48
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Neurodevelopmental multimorbidity and educational outcomes of Scottish schoolchildren: A population-based record linkage cohort study

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Neurodevelopmental conditions commonly coexist in children, but compared to adults, childhood multimorbidity attracts less attention in research and clinical practice. We previously reported that children treated for attention deficit hyperactivity disorder (ADHD) and depression have more school absences and exclusions, additional support needs, poorer attainment, and increased unemployment. They are also more likely to have coexisting conditions, including autism and intellectual disability. We investigated prevalence of neurodevelopmental multimorbidity (≥2 conditions) among Scottish schoolchildren and their educational outcomes compared to peers.

          Methods and findings

          We retrospectively linked 6 Scotland-wide databases to analyse 766,244 children (390,290 [50.9%] boys; 375,954 [49.1%] girls) aged 4 to 19 years (mean = 10.9) attending Scottish schools between 2009 and 2013. Children were distributed across all deprivation quintiles (most to least deprived: 22.7%, 20.1%, 19.3%, 19.5%, 18.4%). The majority (96.2%) were white ethnicity. We ascertained autism spectrum disorder (ASD) and intellectual disabilities from records of additional support needs and ADHD and depression through relevant encashed prescriptions. We identified neurodevelopmental multimorbidity (≥2 of these conditions) in 4,789 (0.6%) children, with ASD and intellectual disability the most common combination. On adjusting for sociodemographic (sex, age, ethnicity, deprivation) and maternity (maternal age, maternal smoking, sex-gestation–specific birth weight centile, gestational age, 5-minute Apgar score, mode of delivery, parity) factors, multimorbidity was associated with increased school absenteeism and exclusion, unemployment, and poorer exam attainment. Significant dose relationships were evident between number of conditions (0, 1, ≥2) and the last 3 outcomes. Compared to children with no conditions, children with 1 condition, and children with 2 or more conditions, had more absenteeism (1 condition adjusted incidence rate ratio [IRR] 1.28, 95% CI 1.27–1.30, p < 0.001 and 2 or more conditions adjusted IRR 1.23, 95% CI 1.20–1.28, p < 0.001), greater exclusion (adjusted IRR 2.37, 95% CI 2.25–2.48, p < 0.001 and adjusted IRR 3.04, 95% CI 2.74–3.38, p < 0.001), poorer attainment (adjusted odds ratio [OR] 3.92, 95% CI 3.63–4.23, p < 0.001 and adjusted OR 12.07, 95% CI 9.15–15.94, p < 0.001), and increased unemployment (adjusted OR 1.57, 95% CI 1.49–1.66, p < 0.001 and adjusted OR 2.11, 95% CI 1.83–2.45, p < 0.001). Associations remained after further adjustment for comorbid physical conditions and additional support needs. Coexisting depression was the strongest driver of absenteeism and coexisting ADHD the strongest driver of exclusion. Absence of formal primary care diagnoses was a limitation since ascertaining depression and ADHD from prescriptions omitted affected children receiving alternative or no treatment and some antidepressants can be prescribed for other indications.

          Conclusions

          Structuring clinical practice and training around single conditions may disadvantage children with neurodevelopmental multimorbidity, who we observed had significantly poorer educational outcomes compared to children with 1 condition and no conditions.

          Abstract

          Michael Fleming and colleagues investigate educational outcomes among children with comorbid depression, attention deficit hyperactivity disorder, autism, or intellectual disability.

          Author summary

          Why was this study done?
          • Children with neurodevelopmental conditions experience difficulties at school.

          • Multiple neurodevelopmental conditions commonly coexist together.

          • We investigated prevalence of neurodevelopmental multimorbidity in Scottish schoolchildren and their educational outcomes compared to peers.

          What did the researchers do and find?
          • We linked Scotland-wide health and education data together to identify neurodevelopmental multimorbidity among children attending school in Scotland between 2009 and 2013, inclusive.

          • We identified children treated for depression, attention deficit hyperactivity disorder (ADHD), autism, and intellectual disability and defined comorbidity as 2 or more of those conditions existing together.

          • Compared to children with no conditions, children with 1 condition, and children with 2 or more of these conditions, experienced increased school absenteeism and exclusion, poorer exam attainment, and increased unemployment.

          What do these findings mean?
          • Structuring clinical practice and training around single conditions may disadvantage children with multimorbidity, who we observed in our study to have significantly increased risk of poor educational outcomes compared to children with 1 condition and no conditions.

          Related collections

          Most cited references52

          • Record: found
          • Abstract: found
          • Article: found

          What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis

          To derive the first systematically calculated estimate of the relative proportion of boys and girls with autism spectrum disorder (ASD) through a meta-analysis of prevalence studies conducted since the introduction of the DSM-IV and the International Classification of Diseases, Tenth Revision.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Depression in adolescence.

            Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising. Copyright © 2012 Elsevier Ltd. All rights reserved.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

              There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.
                Bookmark

                Author and article information

                Contributors
                Role: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Academic Editor
                Journal
                PLoS Med
                PLoS Med
                plos
                plosmed
                PLoS Medicine
                Public Library of Science (San Francisco, CA USA )
                1549-1277
                1549-1676
                13 October 2020
                October 2020
                : 17
                : 10
                : e1003290
                Affiliations
                [1 ] Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
                [2 ] Information Services Division, Edinburgh, United Kingdom
                [3 ] ScotXed, Scottish Government, Edinburgh, United Kingdom
                [4 ] Department of Child Health, University of Aberdeen, Aberdeen, United Kingdom
                Stellenbosch University, SOUTH AFRICA
                Author notes

                The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-2185-4502
                http://orcid.org/0000-0002-6146-3477
                http://orcid.org/0000-0002-2626-1554
                http://orcid.org/0000-0003-4757-4573
                http://orcid.org/0000-0001-6913-1883
                http://orcid.org/0000-0002-1120-6704
                http://orcid.org/0000-0001-6054-7700
                http://orcid.org/0000-0002-8898-7035
                Article
                PMEDICINE-D-19-02781
                10.1371/journal.pmed.1003290
                7553326
                33048945
                8974afa1-bc84-456f-bd2a-8ca85a305665
                © 2020 Fleming et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 July 2019
                : 3 September 2020
                Page count
                Figures: 2, Tables: 4, Pages: 24
                Funding
                Funded by: Health Data Research UK
                Award ID: MR/S003800/1
                Award Recipient :
                Funded by: Mental Health Data Pathfinder
                Award ID: MC_PC_17217
                Award Recipient :
                Funded by: Carnegie Trust
                Award ID: VAC007974
                Award Recipient :
                The study was sponsored by Health Data Research UK ( www.hdruk.ac.uk) (grant reference number MR/S003800/1) (MF) which is a joint investment led by the Medical Research Council, together with the National Institute for Health Research (England), the Chief Scientist Office (Scotland), Health and Care Research Wales, Health and Social Care Research and Development Division (Public Health Agency, Northern Ireland), the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the British Heart Foundation and Wellcome. There was additional funding from the Carnegie Trust for the Universities of Scotland (grant reference VAC007974) (EES) and an MRC Mental Health Data Pathfinder grant (grant reference MC_PC_17217) (MF, JPP, DK, SC).
                Categories
                Research Article
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Medicine and Health Sciences
                Medical Conditions
                Neurodevelopmental Disorders
                Adhd
                Biology and Life Sciences
                Neuroscience
                Developmental Neuroscience
                Neurodevelopmental Disorders
                Adhd
                Medicine and Health Sciences
                Neurology
                Neurodevelopmental Disorders
                Adhd
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Neuropsychiatric Disorders
                Adhd
                Social Sciences
                Sociology
                Education
                Schools
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Medical Conditions
                Disabilities
                Intellectual Disability
                Medicine and Health Sciences
                Neurology
                Intellectual Disability
                Biology and Life Sciences
                Psychology
                Developmental Psychology
                Pervasive Developmental Disorders
                Autism Spectrum Disorder
                Social Sciences
                Psychology
                Developmental Psychology
                Pervasive Developmental Disorders
                Autism Spectrum Disorder
                People and Places
                Population Groupings
                Ethnicities
                European People
                British People
                Scottish People
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Custom metadata
                All health data are owned by the Information Services Division of NHS National Services Scotland ( https://www.isdscotland.org), and all education data are owned by the ScotXed Unit, which is part of the Educational Analytical Services Division within the Learning and Justice Directorate of the Scottish Government ( www2.gov.scot/Topics/Statistics/ScotXed). Interested researchers may apply at these sites for data access.

                Medicine
                Medicine

                Comments

                Comment on this article