Relative age in the school year and risk of mental health problems in childhood, adolescence, and young adulthood

Purpose Relative age within the school year (‘relative age’) is associated with increased rates of symptoms and diagnoses of mental health disorders, including ADHD. We aimed to investigate how relative age influences mental health and behaviour before, during and after school (age range: 4–25 years). Method We used a regression discontinuity design to examine the effect of relative age on risk of mental health problems using data from a large UK population-based cohort (Avon Longitudinal Study of Parents and Children (ALSPAC); N = 14,643). We compared risk of mental health problems between ages 4 and 25 years using the parent-rated Strengths and Difficulties Questionnaire (SDQ), and depression using self-rated and parent-rated Short Mood and Feelings Questionnaire (SMFQ) by relative age. Results The youngest children in the school year have greater parent-rated risk of mental health problems, measured using parent-rated SDQ total difficulties scores. We found no evidence of differences before school entry [estimated standardised mean difference (SMD) between those born on 31 August and 1 September: .02 (−.05, .08)]. We found that estimates of effect size for a 1-year difference in relative age were greatest at 11 years [SMD: .22 (.15, .29)], but attenuated to the null at 25 years [SMD: −.02 (−.11, .07)]. We did not find consistent evidence of differences in self-rated and parent-rated depression by relative age. Conclusions Younger relative age is associated with poorer parent-rated general mental health, but not symptoms of depression

A systematic review of cognitive functioning among young people who have experienced homelessness, foster care, or poverty

Young people who have experienced homelessness, foster care, or poverty are among the most disadvantaged in society. This review examines whether young people who have these experiences differ from their non-disadvantaged peers with respect to their cognitive skills and abilities, and whether cognitive profiles differ between these three groups. Three electronic databases were systematically searched for articles published between 1 January 1995 and 1 February 2015 on cognitive functioning among young people aged 15 to 24 years who have experienced homelessness, foster care, or poverty. Articles were screened using pre-determined inclusion criteria, then the data were extracted, and its quality assessed. A total of 31 studies were included. Compared to non-disadvantaged youth or published norms, cognitive performance was generally found to be impaired in young people who had experienced homelessness, foster care, or poverty. A common area of difficulty across all groups is working memory. General cognitive functioning, attention, and executive function deficits are shared by the homeless and poverty groups. Creativity emerges as a potential strength for homeless young people. The cognitive functioning of young people with experiences of impermanent housing and poverty has been relatively neglected and more research is needed to further establish cognitive profiles and replicate the findings reviewed here. As some aspects of cognitive functioning may show improvement with training, these could represent a target for intervention

Case Report: Novel Pathogenic Variant in NFIX in Two Sisters with Malan Syndrome Due to Germline Mosaicism

Malan syndrome is an autosomal dominant disorder caused by pathogenic variants in NFIX with less than 100 cases reported thus far. NFIX is important for stem cell proliferation, quiescence, and differentiation during development and its protein plays a role in replication, signal transduction, and transcription. As a result of pathogenic variants, symptoms of Malan syndrome include overgrowth, intellectual disability, speech delay, and dysmorphic features. Currently, the recurrence risk for this disorder is indicated at less than 1%, standard for de novo autosomal dominant disorders. Herein, we report an additional set of sisters with the same novel pathogenic variant in NFIX and clinical features consistent with Malan syndrome providing evidence of germline mosaicism. Considering the rarity of this condition in conjunction with three previous reports of germline mosaicism, it is worthwhile to investigate and re-evaluate the proper recurrence risk for this condition. This discovery would be paramount for family planning and genetic counseling practices in families with affected individuals

Musculoskeletal health in ambulatory physically active men with Cerebral Palsy : seasonal variations and the role of vitamin D

Background: Individuals with Cerebral Palsy (CP) show impairments in muscle strength and power. Impairments in strength, in typically developed controls (TDC) low levels of force production and poor bone health are associated with low levels of vitamin D, and a high falls prevalence. It is possible that the severity of musculoskeletal impairments in individuals with CP is exacerbated by living in northern latitudes such as the UK and may contribute to high falls prevalence. Methods: Forty-eight participants were split into two groups of 24 active, ambulant men with CP (Gross Motor Function Classification Score I-II) and 24 healthy TDC completed one in vivo assessment of musculoskeletal health during the winter1, including: Vastus Lateralis anatomical cross-sectional area (VL ACSA), isometric knee extension maximal voluntary contraction (KE iMVC), 10 m sprint, vertical jumps, radius and tibia bones Tus and Zus scores. Plus falls frequency questionnaires to measure fear of falling and risk-taking behaviour were completed by 19 men with CP and 19 TDC. Assessments of vitamin D status through venous samples of serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, dietary vitamin D intake from food diary and total sun exposure via questionnaire were also taken. 16 of the ambulant men with CP and 16 healthy TDC repeated these measures to assess seasonal variations on two separate occasions (the winter and in the summer). Results: Men with CP had 40.5% weaker KE iMVC, 23.7% smaller VL ACSA, 22.2% lower vertical jump, 14.6% lower KE iMVC/VL ACSA ratio, 22.4% lower KE iMVC/body mass (BM) ratio and 25.1% lower KE iMVC/lean body mass (LBM) ratio (all p<0.05). Radius Tus and Zus scores were 1.75 and 1.57 standard deviations lower than TDC, respectively (p<0.05). 25(OH)D was not different between groups, and 90.9% of men with CP and 91.7% of TDC had low 25(OH)D levels when compared to current UK recommendations. 25(OH)D was positively associated with KE iMVC/LBM ratio in men with CP (r = 0.500, p=0.020). Men with CP and TDC showed a 70.5% and 85.7% increase in serum 25(OH)D from winter to summer months (p<0.05) respectively, yet the mean of men with CP was below the adequate threshold of 30 ng∙mL-1 in the summer. PTH decreased with increased levels of 25(OH)D during the summer months in both groups (p<0.05). Men with CP showed an increase in radius Tus and Zus scores in the summer (p<0.05). 47% of men with CP were classified as fallers, fear of falling was 26.2% greater and risk-taking behaviours was 14.5% lower compared to TDC (p<0.05). Lower levels of KE iMVC in men with CP were associated with higher falls prevalence. Conclusion: A higher falls prevalence in men with CP, was associated with muscle weakness (chapter 3), where men with CP also showed large decrements in both bone and muscle outcomes compared to TDC (chapter 4). There was a high prevalence of vitamin D insufficiency presented in men with CP and TDC, and as a result was associated with muscle weakness in men with CP but did not contribute to other musculoskeletal decrements shown in men with CP compared to TDC (Chapter 4). Similarly, these vitamin D insufficiencies were inadequately overcome with an increase in TSE from winter to summer months, showing almost no benefit of large seasonal increases in vitamin D with no musculoskeletal improvement in either men with CP (Chapter 5). The findings of this thesis suggest a greater sensitivity to low vitamin D in men with CP with regards to bone and muscle content and functional outcomes and emphasise the importance for future research into vitamin D supplementation in populations with musculoskeletal impairments

A genetic study of attention deficit hyperactivity disorder: examining environmental influences and phenotypic variation.

This work highlights phenotypic heterogeneity and how this may index underlying aetiological heterogeneity. It also indicates the importance of environmental variables and investigating Gene x Environment interactions in molecular genetic studies of ADHD

Understanding and improving the care pathway for children with autism

Purpose: To describe current care pathways for children with autism including enablers and barriers, as experienced by health professionals, education professionals, and families in South Wales, UK. Design/methodology/approach: A mixed-methods approach using focus group discussions, creative writing workshops and visualisation using rich pictures. Findings: The experiences of the care pathways differed significantly across the three groups. Health professionals described the most rigidly-structured pathways, with clear entry points and outcomes. Education professionals and parents described more complex and confusing pathways, with parents assuming the responsibility of coordinating the health and education activity in a bid to link the two independent pathways. All three groups identified enablers, although these differed across the groups. The barriers were more consistent across the groups (e.g. poor communication, missing information, lack of transparency, limited post diagnosis services and access to services based on diagnosis rather than need). Practical implications: This research could inform the design of new services which are premised on multi-agency and multi-disciplinary working to ensure children with ASD receive joined up services and support. Originality/value: Although this study did not represent all professional groups or all experiences of autism, we examined three different perspectives of the ASD pathway. In addition, we triangulated high-level process maps with rich pictures and creative writing exercises, which allowed us to identify specific recommendations to improve integration and reduce duplication and gaps in provision

Parent psychopathology and neurocognitive functioning in children with ADHD

Objective: The objective of this study was to examine the association between parent mental health (ADHD and depression) and offspring performance on neurocognitive tasks in children with ADHD. Method: The clinical sample consisted of 570 children (85% males, mean age: 10.77 years) with ADHD who completed neurocognitive tasks measuring working memory, attention set-shifting, and motivational deficits. Questionnaire measures were used to assess ADHD and depression symptom presence in parents. Results: Controlling for ADHD severity, children of parents with ADHD had poorer working memory (B = −0.25, 95% confidence interval [CI] [−0.45, −0.07], p = .01) and increased errors on the extra dimensional shift stage of the set-shifting task (B = 0.26 95% CI [0.02, 0.50], p = .04). Parent depression was not associated with offspring performance on any of the assessed neurocognitive tasks. Conclusion: Children with ADHD who have a parent with ADHD symptom presence are a subgroup of children who may have additional neurocognitive impairments that have potential implications when implementing interventions that target cognition and learning

An investigation of changes in children′s mental health in Wales between 2007/2008 and 2012/2013

Improving children’s mental well-being is a recognised public health priority, but evidence on recent trends is lacking. This study updates evidence on differences in child mental health since 2008 by comparing two nationally representative cohorts in Wales, UK. Parents of 4-12 year old children completed the Strength and Difficulties Questionnaire (SDQ). No significant differences were seen for younger girls between 2007/2008 and 2012/2013. There was a decrease in conduct, hyperactivity and total difficulties symptom scores and an increase in prosocial scores for boys’ and older girls. These findings suggest that rates of child mental health problems are stable or falling

Dimensional associations between executive function processes and symptoms of ADHD, ASD, oppositional defiance and anxiety in young school-referred children

Executive function (EF) difficulties are implicated in Neurodevelopmental Disorders (NDDs), such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Because NDDs are highly comorbid and frequently co-occur with additional clinical problems, it is unclear how specific EF problems are associated with symptoms of ASD and ADHD, whilst accounting for co-occurring anxiety or oppositional defiance disorder (ODD) symptoms. The current study utilised a large sample of young children (n = 438, aged 4-8) referred to Cardiff University’s Neurodevelopment Assessment Unit (NDAU) by teachers for cognitive and/or socio-emotional problems. As part of the referral process, the teachers completed the Strengths and Difficulties Questionnaire (SDQ), which revealed that most children displayed moderate to high hyperactivity (86%) and prosocial (73%) problems, as well as high levels of symptoms in other clinical domains (41% emotional, 61% conduct and 68% peer problems). Children completed tasks to assess episodic memory, cognitive inhibition, cognitive flexibility and visuomotor control, whilst parents completed questionnaires to measure symptoms of ASD, ADHD, anxiety and ODD. Dimensional analyses showed that poorer cognitive inhibition and visuospatial episodic memory were significantly associated with ADHD symptoms, whereas cognitive flexibility was negatively associated with ODD symptoms. Having more ASD symptoms was associated with fewer cognitive inhibition problems, whereas anxiety was associated with better cognitive flexibility. Our approach to assessment and analysis shows that specific cognitive processes are associated with distinct neurodevelopmental and clinical symptoms, which is ultimately relevant to early identification of and intervention for young children at risk of cognitive and/or socio-emotional problems