Diabetes has previously been linked to mental health problems in adolescents, but more recent studies have yielded mixed findings. The aim of the current study was to compare symptoms of mental health problems, sleep and eating disturbances in adolescents with and without Type 1 diabetes in a population based sample.
Data were taken from the youth@hordaland study, a large population based study in Hordaland County in Norway conducted in 2012. In all, 9883 adolescents aged 16-19 years (53% girls) provided self-reported data on both diabetes and a range of instruments assessing mental health symptoms, including depression, anxiety, obsessive-compulsive behaviours, hyperactivity, impulsivity, inattention, perfectionism, resilience, sleep problems and eating behaviour.
40 adolescents were classified as having Type 1 diabetes (prevalence 0.4%). We found that adolescents with Type 1 diabetes did not differ from their peers on any of the mental health measures.
This is one of the first population-based studies to examine mental health of adolescents with Type 1 diabetes. There was no evidence of increased psychopathology across a wide range of mental health measures. These findings contradict previous studies, and suggest that Type 1 diabetes is not associated with an increased risk of psychosocial problems.
Cites: J Am Board Fam Med. 2012 Nov-Dec;25(6):847-5323136325
To prospectively investigate the reciprocal relationships between personality traits, lifestyle factors, mental health, sleepiness, and work-related stressors against insomnia.
A total of 799 Norwegian shift-working nurses (mean age 33.2 years, 90% female) participated in this prospective cohort study. They were assessed on self-report instruments (Bergen Insomnia Scale, Diurnal Type Scale, Hospital Anxiety and Depression Scale, Negative Acts Questionnaire-Revised, Work-Family Interface Scale, among others) in 2008/2009 (wave 1) and 2011 (wave 3). Structural equation modeling was employed to investigate the bidirectional relationship between a wide range of individual and work-related variables and insomnia.
Languidity (ß?=?0.18***), anxiety (ß?=?0.11**), depression (ß?=?0.14***), exposure to bullying behavior (ß?=?0.08*), and negative spillover between work and family life (work to family, ß?=?0.08*; family to work, ß?=?0.07*) predicted increased symptoms of insomnia over time. Morningness (ß?=?-0.09*) and positive spillover from work to family (ß?=?-0.11**) predicted less symptoms of insomnia over time. No support was found for night work as a predictor of increased insomnia. Insomnia was a precursor for anxiety (ß?=?0.11**), but not for depression (*p?
This study examined the role of parental emotional well-being and parenting practices as mediators of the association between familial socioeconomic status (SES) and child mental health problems. The sample included 2,043 5th-7th graders (50.7 % female) participating in the second wave of the Bergen Child Study. Children completed the Strengths and Difficulties Questionnaire, parents reported family economy and education level, emotional well-being (measured with the Everyday Feelings Questionnaire), and the use of negative disciplinary and affirmative parenting practices (measured using the Family Life Questionnaire). Path analyses were conducted to examine the associations between SES and externalizing and internalizing problems. Results supported a model where family economy was associated with externalizing problems through parental emotional well-being and parenting practices, whereas maternal education level was associated with externalizing problems through negative discipline. The direct association between paternal education level and externalizing problems was not mediated by parenting. For internalizing problems, we found both direct associations with family economy and indirect associations with family economy through parental emotional well-being and parenting. The results suggest that parental emotional well-being and parenting practices are two potential mechanisms through which low socioeconomic status is associated with child mental health problems.
Numerous studies have documented that lower socioeconomic status (SES) is associated with increased mental health problems in children. One proposed pathway for this association has been differential exposure to accumulated risk factors in children of lower SES. The aim of the current study was to investigate the socioeconomic distribution of exposure to negative life events and family stress and to examine the direct and interactive association between lower SES and exposure to life events and family stress in relation with mental health problems.
Using cross-sectional data from the second wave of the Bergen Child Study (conducted in 2006), the current study investigated the association between lower SES and exposure to negative life events, family life stressors, and mental health problems in a sample of 2043 Norwegian 11-13 years and their parents. Information about mental health was self-reported by the children using the Strengths and Difficulties Questionnaire, whereas information about SES and exposure to negative life events and family stressors were provided by their parents.
The findings showed that lower SES was associated with more symptoms of emotional-, conduct-, hyperactivity/inattention-, and peer problems and that exposure to life events and family stress explained some of this association (10-29% of the total effects).
Low SES and higher prevalence of negative life events and family stressors were associated with more symptoms of mental health problems. Overall, the effect sizes were smaller than previous investigations (f 2s?=?0.015-0.031), perhaps suggesting a buffering effect of the social safety net in place in Norway.
The aim of the current paper was to investigate the association between the patterns of duration, timing and sequencing of exposure to low family income during childhood, and symptoms of mental health problems in adolescence.
Survey administered to a large population-based sample of Norwegian adolescents.
Survey data from 9154 participants of 16-19?years age (53% participation rate; 52.7% girls) were linked to registry-based information about childhood family income from tax return data.
Mental health outcomes were symptoms of emotional, conduct, hyperactivity, peer problems and general mental health problems measured with the Strengths and Difficulties Questionnaire, symptoms of depression measured with Short Mood and Feelings Questionnaire and symptoms of attention-deficit/hyperactivity disorder (ADHD) measured with the Adult ADHD Self-Report Scale.
Latent class analysis and the BCH approach in Mplus were used to examine associations between patterns of poverty exposure and mental health outcomes. Four latent classes of poverty exposure emerged from the analysis. Participants moving into poverty (2.3%), out of poverty (3.5%) or those chronically poor (3.1%) had more symptoms of mental health problems (Cohen's d=16-.50) than those with no poverty exposure (91.1%). This pattern was, however, not found for symptoms of ADHD. The pattern of results was confirmed in robustness checks using observed data.
Exposure to poverty in childhood was found to be associated with most mental health problems in adolescence. There was no strong suggestion of any timing or sequencing effects in the patterns of associations.
The aim of this study was to adapt the Five Factor Mindfulness Questionnaire (FFMQ) for use in Norway. Three studies involving three different samples of university students (mean age 22 years, total N = 792) were conducted. Confirmatory factor analyses showed that a five factor structure provided an acceptable fit to the data. All five factors loaded significantly on the overall mindfulness factor. As expected, correlations between the FFMQ total scores and subscales were positive and significant, ranging from 0.45 to 0.65. Correlations between FFMQ total/subscales and Mindful Attention Awareness Scale (MAAS) were significant and negative (since low scores on the MAAS indicate high mindfulness), ranging from r = -0.17 to -0.69. The Norwegian FFMQ total score was inversely correlated with all indicators of psychological health: neuroticism (r = -0.61), ruminative tendencies (r = -0.41), self-related negative thinking (r = -0.40), emotion regulation difficulties (r = -0.66) and depression (r = -0.46 to r = -0.65). In contrast to the other FFMQ subscales, the FFMQ Observe subscale did not have a positive relation to psychological health in our mostly non-meditating sample. However, being able to non-judgmentally observe one's inner life and environment is a part of the mindfulness construct that might emerge more clearly with more mindfulness training. We conclude that the Norwegian FFMQ has acceptable psychometric properties and can be recommended for use in Norway, especially in studies seeking to differentiate between different aspects of mindfulness and how these may change over time.
Insomnia co-occurs with many health problems, but less is known about the prospective associations. The aim of the current study was to investigate if insomnia predicts cumulative incidence of mental and physical conditions. Prospective population-based data from the two last Nord-Trøndelag Health Studies (HUNT2 in 1995–97 and HUNT3 in 2006–08), comprising 24 715 people in the working population, were used to study insomnia as a risk factor for incidence of physical and mental conditions. Insomnia was defined according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Insomnia at HUNT2 was a significant risk factor for incidence of a range of both mental and physical conditions at HUNT3 11 years later. Most effects were only slightly attenuated when adjusting for confounding factors, and insomnia remained a significant risk factor for the following conditions in the adjusted analyses: depression [odds ratio (OR): 2.38, 95% confidence interval (CI): 1.91–2.98], anxiety (OR: 2.08, 95% CI: 1.63–2.64), fibromyalgia (OR: 2.05, 95% CI: 1.51–2.79), rheumatoidarthritis (OR: 1.87, 95% CI: 1.29–2.52), whiplash (OR: 1.71, 95% CI: 1.21–2.41), arthrosis (OR: 1.68, 95% CI: 1.43–1.98), osteoporosis (OR:1.52, 95% CI: 1.14–2.01, headache (OR: 1.50, 95% CI: 1.16–1.95,asthma (OR: 1.47, 95% CI: 1.16–1.86 and myocardial infarction (OR:1.46, 95% CI: 1.06–2.00). Insomnia was also associated significantly with incidence of angina, hypertension, obesity and stroke in the crude analyses, but not after adjusting for confounders. We conclude that insomnia predicts cumulative incidence of several physical and mental conditions. These results may have important clinical implications, and whether or not treatment of insomnia would have a preventive value for both physical and mental conditions should be studied further.
Previous research suggests a possible link between insomnia and mortality, but findings are mixed and well-controlled studies are lacking. The aim of the current study was to examine the effect of insomnia in middle age on all-cause mortality.
Using a cohort design with 13-15 years follow-up, mortality registry data were linked to health information obtained during 1997-99, as part of the community-based Hordaland Health Study (HUSK), in Western Norway. 6,236 participants aged 40-45 provided baseline information on self- reported insomnia using the Karolinska Sleep Questionnaire Scale (defined according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), sociodemographic factors, health behaviors, shift/night-work, obstructive sleep apnea symptoms, sleep duration, sleep medication use, anxiety, depression, as well as a range of somatic diagnoses and symptoms. Height, weight and blood pressure were measured. Information on mortality was obtained from the Norwegian Cause of Death Registry.
Insomnia was reported by 5.6% (349/6236) at baseline and a significant predictor of all-cause-mortality (hazard ratio [HR] = 2.74 [95% CI:1.75-4.30]). Adjusting for all confounders did not attenuate the effect (HR = 3.34 [95% CI:1.67-6.69]). Stratifying by gender, the effect was especially strong in men (HR = 4.72 [95% CI:2.48-9.03]); but also significant in women (adjusted HR = 1.96 [95% CI:1.04-3.67]). The mortality risk among participants with both insomnia and short sleep duration (
Cites: Int Psychogeriatr. 2000 Sep;12(3):295-30611081951
Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash.
Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n=199) and those who had not (n=20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses.
Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR=2.26, 95%CI: 1.68-3.04). Musculoskeletal pain also increased the risk (OR=1.21, 95%CI: 1.15-1.26), as did diffuse somatic symptoms (OR=2.09, 95%CI: 1.47-2.96), use of different health services (OR=1.31, 95%CI: 1.19-1.45), high use of medications (OR=1.28, 95%CI: 1.14-1.43) and symptoms of anxiety (OR=1.93, 95%CI: 1.39-2.68). Physical activity was protective (OR=0.67, 95%CI: 0.49-0.91). Most socio-demographic variables were not significantly associated with chronic whiplash.
Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash.
Most studies on seasonal variability in sleep have asked participants if they think their sleep quality varies with the seasons, which reveals the research hypothesis to the participants. To date, the hypothesis of seasonal variation in sleep has not been tested in a large population-based fully blinded study. The aim of the current study was to investigate monthly variations in sleep problems in a geographic region of Norway with large seasonal differences in daytime light. Using data from a general health survey, the authors had access to information on sleep in the general population, collected across the seasons over 2 years without linking sleep to seasonal variation. In all, 43,045 participants (mean age, 44.6 years) of the Nord-Trøndelag Health Study, 1995-1997 (referred to as "HUNT-2"), provided reports of insomnia symptoms and time in bed in all months except July. The mean prevalence of insomnia symptoms was 12.4%. No evidence of a seasonal variation on reports of insomnia symptoms or time in bed was found. These null findings are in marked contrast to previous seasonality studies of sleep. Previous studies reporting seasonal variations in sleep and insomnia might have been subject to publication biases and lack of blinding to the research hypothesis.
Physical activity (PA) is associated with lower risk for non-communicable diseases and mortality. We aimed to investigate the prospective association between PA and all-cause and cause-specific mortality, and the impact of other potentially contributing factors.
Data from the community-based Hordaland Health Study (HUSK, 1997-99) were linked to the Norwegian Cause of Death Registry. The study included 20,506 individuals born 1950-1957 and 2,225 born in 1925-1927 (baseline age 40-49 and 70-74). Based on self-report, individuals were grouped as habitually performing low intensity, short duration, low intensity, longer duration or high intensity PA. The hazard ratios (HR) for all-cause and cause-specific mortality during follow-up were calculated. Measures of socioeconomic status, physical health, mental health, smoking and alcohol consumption were added separately and cumulatively to the model.
PA was associated with lower all-cause mortality in both older (HR 0.75 (95% CI 0.67-0.84)) and younger individuals (HR 0.82 (95% CI 0.72-0.92)) (crude models, HR: risk associated with moving from low intensity, short duration to low intensity, longer duration PA, and from low intensity, longer duration to high intensity). Smoking, education, somatic diagnoses and mental health accounted for some of the association between physical activity and mortality, but a separate protective effect of PA remained in fully adjusted models for cardiovascular (HR 0.78 (95% CI 0.66-0.92)) and respiratory (HR 0.45 (95% CI 0.32-0.63) mortality (both age-groups together), as well as all-cause mortality in the older age group (HR 0.74, 95%CI 0.66-0.83).
Low intensity, longer duration and high intensity physical activity was associated with reduced all-cause, respiratory and cardiovascular mortality, indicating that physical activity is beneficial also among older individuals, and that a moderate increase in PA can be beneficial.
Cites: Med Sci Sports Exerc. 2010 May;42(5):879-8519996993
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Cites: Prev Med. 2015 Dec;81:16-4126190368
Cites: Int J Epidemiol. 2012 Apr;41(2):521-3022253311
To examine sleep disturbances as a predictor of cause-specific work disability and delayed return to work.
Prospective observational cohort study linking survey data on sleep disturbances with records of work disability (> or = 90 days sickness absence, disability pension, or death) obtained from national registers.
Public sector employees in finland.
56,732 participants (mean age 44.4 years, 80% female), who were at work and free of work disability at the study inception.
During a mean follow-up of 3.3 years, incident diagnosis-specific work disability was observed in 4,028 (7%) employees. Of those, 2,347 (60%) returned to work. Sleep disturbances 5-7 nights per week predicted work disability due to mental disorders (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.3-1.9) and diseases of the circulatory system (HR = 1.6, 95% CI 1.2-2.1), musculoskeletal system (HR = 1.6, 95% CI 1.4-1.8) and nervous system (HR = 1.5, 95% CI 1.0-2.2), and injuries and poisonings (HR = 1.6, 95% CI 1.2-2.1) after controlling for baseline age, sex, socioeconomic status, night/shift work, health behaviors (e.g., smoking, exercise), diagnosed somatic diseases, use of pain killers, depression, and anxiety. In addition, sleep disturbances prior to disability were associated with higher likelihood of not returning to work after work disability from musculoskeletal diseases (HR = 1.2, 95% CI 1.1-1.7) and, in men, after work disability due to mental disorders (HR = 4.4, 95% CI 1.7-11.1).
Sleep disturbances are associated with increased risk for subsequent disabling mental disorders and various physical illnesses. They also predict the outcome of work disability due to musculoskeletal disorders.
Department of Clinical Science, University of Bergen, Bergen, Norway; Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway. Electronic address: firstname.lastname@example.org.
The Whiteley Index (WI) is a widely used screening instrument for health anxiety/hypochondriasis. Several studies have previously explored the psychometric properties of the WI, but with mixed findings concerning both item composition and factor structure. The main aim of the current study was to examine different factor structures as identified from previous studies using data from a large general population based study. We also wanted to provide gender specific norms.
Data were taken from a large population-based study in Norway, the Hordaland Health Study (HUSK N=7274). Confirmatory factor analysis (CFA) of several models of the WI was conducted. Item response theory (IRT) analysis was performed on the model with the best goodness-of-fit.
CFA of all previously proposed factor models of the WI revealed clearly inadequate model fits. The IRT analysis suggested that a six-item model best described the data, and CFA confirmed an adequate goodness-of-fit across indices.
The current study found evidence for a six-item, single-factor model of the WI. Our findings suggest that this abbreviated version has the best factor structure compared to previously proposed factor models. We recommend that the factor structure identified in this study should be investigated further in independent samples.
The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Health, Uni Research, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
The aim of the current study was to examine sleep patterns and rates of insomnia in a population-based study of adolescents aged 16-19 years. Gender differences in sleep patterns and insomnia, as well as a comparison of insomnia rates according to DSM-IV, DSM-V and quantitative criteria for insomnia (Behav. Res. Ther., 41, 2003, 427), were explored. We used a large population-based study in Hordaland county in Norway, conducted in 2012. The sample included 10,220 adolescents aged 16-18 years (54% girls). Self-reported sleep measurements included bedtime, rise time, time in bed, sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, rate and frequency and duration of difficulties initiating and maintaining sleep and rate and frequency of tiredness and sleepiness. The adolescents reported short sleep duration on weekdays (mean 6:25 hours), resulting in a sleep deficiency of about 2 h. A majority of the adolescents (65%) reported sleep onset latency exceeding 30 min. Girls reported longer sleep onset latency and a higher rate of insomnia than boys, while boys reported later bedtimes and a larger weekday-weekend discrepancy on several sleep parameters. Insomnia prevalence rates ranged from a total prevalence of 23.8 (DSM-IV criteria), 18.5 (DSM-V criteria) and 13.6% (quantitative criteria for insomnia). We conclude that short sleep duration, long sleep onset latency and insomnia were prevalent in adolescents. This warrants attention as a public health concern in this age group.
Economic gender equality is one of the goals of the Nordic Welfare states. Despite this, there is a considerable gender gap in pensionable income in the European Union, and an unmet need for measures that absorb more of the complexity associated with accumulated (dis)advantages across gender and population groups. The aims of the present study were to examine the gender difference in association between average earned pension points and 1) education and 2) current occupational prestige, and to discuss pension points as a possible indicator of accumulated disadvantages.
We linked a community-based survey, the Hordaland Health study (HUSK), to the national register of insurance benefits (FD-trygd). This made it possible to trace gendered patterns of economic (dis)advantages associated with educational level, career development and gainful work over the life course for 17,275 individuals.
We found profound differences in earned accrued pension rights between men and women across socioeconomic strata, and a significant interaction between pension rights and gender in the association with education and occupational prestige. Our findings indicate that men, as a group, may have lower educational attainment and occupational prestige than women, and still earn more pension points throughout their career. These differences place women at risk for future economic strain and deprivation over and above their similarly educated and positioned male counterparts.
We suggest that accrued pension rights may be a relevant measure of accumulated (dis)advantages over the course of working life, and a useful indicator when gender equality is measured and discussed.
The purpose of this study was to examine the prevalence of sleep problems in a community-based sample of patients with Parkinson's disease (PD) in Norway, and their associated factors.
176 consecutive PD outpatients (41% females) were included in a study of non-motor symptoms, including sleep problems. All participants responded to the Parkinson's Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate possible sleep problem. Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS).
The mean age was 68.5?years (range 35-90); the mean Hoehn and Yahr stage was 2.11 (SD 0.86), and the mean UPDRS part III was 22.3 (SD 11.7). Sleep problems were common among PD patients. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. There was no significant association between PD severity and any of the sleep items in the PDSS; whereas fatigue, mental health problems, and RLS were associated with PDSS score.
The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS.
Internationally adopted adolescents are at increased risk for mental health problems. However, little is known about problematic alcohol and drug use, which are important indicators of maladjustment. The aim of this study was to examine the level of problematic alcohol and drug use in internationally adopted adolescents compared to their nonadopted peers. The study is based on data from the youth@hordaland-survey, which was conducted in Hordaland County, Norway, in the spring of 2012. All adolescents born from 1993 to 1995 residing in Hordaland at the time of the study were invited to participate. Information on adoption was obtained from the Central Adoption Registry and linked to self-report data from the youth@hordaland-survey. Among 10,200 participants, 45 were identified as internationally adopted. No significant differences were found between international adoptees and their peers regarding whether or not they had tried alcohol or illicit drugs or their patterns of drinking behavior. However, adopted adolescents had a higher mean score on a measure of problematic alcohol and drug use compared to their nonadopted peers. The difference was attenuated and no longer significant when adjusting for measures of depression and attention-deficit/hyperactivity disorder. Results from a structural equation model indicated a full mediation effect of mental health problems on the association between adoption status and problematic alcohol and drug use. Our findings indicate that internationally adopted adolescents experience more problematic alcohol and drug use than their nonadopted peers, and the difference can largely be explained by mental health problems. (PsycINFO Database Record
Several studies have indicated a high degree of overlap between insomnia and obstructive sleep apnoea, but little is known regarding how the overlap may affect adverse outcomes associated with each of the disorders. The aim of the current study was to examine the separate and combined effects of symptoms of insomnia and obstructive sleep apnoea on long-term sick leave. We used an historical cohort design with 4 years follow-up. Information on sick leave was obtained from Norwegian official registry data, and merged with health information from the Hordaland Health Study in western Norway, 1997-99. A total of 6892 participants aged 40-45 years were assessed for self-reported symptoms of insomnia and obstructive sleep apnoea (snoring and breathing cessations), as well as confounding factors. The level of overlap between insomnia and obstructive sleep apnoea was low (7-12%). Both insomnia and obstructive sleep apnoea alone were significant risk factors for subsequent sick leave after adjusting for confounding factors (odds ratios ranging from 1.4 to 2.3). Having comorbid insomnia and obstructive sleep apnoea increased the risk significantly. There was an additive interaction effect between the two conditions in the unadjusted analyses, but this was reduced to a non-significant level when adjusting for confounders. This study is the first to report the separate and combined effects of insomnia and obstructive sleep apnoea on any adverse outcome. Having both insomnia and obstructive sleep apnoea increased the risk of later sick leave, but there was no evidence of an independent synergy effect of the two conditions.
We aim to estimate the pathways between maternal symptoms of anxiety and depression and child nocturnal awakenings via structural equation modeling using a sibling design.
Structural equation modeling on data from 14,926 sibling dyads or triads from the Norwegian Mother and Child Cohort Study.
At 6?months, we estimated the association between maternal symptoms of anxiety and child nocturnal awakenings to be owing to several nonsignificant pathways. Child nocturnal awakenings at 18?months, however, were influenced by concurrent maternal symptoms of anxiety (ß?=?.10) and depression (ß?=?.12). Neither maternal symptoms of anxiety (ß?=?.04) nor depression (ß?=?-.00) was influenced by concurrent child nocturnal awakenings.
Our findings suggest that maternal mental health influences child sleep behavior at 18?months after birth, and not vice versa. This is in support of hypotheses on maternal mental health influencing child sleep during toddlerhood.