Dental anxiety in relation to emotional and behavioral problems in Croatian adolescents

The investigation was performed on 113 adolescents in the age between 15 and 18 years (63 boys, 50 girls). Corah Dental Anxiety Scale (CDAS) and Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) were used for evaluation of dental fear and Child Medical Fear Questionnaire (CMFQ) for evaluation of the fear of medical treatment. Achenbach Youth Self Report questionnaire (YSR) was used for evaluation of emotional and behavioral problems. The tests were filled in by children. The aim of the study was to evaluate the level of dental anxiety in adolescents and to assess a cause--consequence relationship between dental anxiety and emotional and behavioral problems in adolescents. The results of CDAS, CFSS-DS and CMFQ tests showed that dental anxiety scores and the total internalizing problems were higher in girls. Girls displayed more physical problems (p < 0.001) and were more prone to anxiety/depression disorders (p < 0.05). Both boys and girls were more aggressive, more prone to delinquent behaviour and had more externalizing problems in comparison with the average values obtained for the Croatian population. Significant correlation coefficients for boys were calculated for age and anxiety/depression, and delinquent behaviour and aggression (p < 0.05). Significant correlations were observed between physical problems and dental anxiety measured by the CFSS-DS test (p < 0.01), and between physical problems and the total internalizing problems (p < 0.05). In girls, the CMFQ scores showed significant correlations between dental anxiety and physical problems (p < 0.05), and anxiety/ depression (p < 0.01) and the total internalizing and externalizing problems (p < 0.05). Significant correlations were calculated for age and the total internalizing and externalizing problems for boys (p < 0.05). According to the results of both CDAS and CMFQ tests, anxiety in girls showed significant correlations with delinquent behaviour (p < 0.01). CDAS scores for girls showed significant correlations with aggression (p < 0.05) and the total externalizing problems (p < 0.01).     

Androgen concentrations in umbilical cord blood and their association with maternal, fetal and obstetric factors

The aim of this study was to measure umbilical blood androgen concentrations in a birth cohort using a highly specific liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay and assesses the effects of sex, labor, and gestational age on fetal androgen levels at birth. We performed a prospective cohort study of androgen concentrations in mixed arterial and venous umbilical cord serum from 803 unselected singleton pregnancies from a general obstetric population in Western Australia. Total testosterone (TT), Δ4-androstenedione, and dehydroepiandrosterone were extracted from archived cord serum samples and measured using LC-MS/MS. SHBG was measured by ELISA; free testosterone (FT) and bioavailable testosterone (BioT) values were also calculated. Median values for all three androgens were generally lower than previously published values. Levels of TT, FT, BioT, and SHBG were significantly higher in male verses female neonates (P<0.0001), while dehydroepiandrosterone levels were higher in females (P<0.0001). Labor was associated with a significant (～15-26%) decrease in median cord blood TT and FT levels (both sexes combined), but a modest (～16-31%) increase in SHBG, Δ4-androstenedione, and dehydroepiandrosterone concentrations. TT and FT were significantly negatively correlated with gestational age at delivery, while SHBG, Δ4-androstenedione, and dehydroepiandrosterone were positively correlated. Antenatal glucocorticoid administration also had a significant effect in the multiple regression models. This is the first study to report umbilical cord androgen levels in a large unselected population of neonates using LC-MS/MS. Our findings suggest that previous studies have over-estimated cord androgen levels, and that fetal, maternal, and obstetric factors influence cord androgen levels differentially. Caution should be exercised when interpreting previously-published data that have not taken all of these factors into account.     

Relation between internalizing behaviors,externalizing behaviors,and peer victimization among children with and without ADHD

The current study explored the concurrent and longitudinal association between internalizing behaviors, externalizing behaviors, and peer victimization among children with and without ADHD. Eighty children (42 ADHD, 38 non-ADHD) ages 8–12 participated in the present study conducted over a 6-month period. During the baseline session, parents completed a structured diagnostic interview and the Vanderbilt ADHD Parent Rating Scale to determine whether their child met criteria for ADHD, and the Child Behavior Checklist (CBCL) to assess their child’s internalizing and externalizing behaviors; children completed the Perception of Peer Support Scale (PPSS) to assess experiences of peer victimization. At the 6-month follow-up session, parents completed the CBCL and children completed the PPSS. Concurrently, internalizing behaviors were associated with peer victimization among children with and without ADHD; ADHD moderated this relation, such that internalizing behaviors were more strongly related to peer victimization among children with ADHD. Longitudinally, internalizing behaviors at baseline predicted peer victimization at 6-month follow-up; however, further analyses demonstrated there was a covarying change in internalizing behaviors and peer victimization. These findings suggest internalizing behaviors are related to peer victimization concurrently, and over time, and are associated with increased risk for peer victimization in the presence of ADHD. Additionally, internalizing behaviors and peer victimization appear to share a dynamic relationship; that is, decreases in internalizing behaviors predict similar decreases in peer victimization. No significant relations were observed between externalizing behaviors and peer victimization. Implications and limitations are discussed.     

Mental Health Problems and Educational Attainment in Adolescence: 9-Year Follow-Up of the TRAILS Study

BackgroundThis study examines if mental health problems at age 11 and changes in mental health problems between age 11 and 16 predict educational attainment of adolescents at age 19, overall and stratified by gender.MethodsData from 1711 adolescents (76.8% from initial cohort) of the Tracking Adolescents'' Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 9year follow-up, were used. Mental health problems (externalizing, internalizing and attention problems) were measured by the Youth Self Report and the Child Behavior Checklist at ages 11 and 16. Difference scores for mental health problems between age 11 and 16 were calculated. Educational attainment was assessed at age 19.ResultsExternalizing, internalizing and attention problems at age 11 were significantly associated with low educational attainment at age 19 (crude model). When adjusted for demographic variables and the other mental health problems, only the association for attention problems remained significant (odds ratio (OR), 95% confidence interval: 3.19, 2.11–4.83). Increasing externalizing problems between age 11 and 16 also predicted low educational attainment at age 19 (OR 3.12, 1.83–5.32). Among girls, increasing internalizing problems between age 11 and 16 predicted low educational attainment (OR 2.21, 1.25–3.94). For boys, no significant association was found for increasing internalizing problems and low educational attainment. For increasing attention problems between age 11 and 16 no significant association with low educational attainment was found.ConclusionsExternalizing, internalizing and attention problems at age 11 and an increase of these problems during adolescence predicted low educational attainment at age 19. Early treatment of these mental health problems may improve educational attainment, and reduce socioeconomic health differences in adulthood.     

Adolescents’ Use of Care for Behavioral and Emotional Problems: Types,Trends, and Determinants

Objective

While adolescents use various types of care for behavioral and emotional problems, evidence on age trends and determinants per type is scarce. We aimed to assess use of care by adolescents because of behavioral and emotional problems, overall and by type, and its determinants, for ages 10–19 years.

Methods

We obtained longitudinal data on 2,230 adolescents during ages 10–19 from four measurements regarding use of general care and specialized care (youth social care and mental healthcare) in the preceding 6 months, the Child Behavior Checklist (CBCL) and Youth Self-Report, and child and family characteristics. We analyzed data by multilevel logistic regression.

Results

Overall rates of use increased from 20.1% at age 10/11 to 32.2% at age 19: general care was used most. At age 10/11 use was higher among boys, at age 19 among girls. Use of general care increased for both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change was associated with CBCL externalizing and internalizing problems, school problems, family socioeconomic status, and parental divorce. Preceding CBCL problems predicted more use: most for mental health care and least for general care. Moreover, general care was used more frequently by low and medium socioeconomic status families, with odds ratios (95%-confidence intervals): 1.52 (1.23;1.88) and 1.40 (1.17;1.67); youth social care in case of parental divorce, 2.07 (1.36;3.17); and of special education, 2.66 (1.78;3.95); and mental healthcare in case of special education, 2.66 (1.60;4.51).

Discussion

Adolescents with behavioral and emotional problems use general care most frequently. Overall use increases with age. Determinants of use vary per type.     

A Longitudinal Study: Changes in Cortical Thickness and Surface Area during Pubertal Maturation

Sex hormones have been shown to contribute to the organization and function of the brain during puberty and adolescence. Moreover, it has been suggested that distinct hormone changes in girls versus boys may contribute to the emergence of sex differences in internalizing and externalizing behavior during adolescence. In the current longitudinal study, the influence of within-subject changes in puberty (physical and hormonal) on cortical thickness and surface area was examined across a 2-year span, while controlling for age. Greater increases in Tanner Stage predicted less superior frontal thinning and decreases in precuneus surface area in both sexes. Significant Tanner Stage and sex interactions were also seen, with less right superior temporal thinning in girls but not boys, as well as greater decreases in the right bank of the superior temporal sulcus surface area in boys compared to girls. In addition, within-subject changes in testosterone over the 2-year follow-up period were found to relate to decreases in middle superior frontal surface area in boys, but increases in surface area in girls. Lastly, larger increases in estradiol in girls predicted greater middle temporal lobe thinning. These results show that within-subject physical and hormonal markers of puberty relate to region and sex-specific changes in cortical development across adolescence.     

Internalizing and externalizing behavior in adult ADHD

Although there are many studies available investigating internalizing and externalizing behavior in childhood and adolescent manifestations of attention-deficit/hyperactivity disorder, there is limited information about their relevance in adults featuring persistence of the disease. We examined a large sample of 910 adults affected with attention-deficit/hyperactivity disorders (AADHD) for internalizing and externalizing behavior. Regarding correlates of internalizing behavior, AADHD probands showed significantly higher scores of the anxiety- and depression-related personality traits Neuroticism and Harm Avoidance, compared with reference values. The lifetime comorbidity of depressive disorders, anxiety disorders, and anxious or fearful Cluster C personality disorders (PDs) is elevated in AADHD patients compared with general population. Regarding correlates of externalizing behavior, patients affected with AADHD show significantly lower scores of Conscientiousness and significantly higher scores of Novelty Seeking than the published German reference values. Emotional, dramatic, or erratic Cluster B PDs were most frequent in AADHD. Internalizing and externalizing behavior notably affected psychosocial status to a similar extent. The frequency of both internalizing and externalizing behavior in AADHD might reflect an underlying emotional regulation disorder.     

Intelligence in Taiwan: Progressive Matrices means and sex differences in means and variances for 6- to 17-year-olds

Data for Raven's Progressive Matrices are reported for a sample of 6290 6- to 17-year-olds in Taiwan. The Taiwanese obtained a mean IQ of 109.5, in relation to a British mean of 100. There was no difference in mean scores of boys and girls at age 7 years. At age 10 years girls obtained significantly higher scores than boys, and at ages 13 and 16 years boys obtained significantly higher scores than girls. There was no sex difference in variance at age 7 years. At ages 10, 13 and 16 years variance was significantly greater in boys.     

Competence and behavioral/emotional problems in Croatian children--parents' and teachers' reports: pilot study

Achenbach's Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) were administered to school children aged between 7-11 comprising a non-referred sample (n = 349) drawn from the whole country. Those were the first data on the CBCL and TRF in Croatia. Both in the CBCL and TRF boys had higher scores compared to girls in the Externalizing and Total Problems scale (p < 0.01 and p < 0.05). Parents rated higher scores to the Internalizing and Externalizing scales and the Total Problems scale in both sexes (p < 0.01 and p < 0.05), with the exception of the Internalizing scale in boys. Parents are very important observers of mental health problems in children.     

Childhood Internalizing and Externalizing Problems Predict the Onset of Clinical Panic Attacks over Adolescence: The TRAILS Study

Background

Panic attacks are a source of individual suffering and are an independent risk factor for later psychopathology. However, much less is known about risk factors for the development of panic attacks, particularly during adolescence when the incidence of panic attacks increases dramatically. We examined whether internalizing and externalizing problems in childhood predict the onset of panic attacks in adolescence.

Method

This study is part of the TRacking Adolescents’ Individual Lives Survey (TRAILS), a Dutch longitudinal population cohort study (N = 1,584). Internalizing and Externalizing Problems were collected using the Youth Self-Report (YSR) and the parent-report Child Behavior Checklist (CBCL) at baseline (age 10–12). At age 18–20, DSM-IV defined panic attacks since baseline were assessed with the Composite International Diagnostic Interview (CIDI). We investigated whether early adolescent Internalizing and Externalizing Problems predicted panic attacks between ages 10–20 years, using survival analysis in univariate and multivariate models.

Results

There were N = 314 (19.8%) cases who experienced at least one DSM-IV defined panic attack during adolescence and N = 18 (1.2%) who developed panic disorder during adolescence. In univariate analyses, CBCL Total Problems, Internalizing Problems and three of the eight syndrome scales predicted panic attack onset, while on the YSR all broad-band problem scales and each narrow-band syndrome scale predicted panic attack onset. In multivariate analyses, CBCL Social Problems (HR 1.19, p<.05), and YSR Thought Problems (HR 1.15, p<.05) and Social Problems (HR 1.26, p<.01) predicted panic attack onset.

Conclusion

Risk indicators of panic attack include the wide range of internalizing and externalizing problems. Yet, when adjusted for co-occurring problem behaviors, Social Problems were the most consistent risk factor for panic attack onsets in adolescence.     

Developmental Pathways Among Adaptive Functioning and Externalizing and Internalizing Behavioral Problems: Cascades From Childhood Into Adolescence

Here, a 3-wave multivariate design and developmental cascade analysis were used to investigate pathways among adaptive functioning and externalizing and internalizing behavioral problems in a community sample of 134 children seen at 4, 10, and 14 years. Adaptive functioning in early adolescence was predicted by early childhood adaptive functioning and externalizing behavioral problems, with both effects mediated by late childhood adaptive functioning and internalizing behavioral problems; externalizing behavioral problems in early adolescence were predicted by early childhood internalizing behavioral problems with the effect mediated by late childhood externalizing behavioral problems. These developmental cascades were obtained independent of child intelligence. Strategically timed and targeted interventions designed to address young children's behavioral problems may return investment in terms of an enhanced epidemiology of adaptively functioning teens.     

Trajectories of participation in organized activities and outcomes in young adulthood

To examine whether trajectories of participation in organized activities during the high school years and beyond (from ages 14 to 20) predicted outcomes at age 21 (externalizing problems, internalizing problems, civic engagement, number of years of education, and perception of physical health), 354 youths (60% girls) were surveyed annually over nine years. Four trajectories were found: (a) “Low and decreasing” (71%), (b) “Moderate and stable” (12%), (c) “High and decreasing after high school” (12%), and (d) “High and increasing after high school” (5%). Results revealed that the predicted outcomes varied according to the different trajectories. Pursuing high levels of activity participation beyond high school was especially beneficial with respect to externalizing problems and educational attainment.     

What effect does classroom separation have on twins' behavior, progress at school, and reading abilities?

We investigated the effects of classroom separation on twins' behavior, progress at school, and reading abilities. This investigation was part of a longitudinal study of a nationally-representative sample of twins (the E-risk Study) who were assessed at the start of school (age 5) and followed up (age 7). We examined three groups of twins: pairs who were in the same class at both ages; pairs who were in separate classes at both ages; and pairs who were in the same class at age 5, but separated by age 7. When compared to those not separated, those separated early had significantly more teacher-rated internalizing problems and those separated later showed more internalizing problems and lower reading scores. Monozygotic (MZ) twins showed more problems as a result of separation than dizygotic (DZ) twins. No group differences emerged for externalizing problems, ADHD or prosocial behaviors. The implications of the findings for parents and teachers of twins, and for school practices about separating twins, are discussed.     

Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11.

OBJECTIVE--To investigate the social adjustment in childhood of people who as adults have psychiatric disorders. DESIGN--Subjects in a prospectively followed up cohort (the national child development study) who had been admitted as adults to psychiatric hospitals were compared with the rest of the cohort on ratings of social behaviour made by teachers at the ages of 7 and 11 years. SUBJECTS--40 adult patients with schizophrenic illnesses, 35 with affective psychoses, and 79 with neurotic illness who had been admitted for psychiatric reasons by the age of 28. 1914 randomly selected members of the cohort who had never been admitted for psychiatric treatment. MAIN OUTCOME MEASURES--Overall scores and scores for overreaction (externalising behaviour) and underreaction (internalising behaviour) with the Bristol social adjustment guide at ages 7 and 11. RESULTS--At the age of 7 children who developed schizophrenia were rated by their teachers as manifesting more social maladjustment than controls (overall score 4.3 (SD 2.4) v 3.1 (2.0); P < 0.01). This was more apparent in the boys (5 (2.6)) than the girls (3.4 (1.8)) and related to overreactive rather than underreactive behaviour. At both ages prepsychotic (affective) children differed little from normal controls. By the age of 11 preneurotic children, particularly the girls, had an increased rating of maladjustment (including overreactions and underreactions). CONCLUSION--Abnormalities of social adjustment are detectable in childhood in some people who develop psychotic illness. Sex and the rate of development of different components of the capacity for social interaction are important determinants of the risk of psychosis and other psychiatric disorders in adulthood.     

Comparison of self-reported and parent-reported emotional and behavioral problems in adolescents from Croatia

The first goal of this study was to obtain, Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) problem-scales data for youths in Croatia, and compare them to the original American sample. The second goal of this study was to compare boys -girls problem scales data and CBCL-YSR differences. The instruments were administered to school adolescents aged between 12-18 comprising a non-referred sample (n=611) drawn from the whole country. Youths, compared to their parents, rated higher scores in all scales in both sexes (p < 0.001). According to parents' reports boys had higher scores in more scales (five out of eleven). According to adolescents'self-reports girls had higher scores in more scales (seven out of eleven). Consistent with other studies, Croatian sample confirmed a larger number of serious behavioral and emotional problems reported by adolescents. Adolescents were confirmed as the most reliable informants on their problems.     

Serum leptin concentration and its effect on puberty in Naqu Tibetan adolescents

This study aimed to clarify the regularity of leptin in Naqu Tibetan adolescents. This study investigated the concentration of fasting serum leptin and clarified its relationship between BMI and other indices. Healthy Naqu Tibetan adolescents aged 12-18 were investigated randomly in the study. They were divided into seven groups (each year as one group, 12 boys and 12 girls in each group); serum concentrations of leptin, estradiol, testosterone (T), follicle stimulating hormone (FSH) and luteinizing hormone (LH) were analyzed. The height and body weight of the 168 healthy Naqu Tibetan adolescents were also assessed. The leptin level in boys decreased with age but increased in girls; in boys and girls they both differed between groups (p<0.05). In boys, the leptin level was inversely correlated with body mass index (BMI), FSH, and T (p<0.05), while in girls, it was positively related to BMI, FSH, LH, and E2 (p<0.01).These findings suggested that during puberty the serum leptin concentration increased with age in girls while it decreased in boys; in the same age group, the leptin level in girls was significantly higher than in boys. Leptin may have some relationship with puberty in Tibetan adolescents.     

Significant sex difference in the association between C‐reactive protein concentration and anthropometry among 13‐ to 19‐year olds,but not 6‐ to 12‐year olds in Nepal

Life history theory predicts a trade‐off between immunostimulation and growth. Using a cross‐sectional study design, this study aims to test the hypothesis that C‐reactive protein (CRP) is negatively associated with height‐for‐age z‐scores (HAZ scores) and BMI‐for‐age z‐scores (BAZ scores) among 6‐ to 19‐year olds (N = 426) residing in five Nepalese communities. Dried blood spot (DBS) samples were collected and assayed for CRP using an in‐house enzyme immunoassay (EIA). Sex‐ and age‐group‐specific CRP quartiles were used to examine its association with growth in linear mixed‐effects (LME) models. A significant difference was found in the proportion of elevated CRP (>2 mg/L, equivalent to ～3.2 mg/L serum CRP) between 13‐ and 19‐year‐old boys (12%) and girls (4%). Concentrations of CRP were positively associated with HAZ score among adolescent (13–19 years) boys, which may indicate that individuals with greater energy resources have better growth and a better response to infections, thus eliminating the expected trade‐off between body maintenance (immunostimulation) and growth. Adolescent boys with low BAZ and HAZ scores had low CRP values, suggesting that those who do not have enough energy for growth cannot increase their CRP level even when infected with pathogens. Among adolescent girls a positive association was observed between CRP and BAZ scores suggesting the possible effects of chronic low‐grade inflammation due to body fat rather than infection. The association between CRP and growth was less evident among children (6–12 years) compared with adolescents, indicating that the elevated energy requirement needed for the adolescent growth spurt and puberty may play some role. Am J Phys Anthropol 154:42–51, 2014. © 2014 Wiley Periodicals, Inc.     

Diurnal and seasonal cortisol, testosterone, and DHEA rhythms in boys and girls during puberty

Diurnal and seasonal rhythms of cortisol, testosterone, and DHEA were examined, as little is known about the relationship between these rhythmicities and pubertal development. Salivary samples were obtained from 60 boys and 60 girls at approximately 07:45, 08:00, 08:30, 12:00, 16:50, and 21:00 h. The participants' ages ranged from 8-14 yrs, and each participant was tested three times at six-month intervals. The study was conducted at a General Clinical Research Center (GCRC) and at the homes of the participants. All hormones showed diurnal fluctuations. The acrophase (peak time) of cortisol occurred earlier than for testosterone or DHEA and showed a seasonal effect, with the acrophase occurring earlier in spring than in summer. The cortisol acrophase also occurred later in the day for boys than for girls during later puberty. Seasonal effects were found only for cortisol with higher concentrations in the spring and summer. Cortisol concentrations were relatively stable across pubertal maturation, but significantly lower concentrations were observed at pubertal stage 3 compared to the other stages. Morning cortisol levels were also higher in boys at pubertal stage 2. Testosterone concentrations were higher in boys at pubertal stages 3 and 4, and DHEA was lower at pubertal stage 1 than 3 and 4 for both boys and girls. For the total sample, there was a positive correlation between DHEA and testosterone during early puberty (stages 1-3) but not later puberty (stages 4-5). Awakening secretory activity correlated with daytime secretory activity for testosterone and DHEA, but not for cortisol. These data provide novel chronobiological information on cortisol, testosterone, and DHEA as it relates to sexual maturation and encourage further study on both normal and abnormal endocrine rhythms.     

Diurnal and Seasonal Cortisol,Testosterone, and DHEA Rhythms in Boys and Girls during Puberty

Diurnal and seasonal rhythms of cortisol, testosterone, and DHEA were examined, as little is known about the relationship between these rhythmicities and pubertal development. Salivary samples were obtained from 60 boys and 60 girls at approximately 07∶45, 08∶00, 08∶30, 12∶00, 16∶50, and 21∶00 h. The participants' ages ranged from 8–14 yrs, and each participant was tested three times at six‐month intervals. The study was conducted at a General Clinical Research Center (GCRC) and at the homes of the participants. All hormones showed diurnal fluctuations. The acrophase (peak time) of cortisol occurred earlier than for testosterone or DHEA and showed a seasonal effect, with the acrophase occurring earlier in spring than in summer. The cortisol acrophase also occurred later in the day for boys than for girls during later puberty. Seasonal effects were found only for cortisol with higher concentrations in the spring and summer. Cortisol concentrations were relatively stable across pubertal maturation, but significantly lower concentrations were observed at pubertal stage 3 compared to the other stages. Morning cortisol levels were also higher in boys at pubertal stage 2. Testosterone concentrations were higher in boys at pubertal stages 3 and 4, and DHEA was lower at pubertal stage 1 than 3 and 4 for both boys and girls. For the total sample, there was a positive correlation between DHEA and testosterone during early puberty (stages 1–3) but not later puberty (stages 4–5). Awakening secretory activity correlated with daytime secretory activity for testosterone and DHEA, but not for cortisol. These data provide novel chronobiological information on cortisol, testosterone, and DHEA as it relates to sexual maturation and encourage further study on both normal and abnormal endocrine rhythms.     

Testosterone measured in infancy predicts subsequent sex-typed behavior in boys and in girls

The testes are active during gestation, as well as during early infancy. Testosterone elevation during fetal development has been shown to play a role in human neurobehavioral sexual differentiation. The role of early postnatal gonadal activation in human psychosexual development is largely unknown, however. We measured testosterone in 48 full term infants (22 boys, 26 girls) by monthly urinary sampling from day 7 postnatal to age 6 months, and related the area under the curve (AUC) for testosterone during the first 6 months postnatal to subsequent sex-typed behavior, at the age of 14 months, using the Pre-School Activities Inventory (PSAI), and playroom observation of toy choices. In boys, testosterone AUC correlated significantly with PSAI scores (Spearman's rho = 0.54, p = 0.04). In addition, play with a train and with a baby doll showed the anticipated sex differences, and play with the train correlated significantly and positively with testosterone AUC in girls (Spearman's rho = 0.43, p = 0.05), while play with the doll correlated significantly and negatively with testosterone AUC in boys (Spearman's rho = -0.48, p < 0.03). These results may support a role for testosterone during early infancy in human neurobehavioral sexual differentiation.