Less attention to emotional faces is associated with low empathy and prosociality in 12-to 20-month old infants.

The development of empathy and prosocial behavior begins in infancy and is likely supported by emotion processing skills. The current study explored whether early emerging deficits in emotion processing are associated with disruptions in the development of empathy and prosociality. We investigated this question in a large, diverse sample of 147, 11- to 20-month-old infants (42% female; 61% Black; 67% low socioeconomic status). Infants completed two observational tasks assessing prosocial helping and one task assessing empathy and prosocial comforting behavior. Infants also completed an eye-tracking task assessing engagement and disengagement with negative emotional faces. Infants who attended less to angry, sad, and fearful faces (i.e., by being slower to look at and/or quicker to look away from negative compared to neutral faces) engaged in fewer helping behaviors, and effect sizes were larger when examining infants' attention toward the eye regions of faces. Additionally, infants who were quicker to look away from the eye regions of angry faces, but not the whole face, displayed less empathy and comforting behaviors. Results suggest that as early as 12 months of age, infants' decreased attention toward negative emotional faces, particularly the eye regions, is associated with less empathy and prosociality during a developmental period in which these abilities are rapidly maturing.

Early Emotion Development Intervention Improves Mental Health Outcomes in Low-Income, High-Risk Community Children.

Children living in poverty and facing related forms of adversity are at higher risk for experiencing concurrent and later psychopathology. Although negative psychological outcomes can be improved by enhancing sensitive and responsive caregiving early in development, interventions targeting the caregiver-child dyad are not readily accessible. The present study investigated the feasibility and effectiveness of delivering a shortened eight-session form of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) in-person or remotely as an early intervention for 3-6-year-old children (N = 62) at elevated risk for psychopathology who were growing up in low-income communities. Caregiver-child dyads were randomized to eight-sessions of PCIT-ED or online parenting education. Relative to parenting education, children receiving PCIT-ED exhibited lower externalizing symptoms and functional impairment and more positive peer relationships following the intervention. Findings support the effectiveness of this shortened form of PCIT-ED, delivered in-person or remotely, as an early intervention to improve symptoms of psychopathology and functioning in high-risk children living in poverty.Trial registration Clinicaltrials.gov; NCT04399629.

Developmental pathways from preschool temper tantrums to later psychopathology.

Temper tantrums are sudden, overt negative emotional displays that are disproportionate to the eliciting event. Research supports that severe temper tantrums during the preschool period are associated with preschool psychopathology, but few studies have identified which characteristics of preschool tantrums are predictive of distal psychopathological outcomes in later childhood and adolescence. To examine this question, we used a prospective, longitudinal dataset enriched for early psychopathology. Participants (N = 299) included 3-to 6-year-old children (47.8% female) assessed for tantrums and early childhood psychopathology using diagnostic interviews and then continually assessed using diagnostic interviews over 10 subsequent time points throughout childhood and adolescence. We identified two unique groupings of tantrum behaviors: aggression towards others/objects (e.g., hitting others) and aggression towards self (e.g., hitting self). While both types of tantrum behaviors were associated with early childhood psychopathology severity, tantrum behaviors characterized by aggression towards self were more predictive of later psychopathology. Children displaying high levels of both types of tantrum behaviors had more severe externalizing problems during early childhood and more severe depression and oppositional defiant disorder across childhood and adolescence. Findings suggest that tantrum behaviors characterized by aggression towards self are particularly predictive of later psychopathology.

The reward positivity shows increased amplitude and decreased latency with increasing age in early childhood.

The reward positivity (RewP) is a widely studied measure of neural response to rewards, yet little is known about normative developmental characteristics of the RewP during early childhood. The present study utilized a pooled community sample of 309 4- to 6-year-old children who participated in the Doors guessing game to examine the latency and amplitude of the RewP. Peak detection of the gain-loss difference waveform was conducted for electrodes Fz, Cz, Pz, Oz and the mean activity in a 100 ms window centered around this peak was analyzed. There was a significant decrease in RewP latency (RewP was earlier) and increase in RewP amplitude (RewP magnitude was larger) with advancing age in this cross-sectional analysis. Further, these were independent effects, as both RewP latency and RewP amplitude were uniquely associated with children's age. Moreover, our results indicate that the RewP latency in 4- to 6-year-olds falls outside the 250-350 ms window typically used to quantify the RewP (RewP latency in our sample = 381 ms; SD = 60.15). The internal consistency for latency (.64) and amplitude (.27) of the RewP were characterized by moderate to low reliability, consistent with previous work on the reliability of difference scores. Overall, results demonstrate RewP differences in both timing and amplitude across age in early childhood, and suggest that both amplitude and latency of the RewP might function as individual difference measures of reward processing. These findings are discussed in the context of methodological considerations and the development of reward processing across early childhood.

Picky Eating in Childhood: Associations With Obsessive-Compulsive Symptoms.

OBJECTIVE: To test whether childhood picky eating (PE)-a behavior previously linked to many forms of psychopathology-is specifically associated with symptoms of obsessive-compulsive disorder (OCD). METHODS: We investigated the relationship between PE and symptoms of several forms of psychopathology in two separate observational samples: a sample of 110 children (5 and 6 years old) and a sample of 210 children (8 and 9 years old) drawn from a longitudinal study. In each sample, regression models based on psychiatric symptoms or diagnoses were used to assess the specificity of PE associations while accounting for cooccurring symptoms or comorbidities. RESULTS: Although bivariate associations emerged between PE and multiple forms of psychopathology, multivariate analyses revealed these associations were driven by a strong and specific association between PE and symptoms of OCD in both samples. Moreover, PE among 8- and 9-year-olds in the longitudinal study predicted emergence of additional later psychopathology, specifically attention-deficit/hyperactivity disorder (ADHD). CONCLUSIONS: Findings suggest that PE, an easily identifiable clinical presentation, is also a specific marker for obsessive-compulsive symptomatology in school-age children and may impart risk for ADHD later in childhood.

A Brief Early Childhood Screening Tool for Psychopathology Risk in Primary Care: The Moderating Role of Poverty.

OBJECTIVES: To evaluate the Preschool Feeling Checklist (PFC) utility for predicting later mental disorders and functioning for children and assess whether the PFC's predictive utility differs as a function of childhood poverty. STUDY DESIGN: We analyzed data from a prospective longitudinal study of preschoolers in St Louis. Preschoolers (N = 287) were recruited from primary care sites and were assessed annually for 10-15 years. The PFC screened for depressive symptoms. Later age-appropriate psychiatric diagnostic interviews were used to derive Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnoses. Regression and moderation analyses, and multilevel modeling were used to test the association between the PFC and later outcomes, and whether this relationship was moderated by income-to-needs. RESULTS: The PFC predicted major depressive disorder (OR 1.13, P < .001), attention deficit hyperactivity disorder (OR 1.16, P < .001), and mania (OR 1.18, P < .05) in adolescence and early adulthood. Income-to-needs was a moderator in the predictive pathway between the PFC and later major depressive disorder (OR 1.10, P < .05) and mania (OR 1.19, P < .001) with the measure less predictive for children living in poverty. The PFC predicted worse functioning by the final assessment (b = 1.71, SE = 0.51, P = .001). CONCLUSIONS: The PFC served as an indicator of risk for later attention deficit hyperactivity disorder and impairment in all children. It has predictive utility for later mood disorders only in children living above the poverty line. Predicting depression in children living below the poverty line may require consideration of risk factors not covered by the PFC.

When positive outcomes and reality collide: Children prefer optimists as social partners.

Optimists, by definition, make inaccurate (overly positive) predictions regarding future event outcomes. Adults favor optimists as social partners. If children also prefer optimists, that preference could indicate early social benefits of being optimistic and might also shape how and what children learn regarding the likelihood of future outcomes. The present study thus sought to determine how children integrate the conflicting dimensions of optimism and accuracy in their social (friendship) preferences. Across two experiments (N = 133) 3- to 6-year-old children chose optimists over realists as social partners even if they were able to correctly identify the realist as being the most accurate of the two. However, when children made mistakes in identification, those mistakes primarily took the form of identifying the optimist as most accurate. These findings suggest that young children weigh optimism more heavily than accuracy in their affiliative relationships. Misidentifying the optimist as accurate also supports the notion that children have a bias to expect others to provide positive information. Further, a social preference for optimists might impact children's abilities to learn the true likelihood of event outcomes, as affiliating with optimists may result in setting oneself up to receive more positive (mis)information in the future. Such a preference suggests a mechanism by which optimism is perpetuated and points to potential social benefits that derive from being optimistic.

Preschool Depression: a Diagnostic Reality.

PURPOSE OF REVIEW: We review findings related to predictors, correlates, outcomes, and treatment of preschool depression that have been published in the last 3 years. RECENT FINDINGS: Preschool depression displays a chronic course through late adolescence and is associated with temperamental and personality traits, poorer physical health, and negative parenting practices. Preschool depression predicts deficits into adolescence, including social difficulties and blunted neural response to rewards. Depressed preschoolers can experience suicidal ideation and behaviors and display an accurate understanding of the finality of death. A treatment for preschool depression has now been validated that uses the parent-child relationship to enhance emotion development and reduce depressive symptoms. Preschool depression is homotypic with depression that occurs later in life. Future work elucidating mechanisms through which preschool depression develops and informs the sub-groups for which particular treatments may be most effective will have considerable implications for prevention and early intervention.

Meta-analytic techniques reveal that corvid causal reasoning in the Aesop's Fable paradigm is driven by trial-and-error learning.

The classic Aesop's fable, Crow and the Pitcher, has inspired a major line of research in comparative cognition. Over the past several years, five articles (over 32 experiments) have examined the ability of corvids (e.g., rooks, crows, and jays) to complete lab-based analogs of this fable, by requiring them to drop stones and other objects into tubes of water to retrieve a floating worm (Bird and Emery in Curr Biol 19:1-5, 2009b; Cheke et al. in Anim Cogn 14:441-455, 2011; Jelbert et al. in PLoS One 3:e92895, 2014; Logan et al. in PLoS One 7:e103049, 2014; Taylor et al. in Gray R D 12:e26887, 2011). These researchers have stressed the unique potential of this paradigm for understanding causal reasoning in corvids. Ghirlanda and Lind (Anim Behav 123:239-247, 2017) re-evaluated trial-level data from these studies and concluded that initial preferences for functional objects, combined with trial-and-error learning, may account for subjects' performance on key variants of the paradigm. In the present paper, we use meta-analytic techniques to provide more precise information about the rate and mode of learning that occurs within and across tasks. Within tasks, subjects learned from successful (but not unsuccessful) actions, indicating that higher-order reasoning about phenomena such as mass, volume, and displacement is unlikely to be involved. Furthermore, subjects did not transfer information learned in one task to subsequent tasks, suggesting that corvids do not engage with these tasks as variants of the same problem (i.e., how to generate water displacement to retrieve a floating worm). Our methodological analysis and empirical findings raise the question: Can Aesop's fable studies distinguish between trial-and-error learning and/or higher-order causal reasoning? We conclude they cannot.

Infants' Understanding of Preferences When Agents Make Inconsistent Choices.

This study showed that 8.5-month-old infants seemed to consider the consistency of an agent's choices in attributing preferences to her. When the agent consistently chose one object over another, three or four times consecutively, infants acted as if they had interpreted her actions as evidence for her preference. In contrast, when the agent inconsistently chose between the two objects, at the ratio of 1:3, infants did not seem to interpret her actions as suggesting her preference. Converging evidence was obtained from infants' responses across a looking-time task and an action task. The results are discussed in terms of how infants might use frequencies of agents' actions directed toward different objects to understand agents' preferences.

If you don't want it, neither do I: Social influences on children's choices.

To what extent does knowing what others like influence children's valuation of objects? The current study examined the effect of having observed another person's choices on children's decisions about objects. Specifically, we asked whether children consider what the other person does not choose. In the first of three conditions, 4-year-olds watched as an experimenter looked inside two boxes and then selected the box containing the object she liked best. Children were then asked to choose between the remaining box (that the experimenter did not take) and a neutral box (that replaced the chosen box). Children tended to select the neutral box, suggesting that they had devalued the box the experimenter did not choose. However, in the second condition, when the experimenter chose a box without first looking inside--and thus was ignorant of the contents--children chose randomly. The third condition revealed that children continued to select the neutral box even when the experimenter who made the initial choice was not present. This indicates that children's valuation of the rejected option changed rather than their choices being solely influenced by the social dynamics of the situation (e.g., reluctance to choose the box with the option the experimenter knowingly rejected while in the presence of that experimenter). Taken together, these findings suggest that by 4 years of age, children's own choices--and values--are influenced by observing others' informed choices, including what they do not choose. The findings provide new insight into the potential role of social influence in children's developing preferences.

Preteen Suicide Risk Screening in the Pediatric Outpatient Setting: A Clinical Pathway.

We are in a youth mental health crisis with unprecedented and staggeringly high rates of suicidal ideations and suicide behaviors in preteens. In the United States 14.5% of children aged 9-10 have experienced suicidal thoughts and behaviors, including 1.3% with a suicide attempt. American Academy of Pediatrics guidelines call for universal suicide risk screening of youth aged 12+ years during preventative healthcare visits, and screening in preteens aged 8-11 years when clinically indicated. However, what constitutes a clinical indication at 8-11 years can be difficult to systematically detect and pediatric practitioners may not be equipped with necessary age-specific assessment tools. This is compounded by the lack of emphasis on preteen suicide risk screening (and focus on adolescents), which leaves practitioners without age-appropriate resources to make clinical determinations for at-risk preteens. The objective of this project was thus to develop an evidence-informed suicide risk screening pathway for pediatric practitioners to implement with preteen patients in outpatient settings. Suicide risk assessment in younger children (<8 years) is also briefly addressed. We convened a group of researchers and practitioners with expertise in preadolescent suicide, pediatric medicine, behavioral health screening integration with primary care, and child development. They reviewed the empirical literature and existing practice guidelines to iterate on a multi-informant clinical suicide risk screening pathway for preteens that includes both caregivers and preteens in the screening process. We also developed tools and accompanying guidelines for a preteen suicide risk screening workflow and risk determination to aid practitioners in deciding who, when, and how to screen. Finally, we provide scripts for introducing suicide risk screening to caregivers and preteens and to discuss screening findings.

Preadolescent Suicidal Thoughts and Behaviors: An Intensive Longitudinal Study of Risk Factors.

OBJECTIVE: Dramatic increases in rates of suicidal thoughts and behaviors (STBs) among youth highlight the need to pinpoint early risk factors. This study used intensive longitudinal sampling to assess what the concurrent associations were between risk factors and STB status, how proximal changes in risk factors were related to STB status, and how risk factors prospectively predicted changes in STB status in a preadolescent sample enriched for early childhood psychopathology. METHOD: A total of 192 participants were included from the Parent-Child Interaction Therapy-Emotional Development (PCIT-ED) Study, a longitudinal study of children with and without preschool depression. Participants 7 to 12 years of age completed a diagnostic interview, followed by 12 months of intensive longitudinal sampling, assessing experiences of suicidal ideation and 11 psychosocial variables with known links to STBs in adolescents and adults. Preadolescents with STB history (high-risk) received surveys weekly, and those without STB history (lower-risk) received surveys monthly. RESULTS: Female sex, elevated depressive symptoms, greater use of expressive suppression and rumination, emotional clarity, and perceived burdensomeness were uniquely concurrently associated with the likelihood of STB endorsement. Within the high-risk group, (1) increases in depression, expressive suppression, rumination, and perceived burdensomeness, and decreases in positive affect from weekt to weekt+1 were associated with a higher likelihood of a positive STB status at weekt+1; and (2) higher expressive suppression, perceived burdensomeness, and caregiver criticism and conflict at weekt compared to participants' mean levels prospectively predicted increases in the likelihood of a positive STB report from weekt to weekt+1. CONCLUSION: Psychosocial factors influencing STBs in adolescents and adults also affect preadolescents in day-to-day life. Expressive suppression and perceived burdensomeness consistently emerged as novel risk indicators and potential targets for treatment. In addition, increases in depression, rumination, and caregiver criticism and conflict, as well as decreases in positive affect, might prompt heightened STB screening and assessments for preadolescents with a history of STBs.

The Relationship Between Early Life Adversity and Academic Competence in Early Childhood.

It is well-documented that early life adversity negatively affects children academically and that these impacts magnify as the number of negative life events (NLEs) they experience increases. However, it is unclear whether the types of NLEs children are exposed to differentially relate to their levels of academic competence, a component of educational functioning. The present study addressed this question by assessing the relationships between different types of early life adversity and academic competence in 4- to 6-year-olds (N = 111) using secondary data analyses of parent reports in which respondents indicated children's levels of academic competence and exposure to NLEs. The results showed that family turmoil (b = -2.31, 95% CI [-4.05, -0.57], p = .01, f2 = .07), poverty (b = -2.92, 95% CI [-4.31, -1.53], p < .001, f2 = .16), and violence (b = -3.43, 95% CI [-5.14, -1.73], p < .001, f2 = .15) negatively predicted academic competence, whereas family separation and death/illness did not relate to academic competence. Additionally, poverty negatively predicted academic competence above and beyond family turmoil and violence (b = -2.36, 95% CI [-0.49, 0.72], p = .03, f2 = .04). These findings demonstrate that some, but not all, types of NLEs negatively predict preschoolers' academic competence, illustrating the differential relationship between different types of early life adversity and academic performance. Moreover, these findings reveal the deleterious impacts of certain types of NLEs on children's academics prior to beginning formal education, suggesting the importance of early intervention targeting family turmoil, poverty, and violence from a young age.

Early childhood sleep problems predict increased risk for the later development of suicidal thoughts.

Suicidal thoughts and behaviors in youth are an escalating and immediate public health concern. To better understand youth suicidal thoughts and behaviors, it is important to identify risk factors in early childhood that predict the later emergence of youth suicidal thoughts and behaviors. Research with adults and adolescents has identified sleep disturbances as a risk factor for suicidal thoughts and behaviors, but this has yet to be examined in early childhood. Using a prospective, 17-year longitudinal design, the current study explored the association between early childhood sleep disturbances and concurrent and later suicidal thoughts and behaviors (in separate models) across childhood and adolescence. Results indicate that sleep problems in early childhood are associated with increased probability for suicidal thoughts after age 8, even when controlling for prior and concurrent depression severity. Our findings suggest that early childhood sleep difficulties warrant increased clinical attention and management, as they may contribute to the maintenance and exacerbation of suicidal thoughts over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preschool-Onset Major Depressive Disorder as a Strong Predictor of Suicidal Ideation and Behaviors Into Preadolescence.

OBJECTIVE: Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on 1 understudied candidate risk factor, namely, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence. METHOD: Participants were 137 children 8 to 12 years of age who met criteria for PO-MDD when they were 3 to 6 years of age, and a nondepressed sample of 53 age-, income-, and sex-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews. RESULTS: By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p < .001; 67.9% vs 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p = .012; 21.9% vs 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p = .005; 26.3% vs 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p = .018; 83.1% vs 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence. CONCLUSION: PO-MDD is a strong risk factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions.

Family income buffers the relationship between childhood adverse experiences and putamen volume.

Adverse experiences and family income in childhood have been associated with altered brain development. While there is a large body of research examining these associations, it has primarily used cross-sectional data sources and studied adverse experiences and family income in isolation. However, it is possible that low family income and adverse experiences represent dissociable and potentially interacting profiles of risk. To address this gap in the literature, we examined brain structure as a function of adverse experiences in childhood and family income in 158 youths with up to five waves of MRI data. Specifically, we assessed the interactive effect of these two risk factors on six regions of interest: hippocampus, putamen, amygdala, nucleus accumbens, caudate, and thalamus. Adverse experiences and family income interacted to predict putamen volume (B = 0.086, p = 0.011) but only in participants with family income one standard deviation below the mean (slope estimate = -0.11, p = 0.03). These results suggest that adverse experiences in childhood result in distinct patterns of brain development across the socioeconomic gradient. Given previous findings implicating the role of the putamen in psychopathology-related behaviors, these results emphasize the importance of considering life events and socioeconomic context when evaluating markers of risk. Future research should include interactive effects of environmental exposures and family income to better characterize risk for psychopathology in diverse samples.

Deficits in doors P300 amplitude during adolescence associated with preschool-onset depression.

The psychophysiological underpinnings of preschool-onset depression (PO-MDD) remain underexplored. Moreover, there is currently a limited understanding of the potential impact that PO-MDD might have on neurobiological functions later in development such as general cognitive domains and reward processing. Thus, the current study sought to examine potential neurophysiological differences, measured via electroencephalography (EEG), in adolescents with and without a history of PO-MDD. Participants and their caregivers (N = 138) from a large longitudinal study completed semi-structured clinical interviews at a baseline visit (ages 3-7) to determine PO-MDD status. At a follow-up visit approximately 11 years later, adolescents (ages 13-19) completed the doors gambling task while EEG was recorded to measure event-related potentials (ERPs) elicited by both the doors and feedback stimuli, to index cognitive and reward processing functions (i.e., doors-P300, gain/loss feedback-P300, and RewP). Adolescents with a history of PO-MDD exhibited significantly smaller doors-P300 compared with adolescents with no history of PO-MDD, whereas there were no group differences in gain/loss feedback-P300 or RewP. Additionally, reduced doors-P300 was independently associated with lower baseline income-to-needs ratio, older age, and female gender. The current study suggests that reduced doors-P300 amplitude during adolescence might reflect impaired neurophysiological development related to PO-MDD. Thus, the P300 derived from the doors stimuli might be a valuable neural measure to further our understanding of potential neurophysiological differences associated with early-onset childhood depression.

Young children with suicidal thoughts and behaviors more likely to resolve conflicts with violence, homicide, or suicide: A study of internal working models using narratives.

There is mounting evidence that young children who express suicidal ideation (SI) have a different conceptualization of death than their peers. This study characterizes 3- to 6-year-olds' depictions of violence, death, and suicidal themes in a story completion task as a function of their history of SI. Participants were 228 children with depression (3.0-6.9 years) who completed a comprehensive psychiatric assessment and four story stem narratives. For each narrative, an interviewer began a story with a conflict that the child was encouraged to resolve. Children's resolutions were coded for standard themes and negative atypical themes including violence and homicide, accidental harm or death, and suicidal ideation/acts. Themes were examined as a function of children's SI status: active-SI (n = 25), passive-SI (n = 28), or no history of SI (n = 175). Across the narratives, 89 children described at least one negative atypical theme: violence or homicide (n = 78), accidental harm or death (n = 22), and suicide (n = 13). The responses of children with active-SI included significantly more violence or homicide than children without SI. Moreover, current active-SI predicted suicidal themes. There were no group differences in accidental harm or death, nor in common aggressive or punitive acts (e.g., hitting, yelling, spanking), indicating specificity between active-SI and more intense violence and death-related themes. In sum, young children with active SI are more likely than their depressed peers without SI to incorporate violence, homicide, and suicide into their narratives around conflict resolution. These themes appear more salient to depressed children with SI and pervasive in their thoughts and problem-solving strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence.

OBJECTIVE: Suicidal thoughts and behaviors (STBs) represent a significant and escalating public health concern in youth. Evidence that STBs can emerge in the preschool years suggests that some pathways leading to clinically significant STBs begin early in life. METHOD: This prospective longitudinal study examined the developmental trajectories of STBs in children from ages 3 to 17, oversampled for preschool-onset depression. RESULTS: Three unique trajectories of STBs across childhood and adolescence were identified: low class (n = 273) characterized by low rates of STBs, early-persistent class (n = 21) characterized by steadily increasing STBs, and late-onset class (n = 21) characterized by low rates of STBs through age 10 followed by a dramatic increase from ages 11 to 14 years. Preschool measures of depression symptoms, externalizing symptoms, impulsivity, and lower income relative to needs were associated with both high-risk STB classes. Both high-risk STB classes reported greater functional impairment, more externalizing symptoms, and more cumulative stressful life events in adolescence relative to the low class; the late-onset class also reported poorer academic functioning relative to both the early-persistent and low classes. CONCLUSION: A significant minority of this prospectively followed group of preschool children evidenced STBs by and/or after age 10. Although relatively rare before age 10, approximately half of the children who experienced STBs in adolescence first exhibited STBs in early childhood and comprised a trajectory suggesting increasing STBs. In contrast, approximately half of children first exhibited STBs in early adolescence. Early screening and identification of at-risk youth during both preschool and late childhood is important for early intervention regarding STBs.