free interval: 641 days) and 24.4 % of patients in the generalized seizure population (median duration of first ≥12-month seizure-free interval: 665 days). Improvement during LCM treatment was reported in >75 % of patients by both physicians and caregivers. Treatment-emergent adverse events (TEAEs) were reported by 749 (82.8 %) patients, most commonly pyrexia (18.9 %), upper respiratory tract infection (18.6 %), nasopharyngitis (16.2 %), vomiting (15.7 %), and somnolence (11.8 %). The most common drug-related TEAEs were somnolence (8.5 %), dizziness (7.6 %), and vomiting (5.4 %). Behavioral and emotional function was generally stable in patients 1.5-5 years of age and slightly improved in patients ≥6 years of age, and executive functioning was stable in patients <5 years of age and generally slightly improved in patients 5-18 years of age. CONCLUSIONS: In this analysis of a large patient pool from 2 open-label trials, long-term adjunctive LCM was efficacious and generally well tolerated in children with epilepsy and focal-onset or generalized seizures. Behavior and executive functioning were generally stable without observable worsening during long-term adjunctive LCM treatment.

The correlations on psychopathology in children self-rating, psychopathology in children as related by their parents and psychopathology in parents self-rating in a Kenyan school setting: towards an inclusive family-centered approach.

Several studies have reported on the association between parental and childhood psychopathologies. Despite this, little is known about the psychopathologies between parents and children in a non-clinical population. We present such a study, the first in a Kenyan setting in an attempt to fill this gap. The objective of this study was to determine the association between self-rating psychopathology in children, parent-rating psychopathology in their children and self-rating psychopathology in parents in a non-clinical population of children attending schools in Kenya. We identified 113 participants, comprising children and their parents in 10 randomly sampled primary schools in South East Kenya. The children completed the Youth Self-Report (YSR) scale and parents completed the Child Behavior Check List (CBCL) on their children and the Adult Self-Reports (ASR) on themselves. These instruments are part of the Achenbach System of Empirically Based Assessment (ASEBA), developed in the USA for a comprehensive approach to assessing adaptation and maladaptive behavior in children and adolescents. There was back and forth translation of the instruments from English to Swahili and the local dialect, Kamba. Every revision of the English translation was sent to the instrument author who sent back comments until the revised version was in sync with the version developed by the author. We used the ASEBA in-built algorithm for scoring to determine cut-off points for problematic and non-problematic behavior. Correlations, linear regression and independent sample t-test were used to explore these associations. The mean age of the children was 12.7. While there was no significant association between child problems as measured by YSR (self-reported) and parent problems as measured by ASR and CBCL in the overall correlations, there was a significant association when examining specific groups (clinical range vs. non-clinical). Moreover, significant association existed between total problems on YSR and ASR internalizing problems (t=-2.3,p = 0.023), with clinical range having a higher mean than the normal range. In addition, a significant relationship (p < 0.05) was found between psychopathology in children as reported by both parents (CBCL) and psychopathology in parents as self-reported (ASR).Mothers were more likely to report lower syndrome scores of their children as compared to fathers. Our findings indicate discrepancies between children self-rating and parent ratings, suggesting that one cannot manage psychopathology in children without reference to psychopathology in their parents. We suggest broad-based psycho-education to include children and parents to enhance shared awareness of psychopathology and uptake of treatment.

Vitamin D status in pregnancy and cord blood is associated with symptoms of attention-deficit hyperactivity disorder at age 5 years: Results from Odense Child Cohort.

BACKGROUND: Vitamin D status in pregnancy may affect offspring neurodevelopment. OBJECTIVE: The objective was to investigate the association between serum 25-hydroxyvitamin D in cord blood and pregnancy and symptoms of attention-deficit hyperactivity disorder in 5-year-old offspring. METHOD: In Odense Child Cohort, Denmark, 944 mother-child pairs had data on pregnancy or cord serum 25-hydroxyvitamin D and parent-rated attention-deficit hyperactivity disorder symptom score by Child Behavior Checklist for ages 1.5-5 years. Adjusted multiple linear regression and two-stage exposure analyses were performed for serum 25-hydroxyvitamin D associations to the attention-deficit hyperactivity disorder symptom score. RESULTS: The mean (standard deviation) serum 25-hydroxyvitamin D in cord blood was 48.0 (21.8) nmol/L; early pregnancy was 65.5 (20.2) nmol/L and late pregnancy was 79.3 (25.7) nmol/L. The median (interquartile range) age of child at examination was 5.2 (5.1-5.4) years and median (interquartile range) attention-deficit hyperactivity disorder symptom score was 2 (0-3) points. In adjusted analyses, serum 25-hydroxyvitamin D of <25 nmol/L and <32 nmol/L in cord blood and <25 nmol/L in early pregnancy was associated with 0.9 [95% confidence interval: 0.4, 1.3], 0.5 [0.1, 0.9] and 2.1 [0.8, 3.4] points higher attention-deficit hyperactivity disorder symptom score vs reference. In the two-stage exposure analysis, attention-deficit hyperactivity disorder symptom score decreased by 0.4 points per 25 nmol/L increase in serum 25-hydroxyvitamin D. Moreover, serum 25-hydroxyvitamin D of <25 nmol/L in early pregnancy and cord was associated with a five-fold and a two-fold risk of attention-deficit hyperactivity disorder symptom score ⩾90th percentile, adjusted odds ratio [95% confidence interval] = 4.9 [1.3, 19.0] and 2.2 [1.2, 3.9]. CONCLUSION: In this cohort, serum 25-hydroxyvitamin D <25 nmol/L in cord blood and early pregnancy were risk factors for higher attention-deficit hyperactivity disorder symptom score in 5-year-old children, suggesting a protective effect of vitamin D on attention-deficit hyperactivity disorder traits at preschool age.

Psychopathology of cognitive disengagement syndrome (CDS): a network analysis based on CBCL scales in 72,106 Chinese school students.

Cognitive Disengagement Syndrome (CDS) is a cluster of behavioral problems that severely affect an individual's functioning. Currently, there is no consensus on the main clinical features of CDS, and further exploration in large samples is needed. Using a cluster-stratified random sampling method, 72,106 children and adolescents were recruited from five provinces in mainland China for this study. Using both the traditional two-factor scoring method and the CBCL DSM-oriented scales, we assessed individual behavioral problems from psychopathological and DSM-oriented perspectives. Network analysis was employed to explore the relationship between CDS and behavioral problems. The various networks were compared by gender and age subgroups. Among 72,106 participants (mean age, 11.49 years; minimum age, 5 years; maximum age, 16 years), there were 36,449 males (50.5%) and 35,657 females (49.5%). From a psychopathological perspective, the motor symptoms node was associated with the sad node and the withdrawn node, while the cognitive symptoms node was linked to the nervous node and the self-conscious node. In terms of gender, males had stronger associations of the motor symptoms node with the sad node and the withdrawn node than females (P = 0.043), and weaker associations of the cognitive symptoms node with the nervous node than females (P = 0.027). In terms of growth stage, the adolescent group had stronger associations of the cognitive symptoms node with the nervous node and the self-conscious node than the child group (P = 0.016, 0.001). From DSM perspective, motor symptoms node were associated with sad node, and cognitive symptoms node were related to can't concentrate node, nervous node, and worthless node. With increasing age, there was an upward trend in the strength of the cognitive and motor symptoms node. CDS is closely linked to psychological and behavioral issues, especially internalizing problems, with differences observed by gender and growth stage. The connection between CDS and the affective, anxiety, and ADH symptoms is particularly pronounced.

Behavioural Problems in Preadolescence: Does Nutritional Status Have a Role?

INTRODUCTION: Malnutrition in children and adolescents is a global issue particularly in low- and middle-income countries, while behavioural problems are becoming a growing public health concern in the area of child and adolescent mental health, with very few studies examining their association in preadolescence. This study aimed to assess the epidemiological relationship between malnutrition and behavioural problems in preadolescence. METHODS: A school based, cross-sectional survey was conducted in Karachi, Pakistan. Total 660, 11- to 12-year-old preadolescents were selected from a middle-class, coeducational school chain. Sociodemographic questionnaires and an officially adapted version of Youth Self-Report Form (YSR), which is the child and adolescent reported version of the Child Behavior Checklist (CBCL), were used to collect data, along with anthropometric assessments following the WHO protocol. RESULTS: Thin and stunted preadolescents had significantly higher odds of internalizing problems (AOR = 2.05, p = 0.003 and AOR = 2.09, p = 0.039, respectively) than normal ones. Overnutrition was not associated with any behavioural issues. According to the Composite Index of Anthropometric Failure, 40% of preadolescents had at least one type of malnutrition and among them about 3% had co-occurring malnutrition (stunted and thin or overweight). They significantly had higher risk of being associated with the internalizing problems (AOR 2.92, p = 0.027). The effect was considerably higher than that associated with stunted or thin only, highlighting the cumulative impact of the co-occurring malnutrition on the internalizing problems. CONCLUSION: Our study concludes that overnutrition and undernutrition are prevalent in preadolescents, with significant association of undernutrition with internalizing problems. Moreover, our study is the first that reports that the co-occurrence of malnutrition is significantly associated with increased risk of internalizing problems. This study highlights the importance of the link between physical and mental health and emphasizes the need for holistic interventions and programmes for addressing preadolescents' issues.

The fifth edition of the WHO-Classification - what is new for cutaneous lymphomas?

The recently published 5th edition of the "World Health Organization classification of hematolymphoid tumors: lymphoid neoplasms" provides a hierarchical reorganization. In general, new (definitive) entities as well as tumor-like lesions were included. Primary cutaneous B-cell lymphomas (CBCL) received a thorough review. A new class/family of cutaneous follicle center lymphomas was defined. Primary cutaneous marginal zone lymphoma is now presented as a separate entity independent from extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. In primary cutaneous T-cell lymphoma, former provisional entities were upgraded to definite entities. Sézary Syndrome was sorted into the class/family of mature T-cell and NK-cell leukemias. Additionally, a newly formed entity of primary cutaneous peripheral T-cell lymphoma, NOS was created for CTCL entities that do not fit into the already described CTCL entities. The increasing importance of genomic and molecular data has already been recognized in classifying leukemias and systemic lymphomas. However, in PCL the genomic landscape has not yet been fully described and validated. Therefore, future research is necessary to describe the genomic and molecular mechanisms underlying the disease entities more clearly. This would both meet a diagnostic need and valuably contribute to future classification schemes.

Association between sleep and problematic behaviours in gifted children: a polysomnographic study.

Neurological uniqueness, maladaptive behaviours, as well as atypical sleep patterns are reported to be defining characteristics of giftedness, but this has received little empirical support. We studied the polysomnography recorded sleep of gifted and typically-developing children together with features of maladaptive behaviours. The association of sleep macrostructure and sleep instability with maladaptive behaviours was also investigated in gifted children. In all, 19 gifted children (74% boys) and 17 typically-developing children (76% boys) aged 6-12 years were studied. Giftedness was identified using Renzulli's three-factor definition. The microarousal index, number of awakenings, and number of Stage shifts between sleep stages throughout the night were computed as sleep instability parameters. Maladaptive behaviours were assessed using the Child Behaviour Checklist. We found significantly more Stage N1 and less Stage N3 in gifted children compared to typically-developing children. More Stage N1 sleep was correlated with more externalising problems and less Stage N3 sleep was correlated with more internalising problems. Gifted children also displayed more rapid eye movement (REM) sleep, but this was not significantly correlated with behavioural scales. Gifted children displayed two opposing trends of sleep instability: more instability involving N1 sleep and less instability involving N2, N3 and REM sleep. More total Stage shifts were correlated with more internalising and externalising problems. The results of this study provide initial evidence of polysomnography-based characteristics of giftedness. Further studies are needed to explore common pathways linking sleep alterations and maladaptive behaviours in children with giftedness.

A data-driven approach to categorizing early life adversity exposure in the ABCD Study.

BACKGROUND: Adversity occurring during development is associated with detrimental health and quality of life outcomes, not just following exposure but throughout the lifespan. Despite increased research, there exists both overlapping and distinct definitions of early life adversity exposure captured by over 30 different empirically validated tools. A data-driven approach to defining and cataloging exposure is needed to better understand associated outcomes and advance the field. METHODS: We utilized baseline data on 11,566 youth enrolled in the ABCD Study to catalog youth and caregiver-reported early life adversity exposure captured across 14 different measures. We employed an exploratory factor analysis to identify the factor domains of early life adversity exposure and conducted a series of regression analyses to examine its association with problematic behavioral outcomes. RESULTS: The exploratory factor analysis yielded a 6-factor solution corresponding to the following distinct domains: 1) physical and sexual violence; 2) parental psychopathology; 3) neighborhood threat; 4) prenatal substance exposure; 5) scarcity; and 6) household dysfunction. The prevalence of exposure among 9-and 10-year-old youth was largely driven by the incidence of parental psychopathology. Sociodemographic characteristics significantly differed between youth with adversity exposure and controls, depicting a higher incidence of exposure among racial and ethnic minoritized youth, and among those identifying with low socioeconomic status. Adversity exposure was significantly associated with greater problematic behaviors and largely driven by the incidence of parental psychopathology, household dysfunction and neighborhood threat. Certain types of early life adversity exposure were more significantly associated with internalizing as opposed to externalizing problematic behaviors. CONCLUSIONS: We recommend a data-driven approach to define and catalog early life adversity exposure and suggest the incorporation of more versus less data to capture the nuances of exposure, e.g., type, age of onset, frequency, duration. The broad categorizations of early life adversity exposure into two domains, such as abuse and neglect, or threat and deprivation, fail to account for the routine co-occurrence of exposures and the duality of some forms of adversity. The development and use of a data-driven definition of early life adversity exposure is a crucial step to lessening barriers to evidence-based treatments and interventions for youth.

The relationship between screen time before bedtime and behaviors of preschoolers with autism spectrum disorder and the mediating effects of sleep.

BACKGROUND: There are overlapping effects of screen time and sleep on children's behavior. The purpose of this study was to explore the relationship of screen time with behavior problems in children with autism spectrum disorder (ASD) and the probable mediating effects of sleep, in order to provide evidence for the need for clinical identification and intervention. METHODS: A sample of 358 preschoolers with ASD were included. We investigated the children's basic characteristics of sex and age, ASD symptoms (ABC, CARS, and ADOS-2), neurodevelopment (GDS-C), sleep habits (CSHQ), and behavior (CBCL). Pearson correlation tests were used to determine the direct correlations among children's screen time, CBCL, and CSHQ. Linear regression analysis was used to explore whether screen time predicted total score of CBCL. Multi-step linear regression analysis was used to investigate the mediating effect of sleep on the relationship between screen time and total score of CBCL. RESULTS: Screen time before bedtime was correlated with CBCL and CSHQ, which indicated that screen time before bedtime was correlated with sleep and behavior in children with ASD. Screen time before bedtime was a predictor of CBCL total score (indicating children's behavior), and CSHQ total score (indicating children's sleep habits) played a partial mediating role between screen time before bedtime and children's behavior. CONCLUSION: Clinicians should support and educate parents of children with ASD, which should focus on managing screen time, especially screen time before bedtime.

Sex-specific associations of maternal and childhood urinary arsenic levels with emotional problems among 6-year-age children: Evidence from a longitudinal cohort study in China.

BACKGROUND: Arsenic exposure has been linked to neurobehavior development disorders among children in cross-sectional studies, but there is little information on the effects of prenatal and childhood arsenic exposure on childhood behavior problem, especially emotional problems. OBJECTIVE: To explore the relationship between prenatal and childhood arsenic exposure and behavior problems among six-year-old children. METHODS: 389 mother-child pairs from a longitudinal birth cohort were enrolled in the study. The concentrations of arsenic in maternal and 6-year-old children's urine were measured using inductively coupled plasma mass spectrometry (ICP-MS). Neurobehavioral development in 6-year-old children was assessed by Child Behavior Checklist (CBCL). Generalized linear regression models were used to relate arsenic exposure to the score of different domains in CBCL. RESULTS: The median concentrations of maternal and 6-year-old children's urinary arsenic were 22.22 and 33.86 µg/L, respectively. After adjusting for potential covariates, natural logarithm transformed concurrent urinary arsenic levels were significantly associated with scores of anxious and depressed problems in 6-year-old girls (ß = 0.71, 95% CI: 0.12-1.31, p = 0.018). Furthermore, in terms of the trajectory of arsenic exposure, compared with the "consistently low" group, the "low to high" group (ß = 2.73, 95% CI: -3.99 to 9.45, p = 0.425) had a greater effect on total score of CBCL than "high to low" group (ß = -0.93, 95% CI: -7.22 to 5.36, p = 0.771) in girls, although insignificant. CONCLUSIONS: Our results suggested that concurrent arsenic exposure might have an adverse effect of emotional status in girls. Further studies are needed to verify the findings and explore the mechanisms of the sex-specific association.

A meta-analytic approach to the association between inhibitory control and parent-reported behavioral adjustment in typically-developing children: Differentiating externalizing and internalizing behavior problems.

Impairments in inhibitory control (IC) are traditionally seen as a vital aspect in the emergence and course of maladaptive behavior across early childhood. However, it is currently unclear whether this view applies to both the externalizing and internalizing domain of parent-reported behavioral adjustment. Furthermore, past (meta-analytic) developmental research and theory characterizing this association have largely neglected the vast heterogeneity of IC measures and conceptualizations. The present meta-analyses examined the association of IC with parent-reported externalizing (N = 3160, 21 studies) and internalizing (N = 1758, 12 studies) behavior problems, assessed with the Child Behavior Checklist (CBCL), in non-clinical populations of children aged 2-8 years. They further investigated the moderating effects of a priori IC categorization, according to a recently proposed two-factor model of IC ("Strength/Endurance" account, Simpson & Carroll, 2019). In line with previous research in the clinical domain, the current results corroborate the notion of a robust, but small association between IC and externalizing behavior problems (r = -0.11) in early childhood. However, although frequently proposed in the literature, no significant linear association could be identified with internalizing behavior problems. Furthermore, in both meta-analyses, no significant moderating effects of IC categorization could be revealed. These findings enhance our knowledge about the cognitive underpinnings of early-emerging maladaptive behavior, indicating that different subtypes of IC are statistically related with externalizing, but not internalizing behavior problems. Overall, the small association of IC ability with behavior problems in non-clinical populations provokes broader questions about the role of IC in behavioral adjustment.

Mother-Adolescent Discrepancies in Reporting Sleep Disturbances: Effects of Diagnosis and Mother's Occupation.

BACKGROUND: Sleep disturbances are common in children and adolescents. However, they are rarely diagnosed and treated because parents, who often report the symptoms, may fail to notice the problems. Factors that can affect parent-child discrepancy include child's diagnosis, parent's occupation, and child's sex. The current study retrospectively analyzed the effect of these factors on parent-child discrepancies of sleep disturbance scores. METHODS: Data for sleep-related items in Youth Self-Report (YSR) and Child Behavior Checklist (CBCL) from 2014 to 2020 August in South Korea were collected from psychiatric outpatient clinics at Konkuk University Medical Center and Soonchunhyang University Hospital. RESULTS: A three-way analysis of variance revealed main effect of diagnosis type and interaction between diagnosis type and mother's occupation. Discrepancies were greater for mood and anxiety disorders compared to conduct-related disorder. Interaction effect revealed greater discrepancies in mood disorders for reports completed by working mothers compared to homemaker mothers. CONCLUSION: The results of this study emphasize the need to explore with caution the self-reported sleep disturbances in adolescents, especially in those with mood disorders. The results also suggest that mother's occupation should be taken into account when evaluating sleep reports of parents and adolescents.

Trajectories of dysregulation in preschool age.

Dysregulation of emotions, behaviour and attention is involved in several areas of childhood psychopathology, but knowledge about early developmental trajectories remains scarce. This study aims to explore continuity and associations of dysregulation in preschool age. Dysregulation was measured at age 2½ years and again at 5 years in a community-based birth cohort of 1099 children using the Child Behavior Checklist, preschool version (CBCL1½-5), answered by mothers. Based on the Dysregulation Profile (CBCL-DP) score, we defined four trajectory groups, using the 75th percentile from the Danish norm material as a cut-off. Associations between the four CBCL-DP trajectory groups and potential covariates, including child, parental and family factors, were analysed using univariate and multiple multinomial logistic regression. Nearly half (54%) of the children showed persistent low scores of CBCL-DP, 17% displayed continuing dysregulation problems, 13% had problems that increased from 2½ years to 5 years, whereas 16% of the children showed reduced problems across preschool age. Persistent dysregulation was associated with maternal postpartum depressive symptoms RRR = 2.20 (95% CI 1.29-3.75), low maternal educational level RRR = 1.69 (95% CI 1.08-2.66), and mothers' smoking during pregnancy RRR = 2.87 (95% CI 1.09-7.55). Persistent problems of emotional, behavioural and attention regulation in children aged 2½ years to 5 years is influenced by maternal educational level and post-partum depression symptoms. The study draws clinical attention to early symptoms of dysregulation and to the importance of addressing the specific needs of mentally vulnerable parents in intervention planning.

Stability and Change of Psychopathology Symptoms Throughout Childhood and Adolescence.

Assessing stability and change of children's psychopathology symptoms can help elucidate whether specific behaviors are transient developmental variations or indicate persistent psychopathology. This study included 6930 children across early childhood (T1), late childhood (T2) and early adolescence (T3), from the general population. Latent profile analysis identified psychopathology subgroups and latent transition analysis quantified the probability that children remained within, or transitioned across psychopathology subgroups. We identified four psychopathology subgroups; no problems (T1: 85.9%, T2: 79.0%, T3: 78.0%), internalizing (T1: 5.1%, T2: 9.2%, T3: 9.0%), externalizing (T1: 7.3%, T2: 8.3%, T3: 10.2%) and the dysregulation profile (DP) (T1: 1.7%, T2: 3.5%, T3: 2.8%). From T1 to T2, 44.7% of the children remained in the DP. Between T2 and T3, 33.6% remained in the DP; however, 91.4% were classified in one of the psychopathology subgroups. Our findings suggest that for many children, internalizing or externalizing symptoms encompass a transient phase within development. Contrary, the DP resembles a severe at-risk state in which the predictive value for being in one of the psychopathology subgroups increases over time.

Sleep and behavior in children and adolescents with tuberous sclerosis complex.

Sleep disorders are frequent in tuberous sclerosis complex (TSC) during the developmental age but are not well characterized. Forty-six TSC patients and 46 healthy age- and sex-matched controls were enrolled. Their parents completed the Sleep Disturbances Scale for Children (SDSC) and the Child Behavior Checklist (CBCL). A total of 17.4% of the TSC patients obtained a total pathologic score at the SDSC versus 4.4% in the control group (p = 0.024). 45.7% of individuals with TSC reported a pathologic score in at least one of the factors. We found a statistically significant difference between the TSC cohort and healthy controls for most of the CBCL scales scores. A significant relationship was found between the Total SDSC score and the Total CBCL score (R-square = 0.387, p < 0.0001), between the Total SDSC score and the Internalizing and Externalizing areas scores (R-square = 0.291, p < 0.0001 and R-square = 0.350, p < 0.0001, respectively) of the CBCL. Sleep disorders are more frequent in TSC than in the general population and correlate with behavior. The use of SDSC and CBCL is proposed as part of the surveillance of TSC patients in the developmental age.

The prevalence of behavioral and emotional problems among Chinese school children and adolescents aged 6-16: a national survey.

Improving the mental health of children and adolescents is a critical priority in China. However, only minimal information is available concerning the prevalence of mental disorders. In the present study, a two-stage national survey has been completed in five regions of China. In the first stage, data from the Achenbach Child Behavior Checklist (CBCL) were collected for each participant to identify the prevalence of the behavioral and emotional problems in China. A multistage cluster stratified random sampling design was used, and a total of 71,929 individuals aged 6-16 years were collected. In this large cohort, 36,893 (49.86%) were males, and 49,015 (66.24%) were living in urban communities. Overall, 17.6% (90% confidence interval 17.4%, 17.9%) of the children and adolescents were identified as having behavioral and emotional problems. Moreover, age and sex effect was found for the CBCL scores. The boys' cohort had a higher prevalence of behavioral and emotional problems than girls (18.6% versus 16.6%). In the older cohort aged 12-16, the prevalence was higher than for the younger cohort aged 6-11 (19.0% versus 15.9%). Notably, it seems that the prevalence of the behavioral and emotional problems for children and adolescents had a rise in the past 30 years, but the scarcity of pediatric psychiatrists in China needs to be addressed. To reduce the behavioral and emotional problems, the whole society, including mental health providers, educators, and parents, needs to focus on and pay more attention to it. It will have long-term benefits for China.

Early regulatory problems and parenting: life-long risk, vulnerability or susceptibility for attention, internalizing and externalizing outcomes?

Multiple or persistent crying, sleeping, or feeding problems in early childhood (regulatory problems, RPs) predict increased risk for self-regulation difficulties. Sensitive parenting may protect children from trajectories of dysregulation. Considering self-regulation from a life-course perspective, are children with early multiple and/or persistent RPs affected similarly by parenting as those without (main effects model, ME), or are they more vulnerable (diathesis-stress, DIA-S), or more susceptible (differential susceptibility theory, DST) to variations in sensitive parenting at age 6 years? Participants (N = 302) were studied prospectively from birth to 28 years. RPs were assessed from 5 to 56 months. Sensitive parenting was observed at 6 years. Attention regulation was observed at 8 and 28 years. Internalizing and externalizing problems were rated by parents at 8 years, and by adults at 28 years. Confirmatory-comparative modelling tested whether associations of sensitive parenting with outcomes at 8 and 28 years among individuals with early multiple and/or persistent RPs (n = 74) versus those without (n = 228) were best explained by ME, DIA-S, or DST models. Best fitting models differed according to age at assessment. For childhood attention regulation, the statistically parsimonious DIA-S provided the best fit to the data. At age 28, two additive main effects (ME, RP group and sensitive parenting) fit best. DIA-S and ME explained internalizing and externalizing problems. Using a comprehensive life-span approach, DIA-S and ME models but not DST explained how early RPs and sensitive parenting predicted attention, internalizing, and externalizing outcomes. Individuals with early RPs are vulnerable to insensitive parenting.

Neonatal Negative Emotionality and the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) in middle childhood.

Objective: Determine whether an association exists between neonatal negative emotionality and childhood emotional dysregulation. Background: The Child Behaviour Checklist-Dysregulation Profile (CBCL-DP) has been used as a measure of emotional dysregulation in childhood. Although there is now good evidence that the CBCL-DP predicts later psychopathology, little is known about what factors predict elevations on the CBCL-DP. Methods: 30 mother-child dyads who previously participated in a study of neonatal temperament were recruited to a follow-up study of emotional dysregulation during middle childhood. The Neonatal Behaviour Assessment Scale (NBAS) and the Infant Characteristics Questionnaire (ICQ) were utilised as observer and maternal measures of neonatal negative emotionality, respectively. Maternal post-partum depression was also measured during the neonatal period using the Edinburgh Post-Partum Depression Scale (EPDS). The Child Behaviour Checklist-Dysregulation Profile (CBCL-DP) was used as a measure of childhood emotional dysregulation. Results: The ICQ fussy-difficult scale was significantly correlated with the CBCL-DP score (r = .46, p = .010), and this correlation remained significant after controlling for maternal EPDS score (CBCL-DP r = .51, p = .01). The NBAS irritability score was not associated with the CBCL-DP score. Conclusions: This association provides preliminary results that neonates rated as having high negative emotionality may indeed experience chronic difficulties with emotional dysregulation.

Psychiatric Polygenic Risk Scores as Predictor for Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in a Clinical Child and Adolescent Sample.

Neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are highly heritable and influenced by many single nucleotide polymorphisms (SNPs). SNPs can be used to calculate individual polygenic risk scores (PRS) for a disorder. We aim to explore the association between the PRS for ADHD, ASD and for Schizophrenia (SCZ), and ADHD and ASD diagnoses in a clinical child and adolescent population. Based on the most recent genome wide association studies of ADHD, ASD and SCZ, PRS of each disorder were calculated for individuals of a clinical child and adolescent target sample (N = 688) and for adult controls (N = 943). We tested with logistic regression analyses for an association with (1) a single diagnosis of ADHD (N = 280), (2) a single diagnosis of ASD (N = 295), and (3) combining the two diagnoses, thus subjects with either ASD, ADHD or both (N = 688). Our results showed a significant association of the ADHD PRS with ADHD status (OR 1.6, P = 1.39 × 10-07) and with the combined ADHD/ASD status (OR 1.36, P = 1.211 × 10-05), but not with ASD status (OR 1.14, P = 1). No associations for the ASD and SCZ PRS were observed. In sum, the PRS of ADHD is significantly associated with the combined ADHD/ASD status. Yet, this association is primarily driven by ADHD status, suggesting disorder specific genetic effects of the ADHD PRS.