OBJECTIVE
Accumulating research conducted in high-income countries has reported that early life environmental factors (ELF) are linked to emotional-behavioral problems. However, approximately 90% of the world's children live in low- and middle-income countries, where research remains limited. We investigated the prospective associations between ELF and emotional-behavioral problems in South African children and adolescents.
METHOD
Data were drawn from the Safe Passage Study, a population-derived birth cohort (5,889 mother-child dyads). ELF (pre-, peri-, and postnatal) were collected by questionnaires and clinical assessments and medical records at inception. In this Biomarkers of Neurodevelopmental Outcomes (BONO) follow-up, emotional-behavioral problems (externalizing and internalizing problems) were measured once using caregiver-reported Strengths and Difficulties Questionnaire at age 5-16 years (n=1,284). Associations were examined using regression models adjusted for the child's sex and age at assessment.
RESULTS
Of the 104 ELF, prenatal factors associated with both increased externalizing and internalizing problems were maternal mental health i.e., self-harm (externalizing problems: beta coefficient (β)=0.69; internalizing problems: β=0.60), depression (externalizing problems: β=0.06, internalizing problems: β=0.08) and anxiety (externalizing problems: β=0.05; internalizing problems: β=0.04) and infections (externalizing problems: β=0.65; internalizing problems: β=0.45). Factors only associated with externalizing problems included prenatal maternal substance use, asthma, paternal education, and infant secondhand smoke exposure. Enlarged placenta was associated with internalizing problems. Fetal, birth, and other placental factors showed modest associations.
CONCLUSION
In this South African setting, prenatal maternal mental health and infections emerged as consistent risk factors for both externalizing and internalizing problems. Future studies are needed to elucidate the impact of co-occurring ELF and investigate the mechanisms through which these ELF contribute to the emergence of emotional-behavioral problems.
Cindy Pham, H. Odendaal, Lucy T. Brink et al.· Journal of the American Acad...· 0 citations
BACKGROUND
Autism is most often diagnosed after the age of 3, despite evidence that neurodevelopmental differences emerge within the first 2 years of life and that genetic and familial risk can be identified at birth.
METHODS
Established in September 2022 (anticipated duration of 5-7 years), the Prospective Genetic Risk Evaluation and Assessment (PROGRESS) in Autism Center is an ongoing longitudinal cohort study designed to characterize early developmental trajectories associated with autism and evaluate the impact of providing genetic information to families.
RESULTS
Infants who undergo genomic newborn screening and enroll in PROGRESS are followed from 3 to 24 months of age and categorized into three groups: identified genetic probability (IGP), familial likelihood without identified genetic probability (Baby Siblings), and no identified genetic probability (NGP). Assessments include electroencephalography, electrocardiography, auditory, eye tracking, developmental testing, caregiver-infant interaction, and caregiver-reported measures. Autism screening is conducted at 18 months, with comprehensive diagnostic evaluation at 24 months. Caregiver psychosocial experiences of receiving early genetic information are assessed through surveys and interviews.
CONCLUSION
By integrating genomic probability with early neurobehavioral development and family experiences, PROGRESS provides a framework to inform ethical genomic screening, developmental monitoring, and timely access to early intervention supported by a family navigator.
IMPACT
This study presents the rationale and methods of the ongoing Prospective Genetic Risk Evaluation and Assessment (PROGRESS) in Autism Center at Columbia University, which began in September 2022 (anticipated duration of 5-7 years). PROGRESS is a prospective longitudinal cohort assessing infants with identified genetic probability, familial likelihood, or no identified genetic probability for autism from 3 to 24 months of age. By linking early genetic probability with brain-behavioral trajectories, PROGRESS advances understanding of autism-related differences before clinical diagnosis and provides an empirically grounded foundation for ethical genomic newborn screening and optimized early developmental monitoring and intervention.
Nicolò Pini, Lauren C. Shuffrey, Kally C. O'Reilly Sparks et al.· Pediatric Research· 0 citations