Factors Influencing the Behavioural Strengths and Difficulties in Children with Learning Disabilities

April 27, 2022

Key Takeaway

Ayar et al. reveal relevant factors, including socioeconomic status, prenatal smoking, and screen time duration, associated with strengths and difficulties among children with specific learning disabilities. These results provide key takeaways for parents, educational institutions, and medical practitioners in adjusting their approach to raising and treating this group of children. —Emmy Thamakaison

Ayar et al. share their cross-sectional survey investigating the prevalence of certain social, emotional, and behavioural characteristics among children with specific learning disabilities (SLDs) and factors associated with such characteristics. Among a variety of surveys, the Strengths and Difficulties Questionnaire (SDQ) was administered, which evaluated “Conduct Problems (CP),” “Hyperactivity and Inattention (HI),” “Emotional Symptoms (ES),” “Peer Problems (PP),” and “Prosocial Behaviours (PsB).” Associated factors investigated include family socioeconomic status, early exposure to smoking, breastfeeding duration, early hospitalization, and childhood screen use. 

Environmental factors

Compared to the wealthier subgroup, individuals from a low socioeconomic background were at a higher risk of displaying CP and externalizing problems (EP), which is the sum of HI and PsB. This is supported by existing literature, as low-income families are associated with “unemployment, broken families, mentally unhealthy parents, and the use of improper education methods.”^{1, 2, 3}

Biological factors

Breastfeeding has been thought to play a major role in cognitive development during early childhood.^4,5 The current study found that children who breastfed for more than 12 months were less likely to experience PP, compared to children who breastfed for less than 12 months. These results are consistent with that of Belfort et al. and Bernard et al., which suggest that language development, motor function, and cognitive abilities improve with increased breastfeeding duration.^6,7 Another explanation for this study’s findings is that “breastfeeding [can] have a protective role in preventing children from maltreatment by their mothers,” which translates into rewarding relationships later in life.⁸

Furthermore, maternal prenatal smoking is significantly associated with ES, CP, EP, IP, PsB, and Total Difficulties (TD; The sum of all difficulties scores). The effects of prenatal exposure to toxins through smoking have been well documented, and the results of this study are well supported. Maternal prenatal smoking has an overall negative impact on cognitive development, children’s learning outcomes, and increasing neurological brain abnormalities.^{9, 10, 11} 

Early childhood hospitalization and screen use

The way children with SLDs were raised beyond infancy also plays a role in influencing their characteristics. Children with SLD with hospitalization histories were associated with a higher risk of HI and EP. In explaining this increased risk of SLD-ADHD comorbidity in children with early hospitalization, the authors suggest that “the hyperactivity of children may lead to more hospital visits” or “frequent hospital visits may increase hyperactivity by creating a negative experience.”

Further, abnormal PsB scores were also associated with a decreased age of first screen contact, and CP and EP problems increased with an increased daily preschool screen exposure of ≥4 hours. Ayar et al. suggest that inappropriate parenting styles (ie. low parental acceptance of their children, parental neglect, or overprotective parenting) are associated with increased risk of screen time, and can lead to abnormal prosocial behaviours. Additionally, since hyperactivity-inattention was not found to be associated with “current screen contact time,” authors conclude that “screen contact time was more important for SLD in the preschool period of the study.” Early childhood is a critical period for brain development and screen time exposure may do more harm than good during those years, as it may cause “insomnia, mood swings, and problems at school.”¹²

Ayar et al.’s results provide thoughtful takeaways both on multiple levels: 

• Practitioners should become well aware of the behavioural risks associated with different familial, biological, and environmental factors among children with SLD and may need to provide special support for such groups. The authors state that “combining medical treatment with psychosocial support will increase treatment success” for these children. 
• On a systematic level, schools and educational institutions should become well aware of such risks as well and provide systematic support as needed. 
• To-be or current parents are reminded that prenatal smoking and early screen time exposure may have negative effects on their child’s development and may need to adjust their parenting behaviours accordingly. 

Summarized Article:

Ayar, G., Yalçın, S. S., Tanıdır Artan, Ö., Güneş, H. T., & Çöp, E. (2021). Strengths and difficulties in children with specific learning disabilities. Child: Care, Health and Development, 48(1). https://doi.org/10.1111/cch.12903

Summary by: Emmy Thamakaison—Emmy is an undergraduate student at Stanford University and an enthusiastic advocate of MARIO Framework.

Additional References:

1. Lindström, M., Hansen, K., & Rosvall, M. (2012). Economic stress in childhood and adulthood, and self-rated health: a population based study concerning risk accumulation, critical period and social mobility. BMC Public Health, 12(1). https://doi.org/10.1186/1471-2458-12-761
2. Morrissey, K., & Kinderman, P. (2020). The impact of childhood socioeconomic status on depression and anxiety in adult life: Testing the accumulation, critical period and social mobility hypotheses. SSM – Population Health, 11, 100576. https://doi.org/10.1016/j.ssmph.2020.100576
3. Vogel, L. (2019). Poor mental health, poverty threaten Canadian kids: report. Canadian Medical Association Journal, 191(38), E1065–E1066. https://doi.org/10.1503/cmaj.1095814
4. Horta, B. L., Loret de Mola, C., & Victora, C. G. (2015). Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatrica, 104, 14–19. https://doi.org/10.1111/apa.13139
5. Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., & Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/s0140-6736(15)01024-7
6. Belfort, M. B., Rifas-Shiman, S. L., Kleinman, K. P., Guthrie, L. B., Bellinger, D. C., Taveras, E. M., Gillman, M. W., & Oken, E. (2013). Infant Feeding and Childhood Cognition at Ages 3 and 7 Years. JAMA Pediatrics, 167(9), 836. https://doi.org/10.1001/jamapediatrics.2013.455
7. Bernard, J. Y., De Agostini, M., Forhan, A., Alfaiate, T., Bonet, M., Champion, V., Kaminski, M., de Lauzon-Guillain, B., Charles, M.-A., & Heude, B. (2013). Breastfeeding duration and cognitive development at 2 and 3 years of age in the EDEN mother-child cohort. The Journal of Pediatrics, 163(1), 36-42.e1. https://doi.org/10.1016/j.jpeds.2012.11.090
8. Taghıyev, A. (2020). Protective role of breastfeeding status, chronic health problems and temperament of children in maltreatment by mothers. Türk Pediatri Arşivi. https://doi.org/10.14744/turkpediatriars.2020.54280
9. Anthopolos, R., Edwards, S. E., & Miranda, M. L. (2013). Effects of Maternal Prenatal Smoking and Birth Outcomes Extending into the Normal Range on Academic Performance in Fourth Grade in North Carolina, USA. Paediatric and Perinatal Epidemiology, 27(6), 564–574. https://doi.org/10.1111/ppe.12081
10. Cho, K., Frijters, J. C., Zhang, H., Miller, L. L., & Gruen, J. R. (2013). Prenatal Exposure to Nicotine and Impaired Reading Performance. The Journal of Pediatrics, 162(4), 713-718.e2. https://doi.org/10.1016/j.jpeds.2012.09.041
11. Biederman, J., Petty, C. R., Bhide, P. G., Woodworth, K. Y., & Faraone, S. (2011). Does exposure to maternal smoking during pregnancy affect the clinical features of ADHD? Results from a controlled study. The World Journal of Biological Psychiatry, 13(1), 60–64. https://doi.org/10.3109/15622975.2011.562243
12. Domingues-Montanari, S. (2017). Clinical and psychological effects of excessive screen time on children. Journal of Paediatrics and Child Health, 53(4), 333–338. https://doi.org/10.1111/jpc.13462