Behavioural and emotional disorders in childhood: A brief overview for paediatricians

Table 7 Summary of common risk factors for development of childhood emotional and behavioural disorder

Domain	Characteristic examples	Ref.
Maternal psychopathology (mental health status)	Low maternal education, one or both parents with depression, antisocial behaviour, smoking, psychological distress, major depression or alcohol problems, an antisocial personality, substance misuse or criminal activities, teenage parental age, marital conflict, disruption or violence, previous abuse as a child and single (unmarried status)	[4,54]
Adverse perinatal factors	Maternal gestational moderate alcohol drinking, smoking and drug use, early labour onset, difficult pregnancies, premature birth, low birth weight, and infant breathing problems at birth	[55,56]
Poor child-parent relationships	Poor parental supervision, erratic harsh discipline, parental disharmony, rejection of the child, and low parental involvement in the child’s activities, lack of parental limit setting	[57,58]
Adverse family life	Dysfunctional families where domestic violence, poor parenting skills or substance abuse are a problem, lead to compromised psychological parental functioning, increased parental conflict, greater harsh, physical, and inconsistent discipline, less responsiveness to children’s needs, and less supportive and involved parenting	[59]
Household tobacco exposure	Several studies have shown a strong exposure–response association between second-hand smoke exposure and poor childhood mental health	[60,61]
Poverty and adverse socio-economic environment	Personal and community poverty signs including homelessness, low socio-economic status, overcrowding and social isolation, and exposure to toxic air, lead, and/or pesticides or early childhood malnutrition often lead to poor mental health development Chronic stressors associated with poverty such as single-parenthood, life stress, financial worries, and ever-present challenges cumulatively compromise parental psychological functioning, leading to higher levels of distress, anxiety, anger, depressive symptoms and substance use in disadvantaged parents.	[62-66]
	Chronic stressors in children also lead to abnormal behaviour pattern of ‘reactive responding’ characterized by chronic vigilance, emotional reacting and sense of powerlessness
Early age of onset	Early starters are likely to experience more persistent and chronic trajectory of antisocial behaviours	[67-69]
	Physically aggressive behaviour rarely starts after age 5
Child’s temperament	Children with difficult to manage temperaments or show aggressive behaviour from an early age are more likely to develop disruptive behavioural disorders later in life	[70-72]
	Chronic irritability, temperament and anxiety symptoms before the age of 3 yr are predictive of later childhood anxiety, depression, oppositional defiant disorder and functional impairment
Developmental delay and Intellectual disabilities	Up to 70% of preschool children with DBD are more than 4 times at risk of developmental delay in at least one domain than the general population	[15,73]
	Children with intellectual disabilities are twice as likely to have behavioural disorders as normally developing children
	Rate of challenging behaviour is 5% to 15% in schools for children with severe learning disabilities but is negligible in normal schools
Child’s gender	Boys are much more likely than girls to suffer from several DBD while depression tends to predominantly affect more girls than boys	[24,25,27,47,51]
	Unlike the male dominance in childhood ADHD and ASD, PDA tends to affect boys and girls equally

ADHD: Attention deficit hyperactivity disorder; ASD: Autistic spectrum disorder; DBD: Disruptive behaviour disorder; PDA: Pathological demand avoidance.