Predictors of emotional and behavioral difficulties in adolescence: a longitudinal study

Rosário, Kênia Oliveira; Campagnolo, Paula Dal Bó

doi:10.1590/1806-9304202500000296-en

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 25 • 2025 • https://doi.org/10.1590/1806-9304202500000296-en linkcopy

Predictors of emotional and behavioral difficulties in adolescence: a longitudinal study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives: to investigate predictors of emotional and behavioral difficulties in a sample of adolescents from São Leopoldo/RS.

Methods: longitudinal study that followed children from birth to 13 years of age. Sociodemographic, maternal and perinatal variables were obtained at six months and from 12 to 16 months, anthropometric variables and screen time at four and eight years. At age 13, 174 adolescents completed the Strengths and Difficulties Questionnaire (SDQ).

Results: In the total SDQ assessment, 14.4% presented emotional and behavioral difficulties. In the subscales, we observed: increased changes in conduct among children of mothers with <8 years of schooling (p=0.028); adolescents born to mothers <20 years old showed an increase in emotional changes (p=0.043); greater difficulties in prosocial behavior in male adolescents (p=0.019), white (p=0.049), exclusively breastfed for <4 months (p=0.036), families with monthly income <3 minimum wages (p=0.005) and had a higher mean BMI z-score at four years of age (p=0.003).

Conclusion: Shorter breastfeeding time, excess child weight, young age and low maternal schooling and low socioeconomic conditions were predictors of the outcome, which reinforces the importance of multidisciplinary prevention actions in child and adolescent mental health.

Key words
Adolescent; Breastfeeding; Obesity; Psychosocial functioning; Mental health

Exposure variables	Data collection period
Exposure variables	Hospital record	6 months	12-16 months	4 years	8 years	13 years
Sex	X
Maternal schooling (years)			X
Family income (minimum wages)			X
Child’s skin color	X
Weight and height/body mass index			X	X	X
Screen time				X	X
Exclusive breastfeeding		X
Total breastfeeding time			X
Outcome variables
Emotional and behavioral difficulties						X

Scales	False	Somewhat true	True
Emotional symptoms scale
I have a lot of headaches	0	1	2
I worry a lot	0	1	2
I often feel sad, discouraged or cry	0	1	2
I get nervous in new situations	0	1	2
I have a lot of fears, I get scared easily	0	1	2
Behavior change scale
I often get angry and lose my temper	0	1	2
I usually do what I am told	2	1	0
I am always beating myself up	0	1	2
I am often accused of lying or cheating	0	1	2
I take things that are not mine	0	1	2
Hyperactivity change scale
I am restless, I cannot sit still	0	1	2
I cannot sit still, I am always moving my legs	0	1	2
I am always distracted	0	1	2
I think about things before I do them	2	1	0
I usually finish what I start	2	1	0
Scale of changes in relationships with classmates
I am almost always alone	0	1	2
I have at least one good friend	2	1	0
My classmates generally like me	2	1	0
Other children or young people pick on me with me	0	1	2
I get along better with adults	0	1	2
Pro-social behavior scale
I try to be nice to everyone	0	1	2
I like to share with others	0	1	2
I like to help if someone is hurt	0	1	2
I am nice to little ones	0	1	2
I like to help others	0	1	2

Self-assessment	No Difficulties	Borderline	With Difficulties
Total score for difficulties	0-15	16-19	20-40
Score for emotional symptoms	0-5	6	7-10
Score for behavioral changes	0-3	4	5-10
Score for hyperactivity	0-5	6	7-10
Score for changes with peers	0-3	4-5	6-10
Score for pro-social behavior	6-10	5	0-4

	Altered			No alterations/ Borderline
	n	Mean	SD	n	Mean	SD	p
Alterations of conduct
BMI z-score at age 4	30	0.26	1.64	137	0.24	1.10	0.920
BMI z-score at age 8	30	0.20	1.64	142	0.32	1.43	0.686
Screen time (h) at age 4	27	2.63	1.50	119	2.68	1.70	0.868
Screen time (h) at age 8	31	3.18	2.23	142	3.05	2.01	0.745
Emotional alterations
BMI z-score at age 4	17	022	1.48	150	0.24	1.18	0.310
BMI z-score at age 8	19	0.48	2.16	153	0.35	1.36	0.356
Screen time (h) at age 4	17	2.54	1.49	129	2.69	1.68	0.727
Screen time (h) at age 8	19	3.55	2.49	154	3.01	1.98	0.280
Hyperactivity
BMI z-score at age 4	15	0.61	0.79	152	0.20	1.24	0.212
BMI z-score at age 8	14	0.73	1.35	158	0.27	1.47	0.253
Screen time (h) at age 4	15	3.44	1.86	131	2.59	1.62	0.059
Screen time (h) at age 8	15	3.03	1.79	158	3.08	2.07	0.936
Peer relationships
BMI z-score at age 4	30	0.39	1.04	137	0.21	1.24	0.310
BMI z-score at age 8	30	0.42	1.26	142	0.28	1.51	0.230
Screen time (h) at age 4	24	2.58	1.81	122	2.69	1.63	0.761
Screen time (h) at age 8	31	2.96	1.89	142	3.10	2.08	0.725
Pro-social behavior
BMI z-score at age 4	13	1.20	2.08	154	0.16	1.08	0.003
BMI z-score at age 8	14	0.77	2.11	158	0.26	1.39	0.215
Screen time (h) at age 4	12	2.68	1.65	134	2.67	1.67	0.984
Screen time (h) at age 8	14	3.18	2.20	159	3.06	2.03	0.842
SDQ TOTAL
BMI z-score at age 4	24	0.93	1.84	143	0.12	1.03	0.047
BMI z-score at age 8	24	1.16	1.81	148	0.16	1.36	0.015
Screen time (h) at age 4	22	0.65	1.80	124	2.68	1.64	0.953
Screen time (h) at age 8	25	3.52	2.11	148	3.00	2.03	0.239

	Alterations of Conduct			Hyperactivity			Emotional Alterations			Peer relationships			Pro-social behavior
	n	%	p	n	%	p	n	%	p	n	%	p	n	%	p
Maternal schooling (years)
< 8	21	25.0	0.028	5	5.5	0.222	11	12.2	0.744	14	15.6	0.543	7	7.8	1.000
> 8	10	11.1		5	7.1		8	11.4		17	20.2		7	8.3
Sex
Female	20	19.2	0.552	5	7.1	0.569	8	11.4	0.860	8	11.4	0,071	1	1.4
Male	11	15.7		10	9.6		11	10.6		23	22.1		13	12.5	0.019
Maternal age (years)
< 20	8	30.8	0.061	2	7.7	0.606	6	23.1	0.043	7	26.9	0,150	4	15.4	0.136
>20	23	15.5		13	8.8		13	8.8		24	18.2		10	6.8
Maternal’s occupation
Does not work out	10	16.4	0.450	8	13.1	0.121	13	11.3	0.582	24	20.9	0,141	14	12.2	0.058
Works out	20	18.5		2	3.6		6	10.9		7	12.7		0
Family income
< 3 minimum wages	24	20.9	0.141	13	11.3	0.077	13	11.3	0.092	11	18.0	0,556	2	3.3	0.005
>3 minimum wages	7	12.7		2	3.6		6	10.9		20	18.5		12	11.1
Race
White	24	18.6	0.440	10	7.8	0.323	13	10.1	0.344	22	17.1	0.381	7	5.4	0.049
Other races	7	15.9		5	11.4		6	13.6		9	20.5		7	15.9
Exclusive breastfeeding (months)
< 4	23	20.7	0.173	10	9.0	0.575	4	6.8	0.141	24	21.6	0.085	13	11.7
>4	8	13.6		4	8.5		15	13.5		7	11.9		1	1.7	0.038

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Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
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[TN1] Source: Goodman⁷; SDQ= Strengths and Difficulties Questionnaire.