Executive function deficits mediate the association between very preterm birth and behavioral problems at school-age

Early childhood during its development period experiences significant changes in various aspects, including emotional and behavioral aspects. Problems that arise related to emotion and behavior can affect their overall growth and development. In a previous study, 81 children aged 4-10 years were identified through a Strength and Difficulties Questionnaire (SDQ) filled out by parents in Krendang Village, West Jakarta. The results found significant differences between boys and girls. Boys were more often in the abnormal category, especially in the aspects of emotional, behavioral, and social relationship problems, which means that boys are more vulnerable in these categories. While girls fared better, there’s just little difference in terms of percentages between the two genders. The majority of children, both boys and girls, are still in the normal range, but parents still need to pay attention to signs of behavioral and emotional problems in their children. The results of this study were then socialized back to the parents, accompanied by the provision of psychoeducation about handling emotional and behavioral problems in early childhood. The results of this psychoeducation are considered very useful for parents, because through this psychoeducation and dissemination, tips and knowledge about parenting have been given. That way, parents can also understand that proper parenting can help overcome children's emotional and behavioral problems. Early childhood during its development period experiences significant changes in various aspects, including emotional and behavioral aspects. Problems that arise related to emotion and behavior can affect their overall growth and development. In a previous study, 81 children aged 4-10 years were identified through a Strength and Difficulties Questionnaire (SDQ) filled out by parents in Krendang Village, West Jakarta. The results found significant differences between boys and girls. Boys were more often in the abnormal category, especially in the aspects of emotional, behavioral, and social relationship problems, which means that boys are more vulnerable in these categories. While girls fared better, there’s just little difference in terms of percentages between the two genders. The majority of children, both boys and girls, are still in the normal range, but parents still need to pay attention to signs of behavioral and emotional problems in their children. The results of this study were then socialized back to the parents, accompanied by the provision of psychoeducation about handling emotional and behavioral problems in early childhood. The results of this psychoeducation are considered very useful for parents, because through this psychoeducation and dissemination, tips and knowledge about parenting have been given. That way, parents can also understand that proper parenting can help overcome children's emotional and behavioral problems.

The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID. Parents of 83 young people with ID aged 4-17years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour. The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off. The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information.

To explore the associations between early emotional and behavioral problems, measured by the Strengths and Difficulties Questionnaire (SDQ), and subsequent mental disorders among children in a Swedish context. This cohort study used data on emotional and behavioral problems in children aged 3-5 years old (n = 6,646) from the Focus study in Uppsala Region, Sweden. The data included emotional and behavioral problems using the SDQ rated by mothers (n = 6,616), fathers (n = 6,385) and preschool teachers (n = 5,079). The cohort was followed from 2013 to 2022, with psychiatric diagnoses collected from the National Patient Register. Associations between emotional and behavioral problems and later mental disorders were explored using unadjusted and adjusted Cox regression models. The proportion of children identified with emotional and behavioral problems, based on the SDQ total difficulties score, was 9.4% according to mothers, 12.2% according to fathers and 7.6% according to teachers. Altogether, 9.2% (n = 611) of the children were diagnosed with a mental disorder during the follow-up period. In unadjusted models, the risk of a mental disorder was significantly higher among children with emotional and behavioral problems, as rated by mothers (HR: 3.59), fathers (HR: 2.67) and teachers (HR: 2.95). This elevated risk remained significant in adjusted models for ratings by mothers (AHR: 3.66), fathers (AHR: 2.66) and teachers (AHR: 3.06). Children with difficulties in the hyperactivity and inattention subscale of the SDQ showed a significantly increased risk of being diagnosed with attention-deficit hyperactivity or conduct disorder when rated by mothers (AHR: 4.19), fathers (AHR: 3.21) and teachers (AHR: 4.88). Early emotional and behavioral problems identified using the SDQ are associated with subsequent mental disorders in children in Sweden. These results reinforce the importance of early assessment of children's emotional and behavioral functioning to enable early identification and intervention for children at risk.

Objective:To determine the prevalence of childhood emotional and behavioral problems and examine their associations with cesarean delivery.Methods:Our sample consisted of 8,900 preschoolers from 35 kindergartens in four cities in East China. Parents completed the Strengths and Difficulties Questionnaire (SDQ) and provided other information. Children’s emotional and behavioral problems were assessed using five subscales of the SDQ. Mode of delivery was classified as vaginal or cesarean section (CS); in sub-analyses, we divided CS into elective or emergency delivery. Logistic regression was used to examine associations.Results:A total of 1,209 (13.6%) children had a total SDQ score within abnormal range; 25.5% had peer problems within abnormal range, 9.0% had abnormal emotional symptoms, 13.9% had abnormal conduct problems, 18.9% had abnormal hyperactivity problems, and 16.2% were rated abnormal in pro-social behavior. Overall, 67.3% of the children who participated were delivered by CS. In fully adjusted analysis, CS was significantly associated with abnormal total SDQ score (OR = 1.27; 95%CI 1.10-1.46; p < 0.05) and pro-social behavior (OR = 1.27; 95%CI 1.12-1.45; p < 0.0001). No significant association was found between CS and risk of having conduct problems (OR 1.13; 95%CI 0.98-1.29), peer problems (OR 1.11; 95%CI 0.99-1.24), hyperactivity (OR 1.02; 95%CI 0.91-1.15), or emotional problems (OR 1.06; 95%CI 0.90-1.24).Conclusion:In this sample, CS was associated with risk of behavioral problems, but not with emotional problems. Further research is needed to better understand these associations.

BackgroundIdentification of children at risk for psychosocial problems is important to be able to provide supportive and tailored care at an early stage. Due to its brevity and wide age range, the Strengths and Difficulties Questionnaire (SDQ) Parent Form is an appropriate instrument for use in paediatric clinical practice as it facilitates assessment of psychosocial functioning from young childhood into adulthood. The aim of the present study was to provide Dutch normative data for the SDQ Parent Form.MethodsA sample of 1947 parents with children aged 2–18 years was drawn from a large panel of a Dutch research agency, stratified on Dutch key demographics of the parents.The SDQ Parent Form assesses the child’s Emotional symptoms, Conduct problems, Hyperactivity-Inattention, Peer problems and Prosocial behaviour. Summary scores can be calculated: Internalising, Externalising and Total difficulties.Internal consistency (Cronbach’s alpha coefficient) and normative scores (mean, median, clinical cut-off scores) of the SDQ- Parent Form were calculated in four age-groups 2–3, 4–5, 6–11 and 12–18 years. Gender differences were tested with independent t-tests.ResultsA total of 1174 parents (60.3%) completed the SDQ. In the age-groups 2–3 and 4–5, norm scores are not available for Conduct problems and Peer problems due to insufficient internal consistency. In addition, in age-group 2–3, norm scores for Emotional symptoms and Internalising are not available because of insufficient internal consistency. In the age-groups 6–11 and 12–18, norm scores are available for all scales, with Cronbach’s alpha coefficients 0.53–0.86. The comparison by gender revealed that boys had more behavioural problems than girls (0.000 < p < 0.048), most prevalent for Hyperactivity-Inattention, Peer Problems, Prosocial behaviour, Externalising and Total Difficulties.ConclusionsDutch normative data by age-group and gender are now available for parent-reported SDQ scores in children aged 2–18 years. Due to insufficient internal consistency, normative scores for 2–5 year-old children could not be presented for several SDQ scales. Yet, the SDQ Total score provides a reliable indication of the psychosocial functioning of younger children. In case of high Total scores in children younger than 6 years, alternatively to scale scores, the answers on the individual items could yield useful clinical information about the child’s problems.

Specific domains of adaptive behaviours and academic achievement may, in part, depend on executive function capacities. Executive function deficits have been found to be associated with Attention Deficit Hyperactivity Disorder (ADHD), not Oppositional Defiant Disorder/Conduct Disorder (ODD/CD). Using a sample of 110 adolescents, comprising four groups, ADHD only, co-morbid ADHD and ODD/CD, ODD/CD only, and a normal community control group, we assessed socialisation and communication skills with the Vineland Adaptive Behaviour Scales, along with reading ability, and executive functioning. Poorer adaptive communication skills were specifically associated with ADHD when compared with either ODD/CD or the control group, and the social competence of adolescents with ADHD was as low as the levels associated with ODD/CD. Presence of ADHD was associated with lower word recognition scores, while the reading levels of adolescents with ODD/CD were equivalent to those without behaviour problems. Executive function test scores correlated with all adaptive behaviour outcomes. Multiple regression analyses indicated that verbal ability predicted communication and reading scores, with executive function abilities contributing significant variance to the prediction in the adaptive behaviour, communication, and socialisation domains. Further research with other samples, both community and clinical groups, is needed to assess the generalisability of the findings. Small numbers of girls in the groups gave us insufficient power to adequately address potential gender differences.

Research has demonstrated that better value-based decision making (e.g., waiting or working for rewards) relates to greater executive function (EF) ability. However, EF is not a static ability, but is influenced by the emotional content of the task. As such, EF ability in emotional contexts may have unique associations with value-based decision making, in which costs and benefits are explicit. Participants (N = 229) completed an EF task (with both negative and neutral task conditions) and two value-based decision-making tasks. Willingness to wait and to work were evaluated in separate path models relating the waiting and working conditions to the EF conditions. Willingness to wait and willingness to work showed distinct relationships with EF ability: Greater EF ability on a negative, but not on a neutral, EF task was related to a willingness to wait for a reward, whereas greater EF ability across both EF tasks was related to a greater willingness to work for a reward. EF ability on a negative EF task showed an inverted-U relationship to willingness to wait for reward, and was most related to willingness to wait at a 6-month delay. Greater EF, regardless of whether the task was negative or neutral, was related to a greater willingness to work when reward was uncertain (50%) or was likely (88%), but not when reward was unlikely (12%). This study suggests that the emotional content of value-based decisions impacts the relationship between EF ability and willingness to wait or to work for reward.

Sleep disturbance in children with atopic dermatitis (AD) frequently goes unnoticed and can be associated with behavioral challenges. The aims of this study were to determine (a) the prevalence and factors associated with sleep disturbance and behavioral problems and (b) the correlation between sleep disturbance and behavioral problems in children with AD. This cross-sectional study involved children aged 4-12 years old with moderate to severe AD. Age and sex-matched healthy children were recruited as the comparison group. The Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ) were used to assess sleep disturbance and behavioral problems, respectively. Higher scores in both questionnaires signify more disturbance. Seventy patients and 141 controls were recruited. Median (interquartile range) age of patients was 5 (4,8) years. Patients had later sleep time (p < 0.001), longer night awakening (p < 0.001), and shorter sleep duration (p < 0.001) compared to controls. CSHQ total scores and all its domains, except for sleep-disordered breathing were significantly higher in patients compared to controls. Patients also had significantly higher SDQ total difficulties scores in all domains, except for peer problems. Severity of AD was significantly associated with high CSHQ and SDQ scores. There was a moderate positive correlation between the total CSHQ score and total SDQ score in patients (r=0.532). Children with moderate-to-severe AD had significantly more sleep disturbance and more behavioral problems than their healthy peers. Sleep disturbance had a positive correlation with behavioral problems. Severity of AD was associated with sleep disturbance and behavioral problems.

The authors aim was to examine associations of breastfeeding duration and exclusivity in infancy with executive function, behavior, and social-emotional development in mid-childhood. The authors studied 1037 participants in Project Viva, a prebirth cohort that enrolled pregnant mothers from 1999 to 2002 and followed children for 7 to 10 years. Main exposures were: (1) duration of any breastfeeding in the first 12 months and (2) duration of exclusive breastfeeding in the first 6 months. Main outcomes were child executive function, behavior, and social-emotional development, assessed by (1) the Behavior Rating Inventory of Executive Function (BRIEF) and (2) the Strengths and Difficulties Questionnaire (SDQ), completed independently by parents and teachers. Higher scores indicate greater problems. In linear regression models adjusted for sociodemographics, maternal intelligence, home environment, early child care, and maternal depression, longer breastfeeding duration was not associated with substantially better executive function, behavior, or social-emotional development. For example, for each additional month of any breastfeeding, the BRIEF Global Executive Composite score (parent) was 0.10 points higher (95% confidence interval, -0.01 to 0.22) and the SDQ total difficulties score was 0.06 points higher (-0.01, 0.12). Breastfeeding duration was also not associated with BRIEF or SDQ subscales, nor was exclusive breastfeeding duration associated with any of the outcomes analyzed. Despite beneficial effects on general intelligence, longer duration of any breastfeeding or of exclusive breastfeeding was not associated with better executive function, behavior, or social-emotional development in mid-childhood.

IntroductionMany studies have found impaired performance in executive functions (EF) in children born very preterm (VPT) [1]. EF play a pivotal role for academic achievement and personal autonomy. Demands in...

Objective:Executive function (EF) abilities tend to decline with age, and disproportionately so for people with neurodegenerative disorders such as Parkinson’s Disease (PD), where EF deficits are commonly seen in the early stages of the disease. Due to their nature, EF are essential for performing tasks of daily life, particularly for the more complex instrumental activities of daily living (IADL), and deficits can impair the ability to execute IADL in PD participants. The aim of this study was to examine how EF impairments relate to IADL deficits in both healthy elderly controls and PD participants.Participants and Methods:Seventy-four participants with idiopathic PD and 66 elderly controls were recruited. All participants were non-demented. A comprehensive neuropsychological assessment was administered including the following measures of EF: Hayling Sentence Completion, Brixton Spatial Anticipation, Trail Making Test A and B, Stroop Color-Word Test, Symbol Span (Wechsler Memory Scale-III), Digit Span (Wechsler Adult Intelligence Scale-III), F-A-S test, and Semantic Fluency (Animals and Actions). Z scores were calculated from respective test manuals. Independence was measured using the 8-item Lawton IADL Scale where items are coded from 0 (dependent) to 1 (independent) and the total score ranges from 0 to 8. Motor impairments were assessed using Part III of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Regression models were run with each cognitive measure as the dependent variable, with group (control vs. PD), age, sex, education, and motor severity as predictors, to examine the effect of group on each cognitive variable. Correlations were then run between the total IADL score, demographic variables, and cognitive variables for each participant group separately to identify the relationship between IADL and EF measures.Results:PD participants were predominantly males (n=51, 68.9%), with an average age of 70.64±6.03 and 15.22±2.78 education years. Controls were predominantly female (n=34, 51.5%) and had an average age of 71.19±7.75 and 15.85±2.82 education years. Regarding IADL function, all participants were relatively independent in their IADLs (PD: 7.72±0.69, range 4-8, Controls: 7.98±0.13, range 7-8). The most difficult IADL items for PD participants were shopping (8.2% dependent) and food preparation (12.2% dependent). When correcting for age, education, sex, and motor severity, only the Stroop Interference z-score was significant for participant group (b=0.44, t=2.14, p=0.034), where controls had slightly lower scores (-0.33±0.77) than PD participants (-0.31±0.91). Correlations in controls were significant between IADL total score and Hayling trials 1 (r=0.35, p=0.005) and 2 (r=0.33, p=0.008), and semantic fluency actions trial (r=0.34, p=0.006). In PD participants, IADL total score was only correlated with semantic fluency (animals trial, r=0.26, p=0.028).Conclusions:There were only weak associations between EF abilities and IADL in both healthy controls and PD participants, suggesting that impairments in EF do not necessarily translate into worse ability to execute IADL in PD. More correlations were found in the control group, which may be confounded by the inclusion (in both groups) of participants who already had cognitive impairment. This highlights a further need to examine whether EF impairments in people with PD influence IADL functioning above and beyond normal aging and whether specific deficits have more real-life consequences not attainable through IADL questionnaires.

P03-439 - Suicide attempts and suicide ideation in adolescents: SDQ scores in the Spanish sample of “saving and empowering young lives in Europe” (SEYLE) project

This study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3) whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99 children ages 6-12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).

The prevalence of behavioral problems in children and adolescents living with HIV is high. We investigate associations between oral microbiota and behavioral problems in children living with HIV (CLWH) and children who are HIV-uninfected (CHU). Oral swab samples, assessment of behavioral functioning using the Strengths and Difficulties Questionnaire (SDQ), and clinical and social data were collected from 477 CLWH and 123 CHU at two sites in Johannesburg, South Africa. DNA was extracted from oral swab samples and the V4 amplicon of the 16S rRNA gene sequenced. Behavioral problems were more prevalent in CLWH than in CHU, and in boys than in girls. Oral microbiota diversity and taxa abundances in CLWH did not differ between those with and without behavioral problems. In contrast, in CHU, those with behavioral problems had higher alpha diversity indices and lower abundances of Rothia and Schaalia than those without behavioral problems. Behavioral problems in CLWH were associated with being male, lower Tanner stage, less maternal education, and dental caries. Markers of poor oral health were associated with behavioral problems in CLWH, and oral microbiota profile correlated with behavioral problems in CHU. Oral health may be a preventable factor that could help reduce behavior problems in CLWH.

The aim of the study is to evaluate the effectiveness of the Strength and Difficulties Questionnaire (SDQ) as a screening tool for emotional and behavioral problems in three different populations at risk. The SDQ is a brief screening questionnaire that investigates the presence of emotional and behavioural problems in children and adolescents. We have analyzed 497 questionnaires completed by parents of children referred to Child Neuropsychiatry, Pediatric Endocrinology and Pediatric Oncology Units. Results indicate a higher presence of psychopathological disorders in Neuropsychiatry patients than Oncology and Endocrinology patients. Furthermore the Oncology patients have more emotional and behavioral problems than Endocrinology patients. The findings support the use of the SDQ questionnaire in the assessment of emotional and behavioral problems in these populations at risk. So the SDQ could be used by clinicians to detect early psychopathological disorder in children with different kind of chronic organic diseases.