Co-occurring mental health problems across childhood and adolescence: within-person developmental relations, mediators and antecedents

Approximately 10 to 20% of children and adolescents suffer from a mental health condition. In addition, more than 40% of these children are likely to develop at least one additional mental illness concurrently or later in life. A variety of different theories has tried to explain the high co-occurrence of mental health difficulties. Among these, developmental cascade models hypothesise that difficulties in one domain have directional effects on other mental health domains potentially through mediating factors such as peer problems. Previous research investigating such cascade models has been limited in that these models were mostly applied to the analysis of pairwise comorbidities even though most mental health domains have previously been found to be interconnected. Additionally, previous studies have not adequately operationalised the within-person processes implied by cascade models as methods commonly used (such as the cross-lagged panel model) confound within- and between-person effects. This thesis aimed to gain a comprehensive understanding of the interrelations between multiple mental health domains across childhood and adolescence using methods suitable for disaggregating within- from between-person effects. In addition to domain level analyses, this thesis further intended to provide more detailed insights into the symptom level relations between different mental health problems in order to identify symptoms that might bridge different mental health disorders. Another aim of this thesis was to evaluate potential mediating factors in the developmental relations between different mental health domains. Finally, this thesis explored whether a range of phenotypic and polygenic risk factors increase the risk for developing co-occurring mental health problems. The data used in this thesis came from three longitudinal cohort studies: The Millennium Cohort Study, the Avon Longitudinal Study of Parents and Children and the Zurich Project on the Social Development from Childhood to Adulthood. Results of the empirical studies suggest that all domains of socio-emotional development, that is conduct problems, hyperactivity/inattention, emotional problems, peer problems and prosociality are highly interlinked over development. In addition, findings of symptom level analyses between symptoms of ADHD and internalising problems as well as between symptoms of ADHD and aggressive behaviours indicated that specific symptoms might be particularly relevant in activating symptoms from another mental health domain, thus showing the value of moving beyond domain level analyses. Investigations of potential mediating factors in developmental relations between ADHD symptoms and internalising and externalising problems found no support for parental involvement, peer problems or academic achievement mediating their developmental relations. Finally, analyses of antecedents of co-occurring mental health problems showed that internalising and externalising problems likely share a similar set of underlying phenotypic and polygenic risk factors. Overall, the results of this thesis highlight that there is a clear need to develop more integrative theories of comorbidity as all investigated mental health domains were connected to each other across childhood and adolescence. Such theories should not only acknowledge the complex interplay between different mental health problems but also acknowledge the many biological, sociological, and psychological factors that may affect how different mental health problems relate to each other within an individual

Longitudinal invariance of the strengths and difficulties questionnaire across ages 4 to 16 in the ALSPAC sample

Peer reviewed: TrueFunder: University of Bristol; FundRef: https://doi.org/10.13039/501100000883Funder: Medical Research Council; FundRef: https://doi.org/10.13039/501100000265The Strengths and Difficulties Questionnaire (SDQ) has been widely used to study children's psychosocial development longitudinally; however, such analyses assume longitudinal measurement invariance, that is, they presuppose that symptom manifestations are measured comparably across different ages. Violations of this assumption could bias longitudinal analyses and should therefore be empirically tested. This study tested longitudinal measurement invariance within a confirmatory factor analysis framework in the U.K.-based Avon Longitudinal Study of Parents and Children (N = 13,988). Results indicated that SDQ scores showed configural, metric, scalar, and residual invariance across ages 7, 8, 9, 11, 13, and 16, supporting its use for comparing variances, covariances, and means over time within a latent variable model as well as using observed scores. At age 4, configural invariance was not supported, indicating that mental health symptoms as measured by the SDQ manifest differently at this age, thus necessitating caution when comparing symptoms as measured by SDQ scores at this age to later ages

Investigating moderation effects at the within-person level using intensive longitudinal data:A two-level dynamic structural equation modelling approach in Mplus

Recent technological advances have provided new opportunities for the collection of intensive longitudinal data. Using methods such as dynamic structural equation modelling, these data can provide new insights into moment-to-moment dynamics of psychological and behavioural processes. In intensive longitudinal data (t > 20), researchers often have theories that imply that factors that change from moment to moment within individuals act as moderators. For instance, a person’s level of sleep deprivation may affect how much an external stressor affects mood. Here, we describe how researchers can implement, test and interpret dynamically changing within-person moderation effects using two-level dynamic structural equation modelling as implemented in the structural equation modelling software Mplus. We illustrate the analysis of within-person moderation effects using an empirical example investigating whether changes in spending time online using social media affect the moment-to-moment effect of loneliness on depressive symptoms. We provide annotated Mplus code, enabling researchers to better isolate, estimate and interpret the complexities of within-person interaction effects

The role of harsh parenting practices in early- to middle-childhood socioemotional development:An examination in the Millennium Cohort Study

Patterson's coercion model describes a gradual escalation in maladaptive parent–child transactions whereby externalizing behaviors lead to increases in maladaptive parenting and vice versa. The current study investigates the role of (predominantly mother‐reported) harsh parenting practices in the within‐person development of conduct problems, hyperactive/inattentive behaviors, and emotional problems. A random‐intercept cross‐lagged panel model was fit across ages 3, 5, and 7 (N = 14,037, 49% female, 84% White) using the UK population‐representative Millennium Cohort Study. Findings support Patterson's coercion model, providing evidence for reciprocal within‐family relations between parenting practices and child behaviors. They suggest the importance of addressing parenting difficulties in families where children present with socioemotional difficulties in order to help prevent the accumulation of additional issues

Associations between Student-Teacher Bonds and Oppositional Behavior Against Teachers in Adolescence: A Longitudinal Analysis from Ages 11 to 15

Prior research has found evidence for a positive effect of student-teacher bonds on children’s behavior. However, little research has investigated these relations following a transactional model of child development. This study investigated the bidirectional associations between student-teacher relationships and oppositional behaviors towards teachers using the ‘Zurich Project on the Social Development from Childhood to Adulthood’ (n = 1527; median ages 11, 13 and 15; 49% female). Results of a random-intercept cross-lagged panel model suggested that, among boys, positive student-teacher bonds at age 13 were associated with fewer teacher-reported oppositional behaviors two years later. The results indicated that negative interactions with teachers may be part of vicious cycles of poor relationships and increased levels of oppositional behavior, particularly for boys in late adolescence

Exploring the effect of ADHD traits on the moment‐to‐moment interplay between provocation and aggression: Evidence from dynamic structural equation modeling

The relation between attention deficit hyperactivity disorder (ADHD) symptoms and aggression is well documented; however, the processes that account for higher levels of aggression associated with ADHD in the course of daily life are little understood. The current study used ecological momentary assessment to explore how ADHD traits relate to individual differences in perceiving provocation from others and the resultant aggressive behaviors; and the strengths of the links between provocation and aggression in the flow of daily life. A dynamic structural equation model was fit using data from a subpopulation of young adults involved in the longitudinal z‐proso study (n = 259, median‐age 20). Data on provocation and aggression was collected at four quasi‐random time periods per day over a 14‐day period. Individuals with higher ADHD trait levels reported higher instances of provocation and aggression, with ADHD traits significantly moderating aggression inertia such that those with higher levels of ADHD traits showed greater persistence of aggressive behavior over time. However, ADHD trait levels did not significantly moderate any of the observed cross‐lagged effects. Our findings suggest that individuals with higher levels of ADHD traits are at greater risk of exposure to interpersonal interactions involving interpersonal provocation, show higher levels of aggressive behavior in daily life, and find it more difficult to reduce their aggression once triggered. These findings support the importance of targeting factors such as social skills and emotion regulation that may underpin the increased difficulties in interpersonal interactions often experienced by individuals with high levels of ADHD symptoms

The role of student-teacher relationships in the association between negative parenting practices and emotion dynamics:Combining longitudinal and ecological momentary assessment data

Emotion dysregulation is increasingly implicated as a transdiagnostic risk factor in the etiology of mental health problems. This project aimed to explore the links between emotion regulation, negative parenting and student-teacher relationships using longitudinal and ecologically valid data. A sample of n = 209 young people enrolled in the 'Decades-to-Minutes' (D2M) study, based in Zurich, Switzerland, provided data from the ages of 7-20 via parent- and self-report questionnaires and ecological momentary assessment. Data were analyzed using Dynamic Structural Equation Modeling (DSEM). Worse student-teacher relationships predicted increased negative affectivity and emotional lability. Negative parenting practices predicted emotional lability only via their impact on student-teacher relationships. The findings point to worse student-teacher relationships as risk factors in the socioemotional development of children and young people

The role of moment-to-moment dynamics of perceived stress and negative affect in co-occurring ADHD and internalising symptoms

A maladaptive response to stress in individuals with high ADHD traits may be a key factor explaining co-occurring ADHD symptoms and internalising problems. The current study investigates whether between-person differences in ADHD traits are associated with differences in the within-person moment-to-moment coupling of stress and negative affect; and whether these can explain between-person differences in internalising problems (N = 262, median-age 20). Results of a dynamic structural equation model indicated that between-person differences in ADHD traits significantly moderated the daily life coupling between stress and negative affect. Further, higher ADHD traits were associated with stronger stress carry-over and higher mean levels of negative affect. Stress carry-over and mean levels of negative affect mediated the association between ADHD traits and internalising problems. Keywords: ADHD; Ecological momentary assessment; Internalising problems; Negative affect; Perceived stress

Respondent characteristics associated with adherence in a general population ecological momentary assessment study

Objectives: Ecological momentary assessment (EMA) has seen an explosion in popularity in recent years; however, an improved understanding of how to minimise (selective) non-adherence is needed. Methods: We examined a range of respondent characteristics predictors of adherence (defined as the number of EMA surveys completed) in the D2M EMA study. Participants were a sample of n = 255 individuals drawn from the longitudinal z-proso cohort who completed up to 4 EMA surveys per day for a period of 2 weeks. Results: In unadjusted analyses, lower moral shame, lower self-control, lower levels of self-injury, and higher levels of aggression, tobacco use, psychopathy, and delinquency were associated with lower adherence. In fully adjusted analyses with predictors selected using lasso, only alcohol use was related to adherence: beer and alcopops to higher adherence and spirits to lower adherence. Conclusions: These findings provide potential insights into some of the psychological mechanisms that may underlie adherence in EMA. They also point to respondent characteristics for which additional or tailored efforts may be needed to promote adherence. Keywords: adherence; ecological momentary assessment; experience sampling; missingness; non-response