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This longitudinal study examined the cognitive development of Spanish children from monolingual backgrounds attending schools with varying levels of English exposure (13%–83%) to assess whether higher L2 exposure results in advantages over time. 229 children (ages 6–7) completed background (nonverbal reasoning (NVR), working memory (WM), L1 vocabulary, L2 vocabulary) and experimental tests measuring attentional/executive functions (selective attention, divided attention, switching, inhibition) at the beginning and end of year 1 of primary education. Generalized linear mixed-effects models, accounting for factors such as family educational level, onset of L2 exposure and language exposure outside of school, indicated that children’s cognitive skills benefit from (high) L2 exposure at school, with greater L2 exposure being linked to more enhanced attentional/executive skills as well as to a larger L2 vocabulary. These findings support the positive effects of immersion programs, suggesting that L2 exposure in school settings alone can contribute to more developed attentional/executive skills.
Functional disorders (FDs) are associated with internalizing disorders (IDs). Studies investigating the nature of these associations over time are limited. We tested the direction of causation between measures of IDs (major depressive disorder [MDD], generalized anxiety disorder [GAD]) and FDs (fibromyalgia [FM] and myalgic encephalomyelitis/chronic fatigue syndrome [ME/CFS]) measured across two waves of longitudinal data (N = 108,034 and N = 73,590).
Methods
The Lifelines Cohort Study is a large prospective population-based cohort study in the northeast of the Netherlands. We tested competing causal models for the longitudinal association between IDs and FDs and, to follow-up results from the model with all IDs and FDs, tested the direction of causation between MDD and FM.
Results
FDs were more stable over time than IDs. Initial model comparisons support a bidirectional relationship between most IDs and FDs. Follow-up analyses support a unidirectional model where FM predicts MDD over time (β = 0.14, 95% confidence interval = [0.11, 0.18]), but not vice versa.
Conclusions
The cross-time associations between ME/CFS, MDD, and GAD appear bidirectional (causal in both directions). Our results are consistent with, but not demonstrative of, a causal relationship from FM to MDD. The consequences of specific FDs vary, underscoring the value of studying these conditions as distinct constructs.
Limited longitudinal research examining developmental changes in visuospatial working memory (WM) among children and adolescents with autism spectrum disorder (ASD) has prompted our investigation.
Methods
We assessed 123 autistic children and adolescents and 145 typically developing controls (TDC) using the Cambridge Neuropsychological Test Automated Battery at baseline (Time 1 [mean age ± SD]: ASD: 13.04 ± 2.86; TDC: 11.53 ± 2.81) and 2–9 years later (Time 2: ASD: 18.08 ± 3.17; TDC: 16.41 ± 3.09) to measure changes of visuospatial (working) memory over time. The linear mixed model was used to compare the differences between ASD and TDC and estimate the effect of changes over time, age, ASD diagnosis, and interactions of Time×Age×ASD. The overall Age×ASD effect was calculated in the spline regression.
Results
Autistic children and adolescents exhibited significantly poorer performance on all spatial tasks and some visual tasks than their TDC counterparts at Time 1 and Time 2, after adjusting for sex, age, attention deficit/hyperactivity disorder (ADHD), and full-scale intelligence quotient. There was an overall improvement from Time 1 to Time 2 across all tasks with significant Age×Time interactions. Significant Age×ASD interactions were observed in the delayed matching to sample, pattern recognition memory (PRM), spatial span (SSP), and spatial working memory (SWM) tasks with no significant Time×ASD interactions. In the quadratic nonlinear model, Age×ASD interactions were significant in PRM and SSP.
Conclusion
Despite significant improvements during the follow-up period, autistic children and adolescents continue to experience persistent deficits in SWM, with a weaker age-related improvement in visuospatial WM than TDC.
Postpartum depression is prevalent among Black women and associated with intersecting systemic factors and interpersonal discrimination. However, gaps remain in understanding pregnancy-related changes in discrimination experiences that influence postpartum mental health and could inform preventive interventions. We hypothesized that young Black women would experience increasing levels of discrimination across the transition to parenthood, heightening depression risk relative to non-pregnant peers.
Methods
Participants comprised 335 Black primiparous women (ages 17-30 at delivery) and 335 age- and discriminationmatched non-pregnant controls from the Pittsburgh Girls Study. Self-reported discrimination experiences were collected at four timepoints: two years pre-pregnancy, one year pre-pregnancy, pregnancy, and one year postpartum for the childbearing sample, with corresponding data from the non-pregnant sample across the same interval (matched pairwise).
Results
Linear increases in discrimination were observed for the nonpregnant participants (BS = .480, SE = .090, p <.001), while childbearing participants showed no overall changes, though younger age predicted greater increases over time. For childbearing participants, both baseline discrimination (BI = .626, SE = .077, p < .001) and increasing discrimination (BS = 2.55, SE = .939, p < .01) predicted postpartum depressive symptoms, controlling for pre-pregnancy depression. Among non-pregnant participants, only baseline discrimination predicted later depression (BI = .912, SE = .081, p < .001).
Conclusions
Experiencing increasing levels of interpersonal discrimination across the transition to parenthood may heighten postpartum depression risk among young Black women, indicating a need for interventions supporting well-being and promoting resilience before, during and after pregnancy.
Cognitive impairments are a core feature of psychotic disorders, but their long-term trajectory remains contentious. Previous meta-analyses focused on the first 5 years following psychosis onset. Here, we evaluated the change in cognitive impairments in psychotic disorders with a meta-analysis of studies with follow-ups of 5+ years. Following preregistration, databases were searched for relevant articles until July 2024. Two authors screened the reports for studies reporting on the change in cognitive impairments in global cognition, verbal learning and memory, visual learning and memory, working memory, attention, speed of processing, reasoning and problem-solving, and verbal fluency in individuals with psychotic disorders, with a minimum follow-up of 5 years. Three authors extracted data, and the PRISMA guidelines were followed. Random-effects meta-analyses and moderator analyses were conducted. Twenty-four studies comprising 2,633 patients and 1,019 controls were included in the study. Over an average of 8.46 years, cognitive impairments remained stable in all eight measures: global cognition (g = 0.09; 95% CI = 0.03–0.20), verbal memory (g = 0.05; 95% CI = −0.11, 0.21), visual memory (g = −0.16; 95% CI = −0.35, 0.03), working memory (g = 0.03; 95% CI = −0.09, 0.14), attention (g = 0.22; 95% CI = −0.36, 0.80), speed of processing (g = 0.10; 95% CI = −0.14, 0.35), reasoning and problem-solving (g = 0.16; 95% CI = −0.03, 0.35), and verbal fluency (g = 0.08; 95% CI = −0.03, 0.19). We conclude that cognitive impairments remain stable over time, consistent with the neurodevelopmental view of psychotic disorders.
The moderating roles of friendship and contextual variables on associations between social withdrawal and peer exclusion and growth curves of depressed affect were studied with a three-wave multilevel longitudinal design. Participants were 313 boys and girls aged 10–12 from Canada (n = 139), mostly of European and North African descent, and Colombia (n = 174), mostly mestizo, afrocolombian, and European descent. Depressed affect, peer exclusion, social withdrawal and friendship were assessed with peer-reports, and collectivism and individualism with self-reports. Group-level scores included gender, place and means of social withdrawal, peer exclusion, friendship, collectivism and individualism for each child’s same-gender classroom peer-group. Results indicated that being friended weakened associations between peer exclusion and social withdrawal and depressed affect. The strength of this effect varied across peer-group contexts.
Psychotic-like experiences (PLEs) are associated with cognitive impairment and premature mortality, which may be indicative of accelerated biological ageing. Epigenetic clocks provide a measure of biological age based on DNA methylation, yet the long-term relationship between epigenetic ageing and PLEs remains largely unclear. We tested the relationship between epigenetic ageing and PLEs using a 17-year longitudinal approach.
Methods
Epigenetic ageing was calculated using four epigenetic clocks (DunedinPACE, Cortical EpiAge, Horvath, and PCGrimAge) in a sample from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large population-based birth cohort (n = 1840, 56.8% females). We modeled epigenetic ageing from up to three repeated measures collected between ages 7 and 24 using a linear mixed-effects model to calculate (1) average epigenetic age [mean-centered intercept] and (2) rate of epigenetic ageing over this 17-year period [slope]. We then compared these two measures between individuals who developed PLEs in early adulthood (n = 95) against those who did not (n = 1745).
Results
Results showed that a faster rate (slope) of longitudinal PCGrimAge was predictive of PLEs (OR = 1.79, 95% CI [1.13–2.85], p = .014), although this association was no longer significant after adjusting for smoking. There was a non-significant effect in the same direction for other clocks. Average epigenetic age (mean-centered intercept) was not associated with PLEs.
Conclusions
Our findings suggest that the observed association between accelerated rate of epigenetic ageing, measured with PCGrimAge, from childhood to early adulthood, and the development of PLEs in early adulthood may be explained by smoking.
This study aims to explore the everyday experiences of people living with Lewy body dementia and their families, to deepen understanding of their care needs. Lewy body dementia is a neurodegenerative condition associated with shorter life-expectancy and poorer quality of life than other forms of dementia. Cognitive fluctuations, visual hallucinations, falls, and motor features of Parkinsonism gives rise to complex and debilitating symptoms. Other prominent features include behavioral and emotional problems, rapid eye movement sleep disorder, and autonomic dysfunction. Improving palliative care for people with dementia continues to be an international priority; however, little is known as to how a palliative care approach could support people living with Lewy body dementia and their families.
Methods
Drawing on narrative theory of self and personhood, a qualitative, longitudinal narrative approach provided unique insights into 5 couples’ experiences of living with Lewy body dementia. Analysis was conducted using Murray’s levels of narrative analysis in health psychology to explore stories at the personal, interpersonal, positional, and societal level.
Results
Participants with Lewy body dementia described losses associated with communication, continence, and energy leading to a progressive loss of independence. For their family caregivers a loss of companionship was particularly salient. These losses, compounded by a perceived lack of clinical support, resulted in suffering both for the person with Lewy body dementia, and for those close to them.
Significance of results
There has been a societal and political shift to move beyond loss in dementia, to a focus on abilities and living well. However, acknowledging loss, while supporting symptom management is an important aspect of Lewy body dementia care. Providing person-centered, palliative supportive care throughout the disease trajectory could reduce suffering and enhance well-being.
In recent times, several longitudinal studies aimed at clarifying whether cannabis use during adolescence might play a causal role in the subsequent risk of developing bipolar disorder have been published. Although their methodological heterogeneity precludes any meta-analytic approaches, evidence from these studies can be systematically evaluated using the Bradford Hill criteria. A biological gradient is supported by evidence on the dose–response relationship between exposure severity and outcome. As such, the effect of cannabis use on bipolar disorder onset is likely to be strong, coherent, plausible, and based on a clear temporality. In addition, some analogies can be hypothesized between studies testing the possible causal role of cannabis in the development of bipolar disorder and those is schizophrenia. Cannabis may represent a precipitating agent inducing bipolar disorder in a multicausal model of individual vulnerability. However, this relationship seems to be only partially consistent and nonspecific, and the experimental evidence is strongly suggestive but, as yet, inconclusive. Nevertheless, in summary, it seems there is sufficient support for the hypothesis that cannabis use during adolescence may play a causal role in bipolar disorder, although further studies are needed to consolidate the evidence.
Children adopted from public care are more likely to experience mental health problems associated with their histories of early life adversity and instability, but few studies have investigated children’s mental health longitudinally across developmental turning points. We followed a sample of N = 92 UK domestically adopted children and their families at six time points over eight years post-placement (children’s ages ranged from 2 to 15 years). We used multilevel growth curve analysis to model time-related changes in children’s internalizing symptoms and externalizing problems and spline models to investigate patterns of change before and after school entry. Children’s internalizing symptoms followed a linear increasing trajectory, and externalizing problems followed a quadradic pattern where problems accelerated in early childhood and decelerated in late childhood. Spline models indicated an elevation in internalizing symptoms and externalizing problems as children started school. Internalizing symptoms continued to increase over time after school started and externalizing problems plateaued after the first years in school. Children adopted close in time to school entry displayed more problems when they started school. The transition to school represents a time of vulnerability for adopted children, especially for those who are adopted close in time to this transition, underscoring the need for ongoing support for their mental health across childhood.
Holistic frameworks of mental health outline that a focus on psychopathology does not represent an optimal approach to defining, measuring and treating mental health. Rather, theoretical, empirical, and applied psychological efforts should incorporate psychological well-being (PWB). Studies of PWB have overwhelmingly focused on adult populations, rendering a translation down to adolescence difficult. The current study explores the between-person, as well as within-person short-term, prospective relations between psychopathology and wellbeing within a community sample of adolescents (i.e., 553 youth aged 12 – 18, mean age: 14.97 years, 51.2% Male, 40.7% of participants identified as Hispanic (225 individuals), 38.5% identified as White (213 individuals), and 35.6% identified as Black (197 individuals), 3-wave, 1-year survey). Results demonstrated significant, negative between-person relations between psychopathology and PWB (bPHQ = −0.25, SE = 0.11, p = 0.021, bVDS = −0.39, SE = 0.15, p = 0.011). At the within-person level, consistent positive prospective relations were identified for violent-delinquent behaviors and PWB, such that increases in individual levels of violent-delinquent behaviors tended to forecast higher levels of PWB at the next follow-up (bPWBW2 = 0.21, SEPWBW2 = 0.076, p < 0.01; bPWBW3 = 0.14, SEPWBW3 = 0.051, p < 0.01). At the within-person level, prospective relations between depressive and PWB were not identified. Gender and racial/ethnic identities did not moderate findings.
Ideological and relational polarization are two increasingly salient political divisions in Western societies. We integrate the study of these phenomena by describing society as a multilevel network of social ties between people and attitudinal ties between people and political topics. We then define and propose a set of metrics to measure ‘network polarization’: the extent to which a community is ideologically and socially divided. Using longitudinal network modelling, we examine whether observed levels of network polarization can be explained by three processes: social selection, social influence, and latent-cause reinforcement. Applied to new longitudinal friendship and political attitude network data from two Swiss university cohorts, our metrics show mild polarization. The models explain this outcome and suggest that friendships and political attitudes are reciprocally formed and sustained. We find robust evidence for friend selection based on attitude similarity and weaker evidence for social influence. The results further point to latent-cause reinforcement processes: (dis)similar attitudes are more likely to be formed or maintained between individuals whose attitudes are already (dis)similar on a range of political issues. Applied across different cultural and political contexts, our approach may help to understand the degree and mechanisms of divisions in society.
Posttraumatic stress disorder (PTSD) is often chronic and impairing. Mechanisms that maintain symptoms remain poorly understood because of heterogenous presentation. We parsed this heterogeneity by examining how individual differences in stress-symptom dynamics relate to the long-term maintenance of PTSD.
Methods
We studied 7,308 trauma-exposed World Trade Center responders who self-reported PTSD symptoms and stressful life events at annual monitoring visits for up to 20 years (average = 8.8 visits; [range = 4–16]). We used multilevel structural equation models to separate the stable and time-varying components of symptoms and stressors. At the within-person level, we modeled stress reactivity by cross-lagged associations between stress and future symptoms, stress generation by cross-lagged associations between symptoms and future stress, and autoregressive effects represented symptom persistence and stress persistence. The clinical utility of the stress-symptom dynamics was evaluated by associations with PTSD chronicity and mental health care use.
Results
Stress reactivity, stress generation, and symptom persistence were significant on average (bs = 0.03–0.16). There were significant individual differences in the strength of each dynamic (interquartile ranges = 0.06–0.12). Correlations among within-person processes showed some dynamics are intertwined (e.g. more reactive people also generate stress in a vicious cycle) and others represent distinct phenotypes (e.g. people are reactive or have persistent symptoms). Initial trauma severity amplified some dynamics. People in the top deciles of most dynamics had clinically significant symptom levels across the monitoring period and their health care cost 6–17× more per year than people at median levels.
Conclusions
Individual differences in stress-symptom dynamics contribute to the chronicity and clinical burden of PTSD.
Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.
Methods
We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).
Results
Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.
Conclusions
Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.
Pubertal development variations have consequences for adolescent internalizing problems, which likely continue into adulthood. Key questions concern the extent of these links between pubertal timing and adult symptoms, as well as the underlying mechanisms.
Methods
Longitudinal data were available for 475 female and 404 male participants. Pubertal timing was indicated by age at mid-puberty for both groups and age at menarche for female participants (both assessed continuously). Adult self-reported outcomes of recent and lifetime depression and anxiety were predicted from pubertal timing, also controlling for adolescent (then childhood) internalizing problems. Emerging adulthood self-esteem, body dissatisfaction, education level, and age at sexual initiation were examined as mediators of the pubertal timing-adult internalizing link. Multilevel models tested hypotheses.
Results
Pubertal timing had persisting and sex-dependent psychological associations. Specifically, in female, but not male, adults, early puberty was associated with all adult internalizing outcomes, and for past year and lifetime depression symptoms, even after controlling for adolescent internalizing problems. Pubertal timing links with past-year depression symptoms were mediated by age at sexual initiation, while all other persisting pubertal timing links with adult symptoms were mediated by body dissatisfaction. Most findings concerning depression held when childhood internalizing problems were also a covariate.
Conclusions
Leveraging data spanning four developmental periods, findings highlight the associations between pubertal variations and adult internalizing symptoms by revealing underlying sex-dependent behavioral pathways. Only for female participants did pubertal timing affect depression and anxiety in established adulthood, with body dissatisfaction and age at sexual initiation as unique developmental mechanisms.
The COVID-19 pandemic significantly challenged the mental health of children and adolescents, with existing research highlighting the negative effects of restrictive measures to control the virus’s spread. However, in the specific context of this pandemic, there is limited understanding of how these difficulties have persisted over time after the situation was fully restored. This study sought to evaluate the pandemic’s impact on psychological symptoms in children from Italy, Spain, and Portugal across five-time points (2, 5, and 8 weeks, 6 months, and three and a half years after the pandemic’s onset). A total of 1613 parents completed the Psychological Impact of COVID-19 and Confinement on Children and Adolescents Scale, reporting symptoms in their children aged 3–17 years (39.2% female). The findings reveal an initial surge in psychological difficulties—anxiety, mood, sleep, behavioral, eating, and cognitive disturbances—followed by improvements in these domains three and a half years later. By September 2023, Spanish children experienced more significant reductions in symptoms compared to their Italian and Portuguese peers. While the COVID-19 pandemic has been a prolonged crisis, with varying impacts over time and across regions depending on the strictness of restrictions, the trends suggest a gradual improvement in the psychological well-being of children and adolescents.
‘Living well’ is an important concept across national dementia strategies. Qualitative research has contributed to understanding of living well for people with dementia. Longitudinal qualitative approaches, though fewer, can explore potential changes in accounts of living well, psychological coping and adapting to dementia, and if/how people with dementia maintain continuity in their lives. This longitudinal qualitative study aims to gauge what is important for ‘living well’ with mild-to-moderate dementia and whether this changes over time in a group of older people with mild-to-moderate dementia living at home. Semi-structured, qualitative interviews with 20 people with dementia from the IDEAL cohort study were conducted in 2017 and again one year later then thematically analysed. The overarching narrative was largely that of continuity and adaptation, with incremental not disruptive change. Continuing participation and meaningful occupation were important to maintaining living well over time; individuals pursued new as well as previous interests. As a key psychological coping strategy to support continuity in their lives, individuals emphasised their capabilities to maintain activities in spite of dementia, compartmentalising areas that had become more challenging. Maintaining social networks and accommodating changes in social relationships were also central to living well, including managing the psychological impacts of changes in spousal relationships. People in the earlier stages of dementia emphasise continuity and their capabilities, reporting change over time only in certain aspects of their lives. However, small, incremental changes in their social relationships and opportunities for meaningful occupation may still afford key areas for supporting capability to ‘live well’.
Social anhedonia, indicating reduced pleasure from social interaction, is heightened in autistic youth and associated with increased internalizing symptoms transdiagnostically. The stability of social anhedonia over time and its longitudinal impact on internalizing symptoms in autism have never been examined.
Methods
Participants were 276 autistic children (Mage = 8.60, SDage = 1.65; 211 male) with IQ ≥ 60 (MIQ = 96.74, SDIQ = 18.19). Autism severity was measured using the Autism Diagnostic Observation Schedule, Second Edition. Caregivers completed the Child and Adolescent Symptom Inventory, Fifth Edition (CASI-5) at baseline, 6 weeks, and 6 months. The CASI-5 includes a social anhedonia subscale derived from relevant items across domains. ICC (Intraclass Correlation Coefficient) analysis assessed stability, while cross-lagged panel models examined associations among social anhedonia, depression, and social anxiety across time.
Results
At baseline, social anhedonia correlated with autism severity, as well as parent-reported social anxiety and depression. Social anhedonia showed relative stability (ICC = 0.763) over 6 months, with a significant decline between baseline and 6 weeks (β = −0.52, p < .001). Cross-lagged models revealed a bidirectional relationship between social anhedonia and depression over time, while social anxiety displayed concurrent, but not predictive, associations across time.
Conclusions
Social anhedonia demonstrated stability over 6 months, suggesting that it may be a relatively stable characteristic in autistic children. Concurrent relationships were observed between social anhedonia and depression, as well as social anxiety and attention-deficit/hyperactivity disorder. Only depression demonstrated a bidirectional longitudinal association with social anhedonia. This bidirectional relationship aligns with developmental models linking early negative social experiences to subsequent internalizing symptoms in autistic children, underscoring the clinical significance of social anhedonia assessment in this population.
The cumulative effects of long-term exposure to pandemic-related stressors and the severity of social restrictions may have been important determinants of mental distress in the time of COVID-19.
Aim
This study aimed to investigate mental health among a cohort of Chinese university students over a 28-month period, focusing on the effects of lockdown type.
Methods
Depression, anxiety, stress and fear of COVID-19 infection were measured ten times among 188 Chinese students (females 77.7%, meanage = 19.8, s.d.age = 0.97), every 3 months: from prior to the emergence of COVID-19 in November 2019 (T1) to March 2022 (T10).
Results
Initially depression, anxiety and stress dipped from T1 to T2, followed by a sudden increase at T3 and a slow upward rise over the remainder of the study period (T3 to T10). When locked down at university, participants showed greater mental distress compared with both home lockdown (d = 0.35–0.48) and a no-lockdown comparison period (d = 0.28–0.40). Conversely, home lockdown was associated with less anxiety and stress (d = 0.19 and 0.21, respectively), but not with depression (d = 0.13) compared with a no-lockdown period.
Conclusions
This study highlights the cumulative effects of exposure to COVID-19 stressors over time. It also suggests that the way in which a lockdown is carried out can impact the well-being of those involved. Some forms of lockdown appear to pose a greater threat to mental health than others.
This study tracked the referential production of 25 Japanese-English returnee children for 5 years upon their return to Japan from an English-dominant environment (Mean age = 9.72 at the time of return) and compared their referential strategies to 27 Japanese monolinguals and 27 English monolinguals, age-matched to the returnee’s age at time of return. Returnees used more redundant noun phrases (NPs) in both languages to maintain references compared to monolingual peers. In English, no changes in NP use were noted over time, but increased exposure to English led to fewer redundant NPs when maintaining references. In their native Japanese (L1), returnees used less NPs for maintaining references and more NPs for reintroducing references, indicating improved reference tracking longitudinally. In sum, returnees’ referential production is more sensitive to L1 re-exposure effects than second language (L2) attrition and crucially, increased L2 exposure minimizes redundant referent production among bilingual returnee children.