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Externalizing behavior in preschool children in a South African birth cohort: Predictive pathways in a high-risk

Susan Malcolm-Smith1, Marilyn T Lake2, Akhona Krwece3

  • 1ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.

Development and Psychopathology
|March 15, 2022
PubMed

Insights

Prenatal substance exposure and maternal depression significantly increase preschool externalizing behaviors. Early interventions addressing maternal health and parenting are crucial for child mental health in low-resource settings.

Area of Science:

  • Child Psychology
  • Developmental Psychiatry
  • Global Mental Health

Background:

  • Mental health issues often emerge in early childhood, with preschool years being a critical period.
  • Risk factors for preschool mental health are less understood in low- and middle-income countries (LMICs), where multiple exposures are common.

Purpose of the Study:

  • To identify individual and contextual risk factors for mental health in preschool children.
  • To investigate pathways to externalizing behaviors in a South African birth cohort.

Main Methods:

  • Prospective follow-up of 981 children in the Drakenstein Child Health Study.
  • Assessment of pre- and postnatal exposures and risk factors.
  • Structural equation modeling to predict child mental health using the Child Behavior Checklist.

Main Results:

  • Prenatal substance exposure (alcohol, smoking) directly predicted increased externalizing behavior.
  • Infant negative emotionality partially mediated the link between substance exposure and externalizing behavior.
  • Lower socioeconomic status and maternal prenatal depression predicted coercive parenting, which in turn predicted externalizing behavior.

Conclusions:

  • Findings in a high-risk LMIC cohort align with research from higher-income countries.
  • Integrated screening and intervention for maternal substance use, depression, and parenting are needed.
  • Early identification and support are vital for preschool mental health in vulnerable populations.

Keywords:
LMICSouth Africabirth cohortexternalizing behaviorpreschool mental health

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