Next Article in Journal
Repeated Etching Cycles of Resin Infiltration up to Nine Cycles on Demineralized Enamel: Surface Roughness and Esthetic Outcomes—In Vitro Study
Previous Article in Journal
The Association between the First Cry and Clinical Outcomes in CDH Neonates: A Retrospective Study
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Children
Volume 10
Issue 7
10.3390/children10071146
children-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Association between 24 h Movement Guidelines and Internalising and Externalising Behaviour Problems among Chinese Preschool Children

by
Na Zhu
1,
Hongzhi Guo
2,
Dongmei Ma
3,
Qiang Wang
4,
Jiameng Ma
5 and
Hyunshik Kim
5,*
1
Department of Sports, Shenyang Ligong University, Shenyang 110159, China
2
Graduate School of Human Sciences, Waseda University, Tokorozawa 3591192, Japan
3
Department of Medicine and Science in Sports and Exercise, Graduate School of Medicine, Tohoku University, Sendai 9808576, Japan
4
College of Sports Science, Shenyang Normal University, Shenyang 110034, China
5
Faculty of Sports Sciences, Sendai University, Shibata 9891693, Japan
*
Author to whom correspondence should be addressed.
Children 2023, 10(7), 1146; https://doi.org/10.3390/children10071146
Submission received: 31 May 2023 / Revised: 20 June 2023 / Accepted: 27 June 2023 / Published: 30 June 2023
Browse Figure
Review Reports Versions Notes

Abstract

:
This study examined the relationship between adherence to 24 h movement guidelines (24 h MGs) and internalising and externalising behavioural problems in Chinese children aged 3–6 years, with a specific focus on the differences between weekdays and weekends. The guidelines include recommendations for physical activity (PA), screen time (ST), and sleep duration (SD). The results indicated a stronger association between adherence to these guidelines and behavioural problems on weekends compared to weekdays. Specifically, the odds of experiencing internalising problems were 1.33 higher (95% CI: 1.05–1.69) when not satisfying all three behaviours compared to not satisfying one or two. Moreover, on weekends, when ST was not fulfilled, there was a higher likelihood of externalising behaviour problems compared to when it was fulfilled (OR, 1.18, 95% CI, 1.01–1.38), and when all three behaviours were not met, the likelihood was even higher (OR, 1.50, 95% CI, 1.04–2.18). Children who met all three guidelines had fewer internalising and externalising behavioural problems, suggesting a potential beneficial effect on mental health. The study revealed that a higher adherence to these recommendations corresponded to a lower risk of mental health problems. Additionally, higher screen time was linked to an increase in externalising behavioural issues. These findings underscore the importance of adherence to 24 h MGs for optimal mental health in children. Future interventions should consider these behavioural factors and incorporate strategies to promote adherence to these guidelines, particularly on weekends.

1. Introduction

The World Health Organization (WHO) reports growing concerns regarding the scope and impact of mental illness in children, with an estimated 10–20% of children and adolescents worldwide suffering from mental disorders such as depression, anxiety, and aggressive behaviours [1]. Approximately 70% of mental illnesses develop during childhood and adolescence, and it is predicted that 15–25% of the world population will experience at least one mental health problem before the age of 19 years [2]. In China, the occurrence of mental disorders among children aged 6–16 years is a significant health concern, with a prevalence rate ranging from 9.49% to 15.24% [3]. Considering that mental health problems are likely to begin in early childhood [4] and continue into adulthood [5], the early identification of risk factors for children’s mental health is crucial.
The strengths and difficulties questionnaire (SDQ) is an appropriate tool for screening behavioural and psychopathology issues in children aged 3–16 years, as it can detect internalising and externalising behavioural problems in children [6]. Externalising behaviours are a range of aggressive and uncontrolled behaviours such as aggression, conduct problems, hostility, hyperactivity, and attention issues. Internalising behaviours are actions directed towards oneself and can manifest as anxiety, fear, sadness, depression, social withdrawal, and physical dissatisfaction [7,8]. These two behavioural problems co-occur at high rates among children and are likely to lead to mental disorders in adulthood [9]. Previous studies have reported that irregular PA [10], excessive ST [11], and short SD are associated with internalising and externalising behaviour problems [12]. Nevertheless, prior research has examined these behaviours in isolation, and has disregarded their interconnectedness [13,14]. Our hypothesis posits that achieving the recommended 24 h Movement Guidelines (24 h MGs) for physical activity (PA) in Chinese preschool children may be associated with a decrease in both internalising and externalising behaviour problems.
The interdependence of PA, screen time (ST), and sleep duration (SD) has been established by previous studies [15,16]. Moreover, there exists compelling evidence that supports the notion of an interaction between the health benefits of movement behaviours within a 24 h time frame [17,18,19]. Consequently, in light of the publication of the 24 h MGs for Canadian youth and adolescents (aged 5–17 years) [20], there is a necessity to comprehend the proportion of children who adhere to the guidelines, and to determine which specific amalgamation of behaviours holds the greatest significance in relation to their mental wellbeing. Furthermore, kindergarten children typically experience a less structured and more autonomous environment on weekends, whereas structured and detailed schedules characterize their weekdays. A recent meta-analysis reported that the 24 h MGs of adolescents are generally healthier on days with more structure [21], although there have been no studies, to the author’s knowledge, investigating the impact of structure on children’s behaviour. Therefore, this study aimed to investigate the potential link between adherence to 24 h MGs and internalising and externalising behavioural problems in Chinese children aged 3–6 years, as well as any differences in adherence between weekdays and weekends. In doing so, this study seeks to contribute to promoting mental health in Chinese children and developing evidence-based interventions to address any potential issues that may arise. We hypothesised that meeting 24 h MGs in Chinese preschool children would contribute to a reduction in internalising and externalising behaviour problems.

2. Materials and Methods

2.1. Study Design and Participants

This cross-sectional study partially extracted data from the “International Joint Study for the Improvement of 24 h Movement and Mental Health of East Asian Children”. Accelerometers were used to measure PA and sedentary behaviour from September to October 2022, and a questionnaire survey was administered to investigate internalising and externalising behavioural problems. Regarding participant recruitment, kindergartens in Shenyang, China, were selected through convenience sampling. Per the Declaration of Helsinki, informed consent was obtained from the parents and teachers of children aged 3–6 years from the selected kindergartens in Shenyang, China. Data from 200 children (51.0% boys, 49.0% girls) who provided signed consent forms were collected and analysed. The participation recall rate was 74.6%. The study received prior approval from the Sendai University Ethics Committee, Faculty of Sports Science (SU2021-05).

2.2. Measurements

2.2.1. Physical Activity

The study used a triaxial accelerometer (Active Style Pro HJA-750C; Omron Health Care Co., Ltd., Kyoto, Japan) to quantify PA. The accelerometer is capable of generating the metabolic equivalent of task (MET) values by utilizing predictive equations specifically designed for adults [22]. However, it is important to note that MET values can overestimate results for children, as previously reported [23]. To account for the overestimation of MET values in children compared to adults when using the Active Style Pro accelerometer, the researchers used conversion equations obtained from previous studies.
The study protocol required the participants to wear a triaxial accelerometer around their waist for one week, starting from the time they woke up until their bedtime, which was set between 7:00 and 21:00, except during showering or swimming. If the accelerometer recorded a value of 0 for a duration of 20 min or longer, it was inferred that the individual was not using the wearable device. The accelerometer was used to quantify the duration of sedentary behaviour (defined as activities with a metabolic equivalent of 1.5 or less), light-intensity PA (defined as activities with a metabolic equivalent ranging from 1.6 to 2.9), and moderate to vigorous PA (defined as activities with a metabolic equivalent of 3 or greater). The data were collected at 10-s intervals. To determine the daily PA levels, only the data from days when participants wore the accelerometer for 600 min or more were considered. Additionally, the study required a minimum of four days per week for data inclusion [24]. We calculated the children’s weekly average MVPA (weekly average MVPA = (weekday MVPA) + (weekend MVPA)/2) [25,26].

2.2.2. Screen Time

ST refers to time spent on screen-based behaviours, including recreational, stationary, sedentary, and active screen time [27]. ST data were collected by asking parents about their child’s screen-based behaviours in the past week. Two questions were used to assess screen time. First, “What is the average amount of time that your offspring spends viewing television or DVDs on a daily basis”? The second question pertains to the average duration a child spends using electronic gadgets, such as smartphones and tablets, on a daily basis. The respondents’ answers were obtained in written form, pertaining to the average duration of screen time that their children engage in on both weekdays and weekends. In order to determine the mean duration of screen-viewing activities per week, the researchers multiplied the mid-category values of daily activity duration by the number of days the child engaged in screen-viewing activities during both weekdays and weekends. The researchers proceeded to compute the mean daily screen time of the children by applying the following formula: average daily ST = ((weekday ST × 5) + (weekend ST × 2)/7) [28,29].

2.2.3. Sleep Duration

SD was evaluated through parental inquiry, specifically by asking the following question: “What is the duration of your child’s nocturnal sleep”? The study computed the average daily SD for weekdays and weekends by applying the following formula: average daily SD = ((weekday SD × 5) + (weekend SD × 2)/7) [30].

2.2.4. Strengths and Difficulties Questionnaire

The SDQ was employed to assess the internalising and externalising behaviours of children [31]. The SDQ is a standardized tool comprising 25 items that assess diverse dimensions of a child’s mental health and behaviour. The survey comprises five distinct subscales, namely, emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behaviour. Each subscale consists of five items that are evaluated using a Likert scale. The aforementioned subscales can be divided into two distinct scales, namely, internalising behaviours (including emotional symptoms and peer relationship problems) and externalising behaviours (including conduct problems and hyperactivity/inattention) [32]. The Chinese version of the SDQ has been demonstrated to be reliable in previous research [33].

2.2.5. Adherence to the 24 h Movement Guidelines

Adherence to the 24 h MGs for children was assessed using three recommendations [26,34]: adherence to PA guidelines (consisting of 180 min of total PA, with at least 60 min of moderate to vigorous PA per day), compliance with ST guidelines (limited to less than one hour per day), and adherence to SD guidelines (ranging from 10 to 13 h within a 24 h period).

2.2.6. Demographic Variables

A survey questionnaire was employed to collect demographic data from the study participants. The questionnaire included items on the children’s sex, age, bedtime, wake-up time, weight, height, sports club participation, as well as their mother’s employment status, education level, number of media devices, number of family members, height, and weight. The parents of the children provided this information. The researchers measured the children’s height and weight using units of 0.1 cm and 0.1 kg, respectively. BMI z-scores were computed using the World Health Organization’s growth criteria [35]. Additionally, fat mass was computed using the formulas provided by Wang et al. [36].

2.3. Statistical Analysis

In this study, data from 200 young Chinese children (102 boys and 98 girls) who provided complete information on the study variables were analysed using three models. The initial model examined the differences in demographic variables among the children and guardians, encompassing age, stature, mass, body mass index, and adipose tissue. Statistical analyses in this study involved independent t-tests for continuous variables and chi-squared tests for categorical variables. The second model compared differences in children’s PA, ST, and SD between weekdays and weekends, using independent t-tests to examine adherence to the 24 h MGs (i.e., PA, ST, and SD) between weekday and weekend samples. The third model employed a logistic regression analysis to investigate the correlation between compliance with individual 24 h MGs variables, and internalising and externalising behaviours during weekdays and weekends. Age, BMI, and fat mass were used as covariates. Ternary plots were used to display the data distribution, visualizing the relationships among MVPA, ST, and SD, while also displaying a colour-coded distribution of SDQ scores for internalising or externalising problems. Ternary plots are an efficient technique for illustrating the relationships between three variables, the proportions of which sum to a constant (100%). They can be viewed as scatterplots of compositions that present all possible combinations of variables in a single graph, making it easier to identify underlying patterns or trends [16]. Analyses and visualizations were conducted using R version 4.2.3. For statistical significance, p-values were set at <0.05. Data were analysed using SPSS version 26.0 (IBM, Armonk, NY, USA).

3. Results

3.1. Sample Characteristics

Table 1 compares the children’s and parents’ characteristics between sex. Analysis of the characteristics of the children revealed that boys tended to have higher BMI and fat mass values than girls (p < 0.049, p < 0.003, respectively). Regarding participation in sports clubs, data analysis showed that girls had a higher participation rate (63.3%) than boys (47.1%). Parental characteristics did not show a significant relationship, but overall, the full-time employment rate and the rate of parents with college or higher education were both high.

3.2. Comparison of PA, Sedentary Behaviours, and Sleep on Weekdays and Weekends

The study found that among the PA measures, the MVPA and steps taken were higher on weekends compared to weekdays (MVPA: 82.4 ± 20.5 min vs. 72.1 ± 20.9 min on weekends and weekdays, respectively (p < 0.001) (steps: 9822.2 ± 3416.0 vs. 9210.3 ± 2062.6 on weekends and weekdays, respectively (p < 0.001)). Conversely, light PA showed higher results on weekdays compared to weekends (318.7 ± 44.8 min vs. 302.7 ± 44.4 min, p < 0.031). Among the sedentary behaviour items, TV/DVD and smartphone/tablet use were higher on weekends than weekdays (TV/DVD: 32.9 ± 35.7 min vs. 53.9 ± 57.8 min on weekdays and weekends, respectively (p < 0.001); smartphone/tablet: 20.8 ± 27.2 min vs. 31.7 ± 37.2 min on weekdays and weekends, respectively (p < 0.001)). Among the sleep items, bedtime, wake-up time, and sleep time were found to be later on weekends than weekdays (bedtime: 448.8 ± 39.0 min vs. 415.4 ± 22.2 min on weekends and weekdays, respectively (p < 0.001); wake-up time: 1310.9 ± 38.5 min vs. 1296.5 ± 35.2 min on weekends and weekdays, respectively; sleep duration: 578.0 ± 41.6 min vs. 559.0 ± 35.3 min on weekends and weekdays, respectively (p < 0.001; Table 2).

3.3. Ternary Plot of the Composition of 24 h MGs of SDQ Scores for Internalising/Externalising Behaviour Problems

Using ternary plots, Figure 1 shows the average distribution of children’s MVPA, ST, and SD throughout the week. A colour-coded distribution of the SDQ scores for internalising and externalising problems is also shown. A yellow tendency indicates a lean toward normalcy, whereas a purple indicator denotes an inclination toward the presence of issues. Moreover, it can be observed that as the proportion of screen time (ST) increases, there is a greater tendency for externalising problems.

3.4. Association between 24 h Movement Behaviours and Internalising/Externalising Problems

Table 3 shows a multivariate analysis of the adjusted ORs of 24 h MG constructs on weekdays and weekends for children’s internalising and externalising behavioural problems. Significant differences were observed only on weekends for internalising behavioural problems. The odds of experiencing these problems were 1.33 higher (95% CI:1.05–1.69) when not satisfying the guideline requirements for all three behaviours (PA, ST, and SD) compared to not satisfying one or two. Moreover, the odds of having behavioural problems were higher when combining PA + SD (OR, 1.49, 95% CI, 1.11–1.98), ST + PA (OR, 1.31, 95% CI, 1.00–1.70), or having none of the three behaviours than when meeting all behaviour recommendations (OR, 1.70, 95% CI, 1.08–2.69). Regarding externalising behavioural problems, the study found that on weekdays, when all three behaviour recommendations (PA, ST, and SD) were not met, the likelihood of such problems was lower (OR: 0.75, 95% CI, 0.61–0.92). However, on weekends, when sleep time was not fulfilled, there was a higher likelihood of such problems (OR, 1.18, 95% CI, 1.01–1.38), and when all three behaviour recommendations were not met, the likelihood was even higher (OR, 1.50, 95% CI, 1.04–2.18; Table 3).

4. Discussion

This study hypothesis was that adherence to 24 h MGs would be associated with reduced internalising and externalising behavioural problems in Chinese preschool children aged 3–6 years. To test this hypothesis, we analysed the relationship between adherence to 24 h MGs and internalising and externalising behavioural problems. We further examined whether there were differences in adherence between weekdays and weekends.
First, the results for internalisation confirmed that the likelihood of experiencing internalising behaviour problems increased in the following order: only meeting the ST and PA recommendations (ST + PA), only meeting the PA and SD recommendations (PA + SD), and not meeting any of the three recommendations (none), as compared to meeting all three recommendations. Overall, our results indicate that meeting all three recommendations (PA, ST, and SD) was associated with improved mental health in children compared to a combination of only meeting ST and SD recommendations. This finding is consistent with previous research [12,37,38]. However, our study adds new insights into the role of weekends in the association between 24 h MG adherence and behavioural problems. This study’s results show that the higher the number of recommendations met (PA, ST, and SD), the lower the risk of internalisation and externalisation problems. These findings suggest that there are mental health benefits associated with adhering to 24 h MGs. Numerous studies have reported that internalised behavioural problems, such as anxiety, fear, sadness, depression, social withdrawal, and physical dissatisfaction, are associated with a high risk of persistently exhibiting internalised behavioural problems from early childhood to adolescence [39,40]. Furthermore, children with internalising behavioural problems often face challenges forming positive peer relationships, and are more prone to isolating behaviours and social withdrawal [41].
To address and improve children’s internalised behavioural problems, exploring their relationship with PA, ST, and SD is crucial. Numerous studies have demonstrated that regular engagement in PA is associated with positive mental health outcomes. These studies suggest that PA acts as a protective factor against internalised behavioural problems, including symptoms of depression and anxiety, regardless of age and geographical location [42,43]. Furthermore, it has been found that increased sedentary time, particularly ST, is associated with anxiety, emotional issues, and peer problems [44]. Excessive ST can also decrease the time spent on PA, thus limiting the potential benefits of PA on mental health [45]. While some studies have demonstrated an independent correlation between high ST and these difficulties, recent research suggests that a synergistic effect can be achieved by combining recommended levels of PA with low ST to reduce the risk of emotional difficulties in children [46]. Previous studies have reported that a shorter SD negatively affects the levels of neurotransmitters involved in regulating mood and cognition [47], and experiencing sleepiness and fatigue during morning activities can make it more difficult to maintain a healthy and active lifestyle [48,49]. However, our study found that SD was longer on weekends than on weekdays, despite bedtimes and wake-up times being later on weekends. Previous research has also reported that children with later bedtimes experience symptoms such as anxiety and depression [50], and that irregular sleeping–waking patterns can significantly affect their adaptability in kindergarten settings [51]. Although many studies have reported an association between sleep duration satisfaction and health-related factors, further studies are needed to examine the effects of late bedtime, late awakening, and poor sleep quality.
In addition, our study’s results indicate a higher likelihood of externalising behavioural problems when ST exceeds the recommended amount. Our findings align with studies conducted in other countries using the SDQ to measure the socio-emotional development of preschool children, which have reported an association between increased ST and externalising behavioural problems such as hyperactivity, emotional symptoms, conduct issues, and poor prosocial behaviour [52,53,54]. With the advancement of media technology and increased accessibility, high ST among children in Asia has been highlighted as a significant concern [55]. Our study’s results revealed a favourable association between externalising behaviour problems in children when all three recommended activity guidelines were met. This finding is consistent with previous research that has shown an association between conduct issues, hyperactivity, and meeting these guidelines [56], and other studies have reported better mental health outcomes for individuals who fulfil a greater number of PA behaviour recommendations [18]. Externalising behaviours, such as aggression and destructive behaviour, tend to decrease with the development of cognitive abilities and emotion regulation [57]. However, a small percentage (5–7%) of antisocial children may exhibit persistent or worsening externalising problems [58]. Furthermore, both internalising and externalising behaviours in children can negatively affect children, their families, and society in both the short and long term [59,60]. Therefore, based on our research findings, it is important to identify risk factors for mental health problems early to mitigate potential negative impacts. According to a meta-analysis, children’s movement behaviours are reported to be healthier on weekdays than on weekends, as weekdays are characterised by less autonomy, more structure, and less fragmented routines under adult supervision [21]. Further, children tend to sleep more on weekends than weekdays [61]. As a result, wakeful activities (i.e., sedentary behaviour and PA) decreased on weekends. However, for children, greater autonomy during weekends may lead to a preference for sedentary behaviour, particularly recreational screen time, over PA. Therefore, future intervention studies should consider an ecological model [62] including the individual, family, and environmental factors to examine 24 h behaviours during weekends and ensure that the three recommended guidelines are fulfilled.
Several limitations should be considered when interpreting our findings. First, the cross-sectional design of this study does not allow for the confirmation of a causal relationship between the composition of the 24 h MGs and mental health in Chinese children aged 3–6 years. A longitudinal or interventional study is necessary to establish a clear relationship between these variables. Second, given that our study focused on preschoolers aged 3–6 years in northeast China, concerns arise regarding the extent to which the findings can be generalised to all young children in China. Third, similar to other studies involving preschool children, our study utilised a combination of objective measurements such as accelerometers and questionnaire surveys completed by parents or family members who observed the child’s behaviour. It is important to acknowledge that the parents’ psychological state can impact not only their evaluation of their children’s behaviour but also their responses to the study [63]. Therefore, the results should be interpreted with caution. The results of this study can strengthen the evidence for various factors related to mental health in preschool children, specifically concerning the combination of 24 h MGs. As this study was limited to preschool children in Asian countries, it highlights the need to develop effective intervention programs in the future. These findings hold significant importance in guiding future interventions to promote preschool children’s health and wellbeing.

5. Conclusions

This study investigated the relationship between Chinese preschool children’s compliance with 24 h MGs and internalising and externalising behavioural problems. The results showed that on weekends, children who did not meet all three movement guidelines were more likely to exhibit internalised behavioural problems. Children who did not engage in a specific combination of behaviours, such as PA and ST, or those who did not engage in any of the three behaviours were also more likely to exhibit internalised behavioural problems. Our findings will help inform future updates to the 24 h MGs for early childhood to ensure optimal movement guidelines and comprehensive mental health development in young children.

Author Contributions

Conceptualization, N.Z. and H.K.; methodology, H.G., J.M. and H.K.; validation, J.M. and D.M.; formal analysis, H.G. and H.K.; data curation, Q.W., H.G. and H.K.; writing—original draft preparation, H.G., Q.W. and H.K.; writing—review and editing, N.Z., J.M. and H.K.; visualization, H.G. and Q.W.; supervision, D.M., J.M. and H.K.; project administration, N.Z., Q.W. and H.K.; funding acquisition, N.Z. and H.K. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the Basic Scientific Research Project of Education Department of Liaoning Province of China (No. LJKMR20220629), the JSPS KAKENHI (grant number: JP 21K11555), and the International Joint Research Project at Sendai University (grant number: CER-2022).

Institutional Review Board Statement

The study was conducted in accordance with the guidelines of the Declaration of Helsinki, and was approved by the Institutional Review Board of the Sendai University Ethics Committee of the Faculty of Sports Science (IRB number: SU2021-05, 5 November 2021) and the Ethics Committee of East China Normal University (approval number: HR 571-2021, 4 December 2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data are included in the article.

Acknowledgments

We thank Y.G. and Y.X., who are from East China Normal University and lead the Chinese team in the “International Joint Study for the Improvement of 24 h Movement and Mental Health of East Asian Children”, for providing data.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the study design; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

References

  1. World Health Organization. Caring for Children and Adolescents with Mental Disorders: Setting WHO Directions; World Health Organization: Geneva, Switzerland, 2005. [Google Scholar]
  2. Public Health Agency of Canada. The Human Face of Mental Health and Mental Illness in Canada; Public Health Agency of Canada: Ottawa, ON, Canada, 2006.
  3. Xiaoli, Y.; Chao, J.; Wen, P.; Wenming, X.; Fang, L.; Ning, L.; Huijuan, M.; Jun, N.; Ming, L.; Xiaoxia, A.; et al. Prevalence of Psychiatric Disorders among Children and Adolescents in Northeast China. PLoS ONE 2014, 9, e111223. [Google Scholar] [CrossRef]
  4. von Klitzing, K.; Döhnert, M.; Kroll, M.; Grube, M. Mental Disorders in Early Childhood. Dtsch. Arztebl. Int. 2015, 112, 375–386. [Google Scholar] [CrossRef] [PubMed]
  5. Merikangas, K.R. Epidemiology of Mental Disorders in Children and Adolescents. Dialogues Clin. Neurosci. 2009, 11, 7–20. [Google Scholar] [CrossRef]
  6. Goodman, R. A Modified Version of the Rutter Parent Questionnaire Including Extra Items on Children’s Strengths: A Research Note. J. Child Psychol. Psychiatry 1994, 35, 1483–1494. [Google Scholar] [CrossRef] [PubMed]
  7. Willner, C.J.; Gatzke-Kopp, L.M.; Bray, B.C. The Dynamics of Internalising and Externalising Comorbidity across the Early School Years. Dev. Psychopathol. 2016, 28, 1033–1052. [Google Scholar] [CrossRef] [PubMed]
  8. Yong, M.; Fleming, C.B.; McCarty, C.A.; Catalano, R.F. Mediators of the Associations between Externalising Behaviors and Internalising Symptoms in Late Childhood and Early Adolescence. J. Early Adolesc. 2013, 34, 967–1000. [Google Scholar] [CrossRef] [PubMed]
  9. Basten, M.; Althoff, R.R.; Tiemeier, H.; Jaddoe, V.W.V.; Hofman, A.; Hudziak, J.J.; Verhulst, F.C.; van der Ende, J. The Dysregulation Profile in Young Children: Empirically Defined Classes in the Generation R Study. J. Am. Acad. Child Adolesc. Psychiatry 2013, 52, 841–850. [Google Scholar] [CrossRef]
  10. Kirkcaldy, B.D.; Shephard, R.J.; Siefen, R.G. The relationship between physical activity and self-image and problem behaviour among adolescents. Soc. Psychiatry Psychiatr. Epidemiol. 2002, 37, 544–550. [Google Scholar] [CrossRef]
  11. Guerrero, M.D.; Barnes, J.D.; Chaput, J.-P.; Tremblay, M.S. Screen Time and Problem Behaviors in Children: Exploring the Mediating Role of Sleep Duration. Int. J. Behav. Nutr. Phys. Act. 2019, 16, 105. [Google Scholar] [CrossRef]
  12. Carson, V.; Ezeugwu, V.E.; Tamana, S.K.; Chikuma, J.; Lefebvre, D.L.; Azad, M.B.; Moraes, T.J.; Subbarao, P.; Becker, A.B.; Turvey, S.E.; et al. Associations between Meeting the Canadian 24-Hour Movement Guidelines for the Early Years and Behavioral and Emotional Problems among 3-Year-Olds. J. Sci. Med. Sport 2019, 22, 797–802. [Google Scholar] [CrossRef]
  13. Sund, A.M.; Larsson, B.; Wichstrøm, L. Role of Physical and Sedentary Activities in the Development of Depressive Symptoms in Early Adolescence. Soc. Psychiatry Psychiatr. Epidemiol. 2010, 46, 431–441. [Google Scholar] [CrossRef] [PubMed]
  14. Bélair, M.-A.; Kohen, D.E.; Kingsbury, M.; Colman, I. Relationship between Leisure Time Physical Activity, Sedentary Behaviour and Symptoms of Depression and Anxiety: Evidence from a Population-Based Sample of Canadian Adolescents. BMJ Open 2018, 8, e021119. [Google Scholar] [CrossRef] [PubMed]
  15. Pedišić, Ž. Measurement Issues and Poor Adjustments for Physical Activity and Sleep Undermine Sedentary Behavior Research—The Focus Should Shift to the Balance between Sleep, Sedentary Behavior, Standing and Activity. Kinesiol. Int. J. Fundam. Appl. Kinesiol. 2014, 46, 135–146. [Google Scholar]
  16. Chastin, S.F.M.; Palarea-Albaladejo, J.; Dontje, M.L.; Skelton, D.A. Combined Effects of Time Spent in Physical Activity, Sedentary Behaviors and Sleep on Obesity and Cardio-Metabolic Health Markers: A Novel Compositional Data Analysis Approach. PLoS ONE 2015, 10, e0139984. [Google Scholar] [CrossRef]
  17. Chaput, J.-P.; Saunders, T.J.; Carson, V. Interactions between Sleep, Movement and Other Non-Movement Behaviours in the Pathogenesis of Childhood Obesity. Obes. Rev. 2017, 18, 7–14. [Google Scholar] [CrossRef]
  18. Janssen, X.; Martin, A.; Hughes, A.R.; Hill, C.M.; Kotronoulas, G.; Hesketh, K.R. Associations of Screen Time, Sedentary Time and Physical Activity with Sleep in under 5s: A Systematic Review and Meta-Analysis. Sleep Med. Rev. 2019, 49, 101226. [Google Scholar] [CrossRef]
  19. Chaput, J.-P.; Carson, V.; Gray, C.; Tremblay, M. Importance of All Movement Behaviors in a 24 Hour Period for Overall Health. Int. J. Environ. Res. Public Health 2014, 11, 12575–12581. [Google Scholar] [CrossRef]
  20. Tremblay, M.S.; Carson, V.; Chaput, J.-P. Introduction to the Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. Appl. Physiol. Nutr. Metab. 2016, 41, S311–S327. [Google Scholar] [CrossRef]
  21. Zosel, K.; Monroe, C.; Hunt, E.; Laflamme, C.; Brazendale, K.; Weaver, R.G. Examining Adolescents’ Obesogenic Behaviors on Structured Days: A Systematic Review and Meta-Analysis. Int. J. Obes. 2022, 46, 466–475. [Google Scholar] [CrossRef]
  22. Oshima, Y.; Kawaguchi, K.; Tanaka, S.; Ohkawara, K.; Hikihara, Y.; Ishikawa-Takata, K.; Tabata, I. Classifying Household and Locomotive Activities Using a Triaxial Accelerometer. Gait Posture 2010, 31, 370–374. [Google Scholar] [CrossRef]
  23. Hikihara, Y.; Tanaka, C.; Oshima, Y.; Ohkawara, K.; Ishikawa-Takata, K.; Tanaka, S. Prediction Models Discriminating between Nonlocomotive and Locomotive Activities in Children Using a Triaxial Accelerometer with a Gravity-Removal Physical Activity Classification Algorithm. PLoS ONE 2014, 9, e94940. [Google Scholar] [CrossRef] [PubMed]
  24. Trost, S.G.; Mciver, K.L.; Pate, R.R. Conducting Accelerometer-Based Activity Assessments in Field-Based Research. Med. Sci. Sports Exerc. 2005, 37, S531–S543. [Google Scholar] [CrossRef]
  25. Hyunshik, K.; Jiameng, M.; Sunkyoung, L.; Ying, G. Change in Japanese Children’s 24-Hour Movement Guidelines and Mental Health during the COVID-19 Pandemic. Sci. Rep. 2021, 11, 22972. [Google Scholar] [CrossRef]
  26. Kim, H.; Ma, J.; Harada, K.; Lee, S.; Gu, Y. Associations between Adherence to Combinations of 24-h Movement Guidelines and Overweight and Obesity in Japanese Preschool Children. Int. J. Environ. Res. Public Health 2020, 17, 9320. [Google Scholar] [CrossRef]
  27. Tremblay, M.S.; Aubert, S.; Barnes, J.D.; Saunders, T.J.; Carson, V.; Latimer-Cheung, A.E.; Chastin, S.F.M.; Altenburg, T.M.; Chinapaw, M.J.M. Sedentary Behavior Research Network (SBRN)—Terminology Consensus Project Process and Outcome. Int. J. Behav. Nutr. Phys. Act. 2017, 14, 75. [Google Scholar] [CrossRef] [PubMed]
  28. Wang, Q.; Ma, J.; Harada, K.; Kobayashi, S.; Sano, H.; Kim, H. Associations among Outdoor Playtime, Screen Time, and Environmental Factors in Japanese Preschoolers: The “Eat, Be Active, and Sleep Well” Study. Sustainability 2021, 13, 12499. [Google Scholar] [CrossRef]
  29. Wang, Q.; Ma, J.; Maehashi, A.; Kim, H. The Associations between Outdoor Playtime, Screen-Viewing Time, and Environmental Factors in Chinese Young Children: The “Eat, Be Active and Sleep Well” Study. Int. J. Environ. Res. Public Health 2020, 17, 4867. [Google Scholar] [CrossRef]
  30. Guo, H.; Ma, J.; Chua, T.B.K.; Tay, L.Y.; Chia, M.Y.H.; Kim, H. Associations between Parents’ Digital Media Habits, Engagement, Awareness, and Movement Guidelines among Preschool-Age Children: International Ipreschooler Surveillance Study. Int. J. Environ. Res. Public Health 2022, 19, 10484. [Google Scholar] [CrossRef]
  31. Goodman, R. The Strengths and Difficulties Questionnaire: A Research Note. J. Child Psychol. Psychiatry 1997, 38, 581–586. [Google Scholar] [CrossRef]
  32. Goodman, A.; Lamping, D.L.; Ploubidis, G.B. When to Use Broader Internalising and Externalising Subscales instead of the Hypothesised Five Subscales on the Strengths and Difficulties Questionnaire (SDQ): Data from British Parents, Teachers and Children. J. Abnorm. Child Psychol. 2010, 38, 1179–1191. [Google Scholar] [CrossRef]
  33. Du, Y.; Kou, J.; Coghill, D. The Validity, Reliability and Normative Scores of the Parent, Teacher and Self Report Versions of the Strengths and Difficulties Questionnaire in China. Child Adolesc. Psychiatry Ment. Health 2008, 2, 8. [Google Scholar] [CrossRef] [PubMed]
  34. World Health Organization. Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children under 5 Years of Age; World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]
  35. World Health Organization (WHO); Multicentre Growth Reference Study Group. WHO Child Growth Standards Based on Length/Height, Weight and Age. Acta Paediatr. Int. J. Paediatr. 2006, 450, 76–85. [Google Scholar] [CrossRef]
  36. Wang, Q.; Guo, H.; Chen, S.; Ma, J.; Kim, H. The Association of Body Mass Index and Fat Mass with Health-Related Physical Fitness among Chinese Schoolchildren: A Study Using a Predictive Model. Int. J. Environ. Res. Public Health 2022, 20, 355. [Google Scholar] [CrossRef]
  37. Sampasa-Kanyinga, H.; Colman, I.; Goldfield, G.S.; Janssen, I.; Wang, J.; Podinic, I.; Tremblay, M.S.; Saunders, T.J.; Sampson, M.; Chaput, J.-P. Combinations of Physical Activity, Sedentary Time, and Sleep Duration and Their Associations with Depressive Symptoms and Other Mental Health Problems in Children and Adolescents: A Systematic Review. Int. J. Behav. Nutr. Phys. Act. 2020, 17, 72. [Google Scholar] [CrossRef]
  38. Cliff, D.P.; McNeill, J.; Vella, S.A.; Howard, S.J.; Santos, R.; Batterham, M.; Batterham, M.; Melhuish, E.; Okely, A.D.; de Rosnay, M. Adherence to 24-Hour Movement Guidelines for the Early Years and Associations with Social-Cognitive Development among Australian Preschool Children. BMC Public Health 2017, 17, 207–215. [Google Scholar] [CrossRef]
  39. Duggal, S.; Carlson, E.A.; Sroufe, L.A.; Egeland, B. Depressive Symptomatology in Childhood and Adolescence. Dev. Psychopathol. 2001, 13, 143–164. [Google Scholar] [CrossRef]
  40. Sterba, S.K.; Prinstein, M.J.; Cox, M.J. Trajectories of Internalising Problems across Childhood: Heterogeneity, External Validity, and Gender Differences. Dev. Psychopathol. 2007, 19, 345–366. [Google Scholar] [CrossRef] [PubMed]
  41. Oland, A.A.; Shaw, D.S. Pure versus Co-Occurring Externalising and Internalising Symptoms in Children: The Potential Role of Socio-Developmental Milestones. Clin. Child Fam. Psychol. Rev. 2005, 8, 247–270. [Google Scholar] [CrossRef]
  42. Schuch, F.B.; Vancampfort, D.; Firth, J.; Rosenbaum, S.; Ward, P.B.; Silva, E.S.; Hallgren, M.; Ponce De Leon, A.; Dunn, A.L.; Deslandes, A.C.; et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am. J. Psychiatry 2018, 175, 631–648. [Google Scholar] [CrossRef]
  43. McDowell, C.P.; Dishman, R.K.; Gordon, B.R.; Herring, M.P. Physical Activity and Anxiety: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Am. J. Prev. Med. 2019, 57, 545–556. [Google Scholar] [CrossRef]
  44. Hinkley, T.; Verbestel, V.; Ahrens, W.; Lissner, L.; Molnár, D.; Moreno, L.A.; Pigeot, I.; Pohlabeln, H.; Reisch, L.A.; Russo, P.; et al. Early Childhood Electronic Media Use as a Predictor of Poorer Well-Being. JAMA Pediatr. 2014, 168, 485–492. [Google Scholar] [CrossRef] [PubMed]
  45. Mutz, D.C.; Roberts, D.F.; Van Vuuren, D.P. Reconsidering the Displacement Hypothesis. Television’s Influence on Children’s Time Use. Commun. Res. 1993, 20, 51–75. [Google Scholar] [CrossRef]
  46. Matin, N.; Kelishadi, R.; Heshmat, R.; Motamed-Gorji, N.; Djalalinia, S.; Motlagh, M.E.; Ardalan, G.; Arefirad, T.; Mohammadi, R.; Safiri, S.; et al. Joint Association of Screen Time and Physical Activity on Self-Rated Health and Life Satisfaction in Children and Adolescents: The CASPIAN-IV Study. Int. Health 2016, 9, 58–68. [Google Scholar] [CrossRef] [PubMed]
  47. Goldstein, A.N.; Walker, M.P. The Role of Sleep in Emotional Brain Function. Annu. Rev. Clin. Psychol. 2014, 10, 679–708. [Google Scholar] [CrossRef]
  48. Owens, J. Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences. Pediatrics 2014, 134, e921–e932. [Google Scholar] [CrossRef]
  49. Wolfson, A.R.; Carskadon, M.A. Sleep Schedules and Daytime Functioning in Adolescents. Child Dev. 1998, 69, 875–887. [Google Scholar] [CrossRef]
  50. Yokomaku, A.; Misao, K.; Omoto, F.; Yamagishi, R.; Tanaka, K.; Takada, K.; Kohyama, J. A Study of the Association between Sleep Habits and Problematic Behaviors in Preschool Children. Chronobiol. Int. 2008, 25, 549–564. [Google Scholar] [CrossRef]
  51. Bates, J.E.; Viken, R.J.; Alexander, D.B.; Beyers, J.; Stockton, L. Sleep and Adjustment in Preschool Children: Sleep Diary Reports by Mothers Relate to Behavior Reports by Teachers. Child Dev. 2002, 73, 62–75. [Google Scholar] [CrossRef]
  52. Cheng, S.; Maeda, T.; Yoichi, S.; Yamagata, Z.; Tomiwa, K.; Japan Children’s Study Group. Early Television Exposure and Children’s Behavioral and Social Outcomes at Age 30 Months. J. Epidemiol. 2010, 20, S482–S489. [Google Scholar] [CrossRef]
  53. Ebenegger, V.; Marques-Vidal, P.-M.; Munsch, S.; Quartier, V.; Nydegger, A.; Barral, J.; Hartmann, T.; Dubnov-Raz, G.; Kriemler, S.; Puder, J.J. Relationship of Hyperactivity/Inattention with Adiposity and Lifestyle Characteristics in Preschool Children. J. Child Neurol. 2011, 27, 852–858. [Google Scholar] [CrossRef]
  54. Griffiths, L.J.; Dowda, M.; Dezateux, C.; Pate, R. Associations between Sport and Screen-Entertainment with Mental Health Problems in 5-Year-Old Children. Int. J. Behav. Nutr. Phys. Act. 2010, 7, 30. [Google Scholar] [CrossRef]
  55. Chia, M.; Komar, J.; Buan, T.; Tay, L.Y.; Kim, J.-H.; Hong, K.; Kim, H.; Ma, J.; Vehmas, H.; Sääkslahti, A. Screen Media and Non-Screen Media Habits among Preschool Children in Singapore, South Korea, Japan, and Finland: Insights from an Unsupervised Clustering Approach. Digit. Health 2022, 8, 205520762211390. [Google Scholar] [CrossRef] [PubMed]
  56. Christian, H.; Murray, K.; Trost, S.G.; Schipperijn, J.; Trapp, G.; Maitland, C.; Divitini, M. Meeting the Australian 24-Hour Movement Guidelines for the Early Years Is Associated with Better Social-Emotional Development in Preschool Boys. Prev. Med. Rep. 2022, 27, 101770. [Google Scholar] [CrossRef] [PubMed]
  57. Moffitt, T.E. Adolescence-Limited and Life-Course-Persistent Antisocial Behavior: A Developmental Taxonomy. Psychol. Rev. 1993, 100, 674–701. [Google Scholar] [CrossRef] [PubMed]
  58. Laird, R.D.; Jordan, K.Y.; Dodge, K.A.; Pettit, G.S.; Bates, J.E. Peer Rejection in Childhood, Involvement with Antisocial Peers in Early Adolescence, and the Development of Externalising Behavior Problems. Dev. Psychopathol. 2001, 13, 337–354. [Google Scholar] [CrossRef]
  59. Ogundele, M.O. Behavioural and Emotional Disorders in Childhood: A Brief Overview for Paediatricians. World J. Clin. Pediatr. 2018, 7, 9–26. [Google Scholar] [CrossRef]
  60. Clayborne, Z.M.; Varin, M.; Colman, I. Systematic Review and Meta-Analysis: Adolescent Depression and Long-Term Psychosocial Outcomes. J. Am. Acad. Child Adolesc. Psychiatry 2019, 58, 72–79. [Google Scholar] [CrossRef]
  61. Williams, J.A.; Zimmerman, F.J.; Bell, J.F. Norms and Trends of Sleep Time among US Children and Adolescents. JAMA Pediatr. 2013, 167, 55–60. [Google Scholar] [CrossRef]
  62. Kim, H.; Ma, J.; Akira, M. Factors Impacting Levels of Physical Activity and Sedentary Behavior among Young Children: A Literature Review. Int. J. Appl. Sports Sci. 2017, 29, 1–12. [Google Scholar] [CrossRef]
  63. Treutler, C.M.; Epkins, C.C. Are Discrepancies among Child, Mother, and Father Reports on Children’s Behavior Related to Parents’ Psychological Symptoms and Aspects of Parent-Child Relationships? J. Abnorm. Child Psychol. 2003, 31, 13–27. [Google Scholar] [CrossRef]
Children 10 01146 g001 550
Figure 1. The ternary plot shows the composition of 24 h MGs and SDQ scores for internalising/externalising behaviour problems.
Figure 1. The ternary plot shows the composition of 24 h MGs and SDQ scores for internalising/externalising behaviour problems.
Children 10 01146 g001
Table
Table 1. Characteristics of the participants.
Table 1. Characteristics of the participants.
Total
(n = 200)		Boys
(n = 102)		Girls
(n = 98)		p-Value
Children’s
 Age (months: mean, SD)57.5 ± 10.056.9 ± 10.458.1 ± 9.50.428
 Height (cm: mean, SD)110.0 ± 8.0109.9 ± 8.7110.1 ± 7.20.901
 Weight (kg: mean, SD)19.7 ± 4.120.0 ± 4.019.4 ± 4.30.311
 BMI (kg/m2: mean, SD) a16.2 ± 2.016.4 ± 1.915.9 ± 2.10.049
 Z-score (mean, SD)0.3 ± 1.20.5 ± 1.30.2 ± 1.10.064
 FM (mean, SD) b3.1 ± 2.13.5 ± 2.02.6 ± 2.10.003
 Sports club
  Yes110 (55.0)48 (47.1)62 (63.3)0.021
  No90 (45.0)54 (52.9)36 (36.7)
 SDQ c
  Internalising problems: IP3.9 ± 1.93.9 ± 1.93.8 ± 1.90.891
  Externalising problems: EP4.2 ± 2.04.1 ± 2.14.4 ± 1.80.067
  Total Difficulties8.1 ± 2.97.9 ± 3.18.3 ± 2.70.250
Parents’ (Mother’s)
 Height (cm: mean, SD)160.0 ± 5.0159.1 ± 5.1160.3 ± 4.90.014
 Weight (kg: mean, SD)55.1 ± 6.854.7 ± 6.954.8 ± 6.50.904
 BMI (kg/m2: mean, SD)21.5 ± 2.321.6 ± 2.421.3 ± 2.20.160
 Number of family members 3.6 ± 1.13.6 ± 1.13.7 ± 1.20.921
 Number of media6.5 ± 2.46.5 ± 2.46.6 ± 2.40.748
 Employment status
  Full time150 (75.0)77 (75.5)73 (74.5)0.809
  Part time14 (7.0)6 (5.9)8 (8.2)
  Homemaker36 (18.0)19 (18.6)17 (17.3)
 Education level
  High school or lower4 (2.0)2 (2.0)2 (2.0)0.882
  Tech school or college60 (30.0)29 (28.4)31 (31.6)
  University or above136 (68.0)71 (69.6)65 (66.4)
Abbreviations: SD, standard deviation; FM, fat mass; BMI, body mass index. a BMI percentiles of the participants were classified according to the age criteria of the Center for Disease Control and Prevention growth charts for the United States [34]. b FM was calculated using the height–weight equation [25]. The statistical significance of the continuous variables was determined using a t-test, while the categorical variables were analysed using a chi-square test. c SDQ, strengths and difficulties questionnaire. externalising problems, conduct problems + hyperactivity/inattention problems; internalising problems, emotional symptoms + peer relationship problems [32].
Table
Table 2. Comparison of PA, sedentary behaviours, and sleep on weekdays and weekends.
Table 2. Comparison of PA, sedentary behaviours, and sleep on weekdays and weekends.
WeekdaysWeekendsp-Value
Mean ± SD
Physical activity (min/day)
 MVPA72.1 ± 20.982.4 ± 20.5<0.001
 LPA318.7 ± 44.8302.7 ± 44.4<0.001
 Steps 9210.3 ± 2062.69822.2 ± 3416.00.031
Wear time (min/day)652.3 ± 69.3652.8 ± 73.50.945
Sedentary behaviour (min/day)
 Sedentary time261.5 ± 55.3267.8 ± 51.50.243
 TV/DVD32.9 ± 35.753.9 ± 57.8<0.001
 Smartphone/tablet20.8 ± 27.231.7 ± 37.20.001
Sleep (min/day)
 Wake-up time415.4 ± 22.2448.8 ± 39.0<0.001
 Bedtime1296.5 ± 35.21310.9 ± 38.5<0.001
 Sleep duration559.0 ± 35.3578.0 ± 41.6<0.001
Abbreviations: SD, standard deviation; MVPA, moderate to vigorous physical activity; LPA, light physical activity. A t-test was used to calculate p-values for continuous variables.
Table
Table 3. Associations between meeting the combinations of the 24 h MGs and internalising/externalising problems among Chinese young children.
Table 3. Associations between meeting the combinations of the 24 h MGs and internalising/externalising problems among Chinese young children.
Internalising ProblemsExternalising Problems
WeekdayWeekendWeekdayWeekend
OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)
Model 1
PA
 Meet1111
 Do not meet1.14 (0.97, 1.35)1.03 (0.82, 1.29)1.15 (0.99, 1.35)1.06 (0.86, 1.30)
ST
 Meet1111
 Do not meet1.06 (0.89, 1.26)1.10 (0.94, 1.28)1.05 (0.90, 1.24)1.18 (1.01, 1.38)
SD
 Meet1111
 Do not meet1.12 (0.90, 1.38)1.05 (0.89, 1.22)1.14 (0.92, 1.42)0.99 (0.85, 1.14)
Model 2
 All Meet1111
 PA + SD1.19 (0.69, 2.06)1.49 (1.11, 1.98)1.03 (0.60, 1.75)1.27 (0.97, 1.65)
 ST + SD1.52 (0.94, 2.44)1.45 (0.87, 2.44)0.84 (0.50, 1.38)1.02 (0.60, 1.73)
 ST + PA1.30 (0.92, 1.83)1.31 (1.00, 1.70)1.03 (0.75, 1.40)1.11 (0.86, 1.42)
 None 1.29 (0.86, 1.94)1.70 (1.08, 2.69)1.40 (0.99, 1.98)1.50 (1.04, 2.18)
Abbreviations: PA, physical activity; ST, screen time; SD, sleep duration. OR (95% CI): Odds ratio (95% confidence intervals). Adjusted analyses included children’s age, sex, and BMI. Meeting the recommendations is defined as 180 min of total PA including more than 60 min/day of moderate-to-vigorous PA, no more than 60 min/day for screen time, and between 10 and 13 h/day for sleep duration.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Zhu, N.; Guo, H.; Ma, D.; Wang, Q.; Ma, J.; Kim, H. The Association between 24 h Movement Guidelines and Internalising and Externalising Behaviour Problems among Chinese Preschool Children. Children 2023, 10, 1146. https://doi.org/10.3390/children10071146

AMA Style

Zhu N, Guo H, Ma D, Wang Q, Ma J, Kim H. The Association between 24 h Movement Guidelines and Internalising and Externalising Behaviour Problems among Chinese Preschool Children. Children. 2023; 10(7):1146. https://doi.org/10.3390/children10071146

Chicago/Turabian Style

Zhu, Na, Hongzhi Guo, Dongmei Ma, Qiang Wang, Jiameng Ma, and Hyunshik Kim. 2023. "The Association between 24 h Movement Guidelines and Internalising and Externalising Behaviour Problems among Chinese Preschool Children" Children 10, no. 7: 1146. https://doi.org/10.3390/children10071146

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop