Verhulst, F.C.

Need for mental health care in adolescents and its determinants: The TRAILS Study (Article)

2013-04-01T00:00:00Z

Background: Although a great deal of evidence is available on the patterns and determinants of unmet health care needs among adolescents with mental health problems, little is known about the factors that influence the need for care. The aim of this study is to assess the occurrence of need for care for mental problems in adolescents and the determinants of this need. Methods: Data were obtained from three assessment waves of TRAILS (TRacking Adolescents' Individual Lives Survey) (N = 1406). Need for care was assessed at age 16/17 (parent report). Determinants concerned previous health care utilization, emotional and behavioral problems (child behavior checklist and youth self-report) and child and family characteristics. Results: Of the 1406 parents, 409 parents (29%) reported that their child needed help for mental problems. Of these adolescents, only 29% received specialized mental health treatment. The determinants of need for mental health care at age 16/17 were family break-up and parental internalizing problems (age 10/11), parent-reported internalizing and externalizing (age 10/11 and 13/14) and receiving specialized help (age 13/14). Conclusion: A substantial proportion of all adolescents need care for their mental problems, according to their parent. There is also a large group of adolescents with mental health problems according to their parents, but for whom no parental reported need for care is expressed. The findings stress the importance of early interventions focusing on raising parental and child awareness of mental health problems. © 2012 Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Does the Revised Child Anxiety and Depression Scale (RCADS) measure anxiety symptoms consistently across adolescence? The TRAILS study (Article)

2013-03-19T00:00:00Z

We assessed if the Revised Child Anxiety and Depression Scale (RCADS) measures anxiety symptoms similarly across age groups within adolescence. This is crucial for valid comparison of anxiety levels between different age groups. Anxiety symptoms were assessed biennially in a representative population sample (n=2226) at three time points (age range 10-17years) using the RCADS anxiety subscales (generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD], panic disorder [PD], separation anxiety [SA], social phobia [SP]). We examined longitudinal measurement invariance of the RCADS, using longitudinal confirmatory factor analysis, by examining the factor structure (configural invariance), factor loadings (metric invariance) and thresholds (strong invariance). We found that all anxiety subtypes were configural invariant. Metric invariance held for items on the GAD, OCD, PD and SA subscales; yet, for the SP subscale three items showed modest longitudinal variation at age 10-12. Model fit decreased modestly when enforcing additional constraints across time; however, model fit for these models was still adequate to excellent. We conclude that the RCADS measures anxiety symptoms similarly across time in a general population sample of adolescents; hence, measured changes in anxiety symptoms very likely reflect true changes in anxiety levels. We consider the instrument suitable to assess anxiety levels across adolescence.

Pediatric population-based neuroimaging and the Generation R Study: The intersection of developmental neuroscience and epidemiology (Article)

2013-01-01T00:00:00Z

Neuroimaging studies of typically developing children and adolescents have provided valuable information on global and regional developmental trajectories of brain development. As these studies become larger and population-based, they are generating an intersection between the fields of developmental neuroscience and epidemiology. However, few of these studies have adequately probed the contribution of multiple environmental and genetic factors on brain development. Studies designed to optimally evaluate the role of multiple environmental and genetic factors on brain development require both large sample sizes and the prospective collection of multiple environmental factors. The Generation R Study is a large, prospective, prenatal-cohort study of nearly 10,000 children that began in 2002 in Rotterdam, the Netherlands. In September of 2009, 6-8 year old children from the Generation R Study were invited to participate in a magnetic resonance imaging component of the study. We provide an overview of the study design and experience for the first 801 children recruited for the neuroimaging component of the study. The protocol includes a 1-h neuropsychological assessment using the NEPSY-II, a mock scanning session, and a neuroimaging session that includes high-resolution structural, diffusion tensor, and resting-state functional MRI sequences. Image quality has been good to excellent in over 80 % of the children to date. The infusion of imaging into the Generation R Study will set the stage for evaluating the role of multiple environmental and genetic factors in both typical and atypical neurodevelopment.

The generation R study: A review of design, findings to date, and a study of the 5-HTTLPR by environmental interaction from fetal life onward (Article)

2012-11-01T00:00:00Z

Objective: First, we give an overview of child psychiatric research in the Generation R Study, a population-based cohort from fetal life forward. Second, we examine within Generation R whether the functional polymorphism (5-HTTLPR) in the promoter of the serotonin transporter gene interacts with prenatal maternal chronic difficulties, prenatal maternal anxiety or postnatal maternal anxiety to influence child emotional development. Method: A total of 2,136 northern European children were genotyped for 5-HTTLPR and rs25531. Mothers reported chronic difficulties and anxiety symptoms at 20 weeks' pregnancy and when the child was 3 years old. Child emotion recognition was observed at 3 years, and child emotional problems were assessed with the CBCL/1-5 at 5 years. Results: There were consistent main effects of maternal difficulties and anxiety on child emotional problems, but no main effect of 5-HTTLPR. Moreover, children with the s allele were at increased risk for emotional problems if their mothers reported prenatal anxiety symptoms (β = 2.02, p <.001) or postnatal anxiety symptoms (β = 1.64, p < 0.001). Also, in children of mothers with prenatal anxiety symptoms, the s allele was associated with less accurate emotion-matching (β = -0.11, p =.004). Conclusions: This population-based study shows that vulnerability due to 5-HTTLPR is not specific for certain adverse exposures or severe events, but suggests that the small effects of gene-environment interaction on emotional development become manifest early in life.

Febrile seizures and behavioural and cognitive outcomes in preschool children: The Generation R Study (Article)

2012-11-01T00:00:00Z

Aim General developmental outcome is known to be good in school-aged children who experienced febrile seizures. We examined cognitive and behavioural outcomes in preschool children with febrile seizures, including language and executive functioning outcomes. Method This work was performed in the Generation R Study, a population-based cohort study in Rotterdam from early fetal life onwards. Information about the occurrence of febrile seizures was collected by questionnaires at the ages of 1, 2, and 3years. At the age of 3years, behaviour and emotion were assessed using the Child Behavior Checklist. Information on expressive language development was obtained by the Language Development Survey at the age of 2 years 6 months. To assess executive functioning, parents completed the Behaviour Rating Inventory of Executive Function - Preschool Version when their children were 4years old. Final analyses were based on 3157 children. Results No associations were found between febrile seizures and the risk of behavioural problems or executive functioning. In contrast to single febrile seizures, recurrent febrile seizures were significantly associated with an increased risk of delayed vocabulary development (odds ratio 3.22, [95% confidence interval 1.30-7.94]). Interpretation Febrile seizures are not associated with problem behaviour or executive functioning in preschool children, but the results suggest that children with recurrent febrile seizures might be at risk for delayed language development. © The Authors. Developmental Medicine & Child Neurology

Children's eating behavior, feeding practices of parents and weight problems in early childhood: Results from the population-based Generation R Study (Article)

2012-10-30T00:00:00Z

Background: Weight problems that arise in the first years of life tend to persist. Behavioral research in this period can provide information on the modifiable etiology of unhealthy weight. The present study aimed to replicate findings from previous small-scale studies by examining whether different aspects of preschooler's eating behavior and parental feeding practices are associated with body mass index (BMI) and weight status -including underweight, overweight and obesity- in a population sample of preschool children.Methods: Cross-sectional data on the Child Eating Behaviour Questionnaire, Child Feeding Questionnaire and objectively measured BMI was available for 4987 four-year-olds participating in a population-based cohort in the Netherlands.Results: Thirteen percent of the preschoolers had underweight, 8% overweight, and 2% obesity. Higher levels of children's Food Responsiveness, Enjoyment of Food and parental Restriction were associated with a higher mean BMI independent of measured confounders. Emotional Undereating, Satiety Responsiveness and Fussiness of children as well as parents' Pressure to Eat were negatively related with children's BMI. Similar trends were found with BMI categorized into underweight, normal weight, overweight and obesity. Part of the association between children's eating behaviors and BMI was accounted for by parental feeding practices (changes in effect estimates: 20-43%), while children's eating behaviors in turn explained part of the relation between parental feeding and child BMI (changes in effect estimates: 33-47%).Conclusions: This study provides important information by showing how young children's eating behaviors and parental feeding patterns differ between children with normal weight, underweight and overweight. The high prevalence of under- and overweight among preschoolers suggest prevention interventions targeting unhealthy weights should start early in life. Although longitudinal studies are necessary to ascertain causal directions, efforts to prevent or treat unhealthy child weight might benefit from a focus on changing the behaviors of both children and their parents.

Variation in the glucocorticoid receptor gene at rs41423247 moderates the effect of prenatal maternal psychological symptoms on child cortisol reactivity and behavior (Article)

2012-10-01T00:00:00Z

Prenatal maternal psychopathology affects child development, but some children seem more vulnerable than others. Genetic variance in hypothalamic-pituitary-adrenal axis genes may influence the effect of prenatal maternal psychological symptoms on child emotional and behavioral problems. This hypothesis was tested in the Generation R Study, a population-based cohort from fetal life onward. In total, 1727 children of Northern European descent and their mothers participated in this study and were genotyped for variants in the glucocorticoid receptor (GR) gene (rs6189/rs6190, rs10052957, rs41423247, rs6195, and rs6198) and the FK506-binding protein 5 (FKBP5) gene (rs1360780). Prenatal maternal psychological symptoms were assessed at 20 weeks pregnancy and child behavior was assessed by both parents at 3 years. In a subsample of 331 children, data about cortisol reactivity were available. Based on power calculations, only those genetic variants with sufficient minor allele frequencies (rs41423247, rs10052957, and rs1360780) were included in the interaction analyses. We found that variation in GR at rs41423247 moderates the effect of prenatal maternal psychological symptoms on child emotional and behavioral problems (beta 0.41, SE 0.16, p0.009). This prenatal interaction effect was independent of mother's genotype and maternal postnatal psychopathology, and not found for prenatal psychological symptoms of the father. Moreover, the interaction between rs41423247 and prenatal psychological symptoms was also associated with decreased child cortisol reactivity (beta 2.30, p-value 0.05). These findings emphasize the potential effect of prenatal gene-environment interaction, and give insight in possible mechanisms accounting for children's individual vulnerability to develop emotional and behavioral problems.

Early trauma and familial risk in the development of the extended psychosis phenotype in adolescence (Article)

2012-10-01T00:00:00Z

Objective: Both genetic and environmental factors are thought to play a role in the development of psychotic outcomes; however, their respective contributions over time, including possible developmental interactions, remain largely unknown. Method: The contribution of parental general and psychotic psychopathology as proxies of genetic risk to the development of subthreshold psychosis and its hypothesized interaction with childhood trauma were studied in a general population sample of 2230 adolescents, followed from age 10-16years. Outcome measures were: i) level of psychotic experiences at age 16years and ii) persistence of such experiences over the total follow-up period. Results: General parental psychopathology was associated with CAPE score (OR=1.08; P<0.043 for highest quintile) and suggestively predicted psychosis persistence (OR, 1.16; P<0.072). Psychotic parental psychopathology was suggestively associated with CAPE score (OR, 2.25; P<0.063 for highest quintile), predicted membership of the Persistent group (OR, 3.72; P<0.039) and suggestively predicted membership of the Decreasing group (OR 2.04; P<0.051). Childhood trauma was associated with CAPE score and with all developmental trajectories of subclinical psychosis. No evidence was found for an interaction between trauma and parental psychopathology. Conclusion: The development and persistence of subthreshold psychotic symptoms may be conditional on non-interacting proxy genetic and environmental influences.

Variation in the glucocorticoid receptor gene at rs41423247 moderates the effect of prenatal maternal psychological symptoms on child cortisol reactivity and behavior (Article)

2012-10-01T00:00:00Z

Assessing expressed emotion during pregnancy (Article)

2012-09-26T00:00:00Z

We assessed Expressed Emotion (EE) with an adapted version of the Five Minute Speech Sample in 847 pregnant women. The prevalence of high EE was 6%. High EE was significantly associated with having a first child, low income, maternal childhood trauma and lack of parental emotional warmth during childhood.

Puzzling Findings in Studying the Outcome of "Real World" Adolescent Mental Health Services: The TRAILS Study (Article)

2012-09-19T00:00:00Z

Background: The increased use and costs of specialist child and adolescent mental health services (MHS) urge us to assess the effectiveness of these services. The aim of this paper is to compare the course of emotional and behavioural problems in adolescents with and without MHS use in a naturalistic setting. Method and Findings: Participants are 2230 (pre)adolescents that enrolled in a prospective cohort study, the TRacking Adolescents' Individual Lives Survey (TRAILS). Response rate was 76%, mean age at baseline 11.09 (SD 0.56), 50.8% girls. We used data from the first three assessment waves, covering a six year period. Multiple linear regression analysis, propensity score matching, and data validation were used to compare the course of emotional and behavioural problems of adolescents with and without MHS use. The association between MHS and follow-up problem score (β 0.20, SE 0.03, p-value<0.001) was not confounded by baseline severity, markers of adolescent vulnerability or resilience nor stressful life events. The propensity score matching strategy revealed that follow-up problem scores of non-MHS-users decreased while the problem scores of MHS users remained high. When taking into account future MHS (non)use, it appeared that problem scores decreased with limited MHS use, albeit not as much as without any MHS use, and that problem scores with continuous MHS use remained high. Data validation showed that using a different outcome measure, multiple assessment waves and multiple imputation of missing values did not alter the results. A limitation of the study is that, although we know what type of MHS participants used, and during which period, we lack information on the duration of the treatment. Conclusions: The benefits of MHS are questionable. Replication studies should reveal whether a critical examination of everyday care is necessary or an artefact is responsible for these results.

A brief observational instrument for the assessment of infant home environment: Development and psychometric testing (Article)

2012-09-01T00:00:00Z

The present paper reports on the development and the psychometric properties of a brief observational assessment of home environments for use in large-scale investigations with young infants. We generated observational items conceptually relevant for child development by two methods. First, we adapted the Infant Toddler Home Observation for Measurement of the Environment (IT-HOME) inventory for use in an exclusively observational context. Second, we added new observational items following a review of relevant literature and consulting professionals. The quality of the instrument was first evaluated in a pilot study (n = 926). In our study sample of 3406 families and their children (median age = 3.1 months, range = 1.6-6.0), exploratory factor analysis was used to identify latent constructs, Cronbach's alpha was used as a measure of internal consistency, and convergent validity was evaluated against family socio-demographic characteristics. Inter-observer agreement was investigated in a sub-sample of the respondents (n = 124). The results supported good psychometric properties of the instrument based on: (a) exploratory factor analysis yielding three meaningful latent constructs, (b) Cronbach's alphas ranging from α = 0.66 to α = 0.90, (c) inter-observer agreement ranging from r = 0.75 to r = 0.91, and (d) associations between the instrument and socio-demographic characteristics in the expected direction [e.g. Odds Ratio for low income = 15.24, 95% confidence interval (11.60, 20.01)]

Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in children: The generation r study (Article)

2012-02-01T00:00:00Z

Background: Maternal thyroid status and autoimmunity during pregnancy have been associated with impaired development of the offspring in animal and human studies. Our objective was to examine whether elevated titers of maternal thyroid peroxidase antibodies (TPOAbs) in early pregnancy increased the risk of cognitive impairment and problem behavior in preschool children. Second, we aimed at exploring to what extent any effect on child behavior was mediated by maternal thyroid parameters during pregnancy. Methods: In the Generation R Study, a population-based cohort of 3139 children and their mothers, we measured maternal thyroid parameters (thyrotropin [TSH], free Thyroxine, and TPOAbs) at 13.5±1.8 weeks of gestation. Children's verbal and nonverbal cognitive functioning was measured at 2.5 years using the Language Development Survey and the Parent Report of Children Abilities. At 3 years, children's behavior was assessed using the Child Behavior Checklist. Results: Elevated titers of TPOAbs during pregnancy did not predict the verbal and nonverbal cognitive functioning of the children. However, elevated titers of TPOAbs in mothers were associated with externalizing problems in children (odds ratio [OR]=1.64, 95% confidence interval [CI]: 1.17-2.29, p=0.004). In particular, children of TPOAb-positive mothers were at a higher risk of attention deficit/hyperactivity problems (OR=1.77, 95% CI: 1.15-2.72, p=0.01). To explore whether the effect of maternal TPOAbs on child problem behavior was mediated by maternal thyroid parameters, we added maternal TSH to the model. After correcting for TSH, the effect of TPOAbs on externalizing problems was attenuated slightly but remained significant (OR=1.56, 95% CI: 1.14, 2.14, p=0.005). Conclusions: Our findings imply that the elevated titers of TPOAbs during pregnancy impact children's risk of problem behavior, in particular, attention deficit/hyperactivity. The observed effect is only partially explained by maternal TSH levels. These findings may point to a specific mechanism of Attention Deficit/Hyperactivity Disorder in children. Nevertheless, we can only speculate about public health implication of the study, as there is no specific treatment for TPOAb-positive pregnant women with normal thyroid function. Further investigation is needed to explore whether TPOAb-positive pregnant women and their children can benefit from close monitoring and early detection of developmental delay in populations at risk.

Childhood problem behavior and parental divorce: evidence for gene-environment interaction (Article)

2012-01-12T00:00:00Z

Objective: The importance of genetic and environmental influences on children's behavioral and emotional problems may vary as a function of environmental exposure. We previously reported that 12-year-olds with divorced parents showed more internalizing and externalizing problems than children with married parents, and that externalizing problems in girls precede and predict later parental divorce. The aim of the current study was to investigate as to whether genetic and environmental influences on internalizing and externalizing problems were different for children from divorced versus non-divorced families. Methods: Maternal ratings on internalizing and externalizing problems were collected with the Child Behavior Checklist in 4,592 twin pairs at ages 3 and 12 years, of whom 367 pairs had experienced a parental divorce between these ages. Variance in internalizing and externalizing problems at ages 3 and 12 was analyzed with biometric models in which additive genetic and environmental effects were allowed to depend on parental divorce and sex. A difference in the contribution of genetic and environmental influences between divorced and non-divorced groups would constitute evidence for gene-environment interaction. Results: For both pre- and post-divorce internalizing and externalizing problems, the total variances were larger for children from divorced families, which was mainly due to higher environmental variances. As a consequence, heritabilities were lower for children from divorced families, and the relative contributions of environmental influences were higher. Conclusions: Environmental influences become more important in explaining variation in children's problem behaviors in the context of parental divorce.

Recognition of scared faces and the serotonin transporter gene in young children: The Generation R Study (Article)

2011-12-01T00:00:00Z

Background: Previous research highlights the significance of a functional polymorphism located in the promoter region (5-HTTLPR) of the serotonin transporter gene in emotional behaviour. This study examined the effect of the 5-HTTLPR polymorphism on emotion processing in a large number of healthy preschoolers. Methods: The 5-HTTLPR genotype was classified in 605 children as homozygous for the short allele (SS), homozygous for the long allele (LL), or heterozygous (LS). Emotion-processing was assessed using age-appropriate computer tasks where children matched happy, sad, angry, and fearful facial expressions preceded by a shape-matching task to assess basic matching ability. Results: We found that young children could differentiate between emotion categories (F = 12.1, p <.001). The effect of 5-HTTLPR genotype depended on the emotion category presented (F = 2.3, p =.031). This effect was explained by the finding that SS children were less accurate at recognising fearful faces than LL or LS children (F = 5.3, p =.005). We did not find any significant differences as a result of 5-HTTLPR genotype for happy, sad or angry expressions (p >.05). Conclusions: Results indicate that 5-HTTLPR allele status selectively impacts the processing of fearful but not other facial expressions. This pattern is already apparent in very young typically developing children. Results may signal an early vulnerability for affective problems before disorders emerge.

Dopaminergic, serotonergic, and oxytonergic candidate genes associated with infant attachment security and disorganization? in search of main and interaction effects (Article)

2011-12-01T00:00:00Z

Background and methods: In two birth cohort studies with genetic, sensitive parenting, and attachment data of more than 1,000 infants in total, we tested main and interaction effects of candidate genes involved in the dopamine, serotonin, and oxytocin systems (DRD4, DRD2, COMT, 5-HTT, OXTR) on attachment security and disorganization. Parenting was assessed using observational rating scales for parental sensitivity (Ainsworth, Bell, & Stayton, 1974), and infant attachment was assessed with the Strange Situation Procedure. Results: We found no consistent additive genetic associations for attachment security and attachment disorganization. However, specific tests revealed evidence for a codominant risk model for COMT Val158Met, consistent across both samples. Children with the Val/Met genotype showed higher disorganization scores (combined effect size d =.22, CI =.10-.34, p <.001). Gene-by-environment interaction effects were not replicable across the two samples. Conclusions: This unexpected finding might be explained by a broader range of plasticity in heterozygotes, which may increase susceptibility to environmental influences or to dysregulation of emotional arousal. This study is unique in combining the two largest attachment cohorts with molecular genetic and observed rearing environment data to date.

Prenatal smoking exposure and the risk of behavioral problems and substance use in adolescence: The TRAILS study (Article)

2011-12-01T00:00:00Z

Aims: To study the prospective relationship between maternal smoking during pregnancy (MSP) and behavioral problems, heavy alcohol use, daily smoking, and ever use of cannabis in the offspring, and to assess the role of confounding and mediating factors in a systematic way. Methods: Population-based cohort study of 2,230 respondents, starting in 2001 when respondents were around the age of 11 years, and two follow-up measurements at intervals of about 2.5 years (response rates of 96.0 and 81.4%). Results: Almost one third of the respondents' mothers had smoked tobacco during pregnancy. These respondents were at an increased risk for all outcomes except internalizing problems (significant odds ratios ranged from 1.40 to 2.97). The successive models showed that the potential confounding factors reduced the strength of all relationships. In the full model, the strongest relationship was found for mothers who smoked more than 10 cigarettes a day during pregnancy and daily smoking in early adolescence (odds ratio: 1.56), but none of the relationships were statistically significant. Conclusions: MSP is a marker for future behavioral outcomes in the offspring, but reducing the prevalence of MSP is unlikely to make a meaningful contribution to the prevention of these problems in adolescents. Copyright

Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls (Article)

2011-11-01T00:00:00Z

Background: The development of the fetal endocannabinoid receptor system may be vulnerable to maternal cannabis use during pregnancy and may produce long-term consequences in children. In this study, we aimed to determine the relationship between gestational cannabis use and childhood attention problems and aggressive behavior. Methods: Using a large general population birth cohort, we examined the associations between parental prenatal cannabis and tobacco use and childhood behavior problems at 18 months measured using the Child Behavior Checklist in N= 4077 children. Substance use was measured in early pregnancy. Results: Linear regression analyses demonstrated that gestational exposure to cannabis is associated with behavioral problems in early childhood but only in girls and only in the area of increased aggressive behavior (B= 2.02; 95% CI: 0.30-3.73; p= 0.02) and attention problems (B= 1.04; 95% CI: 0.46-1.62; p< 0.001). Furthermore, this study showed that long-term (but not short term) tobacco exposure was associated with behavioral problems in girls (B= 1.16; 95% CI: 0.20-2.12; p= 0.02). There was no association between cannabis use of the father and child behavior problems. Conclusions: Our results suggest that intrauterine exposure to cannabis is associated with an increased risk for aggressive behavior and attention problems as early as 18 months of age in girls, but not boys. Further research is needed to explore the association between prenatal cannabis exposure and child behavior at later ages. Our data support educating future mothers about the risk to their babies should they smoke cannabis during pregnancy.

Survivors of septic shock caused by Neisseria meningitidis in childhood: Psychosocial outcomes in young adulthood (Article)

2011-11-01T00:00:00Z

Objective: To investigate long-term psychosocial outcomes in young adults who survived septic shock caused by Neisseria meningitidis (meningococcal septic shock) during childhood. Design: A cross-sectional study. Setting: The psychological investigation took place in the department of Child and Adolescent Psychiatry of the Erasmus MC-Sophia Children's Hospital. Patients: All consecutive surviving patients with meningococcal septic shock requiring intensive care treatment at the pediatric intensive care unit between 1988 and 2001. Intervention: To explore biographical characteristics (such as living conditions, educational, occupational, and marital status) and illness-related physical or social consequences a structured interview was used. To assess intellectual functioning the Groninger Intelligence Test 2 was used and to assess behavioral/emotional problems, the Adult Self-Report was used. Measurements and Main Results: Fifty-eight of 83 eligible septic shock survivors were evaluated (response rate: 70%). The patients were 16-31 yrs old at time of follow-up (median age: 21 yrs old). These patients had had meningococcal septic shock before 18 yrs of age. Median follow-up interval was 13 yrs, with a range of 4 to 16 yrs. For the vast majority of meningococcal septic shock patients, outcomes on biographical characteristics, intellectual functioning, and levels of behavioral/emotional problems were comparable to those of reference groups. A minority (5% to 20%) still report illness-related physical or social consequences, behavioral and emotional problems, and lower intellectual functioning. Conclusions: Despite favorable outcomes for the majority of meningococcal septic shock patients in the long term, an important minority (5% to 20%) still struggles with ongoing problems as to behavioral/emotional problems, intellectual functioning, biographical characteristics, and illness-related physical or social consequences.

Generation of interpersonal stressful events: The role of poor social skills and early physical maturation in young adolescents-the trails study (Article)

2011-10-01T00:00:00Z

This study developed two specifications of the social skills deficit stress generation hypothesis: the "gender-incongruence" hypothesis to predict peer victimization and the "need for autonomy" hypothesis to predict conflict with authorities. These hypotheses were tested in a prospective large population cohort of 2,064 Dutch young adolescents. Social skills and pubertal timing were measured when the sample was about 11 years old, and stressful life events were measured 2.5 years later at follow-up. As predicted by the gender-incongruence hypothesis, poor assertion in boys and poor self-control in girls were associated with peer victimization. Consistent with the need for autonomy hypothesis, poor self-control was associated with conflict with authorities, in both boys and girls. Furthermore, early physical maturation exacerbated the effect of poor self-control on conflict with authorities for both genders. These specific associations provide more insights in the pathways that result in the experience of interpersonal stressors in young adolescents.

Spot the red herring: Breastfeeding, fruitpurée, and infant autonomic functioning-the generation R study (Article)

2011-10-01T00:00:00Z

Several studies have suggested that breastfeeding is related to infant autonomic functioning. The authors investigated whether this is a causal relation. In all, 444 mothers reported breastfeeding practices 2 mo postpartum. Infant autonomic functioning was assessed by heart rate variability at age 14 mo, after discontinuation of breastfeeding. The dose-dependent association between breastfeeding and infant autonomic functioning was tested with linear regression models adjusted for multiple confounders. The authors investigated the relation of fruitpurée consumption with infant autonomic functioning. Fruitpurée consumption has similar socioeconomic epiphenomena but is not related via the same causal mechanism to autonomic regulation as breastfeeding. Nonbreastfed infants had high sympathetic modulation [7.87 log (ms)/SD, 95% CI: 7.71-8.02], partially breastfed infants had intermediate sympathetic modulation [7.75 log (ms)/SD, 95% CI: 7.51-7.82], sympathetic modulation of exclusively breastfed infants was low [7.63 log (ms)/SD, 95% CI: 7.50-7.77]. However, this association could be explained by socioeconomic confounders. Furthermore, fruitpurée consumption was similarly associated with reduced infant sympathetic modulation. The association between breastfeeding practices and infant sympathetic modulation was accounted for by socioeconomic and environmental factors. We found a similar association between fruitpurée consumption and autonomic functioning, further suggesting that the association between breastfeeding and infant autonomic functioning is noncausal. Copyright

When parent and teacher ratings don't agree: The Tracking Adolescents' individual lives survey (TRAILS) (Article)

2011-10-01T00:00:00Z

Objectives: A commonly encountered situation for evaluating clinicians is a history of significant problems in one setting with little or no difficulties in another. This study aims to describe this phenomenon and to examine its relations with other child and family characteristics. Method: A total of 1,730 children (mean age 11.05 years) was studied from the first wave of the Tracking Adolescents' Individual Lives Survey (TRAILS), a large population-based study of Dutch youth. Parent and teacher ratings of aggression, rule breaking, inattention, and hyperactivity were obtained. Children were assigned to groups according to the presence of clinically relevant problems at home only, at school only, or in both settings. The rate of setting specific problems was calculated and comparisons between groups were made. Results: Setting specific, especially home-specific, problems were quite common. Among children whom parents rated as having at least borderline-clinical problems, teachers reported clear or very clear behaviors at school at the following rates: aggression (22%), rule breaking (12.5%), inattention (55%), and hyperactivity/impulsivity (33%). Compared with the school-specific group, the home-specific group contained a significantly higher percentage of girls with regard to inattention or hyperactivity and a significantly lower percentage of girls with regards to rule breaking. Logistic regression analyses revealed that home- versus school-specific problems were related to sex, child effortful control, and parental stress. Conclusion: Externalizing problems are frequently encountered only in one setting between home and school and are related to sex, child effortful control, and parental stress.

Social skills as precursors of cannabis use in young adolescents: A trails study (Article)

2011-09-01T00:00:00Z

Social skills (cooperation, assertion, and self-control) were assessed by teachers for a longitudinal cohort of (pre)adolescents, with measurements at average ages 11.1 (baseline) and 16.3 years (follow-up). Prospective associations with participants' self-reported use of cannabis, (age of) onset of cannabis use, and frequency of use at follow-up were examined using multinomial logistic regression analyses. Teacher-reported social skills predicted different aspects of cannabis use independent of better known factors such as presence of externalizing behavior and use of other substances. The direction of associations depended on the type of social skill. Good cooperation skills during early adolescence were associated with a reduced risk of lifetime cannabis use and a reduced risk of using cannabis on a regular basis. On the other hand, assertion at age 11 increased the risk of lifetime cannabis use and of using cannabis on an experimental basis.

The association between parenting and attachment security is moderated by a polymorphism in the mineralocorticoid receptor gene: Evidence for differential susceptibility (Article)

2011-09-01T00:00:00Z

Maternal sensitive responsiveness and extreme insensitivity only partly explain the variance in attachment security. Differences in attachment security may well be rooted in the interplay of genetic variations and environmental factors. The association between parenting (observed sensitive responsiveness and extreme insensitivity) and attachment security (assessed with the Strange Situation Procedure) was hypothesized to be moderated by genes involved in the regulation of the stress response: the glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) genes. A significant G. × E interaction was found: infants carrying the minor MR allele (G) were significantly more securely attached if their mothers showed more sensitive responsiveness and significantly less securely attached if their mothers showed more extremely insensitive behaviors. These associations were not significant for carriers of the AA genotype of MR. Findings are discussed from a differential susceptibility perspective.

Pubertal status predicts back pain, overtiredness, and dizziness in american and dutch adolescents (Article)

2011-09-01T00:00:00Z

OBJECTIVE: Functional somatic symptoms, symptoms for which no organic pathologic basis can be found, are more prevalent in girls than in boys, and this difference tends to increase during adolescence. This might be explained, at least in part, by pubertal development. We hypothesized that pubertal maturation predicts the development of most functional somatic symptoms and that this especially is true for girls. METHOD: We used 2 longitudinal population-based studies to examine our hypotheses: the Longitudinal Study of Pain in Adolescents in Seattle (n = 1996 [49.7% girls]) and the Dutch Tracking Adolescents' Individual Lives Survey (n = 2230 [51.0% girls]). Two assessment waves of each study were used. American adolescents were younger than Dutch adolescents at the first (11.6 vs 13.6) and second (14.5 vs 16.2) assessment waves, but they were in about the same pubertal development stage. Functional somatic symptoms were measured by pain questions, the Symptom Checklist-90, and the Youth Self-report. The Pubertal Development Scale was used to assess pubertal development on a continuous scale in both cohorts. RESULTS: Ordinal logistic regression analyses revealed that American and Dutch adolescents at a later pubertal status at baseline were more likely (odds ratios ranged from 1.24 to 1.61) to report back pain, overtiredness, and dizziness but not stomach pain and headache 2 to 3 years later. Although these relationships were not equally strong for boys and girls, no significant gender differences were found. CONCLUSIONS: Pubertal status predicted the frequency of some, but not all, functional somatic symptoms at follow-up. Copyright

Hypothalamic-pituitary-adrenal axis reactivity to social stress and adolescent cannabis use: The TRAILS study (Article)

2011-08-01T00:00:00Z

Aims To investigate the relationship of life-time and repeated cannabis use with hypothalamic-pituitary-adrenal (HPA) axis reactivity to social stress in a general population sample of adolescents. Design Adolescents who reported life-time or repeated cannabis use, life-time or repeated tobacco use and never use of either cannabis or tobacco were compared with respect to their HPA axis reactivity during the Groningen Social Stress Task (GSST), which was based on the Trier Social Stress Task. Setting A large prospective population study of Dutch adolescents [the TRacking Adolescents' Individual Lives Survey (TRAILS) study]. Participants A total of 591 adolescents (51% male) who participated in the GSST, which was an additional measurement during the third assessment wave. Measurements HPA axis stress-reactivity was indexed by four cortisol samples collected before, during and after the GSST. Furthermore, all adolescents in our study completed self-reported questionnaires on life-time and repeated cannabis and tobacco use. Models were adjusted for sex, recent alcohol use, experimental session risk status, socio-economic status, mood and time of the experimental session. Findings Life-time cannabis users had significantly lower stress-reactivity levels when compared to abstainers [odds ratio (OR)=0.68, confidence interval (CI)=0.55-0.85, P<0.01] and life-time tobacco users (OR=0.79, CI=0.64-0.98, P<0.05). In addition, repeated cannabis users also exhibited lower stress-reactivity levels when compared to life-time ever users of either tobacco or cannabis (OR=0.74, CI=0.53-0.98, P<0.05). Conclusions Lower hypothalamic-pituitary-adrenal-axis stress-reactivity in adolescents is related specifically to life-time and repeated cannabis use. © 2011 The Authors, Addiction

Subcortical structures and the neurobiology of infant attachment disorganization: A longitudinal ultrasound imaging study (Article)

2011-08-01T00:00:00Z

Attachment disorganization in infancy is a risk factor for behavior problems and other psychopathology. Traditionally the role of parental behavior for qualitative differences in early attachment relationships has been emphasized. However, disrupted infant-parent interactions only partly explain attachment disorganization. A complementary focus on child factors such as early differences in the underlying neurobiological systems is needed. We examined whether early structural differences in the gangliothalamic ovoid, comprising the basal ganglia and the thalamus, are involved in the etiology of infant attachment disorganization. Gangliothalamic ovoid diameter was measured by ultrasound in 6-week-old participants of a prospective population-based cohort study. Attachment classification of 629 of these infants was assessed with the strange situation at 14 months of age. Neurobiological differences within the normal range were prospectively associated with attachment disorganization. Infants with a larger gangliothalamic ovoid at 6 weeks had a lower risk of attachment disorganization at 14 months (OR = 0.73 per SD increase in diameter, 95% CI 0.57-0.93, p <.05). Volume of the lateral ventricles as an index of general brain development was not associated with attachment disorganization. These findings provide new insight into the etiology of infant attachment disorganization that may in part be neurodevelopmentally determined.

The structure of the extended psychosis phenotype in early adolescence - A cross-sample replication (Article)

2011-07-01T00:00:00Z

The extended psychosis phenotype, or the expression of nonclinical positive psychotic experiences, is already prevalent in adolescence and has a dose-response risk relationship with later psychotic disorder. In 2 large adolescent general population samples (n = 5422 and n = 2230), prevalence and structure of the extended psychosis phenotype was investigated. Positive psychotic experiences, broadly defined, were reported by the majority of adolescents. Exploratory analysis with Structural Equation Modelling (Exploratory Factor Analysis followed by Confirmatory Factor Analysis [CFA]) in sample 1 suggested that psychotic experiences were best represented by 5 underlying dimensions; CFA in sample 2 provided a replication of this model. Dimensions were labeled Hallucinations, Delusions, Paranoia, Grandiosity, and Paranormal beliefs. Prevalences differed strongly, Hallucinations having the lowest and Paranoia having the highest rates. Girls reported more experiences on all dimensions, except Grandiosity, and from age 12 to 16 years rates increased. Hallucinations, Delusions, and Paranoia, but not Grandiosity and Paranormal beliefs, were associated with distress and general measures of psychopathology. Thus, only some of the dimensions of the extended psychosis phenotype in young people may represent a continuum with more severe psychopathology and predict later psychiatric disorder.

Prenatal and postnatal psychological symptoms of parents and family functioning: The impact on child emotional and behavioural problems (Article)

2011-07-01T00:00:00Z

Although relations of various parental psychological problems and family functioning with child development are well documented, it remains unclear whether specific prenatal or specific postnatal risk factors are independently associated with child emotional and behavioural problems, or whether observed associations can be explained by general parental psychopathology. Using a stepwise approach, we examined the effects of prenatal and postnatal parental depressive symptoms, prenatal and postnatal hostility of the parents, as well as prenatal family functioning on the risk of child emotional and behavioural problems. This study was embedded in Generation R: a population-based cohort from foetal life onwards. Mothers and fathers of 2,698 children provided information about depressive symptoms, symptoms of hostility and family functioning during pregnancy and 3 years after birth. Mother and father each reported on child behaviour when the child was 3 years old. Parental depressive symptoms increased the risk of child emotional and behavioural problems, but this increase was explained by postnatal parental hostile behaviour. Postnatal symptoms of hostility of mothers (OR = 1.34, p value <0.001) and postnatal symptoms of hostility of fathers (OR = 1.30, p value <0.001) each contributed independently to the risk of child emotional and behavioural problems. Postnatal parental hostility is associated with an increased risk of child emotional and behavioural problems, independent of parental depressive symptoms. These findings suggest that prevention and intervention strategies should focus on psychological symptoms of both mothers and fathers, in particular on hostile behaviour, in families with young children.

Self-assessed parental depressive problems are associated with blunted cortisol responses to a social stress test in daughters. The TRAILS Study (Article)

2011-07-01T00:00:00Z

Depression runs in families and is considered a stress-related disorder. Familial risk for depression may be transmitted via deregulated psychophysiological stress responses from parent to child. In this study, we examined the association between self-assessed lifetime parental depressive problems (PDP) and adolescent offspring' cortisol responses to a social stress test. Data were collected as part of the third assessment wave of TRAILS (TRacking Adolescents' Individual Lives Survey), a large prospective population study of Dutch adolescents. Data of 330 adolescents (mean age 16.04; 40.9% girls) who participated in a laboratory session, including a standardized performance-related social stress task (public speaking and mental arithmetic) were examined. Four saliva cortisol samples were collected before, during and after the social stress task which were analyzed with repeated measures Analysis of Variance. Lifetime parental depressive problems were assessed by self-reports from both biological parents. PDP was associated with daughter' cortisol responses (F(3,133) = 3.90, p= .02), but no association was found in sons (F(3,193) = 0.27, p= .78). Girls whose parents ever experienced depressive symptoms displayed a blunted cortisol response to the standardized social stress test, while girls whose parents never had such problems displayed the characteristic curvilinear response pattern. This effect was not mediated by offspring stress history (age 0-16). Analyses were corrected for smoking behaviour and adolescent depressed mood. The fact that PDP were measured by self-report questionnaires and did not reflect clinical DSM-IV diagnosis could be considered a limitation of the study.

Trajectories of CBCL Attention Problems in childhood (Article)

2011-06-29T00:00:00Z

The first aim of this study was to identify developmental trajectories of Attention Problems in twins followed from age 6 to 12 years. Second, we investigated whether singletons follow similar trajectories. Maternal longitudinal ratings on the Attention Problems (AP) subscale of the Child Behavior Checklist were obtained for a sample of 12,486 twins from the Netherlands Twin Register and for a general population sample of 1,346 singletons. Trajectories were analyzed by growth mixture modeling in twins, and compared with singletons. Teacher ratings on the AP subscale of the Teachers' Report Form were available for 7,179 twins and 1,211 singletons, and were used for cross-sectional mean comparisons at each age. All analyses were conducted for boys and girls separately. We identified three linear trajectories in both boys and girls, i.e., stable low (62-71%), low-increasing (15-18%), and high-decreasing (14-21%). Singletons followed three identical trajectories, with similar class proportions. Teacher ratings yielded no differences in mean levels of Attention Problems between twins and singletons. The development of Attention Problems from age 6 to 12 years can be characterized by stable low, low-increasing, and high-decreasing developmental trajectories. Twins and singletons are comparable with respect to the development of Attention Problems in childhood.

The influence of maternal vulnerability and parenting stress on chronic pain in adolescents in a general population sample: The TRAILS study (Article)

2011-06-27T00:00:00Z

Investigating possible psychosocial predictors of unexplained chronic pain in adolescents is crucial in understanding its development and prevention. A general population sample of adolescents (n = 2230) from the TRAILS cohort study was investigated longitudinally to assess the influence of maternal vulnerability, in terms of anxiety, depression and stress, and parenting stress at age 10-12 years, on the presence of chronic pain at age 12-15 years. Of these adolescents, 269 (12.9%) reported experiencing chronic pain, of which 77% reported severe chronic pain and 22% reported multiple chronic pain. Maternal anxiety, maternal stress and higher levels of parenting stress were related to chronic pain at a later age. Subgroup analyses showed similar results for adolescents with severe chronic pain. Mediation analyses indicated that parenting stress mediates the effect between maternal anxiety, or stress, and chronic pain. The findings suggest that interventions to diminish maternal feelings of anxiety and stress, while in turn adjusting maternal behaviour, may prevent the development of chronic pain in adolescence.

Early risk factors for being a bully, victim, or bully/victim in late elementary and early secondary education. the longitudinal TRAILS study (Article)

2011-06-08T00:00:00Z

Background: Data regarding the impact of early risk factors on later involvement in bullying are scarce. We investigated the impact of preschool behaviors, family characteristics (socio-economic status, family breakup) and parental mental health on bullying and victimization at age 11 (T1) and age 13.5 (T2). Methods. longitudinal data from a subsample of the TRacking Adolescents' Individual Lives Survey (TRAILS) (T1: N = 982; T2: N = 977). TRAILS is a prospective study of adolescent mental health in a mixed urban and rural region of the Netherlands. At T1 parents reported on family characteristics, parental mental health and retrospectively on children's preschool behavior at age 4-5. Schoolmates reported involvement of adolescents in bullying or victimization at T1 and T2. Results: Children with preschool anxiety were less likely to be bully/victim at T1. Children with preschool aggressiveness were more likely to be bully (T1), bully/victim (T1 and T2) and victim (T2) and children with good preschool motor functioning were more likely to be bully (T1) and less likely to be victim (T1 and T2). Children from low socioeconomic status families were more likely be to be bully, victim, or bully/victim and less likely to be uninvolved both at T1 and T2. Finally, children from intact two parent families were more likely to be uninvolved at T2. Conclusion: Preschool behavioral, emotional and motor problems, socioeconomic status, and family breakup are related to involvement in bullying at a later age. Prevention of bullying and its consequences can be enhanced by focusing on risk groups in early life.

The parallel development of ODD and CD symptoms from early childhood to adolescence (Article)

2011-06-01T00:00:00Z

This study examined the developmental relations between symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD) from early childhood to adolescence. Specifically we tested, according to parent-reported problems, whether symptoms of ODD precede the development of CD symptoms, whether ODD and CD symptoms are reciprocally associated across time, or whether ODD and CD symptoms develop parallel to each other across time. Participants were a community-based sample (at time 1: N = 485, 48% boys) assessed biannually five times from age 4 to 6 until age 12-14. The findings suggested that, with control for stability effects, baseline SES, and symptoms of attention deficit hyperactivity disorder, ODD and CD symptoms develop parallel to each other. No gender differences were obtained. We conclude that without the initial presence of CD symptoms, ODD symptoms are not developmental precursors to CD symptoms.

Risk indicators of anxiety throughout adolescence: The trails study (Article)

2011-06-01T00:00:00Z

Background: The aim was to identify risk indicators from preadolescence (age period 10-12) that significantly predict unfavorable deviations from normal anxiety development throughout adolescence (age period 10-17 years). Methods: Anxiety symptoms were assessed in a community sample of 2,220 boys and girls at three time-points across a 5-year interval. Risk indicators were measured at baseline and include indicators from the child, family, and peer domain. Associations with anxiety were measured with multilevel growth curve analyses. Results: A stable difference in anxiety over adolescence was found between high and low levels of a range of child factors (frustration, effortful control), family factors (emotional warmth received from parents, lifetime parental internalizing problems), and peer factor (victims of bullying) ( P<.001). In contrast, the difference in anxiety between high and low levels of factors, such as self-competence, unfavorable parenting styles, and bully victims, decreased over adolescence ( P<.001). For other family factors, associations were weaker (.05

Discrepancies between parent-child reports of internalizing problems among preadolescent children: Relationships with gender, ethnic background, and future internalizing problems (Article)

2011-06-01T00:00:00Z

In a multiethnic community sample of 1,170 preadolescent children, it was investigated whether discrepancies in parent-child reports of internalizing problems are related with gender, ethnic background (Dutch, Surinamese/ Antillean, Moroccan, Turkish, Other) and with future internalizing problems. No significant differences in discrepancy scores between boys and girls were found. Parent-child disagreement of internalizing problems varied across ethnic groups, with significant differences among children from Surinamese/Antillean (children reporting more internalizing problems than their parents) and Turkish background (parents reporting more internalizing problems than their children). Disagreement between parents and their preadolescent child significantly contributed to the prediction of self-reported internalizing problems in early adolescence. For the early identification of internalizing problems, it is recommended to include both parent and child self-reports as part of routine health examinations in the setting of preventive youth health care because when parents underreport problems relative to their child, this can predict future internalizing problems.

Examining continuity of early expressive vocabulary development: The generation R study (Article)

2011-06-01T00:00:00Z

The authors investigated continuity and discontinuity of vocabulary skills in a population-based cohort in the Netherlands. Mothers of 3,759 children completed the Dutch version of the MacArthur Short Form Vocabulary Checklist (Zink & Lejaegere, 2003) at 18 months and a Dutch translation of the Language Development Survey (Rescorla, 1989) at 30 months. At both ages, expressive vocabulary delay was defined as vocabulary scores <10th age- and gender-specific percentile. Results: Of the children, 85.2% had normal vocabulary development at both ages, 6.2% were "late bloomers," 6.0% had late onset expressive vocabulary delay, and 2.6% had persistent expressive vocabulary delay. Word production and comprehension at 18 months explained 11.5% of the variance in 30-month vocabulary scores, with low birth weight, child age, gender and ethnicity, maternal age and education, and parenting stress explaining an additional 6.2%. Multinomial logistic regression was used to identify biological, demographic, and psychological factors associated with each of the vocabulary delay outcome groups relative to the typically developing group. Although multiple perinatal, demographic, and maternal psychosocial factors significantly predicted vocabulary skills at 30 months, positive predictive value and sensitivity were low. Future studies should address to what extent additional factors, such as brain maturation and genetic influences, can improve the prediction and understanding of continuity and discontinuity of language delay.

Parental family stress during pregnancy and cognitive functioning in early childhood: The Generation R Study (Article)

2011-05-09T00:00:00Z

We investigated whether parental family stress during pregnancy is associated with cognitive functioning in early childhood in a population-based cohort (n= 3139). Family stress was assessed using the Family Assessment Device at the 20th week of pregnancy and was reported by mothers and fathers. Mothers completed the MacArthur Communicative Development Inventory, measuring children's verbal cognitive functioning, when children were 18 months and they completed the Parent Report of Children's Abilities, measuring nonverbal cognitive functioning, when children were 2 years old. Maternal prenatal family stress was related to children's low word comprehension and poorer nonverbal cognitive development independent of paternal reports. In a subset of 639 children, maternal prenatal family stress was also associated with observational assessments of poor effortful control at age 37 months. Paternal prenatal family stress was only related to poorer nonverbal cognitive development, independent of the mother. When both parents had high levels of prenatal family stress, children displayed particularly poor nonverbal cognitive development. These findings emphasize the significance of parental prenatal family stress for child developmental outcomes.

Maternal thyroid function during pregnancy and behavioral problems in the offspring: The generation R study (Article)

2011-05-01T00:00:00Z

Maternal thyroid function during pregnancy is implicated in the neurodevelopment of the offspring, yet little is known about the effect of maternal thyroid parameters on the behavior of children. We investigated the association of maternal thyroid function during the first half of pregnancy with parent-reported problem behavior of the offspring up to age of 3 y. In the Generation R study, a population-based cohort of 3736 children and their mothers, data on maternal thyroid function and child's behavior were examined. The degree of internalizing and externalizing problems in the children were assessed with the Child Behavior Checklist at ages 11/2 and 3 y. Higher levels of maternal TSH during pregnancy predicted a higher externalizing scores in children at 11/2 and 3 y (B = 0.22 per SD of TSH; 95% CI: 0.04, 0.40; B = 0.10 per SD for internalizing scores; 95% CI:-0.01, 0.21). Maternal free thyroxine (T4) and total T4 were not associated with internalizing or externalizing scores of children. The linear relationship with more externalizing scores was across the range of TSH; this implies that subtle impairments of maternal thyroid function may affect the child. The results suggest that thyroid function is crucial for fetal brain development, which determines problem behavior later in life. Copyright

The relationship between parental religiosity and mental health of pre-adolescents in a community sample: The trails study (Article)

2011-05-01T00:00:00Z

The purpose of this study is to examine the relationship between parental religiosity, parental harmonyonthe subjectofreligiosity, and the mental healthofpre-adolescents. In a community-based sample of 2,230 pre-adolescents (10-12 years), mental health problems were assessed using self-report (Youth Self-Report, YSR), parental report (Child Behavior Checklist, CBCL) aswell as teacher report (Teacher Checklist for Psychopathology, TCP). Information about the religiosity of mother, the religiosity of father and religious harmony between the parents was obtained by parent report. The influence of maternal religiosity on internalizing symptoms depended on the religious harmony between parents. This was particularly apparent on the CBCL. Higher levels of internalizing symptoms were associated with parental religious disharmony when combined with passive maternal religiosity. Boys scored themselves as having more externalizing symptoms in case of religiously disharmonious parents. The levels of internalizing and externalizing symptoms in pre-adolescents were not influenced by parental religiosity. Religious disharmony between parents is a risk factor for internalizing problems when the mother is passive religious. Religious disharmony is a risk factor on its own for externalizing problems amongst boys. Parental religious activity and parental harmony play a role in the mental health of preadolescents.

Maternal smoking during pregnancy, fetal arterial resistance adaptations and cardiovascular function in childhood (Article)

2011-05-01T00:00:00Z

Objective To unravel the mechanisms underlying the previously demonstrated associations between low birthweight and cardiovascular disease in adulthood, we examined whether maternal smoking during pregnancy leads to fetal arterial resistance adaptations, and subsequently to fetal growth retardation and changes in postnatal blood pressure and cardiac development. Design Prospective cohort study from early fetal life onwards. Setting Academic hospital. Population Analyses were based on 1120 children aged 2 years. Methods Maternal smoking during pregnancy [non-smoking, first trimester smoking, continued smoking (<5 and ≥5 cigarettes/day)] was assessed by questionnaire. Main outcome measures Third trimester placental and fetal arterial resistance indices and fetal growth were assessed by ultrasound and Doppler measurements. Postnatal blood pressure and cardiac structures (aortic root diameter, left atrial diameter, left ventricular mass) were measured at 2 years of age. Results First trimester smoking was not associated with third trimester placental and fetal blood flow adaptations. Continued smoking of ≥5 cigarettes/day was associated with an increased resistance in uterine, umbilical and middle cerebral arteries, and with a decreased flow and diameter of the ascending aorta. Among mothers who continued to smoke, the third trimester estimated fetal weights and birthweights were most affected in children with the highest umbilical artery resistance. Fetal arterial resistance indices were also associated with aortic root diameter and left atrial diameter. Conclusions Fetal arterial resistance adaptations may be involved in the pathways leading from maternal smoking during pregnancy to low birthweight and cardiovascular developmental changes in childhood in the offspring.

Predicting adult violent delinquency: Gender differences regarding the role of childhood behaviour (Article)

2011-05-01T00:00:00Z

Adult violent delinquency harms individuals, their families and society at large. Knowledge about childhood predictors of adult delinquency could be helpful in defining at-risk children who will develop into violent adults. This topic is rarely investigated in females. We investigated which behavioural problems in childhood predicted long-term disruptive development in a sample of both males and females. In 1983, behaviour problems were assessed in a community sample of 2076 children; 24 years later, 1335 of these children, who are now adults, reported on their violent delinquency. Girls with conduct problems were at risk of long-term disruptive development. We recommend that health professionals be alert regarding girls with conduct problems, because early identification and treatment of high-risk girls might reduce delinquency in adult life.

Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study (Article)

2011-04-11T00:00:00Z

BACKGROUND: Research suggests that subclinical psychotic experiences during adolescence represent the behavioral expression of liability for psychosis. Little is known, however, about the longitudinal trajectory of liability in general population samples. METHOD: Growth mixture modeling was used to examine longitudinal trajectories of self-reported positive psychotic experiences in the Youth Self Report (YSR), completed three times over a period of 6 years by a general population cohort of adolescents aged 10-11 years at baseline (n=2230). RESULTS: Four groups with distinct developmental trajectories of low, decreasing, increasing and persistent levels of mild positive psychotic experiences were revealed. The persistent trajectory was associated strongly with cannabis use, childhood trauma, developmental problems and ethnic minority status, and consistently displayed strong associations with factors known to predict transition from subclinical psychotic experience to clinical psychotic disorder (severity of and secondary distress due to psychotic experiences, social and attentional problems and affective dysregulation) and also with high levels of parental-reported psychotic experiences and use of mental health care at the end of the follow-up period. Progressively weaker associations were found for the increasing, decreasing and low trajectories respectively. CONCLUSIONS: The results suggest that the outcome of early developmental deviation associated with later expression of psychotic experiences is contingent on the degree of later interaction with environmental risks inducing, first, persistence of psychotic experiences and, second, progression to onset of need for care and service use. Insight into the longitudinal dynamics of risk states in representative samples may contribute to the development of targeted early intervention in psychosis.

The influence of attachment and temperament on venipuncture distress in 14-month-old infants: The Generation R Study (Article)

2011-04-01T00:00:00Z

Objective: This study examined the effects of attachment and temperament on infant distress during venipuncture. Method: The study was embedded in the Generation R Study, a prospective population-based study. Two different research procedures (i.e., blood sampling and the Ainsworth Strange Situation Procedure) yielded measures of venipuncture distress and attachment security and disorganization in 246 infants aged 14 months. Four temperament traits (distress to limitations, fear, recovery from distress, and sadness) were assessed using the maternally reported Infant Behavior Questionnaire - Revised, at the age of 6 months. Results: There were no differences between mean levels of distress during venipuncture in infants classified as having insecure attachment, but there was a trend for disorganized attachment. The temperament traits were not related to distress. However, children with a disorganized attachment and higher temperamental fear had more venipuncture distress. Conclusion: When different risk factors are present simultaneously, infant distress is heightened.

Cognitive coping in anxiety-disordered adolescents (Article)

2011-04-01T00:00:00Z

The present study investigated differences in cognitive coping strategies between anxiety-disordered and non-anxious adolescents. In addition, the interaction effect with gender as well as differences between specific anxiety diagnoses was examined. A clinical sample of 159 anxiety-disordered adolescents and a general community sample of 370 non-anxious adolescents were recruited. Nine cognitive coping strategies were assessed in all adolescents (aged 12-16 years). Results showed that anxiety-disordered adolescents had significantly higher scores on most of the cognitive coping strategies than non-anxious adolescents. The cognitive coping strategies rumination, self-blame and catastrophizing accounted for most of the variance. Gender did not modify the results. Further analyses within the anxiety-disordered sample indicated that adolescents with a generalized anxiety disorder scored significantly higher on rumination, but not on other cognitive coping strategies, than social phobic adolescents. The results suggest that cognitive coping is a valuable target for psychological assessment and treatment in adolescents.

Pre-divorce problems in 3-year-olds: A prospective study in boys and girls (Article)

2011-04-01T00:00:00Z

Objective: We examined to what extent internalizing and externalizing problems at age 3 preceded and predicted parental divorce, and if divorce and the time lapse since divorce were related to internalizing and externalizing problems at age 12. Methods: Parental ratings of internalizing and externalizing problems were collected with the Child Behavior Checklist (CBCL) in a large sample (N = 6,426) of 3-yearold children. All these children were followed through the age of 12 years, at which parents completed the CBCL again, while teachers completed the Teacher's Report Form. Children whose parents divorced between age 3 and age 12 were compared with children whose families remained intact. Results: Girls whose parents divorced between ages 3 and 12 already showed more externalizing problems at age 3 than girls whose parents stayed married. Higher levels of externalizing problems in girls at age 3 predicted later parental divorce. Parental reports indicated that 12-year-olds with divorced parents showed more internalizing and externalizing problems than children with married parents. Levels of teacher-reported problems were not different between children with married versus divorced parents. However, children whose parents divorced between ages 3 and 12 showed more teacher-rated internalizing problems at age 12 when the divorce was more recent than when the divorce was less recent. Parental ratings of both internalizing and externalizing problems at age 12 were not associated with the time lapse since divorce. Conclusion: Externalizing problems in girls precede and predict later parental divorce. Post-divorce problems in children vary by raters, and may depend on the time lapse since divorce.

Recognition of facial expressions of emotions by 3-year-olds (Article)

2011-04-01T00:00:00Z

Very few large-scale studies have focused on emotional facial expression recognition (FER) in 3-year-olds, an age of rapid social and language development. We studied FER in 808 healthy 3-year-olds using verbal and nonverbal computerized tasks for four basic emotions (happiness, sadness, anger, and fear). Three-year-olds showed differential performance on the verbal and nonverbal FER tasks, especially with respect to fear. That is to say, fear was one of the most accurately recognized facial expressions as matched nonverbally and the least accurately recognized facial expression as labeled verbally. Sex did not influence emotion-matching nor emotion-labeling performance after adjusting for basic matching or labeling ability. Three-year-olds made systematic errors in emotion-labeling. Namely, happy expressions were often confused with fearful expressions, whereas negative expressions were often confused with other negative expressions. Together, these findings suggest that 3-year-olds' FER skills strongly depend on task specifications. Importantly, fear was the most sensitive facial expression in this regard. Finally, in line with previous studies, we found that recognized emotion categories are initially broad, including emotions of the same valence, as reflected in the nonrandom errors of 3-year-olds.

Does disturbed sleeping precede symptoms of anxiety or depression in toddlers? the Generation R study (Article)

2011-04-01T00:00:00Z

OBJECTIVE: To examine whether sleep problems in infancy and early toddlerhood precede symptoms of anxiety or depression at 3 years. METHODS: Data on specific sleep problems at 2 months and 24 months were available for 4,782 children participating in a population-based cohort in The Netherlands. The Child Behavior Checklist for toddlers containing the Anxious/Depressed syndrome scale was assessed at 36 months. We adjusted the logistic regression analyses for several confounding factors; the analyses with sleep problems at 24 months were additionally adjusted for preexisting anxiety or depressive symptoms (at 18 months). RESULTS: Dyssomnia and parental presence during sleep onset at 2 months and 24 months were associated with anxiety or depressive symptoms at 3 years (e.g., parental presence: odds ratio2 months, 1.22; 95% confidence interval, 1.04-1.44; odds ratio24months, 1.58; 95% confidence interval, 1.30-1.92). Parasomnia, short sleep duration, and absence of set bedtime at 24 months, but not at 2 months, also preceded anxiety or depressive symptoms. These significant associations were not due to children's anxiety or depressive symptoms at 18 months. Rhythmicity and co-sleeping were not associated with later anxiety or depressive symptoms. Additional analyses provided little evidence for a bidirectional association with anxiety or depressive symptoms preceding later sleep problems. CONCLUSIONS: Our findings highlight the importance of sleep problems early in life, because different sleep problems are associated with the frequency of anxiety or depressive symptoms. Therefore, healthcare practitioners must be particularly attentive to these problems in young children. Future research should address possible mechanisms underlying the association between disturbed sleeping and anxiety or depressive symptoms. Copyright

CHRM2, Parental Monitoring, and Adolescent Externalizing Behavior: Evidence for Gene-Environment Interaction (Article)

2011-04-01T00:00:00Z

Psychologists, with their long-standing tradition of studying mechanistic processes, can make important contributions to further characterizing the risk associated with genes identified as influencing risk for psychiatric disorders. We report one such effort with respect to CHRM2, which codes for the cholinergic muscarinic 2 receptor and was of interest originally for its association with alcohol dependence. We tested for association between CHRM2 and prospectively measured externalizing behavior in a longitudinal, community-based sample of adolescents, as well as for moderation of this association by parental monitoring. We found evidence for an interaction in which the association between the genotype and externalizing behavior was stronger in environments with lower parental monitoring. There was also suggestion of a crossover effect, in which the genotype associated with the highest levels of externalizing behavior under low parental monitoring had the lowest levels of externalizing behavior at the extreme high end of parental monitoring. The difficulties involved in distinguishing mechanisms of gene-environment interaction are discussed.

Serotonin transporter polymorphism moderates effects of prenatal maternal anxiety on infant negative emotionality (Article)

2011-03-15T00:00:00Z

Background: Consistent with the fetal programming hypothesis, effects of maternal prenatal anxiety have been found to predict various measures of infant temperament in the early postnatal period. In recent years, a polymorphism in the serotonin transporter gene (5-HTTLPR) emerged as a moderator of diverse environmental influences on different outcomes, with individuals carrying the short allele being generally more vulnerable to adversity. Methods: We tested whether the association between self-reported maternal anxiety at 20 weeks gestation (Brief Symptom Inventory) and mother-rated infant negative emotionality at 6 months after birth (Infant Behavior Questionnaire-Revised) would be moderated by the 5-HTTLPR in a large Dutch cohort sample (n = 1513). We hypothesized that infants carrying the 5-HTTLPR short allele would be more susceptible and therefore more affected by both low and high prenatal maternal anxiety vis-à-vis negative emotionality than other genotypes. Results: Findings of a significant gene X environment interaction (B = .65, p = .01) were supportive of a vulnerability model, with infants carrying the short allele being more negatively emotional when mothers reported anxiety during pregnancy, whereas there was no difference between genotypes on negative emotionality when maternal anxiety was low. Conclusions: The association between maternal anxiety during pregnancy and negative emotionality in early infancy was significant in infants carrying one or more copies of the short allele but not in those homozygous for the long allele. The 5-HTTLPR short allele might increase vulnerability to adverse environmental influences as early as the fetal period.

No associations between single nucleotide polymorphisms in corticoid receptor genes and heart rate and cortisol responses to a standardized social stress test in adolescents: The TRAILS study (Article)

2011-03-01T00:00:00Z

Previously, sequence variation in the glucocorticoid (GR) and mineralocorticoid (MR) receptor genes (NR3C1 and NR3C2, respectively) have been found to be associated with physiological stress responses to social stress tests in small samples of adult men and oral contraceptives (OC) using women. Associations between single nucleotide polymorphisms (SNPs) in the GR (23EK-rs6190, 9beta-rs6198, BclI-rs4142324) and the MR gene (I180V-rs5522 and -2G/C (rs2070951) with cortisol and heart rate responses to a performance-related social stress task (public speaking and mental arithmetic) were examined in a large sample (n = 553) of adolescents (15-17 years). To make comparisons with previous findings, associations were tested in boys (n = 277), free-cycling (FC) girls (n = 183) and OC users (n = 93). None of the previously reported associations in adults could be replicated in this large adolescent sample. Explanations for non-replication are discussed.

Genetics of cortisol secretion and depressive symptoms: A candidate gene and genome wide association approach (Article)

2011-02-14T00:00:00Z

Background: Depressive patients often have altered cortisol secretion, but few studies have investigated genetic variants in relation to both cortisol secretion and depression. To identify genes related to both these conditions, we: (1) tested the association of single nucleotide polymorphisms (SNPs) in hypothalamic-pituitary-adrenal-axis (HPA-axis) candidate genes with a summary measure of total cortisol secretion during the day (cortisolAUC), (2) performed a genome wide association study (GWAS) of cortisolAUC, and (3) tested the association of identified cortisol-related SNPs with depressive symptoms. Methods: We analyzed data on candidate SNPs for the HPA-axis, genome-wide scans, cortisol secretion (n = 1711) and depressive symptoms (the Centre for Epidemiology Studies Depression Scale, CES-D) (n = 2928) in elderly persons of the Rotterdam Study. We used data from the Whitehall II study (n = 2836) to replicate the GWAS findings. Results: Of the 1456 SNPs in 33 candidate genes, minor alleles of 4 SNPs (rs9470080, rs9394309, rs7748266 and rs1360780) in the FKBP5 gene were associated with a decreased cortisolAUC (p < 1 × 10(-4) after correction for multiple testing using permutations). These SNPs were also associated with an increased risk of depressive symptoms (rs9470080: OR 1.19 (95%CI 1.0; 1.4)). The GWAS for cortisol yielded 2 SNPs with p-values of 1 × 10(-06) (rs8062512, rs2252459), but these associations could not be replicated. Conclusions: These results suggest that variation in the FKBP5 gene is associated with both cortisolAUC and the likelihood of depressive symptoms.

Low autonomic arousal as vulnerability to externalising behaviour in infants with hostile mothers (Article)

2011-01-30T00:00:00Z

Maternal psychopathology and the child's autonomic nervous system functioning are risk factors for aggressive behaviour later in life. While research has shown that maternal psychopathology already affects young children, less is known about the association between autonomic functioning and aggressive behaviour in young children. In addition, maternal psychopathology and autonomic nervous system functioning may interact to determine the risk of aggressive behaviour.In a sample of 375 infants and their mothers, maternal psychiatric symptoms were assessed with the Brief Symptom Inventory and toddler aggressive behaviour with the Child Behaviour Checklist. Infant heart rate was recorded at 14. months.Maternal psychiatric problems, including hostility and depression, were associated with toddler aggressive behaviour. Maternal psychiatric problems interacted with mean heart rate (P= 0.01) and HF variability (P= 0.03) in their effect on toddler aggressive behaviour.Mothers with high psychiatric problems, in particular, high hostility, were more likely to have toddlers with high aggressive behaviour. Moreover, in the presence of maternal risk factors, low autonomic arousal renders children particularly susceptible to aggressive behaviour.

Intrauterine effects of maternal prepregnancy overweight on child cognition and behavior in 2 cohorts (Article)

2011-01-01T00:00:00Z

OBJECTIVE: Greater maternal prepregnancy adiposity has been associated with behavioral problems, such as attention-deficit/hyperactivity disorder, and lower intellectual function in offspring. However, few studies of humans have explored this, and it is unclear if intrauterine mechanisms or confounding factors drive these associations. PATIENTS AND METHODS: Parental adiposity and offspring verbal skills, nonverbal skills, and behavioral problems were assessed in the British Avon Longitudinal Study of Parents and Children (N = ∼5000) and Dutch Generation R (N = ∼2500) cohorts. We aimed to determine the plausibility of intrauterine effects by (1) adjusting for multiple confounders, (2) comparing associations between maternal and paternal overweight with offspring cognition/behaviors, and (3) searching for cross-cohort consistency. RESULTS: Maternal prepregnancy overweight was associated with reduced child verbal skills (unadjusted). However, after adjusting for confounders, this result was not consistently observed in both cohorts. Maternal overweight was also associated with child total behavior problems and externalizing problems even after adjusting for confounders. However, this was observed in Generation R only and was not replicated in the British Avon Longitudinal Study of Parents and Children. No associations of maternal overweight with child attention problems, emotional/internalizing problems, or nonverbal skills were observed in either cohort. Paternal overweight was not associated with any of the child outcomes but was also less strongly related to potential confounding factors than was maternal overweight. CONCLUSIONS: Overall, we found little consistent evidence of intrauterine effects of maternal prepregnancy overweight on child cognition and behavior. Some associations initially observed were not consistently replicated across cohorts or robust to adjustment for confounding factors and, thus, are likely to reflect confounding by socioeconomic or postnatal factors. Copyright

Can the gateway hypothesis, the common liability model and/or, the route of administration model predict initiation of cannabis use during adolescence? A survival analysisthe TRAILS study (Article)

2011-01-01T00:00:00Z

Purpose There is substantial research linking tobacco and alcohol use to subsequent cannabis use, yet the specificity of this relationship is still under debate. The aim of this study was to examine which substance use modelthe gateway hypothesis, the common liability (CL) model and/or the route of administration modelbest explains the relationship between early onset of tobacco and alcohol use and subsequent cannabis use initiation. Methods We used data from 2,113 (51% female) Dutch adolescents who participated in three consecutive assessment waves (mean age: 11.09, 13.56, and 16.27 years, respectively) of the TRacking Adolescents' Individual Lives Survey study. (Pre)adolescent cannabis, tobacco and alcohol use was assessed using the Youth Self-Report and a TRacking Adolescents' Individual Lives Survey developed questionnaire. Results We found that, during adolescence, early onset of tobacco use does not pose a significantly higher risk of initiating cannabis use than early onset alcohol use. Therefore, we can rule out the route of administration model. Moreover, we found that adolescents who reported early onset comorbid use of both tobacco and alcohol have a higher likelihood to initiate cannabis use than adolescents who have tried either tobacco or alcohol. The gateway hypothesis is not broad enough to explain this finding. Therefore, the CL model best predicts our findings. Conclusion Future research on adolescent cannabis initiation should focus on testing the robustness of the CL model. Furthermore, identifying adolescents who use both tobacco and alcohol, before the age of 13, may help to curtail the onset of cannabis use.

Childhood adversity modifies the relationship between anxiety disorders and cortisol secretion (Article)

2010-12-01T00:00:00Z

Background Internalizing psychiatric disorders and early childhood adversity have both been associated with altered basal cortisol secretion. The aim of the present study is to investigate if early childhood adversity modifies the relationship between anxiety and mood disorders and cortisol secretion. Methods A sample of 429 international adoptees was followed from childhood to adulthood. In childhood, adoptive parents provided information about abuse and neglect before adoption. As adults, adoptees completed a standardized psychiatric interview to assess internalizing disorders and collected saliva samples four times a day. Analyses of covariance were performed. Results The relationship between anxiety disorders and cortisol secretion during 1 day, as measured by the area under the curve (AUC), was dependent on the experience of severe early maltreatment (p value of interaction = .03). In adoptees with an anxiety disorder, severe maltreatment was associated with lower daily cortisol secretion compared with nonmaltreated adoptees (respective AUC means: 28.19 and 36.96; difference = -8.78; confidence interval = -14.65 to -2.90; p = .004). In adoptees without an anxiety disorder, no difference in cortisol secretion was found between persons who did or did not experience severe maltreatment early in life (respective AUC means: 34.72 and 34.20; difference = .52; confidence interval = -1.92 to 2.96; p = .67). We found no modifying effect of severe early maltreatment on the relationship between mood disorders and daily cortisol secretion. Conclusions The experience of early adversities modifies the relationship between anxiety disorders and basal cortisol seretion in adults. To understand the relationship between anxiety disorders and cortisol secretion, early maltreatment has to be taken into account.

Agreement between maternal cannabis use during pregnancy according to self-report and urinalysis in a population-based cohort: The generation R study (Article)

2010-12-01T00:00:00Z

Aim: To verify self-reported information on prenatal drug use in urine because reporting in pregnancy is sensitive to stigma and might lead to misclassification. Methods: Using semiquantitative immunochemical analysis, the presence of the urinary metabolite (11-nor-Δ9-tetrahydrocannabinol- 9-carboxylic acid) was compared to self-reported prenatal cannabis use. Sensitivity and specificity for self-report and urinalysis outcomes were calculated and Yule's Y was used as an agreement measure. Results: Urine samples were available for 3,997 pregnant women. Of these women, 92 reported having used cannabis during pregnancy (2.3%) and 71 had positive urine screens (1.8%). In total 35% of the 92 women with self-reported cannabis use also had a positive urine screen. Positive urines were relatively frequent in women reporting cannabis use before pregnancy only (7.6%) and in women with missing information (2.6%). Sensitivity and specificity of urinalysis compared to self-report were 0.46 and 0.98. Sensitivity and specificity of self-report compared to urinalysis were 0.36 and 0.99. Yule's Y amounted to 0.77, indicating substantial agreement between the measures. Conclusions: Our findings illustrate the difficulties in obtaining valid information on prenatal cannabis use. To improve the quality of cannabis use data, we suggest a 2-step approach starting with self-report. Copyright

Medical predictors for long-term behavioral and emotional outcomes in children and adolescents after invasive treatment of congenital heart disease (Article)

2010-11-01T00:00:00Z

Background: The aim of the study was to test the following: (1) the predictive value of medical variables for long-term parent-reported behavioral and emotional problems in children and adolescents who underwent invasive treatment of congenital heart disease in infancy and (2) the relationship between parental psychological distress and parental reports on problems in children. Methods: The Child Behavior Checklist was used to investigate to what extent behavioral and emotional problems in 7- to 17-year-old children with congenital heart disease can be predicted by the following: (1) medical history, (2) therapeutic intervention and direct postinterventional course, (3) long-term medical course, (4) present contact with physicians, and (5) present medical status. The General Health Questionnaire was used to assess parental distress (especially anxiety). Results: Higher Child Behavior Checklist total problems scores were predicted by cardiac medication before therapeutic intervention. Palliative intervention (Rashkind procedure) before therapeutic intervention was associated with more favorable scores on total problems and externalizing. Long-term maternal distress was significantly related to parent-reported problems in children. Conclusion: Long-term behavioral and emotional outcomes are only marginally predicted by medical variables. In counseling of children with congenital heart disease and their parents, attention should be paid to long-term maternal distress that has an influence on parent-reported problems in children.

Adult outcomes of childhood dysregulation: A 14-year follow-up study (Article)

2010-11-01T00:00:00Z

Objective Using a general population sample, the adult outcomes of children who presented with severe problems with self-regulation defined as being concurrently rated highly on attention problems, aggressive behavior, and anxious-depression on the Child Behavior ChecklistDysregulation Profile (CBCL-DP) were examined. Method Two thousand seventy-six children from 13 birth cohorts 4 to 16 years of age were drawn from Dutch birth registries in 1983. CBCLs were completed by parents at baseline when children from the different cohorts were 4 to 16 years of age and sampled every 2 years for the next 14 years. At year 14 the CBCL and DSM interview data were collected. Logistic regression was used to compare and contrast outcomes for children with and without dysregulation, as measured by the latent-classdefined CBCL-DP. Sex and age were covaried and concurrent DSM diagnoses were included in regression models. Results Presence of childhood CBCL-DP at wave 1 was associated with increased rates of adult anxiety disorders, mood disorders, disruptive behavior disorders, and drug abuse 14 years later. After controlling for co-occurring disorders in adulthood, associations with anxiety and disruptive behavior disorders with the CBCL-DP remained, whereas the others were not significant. Conclusions A child reported to be in the CBCL-DP class is at increased risk for problems with regulating affect, behavior, and cognition in adulthood.

National origin and behavioural problems of toddlers: The role of family risk factors and maternal immigration characteristics (Article)

2010-11-01T00:00:00Z

In many societies the prevalence of behavioural problems in school-aged children varies by national origin. We examined the association between national origin and behavioural problems in 11/2-year-old children. Data on maternal national origin and the Child Behavior Checklist for toddlers (n = 4943) from a population-based cohort in the Netherlands were used. Children from various non-Dutch backgrounds all had a significantly higher mean behavioural problem score. After adjustment for family risk factors, like family income and maternal psychopathology, the differences attenuated, but remained statistically significant. Non-Dutch mothers with immigration risk factors, such as older age at immigration or no good Dutch language skills, reported significantly more behavioural problems in their offspring. In conclusion, the present study indicated more behavioural problems in immigrant toddlers from various backgrounds. Researchers and policymakers aiming to tackle disparities in behavioural problems should take into account that risks associated with national origin are intertwined with unfavourable family and immigration characteristics.

FKBP5 and resistant attachment predict cortisol reactivity in infants: Gene-environment interaction (Article)

2010-11-01T00:00:00Z

Quality of the parent-infant attachment relationship influences physiological stress regulation. Genetic factors also contribute to the stress regulatory HPA-axis. Quality of attachment as an index of the rearing environment (measured with the Strange Situation Procedure, SSP), and HPA-axis related SNPs (BclI, rs41423247; TthIIII, rs10052957; GR-9β, rs6198; N363S, rs6195; ER22/23EK, rs6189 and 6190; and FKBP5, rs1360780) were hypothesized to be related to cortisol reactivity in the stressful SSP. In this large population based sample, FKBP5 rs1360780, but not GR haplotype, was related to cortisol reactivity. Moreover, we found a significant interaction effect for insecure-resistant attachment and FKBP5 rs1360780, indicating a double-risk for heightened cortisol reactivity levels in infants with one or two T-alleles of the FKBP5 SNP and an insecure-resistant attachment relationship with their mother. Findings are discussed from the perspective of gene-environment interaction.

The Generation R Study: Design and cohort update 2010 (Article)

2010-11-01T00:00:00Z

The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on four primary areas of research: (1) growth and physical development; (2) behavioural and cognitive development; (3) diseases in childhood; and (4) health and healthcare for pregnant women and children. In total, 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. General follow-up rates until the age of 4 years exceed 75%. Data collection in mothers, fathers and preschool children included questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome wide association screen is available in the participating children. Regular detailed hands on assessment are performed from the age of 5 years onwards. Eventually, results forthcoming from the Generation R Study have to contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.

Children's problems predict adults' DSM-IV disorders across 24 years (Article)

2010-11-01T00:00:00Z

Objective The goal of this study was to determine continuities of a broad range of psychopathology from childhood into middle adulthood in a general population sample across a 24-year follow-up. Method In 1983, parent ratings of children's problems were collected with the Child Behavior Checklist (CBCL) in a general population sample of 2,076 children and young adolescents aged 4 to 16 years. In 2007, 24 years later, 1,339 of these individuals were reassessed with the CIDI, a standardized DSM-IV interview. We used univariate logistic regression analyses to determine the associations between children's problems and adults' psychiatric disorders. Results Parent reported total problems scores in the deviant range (>85th percentile) predicted disruptive disorders in adulthood (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 1.12.8). Adjusted for sex, age, and socioeconomic status in all analyses, deviant levels of parent-reported childhood anxiety predicted anxiety disorders in middle adulthood (OR = 1.6, 95% CI = 1.02.5). Conduct problems (i.e., cruelty to animals, lies) predicted both mood disorders (OR = 2.3, 95% CI = 1.14.8) and disruptive disorders (OR 2.1, 95% CI = 1.33.4), whereas oppositional defiant problems predicted only mood disorders (OR = 2.3, 95% CI = 1.05.2). Attention-deficit/hyperactivity problems did not predict any of the DSM-IV disorders in adulthood (OR = 0.8, 95% CI = 0.51.2). Conclusions Children with psychopathology are at greater risk for meeting criteria for DSM-IV diagnoses in adulthood than children without psychopathology, even after 24 years. Moreover, different types of continuities of children's psychopathology exist across the lifespan. We found that anxious children, oppositional defiant children, and children with conduct problems are at greater risk for adult psychopathology. Effective identification and treatment of children with these problems may reduce long-term continuity of psychopathology.

Developmental trajectories of child to adolescent externalizing behavior and adult DSM-IV disorder: results of a 24-year longitudinal study (Article)

2010-10-11T00:00:00Z

Objective: Childhood externalizing behavior is found to be relatively persistent. Developmental pathways within types of externalizing behavior have been recognized from childhood to adolescence. We aimed to describe the prediction of adult DSM-IV disorders from developmental trajectories of externalizing behavior over a period of 24 years on a longitudinal multiple birth cohort study of 2,076 children. This has not been examined yet. Methods: Trajectories of the four externalizing behavior types aggression, opposition, property violations, and status violations were determined separately through latent class growth analysis (LCGA) using data of five waves, covering ages 4-18 years. Psychiatric disorders of 1,399 adults were assessed with the CIDI. We used regression analyses to determine the associations between children's trajectories and adults' psychiatric disorders. Results: All externalizing behavior types showed significant associations with disruptive disorder in adulthood. In all antisocial behavior types high-level trajectories showed the highest probability for predicting adult disorders. Particularly the status violations cluster predicted many disorders in adulthood. The trajectories most often predicted disruptive disorders in adulthood, but predicted also anxiety, mood, and substance use disorders. Conclusions: We can conclude that an elevated level of externalizing behavior in childhood has impact on the long-term outcome, regardless of the developmental course of externalizing behavior. Furthermore, different types of externalizing behavior (i.e., aggression, opposition, property violations, and status violations) were related to different adult outcomes, and children and adolescents with externalizing behavior of the status violations subtype were most likely to be affected in adulthood.

A systematic review of prospective studies on attention problems and academic achievement: Review (Article)

2010-10-01T00:00:00Z

Objective: Our aim was to provide an overview of prospective studies that have addressed the association between attention problems (AP, i.e. symptoms of hyperactivity and inattentiveness) and academic achievement (AA). Method: We conducted a systematic search in the literature. Normal population studies and clinical studies were included. The methodological quality of each study was evaluated by objective criteria. A best evidence synthesis was used to determine the strengths of the association. Results: Sixteen studies were included. We found convincing evidence for a negative association between AP and AA. After controlling for intelligence, comorbidity, and socioeconomic status (SES), the association between the hyperactive symptoms of AP and AA was non-significant in two studies. Conclusion: Children with AP are at risk for lower AA and subsequent adverse outcomes later in life. Interventions in affected children should focus on their behavioural and educational development.

Mother's educational level and fetal growth: The genesis of health inequalities (Article)

2010-10-01T00:00:00Z

Background: Women of low socio-economic status (SES) give birth to lighter babies. It is unknown from which moment during pregnancy socio-economic differences in fetal weight can be observed, whether low SES equally affects different fetal-growth components, or what the effect of low SES is after taking into account mediating factors. Methods: In 3545 pregnant women participating in the Generation R Study, we studied the association of maternal educational level (high, mid-high, mid-low and low) as a measure of SES with fetal weight, head circumference, abdominal circumference and femur length. We did this before and after adjusting for potential mediators, including maternal height, pre-pregnancy body mass index and smoking. Results: In fetuses of low-educated women relative to those of high-educated women, fetal growth was slower, leading to a lower fetal weight that was observable from late pregnancy onwards. In these fetuses, growth of the head [-0.16 mm/week; 95% confidence interval (CI): -0.25 to -0.07; P = 0.0004], abdomen (-0.10 mm/week; 95% CI: -0.21 to 0.01; P = 0.08) and femur (-0.03 mm/week; 95% CI: -0.05 to -0.006; P = 0.01) were all slower; from mid-pregnancy onwards, head circumference was smaller, and from late pregnancy onwards, femur length was also smaller. The negative effect of low education was greatest for head circumference (difference in standard deviation score in late pregnancy: -0.26; 95% CI: -0.36 to -0.15; P < 0.0001). This effect persevered even after adjustment for the potential mediators (adjusted difference: -0.14; 95% CI: -0.25 to -0.03; P = 0.01). Conclusions: Low maternal education is associated with a slower fetal growth and this effect appears stronger for growth of the head than for other body parts. Published by Oxford University Press on behalf of the International Epidemiological Association

Infant brain development and vulnerability to later internalizing difficulties: The generation R study (Article)

2010-10-01T00:00:00Z

Objective Although clinical studies have demonstrated smaller subcortical volumes in structures such as the amygdala, hippocampus, caudate nucleus, and thalamus in adults and adolescents with depressive disorders and anxiety, no study has assessed such structures in babies, long before the development of the disorders. This study examined whether the size of the "gangliothalamic ovoid" (encompassing the basal ganglia and thalamus) assessed during infancy is associated with increased internalizing problems in early childhood. Method Cranial ultrasounds were used to assess gangliothalamic ovoid diameter and ventricular volume at 6 weeks of postnatal age; moreover, head circumference was measured. Outcome data included ratings of internalizing and externalizing problems using the Child Behavior Checklist (reported by mothers and fathers) at 18 and/or 36 months. Analyses were based on a total of 651 children. Results Smaller gangliothalamic diameter was associated with higher Child Behavior Checklist Internalizing scores at ages 18 and 36 months. Results remained significant after correcting for head circumference and were evident for the DSM-oriented subscales of anxiety problems and affective problems. Total ventricular volume was not consistently associated with Internalizing scores. Conclusions Findings associating infant brain measurements with Child Behavior Checklist mother and father reports at two time points are consistent with previous cross-sectional reports of smaller subcortical volumes in depression. Results were not simply reflective of overall brain development, because the pattern held after adjustment for head circumference. This is the first study to point toward a biological vulnerability evident in infancy, involved in the development of internalizing problems in childhood.

Perinatal complications increase the risk of postpartum depression. The Generation R Study (Article)

2010-10-01T00:00:00Z

Objective: To examine whether specific pregnancy and delivery complications are risk factors for postpartum depression. Design: A prospective longitudinal study. Setting: Rotterdam, the Netherlands. Population A cohort of 4941 pregnant women who enrolled in the Generation R Study. Methods: Information on perinatal complications was obtained from the midwife and hospital registries or by questionnaire. Logistic regression analyses were used to calculate the risk of postpartum depression for the separate perinatal complications. Main outcome measures: Postpartum psychiatric symptoms were assessed 2 months after delivery using the Edinburgh postnatal depression scale. Results: Several perinatal complications were significantly associated with postpartum depression, namely: pre-eclampsia (adjusted OR, aOR 2.58, 95% CI 1.30-5.14), hospitalization during pregnancy (aOR 2.25, 95% CI 1.19-4.26), emergency caesarean section (aOR 1.53, 95% CI 1.02-2.31), suspicion of fetal distress (aOR 1.56, 95% CI 1.08-2.27), a medically indicated delivery provided by an obstetrician (aOR 2.43, 95% CI 1.56-3.78), and hospital admission of the baby (aOR 1.45, 95% CI 1.10-1.92). Unplanned pregnancy, thrombosis, meconium-stained amniotic fluid, and Apgar score were not associated with postpartum depression after adjustment for confounding factors, such as pre-existing psychopathological symptoms and sociodemographic characteristics. The risk of postpartum depression increased with the number of perinatal complications women experienced (P < 0.001). Conclusions: We showed that several pregnancy and delivery complications present a risk for women's mental health in the postpartum period. Obstetricians, midwives, general practitioners, and staff at baby well clinics should be aware that women who experienced perinatal complications-especially those with a number of perinatal complications-are at risk for developing postpartum depression.

Perceived and physiological arousal during a stress task: Can they differentiate between anxiety and depression? (Article)

2010-09-01T00:00:00Z

Background: Anxiety and depression might be two different valid constructs that often co-occur, or they could be different manifestations of the same underlying vulnerability. A theoretical framework to address this question is the tripartite model, by Clark and Watson, which hypothesizes that physiological hyperarousal (PH) is specific for anxiety. Knowledge about the relationship between PH, psychophysiological measures, perceived arousal, and anxiety would increase our understanding of the validity of the PH construct in this model. Our objective was to assess whether (a) hypothalamic-pituitary-adrenocortical (HPA) axis functioning, and (b) perceived arousal before, during and after stress can differentiate anxious from depressive children. Methods: In a general population sample of 225 children aged 8-12 years, self-reported anxiety and depressive symptoms were assessed using the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI). Perceived arousal was assessed using a self-report questionnaire before, during and after a stress task. Basal and reactive HPA-axis functioning were used as indices for psychophysiological arousal. Results: Our data showed that the relation between perceived arousal and anxiety problems is stronger than the relation with depressive problems. Reactive HPA-axis functioning is reduced in children with depressive problems. Conclusions: Some evidence was found in support of the tripartite model. Our findings indicate that perceived arousal to a challenge might be a useful tool to assess the PH component of the tripartite model. Reactive HPA-axis functioning might be able to differentiate between anxiety and depressive problems in children in a general population sample, but effect sizes are small and replication is needed.

Reduced autonomic flexibility as a predictor for future anxiety in girls from the general population: The TRAILS study (Article)

2010-09-01T00:00:00Z

The present study investigated whether autonomic flexibility predicted future anxiety levels in adolescent boys and girls. This study is part of the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective cohort study of Dutch adolescents. The current study included a subsample of 965 individuals. Measures of autonomic flexibility, i.e., heart rate (HR) and respiratory sinus arrhythmia (RSA), were determined during the first assessment wave (T1: participants 10–12 years old). Self-reported anxiety was assessed at the first and second assessment wave (T2: participants 12–14 years old). Possible gender differences and cooccurring depressive problems were examined. In girls, low RSA predicted anxiety levels 2 years later. In boys, no associations between HR and RSA and future anxiety were found. We conclude that in adolescent girls from the general population, signs of reduced autonomic flexibility (i.e., low RSA) predict future anxiety levels. Since the effect size was small, at this point, RSA reactivity alone cannot be used to identify individuals at risk for anxiety, but should be regarded as one factor within a large group of risk factors. However, if the present findings are replicated in clinical studies, intervention programmes – in the future – aimed at normalising autonomic functioning may be helpful.

Maternal thyroid function during early pregnancy and cognitive functioning in early childhood: The generation R study (Article)

2010-09-01T00:00:00Z

Context: Thyroid hormones are essential for neurodevelopment from early pregnancy onward. Yet population-based data on the association between maternal thyroid function in early pregnancy and children's cognitive development are sparse. Objective: Our objective was to study associations of maternal hypothyroxinemia and of early pregnancy maternal TSH and free T4(FT4) levels across the entire range with cognitive functioning in early childhood. Design and Setting: We conducted a population-based cohort in The Netherlands. Participants: Participants included 3659 children and their mothers. Main Measures: In pregnant women with normal TSH levels at 13 wk gestation (SD = 1.7), mild and severe maternal hypothyroxinemia were defined as FT4concentrations below the 10th and 5th percentile, respectively. Children's expressive vocabulary at 18 months was reported by mothers using the MacArthur Communicative Development Inventory. At 30 months, mothers completed the Language Development Survey and the Parent Report of Children's Abilities measuring verbal and nonverbal cognitive functioning. Results: Maternal TSH was not related to the cognitive outcomes. An increase in maternal FT4predicted a lower risk of expressive language delay at 30 months only. However, both mild and severe maternal hypothyroxinemia was associated with a higher risk of expressive language delay across all ages [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.09-1.91; P = 0.010 and OR = 1.80; 95% CI = 1.24-2.61; P = 0.002, respectively]. Severe maternal hypothyroxinemia also predicted a higher risk of nonverbal cognitive delay (OR = 2.03; 95% CI = 1.22-3.39; P = 0.007). Conclusions: Maternal hypothyroxinemia is a risk factor for cognitive delay in early childhood. Copyright

Cognitive ability, parental socioeconomic position and internalising and externalising problems in adolescence: Findings from two European cohort studies (Article)

2010-08-01T00:00:00Z

We investigated whether cognitive ability (CA) may be a moderator of the relationship of parental socioeconomic position (SEP) with internalising and externalising problems in adolescents. We used data from two longitudinal cohort studies; the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Tracking Adolescents' Individual Lives Survey (TRAILS). Indicators of SEP were mother's education and household income. CA was estimated with IQ scores, derived from the Wechsler Intelligence Scale for Children. Internalising and externalising problems were measured with the Strengths and Difficulties Questionnaire in ALSPAC and with the Child Behavior Checklist in TRAILS. Logistic regression analyses were used to estimate the relative index of inequality (RII) for each outcome; the RII provides the odds ratio comparing the most to least deprived for each measure of SEP. In fully adjusted models an association of mother's education with externalising problems was observed [ALSPAC RII 1.42 (95%CI: 1.01-1.99); TRAILS RII 2.21 (95%CI: 1.37-3.54)], and of household income with internalising and externalising problems [pooled ALSPAC & TRAILS internalising RII 1.30 (95%CI: 0.99-1.71); pooled ALSPAC & TRAILS externalising RII 1.38 (95%CI: 1.03-1.84)]. No consistent associations were observed between mother's education and internalising problems. Results of stratified analyses and interaction-terms showed no evidence that CA moderated the association of SEP with internalising or externalising problems.

Fetal growth from mid- to late pregnancy is associated with infant development: The Generation R Study (Article)

2010-07-01T00:00:00Z

Aim: The aim of this study was to investigate within a population-based cohort of 4384 infants (2182 males, 2202 females) whether fetal growth from early pregnancy onwards is related to infant development and whether this potential relationship is independent of postnatal growth. Method: Ultrasound measurements were performed in early, mid-, and late pregnancy. Estimated fetal weight was calculated using head and abdominal circumference and femur length. Infant development was measured with the Minnesota Infant Development Inventory at 12 months (SD 1.1mo, range 10-17mo). Information on postnatal head size and body weight at 7 months was obtained from medical records. Results: After adjusting for potential confounders and for postnatal growth, faster fetal weight gain from mid- to late pregnancy predicted a reduced risk of delayed social development (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.71-0.95, p=0.008), self-help abilities (OR 0.84; 95% CI 0.73-0.98, p=0.023), and overall infant development (OR 0.65; 95% CI 0.49-0.87, p=0.003). Similar findings were observed for fetal head growth from mid- to late pregnancy. Interpretation: Faster fetal growth predicts a lower risk of delayed infant development independent of postnatal growth. These results suggest that reduced fetal growth between mid- and late pregnancy may determine subsequent developmental outcomes.

Attachment, depression, and cortisol: Deviant patterns in insecure-resistant and disorganized infants (Article)

2010-07-01T00:00:00Z

Both attachment insecurity and maternal depression are thought to affect infants' emotional and physiological regulation. In the current study, Strange Situation Procedure (SSP) attachment classifications, and cortisol stress reactivity and diurnal rhythm were assessed at 14 months in a prospective cohort study of 369 mother-infant dyads. Maternal lifetime depression was diagnosed prenatally using the Composite International Diagnostic Interview (CIDI). Insecure-resistant infants showed the largest increase in cortisol levels from pre-to post-SSP; the effect was even stronger when they had depressive mothers. Disorganized children showed a more flattened diurnal cortisol pattern compared to nondisorganized children. Findings are discussed from the perspective of a cumulative risk model.

Externalizing behaviors in preadolescents: Familial risk to externalizing behaviors and perceived parenting styles (Article)

2010-07-01T00:00:00Z

The aim was to investigate the contribution of familial risk to externalizing behaviors (FR-EXT), perceived parenting styles, and their interactions to the prediction of externalizing behaviors in preadolescents. Participants were preadolescents aged 10-12 years who participated in TRAILS, a large prospective populationbased cohort study in the Netherlands (N = 2,230). Regression analyses were used to determine the relative contribution of FR-EXT and perceived parenting styles to parent and teacher ratings of externalizing behaviors. FREXT was based on lifetime parental externalizing psychopathology and the different parenting styles (emotional warmth, rejection, and overprotection) were based on the child's perspective. We also investigated whether different dimensions of perceived parenting styles had different effects on subdomains of externalizing behavior. We found main effects for FR-EXT (vs. no FR-EXT), emotional warmth, rejection, and overprotection that were fairly consistent across rater and outcome measures. More specific, emotional warmth was the most consistent predictor of all outcome measures, and rejection was a stronger predictor of aggression and delinquency than of inattention. Interaction effects were found for FR-EXT and perceived parental rejection and overprotection; other interactions between FR-EXT and parenting styles were not significant. Correlations between FR-EXT and perceived parenting styles were absent or very low and were without clinical significance. Predominantly main effects of FR-EXT and perceived parenting styles independently contribute to externalizing behaviors in preadolescents, suggesting FREXT and parenting styles to be two separate areas of causality. The relative lack of gene-environment interactions may be due to the epidemiological nature of the study, the preadolescent age of the subjects, the measurement level of parenting and the measurement level of FREXT, which might be a consequence of both genetic and environmental factors.

Predicting adult emotional and behavioral problems from externalizing problem trajectories in a 24-year longitudinal study (Article)

2010-07-01T00:00:00Z

The aim of this study was to examine the prediction of adult behavioral and emotional problems from developmental trajectories of externalizing behavior in a 24-years longitudinal population-based study of 2,076 children. The adult psychiatric outcome of these trajectories has not yet been examined. Trajectories of the four externalizing behavior types: aggression, opposition, property violations and status violations were determined separately through latent class growth analysis using data of five waves, covering ages 4-18 years. We used regression analyses to determine the associations between children's trajectories and adults' psychiatric problems based on the Adult Self-Report. The developmental trajectories of the four types of externalizing behavior mostly predicted intrusive, aggressive and rule-breaking behavior in adulthood. Non-destructive behaviors in childhood such as opposition and status violations predict adult problems to a larger extent than destructive behaviors such as aggression and property violations. In general, children who develop through high-level trajectories are likely to suffer from both internalizing and externalizing problem behavior in adulthood, regardless the direction of change (i.e. increasing/decreasing/persisting) of the high-level trajectory. We can conclude that the level rather than the developmental change of externalizing behavior problems has a larger impact on adult outcome.

Recovery in parents of children and adolescents who survived septic shock caused by Neisseria meningitidis: A cross-sectional study (Article)

2010-06-01T00:00:00Z

Objectives: To assess psychological distress, styles of coping and disease-related psychosocial limitations in parents of children and adolescents who survived meningococcal septic shock (MSS) 4-16 years ago. Research methodology: An exploratory design using standardised questionnaires and interviews. Setting: The psychological investigation took place in the department of Child and Adolescent Psychiatry of the ErasmusMC-Sophia Children's Hospital. Main outcome measures: 87 mothers and 77 fathers participated in this study. The General Health Questionnaire was used to assess parents' psychological distress; the Utrecht Coping List to assess styles of coping. A semi-structured disease-specific interview served to explore long-term disease-related psychosocial limitations for parents. Results: MSS parents reported similar psychiatric symptoms and styles of coping in comparison to reference groups. Severity of illness and the child's age at time of illness were not significant predictors of parental psychological distress and styles of coping. The presence of somatic sequelae, cognitive or behavioural and emotional problems was not associated with the levels of parental psychiatric symptoms or styles of coping. The vast majority of parents reported no current disease-related psychosocial limitations due to the MSS. Conclusion: Parents of children who survived MSS show recovery. Nevertheless a minority still experiences emotional burden and disease-related limitations.

Employment status and the risk of pregnancy complications: The Generation R Study (Article)

2010-06-01T00:00:00Z

Objectives: This study explored the relationships of employment status, type of unemployment and number of weekly working hours, with a wide range of pregnancy outcomes. Methods: Information on employment characteristics and pregnancy outcomes was available for 6111 pregnant women enrolled in a population-based cohort study in the Netherlands. Results: After adjustment for confounders, there were no statistically significant differences in risks of pregnancy complications between employed and unemployed women. Among unemployed women, women receiving disability benefit had an increased risk of preterm ruptured membranes (OR 3.16, 95% CI 1.49 to 6.70), elective caesarean section (OR 2.98, 95% CI 1.21 to 7.34) and preterm birth (OR 2.64, 95% CI 1.32 to 5.28) compared to housewives. Offspring of students and women receiving disability benefit had a significantly lower mean birth weight than offspring of housewives (difference: -93, 95% CI -174 to -12; and -97, 95% CI -190 to -5, respectively). In employed women, long working hours (≥40 h/week) were associated with a decrease of 45 g in offspring's mean birth weight (adjusted analysis; 95% CI -89 to -1) compared with 1-24 h/weekly working hours. Conclusions: We found no indications that paid employment during pregnancy effects the health of the mother and child. However, among unemployed and employed women, women receiving disability benefit, students and women with long working hours during pregnancy were at risk for some adverse pregnancy outcomes. More research is needed to replicate these results and explain these findings. Meanwhile, prenatal care providers should be made aware of the risks associated with specific types of unemployment and long working hours.

Peer Stressors and Gender Differences in Adolescents' Mental Health: The TRAILS Study (Article)

2010-05-01T00:00:00Z

Purpose: This study tested two hypotheses about gender-specific mental health effects of peer stressors during early adolescence: (1) boys and girls are sensitive to different types of peer stressors, and (2) peer stress is associated with different mental health problems in boys and girls. Methods: These two hypotheses were tested in a prospective large population cohort of 2,084 Dutch young adolescents. Internalizing and externalizing problems were measured at baseline and follow-up, whereas stressful life events in the period between baseline and follow-up were measured retrospectively at follow-up. We performed the analyses with two types of peer stressors; victimization at school and relationship losses. Results: Relationship losses were more strongly associated with internalizing and externalizing problems in girls than boys, supporting the first hypothesis. Peer victimization at school was also associated with both types of mental health problems, but equally strong in boys and girls. Conclusions: Peer stress is unlikely to be associated with different mental health problems in boys and girls. Instead, boys and girls are more likely to be susceptible to different types of peer stressors.

Early findings of preventive child healthcare professionals predict psychosocial problems in preadolescence: The TRAILS study (Article)

2010-04-08T00:00:00Z

Objective: To develop and validate a prediction model for psychosocial problems in preadolescence using data on early developmental factors from routine Preventive Child Healthcare (PCH). Study design: The data come from the 1692 participants who take part in the TRacking Adolescents' Individual Lives Survey, a longitudinal study. Information on early developmental factors (ages 0 to 4 years) was collected from the PCH file. Parents complete the Child Behavior Checklist when their child is age 11. To examine the predictive value of PCH-registered developmental factors on preadolescent problems, several multiple logistic regression analysis were performed, in a derivation sample (n = 1058). The predictive performance of the models was then assessed with area under the curve (AUC) in a validation sample (n = 643) to evaluate the validity of these models. Results: PCH-registered behavioral problems, attention/hyperactivity problems, enuresis, education level of the father, and being male were found to significantly predict externalizing problems (odds ratios [OR] between 1.4 and 3.7). Internalizing problems were predicted by maternal smoking during pregnancy, sleep problems, and being male (ORs between 1.7 and 3.0). The model for externalizing problems had a modest discriminatory power (AUC 0.66, 95% confidence interval 0.59-0.72). However, for internalizing problems the AUC was 0.54 (95% confidence interval 0.47-0.60), indicating poor discriminatory power. Conclusions: Findings on early development as registered by PCH are modestly predictive for externalizing problems in preadolescents, but only slightly for internalizing problems. Copyright

Maternal psychological distress and fetal growth trajectories: the Generation R Study (Article)

2010-04-01T00:00:00Z

Abstract BACKGROUND: Previous research suggests, though not consistently, that maternal psychological distress during pregnancy leads to adverse birth outcomes. We investigated whether maternal psychological distress affects fetal growth during the period of mid-pregnancy until birth. METHOD: Pregnant women (n=6313) reported levels of psychological distress using the Brief Symptom Inventory (anxious and depressive symptoms) and the Family Assessment Device (family stress) at 20.6 weeks pregnancy and had fetal ultrasound measurements in mid- and late pregnancy. Estimated fetal weight was calculated using head circumference, abdominal circumference and femur length. RESULTS: In mid-pregnancy, maternal distress was not linked to fetal size. In late pregnancy, however, anxious symptoms were related to fetal size after controlling for potential confounders. Anxious symptoms were also associated with a 37.73 g [95% confidence interval (CI) -69.22 to -6.25, p=0.019] lower birth weight. When we related maternal distress to fetal growth curves using multilevel models, more consistent results emerged. Maternal symptoms of anxiety or depression were associated with impaired fetal weight gain and impaired fetal head and abdominal growth. For example, depressive symptoms reduced fetal weight gain by 2.86 g (95% CI -4.48 to -1.23, p<0.001) per week. CONCLUSIONS: The study suggests that, starting in mid-pregnancy, fetal growth can be affected by different aspects of maternal distress. In particular, children of prenatally anxious mothers seem to display impaired fetal growth patterns during pregnancy. Future work should address the biological mechanisms underlying the association of maternal distress with fetal development and focus on the effects of reducing psychological distress in pregnancy.

Serious, minor, and non-delinquents in early adolescence: The impact of cumulative risk and promotive factors. The TRAILS study (Article)

2010-04-01T00:00:00Z

This study uses a social-ecological approach to the development of delinquency. The authors emphasize that a balance between eliminating risk and enhancing protection across domains is essential in reducing problems and promoting competence. The cumulative risk and promotive effects of temperament, family and school factors in preadolescence were examined on different groups of delinquents (based on self-report) in early adolescence. Data from the first two waves of the TRAILS study (N=2,230) were used. The results provide evidence for a compensatory model that assumes main effects of risk and promotive factors on problem behavior. Accumulation of risks in preadolescence promoted being a serious delinquent in early adolescence, with the strongest effects for temperament. Accumulation of promotive effects decreased being a delinquent and supported being a nondelinquent. Furthermore, evidence is found for a counterbalancing effect of cumulative promotive and risk factors. Exposure to more promotive domains in the relative absence of risk domains decreased the percentage of serious delinquents. Our results did not support a protective model. Implications for prevention and intervention are discussed.

Determinants of somatic complaints in 18-month-old children: The generation R study (Article)

2010-04-01T00:00:00Z

ObjectiveTo investigate the effect of child temperament, maternal psychologic symptoms, maternal chronic pain, and parenting stress on children's somatic complaints.MethodsThe study was embedded in the Generation R Study, a population-based cohort study. Child somatic complaints were assessed via mother-report in 5,171 children of 18 months of age. Questionnaires assessed maternal somatic symptoms, symptoms of depression, anxiety during pregnancy and 2 months after delivery, maternal chronic pain during pregnancy, parenting stress 18 months after birth, and mother-reported child temperament 6 months after birth, as the determinants.ResultsFearful temperament, temperamental falling reactivity, maternal somatic symptoms, anxiety symptoms, and parenting stress each independently and prospectively increased the likelihood of children's somatic complaints at 18 months of age.ConclusionsIn toddlers, temperament, maternal stress, and maternal somatic symptoms seem particularly important for the development of somatic complaints, but long-term research is needed to establish causality and predictive value of these factors.

A prospective study on intrauterine cannabis exposure and fetal blood flow (Article)

2010-04-01T00:00:00Z

Background: Cannabis is commonly used among pregnant women. It is unclear whether cannabis exposure causes hemodynamic modifications in the fetus, like tobacco does. Aims: This study aims to ascertain fetal blood redistribution due to intrauterine cannabis exposure. Methods: This study was embedded in the Generation R Focus Study, a population-based cohort of parents and children followed from pregnancy onwards. In late pregnancy, fetal hemodynamics was assessed with ultrasound measurements in cannabis-exposed and non-exposed fetuses. Pregnant women reported about substance use during pregnancy. A distinction was made between continued cannabis use (n=9), cannabis use only in early pregnancy (n=14), continued tobacco use (n=85), tobacco use only in early pregnancy (n=92), and no tobacco or cannabis use during pregnancy (n=85). Results: Continued cannabis use was associated with an increased pulsatility and resistance index of the uterine artery, while discontinued cannabis use was associated with a decreased pulsatility, and resistance index, as compared to controls. Additionally, continued cannabis exposure resulted in a significantly higher uterine pulsatility index and uterine resistance index compared to tobacco exposure. Continued cannabis use was found to be associated with a smaller aortic diameter, as well. No association between intrauterine cannabis exposure and the fetal cerebral vascular system was found. Conclusions: Our findings suggest that intrauterine cannabis exposure was associated with changes in hemodynamic programming of the vascular system of the fetus in late pregnancy mainly due to tobacco exposure, but intrauterine cannabis exposure did demonstrate a specific effect on the uterine blood flow.

Predicting life-time and regular cannabis use during adolescence; The roles of temperament and peer substance use: The TRAILS study (Article)

2010-04-01T00:00:00Z

Aims The aim of the present study was to determine the mediating role of affiliation with cannabis-using peers in the pathways from various dimensions of temperament to life-time cannabis use, and to determine if these associations also contributed to the development of regular cannabis use. Methods Objectives were studied using data from 1300 participants of the Tracking Adolescents' Individual Lives Survey (TRAILS), a large, general population study of Dutch adolescents. We used parent-reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high-intensity pleasure, shyness, fearfulness, frustration and effortful control at age 10-12 years. By means of self-reports, life-time and regular cannabis use were determined at age 15-18 years, and proportion of substance-using peers was determined at ages 12-15 and 15-18 years. Models were adjusted for age, sex, intelligence and parental cannabis use. Results High-intensity pleasure odds ratio (OR) = 1.09, 95% confidence interval (CI) = 1.05-1.13 and effortful control (OR = 0.92, 95% CI = 0.89-0.96) affected the risk for life-time cannabis use through their influence on affiliation with cannabis-using peers. Shyness affected this risk independently from peer cannabis use. Only the pathway from effortful control was associated additionally with the development of regular cannabis use (OR = 0.93, 95% CI = 0.89-0.98). Conclusions Peer cannabis use and, to a lesser extent, certain temperamental characteristics affect an adolescent's risk of cannabis use, and should be considered in prevention programmes. We recommend future research to focus upon factors that potentially modify the association between temperament, affiliation with cannabis-using peers and cannabis use.

Fetal programming of infant neuromotor development: The generation R study (Article)

2010-02-01T00:00:00Z

The objective of the study was to examine whether infant neuromotor development is determined by fetal size and body symmetry in the general population. This study was embedded within the Generation R Study, a population-based cohort in Rotterdam. In 2965 fetuses, growth parameters were measured in mid-pregnancy and late pregnancy. After birth, at age 9 to 15 wks, neuromotor development was assessed with an adapted version of Touwen's Neurodevelopmental Examination. Less optimal neuromotor development was defined as a score in the highest tertile. We found that higher fetal weight was beneficial to infant neurodevelopment. A fetus with a 1-SD score higher weight in mid-pregnancy had an 11% lower risk of less optimal neuromotor development (OR: 0.89; 95% CI: 0.82-0.97). Similarly, a fetus with a 1-SD score larger abdominal-to-head circumference (AC/HC) ratio had a 13% lower risk of less optimal neuromotor development (OR: 0.87; 95% CI: 0.79-0.96). These associations were also present in late pregnancy. Our findings show that fetal size and body symmetry in pregnancy are associated with infant neuromotor development. These results suggest that differences in infant neuromotor development, a marker of behavioral and cognitive problems, are at least partly caused by processes occurring early in fetal life.

CBT for childhood anxiety disorders: differential changes in selective attention between treatment responders and non-responders (Article)

2010-02-01T00:00:00Z

Abstract BACKGROUND: This study examined whether treatment response to stepped-care cognitive-behavioural treatment (CBT) is associated with changes in threat-related selective attention and its specific components in a large clinical sample of anxiety-disordered children. METHODS: Ninety-one children with an anxiety disorder were included in the present study. Children received a standardized stepped-care CBT. Three treatment response groups were distinguished: initial responders (anxiety disorder free after phase one: child-focused CBT), secondary responders (anxiety disorder free after phase two: child-parent-focused CBT), and treatment non-responders. Treatment response was determined using a semi-structured clinical interview. Children performed a pictorial dot-probe task before and after stepped-care CBT (i.e., before phase one and after phase two CBT). RESULTS: Changes in selective attention to severely threatening pictures, but not to mildly threatening pictures, were significantly associated with treatment success. At pre-treatment assessment, initial responders selectively attended away from severely threatening pictures, whereas secondary responders selectively attended toward severely threatening pictures. After stepped-care CBT, initial and secondary responders did not show any selectivity in the attentional processing of severely threatening pictures. Treatment non-responders did not show any changes in selective attention due to CBT. CONCLUSIONS: Initial and secondary treatment responders showed a reduction of their predisposition to selectively attend away or toward severely threatening pictures, respectively. Treatment non-responders did not show any changes in selective attention. The pictorial dot-probe task can be considered a potentially valuable tool in assigning children to appropriate treatment formats as well as for monitoring changes in selective attention during the course of CBT.

Do social disadvantage and early family adversity affect the diurnal cortisol rhythm in infants? The Generation R Study (Article)

2010-02-01T00:00:00Z

Dysregulation of diurnal cortisol secretion patterns may explain the link between adversities early in life and later mental health problems. However, few studies have investigated the influence of social disadvantage and family adversity on the hypothalamic-pituitary-adrenal (HPA) axis early in life. In 366 infants aged 12-20 months from the Generation R Study, a population-based cohort from fetal life onwards, parents collected saliva samples from their infant at 5 moments over the course of 1 day. The area under the curve (AUC), the cortisol awakening response (CAR) and the diurnal cortisol slope were calculated as different composite measures of the diurnal cortisol rhythm. Information about social disadvantage and early adversity was collected using prenatal and postnatal questionnaires. We found that older infants showed lower AUC levels; moreover, infants with a positive CAR were significantly older. Both the AUC and the CAR were related to indicators of social disadvantage and early adversity. Infants of low income families, in comparison to high income families, showed higher AUC levels and a positive CAR. Infants of mothers who smoked during pregnancy were also significantly more likely to show a positive CAR. Furthermore, infants of mothers experiencing parenting stress showed higher AUC levels. The results of our study show that effects of social disadvantage and early adversity on the diurnal cortisol rhythm are already observable in infants. This may reflect the influence of early negative life events on early maturation of the HPA axis.

Cognitive coping and childhood anxiety disorders (Article)

2010-02-01T00:00:00Z

To investigate differences in cognitive coping strategies between anxiety-disordered and non-anxious 9-11-year-old children. Additionally, differences in cognitive coping between specific anxiety disorders were examined. A clinical sample of 131 anxiety-disordered children and a general population sample of 452 non-anxious children were gathered. All children filled out the child version of the Cognitive Emotion Regulation Questionnaire (CERQ-k). Structured clinical interviews were used to assess childhood anxiety disorders. Results showed that anxiety-disordered children experience significantly more 'lifetime' negative life events than non-anxious children. Adjusted for the 'lifetime' experience of negative life events, anxiety-disordered children scored significantly higher on the strategies catastrophizing and rumination, and significantly lower on the strategies positive reappraisal and refocus on planning than non-anxious children. No significant differences in cognitive coping were found between children with specific anxiety disorders. Anxiety-disordered children employ significantly more maladaptive and less adaptive cognitive coping strategies in response to negative life events than non-anxious children. The results suggest that cognitive coping is a valuable target for prevention and treatment of childhood anxiety problems.

Area Deprivation Affects Behavioral Problems of Young Adolescents in Mixed Urban and Rural Areas: The TRAILS Study (Article)

2010-02-01T00:00:00Z

Purpose: Behavioral problems occur more frequently among adolescents in deprived areas, but most evidence concerns urbanized areas. Our aim was to assess the impact of area deprivation and urbanization on the occurrence and development of behavioral problems among adolescents in a mixed urban and rural area and to examine the contributory factors. Methods: We obtained data from the first two waves (n = 2,230; mean ages, 11.5 and 13.5 years respectively; response at follow-up, 96.4%) of the TRacking Adolescents' Individual Lives Survey (TRAILS). TRAILS is a prospective study of adolescent mental health in a mixed urban and rural region of the Netherlands. We assessed adolescent behavioral problems using the parent-reported Child Behavior Checklist (CBCL), the adolescent-reported Youth Self-Report (YSR) and the Antisocial Behavior Scale (ABS). Living areas were categorized into tertiles of deprivation. We further collected data on child temperament, perceived rearing style, parental socioeconomic position (education, income and occupation), family composition, and parental mental health history. Results: At baseline, adolescents living in the most deprived tertile more frequently had elevated behavioral problem scores than those from the least deprived tertile on the CBCL (11.2% against 7.1%), YSR (11.9% against 6.9%), and ASB (11.5% against 7.4%) (all p < .05). Socioeconomic position explained half of the differences due to area deprivation. Other familial and parental characteristics did not significantly contribute to the explanation of observed area differences. Conclusions: As in highly urbanized areas, behavioral problems occur more frequently among adolescents in deprived mixed rural and urban areas. Urbanization has little effect on these area differences.

A twin-singleton comparison of developmental trajectories of externalizing and internalizing problems in 6- to 12-year-old children (Article)

2010-02-01T00:00:00Z

Research on twin-singleton differences in externalizing and internalizing problems in childhood is largely cross-sectional and yields contrasting results. The goal of this study was to compare developmental trajectories of externalizing and internalizing problems in 6- to 12-year-old twins and singletons. Child Behavior Checklist (CBCL) maternal reports of externalizing and internalizing problems were obtained for a sample of 9651 twins from the Netherlands Twin Register and for a representative general population sample of 1351 singletons. Latent growth modeling was applied to estimate growth curves for twins and singletons. Twin-singleton differences in the intercepts and slopes of the growth curves were examined. The developmental trajectories of externalizing problems showed a linear decrease over time, and were not significantly different for twins and singletons. Internalizing problems seem to develop similarly for twins and singletons up to age 9. After this age twins' internalizing symptoms start to decrease in comparison to those of singletons, resulting in less internalizing problems than singletons by the age of 12 years. Our findings confirm the generalizability of twin studies to singleton populations with regard to externalizing problems in middle and late childhood. The generalizability of studies on internalizing problems in early adolescence in twin samples should be addressed with care. Twinship may be a protective factor in the development of internalizing problems during early adolescence.

Mental health problems during puberty: Tanner stage-related differences in specific symptoms. The TRAILS study (Article)

2010-01-01T00:00:00Z

The aim of this study was to investigate associations between specific mental health problems and pubertal stage in (pre)adolescents participating in the Dutch prospective cohort study TRAILS (first assessment: N = 2230, age 11.09 ± 0.56, 50.8% girls; second assessment: N = 2149, age 13.56 ± 0.53, 51.0% girls). Mental health was assessed by the Youth Self-Report, pubertal (Tanner) stage by parent-rated drawings of secondary sex characteristics. Overall, higher Tanner stages were related to more reported tiredness, irritability, rule-breaking behaviors, and substance use; and fewer fears and somatic complaints. Girls showed increases in social uncertainty, depressed mood, and worries; boys a decrease in self-criticism. Increasing problems during puberty were mostly related to the process of physical maturation, whereas decreasing problems were rather related to general age-related developments. Pubertal timing was associated with different symptoms than pubertal status or age. Puberty seems to affect girls more negatively than boys.

Cross-national comparison of the link between socioeconomic status and emotional and behavioral problems in youths (Article)

2010-01-01T00:00:00Z

Introduction: In previous longitudinal studies in the US, lower socioeconomic status (SES) was associated with more emotional and behavioral problems. It remains unclear whether these findings can be generalized outside the US, as different countries vary in their health care systems and prevention of psychopathology in youth. Therefore, we studied the same associations in a comparable sample in The Netherlands and directly tested for differences between the US and The Netherlands. Methods: The US (N = 833) and Dutch (N = 708) population samples were followed-up for 9 years. Age at baseline ranged from 8 to 16 years. Parents filled out behavior checklists. Results: Analyses revealed very few differences between the two countries. In both countries, SES predicted syndrome scores and cumulative prevalence rates for internalizing and externalizing problems (withdrawn and aggressive behavior) and for thought and attention Problems. The SES gradient in syndrome scores was stable over time. Only for withdrawn behavior, the gradient was larger in young adulthood. Conclusion: Although the health care systems differ between the US and The Netherlands, the socioeconomic disparities in emotional and behavioral problems were similar.

Grandparental anxiety and depression predict young children's internalizing and externalizing problems. The generation R study (Article)

2010-01-01T00:00:00Z

Background: Family history is a major risk factor for child problem behaviour, yet few studies have examined the association between grandparental psychiatric disorder and child problem behaviour. Results are inconsistent as to whether the effect of grandparental depression on child problem behaviour is independent of parental psychopathology. Methods: Mothers and their children participated in an ethnically Dutch subcohort of a population-based prospective cohort in the Netherlands. N = 816 (66%) mothers and n = 691 fathers participated in the prenatal interviews. N = 687 (84%) mothers and children and n = 565 (82%) fathers participated three years postpartum. (Grand)parental psychopathology was assessed during pregnancy of the mothers with the Family Informant Schedule and Criteria (FISC), the Composite International Diagnostic Interview (CIDI) and the Brief Symptom Inventory (BSI). Child behaviour was assessed with the Child Behavior Checklist (CBCL) by mother and father when the child was three years old. Results: Grandparental anxiety disorder predicted maternal reports of children's internalizing problems (OR = 1.98, 95% C.I. (1.20, 3.28), p-value < 0.01) and externalizing problems (OR = 1.73, 95% C.I. (1.04, 2.87), p-value = 0.03), independent of parental psychopathology. Results were similar for grandparental depression; internalizing OR = 1.75, 95% C.I (1.11, 2.75), p-value = 0.02 and externalizing OR = 1.67, 95% C.I. (1.05, 2.64) p-value = 0.03. However, grandparental psychopathology was not associated with children's problem behaviour as reported by the father. Limitations: Information on grandparental lifetime psychiatric disorder was assessed through a parental interview which may have led to an underestimation of the prevalence rates. Conclusions: These results confirm the importance of a family history including not only the parental but also the grandparental generations.

DRD2 and DRD4 in relation to regular alcohol and cannabis use among adolescents: Does parenting modify the impact of genetic vulnerability? The TRAILS study (Article)

2010-01-01T00:00:00Z

Aims: The aims of the present study were to determine the direct effect of DRD2 and DRD4, as well as their interaction with parenting (i.e. rejection, overprotection and emotional warmth), on the development of regular alcohol and cannabis use in 1192 Dutch adolescents from the general population. Methods: Information was obtained by self-report questionnaires. Perceived rejection, overprotection and emotional warmth were assessed at age 10-12. Regular alcohol and cannabis use were determined at age 15-18 and defined as the consumption of alcohol on 10 or more occasions in the past four weeks, and the use of cannabis on 4 or more occasions in the past four weeks. Models were adjusted for age, sex, parental alcohol or cannabis use, and externalizing behavior. Results: Carrying the A1 allele of the DRD2 TaqIA polymorphism, or the 7 repeat DRD4, was not directly related to regular alcohol or cannabis use. In addition, adolescent carriers of these genetic risk markers were not more susceptible to the influence of less optimal parenting. Main effects for parenting indicated that overprotection increased the risk of regular alcohol use, whereas the risk of cannabis use was enhanced by parental rejection and buffered by emotional warmth. Conclusions: Our findings do not support an association between DRD2/DRD4 and regular alcohol and cannabis use in adolescents. Given the substance-specific influences of rejection, overprotection and emotional warmth, these parenting factors might be promising candidates for prevention work.

Adolescent Family Adversity and Mental Health Problems: The Role of Adaptive Self-regulation Capacities. The TRAILS Study (Article)

2010-01-01T00:00:00Z

Adolescent family adversity is a considerable adaptive challenge in an increasingly turbulent developmental period. Using data from a prospective population cohort of 2230 Dutch adolescents, we tested risk-buffering interactions between adolescent family adversity and self-regulation capacities on mental health. We used two adaptive self-regulation capacities that could allow adolescents to manage relatively well with family adversity: (1) parent-reported effortful control, and (2) an attentional flexibility (in this case, set-shifting) task. Adolescent family adversity was associated with internalizing problems and externalizing problems. The risk-buffering effects of effortful control were found for externalizing problems but not for internalizing problems. There were no risk-buffering effects of attentional flexibility on both types of mental health problems. Effortful control is likely to benefit adolescents' ability to channel their frustrations in adaptive ways in the presence of family adversity. Additionally, (attentional) set-shifting tasks might have a limited predictive value for risk-buffering research.

Testing developmental pathways to antisocial personality problems (Article)

2010-01-01T00:00:00Z

This study examined the development of antisocial personality problems (APP) in young adulthood from disruptive behaviors and internalizing problems in childhood and adolescence. Parent ratings of 507 children's (aged 6-8 years) symptoms of attention deficit hyperactivity disorder, oppositional defiant disorder, and anxiety, were linked to self-ratings of adolescents' (aged 14-16 years) symptoms of depression, substance use, conduct problems, and somatic problems, to predict self-ratings of APP in young adulthood (age 20-22 years). The findings suggested a hierarchical development of antisocial behavior problems. Despite being positively associated with conduct problems in adolescence, neither internalizing problems nor substance use added to the prediction of APP in young adulthood from conduct problems in adolescence. The developmental pathways to APP in young adulthood did not differ by gender.

No effect of classroom sharing on educational achievement in twins: A prospective, longitudinal cohort study (Article)

2010-01-01T00:00:00Z

Background: A returning dilemma for families with multiple births is whether twins should share the same, or a parallel classroom, or in other words, whether they should be separated at school or not. This study investigated the effects of sharing a classroom during primary school on cognitive achievement in twins. Method: Subjects were 839 monozygotic and 1164 dizygotic twin pairs who were registered at birth at The Netherlands Twin Register. A prospective, longitudinal study design was used with educational achievement at age 12 years, measured with a standardised test (CITO test), as outcome measure. Results: Most twin pairs (72%) shared a classroom during their schooling, 19% were in separate, but parallel, classes, and 9% "partly" shared a classroom. Twins who were in parallel classrooms had higher CITO scores (mean 539.51; SD 8.12), compared to twins who shared a classroom (537.99; SD 8.52). When controlling for socioeconomic status, and externalising problems before starting primary school (age 3), there was no significant difference in educational achievement between separated and non-separated twin pairs (p = 0.138). In addition, there was no interaction with sex or zygosity of the twins (p = 0.798). Conclusion: There is no difference in educational achievement between twins who share a classroom and twins who do not share a classroom during their primary school time. The choice of separation should be made by teachers, parents and their twin children, based on individual characteristics of a twin pair.

Temperamental risk factors for adolescent cannabis use: A systematic review of prospective general population studies temperamental risk factors for adolescent cannabis use creemers et al. (Article)

2009-12-16T00:00:00Z

In order to establish the evidence for prospective relationships between temperamental and personality indicators of behavioral undercontrol and adolescent cannabis use, we systematically searched relevant papers published through April 2008. We assessed and evaluated 14 studies, of which only 4 were considered of high quality. Using "best evidence" synthesis, we found weak to moderate evidence for prospective relations between a combination of high approach and low avoidance and several measures of cannabis use. The study's limitations are noted. This review provides suggestions and recommendations for future studies in this area. Copyright

Hypothalamic-pituitary-adrenal axis and smoking and drinking onset among adolescents: The longitudinal cohort TRacking Adolescents' Individual Lives Survey (TRAILS) (Article)

2009-11-01T00:00:00Z

Aims We examined within a prospective longitudinal study whether cortisol levels were associated with smoking or drinking behaviours, taking parental substance use into account. Design The influence of parental substance use on cortisol levels of their adolescent offspring at age 10-12 years was examined. Next, cortisol levels of adolescents who initiated smoking or drinking at the first data collection (age 10-12) were compared to non-users. Finally, we examined whether cortisol levels could predict new onset and frequency of smoking and drinking 2 years later. Setting and participants First and second assessment data of the TRacking Adolescents' Individual Lives Survey (TRAILS) were used, including 1768 Dutch adolescents aged 10-12 years, who were followed-up across a period of 2 years. Measurements Cortisol was measured in saliva samples at awakening, 30 minutes later, and at 8 p.m. at age 10-12. Self-reported substance use at age 10-12 and 13-14, and parental self-reported substance use were used. Findings Only maternal substance use was related to slightly lower adolescent cortisol levels at 8 p.m. Both maternal and paternal substance use were associated with adolescent smoking and drinking at age 13-14, although fathers' use only predicted the amount used and not the chance of ever use. Finally, higher cortisol levels were related moderately to current smoking and future frequency of smoking, but not to alcohol use. Conclusions In a general population, parental heavy substance use does not seem to affect cortisol levels consistently in their offspring. We found some evidence for higher, instead of lower, hypothalamic-pituitary-adrenal axis activity as a predictor of smoking in early adolescence.

Preadolescents' somatic and cognitive-affective depressive symptoms are differentially related to cardiac autonomic function and cortisol: The TRAILS study (Article)

2009-11-01T00:00:00Z

OBJECTIVE: To examine in a nonclinical sample of preadolescents the possibility that somatic and cognitive-affective depressive symptoms are differentially related with the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. Depression is a well-known risk factor for cardiovascular disease and mortality. Dysregulation of the ANS and the HPA axis have been proposed as underlying mechanisms. Several studies suggest that only a subset of the depression symptoms account for associations with cardiovascular prognosis. METHODS: Self-reported somatic and cognitive-affective depressive symptoms were examined in relationship to heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and the cortisol awakening response (CAR) in 2049 preadolescents (mean age = 11.1 years; 50.7% = girls) from the Tracking Adolescents' Individual Lives Survey (TRAILS). RESULTS: Physiological measurements were not associated with the overall measure of depressive symptoms. Somatic depressive symptoms were negatively related to HRV and BRS, and positively to the CAR; cognitive-affective depressive symptoms were positively related to HRV and BRS, and negatively to the CAR. Associations with the CAR pertained to boys only. CONCLUSIONS: Somatic and cognitive-affective depressive symptoms differ in their association with both cardiac autonomic and HPA axis function in preadolescents. Particularly, somatic depression symptoms may mark cardiac risk. Copyright

Seasonal variation in self-reported health and health-related behaviour in Dutch adolescents (Article)

2009-10-01T00:00:00Z

The developmental course of anxiety symptoms during adolescence: The TRAILS study (Article)

2009-10-01T00:00:00Z

Background: Little is known about the development of anxiety symptoms from late childhood to late adolescence. The present study determined developmental trajectories of symptoms of separation anxiety disorder (SAD), social phobia (SoPh), generalized anxiety disorder (GAD), panic disorder (PD), and obsessive-compulsive disorder (OCD) in a large prospective community cohort. Methods: Anxiety symptoms were assessed in a community sample of 2220 boys and girls at three time-points across a 5-year interval. The Revised Child Anxiety and Depression Scale (RCADS) was used to assess anxiety symptoms, and multilevel growth-curve analyses were performed. Results: All subtypes of anxiety first showed a decrease in symptoms (beta for age ranged from -.05 to -. 13, p < .0001), followed by a leveling off of the decrease, and a subsequent slight increase in symptoms (beta for age-squared ranged from .006 to .01, p < .0001) from middle adolescence (GAD, SoPh, SAD) or late adolescence (PD and OCD) onwards. This increase in anxiety symptoms could not be explained by a co-occurring increase in depression symptoms. Girls had more anxiety symptoms than boys, and this difference remained stable during adolescence (p < .0001). Gender differences were strongly attenuated by adjustment for symptoms of depression. Conclusions: The current study shows that, in the general population, anxiety symptoms first decrease during early adolescence, and subsequently increase from middle to late adolescence. These findings extend our knowledge on the developmental course of anxiety symptoms during adolescence. This is the first study to separate the development of anxiety symptoms from that of symptoms of depression.

Childhood-limited versus persistent antisocial behavior: Why do some recover and others do not? the TRAILS study (Article)

2009-10-01T00:00:00Z

Possible differences between childhood-limited antisocial youth and their stable high-antisocial counterparts were examined. Children were 11 years old at wave 1 (T1) and 13.5 at wave 2 (T2). At both waves, the same parent, teacher, and self-reports of antisocial behavior were used. Stable highs and childhood-limited antisocial youth differed somewhat in family and individual background. Stable highs had less effortful control, perceived more overprotection, had a higher level of familial vulnerability to externalizing disorder, and lived less often with the same parents throughout their lives than the childhood-limited group. Both groups had similar levels of service use before T1, but after that period, the childhood-limited youth received more help from special education needs services than from problem behavior services, and vice versa for stable highs. The results suggest that the childhood-limited antisocial youth recovered not only from antisocial behavior but also from academic failure, peer rejection, and internalizing problems.

The role of temperament in the relationship between early onset of tobacco and cannabis use: The TRAILS study (Article)

2009-09-01T00:00:00Z

Background: While temperamental characteristics have been related to the onset of cannabis use, it is not clear at what point(s) along the trajectory from early onset of tobacco use (EOT) to early onset of cannabis use (EOC) these characteristics exert their impact. This study examined if (1) temperamental characteristics predispose to EOT that on its turn predisposes to EOC, and (2) temperament moderates the importance of EOT on the progression to EOC. Methods: Data from 1848 (83%) participants in the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective population study of Dutch adolescents, were analyzed. We used parent-reports on the Early Adolescent Temperament Questionnaire to assess the dimensions of high-intensity pleasure, frustration, effortful control, shyness and fearfulness at age 10-12. EOT and EOC were defined as use at least once before the ages of 12 and 13 years, respectively, assessed by means of self-reports. We performed mediation and moderation analyses in Mplus. Results: High levels of high-intensity pleasure predisposed to entrance in the trajectory from EOT to EOC. Once tobacco use had been initiated at early age, low levels of shyness and high levels of high-intensity pleasure increased the risk of progression to EOC. Conclusions: Besides a common liability for EOT and EOC based on temperament, the risk of transition from tobacco to cannabis use is modified by temperamental characteristics. Differences in interplay with other risk factors may explain the impact of temperament on distinct points along the substance use trajectory.

The relation between popularity and aggressive, destructive, and norm-breaking behaviors: Moderating effects of athletic abilities, physical attractiveness, and prosociality (Article)

2009-09-01T00:00:00Z

The aim of this study was to examine the relations between popularity and different types of aggressive, destructive, and norm-breaking behaviors in a large cross-sectional sample of adolescents (N=3,312, M age=13.60). We were interested in the extent to which the relations of these behaviors with popularity were moderated by positive features (i.e., athletic abilities, physical attractiveness, and prosociality). From a goal-framing perspective, it was argued that positive features evoke positive affect, which in turn enhances the positive impact of aggressive, destructive, and norm-breaking behaviors on popularity. The results supported our notion that these latter behaviors are especially related to popularity in adolescents who also exhibit positive features.

Baseline cortisol measures and developmental pathways of anxiety in early adolescence (Article)

2009-09-01T00:00:00Z

Objective: This study investigated whether baseline cortisol measures predicted future anxiety, and compared cortisol values of groups with different developmental pathways of anxiety. Method: Cortisol levels were assessed in 1768 individuals (10-12 years). Anxiety levels were assessed at the same age and 2 years later. Results: Cortisol measures did not predict future anxiety levels. Individuals with persistent anxiety problems did not show higher morning cortisol levels than those with persistently low, decreasing, or increasing anxiety levels. Instead, individuals with persistently high anxiety levels showed significantly lower evening cortisol levels than all other individuals. Further, participants with increasing anxiety levels showed higher morning cortisol levels (area under the curve; AUC) than individuals with persistently low anxiety levels. Conclusion: The extent to which the HPA-axis - by itself - plays a role in the aetiology of anxiety is questionable. Interactions of the HPA-axis with other biological or environmental factors may be more important.

Child to adult continuities of psychopathology: A 24-year follow-up (Article)

2009-09-01T00:00:00Z

Objective: To determine continuities of mental health problems of children across a 24-year follow-up period. Method: In 1983, parent ratings of emotional and behavioral problems were collected with the Child Behavior Checklist (CBCL) in a general population sample of 2076 children. Twenty-four years later, 1365 participants completed Adult Self-Reports (ASR) to assess emotional and behavioral problems. Results: Of the participants who were classified as deviant in childhood, 22.2% were also classified as deviant in adulthood. Both homotypic and heterotypic continuity was found. Childhood aggressive, delinquent, and anxious\depressed problems were associated with most adult psychopathology. Attention problems did not predict later problems independently. Conclusion: Even though assessed with parent-reports in childhood and analogous self-reports in adulthood, and over a large period of 24 years, continuity of psychopathology was found from childhood into adulthood. Anxious\depressed problems, delinquent behavior and aggressive behavior in childhood are core predictors for adult psychopathology.

Long-term cognitive functioning in children and adolescents who survived septic shock caused by Neisseria meningitidis (Article)

2009-08-10T00:00:00Z

Aims. To assess long-term cognitive functioning and its predictors, in children and adolescents who survived meningococcal septic shock (MSS) 4 to 16 years ago. Methods. The Wechsler Intelligence Scale for Children - third edition was used to measure intellectual functioning and neuropsychological tests were used to measure attention, verbal memory, visual-motor integration, and executive skills. Results. Overall, results of the total MSS sample (N = 77) as to neuropsychological functioning were similar to those of normative reference groups. On social and practical reasoning and visual-motor integration, however,MSS children obtained poorer outcomes compared to normative data. Two children had mental retardation (estimated IQ < 70) due to the MSS. The percentage of children with mental retardation or borderline intellectual functioning (15%) was similar to that in the general population (16%). Eighteen children (23%) had a z score < - 22, indicating unusual poor functioning, on one or more domains of neuropsychological functioning (selective attention, sustained attention, and executive functioning). Compared to normative data, significantly more children had received special education services in the past. Older age at time of follow-up was the most important significant predictor of poorer long-term cognitive functioning. Conclusion. Overall, long-term outcomes as to cognitive functioning of the total MSS sample were similar to those of normative reference groups, but MSS children showed long-term impairments on social and practical reasoning, visual-motor integration, attention, and executive functioning. Older age at time of follow-up was a significant predictor.

High activity of Monoamine oxidase A is associated with externalizing behaviour in maltreated and nonmaltreated adoptees (Article)

2009-08-01T00:00:00Z

Individual differences in a functional polymorphism of the promoter of the Monoamine oxidase A (MAO-A) gene might partly explain the increased vulnerability of maltreated children for externalizing behaviour. A sample of 239 internationally adopted boys was studied. Adoptive parents provided the information about abuse and neglect before the adoption and rated externalizing behaviour of their adopted children, using the Child Behaviour Checklist. MAO-A alleles were classified in high and low activity. We found that individuals with high MAO-A activity had more externalizing behaviour than those with low MAO-A activity. No modifying effect of MAO-A on the relationship between early maltreatment on externalizing behaviour was observed. Our results suggest that in severely maltreated children, high MAO-A activity may not protect against the effects of maltreatment but may convey an increased risk for externalizing behaviour.

Adolescents' cortisol responses to awakening and social stress; Effects of gender, menstrual phase and oral contraceptives. The TRAILS study (Article)

2009-07-01T00:00:00Z

Studies on the influence of sex hormones on cortisol responses to awakening and stress have mainly been conducted in adults, while reports on adolescents are scarce. We studied the effects of gender, menstrual cycle phase and oral contraceptive (OC) use on cortisol responses in a large sample of adolescents. Data come from TRAILS (TRacking Adolescents' Individual Lives Survey), a prospective population study of Dutch adolescents. This study uses data of 644 adolescents (age 15-17 years, 54.7% boys) who participated in a laboratory session including a performance-related social stress task (public speaking and mental arithmetic). Free cortisol levels were assessed by multiple saliva samples, both after awakening and during the laboratory session. No significant effects of gender and menstrual phase on cortisol responses to awakening were found, while girls using OC displayed a slightly blunted response (F(1, 244) = 5.30, p = .02). Cortisol responses to social stress were different for boys and free-cycling girls (F(3, 494) = 9.73, p < .001), and OC users and free-cycling girls (F(3, 279) = 15.12, p < .001). Unexpectedly, OC users showed no response at all but displayed linearly decreasing levels F(1, 279) = 19.03, p < .001) of cortisol during the social stress test. We found no effect of menstrual cycle phase on cortisol responses to social stress (F(3, 157) = 0.58, p = .55). The absence of a gender difference in the adolescents' cortisol awakening response found in this study is consistent with previous reports. Our results further suggest that adolescent OC users display slightly blunted cortisol responses after awakening, and that gender differences in cortisol responses to social stress during adolescence are comparable to those described for adult populations, that is, stronger responses in men than in women. Whereas previous work in adults suggested blunted stress responses in OC users compared to men and free-cycling women, adolescent OC users showed no cortisol response. Effects of type of OC could not be studied because of low numbers of OC that were only progestin based.

Maternal symptoms of anxiety during pregnancy affect infant neuromotor development: The generation R study (Article)

2009-07-01T00:00:00Z

Several studies found that maternal symptoms of anxiety or depression are related to functioning and development of the offspring. Within a population-based study of 2,724 children, we investigated the effect of maternal anxiety or depression on infant neuromotor development. Symptoms of anxiety and depression were measured during pregnancy and after giving birth; infant neuromotor development was assessed by trained research nurses during a home visit at the age of 3 months. The current study showed that mothers who were anxious during pregnancy had an elevated risk of having an infant with non-optimal neuromotor development.

Paternal depressive symptoms during pregnancy are related to excessive infant crying (Article)

2009-07-01T00:00:00Z

OBJECTIVE: Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse. From previous research it is known that maternal depression is related to excessive crying, but so far little is known about the influence of paternal depression. METHODS: In a prospective, population-based study, we obtained information on both maternal and paternal depressive symptoms at 20 weeks of pregnancy by using the Brief Symptom Inventory. Parental depressive symptoms were related to excessive crying in 4426 two-month-old infants. The definition of excessive crying was based on the widely used Wessel's criteria (ie, crying >3 hours for >3 days in the past week). RESULTS: After adjustment for depressive symptoms of the mother and relevant confounders, we found a 1.29 (95% confidence interval: 1.09-1.52) higher risk of excessive infant crying per SD of paternal depressive symptoms. CONCLUSIONS: Our findings indicate that paternal depressive symptoms during pregnancy might be a risk factor for excessive infant crying. This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress. Copyright

Maternal smoking during pregnancy and child behaviour problems: The generation R study (Article)

2009-06-15T00:00:00Z

Background: Several studies showed that maternal smoking in pregnancy is related to behavioural and emotional disorders in the offspring. It is unclear whether this is a causal association, or can be explained by other smoking-related vulnerability factors for child behavioural problems. Methods: Within a population-based birth cohort, both mothers and fathers reported on their smoking habits at several time-points during pregnancy. Behavioural problems were measured with the Child Behavior Checklist in 4680 children at the age of 18 months. Results: With adjustment for age and gender only, children of mothers who continued smoking during pregnancy had higher risk of Total Problems [odds ratio (OR) 1.59, 95% confidence interval (CI): 1.21-2.08] and Externalizing problems (OR 1.45, 95% CI: 1.15-1.84), compared with children of mothers who never smoked. Smoking by father when mother did not smoke, was also related to a higher risk of behavioural problems. The statistical association of parental smoking with behavioural problems was strongly confounded by parental characteristics, chiefly socioeconomic status and parental psychopathology; adjustment for these factors accounted entirely for the effect of both maternal and paternal smoking on child behavioural problems. Conclusions: Maternal smoking during pregnancy, as well as paternal smoking, occurs in the context of other factors that place the child at increased developmental risk, but may not be causally related to the child's behaviour. It is essential to include sufficient information on parental psychiatric symptoms in studies exploring the association between pre-natal cigarette smoke exposure and behavioural disorders. © Published by Oxford University Press on behalf of the International Epidemiological Association

Fetal size in mid- and late pregnancy is related to infant alertness: The generation R study (Article)

2009-06-03T00:00:00Z

The vulnerability for behavioral problems is partly shaped in fetal life. Numerous studies have related indicators of intrauterine growth, for example, birth weight and body size, to behavioral development. We investigated whether fetal size in mid- and late pregnancy is related to infant irritability and alertness. In a population-based birth cohort of 4,255 singleton full-term infants ultrasound measurements of fetal head and abdominal circumference in mid- and late pregnancy were performed. Infant irritability and alertness scores were obtained by the Mother and Baby Scales at 3 months and z-standardized. Multiple linear regression analyses revealed curvilinear associations (inverted J-shape) of measures of fetal size in both mid- and late pregnancy with infant alertness. Fetal size characteristics were not associated with infant irritability. These results suggest that alterations of intrauterine growth affecting infant alertness are already detectable from mid-pregnancy onwards.

Early neglect and abuse predict diurnal cortisol patterns in adults. A study of international adoptees (Article)

2009-06-01T00:00:00Z

Neglect and abuse early in life have been associated with increased and decreased cortisol levels, and also with an altered diurnal cortisol slope. In the present study, we investigated the long-term relationship between early maltreatment - at different levels of severity - and basal cortisol secretion in adults adopted as children. A sample of international adoptees was followed from childhood to adulthood. In childhood, adoptive parents had provided information about neglect and abuse prior to adoption. As adults, adoptees collected saliva samples four times a day. The relationship between early maltreatment and cortisol secretion was examined, primarily with multilevel analyses in 623 adoptees. Morning cortisol levels were lower in adoptees whose adoptive parents had reported severe neglect or abuse than in non-neglected or non-abused participants (respective estimates (standard errors (SEs)) and p-values: -0.33 (0.090), p = 0.0002 and -0.63 (0.20), p = 0.002). Relative to non-neglected adoptees, those who had allegedly experienced severe neglect also had a flatter diurnal slope (estimate (SE) and p-value: 0.028 (0.0088), p = 0.002). In contrast, relative to non-abused participants, adoptees whose reported abuse was moderately severe had high cortisol levels and a steeper cortisol diurnal slope (respective estimates (SEs) and p-values: 0.29 (0.13), p = 0.003 and -0.039 (0.012), p = 0.01). Thus, early neglect and abuse appear to have associations with cortisol levels and the diurnal slope, even when children are raised in another environment after their early maltreatment. Our study suggests that the severity of the early maltreatment may be related to the basal cortisol pattern.

Explaining educational inequalities in birthweight: The Generation R Study (Article)

2009-05-01T00:00:00Z

Although low socio-economic status has consistently been associated with lower birthweight, little is known about the factors whereby socio-economic disadvantage influences birthweight. We therefore examined explanatory mechanisms that may underlie the association between the educational level of pregnant women, as an indicator of socio-economic status, and birthweight. The study was embedded within a population-based cohort study in the Netherlands. Information on maternal education, offspring's birthweight and several determinants of birthweight was available for 3546 pregnant women of Dutch origin. Infants of the lowest educated women had a statistically significantly lower birthweight than infants of the highest educated women [difference adjusted for gender and gestational age: -123 g (95% CI -167, -79)]. Parity, age of the pregnant women, hypertension, parental height and parental birthweight, marital status, pregnancy planning, financial concerns, number of people in household, weight gain and smoking habits individually explained part of the differences in birthweight, while adjustment for working hours and body mass index resulted in increases in birthweight differences between the educational levels. After full adjustment, the difference in birthweight between lowest and highest education was reduced by 66%. Our study confirmed remarkable educational inequalities in birthweight, a large part of which was explained by pregnancy characteristics, anthropometrics, the psychosocial and material situation, and lifestyle-related factors. Altering smoking habits may be an option to reduce educational differences in birthweight, as many lower-educated women tend to continue smoking during pregnancy. In order to tackle inequalities in birthweight, it is important that interventions are accessible for pregnant women in lower socio-economic strata.

Attention Problems, Inhibitory Control, and Intelligence Index Overlapping Genetic Factors: A Study in 9-, 12-, and 18-Year-Old Twins (Article)

2009-05-01T00:00:00Z

It is assumed that attention problems (AP) are related to impaired executive functioning. We investigated the association between AP and inhibitory control and tested to what extent the association was due to genetic factors shared with IQ. Data were available from 3 independent samples of 9-, 12-, and 18-year-old twins and their siblings (1,209 participants). AP were assessed with checklists completed by multiple informants. Inhibitory control was measured with the Stroop Color Word Task (Stroop, 1935), and IQ with the Wechsler Intelligence Scale for Children (Wechsler et al., 2002) or Wechsler Adult Intelligence Scale (Wechsler, 1997). AP and inhibitory control were only correlated in the 12-year-old cohort (r = .18), but appeared non-significant after controlling for IQ. Significant correlations existed between AP and IQ in 9- and 12-year olds (r = -.26/-.34). Inhibitory control and IQ were correlated in all cohorts (r = -.16, -.24 and -.35, respectively). Genetic factors that influenced IQ also influenced inhibitory control. We conclude that the association between AP and inhibitory control as reported in the literature may largely derive from genetic factors that are shared with IQ.

Stressful life events and depressive symptoms in young adolescents: Modulation by respiratory sinus arrhythmia? The TRAILS study (Article)

2009-04-01T00:00:00Z

Background: Respiratory sinus arrhythmia (RSA) has been proposed as a physiological marker of emotion-regulation capacity, and shown to be cross-sectionally associated with depression. Little is known about the role of RSA as a predictor of (subclinical) depressive symptoms over time and as a modifier of the depressogenic effect of stressful life events (SLEs). Methods: In a longitudinal population-based study with data collected in 1653 adolescents twice (at age 11 and 13.5 years, respectively), RSA was assessed in supine position at the first assessment wave. Depressive symptoms were assessed at both waves and SLEs experienced between the two waves at the last wave. Results: Low levels of RSA were not associated with concurrent or future depressive symptoms, and did not enhance the depressogenic effects of SLEs. Conclusions: In a normal population of young adolescents, a low level of RSA does not identify adolescents at risk for depressive symptoms when confronted with SLEs. In post hoc analyses, among those reporting high exposure to stressful life events, higher RSA tended to predict less self-reported anxiety and more self-reported somatic symptoms as compared to those with lower RSA.

Maternal Psychopathology Influences Infant Heart Rate Variability: Generation R Study (Article)

2009-04-01T00:00:00Z

Abstract OBJECTIVE: To assess the determinants of heart rate (HR) and heart rate variability (HRV) in children. The autonomic nervous system as measured by HR and HRV is considered a biological marker of psychopathology in children. METHODS: We examined the relationship of maternal psychopathology with infant HR and HRV. HR was recorded at 14 months in 528 infants. The high-frequency component of HRV was used as an indicator of cardiac vagal modulation. The presence of a lifetime maternal psychiatric diagnosis was assessed with the Composite International Diagnostic Interview. Presence of maternal psychiatric symptoms during pregnancy and 2 months after birth was assessed, using the Brief Symptom Inventory. RESULTS: A maternal history of a psychiatric disorder was associated with a 0.24-standard deviation (SD) higher mean HR in the infant (beta = 0.24, 95% Confidence Interval (CI) = 0.03, 0.4, p = .025) and a 0.14-SD lower high-frequency power (beta = -0.14, 95% CI = -0.6, -0.03, p = .003). Likewise, postnatal maternal anxiety and depression symptoms were associated with infant mean HR. A 1-point increase in the mean anxiety symptom score was associated with 0.14-SD higher mean HR in the infant (beta = 0.14, 95% CI = 0.05, 0.2, p = .004), and a 1-point increase in mean depression score with a 0.11-SD increase (beta = 0.11, 95% CI = 0.01, 0.2, p = .025). No significant associations of prenatal maternal affective symptoms with infants autonomic functioning were found. CONCLUSION: Maternal lifetime psychiatric diagnosis and postnatal psychiatric symptoms are associated with infant autonomic functioning, namely, higher mean HR and lower vagal modulation.

Buffers and Risks in Temperament and Family for Early Adolescent Psychopathology: Generic, Conditional, or Domain-Specific Effects? The TRAILS Study (Article)

2009-03-01T00:00:00Z

This study examined the possible risk-buffering and risk-enhancing role of family characteristics on the association between temperament and early adolescent externalizing and internalizing problems, adjusted for familial vulnerability for psychopathology and early childhood problem behavior. Furthermore, it explored whether these effects were specific or conditional for either internalizing or externalizing problems or more generic for psychopathology. Data on temperament (frustration and fearfulness) and family characteristics (overprotection, rejection, emotional warmth, and socioeconomic status) came from a large longitudinal Dutch population sample of early adolescents (n = 2,149; M age = 13.55 years; 51.2% girls). Hypotheses on the direction and the specificity of the effects were derived from a goal-framing approach. The findings indicate that family characteristics can either buffer or enhance the temperamental risk in the development of psychopathology. Analyses on the direction of these effects resulted in a descriptive classification of domain-specific, conditional, and generic factors that promote or protect the development of psychopathology. Implications of the results are discussed, and directions for future research are given.

Impact of early childhood adversities on adult psychiatric disorders (Article)

2009-02-12T00:00:00Z

Background: This study investigated international adoptees who were taken out of their problematic environments as a consequence of their adoption to determine the effects of early adversities on adult psychiatric disorders, and to study whether these effects emerged de novo after childhood. Methods: A total of 1,364 adoptees (63.5% of the baseline sample) were followed. Parents provided information about early adversities prior to adoption, and mental health problems in childhood and adolescence. In adulthood, adoptees completed a standardized interview, generating DSM-IV diagnoses. Results: Children who experienced multiple adversities had an increased risk of having anxiety disorders (OR = 2.22; 95% CI: 1.11-4.45), mood disorders (OR = 2.20; 95% CI: 1.00-4.86) or substance abuse/dependence (OR = 3.81; 95% CI: 1.62-8.98) in adulthood. Several effects remained significant after correction for mental health problems in childhood and adolescence. Conclusions: Severe early adversities increase the risk ofadult psychopathology, even when children are taken out of their problematic environments. Results suggest that psychiatric disorders may arise de novo after childhood due to early experiences.

Threat-Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders (Article)

2009-02-01T00:00:00Z

Abstract OBJECTIVE: The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. METHOD: Participants consisted of 131 children with anxiety disorders (aged 8-16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-probe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children). RESULTS: Selective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success. CONCLUSIONS: Threat-related selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral therapy. For these children, additional training focused on learning to disengage attention away from anxiety-arousing stimuli may be beneficial.

Externalizing behaviors in preadolescents: Familial risk to externalizing behaviors, prenatal and perinatal risks, and their interactions (Article)

2009-02-01T00:00:00Z

Background: Accumulating evidence indicates that there is a rich and varied interplay between persons and their environments, which strongly suggests that this involves gene-environment correlations and interactions. We investigated whether familial risk (FR) to externalizing behaviors and prenatal and perinatal risk factors, separately or in interaction with each other, predicted externalizing behaviors. Methods: The subjects were 10- to 12-year-old preadolescents who were taking part in TRAILS, a large prospective population-based cohort study (N = 2,230). Regression analyses were used to determine the relative contribution of FR and prenatal and perinatal risks to parent and teacher ratings of inattention, hyperactivity/impulsivity aggression, and delinquency. Results: Regression models explained between 6 and 11% of the variance of externalizing behaviors. We found main effects of FR (vs. no FR), macrosomia (birth weight > 4,500 g), maternal prenatal smoking (MPS), pregnancy and delivery complications (PDCs), and gender that were rather consistent across rater and outcome measures. For some outcome measures, the effect of MPS and PDCs depended on the presence of FR. These included both positive and negative interaction effects. Correlations between FR and prenatal and perinatal risks were significant but rather low. Conclusions: Both main effects and interaction effects of FR and prenatal and perinatal risks contributed to externalizing behaviors in preadolescents, but all effects were of small size. Further research including use of candidate gene polymorphisms is necessary to identify the underlying neurobiological mechanisms of these main and interaction effects.

Early childhood adversities and trajectories of psychiatric problems in adoptees: Evidence for long lasting effects (Article)

2009-02-01T00:00:00Z

The aim of the present study is to investigate whether early childhood adversities determine the longitudinal course of psychiatric problems from childhood to adulthood; in particular if the impact of early maltreatment on psychopathology decreases as time passes. A sample of 1,984 international adoptees was followed (955 males and 1029 females; adopted at the mean age of 29 months). Parents provided information about abuse, neglect and number of placements prior to adoption at baseline and completed the Child Behavior Checklist or the Young Adult Behavior Checklist three times when their children were between 10 and 30 years of age. Multilevel analyses were performed to determine trajectories of psychiatric problems. Experience of early childhood adversity prior to adoption substantially increased the level of psychiatric problems, especially when maltreatment was severe. Moreover, the impact of early adversities on psychiatric problems remained markedly stable. This suggests that vulnerability of early-maltreated children persists even if they are taken out of their problematic environments and are raised in enriched circumstances.

Intergenerational transmission of child problem behaviors: A longitudinal, population-based study (Article)

2009-02-01T00:00:00Z

Objective: From a developmental perspective, it is important to know to what extent childhood problem behaviors are transmitted across generations. In a longitudinal community study, we compared child behavior of parents with the behavior of their offspring. Intergenerational transmission was investigated for a broad range of problem behaviors, including internalizing problems and externalizing behavior. Sex differences were investigated as well. Method: We compared Child Behavior Checklist scores of 4- to 16-year-old children (N= 271) from a community sample assessed in 1983 with Child Behavior Checklist scores of their 6- to 18-year-old offspring (N = 424) who were assessed in 2007. Multilevel modeling was used to test intergenerational associations. Results: Most forms of problem behavior in children were predicted by the behavior of their parents as children. Parents' Internalizing, Externalizing, and Total Problem scores in childhood all predicted similar problems in their children. Sex differences were found for Delinquent Behavior: continuity was stronger in mothers than it was in fathers, and it was also stronger in sons than in daughters. Conclusions: The finding that child behavior continues across generations poses challenges in finding ways to prevent problems from being transmitted across generations.

Suggestive linkage of ADHD to chromosome 18q22 in a young genetically isolated Dutch population (Article)

2009-01-22T00:00:00Z

Attention deficit/hyperactivity disorder (ADHD) is a common, highly heritable, neuropsychiatric disorder among children. Linkage studies in isolated populations have proved powerful to detect variants for complex diseases, such as ADHD. We performed a genome-wide linkage scan for ADHD in nine patients from a genetically isolated population in the Netherlands, who were linked to each other within 10 generations through multiple lines of descent. The genome-wide scan was performed with a set of 400 microsatellite markers with an average spacing of ± 10-12cM. We performed multipoint parametric linkage analyses using both recessive and dominant models. Our genome scan pointed to several chromosomal regions that may harbour ADHD susceptibility genes. None exceeded the empirical genome-wide significance threshold, but the Log of odds (LOD) scores were > 1.5 for regions 6p22 (Heterogenetic log of odds (HLOD) = 1.67) and 18q21 - 22 (HLOD = 2.13) under a recessive model. We followed up these two regions in a larger sample of ADHD patients (n = 21, 9 initial and 12 extra patients). The LOD scores did not increase after increasing the sample size (6p22 (HLOD = 1.51), 18q21 - 22 (HLOD = 1.83)). However, the LOD score on 6p22 increased to 2 when a separate analysis was performed for the inattentive type ADHD children. The linkage region on chromosome 18q overlaps with the findings of association of rs2311120 (P = 10-5) and rs4149601 (P = 10-4) in the genome-wide association analysis for ADHD performed by the Genetic Association Information Network consortium. Furthermore, there was an excess of regions harbouring serotonin receptors (HTR1B, HTR1E, HTR4, HTR1D, and HTR6) that showed a LOD score > 1 in our genome-wide scan.

Socioeconomic position and mental health problems in pre- and early-adolescents: The trails study (Article)

2009-01-01T00:00:00Z

Background: Family socioeconomic position (SEP) is known to be associated with adolescent mental health. Whether the relationship is different for different mental health dimensions is unknown. Methods: Using a cross-sectional design, we investigated the differential effects of family SEP on multiple mental health dimensions in preadolescents (N = 2230, baseline age 10-12, 49% boys) using reports from multiple informants (parent, self, and teachers). A score equal to or higher than the 85th percentile (averaged across informants) defined mental health problems. Results: SEP was inversely associated with all dimensions. Compared to high SEP, the odds ratios (OR) for externalizing problems were 3.88 (95% confidence interval (CI): 2.56, 5.90) and 2.05 (CI: 1.34, 3.14) for low and intermediate SEP, respectively. For internalizing problems, they were 1.86 (CI: 1.28, 2.70) and 1.37 (CI: 0.94, 2.00), respectively. When adjusted for externalizing problems, SEP effects on internalizing problems materially attenuated (OR: 1.47, CI: 0.78, 1.68 and OR: 1.34, CI: 0.91, 1.96) while the converse was less pronounced (OR: 3.39, CI: 2.24, 5.15) and (OR: 1.91, CI: 1.25, 2.94). Conclusion: In early adolescence, the risk of mental health problems increases with decreasing SEP, particularly for externalizing problems. Further, the SEP-internalizing problems relationship is partly explained by shared aspects with externalizing problems.

Socioeconomic inequalities in infant temperament: The Generation R Study (Article)

2009-01-01T00:00:00Z

Background: A low socioeconomic status (SES) has consistently been associated with behavioural problems during childhood. The studies of SES and behaviour in infants used temperament as a behavioural measure. However, these studies in younger children yielded inconsistent findings. Furthermore, they generally did not examine explanatory mechanisms underlying the association between SES and temperament. We investigated the association between SES and temperament in infancy. Methods: The study was embedded in the Generation R study, a population-based cohort in The Netherlands. Maternal and paternal education, family income, and maternal occupational status were used as indicators of SES. At the age of 6 months, 4,055 mothers filled out six scales of the Infant Behaviour Questionnaire-Revised. Results: Lower SES was associated with more difficult infant temperament as measured by five of the six temperament dimensions (e.g. Fear: unadjusted z-score difference between lowest and highest education: 0.57 (95%CI: 0.43, 0.71)). Only the direction of the association between SES and Sadness was reversed. The effect of SES on Distress to Limitations, Recovery from Distress, and Duration of Orienting scores was largely explained by family stress and maternal psychological well-being. These covariates could not explain the higher levels of Activity and Fear nor the lower Sadness scores of infants from low SES groups. Conclusions: SES inequalities in temperament were already present in six months old infants and could partially be explained by family stress and maternal psychological well-being. The results imply that socioeconomic inequalities in mental health in adults may have their origin early in life.

Limited validity of parental recall on pregnancy, birth, and early childhood at child age 10 years (Article)

2009-01-01T00:00:00Z

Objective: Evidence on the validity of parental recall of early childhood behavior is lacking. Our aim was to examine the validity of parental recall at child age 10-12 years for maternal lifestyle during pregnancy, the birth characteristics, and early childhood behavior. Study Design and Setting: The study population comprised 2,230 children and their parents. Children aged 10-12 years were recruited from elementary schools (response: 76.0%). Parents were asked to recall lifestyle during pregnancy, birth characteristics, and childhood behavior at age 4-6 years. Recalled data were compared with information registered by Preventive Child Healthcare (PCH) from birth onwards. Results: For birth weight and gestational age, we found no systematic difference between recalled and PCH-registered data; 95% limits of agreement were ±1.2 pounds (600 g) and ±2.4 weeks, respectively. For maternal alcohol use during pregnancy and early childhood behavior problems, Cohen's kappas were low (0.03-0.11). Compared with PCH registration, parents tended to overreport at age 10-12 years. In contrast, kappa was high for maternal smoking during pregnancy (0.77). Conclusion: Retrospectively collected information on lifestyle during pregnancy, birth, and early childhood behavior is sometimes biased, which limits its value in estimating the contribution of early-life adversity to health in later life.

Maternal folic acid supplement use in early pregnancy and child behavioural problems: The Generation R Study (Article)

2009-01-01T00:00:00Z

Folate deficiency during embryogenesis is an established risk factor for neural tube defects in the fetus. An adequate folate nutritional status is also important for normal fetal growth and brain development. The aim of the present research was to study the association between folic acid use of the mother during pregnancy and child behavioural development. Within a population-based cohort, we prospectively assessed folic acid supplement use during the first trimester by questionnaire. Child behavioural and emotional problems were assessed with the Child Behaviour Checklist at the age of 18 months in 4214 toddlers. Results showed that children of mothers who did not use folic acid supplements in the first trimester had a higher risk of total problems (OR 1·44; 95 % CI 1·12, 1·86). Folic acid supplement use protected both from internalising (OR of no supplement use 1·65; 95 % CI 1·24, 2·19) and externalising problems (OR 1·45; 95 % CI 1·17, 1·80), even when adjusted for maternal characteristics. Birth weight and size of the fetal head did not mediate the association between folic acid use and child behaviour. In conclusion, inadequate use of folic acid supplements during early pregnancy may be associated with a higher risk of behavioural problems in the offspring. Folic acid supplementation in early pregnancy, aimed to prevent neural tube defects, may also reduce mental health problems in children.

Maternal depressive symptoms, and not anxiety symptoms, are associated with positive mother-child reporting discrepancies of internalizing problems in children: a report on the TRAILS Study (Article)

2009-01-01T00:00:00Z

Maternal internalizing problems affect reporting of child's problem behavior. This study addresses the relative effects of maternal depressive symptoms versus anxiety symptoms and the association with differential reporting of mother and child on child's internalizing problems. The study sample comprised a cohort of 1,986 10- to 12-year-old children and their mothers from the Dutch general population in a cross sectional setup. Children's internalizing problems were assessed with the DSM-IV anxiety and affective problem scales of the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). Current maternal internalizing problems were assessed with the depressive and anxiety symptom scales of the Depression Anxiety Stress Scale (DASS), while the TRAILS Family History Interview (FHI) measured lifetime maternal depression and anxiety. Results show that current and lifetime maternal depressive symptoms were associated with positive mother-child reporting discrepancies (i.e. mothers reporting more problems than their child). Considering the small amount of variance explained, we conclude that maternal depressive symptoms do not bias maternal reporting on child's internalizing problems to a serious degree. Studies concerning long term consequences of mother-child reporting discrepancies on child's internalizing problems are few, but show a risk for adverse outcome. More prognostic research is needed.

Prospective community study of family stress and anxiety in (pre)adolescents: the TRAILS study (Article)

2009-01-01T00:00:00Z

For prevention of anxiety in children and adolescents, it is important to know whether family stress is a predictor of anxiety. We studied this in 1,875 adolescents from the Tracking Adolescents' Individual Lives Survey (TRAILS) who were followed up for 2 years, from age 10-12 to 12-14 years. Adolescents reported anxiety and depression symptoms at both assessments, and parents reported family stress (family dysfunction and parenting stress) at the first assessment. Family dysfunction was not associated with future anxiety, whereas high parenting stress was. Furthermore, family dysfunction was more strongly associated with anxiety than with depression, whereas parenting stress was more strongly associated with depression. Level of parental psychopathology explained part of the association of family stress with anxiety. The associations were modest and the understanding of the origins of adolescents' anxiety will require identifying other factors than family stress that account for more of the variance.

Beliefs about mental health problems and help-seeking behavior in Dutch young adults (Article)

2009-01-01T00:00:00Z

Abstract BACKGROUND: Mental health problems in young adults are frequent and impairing, but are often left untreated. This study among young adults with self-perceived mental health problems examines beliefs about mental health problems (i.e. their cause, consequences, timeline, and controllability) and help-seeking behaviour. METHOD: A cross-sectional population survey (n = 2,258) in the south-west Netherlands. Participants were included who reported having mental health problems during the past year (n = 830). Beliefs about cause, consequences, timeline, and controllability of self-perceived mental health problems were assessed with the Illness Perception Questionnaire. Internalizing and externalizing psychopathology was assessed with the Adult Self-Report. RESULTS: A multivariate logistic regression analysis indicates that independent of sex, age, and severity of psychopathology, higher levels on the intra-psychic causes scale (OR = 1.95, 95%CI = 1.48-2.58), the consequences scale (OR = 1.81, 95%CI = 1.40-2.33), and the treatment control scale (OR = 1.97, 95%CI = 1.60-2.41) are associated with an increased likelihood of mental health service use, while higher levels of personal control (OR = 0.76, 95%CI = 0.62-0.93) are associated with a decreased likelihood. CONCLUSIONS: Beliefs that may encourage young adults with mental health problems to seek professional help include the beliefs that mental health problems have adverse consequences and that treatment can help. Since these beliefs are related to young adults' knowledge of mental health problems, help-seeking behavior may be encouraged by educating young adults about mental health problems and the effective mental health treatments which are available.

Cohort profile: The Dutch 'TRacking Adolescents' individual lives' survey'; TRAILS (Article)

2008-12-15T00:00:00Z

The generation R study: Design and cohort update until the age of 4 years (Article)

2008-12-01T00:00:00Z

The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health from fetal life until young adulthood. The study focuses on four primary areas of research: (1) growth and physical development; (2) behavioural and cognitive development; (3) diseases in childhood; and (4) health and healthcare for pregnant women and children. In total, 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Of all eligible children at birth, 61% participate in the study. In addition, more detailed assessments are conducted in a subgroup of 1,232 pregnant women and their children. Data collection in the prenatal phase and postnatal phase until the age of 4 years includes questionnaires, detailed physical and ultrasound examinations, behavioural observations and biological samples. This paper gives an update of the study design and cohort profile until the children's age of 4 years. Eventually, results forthcoming from the Generation R Study have to contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.

Demographic, emotional and social determinants of cannabis use in early pregnancy: The Generation R study (Article)

2008-12-01T00:00:00Z

Aims: To ascertain demographic, emotional and social determinants of cannabis use in early pregnancy. Design: This study was embedded in the Generation R study, a multiethnic population-based cohort of parents and their children, followed from pregnancy to childhood. Setting: Rotterdam, The Netherlands. Participants: Mothers enrolled in pregnancy who answered questions about their own and their partners substance use before and during pregnancy (n = 7610). Measurements: Using self-report questionnaires, information was collected on maternal demographics, psychopathology, delinquency, childhood trauma, social stress, family functioning, and parental alcohol, tobacco and substance use. Multinomial logistic regression analysis was used, with non-using women as reference. Findings: 246 (3.2%) women used cannabis before pregnancy and 220 (2.9%) women used cannabis both before and during pregnancy. The strongest determinant for maternal cannabis use during pregnancy was cannabis use by the biological father of the child (OR = 38.56; 95%CI = 26.14-58.88). Maternal cannabis use during pregnancy was also independently associated with being single (OR = 4.25; 95%CI = 2.33-7.75) or having a partner without being married (OR = 2.75; 95%CI = 1.56-4.85), childhood trauma (OR = 1.39; 95%CI = 1.22-1.57) and delinquency (OR = 3.37; 95%CI = 1.90-5.98), but not with maternal age, ethnicity, psychopathology, family functioning and perceived stress. Being religious was protective (Islam: OR = 0.25; 95%CI = 0.09-0.65) for maternal cannabis use during pregnancy. Additionally, lower educational level determined continued cannabis use in ever-users (OR = 3.22; 95%CI = 1.54-6.74). Conclusions: Our results showed that multiple demographic, emotional and social characteristics were associated with maternal cannabis use. These characteristics should be considered when investigating offspring exposed to cannabis in utero, as they may play an important role in mother-child interaction and child development.

What is spared by fetal brain-sparing? Fetal circulatory redistribution and behavioral problems in the general population (Article)

2008-11-01T00:00:00Z

Intrauterine growth restriction has been linked to infant behavioral problems. While typically only birth weight is examined, here the authors assessed fetal circulatory redistribution, also called the "brain-sparing effect," which is a fetal adaptive reaction to placental insufficiency. They aimed to investigate whether fetal circulatory redistribution protects against behavioral problems. Within the Generation R Study (Rotterdam, the Netherlands, 2003-2007), fetal circulation variables for the umbilical artery and the middle and anterior cerebral arteries were assessed with Doppler ultrasound in late pregnancy. Ratios between placental resistance and cerebral resistance were related to behavioral problems, as measured by the Child Behavior Checklist, in 935 toddlers aged 18 months. The umbilical/anterior cerebral ratio was associated with the Total Problems summary score from the Child Behavior Checklist (per standard-deviation increase, odds ratio = 1.2, 95% confidence interval: 1.0, 1.5). Children with higher umbilical/anterior cerebral ratios had higher risks of internalizing problems, emotional reactivity, somatic complaints, and attention problems. A high umbilical/middle cerebral ratio was related to higher scores on the Internalizing and Somatic Complaints scales. The authors conclude that infants with circulatory redistribution in gestation are more likely to have behavioral problems. This suggests that "brain-sparing" does not completely spare the brain and indicates underlying pathology with consequences for later behavior.

Long-term intellectual functioning and school-related behavioural outcomes in children and adolescents after invasive treatment for congenital heart disease (Article)

2008-11-01T00:00:00Z

In this study, long-term intellectual functioning and school-related behavioural outcomes were assessed in a patient sample that underwent invasive treatment for congenital heart disease (ConHD) between 1990 and 1995. The Wechsler Intelligence Scale for Children-Revised was used to measure intellectual functioning and the Teacher's Report Form to assess teacher-reported behavioural and emotional problems. Overall, patients had IQ scores that fell within the normal range. The total sample of ConHD children (N=117, 7-16 years old), however, obtained significantly lower mean scores on Verbal IQ and Verbal Comprehension than reference children. When compared with same-aged reference peers from the general population, 7-11-year-old ConHD children obtained significantly lower mean scores on Total IQ, Verbal IQ, Verbal Comprehension, and Perceptual Organization. In contrast, scores of 12-16-year-old ConHD children appeared to be significantly lower on Verbal Comprehension only and significantly higher on Performance IQ. No significant differences were found in intellectual functioning between ConHD boys and girls, nor between different diagnostic groups. The school-related behavioural and emotional adjustment of this sample of children with treated ConHD was favourable. Overall, this sample of recently treated ConHD children, and especially children aged 7-11 years, showed poorer intellectual functioning in several areas. These findings deserve further attention.

Does gestational duration within the normal range predict infant neuromotor development? (Article)

2008-10-01T00:00:00Z

Aim: To examine the extent to which infant neuromotor development is determined by gestational duration and birth weight within the normal range. Methods: The study was embedded within the Generation R Study, a population-based cohort in Rotterdam, the Netherlands. An adapted version of Touwen's Neurodevelopmental Examination was used to assess 3224 infants (1576 males and 1648 females) at corrected ages between 9 and 15 weeks. Non-optimal neuromotor development was defined as a score in the highest tertile. Results: Infant neuromotor development was significantly affected by gestational duration (odds ratio 0.8, 95% confidence interval 0.7;0.8). Adding a quadratic term of gestational duration to the model revealed a highly significant curvilinear association between gestational duration and neuromotor development; after adjusting for post-conceptional age this was still significant. Although babies with a 1 kg lower birth weight had a 30% higher risk of non-optimal neuromotor development, this association disappeared after adjustment for post-conceptional age. Conclusions: Our findings indicate that differences in infant neuromotor development can be explained even by variations in gestational duration within the normal range. If an infant is found to have minor neuromotor delays, account should be taken of this.

Young adults face major barriers to seeking help from mental health services (Article)

2008-10-01T00:00:00Z

Objective: Mental health problems often emerge in young adulthood. Although effective treatments are available, young adults are unlikely to seek professional help. This study examined barriers-to-care in young adults with serious internalizing or externalizing problems. Methods: Population-based study among 2258 19-32-year olds in the south-west region of the Netherlands. Barriers-to-care were examined in participants with serious internalizing or externalizing problems who did not seek professional help. A potential barrier was that participants denied that they had mental health problems. In those admitting problems, barriers were assessed with the Barriers-to-Care checklist and analyzed with Latent Class Analysis. Results: Of 362 participants with serious internalizing or externalizing problems 237 (65.5%) did not seek professional help. Of non-help-seeking young adults 36% denied having problems; additionally Latent Class Analysis revealed that 37% Perceived Problems as Self-Limiting (e.g., they believed that problems were not serious) and 24% Perceived Help-Seeking Negatively (e.g., they believed that treatment would not help). Conclusions: Young adults' barriers-to-care reflect limitations in their knowledge of mental health problems and available treatments, but possibly also a failure of existing mental health services to engage young people. More knowledge is urgently needed about the effectiveness of mental health treatments for young adults specifically. Practice implications: Treatment accessibility for young adults may be augmented by improving their mental health literacy.

Optimal use of multi-informant data on co-occurrence of internalizing and externalizing problems: The TRAILS study (Article)

2008-09-30T00:00:00Z

Strong between-informant discrepancies are found in ratings of (pre)adolescent problems and in co-occurrence rates between different domains of psychopathology. These discrepancies can be caused by differences in the context of measurement and the perspective of informants. The aim of this study was to develop a "Multi-Informant Co-occurrence" model (MIC), which takes into account these differences in context and perspective. In a population-based cohort of (pre)adolescents (n = 2230) from a longitudinal study in the north of the Netherlands, internalizing (INT) and externalizing (EXT) problems were rated by the (pre)adolescents themselves, their teachers, and their parents. As hypothesized Principal Component Analysis revealed four independent main components: Between-domain convergence was captured by a severity component (S), while between-domain discrepancy was captured by a direction component (D). Between-informant discrepancies were captured by a perspective (P) and a context (C) component. The use of this MIC-model will increase reliability and validity of measures of psychopathology and the four components each provide useful specific information. Copyright

Behavioural, emotional, and post-traumatic stress problems in children and adolescents, long term after septic shock caused by Neisseria meningitidis (Article)

2008-09-01T00:00:00Z

Objectives. To assess the occurrence of a wide range of behavioural, emotional, and post-traumatic stress problems in children and adolescents, long term after septic shock caused by Neisseria meningitidis (MSS). Design. This study included 6- to 17-year-old patients who survived MSS and were admitted to the PICU of the Medical Centre between 1988 and 2001. To assess behavioural, emotional, and post-traumatic stress problems, the Child Behaviour Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR) were used. Methods. Parents of 89 MSS children, aged 6-17 years, completed the CBCL. Teachers of 65 same-aged MSS children completed the TRF, and 45 11- to 17-year-old MSS children completed the YSR. These data were compared with those from the normative reference groups. Results. Overall, the proportions of MSS children scoring in the deviant range for problem behaviour were comparable to the proportions in the reference groups, according to parents', teachers', and self-reports. As to the level of emotional and behavioural problems, mothers of the MSS children reported more somatic complaints regarding their children in comparison with the reference groups. Severity of illness was not a significant predictor of behavioural, emotional, and post-traumatic stress problems. Age at the time of illness was a significant predictor of behavioural, emotional, and post-traumatic stress problems in MSS children, indicating that the younger the child at the time of illness, the more problems were reported by parents at follow-up. Conclusion. Overall, the results showed long-term behavioural, emotional, and post-traumatic stress outcomes for MSS children, which were comparable to those in the general population.

Ten-year increase in service use in the Dutch population (Article)

2008-09-01T00:00:00Z

Since earlier research has indicated an increase in mental health problems among Dutch children, we investigated whether service use for mental health problems has also increased. Subsequently, we investigated whether a possible increase could be explained by child, family and socio-demographic characteristics that increase the likelihood of service use. We compared two population samples of 6- to 18-year-olds, one assessed in 1993 and one in 2003. Chi-square tests were conducted to examine differences between the proportions of service-users. We performed a logistic regression to test whether care-promoting factors accounted for the effect of year. Results showed that service use increased from 1993 to 2003, but not among children with high CBCL scores. Having serious problems, living in a family other than two biological parents, and having educational problems all increased the likelihood of service use and became more present in the Dutch population. These variables accounted for 49% reduction in the Odds Ratio of the effect of year. Although the proportion of children who used services increased from 1993 to 2003, still a large number of children experience an unmet need. The increase in the number of children from a family structure other than two biological parents or who have educational problems is a worrisome development in itself.

Associations between ethnicity and self-reported hallucinations in a population sample of young adults in The Netherlands (Article)

2008-08-01T00:00:00Z

Background: Psychotic disorders are more common in people from ethnic minorities. If psychosis exists as a continuous phenotype, ethnic disparities in psychotic disorder will be accompanied by similar ethnic disparities in the rate of psychotic symptoms. This study examined ethnic disparities in self-reported hallucinations in a population sample of young adults. Method: A cross-sectional population survey (n=2258) was carried out in the south-west Netherlands. Seven ethnic groups were delineated: Dutch natives, Turks, Moroccans, Surinamese/Antilleans, Indonesians, other non-Western immigrants (mostly from Africa or Asia) and Western immigrants (mostly from Western Europe). Self-reported auditory and visual hallucinations were assessed with the Adult Self-Report (ASR). Indicators of social adversity included social difficulties and a significant drop in financial resources. Results: Compared to Dutch natives, Turkish females [odds ratio (OR) 13.48, 95% confidence interval (CI) 5.97-30.42], Moroccan males (OR 8.36, 95% CI 3.29-21.22), Surinamese/Antilleans (OR 2.19, 95% CI 1.05-4.58), Indonesians (OR 4.15, 95% CI 1.69-10.19) and other non-Western immigrants (OR 3.57, 95% CI 1.62-7.85) were more likely to report hallucinations, whereas Western immigrants, Turkish males and Moroccan females did not differ from their Dutch counterparts. When adjusting for social adversity, the ORs for self-reported hallucinations among the non-Western immigrant groups showed considerable reductions of 28% to 52%. Conclusions: In a general population sample, several non-Western immigrant groups reported hallucinations more often than Dutch natives, which is consistent with the higher incidence of psychotic disorders in most of these groups. The associations between ethnicity and hallucinations diminished after adjustment for social adversity, which supports the view that adverse social experiences contribute to the higher rate of psychosis among migrants. Copyright

Victimisation and suicide ideation in the TRAILS study: Specific vulnerabilities of victims (Article)

2008-08-01T00:00:00Z

Background: Scientific studies have provided some support for a link between being a victim of bullying and suicide ideation. We examine whether (1) parental psychopathology and (2) feelings of rejection (at home and at school) exacerbate vulnerability to suicide ideation in victims of bullying (pure victims and bully-victims). Method: Data were from a population-based cohort study of Dutch children (n = 1526, mean age = 12.29 years). Using peer nominations, three groups were established: (1) victim only; (2) bully-victims (children who are victims and who also bully others); (3) uninvolved. Self-report data on suicide ideation were obtained using two items from the Youth Self-Report (Achenbach, 1991). Parental internalising and externalising disorders were assessed, as were self-reported feelings of rejection at home and social well-being among classmates. Results: The association between victimisation and suicide ideation was moderated by parental internalising disorders (but not externalising disorders) and feelings of rejection at home. Victims (but not bully-victims) with parents with internalising disorders reported elevated levels of suicide ideation compared to children uninvolved in bullying. Victims feeling more rejected at home also reported more suicide ideation. There were no overall sex differences in suicide ideation. Surprisingly, bully-victims did not report higher levels of suicide ideation compared to children uninvolved in bullying. Conclusions: Parental internalising disorders and feelings of rejection at home confer a specific vulnerability for suicide ideation among victims of bullying.

Smoking during pregnancy in ethnic populations: The Generation R study (Article)

2008-08-01T00:00:00Z

Patterns and correlates of maternal smoking could differ according to ethnic background, and these differences might have consequences for intervention strategies. In the Generation R study, we examined patterns of smoking during pregnancy and the associations of socioeconomic (educational level), demographic (maternal age, marital status, generational status, parity) and lifestyle (alcohol consumption, partner smoking) correlates with smoking during pregnancy in 5,748 women of Dutch, Turkish, Moroccan, Surinamese-Hindustani, Surinamese-Creole, Capeverdean and Antillean ethnic background. Smoking rates before pregnancy were highest in the Turkish group (43.7%) and lowest in the Moroccan group (7.0%). Compared with Dutch women (24.1%), Turkish and Moroccan women were less likely to quit smoking before pregnancy (17.0% and 5.9%, respectively; p<.001). Turkish and Moroccan women (72.0% and 70.6%, respectively) were more likely to continue smoking during pregnancy compared to Dutch women (58.6%, p<.001). Lower education was associated with smoking during pregnancy only in the Dutch group. No significant association of education with smoking was seen in the non-Dutch groups. Second-generation (i.e., foreign-born) Turkish and Capeverdean women were more likely to smoke during pregnancy compared with first-generation women. Partner smoking was associated with smoking during pregnancy in all ethnic groups except for Surinamese-Creole and Antillean. Maternal alcohol consumption was associated with smoking during pregnancy in all ethnic groups except for Capeverdean. Smoking rates and correlates of smoking during pregnancy varied by ethnic background. These observations should be considered when designing maternal smoking prevention and intervention strategies.

Predicting young adult social functioning from developmental trajectories of externalizing behaviour (Article)

2008-07-01T00:00:00Z

Background. The long-term consequences of child and adolescent externalizing problems often involve a wide spectrum of social maladaptation in adult life. The purpose of this study was to describe the predictive link of child and adolescent externalizing developmental trajectories to social functioning in adulthood. Method. Social functioning was predicted from developmental trajectories of parent-reported aggression, opposition, property violations and status violations that were defined in a longitudinal multiple birth cohort study of 2076 males and females aged 4-18 years. Social functioning was assessed using self-reports by young adults aged 18-30 years. Linear and logistic regression analyses were used to describe the extent to which developmental trajectories are prospectively related to social functioning. Results. Children with high-level trajectories of opposition and status violations reported more impaired social functioning as young adults than children with high-level trajectories of aggression and property violations. Young adults who showed onset of problems in adolescence reported overall less impaired social functioning than individuals with high-level externalizing problems starting in childhood. Overall, males reported more impaired social functioning in adulthood than females. However, females with persistent high-level externalizing behaviour reported more impairment in relationships than males with persistent high-level externalizing behaviour. Conclusion. The long-term consequences of high levels of opposition and status violations in childhood to serious social problems during adulthood are much stronger than for individuals who show only high levels of aggressive antisocial behaviours. Copyright

Explaining Educational Inequalities in Preterm Birth. The Generation R Study (Article)

2008-06-18T00:00:00Z

BACKGROUND: Although a low socioeconomic status has consistently been associated with an increased risk of preterm birth, little is known about the pathways through which socioeconomic disadvantage influences preterm birth. AIM: To examine mechanisms that might underlie the association between the educational level of pregnant women as an indicator of socioeconomic status, and preterm birth. METHODS: The study was nested in a population-based cohort study in the Netherlands. Information was available for 3830 pregnant women of Dutch origin. FINDINGS: The lowest-educated pregnant women had a statistically significant higher risk of preterm birth (odds ratio (OR) = 1.89 (95% CI 1.28 to 2.80)) than the highest educated women. This increased OR was reduced by up to 22% after separate adjustment for age, height, preeclampsia, intrauterine growth restriction, financial concerns, long-lasting difficulties, psychopathology, smoking habits, alcohol consumption, and body mass index (BMI) of the pregnant women. Joint adjustment for these variables resulted in a reduction of 89% of the increased risk of preterm birth among low-educated pregnant women (fully adjusted OR = 1.10 (95% CI 0.66 to 1.84)). CONCLUSIONS: Pregnant women with a low educational level have a nearly twofold higher risk of preterm birth than women with a high educational level. This elevated risk could largely be explained by pregnancy characteristics, indicators of psychosocial well-being, and lifestyle habits. Apparently, educational inequalities in preterm birth go together with an accumulation of multiple adverse circumstances among women with a low education. A number of explanatory mechanisms unravelled in the present study seem to be modifiable by intervention programmes.

Low Heart Rate: A Marker of Stress Resilience. The TRAILS Study (Article)

2008-06-15T00:00:00Z

Background: The stimulation-seeking theory posits that individuals with low habitual autonomic arousal levels will seek stimulation to increase their arousal to more optimal levels. Because of their assumed high optimal stimulation levels, persons characterized by low autonomic arousal may be better able to endure stressors than those with higher levels. In this study, we tested the hypothesis that low resting heart rate (HR) and high respiratory sinus arrhythmia (RSA) protect against the detrimental effects of stressors on mental health in early adolescents from the general population. Methods: Data were collected as part of TRacking Adolescents' Individual Lives Survey (TRAILS), a large prospective cohort of Dutch (pre)adolescents (N = 1478), with measurements at approximately age 11 (T1) and age 13.5 (T2). Internalizing and externalizing mental health problems were assessed at both waves, using multiple informants. Resting HR ands RSA were assessed at T1 and the amount of parent-reported stressors and long-term difficulties at T2. Results: Stressors predicted mental health problems in adolescents with intermediate and high HR, but not in those with low HR. These findings were consistent regardless of the measure used to assess stressors and of adjustment for T1 mental health problems. Furthermore, the stress-buffering effects of low HR pertained to both externalizing problems and internalizing problems. No stress-buffering effects were found for RSA, suggesting predominantly sympathetic influences. Conclusions: Our study, which linked physiologic measures to stress sensitivity in real life, suggests that low HR is a marker of resilience to the effects of environmental challenges in early adolescence.

Parental divorce and offspring depressive symptoms: Dutch developmental trends during early adolescence (Article)

2008-05-01T00:00:00Z

In this study, we investigated if the association between parental divorce and depressive symptoms changes during early adolescence and if developmental patterns are similar for boys and girls. Data were collected in a prospective population cohort of Dutch adolescents (N = 2,149), aged 10 - 15 years. Outcome variables were self-reported and parent-reported depressive symptoms. The effects of divorce were adjusted for parental depression. In both self-reported and parent-reported data, we found a three-way interaction of gender, age, and parental divorce, indicating that with increasing age, parental divorce became more strongly associated with depressive symptoms among girls, but not boys. These results suggest that girls with divorced parents are at particularly high risk to develop depressive symptoms during adolescence.

HPA-axis activity as a predictor of future disruptive behaviors in young adolescents (Article)

2008-05-01T00:00:00Z

Low HPA-axis activity has been proposed as a risk factor for disruptive behaviors. However longitudinal data on this topic are practically lacking. In the present study we investigated if low HPA-axis activity predicted future disruptive behaviors. We included 1,399 boys and girls from the Dutch general population, initially aged 10-12 years. At the first assessment, basal cortisol levels were assessed. At the first assessment and at follow-up 2 years later disruptive behaviors were assessed with parent and self-report questionnaires. The results suggest that the association between low cortisol levels at 8.00 p.m. and future disruptive behaviors according to the parents was only present for boys. More importantly however, the results suggest that low HPA-axis activity is not a good predictor for disruptive behaviors, but could be valuable to identify those with a poor prognosis, once disruptive behaviors are present in preadolescence. Copyright

Prosocial and antisocial behavior in preadolescence: Teachers' and parents' perceptions of the behavior of girls and boys (Article)

2008-05-01T00:00:00Z

There has been recent emphasis on the importance of investigating prosocial and antisocial behavior simultaneously owing to doubts about whether examining one automatically gives information about the other. However, there has been little empirical research into this question. The present study (based on a large population sample of preadolescents, N = 2,230) simultaneously examines prosocial and antisocial behavior, explicitly including the possibility that children might show prosocial behavior according to one informant and antisocial behavior according to another. When parents and teachers agreed in their judgments, children were distinctly profiled and differed clearly in effortful control, intelligence, academic performance, and several peer nominations and family characteristics. The correlates were more rater-specific for children that were prosocial according to one informant and antisocial according to the other informant. Teachers and parents used different context-dependent criteria for judging children to be prosocial or antisocial. Academic performance and peer relations were related to the teacher's judgment of prosocial and antisocial behavior. By contrast, children's being problematic at home (and thus causing stress for the parents) was related to the parents' judgment.

Ten-year trends in self-reported emotional and behavioral problems of Dutch adolescents (Article)

2008-05-01T00:00:00Z

Background: Research comparing population samples from different time periods to investigate secular changes in adolescents' psychosocial problems have mostly focused on parent and teacher reports. The few studies using self-reports have limitations, such as using only school-based samples or investigating a limited range of problems. Aim: We investigated changes from 1993 to 2003 in Dutch 11- to 18-year-old girls' and boys' self-reported emotional and behavioral problems. We also examined whether trends were different for various socio-demographic groups. Method: We used the Youth Self-Report (YSR) to assess emotional and behavioral problems, and obtained self-reports of police contact, substance abuse, suicidal ideation and self-harm across two adolescent population samples, assessed in 1993 and 2003. To investigate whether reports were different for the 2 years, we performed analyses of variance on the mean scores, and chi-square analyses on the percentages of deviant-scoring children and children reporting specific problem behaviors for boys and girls separately. Logistic regressions were conducted to investigate interactions of year with various socio-demographic variables. Results: For boys, results showed a few small changes, indicating decreases from 1993 to 2003 in self-reported Social Problems, Externalizing, Aggressive Behavior, and Rule- Breaking Behavior. For girls, Thought problems, Somatic Complaints, Internalizing problems, suicidal ideation and self-harm increased. Drunkenness and drug use increased for both boys and girls. There were some differences between socio-demographic groups. Boys from low-SES families and younger adolescent girls experienced most increases. Conclusion: We found evidence for some small trends in self-reported problems. For boys, some decreases were seen, regarding mostly behavioral problems, whereas for girls, some increases were seen in emotional and behavioral problems. Changes appeared to have most negatively affected young adolescent girls' functioning.

Parent-reported sleep problems during development and self-reported anxiety/depression, attention problems, and aggressive behavior later in life (Article)

2008-04-01T00:00:00Z

Objective: To examine associations between sleep problems during development and subsequent emotional and behavioral difficulties. Design: Prospective longitudinal study. Setting: The Dutch province of Zuid-Holland. Participants: At time 1 of data collection, a representative sample of 2076 children aged 4 to 16 years participated in the study. Outcome Measures: Parents rated their children's (4-19 years old) sleep at 5 assessments by completing the Child Behavior Checklist. Participants reported on their own emotional and behavioral symptoms at a later assessment (when aged 18-32 years) by completing the Young Adult Self-Report. Results: After adjusting for sex, age, socioeconomic status, and parent-rated scores through development for the difficulty being predicted, having any parental reports of sleeping less than others was a risk indicator of high scores on the Anxious/Depressed scale (odds ratio, 1.43; 95% confidence interval, 1.07-1.90; P=.01) and the Aggressive Behavior scale (odds ratio, 1.51; 95% confidence interval, 1.13-2.02; P=.005). There was some (albeit less robust) support for links between other reported sleep difficulties and later problems. Parental reports of sleeping more than others and nightmares were not associated with later difficulties. Conclusions: Physicians should inquire about sleep problems during child development and should be aware that some, but perhaps not others, may constitute risk indicators of later difficulties.

Maternal anxiety predicts favourable treatment outcomes in anxiety-disordered adolescents (Article)

2008-04-01T00:00:00Z

Objective: To determine the differential impact of maternal and paternal internalizing psychopathology on cognitive-behavioural treatment (CBT) outcome of anxiety-disordered children and adolescents. Method: Participants consisted of 127 children and 51 adolescents with a primary anxiety diagnosis. Children were randomly assigned to a standardized group CBT or individual CBT; adolescents received individual CBT. Parents received four training sessions. Participants were evaluated at pre- and post-treatment with a clinical interview and with self- and parent-reported questionnaires. Lifetime anxiety and mood disorders in parents were obtained with a clinical interview. Results: For children, no associations were found between maternal and paternal anxiety or mood disorders and treatment outcome. For adolescents, however, maternal lifetime anxiety disorders were positively associated with pre-post-treatment improvement in clinician severity ratings and with treatment success. Conclusion: Lifetime maternal anxiety disorders were significantly associated with favourable treatment outcomes in adolescents. Paternal disorders were not associated with treatment response.

Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: Evidence for distinctions between DSM-IV subtypes (Journal of Abnormal Child Psychology DOI: 10.1007/s10802-006-9093-0) (Article)

2008-04-01T00:00:00Z

Self-Esteem in Children and Adolescents After Septic Shock Caused by Neisseria meningitidis: Scars Do Matter (Article)

2008-04-01T00:00:00Z

Purpose: To investigate self-esteem and its relation to scars, amputations, and orthopedic sequelae in children and adolescents long term after meningococcal septic shock (MSS) caused by Neisseria meningitidis. Methods: The Dutch versions of the Self-Perception Profile for Children (SPP-C; 8-11 years) and the Self-Perception Profile for Adolescents (SPP-A; 12-17 years) were used to assess self-esteem. The Patient and Scar Assessment Scale (PSAS) was used to evaluate scar severity. Results: MSS boys aged 8-11 years achieved higher, more favorable scores on self-esteem, whereas same-aged MSS girls reported comparable levels of self-esteem compared with the respectively same-aged reference boys and girls. MSS boys and girls aged 12-17 years obtained unfavorable scores on self-esteem compared with respectively same-aged reference boys and girls. Overall gender did not have an effect on self-esteem. Severity of illness, age at time of illness, and age at time of follow-up were not significant predictors of self-esteem. MSS adolescents with scars reported lower global self-worth than MSS adolescents without scars. The worse MSS children evaluated their scars, the worse their outcomes on social acceptance. The worse MSS adolescents evaluated their scars, the worse their outcomes on close friendship, but the better their outcomes on social acceptance and behavioral conduct. Conclusion: In this cross-sectional study, favorable outcomes for self-esteem were found in MSS children, whereas MSS adolescents reported lower self-esteem compared with reference adolescents. Adolescents with scars reported lower global self-worth than MSS adolescents without scars.

Long-term behavioural and emotional problems in four cardiac diagnostic groups of children and adolescents after invasive treatment for congenital heart disease (Article)

2008-03-28T00:00:00Z

Aims: To assess the occurrence of a wide range of behavioural and emotional problems long-term after invasive treatment for congenital heart disease (ConHD) in infancy and childhood. Methods: Parents of 125 ConHD children, aged 7-17, completed the Child Behavior Checklist and 85, 11-17-year-old, ConHD children completed the Youth Self-Report. Results: According to parents' reports of problem behaviours a significant proportion of ConHD children scored in the deviant range (16.9%) compared to the reference group (10.2%). The proportion of ConHD boys scoring in the deviant range according to parents (21.4%) was significantly greater than that in the reference sample (10%). Parents reported significantly higher problems scores for the scales Somatic Complaints, Social Problems, Attention Problems, Internalising and Total Problems compared to the reference group. In contrast, reports of patients were comparable to those of reference peers. No differences were found on the self-reports between problem scores for different cardiac diagnostic groups. Discrepancies between self- and parent-reports were found, indicating that more problems were reported by ConHD patients themselves than by their parents. Conclusion: Overall, parents of ConHD patients reported higher levels of behavioural and emotional problems compared to the reference group whereas patients themselves reported no long-term behavioural impairment compared to same-sex reference peers. Assessing behavioural and emotional problems in ConHD patients can be helpful to detect children at risk for developing psychopathology. Especially younger male ConHD patients deserve special attention.

A historical comparison of long-term behavioral and emotional outcomes in children and adolescents after invasive treatment for congenital heart disease (Article)

2008-03-01T00:00:00Z

Background/Purpose: Children with congenital heart disease (ConHD) are known to be vulnerable to behavioral and emotional problems. In this study, a historical comparison is made between the level of behavioral and emotional problems in a sample of children and adolescents with ConHD treated recently vs a comparable historical sample operated upon before 1980 in the same institute. The hypothesis was that improvements in medical care would result in more favorable behavioral and emotional outcomes for children and adolescents with ConHD treated recently, that is, between 1990 and 1995, compared with same-aged patients operated on before 1980. Methods: To assess behavioral and emotional problems, the Child Behavior Checklist (parent report) and Youth Self-Report were used. The historical samples (n = 98 and n = 123, respectively) and recent samples (n = 90 and n = 84, respectively) consisted of 4 diagnostic groups. Results: Parents and patients from the recent sample with ConHD reported fairly similar levels of behavioral and emotional problems compared with parents and patients in the historical sample with ConHD. Conclusion: Despite evident improvements in diagnostic and surgical techniques and medical treatment of ConHD over the past decades, virtually no changes were found in levels of problem behavior of the recent patient sample compared with the historical patient sample, who both underwent invasive treatment for ConHD.

Foetal growth determines cerebral ventricular volume in infants. The Generation R Study (Article)

2008-02-15T00:00:00Z

The cerebral ventricular system is a marker of brain development and a predictor of neurodevelopmental outcome. In premature or dysmature neonates, neuroanatomical structures including the ventricular system appear to be altered. The present study aims to provide information on the association between foetal growth and neonatal cerebral ventricular size in the normal population. Within the Generation R Study, a population-based cohort study, we used three-dimensional cranial ultrasound to determine lateral ventricular volume in 778 term infants aged 4-12 weeks. Foetal growth characteristics were repeatedly measured in early, mid- and late pregnancy and analysed in relation to ventricular volume divided by head circumference. Results revealed positive associations between foetal head circumference in late pregnancy and log-transformed ventricular volume (β = 0.077, 95% confidence interval (0.017; 0.136), equivalent to a 7.7% increase in ventricular volume per standard deviation of head circumference). Similarly, in a per week-longer gestational duration, ventricular volume in infancy was 6.0% larger. Multilevel modelling demonstrated that reduced growth of foetal head circumference and biparietal diameter during pregnancy were associated with decreased ventricular volume in infancy. In conclusion, foetal maturation is positively associated to cerebral ventricular size in term infants. Larger ventricular size in term infants needs to be distinguished from ventricular enlargement due to intraventricular haemorrhage or white matter damage in premature or dysmature infants. Moreover, the naturally occurring enlargement of ventricles during infancy should be considered in interpreting reports on increased ventricular volumes in several neuropsychiatric disorders.

Genetic and environmental influences on self-reported and parent-reported behavior problems in young adult adoptees (Article)

2008-02-01T00:00:00Z

The aim of the present study was to estimate the genetic, shared and nonshared environmental contributions to self-reported and parent-reported internalizing and externalizing problems in a follow-up study of intercountry adopted young adults. Young Adult Self-Report ratings were obtained from 1475 adoptees aged 22-32 years and Young Adult Behavior Checklist ratings from 1115 adoptive parents. For the genetic analyses, a subset of 143 adopted biologically related and 295 unrelated siblings was used. The data were subjected to model fitting decomposing three sources of variance: genetic factors (A) shared environment (C) and nonshared environment (E). Genetic factors were of more importance in both self-reported (A2= 54%, C2= 0, and E2= 46%) and parent-reported (A2= 76%, C2= 15% and E2= 9%) internalizing problems. Environmental factors were of more importance in both self-reported (A2= 33%, C2= 17% and E2= 50%) and parent-reported (A2= 28%, C2= 27% and E2= 45%) externalizing problems. This was in contrast with findings from the first and second assessments in the same sample during adolescence when genetic factors were more important in explaining externalizing problems compared with internalizing problems. Our results suggest a developmental reversal in genetic and environmental influences on behavior problems from early adolescence into adulthood, which could be related to different underlying developmental trajectories.

Genetic and environmental influences on the relation between attention problems and attention deficit hyperactivity disorder (Article)

2008-01-01T00:00:00Z

Objective: The assessment of symptoms of ADHD in children is usually based on a clinical interview or a behavior checklist. The aim of the present study is to investigate the extent to which these instruments measure an underlying construct and to estimate the genetic and environmental influences on individual differences in ADHD. Methods: Maternal ratings were collected on 10,916 twins from 5,458 families. Child Behavior Checklist (CBCL) ratings were available for 10,018, 6,565, and 5,780 twins at the ages 7, 10, and 12, respectively. The Conners Rating Scale (4,887 twins) and the DSM interview (1,006 twins) were completed at age 12. The magnitude of genetic and environmental influences on the variance of the three measures of ADHD and the covariance among the three measures of ADHD was obtained. Results: Phenotypic correlations range between .45 and .77. Variances and covariances of the measurements were explained mainly by genetic influences. The model that provided the best account of the data included an independent pathway for additive and dominant genetic effects. The genetic correlations among the measures collected at age 12 varied between .63 and 1.00. Conclusions: The genetic overlap between questionnaire ratings and the DSM-IV diagnosis of ADHD is high. Clinical and research implications of these findings are presented.

Sex differences on the WISC-R in Belgium and The Netherlands (Article)

2008-01-01T00:00:00Z

Sex differences on the Dutch WISC-R were examined in Dutch children (350 boys, 387 girls, age 11-13 years) and Belgian children (370 boys, 391 girls, age 9.5-13 years). Multi-group covariance and means structure analysis was used to establish whether the WISC-R was measurement invariant across sex, and whether sex differences on the level of the subtests were indicative of sex differences in general intelligence (g). In both samples, girls outperformed boys on the subtest Coding, while boys outperformed girls on the subtests Information and Arithmetic. The sex differences in the means of these three subtests could not be accounted for by the first-order factors Verbal, Performance, and Memory. Measurement invariance with respect to sex was however established for the remaining 9 subtest. Based on these subtests, no significant sex differences were observed in the means of the first-order factors, or the second-order g-factor. In conclusion, the cognitive differences between boys and girls concern subtest-specific abilities, and these sizeable differences are not attributable to differences in first-order factors, or the second-order factor g.

Stressful life events and depressive problems in early adolescent boys and girls: The influence of parental depression, temperament and family environment (Article)

2008-01-01T00:00:00Z

Background: Stressful life events increase the probability of depressive problems in early adolescence. Several genetic and environmental risk factors may change individual sensitivity to the depressogenic effect of these events. We examined modification by parental depression and gender, and mediation of the former by temperament and family environment. Methods: Data were collected as part of a longitudinal cohort study of (pre)adolescents (n = 2127). During the first assessment wave at approximately age 11, we assessed parental depression, family functioning, perceived parenting behaviours, and temperamental frustration and fearfulness. At the second wave, about two and a half years later, stressful life events between the first and second assessment were assessed. Depressive problems were measured at both waves. Results: Adolescents with parents who had a (lifetime) depressive episode were more sensitive to the depressogenic effect of stressful events than adolescents without depressed parents. Furthermore, girls are more sensitive to these effects than boys. The modifying effect of parental depression was not mediated by temperament, family functioning and perceived parenting. Limitations: Life events were assessed without consideration of contextual information. Depressive problems were measured by questionnaires that did not directly represent DSM-IV criteria. The measure of parental depression was unspecific regarding severity and timing of depressive episodes. Conclusion: The results suggest that gender and parental depression are associated with increased sensitivity to depression after experiencing stressful life events during adolescence.

Development of parent- and teacher-reported emotional and behavioural problems in young people with intellectual fisabilities: Does level of intellectual disability matter? (Article)

2008-01-01T00:00:00Z

This study described similarities and differences in the 5-year stability and change of problem behaviour between youths attending schools for children with mild to borderline (MiID) versus moderate intellectual disabilities (MoID). A two-wave multiple-birth-cohort sample of 6 to 18-year-old was assessed twice across a 5-year interval using the Developmental Behaviour Checklist Primary Carer version (n = 718) and Teacher version (n = 313). For most types of problem behaviour youths with MiID and MoID showed similar levels of stability of individual differences, persistence and onset of psychopathology. Whenever differences were found, youths with MoID showed the highest level of stability, persistence and onset across informants. Mean levels of parent-reported, but not teacher-reported, problem behaviour, regardless of level of intellectual disability, decreased during the 5-year follow-up period. Youths with MoID and MiID are at risk for persistent psychopathology to a similar degree. Different informants showed to have a different evaluation of the level and the amount of change of problem behaviour, and should be considered complementary in the diagnostic process.

Twenty-year trends in emotional and behavioral problems in Dutch children in a changing society (Article)

2007-12-01T00:00:00Z

Objective: Research into changes in the prevalence of children's psychiatric diagnoses has indicated an increase in recent decades. However, methodological problems may have influenced results. This study compared children's emotional and behavioral problem levels across three population samples from different time points across 20 years, assessed with identical methodologies. Method: We compared Child Behavior Checklists and Teacher's Report Forms across three population samples of 6- to 16-year olds, assessed in 1983, 1993, and 2003. Results: We found evidence for small increases in the mean population levels of parent-reported problems, and in the percentages of children with serious problems. These changes concerned mostly internalizing problems. Teacher reports showed less changes. Decreases in scores were found on several areas of competence. Changes were the strongest between 1993 and 2003. Conclusion: We found evidence for small increases in Dutch children's problems. Further developments must be monitored, as this trend may continue and have serious societal consequences.

The Generation R Study Biobank: A resource for epidemiological studies in children and their parents (Article)

2007-12-01T00:00:00Z

The Generation R Study is a population-based prospective cohort study from fetal life until young adulthood. The study is designed to identify early environmental and genetic causes of normal and abnormal growth, development and health from fetal life until young adulthood. In total, 9,778 mothers were enrolled in the study. Prenatal and postnatal data collection is conducted by physical examinations, questionnaires, interviews, ultrasound examinations and biological samples. Major efforts have been conducted for collecting biological specimens including DNA, blood for phenotypes and urine samples. In this paper, the collection, processing and storage of these biological specimens are described. Together with detailed phenotype measurements, these biological specimens form a unique resource for epidemiological studies focused on environmental exposures, genetic determinants and their interactions in relation to growth, health and development from fetal life onwards.

Explaining differences in birthweight between ethnic populations. The Generation R Study (Article)

2007-12-01T00:00:00Z

Objective: To examine whether differences in birthweight of various ethnic groups residing in the Netherlands can be explained by determinants of birthweight. Design: Population-based birth cohort study. Setting: Data of pregnant women and their partners in Rotterdam, the Netherlands. Population: We examined data of 6044 pregnant women with a Dutch, Moroccan, Turkish, Capeverdean, Antillean, Surinamese-Creole, Surinamese-Hindustani and Surinamese-other ethnic background. Methods: Regression analyses were used to assess the impact of biomedical, socio-demographic and lifestyle-related determinants on birthweight differences. Main outcome measure: Birthweight was established immediately after delivery in grams. Results: Compared with mean birthweight of offspring of Dutch women (3485 g, SD 555), the mean birthweight was lower in all non-Dutch populations, except in Moroccans. Differences ranged from an 88-g lower birthweight in offspring of the Turkish women to a 424-g lower birthweight in offspring of Surinamese-Hindustani women. Differences in gestational age, maternal and paternal height largely explained the lower birthweight in the Turkish, Antillean, Surinamese-Creole and Surinamese-other populations. Differences in birthweight between the Dutch and the Capeverdean and Surinamese-Hindustani populations could only partly be explained by the studied determinants. Conclusions: These results confirm significant differences in birthweight between ethnic populations that can only partly be understood from established determinants of birthweight. The part that is understood points to the importance of determinants that cannot easily be modified, such as parental height. Further study is necessary to obtain a fuller understanding.

Across the continuum of attention skills: A twin study of the SWAN ADHD rating scale (Article)

2007-11-01T00:00:00Z

Introduction: Most behavior checklists for attention problems or attention deficit/hyperactivity disorder (ADHD) such as the Child Behavior Checklist (CBCL) have a narrow range of scores, focusing on the extent to which problems are present. It has been proposed that measuring attention on a continuum, from positive attention skills to attention problems, will add value to our understanding of ADHD and related problems. The Strengths and Weaknesses of ADHD symptoms and Normal behavior scale (SWAN) is such a scale. Items of the SWAN are scored on a seven-point scale, with in the middle 'average behavior' and on the extremes 'far below average' and 'far above average'. Method: The SWAN and the CBCL were completed by mothers of respectively 560 and 469 12-year-old twin pairs. The SWAN consists of nine DSM-IV items for Attention Deficit (AD) and nine DSM-IV items for Hyperactivity/Impulsivity (HI). The CBCL Attention Problem (AP) scale consists of 11 items, which are rated on a three-point scale. Results: Children who had a score of zero on the CBCL AP scale can be further differentiated using the SWAN, with variation seen between the average behavior and far above average range. In addition, SWAN scores were normally distributed, rather than kurtotic or skewed as is often seen with other behavioral checklists. The CBCL AP scale and the SWAN-HI and AD scale were strongly influenced by genetic factors (73%, 90% and 82%, respectively). However, there were striking differences in genetic architecture: variation in CBCL AP scores is in large part explained by non-additive genetic influences. Variation in SWAN scores is explained by additive genetic influences only. Conclusion: Ratings on the SWAN cover the continuum from positive attention skills to attention and hyperactivity problems that define ADHD. Instruments such as the SWAN offer clinicians and researchers the opportunity to examine variation in both strengths and weaknesses in attention skills.

Ethnic disparities in mental health and educational attainment: Comparing migrant and native children (Article)

2007-11-01T00:00:00Z

Study background and aims: Ethnic disparities in mental health in adolescence may play a role in the development of ethnic disparities in educational attainment. The aim of this study was to assess the contribution of ethnic disparities in mental health problems in adolescence to ethnic disparities in educational attainment in adulthood. Methods: We followed two community samples of respectively 486 Dutch native and 168 Turkish migrant adolescents (11-15 years old) into adulthood (21-25 years old). Mental health was measured in adolescence, and educational attainment was assessed in adulthood. The contribution of mental health disparities to educational disparities was estimated by the degree of attenuation of the odds ratio (OR) for low education after adjustment for mental health problems. Results: Adult Turkish men more often had attained lower education than Dutch men (OR 1.81 (1.01-3.25)). Additional adjustment for mental health problems during adolescence did not change the OR. In Turkish women, however, the OR was 1.94 (1.04-3.62), and adjustment for mental health problems lowered it by 96% to 1.04 (0.51-2.14). The contribution was mostly due to ethnic disparities in internalizing problems. Conclusion: In women, but not in men, ethnic disparities in mental health, especially internalizing problems, were a strong predictor for the development of ethnic disparities in educational attainment. Prevention or treatment of internalizing problems among Turkish girls will probably contribute to the prevention of educational disparities.

The dyadic nature of bullying and victimization: Testing a dual-perspective theory (Article)

2007-11-01T00:00:00Z

For this study, information on Who Bullies Who was collected from 54 school classes with 918 children (M age = 11) and 13,606 dyadic relations. Bullying and victimization were viewed separately from the point of view of the bully and the victim. The two perspectives were highly complementary. The probability of a bully-victim relationship was higher if the bully was more dominant than the victim, and if the victim was more vulnerable than the bully and more rejected by the class. In a bully-victim dyad, boys were more often the bullies. There was no finding of sex effect for victimization. Liking reduced and disliking increased the probability of a bully-victim relationship.

Long-term associations of childhood suicide ideation (Article)

2007-11-01T00:00:00Z

OBJECTIVE: We investigated in a prospective longitudinal population-based study whether childhood suicide ideation is associated with negative mental health outcome in adulthood. METHOD: A total of 1,022 Dutch children who were 11 years or younger in 1983 were prospectively followed over 10 to 14 years into adulthood. Parent reports of suicide ideation in childhood (11 years or younger; n = 20) were examined in relation to mental health in adulthood assessed with a structured psychiatric interview (mood disorder, anxiety disorder, alcohol abuse/dependence, and externalizing disorder) and self-reported suicide ideation and history of suicide attempt. RESULTS: Childhood suicide ideation was highly predictive of suicide ideation in adulthood (odds ratio 10.70, 95% confidence interval 3.26-35.09), and lifetime history of suicide attempt (odds ratio 5.80, 95% confidence interval 1.53-22.02). Childhood suicide ideation was associated with an increased likelihood of mood disorder and anxiety disorder in adulthood and to a lesser extent externalizing disorder, although these effects decreased considerably after adjusting for childhood internalizing and externalizing behavior. CONCLUSIONS: Suicide ideation in childhood may be a stable characteristic with worrying consequences in adulthood. Children with parent-reported suicide ideation at a young age may require additional resources, age-appropriate intervention, and careful monitoring into adulthood. Copyright 2007

Disruptive behaviors and HPA-axis activity in young adolescent boys and girls from the general population (Article)

2007-10-01T00:00:00Z

It is important to investigate associations between biological factors and disruptive behaviors in children and adolescents. Antisocial, aggressive, and criminal behaviors in adults often begin early in life. Disruptive behaviors are often thought to be associated with low activity of the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol, the end-product of this axis, can be measured to investigate HPA-axis activity. Previous studies on this topic concerned clinical or high risk samples. The aim of the present study was to investigate to which extent HPA-axis functioning plays a role in disruptive behaviors in pre-adolescents from the general population. One thousand seven hundred and sixty eight 10- to 12-year-olds from the Dutch general population were investigated. Disruptive behaviors were assessed with the Child Behavior Checklist, the Youth Self-Report, and the Antisocial Behavior Questionnaire. Baseline morning and evening salivary cortisol levels were assessed. Unexpectedly, small associations were found between disruptive behaviors, including attention problems, and higher cortisol levels. However, all effect sizes of significant effects were very small. Our study indicated that HPA-axis functioning may be more relevant in clinical or high risk samples than at the general population level. The association between HPA-axis functioning and attention problems, that has gotten less attention than that with aggressive or delinquent behaviors, requires further research. Furthermore, because effect sizes were relatively small, it can be concluded that, in pre-adolescence, the measures of baseline HPA-axis functioning that were used for the present study can not be used as biological markers for disruptive behaviors.

14-Year changes in emotional and behavioral problems of very young Dutch children (Article)

2007-10-01T00:00:00Z

OBJECTIVE: The societal changes experienced by Western societies in recent decades have raised concerns about increases in the level of children's mental health problems. Although studies of secular changes in the prevalence of psychiatric diagnoses have indeed shown increases, their results may have been influenced by methodological problems, such as changing diagnostic criteria. Although repeated population studies using identical measures have not indicated such a clear increase in mental health problems, these studies have been limited to school-age children. We therefore investigated changes in Dutch parents' reports of very young children's emotional and behavioral problems over a 14-year period. METHOD: We compared Child Behavior Checklist scores across two Dutch general population samples of 2- and 3-year-olds, one sample assessed in 1989 and one in 2003. RESULTS: Results revealed only a few changes over time, indicating small decreases in parent-reported problems. Between 1989 and 2003, there were decreases in the mean scores and in the proportions of children with deviant scores on the Anxious/Depressed, Total Problems, Internalizing, and DSM-oriented attention-deficit/hyperactivity problems scales. CONCLUSIONS: Despite indications of increasing problems among school-age children and adolescents, parent-reported problem levels of very young Dutch children have not increased. Our findings even showed some small improvements in parents' reports of very young children's functioning between 1989 and 2003. Copyright 2007

The different stages and actors involved in the process leading to the use of adolescent mental health services (Article)

2007-10-01T00:00:00Z

Although a substantial number of adolescents suffer from emotional or behavioural problems, only a minority receive mental health care. In order to understand this discrepancy, this article aims to increase insight into the help-seeking process. First, a model of the help-seeking process for adolescent psychopathology was formulated. This model takes into account the sequential nature of help seeking and the involvement of multiple actors (adolescents, parents and teachers) and service providers (general practitioners, mental health care professionals, teachers, and friends/relatives). Using structural equation modelling, the model was empirically tested on 114 Dutch adolescents (aged 12-17 years), who were selected for having emotional or behavioural problems from a representative general practice sample. Of these 16.5% had used mental health services. The sequence of stages and the actors involved in the process leading to mental health care use was similar across gender. Parents and adolescents had a comparable impact on this process. The general practitioner functioned as gatekeeper to mental health care, whereas the teacher's role in the process was limited. Interventions aimed at increasing adolescent mental health service use should be directed at parents and adolescents, and at the roles of school personnel and general practitioners in the detection of problems and referral. Copyright

Testing the tripartite model in young adolescents: Is hyperarousal specific for anxiety and not depression? (Article)

2007-09-01T00:00:00Z

Background: To clarify the distinction between anxiety and depression, the tripartite model was introduced. According to this model, physiological hyperarousal (PH, i.e. autonomic hyperactivity) is specific for anxiety and not depression. Research on the relation between anxiety, depression and physiological measures representing arousal is lacking. Methods: Parent- and self-reported anxiety and depressive problems were assessed using the CBCL and RCADS. Heart rate (HR), heart rate variability in the low frequency (HRV LF) and respiratory sinus arrythmia (RSA) were used as indices for autonomic arousal. Results: Parent-reported anxiety was associated with low RSA in supine posture. This association was also found for self-reported anxiety problems, but only in boys. These findings point towards high arousal in anxiety. Self-reported depressive problems were associated with low HRV LF in standing posture and high RSA in supine posture in boys, pointing towards low arousal in depression. However, self-reported depressive problems were also associated with high HR in standing posture and with low HRV LF in supine posture in girls, suggesting high arousal in depression. Limitations: Although HRV LF in standing posture is primarily sympathetically mediated, and HRV LF in supine posture is primarily vagally mediated, the association between HRV LF and sympathetic versus vagal function is not exclusive. Thus, HRV LF measures are merely approaches of high or low arousal. Conclusions: Some evidence was found for hyperarousal in anxiety, but also for hyperarousal in depression. Apparently, the idea of hyperarousal in anxiety and not in depression is too simple to reflect the more complex reality.

Classes of disruptive behavior problems in referred adolescents (Article)

2007-09-01T00:00:00Z

Background: Previous studies have found considerable overlap between attention/hyperactivity problems, aggressive/oppositional problems and delinquent/conduct problems in adolescents. Sampling and Methods: Mothers of 1,965 11- to 18-year-olds (1,116 boys, 849 girls), referred to mental health agencies, completed the Child Behavior Checklist (CBCL). Latent class analysis was conducted on the Attention Problems scale (representing problems with attention, impulsivity and hyperactivity), Aggressive Behavior and Rule-Breaking Behavior scales of the CBCL. Results: Six latent classes were found. One of these classes contained individuals who suffered predominantly from attention problems and to a far lesser degree from aggressive or rule-breaking behaviors. The other 5 classes represented individuals with varying degrees of attention problems, aggressive behaviors and rule-breaking behaviors. Conclusions: Contrary to previous studies, the present study indicated that, in a large referred sample, problems with attention, impulsivity and hyperactivity can be considered as a diagnostic construct that should be distinguished from aggressive or rule-breaking behaviors. However, the present study did not support the existence of diagnostic classes constituted by individuals who primarily suffer from aggressive behaviors or rule-breaking behaviors, and not from attention problems or hyperactivity. Implications of these findings for future research and clinical practice are discussed. The value of the study was limited by the use of parent reports only. Copyright

Behavioral and emotional problems reported by parents of children ages 6 to 16 in 31 societies (Article)

2007-09-01T00:00:00Z

This study compared parents' ratings of behavioral and emotional problems on the Child Behavior Checklist (Achenbach, 1991; Achenbach & Rescorla, 2001) for general population samples of children ages 6 to 16 from 31 societies (N = 55,508). Effect sizes for society ranged from .03 to .14. Effect sizes for gender were ≤ .01, with girls generally scoring higher on Internalizing problems and boys generally scoring higher on Externalizing problems. Effect sizes for age were ≤ .01 and varied across types of problems. Total Problems scores for 19 of 31 societies were within 1 SD of the overall mean of 22.5. Bisociety correlations for mean item scores averaged .74. The findings indicate that parents' reports of children's problems were similar in many ways across highly diverse societies. Nonetheless, effect sizes for society were larger than those for gender and age, indicating the need to take account of multicultural variations in parents' reports of children's problems.

Higher cortisol awakening response in young adolescents with persistent anxiety problems (Article)

2007-08-01T00:00:00Z

Objective: The aims of the present study were to test the association between current anxiety problems and basal cortisol levels in a large population sample of young preadolescents, and to test if HPA-axis activity differs between individuals with no, only current, or persistent anxiety problems. Method: Cortisol levels of 10- to 12-year olds (n = 1768) from the general population were measured on three time points during the day. A self-report questionnaire (RCADS) was used to assess current anxiety, a parent-report questionnaire (TPBQ) to assess anxiety problems at age 4. Results: Associations between cortisol levels and current anxiety problems were not found. However, individuals with persistent anxiety problems had higher morning cortisol levels and a higher cortisol awakening response. Conclusion: Apparently, only persistent, and not current, anxiety problems are associated with higher HPA-axis activity. Alterations in HPA-axis activity might underlie persistent anxiety problems, or result from the stress accompanied by persistent anxiety problems.

Developmental trajectories of depressive symptoms from early childhood to late adolescence: Gender differences and adult outcome (Article)

2007-07-01T00:00:00Z

Backround: Limited information is available on gender differences and young-adult poor outcome in children and adolescents following distinct developmental trajectories of depressive symptoms. Methds: Parent information on depressive symptoms of 4- to 18-year-olds from an ongoing Dutch community-based longitudinal multiple-cohort study (N=2,076) was used to estimate trajectories from semi-parametric mixture models. The identified trajectories were used to predict depressive problems, general mental health problems, referral to mental health care, and educational attainment in young adulthood. Results: In both genders six distinct developmental trajectories were identified. Gender differences existed not only in level, but also in shape and timing of onset of depressive problems. Only in girls was a chronic trajectory of early childhood-onset depression identified. In both boys and girls a group with increasing levels of depressive symptoms was identified that reached a high level around adolescence, although boys showed an earlier onset. Two decreasing trajectories were found in boys, one reaching normative levels of depressive symptoms around late childhood and one around mid-adolescence, while none was found for girls. Individuals who followed elevated trajectories during their whole childhood or starting at adolescence had significantly more depressive and other mental health problems in young adulthood compared to those who followed normative trajectories. Boys in these elevated trajectories showed lower educational attainment, while girls were more likely to have been referred to mental health care. Conclusions: This study shows the value of estimating growth-mixture models separately for boys and girls. Girls with early childhood or adolescence-onset depressive problems and boys with depressive problems during childhood or starting in adolescence are especially at risk for poor outcome as young adults and should be considered candidates for intervention. © 2007 The Authors Journal compilation

Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: Evidence for distinctions between DSM-IV subtypes (Article)

2007-06-01T00:00:00Z

Objective: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. Method: 2,067 individuals (51.4% girls) from a Dutch community sample, who were assessed for the first time when they were aged 10 to 12 years, were followed up across a period of two years. At both assessments, anxiety symptoms were assessed with the RCADS, a self-report questionnaire. Results: Regression analyses indicated that homotypic continuity was relatively high for SAD, GAD, and SoPh symptoms, and for PD in girls. Conclusions: In many studies, anxiety disorders are treated as one group of disorders, and some widely used assessment instruments, such as the Child Behavior Checklist, do not even contain scales that tap different anxiety dimensions. In the present study, evidence for homotypic continuity was found, especially for symptoms of separation, social, and generalized anxiety, and for symptoms of panic disorder in girls, underscoring the usefulness of making distinctions between different anxiety constructs.

Which better predicts conduct problems? The relationship of trajectories of conduct problems with ODD and ADHD symptoms from childhood into adolescence (Article)

2007-06-01T00:00:00Z

Background: To assess the co-occurrence in deviant trajectories of parent-rated symptoms of conduct disorder (CD), oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) from age 4 to 18 years old in a general population sample of Dutch children. Methods: Developmental trajectories of CD, ODD, and ADHD were estimatedin a sample of 1,016 males and 1,060 females. Children's disruptive problem behaviors were rated at 5 time-points. The co-occurrence patterns between the deviant CD trajectory, and the high ODD and high ADHD trajectory were studied for males and females separately. Results: Four percent of males and 2% of females followed a deviant CD trajectory. Six percent of the sample followed a high ODD trajectory, and 5% a high ADHD trajectory. Engagement in the deviant CD trajectory was predicted by ODD and ADHD in females, but only by ODD in males. Conclusions: Although ADHD co-occurs with CD, the association between ADHD and CD is largely accounted for by accompanying ODD. Gender differences should be taken into account in understanding the onset of CD. © 2007 The Authors Journal compilation

Developmental course of psychopathology in youths with and without intellectual disabilities (Article)

2007-05-01T00:00:00Z

Background: We aimed to describe similarities and differences in the developmental course of psychopathology between children with and without intellectual disabilities (ID). Method: Multilevel growth curve analysis was used to analyse the developmental course of psychopathology, using the Child Behavior Checklist (CBCL), in two longitudinal multiple-birth-cohort samples of 6- to 18-year-old children with ID (N=978) and without ID (N=2,047) using three repeated measurements across a 6-year period. Results: Children with ID showed a higher level of problem behaviours across all ages compared to children without ID. A significant difference between the samples in the developmental courses was found for Aggressive Behaviour and Attention Problems, where children with ID showed a significantly larger decrease. Gender differences in the development of psychopathology were similar in both samples, except for Social Problems where males with ID showed a larger decrease in problem behaviour across time than females with ID and males and females without ID. Conclusion: Results indicate that children with ID continue to show a greater risk for psychopathology compared to typically developing children, although this higher risk is less pronounced at age 18 than it is at age 6 for Aggressive Behaviour. Contrary to our expectations, the developmental course of psychopathology in children with ID was quite similar from age 6 to 18 compared to children without ID. The normative developmental trajectories of psychopathology in children with ID, presented here, can serve as a yardstick against which development of childhood psychopathology can be detected as deviant. © 2007 The Authors Journal compilation

Signs of a higher prevalence of autoimmune thyroiditis in female offspring of bipolar parents (Article)

2007-05-01T00:00:00Z

Background: Studies are inconsistent as to whether patients with bipolar disorder are more frequently affected by autoimmune thyroiditis. Aim: To study the prevalence of autoimmune thyroiditis in offspring of bipolar patients. Method: In 1998 140 children (age 12-21 years) of bipolar parents were evaluated psychiatrically using the K-SADS-PL and blood was drawn to determine thyroperoxidase antibodies (TPO-Abs) and serum TSH. Blood samples of high school students (aged 12-19 years, n = 77) and young adults (aged 20-35 years, n = 52) were used as comparisons. At follow-up the offspring were psychiatrically evaluated and tested for TPO-Abs and TSH twice (14 months and 55 months after enrollment). Results: TPO-Abs were predominantly found in female bipolar offspring, who had a significantly higher prevalence of positive TPO-Ab titers (9 out of 57 female offspring subjects) as compared to the female high school and young adult comparisons (4 out of 103 female control subjects). In TPO-Ab positive offspring (n = 11) a raised prevalence of 55% of thyroid failure (i.e. a raised serum TSH or l-thyroxine treatment) was evident. TPO-Ab positive offspring did not show a raised prevalence of mood disorders (or any psychopathology) as compared to the TPO-Ab negative offspring. Conclusion: Our study suggests that bipolar offspring are more vulnerable to develop thyroid autoimmunity independently from the vulnerability to develop psychiatric disorders.

Effortful control as modifier of the association between negative emotionality and adolescents' mental health problems (Article)

2007-04-01T00:00:00Z

This study examined the extent to which effortful control moderated the risk of internalizing or externalizing problems associated with high negative emotionality in a Dutch population sample of pre- and early adolescents (N = 1,922). Internalizing and externalizing problems were assessed with the Child Behavior Checklist, Youth Self-Report, and Teacher Checklist of Psychopathology. Temperament (effortful control, fearfulness, frustration) was assessed with the parent version of the Revised Early Adolescent Temperament Questionnaire. The effects of fearfulness and frustration appeared to be attenuated by high levels of effortful control. The associations differed between the two domains of mental health investigated: effortful control reduced the effect of fearfulness on internalizing problems and the effect of frustration on externalizing problems. The effects were stronger for externalizing problems and similar for preadolescent (age 11) and adolescent (age 13/14) outcomes.

Social functioning of bipolar offspring (Article)

2007-03-01T00:00:00Z

Background: Bipolar patients have impaired social functioning compared to people in the general population. It has been suggested that children of bipolar patients also have impaired social functioning. The objective of this study was to compare social functioning of adolescent and young adult offspring of bipolar parents with social functioning of adolescents and young adults in the general population. Method: Subjects were 140 offspring of bipolar parents and 1122 adolescents and 1175 young adults from the general population. Parent, teacher and self-report ratings were used to assess social functioning. Results: Analyses revealed no differences in scores on social functioning for offspring aged 11 to 18 years, and few differences for ages 18 to 26 years compared to same aged individuals from the general population. Offspring with a DSM-IV disorder showed a lower level of social functioning compared to Dutch subjects from the general population in the same age range. Limitations: The limitations of this study are lack of information on the representativeness of the sample and use of one measure for social functioning. Conclusions: Bipolar offspring in the adolescent age range have good overall level of social functioning. Social functioning in offspring aged 18 years or older with a bipolar or other mood disorder is impaired.

Parent-teacher disagreement regarding behavioral and emotional problems in referred children is not a risk factor for poor outcome (Article)

2007-03-01T00:00:00Z

Objective: To investigate whether parent-teacher disagreement regarding the presence of psychopathology predicts poor outcome in children who have been referred to mental health services Methods: A total of 532 6- to 12-year-old children who had been referred to an outpatient department for child and adolescent psychiatry were followed up across an average period of 6.3 years. At initial assessment, standardized parent and teacher ratings of the child's psychopathology were obtained with the Child Behavoir Checklist (CBCL) and Teacher's Reprot form (TRF). At follow-up, indices of poor outcome were assessed. Results: Several CBCL and TRF scale scores predicted poor outcome. Discrepancies between CBCL and TRF scores were not useful as additional predictors. Some additive effects were found; future police/judicial contacts and disciplinary problems in school were predicted by CBCL and TRF scores. Conclusions: The findings underscored the need for information from different informants in clinical practice. However, discrepancies between parent and teacher ratings do not predict outcome, and should not alert clinicians.

Information processing profiles of internalizing and externalizing behavior problems: Evidence from a population-based sample of preadolescents (Article)

2007-02-01T00:00:00Z

Background: The present study explores the relationships between several information processing capacities and internalizing and externalizing behavior problems in a general population sample of 10- to 12-year olds (N = 2,037 51% girls). Methods: Parent-reported behavior problems as assessed by the Child Behavior Checklist were used to form four groups of children with 1) neither internalizing nor externalizing problems (n = 1,470), 2) only internalizing problems (n = 237), 3) only externalizing problems (n = 182), and 4) both internalizing and externalizing problems (n = 148). These groups were compared on measures of speed and accuracy from the Amsterdam Neuropsychological Tasks program reflecting the efficiency of several input-, central cognitive-, and output-related information processing capacities. Results: Children with both internalizing and externalizing problems demonstrated the least efficient performance, followed by children with only externalizing problems, whereas children with only internalizing problems did not differ from children without problems. More specifically, response variability and the ability to maintain and quickly compare information in working memory were found to be related to the severity of problem behavior. The ability to inhibit prepotent responses was related to the type of problem behavior, discriminating between the children with only internalizing problems and only externalizing problems. However, this latter capacity no longer differentiated when controlling for IQ. No differences were found between boys and girls. Conclusions: The results suggest that, in gener al, cognitive processing deficits are more strongly related to the degree than to the type of maladaptive behavior. Furthermore, response variability and working memory may serve as potential markers for identifying high-risk children and response inhibition as an indicator of the type of maladaptive behavior. & copy; 2007 The Authors Journal compilation 2007 Association for Child and Adolescent Mental Health.

Development of ethnic disparities in internalizing and externalizing problems from adolescence into young adulthood (Article)

2007-02-01T00:00:00Z

Background: Little is known about changes in ethnic disparities in mental health during the development of adolescents into young adults. The aim of this study was to study the development of disparities in internalizing and externalizing problems between Dutch natives and Turkish migrant children from adolescence into adulthood. Methods: Turkish migrants (n = 217) and Dutch natives (n = 723) completed two comparable questionnaires about internalizing and externalizing problems: the Youth Self-Report at age 11-18 and the (Young) Adult Self-Report ten years later, at age 21-28. We used mixed linear regression models to model development of mental health problems and to test changes in disparities in mental health between Turkish migrants and Dutch natives. Results: Both in adolescence and in adulthood migrants reported more internalizing and externalizing problems than natives, most pronounced for internalizing problems. Disparities decreased from adolescence into adulthood for both internalizing problems (-52%, p <.0001) and externalizing problems (-67%, p =.01), independently of gender, age, country of birth of Turkish adolescents, and parental socio-economic position. The favorable changes in the disparities over time were due to more favorable development among Turkish migrants than among natives. Conclusion: In this prospective study, ethnic disparities in internalizing and externalizing problems decreased as adolescents entered adulthood. Different explanations are discussed.

Effects of maternal smoking in pregnancy on prenatal brain development. The generation R study (Article)

2007-02-01T00:00:00Z

Nicotine, as has been shown in animal studies, is a neuroteratogen, even in concentrations that do not cause growth retardation. In humans, there is only indirect evidence for negative influences of nicotine on brain development from studies on the association between maternal smoking in pregnancy and behavioural and cognitive development in the offspring. We investigated the associations of maternal smoking in pregnancy with foetal head growth characteristics in 7042 pregnant women. This study was embedded in the Generation R Study, a population-based prospective cohort study from foetal life until adulthood. Maternal smoking was assessed by questionnaires in early, mid- and late pregnancy. Head circumference, biparietal diameter, transcerebellar diameter and atrial width of lateral ventricles were repeatedly measured by ultrasound. When mothers continued to smoke during pregnancy, foetal head circumference showed a growth reduction of 0.13 mm [95% confidence interval (CI): -0.18, -0.09] per week compared to foetuses of mothers who never smoked during pregnancy. Biparietal diameter of foetuses with smoking mothers grew 0.04 mm (95% CI: -0.05, -0.02) less per week than that of foetuses of nonsmoking mothers. Atrial width of lateral ventricle was 0.12 mm (95% CI: -0.22, -0.02) smaller and transcerebellar diameter was 0.08 mm (95% CI: -0.15, -0.00) smaller if mothers smoked, but growth per week of these characteristics was not affected by maternal smoking in pregnancy. In conclusion, continuing to smoke during pregnancy leads to reduced growth of the foetal head. Further research should focus on the causal pathway from prenatal cigarette exposure via brain development to behavioural and cognitive functions.

No hyperactive-impulsive subtype in teacher-rated attention-deficit/ hyperactivity problems (Article)

2007-02-01T00:00:00Z

The aim of this study was to investigate which homogeneous groups, according to teacher reports of attention-deficit/hyperactivity (ADH) Problems on the Teacher's Report Form (TRF), can be identified in a referred sample (n = 4,422; age = 6-18 years; mean age = 9.9 years; 66% boys, 34% girls). Latent class analysis (LCA) was conducted on ADH Problems. In addition, co-morbidity levels in the different ADH Problems groups were compared. LCA yielded three different groups of children and adolescents with both Inattention and hyperactivity-impulsivity, and one group with high scores on Inattention but low scores on hyperactivity-impulsivity. A group of patients with predominantly hyperactivity and impulsivity was not found. Individuals in groups with higher levels of ADH Problems had significantly higher levels of oppositional defiant (OD) and conduct problems, and, although to a lesser extent, significantly higher levels of affective and anxiety problems than individuals in groups with lower levels of ADH Problems. It may not be useful to discern the hyperactive-impulsive type of ADHD.

Perceived parental rearing of bipolar offspring (Article)

2007-01-01T00:00:00Z

Objective: To explore the impact of growing up with a parent with a bipolar disorder. First, we compared parental rearing behavior perceived by young adult offspring of bipolar parents with parental rearing behavior perceived by same aged young adults from the general population. Secondly, we examined the associations between perceived parental rearing behavior and parental psychopathology and psychopathology in offspring. Method: Subjects were 129 offspring of 80 bipolar parents and their spouses and 1122 young adults from the general population. In offspring the Structured Clinical Interview for DSM-IV was used to assess DSM-IV diagnoses and the EMBU was used to assess perceived parental rearing in both groups. Results: In general, offspring growing up in a family with a bipolar parent perceived their mothers as less rejecting, more emotionally warm and less overprotecting and their fathers as less emotionally warm and less overprotecting compared with young adults from the general population. Perceived rejection was related to psychopathology in offspring. Conclusion: Overall, parental rearing in families with a parent with a bipolar disorder is not more dysfunctional, as perceived by their offspring, than in families from the general population. Offspring with a bipolar disorder perceive their parents as more rejecting.

Parent-teacher disagreement regarding psychopathology in children: A risk factor for adverse outcome? (Article)

2007-01-01T00:00:00Z

Objective: To investigate if parent-teacher discrepancies in reports of behavioral/emotional problems in children predict poor outcome. Method: A total of 1154 4- to 12-year-old children from the general population were followed up. At the first assessment, parent and teacher ratings were obtained with the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF). Fourteen years later, DSM-IV diagnoses were assessed, and ratings of self-reported and parent-rated behavioral and emotional problems were obtained. Results: CBCL and TRF scores predicted most of the outcomes, but in general, discrepancies between CBCL and TRF scores did not. There were some exceptions. For instance, higher parental vs. teacher ratings of aggressive behaviors increased the risk of suicide attempts/self-mutilation. Conclusion: Risk factors for self-mutilating behaviors may be supplemented with parent-reported aggressive behaviors that are not observed by the teachers. In general, whereas CBCL and TRF scale scores were useful predictors of outcome, parent-teacher discrepancies were not.

Predictors of future depression in early and late adolescence (Article)

2007-01-01T00:00:00Z

Background: This study examined whether the possibility to predict future DSM-IV depressive disorder can be increased with recurrent screening for depression in community adolescents, compared to single screening in early or in late adolescence. In addition, it examined which depressive symptoms in early and late adolescence predicted future depressive disorder most accurately. Methods: Participants from an ongoing longitudinal cohort study were assessed when they were aged between 10 and 15 (early adolescence), and between 14 and 19 (late adolescence), and were followed until they were 20-25 (young adulthood). The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) were used to screen for depression in early and late adolescence, and CIDI/DSM-IV diagnoses of depressive disorder were used as the outcome measure during follow-up. Results: Recurrent screening only slightly improved the prediction of future depression, and cognitive and physical symptoms in late adolescence predicted future depression accurately in boys. Sleeping problems in early adolescence predicted future depression in girls. Limitations: The main limitation was the retrospective recall of the age of onset of a depressive disorder. Conclusions: Recurrent screening for depression did not predict future depressive disorder better than single screening in late adolescence. However, depressive symptoms like sleeping problems predicted future depression quite accurately in adolescent boys and girls. This indicates that it may be useful to screen adolescents for the presence of such symptoms, for instance in school settings, to predict which adolescents are at risk to develop DSM-IV depressive disorder in early adulthood.

Ethnic disparities in problem behaviour in adolescence contribute to ethnic disparities in social class in adulthood (Article)

2007-01-01T00:00:00Z

Background: It is important for prevention of social class disparities to know how ethnic disparities in social class arise among migrant children. We contribute to this understanding by examining the role of problem behaviour in adolescence. Methods: Prospective observational study with 753 Dutch native and 217 Turkish migrant adolescents (11-18 year) followed for 10 years. Internalising and externalising problems were assessed in adolescence and employment status and occupational level were assessed in adulthood. The difference in odds ratios (OR) before and after adjustment for internalising and externalising problems was an indication of the predictive value of disparities in internalising and externalising problems for the development of social class disparities. Results: A total of 135 (62%) of the Turkish and 602 (80%) of the Dutch adults were employed. Internalising and externalising problems were not associated with employment status. Of the employed, 65 (48%) Turkish and 179 (30%) Dutch adults worked in low-level occupations (p < 0.0001). Internalising and externalising problems were associated with both ethnicity and occupation. The OR for low-level occupation for Turkish adults was 1.78 (1.19-2.65), indicating ethnic disparities. Adjustment for internalising problems lowered the OR with 36% to 1.50 (0.97-2.31), and adjustment for externalising problems lowered it with 8% to 1.72 (1.15-2.57). Findings were similar for men and women and did not vary by age. Conclusions: Ethnic disparities in occupational level in adulthood could partly be attributed to disparities in mental health between Turkish migrants and Dutch natives in adolescence. Prevention of ethnic disparities in mental health at young age may therefore also contribute to the prevention of occupational differences in adulthood.

Signaleringslijsten psychische problematiek bij jeugdigen (Article)

2006-01-01T00:00:00Z

Samenvatting: Met beknopte gestandaardiseerde vragenlijsten gericht op psychische problemen kan men snel jeugdigen selecteren die voor nader psychodiagnostisch onderzoek, preventie- en behandelprogramma’s of wetenschappelijk onderzoek in aanmerking komen. We presenteren een actueel overzicht van het Nederlandse en (deels al in het Nederlands vertaalde) internationale aanbod van signaleringslijsten voor psychische problematiek bij kinderen en adolescenten die door ouders, adolescenten en/of leerkrachten binnen maximaal twintig minuten zijn in te vullen. Bij het gepresenteerde aanbod van zestien lijsten wordt nagegaan of er normen bestaan voor Nederlandse kinderen en adolescenten en in hoeverre onderzoek hiernaar plaatsvindt. Het aanbod voor ons land gevalideerde en genormeerde Nederlandstalige instrumenten blijkt beperkt tot twee: de aseba-vragenlijsten en de sdq. Summary: Using concise standardised questionnaires for psychopathology, we are able to select young people eligible for further psychodiagnostic assessment, prevention and treatment programmes or scientific research. In this article we present an overview of current Dutch and international screening instruments (some already translated into Dutch) used to detect psychopathological problems in children and adolescents. Parents, adolescents and/or teachers have a maximum of twenty minutes to fill in the questionnaires. We examine, for the sixteen instruments, whether there are norms for the Dutch population of children and adolescents, and the extent to which research is being conducted in this field. The Dutch-language instruments validated and standardized for our country is limited to two: the aseba questionnaires and the sdq.

Symptoms of anxiety and depression in childhood and use of MDMA: prospective, population based study (Article)

2006-01-01T00:00:00Z

OBJECTIVE: To investigate whether using ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is preceded by symptoms of behavioural and emotional problems in childhood and early adolescence. DESIGN: Prospective, longitudinal, population based study SETTING: The Dutch province of Zuid-Holland. PARTICIPANTS: A sample of 1580 individuals, followed up across a 14 year period, from childhood into adulthood. MAIN OUTCOME MEASURES: The first assessment took place in 1983 before MDMA appeared as a recreational drug in the Netherlands and included the child behaviour checklist to obtain standardised parents' reports of their children's behavioural and emotional problems. Use of the drug was assessed with the composite international diagnostic interview 14 years later. RESULTS: Eight syndrome scales of childhood behaviour were examined. Scores in the deviant range for the scales designated as anxious or depressed in childhood were significantly related to use of MDMA in adolescents and adults, resulting in an increased risk (hazard ratio 2.22, 95% confidence interval 1.20 to 4.11, P = 0.01). CONCLUSIONS: Individuals with childhood symptoms of anxiety and depression may have an increased tendency to use MDMA in adolescence or young adulthood. Its effects are supposed to include enhanced feelings of bonding with other people, euphoria, or relaxation. Especially individuals with symptoms of anxiety or depression may be susceptible to these positive effects.

Psychiatric disorders in young adult intercountry adoptees: an epidemiological study. (Article)

2005-03-01T00:00:00Z

OBJECTIVE: The prevalences of psychiatric disorders in young adult intercountry adoptees and nonadopted young adults from the general population were compared. METHOD: In the Netherlands, a total of 1,484 young adult intercountry adoptees (72.5% of the original sample at age 10-15 years) and 695 nonadopted subjects (78.1% of the original sample) of comparable age from the general population were interviewed by using a standardized psychiatric interview generating DSM-IV diagnoses. RESULTS: The adopted young adults were 1.52 times as likely to meet the criteria for an anxiety disorder as the nonadopted young adults; the 95% confidence interval (CI) was 1.15-2.00. The adoptees were 2.05 (95% CI=1.32-3.17) times as likely to meet the criteria for substance abuse or dependence. The adopted men were 3.76 (95% CI=1.69-8.37) times as likely to have a mood disorder as nonadopted men, while for women there was no significant difference between adoptees and nonadoptees. No significant difference for the diagnosis of disruptive disorder was found. For all diagnoses together, adoptees with low and middle parental socioeconomic status in childhood did not differ from the comparison subjects, while adoptees with high parental socioeconomic status were 2.17 times (95% CI=1.50-3.13) as likely to meet the criteria for a disorder as nonadoptees with high parental socioeconomic status. CONCLUSIONS: Intercountry adoptees run a higher risk of having severe mental health problems in adulthood than nonadoptees of the same age. The risk of later malfunctioning differs for different disorders and different groups of adoptees.

Psychosocial functioning of the adult with congenital heart disease: a 20-33 years follow-up (Article)

2003-04-01T00:00:00Z

AIMS: Since knowledge about the psychosocial function of adult patients with congenital heart disease is limited, we compared biographical characteristics, and emotional and social functioning of these patients with that of the reference groups. METHODS AND RESULTS: Patients with congenital heart disease (N=362, aged 20-46 years), belonging to five diagnostic groups, were subjected to extensive medical and psychological examination, 20-33 years after their first open heart surgery. All the patients were seen by the same psychologist, who examined their psychosocial functioning using a structured interview and questionnaires. The majority (78%)was living independently and showed favourable outcome regarding the marital status. Among married/cohabitant patients, 25-39-year-olds showed normal offspring rates. None of the 20-24-year-old patients had any children. The offspring rate dropped after the age of 40. The proportion of adult patients with a history of special education was high (27%). Accordingly, patients showed lower educational and occupational levels compared to reference groups. As regard to the emotional and social functioning (leisure-time activities), the sample showed favourable results. CONCLUSIONS: Overall, this sample of patients with congenital heart disease seemed capable of leading normal lives and seemed motivated to make good use of their abilities.

Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: a 14-year follow-up during childhood, adolescence, and young adulthood (Article)

2003-01-01T00:00:00Z

OBJECTIVE: The goal of this study was to predict the onset of mood and anxiety disorders from parent-reported emotional and behavioral problems in childhood across a 14-year period from childhood into young adulthood. METHOD: In 1983, parent reports of behavioral and emotional problems were obtained with the Child Behavior Checklist for children and adolescents 4-16 years of age from the Dutch general population. At follow-up 14 years later, lifetime mood and anxiety diagnoses were obtained by a standardized DSM-IV interview for 1,580 subjects. Cox proportional hazards models were used to predict the incidence of mood and anxiety disorders from childhood problems and demographic covariates. RESULTS: Mood disorders were significantly predicted by high scores on the anxious/depressed scale and on the internalizing composite (withdrawn, somatic complaints, and anxious/depressed). Anxiety disorders were significantly predicted by the social problems scale and the externalizing composite (delinquent behavior and aggressive behavior). Anxiety disorders predominantly started in childhood and early adolescence, whereas the incidence of mood disorders increased sharply in adolescence and young adulthood. CONCLUSIONS: These results suggest different developmental pathways for mood and anxiety disorders. The predictions based on problem behavior remained stable during the 14-year period across adolescence and young adulthood. The results therefore underline the importance of early intervention and prevention of behavioral and emotional problems in childhood.

Pathways of self-reported problem behaviors from adolescence into adulthood (Article)

2002-01-01T00:00:00Z

OBJECTIVE: The authors determined the impact of different pathways of psychopathological development on adult outcome in subjects followed from ages 11-18 to ages 21-28. METHOD: Problem behaviors of subjects from a general population sample were assessed through the Youth Self-Report and the Young Adult Self-Report given at four time points (1987, 1989, 1991, and 1997). In addition, DSM-IV diagnoses, information pertaining to signs of maladjustment, and measures of social functioning were obtained at the last assessment. On the basis of the self-report ratings, four contrasting developmental pathways of psychopathology were determined: persistent, decreasing, increasing, and consistently normal. RESULTS: Subjects whose overall level of psychopathology was persistent over time had a higher lifetime prevalence of DSM-IV diagnoses and a poorer general outcome in adulthood than did subjects whose level of psychopathology increased. Subjects whose level of psychopathology returned to normal after high levels of problems in adolescence were only slightly different in terms of outcome from subjects with consistently normal ratings. CONCLUSIONS: 1) People who showed high levels of problems in early adolescence but whose level of psychopathology diminished by adulthood seemed to be as healthy as people who never attained a serious level of psychopathology. 2) An ongoing devious pathway into adulthood had negative effects on many domains of functioning. These two findings are both powerful arguments for early intervention in adolescence.

Adolescents' self-reported problems as predictors of psychopathology in adulthood: 10-year follow-up study (Article)

2001-01-01T00:00:00Z

BACKGROUND: Knowledge of the course of psychopathology from adolescence into adulthood is needed to answer questions concerning origins and prognosis of psychopathology across a wide age range. AIMS: To investigate the 10-year course and predictive value of self-reported problems in adolescence in relation to psychopathology in adulthood. METHOD: Subjects from the general population, aged 11-19 years, were assessed with the Youth Self-Report (YSR) at initial assessment, and with the Young Adult Self-Report (YASR), the Composite International Diagnostic Interview (CIDI) and three sections of the Diagnostic Interview Schedule (DIS) 10 years later. RESULTS: Of the subjects with deviant YSR total problem scores, 23% (males) and 22% (females) had deviant YASR total problem scores at follow-up. Subjects with initial deviant YSR total problem, internalising and externalising scores had higher prevalences of DSM-IV diagnoses at follow-up. CONCLUSIONS: Adolescent problems tended to persist into adulthood to a moderate degree. High rates of problems during adolescence are risk factors for psychiatric disorders in adulthood.

Predictors of psychopathology in young adults referred to mental health services in childhood or adolescence (Article)

2000-01-01T00:00:00Z

BACKGROUND: For children referred to mental health services future functioning may be hampered. AIMS: To examine stability and prediction of behavioural and emotional problems from childhood into adulthood. METHOD: A referred sample (n = 789) aged 4-18 years was followed up after a mean of 10.5 years. Scores derived from the Child Behavior Checklist, Youth Self-Report and Teacher Report Form were related to equivalent scores for young adults from the Young Adult Self-Report and Young Adult Behavior Checklist. RESULTS: Correlations between first contact (T1) and follow-up (T2) scores were 0.12-0.53. Young adult psychopathology was predicted by corresponding T1 problem scores. Social problems and anxious/depressed scores were predictors of general problem behaviour. CONCLUSIONS: Problem behaviour of children and adolescents referred to outpatient mental health services is highly predictive of similar problem behaviour at young adulthood. Stability is higher for externalizing than for internalizing behaviour and for intra-informant than for inter-informant information. Stabilities are similar across gender. To obtain a comprehensive picture of the young adult's functioning, information from related adults may prove valuable.

Problems reported by parents of children in multiple cultures: the Child Behavior Checklist syndrome constructs (Article)

1999-01-01T00:00:00Z

OBJECTIVE: The purpose of this study was to compare syndromes of parent-reported problems for children in 12 cultures. METHOD: Child Behavior Checklists were analyzed for 13,697 children and adolescents, ages 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand, and the United States. RESULTS: Comparisons of nine cultures for subjects ages 6 through 17 gave medium effect sizes for cross-cultural variations in withdrawn and social problems and small effect sizes for somatic complaints, anxious/depressed, thought problems, attention problems, delinquent behavior, and aggressive behavior. Scores of Puerto Rican subjects were the highest, whereas Swedish subjects had the lowest scores on almost all syndromes. With great cross-cultural consistency, girls obtained higher scores than boys on somatic complaints and anxious/depressed but lower scores on attention problems, delinquent behavior, and aggressive behavior. Although remarkably consistent across cultures, the developmental trends differed according to syndrome. Comparison of the 12 cultures across ages 6 through 11 supported these results. CONCLUSIONS: Empirically based assessment in terms of Child Behavior Checklist syndromes permits comparisons of problems reported for children from diverse cultures.

Mental health in Dutch children : an epidemiological study (Doctoral Thesis)

1985-09-18T00:00:00Z

At the time the present study was started (1982) correlations were not available between CBCL scores obtained from parents and independently obtained inforrnation on the same child through a teacher questionnaire~ nor between the CBCL and intensive clinical assessment of the same chi1d. A1though the number of publications on chi1d psychiatrie epidemio1ogy has increased over the last ten years, there are very few published accounts of investigations which atte~pt te replicate and refine existing techniques in pepulations different frem these for which the techniques were origina11y deve1oped. Ear1s (1980) stresses that trans-cultura1 attempts at replicating resu1ts with the samemethad represent an essentia1 means of assessing the extent to which features of children's behavior disorders are universal. At the time the present study was started, except for studies concerned with iso1ated symptoms such as sleep problems (Cohen-Matthijsen, 1980) and enuresis (Oe Jonge, 1969), there were no data available in the Nether1ands on the prevalenee and distribution of child mental health prob1ems of a wide age and behavier range in representative population samples. The availability of outpatient and inpatient child mental hea1th facilities in this country is in general arbitrarily determined and is not based on population data on the prevalenee and distri bution of behaviaral, emotional and developmental problems. Furthermore we were confronted with the fact that virtual1y no va1idated instruments for determining degree and type of child psychiatrie disorder in the Duteh popuiatien were avai1able. This serieus lack of basic research toe1s was not only felt as an obstaele for epidemiologie research. Therapy-eva1uation and etiological studies were a1so hampered by this situation