Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age.
Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age.
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DOI：
10.1001/jamanetworkopen.2023.10059
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发表时间：
2023-04-03
影响因子：
13.8
通讯作者：
Lester, Barry
中科院分区：
文献类型：
--
作者：
Hofheimer, Julie A.;McGrath, Monica;Musci, Rashelle;Wu, Guojing;Polk, Sarah;Blackwell, Courtney K.;Stroustrup, Annemarie;Annett, Robert D.;Aschner, Judy;Carter, Brian S.;Check, Jennifer;Conradt, Elisabeth;Croen, Lisa A.;Dunlop, Anne L.;Elliott, Amy J.;Law, Andrew;Leve, Leslie D.;Neiderhiser, Jenae M.;O'Shea, T. Michael;Salisbury, Amy L.;Sathyanarayana, Sheela;Singh, Rachana;Smith, Lynne M.;Aguiar, Andrea;Angal, Jyoti;Carliner, Hannah;McEvoy, Cindy;Ondersma, Steven J.;Lester, Barry
不良的产前、新生儿和社会心理状况能否确定与幼儿期持续行为和情绪失调相关的最早危险因素？在这项针对 3934 对母子的队列研究中，早产以及累积的产前物质暴露和心理社会逆境的交互影响与 18 至 72 个月龄持续的高和边缘儿童行为检查表失调轨迹相关。这些发现表明了持续情绪和行为失调的恢复力和风险的显着指标，可以为更早和更具体的行为筛查提供信息，并有针对性地采取可能促进高危儿童适应性发展的干预措施。这项队列研究调查了儿童的情绪和行为调节轨迹，并评估社会心理或新生儿危险因素是否与幼儿期持续失调有关。幼儿期的情绪和行为失调与成年后严重的精神、行为和认知障碍有关。识别持续情绪和行为失调的最早前因可以为风险检测实践和有针对性的干预措施提供信息，以促进高危儿童的适应性发展轨迹。描述儿童的情绪和行为调节轨迹，并检查与幼儿期持续失调相关的风险因素。这项队列研究检查了参与环境对儿童健康结果影响的 20 个美国队列的数据，其中包括 1990 年至 2019 年的 3934 对母子（单胎）。统计分析于 2022 年 1 月至 8 月进行。标准化的自我报告和医疗数据确定了孕产妇、儿童和环境特征，包括产前物质暴露、早产和多种心理社会逆境。儿童行为检查表看护者在 18 至 72 个月大时报告，包括失调概况（CBCL-DP = 焦虑/抑郁、注意力和攻击性的总和）。样本包括 3934 对 18 至 72 个月大的母子。在母亲中，718 名（18.7%）为西班牙裔，275 名（7.2%）为非西班牙裔亚裔，1220 名（31.8%）为非西班牙裔黑人，1412 名（36.9%）为非西班牙裔白人； 3501 名 (89.7%) 分娩时年龄至少为 21 岁。在这些儿童中，2093名（53.2%）为男性，2143名有心理社会逆境指数[PAI]数据的儿童中有1178名（55.0%）经历过多种心理社会逆境，1148名（29.2%）在产前接触过至少一种精神活性物质，3066名（80.2%）是足月出生（妊娠≥37周）。生长混合模型表征了 3 类 CBCL-DP 轨迹模型：高且递增 (2.3% [n = 89])、边界和稳定 (12.3% [n = 479]) 和低且递减 (85.6% [n = 3366])。处于高度和边缘失调轨迹的儿童面临更普遍的母亲心理挑战（29.4%-50.0%）。多项逻辑回归分析表明，早产儿更有可能处于高度失调轨迹（调整后优势比[aOR]，2.76；95% CI，2.08-3.65；P < .001）或边缘失调轨迹（aOR，1.36；95% CI，1.06-1.76；P = .02） vs 低失调轨迹。与男孩（aOR，0.60；95% CI，0.36-1.01；P = .05）和 PAI 较低的儿童（aOR，1.94；95% CI，1.51-2.49；P < .001）相比，女孩的高与低失调轨迹不太常见。 PAI 和产前物质暴露的综合增加与高失调与临界失调的几率增加相关（aOR，1.28；95% CI，1.08-1.53；P = .006），并且与低失调与高失调的几率降低相关（aOR，0.77；95% CI，0.64-0.92；95% CI，0.64-0.92；P=0.006）。 P = .005)。在这项行为失调轨迹的队列研究中，发现了与早期危险因素的关联。这些发现可能为筛查和诊断实践提供信息，以解决在高危儿童中出现的持续失调的前兆。
Can adverse prenatal, neonatal, and psychosocial conditions identify the earliest risk factors associated with persistent behavioral and emotional dysregulation across early childhood? In this cohort study of 3934 mother-child pairs, preterm birth and the interactive influences of cumulative prenatal substance exposures and psychosocial adversities were associated with persisting high and borderline Child Behavior Checklist-Dysregulation trajectories across 18 to 72 months of age. These findings suggest salient indicators of resilience and risk for persisting emotional and behavioral dysregulation to inform earlier and more specific behavioral screening and to target interventions with potential to promote adaptive development among at-risk children. This cohort study investigates children’s emotional and behavioral regulation trajectories and assesses whether psychosocial or neonatal risk factors are associated with persisting dysregulation across early childhood. Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children. To characterize children’s emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood. This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022. Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities. Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression). The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks’ gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005). In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.
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DOI：
10.1016/j.jaac.2013.05.007
发表时间：
2013-08-01
影响因子：
13.3
作者：
Basten, Maartje M. G. J.;Althoff, Robert R.;van der Ende, Jan
通讯作者：
van der Ende, Jan
影响因子：
3.6
作者：
de Lijster, Jasmijn M.;van den Dries, Michiel A.;Legerstee, Jeroen S.
通讯作者：
Legerstee, Jeroen S.
影响因子：
15.1
作者：
Anderson PJ;de Miranda DM;Albuquerque MR;Indredavik MS;Evensen KAI;Van Lieshout R;Saigal S;Taylor HG;Raikkonen K;Kajantie E;Marlow N;Johnson S;Woodward LJ;Austin N;Nosarti C;Jaekel J;Wolke D;Cheong JL;Burnett A;Treyvaud K;Lee KJ;Doyle LW
通讯作者：
Doyle LW
影响因子：
5
作者：
Denckla CA;Cicchetti D;Kubzansky LD;Seedat S;Teicher MH;Williams DR;Koenen KC
通讯作者：
Koenen KC
影响因子：
1.2
作者：
Choi, S. W.;Lim, S.;Cella, D.
通讯作者：
Cella, D.