Search Results (192)

Background: Exposure to intimate partner violence (IPV) represents a major risk factor for both maternal psychological well-being and child development. Maternal psychopathology—particularly depression and post-traumatic stress disorder (PTSD)—has been shown to impair parenting functioning and increase children’s vulnerability to emotional and behavioral difficulties. Objectives: This study examined the associations between maternal depression and PTSD symptoms and children’s internalizing and externalizing problems, and explored whether parenting stress and maternal mentalization capacities mediate these relationships. Methods: The sample included 42 mothers (mean age = 43.38, SD = 10.56) and their preschool- and school-aged children (n = 42; mean age = 8.30, SD = 2.53) exposed to IPV. Mothers completed self-report measures assessing depressive and PTSD symptoms, parenting stress, and mentalization (uncertainty and certainty about mental states). Children’s internalizing and externalizing problems were assessed through maternal report. Mediation analyses with bootstrapping procedures were conducted to examine indirect effects. Results: Maternal depressive symptoms emerged as the strongest predictor of children’s internalizing problems. Parenting stress was associated with stronger relationships between maternal symptoms and children’s internalizing problems, while polarized mentalization—particularly uncertainty and, to a lesser extent, excessive certainty about mental states—partially mediated the relationship. Maternal PTSD symptoms predicted both internalizing and externalizing problems. Parenting stress fully mediated the association between PTSD symptoms and children’s externalizing behaviors, whereas excessive certainty and uncertainty about mental states showed partial mediation effects. Conclusions: These findings suggest that maternal psychopathology may influence child adjustment both directly and indirectly through increased parenting stress and dysregulated mentalization. The results highlight the importance of trauma-informed, dyadic interventions targeting maternal mental health, parenting stress, and reflective functioning to prevent the intergenerational transmission of trauma and support resilience in families exposed to IPV. Full article

Background/Objectives: Maternal postpartum depressive symptoms and the COVID-19 pandemic have both been identified as potential risk factors for socioemotional difficulties in children. This study aimed to assess behavioral outcomes in young children born to mothers previously screened for postpartum depressive symptoms, comparing cohorts evaluated during and after the pandemic using the Child Behavior Checklist (CBCL 1½–5). Methods: An observational follow-up cohort study was conducted on 52 mother–child dyads derived from a previously established maternal cohort screened with the Edinburgh Postnatal Depression Scale (EPDS). Two cohorts were defined according to the child’s birth period: during-pandemic (January–April 2022) and post-pandemic (October–November 2023) groups. Behavioral outcomes were assessed using CBCL 1½–5. Group differences were tested using parametric or non-parametric methods for continuous variables and χ2 or Fisher’s exact tests for categorical variables. Exploratory regression models and sensitivity analyses were also performed. Results: Children assessed in the post-pandemic cohort showed a lower prevalence of non-normal internalizing scores than those assessed in the during-pandemic cohort, whereas externalizing outcomes and Total Problems did not significantly differ between groups. In exploratory models, a child’s age showed a near-significant association with internalizing outcomes, suggesting that developmental stage at assessment may have contributed to the observed cohort difference. Maternal SARS-CoV-2 infection at delivery was not associated with children’s behavioral outcomes. Conclusions: These findings suggest a possible difference in internalizing behavioral profiles between children assessed in during-pandemic and post-pandemic cohorts. However, this pattern should be interpreted cautiously because the cohorts differed substantially in age at follow-up, and age-related factors may have affected symptom detectability. Continued longitudinal follow-up will be important to clarify whether the observed differences persist over time. Full article

(1) Background: Few studies have examined gestational paraben exposure and early childhood neurodevelopment. We evaluated associations between gestational exposure to methyl, ethyl and propyl paraben and neurodevelopment via the Child Behavior Checklist (CBCL) administered at ages 2, 3, and 4 years. (2) Methods: Gestational exposures were assessed using pooled prenatal urine samples from five time points across pregnancy. CBCL outcomes included internalizing, externalizing, and sub-scale scores. Covariate-adjusted generalized linear regression was employed to assess individual paraben exposures. Mixture analysis was performed using Bayesian Kernel Machine Regression and Quantile g-computation. (3) Results: In individual paraben analyses, each paraben was associated with increased externalizing behaviors, particularly ethylparaben (age 2: β = 0.40, 95% CI = −0.02, 0.83; age 3: β = 0.42, 95% CI = −0.19, 0.01; age 4: β = 0.18, 95% CI = −0.34, 0.70), ADHD problems at age 2 (β = 0.21, 95% CI = 0.05, 0.37), and both aggressive behavior (β = 0.38, 95% CI = 0.01, 0.74) and oppositional defiant problems (β = 0.25, 95% CI = 0.09, 0.41) at age 3. All three parabens were also associated with a reduction in withdrawn symptoms for males, especially at age 2 (ethylparaben: β = −0.09, 95% CI = −0.01, 0.85; methylparaben: β = −0.20, 95% CI = −0.34, −0.05; propylparaben: β = −0.13, 95% CI = −0.24, −0.03). The parabens mixture was associated with elevated scores in multiple CBCL subscales, though only association with oppositional defiant scores at age 3 reached significance in both BKMR (change in score when all components are at 50th percentile values compared with their 75th percentile values = 0.15; 95% CI = 0.01, 0.29) and quantile g-computation (β = 0.33, 95% CI = 0.02, 0.65), driven primarily by ethylparaben. (4) Conclusions: Individual parabens and the paraben mixture showed significant association with domains of childhood neurodevelopment, with possible detriments especially evident (a) at earlier time points, (b) in male children, and (c) in terms of externalizing behaviors. Full article

Objective: The current study tested (1) how ADHD symptoms and internalizing or externalizing problems covaried across ages 3–18 in children with neurofibromatosis type 1 (NF1), and (2) whether demographic and NF1-specific factors moderated the associations. Method: We analyzed integrated cross-sectional data of 685 observations from 455 children and adolescents with NF1 (M_age = 9.79 years, SD = 3.88; 43% female) across six institutions in the United States and Australia. ADHD symptoms (inattention and hyperactivity/impulsivity) and internalizing/externalizing problems were assessed via parent-report measures. Time-varying effect modeling was employed to examine the age-specific associations between ADHD symptoms and internalizing/externalizing problems. Moderation analyses tested effects of sex, parental education, and NF1 inheritance mode (familial vs. sporadic). Results: Inattention and hyperactivity/impulsivity symptoms were associated with greater internalizing and externalizing problems across ages 3–17. Inattention links were similar across ages, while the hyperactivity/impulsivity-externalizing link was stronger in early childhood than during adolescence. NF1 inheritance mode significantly moderated the inattention-externalizing link, with stronger associations observed among children with familial NF1. Other moderators were nonsignificant. Conclusions: ADHD symptoms are robustly linked to internalizing and externalizing problems from childhood to middle adolescence in children with NF1, with familial NF1 emerging as a potentially elevated risk factor. Future longitudinal and experimental research is needed to inform integrated intervention approaches, especially for those with familial NF1. Full article

Background: Parenting is increasingly recognized as a highly demanding and stressful role that, in the absence of sufficient resources, may lead to parental burnout (PB). This risk may be particularly pronounced in the Russian context, where limited access to childcare for children under three and reduced extended family support coincide with strong social expectations of intensive parenting. Although PB and maternal depression frequently co-occur, it remains unclear whether PB exerts a unique influence on child development, especially during toddlerhood. The present study examined the association between PB and behavioral problems in children aged 1.5 to 4 years while controlling for maternal depression assessed both during the first year postpartum and concurrently with PB. Methods: Using a longitudinal design, maternal mental health was assessed within the first 12 months postpartum (Stage 1) and again at follow-up (Stage 2), on average 2.24 years later, in 419 Russian mother–child dyads. Mothers completed measures of postpartum depression (PPD) (Edinburgh Postnatal Depression Scale), current depressive symptoms (Beck Depression Inventory-II), and PB (Parental Burnout Inventory). Child emotional and behavioral problems were assessed at Stage 2 using the Russian version of the Child Behavior Checklist (CBCL/1½–5). Results: Mothers of children with borderline/clinically significant internalizing, externalizing, and total problems had significantly higher PB, PPD, and present maternal depressive symptoms, although the effect sizes were small. PB was strongly associated with all domains of child behavioral problems, also after correction for both postpartum and present depressive symptoms, as well as for other important covariates. Higher maternal PB symptoms further increased the odds of children having borderline/clinically significant internalizing and externalizing problems, although those effects were not independent of maternal depression. In turn, neither postpartum nor present maternal depressive symptoms were associated with any of the child behavioral problems domains. Conclusions: PB represents a distinct and clinically relevant risk factor for emotional and behavioral problems in toddlers, beyond the effects of maternal postpartum or present depression, in a context characterized by high caregiving demands and limited institutional support. These findings highlight an urgent need for programs aimed at identifying and supporting families in which parents experience high levels of exhaustion, regardless of whether they meet the criteria for other diagnosable mental health disorders. Addressing PB during toddlerhood may be critical for protecting both parental well-being and early child development. Full article

Active music and movement engagement has been widely integrated in human socialization across history and cultures, and is particularly prevalent in early childhood play and learning. For clinical populations, music therapy is known to support social skills and wellbeing for young children. However, there is less evidence for the value of active music engagement for non-clinical populations in terms of supporting social and behavioral wellbeing in the early years. This study reports results from the Rhythm and Movement for Self-Regulation (RAMSR) program delivered by generalist kindergarten teachers in low socioeconomic communities. This randomized control trial involved 213 children across eight preschools in disadvantaged communities in Queensland, Australia. The intervention group received 16 to 20 sessions of RAMSR over eight weeks, while the control group undertook usual preschool programs. Data was collected through teacher report at pre and post intervention, and again six months later once children had transitioned into their first year of school. Robust mixed models accounting for repeated measures and clustering of children within kindergartens (random effects), evidenced significant intervention effects across the three time points for improved prosocial skills (p = 0.04, n_p² = 0.02), and reduced externalizing (p < 0.01, n_p² = 0.03) and internalizing behavior problems (p = 0.04; n_p² = 0.02), with small to moderate effect sizes. These findings highlight the valuable role that intentional active music engagement in universal settings such as preschool can play in terms of social and behavioral wellbeing. The importance of these results lies in the fact that children from lower socioeconomic backgrounds are more likely to experience risks to social and behavioral development, requiring additional supports, yet experience inequities in access to high-quality music and movement programs. Full article

The location of mental health services in schools increases access for children and youth. This may be especially important in rural communities, where youth have more significant mental health needs and less access to services. Yet, few studies exist that explore the outcomes of student participation in school-based services. The present study evaluates student behavioral health needs and outcomes, as measured by the strengths and difficulties questionnaire (SDQ), of students (N = 43) participating in therapeutic mental health services (Tier 3) provided in three rural Midwest communities in the United States. At baseline, SDQ scores indicated that over half of students’ total difficulties scores fell in the Borderline or Abnormal categories, and over 40% of students demonstrated high needs related to emotional problems and hyperactivity. At the conclusion of services, students experienced statistically significant improvements in mean scores (compared to baseline) in total difficulties, externalizing problems, and internalizing problems, and on subscales measuring emotional problems, conduct problems, and hyperactivity. Significant differences were not found in the subscales measuring peer problems and prosocial behavior. High levels of satisfaction with services were also reported. Limitations and conclusions are discussed. Full article

Background: Overweight and obesity in childhood and adolescence represent one of the most significant public health challenges of our century. Affected children and adolescents often face psychosocial maladaptation, including low self-esteem, depressive and anxiety symptoms, and behavioral problems, many of which may persist till later in life. The aim of our study was to evaluate the impact of a multidisciplinary, personalized lifestyle intervention program on psychosocial and behavioral symptoms, assessed through standardized psychometric questionnaires, and to investigate their relation with cardiometabolic parameters in children and adolescents with overweight and obesity. Methods: In this prospective cohort study, 537 children and adolescents (6–18 years; females: 52.9%; pubertal: 43.6%) with obesity (n = 44.3%), overweight (n = 33.7%), or normal BMI (n = 22%) participated in a personalized lifestyle intervention program for one year. Clinical and laboratory evaluations, including anthropometric, cardiometabolic, and endocrinologic parameters, as well as psychosocial functioning assessed by the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR), were performed at the beginning and the end of the study. Linear regression analyses identified predictors of psychometric change. Results: At initial evaluation, children and adolescents with obesity displayed a less favorable cardiometabolic profile and greater emotional/conduct difficulties compared to their overweight and normal-BMI counterparts. Following the intervention, significant improvements were observed in BMI, anthropometric and cardiometabolic parameters, as well as reductions in internalizing, externalizing, and total problem scores across multiple CBCL and YSR domains (p < 0.05). The improvements in psychosocial functioning were partly independent of BMI reduction. Linear regression analyses identified cardiometabolic and endocrine markers as significant predictors of psychometric change (p < 0.05), highlighting interactions between metabolic recovery, pubertal hormones, and stress physiology. Conclusions: A personalized, multidisciplinary lifestyle intervention program implemented for 1 year led to parallel improvements in psychosocial and cardiometabolic health in children and adolescents with overweight and obesity. Identification of specific metabolic and endocrine predictors provides novel insights into potential biological mechanisms associated with adiposity, emotional well-being, and neurodevelopment. Full article

Background/Objectives: Behavioral inhibition (BI) has been extensively studied as an early-appearing risk factor for adverse developmental outcomes. One pathway through which BI may confer risk is via reduced competence to interact effectively with peers. Research demonstrating concurrent relations between BI and social competence supports this pathway, yet not all inhibited children experience social difficulties. This study adopted a person-centered approach to examine heterogeneity of temperament traits within a highly inhibited preschool sample and to identify how broader temperament traits contribute to variability in social functioning. Methods: Parents of preschoolers (N = 254) who met criteria for BI (≥85th percentile on the Behavioral Inhibition Questionnaire) completed measures of their child’s temperament (Children’s Behavior Questionnaire) and social competence (Social Skills Improvement System). Latent Profile Analysis was conducted using six temperament traits reflecting regulation and reactivity (anger, attentional focusing, inhibitory control, high-intensity pleasure, perceptual sensitivity, and approach). Profile differences in social competence were examined using multivariate analyses controlling for age and gender. Results: A three-profile solution emerged: Regulated, Unregulated and Angry, and Typical BI. Profile membership accounted for almost 37% of the variance in social skills scores. The Regulated group, marked by high attentional and inhibitory control and low anger, demonstrated the strongest social skills and lowest internalizing and externalizing problems. The Unregulated and Angry group, characterized by high anger and poor regulation, exhibited the greatest social difficulties. BI level itself did not significantly differentiate profiles or predict social competence. Conclusions: Findings underscore that BI is not a uniform risk factor but joins with other temperamental traits to shape social outcomes. Level of BI did not differentiate profiles or relate to social functioning, highlighting the importance of considering co-occurring regulatory and reactive traits to explain variability in outcomes among inhibited children. Identifying specific temperamental constellations may enhance early identification and inform targeted interventions for socially at-risk inhibited children. Full article

Background: Mental health problems are increasingly common among children and adolescents, making schools a key setting for health promotion. Nurses can play a central role in prevention and support, but in Chile, the role of the school nurse has not yet been formally established. Understanding nursing students’ experiences in school-based mental health promotion can inform curriculum development and strengthen professional identity. Methods: A qualitative study with a phenomenological approach was conducted with third-year nursing students enrolled in a mental health course (N = 64). Data was collected through six individual interviews and one focus group, transcribed verbatim and analyzed using ATLAS.ti 25.0.1^®. To ensure rigor, the study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ), and trustworthiness was ensured following Lincoln and Guba’s criteria. Results: Five main categories emerged: nursing’s role in mental health promotion; perceptions of health promotion as prevention; use of the educational process, with difficulties in formulating objectives; perceived self-efficacy, marked by initial uncertainty in working with children; and experiences in implementing projects, including reflections on the professional role, mixed feelings, facilitators, barriers, and coping strategies. Facilitators included faculty support, teacher collaboration, and group cohesion, while barriers were related to limited experience, challenges in managing children, and external conditions such as noise and unsuitable classroom conditions. Conclusions: School-based practicums in mental health promotion are valuable opportunities to integrate theory and practice, strengthen professional identity, and develop communication. Strengthening undergraduate curricula with systematic training in these areas is essential for preparing nurses for their role in school and community health. Integrating these experiences into clinical and assistive practice can enhance early detection, interprofessional collaboration, and the promotion of healthier school environments. Full article

Objective: This scoping review aims to map the scientific literature of the last five years to characterize behavioral patterns in children with snoring and sleep-disordered breathing (SDB), ranging from primary snoring (PS) to obstructive sleep apnea syndrome (OSAS). The review seeks to identify the main diagnostic and assessment methods, differentiate the behavioral findings between PS and OSAS where possible, and pinpoint key research gaps. Methods: A systematic scoping review was conducted following the PRISMA-ScR guidelines. The PubMed/MEDLINE, LILACS, and SciELO databases were searched in April 2024 for observational studies published between 2019 and 2024 that addressed the coexistence of snoring and behavioral changes in the pediatric population. Only articles in English, Spanish, or Portuguese were analyzed. Data were charted and analyzed thematically to map the scope of the evidence. Results: The initial search yielded 129 articles, with 22 ultimately included in the final analysis. The findings reveal profound methodological heterogeneity. While questionnaires are universally applied (n = 22), polysomnography (n = 21) remains the gold standard for SDB diagnosis. Behavioral assessments were inconsistent, identifying a broad spectrum of externalizing (e.g., hyperactivity, aggression) and internalizing (e.g., anxiety, depression) problems, with no clear predominant pattern. Obesity and Down’s syndrome were the most frequently associated comorbidities. Conclusions: The literature reaffirms the strong correlation between SDB and adverse neurobehavioral outcomes in children. This association is present in primary snoring but is most pronounced in children with diagnosed OSAS. However, progress is constrained by a lack of standardization and, critically, a frequent failure to differentiate between PS and OSAS, which hinders clinical interpretation and evidence synthesis. Full article

Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) in children is a developmental disorder that has been rapidly increasing worldwide. Its core symptoms, which include inattention, impulsivity, and hyperactivity, are often accompanied by emotional and behavioral problems such as depression and aggression. These factors can significantly impair a child’s development and functioning, making effective therapeutic intervention essential. This non-randomized controlled trial with parallel-group design examined the intervention effects of a 10-week school group sandplay therapy (SGST) program on internalizing and externalizing problems in children at risk for ADHD. Methods: This non-randomized controlled trial involved 101 fifth- and sixth-grade students (ages 11–12) from an elementary school in a mixed urban–rural area. Participants were divided into a control group (n = 47) and an intervention group (n = 54). The intervention group participated in a 10-session SGST program held once a week, while the control group received no intervention. The Korean Youth Self-Report (K-YSR) was used to evaluate the effects of the intervention, and a Repeated Measures ANOVA (RM-ANOVA) was conducted to analyze the program’s effectiveness. Results: The results revealed significant interaction effects between group and time in the SGST intervention group for several K-YSR subscales. The intervention group showed statistically significant differences in the areas of anxiety/depression (p < 0.04; η² = 0.043), somatic symptoms (p < 0.04; η² = 0.040), social immaturity (p < 0.01; η² = 0.061), and rule-breaking behavior (p < 0.04; η² = 0.044). Conclusions: SGST was found to be associated with improving not only internalizing problems like anxiety/depression, somatic symptoms in children at risk for ADHD but also externalizing problem like rule-breaking behavior and social problem like social immaturity. These findings demonstrate that school sand play therapy can be used as a non-pharmaceutical intervention for school-age children at risk of ADHD, and suggest that it can also be useful in an educational context. Full article

Early childhood education is a demanding profession. Understanding how early childhood (EC) professionals’ draw on internal assets and external resources to sustain well-being is critical, as their well-being is linked to the quality of the care and education they provide. This phenomenological study examined professionals’ strengths and assets, how they used them to manage workplace demands to sustain well-being, and how they engaged with broader systems to enhance the quality of care and education they provide. Thirteen focus groups were conducted with 98 English-speaking (n = 87 female, 3 male, 8 missing gender) and 23 Spanish-speaking (n = 22 female, 1 missing gender) EC professionals. Analysis identified three interdependent themes: (1) holistic well-being; (2) centrality of relationships; and (3) interactions with systems. Participants reported well-being ranging from struggling to sustaining. Relationships with children, families, and co-workers were a source of motivation, commitment, and satisfaction with their work. Participants emphasized the importance of caring for their own well-being to effectively care for others. Systems both supported and hindered well-being. Participants used support-seeking, problem-focused, proactive, and restorative strategies to cope with stressors. Findings underscore the relational and systemic dimensions of EC professionals’ well-being and the strategies they employ to sustain it. Full article

Background: The general psychopathology factor (p factor) is central to understanding the shared variance across mental disorders, offering a dimensional alternative to traditional diagnostic models. The early identification of this factor in childhood is key for improving prevention and intervention strategies. This study evaluated the Strengths and Difficulties Questionnaire (SDQ) as a brief measure to assess p factor in children. Methods: A community sample of 284 children, ages 6 to 12, was assessed using parent-reported SDQ and the Child Behavior Checklist (CBCL). Confirmatory Factor Analyses compared two models of psychopathology: a higher-order model and a first-order bifactor model. Results: Results showed that the bifactor model provided a better fit for both instruments, with the SDQ showing particularly strong fit indices. Moreover, SDQ-derived p factor scores were strongly correlated with key CBCL scales, particularly attention and externalizing problems, supporting its concurrent validity. Conclusions: These findings suggest that the SDQ, due to its brevity and psychometric robustness, is a valid alternative to the CBCL for assessing general psychopathology in children. Full article

Caregiver self-regulation may be a critical component of caregivers’ effective delivery of caregiver-mediated interventions (CMIs). CMIs are a highly evidence-based group of interventions that target a broad range of challenges, including social communication, emotion regulation, and externalizing behaviors, for autistic and neurotypical children. CMIs teach caregivers to be “coaches” to help their children learn and practice skills in daily life. However, being a good “coach” likely requires caregivers to optimally self-regulate their emotions, thoughts, and behaviors when working with their children in moments that are often emotionally heightened. Caregiver self-regulation is a set of skills that promote parenting autonomy and confidence: self-sufficiency, self-efficacy, self-management, personal agency, and problem solving. This conceptual paper will briefly discuss the literature on the role of caregiver self-regulation in CMIs and argue that future implementation research on CMIs should measure caregiver self-regulation because, in line with recent expansion of the theory of planned behavior, caregiver self-regulation may predict more effective implementation of CMIs. We also argue, in line with CFIR 2.0, that supporting caregiver self-regulation could ultimately improve the implementation of CMIs with regard to each implementation outcome in the Implementation Outcomes Framework. For example, enhancing caregiver self-regulation may improve CMI appropriateness (by increasing alignment with each caregiver’s values and culture), adoption (by increasing engagement to finish the full CMI protocol), and even CMI sustainability (by increasing caregivers’ ability to problem-solve and generalize to new child challenges independently, freeing up provider time to work with new caregivers and allowing the agency to provide the CMI for a reduced relative cost). Should future research demonstrate that caregiver self-regulation is an implementation determinant, future implementation strategies may need to include support for caregiver self-regulation, because it may explain or enhance the implementation of CMIs across early intervention and community mental health systems. Full article