Investigation Into the Physical Environmental Correlates of Aggressive Behaviour in Children with Neurodevelopmental Disorders (NDDs)

Background: Physical environmental influences on childhood aggression in children with neurodevelopmental disabilities is a severely under-researched research locus. The aim of this doctorate was to elucidate specific associations between children’s developmental environment and aggressive behaviours, using this evidence to reciprocally inform an experimental psychology project to investigate underlying mechanisms. To explore these effects, the programme of study was broadly divided into three reflexive workstreams using diverse research methodologies. Methods: In the first workstream, I conducted a systematic review of the current literature examining physical environmental influences on childhood aggressive behaviours in both typically developing children (aged 0 – 18) and those diagnosed with NDDs. The literature on children with NDDs was substantially limited in comparison to peers without NDDs. The second workstream was comprised of a large-scale secondary data analysis (multiply imputed growth curve modelling) to investigate environmental influences on conduct problems across early development. I used data from the Millennium Cohort Study (MCS) to assess how physical environmental metrics, such as neighbourhood greenspace, air pollution, household crowding, and presence of home damp influenced the development and severity of conduct problems in children with (n=8013) and without NDDs (n=155) between the ages of 3 – 11 years. Finally, building upon evidence from the previous two workstreams, I designed a proof-of-principle psychological experiment to examine the influence of urban nature exposure on children with NDDs. Specifically, simulating a real-world urban greenspace using a Person-Environment-Activity Research Laboratory (PEARL). This facilitated the ability to manipulate and isolate individual environmental aspects of urban nature exposure (light, sound, and projection). Following ethical review and approval, I recruited 3 children (100% male) with mild and moderate intellectual disability aged between 12 – 15 years (Mean age = 14) attending a local school for children with special educational needs. We examined their physiological reactions to four simulated urban green space aspects (light, sound, landscape projections, and vegetation) against a baseline control condition. I also collected demographic information on parent reported aggressive behaviours, exposure to local greenspace(s), physical and mental health history, medication, and adaptive behaviours (ABAS-3). This research lays the foundation for future large scale experimental paradigms that can disentangle the effects of nature exposure in these children, with the aim of translating these findings into real world therapeutic design interventions and relevant policy changes to improve the quality of the built environment for these children. Findings: From articles retrieved from my systematic review I found evidence for the beneficial influences of nature in both populations, and simultaneously negative effects of both noise and air pollution in typically developing children only. Evidence for other environmental aspects such as crowding, music, urbanicity, meteorology, and interior design had either insufficient or inconsistent evidence to extrapolate concreate conclusions. More evidence on the effect of these exposures on child aggression outcomes is recommended. From the analysis of the MCS cohort I found various sociodemographic factors (ethnicity, sex, poverty, family structure, maternal distress) and internal residential conditions were associated with increased childhood conduct problem trajectories in both groups of children. I also discovered potential evidence of a moderating influence effect of intellectual disability on the relationship between spatial density and conduct problems. From the final experimental project, I report preliminary evidence for the influence of urban greenspaces to reduce physiological arousal in children with complex neurodisability profiles. Initial evidence for the hierarchical nature of urban greenspace sensorial aspects was reported, for example: that urban nature soundscapes maybe a more influential environmental stimuli than lighting or landscape projections. Conclusion: Drawing together multi-disciplinary research methodologies facilitated the ability to identify disparities in research examining physical environmental determinants of aggression in neurodiverse child populations. Reciprocally, the systematic review and secondary data analysis contributed incrementally to filling this lacuna of research. Using findings from these two work streams, I identified that exploring the potentially therapeutic influences of urban nature exposure on children with neurodevelopmental disorders may provide novel indicators of its aetiological mechanisms. I reported original findings supporting these research aims, elucidating the potential hierarchical nature of urban greenspace elements. This was also the first study of its kind reporting the potential for simulated urban park spaces to reduce physiological arousal in neurodivergent children with aggressive behavioural difficulties

The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review

The physical environment is of critical importance to child development. Understanding how exposure to physical environmental domains such as greenspace, urbanicity, air pollution or noise affects aggressive behaviours in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review, we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of aggressive behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0-18 years. We used the GRADE system to appraise the evidence. Searches were performed in eight databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and interior home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of aggressive behaviour. Most of the studies were rated as having low or unclear risk of bias. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of aggressive behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of aggressive behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and aggression problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the underlying aetiological mechanisms for environmental influences on aggression, the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people

The use of social robots with children and young people on the autism spectrum: A systematic review and meta-analysis

© 2022 Kouroupa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by/4.0/Background: Robot-mediated interventions show promise in supporting the development of children on the autism spectrum. Objectives: In this systematic review and meta-analysis, we summarize key features of available evidence on robot-interventions for children and young people on the autism spectrum aged up to 18 years old, as well as consider their efficacy for specific domains of learning. Data sources: PubMed, Scopus, EBSCOhost, Google Scholar, Cochrane Library, ACM Digital Library, and IEEE Xplore. Grey literature was also searched using PsycExtra, OpenGrey, British Library EThOS, and the British Library Catalogue. Databases were searched from inception until April (6th) 2021. Synthesis methods: Searches undertaken across seven databases yielded 2145 articles. Forty studies met our review inclusion criteria of which 17 were randomized control trials. The methodological quality of studies was conducted with the Quality Assessment Tool for Quantitative Studies. A narrative synthesis summarised the findings. A meta-analysis was conducted with 12 RCTs. Results: Most interventions used humanoid (67%) robotic platforms, were predominantly based in clinics (37%) followed home, schools and laboratory (17% respectively) environments and targeted at improving social and communication skills (77%). Focusing on the most common outcomes, a random effects meta-analysis of RCTs showed that robot-mediated interventions significantly improved social functioning (g = 0.35 [95%CI 0.09 to 0.61; k = 7). By contrast, robots did not improve emotional (g = 0.63 [95%CI -1.43 to 2.69]; k = 2) or motor outcomes (g = -0.10 [95%CI -1.08 to 0.89]; k = 3), but the numbers of trials were very small. Meta-regression revealed that age accounted for almost one-third of the variance in effect sizes, with greater benefits being found in younger children. Conclusions: Overall, our findings support the use of robot-mediated interventions for autistic children and youth, and we propose several recommendations for future research to aid learning and enhance implementation in everyday settings. PROSPERO registration: Our methods were preregistered in the PROSPERO database (CRD42019148981).Peer reviewe

Electrophysiological network alterations in adults with copy number variants associated with high neurodevelopmental risk

Rare copy number variants associated with increased risk for neurodevelopmental and psychiatric disorders (referred to as ND-CNVs) are characterized by heterogeneous phenotypes thought to share a considerable degree of overlap. Altered neural integration has often been linked to psychopathology and is a candidate marker for potential convergent mechanisms through which ND-CNVs modify risk; however, the rarity of ND-CNVs means that few studies have assessed their neural correlates. Here, we used magnetoencephalography (MEG) to investigate resting-state oscillatory connectivity in a cohort of 42 adults with ND-CNVs, including deletions or duplications at 22q11.2, 15q11.2, 15q13.3, 16p11.2, 17q12, 1q21.1, 3q29, and 2p16.3, and 42 controls. We observed decreased connectivity between occipital, temporal and parietal areas in participants with ND-CNVs. This pattern was common across genotypes and not exclusively characteristic of 22q11.2 deletions, which were present in a third of our cohort. Furthermore, a data-driven graph theory framework enabled us to successfully distinguish participants with ND-CNVs from unaffected controls using differences in node centrality and network segregation. Together, our results point to alterations in electrophysiological connectivity as a putative common mechanism through which genetic factors confer increased risk for neurodevelopmental and psychiatric disorders

Psychopathology in adults with copy number variants

Background Copy number variants (CNVs) have been associated with the risk of schizophrenia, autism and intellectual disability. However, little is known about their spectrum of psychopathology in adulthood. Methods We investigated the psychiatric phenotypes of adult CNV carriers and compared probands, who were ascertained through clinical genetics services, with carriers who were not. One hundred twenty-four adult participants (age 18–76), each bearing one of 15 rare CNVs, were recruited through a variety of sources including clinical genetics services, charities for carriers of genetic variants, and online advertising. A battery of psychiatric assessments was used to determine psychopathology. Results The frequencies of psychopathology were consistently higher for the CNV group compared to general population rates. We found particularly high rates of neurodevelopmental disorders (NDDs) (48%), mood disorders (42%), anxiety disorders (47%) and personality disorders (73%) as well as high rates of psychiatric multimorbidity (median number of diagnoses: 2 in non-probands, 3 in probands). NDDs [odds ratio (OR) = 4.67, 95% confidence interval (CI) 1.32–16.51; p = 0.017) and psychotic disorders (OR = 6.8, 95% CI 1.3–36.3; p = 0.025) occurred significantly more frequently in probands (N = 45; NDD: 39[87%]; psychosis: 8[18%]) than non-probands (N = 79; NDD: 20 [25%]; psychosis: 3[4%]). Participants also had somatic diagnoses pertaining to all organ systems, particularly conotruncal cardiac malformations (in individuals with 22q11.2 deletion syndrome specifically), musculoskeletal, immunological, and endocrine diseases. Conclusions Adult CNV carriers had a markedly increased rate of anxiety and personality disorders not previously reported and high rates of psychiatric multimorbidity. Our findings support in-depth psychiatric and medical assessments of carriers of CNVs and the establishment of multidisciplinary clinical services

The role of physical environmental characteristics and intellectual disability in conduct problem trajectories across childhood: A population-based Cohort study

BACKGROUND: The paucity of research investigating the role of the physical environment in the developmental progression of conduct problems and the potential moderating effects of intellectual disability (ID) is surprising, given the clinical relevance of elucidating environmental determinants of disruptive behaviours. AIMS: To use data from a large UK cohort study to assess associations between physical environmental exposures, ID, and conduct problem trajectories. METHOD: The sample included 8168 Millennium Cohort Study children (1.9% with ID). Multilevel growth curve modelling was used to examine the role of physical environment characteristics in the developmental trajectories of conduct problems after adjustments for ID status. RESULTS: Exposure to external environmental domains was not associated with differences in children's conduct problems across development. Alternatively, internal aspects of the household environment: spatial density (b = 0.40, p < .001) and damp problems (b = 0.14, p < .001) were both significantly associated with increased trajectories. Various individual and familial covariates were positively associated with conduct problems over time, including: presence of ID (b = 0.96, p < .001), autism spectrum disorder (b = 1.18, p < .001), male sex (b = 0.26, p < .001), poverty (b = 0.19, p < .001), maternal depression (b = 0.65, p < .001), and non-nuclear family structure (b = 0.35, p < .001). Positive ID status appeared to moderate the effects of internal household spatial density, reporting a non-linear negative association with spatial density and conduct problems across development (b = -1.08, p < .01). CONCLUSIONS: Our findings highlight the potential harmful consequences of poor internal residential conditions on children's development of disruptive behaviours

The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review

The physical environment is of critical importance to child development. Understanding how exposure to physical environmental domains such as greenspace, urbanicity, air pollution or noise affects aggressive behaviours in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review, we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of aggressive behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0&ndash;18 years. We used the GRADE system to appraise the evidence. Searches were performed in eight databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and interior home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of aggressive behaviour. Most of the studies were rated as having low or unclear risk of bias. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of aggressive behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of aggressive behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and aggression problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the underlying aetiological mechanisms for environmental influences on aggression, the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people