Relative age within the school year and diagnosis of attention-deficit hyperactivity disorder: a nationwide population-based study

Background There are mixed findings on the relationship between ADHD and younger relative age in class. This study examines whether relative age is associated with ADHD diagnosis in a country where treatment prevalence rates are low and whether any such association has changed over time or relates to comorbid disorders. Methods Using nationwide population-based registers, all Finnish children born between 1991 and 2004 who were diagnosed with ADHD from age 7 years onwards (school starting age), between 1998 and 2011, were identified (n=6136). Incidence ratios (IRs) were used to examine the inter-relationships between relative age, actual age at ADHD diagnosis, and year of diagnosis (1998-2003 vs. 2004-2011). Findings The cumulative incidence of ADHD diagnosis was greatest for younger children within the schoolyear - IRs of 1.26 (boys) and 1.31 (girls). The association between relative age and ADHD diagnosis reflected children diagnosed before the age of 10 years. The strength of this association increased during recent years – for 2004-2011, IRs were 1.37 (95% CI 1.24,1.53) for May-August and 1.64 (95% CI 1.48,1.81) for September-December compared with January-April births (oldest). The relative age effect was not explained by comorbid disorders. Interpretation In a health service system with low prescribing rates for ADHD, younger relative age is associated with an increased likelihood of receiving a clinical diagnosis of ADHD. This influence has increased in recent years. Teachers, parents and clinicians should take relative age into account when considering the possibility of ADHD in a child or encountering a child with a pre-existing diagnosis

Register-based study of the incidence, comorbidities and demographics of obsessive-compulsive disorder in specialist healthcare

Background: Incidence of obsessive-compulsive disorder (OCD) has been suspected to increase but nationwide epidemiological studies are limited. This study aims to examine sex-specific incidence time trends and characterize psychiatric and neurodevelopmental comorbidities and sociodemographic risk factors of OCD in specialist healthcare in Finland. Methods: A nationwide register-based study using data from four Finnish registers identified 3372 OCD cases and 13,372 matched controls (1: 4). Cumulative incidence in subjects born between 1987 and 2001 was estimated at ages of 10, 15, 20 and 23 years. Conditional logistic regression was used to examine the sociodemographic factors. Results: The cumulative incidence of OCD was 0.4% by age 23. Incidence by age 15 among three cohorts increased from 12.4 to 23.7 /10000 live born males and 8.5 to 28.0 /10000 live born females. 73% of the sample had a comorbid condition. Males were significantly more comorbid with psychotic and developmental disorders; females were more comorbid with depressive and anxiety disorders (p <0.001). Higher maternal SES was associated with an increased risk of OCD (OR 1.4; 95% CI 1.1-1.6). Conclusions: These findings suggest that incidence of treated OCD in specialist healthcare has increased. The reason may be increased awareness and rate of referrals but a true increase cannot be ruled out. Further research on risk factors of OCD is warranted.Peer reviewe

Who escapes or remains a victim of bullying in primary school?

The stability of both direct and relational victimisation and factors that contribute to remaining, escaping or becoming a victim of bullying were investigated. 663 children at baseline aged 6-9 (years 2-4) were interviewed about their bullying experiences and parents completed a behaviour and health measure. Children’s perception of the degree of social hierarchical structuring and social prominence in their class was determined by peer nominations. 432 children participated in the follow-up either 2 or 4 years after baseline aged 10-11 (year 6) and completed a bullying questionnaire. Relational victims and children from classes with a high hierarchical structure were more likely to have dropped out of the study compared to neutral children, and children from classes with a low hierarchical structure. Relative risk analyses indicated a two-fold increased risk of remaining a direct victim at follow-up, compared to a child not involved at baseline becoming a victim over the follow-up period. In contrast, relational victimisation increased but was not found to be stable. Logistic regression analyses revealed that being a girl, and receiving few positive peer nominations predicted remaining a direct victim. Becoming a relational victim at follow-up was predicted by a strong class hierarchy. The implications for future study of early recognition of likely long term victims and early preventative bullying initiatives are discussed

Vulnerability to bullying of children with autism spectrum conditions in mainstream education: a multi-informant qualitative exploration

Young people with autism spectrum conditions (ASC) are widely reported by parents and teachers to be bullied by peers during their school years. Research in this area is still in its relative infancy with the majority of studies quantitative in nature. The aim of the current study was therefore to investigate vulnerability to bullying of young people with ASC in mainstream schools in England. Five pupils aged 5-13 (3 male, 2 female) were selected. Semi-structured interviews were conducted with the children (where possible), their parents and teachers to explore vulnerability to being bullied in the context of school. While none of the pupils were being seriously bullied, they were all recognised as vulnerable, especially as they grew older. Difficulties in conceptualising bullying emerged among the children, along with challenges forming and maintaining peer relationships. Behaviour difficulties risked isolating the pupils, potentially making them more vulnerable to bullies. However, school emerged as having a powerful protective role to play, with a positive ethos and zero tolerance of bullying, promotion of good relationships and communication with parents crucial in mitigating the risk of being bullied. The implications of these findings are discussed in relation to research and practice

Absence of association between behavior problems in childhood and hypertension in midlife

Background It is known that behavior in childhood is associated with certain physical and mental health problems in midlife. However, there is limited evidence on the role of childhood behavior problems in the development of hypertension in adulthood. The present study aimed to examine whether behavior problems in childhood influenced the risk of hypertension in midlife in the United Kingdom 1958 birth cohort. Methods The 1958 British birth cohort comprised 17,638 individuals born in the first week of March 1958 in the United Kingdom. Behavior problems were assessed at 7, 11, and 16 years of age by parents and teachers. At age 45, blood pressure was measured and hypertension was recorded if blood pressure was ≥140/90 mm Hg or if the participants were informed by their health professionals that they had high blood pressure. Behavioral information was reported according to the Rutter Children's Behaviour Questionnaire (RCBQ) and the Bristol Social Adjustment Guide (BSAG). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine behavior problems in childhood in relation to hypertension at 45 years of age according to logistic regression analysis, with adjustment for sex, social class in childhood and adulthood, childhood cognition, birth weight, gestational age at birth, body mass index (BMI), smoking, alcohol consumption, and physical activity. Results Behavior problems reported by parents at 7, 11, and 16 years were not associated with hypertension in midlife (OR, 0.93; 95% CI, 0.81, 1.07; OR, 0.95; 95% CI, 0.81, 1.11; OR, 0.98; 95% CI, 0.85, 1.12, respectively). Similarly, teacher-reported behavior problems at 7, 11, and 16 years were not associated with hypertension in midlife (OR, 0.92; 95% CI, 0.72, 1.18; OR, 0.92; 95% CI, 0.84, 1.02; OR, 1.03; 95% CI, 0.92, 1.15, respectively). Further separate analyses showed similar results for males and females. Conclusion There is no association between behavior problems in childhood and hypertension in midlife

Social risk factors for speech, scholastic and coordination disorders : a nationwide register-based study

Background: Broadly defined learning and coordination disorders (LCDs) are common in the population and have previously been associated with familial social risk factors and male sex. However, comprehensive nationwide studies of these risk factors in LCD subgroups are lacking. Our objective was to assess different LCDs in relation to sex and maternal education, marital status and socioeconomic status based on occupation. Methods: We conducted a nationwide register-based study. The following diagnoses were identified from the Finnish Hospital Discharge Register (FHDR) according to the ICD-10 (n = 28,192): speech disorders (F80), scholastic disorders (F81), motor and coordination disorders (F82) and mixed developmental disorder (F83). To study cumulative incidence and male: female ratios of service use of LCDs, we used a cohort design among all Finnish children born singleton 1996-2007 (n = 690,654); to study social risk factors, we used a nested case-control design with extensive register data on both cases and matched controls (n = 106,616). Results: The cumulative incidence was 4.7% for any LCD by age 15 and the changes in cumulative incidence over time were minor. The male: female ratios were 2.2-3.0 across LCD subgroups. Learning and coordination disorders were more common in households with lower maternal education, socioeconomic status based on occupation and among children with single mothers at the time of birth; the odds ratios (OR) for any LCD were 1.2-1.9 across risk factors. The odds for LCD diagnosis increased linearly with the number of social risk factors, except for coordination disorder. The effect size of three risk factors was highest in the group with mixed or multiple LCDs; OR 3.76 (95% CI 3.31-4.28). Conclusions: Multiple social risk factors increase the odds for multiple, more comprehensive learning difficulties. The findings have implications for service planning, as early identification and interventions of learning and coordination disorders might reduce related long-term social adversities.Peer reviewe

Ennenaikaisuuden ja sikiön pienen syntymäpainon vaikutus oppimishäiriöiden ilmenemiseen - systemaattinen kirjallisuuskatsaus

Ennenaikaisen syntymän määritelmän mukaan lapsi on ennenaikainen, mikäli hän syntyy kolme viikkoa ennen laskettua aikaa, eli ennen raskausviikkoa 37. Tämän määritelmän mukaan kehittyneissä maissa syntyneistä lapsista ennenaikaisia on 5-10%. Hyvin ennenaikaiseksi luetaan lapsi, joka syntyy ennen raskausviikkoa 32. Erittäin ennenaikainen lapsi syntyy ennen raskausviikkoa 28. Ennenaikaisuuden ennustaminen on haastavaa, sillä kyseessä on monen tekijän yhteisvaikutus. Raskauden kulkuun vaikuttaa geneettiset ja biologiset sekä psykososiaaliset ja sosioekonomiset tekijät. Pienipainoinen keskonen painaa syntyessään alle 1500 g, hyvin pienipainoinen keskonen painaa syntyessään alle 1000 g. Lapsi on alipainoinen, mikäli hän painaa syntyessään alle -2 SD raskauden kestoon nähden. Pienelle syntymäpainolle (SGA, small for gestational age) voi olla sikiöperäinen syy tai se voi johtua äidin sairaudesta tai häiriöstä, toisaalta syynä voi myös olla istukan toiminnan ongelma. Oppimis- ja koodinaatiohäiriö -termi kattaa alleen puheen, matemaattisen sekä motorisen koordinaation vaikeuden. Oppimishäiriö tarkoittaa vaikeutta suorittaa tiettyä kognitiivista prosessia, mikä ei kuitenkaan ole sidoksissa henkilön älylliseen lahjakkuuteen. Samalla henkilöllä voi ilmetä monenlaisia oppimisen vaikeuksia samanaikaisesti. Oppimishäiriön laajuus vaikuttaa suoriutumiskykyyn yhdellä tai useammalla osa-alueella. Oppimishäiriön etiologia on moninainen ja sillä on vahva, mutta vaikeasti määriteltävä geneettinen tausta yhdistettynä pre- ja postnataalisiin ympäristötekijöihin. Syventävän työn tavoitteena on tutustua ja käydä analyyttisesti läpi kirjallisuutta, joka käsittelee pienen syntymäpainon ja ennenaikaisuuden vaikutusta oppimishäiriöiden ilmenemiseen myöhemmin nuoruudessa. Kirjallisuuden pohjalta toteutettiin systemaattinen kirjallisuuskatsaus

Social risk factors for speech, scholastic and coordination disorders : a nationwide register-based study

Background: Broadly defined learning and coordination disorders (LCDs) are common in the population and have previously been associated with familial social risk factors and male sex. However, comprehensive nationwide studies of these risk factors in LCD subgroups are lacking. Our objective was to assess different LCDs in relation to sex and maternal education, marital status and socioeconomic status based on occupation. Methods: We conducted a nationwide register-based study. The following diagnoses were identified from the Finnish Hospital Discharge Register (FHDR) according to the ICD-10 (n = 28,192): speech disorders (F80), scholastic disorders (F81), motor and coordination disorders (F82) and mixed developmental disorder (F83). To study cumulative incidence and male: female ratios of service use of LCDs, we used a cohort design among all Finnish children born singleton 1996-2007 (n = 690,654); to study social risk factors, we used a nested case-control design with extensive register data on both cases and matched controls (n = 106,616). Results: The cumulative incidence was 4.7% for any LCD by age 15 and the changes in cumulative incidence over time were minor. The male: female ratios were 2.2-3.0 across LCD subgroups. Learning and coordination disorders were more common in households with lower maternal education, socioeconomic status based on occupation and among children with single mothers at the time of birth; the odds ratios (OR) for any LCD were 1.2-1.9 across risk factors. The odds for LCD diagnosis increased linearly with the number of social risk factors, except for coordination disorder. The effect size of three risk factors was highest in the group with mixed or multiple LCDs; OR 3.76 (95% CI 3.31-4.28). Conclusions: Multiple social risk factors increase the odds for multiple, more comprehensive learning difficulties. The findings have implications for service planning, as early identification and interventions of learning and coordination disorders might reduce related long-term social adversities.Peer reviewe

Mental health services and allocation of resources : where should the money flow? Reply

Non peer reviewe

Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis

Objective: Bullying is a common childhood experience with enduring psychosocial consequences. The aim of this study was to test whether bullying increases risk for eating disorder symptoms. Method: Ten waves of data on 1,420 participants between ages 9 and 25 were used from the prospective population-based Great Smoky Mountains Study. Structured interviews were used to assess bullying involvement and symptoms of anorexia nervosa and bulimia nervosa as well as associated features. Bullying involvement was categorized as not involved, bully only, victim only, or both bully and victim (bully-victims). Results: Within childhood/adolescence, victims of bullying were at increased risk for symptoms of anorexia nervosa and bulimia nervosa as well as associated features. These associations persisted after accounting for prior eating disorder symptom status as well as preexisting psychiatric status and family adversities. Bullies were at increased risk of symptoms of bulimia and associated features of eating disorders, and bully-victims had higher levels of anorexia symptoms. In terms of individual items, victims were at risk for binge eating, and bully-victims had more binge eating and use of vomiting as a compensatory behavior. There was little evidence in this sample that these effects differed by sex. Childhood bullying status was not associated with increased risk for persistent eating disorder symptoms into adulthood (ages 19, 21, and 25). Discussion: Bullying predicts eating disorder symptoms for both bullies and victims. Bullying involvement should be a part of risk assessment and treatment planning for children with eating problems