Childhood signs of ADHD and psychosocial outcomes in adolescence : a longitudinal study of boys and girls

Childhood neurodevelopmental problems (NDPs; encompassing attention deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], tic disorder [TD], learning disorder [LD], and developmental coordination disorder [DCD]), affect around 10% of children worldwide. ADHD is the most common disorder, with an estimated prevalence between 5 and 10%. Based on its relatively high prevalence and associated impairments and adverse outcomes, ADHD is considered a major public health problem. The etiology of ADHD is multifactorial, including both genetic and environmental factors. ADHD affects both boys and girls in various areas of functioning; including academic, cognitive, psychosocial, and mental health. Previous longitudinal research on ADHD has rarely included aspects of comorbidity in relation to such outcomes. Also, it remains unclear how genetic and environmental factors influence the association between ADHD and internalizing problems during childhood and adolescence. To avoid the potentially artificial demarcation of a diagnostic cut-off, several studies have assessed the degree of core ADHD-symptoms rather than the clinical diagnosis. Such work indicates that subthreshold levels of ADHD may also be associated with negative outcomes such as poorer academic achievements, lower selfesteem, and relationship problems. A particular challenge for society lies in the fact that only children who are clinically assessed and diagnosed with ADHD may be entitled to care and support, when in fact individuals with subthreshold level symptoms might also benefit from such interventions. The general aim of this thesis was to investigate how childhood symptoms of ADHD affect psychosocial outcomes in adolescence, with a special focus on gender differences. We used data from a population-based cohort of twins, who were assessed for the presence of NDP symptoms during childhood and followed up at age 15. Study I investigated the diagnostic predictive validity of the screening-interview A-TAC, an instrument that is used throughout all studies in this thesis. The results demonstrated that ATAC is an effective screening tool for NDPs, and that it can be used for the purpose of predictive assessment in the general population. Overall, A-TAC demonstrated satisfactory psychometric properties as a screening instrument. Study II examined the association between childhood signs of ADHD and/or other NDPs (at age 9 or 12) and psychosocial outcomes at age 15. The results demonstrated that symptoms of NDPs or other mental health problems at the age of 9 or 12 were associated with a higher degree of psychosocial problems during adolescence. Despite the presence of comorbidity, childhood ADHD symptoms stood out as the most important risk factor for later antisocial development and impaired daily functioning. Study III examined if different levels of ADHD symptoms were differentially associated with psychosocial problems in adolescent boys and girls. ADHD symptoms as well as their associated negative outcomes were dimensionally distributed in the study cohort. Girls and boys displayed somewhat different risk profiles, even after controlling for other neuropsychiatric symptoms. Study IV explored the relative contribution of genetic and environmental influences associated with childhood ADHD and internalizing problems to symptoms of internalizing problems during adolescence. ADHD and internalizing problems were associated. There was a gender difference in the genetic explanation of internalizing problems at age 15. In both boys and girls, both new genetic and new environmental factors emerged in adolescence. In summary, childhood symptoms of ADHD turned out to be the most important risk factor for adolescent antisocial behavior and impaired daily functioning, despite the presence of comorbid symptoms. During adolescence, increasing levels of ADHD-related symptoms were associated with increasing levels of psychosocial problems. Girls and boys displayed somewhat different risk profiles, e.g. girls displayed more internalizing symptoms and seemed to have a higher risk for drug misuse. The finding that ADHD symptoms were associated with higher drug misuse in girls motivates particular attention and active screening routines. The findings also point to the need for increased awareness and further study of the complex etiologic and developmental relationship between internalizing symptoms and ADHD

Inattention and hyperactivity symptoms in childhood predict physical activity in adolescence.

BACKGROUND: Physical activity has been documented to influence several aspects of physical and mental health. Growing evidence shows that physical activity can improve attention. Less is known about how symptoms of inattention and hyperactivity / impulsivity in childhood are associated with physical activity in adolescence. We aimed to explore this relationship further. METHODS: We used a cohort of 3949 Swedish children (1884 boys and 2065 girls) with data collected at ages 9 (or 12) and 15. We investigated the influence of symptoms of inattention and hyperactivity / impulsivity in childhood - age 9/12 (inattention and hyperactivity/impulsivity separately) on self-rated physical activity at age 15, using multiple logistic regression models. We considered potential confounders such as sex, parental education level, physical activity in childhood and neurodevelopmental comorbidity. A cluster robust sandwich estimator was applied to adjust the standard errors for the nested twin data when computing the regression models. RESULTS: Symptoms of inattention in childhood (9/12) predicted less physical activity in adolescence (age 15) (OR = 0.83 CI = 0.78-0.89), whereas the opposite was true for hyperactivity/impulsivity (OR = 1.08 CI = 1.02-1.10). These associations still remained when taking possible confounders into account including neurodevelopmental and neurodevelopmental related comorbidity. CONCLUSIONS: These findings support the importance of helping children and adolescents with inattention symptoms to engage in physical activity in suitable settings

Trends in childhood and adolescent internalizing symptoms : results from Swedish population based twin cohorts

BACKGROUND: Previous research has noted trends of increasing internalizing problems (e.g., symptoms of depression and anxiety), particularly amongst adolescent girls. Cross-cohort comparisons using identical assessments of both anxiety and depression in youth are lacking, however. METHODS: In this large twin study, we examined trends in internalizing symptoms in samples of 9 year old children and 15 year old adolescents, gathered from successive birth cohorts from 1998 to 2008 (age 9) and 1994-2001 (age 15). Assessments at age 9 were parent-rated, and at age 15 self- and parent-rated. We examined (i) the relation between birth cohorts and internalizing symptoms using linear regressions, and (ii) whether percentages of participants exceeding scale cut-off scores changed over time, using Cochrane Armitage Trend Tests. RESULTS: Among 9 year old children, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off on anxiety symptoms, but not on depressive symptoms. At age 15, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off particularly on self-reported internalizing symptoms. On parent-reported internalizing symptoms, only girls demonstrated a corresponding trend. CONCLUSION: In line with previous studies, we found small changes over sequential birth cohorts in frequencies of depression and anxiety symptoms in children. Further, these changes were not exclusive to girls

Childhood Symptoms of ADHD Overrule Comorbidity in Relation to Psychosocial Outcome at Age 15: A Longitudinal Study.

Neurodevelopmental problems (NDPs) may influence the transition from childhood to adolescence. Our aim was to study long-term psychosocial outcomes of NDPs, focusing on ADHD.Data was collected through a telephone interview with parents of twins at ages 9 or 12 years. NDP screen-positive children were clinically assessed at age 15; N = 450. Psychosocial outcome concerning peers, school, internalizing problems, antisocial behavior, alcohol misuse, drug misuse, and impaired daily functioning was examined.Even after controlling for other NDP comorbidity, screen-positivity for ADHD doubled or tripled the odds of later psychosocial problems. When controlling for parental education level, the significant effect of ADHD remained only for antisocial behavior and impaired daily functioning.Signs of NDPs as well as other psychiatric diagnoses at ages 9 or 12 years are associated with a more problematic adolescence. However, despite the presence of comorbidity, early ADHD symptoms stand out as the most important risk factor for later antisocial development and impaired daily functioning

Flowchart of data collection.

BackgroundChildren with disabilities have an increased risk of mental health problems. Patterns of mental health problems and well-being may vary.AimsTo identify patterns of mental health problems and well-being in children with disabilities in Sweden, and investigate the influence of parental background (migration, education), and child cognitive level.MethodIn this cross-sectional study, cluster analysis was used to analyse parents’ ratings of conduct problems, emotional symptoms, and prosocial behaviour on the Strengths and Difficulties Questionnaire (SDQ) in children with disabilities (n = 136). The influence of parental background (migration, education) and child cognitive level on cluster membership was explored through multinomial logistic regression.ResultsFive clusters of mental health patterns emerged. Three clusters had mean ratings near or past clinical cut-off for one each of the SDQ-subscales. One cluster had difficulties on all three subscales. Greater child cognitive difficulties increased the likelihood of low prosocial behaviour (OR 2.501, p ConclusionChildren with disabilities display varying mental health patterns. Awareness of the complexity of mental health patterns among children with disabilities is important. Screening and support for emotional symptoms and prosocial behaviour deficits should be considered for children with conduct problems.</div

CL2 profile of SDQ scores on the subscales conduct problems, emotional symptoms and prosocial behaviour.

Note. The shaded areas show the combined high and very high bands of the UK four-band scoring for parent rated SDQ 4–17 years.</p

Characteristics of the children included in this study, by age cohort and in the total sample.

Characteristics of the children included in this study, by age cohort and in the total sample.</p

CL3 profile of SDQ scores on the subscales conduct problems, emotional symptoms and prosocial behaviour.

Note. The shaded areas show the combined high and very high bands of the UK four-band scoring for parent rated SDQ 4–17 years.</p

CL1 profile of SDQ scores on the subscales conduct problems, emotional symptoms and prosocial behaviour.

Note. The shaded areas show the combined high and very high bands of the UK four-band scoring for parent rated SDQ 4–17 years.</p