The Confluence of Mental, Physical, Social, and Academic Difficulties in Middle Childhood. I: Exploring the “Headwaters” of Early Life Morbidities

doi:10.1097/00004583-200205000-00016

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 41, Issue 5, May 2002, Pages 580-587

https://doi.org/10.1097/00004583-200205000-00016 Get rights and content

ABSTRACT

Objective

To present the conceptual and methodological backgrounds for development of the MacArthur Assessment Battery for Middle Childhood and one of its constituent instruments, the MacArthur Health and Behavior Questionnaire (HBQ).

Method

As a component of HBQ development, research addressing “developmental psychopathology” as a nosological category of human disorder was reviewed. Such research bears, as its conceptual legacy, the strengths and frailties of the nosology from which the category was derived.

Results

Defining developmental psychopathology has done much to foster psychiatric and medical awareness of the particular dilemmas and problems intrinsic to childhood psychopathology. On the other hand, its delineation has obscured the tendency for psychiatric morbidities to emerge gradually along trajectories of development, to involve interactions among organismic and contextual factors, and to represent “confluences” of childhood difficulties suggesting common, less distinctive origins among psychiatric and biomedical disorders. The recognizable psychopathology of adolescence is most often preceded by protean manifestations of early difficulties resulting from the conjoint operation of child-specific vulnerabilities and context-derived risk factors. Co-occurrences of mental, physical, social, and academic difficulties in children's lives are more frequently the rule than the exception, and isolated, singular psychopathology is less common in childhood than the prevailing diagnostic nosology may imply.

Conclusions

The MacArthur Assessment Battery represents an effort to assemble, in a single set of instruments, measures of child, context, and health risk factors for the prevalent morbidities of middle childhood. The HBQ, a component of the Battery, is a parent- and teacher-report instrument that assesses mental health, physical health, social, and school adaptation in 4- to 8-year-old children.

Section snippets

MIDDLE CHILDHOOD

A research territory in particular need of new methodological approaches is the period of “middle childhood,” that is, the several years between the psychosocial transition to primary school at age 5 years and the biological transition to puberty that begins variably from 8 to 14 years of age. Much developmental research has focused on infancy and the first 3 years of life, during which critical events in brain development and human relationships occur (Nelson and Bosquet, 1999), and on

CONTINUITIES FROM EARLY CHILDHOOD

Given these challenges and transitions, it is not surprising that longitudinal studies of children with preschool behavioral disorders have increasingly documented prospective continuities of such disorders into primary school and beyond. Campbell and Ewing (1990), for example, found that young children with significant externalizing problems at 3 years of age were more likely than control children to show difficulties in behavioral control during middle childhood in both the home and school

MacARTHUR ASSESSMENT BATTERY

To generate and examine hypotheses that might reflect such a vision, researchers in the MacArthur Research Network on Psychopathology and Development are assembling an integrated assessment battery, based on a dynamic, multidimensional model of developmental psychopathology and addressing biological, neurological, psychosocial, and contextual aspects of middle childhood development. Rooted in the work of investigators such as Hamburg et al. (1974), Sameroff and Chandler (1975), and

CONCLUSION

We conclude with a summing up of our theoretical positions regarding the assessment and study of developmental psychopathology and with an introduction to the empirical and methodological results that follow. Contrary to widely held beliefs that young children generally “outgrow” behavioral and emotional difficulties, more than half of those with psychiatric disorders in the preschool years continue to show evidence of mental illness well into middle childhood and beyond (Lavigne et al., 1998a,

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Increasing evidence has demonstrated that childhood adversity was a predictor of pain and hypothalamic-pituitary-adrenal (HPA) axis genetic variation is associated with pain risk. This study aims to explore possible effects of prolonged childhood separation from parents and HPA polygenic risk score (PRS) on pain among adolescents in rural China.
We used data from 219 adolescents in rural area of Fuyang city, Anhui province, China. Parent-child separation was collected through interview and pain intensity was reported using the 11-point Numerical Rating Scale. SNP genotyping was performed using an improved multiplex ligation detection reaction (iMLDR) technique. The PRS was computed based on 3 single nucleotide polymorphisms (SNPs) in 2 genes (FKBP5 and NR3C1) related to HPA-axis stress reactivity.
Pain among adolescents separated from both parents scored higher compared to those without parent-child separation, however, this association was only observed in adolescents with moderate to high tertiles of PRS groups (parent-child separation in moderate group vs. no parent-child separation in moderate group: 3.07 vs. 1.57, P < 0.001; parent-child separation in highest group vs. no parent-child separation in highest group: 3.02 vs. 1.26, P < 0.001; parent-child separation in lowest group vs. no parent-child separation in lowest group: 2.34 vs. 1.25, P = 0.225). After controlled for demographic characteristics, psychopathological symptoms, adverse childhood experiences, parental warmth, prolonged childhood parent-child separation increased pain scores by 1.52 points (95% CI:0.72, 2.33) and 1.72 points (95% CI:1.13, 2.31) in moderate and high PRS groups, respectively.
Our findings suggest that adolescents separated from both parents while carrying more risk alleles related to HPA-axis stress reactivity are at heightened risk of pain.
Relational aggression during early childhood: A systematic review
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Compared to other measures of relational aggression, the PSBS-TF has consistently shown high reliability ranging from >0.70 to 0.96. Other frequently utilised measures included naturalistic observations (n = 22), the Preschool Proactive and Reactive Aggression – Teacher Report (PPRATR; Ostrov & Crick, 2007) (n = 11), sociometric nomination procedures (n = 9), the Children's Social Behavior Scale – Teacher Form (CSBS-T; Crick, 1996) (n = 7), and the MacArthur Health and Behavior Questionnaire (MHQ; Boyce et al., 2002) (n = 4). Sociometric nominations generally had the lowest reliability scores (or reliability was not reported) compared to the other common measures of relational aggression.
Seminal work on relational aggression in middle childhood began in 1995 and the first study to examine relational aggression in early childhood was published in 1996 in the Journal of Research in Childhood Education. Since then, an abundance of research examining the prevalence of relational aggression during early childhood has been published in over 53 peer-reviewed journals. This review summarises the empirical evidence from these studies. A systematic search of the literature published between 1995 and 2019 identified 106 studies for inclusion. Studies were coded to extract data on participant characteristics, measurement characteristics, the prevalence of relational aggression, dependent variables (psychosocial factors), and research rigor. Results indicate that the prevalence of relational aggression during early childhood has remained stable over the past 25 years. However, we observed considerable heterogeneity regarding the instruments and informants that were used and psychosocial factors that were evaluated in the different studies. Recommendations and consideration are given to future directions in the study of relational aggression during early childhood.
Poly-victimization and psychopathological symptoms in adolescence: Examining the potential buffering effect of positive childhood experiences
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Total score was calculated if they had completed all questions (Wood et al., 1995). ODD and CD were reported by adolescents using the MacArthur Health & Behavior Questionnaire (Boyce et al., 2002) for Late Childhood and Adolescence (9–18 years). The score of each externalizing dimension was obtained by computing the mean of the item scores of the dimension.
Childhood maltreatment are well-established risk factors for adolescent psychopathology. Positive childhood experiences (PCEs) known protective factors. However, few studies have simultaneously investigated childhood maltreatment and PCEs in the context of longitudinal study. The aim of this paper was to assess the buffering effect of PCEs in adolescence in the association between chronic childhood maltreatment and psychological symptoms in adolescence.
Data were from an ongoing longitudinal study with 2288 children aged 8.15 y at baseline who were recruited from 3 large elementary schools in China. Participants were followed up for four waves across 6 years. The associations between re-victimization and poly-victimization with adolescent psychopathological symptoms across different PCEs contexts were explored.
Poly-victimization was highly predictive of depressive symptoms, oppositional defiant disorder and conduct disorder. PCEs may mitigate the negative effect of chronic childhood maltreatment on adolescent psychopathology in a dose-response manner. For adolescents with 4-5 PCEs, psychopathological symptoms score decreased significantly and showed similar level with those low/no-victimization comparison peers. While experiencing multiple PCEs does decrease the risk of psychopathological symptoms, certain PCEs, such as parental warmth and peer support, appear to entailed protective effect on all the three psychopathological symptoms.
It is not clear whether the patterns of effects would vary across developmental periods.
A focus of interventions should be not only on ameliorating childhood maltreatment, but also on expanding the availability of social support related PCEs, which may help inform suitable strategies for providing intervention and support to best help reduce the psychopathology burden for children.
Academic implications of insensitive parenting: A mediating path through children's relational representations
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All analyses also controlled for prior harsh maternal representations, which were assessed at age 4, using the same administration and coding protocols, but with a slightly different subset of stories (i.e., the Spilled Juice and Park Outing stories assessed parental comfort at wave 1, rather than Monster Under the Bed, yielding a total of six stories at age 4; ICC = 0.850 across 48.4% of cases). Following the assessments at ages 6 and 7, children's teachers completed a modified short-form of the Student Teacher Relationship Scale (STRS; Pianta, 2001), which was included in the MacArthur Health and Behavior Questionnaire (MHBQ; Boyce et al., 2002; Essex et al., 2002). Teachers indicated how much they agreed with five statements pertaining to conflict in the teacher-child relationship (e.g., “You and this child always seem to be struggling with each other”) on a 5- point Likert scale from definitely applies (5) to definitely does not apply (1).
Despite evidence that insensitive parenting is associated with later academic achievement, few studies have evaluated mechanisms that may account for these effects. This study utilized a diverse sample of child-caregiver dyads (N = 245, 50.2% male, 46.5% Latinx) to evaluate a sequential mediation model from observations of female caregivers' insensitive parenting behaviors at age 4 to children's maternal representations at age 6, to teachers' reports of conflict in the teacher-child relationship at age 7 and, ultimately, to children's academic achievement at age 8. Even when holding prior levels of each study construct constant, analyses revealed a significant sequential mediation such that insensitive parenting contributed to increases in children's harsh maternal representations, which, in turn, predicted increases in teacher-child conflict at school and, ultimately, decreases in children's reading and math achievement. These findings highlight parenting and teacher-child relationship qualities as promising targets for interventions to promote children's academic achievement.
The patterns of adverse childhood experiences among Chinese children: Four-year longitudinal associations with psychopathological symptoms
2020, Journal of Psychiatric Research
The objective of this longitudinal study was to identify the contribution of individual, cumulative and patterns of adverse childhood experiences (ACEs) exposure in the prediction of psychopathological outcomes during adolescence in the context of Chinese culture. Children from 3 large elementary schools of Bengbu, Anhui Province, China were enrolled in the 3 waves survey from 2013 (mean age = 8.15 years, SD = 0.88) to 2017 (mean age = 11.92 years, SD = 0.88). Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive “classes” of 10 most common ACEs. Logistic regression was used to examine the association between individual, cumulative and patterns of ACEs and depressive and externalizing symptoms at Wave 3. Of the 1766 respondents included in the sample, 75% had at least 1 and 21.5% reported 4 or more ACEs. We found the dose-response relationship between cumulative ACEs and psychopathological outcomes. Results from LCA revealed three high-risk profiles and one low-risk profile, which were labeled: high ACEs (5.7%), highly abusive and adverse events (20.1%), highly abusive and neglected (21.3%), and low ACEs (52.9%). Compared to low ACEs class, each high-risk profile was differentially associated with psychopathological outcomes over 4-year period. Children exposed to high ACEs were at higher risk for future depressive and externalizing symptoms than other classes. This study provides evidence for the predictive impact of ACEs on adolescent psychopathological symptoms in Chinese culture. Clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE patterns and provide preventive intervention immediately, rather than provide treatment later in life.
Associations between early life parent-child separation and shortened telomere length and psychopathological outcomes during adolescence
2019, Psychoneuroendocrinology
Given the ethical limitations of exposing children to experimentally manipulated adverse experiences, evidence of the effects of parent-child separation on subsequent psychopathology are based mostly on animal studies. Left-behind children phenomenon resulting from rural-urban mobility in China offers unique “natural experiments” to explore the long-term physical and mental health consequences of parent-child separation in childhood.
To test the associations between parent-child separation with telomere length (TL) and psychopathology during adolescence.
A total of 710 adolescents (age: M = 16.86, SD = 1.52) were recruited from local schools in rural area of Fuyang, one of the top inland areas for outward migration in Anhui province, China. Parent-child separation was collected through face to face interview. The MacArthur Health & Behavior Questionnaire (HBQ) was used to assess internalizing and externalizing symptoms. Quantitative polymerase chain reaction was used to measure buccal TL.
Nearly 60% (399/695) of the participants experienced separation from both parents. Childhood or persistent separation from parents was associated with increased internalizing symptoms (childhood: β = 0.13, 95% CI: 0.02, 0.23; persistent: β = 0.23, 95% CI: 0.14, 0.31), increased externalizing symptoms (childhood: β = 0.17, 95% CI: 0.03, 0.32; persistent: β = 0.23, 95% CI: 0.10, 0.35) and shorter telomere length (childhood: β = −0.16, 95% CI: −0.26, −0.05; persistent: β = −0.13, 95% CI: −0.22, −0.03). Shortened TL was estimated to explain 15.2% and 12.7% of the total effect of separation on internalizing and externalizing symptoms, while internalizing and externalizing symptoms explained 23.4% and 12.3% of the effect of separation on shortened TL.
Childhood and persistent parent-child separation, as experienced by rural left-behind children in China, associates with increased vulnerability for psychopathological symptoms and makers of cellular aging. The challenge for future research is to determine whether short telomere length is in fact a long-term consequence or an underlying vulnerability factor for future mental disorders.

View all citing articles on Scopus

: The research on which this paper was based was supported by the John D. and Catherine T. MacArthur Foundation's Research Network on Psychopathology and Development and by NIMH grant R01-MH44340. The MacArthur Assessment Battery Working Group comprises Jennifer C. Ablow, Abbey Alkon, Jeffrey M. Armstrong, W. Thomas Boyce, Marilyn J. Essex, Lauren H. Goldstein, Richard Harrington, Helena C. Kraemer, David J. Kupfer, Jeffrey R. Measelle, Charles A. Nelson, Jodi Quas, Nancy A. Smider, and Laurence Steinberg.

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ARTICLESThe Confluence of Mental, Physical, Social, and Academic Difficulties in Middle Childhood. I: Exploring the “Headwaters” of Early Life Morbidities

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

MIDDLE CHILDHOOD

CONTINUITIES FROM EARLY CHILDHOOD

MacARTHUR ASSESSMENT BATTERY

CONCLUSION

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Psychosom Res

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Affective Disord

First-grade classroom behavior: its short- and long-term consequences for school performance

Child Dev

Predicting conduct problems: can high-risk children be identified in kindergarten and grade 1?

J Consult Clin Psychol

Do measures of externalising behaviour in normal populations predict later outcome? Implications for targeted interventions to prevent conduct disorder

J Child Psychol Psychiatry

Biobehavioral reactivity and injuries in children and adolescents

Adrenocortical and behavioral predictors of immune responses to starting school

Pediatr Res

Psychobiologic reactivity to stress and childhood respiratory illnesses: results of two prospective studies

Psychosom Med

Social context in developmental psychopathology: recommendations from the MacArthur Network on Psychopathology and Development

Dev Psychopathol

Crowding stress and violent injuries among behaviorally inhibited rhesus macaques

Health Psychol

The Ecology of Human Development: Experiments by Nature and Design

The ecology of developmental processes

Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study

Pediatrics

Children with chronic illness: family and parent demographic characteristics and psychosocial adjustment

Pediatrics

Follow-up of hard-to-manage preschoolers: adjustment at age 9 and predictors of continuing symptoms

J Child Psychol Psychiatry

Neurodevelopmental processes in the ontogenesis and epigenesis of psychopathology

Dev Psychopathol

The development of depression in children and adolescents

Am Psychol

Prospective associations between somatic illness and mental illness from childhood to adulthood

Am J Epidemiol

Psychopathology in pediatric primary care

Pediatrics

Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model

Arch Gen Psychiatry

The life course as developmental theory

Child Dev

ARTICLES
The Confluence of Mental, Physical, Social, and Academic Difficulties in Middle Childhood. I: Exploring the “Headwaters” of Early Life Morbidities