Thursday, May 18, 2023

Study Identifies Maternal Risk Factors Associated With Behavioral Challenges in Youth

Developing an infection and/or smoking while pregnant are just two of several factors that a study in the Journal of the American Academy of Child & Adolescent Psychiatry suggests may put offspring at risk of emotional, cognitive, and behavioral dysregulation.

“Emotional, cognitive, and behavioral dysregulation in childhood is associated with impaired psychosocial functioning, poor school performance and with increased rates of psychiatric disorders, suicidality, and functional impairment in adulthood,” wrote Jean Frazier, M.D., of UMass Chan Medical School and colleagues.

Frazier and colleagues used data from the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) research program. The seven-year research project includes 69 pediatric longitudinal cohorts and aims to investigate the effects of environmental exposures on child health. The ECHO data include information about mothers, including family history of psychiatric illnesses; tobacco use during pregnancy; pre-pregnancy body mass index; educational attainment; gestational diabetes diagnoses; and prenatal infections such as fever, flu, or sexually transmitted infections. Frazier and colleagues limited their analysis to include only ECHO studies in which researchers collected information about children aged 6 to 18 using the Child Behavior Checklist as well as mothers’ experience with prenatal infection. No studies with less than 10 children were included in the analysis.

The Child Behavior Checklist is a tool that is administered to parents and includes 120 questions about the child/adolescent’s behavior. Children are considered to meet the criteria for a dysregulation profile if their sum scores for three of the checklist’s subscales (attention, anxious/depressed, and aggression) is 180 or higher.

The authors analyzed data from 4,595 youth from 18 ECHO cohorts (25% of these youth were born preterm, or before 37 weeks gestation; 17% were born extremely preterm, or before 28 weeks gestation). Over 600 children (13.4%) met the criteria for a dysregulation profile. The frequency of dysregulation profiles was 11.5% for girls and 15.1% for boys. Additional findings include the following:

  • Youth with a dysregulation profile had higher odds of having a close relative (parent or sibling) with a psychiatric disorder than those without the dysregulation profile.
  • Youth with a mother who had less than a high school education had higher odds of having a dysregulation profile compared with those whose mothers had some college or above.
  • Compared with those without a dysregulation profile, youth with a dysregulation profile were more likely to be born to mothers considered overweight prior to pregnancy, more likely to be exposed to prenatal tobacco use, and more likely to be exposed to a prenatal infection.

“Social and educational interventions could possibly target the modifiable risk factors (e.g., maternal obesity, prenatal tobacco use, maternal education) and modify the developmental trajectories associated with the [dysregulation profile], particularly if there are multiple modifiable risk factors seen in an individual child,” the authors concluded. “Critically important to the overall management of these dysregulated youth is more fully understanding the drivers behind a child’s behavior and providing support and intervention in a sustained way.”

For related information, see the Psychiatric News article “Special Report: Stress and Distress During Pregnancy—How to Protect Both Mother and Child.”

(Image: iStock/fotostorm)

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