Child demographics and DSM diagnosis: a multi-axis study

Preschool developmental concerns and adjustment in the early school years: Evidence from a Scottish birth cohort

BACKGROUND

Preschool language and behavioural difficulties impact on multiple domains of the child's early life and can endure into adulthood, predicting poor educational, social, and health outcomes. Highlighting risk factors associated with poor outcomes following language and behavioural difficulties raised in early childhood may facilitate early identification and intervention.

METHODS

Data from the Growing Up in Scotland national birth cohort study were used. Language and behavioural difficulties were assessed at age 4 years using parent-reported language concerns and the Strengths and Difficulties Questionnaire. Measures of adjustment were collated into four key outcome domains: attitude to school life, language and general development, behaviour, and general health at age 6 years. Both univariate and multivariate logistic regression models were fitted in order to explore independent associations between language and behavioural difficulties at age 4 years and adjustment to life circumstances at age 6 years, whilst controlling for other risk factors.

RESULTS

Language difficulties at age 4 years increased the odds of the child experiencing difficulty with language and general development, poorer health outcomes, and behavioural difficulties at age 6 years. Behavioural difficulties alone at age 4 years were associated with increased odds of the child experiencing all of the aforementioned outcomes and difficulties in early school life. Lone parent family, low income, and male gender were identified as risk factors for poorer outcomes in the domains measured. At age 4 years, there was no additive effect found with the presence of behaviour difficulties on the relationship between language difficulties and language and developmental outcomes at 6 years.

CONCLUSIONS

This paper demonstrates language and behavioural difficulties are associated with poor social, educational, health, and behavioural outcomes. Taking seriously parent-reported concerns and identifying risk factors could limit negative outcomes for the child, their family, and society.

Conduct Disorder-Related Hospitalization and Substance Use Disorders in American Teens

Objective: Our study aimed to compare the demographic characteristics of conduct disorder (CD) inpatients versus other psychiatric inpatients in children and adolescents, and assess the association between conduct disorder patients and the spectrum of substance use disorders (SUD). Methods: We included 800,614 psychiatric adolescent (12–18 years) inpatients, and this included 8885 inpatients (1.1%) primarily for conduct disorder in the Nationwide Inpatient Sample (2010–2014). ICD-9 codes were used to detect SUD, and a logistic regression model was used to evaluate the odds ratio (OR) for SUD in conduct disorder inpatients. Results: A higher proportion of conduct disorder inpatients were of 12–15 years of age (62.6%), male (64.4%), and White (45.7%). The lower median household income was correlated with a higher prevalence of conduct disorder (36.4%). Among SUD, cannabis use (23.7%) was most prevalent in conduct disorder inpatients followed by tobacco and alcohol use (10.1% each). Conduct disorder inpatients have 1.7-fold higher odds (95% confidence interval (CI) 1.52–1.82) for alcohol use and 1.4-fold higher odds (95% CI 1.31–1.49) for cannabis use compared to the non-conduct disorder inpatients. Cannabis use was seen significantly in adolescents (49.1%, 12–15 years), male (75.6%), and African Americans (45.6%). Conclusion: Conduct disorder inpatients have a higher risk of comorbid SUD compared to other psychiatric illnesses. The most common substance to be abused is cannabis followed by tobacco and alcohol. Varying pattern of substance use was seen by demographics and these predictors may help the clinicians for early diagnosis and treatment to improve overall health-related quality of life.

Understanding the Demographic Predictors and Associated Comorbidities in Children Hospitalized with Conduct Disorder

Objective: To determine the demographic predictors and comorbidities in hospitalized children with conduct disorder. Methods: A retrospective analysis was performed using the Nationwide Inpatient Sample (2012–2014). All patients were ≤18 years old and cases with a primary diagnosis of conduct disorder (n = 32,345), and a comparison group with another psychiatric diagnosis (n = 410,479) were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)diagnosis codes. A logistic regression model was used to generate the odds ratio (OR) between both groups. Results: Children < 11 years old have a five times greater chance of admission for conduct disorder than adolescents (OR = 5.339). African American males are more likely to be admitted for conduct disorder. Children with conduct disorder from low-income families have a 1.5 times higher likelihood of inpatient admission compared to high-income families. These children have an about eleven times higher odds of comorbid psychosis (OR = 11.810) and seven times higher odds of depression (OR = 7.093) compared to the comparison group. Conclusion: Conduct disorders are more debilitating for children and families than many providers realize. African American males under 11 years are at the highest risk of inpatient management for conduct disorder. These patients have a higher risk of comorbid psychosis and depression, which may further deteriorate the severity of illness and require acute inpatient care.

Ethnicity differences in child and parental outcomes following involvement the PACE program

This study investigated ethnic differences in the extent to which engagement (i.e., attendance and quality of participation) in the PACE (Parenting our Children to Excellence) program predicted positive child and parent outcomes. PACE is an 8-week preventive intervention aimed at parents of preschool children. The study investigated the relation of engagement to outcomes in an ethnically diverse sample of 298 African American and 280 European American parents. Overall results demonstrated that engagement in PACE significantly improved child and parent outcomes for both African American and European American participants. Some improvements were evident at post-assessment already and were maintained or became stronger at a one-year follow-up assessment, whereas others only became evident at follow-up. Specifically, results revealed that attendance in PACE significantly improved child coping competence and parenting stress for both the African American and European American samples. PACE attendance also significantly improved child behavior problems, parental satisfaction and parental efficacy for the European American sample. Findings indicate that PACE is a promising intervention for parents of African American and Caucasian preschoolers; although further research and program refinement is necessary in order to understand the mechanisms with the PACE intervention that seem to vary for African American compared to Caucasian families.

Reversals of fortune? Sex differences in health in childhood and adolescence

This paper reviews findings on sex differences in health among children and adolescents, concentrating particularly on the ages 7-15 years. The overall picture is of a gradual emergence of excess morbidity in females over this life stage. In respect of overall levels of chronic illness, higher male rates in childhood are replaced by higher female rates which emerge in early-mid adolescence. This pattern is also seen in an examination of the rates of two common childhood conditions, asthma and migraine/headaches. An excess of psychological disturbance (largely neurotic disorders) among females emerges in early-mid adolescence, in comparison with younger ages where males predominate. Sex differences in the utilization of health services appear to mirror these patterns of excess morbidity. There is also evidence that with increasing age there is a strengthening in the sex patterning of illness behaviour. In contrast to the emphasis which has been given to explaining the emergence of a female excess in psychological disturbance and illness-related behaviours and attitudes during early adolescence, much less attention has been given to the understanding of the excess in physical complaints among females which also arises over this period. The paper suggests that this may be directly related to the relative lowering of their psychological well-being during early adolescence. Longitudinal studies are required in order to answer questions concerning age by sex interactions in respect of morbidity in childhood and adolescence.