[Prevalence of neurodevelopmental, behavioural and learning disorders in Pediatric Primary Care]

Prevalence, comorbidities, and profiles of neurodevelopmental disorders according to the DSM-5-TR in children aged 6 years old in a European region

Background

There are no studies that measure the prevalence and real comorbidities of neurodevelopmental disorders (NDDs) according to the DSM-5-TR in 6-year-old children in population and clinical samples or studies that measure them as a whole. The data on the prevalence of these disorders are usually disparate because of the estimation methods (direct/indirect), the type of sample (population/clinical/school), and the ages studied.

Methods

The initial sample (289 subjects) was representative of 6-year-old children in the entire population of Menorca, obtained from pediatric primary care services (100% of the sample). The patients were divided into two groups based on the criterion of verification of clinical warning signs. One of the groups represented the clinical or experimental sample (EG) (81 subjects) at risk of NDDs; the other group was considered the control sample (CG) (210 subjects), and they were subjects without risk of suffering NDDs. A direct clinical assessment of the clinical sample was carried out, and they were administered the Wechsler Intelligence Scale for Children (WISC-V), the Clinical Evaluation of Language Fundamentals (CELF-5), the Battery for the evaluation of the processes of revised reading (Batería para la evaluación de los procesos de lectura revisada - PROLEC-R), the Test for the Diagnosis of Basic Mathematical Competences, (TEDI-MATH), and the Developmental Coordination Disorder Questionnaire (DCDQ).

Results

A total of 21.5% of the initial sample suffered from an NDD. A total of 2.4% presented autism spectrum disorder (ASD); 14% presented attention-deficit hyperactivity disorder (ADHD); 0.34% presented mild intellectual disability; 9.54% presented communication disorder (CD) (5.8% language disorder, 3.4% phonological disorder, and 0.34% stuttering); 10% presented learning disorder with reading difficulties; 5.8% presented learning disorder with difficulties in writing; 3.11% presented learning disorder with difficulties in mathematics; 1% presented transitory tic disorder; 0.34% presented chronic tic disorder; 1% presented Tourette syndrome; 2% presented motor coordination disorder (MCD); and 0.34% presented stereotypic movement disorders. Male children were more affected than female children in general, with male/female ORs of 0.14/0.92 for the presence of comorbidities, 0.11/0.88 for combined ADHD, 0.06/0.87 for language disorder, 1.02/1.27 for MCD, and 1.39/1.02 for inattentive ADHD.

Conclusion

In disadvantaged contexts, there was a higher prevalence of NDDs and comorbidities, unless the disorder was extreme, in which case only the NDD manifestations were presented. A significant proportion of the sample had not been previously diagnosed (88.6%); therefore, early detection programs are recommended to identify warning signs and develop policies that help and support the most disadvantaged sectors of the population.

An approach for prevention planning based on the prevalence and comorbidity of neurodevelopmental disorders in 6-year-old children receiving primary care consultations on the island of Menorca

BACKGROUND

Few studies have estimated the real prevalence of neurodevelopmental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in Spain and worldwide. However, there are disparate prevalence figures. We consider research in this field essential to improve early detection, secondary prevention, and health planning.

METHODS

The Minikid ADHD and TICS-Mini International Neuropsychiatric Interview for Children and Adolescents, the Autism Spectrum Quotient (Children's version, AQ- Child) and a protocol of general medical questions were administered for screening purposes. The PROLEXIA battery for children aged from 4 to 6 years was used for direct assessments. Parents provided information on emotional, medical, and school aspects. The final population evaluated using these tools consisted of 291 6-year-old subjects.

RESULTS

The overall risk of presenting with a neurodevelopmental disorder was 55.4%. A 23.4% risk of presenting with attention-deficit/hyperactivity disorder (ADHD) in any modality (inattentive, hyperactive-impulsive and combined), a 2.8% risk of developing autism spectrum disorder (ASD), a 30.6% risk of presenting with a learning disorder with reading difficulties, a 5.5% risk of tics and a 22.5% risk of language problems (incomprehensible language or minor language problems) were detected in the sample. The most common combination of disorders was learning and language difficulties, accounting for 6.9% of the sample. The second most frequent combination was the presence of learning and language difficulties and ADHD, accounting for 4.5% of the sample.

CONCLUSIONS

The prevalence of risks detected in our sample seems to be consistent with national and international studies. A significant proportion of our sample had never been previously diagnosed (85%), so early detection programs are recommended.

Neurological Short-Term Outcomes of a Cohort of Children Born to Zika Virus-Infected Mothers in Barcelona

Zika virus (ZIKV) is a vector-borne flavivirus with a known teratogenic effect, yet the full spectrum has not been delineated. Studies on endemic areas tried to characterize the clinical outcomes of ZIKV intrauterine exposure. We aimed to describe early neurodevelopmental outcomes on prenatally ZIKV-exposed children in a non-endemic ZIKV area. This is a prospective observational cohort study conducted from May 2016 to December 2021 at Hospital Universitari Vall d’Hebron in Barcelona, Catalonia, Spain. We monitored for up to 24 months 152 children extracted from a pregnant women cohort with suspected ZIKV infection; eleven women (11/150; 7.3%) fulfilled the criteria for a confirmed ZIKV infection. Among the 152 children included, we describe two cases of congenital ZIKV syndrome (CZS) born from women with a confirmed ZIKV infection. Additionally, we describe five cases of other potentially ZIKV-related outcomes (OPZROs), all with normal birth cranial circumference and born to women with probable ZIKV infection. The low exposed prevalence of adverse outcomes in asymptomatic children at birth in a non-endemic area suggests that close follow-up should be addressed by primary care pediatricians instead of pediatric specialists. Further studies are needed to assess the effects of ZIKV intrauterine exposure beyond two years of life.

Neurodevelopmental disorders among Spanish school-age children: prevalence and sociodemographic correlates

BACKGROUND

Prevalence estimates of neurodevelopmental disorders (ND) are essential for treatment planning. However, epidemiological research has yielded highly variable rates across countries, including Spain. This study examined the prevalence and sociodemographic correlates of ND in a school sample of Spanish children and adolescents.

METHODS

The Child Behaviour Checklist/Teacher's Report Form/Youth Self-Report and the Conners' Rating Scales were administered for screening purposes. Additionally, teachers provided information on reading and writing difficulties. Subjects who screened positive were interviewed for diagnostic confirmation according to the Diagnostic and Statistical Manual of Mental Disorders criteria. The final population comprised 6834 students aged 5-17. Multivariate analyses were performed to determine the influence of gender, age, educational stage, school type, socioeconomic status (SES), and ethnicity on the prevalence estimates.

RESULTS

A total of 1249 (18.3%) subjects met criteria for at least one ND, although only 423 had already received a diagnosis. Specifically, the following prevalence rates were found: intellectual disabilities (ID), 0.63%; communication disorders, 1.05%; autism spectrum disorder (ASD), 0.70%; attention-deficit/hyperactivity disorder (ADHD), 9.92%; specific learning disorder (SLD), 10.0%; and motor disorders, 0.76%. Students of foreign origin and from low SES evidenced higher odds of having ID. Boys were more likely to display ASD or a motor disorder. Age, SES, and ethnicity were significant predictors for SLD, while communication disorders and ADHD were also associated with gender.

CONCLUSIONS

The prevalence of ND among Spanish students is consistent with international studies. However, a substantial proportion had never been previously diagnosed, which emphasise the need for early detection and intervention programmes.

Current state of knowledge on the prevalence of neurodevelopmental disorders in childhood according to the DSM-5: a systematic review in accordance with the PRISMA criteria

OBJECTIVE

To interpret the current evidence on the prevalence of neurodevelopmental disorders (NDDs) through a systematic review based on both DSM-5 (2013) and PRISMA criteria.

METHOD

Empirical studies complying with the PRISMA guidelines were identified from four databases (PubMed, Scopus, Science Direct, and ProQuest) and systematically reviewed. In total, 17 articles were selected for the study.

RESULTS

In the scientific literature, there have been only a few studies measuring the prevalence of NDDs according to the DSM-5 (2013) criteria in people under 18 years old. The reported prevalence rates were as follows: intellectual disability (ID), 0.63%; attention-deficit/hyperactivity disorder (ADHD), 5-11%; autism spectrum disorder (ASD), 0.70-3%; specific learning disorder (SLD), 3-10%; communication disorders (CDs), 1-3.42%; and motor disorders (MDs), 0.76-17%. Although there is extensive literature on specific disorders, NDDs have rarely been assessed as a whole. All of the reviewed studies support the idea that such disorders can be considered chronic, heterogeneous, underdiagnosed conditions and that comorbidity of multiple NDDs is the norm. Likewise, it is estimated that the prevalence of the most studied disorders, such as ADHD, ASD and SLD, remains stable over time and is consistent in different cultures, ages, ethnicities and sexes.

CONCLUSION

The studies reviewed lead us to conclude that the prevalence rate of NDDs fluctuates globally between 4.70 and 88.50%; these variations depend on methodological aspects such as estimation procedures, as well as on sociocontextual phenomena. It is also important to consider that the prevalence found is probably highly influenced by the activity of the countries in the diagnosis and training of professionals who care for children and adolescents. Hence, there is a need for a secondary intervention in the fields of public health and education to minimize socioemotional consequences, prevent academic failure, and reduce the economic cost to society.

Universal Screening in Positive School Mental Health Using the ASEBA Methodology for Teachers: A Pilot Epidemiological Study

School-based detection and intervention are critical components in ensuring positive mental health in children, with teachers playing an essential role in assessing students’ well-being. The current research aims to be a pilot epidemiological study on positive school mental health in Malaga, Spain, using the Achenbach System of Empirically Based Assessment (ASEBA). Data were collected in the COVID-19 pre-pandemic setting, using the Caregiver-Teacher Report Form (C-TRF) and the Teacher Report Form (TRF) in a sample of 420 children, who were between 5 and 8 years old at the time of the data collection. In 5-year-old children, the DSM-oriented scale with the highest clinical prevalence corresponds to attention deficit and hyperactivity problems (1.13%). In this same sub-sample, clinical levels of externalizing problems (4.52%) were non-significantly more common than internalizing conditions (1.69%). As for children between 6 and 8 years old, the DSM-oriented scale with the highest prevalence of clinical scores corresponds to anxiety problems (4.12%) and conduct problems (2.88%). Clinical levels of externalizing problems (9.47%) were non-significantly more prevalent than internalizing problems (6.58%). The results present 95% confidence intervals prevalence data in the general population and sex-differentiated descriptive statistics. The results are discussed according to their implication for school mental health.

An 88.8-kb Novel Deletion of 19q13.2 Encompassing the ATP1A3 Gene Detected by Array CGH in a Patient with Delayed Psychomotor Development, Generalized Hypotonia and Macrocephaly

Many neurodevelopmental disorders are caused by the presence of CNVs. Chromosome microarray technology is widely used to accurately detect CNVs. We report the case of a male, aged 3 years, presenting with delayed psychomotor development, generalized hypotonia, encephalopathy, delayed myelination in the central nervous system, and poor motor coordination. The array CGH revealed an interstitial deletion of chromosome 19q13.2 with a size of 88.8 kb involving 3 OMIM genes: RABAC1, ARHGEF1, and ATP1A3. Heterozygous mutations in the ATP1A3 gene are associated with delayed psychomotor development, alternating hemiplegia of childhood type 2 (AHC2), dystonia type 12, and cerebellarataxia-areflexia-pes cavus-optic atrophy-sensorineural hearing loss syndrome, also called CAPOS syndrome. The phenotypic expression of partial ATP1A3 deletion is, however, poorly described in the literature. The deletion was confirmed by MLPA, and we identified a hitherto undescribed novel deletion of exons 3b-21 of the ATP1A3 gene. Our data suggest that the deletion of the ATP1A3 gene is a causative factor of the AHC2 phenotype in the patient.

Cross-Cultural Adaptation and Preliminary Reliability of the Adolescents and Adults Coordination Questionnaire into European Spanish

Developmental Coordination Disorder (DCD) is a developmental disorder affecting motor coordination skills, that frequently persists into adolescence and adulthood. Despite this, very few instruments exist to identify DCD in this population, and none of them are available for Spanish young adults. The purpose of this study was to cross-culturally adapt and preliminarily validate the Adolescents and Adults Coordination Questionnaire (AAC-Q) into European Spanish. The AAC-Q was translated and adapted following international recommendations, including: (a) two independent forward translations; (b) synthesis and reconciliation; (c) expert committee review; and (d) a comprehensibility test. In addition, the internal consistency and homogeneity were examined using a sample of 100 Spanish higher education students. Cultural equivalence and idiomatic differences were addressed to produce the AAC-Q-ES. Findings show that the AAC-Q-ES is a cross-culturally adapted instrument with good preliminary reliability indicators in Spanish young adults (Cronbach’s α = 0.74; corrected item-total correlations = 0.217–0.504).

Effects of early intervention on parenting stress after preterm birth: A meta-analysis

BACKGROUND

Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies.

METHODS

Systematic review and meta-analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work.

RESULTS

Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta-analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I² heterogeneity statistic. The domains most commonly reported in the trials were the childcare-related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years.

CONCLUSIONS

This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area.

Developmental Coordination Disorder, Motor Performance, and Daily Participation in Children with Attention Deficit and Hyperactivity Disorder

Children with Attention Deficit and Hyperactivity Disorder (ADHD) often present with Developmental Coordination Disorder (DCD) or motor coordination problems that further impact their daily functioning. However, little is known about the prevalence of co-occurring DCD and ADHD in the Spanish context, and research about the impact of ADHD on performance and participation in motor-based activities of daily living (ADL) is scarce. The aims of this study were to explore the prevalence of co-occurring DCD in children with ADHD, and to examine differences in performance and participation in motor-based ADL between children with ADHD and typically developing children. We conducted a case-control study including 20 children with ADHD and 40 typically developing controls randomly matched for exact age and sex (males = 80%; mean age = 8, 9 (2, 3) years). Presence of probable DCD (p-DCD) was confirmed with the Developmental Coordination Disorder Questionnaire (DCDQ). The DCDDaily-Q was administered to assess performance and participation in ADL. A 75% prevalence of p-DCD was found in the ADHD group (OR = 27; p < 0.001). Children with ADHD showed poorer motor performance and less participation in ADL (p < 0.01; d = 0.9-1.4). These findings contribute to understand the functional consequences of ADHD in motor-based ADL and its relationship with DCD.

Play in Children with Neurodevelopmental Disorders: Psychometric Properties of a Parent Report Measure 'My Child's Play'

Play is essential in childhood, allowing for a positive trend in development and learning. Health professionals need useful tools to assess it, especially in the case of children with neurodevelopmental disorders. The aim of this study was to validate and cross-culturally adapt the My Child's Play questionnaire and to find out if this instrument allows us to differentiate the play of children with neurodevelopmental disorders from the play of children with neurotypical development. A total of 594 parents completed the questionnaire. A confirmatory factor analysis was conducted, which showed a similar structure to the English version: (1) executive functions; (2) environmental context; (3) play characteristics; and (4) play preferences and interpersonal interactions. The reliability of the analysis was high, both for the whole questionnaire and for the factors it comprises. The results provide evidence of the potential usefulness of the My Child's Play questionnaire for determining play needs and difficulties of children; moreover, this tool can also be used to plan intervention programs according to the needs of each child and family.

[Screening of the risk of mental and developmental disorders in children of early age in the Russian population (2017-2019)]

OBJECTIVE

Screening of children 18-48 months of age at risk of mental and developmental disorders in the general population.

MATERIAL AND METHODS

The survey was conducted by a continuous epidemiological method in primary health care institutions in the nine largest regions of Russia. For the period 2017-2019, 595 691 parents of children, aged 18-48 months, were surveyed.

RESULTS AND CONCLUSION

The prevalence risk rate for mental and developmental disorders was determined as 1.307:10 000. The prevalence rate for mental and behavioural disorders (ICD-10) was 151:10 000. The analysis of the structure of mental and behavioural disorders was carried out. An increase in cases of pervasive developmental disorders (item F84) was detected - autism spectrum disorders (ASD) with an increase in the age of children. The prevalence of ASD under the age of 48 months was found to be 18:10 000, compared with 2015-2016 - 5:10 000 under the age of 24 months.

Language Development Disorder in Fetal Alcohol Spectrum Disorders (FASD), a Case Study

Prenatal alcohol exposure can cause developmental damage in children. There are different types and ranges of alterations that fall under the name of fetal alcohol spectrum disorders (FASD). Disabilities in learning, cognition, and behavior are observed. Environmental conditions are an influencing factor in this population since they are generally adverse and are either not diagnosed at an early stage or given the appropriate support and approach. We present a case study of a 9-year-old child, in which all the variables affecting his development (FASD diagnosis and socioenvironmental conditions) were observed and analyzed. His early childhood under institutional care, the move to a foster home at the age of 6, and several measures of evaluation from foster care to the present are described. Difficulties in vocabulary, access to vocabulary, morphology, syntax, grammar, oral narrative, pragmatics, speech, and communication were observed, along with cognitive difficulties in memory, perception and executive functioning, social adaptation, learning, and behavior. An early diagnosis and approach enable this population to develop skills in different dimensions to address early adversity despite their neurological and behavioral commitment. Speech-language pathologist services are crucial for the diagnosis and treatment of the language and communication difficulties that characterize this syndrome.

Participation in Everyday Activities of Children with and without Neurodevelopmental Disorders: A Cross-Sectional Study in Spain

Children with neurodevelopmental disorders (NDDs) often report significant difficulties performing activities of daily living (ADLs), which may restrict their daily participation. The aim of this study was to investigate the differences in ADLs participation between children with NDDs and typically developing (TD) children, and to explore the associations between different daily participation contexts. A cross-sectional study was conducted that included twenty children with a medical diagnosis of an NDD and 26 sex- and age-matched TD controls. The daily participation across home, community, school, and instrumental living activities was measured using the Child and Adolescent Scale of Participation (CASP). The results show that children with NDDs engaged in lower participation in all CASP contexts (Δ = 1.7-5.5, p < 0.001) and had a significantly higher prevalence of moderate or severe restricted participation than their TD peers (OR = 23.4, 95% CI = 3.6-154.2, p < 0.001). Additionally, a strong association was found between the different contexts of participation (r = 0.642-0.856). Overall, the children with NDDs experienced significant participation restrictions on their daily activities. This study adds to the growing evidence showing that intervention strategies in this population should adopt a participation-oriented approach.

Assessment of Motor Activities of Daily Living: Spanish Cross-Cultural Adaptation, Reliability and Construct Validity of the DCDDaily-Q

The DCDDaily-Q is an instrument that aims to comprehensively assess motor performance in a broad range of activities of daily living (ADL) and to identify risk of Developmental Coordination Disorder (DCD) in children. The aim of this study was to cross-culturally adapt the DCDDaily-Q into European Spanish (DCDDaily-Q-ES) and to test its psychometric properties in Spanish 5 to 10 year old children. The DCDDaily-Q was translated and cross-culturally adapted into Spanish following international guidelines. Two-hundred and seventy-six parents of typically developing Spanish children completed the final version of the DCDDaily-Q-ES (M = 7.5 years, SD = 1.7; girls = 50%). Confirmatory Factor Analysis (CFA), internal consistency, and corrected item-total correlations were conducted to test construct validity, internal consistency, and homogeneity of the DCDDaily-Q-ES. The DCDDaily-Q-ES achieved good semantic, conceptual, and cultural equivalence. CFA supported construct validity of the DCDDaily-Q-ES. Reliability values were also good (Cronbach's alpha = 0.703-0.843; corrected item-total correlations = 0.262-0.567). This is the first study to cross-culturally adapt and examine the DCDDaily-Q outside the Netherlands. The findings suggest that the DCDDaily-Q-ES is a reliable and valid measure to assess learning, participation, and performance in a broad range of ADL.

Psychometric Validation and Reference Norms for the European Spanish Developmental Coordination Disorder Questionnaire: DCDQ-ES

The Developmental Coordination Disorder Questionnaire (DCDQ) is a widely used and well-validated tool that contributes to the diagnosis of Developmental Coordination Disorder (DCD). The aim of this study was to further analyze the psychometric properties of the European Spanish cross-culturally adapted version of the Developmental Coordination Disorder Questionnaire (DCDQ-ES) in a sample of Spanish children aged 6-11 years and to establish reference norms with respect to age groups. Parents of 540 typically developing children completed the DCDQ-ES. A second sample of 30 children with probable DCD (pDCD) was used to test its discriminant validity. Confirmatory factor analysis supported the original three-factor structure and the internal consistency was excellent (Cronbach's α = 0.907). Significant differences between age groups were found. The pDCD group scored significantly lower than the reference sample in the three subscales and DCDQ-ES total score (p < 0.001; AUC = 0.872). The DCDQ-ES is a reliable and valid tool for screening motor coordination difficulties in Spanish children and for identifying children with probable DCD. The findings of this research suggest that context-specific cut-off scores should be systematically utilized when using cross-cultural adaptations of the DCDQ. Age-specific cut-off scores for Spanish children are provided.

Identifying Children with Developmental Coordination Disorder via Parental Questionnaires. Spanish Reference Norms for the DCDDaily-Q-ES and Correlation with the DCDQ-ES

Developmental Coordination Disorder (DCD) is one of the most prevalent neurodevelopmental disorders in school-aged children, with major consequences in psychosocial and physical health. Adequate identification of this disorder is necessary to prompt effective interventions. The aims of this study were to develop the Spanish adjusted reference norms for the DCDDaily-Q and to test the correlation and agreement between the Spanish versions of the DCDDaily-Q (DCDDaily-Q-ES) and the Developmental Coordination Disorder Questionnaire (DCDQ-ES), two reliable instruments to assess motor performance and DCD. Clinically relevant percentiles were calculated for the DCDDaily-Q-ES using a representative sample of Spanish children aged 5 to 10 years (n = 356; M = 7.3 years, SD = 1.8; boys = 50%). Pearson's correlation coefficient and intraclass correlation coefficient (ICC) were used to determine correlation and agreement between questionnaires, respectively. A moderate and significant correlation and agreement between DCDDaily-Q-ES and DCDQ-ES was found (r = 0.406; ICC = 0.381; p < 0.001). Differences in daily participation and performance were found between age groups, but not between boys and girls. Spanish age-adjusted percentiles and cutoff scores for DCDDaily-Q-ES are provided. This study offers further validation and relevant information regarding assessment of DCD and has practical implications for clinical practice and research.

Assessment of Sensory Processing and Executive Functions at the School: Development, Reliability, and Validity of EPYFEI-Escolar

The aim of this study was to determine the psychometric properties of the Assessment of Sensory Processing and Executive Functions at the School (EPYFEI-Escolar), a questionnaire designed to assess the sensory processing and executive functions as underlying processes for school participation. The total sample consisted of 536 children aged between 3 and 11 years old who lived in Spain. A total of 103 teachers completed the questionnaire. An exploratory factor analysis was conducted, which showed five main factors: (1) initiation, organization, execution, and supervision of the action; (2) inhibitory control; (3) sensory processing; (4) emotional self-regulation and play; and (5) self-competence. Some of these factors were similar to those found in the EPYFEI for parents in the home context. The reliability of the analysis was high, both for the whole questionnaire and for the factors it is composed of. The results provide evidence of the potential usefulness of the EPYFEI-Escolar in school contexts for determining academic needs and difficulties of children; moreover, this tool can also be used to plan intervention programs in the school environment according to the needs of each child and school.

Prevalence and comorbidity of autism spectrum disorder in Spain: study protocol for a systematic review and meta-analysis of observational studies

BACKGROUND

Autism spectrum disorder (ASD) is a complex developmental disorder characterised by impaired social interaction and communication, and restrictive and repetitive behaviour. Previous systematic reviews have traditionally assessed the prevalence of ASD on global or regional context, with very few meta-analyses at the country level. The objective of this study will be to systematically evaluate published and unpublished observational studies that present prevalence and comorbidity of ASD among children, adolescent and adult population in Spain.

METHODS/DESIGN

We designed and registered a study protocol for a systematic review and meta-analysis of descriptive epidemiology data. Observational studies (cohort, cross-sectional) reporting the prevalence of ASD and conducted in a wide range of people (e.g. general population, outpatient and/or school settings) will be included. The primary outcome will be the prevalence of ASD. Secondary outcomes will be the prevalence of any physical or mental comorbidity in association with ASD. No limitations will be imposed on publication status, study conduct period, and language of dissemination. Comprehensive literature searches will be conducted in seven electronic databases (from January 1980 onwards), including PubMed/MEDLINE, EMBASE, Scopus, Web of Science, PsycINFO, IME-Spanish Medical Index and IBECS-Spanish Bibliographic Index of Health Sciences. Grey literature will be identified through searching dissertation databases, Google Scholar and conference abstracts. Two team members will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis of observational data. Prevalence estimates will be stratified according to gender, age and geographical location. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. methodological quality, sample size, diagnostic criteria).

DISCUSSION

This systematic review and meta-analysis of observational data will identify, evaluate and integrate the epidemiological knowledge underlying the prevalence of ASD in Spain. The results of this study will be of interest to multiple audiences including patients, their families, caregivers, healthcare professional, scientists and policy makers. Results will be published in a peer-reviewed journal. Implications for future epidemiological research will be discussed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018090372.

Prevalence of suspected developmental coordination disorder and associated factors in Spanish classrooms

BACKGROUND

Developmental Coordination Disorder (DCD) is a multifactorial, neurodevelopmental motor disorder that severely affects the activities of a child's daily life and classroom performance. The aim of this study was to determine the prevalence of suspected DCD in a sample of Spanish schoolchildren and its association with socio-demographic factors.

METHODS

We conducted a cross-sectional study including a random sample of 460 children attending mainstream schools in northwest Spain in 2017. A Developmental Coordination Disorder Questionnaire-European Spanish was used to evaluate suspected DCD prevalence. We performed multivariate logistic and linear regression analysis to determine the socio-demographic variables associated with suspected DCD and problematic motor coordination performance.

RESULTS

The prevalence of suspected DCD was 12.2%. According to the multivariate analysis, DCD symptoms were significantly associated with males (OR = 3.0), ages above 10 years old (OR = 5.0) and low participation in out-of-school physical activities (OR = 2.3). Preterm birth children were twice as likely to show suspected DCD, although this association was not statistically significant (OR = 2.1).

CONCLUSIONS

A high percentage of Spanish schoolchildren are at risk for developing DCD. There is a strong connection between suspected DCD and socio-demographic factors. Protocols aimed to detect DCD and intervention programmes in classrooms designed to promote motor coordination skills need to take these factors into consideration.

Prevalence and comorbidity of attention deficit hyperactivity disorder in Spain: study protocol for extending a systematic review with updated meta-analysis of observational studies

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset disorder characterized by a persistent pattern of symptoms of developmentally inappropriate and impaired inattention and/or hyperactivity/impulsivity, with difficulties often continuing into adulthood. ADHD can come with other comorbid conditions. The aim of this study will be to quantify the prevalence and comorbidity of ADHD among children, adolescent, and adult population in Spain.

METHODS/DESIGN

We designed and registered a study protocol for an update and expansion of a systematic review and meta-analysis of pooled prevalence data. We will include cross-sectional observational studies reporting prevalence of ADHD in Spain and conducted in the general population, outpatient, and/or school settings. The primary outcome will be the prevalence of ADHD. Secondary outcomes will be the prevalence of any physical or mental comorbidity in association with ADHD. No limitations will be imposed on publication status, study conduct period, and language of dissemination. Comprehensive literature searches will be conducted in multiple electronic databases, including PubMed/MEDLINE, EMBASE, Scopus, Web of Science, PsycINFO, IME - Spanish Medical Index, and IBECS - Spanish Bibliographic Index of Health Sciences. We will also search Google Scholar, dissertation databases, and conference abstracts. Two team members will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis. Prevalence estimates will be stratified according to gender, age, and geographical location. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., methodological quality, sample size, diagnostic criteria).

DISCUSSION

This systematic review and meta-analysis of observational data will provide an updated synthesis of the prevalence and comorbidity of ADHD in Spain. This study will also examine factors that may explain potential variations in prevalence data. The findings of this study will be published in a peer-reviewed journal.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018106082 .

Questionnaire on adaptation to type 1 diabetes among children and its relationship to psychological disorders

Objective:

to study the psychometric properties of an adaptive disease response questionnaire for use with Spanish children with type 1 diabetes; to analyse this response in this sample and to observe the relationship between adaptive response and levels of anxiety-depression.

Method:

a total of 100 patients with type 1 diabetes aged between nine and 16 years (M=12.28, SD=1.78) participated in the study, of which 59% were children. Data was collected in public hospitals via interviews using the Adaptive Disease Response Questionnaire and Anxiety and Depression Scale. The data was analysed using Pearson correlations, multiple hierarchical linear regressions, Student’s t Test for independent samples, and Cohen’s d effect size to determine reliability and validity.

Result:

the instrument was shown to have adequate psychometric properties. Adaptive response was generally high. Adaptive response is negatively related to emotional distress, being a better predictor of depression than of anxiety. There was no association betwee adaptation and sex and age.

Conclusion:

promoting a better adaptive response appears to reduce emotional distress, especially in the case of depression, regardless of the age or gender of the patients.

Assessment of Sensory Processing and Executive Functions in Childhood: Development, Reliability, and Validity of the EPYFEI

The aim of this study was to determine the psychometric properties of the "Assessment of Sensory Processing and Executive Functions in Childhood" (EPYFEI), a questionnaire designed to assess the sensory processing and executive functions of children aged between 3 and 11 years. The EPYFEI was completed by a sample of 1,732 parents of children aged between 3 and 11 years who lived in Spain. An exploratory factor analysis was conducted and showed five main factors: (1) executive attention, working memory, and initiation of actions; (2) general sensory processing; (3) emotional and behavioral self-regulation; (4) supervision, correction of actions, and problem solving; and (5) inhibitory. The reliability of the analysis was high both for the whole questionnaire and for the factors it is composed of. Results provide evidence of the potential usefulness of the EPYFEI in clinical contexts for the early detection of neurodevelopmental disorders, in which there may be a deficit of executive functions and sensory processing.