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Kojima K, Lin L, Petley L, Clevenger N, Perdew A, Bodik M, Blankenship CM, Motlagh Zadeh L, Hunter LL, Moore DR. Childhood Listening and Associated Cognitive Difficulties Persist Into Adolescence. Ear Hear 2024:00003446-990000000-00275. [PMID: 38764146 DOI: 10.1097/aud.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Listening difficulty (LiD) refers to the challenges individuals face when trying to hear and comprehend speech and other sounds. LiD can arise from various sources, such as hearing sensitivity, language comprehension, cognitive function, or auditory processing. Although some children with LiD have hearing loss, many have clinically normal audiometric thresholds. To determine the impact of hearing and cognitive factors on LiD in children with a clinically normal audiogram, we conducted a longitudinal study. The Evaluation of Children's Listening & Processing Skills (ECLiPS), a validated and standardized caregiver evaluation tool, was used to group participants as either LiD or typically developing (TD). Our previous study aimed to characterize LiD in 6- to 13-year-old children during the project's baseline, cross-sectional phase. We found that children with LiD needed a higher signal-to-noise ratio during speech-in-speech tests and scored lower on all assessed components of the NIH Cognition Toolbox than TD children. The primary goal of this study was to examine if the differences between LiD and TD groups are temporary or enduring throughout childhood. DESIGN This longitudinal study had three data collection waves for children with LiD and TD aged 6 to 13 years at Wave 1, followed by assessments at 2-year (Wave 2) and 4-year (Wave 3) intervals. Primary analysis focused on data from Waves 1 and 2. Secondary analysis encompassed all three waves despite high attrition at Wave 3. Caregivers completed the ECLiPS, while participants completed the Listening in Spatialized Noise-Sentences (LiSN-S) test and the NIH-Toolbox Cognition Battery during each wave. The analysis consisted of (1) examining longitudinal differences between TD and LiD groups in demographics, listening, auditory, and cognitive function; (2) identifying functional domains contributing to LiD; and (3) test-retest reliability of measures across waves. Mixed-effect models were employed to analyze longitudinal data. RESULTS The study enrolled 169 participants, with 147, 100, and 31 children completing the required testing during Waves 1, 2, and 3, respectively. The mean ages at these waves were 9.5, 12.0, and 14.0 years. On average, children with LiD consistently underperformed TD children in auditory and cognitive tasks across all waves. Maternal education, auditory, and cognitive abilities independently predicted caregiver-reported listening skills. Significant correlations between Waves 1 and 2 confirmed high, long-term reliability. Secondary analysis of Wave 3 was consistent with the primary analyses of Waves 1 and 2, reinforcing the enduring nature of listening difficulties. CONCLUSION Children with LiD and clinically normal audiograms experience persistent auditory, listening, and cognitive challenges through at least adolescence. The degree of LiD can be independently predicted by maternal education, cognitive processing, and spatial listening skills. This study underscores the importance of early detection and intervention for childhood LiD and highlights the role of socioeconomic factors as contributors to these challenges.
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Affiliation(s)
- Katsuaki Kojima
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Li Lin
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lauren Petley
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Psychology, Clarkson University, Potsdam, New York
| | - Nathan Clevenger
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Audrey Perdew
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Bodik
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Cornell University, Ithaca, New York
| | - Chelsea M Blankenship
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lina Motlagh Zadeh
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa L Hunter
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- College of Allied Health, Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio
- Departments of Otolaryngology and Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Departments of Otolaryngology and Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
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Claussen AH, Holbrook JR, Hutchins HJ, Robinson LR, Bloomfield J, Meng L, Bitsko RH, O'Masta B, Cerles A, Maher B, Rush M, Kaminski JW. All in the Family? A Systematic Review and Meta-analysis of Parenting and Family Environment as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:249-271. [PMID: 35438451 PMCID: PMC9017071 DOI: 10.1007/s11121-022-01358-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.
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Affiliation(s)
- Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helena J Hutchins
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Atlanta, GA, USA
| | - Lara R Robinson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeanette Bloomfield
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lu Meng
- Covid-19 Response Health System and Worker Safety Task Force, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Xie T, Zhu B, Li HR, Xu JF, Mao Y. Educational attainment, income, and attention deficit hyperactivity disorder: A mediation analysis based on two-step Mendelian randomization. Soc Sci Med 2024; 345:116680. [PMID: 38394947 DOI: 10.1016/j.socscimed.2024.116680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/17/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Previous studies have reported the relationship between educational attainment and attention deficit hyperactivity disorder (ADHD). However, the mechanism of this relationship remains unknown. It is well known that educational attainment correlates with income. Therefore, based on summary data from a genome-wide association study we used two-step Mendelian randomization (MR) to explore the role of income between education and ADHD. The inverse variance weighted (IVW) method was used in our analysis. The IVW results suggested that educational attainment and income were protective factors against ADHD. Educational attainment affects ADHD through income [ADHD: Beta = -0.68, 95% confidence interval (CI) = -0.87, -0.49; female: Beta = -0.87, 95% CI = -1.28, -0.47; male: Beta = -1.01, 95% CI = -1.34, -0.68; childhood: Beta = -0.52, 95% CI = -0.74, -0.30; late-diagnosed: Beta = -0.78, 95% CI = -1.11, -0.47; persistent: Beta = -0.82, 95% CI = -1.33, -0.31]. Income also affected ADHD through educational attainment [female: Beta = -1.08, 95% CI = -1.35, -0.83; male: Beta = -1.16, 95% CI = -1.57, -0.77; persistent: Beta = -1.48, 95% CI = -2.09, -0.94]. In the final analysis, data with heterogeneity were analyzed using IVW random effects results. The mechanism is that income will mediate the relationship between educational attainment and ADHD.
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Affiliation(s)
- Tao Xie
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Bin Zhu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China.
| | - Hao-Ran Li
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Jin-Feng Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, 610041, China; West China School of Medicine, Sichuan University, Chengdu, 610041, China.
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, China.
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Federico A, Zgodic A, Flory K, Hantman RM, Eberth JM, Mclain AC, Bradshaw J. Predictors of Autism Spectrum Disorder and ADHD: Results from the National Survey of Children's Health. Disabil Health J 2024; 17:101512. [PMID: 37838574 DOI: 10.1016/j.dhjo.2023.101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/19/2023] [Accepted: 07/30/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders with comorbidity rates of up to 70%. Population-based studies show differential rates of ADHD and ASD diagnosis based on sociodemographic variables. However, no studies to date have examined the role of sociodemographic factors on the likelihood of receiving an ADHD, ASD, or comorbid ASD + ADHD diagnosis in a large, nationally representative sample. OBJECTIVE This study aims to examine the impact of sociodemographic factors on the odds of experiencing ASD-only, ADHD-only, or both diagnoses for children in the United States. METHODS Using a mixed effects multinomial logistic modeling approach and data from the 2016-2018 National Survey of Children's Health, we estimated the association between sociodemographic variables and the log odds of being in each diagnostic group. RESULTS Sociodemographic variables were differentially related to the three diagnostic groups: ASD-only, ADHD-only, and ASD + ADHD. Compared to girls, boys experienced higher odds of all three diagnosis categories. White children had higher odds of having an ADHD-only or ASD + ADHD diagnosis compared to non-Hispanic (NH) Black, NH multiple/other race, and Hispanic children. Odds ratios for levels of parent education, household income, and birth characteristics showed varying trends across diagnostic groups. CONCLUSIONS Overall, our findings point to unique sets of risk factors differentially associated ASD and ADHD, with lower income standing out as an important factor associated with receiving a diagnosis of ASD + ADHD.
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Affiliation(s)
- Alexis Federico
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Anja Zgodic
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Rachel M Hantman
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA; Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA; Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alexander C Mclain
- Rural and Minority Health Research Center, University of South Carolina, Columbia, SC, USA
| | - Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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5
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Muwonge JJ, Dalman C, Burström B, de Leon AP, Galanti MR, Jablonska B, Hollander AC. Are the estimated needs for mental health care among adolescents from different socioeconomic backgrounds met equally in Sweden? A longitudinal survey-registry linkage study. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02341-2. [PMID: 38157010 DOI: 10.1007/s00787-023-02341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
Evidence of inequality in the utilisation of mental health care (MHC) by adolescents in Nordic countries is mixed. This study aims to investigate if there are socioeconomic differences in the utilisation of MHC, while accounting for adolescents' mental health status. We analysed a cohort of 3517 adolescents, followed from 7 to 9th grade (ages 13-16), to examine the association between parental socioeconomic position (SEP: education and disposable income), adolescents' estimated needs, and the utilisation of MHC (defined as visits to secondary psychiatric care or receipt of psychotropic medication). Logistic and negative binomial regression models, with mental health status as moderator, were used to predict utilisation during each grade. Lower SEP predicted higher odds of utilising MHC in adolescents with no/mild symptoms (e.g., odds ratio, OR = 1.33, 95% CI 1.04-1.72, lower vs highest education), but not in those with moderate-to-severe symptoms (estimates close to one and non-significant). This pattern was largely explained by treatment of attention deficit hyperactivity disorder/autism spectrum disorders (ADHD/ASD) in boys. For girls with severe symptoms, lower SEP predicted reduced odds of utilising MHC for other mental disorders (OR = 0.48, 95% CI 0.25-0.92, lower education), and fewer outpatient visits when in contact with such care, although non-significant (incidence rate ratio, IRR = 0.51, 95% CI 0.25-1.05, lowest vs highest income). Our findings suggest a more equitable use of MHC for treating ADHD/ASD, but not other mental disorders such as depression and anxiety, particularly among girls.
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Affiliation(s)
- Joseph Jr Muwonge
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden.
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
| | - Christina Dalman
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Bo Burström
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Antonio Ponce de Leon
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Beata Jablonska
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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6
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Hjern A, Nyberg C, Burström B. Did the choice reform in Stockholm change social disparities in use of outpatient health services for children? Acta Paediatr 2023; 112:1973-1981. [PMID: 37271941 DOI: 10.1111/apa.16864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/20/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
AIM The aim of this study was to investigate whether the choice reforms in healthcare in Stockholm county in 2008 and 2013 changed the sociodemographic user patterns of outpatient healthcare services for children. METHODS The study used regional data on healthcare use linked to sociodemographic data from national registers in the total population of children 0-15 years in the Stockholm county. Change in use of healthcare services was analysed in multiple linear regression in a difference in differences approach of socio-economic indicators. RESULTS The choice reform of 2013 increased children's overall use of specialised care by around 30% until 2017 while primary care use decreased by the same degree. The mean number of physician visits in specialised care for children with severe asthma increased from 3.9 to 5.2 per year. Overall, children in families with low maternal education, low disposable income and a non-Western background increased their use of specialised care more than children from families with a more privileged socio-economic situation. CONCLUSION There was no indication that the choice reform in Stockholm county increased the social disparities in use of primary and specialised outpatient care for children, rather the opposite.
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Affiliation(s)
- Anders Hjern
- Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Clinical Epidemiology/Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Duffy KA, Gandhi R, Falke C, Wiglesworth A, Mueller BA, Fiecas MB, Klimes-Dougan B, Luciana M, Cullen KR. Psychiatric Diagnoses and Treatment in Nine- to Ten-Year-Old Participants in the ABCD Study. JAACAP OPEN 2023; 1:36-47. [PMID: 38405128 PMCID: PMC10890826 DOI: 10.1016/j.jaacop.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objective Psychiatric disorders commonly emerge prior to adulthood. Identification and intervention may vary significantly across populations. We leveraged a large population-based study to estimate the prevalence of psychiatric disorders and treatments, and evaluate predictors of treatment, in children ages 9-10 in the United States. Method We analyzed cross-sectional data from the Adolescent Brain Cognitive Developmental (ABCD) Study. The Computerized Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-COMP) was used to estimate clinical diagnoses, and the Child Behavior Checklist (CBCL) was used to assess internalizing and externalizing psychopathology. Parents reported on prescription medications and other mental health interventions. Prevalence rates of KSADS diagnoses and treatments were calculated. Logistic regression analyses estimated associations between clinical and sociodemographic predictors (sex at birth, race, ethnicity, income, education, urbanicity) and treatments. Results The most common KSADS diagnoses were anxiety disorders, followed by attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder. ADHD and depression diagnoses predicted stimulant and antidepressant medication use, respectively. Bipolar and ADHD diagnoses also predicted antidepressant medications, outpatient treatment and psychotherapy. The odds of reporting specific treatments varied by sex, ethnic and racial identities, urbanicity, and income. Conclusion Expected rates of KSADS-based psychiatric symptoms are present in the ABCD sample at ages 9-10, with treatment patterns broadly mapping onto psychopathology in expected ways. However, we observed important variations in reported treatment utilization across sociodemographic groups, likely reflecting societal and cultural influences. Findings are considered in the context of potential mental health disparities in U.S. children.
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Affiliation(s)
- Kelly A. Duffy
- University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Raghu Gandhi
- University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Chloe Falke
- University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | | | | | - Mark B. Fiecas
- University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | | | - Monica Luciana
- University of Minnesota, Minneapolis, Minnesota, 55455, USA
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Hall JM, Chakrabarti C, Mkuu R, Thompson LA, Shenkman EA, Theis RP. The Association of Socioeconomic Vulnerability and Race and Ethnicity With Disease Burden Among Children in a Statewide Medicaid Population. Acad Pediatr 2023; 23:372-380. [PMID: 36122832 DOI: 10.1016/j.acap.2022.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individuals enrolled in Medicaid have disproportionately worse health outcomes due to challenges related to Social Determinants of Health. We aim to examine the prevalence of 3 childhood conditions (asthma, type 2 diabetes, and attention deficit hyperactivity disorder [ADHD]) in children within the Texas Medicaid system. In order to recognize the layers of vulnerability, we examine prevalence at the intersection of socioeconomic status with race and ethnicity within this economically challenged population. METHODS Children ages 0 to 17 were identified from claims and encounter data for all children enrolled in Texas Medicaid in 2017 for at least 6 months. All children were placed into one of 5 quintiles based on their census tract socioeconomic vulnerability. The Rate Ratio statistical test was employed to identify the statistical significance of the disparity in health outcomes related to higher neighborhood vulnerability within each racial or ethnic group. RESULTS Asthma for each race and ethnicity group was significantly more prevalent in the higher vulnerability census tracts. Increased vulnerability related to significant increase in type 2 diabetes for Hispanic children, but not for other groups. Diagnosed ADHD prevalence was significantly higher in less vulnerable non-Hispanic white children compared to more vulnerable. CONCLUSIONS This study found that even among children who receive Medicaid and are thus economically disadvantaged, socioeconomic vulnerability applies an additional burden within racial and ethnic groups to produce disparities in health-related burden. However, the trend of the relationship varied by race and ethnicity group and health condition.
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Affiliation(s)
- Jaclyn M Hall
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla.
| | - Choeeta Chakrabarti
- Department of Anthropology, College of Arts and Sciences, Florida State University (C Chakrabarti), Tallahassee, Fla
| | - Rahma Mkuu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla; Department of Pediatrics, College of Medicine, University of Florida (LA Thompson), Gainesville, Fla
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla; Institute for Child Health Policy, University of Florida (JM Hall, LA Thompson, and EA Shenkman), Gainesville, Fla
| | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida (JM Hall, R Mkuu, LA Thompson, EA Shenkman, and RP Theis), Gainesville, Fla
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Developmental disorders among Norwegian-born children with immigrant parents. Child Adolesc Psychiatry Ment Health 2023; 17:3. [PMID: 36609392 PMCID: PMC9825022 DOI: 10.1186/s13034-022-00547-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Risk of being diagnosed with different developmental disorders is found to vary with immigrant background. Knowledge about such differences in Norway are a starting point for equity in health services quality, and for early identification and prevention. Our objective was to assess the risk of receiving diagnoses of developmental disorders among children born in Norway (2006-2017) to two or one immigrant parent compared to children with two Norwegian-born parents. METHODS Information on developmental disorders was from the Norwegian Patient Register (NPR) and information on immigrant background, parental country of origin, parental education, and household income from Statistics Norway. We estimated hazard ratios (HR) with Cox proportional hazard regressions. With children with Norwegian background as reference category, we estimated HRs for immigration background and region of origin. All analyses were adjusted for sex, year of birth, parental education, and household income. RESULTS Children with two immigrant parents had a lower risk of receiving any developmental disorder diagnosis [HR 0.80 (95% CI 0.77, 0.82)] than children with Norwegian background, and lower risk of being diagnosed with attention deficit hyperactivity disorder (ADHD) diagnosis [HR 0.24 (95% CI 0.22, 0.27)], learning difficulties diagnosis [HR 0.39 (95% CI 0.33, 0.47)], and behavioral and emotional disorders [HR 0.52 (95% CI 0.49, 0.55)]. Children with immigrant parents had higher hazard than Norwegian background children of autism spectrum disorder (ASD) [HR 2.21 (95% CI 2.04, 2.39)], mental retardation [HR 1.84 (95% CI 1.64, 2.07)], language disorders [HR 1.30 (95% CI 1.20, 1.40)], and unspecified developmental disorders [HR 1.22 (95% CI 1.17, 1.28)]. Children with only one immigrant parent had lower risk of diagnoses than children of two immigrants. CONCLUSION Risk of receiving a diagnosis of various developmental disorders varied substantially by immigrant background. Understanding the underlying mechanisms of these differences is warranted to ensure equity in health services and timely intervention.
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Gémes K, Taipale H, Björkenstam E, Rahman S, Gustafsson K, Tanskanen A, Ekselius L, Mittendorfer-Rutz E, Helgesson M. The role of sociodemographic and clinical factors in the initiation and discontinuation of attention deficit hyperactivity disorder medication among young adults in Sweden. Front Psychiatry 2023; 14:1152286. [PMID: 37168083 PMCID: PMC10165120 DOI: 10.3389/fpsyt.2023.1152286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Long-term medication use is a recommended treatment for attention-deficit/hyperactivity disorder (ADHD), however, discontinuation is common. Non-medical factors which might influence initiation and discontinuation are understudied. Therefore, we investigated how different sociodemographic factors and comorbidities were associated with the initiation and discontinuation of ADHD medication use among young adults. Methods and results We conducted a population-based prospective cohort study using individually linked administrative register data, in which we included all individuals residing in Sweden, between the age of 19 and 29 who were first diagnosed with ADHD between January 2006 and December 2016 (n = 59224). ADHD medication initiation was defined as the first prescription of ADHD medication in the period from 3 months before to 6 months after the cohort entry date. Those who initiated ADHD medication were followed up for medication use until discontinuation, death/emigration, or until 2019. Logistic and Cox regression models were used to investigate the associations between sociodemographics, health-related predictors and initiation, as well as discontinuation. Overall, 48.7% of the 41399 individuals initiated ADHD medication, most often methylphenidate (87%). Among the initiators, 15462 (77%) discontinued medication use during the follow-up (median time: 150 days). After mutually adjusting all other predictors, initiation was positively associated with older age, male sex, higher level of education, and negatively associated with living at home with parents, immigrant status, being unemployed during the year before inclusion, being on disability pension, having autism, substance use, schizophrenia-spectrum disorders, other mental disability/developmental disorders, cardiovascular diseases or previous accidents. Discontinuation was positively associated with being born abroad, living in big cities, being unemployed during the year before inclusion, having cancer, and negatively associated with a higher educational level, having depression, anxiety or stress-related disorder, autism spectrum disorder or diabetes. Conclusion Besides medical factors, sociodemographics, such as educational attainment and immigrant status might also play a role in the initiation and discontinuation of ADHD medication use among young adults newly diagnosed with ADHD.
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Affiliation(s)
- Katalin Gémes
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- *Correspondence: Katalin Gémes,
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Klas Gustafsson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Niuvanniemi Hospital, Kuopio, Finland
| | - Lisa Ekselius
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
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11
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Riglin L, Wootton RE, Livingston LA, Agnew-Blais J, Arseneault L, Blakey R, Agha SS, Langley K, Collishaw S, O’Donovan MC, Smith GD, Stergiakouli E, Tilling K, Thapar A. "Late-onset" ADHD symptoms in young adulthood: Is this ADHD? J Atten Disord 2022; 26:1271-1282. [PMID: 35034501 PMCID: PMC7612898 DOI: 10.1177/10870547211066486] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: We investigated whether "late-onset" ADHD that emerges in adolescence/adulthood is similar in risk factor profile to: (1) child-onset ADHD, but emerges later because of scaffolding/compensation from childhood resources; and (2) depression, because it typically onsets in adolescence/adulthood and shows symptom and genetic overlaps with ADHD. Methods: We examined associations between late-onset ADHD and ADHD risk factors, cognitive tasks, childhood resources and depression risk factors in a population-based cohort followed-up to age 25 years (N=4224-9764). Results: Parent-rated late-onset ADHD was like child-onset persistent ADHD in associations with ADHD polygenic risk scores and cognitive task performance, although self-rated late-onset ADHD was not. Late-onset ADHD was associated with higher levels of childhood resources than child-onset ADHD and did not show strong evidence of association with depression risk factors. Conclusions: Late-onset ADHD shares characteristics with child-onset ADHD when parent-rated, but differences for self-reports require investigation. Childhood resources may delay the onset of ADHD.
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Affiliation(s)
- Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Robyn E Wootton
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK,Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Lucy A Livingston
- School of Psychology, Cardiff University, Wales, UK,Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jessica Agnew-Blais
- Department of Psychology, School of Biological and Chemical Sciences, Queen Mary University London, UK
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rachel Blakey
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Sharifah Shameem Agha
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,Cwm Taf Morgannwg University Health Board, Wales, UK
| | - Kate Langley
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,School of Psychology, Cardiff University, Wales, UK
| | - Stephan Collishaw
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Michael C O’Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - George Davey Smith
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Evie Stergiakouli
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Tilling
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,Corresponding author. Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ. Tel: +442920 688325.
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12
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White H, Heck A, Jubran R, Chroust A, Bhatt RS. Average fixation duration in infancy: Stability and predictive utility. INFANCY 2022; 27:866-886. [PMID: 35624554 DOI: 10.1111/infa.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 11/27/2022]
Abstract
The current study examined the stability, consistency, and predictive utility of average fixation durations in infancy. In Study 1, infants' (N = 80) average fixation duration when viewing social stimuli was found to show strong relative stability from 3.5 to 9 months of age. In Study 2, strong within-infant consistency was found in 3.5-month-old infants' (N = 73) average fixation durations to social and nonsocial stimuli. In Study 3, 3.5- to 9-month-old infants' (N = 89) average fixation duration was found to systematically vary with parent-reported symptoms of attention deficit hyperactivity disorder (ADHD) at 4-6 years of age. These results suggest that average fixation duration serves as a stable and systematic measure of individual differences in cognitive development beginning early in life.
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Affiliation(s)
- Hannah White
- Department of Psychological Sciences, University of Missouri, St. Louis, Missouri, USA
| | - Alison Heck
- Department of Psychology, Berea College, Berea, Kentucky, USA
| | - Rachel Jubran
- Department of Behavioral & Social Sciences, University of Montevallo, Montevallo, Alabama, USA
| | - Alyson Chroust
- College of Arts and Sciences, East Tennessee State University, Johnson City, Tennessee, USA
| | - Ramesh S Bhatt
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
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13
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Social gradients in ADHD by household income and maternal education exposure during early childhood: Findings from birth cohort studies across six countries. PLoS One 2022; 17:e0264709. [PMID: 35294456 PMCID: PMC8926184 DOI: 10.1371/journal.pone.0264709] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/15/2022] [Indexed: 01/26/2023] Open
Abstract
Objective This study aimed to examine social gradients in ADHD during late childhood (age 9–11 years) using absolute and relative relationships with socioeconomic status exposure (household income, maternal education) during early childhood (<5 years) in seven cohorts from six industrialised countries (UK, Australia, Canada, The Netherlands, USA, Sweden). Methods Secondary analyses were conducted for each birth cohort. Risk ratios, pooled risk estimates, and absolute inequality, measured by the Slope Index of Inequality (SII), were estimated to quantify social gradients in ADHD during late childhood by household income and maternal education measured during early childhood. Estimates were adjusted for child sex, mother age at birth, mother ethnicity, and multiple births. Findings All cohorts demonstrated social gradients by household income and maternal education in early childhood, except for maternal education in Quebec. Pooled risk estimates, relating to 44,925 children, yielded expected gradients (income: low 1.83(CI 1.38,2.41), middle 1.42(1.13,1.79), high (reference); maternal education: low 2.13(1.39,3.25), middle 1.42(1.13,1.79)). Estimates of absolute inequality using SII showed that the largest differences in ADHD prevalence between the highest and lowest levels of maternal education were observed in Australia (4% lower) and Sweden (3% lower); for household income, the largest differences were observed in Quebec (6% lower) and Canada (all provinces: 5% lower). Conclusion Findings indicate that children in families with high household income or maternal education are less likely to have ADHD at age 9–11. Absolute inequality, in combination with relative inequality, provides a more complete account of the socioeconomic status and ADHD relationship in different high-income countries. While the study design precludes causal inference, the linear relation between early childhood social circumstances and later ADHD suggests a potential role for policies that promote high levels of education, especially among women, and adequate levels of household income over children’s early years in reducing risk of later ADHD.
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14
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Michaëlsson M, Yuan S, Melhus H, Baron JA, Byberg L, Larsson SC, Michaëlsson K. The impact and causal directions for the associations between diagnosis of ADHD, socioeconomic status, and intelligence by use of a bi-directional two-sample Mendelian randomization design. BMC Med 2022; 20:106. [PMID: 35399077 PMCID: PMC8996513 DOI: 10.1186/s12916-022-02314-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/21/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Previous studies have reported associations between attention-deficit/hyperactivity disorder (ADHD) and lower socioeconomic status and intelligence. We aimed to evaluate the causal directions and strengths for these associations by use of a bi-directional two-sample Mendelian randomization (MR) design. METHODS We used summary-level data from the largest available genome-wide association studies (GWAS) to identify genetic instruments for ADHD, intelligence, and markers of socioeconomic status including the Townsend deprivation index, household income, and educational attainment. Effect estimates from individual genetic variants were combined using inverse-variance weighted regression. RESULTS A genetically predicted one standard deviation (SD) increment in the Townsend deprivation index conferred an odds ratio (OR) of 5.29 (95% confidence interval (CI) 1.89-14.76) for an ADHD diagnosis (p<0.001). A genetically predicted one SD higher education level conferred an OR of 0.30 (95% CI 0.25-0.37) (p<0.001), and a genetically predicted one SD higher family income provided an OR of 0.35 (95% CI 0.25-0.49; p<0.001). The associations remained after adjustment for intelligence whereas the lower odds of an ADHD diagnosis with higher intelligence did not persist after adjustment for liability to greater educational attainment (adjusted OR 1.03, 95% CI 0.68-1.56; p=0.87). The MR analysis of the effect of ADHD on socioeconomic markers found that genetic liability to ADHD was statistically associated with each of them (p<0.001) but not intelligence. However, the average change in the socioeconomic markers per doubling of the prevalence of ADHD corresponded only to 0.05-0.06 SD changes. CONCLUSIONS Our results indicate that an ADHD diagnosis may be a direct and strong intelligence-independent consequence of socioeconomic related factors, whereas ADHD appears to lead only to modestly lowered socioeconomic status. Low intelligence seems not to be a major independent cause or consequence of ADHD.
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Affiliation(s)
| | - Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Clinical Pharmacology, Uppsala University, Uppsala, Sweden
| | - John A Baron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Unit of Medical Epidemiology, Uppsala University, Uppsala, Sweden.
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15
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Iv N, Herbein M, Heude B, van der Waerden J, Melchior M, Feart C, Delcourt C, Côté S, De Lauzon-Guillain B, Lioret S, Galera C. Children's Diet at 2 Years and Trajectories of Hyperactivity-Inattention Symptoms and Conduct Problems Between 3 and 8 Years: The EDEN Cohort. J Nutr 2022; 152:484-491. [PMID: 35051294 DOI: 10.1093/jn/nxab398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although the role of diet is increasingly acknowledged in psychiatry, data are still scarce regarding its early impact on the most significant behavioral disorders of childhood (i.e., hyperactivity-inattention and conduct problems). OBJECTIVES The objective of this study was to explore the relation between children's dietary patterns at 2 years and developmental trajectories of hyperactivity-inattention and conduct problems between 3 and 8 years. METHODS We recruited 1432 mother-child dyads from the French EDEN (etude sur les déterminants pré- et postnatals du développement et de la santé de l'enfant) mother-child cohort to conduct the analyses. Three dietary patterns, labeled guidelines, processed and fast foods, and baby foods, were identified using an FFQ in children aged 2 years in a previous study. The Strengths and Difficulties Questionnaire was used to assess hyperactivity-inattention and conduct problems at 3, 5, and 8 years of age and build related trajectories from 3 to 8 years. The relation between children's dietary patterns at 2 years and the worst developmental trajectories of hyperactivity-inattention and conduct problems were determined with multivariable logistic regressions adjusted for potential socioeconomic, maternal, and child confounders. RESULTS The score on the guidelines dietary pattern was negatively associated with the risk of hyperactivity-inattention problems (OR: 0.75; 95% CI: 0.60-0.94), contrary to adherence to the baby foods dietary pattern (OR: 1.41; 95% CI: 1.16-1.71). CONCLUSIONS Distinct patterns of children's diet at 2 years were predictive of developmental trajectories of hyperactivity-inattention problems between 3 and 8 years. These results highlight the relevance of conducting further studies to clarify the mechanisms involved.
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Affiliation(s)
- Nicolas Iv
- Institut national de la santé et de la recherche médicale (INSERM) unité mixte de recherche 1219 (UMR1219), Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Marie Herbein
- Institut national de la santé et de la recherche médicale (INSERM) unité mixte de recherche 1219 (UMR1219), Bordeaux, France.,University of Bordeaux, Bordeaux, France.,Centre Hospitalier Perrens, Bordeaux, France
| | - Barbara Heude
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France
| | - Judith van der Waerden
- Social Epidemiology Research Group, Institut Pierre Louis d'Epidémiologie et de Santée Publique (IPLESP), Institut national de la santé et de la recherche médicale (INSERM), unité mixte de recherche scientifique (UMR-S) 1136, Paris, France.,Sorbonne Universitées, Université Pierre-et-Marie-Curie (UPMC) Univ Paris 06, Paris, France
| | - Maria Melchior
- Social Epidemiology Research Group, Institut Pierre Louis d'Epidémiologie et de Santée Publique (IPLESP), Institut national de la santé et de la recherche médicale (INSERM), unité mixte de recherche scientifique (UMR-S) 1136, Paris, France.,Sorbonne Universitées, Université Pierre-et-Marie-Curie (UPMC) Univ Paris 06, Paris, France
| | - Catherine Feart
- Institut national de la santé et de la recherche médicale (INSERM) unité mixte de recherche 1219 (UMR1219), Bordeaux, France
| | - Cécile Delcourt
- Institut national de la santé et de la recherche médicale (INSERM) unité mixte de recherche 1219 (UMR1219), Bordeaux, France
| | - Sylvana Côté
- Institut national de la santé et de la recherche médicale (INSERM) unité mixte de recherche 1219 (UMR1219), Bordeaux, France.,Centre Hospitalier Perrens, Bordeaux, France.,Research Unit on Children's Psychosocial Maladjustment, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Blandine De Lauzon-Guillain
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France
| | - Sandrine Lioret
- Université de Paris, Centre for Research in Epidemiology and Statistics (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France
| | - Cédric Galera
- Institut national de la santé et de la recherche médicale (INSERM) unité mixte de recherche 1219 (UMR1219), Bordeaux, France.,University of Bordeaux, Bordeaux, France.,Centre Hospitalier Perrens, Bordeaux, France.,Research Unit on Children's Psychosocial Maladjustment, Montreal, Quebec, Canada
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16
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Dardani C, Riglin L, Leppert B, Sanderson E, Rai D, Howe LD, Davey Smith G, Tilling K, Thapar A, Davies NM, Anderson E, Stergiakouli E. Is genetic liability to ADHD and ASD causally linked to educational attainment? Int J Epidemiol 2022; 50:2011-2023. [PMID: 34999873 PMCID: PMC8743131 DOI: 10.1093/ije/dyab107] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The association patterns of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) with educational attainment (EA) are complex; children with ADHD and ASD are at risk of poor academic outcomes, and parental EA has been associated with risk of ADHD/ASD in the offspring. Little is known on the causal links between ADHD, ASD, EA and the potential contribution of cognitive ability. METHODS Using the latest genome-wide association studies (GWAS) summary data on ADHD, ASD and EA, we applied two-sample Mendelian randomization (MR) to assess the effects of genetic liability to ADHD and ASD on EA. Reverse direction analyses were additionally performed. Multivariable MR was performed to estimate any effects independent of cognitive ability. RESULTS Genetic liability to ADHD had a negative effect on EA, independently of cognitive ability (MVMRIVW: -1.7 months of education per doubling of genetic liability to ADHD; 95% CI: -2.8 to -0.7), whereas genetic liability to ASD a positive effect (MVMRIVW: 30 days per doubling of the genetic liability to ASD; 95% CI: 2 to 53). Reverse direction analyses suggested that genetic liability to higher EA had an effect on lower risk of ADHD, independently of cognitive ability (MVMRIVWOR: 0.33 per SD increase; 95% CI: 0.26 to 0.43) and increased risk of ASD (MRIVWOR: 1.51 per SD increase; 95% CI: 1.29 to 1.77), which was partly explained by cognitive ability (MVMRIVWOR per SD increase: 1.24; 95%CI: 0.96 to 1.60). CONCLUSIONS Genetic liability to ADHD and ASD is likely to affect educational attainment, independently of underlying cognitive ability.
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Affiliation(s)
- Christina Dardani
- Centre of Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Beate Leppert
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eleanor Sanderson
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dheeraj Rai
- Centre of Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura D Howe
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Emma Anderson
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Evie Stergiakouli
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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17
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Peasgood T, Bhardwaj A, Brazier JE, Biggs K, Coghill D, Daley D, Cooper CL, De Silva C, Harpin V, Hodgkins P, Nadkarni A, Setyawan J, Sonuga-Barke EJS. What Is the Health and Well-Being Burden for Parents Living With a Child With ADHD in the United Kingdom? J Atten Disord 2021; 25:1962-1976. [PMID: 32552265 PMCID: PMC8527548 DOI: 10.1177/1087054720925899] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective: To explore the burden associated with childhood ADHD in a large observational study. Methods: We recruited familes with at least one child (6-18 years) with ADHD via 15 NHS trusts in the UK, and collected data from all family members. We made careful adjustments to ensure a like-for-like comparison with two different control groups, and explored the impact of controlling for a positive parental/carer ADHD screen, employment, and relationship status. Results: We found significant negative impacts of childhood ADHD on parents'/carers' hours and quality of sleep, satisfaction with leisure time, and health-related quality of life (measured by the EuroQol-5D [EQ-5D]). We found a decrement in life satisfaction, mental well-being (as measured by the Short-Warwick Edinburgh Mental Well-Being Scale [S-WEMWBS]), and satisfaction with intimate relationships, but this was not always robust across the different control groups. We did not find any decrement in satisfaction with health, self-reported health status, or satisfaction with income. Conclusion: The study quantifies the impact on the health and well-being of parents living with a child with ADHD using a survey of families attending ADHD clinics in the United Kingdom.
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Affiliation(s)
- Tessa Peasgood
- School of Health and Related Research
(ScHARR), Sheffield, UK
| | - Anupam Bhardwaj
- Cambridgeshire and Peterborough NHS
Foundation Trust, Cambridge, UK
| | - John E. Brazier
- School of Health and Related Research
(ScHARR), Sheffield, UK
| | - Katie Biggs
- Clinical Trials Research Unit (CTRU),
ScHARR, Sheffield, UK,Katie Biggs, Clinical Trials Research Unit,
School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield
S1 4DA, UK.
| | - David Coghill
- Department of Paediatrics &
Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - David Daley
- Division of Psychiatry & Applied
Psychology & Centre for ADHD and Neurodevelopmental Disorders Across the
Lifespan, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | | | - Val Harpin
- Sheffield Children’s NHS Foundation
Trust, UK
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18
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Bernstorff M, Rask CU, Rytter D, Hansen SN, Bech BH. Pre-adolescents with multiple health complaints redeem more prescriptions: A follow-up study in the Danish National Birth Cohort. Scand J Public Health 2021; 50:1071-1080. [PMID: 34448658 DOI: 10.1177/14034948211036619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: This study aimed to examine the association between multiple health complaints (MHC) in pre-adolescence and prescription redemption in adolescence. Methods: This was a nationwide population-based study based on the Danish National Birth Cohort for an average of 6.9 years (2010-2018). A total of 96,382 children were invited at the age of 11. A modified version of the Health Behaviour in School Children Symptom Checklist was dichotomised into the World Health Organization's definition of MHC (⩾2 complaints, each with a frequency of at least weekly, yes/no). The number of prescriptions was retrieved from Danish registries. Negative binomial regression estimated incidence rate ratios (IRRs) comparing children with MHC to children without. Prescription redemption was further stratified by psychiatric/somatic medication and into subtypes of prescriptions. Results: A total of 47,365 (49.1%) children participated (Mage=11.2 years, 52% girls). MHC were reported by 10.3%. The unadjusted IRR (MHC vs. no MHC) of all types of redemptions was 1.57 (95% confidence interval (CI) 1.49-1.64). Results were robust to adjustment for socio-demographic variables and somatic/psychiatric morbidity at baseline (IRR=1.47; 95% CI 1.40-1.54). Associations were especially strong for psychiatric medication (adjusted IRR=3.88; 95% CI 3.43-4.40) and were modified by neither sex nor maternal education. Conclusions: MHC in pre-adolescents predict prescription redemption. This implies that changes in MHC might be indicative of changes in public health. This requires further study, as the cause of a change in reporting of symptoms might also cause a change in treatment response. The latter determines whether prescriptions are treating ill-being or needlessly medicalising subjective symptoms.
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Affiliation(s)
- Martin Bernstorff
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark
| | - Charlotte Ulrikka Rask
- Research Unit for Biostatistics, Department of Public Health, Aarhus University, Denmark.,Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Dorte Rytter
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark
| | - Stefan Nygaard Hansen
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Denmark
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19
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Batstra L, Foget L, van Haeringen C, Te Meerman S, Thoutenhoofd ED. What children and young people learn about ADHD from youth information books: A text analysis of nine books on ADHD available in Dutch. Scand J Child Adolesc Psychiatr Psychol 2021; 8:1-9. [PMID: 33520773 PMCID: PMC7685495 DOI: 10.21307/sjcapp-2020-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is not a singular concept. For the purposes of this study, understandings of ADHD are assumed also to spread along a conceptual dimension that includes some combination of biomedical and psychosocial knowledge. Biomedically, ADHD may be considered a somatic affliction causing inattention and hyperactivity, amenable to pharmaceutical treatment. Psychosocially, ADHD ranks among adverse behaviour patterns that are amenable to psychosocial and pedagogical intervention. Considering both biomedical and psychosocial factors are associated with the ADHD construct, it seems self-evident that young people should be offered information that gives equal consideration to both ways of addressing ADHD, but the question is just how balanced the information available to young people is. This study investigated nine information books on ADHD available in the Netherlands in Dutch, aimed at children and young people up to age 17. Thirteen perspective-dependent text elements were identified in qualitative content analysis. Eight attributes associate with a biomedical view: ADHD as cause, biological factors, clinical diagnosis, brain abnormality, medication, neurofeedback, heritability and persistence. Five text elements associate with a psychosocial view: ADHD as perceived behaviour, environmental factors, descriptive diagnosis, behavioural intervention and normalisation. The most frequent text passages encountered describe ADHD as a brain abnormality, along with medical and behavioural treatment. Providing the main focus for information in eight out of nine books, biomedical information about ADHD predominates in the available youth information books, while psychosocial information about ADHD is far less well covered.
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Affiliation(s)
- Laura Batstra
- Faculty of Behavioral and Social Sciences, The University of Groningen, Groningen, The Netherlands
| | - Linda Foget
- Faculty of Behavioral and Social Sciences, The University of Groningen, Groningen, The Netherlands
| | - Caroline van Haeringen
- Faculty of Behavioral and Social Sciences, The University of Groningen, Groningen, The Netherlands
| | - Sanne Te Meerman
- Youth, Education and Society, Centre of Expertise Healthy Ageing, Hanze University of Applied Sciences, Groningen, The Netherlands
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20
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Mykletun A, Widding-Havneraas T, Chaulagain A, Lyhmann I, Bjelland I, Halmøy A, Elwert F, Butterworth P, Markussen S, Zachrisson HD, Rypdal K. Causal modelling of variation in clinical practice and long-term outcomes of ADHD using Norwegian registry data: the ADHD controversy project. BMJ Open 2021; 11:e041698. [PMID: 33468528 PMCID: PMC7817799 DOI: 10.1136/bmjopen-2020-041698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is among the most common mental disorders in children and adolescents, and it is a strong risk factor for several adverse psychosocial outcomes over the lifespan. There are large between-country and within-country variations in diagnosis and medication rates. Due to ethical and practical considerations, a few studies have examined the effects of receiving a diagnosis, and there is a lack of research on effects of medication on long-term outcomes.Our project has four aims organised in four work packages: (WP1) To examine the prognosis of ADHD (with and without medication) compared with patients with other psychiatric diagnoses, patients in contact with public sector child and adolescent psychiatric outpatient clinics (without diagnosis) and the general population; (WP2) Examine within-country variation in ADHD diagnoses and medication rates by clinics' catchment area; and(WP3) Identify causal effects of being diagnosed with ADHD and (WP4) ADHD medication on long-term outcomes. METHOD AND ANALYSIS Our project links several nationwide Norwegian registries. The patient sample is all persons aged 5-18 years that were in contact with public sector child and adolescent psychiatric outpatient clinics in 2009-2011. Our comparative analysis of prognosis will be based on survival analysis and mixed-effects models. Our analysis of variation will apply mixed-effects models and generalised linear models. We have two identification strategies for the effect of being diagnosed with ADHD and of receiving medication on long-term outcomes. Both strategies rely on using preference-based instrumental variables, which in our project are based on provider preferences for ADHD diagnosis and medication. ETHICS AND DISSEMINATION The project is approved by the Regional Ethics Committee, Norway (REC number 2017/2150/REC south-east D). All papers will be published in open-access journals and results will be presented in national and international conferences. TRIAL REGISTRATION NUMBERS ISRCTN11573246 and ISRCTN11891971.
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Affiliation(s)
- Arnstein Mykletun
- Department of Community Medicine, University of Tromso Faculty of Health Sciences, Tromso, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ashmita Chaulagain
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Lyhmann
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvar Bjelland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Anne Halmøy
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Felix Elwert
- Department of Sociology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Peter Butterworth
- Research School of Population Health, The Australian National University, Canberra, Victoria, Australia
| | | | | | - Knut Rypdal
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
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21
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Muggli Z, Mertens T, -Sá S, Amado R, Teixeira AL, Vaz D, O. Martins MR. Migration as a Determinant in the Development of Children Emotional and Behavior Problems: A Quantitative Study for Lisbon Region, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020375. [PMID: 33418982 PMCID: PMC7825293 DOI: 10.3390/ijerph18020375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/26/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
The role of migration as a determinant in child mental health has been demonstrated in a number of studies. However, results are not always consistent, and the research continues to be scarce, especially in Portugal. We examined the association between sociodemographic profiles and the chance for the development of emotional and behavioral difficulties in a group of 420 children, immigrant (n = 217) and born in Portugal to Portuguese born parents (n = 203). We used a structured questionnaire to obtain sociodemographic information and the Strength and Difficulties Questionnaire (SDQ). Descriptive statistics were used to characterize children and their families; variables were compared between groups using the Chi-squared, Fisher’s Exact Test, or the Mann–Whitney U test and logistic regression was used to analyze the association between socio-demographic factors and emotional and behavioral difficulties. Results showed a pattern of social and mental health inequalities with immigrant children at a disadvantage: they are more often part of families with low income and where parents had low skilled jobs. Internalizing behaviors are more frequent in immigrants than in children born in Portugal to Portuguese-born parents (p = 0.001) whereas a high total SDQ difficulties score (p = 0.039) and externalizing behaviors were more frequent in 1st generation immigrant children (p = 0.009). A low family income (aOR 4.5; 95% CI: 1.43–13.95), low parental education level (aOR 2.5; 95% CI: 1.11–5.16), and being a first-generation immigrant child (aOR 2.2; 95% CI: 1.06–4.76) increased significantly the chance of developing emotional and behavioral difficulties. This study contributes to the identification of children vulnerable to mental health problems who can benefit from monitoring, early detection and preventive interventions in order to mitigate possible negative outcomes in the future.
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Affiliation(s)
- Zélia Muggli
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisboa, 1349-008 Lisbon, Portugal; (Z.M.); (T.M.); (S.-S.); (R.A.)
| | - Thierry Mertens
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisboa, 1349-008 Lisbon, Portugal; (Z.M.); (T.M.); (S.-S.); (R.A.)
| | - Silva -Sá
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisboa, 1349-008 Lisbon, Portugal; (Z.M.); (T.M.); (S.-S.); (R.A.)
| | - Regina Amado
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisboa, 1349-008 Lisbon, Portugal; (Z.M.); (T.M.); (S.-S.); (R.A.)
| | - Ana L. Teixeira
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Faculty of Social Sciences and Humanities (NOVA FCSH), 1070-312 Lisbon, Portugal;
| | - Dora Vaz
- Amadora Primary Care Health Centers Group, Regional Health Administration of Lisbon and Tagus Valley, 2700-856 Amadora, Portugal;
| | - Maria Rosário O. Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisboa, 1349-008 Lisbon, Portugal; (Z.M.); (T.M.); (S.-S.); (R.A.)
- Correspondence:
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22
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Hemmingsen CH, Kjaer SK, Jezek AH, Verhulst FC, Pagsberg AK, Kamper-Jørgensen M, Mørch LS, Hargreave M. Maternal use of hormonal contraception and risk of childhood ADHD: a nationwide population-based cohort study. Eur J Epidemiol 2020; 35:795-805. [PMID: 32968938 DOI: 10.1007/s10654-020-00673-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Abstract
Although maternal use of hormones has been suspected of increasing the risk for childhood attention-deficit/hyperactivity disorder (ADHD), no study has examined hormonal contraception use in this context. We examined the association between maternal hormonal contraception use before or during pregnancy and ADHD risk in children. This nationwide population-based cohort study included 1,056,846 children born in Denmark between 1998 and 2014. Prescriptions for hormonal contraceptives redeemed by the mother was categorized as: no use, previous use (> 3 months before pregnancy), and recent use (≤ 3 months before or during pregnancy). Children were followed for ADHD, from birth until 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During 9,819,565 person-years of follow-up (median: 9.2), ADHD was diagnosed or a prescription for ADHD medication redeemed for 23,380 children (2.2%). The adjusted HR for ADHD was higher in children of mothers who had previously (HR 1.23; 95% CI 1.18-1.28) or recently (HR 1.30; 95% CI 1.24-1.37) used hormonal contraception than in those of mothers with no use. The highest estimates were seen for use of non-oral progestin products with HRs of 1.90 (95% CI 1.59-2.26) for previous use, 2.23 (95% CI 1.96-2.54) for recent use, and 3.10 (95% CI 1.62-5.91) for use during pregnancy. Maternal use of hormonal contraception was associated with an increased risk for ADHD in the offspring; more pronounced for non-oral progestin-only than other products.
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Affiliation(s)
- Caroline H Hemmingsen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark
| | - Andrea H Jezek
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Kamper-Jørgensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lina S Mørch
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marie Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
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23
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Oerbeck B, Furu K, Zeiner P, Aase H, Reichborn-Kjennerud T, Pripp AH, Overgaard KR. Child and Parental Characteristics of Medication Use for Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:456-464. [PMID: 32672488 PMCID: PMC7475088 DOI: 10.1089/cap.2019.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: To investigate child and parental characteristics of medication use for attention-deficit/hyperactivity disorder (ADHD). Methods: Participants were part of the prospective population-based Norwegian Mother, Father and Child Cohort study (MoBa) (n = 114,500 children, 95,000 mothers, and 75,000 fathers). This cohort was linked to the Norwegian Prescription Database (NorPD) and the Norwegian Patient Registry (NPR) to compare child and parental characteristics in children medicated and not medicated for ADHD during years 2008-2013. Results: One thousand seven hundred and sixty-four children (74% boys) with ADHD (International Classification of Diseases [ICD-10]: F90 and F98.8) were identified. One thousand three hundred and sixty-two (77%) used medication. Boys and girls did not differ in the use of ADHD medication (both 77%). Mean age at first prescription was 9 years in both boys and girls, and age at ADHD diagnosis was 8 years in medicated and unmedicated children. Significantly more hyperkinetic conduct disorders (F90.1), and significantly fewer with attention-deficit disorder (F98.8) were found among the medicated children compared to the unmedicated children. The medicated children also had a significantly lower global functioning (Child Global Assessment Scale). Child disruptive symptoms reported in the MoBa child age 3 year questionnaire were significantly higher in children who used medication compared to the nonusers (t = 2.2, p = 0.03), and group differences in ADHD symptoms at age 3 years were close to significant (t = 1.8, p = 0.07). Other preschool child and parental characteristics were not significantly different in the two groups. Conclusion: In this large birth cohort study, where a great majority of children with ADHD used medication, only child characteristics were significantly associated with the use of medication. We could not replicate previous findings suggesting that "environmental factors," such as parental education and psychopathology, drive medication use. The small differences between medicated and unmedicated children in this cohort study, where a majority used medication, might be due to strong established clinical practices where medication is offered as a treatment option, particularly for hyperkinetic conduct disorder in an egalitarian high-income society.
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Affiliation(s)
- Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Address correspondence to: Beate Oerbeck, PhD, Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, Oslo 0424, Norway
| | - Kari Furu
- Department of Chronic Diseases & Ageing, Centre of Fertility & Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pal Zeiner
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Heidi Aase
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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24
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Torvik FA, Eilertsen EM, McAdams TA, Gustavson K, Zachrisson HD, Brandlistuen R, Gjerde LC, Havdahl A, Stoltenberg C, Ask H, Ystrom E. Mechanisms linking parental educational attainment with child ADHD, depression, and academic problems: a study of extended families in The Norwegian Mother, Father and Child Cohort Study. J Child Psychol Psychiatry 2020; 61:1009-1018. [PMID: 31957030 PMCID: PMC8607471 DOI: 10.1111/jcpp.13197] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Low educational attainment in parents is associated with child psychopathology. It is not clear whether the associations are due to risk factors that family members share or due to effects of maternal or paternal education on the offspring. We investigate whether associations between maternal and paternal educational attainment and child symptoms of attention deficit/hyperactivity disorder (ADHD), depression, and academic problems are due to shared genetic factors, shared family environmental factors, or effects of the parental phenotype educational attainment itself. METHODS This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The sample comprised 34,958 children (17,128 girls) in 28,372 extended-family units. We used data from related nuclear families linked by siblings in the parent generation. We applied a quasi-experimental extended children-of-twins design that included siblings in both generations and took account of nonrandom mating by including partners. Educational attainment was self-reported by mothers and fathers. Mothers reported children's symptoms of ADHD, symptoms of depression, and academic problems by questionnaire when the children were 8 years old. RESULTS Children of lowly educated parents scored higher on all outcomes and had an approximate doubling of the risk of high symptom levels. The association between maternal and paternal educational attainment and child symptoms of ADHD and academic problems persisted after controlling for shared genetic and family environmental factors. Phenotypic transmission to depression was weaker and in the best fitting model fully explained by genetic factors shared by the two generations. CONCLUSIONS Associations between educational attainment of mothers and fathers and child symptoms of ADHD and academic problems could not be ascribed to shared familial risk factors, whereas associations with symptoms of depression could. Parental education or resources and behaviors resulting from low education might be targets of interventions aimed at reducing symptoms of ADHD and academic problems.
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Affiliation(s)
- Fartein Ask Torvik
- Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway,Department of PsychologyUniversity of OsloOsloNorway
| | | | - Tom A. McAdams
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Promenta Research CentreUniversity of OsloOsloNorway
| | - Kristin Gustavson
- Department of PsychologyUniversity of OsloOsloNorway,Norwegian Institute of Public HealthOsloNorway
| | | | | | - Line C. Gjerde
- Norwegian Institute of Public HealthOsloNorway,Promenta Research CentreUniversity of OsloOsloNorway
| | - Alexandra Havdahl
- Norwegian Institute of Public HealthOsloNorway,Nic Waals InstituteLovisenberg Diaconal HospitalOsloNorway,MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Camilla Stoltenberg
- Norwegian Institute of Public HealthOsloNorway,Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Helga Ask
- Norwegian Institute of Public HealthOsloNorway
| | - Eivind Ystrom
- Norwegian Institute of Public HealthOsloNorway,Promenta Research CentreUniversity of OsloOsloNorway,PharmacoEpidemiology and Drug Safety Research GroupSchool of PharmacyUniversity of OsloOsloNorway
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25
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dosReis S, Zhang C, Qato DM, Camelo Castillo W, Reeves G. Family Adverse Experiences and Psychotropic Polypharmacy Among US Youth: 2009-2015. Pediatrics 2020; 145:peds.2019-2705. [PMID: 32430443 DOI: 10.1542/peds.2019-2705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine if adverse family factors are associated with a higher likelihood of psychotropic polypharmacy among US youth with a mental health condition. METHODS The 2009-2015 Medical Expenditure Panel Survey data were used to identify family characteristics of 5136 youth aged ≤18 years with an emotional or behavioral health condition. Family adversity was based on family size, number of parents in the household, parental education and income, and parent-reported physical and/or cognitive or mental health disability. Cluster analysis identified family adversity subgroups. Polypharmacy was defined as 3 or more psychotropic classes (eg, stimulants, antipsychotics, antidepressants, mood stabilizers, and sedatives) in at least 1 interview round in a calendar year. Weighted logistic regression evaluated associations between family adversity and psychotropic polypharmacy among youth. RESULTS Nearly half (47.8%) of youth lived with parents who had a disability. Parents in the least socioeconomically disadvantaged cluster mainly had a mental illness, and 94% of parents in the most socioeconomically disadvantaged cluster had a parent-reported physical and/or cognitive disability and mental illness. Among youth, mood disorder (24.2%; 95% confidence interval [CI]: 12.6%-16.0%), antidepressant use (16.0%; 95% CI: 10.6%-21.5%), and antipsychotic use (7.5%; 95% CI: 5.4%-9.6%) were higher in the most socioeconomically disadvantaged cluster relative to the other clusters. Approximately 3% of youth received psychotropic polypharmacy. The odds of psychotropic polypharmacy were 2.7 (95% CI: 1.1-6.4) times greater among youth in the most relative to the least socioeconomically disadvantaged cluster. CONCLUSIONS Higher use of psychotropic polypharmacy among youth with parents who have multiple disabilities raises concerns about oversight and monitoring of complex psychotropic treatment.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Chengchen Zhang
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Wendy Camelo Castillo
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, School of Medicine and
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26
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Keilow M, Wu C, Obel C. Cumulative social disadvantage and risk of attention deficit hyperactivity disorder: Results from a nationwide cohort study. SSM Popul Health 2020; 10:100548. [PMID: 32072007 PMCID: PMC7016018 DOI: 10.1016/j.ssmph.2020.100548] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 11/16/2022] Open
Abstract
Socioeconomic factors correlate with mental health and affect individual life chances. However, the influence of specific and cumulative social disadvantages on children's mental health problems has received little attention. Previous studies have primarily used global measures of mental health problems or aggregated indicators of socioeconomic status. We contribute to this research by including multiple indicators of parental social disadvantage to study independent and accumulative effects. The study focuses on the Attention Deficit/Hyperactivity Disorder (ADHD), which is known to affect children's educational and socioeconomic trajectories. ADHD is one of the most common child mental health problems and although heredity has been estimated to 76 percent, research suggests that a large social component remains in the prevalence. We exploit comprehensive high-quality registry data for the entire population of children born 1990-1999 in Denmark (N = 632,725). The ADHD prevalence is 3.68 percent. Estimates from linear probability models show that parental unemployment, relative income poverty, and low educational attainment increase children's risk of ADHD with 2.1 (95% CI 1.8-2.3), 2.3 (95% CI 2.1-2.5), and 3.5 percentage points (95% CI 3.3-3.7), respectively. Children who live with all three disadvantages face an increased risk of 4.9 percentage points.
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Affiliation(s)
- Maria Keilow
- VIVE – the Danish Center for Social Science Research, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chunsen Wu
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Aarhus, Denmark
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27
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Nunn SPT, Kritsotakis EI, Harpin V, Parker J. Social gradients in the receipt of medication for attention-deficit hyperactivity disorder in children and young people in Sheffield. BJPsych Open 2020; 6:e14. [PMID: 32029022 PMCID: PMC7176834 DOI: 10.1192/bjo.2019.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by inattention and hyperactivity-impulsivity that can affect people throughout their life course. A social gradient exists in the prevalence of ADHD in the UK. Studies in other countries have shown that social gradients also exist in the receipt of medication for ADHD. Socioeconomic position is potentially an unrecognised and modifiable factor in children and young people's receipt of medication for ADHD in the UK. AIM The aim of the study was to investigate if socioeconomic position could explain in part whether or not children and young people in Sheffield are receiving medication for ADHD. METHOD We used multivariate logistic regression modelling to investigate whether socioeconomic position could explain variation in receipt of medication for ADHD in children and young people in a cross-sectional study. We collected data from 1354 children and young people with a diagnosis of ADHD across three Sheffield centres between January and December 2016. Independent variables were age, gender, religion, ethnicity, comorbidities, and Index of Multiple Deprivation decile (derived from home postcode). RESULTS Our results showed a social gradient in the receipt of medication for ADHD (P<0.01); an increase in one decile of the Index of Multiple Deprivation was associated with 10% lower odds of receipt of medication for ADHD (adjusted odds ratio 0.90, 95% CI 0.84-0.97). CONCLUSION Children and young people from more deprived backgrounds are more likely to receive medication for ADHD. This is the first time that a social gradient in children and young people's receipt of medication for ADHD has been shown in a UK sample.
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Affiliation(s)
| | - Evangelos I Kritsotakis
- Honorary Lecturer in Epidemiology & Medical Statistics, School of Health and Related Research, University of Sheffield, UK; and Associate Professor of Biostatistics, School of Medicine, University of Crete, Greece
| | - Val Harpin
- Consultant Neurodevelopmental Paediatrician, Ryegate Children's Centre, UK
| | - Jack Parker
- Research Fellow, School of Health and Related Research, University of Sheffield, UK
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28
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Wernersson R, Johansson J, Andersson M, Jarbin H. Evaluation of a new model for assessment and treatment of uncomplicated ADHD - effect, patient satisfaction and costs. Nord J Psychiatry 2020; 74:96-104. [PMID: 31596156 DOI: 10.1080/08039488.2019.1674377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: Attention-deficit/hyperactivity disorder (ADHD) is the most common diagnosis within child- and adolescent psychiatry. Waiting lists and delayed care are major issues. The aim was to evaluate if standardized care (SC) for assessment and treatment of uncomplicated ADHD would reduce resource utilization and increase satisfaction with preserved improvement within the first year of treatment.Method: Patients 6-12 years with positive screen for uncomplicated ADHD at the brief child and family phone interview (BCFPI), a routine clinical procedure, were triaged to SC. The control group consisted of patients diagnosed with ADHD in 2014 and treated as usual. BCFPI factors at baseline and follow-up after one year and resource utilization were compared.Results: Patients improved in ADHD symptoms (Cohen's d = 0.78, p < 0.001), child function (Cohen's d = 0.80, p < 0.001) and in family situation (Cohen's d = 0.61, p < 0.001) without group differences. Parents of SC patients participated more often in psychoeducational groups (75.5 vs. 49.5%, p < 0.001). SC had shorter time to ADHD diagnosis (8.4 vs. 15.6 weeks, p = 0.01) and to medication (24.6 vs. 32.1 weeks, p = 0.003). SC families were more satisfied with the waiting time (p = 0.01), otherwise there were no differences in satisfaction between the groups. Families of SC patients had fewer visits (4.7 vs. 10.8, p < 0.001) but used the same number of phone calls (6.3 vs. 6.2, p = 0.71). Costs were 55% lower.Conclusions: A SC for ADHD can markedly reduce costs with preserved quality. As resources are limited, child psychiatry would benefit from standardization.
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Affiliation(s)
- Rebecca Wernersson
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Jan Johansson
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Markus Andersson
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Håkan Jarbin
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden.,Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
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Jablonska B, Kosidou K, Ponce de Leon A, Wettermark B, Magnusson C, Dal H, Dalman C. Neighborhood Socioeconomic Characteristics and Utilization of ADHD Medication in Schoolchildren: A Population Multilevel Study in Stockholm County. J Atten Disord 2020; 24:265-276. [PMID: 27095559 DOI: 10.1177/1087054716643257] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: To examine the effects of neighborhood socioeconomic disadvantage and ethnic composition on the utilization of ADHD medication in schoolchildren after accounting for individual- and family-level characteristics. Method: A cohort of all schoolchildren living in Stockholm County was prospectively followed for new prescriptions of ADHD medication (N = 276,955). Three-level logistic regression models were used with individual/family characteristics (e.g., immigrant background) at the first level and small area market statistics (SAMS) and municipality characteristics (i.e., socioeconomic disadvantage and ethnic composition) at the second and third level. Results: SAMS socioeconomic disadvantage was associated with increased utilization of ADHD medication. The utilization of ADHD medication was lower among immigrant children as compared with natives, and their odds of not utilizing medication increased as the degree of concentration of foreign-born increased. Conclusion: These results suggest that interventions at the neighborhood level may offer an additional route for the prevention of the disorder and/or alleviation of its consequences.
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Affiliation(s)
- Beata Jablonska
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Kyriaki Kosidou
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | | | | | - Cecilia Magnusson
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Henrik Dal
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
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Russell AE, Ford T, Russell G. Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1555-1564. [PMID: 31073627 PMCID: PMC6858474 DOI: 10.1007/s00127-019-01720-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/25/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Little is known about sociodemographic and clinical factors that predict and act as barriers to ADHD medication independently of symptom severity. We examined the proportion of children using medication for ADHD, age of initiation of medication, and predictors of medication use in a population-representative cohort. METHODS Data from the Millennium Cohort Study on child ADHD, medication use for ADHD at age 14 (in 2014-2015) and child, parent and sociodemographic variables were collated. Logistic regression models were used to identify factors that predict medication use for ADHD (the main outcome measure), adjusting for symptom severity at age seven. RESULTS The weighted prevalence of ADHD was 3.97% (N = 11,708). 45.57% of children with ADHD (N = 305) were taking medication. The median age at initiation was 9 years (range 3-14). Male gender (AOR 3.66, 95% CI 1.75, 7.66) and conduct problems at age seven (AOR 1.24 95% CI 1.04, 1.47) and 14 predicted medication use at age 14 after adjusting for symptom severity. CONCLUSIONS Our study is the first to assess predictors of medication whist adjusting for ADHD symptom severity. Girls with ADHD were less likely to be prescribed medication, even when they displayed similar ADHD symptom levels to boys. Conduct problems also predicted medication independently of ADHD symptoms. ADHD may be more often medicated in boys because clinicians may think a prototypical ADHD child is male, and perhaps conduct problems make boys more disruptive in the classroom, leading to boys being more often treated.
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Affiliation(s)
- A E Russell
- Centre for Academic Mental Health, University of Bristol Medical School, Oakfield House, Bristol, BS8 2BN, UK.
| | - T Ford
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
| | - G Russell
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, UK
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31
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Böhm S, Curran EA, Kenny LC, O'Keeffe GW, Murray D, Khashan AS. The Effect of Hypertensive Disorders of Pregnancy on the Risk of ADHD in the Offspring. J Atten Disord 2019; 23:692-701. [PMID: 28162026 DOI: 10.1177/1087054717690230] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Evidence suggests that perinatal factors may contribute to the development of ADHD. Our objective was to examine the association between hypertensive disorders of pregnancy (HDP) and ADHD, and behavioral difficulties among 7-year-old children. METHOD The study cohort consisted of 13,192 children (weighted = 13,500) who participated in the Millennium Cohort Study (MCS) at age 7. HDP (raised blood pressure, preeclampsia, eclampsia, and toxemia) were reported by mothers 9 months postdelivery. ADHD was reported by parents at age 7 years. Weighted logistic regression models were used to assess the association. RESULTS In all, 1,069 (7.9%) women reported HDP and 166 (1.2%) children had an ADHD diagnosis. There was a significant association between HDP and ADHD (adjusted odds ratio [OR] = 1.78, 95% confidence interval [CI] = [1.03, 3.07]). CONCLUSION These findings suggest that HDP is associated with an increased risk of ADHD. It is important to confirm this in larger cohorts and to understand the biological basis of this association.
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Whitely M, Raven M, Timimi S, Jureidini J, Phillimore J, Leo J, Moncrieff J, Landman P. Attention deficit hyperactivity disorder late birthdate effect common in both high and low prescribing international jurisdictions: a systematic review. J Child Psychol Psychiatry 2019; 60:380-391. [PMID: 30317644 PMCID: PMC7379308 DOI: 10.1111/jcpp.12991] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple studies have found that the youngest children in a classroom are at elevated risk of being diagnosed with, or medicated for, ADHD. This systematic review was conducted to investigate whether this late birthdate effect is the norm and whether the strength of effect is related to the absolute risk of being diagnosed/medicated. METHODS A literature search of the PubMed and ERIC databases and snowball and grey literature searching were conducted. RESULTS A total of 19 studies in 13 countries covering over 15.4 million children investigating this relationship were identified. Three other studies exploring related topics were identified. The diversity of methodologies prevented a meta-analysis. Instead a systematic review of the 22 studies was conducted. A total of 17 of the 19 studies found that the youngest children in a school year were considerably more likely to be diagnosed and/or medicated than their older classmates. Two Danish studies found either a weak or no late birth date effect. There was no consistent relationship between per-capita diagnosis or medication rates and the strength of the relative age effect, with strong effects reported in most jurisdictions with comparatively low rates. CONCLUSIONS It is the norm internationally for the youngest children in a classroom to be at increased risk of being medicated for ADHD, even in jurisdictions with relatively low prescribing rates. A lack of a strong effect in Denmark may be accounted for by the common practice of academic 'redshirting', where children judged by parents as immature have a delayed school start. Redshirting may prevent and/or disguise late birthdate effects and further research is warranted. The evidence of strong late birthdate effects in jurisdictions with comparatively low diagnosis/medication rates challenges the notion that low rates indicate sound diagnostic practices.
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Affiliation(s)
- Martin Whitely
- John Curtin Institute of Public PolicyCurtin UniversityBentleyWAAustralia
| | - Melissa Raven
- Robinson Research InstituteUniversity of AdelaideAdelaideSAAustralia
| | - Sami Timimi
- Lincolnshire Partnership NHS Foundation Trust, Horizon CentreLincolnUK
| | - Jon Jureidini
- Robinson Research InstituteUniversity of AdelaideAdelaideSAAustralia
| | - John Phillimore
- John Curtin Institute of Public PolicyCurtin UniversityBentleyWAAustralia
| | | | - Joanna Moncrieff
- Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK
| | - Patrick Landman
- Centre de Recherche PsychanalyseMedecine et SociétéParisFrance
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33
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Vergunst F, Tremblay RE, Galera C, Nagin D, Vitaro F, Boivin M, Côté SM. Multi-rater developmental trajectories of hyperactivity-impulsivity and inattention symptoms from 1.5 to 17 years: a population-based birth cohort study. Eur Child Adolesc Psychiatry 2019; 28:973-983. [PMID: 30506420 PMCID: PMC6647515 DOI: 10.1007/s00787-018-1258-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022]
Abstract
The developmental course of hyperactivity-impulsivity and inattention symptoms from infancy to adolescence has not been documented in a population sample. The aim of this study was to describe the developmental course of hyperactivity-impulsivity and inattention symptoms from 1.5 to 17 years using multiple informants, and to identify perinatal risk factors associated with following elevated (high-risk) trajectories. Using a population-based birth cohort (n = 1374), symptom ratings from mothers (1.5-8 years), teachers (6-13 years) and participant self-reports (10-17 years) were combined using group-based multi-trajectory modeling to identify informants' convergence in identifying high-symptom trajectories of hyperactivity-impulsivity and inattention over time. Perinatal risk factors associated with high-symptom trajectories were identified using stepwise logistic regression. The study found that symptoms of hyperactivity-impulsivity broadly declined from 1.5 to 17 years while symptoms of inattention remained constant. 21.4% of participants followed elevated trajectories of hyperactivity-impulsivity and 20.2% followed elevated trajectories of inattention; 11.6% followed elevated trajectories of both types of symptoms concurrently. Risk factors for high-risk trajectories of hyperactivity-impulsivity were low maternal education, prenatal alcohol exposure, non-intact family, maternal depression, and low child IQ; for high-risk inattention they were prenatal street drug exposure, early motherhood, low maternal education, maternal depression and low child IQ. Risk factors for trajectories of high-risk hyperactivity-impulsivity and inattention concurrently were low maternal education, maternal depression, and low child IQ. The combination of longitudinal assessments from multiple informants (i.e., mother, teacher, participant-reports) provides a new way to characterize hyperactivity-impulsivity and inattention phenotypes over time.
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Affiliation(s)
- Francis Vergunst
- Sainte-Justine University Hospital, Université de Montréal, Montreal, Canada
| | - Richard E Tremblay
- Sainte-Justine University Hospital, Université de Montréal, Montreal, Canada
- Department of Pediatrics and Psychology, University of Montreal, Montreal, Canada
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Cédric Galera
- INSERM U1219, Université de Bordeaux, Bordeaux, France
| | | | - Frank Vitaro
- Sainte-Justine University Hospital, Université de Montréal, Montreal, Canada
- School of Psycho-Education, University of Montreal, Montreal, Canada
| | - Michel Boivin
- Sainte-Justine University Hospital, Université de Montréal, Montreal, Canada
- School of Psychology, Université Laval, Quebec, Canada
- Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
| | - Sylvana M Côté
- Sainte-Justine University Hospital, Université de Montréal, Montreal, Canada.
- INSERM U1219, Université de Bordeaux, Bordeaux, France.
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Bélanger SA, Andrews D, Gray C, Korczak D. Le TDAH chez les enfants et les adolescents, partie 1 : l’étiologie, le diagnostic et la comorbidité. Paediatr Child Health 2018; 23:454-461. [PMCID: PMC6199646 DOI: 10.1093/pch/pxy110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Le trouble de déficit de l’attention/hyperactivité (TDAH) est un trouble neurodéveloppemental chronique. La Société canadienne de pédiatrie a préparé trois documents de principes après avoir effectué des analyses bibliographiques systématiques. Leurs objectifs s’établissent comme suit : 1) Résumer les données probantes cliniques à jour sur le TDAH. 2) Établir une norme pour les soins du TDAH. 3) Aider les cliniciens canadiens à prendre des décisions éclairées et fondées sur des données probantes pour rehausser la qualité des soins aux enfants et aux adolescents qui présentent cette affection. Les thèmes abordés dans la partie 1, qui est axée sur le diagnostic, incluent la prévalence, la génétique, la physiopathologie, le diagnostic différentiel, ainsi que les troubles psychiatriques et les troubles du développement comorbides. En plus des recherches dans les bases de données, les auteurs ont analysé les directives les plus récentes de l’American Academy of Pediatrics , de l’American Academy of Child and Adolescent Psychiatry , du National Institute for Health and Clinical Excellence , du Scottish Intercollegiate Guidelines Network et de l’Eunethydis European ADHD Guidelines Group . Puisque le TDAH est un trouble hétérogène, son évaluation médicale complète devrait toujours inclure une anamnèse fouillée, un examen physique et une évaluation approfondie du diagnostic différentiel et des comorbidités connexes. Les auteurs proposent des recommandations précises sur la récolte d’information, les tests à effectuer et les orientations vers divers services.
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Affiliation(s)
- Stacey A Bélanger
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Debbi Andrews
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Clare Gray
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
| | - Daphne Korczak
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles du développement, Ottawa (Ontario)
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35
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Bélanger SA, Andrews D, Gray C, Korczak D. ADHD in children and youth: Part 1-Etiology, diagnosis, and comorbidity. Paediatr Child Health 2018; 23:447-453. [PMID: 30681669 DOI: 10.1093/pch/pxy109] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder. Three position statements have been developed by the Canadian Paediatric Society, following systematic literature reviews. Statement objectives are to: 1) Summarize the current clinical evidence regarding ADHD,2) Establish a standard for ADHD care, and3) Assist Canadian clinicians in making well-informed, evidence-based decisions to enhance care of children and youth with this condition. Specific topics reviewed in Part 1, which focuses on diagnosis, include: prevalence, genetics, pathophysiology, differential diagnosis and comorbid psychiatric disorders and developmental disorders. In addition to database searches, the most recent guidelines of the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the National Institute for Health and Clinical Excellence, the Scottish Intercollegiate Guidelines Network, and the Eunethydis European ADHD Guidelines Group, were reviewed. Because ADHD is a heterogeneous disorder, comprehensive medical assessment for ADHD should always include a complete history, a physical examination, and a thorough consideration of differential diagnosis and related comorbidities. Specific recommendations for information gathering, testing, and referral are offered.
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Affiliation(s)
- Stacey A Bélanger
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Debbi Andrews
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Clare Gray
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
| | - Daphne Korczak
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario
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Al-Ghannami SS, Al-Adawi S, Ghebremeskel K, Cramer MT, Hussein IS, Min Y, Jeyaseelan L, Al-Sibani N, Al-Shammakhi SM, Al-Mamari F, Dorvlo ASS. Attention Deficit Hyperactivity Disorder and Parental Factors in School Children Aged Nine to Ten Years in Muscat, Oman. Oman Med J 2018; 33:193-199. [PMID: 29896326 DOI: 10.5001/omj.2018.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives The objectives of this study were to determine the prevalence of attention deficit hyperactivity disorder (ADHD) and specific parental risk factors that may contribute to the development of ADHD in children. Methods The study was conducted in Oman among fourth-grade students (aged nine to 10 years). A standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scale (Teachers questionnaire) was used to determine the presence of ADHD. Parental factors such as socioeconomic status, education, and occupation were documented. Results The prevalence rate of ADHD was 8.8%. Poor maternal education status, low familial socioeconomic status, and paternal occupation were significantly associated with an increased risk of ADHD. Conclusions This was the first study that examined familial and parental characteristics of children with ADHD as potential risk factors for the condition. Such psychosocial factors could be employed to further the development of more proficient preventative measures and remedial services.
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Affiliation(s)
- Samia S Al-Ghannami
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, London, UK.,Department of Nutrition, Ministry of Health, Muscat, Oman
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos
| | - Kebreab Ghebremeskel
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, London, UK
| | - Mathias T Cramer
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos
| | - Izzeldin S Hussein
- Nutrition Department, UNICEF Oman, Eastern Mediterranean Region / Middle East and North Africa
| | - Yoeju Min
- Lipidomics and Nutrition Research Centre, School of Human Sciences, London Metropolitan University, London, UK
| | - Lakshmanan Jeyaseelan
- Department of Statistics and Health Information, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasser Al-Sibani
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos
| | | | | | - Atsu S S Dorvlo
- Department of Basic Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, HO Volta Region, Ghana
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Te Meerman S, Batstra L, Grietens H, Frances A. ADHD: a critical update for educational professionals. Int J Qual Stud Health Well-being 2018; 12:1298267. [PMID: 28532329 PMCID: PMC5510202 DOI: 10.1080/17482631.2017.1298267] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A medical approach towards behavioural problems could make professionals without a medical background, like teachers and other educational professionals feel inapt. In this article, we raise six scientifically grounded considerations regarding ADHD, currently the most prevalent childhood psychiatric diagnosis. These "need to knows" show just how misguided and potentially stigmatizing current conceptualizations of unruly behaviour have become. Some examples are given of how teachers are misinformed, and alternative ways of reporting about neuropsychological research are suggested. A reinvigorated conceptual understanding of ADHD could help educational institutions to avoid the expensive outsourcing of behavioural problems that could also-and justifiably better-be framed as part of education's primary mission of professionalized socialization.
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Affiliation(s)
- Sanne Te Meerman
- a Department of Special Needs Education and Child Care , University of Groningen , Groningen , the Netherlands
| | - Laura Batstra
- a Department of Special Needs Education and Child Care , University of Groningen , Groningen , the Netherlands
| | - Hans Grietens
- a Department of Special Needs Education and Child Care , University of Groningen , Groningen , the Netherlands
| | - Allen Frances
- b Department of Psychiatry , School of Medicine, Duke University , NC , USA
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Madsen KB, Ravn MH, Arnfred J, Olsen J, Rask CU, Obel C. Characteristics of undiagnosed children with parent-reported ADHD behaviour. Eur Child Adolesc Psychiatry 2018; 27:149-158. [PMID: 28733915 DOI: 10.1007/s00787-017-1029-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/15/2017] [Indexed: 12/01/2022]
Abstract
There is an ongoing public debate on the diagnosis of attention deficit hyperactivity disorder (ADHD) in which critics have claimed that the disorder is over-diagnosed, while the potential under-diagnosis of children with ADHD has received little attention. In this study we estimate the number of children with parent-reported ADHD behaviour at age 7 and absence of recorded ADHD diagnosis through adolescence, and investigate whether socio-demographic characteristics of this group differed from the children diagnosed with ADHD during follow-up. Our study was based on data from the Danish National Birth Cohort, where parents of 51,527 children completed questionnaires, including the Strength and Difficulties Questionnaire (SDQ). ADHD diagnosis was identified through Danish registers and parent-reported ADHD behaviour by the specific SDQ subscale. Socio-demographic predictors of positive parent-reported SDQ ADHD behaviour and absence of recorded ADHD diagnosis in their children were examined using logistic regression analyses. Children with parent-reported ADHD behaviour and no diagnosis (1.3%) were more likely to be girls (OR 1.83; 95% CI 1.45; 2.29), more likely to have mothers with a low socioeconomic status (OR high vs. low 1.49; 95% CI 1.10; 2.02), and to live in certain regions of the country (OR: Capital vs. Southern: 2.04; 95% CI 1.51; 2.73) than children with an ADHD diagnosis. The children showed markedly impairments on all the SDQ subscales. The results demonstrate a considerable number of children with ADHD symptoms who potentially go undetected and underline the influence of socio-demographic factors in the pathway to a diagnosis of ADHD.
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Affiliation(s)
- Kathrine Bang Madsen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Mette Holmelin Ravn
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jon Arnfred
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Charlotte Ulrikka Rask
- Child and Adolescent Psychiatric Center, Aarhus University Hospital, Skovagervej 2, 8240, Risskov, Denmark.,Department of Clinical Medicine, Aarhus University, Barthsgade 5, 8200, Aarhus N, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Center for Collaborative Health, Aarhus University, Høegh Guldbergsgade 6, 8000, Aarhus C, Denmark
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Björkenstam E, Björkenstam C, Jablonska B, Kosidou K. Cumulative exposure to childhood adversity, and treated attention deficit/hyperactivity disorder: a cohort study of 543 650 adolescents and young adults in Sweden. Psychol Med 2018; 48:498-507. [PMID: 28738913 DOI: 10.1017/s0033291717001933] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Though childhood adversity (CA) has been associated with the risk of attention deficit/hyperactivity disorder (ADHD), little is known about the effect of cumulative CAs and whether there are clusters of CAs that are more closely related with ADHD. METHODS We used a Swedish cohort of 543 650 individuals born 1987-1991. Register-based CAs included familial death, substantial parental substance abuse and psychiatric disorder, substantial parental criminality, parental separation, household public assistance recipiency, and residential instability. Individuals were followed from year 2006 when they were 15-19 years of age, for treated ADHD, defined as a registered ICD diagnosis and/or prescription of medications to treat ADHD. Logistic regression analysis was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses (LCA) were used to identify clusters based on the different CAs. RESULTS All CAs increased the odds of ADHD in late adolescence and early adulthood; ORs ranged from 1.6 (95% CI 1.5-1.8) for familial death to 2.7 (95% CI 2.6-2.9) for household public assistance. We found a dose-response relationship between cumulative CA and ADHD; individuals with 4+ CAs had a markedly increased risk for ADHD (OR 5.5, 95% CI 5.0-6.0). LCA analyses revealed six distinct classes of CA associated with ADHD, of which 'exposure to most adversities' entailed highest risk. CONCLUSION CA is a strong risk factor for ADHD, particularly when accumulated. Early and efficient detection of CA is of importance for interventions targeted to improve long-term mental health outcomes among disadvantaged children.
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Affiliation(s)
- E Björkenstam
- Division of Social Medicine,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
| | - C Björkenstam
- Department of Epidemiology,Fielding School of Public Health, University of California Los Angeles,Los Angeles,USA
| | - B Jablonska
- Division Public Health Epidemiology,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
| | - K Kosidou
- Division Public Health Epidemiology,Department of Public Health Sciences,Karolinska Institutet,Stockholm,Sweden
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40
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Arat A, Östberg V, Burström B, Hjern A. ADHD medication in offspring of immigrants - does the income level of the country of parental origin matter? BMC Psychiatry 2018; 18:3. [PMID: 29310624 PMCID: PMC5759312 DOI: 10.1186/s12888-017-1572-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/06/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Child psychiatric treatment facilities vary greatly worldwide and are virtually non-existent in many low-income countries. One of the most common psychiatric disorders in childhood is ADHD, with an estimated prevalence of 3-5% in Sweden. Previous studies have shown a similar prevalence of ADHD in minority and majority children in Sweden and the UK. However, clinical studies demonstrated that children from immigrant families living in Sweden received less psychiatric care than those of native-born parents. We tested the hypothesis that the consumption of child psychiatric care in immigrant families would be determined by the availability of such treatment in the parents' country of origin. Patterns of medication for attention-deficit hyperactivity disorder (ADHD) were studied as a proxy for child psychiatric care. METHODS This was a register study of dispensed stimulant medication during 2013-2014 in Swedish national birth cohorts from 1995-2009. The study population, consisting of nearly 1.4 million children, was divided by national income of the parental country of origin and whether the parents were native Swedes, European immigrants, non-European immigrants or a mixture. Logistic regression was used to calculate the odds ratios of having been dispensed at least one ADHD drug during 2013, with adjustments for gender, family status indicating whether the child is living with both parents, household income and area of residence. RESULTS Having parents born in low-income (OR [95% confidence interval] 0.27 [0.24-0.29]) or middle-income (European: OR 0.23 [0.20-0.26], non-European: OR 0.39 [0.34-0.41]) countries was associated with lower ADHD treatment levels than having parents born in high-income countries (European: OR 0.60 [0.54-0.66], non-European: OR 0.68 [0.59-0.79]), when compared to children of parents born in Sweden. In families with a background in low or middle income countries, there was no significant association between household income and ADHD medication, while in children with Swedish and mixed backgrounds high level of disposable income was associated with lower levels of ADHD medication. CONCLUSION The use of child psychiatric care by immigrant families in Sweden was largely associated with the income level of the country of origin.
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Affiliation(s)
- Arzu Arat
- Department of Medicine, Karolinska Institute, 171 76, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, 106 91 Stockholm, Sweden
| | - Viveca Östberg
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, 106 91 Stockholm, Sweden
| | - Bo Burström
- Department of Public Health Sciences, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Anders Hjern
- Department of Medicine, Karolinska Institute, 171 76, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, 106 91 Stockholm, Sweden
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41
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Abstract
OBJECTIVE To determine the prevalence and psychosocial correlates of ADHD among adolescents in Jos, Nigeria. METHOD A cross-sectional descriptive two-stage study of 487 randomly selected participants using Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL), Raven's Standard Progressive Matrix (SPM) and the Children's Global Assessment Score (CGAS). RESULTS The prevalence of ADHD was 8.8%. The subtypes found were inattentive (3.08%), hyperactive-impulsive (2.05%), and combined (3.08%); male:female ratio of 1.4:1. ADHD was significantly associated with use of substance by father (odds ratio [OR] = 0.35; 95% confidence interval [CI] = [0.154, 0.781]), use of substance by mother (OR = 0.2; 95% CI = [0.055, 0.711]), and lower education of mother (OR = 0.3 95% CI = [0.116, 0.693]). Poor quality of handwriting (χ2 = 8.120; p = .010) and impaired global functioning ( t test = 10.756; p < .001) were significantly associated with ADHD in the adolescents. CONCLUSION Given the burden of ADHD, efforts should be made to establish a system for the early identification and management.
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Affiliation(s)
- M U Umar
- 1 Bayero University, Kano, Nigeria
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42
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Hire AJ, Ashcroft DM, Springate DA, Steinke DT. ADHD in the United Kingdom: Regional and Socioeconomic Variations in Incidence Rates Amongst Children and Adolescents (2004-2013). J Atten Disord 2018; 22:134-142. [PMID: 26604267 DOI: 10.1177/1087054715613441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the incidence and distribution of ADHD within the United Kingdom, and to examine whether there was any association between ADHD incidence and socioeconomic deprivation. METHOD The study used data from the Clinical Practice Research Datalink (CPRD). Patients diagnosed with ADHD before the age of 19 between January 1, 2004 and December 31, 2013 were stratified according to the region in which their general practice was based. Practice Index of Multiple Deprivation (IMD) score was used as a surrogate measure of patients' deprivation status. RESULTS ADHD incidence was relatively stable between 2004 and 2013, but peaked in the last 2 years studied. Statistically significant ( p ≤ .05) differences in incidence were observed between U.K. regions. In almost every year studied, incidence rates were highest among the most deprived patients and lowest among the least deprived patients. CONCLUSION In the United Kingdom, ADHD may be associated with socioeconomic deprivation.
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43
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Análisis de los factores ligados al diagnóstico del trastorno por déficit de atención e hiperactividad en la infancia. Neurologia 2017; 32:431-439. [DOI: 10.1016/j.nrl.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/08/2016] [Accepted: 01/26/2016] [Indexed: 11/24/2022] Open
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44
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Rivas-Juesas C, de Dios J, Benac-Prefaci M, Colomer-Revuelta J. Analysis of the factors linked to a diagnosis of attention deficit hyperactivity disorder in children. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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45
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Boukhris T, Sheehy O, Bérard A. Antidepressant Use in Pregnancy and the Risk of Attention Deficit with or without Hyperactivity Disorder in Children. Paediatr Perinat Epidemiol 2017. [PMID: 28640459 DOI: 10.1111/ppe.12378] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between antidepressant (AD) use during pregnancy and the risk of attention deficit with or without hyperactivity disorder (ADHD) in children is debated. We investigated the risk of ADHD associated with overall and class-specific antidepressant exposure in utero. METHODS We designed a register-based cohort study using the Quebec Pregnancy/Children Cohort (QPC). A total of 144 406 singleton full-term live-born from 1998 to 2009 were included. Cox proportional hazards regression models were used to estimate unadjusted and adjusted hazard ratio with 95% confidence interval (CI). RESULTS During 542 897 person-years of follow-up, 4564 (3.2%) infants were identified with ADHD. The mean age at first ADHD diagnosis was 6.3 ± 2.3 years (range 0-11 years), and the mean age at first ADHD medication use was 7.0 ± 1.5 years. Adjusting for potential confounders, including maternal history of depression/anxiety and ADHD, AD use during the 2nd or 3rd trimester of pregnancy was associated with an increased risk of (HR 1.3, 95% CI 1.0, 1.6; 134 exposed cases). More specifically, tricyclic use was associated with an increased risk of ADHD (HR 1.8, 95% CI 1.0, 3.1; 16 exposed cases); SSRI and SNRI use were not associated with increased ADHD risk. CONCLUSION This study suggests that AD use during the 2nd and 3rd trimester of pregnancy, specifically tricyclics, is an independent risk factor for ADHD in children above and beyond the risk associated with maternal depression/anxiety or ADHD. However, residual confounding by indication severity could not be completely ruled out.
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Affiliation(s)
- Takoua Boukhris
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada
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46
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Vieira VM, Fabian MP, Webster TF, Levy JI, Korrick SA. Spatial Variability in ADHD-Related Behaviors Among Children Born to Mothers Residing Near the New Bedford Harbor Superfund Site. Am J Epidemiol 2017; 185:924-932. [PMID: 28444119 PMCID: PMC5430935 DOI: 10.1093/aje/kww208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/25/2016] [Indexed: 12/24/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has an uncertain etiology, with potential contributions from different risk factors such as prenatal environmental exposure to organochlorines and metals, social risk factors, and genetics. The degree to which geographic variability in ADHD is independent of, or explained by, risk factors may provide etiological insight. We investigated determinants of geographic variation in ADHD-related behaviors among children living near the polychlorinated biphenyl-contaminated New Bedford Harbor (NBH) Superfund site in Massachusetts. Participants were 573 children recruited at birth (1993-1998) who were born to mothers residing near the NBH site. We assessed ADHD-related behaviors at age 8 years using Conners' Teacher Rating Scale-Revised: Long Version. Adjusted generalized additive models were used to smooth the association of pregnancy residence with ADHD-related behaviors and assess whether prenatal organochlorine or metal exposures, sociodemographic factors, or other factors explained spatial patterns. Models that adjusted for child's age and sex displayed significantly increased ADHD-related behavior among children whose mothers resided west of the NBH site during pregnancy. These spatial patterns persisted after adjusting for prenatal exposure to organochlorines and metals but were no longer significant after controlling for sociodemographic factors. The findings underscore the value of spatial analysis in identifying high-risk subpopulations and evaluating candidate risk factors.
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Affiliation(s)
- Verónica M. Vieira
- Correspondence to Dr. Verónica M. Vieira, Program in Public Health, University of California, Irvine, 653 East Peltason Drive, AIRB 2042, Irvine, CA 92697 (e-mail: )
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47
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Sigfusdottir ID, Asgeirsdottir BB, Hall HA, Sigurdsson JF, Young S, Gudjonsson GH. An epidemiological study of ADHD and conduct disorder: does family conflict moderate the association? Soc Psychiatry Psychiatr Epidemiol 2017; 52:457-464. [PMID: 28236147 DOI: 10.1007/s00127-017-1352-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the role of family conflict in the relationship between attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD). METHODS A cross-sectional national population survey was carried out among 10,838 14-16 year old students in all secondary schools in Iceland. Three latent measures, financial status, ADHD and CD, and one observed measure, family structure, were included in the study. A structural equation model was used to evaluate direct effects between ADHD and CD for four different groups; females and males, experiencing family conflict and those not experiencing family conflict. RESULTS ADHD was significantly and positively associated with CD for all groups. When controlling for financial status and family structure it was found that ADHD was positively and significantly associated with CD for adolescent females and males not experiencing family conflict as well as for those experiencing family conflict. The link between ADHD and CD was significantly stronger for those adolescents who had experienced family conflict compared to those who had not experienced family conflict. These results suggest that family conflict moderates the association between ADHD and CD for both girls and boys. CONCLUSIONS The results of this study indicate that family environment and ADHD symptoms are important when predicting CD among adolescent youth. Most notably, family conflict exacerbates the effects of ADHD symptoms on CD among both females and males.
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Affiliation(s)
- Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Menntavegi 1, 101, Reykjavik, Iceland. .,Teacher's College, Columbia University, 525 west, 120th street, Manhattan, NY, 10027, USA.
| | | | - Hildigunnur Anna Hall
- Department of Psychology, Reykjavik University, Menntavegi 1, 101, Reykjavik, Iceland
| | - Jon Fridrik Sigurdsson
- Department of Psychology, Reykjavik University, Menntavegi 1, 101, Reykjavik, Iceland.,University of Iceland, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland
| | - Susan Young
- Department of Psychology, Reykjavik University, Menntavegi 1, 101, Reykjavik, Iceland.,Imperial College of Science, Technology and Medicine, University of London, London, SW7 2AZ, UK.,West London Mental Health, Broadmoor Hospital, Regional Secure Unit, St Bernard's Hospital, Uxbridge Rd, Southall, UB1 3EU, UK.,Imperial College of Science, Technology and Medicine, Centre for Mental Health, Faculty of Medicine, University of London, 7th Floor Commonwealth Building, Cane Road, London, W12 0NN, UK
| | - Gisli H Gudjonsson
- Department of Psychology, Reykjavik University, Menntavegi 1, 101, Reykjavik, Iceland.,King's College London, Institute of Psychiatry, Denmark Hill, London, SE5 8AF, UK
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48
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Heins MJ, Bruggers I, Dijk LV, Korevaar JC. ADHD medication prescription: Effects of child, sibling, parent and general practice characteristics. J Child Health Care 2016; 20:483-493. [PMID: 27708116 DOI: 10.1177/1367493515620913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many children receive attention-deficit hyperactivity disorder (ADHD) medication, but factors that determine medication prescription are largely unknown. This study aimed to determine the relative impact of factors on the child, family and general practitioner (GP) practice level on ADHD medication prescription. We included 1259 Dutch children aged 6-18 years with a diagnostic code of ADHD or related behavioural problems (ICPC codes P20-P22) in NIVEL primary care database. Using multilevel analyses, we examined predictors of ADHD medication prescription. Children diagnosed as 'hyperactive' were 16 times more likely to be prescribed ADHD medication than those with 'behavioural concerns'. Children with a parent or sibling receiving ADHD medication were three to four times more likely to be prescribed ADHD medication themselves. Children from GP practices with a high percentage of children with ADHD were twice as likely to be prescribed ADHD medication. Concluding, factors on the individual, family and GP practice level determine ADHD medication prescription. Future research into the decision-making process for ADHD medication is warranted.
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Affiliation(s)
- Marianne J Heins
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Inge Bruggers
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Liset van Dijk
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Joke C Korevaar
- 1 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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49
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Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 44:155-66. [PMID: 25663589 DOI: 10.1007/s10802-015-9984-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with interpersonal dysfunction during childhood and adolescence, yet little is known about the romantic relationships of young women with childhood ADHD. In the present study, we draw from a longitudinal sample of girls followed prospectively into young adulthood, comparing those with (n = 114) and without (n = 79; comparisons) childhood ADHD in terms of their risk for physical victimization by an intimate partner (physical IPV; e.g., slapping, punching) by 17-24 years of age. We examined ADHD both diagnostically and dimensionally, at the same time establishing reliable indicators of young adult physical IPV. Externalizing and internalizing problems, and academic achievement during adolescence, were tested as potential mediators. Overall, participants with a childhood diagnosis of ADHD experienced more physical IPV than did comparisons (30.7% vs. 6.3%). In parallel, IPV was associated with higher levels of childhood ADHD symptomatology (d = 0.73). Young women with persistent ADHD stood the highest risk of experiencing IPV (37.3%), followed by those with transient ADHD (19.0%) and those never-diagnosed (5.9%). Academic achievement measured during adolescence was a significant partial mediator of the childhood ADHD symptomatology-young adult IPV relationship, even with control of sociodemographic, psychiatric, and cognitive factors, including childhood reading and math disorders. Findings indicate that in young women, childhood ADHD is a specific and important predictor of physically violent victimization in their intimate relationships. This vulnerable population requires IPV prevention and intervention, with academic empowerment as a key target.
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50
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Joelsson P, Chudal R, Gyllenberg D, Kesti AK, Hinkka-Yli-Salomäki S, Virtanen JP, Huttunen J, Ristkari T, Parkkola K, Gissler M, Sourander A. Demographic Characteristics and Psychiatric Comorbidity of Children and Adolescents Diagnosed with ADHD in Specialized Healthcare. Child Psychiatry Hum Dev 2016; 47:574-82. [PMID: 26399420 DOI: 10.1007/s10578-015-0591-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Recent studies have shown an increasing incidence of attention-deficit/hyperactivity disorder (ADHD) among children diagnosed in specialized services. This study aims to describe children with ADHD in Finnish specialized healthcare by reporting the demographic characteristics, time trends in diagnosis, psychiatric comorbidity, and the validity of register-based diagnoses. All the singletons born in Finland between 1991 and 2005 and diagnosed with ADHD by 2011 were identified and their psychiatric comorbidity data was obtained from the Finnish Hospital Discharge Register (FHDR). Parents of 69 patients were interviewed via telephone for a diagnostic validation. A total of 10,409 children were identified with ADHD, with a male: female ratio of 5.3:1 and a psychiatric comorbidity rate of 76.7 %. Of the validation sample 88 % met the diagnostic criteria of ADHD for DSM-IV. There is an increasing trend of ADHD diagnosis among both males and females. Psychiatric comorbidity is common and includes a wide range of disorders among children with ADHD. There was an increase of ADHD diagnoses especially among boys. More attention is needed to detect ADHD among girls in health services. Diagnoses in the FHDR show diagnostic validity and their sociodemographic patterns are in line with previous studies.
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Affiliation(s)
- Petteri Joelsson
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.
| | - Roshan Chudal
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - David Gyllenberg
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Anna-Kaisa Kesti
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Juha-Pekka Virtanen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Jukka Huttunen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland
| | - Kai Parkkola
- Navy Command Finland, Turku, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Nordic School of Public Health, Gothenburg, Sweden.,National Institute for Health and Welfare, Helsinki, Finland.,New York State Psychiatric Institute, New York, NY, USA
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori. 3rd Floor, 20014, Turku, Finland.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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