Search Results (152)

This cross-sectional study aims to identify clusters of internalizing and externalizing traits during adolescence using a bottom-up approach. The second aim is to investigate whether the different clusters differ by environmental risk factors and specific epigenetic profiles. A total of 205 adolescents, who had been referred for psychopathology in childhood, were recruited. Behavioral problems were assessed using the Child Behavior Checklist/6–18 (CBCL). Different clusters of psychopathological profiles were analyzed using a Finite mixture model. Differences in environmental risk factors and epigenetic profiles were tested with χ²-tests and Bonferroni-corrected t-tests. Two clusters were identified: a LOW cluster (51% of the sample), characterized by the presence of subclinical mean scores in both internalizing and externalizing problems, and a HIGH cluster (49% of the sample), characterized by high mean scores in both domains. The HIGH cluster had a significantly greater number of perinatal complications and changes in methylation of specific CpG sites of Brain-derived neurotrophic factor, Insulin-like growth factor-2, and Oxytocin receptor, whereas no difference was found for FK506-binding protein 5. Our results confirm the existence of a strong association between early adverse events, DNA methylation, and the presence of behavioral problems and psychopathological traits in adolescence. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

Background: Developmental dyslexia (DD) affects reading ability and exacerbates mental health challenges among children. This study examines the relationships between reading ability, depressive symptoms, and internalizing and externalizing behavior problems in Chinese school-age children, focusing on potential mediating effects. Methods: A case–control study was conducted with 44 dyslexic children and 81 controls from Shantou, China. Assessments included phonological processing tasks for reading ability, the Depression Self-Rating Scale for Children (DSRS) for depressive symptoms, and the Child Behavior Checklist/6–18 (CBCL/6–18) for behavior problems. Mediation analyses were performed using the PROCESS macro 4.1 for SPSS. Results: Dyslexic children showed significantly poorer reading ability (all phonological tasks, p < 0.001), higher prevalence of depressive symptoms (40.9% vs. 17.3%, p < 0.01), and greater behavior problems (internalizing and externalizing, both p < 0.001) compared to controls. Both depressive symptoms and behavior problems significantly mediated the effects of reading ability on each other, forming a feedback loop that further impairs reading skills. Externalizing behavior problems showed the strongest mediation effect, explaining up to 33.53% of the relationship between depressive symptoms and reading ability. Conclusions: The study reveals a complex interaction between reading ability, depressive symptoms, and internalizing and externalizing behavior problems in Chinese school-age children, suggesting the need for integrated interventions targeting educational and psychological aspects. Further longitudinal research is needed to clarify causal relationships and refine intervention strategies. Full article

Background/Objectives: Parenting stress, the emotional strain resulting from the demands of child-rearing, can profoundly affect both parental well-being and children’s emotional and behavioral development. This study examined the impact of maternal parenting stress during early childhood on the longitudinal progression of children’s internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) symptoms, from early childhood through adolescence. Methods: The study included 406 mother–child pairs from the Rhea mother–child cohort in Crete, Greece. Maternal parenting stress was assessed at age 4 using the Parental Stress Scale (PSS). Children’s symptoms were evaluated at ages 4 (Strengths and Difficulties Questionnaire, ADHD Test), 6, 11, and 15 years (Child Behavior Checklist, Conners’ Parent Rating Scale) through maternal reports. Multivariate mixed regression models, incorporating a random intercept for each child and a random slope for age at follow-up, were used to analyze the trajectories of symptoms from ages 4 to 15. Group-based trajectory modeling was applied to identify trajectory groups from 4 to 15 years, and multinomial logistic regression models were implemented to examine the associations between parental stress and group trajectories. Results: The results revealed that higher parental stress at age 4 was significantly associated with increased internalizing (b = 0.94, 95% CI: 0.68, 1.21), externalizing (b = 1.03, 95% CI: 0.75, 1.30), and ADHD symptoms (b = 0.86, 95% CI: 0.58, 1.14) over the study period. Notably, the impact of parenting stress on behavioral problems decreased with age (interaction with age, p = 0.032). Additionally, higher parenting stress at age 4 was linked to a greater likelihood of belonging to adverse symptom trajectories, including high decreasing, low increasing, and stable high trajectories for both internalizing and externalizing problems. Conclusions: These findings underscore the importance of early maternal parenting stress as a predictor of long-term emotional and behavioral difficulties in children, emphasizing the need for early intervention programs that support maternal mental health and children’s emotional development. Full article

Background: This longitudinal study aims to explore the stability and changes in child temperament dimensions between the ages of three and six, analyzing their relationship with emotional and behavioral problems, differentiated by gender. Method: This study involved 24 boys and 25 girls from various early childhood education centers in Málaga, Spain. To assess temperament, the Spanish adaptation of the Children’s Behavior Questionnaire was used, while emotional and behavioral problems were evaluated using the SPECI Screening for Emotional and Behavioral Problems in Children. Results: Findings indicate that 9 out of the 15 temperament dimensions remained stable, while 4—anger/frustration, attentional focusing, perceptual sensitivity, and sadness—showed significant changes in the total sample. The gender-specific analysis revealed different developmental patterns for boys and girls. Girls exhibited changes in attentional focusing, fear, and perceptual sensitivity, while boys showed changes in anger/frustration and attentional focusing. In addition, girls scored higher in discomfort and fear, whereas boys stood out in activity levels. Regarding behavioral problems, girls’ externalizing symptoms were significantly associated with attentional focusing and smiling/laughter, while internalizing symptoms were linked to low-intensity pleasure and perceptual sensitivity. Conclusions: These findings highlight the importance of addressing temperament from a gender-differentiated perspective when designing educational and family interventions aimed at promoting socioemotional development. Full article

Objective: This study aimed to investigate the relationship between social media use (SMU) in children diagnosed with major depression (MD) or attention deficit hyperactivity disorder (ADHD) and various psychosocial factors, including familial functioning, parental SMU, and parent-reported internalizing and externalizing symptoms. A healthy control group was included for comparison. Methods: The study included 121 children and adolescents aged 10–18 years (36 with MD, 41 with ADHD, and 44 healthy controls). The Social Media Addiction Scale—Short Form (SMDS) was administered to all participants, while mothers completed the McMaster Family Assessment Scale (FAS), the Social Media Addiction Scale—Adult Form (SMAS-AF), and the Child Behavior Checklist (CBCL). Psychiatric diagnoses were made using the K-SADS-PL DSM-5-T. Correlation and linear regression analyses were used to assess associations among variables. Results: SMU scores were significantly higher in the ADHD group compared to both the depression and control groups. Parental SMU was also higher in the ADHD group. In the depression group, child SMU was significantly associated with internalizing symptoms and impaired family communication. In the ADHD group, child SMU was predicted by poor family problem-solving and communication. Regression analyses showed that internalizing symptoms and family communication predicted SMU in the depression group (R² = 0.335), while family problem-solving and communication predicted SMU in the ADHD group (R² = 0.709). Conclusion: The findings suggest that social media use in children with depression and ADHD is associated with different psychosocial factors. While internalizing symptoms and family communication are more prominent in depressed children, family functioning—particularly problem-solving and communication—plays a larger role in children with ADHD. These results emphasize the need for targeted family-based interventions to mitigate problematic SMU in clinical populations. Full article

Family structure has long been regarded as an important determinant of household saving, yet the empirical evidence for developing economies remains limited. Using the 2018–2022 panels of the China Family Panel Studies (CFPS), a nationwide survey that follows 16,519 households across three waves, the present study investigates how family size, the elderly share, and the child share jointly shape saving behavior. A household fixed effects framework is employed to control for time-invariant heterogeneity, followed by a sequential endogeneity strategy: external-shock instruments are tested and rejected, lagged two-stage least squares implement internal instruments, and a dynamic System-GMM model is estimated to capture saving persistence. Robustness checks include province-by-year fixed effects, inverse probability weighting for attrition, balanced-panel replication, alternative variable definitions, lag structures, and sample filters. Family size raises the saving rate by 4.6 percentage points in the preferred dynamic specification (p < 0.01). The elderly ratio remains insignificant throughout, whereas the child ratio exerts a negative but model-sensitive association. A three-path mediation analysis indicates that approximately 26 percent of the total family size effect operates through scale economy savings on quasi-fixed expenses, 19 percent is offset by resource dilution pressure, and less than 1 percent flows through a precautionary saving channel linked to income volatility. These findings extend the resource dilution literature by quantifying the relative strength of competing mechanisms in a middle-income context and showing that cost-sharing economies dominate child-related dilution for most households. Policy discussion highlights the importance of public childcare subsidies and targeted credit access for rural parents, whose saving capacity is the most constrained by additional children. The study also demonstrates that fixed effects estimates of family structure can be upward-biased unless dynamic saving behavior and internal instruments are considered. Full article

Background: A growing body of literature suggests that there are two variants of callous–unemotional (CU) traits—primary (with low anxiety) and secondary (with high anxiety)—although whether these traits differ in emotional regulation is unknown. The present study aimed to further our understanding of these variants by comparing the two variant groups (high CU/low anxiety and high CU/high anxiety) with two control groups (low CU/low anxiety and low CU/high anxiety) on emotional regulation, along with a variety of psychosocial and externalizing behavioral measures. Methods: A community sample of children aged 8 to 10 years (N = 340) from the northeast United States and their main caregivers participated in this study. Children completed an emotional regulation task while their sympathetic and parasympathetic nervous system activities were recorded. Prenatal and postnatal adversity and externalizing behaviors of the children were assessed using caregiver and child reports. Results: It was found that children with high CU/high anxiety were characterized by elevated parasympathetic activities during the emotional regulation task, along with more adversity and externalizing behaviors. Conclusions: These findings extend our knowledge on CU by highlighting the emotional dysregulation and more severe clinical picture that were associated with more psychosocial adversity in the high CU/high anxiety variants. Full article

Background/Objectives: Parental emotion socialization is a key influence on children’s emotional regulation and psychosocial development. This study examined how supportive and non-supportive parental responses to children’s negative emotions are associated with internalizing and externalizing problems and social competence among Greek children aged 6–12 years. Methods: A non-experimental, cross-sectional correlational study using convenience sampling was conducted with 100 Greek parents who completed the Coping with Children’s Negative Emotions Scale and the Child Behavior Checklist. Correlation and multiple regression analyses were used to examine associations between parenting responses and child outcomes, controlling for child age, child gender, and parent gender. Results: Minimization/devaluation responses were significantly associated with higher internalizing problems (β = 0.396, p = 0.009), externalizing problems (β = 0.264, p = 0.048), and total problems (β = 0.320, p = 0.012). Punitive responses significantly predicted externalizing (β = 0.383, p = 0.003) and total problems (β = 0.304, p = 0.004). Supportive strategies (e.g., emotion-focused and problem-focused responses) did not significantly predict lower problem scores but were positively correlated with social competence (e.g., problem-focused response: ρ = 0.25, p = 0.017). Parent gender predicted minimization/devaluation responses, with mothers scoring higher than fathers (β = 0.308, p = 0.006). Conclusions: Non-supportive parental responses—especially punitive and dismissive behaviors—are robustly associated with increased behavioral and emotional difficulties in children. While supportive strategies may contribute to social competence, their benefits appear diminished in the presence of negative parenting practices. These findings highlight the importance of culturally sensitive interventions tailored to Greek family dynamics. Despite limitations such as the use of self-report measures and a non-representative sample, this study contributes valuable insights into emotion socialization and child adjustment in a specific cultural context. Full article

Previous research has found the link between adverse childhood experiences (ACEs) and externalizing behaviors later in adolescence and adulthood. However, limited studies have explored longitudinal trajectories of aggressive behaviors affected by ACEs. This study aimed to investigate how aggressive behaviors change over time and compare the trajectories of aggressive behaviors between children with three or fewer (low-risk ACEs) and those with four or more ACEs (high-risk ACEs) with the role of school connectedness on the trajectories of aggressive behaviors over time. The study sample consisted of 4231 children collected by the Future of Families and Child Wellbeing Study, a longitudinal birth cohort study focusing on children in high-risk families across 20 U.S. cities. The mean age of the sample was 15.59 years, with 81.9% of the participants being minorities and 51.9% being boys. The results indicated that children with high-risk ACEs showed twice as high levels of aggressive behaviors as those with low-risk ACEs. School connectedness decreased the starting level and change rate of aggressive behavior for children with high-risk ACEs, while it decreased the starting level of aggressive behavior for those with low-risk ACEs. These findings underscore the protective role of school connectedness on aggressive behavior. Practitioners and policymakers need to make an effort to build safe and supportive social environments for all children, especially for children with high-risk ACEs. Full article

In Colombia and Mexico, an increase in emotional, behavioral, and eating problems in adolescents has been documented after the pandemic. The objective was to characterize the relationship between internalizing and externalizing behaviors in adolescents with eating disorders in Colombia and Mexico according to the adolescents’ self-report and the parents’ report. In Colombia, 17 adolescents between 12 and 18 years old (M = 15.4; SD = 1.8) and one of their parents (n = 17); in Mexico, 8 adolescents between 12 and 17 years old (M = 14.6; SD = 1.6) and one of their parents (n = 8) were evaluated. The parents completed the Child Behavior Checklist (CBCL), and the adolescents completed the self-report (YSR) and the EAT-26. The analyses showed a statistically significant correlation between eating problems and anxiety/depression of the YSR (r = 0.39; p = 0.031). Statistically significant differences (p < 0.05) were found in the CBCL scores for externalizing problems, somatic complaints, and rule-breaking behavior; all scores were higher in the Colombian sample. The findings provided partial support for differences between adolescents with eating disorders and parental reports. A higher percentage of clinical levels was reported by adolescents compared to their parents, except for the anxious/depressive and aggressive behavior subscales. Full article

Research suggests that maternal stress is related to aspects of child development. Positive and stimulating interactions, such as shared reading, may act as protective factors, mitigating the negative effects of maternal stress on children’s development and behavior. This cohort study investigated the predictive relationship between maternal stress and children’s milestones and behavioral problems, with maternal interactive style during shared reading as a moderator. A total of 91 mother–child dyads participated. During the shared reading session, conducted in a private room at a research center, each mother and child interacted freely while reading a book, without specific instructions. The sessions were video-recorded and later analyzed by trained researchers using an established method. Children’s data were assessed using questionnaires completed by the mother on the same day. Descriptive, bivariate, and multivariate analyses were performed to build regression models with moderation analysis. Results revealed that maternal stress significantly predicted children’s internalizing and externalizing symptoms. Notably, more affectionate interactions during shared reading can moderate the effect of stress on children’s externalizing difficulties. These findings suggest that fostering positive and engaging interactions between mothers and children, such as shared reading, may have a beneficial impact on children’s behavioral development, even in the presence of maternal stress. Full article

Background/Objectives: Internalizing and externalizing problems have been associated with sensory processing (SP) alteration, where severe alterations are equivalent to sensory processing disorder (SPD). This study aims to examine the relationship between childhood problems and the degree of SP alteration in children referred to a child mental health center (CMHC). Methods: The study included sixty-four children (44 boys and 20 girls), aged 6 to 8 years, referred to a CMHC in Gipuzkoa, Spain. Parents completed the Child Behavior Checklist (CBCL/6–18) and the Child Sensory Profile (CSP-2). Analyses of variance and qualitative analyses were conducted to compare T-scores of childhood problems across SP alteration groups (no alteration, mild, moderate, and severe). Results: Of the participants, 31.3% (n = 20) exhibited a severe SP alteration and obtained significantly higher scores than those without SP alteration on the Withdrawn/Depressed and Attention, Social, and Thought Problems syndrome scales, as well as on the Internalizing Problems and Total Problems scales. Furthermore, children with severe SP alteration scored within the clinical range on the Anxious/Depressed and Attention Problems scales. Mean scores for Internalizing, Externalizing and Total Problems reached the clinical threshold when the SP alteration was classified as moderate or severe. These findings indicate that SP alteration is associated with increased internalizing and externalizing problems in children referred to the CMHC, with clinical levels observed particularly in cases of moderate to severe SP alteration. Conclusions: This study highlights the importance of including SP assessment in the diagnostic evaluation of childhood mental health problems. Full article

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by symptoms that vary in how severe they are. ASD individuals often present with psychiatric comorbidities that significantly impact their well-being and quality of life (QoL), with possible impacts on their family. Aims: This preliminary study aims to assess the impact of internalizing and externalizing behaviors, not closely related to the core symptoms of autism, on the QoL of their caregivers. Method: A pilot study was conducted with a sample of 58 children diagnosed with ASD and their caregivers, using the Quality of Life in Autism (QoLA) questionnaires for caregivers and the Child Behavior Checklist (CBCL) to evaluate the children’s behavioral and emotional problems. Results and Conclusions: The results revealed significant differences in the mean age of the children (3.32 ± 0.88 vs. 8.47 ± 2.51 years) and caregivers (35.68 ± 7.57 vs. 40.42 ± 6.43 years), with a notable impact of specific behavioral issues, such as attention, aggression, and externalizing behaviors, on the QoL of caregivers. In younger children, caregivers’ QoL was positively correlated with their age, with sleep problems being the primary source of stress. In older children, a negative correlation was found between caregivers’ age and their QoL, with conduct and social problems in children having a negative effect on caregivers’ well-being. These findings highlight the importance of targeted interventions to mitigate the impact of these factors on the QoL of caregivers of ASD children. Full article

Adolescent externalizing problems are commonly linked to maternal psychological distress and family functioning, but these associations remain underexplored in the Greek sociocultural context. This study examined how maternal symptoms of depression, anxiety, and stress, along with adolescent-perceived family functioning, predict externalizing behaviors in Greek adolescents. A total of 563 adolescent–mother dyads (63.4% girls; M_age = 15.03 and SD = 0.83) participated. Mothers completed the Child Behavior Checklist (CBCL), the Depression Anxiety Stress Scales (DASS-21), and the Family Assessment Device (FAD–GF), while adolescents completed the Youth Self-Report (YSR) and FAD–GF. Hierarchical regression analysis showed that adolescent-perceived family functioning was the strongest predictor of externalizing behavior (β = 0.24 and p < 0.001), even after accounting for demographic and maternal mental health variables. The final model explained 18% of the variance in adolescent externalizing problems. Mediation analysis confirmed that family functioning partially mediated the relationship between maternal depression and adolescent externalizing problems, with a significant indirect effect (a × b = 0.088, Sobel z = 2.90, and p = 0.004). Gender differences were found for self-reported aggressive behavior (t = −2.40, p = 0.017, and d = 0.20), with girls scoring higher than boys. These findings highlight the indirect impact of maternal depression through family dynamics and underscore the importance of culturally sensitive, family-centered interventions to reduce adolescent externalizing problems. Full article