How to prevent behavioural problems, in utero.

14 Nov 2022 | By Hayley Tomes
14 Nov 2022 | By Hayley Tomes

You may read this title and ponder that the only way to prevent antisocial and aggressive behaviour in utero is to prevent the birth in the first place. And you’d be forgiven for thinking as much, however, there is another way.

A functioning society requires investment in mothers, and when you hear this disconcerting tale about some recently published science I think you’ll agree. The Neuroscience Institute researchers set about measuring so called ‘externalizing behaviour’ in 3.5 year olds which can often equate to behavioural problems in adolescence and early adulthood. This includes antisocial behaviour, hyperactivity, aggression and oppositional behaviour. They wanted to know what predictive factors contributed to this behaviour and so naturally turned to studying the factors affecting the children both prenatally and postnatally, in particular the mothers.

Predictive factors are tricky and tend to be correlated with one another creating complex association patterns that all have a bearing on child mental health. It’s very hard to pick out the effect of individual factors and look at direct pathways when this is the case. Luckily this study used multigroup hierarchical covariance-based structural equation modelling, which sounds suitably complex. This enabled them to pick out patterns of factors individually and combined that all act on child mental health.

Factors of interest prenatally included maternal substance use (both alcohol and tobacco), socioeconomic status (SES), mental health and exposure to intimate partner violence. Postnatally they included maternal depression, social support, exposure to community violence and parenting style.

Women a month or two away from giving birth were enrolled and mother-child pairs were then followed after birth for at least 3.5 years. The cohort is from a peri-urban population of low SES and high rates of depression, intimate-partner violence and alcohol use. 

The Western Cape has some of the highest rates of foetal alcohol spectrum disorders in the world, at 347.6 per 1000.  The study found a strong, direct relationship between prenatal exposure to substances and greater externalizing behaviour at 3.5 years. Another study found that heavy prenatal alcohol exposure was correlated with 91% of children displaying externalizing behaviour whereas in normal conditions only 27% of children display this behaviour. In this study, substance use (alcohol and tobacco) was the strongest predicter of problematic behaviour, which was present in 6.2% of the cohort. It is theorised that perhaps when mothers-to-be ingest these substances they cause teratogenic effects on the developing foetus, in other words they interfere with normal cellular development.

There is a dearth of studies that are able to look at relationships, and not just associations, in the way that this study does. This study, because of its statistics and longitudinal design, is able to demonstrate the effects of maternal alcohol and tobacco use on children’s behaviour over and above other salient risk factors. Another relationship found in this study is that of low SES and increased externalizing behaviour at age 3.5 years. Low SES is highly associated with maternal prenatal depression which is in turn associated with parenting style. When one is depressed one is not always the ideal parent and may resort to undesirable techniques to try to ‘reign children in’. A coercive parenting style is one such example that has been shown to increase externalizing behaviour in children. Maternal depression and low SES seem to exacerbate authoritarian parenting styles and the physical disciplining of children, which are the norm within many South African communities. A further complication is that depressed mothers often have less social support.

It’s clear that it is with the mothers that the key interventions need to happen. Too many effects happen in utero for interventions to begin with the children. The paper suggests interventions targeting maternal mental health as well as substance use as a matter of urgency and further suggests the implementation of parenting programs, which have been shown to have benefits on child mental health in other low and middle-income countries. These are of critical importance as early externalizing behaviour is established as a major public health problem.

The good news is that factors such as positive parenting and higher child IQ appear protective against the risk factors mentioned above. As such, supporting mothers with parenting programs and education should show considerable benefits. In this way the problem can be fixed before it arises. As Frederick Douglass said: “it is easier to build strong children than to repair broken (adults)”.

Read the full article here