Selenium is an essential micronutrient that the human body incorporates into a family of proteins known as selenoproteins. These proteins perform a remarkable range of biochemical duties, including antioxidant defense, thyroid hormone metabolism, and immune regulation. The brain is particularly dependent on this system because neural tissue consumes a disproportionate share of the body’s oxygen and generates a steady stream of reactive oxygen species as a byproduct of its relentless metabolic activity. When selenium is scarce, the antioxidant capacity of developing neurons may be compromised at precisely the moment when the brain is wiring itself at its most furious pace. Deficiency has also been linked in animal studies to alterations in neurotransmitter systems, including dopaminergic and serotonergic pathways, which are central to attention regulation and impulse control. This biological plausibility is what motivated the research team to ask whether a mother’s selenium status during pregnancy leaves a measurable trace in her child’s behavior years later.

The study drew on a well-established cohort in Bhaktapur, a city in the Kathmandu Valley where the research group has conducted nutrition studies for more than a decade. In total, 720 mother-infant dyads were enrolled, and maternal plasma selenium concentrations were measured in blood samples taken early in pregnancy. This timing matters. The first trimester and early second trimester are periods of rapid neural tube formation, neuronal proliferation, and the beginnings of synaptic architecture, so any nutritional insult during this window could theoretically have outsized consequences. The researchers then waited, quite literally, for the children to grow. When the children reached four years of age, their mental health was assessed using a parent-reported questionnaire called the Strengths and Difficulties Questionnaire, or SDQ, in its Nepalese version.

The SDQ is one of the most widely used brief behavioral screening instruments in the world. It asks parents to rate their child on a series of attributes that cluster into five subscales: emotional symptoms, conduct problems, hyperactivity-inattention, peer relationship problems, and prosocial behavior. Because the questionnaire had not previously been validated in this specific Nepalese preschool population, the team took the methodologically important step of testing whether the original five-factor structure actually held up in their data. Using confirmatory factor analysis, a statistical technique that evaluates how well observed responses map onto hypothesized underlying dimensions, they found that the five-factor model fit the data well after some modifications. The comparative fit index reached 0.967, comfortably above conventional thresholds, while the root mean square error of approximation was 0.059, indicating acceptable approximation error. In practical terms, this means the Nepalese version of the parent-rated SDQ can be considered a psychometrically sound tool for assessing preschool mental health in this setting, a contribution that will benefit future research in the region regardless of what the selenium analysis showed.

The average maternal plasma selenium concentration in the cohort was 74.7 micrograms per liter, with a standard deviation of 10.2 micrograms per liter. This figure sits in an interesting zone. It is not low enough to constitute overt deficiency by most clinical standards, but it is well below the concentrations typically observed in selenium-replete populations in North America and parts of Europe, where means can exceed 100 micrograms per liter. Nepal’s soil is known to be variable in selenium content, and the predominantly cereal-based local diet does not necessarily compensate for that variability. The researchers therefore had genuine reason to suspect that a meaningful fraction of the pregnant women in the cohort might be experiencing suboptimal selenium status during a critical developmental window.

To analyze the relationship between prenatal selenium and child behavior, the team used generalized linear models, examining maternal plasma selenium both as a continuous variable and in categorized forms, including tertiles that divided the sample into thirds of exposure. The children’s SDQ subscale scores served as the outcomes. The headline finding emerged from the tertile analysis: children whose mothers fell in the lowest selenium tertile during pregnancy had significantly higher hyperactivity-inattention scores at age four than children whose mothers were in the middle tertile. The adjusted regression coefficient was 0.329, with a 95 percent confidence interval running from 0.023 to 0.636, meaning the difference was statistically significant but modest in magnitude, and the confidence interval only narrowly excluded the null value of zero.

Crucially, however, the pattern did not behave the way a classic dose-response relationship would. If selenium deficiency were driving hyperactive behavior in a straightforward manner, one might expect the lowest tertile to differ from the middle tertile, and the middle tertile to differ from the highest, producing a graded gradient across the exposure distribution. Instead, the association appeared only when the lowest and middle tertiles were compared, and no corresponding difference emerged between the middle and highest groups. The analysis of selenium as a continuous variable likewise did not yield significant associations. The authors are appropriately cautious on this point, describing their evidence as limited and noting that the isolated finding lacks the clear exposure-response pattern that would strengthen a causal interpretation. It is possible that a threshold effect exists, in which only selenium status below a certain level matters, but it is equally possible that the result reflects chance, residual confounding, or the many comparisons inherent in examining multiple subscales across multiple exposure parameterizations.

Several other limitations deserve attention. The SDQ was completed by parents, which introduces the possibility of reporting bias, although the validation work strengthens confidence that the instrument measures coherent behavioral dimensions in this population. Plasma selenium reflects relatively recent intake and is influenced by the proteins that transport the element, notably selenoprotein P, so a single early-pregnancy measurement may not perfectly capture selenium status across the full gestational period. The Bhaktapur cohort, while valuable, is drawn from one urbanizing South Asian community, and its selenium distribution differs from that of populations where deficiency is rare, which limits generalizability in both directions. Confounding by overall nutritional quality is also a real concern, since women with low selenium may differ in other dietary and socioeconomic respects that independently influence child development, even though the models adjusted for available covariates.

Still, the study’s strengths are considerable. The prospective design, in which exposure was measured in pregnancy and outcome years later, removes much of the reverse-causation ambiguity that plagues cross-sectional nutrition research. The sample size of 720 dyads is respectable for a birth cohort study of this kind, and the dual contribution of a validated behavioral instrument and a novel exposure-outcome analysis makes the paper useful on two fronts. For selenium biology, the findings add a tentative data point to a small but growing literature linking maternal micronutrient status to child neurobehavioral outcomes, a field that has historically focused more heavily on iron, iodine, and folate. For public health in South Asia, the results raise the possibility that selenium, a mineral rarely included in prenatal supplementation programs, deserves closer scrutiny. The authors themselves conclude that confirmation in further studies is required, and that is the right note: one modest association, in one cohort, at one age, is a signal worth chasing rather than a conclusion worth announcing. Future work with repeated selenium measurements, biomarkers of selenium-dependent enzyme activity, and follow-up into school age will be needed to determine whether the trace element truly shapes the developing mind, or whether this finding dissolves under the weight of replication.

Subject of Research: The association between prenatal maternal selenium concentration and mental health outcomes in four-year-old children in a Nepalese mother-child cohort study.

Article Title: The association between prenatal maternal selenium concentration and mental health in early childhood, a mother-child cohort study

Article References: Ranjitkar, S., Kvestad, I., Chandyo, R. K., Bakken, K. S., Ulak, M., Strand, T. A., Huber, S., Averina, M., & Hysing, M. (2026). The association between prenatal maternal selenium concentration and mental health in early childhood, a mother-child cohort study. PLOS One, 21(10), e0360527. https://doi.org/10.1371/journal.pone.0360527

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360527

Keywords: selenium, prenatal nutrition, child mental health, hyperactivity, inattention, Nepal, birth cohort, Strengths and Difficulties Questionnaire, micronutrients, neurodevelopment, pregnancy, PLOS One

The research team recruited 760 children through primary health care centres in the Lisbon Metropolitan Area and focused their analysis on the 453 children aged at least four years whose caregivers completed a valid Strengths and Difficulties Questionnaire, or SDQ. This instrument, which is used extensively in developmental epidemiology, asks parents to rate their child across domains including emotional symptoms, conduct problems, hyperactivity, peer relationship problems and prosocial behaviour. The researchers defined early mental health difficulties as a Total Difficulties score of 14 or higher, the threshold that places a child in the borderline or abnormal range. Children were classified as having an immigrant background if the child or at least one parent had been born outside the European Union, a definition that captures a broad swath of families in the Lisbon region.

The headline finding is stark: nearly a quarter of the screened children exhibited difficulties at a level that would typically warrant clinical attention or further assessment. But the study’s most valuable contribution lies in its multivariable logistic regression analysis, conducted on the 417 children with complete data, which teased apart which social, family and behavioural factors were independently associated with elevated scores. Three factors stood out after adjustment for the others: household income, family structure and sports participation.

Income emerged as a powerful correlate. Children living in households earning between roughly 750 and 1,500 euros per month had more than double the adjusted odds of scoring in the borderline or abnormal range compared with children from households earning above 1,500 euros per month, with an adjusted odds ratio of 2.10 and a 95 percent confidence interval of 1.13 to 3.90. This gradient is consistent with a substantial body of international literature linking economic hardship to early childhood psychopathology, but the Portuguese data are notable because they come from a community sample recruited through routine primary care rather than from clinical referrals, meaning the findings reflect the general preschool population rather than children already in treatment.

Family structure also mattered. Children living in extended families or other non-nuclear arrangements had 82 percent higher adjusted odds of elevated Total Difficulties scores than children in nuclear households, with an adjusted odds ratio of 1.82 and a confidence interval of 1.02 to 3.26. The authors are careful to note that this association does not imply that extended families are inherently harmful; such households may, for instance, be more common among families navigating economic precarity, housing constraints or the demands of migration, and the cross-sectional design cannot disentangle these overlapping influences. What the finding does suggest is that the composition and circumstances of a child’s household carry measurable weight in early mental health screening.

The strongest behavioural association involved physical activity. Children who did not participate in sports had nearly three times the adjusted odds of elevated difficulties compared with their peers who did, with an adjusted odds ratio of 2.80 and a confidence interval of 1.59 to 4.94. This result was the most robust across the study’s two analytical approaches. In addition to the dichotomised logistic regression, the researchers ran a negative binomial model on the undichotomised SDQ Total Difficulties score, a technique suited to count-like outcome data that preserves the full granularity of the scale. That full-score analysis supported the sports participation association, while the estimates for income and family structure were less conclusive, suggesting those relationships warrant further scrutiny in larger or longitudinal samples.

A central question driving the study was whether children with an immigrant background face a heightened burden of early mental health difficulties. The descriptive data showed real disparities: immigrant-background children experienced greater socioeconomic disadvantage, higher screen exposure and lower sports participation, and they more often scored in the abnormal range for peer relationship problems, at 12.5 percent versus 5.7 percent among children without an immigrant background. Yet when the researchers adjusted for socioeconomic and family circumstances, the association between immigrant background and overall difficulties largely disappeared, with an adjusted odds ratio of 1.09 and a confidence interval spanning 0.66 to 1.79. In other words, the apparent gap appears to be explained largely by the social and economic conditions in which these children are growing up rather than by their migrant status itself.

This pattern, often described in social epidemiology as attenuation through adjustment, carries significant policy implications. If the elevated risk among immigrant-background children flows primarily through poverty, family arrangements and daily routines, then interventions targeting those upstream conditions could benefit all vulnerable children regardless of origin. The authors argue that primary care and community services are well positioned to help families access appropriate support, since the study’s recruitment through primary health care centres demonstrates that these settings already reach the families in question. Screening embedded in routine paediatric visits, combined with referral pathways to mental health and social services, could identify children during the developmental window when intervention is most effective.

The study’s methodology reflects standard practice in observational epidemiology. The researchers followed the STROBE reporting guidelines for cross-sectional studies, assessed multicollinearity among predictors using variance inflation factors, and obtained ethics approval from the Research Ethics Committee of the Regional Health Administration of Lisboa e Vale do Tejo, with written informed consent from all participating parents and caregivers. The work was funded by the Portuguese Foundation for Science and Technology under grant PTDC/SAU-SER/4664/2020, with additional support through the Global Health and Tropical Medicine research unit and the REAL associated laboratory. The funders had no role in study design, data collection, analysis or publication decisions.

Like all cross-sectional studies, this one has inherent limits. The data capture a single moment in time, so the observed associations cannot establish whether low income, non-nuclear family structures or lack of sports participation cause mental health difficulties, or whether families facing other challenges are simply more likely to experience all of these conditions together. Parent-reported questionnaires, while validated and widely used, reflect caregiver perception rather than clinical diagnosis. The authors themselves call for longitudinal and intervention studies to clarify these relationships and assess whether modifying daily routines, such as increasing sports participation, could have preventive effects. Still, the message for public health is clear and actionable: early mental health inequalities are already visible at age four, they track closely with economic and family circumstances, and the primary care system is a viable front line for finding and supporting the children who need help most.

Subject of Research: Social, family and health behaviour correlates of early mental health difficulties among preschool children in Portugal

Article Title: Early mental health inequalities among preschool children in Portugal: a cross-sectional study of social, family and health behaviour correlates

Article References: Gonçalves, R., Dias, S., & Martins, M. R. O. (2026). Early mental health inequalities among preschool children in Portugal: a cross-sectional study of social, family and health behaviour correlates. BMC Public Health. https://doi.org/10.1186/s12889-026-29767-y

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29767-y

Keywords: preschool children, mental health difficulties, health inequalities, social determinants of health, Strengths and Difficulties Questionnaire, immigrant background, sports participation, household income, family structure, primary health care, Portugal, cross-sectional study

The research team, led by Varsha Singh with colleagues Harish Chaudhury and Mahim Sagar, set out to fill a conspicuous gap in the scientific literature. Most of what psychologists know about adolescent mental health comes from Western, industrialized nations, yet the majority of the world’s adolescents live elsewhere, often in societies with very different family structures, gender norms, and resource constraints. In developing countries with patriarchal traditions, early gender inequity can shape everything from nutrition to freedom of movement, potentially leaving distinct fingerprints on physical health, family life, and the social worlds teenagers inhabit. Whether the well-established Western patterns of sex differences in psychological problems hold in such contexts was, until now, an open question.

To answer it, the researchers administered the Indian Adolescent Health Questionnaire alongside the widely used Strengths and Difficulties Questionnaire to 5,121 students. The sample was 48 percent male and 39 percent female, with 13 percent of respondents not reporting sex. The health questionnaire captured physical health, nutrition, hygiene, safety attitudes, substance use, academics, and perceptions of family and school environments, while the Strengths and Difficulties Questionnaire measured adjustment problems along two broad axes: internalizing difficulties, which turn distress inward as emotional symptoms, peer problems, and withdrawal, and externalizing difficulties, which turn it outward as conduct problems, hyperactivity, and risk-taking.

The physical health results alone reveal how early and how differently gender inequity can register in the body. Male adolescents reported better overall physical health and better nutrition than their female classmates. Female adolescents, by contrast, reported more favorable attitudes toward safety, substance use, and academics. In a society where girls may eat last, move less, and enjoy less autonomy, the researchers argue, these divergences are not trivial quirks of self-report but early markers of a gender gap in health that can widen across the lifespan. Notably, the sexes did not differ on every dimension: hygiene attitudes and perceptions of the family environment were statistically indistinguishable between boys and girls, suggesting that some foundations of adolescent wellbeing are shared even where risks diverge.

Correlation analyses confirmed that the domains of adolescent life do not operate in isolation. Physical health, family environment, school environment, and broader social environment were all significantly intercorrelated, with correlations reaching significance at p = .00. In other words, a teenager who is physically run down is more likely to be embedded in strained family or school contexts, and vice versa. Independent-samples t-tests showed significant sex differences in nearly every subdomain measured, with hygiene and family environment the only exceptions. This dense web of associations underscores a central premise of the study: adolescent maladjustment cannot be understood as a purely psychological phenomenon detached from the body, the household, and the classroom.

The scale of psychological difficulty the survey uncovered is sobering. Using standard cutoffs on the Strengths and Difficulties Questionnaire, the researchers found that 22.8 percent of the school students fell into the borderline range for adjustment problems, while 16 percent were categorized as highly problematic—roughly one in six adolescents showing clinically concerning levels of difficulty. Contrary to the pattern often reported in Western samples, where girls predominate in internalizing problems and boys in externalizing ones, this study found no significant sex difference in internalizing problems. Boys and girls were equally likely to report emotional symptoms and peer difficulties. Externalizing problems, however, did show the expected male skew, with boys displaying higher overall maladjustment and more outward-directed difficulties.

One of the most intriguing findings concerns what drives boys’ internalizing distress. In Western literature, girls’ emotional problems are typically attributed to relational and internal pressures, while boys’ difficulties are framed as behavioral. Here, the researchers found that male students’ internalizing problems were linked specifically to their peer relationships. This suggests that in the Indian school context, boys’ emotional lives may be more vulnerable to peer dynamics than conventional frameworks anticipate—a finding with direct implications for how anti-bullying programs, friendship interventions, and school counseling are designed. If peer problems are the gateway to boys’ emotional distress, interventions targeting peer culture may pay dividends in both internalizing and externalizing outcomes.

The study also quantified the protective role of family with unusual precision. Using partial correlations that statistically controlled for both sex and grade level, the researchers found that family support was negatively correlated with emotional problems (r = -.05, p < .05), meaning that adolescents reporting stronger family support reported fewer emotional difficulties even after accounting for demographic differences. Interestingly, hygiene attitude showed a small positive correlation with hyperactivity problems (r = .033, p < .05), a counterintuitive association the authors note as a target for further investigation. The effect sizes are modest, as is typical in large correlational studies, but the direction of the family finding is consistent with a broad literature: the household remains a critical buffer against the development of emotional disorders during adolescence.

The practical implications the authors draw are twofold. First, school-based interventions that actively involve families may shield adolescents from mental health problems, leveraging the demonstrated protective association between family support and emotional wellbeing. Second, prevention efforts should be sex-specific in their targets: nutrition and physical activity for girls, whose physical health and dietary status lag behind boys’ in this sample, and drug awareness and safety for boys, whose externalizing risks and substance-related attitudes are more concerning. Rather than a one-size-fits-all mental health curriculum, the data argue for calibrated programs that address the distinct risk profiles each sex carries into adolescence in this cultural context.

The researchers are careful to frame their work as a foundation rather than a final word. They call for the use of standardized health measures that would allow longitudinal follow-up, enabling researchers to track how the health gender gap evolves across developmental phases from adolescence into adulthood. They also emphasize the need to account for the urban-rural divide that accentuates health disparities in developing countries, and for samples that reflect the diversity of national populations. With nearly four in ten adolescents in their own sample showing borderline or clinically significant difficulties, the stakes of that research agenda are clear. Adolescence, the study reminds us, is not merely a turbulent phase to be survived; it is the period in which the biological, psychological, and social foundations of adult health are poured—and in India’s classrooms, those foundations are being laid unevenly along lines of sex, family, and circumstance.

Subject of Research: Sex-specific associations between physical health, social support, and mental health maladjustment among school-going adolescents in India

Article Title: Association between physical and mental health in school-going adolescents: Sex-specific patterns of maladjustment in formative years of life

Article References: Singh, V., Chaudhury, H., & Sagar, M. (2026). Association between physical and mental health in school-going adolescents: Sex-specific patterns of maladjustment in formative years of life. PLOS Mental Health, 3(9), e0000708. https://doi.org/10.1371/journal.pmen.0000708

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000708

Keywords: adolescent mental health, internalizing problems, externalizing problems, sex differences, physical health, family support, school environment, Strengths and Difficulties Questionnaire, India, gender inequity, nutrition, peer problems

The study team, led by pediatric researchers from Ningde Municipal Hospital and Pingnan County Hospital in Fujian Province, surveyed 3,050 children aged 6 to 12 years. Parents completed the Strengths and Difficulties Questionnaire, a widely validated screening instrument that measures five dimensions: emotional symptoms, conduct problems, hyperactivity and inattention, peer relationship problems, and prosocial behavior. Rather than simply adding these subscales into a total difficulties score, the researchers applied latent profile analysis, a person-centered method that asks whether the population contains subgroups of children who share similar response patterns across all five dimensions simultaneously.

The technical logic behind this approach matters. Variable-centered methods, such as ordinary correlation and regression on summary scores, assume that the sample is homogeneous and that associations apply uniformly to everyone. Latent profile analysis instead models the data as a mixture of unobserved subpopulations, estimating the probability that each child belongs to each profile. The researchers fit a series of competing models and selected the optimal solution using standard fit criteria, including the Akaike information criterion, the Bayesian information criterion, entropy as a measure of classification precision, and the requirement that each resulting class contain a practically meaningful proportion of children. The five-profile solution emerged as the best balance of statistical parsimony and interpretive clarity.

The largest group, comprising 56.8 percent of the children, was labeled the Normative profile, showing no marked elevations on any subscale. But nearly half the sample fell into one of four atypical profiles. The most common of these, at 18.1 percent, was Elevated Emotional Symptoms, in which children showed heightened anxiety and low mood without corresponding behavioral dysregulation. A further 12.3 percent belonged to a profile the authors called Low Hyperactivity and Low Prosocial Behavior, a quieter pattern in which children were neither restless nor particularly socially engaged. Two smaller but clinically concerning groups completed the picture: Elevated Conduct Problems and Low Prosocial Behavior, at 7.6 percent, and High Emotional and Multi-Domain Difficulties, at 5.2 percent, the latter representing children struggling across nearly every measured domain.

The most striking results came from the analysis of what distinguishes these profiles. Physical punishment showed a graded, dose-like cross-sectional association with profile membership. Compared with children who had never been physically punished, those with frequent exposure had substantially higher odds of belonging to the Elevated Conduct Problems and Low Prosocial Behavior profile and to the High Emotional and Multi-Domain Difficulties profile. Family conflict followed a strikingly similar pattern, with adjusted odds ratios of 3.42 for the conduct-problems profile and 3.55 for the multi-domain difficulties profile. In other words, children growing up amid frequent family conflict were roughly three and a half times more likely to land in the most troubled groups than their peers from low-conflict households, even after accounting for other measured characteristics.

Lifestyle factors told a complementary story. Excessive weekend screen time, defined in the study as more than two hours per day, was associated with higher odds of membership in the Elevated Emotional Symptoms profile and, with an adjusted odds ratio of 1.91, in the Elevated Conduct Problems and Low Prosocial Behavior profile. Short sleep duration, below the nine-hour threshold recommended for school-aged children, showed its most pronounced association with the conduct-problems profile, where it carried an adjusted odds ratio of 2.12. These associations were profile-specific: a given risk factor did not raise the odds of every atypical profile equally, which is precisely the kind of differentiated signal that a person-centered analysis is designed to detect and that a single total-difficulties score would obscure.

The differential patterning is what gives the study its practical bite. Emotional symptoms in middle childhood often fly under the radar because they do not disrupt classrooms the way hyperactivity or aggression do, yet the Elevated Emotional Symptoms profile captured nearly one in five children in this sample. The finding that weekend screen time, but not necessarily the family-conflict variables, was the factor most clearly tied to this profile suggests that different intervention levers may be needed for internally directed versus externally directed difficulties. Conversely, for children in the conduct-problems and multi-domain profiles, the dominant correlates were punitive discipline, household conflict and insufficient sleep, pointing toward family-system and sleep-hygiene interventions rather than screen-time limits alone.

The authors frame their conclusions as a call to prioritize the family parenting environment and healthy lifestyle habits in child health management. That framing is consistent with a substantial body of developmental science linking harsh discipline to externalizing behavior and linking sleep restriction to emotional and behavioral dysregulation, but the present study adds granularity by showing that these exposures cluster with particular symptom configurations. It is worth emphasizing the study’s cross-sectional design: the data capture associations at a single point in time, so they cannot establish whether physical punishment causes conduct problems, whether children with difficult behavior elicit harsher discipline, or whether both are shaped by unmeasured factors. Longitudinal follow-up would be needed to disentangle those directions of effect.

Methodologically, the study has notable strengths. The sample of 3,050 children is large enough to support stable profile estimation, and the use of multiple fit indices guards against over-extracting or under-extracting latent classes. The Strengths and Difficulties Questionnaire is one of the most extensively validated child mental health screens worldwide, and the anonymous administration of the survey, along with ethics approval from Pingnan County Hospital and informed consent from parents, addresses common concerns about reporting sensitive family variables. The research was supported by the Ningde Natural Science Foundation, and the authors report no competing interests.

For clinicians, educators and policymakers, the message is that childhood mental health screening may benefit from moving beyond aggregate scores toward pattern recognition. A child with moderate scores spread thinly across several subscales and a child with a sharp spike in emotional symptoms alone may both escape attention under a total-difficulties cutoff, yet they belong to different profiles with different correlates and potentially different intervention needs. As screen time and sleep debt continue to rise among school-aged children worldwide, and as debates over disciplinary practices persist, this study offers a data-driven map of how those everyday exposures align with the actual shapes of childhood distress, and a reminder that the household remains the most powerful lever available for shaping it.

Subject of Research: Latent profiles of emotional and behavioral problems and their environmental and lifestyle correlates among Chinese school-aged children

Article Title: Latent profiles of emotional and behavioral problems in Chinese school-aged children and their associations with environmental and lifestyle factors

Article References: Lu, Y., He, D., wang, T., Qian, F., Lin, Z., Zheng, Y., Zheng, M., Zhang, J., & Wang, J. (2026). Latent profiles of emotional and behavioral problems in Chinese school-aged children and their associations with environmental and lifestyle factors. BMC Psychology. https://doi.org/10.1186/s40359-026-05680-2

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05680-2

Keywords: latent profile analysis, emotional and behavioral problems, school-aged children, Strengths and Difficulties Questionnaire, physical punishment, family conflict, screen time, sleep duration, prosocial behavior, child mental health, BMC Psychology, China

The research drew on 905 autistic children enrolled in the Shanghai Autism Early Developmental study, a cohort that recruits children diagnosed with autism spectrum disorder at Xinhua Hospital. This sample size matters enormously in psychometric research, the branch of psychology concerned with the theory and technique of psychological measurement. Small validation studies can produce unstable estimates of reliability and validity that collapse when a test is used in new populations. By evaluating the scale in nearly a thousand young children, the researchers could examine not just whether the instrument works overall, but whether it performs consistently across clinically meaningful subgroups defined by age, sex, severity of autistic symptoms, and intellectual functioning or developmental status. That subgroup analysis is what elevates the study from a routine validation exercise to a genuinely informative test of how anxiety presents in this population.

The Preschool Anxiety Scale asks parents to rate the frequency of anxiety-related behaviors in their child, covering domains such as separation anxiety, social phobia, generalized anxiety, obsessive-compulsive behaviors, and fears of physical injury. For a scale to be considered trustworthy, it must demonstrate several distinct properties. Internal consistency, typically quantified by Cronbach’s alpha, reflects how coherently the items hang together as a measure of a single underlying construct. Construct validity concerns whether the statistical structure of the items matches the theoretical organization of anxiety. Convergent validity asks whether scores correlate with other measures of related constructs, while divergent validity confirms that the scale does not simply register any and all childhood distress.

On the core reliability metric, the results were striking. The scale achieved a Cronbach’s alpha of 0.896 across the full sample, a value comfortably within the range conventionally regarded as good, and one that indicates parents’ responses to the individual items were highly coherent. Equally important, this internal consistency held up across the examined subgroups, suggesting the instrument behaves similarly whether the child is a two-year-old or a six-year-old, a boy or a girl, or a child with more or less severe autistic features. For clinicians screening a heterogeneous population, this stability is essential: a questionnaire that works only for verbal, high-IQ children would be of limited use in a clinical setting where intellectual disability and global developmental delay are common.

The validity analyses provided further support. The researchers correlated PAS scores with the internalizing and externalizing subscales of the Strengths and Difficulties Questionnaire, a widely used behavioral screening instrument. Internalizing scores capture emotional symptoms such as worry and unhappiness, while externalizing scores reflect hyperactivity, conduct problems, and impulsive behavior. If the PAS truly measures anxiety, it should correlate more strongly with internalizing than with externalizing symptoms. That is precisely what the team found: a Pearson correlation of 0.278 with the SDQ internalizing score, compared with a weaker 0.151 with the externalizing score. The pattern of a stronger association with the conceptually related construct and a weaker one with the unrelated construct satisfies the classic requirements for convergent and divergent validity, and the same pattern was reproduced within the demographic and clinical subgroups.

But the study also delivered a surprise, and it is here that the findings become most scientifically interesting. When the researchers subjected the item responses to confirmatory factor analysis, the original five-factor model of the PAS—the structure separating separation anxiety, social phobia, generalized anxiety, obsessive-compulsive behaviors, and physical injury fears—showed suboptimal fit. In other words, the neat theoretical partitioning of preschool anxiety into five distinct syndromes did not hold in this autistic sample. An exploratory factor analysis, which lets the data reveal their own structure rather than testing a predetermined one, pointed toward a far more parsimonious solution: either a single general anxiety factor or a two-factor structure. The implication is that in young autistic children, anxiety symptoms as captured by the PAS may be less clearly differentiated than in typically developing preschoolers.

There are several plausible reasons for this structural shift, and the authors’ findings invite careful interpretation. One possibility is developmental: the boundaries between anxiety subtypes may simply not yet be carved out in children this young, particularly when communication difficulties limit how children can express the content of their fears. Another possibility is specific to autism itself. Overlap between autistic traits and anxious behaviors—restricted interests that resemble compulsions, social withdrawal that resembles social phobia, distress at change that resembles generalized anxiety—could blur the distinctions between subscales, causing items from different theoretical domains to load together. A third consideration is cultural and linguistic: the scale was completed by Chinese-speaking parents, and cross-cultural differences in how anxiety behaviors are described and noticed could influence the factor structure. The study cannot disentangle these explanations definitively, but the practical message is clear: the total PAS score is a reliable and valid index of overall anxiety burden in this population, while interpretation of individual subscale scores should be made with caution until the instrument is further adapted for autistic preschoolers.

The clinical stakes of this work are considerable. Anxiety in autistic children is associated with poorer outcomes across domains ranging from sleep and feeding to family stress and school readiness, and effective interventions exist—but only if anxiety is recognized in the first place. In children aged two to six, whose autistic diagnosis has often just been established and whose families are navigating a new and overwhelming clinical landscape, a brief parent-report measure that reliably flags anxiety could change the trajectory of early intervention. The subgroup analyses conducted by the Shanghai team suggest that clinicians can deploy the PAS across their entire preschool autism caseload without worrying that the instrument will behave differently for children with global developmental delay or intellectual disability, groups that are frequently excluded from validation research and therefore poorly served by standard assessment tools.

The study also carries a broader methodological lesson for the field of autism research. Instruments developed and validated in general populations are routinely imported into autistic samples on the assumption that they measure the same construct in the same way. This study demonstrates both the value and the limits of that assumption. The reliability and convergent validity findings justify the use of the PAS total score; the factor-analytic findings warn against uncritical use of the original scoring structure. The authors themselves frame this as a call for future adaptation of the scale to this population, and their large, well-characterized cohort provides exactly the kind of data foundation that such adaptation requires. It is a model of how psychometric validation should proceed: not merely asking whether a test works, but probing where it begins to bend.

For researchers and clinicians outside China, the findings raise an obvious question of generalizability, and replication in other linguistic and cultural contexts will be needed before the conclusions can be considered universal. Still, the core result—that a brief parent-report anxiety scale can be trusted to measure overall anxiety in autistic toddlers and preschoolers, with a caveat about its internal structure—represents a meaningful step forward. Early identification of anxiety in autism has long been hampered by the absence of validated tools for the youngest children, and this study, grounded in the Shanghai Autism Early Developmental cohort and published open access in BMC Psychiatry, offers clinicians a tested instrument and offers researchers a clearer picture of how anxiety is organized in the developing autistic brain. As screening programs for autism expand worldwide, ensuring that the emotional lives of these children are measured as carefully as their diagnostic symptoms may prove one of the most consequential tasks in developmental pediatrics.

Subject of Research: Validation of the Preschool Anxiety Scale for measuring anxiety in young autistic children

Article Title: Psychometric properties of the Preschool Anxiety Scale in 2-6-year-old Chinese autistic children

Article References: Wang, M., Chen, R., Huang, C., Tan, H., Chen, J., Huang, L., Pu, Y., Zhang, L., Li, F., Du, W., Zhou, W., & Ren, T. (2026). Psychometric properties of the Preschool Anxiety Scale in 2-6-year-old Chinese autistic children. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08666-x

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08666-x

Keywords: autism spectrum disorder, anxiety, psychometrics, Preschool Anxiety Scale, preschool children, validation study, internal consistency, factor analysis, Strengths and Difficulties Questionnaire, China, early intervention, BMC Psychiatry

The study was conducted between April and August 2023 by a team based at Shandong University’s School of Nursing and Rehabilitation, working with colleagues at the Second Qilu Hospital of Shandong University and the Qingdao Mental Health Center. Each participating family consisted of a child with autism spectrum disorder and one parent, forming what researchers call a dyad. Parents completed the Strengths and Difficulties Questionnaire, a brief parent-report instrument developed by child psychiatrist Robert Goodman that screens for emotional symptoms, conduct problems, hyperactivity, peer relationship difficulties, and prosocial behavior. Because parents observe children across everyday settings rather than in a single clinical session, parent-report measures of this kind are often used to capture the real-world expression of a child’s difficulties.

The headline finding was the sheer prevalence of difficulty: 81.3 percent of the children were flagged as having emotional or behavioral problems according to the questionnaire. That figure is consistent with a broader literature. A 2023 systematic review and meta-analysis published in Neuroscience and Biobehavioral Reviews documented high rates of co-occurring conditions in autistic children and adults, and longitudinal work following autistic people from childhood into early adulthood has shown that emotional and behavioral problems frequently persist across development. For families, this means the challenges associated with autism rarely stop at the core diagnostic features; they extend into anxiety, dysregulation, and conduct difficulties that shape daily life at home and at school.

What sets the new study apart is its analytical approach. Rather than averaging scores across the whole sample or treating problem severity as a single continuous scale, the researchers used latent profile analysis, a person-centered statistical method that searches for unobserved subgroups within a population. The technique asks a simple but powerful question: do children cluster into recognizable patterns of emotional and behavioral difficulty, or do their scores vary smoothly along one continuum? In this sample, the answer was that three distinct latent profiles best described the data, implying that autistic children do not form one uniform group but instead occupy meaningfully different positions with respect to their emotional and behavioral adjustment.

Identifying the profiles was only the first step. The team then wanted to know what distinguished families whose children fell into the more affected profiles from those in the less affected ones. To do this, they used the R3STEP procedure in the Mplus statistical software, an automatic three-step method that has become a standard tool in latent profile research. The procedure’s key virtue is that it accounts for classification uncertainty. Latent profile analysis never assigns a child to a profile with absolute certainty; instead, each child carries a probability of belonging to each group. Older approaches that simply assigned children to their most likely profile and then ran ordinary statistical tests treat those assignments as if they were error-free, which can bias estimates. The three-step method keeps the classification uncertainty in the model, producing more honest estimates of how observed variables relate to profile membership.

The covariates the researchers examined came from two domains of family life. The first was parenting stress, measured with an instrument whose Chinese-language version has been validated in prior psychometric work. Parenting stress in this context refers to the strain a parent experiences in the parenting role, encompassing perceptions of the child as demanding, a sense of incompetence or distress in the parental role, and restrictive or disrupted interactions between parent and child. The second domain was family management, assessed with a Chinese version of the Family Management Measure, a framework originally developed by nursing scientists to describe how families organize daily life around a child’s condition. Family management spans both difficult dimensions, such as difficulty managing the child’s condition and disruption of family routines, and positive dimensions, such as family life difficulty being managed with confidence, developmental competence in parents, and the family’s ability to maintain normalcy.

The associations that emerged were directionally coherent. Higher parenting stress was positively associated with membership in the profiles characterized by more emotional and behavioral problems. Negative family management, meaning families reporting greater difficulty and disruption in handling the child’s condition, was likewise positively associated with the high-problem profiles. Positive family management, by contrast, was inversely associated with membership in the most affected groups. In other words, after the model accounted for the probabilistic nature of profile assignment, families reporting more stress and more struggle tended to have children in the more difficult profiles, while families reporting confidence and competence in managing daily life tended to have children in the less affected ones.

The authors are careful about what this pattern does and does not establish. The study is cross-sectional, meaning stress, family management, and child outcomes were measured at the same point in time. That design cannot determine whether parenting stress drives children’s emotional and behavioral problems, whether challenging child behavior drives parental stress, or whether the two reinforce each other in a bidirectional loop. There is substantial evidence that such loops exist. A 2024 meta-analysis in Jornal de Pediatria synthesized studies linking parental stress to emotional and behavioral problems in offspring, and research on Chinese families of autistic children published in Autism Research has examined how child behavior problems and parental psychological distress relate to one another, with social support and cultural values as potential moderators. Other work has traced pathways from parental social support through family functioning to child outcomes, suggesting that the family system operates as an interconnected whole rather than as a set of independent variables.

Still, the practical implications of the study are relatively clear, and the authors frame them in terms of family-based support strategies. If parenting stress and negative family management are reliably associated with children landing in the most affected profiles, then interventions that reduce parental strain and strengthen families’ capacity to organize and manage daily life may be relevant to children’s emotional and behavioral adjustment. This aligns with a growing body of intervention research. Group counseling programs for parents of autistic children have been shown to improve psychological resilience, life satisfaction, and family functioning, and studies of family-school partnerships have linked them to lower parenting stress and better parent mental health. The family management framework, adapted over the past decade to include children with a range of conditions, gives clinicians a vocabulary for identifying families who feel overwhelmed by their child’s condition and for targeting support toward routine-building and confidence rather than only toward the child’s symptoms.

For the autism research community, the study’s contribution is methodological as much as substantive. By demonstrating that emotional and behavioral problems in autistic children fall into heterogeneous latent profiles, and that family variables predict profile membership even when classification uncertainty is modeled explicitly, the work adds to a shift away from treating autistic children as a single diagnostic block. Researchers have increasingly argued for plural understandings of autism, noting differences in developmental trajectories and symptom combinations, and the profile approach offers a quantitative way to capture that heterogeneity. The study was funded by the National Natural Science Foundation of China and the Natural Science Foundation of Shandong Province, and the authors report no competing financial interests. Its limitations, including the cross-sectional design and reliance on parent report, leave open the causal questions that longitudinal and multi-informant studies will need to address. But for families and clinicians, the message is concrete: the emotional lives of autistic children are entangled with the stress levels and management capacities of the households around them, and supporting the family may be one of the most direct routes to supporting the child.

Subject of Research: Latent profile analysis of parenting stress and family management in relation to emotional and behavioral problems in children with autism spectrum disorder

Article Title: Association of Parenting Stress and Family Management With Emotional and Behavioral Problems in Children With Autism Spectrum Disorders: A Latent Profile Analysis

Article References: Ma, B., Wang, J., Zhang, M., Hou, Y., & Chen, O. (2026). Association of Parenting Stress and Family Management With Emotional and Behavioral Problems in Children With Autism Spectrum Disorders: A Latent Profile Analysis. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07510-1

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07510-1

Keywords: autism spectrum disorder, parenting stress, family management, emotional and behavioral problems, latent profile analysis, Strengths and Difficulties Questionnaire, R3STEP procedure, Mplus, parent-child dyads, family-based intervention, child mental health, cross-sectional study

The research team, led by Billy Fitzgerald with colleagues Christopher McCusker, Maria Dempsey and Audrey Dunn Galvin, recruited 117 caregivers of autistic children aged 4 to 12 years who were enrolled in mainstream education. Roughly two-thirds of the children were male, reflecting the well-documented gender skew in autism diagnoses. Caregivers completed a battery of validated questionnaires covering five distinct family processes: parenting stress, parental mental health problems, marital satisfaction, family cohesion and family conflict. They also reported on child characteristics including age, gender, autistic traits, comorbid diagnostic status and sleep quality, provided family structural information such as household income, caregiver education and family composition, and rated their satisfaction with the family’s relationships with healthcare and educational professionals.

Child outcomes were measured using the Strengths and Difficulties Questionnaire, a widely used screening instrument that captures emotional symptoms, conduct problems, hyperactivity, peer problems and prosocial behavior, alongside caregiver ratings of academic performance. The analytical strategy was deliberately staged. The researchers first ran exploratory bivariate analyses to identify which individual variables were associated with outcomes, and then used hierarchical regression models to test the unique and combined contributions of family processes after accounting for child and systemic factors. This approach allowed them to partition the variance in outcomes across the different levels of the child’s ecology, which is precisely the kind of multilevel accounting the bioecological model demands.

The headline finding concerns behavior problems. Two variables emerged as significant individual predictors: caregiver and parenting-related stress, and child sleep quality. Poorer sleep and higher parenting stress both tracked with more behavioral difficulties. But when the researchers looked at the collective contribution of the family process variables as a block, family processes accounted for more of the variance in behavior problems than any other set of factors. In other words, the emotional temperature of the household, the mental health of the parents, the quality of the couple relationship and the degree of cohesion or conflict in the family together formed the strongest statistical signal in the data.

The picture changed sharply for competence-related outcomes. Prosocial behavior, the capacity to engage positively with peers and adults, was predicted by autistic traits alone: children with higher trait severity showed lower prosocial scores. Academic performance, meanwhile, was predicted only by the presence of a comorbid diagnosis, meaning children with an additional condition such as ADHD or a language disorder tended to perform worse academically. Family processes, family structure and satisfaction with professionals did not add predictive power for these outcomes once child characteristics were taken into account. The study thus draws a clean statistical dividing line: the family shapes how autistic children behave, but child-level characteristics dominate how they perform and connect.

That division has a compelling logic rooted in developmental science. Behavior problems in childhood are highly stress-reactive; they fluctuate with the emotional climate a child inhabits day to day. Sleep is a particularly interesting variable here because it sits at the intersection of child and family. Sleep difficulties are among the most common co-occurring conditions in autistic children, and disrupted sleep is known to amplify emotional and behavioral dysregulation in neurotypical children as well. At the same time, a child’s chronic sleep problems feed back into parental stress, creating a bidirectional loop in which exhausted parents and sleep-deprived children each worsen the other’s state. The bioecological framework explicitly models these reciprocal processes rather than treating the child as a fixed set of traits acting on a passive environment.

The null findings for systemic factors deserve equally careful attention. Family satisfaction with relationships with healthcare and educational professionals did not predict behavioral or academic outcomes in the final models, and neither did household income, caregiver education or family composition. This is not to say that professional partnerships and socioeconomic resources are irrelevant; a substantial literature links family–professional partnership quality to family quality of life and service adequacy. But in this sample, once family processes and child characteristics were modeled, the systemic layer added little explanatory power for the specific outcomes measured. For clinicians and educators, the implication is that interventions targeting only the professional interface or only material resources may miss the more proximal levers of change.

The practical implications are concrete. Parenting stress emerged as a central, modifiable target, and there is an established evidence base for addressing it: randomized trials of structured parent training have shown meaningful reductions in behavioral problems in autistic children, and mindfulness-based stress reduction programs for caregivers of children with developmental disabilities have demonstrated reductions in parental distress. Sleep interventions, including behavioral sleep programs tailored to autistic children, represent another tractable avenue, given that sleep quality independently predicted behavior problems in this study. The findings suggest that family-level supports should not be treated as peripheral add-ons to child-focused services but as core components of any strategy aimed at improving behavioral outcomes for autistic children in mainstream schools.

The study also carries implications for how schools interpret difficult behavior. If a significant share of the variance in behavioral difficulties is attributable to family processes, then classroom behavior may often function as a barometer of family stress and child sleep rather than as a straightforward reflection of classroom management or autism severity. This reframing does not absolve schools of responsibility for creating supportive environments, but it argues against locating the entire problem, and the entire solution, within the school gates. A coordinated response that includes screening for parental stress and sleep problems, and offering family-based support where indicated, may be more effective than behavior plans alone.

As the first wave of a longitudinal study, this research captures a snapshot, and the authors frame it accordingly. Cross-sectional regressions identify associations and relative contributions at one point in time; they cannot establish that family processes cause behavior problems or that improving sleep will definitively reduce them. The longitudinal design will allow the team to test whether family processes measured now predict change in outcomes over time, which would substantially strengthen the causal case. Sample size is another consideration, as 117 caregiver–child dyads limit the number of predictors that can be modeled simultaneously and the precision of the estimates. Even so, the study offers one of the clearest head-to-head comparisons to date of family, child and systemic influences on autistic children’s outcomes in mainstream education, and its central message is hard to ignore: to understand and support autistic children’s behavior, look first to the family system that surrounds them.

Subject of Research: Multilevel influences of family processes, child characteristics and systemic factors on behavioral and academic outcomes of autistic children in mainstream education

Article Title: Relative Impact of Family Processes and Child and Systemic Factors on Behavioral and Academic Outcomes for Autistic Children in Mainstream Education

Article References: Fitzgerald, B., McCusker, C., Dempsey, M., & Galvin, A. D. (2026). Relative Impact of Family Processes and Child and Systemic Factors on Behavioral and Academic Outcomes for Autistic Children in Mainstream Education. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07362-9

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07362-9

Keywords: autism, autistic children, family processes, parenting stress, sleep quality, behavior problems, academic performance, mainstream education, bioecological model, Strengths and Difficulties Questionnaire, family-professional relationships, child mental health

The study, led by Molly Yeoman with colleagues including Vaso Totsika, analysed data from the UK Millennium Cohort Study, a longitudinal project following children born between 2000 and 2002 across seven waves of data collection spanning from 9 months to 17 years of age. Of the 10,228 participants with usable autism data, 160 had a parent-reported autism spectrum condition diagnosis recorded between the ages of 5 and 11. Parents also reported whether their child had been temporarily suspended or permanently excluded between ages 11 and 14, and the adolescents themselves completed the well-validated Strengths and Difficulties Questionnaire at 17, providing self-reported scores for both internalising difficulties—anxiety, depression and social withdrawal—and externalising difficulties.

The raw numbers were stark. By age 14, 21.9 percent of autistic children in the cohort had been excluded or suspended from school, compared with just 4.6 percent of their non-autistic peers. By 17, autistic adolescents reported significantly higher scores on both dimensions of mental health: internalising scores averaged 19.46 in the autism group versus 18.21 among peers, and externalising scores averaged 18.50 versus 17.34. After adjusting for a comprehensive set of confounders—sex, ethnicity, maternal age, socioeconomic deprivation, family structure, child health, prior behavioral difficulties, maternal psychological distress and parental school engagement—autism remained associated with 1.43 points higher internalising scores and 0.78 points higher externalising scores, and with more than double the odds of exclusion (an odds ratio of 2.32).

What distinguishes this study from earlier work is its statistical machinery. Simple associations between exclusion and poor mental health are notoriously difficult to interpret, because children who act out are more likely to be excluded in the first place, making the direction of cause and effect ambiguous. The research team confronted this head-on using causal mediation analysis under the counterfactual framework, employing the g-formula to estimate randomised interventional analogues of natural direct and indirect effects. This approach matters because the data contained intermediate confounders—prior externalising difficulties and maternal mental health—that are themselves influenced by autism and that also shape both exclusion and later outcomes. Simpler mediation methods would have produced biased estimates in this situation, so the g-computation procedure was essential for cleanly decomposing the total effect of autism into its direct and exclusion-mediated components.

The decomposition produced a clear and, in some ways, surprising result. For externalising symptoms, the total effect of autism was 0.69 points, of which 0.66 was a direct effect and 0.03 travelled through school exclusion—a small but statistically significant indirect pathway (95 percent confidence interval 0.004 to 0.06, p = 0.024). In other words, exclusion accounted for a modest slice of the association, estimated at roughly 4.9 percent, though the proportion itself was not statistically significant. For internalising symptoms, by contrast, the indirect effect was essentially zero (−0.0008, p = 0.936), with the entire association between autism and later anxiety and depression operating through the direct pathway. Exclusion, it seems, is a mechanism for behavioral deterioration specifically, not emotional deterioration generally.

The theoretical interpretation offered by the authors draws on the idea that schools function as protective environments, particularly for autistic young people who often depend heavily on routine, structure, predictable schedules and supportive adult supervision to regulate their behavior and emotions. When exclusion removes these scaffolds during adolescence—a developmental window already marked by heightened emotional reactivity and social pressure—the result may be a destabilising loss of exactly the supports that many autistic students rely on most. This aligns with Problem Behaviour Theory, which holds that adverse shifts in environmental context can interact with individual vulnerabilities, such as cognitive inflexibility, to elevate the risk of behavioral difficulties. Consistent with this account, research on residential mobility has shown that disrupting embedded routines and social networks predicts externalising problems more strongly than internalising ones, a pattern that mirrors the asymmetry observed here.

The findings also carry a subtler implication: exclusion does not simply reflect pre-existing behavioral problems but actively contributes to their development and escalation. Earlier studies in neurotypical populations, including work by Ford and colleagues and by Obsuth and colleagues, had already suggested that exclusion predicts later psychiatric difficulties even after accounting for prior vulnerabilities. The new study extends that logic to autistic adolescents, showing that exclusion operates as a pathway through which autism leads to externalising outcomes, rather than merely a consequence of them. A sensitivity analysis restricted to temporary suspensions only produced a similar-sized indirect effect that fell short of significance, possibly because fewer participants experienced only temporary exclusion, or because shorter removals from school are genuinely less damaging than permanent expulsion.

Why did exclusion fail to mediate internalising difficulties, when qualitative research has documented shame, low self-worth and social isolation among excluded autistic students? The authors offer several explanations. The direct pathway may reflect core features of autism itself, such as intolerance of uncertainty and sensory sensitivities, which generate emotional distress independently of school events. Measurement differences may also play a role: this study relied on adolescent self-report of internalising symptoms, whereas earlier work used parent reports, teacher reports, broader distress measures or retrospective interviews, each of which may capture different facets of emotional functioning. There is also the possibility of heterogeneity in individual experience—for some autistic adolescents facing chronic peer victimisation, which can affect a large majority of autistic students, exclusion may even offer temporary relief from bullying or the exhausting demands of camouflaging, potentially suppressing the group-level indirect effect.

The study is not without limitations, and the authors are candid about them. The autistic subsample of 160 participants is small, producing sparse data in some covariate strata and a positivity violation that the g-formula could only address through extrapolation, so the estimates warrant caution. Survey weights were not applied, limiting population representativeness, and residual confounding cannot be fully excluded despite the careful use of a directed acyclic graph to guide covariate selection. Missing data, ranging up to 34 percent across variables, were handled with multiple imputation by chained equations under a missing-at-random assumption, and the mediation models were run with 500 bootstrap replications to generate bias-corrected confidence intervals.

Even with those caveats, the practical message is pointed. Because exclusion is a modifiable environmental factor, the findings argue for preventative, autism-informed strategies that reduce reliance on exclusionary discipline altogether—better staff training, flexible policies, tailored support plans and structured reintegration programs such as low-stimulation learning hubs with one-to-one support. They also suggest that mental health outcomes in autism are not fixed by neurology alone but are shaped by social and institutional contexts that unfold over time. If a small but real share of behavioral difficulties in autistic adolescents traces back to the moment a school removes them from its community, then keeping that community intact, responsive and informed may be one of the most concrete levers available for improving autistic young people’s lives.

Subject of Research: The mediating role of school exclusion in the association between autism and adolescent internalising and externalising mental health outcomes

Article Title: School Exclusion as a Partial Mediator Between Autism and Adolescent Mental Health

Article References: Yeoman, M., Cieplinska, V., Lye, V., & Totsika, V. (2026). School Exclusion as a Partial Mediator Between Autism and Adolescent Mental Health. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07550-7

Image Credits: AI Generated

DOI: 10.1007/s10803-026-07550-7

Keywords: autism spectrum conditions, school exclusion, adolescent mental health, externalising difficulties, internalising difficulties, Millennium Cohort Study, causal mediation analysis, g-formula, Strengths and Difficulties Questionnaire, inclusive education, school discipline, UK cohort study

The research team, led by Abir Nagata of Hamamatsu University School of Medicine together with Rina Yamauchi of the National Center for Child Health and Development and colleagues at several other Japanese institutions, designed the study to move beyond broad statements about ‘good parenting’ and focus instead on concrete communication behaviors that parents report engaging in. Previous work had linked supportive parent–adolescent communication to better psychosocial outcomes, but the authors noted that evidence on specific practices during the COVID-19 pandemic was sparse. Their goal was to identify which, if any, of three commonly recommended practices — explaining matters in easy-to-understand words, empathizing with adolescents’ feelings, and holding family discussions — were associated with adolescents’ behavioral profiles during the pandemic’s first year.

To do this, the researchers conducted a nationwide, population-based cross-sectional survey in December 2020, using a stratified two-stage cluster sampling method designed to produce a sample representative of Japanese households. The analysis included 641 parent–adolescent pairs, with adolescents drawn from two school grades — fifth grade and eighth grade — capturing both late childhood and mid-adolescence. Each parent reported on how frequently they engaged in the three positive communication practices, while the adolescent in each pair completed the Strengths and Difficulties Questionnaire, a widely used and well-validated screening instrument that measures emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior. From these responses, the team derived scores for total difficulties as well as separate internalizing difficulties, which reflect emotional distress turned inward, and externalizing difficulties, which manifest as outward behavioral problems such as acting out.

The survey revealed substantial variation in how often parents engaged in each practice. Just over 80 percent of parents — 80.3 percent — reported explaining things to their adolescent in easy-to-understand words, making this by far the most common practice. Empathizing with adolescents’ feelings was reported by 57.9 percent of parents, and 59.4 percent said they held family discussions. This variation mattered, because when the researchers ran weighted multivariable linear regression models — adjusting for demographic, household, and parental factors such as family structure and parental characteristics — the three practices showed distinct and statistically robust associations with adolescent behavioral outcomes. The use of weighted models and the population-based sampling framework strengthen the argument that these patterns reflect the broader Japanese population of families with adolescents rather than an unrepresentative convenience sample.

Explaining in easy-to-understand words was associated with lower total difficulties on the SDQ, with a regression coefficient of −1.79 and a 95 percent confidence interval spanning −3.56 to −0.03, a range that narrowly excludes zero. The same practice was also associated with lower internalizing difficulties, with a coefficient of −0.87 and a confidence interval of −1.73 to −0.01. In practical terms, adolescents whose parents took the trouble to translate complex information — pandemic rules, health risks, changes to daily routines — into language a young person could genuinely grasp tended to show fewer emotional and behavioral problems, particularly the anxiety- and mood-related difficulties that internalizing captures. During a period when adults themselves struggled to make sense of rapidly changing guidance, this capacity to communicate clearly appears to have given adolescents a firmer footing.

Empathizing with adolescents’ feelings told a somewhat different story. This practice was associated with lower total difficulties, with a coefficient of −1.69 and a confidence interval of −3.13 to −0.25, and notably with lower externalizing difficulties, with a coefficient of −1.02 and a confidence interval of −1.65 to −0.38. Externalizing problems — anger, defiance, acting out — are among the behaviors most commonly reported to spike during periods of household stress, and they often strain parent–child relationships further. The pattern observed here fits a familiar psychological account: when parents acknowledge and validate what an adolescent is feeling rather than dismissing or punishing emotional expression, the adolescent has less need to express distress through disruptive behavior. Empathy, in this framing, functions as an emotional regulator for the household as a whole.

But it was the third practice — family discussions — that produced the strongest and most consistent associations across every outcome the researchers measured. Adolescents whose parents engaged in family discussions showed lower total difficulties, with a coefficient of −2.40 and a 95 percent confidence interval of −3.62 to −1.18; lower internalizing difficulties, with a coefficient of −1.09 and a confidence interval of −1.79 to −0.39; lower externalizing difficulties, with a coefficient of −1.31 and a confidence interval of −1.98 to −0.63; and, uniquely among the three practices, higher prosocial behavior, with a coefficient of 1.08 and a confidence interval of 0.71 to 1.46. The prosocial finding is particularly striking. Prosocial behavior — the tendency to help, share, and cooperate with others — is not simply the absence of problems but a positive dimension of development that predicts later social competence and mental health. That family discussions were the only practice associated with boosting this positive trait suggests that structured opportunities for children to speak and be heard within the family may cultivate social skills that extend beyond the home.

The authors emphasize that their findings support promoting supportive parent–adolescent communication as a practical, low-cost approach to fostering adolescent well-being — both during periods of widespread disruption such as the pandemic and in ordinary family life. Unlike clinical interventions that require specialists, training, or significant expense, the three practices studied here are behaviors that most families can adopt with modest effort and no formal resources. Public health messaging during future crises, the study implies, might do well to include not just epidemiological guidance but concrete communication guidance for parents: explain what is happening in words your child can understand, acknowledge their feelings, and make space for the family to talk together regularly. The fact that these associations held even after adjusting for demographic and household factors suggests the practices carry independent weight rather than simply serving as proxies for affluent or otherwise advantaged homes.

As with all cross-sectional research, the study has limitations worth keeping in view. Because exposure and outcome were measured at the same point in time, the design cannot establish causality: it is possible that adolescents with fewer behavioral difficulties are simply easier to talk with, inviting more family discussion rather than benefiting from it. The data rely on parent-reported communication practices and adolescent-completed questionnaires, which introduces the possibility of reporting bias, and the survey captured a single moment — December 2020 — during a pandemic whose pressures evolved over time. The authors report no competing interests, and the study was conducted in accordance with the Declaration of Helsinki with written informed consent from parents and assent from adolescents, supported by grants from Japan’s Ministry of Health, Labour, and Welfare, the Japan Science and Technology Agency, and the Japan Society for the Promotion of Science, none of which influenced the design or interpretation. Even with these caveats, the consistency of the pattern — three distinct communication practices, each linked to better outcomes, with family discussions emerging as the most powerful of all — offers families and policymakers a rare commodity in adolescent mental health research: a simple, actionable finding grounded in a large, nationally representative sample. In a crisis that took so much ordinary life away from young people, the ordinary act of talking together at home appears to have given some of it back.

Subject of Research: Parental communication practices and adolescent behavioral health during the COVID-19 pandemic in Japan

Article Title: Association of parental communication practices with adolescent behavioral difficulties and prosocial behavior during the COVID-19 pandemic: a nationwide cross-sectional study in Japan

Article References: Nagata, A., Yamauchi, R., Ishitsuka, K., Morisaki, N., & Yamaoka, Y. (2026). Association of parental communication practices with adolescent behavioral difficulties and prosocial behavior during the COVID-19 pandemic: a nationwide cross-sectional study in Japan. BMC Public Health. https://doi.org/10.1186/s12889-026-29607-z

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29607-z

Keywords: parent–adolescent communication, COVID-19 pandemic, adolescent mental health, prosocial behavior, family discussions, Strengths and Difficulties Questionnaire, Japan, cross-sectional study, internalizing difficulties, externalizing difficulties, behavioral difficulties, health communication

Early childhood is a period of extraordinarily rapid development, and the habits formed during these years can echo across a lifetime. The World Health Organization has long emphasized that children under five need to sit less, play more, and sleep well to grow up healthy. Yet despite guidelines, public health initiatives, and childcare structures designed to promote movement, many German children under the age of six fail to reach recommended levels of physical activity, sedentary behavior, and sleep. Survey data from nearly 13,000 German children and adolescents revealed that only about a quarter achieved a minimum of 60 minutes of moderate-to-vigorous physical activity daily, a shortfall that researchers warn may undermine healthy lifestyle formation and long-term wellbeing.

The research team, led by Katarina Osojnicki of the University of Guelph and Christoph Buck of the Leibniz Institute for Prevention Research and Epidemiology in Bremen, set out to close a persistent gap in the literature. Most previous studies of the relationship between movement and mental health have focused on school-aged children and adolescents, and few investigations in the early years have relied on device-based measurement rather than parent reports, which are vulnerable to recall bias and social desirability effects. In a systematic review of studies on physical activity and sleep in young children, the authors note, only three had used objective measures of both behaviors in children between two and seven years of age.

The data came from a subsample of children enrolled in a Germany-wide daycare health promotion trial called JolinchenKids – Fit and Healthy in Daycare, originally launched by the health insurance company AOK. Baseline measurements were collected between September and December 2016, with one-year follow-up the following autumn. Children wore GENEActiv triaxial accelerometers taped to the left wrist for seven consecutive days and nights at 100 Hz sampling, while parents kept logbooks to record non-wear time. In total, 212 children aged two to six years provided valid accelerometer data at both time points; just over half were female, and roughly five percent were classified as overweight or obese.

Raw accelerometer signals were processed with the open-source GGIR software package in R, using the Euclidean Norm Minus One with Adjustment method and age-specific cut-points calibrated for preschoolers. Light physical activity was defined by accelerations of at least 61.8 milligravity, moderate-to-vigorous activity by 100.4 milligravity or more, and inactivity below that threshold served as a proxy for sedentary behavior. Sleep was detected with the van Hees algorithm, which identifies sustained periods when the arm remains within five degrees of horizontal for at least five minutes, allowing the researchers to derive total sleep time and sleep efficiency, the proportion of time in bed actually spent asleep.

The results paint a vivid picture of an active, well-rested cohort. At baseline, children spent an average of 418.7 minutes per day inactive, 112.7 minutes in light activity, and a striking 252.6 minutes in moderate-to-vigorous activity, comfortably exceeding the WHO recommendation of 60 daily minutes. They slept roughly eight hours per night with a sleep efficiency of about 80 percent. Mental health was assessed through the parent-completed Strengths and Difficulties Questionnaire, a validated screening tool for social, emotional, and behavioral difficulties, and average scores fell well within the normal range at both measurement points, declining slightly over the year.

Statistical modeling with linear mixed models, adjusted for the child’s age and sex, household income, parental education, migration background, and urbanity, revealed clear and consistent patterns. Moderate-to-vigorous and total physical activity were positively associated with both total sleep time and sleep efficiency, and all activity variables were positively associated with sedentary time, findings that held in both crude and adjusted analyses. In plain terms, the most vigorously active children also tended to sleep longer and better. Girls scored lower on the difficulties questionnaire, while children of parents with lower educational attainment or income scored higher, an important socioeconomic signal within the data.

Notably, however, the study found no association between physical activity and mental health scores in this age group. The authors point to a recent meta-analysis reporting similarly modest effects, suggesting that younger children generally enjoy high baseline levels of mental health, leaving little room for improvement detectable by broad screening instruments. It is also plausible that in early childhood, psychological wellbeing is shaped more powerfully by the home environment, relationships, and developmental processes than by activity duration and intensity alone. Subtle benefits to behavioral regulation or emotional competence may simply be invisible to a general-purpose questionnaire validated primarily for children aged four and older.

The findings sit within a complicated and sometimes contradictory literature. Some studies have reported no link between activity and sleep in preschoolers, others found that more active children took longer to fall asleep, and one analysis even observed an inverse relationship between high activity and total sleep duration. The researchers attribute these inconsistencies to differences in accelerometer placement, wear time, cut-point selection, and sleep algorithms, as well as the natural variability of young children’s routines, which are shaped by parental attitudes, weather, the built environment, screen time, bedtime rituals, and nutrition. They also acknowledge limitations of their own work: daytime naps could not be captured without sleep diaries, the sample skewed toward high-income households, and the analysis was underpowered and exploratory in nature.

Looking ahead, the team argues that tracking 24-hour movement behaviors with device-based measures over time is essential for understanding how activity, sedentary time, and sleep jointly influence development, and they call for future multi-component interventions that address all three behaviors simultaneously to test for synergistic benefits to mental health. Compositional data analysis, which treats the 24-hour day as a fixed budget of interdependent behaviors, may offer a more realistic statistical framework than examining each behavior in isolation. For now, the message for parents and educators is straightforward: keeping preschoolers vigorously active during the day appears to pay dividends at bedtime, in deeper and longer sleep during a stage of life when every hour of rest counts toward growing bodies and minds.

Subject of Research: Associations between device-measured physical activity, sedentary behavior, sleep, and mental health in German preschool children

Article Title: Exploring the associations between physical activity, sleep, sedentary behaviour, and mental health in young German children

Article References: Osojnicki, K., Brandes, B., Brandes, M., Zeeb, H., Vallis, L. A., & Buck, C. (2026). Exploring the associations between physical activity, sleep, sedentary behaviour, and mental health in young German children. Journal of Activity, Sedentary and Sleep Behaviors, 5(1), Article 12. https://doi.org/10.1186/s44167-026-00104-3

Image Credits: AI Generated

DOI: 10.1186/s44167-026-00104-3

Keywords: physical activity, sleep, sedentary behavior, mental health, preschool children, accelerometry, GGIR, Strengths and Difficulties Questionnaire, 24-hour movement behaviors, early childhood, Germany, public health