Trajectories of Externalizing and Internalizing Behaviors in Preterm Children Admitted to a Neonatal Intensive Care Unit
Objective To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting. Study design T...
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Published in | The Journal of pediatrics Vol. 187; pp. 111 - 118 |
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Language | English |
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01.08.2017
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Abstract | Objective To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting. Study design This longitudinal study followed 148 children and their mothers from neonatal intensive care unit discharge until 6 years of age. Gestational ages ranged from 23 to 36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semiparametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors. Results Three distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the 2 groups with greater behavior problems (groups 1 and 2), trajectories reached their peak between 24 and 36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories. Conclusions Children born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children. |
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AbstractList | OBJECTIVETo examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting.STUDY DESIGNThis longitudinal study followed 148 children and their mothers from neonatal intensive care unit discharge until 6 years of age. Gestational ages ranged from 23 to 36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semiparametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors.RESULTSThree distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the 2 groups with greater behavior problems (groups 1 and 2), trajectories reached their peak between 24 and 36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories.CONCLUSIONSChildren born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children. Objective To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting. Study design This longitudinal study followed 148 children and their mothers from neonatal intensive care unit discharge until 6 years of age. Gestational ages ranged from 23 to 36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semiparametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors. Results Three distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the 2 groups with greater behavior problems (groups 1 and 2), trajectories reached their peak between 24 and 36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories. Conclusions Children born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children. To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting. This longitudinal study followed 148 children and their mothers from neonatal intensive care unit discharge until 6 years of age. Gestational ages ranged from 23 to 36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semiparametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors. Three distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the 2 groups with greater behavior problems (groups 1 and 2), trajectories reached their peak between 24 and 36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories. Children born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children. |
Author | Poehlmann-Tynan, Julie, PhD Gerstein, Emily D., PhD Woodman, Ashley C., PhD Cheng, Erika R., PhD, MPA Burnson, Cynthia, PhD |
AuthorAffiliation | a University of Missouri-St. Louis c University of Massachusetts- Amherst, and d Indiana University School of Medicine b University of Wisconsin-Madison |
AuthorAffiliation_xml | – name: b University of Wisconsin-Madison – name: a University of Missouri-St. Louis – name: c University of Massachusetts- Amherst, and – name: d Indiana University School of Medicine |
Author_xml | – sequence: 1 fullname: Gerstein, Emily D., PhD – sequence: 2 fullname: Woodman, Ashley C., PhD – sequence: 3 fullname: Burnson, Cynthia, PhD – sequence: 4 fullname: Cheng, Erika R., PhD, MPA – sequence: 5 fullname: Poehlmann-Tynan, Julie, PhD |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28533035$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1016_j_scitotenv_2024_170891 crossref_primary_10_3389_fped_2024_1406637 crossref_primary_10_1016_j_infbeh_2020_101421 crossref_primary_10_3390_ijerph17207675 crossref_primary_10_1002_imhj_21924 crossref_primary_10_3390_children11020206 crossref_primary_10_1001_jamanetworkopen_2022_38088 crossref_primary_10_3390_children10091565 crossref_primary_10_1111_infa_12437 crossref_primary_10_1080_14616734_2023_2210122 crossref_primary_10_1038_s41390_021_01808_9 crossref_primary_10_1136_archdischild_2021_323405 crossref_primary_10_1057_s41599_024_02867_z crossref_primary_10_3389_fpsyg_2022_788290 crossref_primary_10_1136_bmjopen_2022_063706 crossref_primary_10_1590_1982_4327e3012 |
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Keywords | SES Child Behavior Checklist prematurity Socioeconomic status dysregulation NICU parent–child interactions Neonatal intensive care unit CBCL CES-D behavior problems longitudinal Bayesian information criterion BIC maternal depression parenting Center for Epidemiologic Studies Depression Scale |
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Snippet | Objective To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and... To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of... OBJECTIVETo examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and... |
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SubjectTerms | behavior problems Child Child Behavior Child Behavior Disorders - diagnosis Child, Preschool Depression - psychology dysregulation Female Humans Infant Infant, Newborn Infant, Premature - psychology Intensive Care Units, Neonatal longitudinal Longitudinal Studies Male Maternal Behavior maternal depression Mother-Child Relations - psychology Mothers - psychology parenting parent–child interactions Pediatrics prematurity Risk Factors |
Title | Trajectories of Externalizing and Internalizing Behaviors in Preterm Children Admitted to a Neonatal Intensive Care Unit |
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