Behaviour problems in children followed from 5 to 8½-9 years of age and their relation to educational attainment

Children from a cohort of consecutive births identified with behaviour problems by the Richman Screening Questionnaire at the age of 5 years continued to have behaviour problems, as assessed by the Rutter parental questionnaire and the Bristol Social Adjustment Guide, more frequently at the age of 8 1/2-9 years than matched control children. No difference between the groups in non-verbal IQ was identified by the Pidgeon Non-Verbal Test BD. The Neale Test of Reading Ability showed delays of 5 months for both accuracy and comprehension for the study group compared with the controls. These results confirm the recent findings of Richman and others (1982) in a different setting.     

Social patterning and prediction of parent-reported behaviour problems at 3 years in a cohort study

OBJECTIVE: To study the determinants of parent-reported behaviour problems at 3 years and the value of behaviour problems reported at 8 and 18 months as predictors of behaviour at 3 years STUDY DESIGN: A whole year birth cohort SETTING: Coventry MAIN OUTCOMES: Parent-reported behaviour problems at 3 years PARTICIPANTS: A total of 2580 infants were enrolled into the Coventry Cohort Study at the birth visit by their family health visitor. Data on parent-reported behaviour at all three ages (8 months, 18 months and 3 years) were available on 775 infants. RESULTS: Living in rented accommodation [adjusted OR 2.38 (95% CI 1.36, 4.21); OR, odds ratio; CI, confidence intervals] and living in a smoking household [adjusted OR 2.47 (95% CI 1.53, 3.99)] were independently associated with parent-reported behaviour problems at 3 years after controlling for other sociodemographic variables in logistic regression. The risk of behaviour problems at 3 years was increased in those reporting behaviour problems at 8 months [OR 3.77 (95% CI 1.73, 8.20)] and 18 months [OR 5.84 (95% CI 3.34, 10.23)] after adjustment for sociodemographic variables and other health problems. Behaviour at 8 months as a predictor of behaviour at 3 years had a sensitivity of 13.9%, a specificity of 95.7%, a positive predictive value of 32.6%, and positive and negative likelihood ratios of 3.23 and 0.90. For behaviour at 18 months, the sensitivity was 35.6%, the specificity 92.9%, the positive predictive value 42.9%, and positive and negative likelihood ratios 5.01 and 0.69. CONCLUSIONS: Parent-reported behaviour problems at 8 and 18 months are highly specific but not particularly sensitive as predictors of behaviour problems at 3 years. Assuming the availability of an effective early intervention, use of a question such as that in the Warwick Child Health and Morbidity Profile at 8 and 18 months will identify, respectively, 21% and 36% of children at risk of parent-reported behaviour problems at 3 years.     

Behaviour problems in children with learning disabilities: to what extent do they exist and are they a problem?

Summary The parents of 68 young children with learning disabilities were interviewed to assess the number and type of behaviour problems that their child exhibited. Parents' perceptions of their ability to cope with the behaviours were sought. The average number of behaviour problems was 7·4 per child, with poor concentration and sleep problems occurring most frequently. Fifty-seven per cent of parents who reported that their child hurt themself felt unable to cope with those behaviours. Scores of parents' perceived coping skills and malaise were associated with the number of behaviour problems. Parents who reported that their child hurt themself, hurt others or had a sleep problem were likely to have a higher malaise score.     

Outcome of 100 randomly positioned children of very low birthweight at 2 years

Prematurely born children often show a tendency to adopt extensor motor patterns during the first years of life. These children and especially those children of very low birthweight are considered to be at high risk for abnormal development. Positioning in an ordinary manner or in a more flexed position imposed at random during the neonatal period until discharge from hospital did not have a statistically significant influence on the development of these children at 24 months after term. Analysis of the optimality score of the 100 randomly selected children, born consecutively at the University Women's Hospital, Bern, showed a significant influence of prenatal optimality and congenital malformations on their later outcome.     

Respiratory symptoms at age 8 years in a cohort of very low birth weight children.

The childhood respiratory consequences of very low birth weight (birth weight < or =1,500 g) are incompletely understood, especially since the introduction of recent changes in neonatal care. To assess prevalence, trends, and risk factors for respiratory symptoms, the authors followed to age 8 years a cohort of 384 very low birth weight children from six regional neonatal intensive care units in Wisconsin and Iowa who were born between August 1, 1988, and June 30, 1991. A control group of 154 Wisconsin schoolchildren was also assembled. Respiratory symptoms in the past 12 months and history of asthma ("asthma ever") were reported by parents on a questionnaire used in the International Study of Asthma and Allergies in Childhood (ISAAC). Control group prevalence resembled ISAAC prevalence worldwide and in Canada, but respiratory symptoms were twice as common among very low birth weight children. With advent of the availability of pulmonary surfactants, the prevalence of wheezing at age 8 decreased from 50% to 16% (p = 0.002) among children with bronchopulmonary dysplasia, but it increased from 14% to 38% among those with milder neonatal respiratory disease. Bronchopulmonary dysplasia, family history of asthma, smoking in the household, and patent ductus arteriosus were predictive of wheezing in the previous 12 months. Antenatal steroid therapy had a borderline-significant protective association with wheezing (odds ratio = 0.56, 95% confidence interval: 0.29, 1.1). There were interaction effects between several of the predictors.     

Glutamine-enriched enteral nutrition in very low birthweight infants and allergic and infectious diseases at 6 years of age

In a previous randomised controlled trial, we found that glutamine-enriched enteral nutrition in 102 very low birthweight (VLBW) infants decreased both the incidence of serious infections in the neonatal period and the risk of atopic dermatitis during the first year of life. We hypothesised that glutamine-enriched enteral nutrition in VLBW infants in the neonatal period influences the risk of allergic and infectious disease at 6 years of age. Eighty-eight of the 102 infants were eligible for the follow-up study (13 died, 1 chromosomal abnormality). Doctor-diagnosed allergic and infectious diseases were assessed by means of validated questionnaires. The association between glutamine-enriched enteral nutrition in the neonatal period and allergic and infectious diseases at 6 years of age was based on univariable and multivariable logistic regression analyses. Seventy-six of the 89 (85%) infants participated, 38 in the original glutamine-supplemented group and 38 in the control group. After adjustment, we found a decreased risk of atopic dermatitis in the glutamine-supplemented group: adjusted odds ratio (aOR) 0.23 [95% CI 0.06, 0.95]. No association between glutamine supplementation and hay fever, recurrent wheeze and asthma was found. A decreased risk of gastrointestinal tract infections was found in the glutamine-supplemented group (aOR) 0.10 [95% CI 0.01, 0.93], but there was no association with upper respiratory, lower respiratory or urinary tract infections. We concluded that glutamine-enriched enteral nutrition in the neonatal period in VLBW infants decreased the risk of atopic dermatitis and gastrointestinal tract infections at 6 years of age.     

Prenatal exposure to perfluorinated chemicals and behavioral or coordination problems at age 7 years

Objective

Potential neurotoxic effects of perfluorinated compounds (PFCs) have been reported in highly exposed animals, but whether these chemicals are neurotoxic in humans is not known. We therefore investigated whether prenatal exposure to perfluorooctanoic acid (PFOA) or perfluorooctane sulfate (PFOS), two of the most prevalent PFCs, are associated with behavioral or coordination problems in early childhood.

Methods

We used data from the Danish National Birth Cohort, which enrolled mothers in early pregnancy, and we measured maternal blood levels of PFOA and PFOS using specimens drawn around 8 weeks of gestation. When the children reached 7 years of age, mothers completed the Strengths and Difficulties Questionnaire (SDQ, n = 787) and the Developmental Coordination Disorder Questionnaire (DCDQ, n = 526) to assess behavioral health and motor coordination of their children. SDQ scores above the 90th percentile were a priori defined to identify behavioral problems and DCDQ scores below the 10th percentile were defined as a potential DCD.

Results

The median concentrations of PFOS and PFOA in maternal blood were 34.4 ng/mL [interquartile range (IQR), 26.6–44.5] and 5.4 ng/mL (IQR, 4.0–7.1), respectively, similar to distributions reported for populations without occupational exposure. We found no association between higher SDQ scores and maternal levels of PFOS or PFOA, nor did we see any statistically significant association with motor coordination disorders.

Conclusion

The findings suggest that background levels of PFOA and PFOS are not associated with behavioral and motor coordination problems in childhood. However, effects on other developmental end points, including cognitive, attentional, and clinical mental disorders not measured in this study, cannot be ruled out.     

Follow up of extremely low birth weight infants at the age of 8-11 years (late prognosis of perinatal factors)

Thirty-four long-term survivors of a five-year period (1977-1981) weighing 1000 g or less at birth were followed-up at 8-11 years of age. Fifty per cent of this population was qualified as normal. The great majority of the children (24) attended normal school but 7 (20.6%) with need of special help. There were only three children (8.8%) with severe functional impairment. The rate of survival was 30% at the Neonatal Intensive Care Unit of the Department of Pediatrics, University Medical School, Debrecen at that period of time. The authors analyze in detail the connections of the perinatal events and the outcome. While survival was influenced primarily by hemorrhagic complications beyond immaturity, the long-term prognosis depended on birth asphyxia, recurrent apneic spells and requirements for oxygen therapy.     

家庭环境与4～5岁儿童行为问题关系的研究

目的了解家庭环境对4～5岁儿童行为问题发生的影响，为儿童和家庭干预提供可靠的依据。方法采用自拟儿童心理卫生调查表、Achenbach’s儿童行为量表（CBCL）以及家庭环境量表中文版（YES—CV）对武汉市武昌区17所幼儿园共617名4～5岁儿童进行调查，并将结果采用SPSS10．0软件包进行数据分析。结果筛选出存在行为问题的儿童103例，检出率为16．70％，检出率高于全国常模12.19％（P〈0．05）。相关分析发现男孩行为问题的发生与其家庭环境的亲密度、情感表达、知识性、娱乐性、组织性、控制性因子呈负相关关系（P〈0．01），与其家庭环境的矛盾性呈正相关关系（P〈0．05）；女孩行为问题的发生与其家庭环境内外的亲密度、情感表达、成功性、知识性、娱乐性因子呈负相关关系，与其家庭环境的矛盾性呈正相关（P〈0．01）。结论湖北省武汉市武昌区4～6岁儿童行为问题发生率高于全国平均水平。家庭环境特征对男女儿童不同行为问题发生的影响不同。儿童行为问题的发生与儿童的家庭环境有关。     

厦门市学龄儿童注意缺陷多动障碍流调分析

【目的】为了解厦门市学龄儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)发病状况,探讨与其发病的相关因素。【方法】采用整群分层抽样法及Conners量表(家长问卷),应用DSM-Ⅳ诊断标准确诊。调查了厦门市6所不同层次的小学1～5年级学生。【结果】厦门市小学生ADHD患病情况调查3989人,确诊ADHD256人,患病率6.42%。ADHD儿童男女之比约6∶1。单亲家庭与大家庭和核心家庭,差异有显著性。【结论】家庭内部社会化不足和过度及家庭外部社会化失控和不足均可对儿童产生不良影响。     

Services for pre-school children with behaviour problems in a Midlands city

OBJECTIVES: To study the services for pre-school children with behaviour problems in a Midlands city and the level of co-ordination and co-operation between providers. SETTING: A socially and ethnically diverse Midlands city in the UK. METHODS: Survey methods were employed with city health visitors in order to determine their role and identify service providers. Service providers from different agencies were interviewed and data collected related to service offered, materials used, theoretical basis of interventions, referrals to and from the service, inclusion and exclusion criteria and co-ordination and co-operation with other providers. Themes were identified related to the content and process of the services using qualitative data analysis methods. Frequencies of themes were estimated for different provider groups. RESULTS: Health visitors and nursery nurses working in the primary care services were the primary point of contact for children with pre-school behaviour problems. Nursery nurses were one of the major sources of referral for children with pre-school behaviour problems and a significant majority of these providers had not received any specific training for this role. The majority of the providers used evidence-based programmes but few adhered strictly to a particular programme and instead used a mixture of materials drawn from different programmes. Many health service providers in particular offered interventions to parents on a one-to-one basis only. Most providers used behaviour modification approaches. While many providers claimed to have knowledge of other local providers and have good links, there was little evidence of co-ordination within and between agencies. CONCLUSIONS: While there appears to be high levels of activity by providers from both statutory and voluntary sectors in providing services for pre-school children with behaviour problems, there is evidence to suggest that some of the main providers of services are not being adequately prepared and supported in the role. There is a lack of co-ordination within and between services, and indication that evidence-based programmes are being modified and used in an ad hoc manner. It is concluded that surveys of this nature may be an important preliminary step in establishing co-ordinated services for the primary and secondary prevention of pre-school behaviour problems.     

Assessment of health status at two years of very low birthweight infants--clinical governance

Aims to establish a mechanism to determine prospectively the health status at two years of babies who weighed less than 1.5 kg at birth, born and receiving neonatal intensive care in North Wales. Maternal and neonatal data on all babies discharged from each of the three units in North Wales meeting this criteria were collated by the study coordinator. A mechanism for review of the health status at two years, corrected for gestational age, was established using the data set recommended by a working group convened by the National Perinatal Epidemiology Unit and Oxford Regional Health Authority. The procedures developed and the outcome data, for a two year cohort of babies born in 1995 and 1996, are reported. Concludes that prevalence of severe disability was similar to that found in other studies, with a considerable number exhibiting impaired growth and delay in speech development.     

Sleep problems and “sleep-aids” in low birth weight children during the first three years

Bedtime patterns of 66 low birth weight children were compared to those of 109 normal birth weight children longitudinally at ages one, two and three years. At age one, the low birth weight children were less likely to have problems falling asleep and awakening during the night than the normal birth weight children. They were also less likely to use night lights and special blankets or other objects as aids to falling asleep, and more likely to engage in the self-contained pre-sleep activity of rhythmic body rocking. Although at ages two and three the two groups were comparable in terms of the frequency of sleep problems, the low birth weight children's higher frequency of self-rocking and lower frequency of use night lights and special objects continued over time.     

Twinship as a protective factor against behavioural and emotional problems at preschool age

Early attachment has both protective and risk factors as regards later mental health. In Finland, insecure-avoidant-type attachment is overrepresented. Does this indicate a risk for emotional and behavioural problems at preschool age? In this study, we examined and compared the association between attachment and mental health in Finnish singletons and twins. The attachment of 27 singletons and 58 twins with both parents had previously been examined at the age of 18 months using Preschool Assessment of Attachment criteria. At the age of 4, the children's emotional and behavioural symptoms were assessed using Child Behavior Checklist questionnaires reported by parents. The mothers and fathers reported significantly more behavioural and emotional problems at preschool age in singletons than in twins. Insecure-avoidant-type attachment to the mother was significantly associated with higher scores concerning withdrawal, somatic problems and total internalising symptoms among singleton preschoolers, whereas among twins, no such correlations were observed. The results thus suggest that twinship is a protective factor in the trajectory from toddler avoidant attachment to internalising problems at preschool age.     

Health status and health behaviour in men and women at the age of 34 years

The aim of this investigation was to study relationships betweenhealth status and health behaviour in men and women. A groupof 425 Swedish students were randomly selected in 1974 at theage of 16 years. In 1992, at the age of 34 years, those whowere investigated comprised 88% of the original sample. Cross-sectionaldata on health status and health behaviour were obtained througha self-administered questionnaire. Among the men, leisure-timephysical activity, smoking cigarettes and use of smokeless tobaccowere significantly associated with perceived health, diseaseand perceived health, and impaired musculoskeletal functionrespectively. Among the women walking/cycling to work and choosinghealthy foods significantly decreased the likelihood of impairedmusculoskeletal function and being overweight respectively.     

4～5岁学龄前儿童血铅与行为问题关系的研究

目的:了解珠海市4~5岁学龄前儿童血铅水平及行为问题的现况,探讨铅中毒对4~5岁学龄前儿童行为问题的影响。方法:采用末梢血对珠海市3所幼儿园427名4~5岁儿童进行血铅水平测定,同时采用Achenbach(CBCL)量表对儿童行为进行评估。以血铅水平100μg/L为界,分为高血铅(≥100μg/L)和低血铅(<100μg/L)两组。男童CBCL总粗分≥42分,女童CBCL总粗分≥45分即判定其有行为问题。结果:珠海市4~5岁儿童血铅均值为(65.02±49.35)μg/L,血铅≥100μg/L的检出率为28.13%,儿童行为问题总检出率为16.52%。高血铅组CBCL总粗分(29.24±18.49)明显高于低血铅组(22.17±15.22)(P<0.01)。行为问题检出率高血铅组为24.20%,低血铅组为11.60%,差异有极显著性(P<0.01)。男童高血铅组与低血铅组行为问题检出率分别为26.98%和12.42%,差异有极显著性(P<0.01),女童高血铅组与低血铅组行为问题检出率分别为19.44%、10.78%,差异无显著性(P>0.05)。男童高血铅组违纪因子检出率显著高于低血铅组(P<0.05),女童高血铅组攻击因子检出率高于低血铅组,差异有显著性(P<0.05)。结论:铅中毒与学龄前儿童行为问题有密切关系,男童铅中毒较女童铅中毒更易出现行为问题。建议对有行为问题的学龄前儿童常规开展血铅筛查。     

Obstetrical judgments of viability and perinatal survival of extremely low birthweight infants.

OBJECTIVES. The purpose of the study was to determine whether the obstetrical judgment of viability makes a difference to fetal and neonatal survival of extremely low birthweight infants (500-749 g). METHODS. We assessed the effect of the antenatal judgment of viability in a group of 66 infants born weighing from 500 to 749 g. These infants were alive at maternal hospital admission and were subsequently live-born or stillborn between January 1, 1984, and December 31, 1985. We related the antepartum assessment of viability and other factors recorded in the medical record to fetal survival and to postneonatal survival to hospital discharge. RESULTS. The obstetrical judgement of viability was strongly associated with outcome. After birthweight and gestational age were controlled, fetuses considered viable were 18 times more likely to survive (95% confidence interval = 2, 175) than those considered nonviable. CONCLUSIONS. The effects of obstetrical practices on perinatal mortality must be taken into consideration in estimating the survival potential of very small fetuses and in evaluating the relationship between survival and disability.     

Efficacy of the Incredible Years Basic parent training programme as an early intervention for children with conduct problems and ADHD

BACKGROUND: The efficacy of the Incredible Years (IY) Basic parent training (PT) programme for a community-based sample of families with pre-school children at risk of developing both conduct problems and attention deficit hyperactivity disorder (ADHD) was examined. METHODS: Pre-school children displaying signs of both early-onset conduct problems and ADHD were randomly allocated to either IY PT intervention, or to a waiting list (WL) control group. Child symptoms were assessed before and after the intervention. RESULTS: Post intervention, the intervention group was associated with significantly lower levels of parent-reported inattention and hyperactive/impulsive difficulties, even after controlling for post-intervention changes in child deviance. In addition, 52% of those in the intervention condition, compared with 21% in the control condition, displayed clinically reliable improvements post intervention, giving an absolute risk reduction of 31% and a number needed to treat of 3.23. CONCLUSIONS: Findings from this study indicate that the IY PT programme is a valuable intervention for many pre-school children displaying early signs of ADHD.     

Gender differences in externalising problems among preschool children: implications for early childhood educators

Gender differences in student achievement have been widely studied. Considering the long‐term effects of externalising behaviour problems on children’s later academic performance, it can be conjectured that gender disparities in student achievement may be rooted in developmental characteristics in early childhood. As an effort towards contributing insights to the growing body of knowledge on child development, this study investigated whether variability in externalising behaviour problems among preschool children could be attributed to gender differences. Participants were 110 parents who completed a sociodemographic questionnaire, and rated their child’s behaviour on the Achenbach Child Behaviour Checklist. The children (mean age in months = 45.62 (SD = 10.12)) consisted of 52 boys and 58 girls. This study revealed that boys were reported to exhibit higher rates of externalising problems than girls, and that higher rates of internalising problems also predicted higher rates of externalising problems among these preschool children.     

北京市6~12岁儿童行为问题现状及相关因素分析

【目的】 了解北京市6~12岁儿童行为问题的现状及相关影响因素,以便有针对性地采取干预措施。 【方法】 采用Achenbach儿童行为量表(Child Behavior Checklist,CBCL),对北京市城区236名6~12岁儿童的行为及相关因素进行调查并分析。 【结果】 儿童行为问题检出率为18.2%,分析显示父母文化程度、主要带养人学历、感染性疾病等因素对儿童行为发育有明显影响。 【结论】 家庭环境是影响儿童行为的重要因素,降低儿童不良行为问题的发生率,应注意改善不良的家庭环境因素。