New research
A Prospective Cohort Study of Influences on Externalizing Behaviors Across Childhood: Results From a Nurse Home Visiting Randomized Controlled Trial

https://doi.org/10.1016/j.jaac.2016.02.007Get rights and content

Objective

This study investigated genetic and environmental influences on behavior in a cohort of 600 children followed prenatally to 18 years.

Method

A randomized controlled trial of prenatal/infancy nurse home visits (NHV) was conducted in 600 predominantly African American mothers and their firstborn children from Memphis, TN. Mothers were assessed in pregnancy for mental health (MH), self-efficacy, and mastery. Mothers reported longitudinally on smoking and alcohol/drug use. The functional polymorphisms SLC6A4 5-HTTLPR, FKBP5 rs1360780 and DRD2/ANKK1 rs1800497 were genotyped together with 186 ancestry informative markers. Composite externalizing disorders (ED) continuous total scores from the mother-report Achenbach Child Behavior Checklist were included as dependent variables in regression analyses for time points 2, 6, 12, and 18 years.

Results

Behaviors at younger ages strongly predicted later behaviors (p < .0001). Children whose mothers had high self-efficacy and had received NHV were better behaved at age 2 years. Poorer maternal MH adversely influenced ED up to 12 years, but at age 18 years, maternal mastery exerted a strong, positive effect (p = .0001). Maternal smoking was associated with worse ED at 6 and 18 years. Main and interactive effects of genetic polymorphisms varied across childhood: FKBP5 rs1360780 up to age 6, 5-HTTLPR from 6 to 12, and DRD2/ANKK1 rs1800497 from 2 to 18 years.

Conclusion

Our study suggests that maternal MH and resilience measured in pregnancy have long-lasting effects on child behavior. Maternal smoking across childhood and genetic factors also play a role. NHV had a positive effect on early behavior. Our findings have implications for prevention of pathological behaviors in adulthood.

Clinical trial registration information—Age-17 Follow-Up of Home Visiting Intervention; http://clinicaltrials.gov/; NCT00708695.

Section snippets

Method

Full details of the study, including participant retention rates and visit attendance patterns, have been published.15, 21, 22 A total of 1,289 eligible women, living in highly disadvantaged urban neighborhoods, were consecutively recruited from a public system for obstetric and pediatric care between 1990 and 1991. Of these, 151 declined to participate. In all, 1,138 primarily self-described African American women at less than 29 weeks gestation with no previous live births and with at least 2

Results

Mothers’ demographic characteristics are presented in Table S1 (available online). CBCL ED continuous total scores were correlated over time (r = 0.57–0.23, p < .0001) (Figure S1, available online).

Discussion

This is a substudy using data derived from a longitudinal study of the effects of prenatal and infancy NHV on health outcomes in a group of urban, predominantly African American mothers and their firstborn children in Memphis, TN. Previous publications based on this dataset (discussed later here) have focused on outcomes in children at the time points 2, 6, 9, and 12 years; however, this is the first longitudinal analysis. This is the first published article to include genetic analyses.

Our

References (44)

  • D.M. Bagner et al.

    Disentangling the temporal relationship between parental depressive symptoms and early child behavior problems: a transactional framework

    J Clin Child Adolesc Psychol

    (2013)
  • L. Burke

    The impact of maternal depression on familial relationships

    Int Rev Psychiatry

    (2003)
  • J. Evans et al.

    Emotional symptoms in children: the effect of maternal depression, life events, and COMT genotype

    Am J Med Genet B Neuropsychiatr Genet

    (2009)
  • J. Kim-Cohen et al.

    Maternal depression and children's antisocial behavior: nature and nurture effects

    Arch Gen Psychiatry

    (2005)
  • K.T. McLearn et al.

    The timing of maternal depressive symptoms and mothers' parenting practices with young children: implications for pediatric practice

    Pediatrics

    (2006)
  • A. Barlow et al.

    Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial

    Am J Psychiatry

    (2015)
  • D. Olds et al.

    Long-term effects of nurse home visitation on children's criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial

    JAMA

    (1998)
  • J. Eckenrode et al.

    Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial

    Arch Pediatr Adolesc Med

    (2010)
  • H. Kitzman et al.

    Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial

    JAMA

    (1997)
  • C. Nymberg et al.

    IMAGEN consortium. DRD2/ANKK1 polymorphism modulates the effect of ventral striatal activation on working memory performance

    Neuropsychopharmacology

    (2014)
  • A. Caspi et al.

    Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits

    Am J Psychiatry

    (2010)
  • N.E. Holz et al.

    Role of FKBP5 in emotion processing: results on amygdala activity, connectivity and volume

    Brain Struct Funct

    (2015)

    • Cited by (10)

    • Alcohol use disorders among adult children of alcoholics (ACOAs): Gene-environment resilience factors

      2021, Progress in Neuro-Psychopharmacology and Biological Psychiatry
      Citation Excerpt :

      As a cascade effect, self-medication with alcohol might then prevent the adoption of more mature and efficient coping strategies,exacerbating the problem (Marmorstein et al., 2010). The association between AUD and the risk genotypes of 5HTTLPR and Taq1A polymorphisms confirms previous studies in ACOAs (Brown-rice et al., 2018; Ratsma et al., 2001) and in longitudinal cohorts (Enoch et al., 2016). Interestingly, the cluster with both the low risk genotypes LL and CC, that does not have the short-allele for the serotonin transporter nor the t-substitution in the dopamine receptor, was not associated with resilience through AUD.

    • Prenatal parenting

      2017, Current Opinion in Psychology
      Citation Excerpt :

      The nurses give considerable social support but also teach aspects of parenting, as well as helping with other things such as diet. The children have been followed up into early adulthood and show remarkable improvement in a variety of ways (e.g. [44]). However an attempted replication in England, which has followed the children until two years old has shown little benefit [42].

    • Cumulative prenatal exposure to adversity reveals associations with a broad range of neurodevelopmental outcomes that are moderated by a novel, biologically informed polygenetic score based on the serotonin transporter solute carrier family C6, member 4 (SLC6A4) gene expression

      2017, Development and Psychopathology

    • Parenting in the Context of the Child: Genetic and Social Processes

      2022, Monographs of the Society for Research in Child Development

    • Serotonin system genes contribute to the susceptibility to obesity in Black adolescents

      2021, Obesity Science and Practice

    • Look to Norway: Serving new families and infants in a multiethnic population

      2019, Infant Mental Health Journal
    View all citing articles on Scopus

    The research was supported by the Robert Wood Johnson Foundation (017934, 11084, 027901); the Carnegie Corporation of New York (B 5492); the Pew Charitable Trusts (88-0211-000, 93-02363-000); the William T. Grant Foundation (88-1246-88, 91-1246-88); and a Senior Research Scientist Award (1-K05-MH01382-01) to David Olds. Further grants: National Institute of Mental Health (NIMH): 1R01MH68790-01, R01-MH61428-01; National Institute of Child Health and Human Development: R01-HD-043492; National Institute of Nursing Research (NINR): NR01-01691-05; Department of Health and Human Services (DHHS) and the National Center for Child Abuse and Neglect, through a transfer of funds to the NINR; Office of Juvenile Justice and Delinquency Prevention grant 2004-52854-CO-JS0; the Administration for Children and Families, DHHS, 90PD0215/01, 90PJ0003; the Bureau of Maternal and Child Health MCJ 360579; and the Hearst Foundation. This research was funded in part by the intramural program of the National Institute on Alcohol Abuse and Alcoholism, NIH.

    Disclosure: The Prevention Research Center for Family and Child Health, directed by Dr. David Olds of the University of Colorado School of Medicine, has a contract with the Nurse–Family Partnership (NFP) to conduct research to improve the NFP program and its implementation. Dr. Olds was employed by this center at the time the study was conducted. Dr. Olds is the founder of the Nurse–Family Partnership. Drs. Enoch, Kitzman, Smith, Hodgkinson, Goldman, Olds, and Ms. Anson report no biomedical financial interests or potential conflicts of interest.

    View full text