Temperamento e comportamentos positivos de crianças e adolescentes e suas relações com desfechos escolares

Nas ultimas décadas, os desafios educacionais foram sendo modificados. Na medida que se consegue colocar a maioria dos jovens na escola, a ênfase pela quantidade da educação ofertada passa a ser por entender fatores associados a melhor qualidade educacional. A partir de meados do século XX, as habilidades cognitivas, como a inteligência, foram intensamente estudadas em sua relação com a educação. Mais recentemente, habilidades socioemocionais (não cognitivas) têm sido associadas com a promoção de maiores níveis educacionais que impactam nos níveis socioeconômicos, oriundos de melhoria das habilidades para o mercado de trabalho. Porém, não há clara definição do que poderiam ser as habilidades socioemocionais, sendo na maioria das vezes associadas a traços do funcionamento individual, como personalidade, temperamento ou até mesmo autoestima e baixos níveis de sintomas de transtornos mentais. Os artigos desta tese são relacionados a este tema, enquanto buscam avaliar a associação de medida unidimensional de comportamentos positivos em relação a aprendizagem e rendimento escolar (artigo #1), avaliar a estrutura de medidas multidimensionais de temperamento (artigo #2) e a relação dessas medidas com desfechos educacionais (artigo #3). Esses artigos utilizaram dados de um grande estudo comunitário realizado no Brasil, nas cidades de Porto Alegre e São Paulo – a Coorte de Alto Risco para Transtornos Psiquiátricos. O primeiro artigo avalia a distinção de sintomas mentais e traços gerais de comportamentos positivos e a modificação da associação deletéria de baixa inteligência e altos níveis de sintomas mentais em aprendizagem e rendimento escolar por habilidades positivas do comportamento. Este estudo avança no entendimento de que atributos positivos do comportamento de crianças e adolescentes são um construto distinto de sintomas de transtornos mentais e tem associações independentes com menor nível de problemas de aprendizagem e melhor rendimento acadêmico. Além disso, este estudo demonstra que os efeitos negativos de baixa inteligência e altos níveis de sintomas mentais na aprendizagem e rendimento acadêmico podem ser tamponadas por altos níveis de atributos positivos do comportamento. No segundo artigo é analisado um modelo de temperamento no qual inclui, além de dimensões clássicas, um fator de autoavaliação negativa, juntamente com suas associações a grupos de psicopatologias não comórbidas. Dentre os resultados, menor controle de esforço esteve associado com diversas categorias diagnósticas. De maneira específica, foi encontrado maior nível de autoavaliação negativa nos sujeitos pertencentes ao grupo diagnostico que inclui transtornos emocionais, bem como menor nível de timidez nos sujeitos com transtorno de déficit de atenção e hiperatividade e maior nível de extroversão nos sujeitos com transtorno de conduta e de oposição e desafio. Esse estudo avança no sentido de apontar que autorrelato em sujeitos com determinados diagnósticos podem sofrer influência de uma maior tendência de se avaliarem negativamente, bem como é possível distinguir diagnósticos agrupados classicamente em transtornos externalizantes, através do temperamento. O terceiro artigo avalia as associações principais, independentes e interativas de dimensões do temperamento com desfechos escolares distintos. Neste estudo, demonstrou-se que o controle de esforço é associado à menor índice de eventos escolares negativos (suspensão, repetência e evasão escolar), bem como melhor rendimento escolar e habilidade de leitura e escrita. Esses efeitos foram independente da idade, sexo, nível socioeconômico, inteligência, sintomas mentais e outros temperamentos. No entanto, este estudo avança ao demonstrar que frustração e controle de esforço interagem para associarem-se a melhores níveis de habilidade de leitura. Especificamente, se o controle de esforço é baixo (ou frustração), níveis altos de frustração (ou controle de esforço) estão associados a melhor habilidade de leitura. Compreender as associações e distinções de medidas uni ou multidimensionais das habilidades não-cognitivas pode ser útil para a compreensão do papel destes construtos nas diferentes etapas do processo escolar, a fim de promover a elevação da qualidade educacional.During the last decades, educational challenges have changed. As most of youths can be placed at school, the emphasis on studying educational supply shifted to the understanding of educational quality. From the mid-twentieth century, cognitive skills, such as intelligence, were intensely studied in their relationship with education. More recently, socioemotional (non-cognitive) skills have been associated with the promotion of higher educational levels that impact on socioeconomic levels, resulting from improved skills for the job market. However, there is no clear definition of what socioemotional skills could be and are most often associated with traits of individual functioning such as personality, temperament or even self-esteem and low levels of symptoms of mental disorders. The articles of this thesis are related to this theme, while evaluating the association of a single dimensional measure of positive attributes of behavior in relation to learning and school performance (article # 1), evaluating the structure of multidimensional measures of temperament (article # 2) and the relation of temperament measures with educational outcomes (article # 3). These articles use data from a large community study conducted in Brazil, in the cities of Porto Alegre and São Paulo - the High Risk Cohort for Psychiatric Disorders. The first article evaluates the distinction of mental symptoms and general traits of positive behaviors and modification of the deleterious association of low intelligence and high levels of psychopathology in learning and school performance by positive attributes of behavior. This study advances the understanding that positive attributes of the behavior of children and adolescents are a distinct construct of symptoms of mental disorders and have independent associations with low learning problems and better academic performance. In addition, this study demonstrates that the negative effects of low intelligence and high levels of psychopathology in learning and academic achievement may be buffered by high levels of positive attributes of behavior. The second article analyzes a model of temperament in which includes, besides classic dimensions, a negative self-evaluation factor, together with their associations to groups of non-overlapping psychiatric diagnosis. Among the results, less effort control was associated with several diagnostic categories. Specifically, a higher level of negative self-evaluation was found in subjects belonging to the diagnostic group that included emotional disorders, as well as a lower level of shyness in subjects with attention deficit hyperactivity disorder and a higher level of extroversion in subjects with conduct disorder and of oppositional-defiant disorders. This study advances in the sense of pointing out that self-report in subjects with certain diagnoses may be influenced by a greater tendency to be evaluated negatively, as well as it is possible to distinguish diagnoses classically grouped as externalizing disorders, through temperament. The third article evaluates the main, independent and interactive associations of temperament dimensions with different school outcomes. In this study, effortful control was shown to be associated with a lower index of negative school events (suspension, repetition and dropout), as well as better school performance and reading and writing abilities. These effects were independent of age, gender, socioeconomic status, intelligence, mental symptoms and other temperaments. However, this study advances by demonstrating that frustration and effort control interact to associate with better levels of reading ability. Specifically, if effort control is low (or frustration), high levels of frustration (or effort control) are associated with better reading ability. Understanding the associations and distinctions of single or multidimensional measures of non-cognitive skills may be useful for understanding the role of these constructs in the different stages of the school process in order to promote the elevation of educational quality

Subjective well-being and psychopathology symptoms: mental health profiles and their relations with academic achievement in brazilian children

The aim of this study is to examine the differences in children’s academic achievement considering their mental health profiles. Previous studies have started to seek those differences. However, it is not clear what are the academic achievement differences considering distinct children’s mental health profile. We used a cross-sectional study sample of 273 students from an elementary school (6–11 years of age) in Porto Alegre, Brazil. Mental health profiles were empirically investigated using latent class analysis by combining a subjective well-being measure and a psychopathology symptom screening. Standardized tests and school grades were considered to assess academic achievement. Findings reveal an empirical division of the sample into four mental health groups. The adjusted analysis revealed that the group with a high level of symptoms, despite having high subjective well-being, had lower levels of academic achievement when compared with the other groups, which have low to moderate levels of psychopathology. Present findings support the idea that psychopathology is a detrimental factor for educational achievement regardless of the levels of wellbeing

Harmonizing bifactor models of psychopathology between distinct assessment instruments: reliability, measurement invariance, and authenticity

Objectives: Model configuration is important for mental health data harmonization. We provide a method to investigate the performance of different bifactor model configurations to harmonize different instruments. Methods: We used data from six samples from the Reproducible Brain Charts initiative (N = 8,606, ages 5–22 years, 41.0% females). We harmonized items from two psychopathology instruments, Child Behavior Checklist (CBCL) and GOASSESS, based on semantic content. We estimated bifactor models using confirmatory factor analysis, and calculated their model fit, factor reliability, between-instrument invariance, and authenticity (i.e., the correlation and factor score difference between the harmonized and original models). Results: Five out of 12 model configurations presented acceptable fit and were instrument-invariant. Correlations between the harmonized factor scores and the original full-item models were high for the p-factor (>0.89) and small to moderate (0.12–0.81) for the specific factors. 6.3%–50.9% of participants presented factor score differences between harmonized and original models higher than 0.5 z-score. Conclusions: The CBCL-GOASSESS harmonization indicates that few models provide reliable specific factors and are instrument-invariant. Moreover, authenticity was high for the p-factor and moderate for specific factors. Future studies can use this framework to examine the impact of harmonizing instruments in psychiatric research

Specific and social fears in children and adolescents : separating normative fears from problem indicators and phobias

Objective: To distinguish normative fears from problematic fears and phobias. Methods: We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve. Results: According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive. Conclusion: These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears

Childhood individual and family modifiable risk factors for criminal conviction: a 7-year cohort study from Brazil

Crime is a major public problem in low- and middle-income countries (LMICs) and its preventive measures could have great social impact. The extent to which multiple modifiable risk factors among children and families influence juvenile criminal conviction in an LMIC remains unexplored; however, it is necessary to identify prevention targets. This study examined the association between 22 modifiable individual and family exposures assessed in childhood (5–14 years, n = 2511) and criminal conviction at a 7-year follow-up (13–21 years, n = 1905, 76% retention rate) in a cohort of young people in Brazil. Population attributable risk fraction (PARF) was computed for significant risk factors. Criminal convictions were reported for 81 (4.3%) youths. Although most children living in poverty did not present criminal conviction (89%), poverty at baseline was the only modifiable risk factor significantly associated with crime (OR 4.14, 99.8% CI 1.38–12.46) with a PARF of 22.5% (95% CI 5.9–36.1%). It suggests that preventing children’s exposure to poverty would reduce nearly a quarter of subsequent criminal convictions. These findings highlight the importance of poverty in criminal conviction, as it includes several deprivations and suggest that poverty eradication interventions during childhood may be crucial for reducing crime among Brazilian youth

Telomere length and epigenetic age acceleration in adolescents with anxiety disorders

Evidence on the relationship between genetics and mental health are flourishing. However, few studies are evaluating early biomarkers that might link genes, environment, and psychopathology. We aimed to study telomere length (TL) and epigenetic age acceleration (AA) in a cohort of adolescents with and without anxiety disorders (N = 234). We evaluated a representative subsample of participants at baseline and after 5 years (n = 76) and categorized them according to their anxiety disorder diagnosis at both time points: (1) control group (no anxiety disorder, n = 18), (2) variable group (anxiety disorder in one evaluation, n = 38), and (3) persistent group (anxiety disorder at both time points, n = 20). We assessed relative mean TL by real-time quantitative PCR and DNA methylation by Infinium HumanMethylation450 BeadChip. We calculated AA using the Horvath age estimation algorithm and analyzed differences among groups using generalized linear mixed models. The persistent group of anxiety disorder did not change TL over time (p = 0.495). The variable group had higher baseline TL (p = 0.003) but no accelerated TL erosion in comparison to the non-anxiety control group (p = 0.053). Furthermore, there were no differences in AA among groups over time. Our findings suggest that adolescents with chronic anxiety did not change telomere length over time, which could be related to a delay in neuronal development in this period of life

The impact of child psychiatric conditions on future educational outcomes among a community cohort in Brazil

Aims. Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational outcomes which can be attributed to psychiatric conditions. Methods. Participants (N = 2511) were from a school-based community cohort of Brazilian children and adolescents aged 6–14 years enriched for high family risk of psychiatric conditions. We examined the impact of fear- (panic, separation and social anxiety disorder, specific phobia, agoraphobia and anxiety conditions not otherwise specified), distress- (generalised anxiety disorder, major depressive disorder and depressive disorder not otherwise specified, bipolar, obsessive-compulsive, tic, eating and post-traumatic stress disorder) and externalising- related conditions (attention deficit and hyperactivity disorder, conduct and oppositional- defiant conditions) on grade repetition, dropout, age-grade distortion, literacy performance and bullying perpetration, 3 years later. Psychiatric conditions were ascertained by psychiatrists, using the Development and Well-Being Behaviour Assessment. Propensity score and inverse probability weighting were used to adjust for potential confounders, including comorbidity, and sample attrition. We calculated the population attributable risk percentages to estimate the proportion of adverse educational outcomes in the population which could be attributed to psychiatric conditions. Analyses were conducted separately for males and females. Results. Fear and distress conditions in males were associated with school dropout (odds ratio (OR) = 2.76; 95% confidence interval (CI) = 1.06, 7.22; p < 0.05) and grade repetition (OR = 2.76; 95% CI = 1.32, 5.78; p < 0.01), respectively. Externalising conditions were associated with grade repetition in males (OR = 1.66; 95% CI = 1.05, 2.64; p < 0.05) and females (OR = 2.03; 95% CI = 1.15, 3.58; p < 0.05), as well as age-grade distortion in males (OR = 1.66; 95% CI = 1.05, 2.62; p < 0.05) and females (OR = 2.88; 95% CI = 1.61, 5.14; p < 0.001). Externalising conditions were also associated with lower literacy levels (β = −0.23; 95% CI = −0.34, −0.12; p < 0.001) and bullying perpetration (OR = 3.12; 95% CI = 1.50, 6.51; p < 0.001) in females. If all externalising conditions were prevented or treated, we estimate that 5.0 and 4.8% of grade repetition would not have occurred in females and males, respectively, as well as 10.2 (females) and 5.3% (males) of age-grade distortion cases and 11.4% of female bullying perpetration. Conclusions. The study provides evidence of the negative impact of psychiatric conditions on educational outcomes in a large Brazilian cohort. Externalising conditions had the broadest and most robust negative impacts on education and these were particularly harmful to females which are likely to limit future socio-economic opportunities

Temperamento e comportamentos positivos de crianças e adolescentes e suas relações com desfechos escolares

Nas ultimas décadas, os desafios educacionais foram sendo modificados. Na medida que se consegue colocar a maioria dos jovens na escola, a ênfase pela quantidade da educação ofertada passa a ser por entender fatores associados a melhor qualidade educacional. A partir de meados do século XX, as habilidades cognitivas, como a inteligência, foram intensamente estudadas em sua relação com a educação. Mais recentemente, habilidades socioemocionais (não cognitivas) têm sido associadas com a promoção de maiores níveis educacionais que impactam nos níveis socioeconômicos, oriundos de melhoria das habilidades para o mercado de trabalho. Porém, não há clara definição do que poderiam ser as habilidades socioemocionais, sendo na maioria das vezes associadas a traços do funcionamento individual, como personalidade, temperamento ou até mesmo autoestima e baixos níveis de sintomas de transtornos mentais. Os artigos desta tese são relacionados a este tema, enquanto buscam avaliar a associação de medida unidimensional de comportamentos positivos em relação a aprendizagem e rendimento escolar (artigo #1), avaliar a estrutura de medidas multidimensionais de temperamento (artigo #2) e a relação dessas medidas com desfechos educacionais (artigo #3). Esses artigos utilizaram dados de um grande estudo comunitário realizado no Brasil, nas cidades de Porto Alegre e São Paulo – a Coorte de Alto Risco para Transtornos Psiquiátricos. O primeiro artigo avalia a distinção de sintomas mentais e traços gerais de comportamentos positivos e a modificação da associação deletéria de baixa inteligência e altos níveis de sintomas mentais em aprendizagem e rendimento escolar por habilidades positivas do comportamento. Este estudo avança no entendimento de que atributos positivos do comportamento de crianças e adolescentes são um construto distinto de sintomas de transtornos mentais e tem associações independentes com menor nível de problemas de aprendizagem e melhor rendimento acadêmico. Além disso, este estudo demonstra que os efeitos negativos de baixa inteligência e altos níveis de sintomas mentais na aprendizagem e rendimento acadêmico podem ser tamponadas por altos níveis de atributos positivos do comportamento. No segundo artigo é analisado um modelo de temperamento no qual inclui, além de dimensões clássicas, um fator de autoavaliação negativa, juntamente com suas associações a grupos de psicopatologias não comórbidas. Dentre os resultados, menor controle de esforço esteve associado com diversas categorias diagnósticas. De maneira específica, foi encontrado maior nível de autoavaliação negativa nos sujeitos pertencentes ao grupo diagnostico que inclui transtornos emocionais, bem como menor nível de timidez nos sujeitos com transtorno de déficit de atenção e hiperatividade e maior nível de extroversão nos sujeitos com transtorno de conduta e de oposição e desafio. Esse estudo avança no sentido de apontar que autorrelato em sujeitos com determinados diagnósticos podem sofrer influência de uma maior tendência de se avaliarem negativamente, bem como é possível distinguir diagnósticos agrupados classicamente em transtornos externalizantes, através do temperamento. O terceiro artigo avalia as associações principais, independentes e interativas de dimensões do temperamento com desfechos escolares distintos. Neste estudo, demonstrou-se que o controle de esforço é associado à menor índice de eventos escolares negativos (suspensão, repetência e evasão escolar), bem como melhor rendimento escolar e habilidade de leitura e escrita. Esses efeitos foram independente da idade, sexo, nível socioeconômico, inteligência, sintomas mentais e outros temperamentos. No entanto, este estudo avança ao demonstrar que frustração e controle de esforço interagem para associarem-se a melhores níveis de habilidade de leitura. Especificamente, se o controle de esforço é baixo (ou frustração), níveis altos de frustração (ou controle de esforço) estão associados a melhor habilidade de leitura. Compreender as associações e distinções de medidas uni ou multidimensionais das habilidades não-cognitivas pode ser útil para a compreensão do papel destes construtos nas diferentes etapas do processo escolar, a fim de promover a elevação da qualidade educacional.During the last decades, educational challenges have changed. As most of youths can be placed at school, the emphasis on studying educational supply shifted to the understanding of educational quality. From the mid-twentieth century, cognitive skills, such as intelligence, were intensely studied in their relationship with education. More recently, socioemotional (non-cognitive) skills have been associated with the promotion of higher educational levels that impact on socioeconomic levels, resulting from improved skills for the job market. However, there is no clear definition of what socioemotional skills could be and are most often associated with traits of individual functioning such as personality, temperament or even self-esteem and low levels of symptoms of mental disorders. The articles of this thesis are related to this theme, while evaluating the association of a single dimensional measure of positive attributes of behavior in relation to learning and school performance (article # 1), evaluating the structure of multidimensional measures of temperament (article # 2) and the relation of temperament measures with educational outcomes (article # 3). These articles use data from a large community study conducted in Brazil, in the cities of Porto Alegre and São Paulo - the High Risk Cohort for Psychiatric Disorders. The first article evaluates the distinction of mental symptoms and general traits of positive behaviors and modification of the deleterious association of low intelligence and high levels of psychopathology in learning and school performance by positive attributes of behavior. This study advances the understanding that positive attributes of the behavior of children and adolescents are a distinct construct of symptoms of mental disorders and have independent associations with low learning problems and better academic performance. In addition, this study demonstrates that the negative effects of low intelligence and high levels of psychopathology in learning and academic achievement may be buffered by high levels of positive attributes of behavior. The second article analyzes a model of temperament in which includes, besides classic dimensions, a negative self-evaluation factor, together with their associations to groups of non-overlapping psychiatric diagnosis. Among the results, less effort control was associated with several diagnostic categories. Specifically, a higher level of negative self-evaluation was found in subjects belonging to the diagnostic group that included emotional disorders, as well as a lower level of shyness in subjects with attention deficit hyperactivity disorder and a higher level of extroversion in subjects with conduct disorder and of oppositional-defiant disorders. This study advances in the sense of pointing out that self-report in subjects with certain diagnoses may be influenced by a greater tendency to be evaluated negatively, as well as it is possible to distinguish diagnoses classically grouped as externalizing disorders, through temperament. The third article evaluates the main, independent and interactive associations of temperament dimensions with different school outcomes. In this study, effortful control was shown to be associated with a lower index of negative school events (suspension, repetition and dropout), as well as better school performance and reading and writing abilities. These effects were independent of age, gender, socioeconomic status, intelligence, mental symptoms and other temperaments. However, this study advances by demonstrating that frustration and effort control interact to associate with better levels of reading ability. Specifically, if effort control is low (or frustration), high levels of frustration (or effort control) are associated with better reading ability. Understanding the associations and distinctions of single or multidimensional measures of non-cognitive skills may be useful for understanding the role of these constructs in the different stages of the school process in order to promote the elevation of educational quality