Teacher-reported emotional and behavioural problems and ethnic background associated with children’s psychosocial care use: a longitudinal population-based study

Approximately, 15% of children in Western countries suffer from emotional and behavioural problems. However, not all children receive the psychosocial care they need, especially children with a non-Western background experience an unmet need for care. This might be because parents of non-Western children report a lower need for care than parents of Western children, unrelated to the actual need. This study examined the association between teacher-reported problems and psychosocial care use, independent of mother-reported problems. Further, the role of ethnic background in this association was investigated. The study sample of 9-year-old children was retrieved from the Generation R Study (N = 3084), a prospective, population-based cohort of children born in Rotterdam, the Netherlands. Teacher- and mother-reported problems were measured via questionnaire when the children were 6/7 years old. Psychosocial care use was mother-reported at the research centre when children were 9 years old (8.1%). Hierarchical logistic regressions showed significant positive associations between teacher-reported total, externalising and internalising problems and later psychosocial care use. These associations were independent of mother-reported problems. Children with a non-Western background used less care, but ethnic background did not moderate the association between teacher-reported problems and care use. Our findings suggest that teachers might have an important role, next to parents, in the identification of problems and children’s access to care. This may be particularly important for non-Western children, as they use less psychosocial care than Western children, despite other research showing that they generally display higher levels of problems. Directions for future research and implications are discussed.

Childhood trajectories of internalising and externalising problems associated with a polygenic risk score for neuroticism in a UK birth cohort study

Neuroticism represents a personality disposition towards experiencing negative emotions more frequently and intensely. Longitudinal studies suggest that neuroticism increases risk of several psychological and physical problems. Improved understanding of how this trait manifests in early life could help inform preventative strategies in those liable to neuroticism. This study explored how a polygenic risk score (PRS) for neuroticism is expressed from infancy to late childhood across various psychological outcomes and how it associates with trajectories of internalising and externalising problems from ages 4-11 in the Avon Longitudinal Study of Parents and Children (N=5,279). We employed multivariable linear and ordinal regression models to estimate associations between a child neuroticism PRS and psychological outcomes. A three-level mixed-effect model was employed to characterise child internalising and externalising trajectories and estimate how a child PRS associated with both their overall levels and rates of change. We found evidence that the PRS for neuroticism was associated with a more sensitive temperament in early infancy in addition to higher emotional and behavioural problems and a higher risk of being diagnosed with a variety of clinical disorders, particularly anxiety disorders, in childhood. We also found strong evidence that the PRS for neuroticism was associated with overall levels of internalising and externalising trajectories, with a larger magnitude of effect on the internalising trajectory. The PRS was also associated with slower rates of reduction of internalising problems. Our findings using a large, well-characterised birth cohort study suggest that phenotypic manifestations of a PRS for adult neuroticism can be detected as early as in infancy and that this PRS associates with several mental health problems and differences in emotional trajectories across childhood.

Eating disorders symptoms and excessive internet use in adolescents: the role of internalising and externalising problems

Background Both eating disorders and excessive internet use represent significant health issues for contemporary adolescents. Yet, the link between them has seldom been investigated. We aim to study this association through their common underlying psychological factors: internalising problems and externalising problems. Methods A representative sample of 7,083 adolescents (Mage = 13.48 years; SDage = 1.32; 50.3% girls) from Slovakia was obtained from the Health Behaviour in School-aged Children (HBSC) project in 2018. Study variables included the Excessive Internet Use Scale (EIU) and the Strength and Difficulties Questionnaire (SDQ). Eating disorders symptoms (EDS) were assessed by SCOFF and selected items from the Eating Disorder Screen for Primary Care (ESP). Data were analysed separately for boys and girls with Structural Equation Modelling. Results There was a partial correlation between EDS and EIU (r = 0.36 for boys and r = 0.29 for girls) after controlling for the internalising and externalising of problems. Internalising and externalising problems were positively associated with EDS, while EIU was only associated with externalising problems. The results were comparable for both genders. Conclusion The study provides evidence that, during adolescence, EDS and EIU are related and have a tendency to occur together. Also, they are related even when controlled for their shared underlying psychological factors, namely the emotional and attentional/behavioural difficulties.

Interpersonal Cognitive Biases in Children and Young People with Neurodevelopmental Disorders: A Systematic Review

Purpose of Review Interpersonal cognitive biases have been linked to externalising and internalising problems. This systematic review investigates their role in children and young people with neurodevelopmental disorders (NDD), who have a high risk of experiencing such problems. Recent Findings With 16 identified studies, this is a widely under-recognised research area. The three studies conducted within the last 5 years focused on threat interpretation and its association with anxiety. No difference between children and young people with and without NDD was found in the eleven studies investigating hostile attribution of intent, of which the most recent is nearly a decade old. No studies addressed attention or memory bias towards ambiguous interpersonal information. Summary The scarcity and heterogeneity of research highlighted in this paper demonstrate the urgency to use standardised and accessible research methods to develop a strong evidence base regarding the potential content-specific interpretation bias in individuals with NDD.

Evaluating the effectiveness of a universal eHealth school-based prevention program for depression and anxiety, and the moderating role of friendship network characteristics

Background. Lifetime trajectories of mental ill health are often established during adolescence. Effective interventions to prevent the emergence of mental health problems are needed. In the current study we assessed the efficacy of the CBT informed Climate Schools universal eHealth preventive mental health program, relative to a control. We also explored whether the intervention had differential effects on students with varying degrees of social connectedness. Method. We evaluated the efficacy of the Climate Schools mental health program (19 participating schools; average age at baseline was 13.6) versus an active control group (18 participating schools; average age at baseline was 13.5) which formed part of a large cluster randomised controlled trial in Australian schools. Measures of internalising problems, depression and anxiety were collected at baseline, immediately following the intervention and at 6-, 12- and 18-months post intervention. Immediately following the intervention, 2539 students provided data on at least one outcome of interest (2065 students at 18 months post intervention). Results. We found no evidence that the stand-alone mental health intervention improved outcomes, on any measure, relative to a control. Across all participants we observed small, but significant, increases in internalising problems, depression, and anxiety at 18 months post intervention, relative to baseline. Student’s social connectedness did not influence intervention outcomes. Conclusion. These results are consistent with recent findings that universal school-based, CBT informed, preventive interventions for mental health have limited efficacy when delivered alone. We highlight the potential for combined intervention approaches, and more targeted interventions, to better improve outcomes.

Family Dynamics and Children's Outcomes: the Role of Silent Interparental Conflict

<p><b>Conflict between parents has been widely studied and its detrimental consequences for children have been documented across domains of psychological functioning, academic performance and social adjustment. Research has focused on the verbal and physical expressions of interparental conflict, however, when tested for, strong indications have been emerging that its non-verbal non-physical forms have similarly serious implications for the young people‟s wellbeing as the overt ones. The scarceness of findings related to covert forms of interparental conflict provided impetus for qualitative research with parents and adolescents (Kielpikowski & Pryor, 2008; Pryor & Pattison, 2007). The research has resulted in proposing a construct of silent interparental conflict (SIC) and provided the conceptual foundation for this thesis. Adopting a systemic approach to the functioning of families characterised by interrelatedness and reciprocity of influences among the members, this thesis investigated processes related to silent interparental conflict through a series of empirical studies with New Zealand families.</b></p> <p>The need for developing the Silent Interparental Conflict Scale (SICS) for parents was rationalised following a review of a comprehensive assembly of representative instruments for measuring couples‟ conflict. The items were derived from the qualitative data corpus (Kielpikowski, 2004). A three factor structure was established and supported by confirmatory factor analyses using data from two samples of parents (Ns = 108 and 260). The SICS demonstrated excellent psychometric qualities and stability over time.</p> <p>The modus operandi of SIC was hypothesises and tested from the perspectives of parents and adolescents. Drawing from multidisciplinary scholarship, predictors and psychological outcomes of SIC for parents were hypothesised. Theoretical models were tested concurrently and after a lapse of one year utilising data from 115 parental dyads. The findings suggested divergent processes for mothers and fathers. The hypothesised links between the incidence and the Costs of SIC and psychological maladjustment were supported concurrently. Additionally, uniquely for mothers, their perception of the Benefits of silent conflict resulted in reduced maladjustment over time. SIC for fathers was consistently predicted by own avoidance of conflict both concurrently and over time. For mothers the consistent concurrent and longitudinal predictor of SIC was the perceived hostility from partner. Protectiveness towards children acted as a concurrent predictor of SIC for mothers and fathers, for whom additionally it predicted SIC over time. Tests for reciprocal influences using the Actor Partner Interdependence Model (Kenny, Kashy, & Cook, 2006) indicated a significant Partner effect from fathers‟ own avoidance to mothers‟ perceptions of SIC. Parents differed significantly on Actor effects with path coefficients higher on conflict avoidance for fathers and on partner‟s hostility for mothers.</p> <p>The impact of SIC on the wellbeing of adolescents was hypothesised within the cognitive contextual framework (Grych & Fincham, 1990) and the spillover hypothesis (Erel & Burman, 1995). Adolescents‟ adjustment was conceptualised as consisting of internalising and externalising problems measured with items from the SDQ (Goodman, Melzer, & Bailey, 1998), and of positive expectations of the future measured with a scale designed for the study. Threat, self-blame and parental SIC-related spillover behaviour represented by hostility towards the adolescents were posed as mediators of the effects of SIC on adolescents‟ adjustment. Separate models were tested for boys and girls and for the parent-child gender constellations. Over time the effect of SIC on boys‟ internalising problems was fully mediated by father‟s hostility. In contrast, the longitudinal effect of SIC on girls‟ internalising problems was fully mediated by the appraisal of threat and the effect on their expectations of the future was fully mediated by mother‟s hostility. Analyses of longitudinal familywide models revealed that fathers‟ perceptions of SIC differentially influenced the boys‟ and girls‟ processes.</p> <p>The findings advance our understanding of the functioning of SIC and highlight the relatedness and the uniqueness of associated processes for family members depending on their gender and role within the family system.</p>

Family Dynamics and Children's Outcomes: the Role of Silent Interparental Conflict

<p><b>Conflict between parents has been widely studied and its detrimental consequences for children have been documented across domains of psychological functioning, academic performance and social adjustment. Research has focused on the verbal and physical expressions of interparental conflict, however, when tested for, strong indications have been emerging that its non-verbal non-physical forms have similarly serious implications for the young people‟s wellbeing as the overt ones. The scarceness of findings related to covert forms of interparental conflict provided impetus for qualitative research with parents and adolescents (Kielpikowski & Pryor, 2008; Pryor & Pattison, 2007). The research has resulted in proposing a construct of silent interparental conflict (SIC) and provided the conceptual foundation for this thesis. Adopting a systemic approach to the functioning of families characterised by interrelatedness and reciprocity of influences among the members, this thesis investigated processes related to silent interparental conflict through a series of empirical studies with New Zealand families.</b></p> <p>The need for developing the Silent Interparental Conflict Scale (SICS) for parents was rationalised following a review of a comprehensive assembly of representative instruments for measuring couples‟ conflict. The items were derived from the qualitative data corpus (Kielpikowski, 2004). A three factor structure was established and supported by confirmatory factor analyses using data from two samples of parents (Ns = 108 and 260). The SICS demonstrated excellent psychometric qualities and stability over time.</p> <p>The modus operandi of SIC was hypothesises and tested from the perspectives of parents and adolescents. Drawing from multidisciplinary scholarship, predictors and psychological outcomes of SIC for parents were hypothesised. Theoretical models were tested concurrently and after a lapse of one year utilising data from 115 parental dyads. The findings suggested divergent processes for mothers and fathers. The hypothesised links between the incidence and the Costs of SIC and psychological maladjustment were supported concurrently. Additionally, uniquely for mothers, their perception of the Benefits of silent conflict resulted in reduced maladjustment over time. SIC for fathers was consistently predicted by own avoidance of conflict both concurrently and over time. For mothers the consistent concurrent and longitudinal predictor of SIC was the perceived hostility from partner. Protectiveness towards children acted as a concurrent predictor of SIC for mothers and fathers, for whom additionally it predicted SIC over time. Tests for reciprocal influences using the Actor Partner Interdependence Model (Kenny, Kashy, & Cook, 2006) indicated a significant Partner effect from fathers‟ own avoidance to mothers‟ perceptions of SIC. Parents differed significantly on Actor effects with path coefficients higher on conflict avoidance for fathers and on partner‟s hostility for mothers.</p> <p>The impact of SIC on the wellbeing of adolescents was hypothesised within the cognitive contextual framework (Grych & Fincham, 1990) and the spillover hypothesis (Erel & Burman, 1995). Adolescents‟ adjustment was conceptualised as consisting of internalising and externalising problems measured with items from the SDQ (Goodman, Melzer, & Bailey, 1998), and of positive expectations of the future measured with a scale designed for the study. Threat, self-blame and parental SIC-related spillover behaviour represented by hostility towards the adolescents were posed as mediators of the effects of SIC on adolescents‟ adjustment. Separate models were tested for boys and girls and for the parent-child gender constellations. Over time the effect of SIC on boys‟ internalising problems was fully mediated by father‟s hostility. In contrast, the longitudinal effect of SIC on girls‟ internalising problems was fully mediated by the appraisal of threat and the effect on their expectations of the future was fully mediated by mother‟s hostility. Analyses of longitudinal familywide models revealed that fathers‟ perceptions of SIC differentially influenced the boys‟ and girls‟ processes.</p> <p>The findings advance our understanding of the functioning of SIC and highlight the relatedness and the uniqueness of associated processes for family members depending on their gender and role within the family system.</p>

The role of moment-to-moment dynamics of perceived stress and negative affect in co-occurring ADHD and internalising symptoms

A maladaptive response to stress in individuals with high ADHD traits may be a key factor that explains the co-occurrence between ADHD symptoms and internalising problems. The current study investigates whether between-person differences in ADHD traits are associated with differences in the within-person moment-to-moment coupling of stress and negative affect; and whether these can explain between-person differences in internalising problems (N=262, median age 20). Results of a dynamic structural equation model indicated between-person differences in ADHD traits significantly moderated the coupling between stress and negative affect. Further, higher ADHD traits were associated with stronger stress carry-over and higher mean levels of negative affect. Stress carry-over and mean levels of negative affect mediated the association between ADHD and internalising problems.

Cultural adaptation of a scalable psychological intervention for Burundian refugee adolescents in Tanzania: a qualitative study

Background There is an urgent need for evidence-based, scalable, psychological interventions to improve the mental health of adolescents affected by adversity in low-resource settings. Early Adolescents Skills for Emotions (EASE) was developed by the WHO as a brief, transdiagnostic, group intervention for early adolescents exhibiting internalising problems, delivered by trained and supervised lay providers. This study describes the cultural adaptation of EASE for Burundian adolescents living in Mtendeli refugee camps in Tanzania. Methods A phased approach to adaptation of the EASE intervention and its implementation, was adopted and comprised of: (1) a desk review to synthesize existing research on mental health issues in conflict-affected Burundian communities, (2) a rapid qualitative assessment involving free listing and key informant interviews with multiple stakeholders, (3) cognitive interviews with end users, and (4) a two-part adaptation workshop involving the implementing partner staff, members of the refugee community and mental health experts. We applied the Bernal framework to systematically document and track adaptations across eight dimensions of the intervention. Results Problems associated with worry, stress, sadness, shame and fear were identified as amongst the most critical mental health concerns, alongside a range of experiences of different forms of violence (such as gender-based violence, violence when fleeing from their homes) and associated problems. Problems associated with violence that included past experiences of fleeing as well as ongoing problems of gender-based violence in the camp. The most significant adaptations that were required included providing options for low literacy of participants, safety planning to address the high prevalence of sexual violence, simplification of strategies for the benefit of the end users and of lay facilitators, and implementation changes to consider involvement of refugee incentive workers. A majority of changes were across dimensions of language, people, metaphors, content, methods and context, while there were fewer changes regarding the goals and concepts of EASE. Conclusions The approach to adaptation of a psychological intervention suggested both minor and major required changes. Adaptations based on the findings of this study are anticipated to enhance relevance and acceptability of the EASE intervention and its delivery for camp-residing Burundian refugees in Tanzania.

Infant Effortful Control Mediates Relations Between Nondirective Parenting and Internalising-Related Child Behaviours in an Autism-Enriched Infant Cohort

Internalising problems are common within Autism Spectrum Disorder (ASD); early intervention to support those with emerging signs may be warranted. One promising signal lies in how individual differences in temperament are shaped by parenting. Our longitudinal study of infants with and without an older sibling with ASD investigated how parenting associates with infant behavioural inhibition (8–14 months) and later effortful control (24 months) in relation to 3-year internalising symptoms. Mediation analyses suggest nondirective parenting (8 months) was related to fewer internalising problems through an increase in effortful control. Parenting did not moderate the stable predictive relation of behavioural inhibition on later internalising. We discuss the potential for parenting to strengthen protective factors against internalising in infants from an ASD-enriched cohort.