Household chaos and child problem behaviors: A cross-cultural examination of the mediating and moderating role of mindful parenting.

Household chaos has been shown to adversely associate with children's behavioral adjustment. However, the mechanism underlying the relationship between household chaos and children's behaviors is not yet fully understood. The current study proposes mindful parenting as an important mediating and moderating factor in the relationship between household chaos and child problem behaviors. This study also examines cultural influences in this process, comparing the UK and Türkiye, considering both mothers' and children's perspectives on mindful parenting. Cross-sectional questionnaires were administered to mothers and their children aged 11-16 years in the UK (n = 90; 53.3% girl) and Türkiye (n = 154; 54.5% girl) in 2021. Mother reports of the Confusion, Hubbub, and Order Scale and the Strengths and Difficulties Questionnaire, as well as mother and child reports of Mindful Parenting Inventories for Parents (MPIP) and Children (MPIC), were used to assess household chaos, child problem behaviors, and mindful parenting, respectively. Multiple-group path analysis revealed that household chaos was a significant indirect predictor of child problem behaviors via mindful parenting in both countries. Furthermore, simple slopes analysis showed that mindful parenting moderated the link between household chaos and child problem behaviors in the UK. Overall, our study sheds light on the importance of micro- and macro-environmental factors and their interactions in children's adjustment.

Paternal and maternal psychological distress and adolescent health risk behaviors: The role of sensitive periods.

INTRODUCTION: Adolescent health risk behaviors are linked to poor physical and mental health outcomes. While past research shows that maternal psychological distress predicts those behaviors, we know less about the role of paternal psychological distress and the role of sensitive periods. METHODS: Using 11,128 data from families (50.5% female children) from the UK's Millennium Cohort Study, we examined the role of timing of exposure to paternal and maternal psychological distress in engagement in health risk behaviors (smoking, alcohol use, binge drinking, and sexual activity) at age 14. Paternal and maternal psychological distress, measured with the Kessler-6 scale, were assessed at child ages 3, 7, and 11. We performed path analysis, adjusting for key covariates, modeling maternal distress parallel to paternal, and allowing for autoregressive paths. RESULTS: Paternal distress experienced at age 11 predicted a higher likelihood of smoking at age 14. Maternal distress at age 7 also predicted a higher likelihood of smoking, alcohol use, and binge drinking, but only for boys. Moreover, maternal distress at age 3 was associated with a lower risk for alcohol use. Effects were not replicated in the sensitivity analysis we performed, including only families with resident biological fathers across the study period. Instead, maternal and paternal distress at age 11 raised girls' risk for binge drinking and sexual activity, respectively. CONCLUSIONS: Parental distress in early childhood does not predict adolescent health risk behaviors. In late childhood, however, both paternal and maternal distress seem to influence the likelihood of engagement in such behaviors.

Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence.

BACKGROUND: Autism can be diagnosed from 2 years of age, although most autistic people receive their diagnosis later than this after they have started education. Research is required to understand why some autistic children are diagnosed late, and the level and nature of unmet need prior to diagnosis for late-diagnosed children. METHODS: We examined trajectories of emotional, behavioural and social difficulties (EBSDs) across childhood and adolescence, comparing 'earlier-diagnosed' (diagnosed 7 years or younger) with 'late-diagnosed' (diagnosed between 8 and 14 years) autistic children. Data were from the Millennium Cohort Study, a population-based UK birth cohort. EBSDs were measured using the parent-report Strengths and Difficulties Questionnaire, at 3, 5, 7, 11 and 14 years. We used Growth Curve Modelling to investigate levels and rates of change in these difficulties, and to compare earlier- (n = 146) and late-diagnosed (n = 284) autistic children. RESULTS: Aged 5, earlier-diagnosed autistic children had more emotional (i.e., internalising), conduct, hyperactivity and social difficulties; although clinical difficulties in these areas were nevertheless common in late-diagnosed children. There was a faster annual increase in scores for all domains for late-diagnosed children, and by age 14 years, they had higher levels of EBSDs. These results persisted when we ran adjusted models, to account for the late-diagnosed group having higher rates of late-diagnosed attention deficit/hyperactivity disorder, higher IQ, a higher proportion of females and older and more educated mothers. CONCLUSIONS: Emotional, behavioural and social difficulties are associated with, and may influence, the timing of autism diagnosis. Late-diagnosed autistic children often have high levels of mental health and social difficulties prior to their autism diagnosis, and tend to develop even more severe problems as they enter adolescence.

Ability-grouping and problem behavior trajectories in childhood and adolescence: Results from a U.K. population-based sample.

Ability-grouping has been studied extensively in relation to children's academic, but not emotional and behavioral outcomes. The sample comprised 7259 U.K. children (50% male) with data on between-class and within-class ability-grouping at age 7. Peer, emotional, hyperactivity, and conduct problems were measured at ages 7, 11, and 14 years. Children in low within-class ability groups showed more hyperactivity and emotional problems across the study period compared to non-grouped children, after adjustments for the different types of ability grouping and confounding. Additionally, children in the middle within-class ability groups showed more, and those in the top within-class groups less, hyperactivity compared to non-grouped children, after adjustment. Children in lower within-class groups should be monitored closely to ensure that their well-being is not compromised.

Reciprocal relationships between paternal psychological distress and child internalising and externalising difficulties from 3 to 14 years: a cross-lagged analysis.

Research shows that paternal psychological distress is associated with child emotional and behavioural difficulties. However, little is known about the direction of this association including whether it is bidirectional. The aim of this study was to explore the reciprocal relationships between paternal psychological distress and child emotional and behavioural problems longitudinally (at ages 3, 5, 7, 11 and 14 years) in a sample of 13,105 children (49% girls) who participated in the UK's Millennium Cohort Study (MCS), a large-scale, nationally representative, longitudinal survey. Four domains of child problems (emotional symptoms, peer relations, conduct problems and hyperactivity/inattention) were measured with the Strengths and Difficulties Questionnaire and paternal psychological distress was measured with the Kessler K-6 scale. Data were analysed using cross-lagged path models. At all ages, paternal psychological distress predicted both subsequent child emotional symptoms as well as peer problems. Paternal psychological distress at child's age 3 was related to more hyperactivity at age 5 and, at age 5, paternal psychological distress was associated with more conduct problems at age 7. At age 11, paternal distress was also related to age 14 conduct problems and hyperactivity. Child effects were fewer and were found mainly for behavioural problems. Notably, we found bidirectional links between paternal psychological distress and child peer difficulties, from 11 to 14 years. Paternal psychological distress appears to influence child behaviour more consistently than the converse. However, in early adolescence, there appears to be a reciprocal relationship between fathers' mental health problems and children's peer problems.

Do upsetting life events explain the relationship between low socioeconomic status and systemic inflammation in childhood? Results from a longitudinal study.

BACKGROUND: Children from families of low socioeconomic status (SES) are more likely to be exposed to upsetting situations and stressors. Such exposures have, in turn, been linked to inflammation in some studies. In this study we explore if low SES is related to inflammation in children via such stressful life events. METHODS: Data on 4525 children of the Avon Longitudinal Study of Parents and Children, a general population birth cohort, were used to explore associations between SES at ages 0-3 years, upsetting life events at ages 3-9 years and inflammatory markers [interleukin 6 (IL-6) and C-reactive protein (CRP)] at age 9 years. Confounders included body mass index, gender, financial problems, and upsetting life events at ages 0-3 years. RESULTS: Using Structural Equation Modelling, we found that early socioeconomic disadvantage predicted higher levels of IL-6 (ß = 0.034, 95% CI = 0.005, 0.063) even after adjusting for confounders. This association was partially mediated by upsetting life events (ß = 0.003, 95% CI = 0.001, 0.006). CONCLUSIONS: In the general child population, low SES is associated with increased exposure to stressful life events, in turn associated with later inflammation. These findings highlight the role of stressors associated with poverty and disadvantage in the development of inflammation among children in the general population.

Prenatal and childhood adversity and inflammation in children: A population-based longitudinal study.

BACKGROUND: Stressful life events experienced during childhood and early prenatal development have been associated with inflammation during childhood. However, no study has considered these two exposures jointly, or has investigated the effect of their interaction. METHODS: In the Avon Longitudinal Study of Parents and Children, a general-population birth cohort, we explored if inflammatory markers [serum C-reactive protein (CRP) and interleukin 6 (IL-6)] at age 9 years were related to early prenatal events (at 18 weeks pregnancy), childhood events (measured on seven occasions at ages 0-9 years) and their interaction (n = 3,915). Latent growth curve modelling estimated trajectories of childhood events, and linear regression explored associations of prenatal and childhood events with inflammatory markers. Models controlled for ethnicity, socioeconomic status and body mass index, were stratified by gender and considered both unweighted and weighted (by impact) event exposures. RESULTS: Even after adjustment for confounders and prenatal events, both the intercept and the slope of number of childhood events were associated with IL-6, but only in females. The significant effect of the slope held for both weighted (by impact) and unweighted event specifications. Prenatal events were not associated with either inflammatory marker when childhood events were controlled. There was no evidence for synergistic effects of prenatal and childhood events. CONCLUSION: Independently of prenatal adverse life events, the number and increase in number of adverse life events experienced in childhood were associated positively with plasma levels of inflammatory markers, such as IL-6, in girls. This gender specificity warrants further research.

Stressful life events, inflammation and emotional and behavioural problems in children: A population-based study.

OBJECTIVE: To test the hypothesis that higher plasma levels of inflammatory markers due to exposure to adverse life events may lead to internalising and externalising symptoms in children. METHOD: Using data from the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we explored if inflammatory markers [serum C-reactive protein (CRP) and interleukin-6 (IL-6)] at age 9 years explain the longitudinal association between adverse life events (at ages 1-9 and 9-11 years) and internalising and externalising symptoms (at ages 9 and 11 years). Data (n = 4583) were analysed using cross-lagged panel modelling to take into account reciprocal associations and reverse causality, and path analyses to test for mediation. Gender, ethnicity, body mass index, maternal education, paternal social class and maternal depression were used as potential confounders. RESULTS: CRP was not associated with adverse life events. There was evidence for partial mediation by IL-6 such that exposure to adverse life events was associated with increased levels of IL-6 later, in turn associated with later internalising symptoms. These associations were robust to adjustment for confounders. IL-6 did not explain part of the opposite association, that of earlier internalising symptoms and later life events, nor did it explain either direction of the association between life events and externalising symptoms. CONCLUSION: Our findings suggest a pathway that may connect early psychosocial adversity and childhood internalising symptoms via higher plasma levels of inflammatory markers, such as IL-6.

The quality of air outside and inside the home: associations with emotional and behavioural problem scores in early childhood.

BACKGROUND: This study explored the role of outdoor air pollution [nitrogen dioxide (NO2) and sulphur dioxide (SO2)] and indoor air quality (measured with damp or condensation and secondhand smoke exposures) at age 9 months in emotional, conduct and hyperactivity problems at age 3 years. METHOD: Data from 11,625 Millennium Cohort Study children living in England and Wales were modelled using multilevel regression. RESULTS: After adjusting for a host of confounders, having a damp or condensation problem at home was related to both emotional and conduct problems. Secondhand smoke exposure was associated with all three problem types. Associations with outdoor air pollution were less consistent. CONCLUSIONS: Exposures to damp or condensation and secondhand smoke in the home are likely to be risk factors for child emotional and behavioural problems. Parents should continue to be educated about the dangers of exposing their children to poor air quality at home.

Outdoor and indoor air quality and cognitive ability in young children.

BACKGROUND: This study examined outdoor and indoor air quality at ages 9 months and 3 years and their association with cognitive ability at age 3 in England and Wales. METHOD: Data from 8198 Millennium Cohort Study children were analysed using multilevel regression. Outdoor air quality was assessed with mean annual estimates of nitrogen dioxide (NO2) levels within a standard small area (ward). Indoor air quality was measured with parent-reports of damp or condensation in the home and exposure to secondhand smoke in the home. Cognitive ability was assessed with the British Ability Scales Naming Vocabulary subscale and the Bracken School Readiness Assessment. RESULTS: In adjusted models, consistent exposure to high levels of NO2 at age 9 months and age 3 years was associated with lower verbal ability at age 3 years. Damp/condensation and secondhand smoke in the home at either age or at both ages were correlated with lower school readiness at age 3 years. Exposures to damp/condensation at age 3 years or at both ages and secondhand smoke at either age or at both ages were associated with lower verbal ability at age 3 years. CONCLUSION: Young children's exposures to indoor damp or condensation and secondhand smoke are likely to be detrimental for their cognitive outcomes. However, there do not appear to be any short-term effects of NO2.

Early adolescent outcomes of joint developmental trajectories of problem behavior and IQ in childhood.

General cognitive ability (IQ) and problem behavior (externalizing and internalizing problems) are variable and inter-related in children. However, it is unknown how they co-develop in the general child population and how their patterns of co-development may be related to later outcomes. We carried out this study to explore this. Using data from 16,844 Millennium Cohort Study children, we fitted three-parallel-process growth mixture models to identify joint developmental trajectories of internalizing, externalizing and IQ scores at ages 3-11 years. We then examined their associations with age 11 outcomes. We identified a typically developing group (83%) and three atypical groups, all with worse behavior and ability: children with improving behavior and low (but improving in males) ability (6%); children with persistently high levels of problems and low ability (5%); and children with worsening behavior and low ability (6%). Compared to typically developing children, the latter two groups were more likely to show poor decision-making, be bullies or bully victims, engage in antisocial behaviors, skip and dislike school, be unhappy and have low self-esteem. By contrast, children (especially males) in the improver group had outcomes that were similar to, or even better than, those of their typically developing peers. These findings encourage the development of interventions to target children with both cognitive and behavioral difficulties.

The role of socio-economic disadvantage in the development of comorbid emotional and conduct problems in children with ADHD.

Previous research shows that, compared to children without ADHD, children with ADHD have worse socio-emotional outcomes and more experience of socio-economic disadvantage. In this study, we explored if and how the increased emotional and behavioural difficulties faced by children with ADHD may be accounted for by their more disadvantaged socio-economic circumstances. Our study, using data from 180 children (149 boys) with ADHD from the Millennium Cohort Study, had two aims. First, to examine the role of socio-economic disadvantage in the trajectories of emotional and conduct problems in children with ADHD at ages 3, 5, 7 and 11 years. Second, to explore the roles of the home environment (household chaos) and parenting (quality of emotional support, quality of the parent-child relationship and harsh parental discipline) in mediating any associations between socio-economic disadvantage and child emotional and conduct problems. Using growth curve models, we found that socio-economic disadvantage was associated with emotional and conduct problems but neither the home environment nor parenting attenuated this association. Lower quality of the parent-child relationship and harsher discipline were associated with more conduct problems. It appears that socio-economic disadvantage and parenting contribute independently to the prediction of comorbid psychopathology in children with ADHD.

School composition, family poverty and child behaviour.

PURPOSE: There is little research on the role of school composition in young children's behaviour. School composition effects may be particularly important for children in disadvantaged circumstances, such as those growing up in poverty. We explored the role of school academic and socio-economic composition in internalising problems, externalising problems and prosocial behaviour at age 7 years, and tested if it moderates the effect of family poverty on these outcomes. METHODS: We used data from 7225 7-year-olds of the Millennium Cohort Study who attended state primary schools in England and for whom we had information on these outcomes. In multiple membership models, we allowed for clustering of children in schools and moves between schools since the beginning of school, at age 5. Our school academic and socio-economic composition variables were school-level achievement and % of pupils eligible for free school-meals, respectively. Poverty (family income below the poverty line) was measured in all sweeps until age 7. We explored the roles of both timing and duration of poverty. RESULTS: The effects of poverty were strong and robust to adjustment. School socio-economic composition was associated with individual children's internalising and externalising problems, even in adjusted models. School composition did not interact with poverty to predict any of the outcomes. CONCLUSIONS: Neither the academic nor the socio-economic composition of the school moderated the effect of family poverty on children's behaviour in primary school. However, children attending schools with more disadvantaged socio-economic intakes had more internalising and externalising problems than their counterparts.

Neighbourhood and own social housing and early problem behaviour trajectories.

PURPOSE: To explore the roles of proportion of social rented housing in the neighbourhood ('neighbourhood social housing'), own housing being socially rented, and their interaction in early trajectories of emotional, conduct and hyperactivity symptoms. We tested three pathways of effects: family stress and maternal psychological distress, low quality parenting practices, and peer problems. METHODS: We used data from 9,850 Millennium Cohort Study families who lived in England when the cohort children were aged 3. Children's emotional, conduct and hyperactivity problems were measured at ages 3, 5 and 7. RESULTS: Even after accounting for own social housing, neighbourhood social housing was related to all problems and their trajectories. Its association with conduct problems and hyperactivity was explained by selection. Selection also explained the effect of the interaction between neighbourhood and own social housing on hyperactivity, but not why children of social renter families living in neighbourhoods with lower concentrations of social housing followed a rising trajectory of emotional problems. The effects of own social housing, neighbourhood social housing and their interaction on emotional problems were robust. Peer problems explained the association of own social housing with hyperactivity. CONCLUSIONS: Neither selection nor the pathways we tested explained the association of own social housing with conduct problems, the association of neighbourhood social housing with their growth, or the association of neighbourhood social housing, own social housing and their interaction with emotional problems. Children of social renter families in neighbourhoods with a low concentration of social renters are particularly vulnerable to emotional problems.

Emotional and behavioural resilience to multiple risk exposure in early life: the role of parenting.

Ecological and transactional theories link child outcomes to neighbourhood disadvantage, family poverty and adverse life events. Traditionally, these three types of risk factors have been examined independently of one another or combined into one cumulative risk index. The first approach results in poor prediction of child outcomes, and the second is not well rooted in ecological theory as it does not consider that distal risk factors (such as poverty) may indirectly impact children through proximal risk factors (such as adverse life events). In this study, we modelled simultaneously the longitudinal effects of these three risk factors on children's internalising and externalising problems, exploring the role of parenting in moderating these effects. Our sample followed 16,916 children (at ages 3, 5 and 7 years; N = 16,916; 49% girls) from the UK Millennium Cohort Study. Parenting was characterised by quality of parent-child relationship, parental involvement in learning and parental discipline. Neighbourhood disadvantage, family poverty and adverse events were all simultaneously related to the trajectories of both outcomes. As expected, parenting moderated risk effects. Positive parent-child relationship, rather than greater involvement or authoritative discipline, most consistently 'buffered' risk effects. These findings suggest that a good parent-child relationship may promote young children's emotional and behavioural resilience to different types of environmental risk.

Harsh Parenting and Trajectories of Emotional and Behavioural Difficulties in Autistic Children.

Autistic children show higher rates of co-occurring emotional and behavioural difficulties compared to other children in the general population. However, the environmental factors which contribute to the development of emotional (internalising) and behavioural (externalising) difficulties in autistic individuals are poorly understood. This study sought to investigate the association between harsh parenting (smacking, shouting, telling off) and the trajectories of emotional and behavioural difficulties in autistic children from ages 3 to 7. A sample comprising of 349 autistic children participated from the UK's Millennium Cohort Study. Associations between harsh parenting and child emotional and behavioural difficulties were modelled using multilevel growth curve models. In autistic children, harsh parenting was associated with total emotional and behavioural difficulties and behavioural (but not emotional) problems concurrently. Moreover, harsh parenting was not associated with changes in emotional and behavioural difficulties over time. Harsh parenting may have an important role in externalising problems in young autistic children indicating the need for public health strategies which educate parents on its effects.

Maternal mental-health treatment moderates the association between psychological distress and harsh parenting: A prospective cohort study.

OBJECTIVE: Parental psychological distress (depression, anxiety) is detrimental to child mental health. A key reason for this is that depressed and anxious parents are at risk of engaging in more negative, reactive and harsh parenting. While treatment for psychological distress has a long history of success in adults, less is known about how treatment for parental psychological distress may positively influence parenting behaviours, particularly in the general population. We examined the moderating role of mothers receiving treatment for depression or anxiety on the longitudinal relationship between maternal psychological distress and the development of harsh parenting (smacking and shouting) across early childhood (ages 3 to 7). METHOD: Using prospective data from 16,131 families participating in the UK's Millennium Cohort Study, we conducted moderator analysis within a multilevel repeated measures model to test whether receiving treatment for mental health problems could protect mothers with high psychological distress from engaging in harsh parenting. RESULTS: In each wave, about 7% of mothers reported undergoing treatment for depression or anxiety at that time. Maternal psychological distress was associated with increased use of harsh parenting and that, adjusting for psychological distress, receiving psychological treatment was related to decreased use of harsh parenting. Importantly, receiving psychological treatment buffered the negative effect of psychological distress on harsh parenting. CONCLUSION: In early-to-middle childhood, mental health treatment may help mothers with depression or anxiety to be less harsh toward their children, thereby benefiting their child's psychological adjustment.

Maternal psychological distress and children's adjustment problems: Mediation by household chaos.

Research over many decades has considered the crucial role of maternal psychological distress (e.g., depression, anxiety) for children's psychological adjustment (externalizing and internalizing problems), suggesting bidirectional influences over time. However, little is known about the extent to which household chaos (e.g., noise, disorganization, lack of calm) may mediate this mutual association, despite an understanding that chaos is a powerful stressor in the home. Conducting secondary data analysis in a large scale, prospective longitudinal study of families with children-the U.K.'s Millennium Cohort Study-we accounted for stability in both maternal psychological distress and children's internalizing and externalizing problems and examined the extent to which household chaos mediated the mutual association between maternal psychological distress and children's behaviors. Using what we term a mutual-mediation model, we found that both maternal psychological distress and children's adjustment problems predicted household chaos at Age 5, and in turn, that chaos predicted maternal psychological distress and child adjustment problems at Age 7. We found a dominance of children's externalizing problems in the prediction of household chaos, and all pathways were strongest for maternal psychological distress and externalizing problems compared to child internalizing problems. Our findings suggest that research would be well-minded to consider both child and parent effects on household chaos, as well as its mediation potential. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effects of cumulative stressful educational events on the mental health of doctoral students during the Covid-19 pandemic.

High rates of psychological distress including anxiety and depression are common in the doctoral community and the learning environment has a role to play. With the coronavirus disease (Covid-19) pandemic taking a toll on mental health it is necessary to explore the risk and protective factors for this population. Using data from the Covid-19: Global Study of Social Trust and Mental Health, the present study examined the relationship between Covid-19-related stressful educational experiences and doctoral students' mental health problems. Moreover, it assessed the role of attentional ability and coping skills in promoting good mental health. One hundred and fifty-five doctoral students completed an online survey where micro-, meso- and macro-level educational stressors were measured. The Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire were used to measure depression and anxiety symptoms, respectively. We also measured coping skills using a 13-item scale and attentional ability using a questionnaire. The results of multiple linear regression analyses showed that specific stressful educational experiences were unrelated but cumulative stressful educational experiences were related to increased depression symptoms (but not anxiety symptoms) in fully adjusted models. Additionally, higher coping skills and attentional ability were related to fewer depression and anxiety symptoms. Finally, no associations between demographics and other covariates and mental health problems were found. The experience of multiple educational stressful events in their learning environment due to Covid-19 is a key risk factor for increased mental illness in the doctoral community. This could be explained by the uncertainty that the Covid-19 pandemic has caused to the students.

The role of inflammation in the association between poverty and working memory in childhood.

BACKGROUND: Family financial difficulties have been directly linked to poorer executive functioning in childhood. However, recent studies suggest that difficulties in affording basic items and other necessities may also indirectly affect children's executive functions through several psychological but also physiological paths. One of the latter may be inflammation, which has been related to both financial difficulties and executive functioning. In this study, we explored for the first time if the relationship between early family financial difficulties and working memory in middle childhood can be explained by inflammation. METHODS: Using data from 4,525 children of the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we tested associations between parents' perceptions at ages 0-3 years of having difficulties in affording basic items for their children including food and clothing, children's inflammation [measured by interleukin 6 (IL-6) and C-reactive protein (CRP)] at age 9 years and working memory performance at age 10 years. Confounders included socioeconomic status at ages 0-3 years, economic hardship between ages 3-9 years, BMI and gender. RESULTS: Using Structural Equation Modelling, we found that financial difficulties were associated with worse working memory (ß=-0.076, 95 % CI=-0.105, -0.043) even after adjusting for confounders. This association was partially explained by inflammation (ß=-0.002, 95 % CI=-0.005, -0.001) as measured by IL-6. CONCLUSIONS: Children in families struggling to afford necessities early in life have higher levels of inflammation, in turn related to poorer executive functioning in middle childhood. These findings suggest that living under financial strain has a unique effect on children's cognitive development through inflammation in the general population.