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Lillvis D, Harmon B, Osei H, Ribeiro S, Zrik A, Janjua V, Assioun J, Aronoff N, Kuo DZ. Accidental Physical Trauma in Children and Youth with Special Health Care Needs: A Scoping Review. Acad Pediatr 2024:S1876-2859(24)00535-7. [PMID: 39395611 DOI: 10.1016/j.acap.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 09/30/2024] [Accepted: 10/01/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND Children and youth with special health care needs (CYSHCN) may be at greater risk for accidental physical trauma. Interventions should be informed by the literature indicating incident characteristics and at-risk subpopulations. OBJECTIVE To conduct a scoping review of accidental physical trauma in CYSHCN to characterize published literature and identify gaps. DATA SOURCES Peer-reviewed literature within CINAHL, Embase, and PubMed, 1998 to February 2021. STUDY ELIGIBILITY CRITERIA Studies that included individuals younger than 19 with special health care need(s) with accidental injuries classified as trauma. STUDY APPRAISAL AND SYNTHESIS METHODS The study team extracted: research method, author field, special health care needs, geographic scope, author country, demographics, incident characteristics, and injury characteristics. RESULTS We included 85 articles from an initial yield of 10,481. Pediatrics (32%) was the most-represented field among authors published on this topic. Publications most often considered developmental conditions (77.7%), including ADD/ADHD. Studies differed in how often they reported demographic characteristics: gender (96.5%); social determinants of health/socioeconomic status (41.2%) or race/ethnicity (25.9%). Few articles included injury time of day (10.6%) and day of week (2.4%); 40% did not include information about the place of injury. LIMITATIONS Our search term development focused on diagnosis rather than need; we did not search reference lists or grey literature. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS This review reveals key gaps in the literature pertaining to incident characteristics and place of injury for CYSHCN. Those advising families and/or planning interventions focused on mitigating risk for CYSHCN have limited evidence upon which to rely for certain conditions. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO registration is not applicable to scoping reviews.
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Affiliation(s)
- Denise Lillvis
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, Buffalo, New York, USA, 14214-8001; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Brooks Harmon
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, Buffalo, New York, USA, 14214-8001; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Hector Osei
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Department of Pediatric Surgery, John R. Oishei Children's Hospital, 818 Ellicott St., Buffalo, New York, USA, 14203; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Samantha Ribeiro
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Ahmad Zrik
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Vipreet Janjua
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Justin Assioun
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Nell Aronoff
- University Libraries, University at Buffalo, 433 Capen Hall, Buffalo, New York, USA, 14260-1625; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
| | - Dennis Z Kuo
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main St., Buffalo, New York, USA, 14203; Pediatric Emergency Department, SUNY Upstate Medical University, 550 East Genesee St., Syracuse, New York, USA, 13202; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, USA; Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, San Diego, California, USA.
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Tabibi Z, Schwebel DC, Juzdani MH. How does attention deficit hyperactivity disorder affect children's road-crossing? A case-control study. TRAFFIC INJURY PREVENTION 2023; 24:315-320. [PMID: 36867075 PMCID: PMC10400341 DOI: 10.1080/15389588.2023.2181664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 05/23/2023]
Abstract
Objective: Children diagnosed with attention-deficit/hyperactivity disorder (ADHD) may have particularly high pedestrian injury risk given their deficits in attention, inhibition, and concentration. The aims of this study were a) to assess differences in pedestrian skill between children with ADHD and typically-developing children and b) to examine relations between pedestrian skill and attention, inhibition, and executive function among children with ADHD as well as among typically-developing children.Methods: A sample of 50 children with mean age of 9 years participated, 56% of them diagnosed with ADHD. Children completed IVA + Plus, an auditory-visual test evaluating impulse response control and attention and then engaged in a Mobile Virtual Reality (MVR) pedestrian task to assess pedestrian skills. Parents completed the Barkley's Deficits in Executive Functions Scale-Child & Adolescents (BDEFS-CA) to rate children's executive function. Children with ADHD engaged in the experiment off any ADHD medications.Results: Independent samples t-tests indicated significant differences between the two groups in all IVA + Plus and BDEFS_CA scores, supporting the clinical diagnoses of ADHD and the distinction between the two groups. Independent samples t-tests also indicated differences in pedestrian behavior: Children in the ADHD group had significantly higher numbers of unsafe crossings in the MVR environment. Partial correlations within samples stratified by ADHD status indicated that for both groups of children, there were positive correlations between unsafe pedestrian crossings and executive dysfunction. There were no relations between IVA + Plus attentional measures and unsafe pedestrian crossings in either group. A linear regression model predicting unsafe crossings was significant, with children with ADHD more likely to cross in a risky manner after controlling for executive dysfunction and child age.Conclusions: ADHD children exhibited riskier street-crossing behavior in the MVR, confirming an increased risk of pedestrian injury among children with ADHD compared to typically-developing children. Risky crossing among the typically-developing children and ADHD was related to deficits in executive function. Implications are discussed in relation to parenting and professional practice.
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Affiliation(s)
- Zahra Tabibi
- Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Tabibi Z, Schwebel DC, Zolfaghari H. Road-Crossing Behavior in Complex Traffic Situations: A Comparison of Children With and Without ADHD. Child Psychiatry Hum Dev 2022; 53:1186-1193. [PMID: 34106381 PMCID: PMC10404361 DOI: 10.1007/s10578-021-01200-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
All children are vulnerable to pedestrian injuries, but previous research suggests children diagnosed with ADHD may have elevated risk. Child pedestrian injury risk also increases with increasing traffic volume and speed. The current study examined three hypotheses: (a) Pedestrian behavior of children with ADHD is riskier than that of typically-developing children; (b) Children's pedestrian behavior is riskier with increased traffic complexity; and (c) Pedestrian behavior of children with ADHD is influenced more by complex traffic situations than behavior of typically-developing children. A sample of 38 children ages 8-12 years, 45% diagnosed with ADHD, completed 21 virtual street-crossings, 7 in each of three levels of traffic complexity. Outcome measures included unsafe crossings, ratio of looking at traffic by time, start-delay to enter the road, time to contact with oncoming vehicles, and time waiting to cross. A repeated measure MANOVA and follow-up tests showed that all children had more unsafe crossings, shorter start-delays and shorter TTCs when exposed to increased traffic complexity compared to lighter traffic. Children with ADHD had more unsafe crossings than typically-developing children. Further, compared to typically-developing children, ADHD children had comparatively more unsafe crossings, lower time to contact and longer wait-time in more complex traffic environments. Executive function deficits among children with ADHD likely influence their behavior in complex traffic environments. Implications of the results for policy-making and preventive strategies are discussed.
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Affiliation(s)
- Zahra Tabibi
- Department of Psychology, Ferdowsi University of Mashhad, Azadi Sq., PO Box: 1518, 9177948974, Mashhad, Iran.
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, USA
| | - Hamid Zolfaghari
- Department of Psychology, Ferdowsi University of Mashhad, Azadi Sq., PO Box: 1518, 9177948974, Mashhad, Iran
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Lillvis DF, Sheehan KM, Yu J, Noyes K, Bass KD, Kuo DZ. Characterizing physical trauma in children and youth with special health care needs. J Trauma Acute Care Surg 2022; 93:299-306. [PMID: 35293370 DOI: 10.1097/ta.0000000000003608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children and youth with special health care needs (CYSHCN) have or are at an increased risk for a chronic condition necessitating medical and related services beyond what children usually require. While evidence suggests that CYSHCN are at an increased risk of injury, little is known about this population within the trauma system. This study describes CYSHCN within the pediatric trauma system and examines patterns of injury risk (i.e., intent, place of injury, trauma type, and mechanism of injury) based on special health care need (SHCN) status. METHODS For this cross-sectional study, we used data from the 2018 National Trauma Data Bank to identify pediatric encounters (1-18 years, N = 115,578) and compare demographics (sex, race/ethnicity, insurance status, and age) by CYSHCN status using χ 2 and t tests. Children and youth with special health care needs encounters were compared with non-SHCN encounters using multinomial logistic regression models, controlling for demographics. RESULTS Overall, 16.7% pediatric encounters reported an SHCN. Children and youth with special health care needs encounters are older, and a higher proportion is publicly insured than non-SHCN encounters ( p < 0.001). Furthermore, CYSHCN encounters have a higher risk of assault (relative risk, 1.331) and self-inflicted (relative risk, 4.208) injuries relative to unintentional injury ( p < 0.001), as well as a higher relative risk of traumatic injury occurring in a private residence ( p < 0.01) than other locations such as school (relative risk, 0.894). Younger CYSHCN encounters have a higher risk of assault relative to unintentional injury when compared with non-SHCN encounters ( p < 0.01). Pediatric trauma encounters reporting mental health and alcohol/substance use disorder SHCN have a higher probability of self-inflicted and assault injuries than non-SHCN encounters ( p < 0.001). CONCLUSIONS These findings suggest that CYSHCN have different traumatic injury patterns than their non-SHCN peers, particularly in terms of intentional and private residence injury, and deserve a special focus for traumatic injury prevention. LEVEL OF EVIDENCE Prognostic/epidemiologic, level III.
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Affiliation(s)
- Denise F Lillvis
- From the Department of Pediatric Surgery (D.F.L., K.D.B.), John R. Oishei Children's Hospital, Buffalo, New York; Department of Surgery (D.F.L., K.D.B.), Jacobs School of Medicine and Biomedical Sciences; Department of Epidemiology and Environmental Health (D.F.L., K.N.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; Department of Pediatrics (K.M.S.), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Biostatistics (J.Y.), School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; and Department of Pediatrics (D.Z.K.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Methylphenidate and TBI in ADHD and co-occurring epilepsy and mental disorders: a self-controlled case series study. Eur Child Adolesc Psychiatry 2022; 31:361-368. [PMID: 33389157 DOI: 10.1007/s00787-020-01694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/20/2020] [Indexed: 01/28/2023]
Abstract
It is suggested that medication for attention-deficit hyperactivity disorder (ADHD) links to lower risk of traumatic brain injury (TBI). Little is known about whether the beneficial effect of methylphenidate is persistent in individuals with other comorbid mental disorders and epilepsy. We identified 90,634 participants who were less than 18 years old and diagnosed with ADHD from Taiwan's National Health Insurance Research Database (NHIRD) from January 1, 2000 to December 31, 2013. Cox proportional hazards models with hazard ratio (HR) and 95% confidence interval were conducted to compare the risks of TBI event between groups of ADHD-only and ADHD with co-occurring other mental disorders. Within-individual comparisons using a self-controlled case series study design were conducted using conditional Poisson regression models with relative incidence (RR) and 95% CI to examine the effect of methylphenidate on TBI with adjustment for medication of psychotropics and anticonvulsants. For children and adolescents with ADHD, we found comorbid mental disorders and epilepsy increase the risk of TBI, with HRs ranged from 1.21 to 1.75. For the effect of MPH, we found reduced risks for TBI in ADHD (RR = 0.83, 95% CI = 0.70-0.98). Similar results were found among individuals with co-occurring oppositional defiant disorders or conduct disorder, MDD, tic disorders and epilepsy. Methylphenidate treatment was linked to lower risk for TBI in patients with ADHD and the inverse association was persistent among those with other comorbid mental disorders and epilepsy.
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Learning and Attention Deficit/Hyperactivity Disorders as Risk Factors for Prolonged Concussion Recovery in Children and Adolescents. J Int Neuropsychol Soc 2022; 28:109-122. [PMID: 33745491 DOI: 10.1017/s1355617721000229] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Examine pre-existing learning disorders (LD) and attention deficit/hyperactivity disorders (ADHD) as risk factors for prolonged recovery and increased symptomology following pediatric mild traumatic brain injury (mTBI). METHODS We conducted a retrospective cohort study of children/adolescents (5-17 years) with mTBI who presented to a Children's Minnesota Concussion Clinic between April 2018 and March 2019. Differences across strata of pre-existing conditions (present vs. absent) in time to recovery measures were estimated via Kaplan-Meier and Cox proportional hazards analyses and differences in symptom trajectories were examined via linear mixed-effects regression models. Regression models were adjusted for age, sex and other confounders. RESULTS In our cohort of 680 mTBI patients, those with LD (n = 70) or ADHD (n = 107) experienced significantly longer median durations of symptoms (58 and 68 days, respectively) than those without (43 days). Accordingly, LD was significantly associated with delayed symptom recovery (adjusted hazard ratio (aHR) = 1.63, 95% CI: 1.16-2.29), return to school (1.47, 1.08-2.00), and return to physical activity (1.50, 1.10-2.04). Likewise, ADHD was associated with delayed recovery (1.69, 1.28-2.23), return to school (1.52, 1.17-1.97) and physical activity (1.55, 1.19-2.01). Further, patients with LD or ADHD reported, on average, significantly more concussion symptoms and higher vision symptom scores throughout recovery versus those without. There was no evidence that concussion or vision symptom recovery trajectories varied over time between those with/without LD or ADHD (joint P-interactions > 0.05). CONCLUSION Pre-existing LD and ADHD are risk factors for prolonged and more symptomatic mTBI recovery in youth. These results can inform clinical concussion management and recovery expectations.
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Cook NE, Iverson GL. Concussion Among Children in the United States General Population: Incidence and Risk Factors. Front Neurol 2021; 12:773927. [PMID: 34790165 PMCID: PMC8591091 DOI: 10.3389/fneur.2021.773927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to examine the incidence of concussion and risk factors for sustaining concussion among children from the United States general population. This prospective cohort study used data from the Adolescent Brain Cognitive Development (ABCD) Study®. Children were recruited from schools across the US, sampled to reflect the sociodemographic variation of the US population. The current sample includes 11,013 children aged 9 to 10 years old (47.6% girls; 65.5% White) who were prospectively followed for an average of 1 year (mean = 367.9 days, SD = 40.8, range 249–601). The primary outcome was caregiver-reported concussion during a 1 year follow-up period. Logistic regression was used to determine which potential clinical, health history, and behavioral characteristics (assessed at baseline) were prospectively associated with concussion. In the 1 year follow-up period between ages 10 and 11, 1 in 100 children (n = 123, 1.1%) sustained a concussion. In univariate models, three baseline predictors (ADHD, prior concussion, and accident proneness) were significantly associated with sustaining a concussion. In a multivariate model, controlling for all other predictors, only prior concussion remained significantly associated with the occurrence of a concussion during the observation period (Odds Ratio = 5.49, 95% CI: 3.40–8.87). The most robust and only independent prospective predictor of sustaining a concussion was history of a prior concussion. History of concussion is associated with 5.5 times greater odds of sustaining concussion between ages 10 and 11 among children from the general US population.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States.,Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Spaulding Research Institute, Charlestown, MA, United States
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Seens H, Modarresi S, MacDermid JC, Walton DM, Grewal R. Prevalence of bone fractures among children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. BMC Pediatr 2021; 21:354. [PMID: 34412606 PMCID: PMC8375159 DOI: 10.1186/s12887-021-02821-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 07/26/2021] [Indexed: 12/20/2022] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is a significant neurodevelopment disorder among children and adolescents, with 5 % prevalence. Bone fractures account for 25 % of accidents and injuries among all children and adolescents. Considering the characteristics of inattention, hyperactivity, and impulsivity in children with ADHD, it is critical to examine bone fractures among these children. The objective of our meta-analysis was to determine the prevalence of bone fractures among children and adolescents with ADHD. Methods We completed a systematic review and meta-analysis using an electronic search of the following databases: CINAHL, EMBASE, PsycINFO, PubMed, and Scopus. The search terms used were: “attention deficit hyperactivity disorder OR attention deficit disorder” and “bone fracture*.” We included studies examining patients 18 years or younger who were diagnosed with ADHD and tracked (prospectively or retrospectively) for five or more years. Effect size (es), using a random effects model, was calculated. We registered the review protocol with PROSPERO (CRD42019119527). Results From 445 records retrieved, 31 full text articles were reviewed and 5 articles met inclusion criteria for meta-analysis. The summary es revealed the prevalence of bone fractures among children and adolescents with ADHD to be 4.83 % (95 % CI: 3.07–6.58 %). The location of bone fractures, using a subset of data, showed a distribution of 69.62 %, 22.85 %, and 7.53 % in the upper limbs, lower limbs, and other anatomical regions, respectively. Another subset of studies revealed a 2.55-fold increase in the prevalence of fractures among the children with ADHD compared to their counterparts. Conclusions Awareness of these findings is critical to physicians, parents, and policy makers to create safe environments and provide supports in order to optimize the health and safety of children and adolescents with ADHD.
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Affiliation(s)
- Hoda Seens
- Health and Rehabilitation Sciences, Western University, London, ON, Canada. .,Windsor University School of Medicine, Cayon, Saint Kitts and Nevis.
| | - Shirin Modarresi
- Health and Rehabilitation Sciences, Western University, London, ON, Canada.,School of Physical Therapy, Western University, London, ON, Canada
| | - Joy C MacDermid
- Health and Rehabilitation Sciences, Western University, London, ON, Canada.,School of Physical Therapy, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
| | - David M Walton
- Health and Rehabilitation Sciences, Western University, London, ON, Canada.,School of Physical Therapy, Western University, London, ON, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Genç E, Genç HA, Bulut GC. Children with supracondylar humerus fractures have an increased risk of attention deficit hyperactivity disorder. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sustaining fractures during their preschool years. Supracondylar humerus fractures (SHFs) comprise the majority of fracture surgeries in the pediatric age range. We hypothesized that ADHD symptoms would be present in children with SHFs, and this characteristic trauma may be associated with an ADHD diagnosis. Thus, we compared the ADHD symptoms of children with and without SHFs. Further, we compared the trauma characteristics, gender, proneness to injury, and presence of prior trauma history of children diagnosed with and without ADHD. We recruited 41 children who were admitted to emergency service with an SHF and 41 age- and gender-matched children without a fracture history. A semi-structured diagnostic inter- view and a Swanson Nolan Pelham questionnaire were used to obtain data about ADHD symptoms. A clinical intake form was utilized for further clinical data. ADHD symptoms were significantly higher in the fracture group ; male gender, parent- reported proneness to injury, and prior history of trauma were significantly associated with ADHD. Orthopedic surgeons may provide early detection of ADHD by using screening tools or asking questions to caregivers and making referrals when needed. This may lead to prevention of further injuries.
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Abstract
AIMS Although the relationship between attention-deficit/hyperactivity disorder (ADHD) and transport accidents has been shown, there is limited information on the relationship between medication and dose-response effects and transport accident risk. This study aims to determine whether young people with ADHD, including adolescents, are more prone to transport accidents than those without, and the extent to which methylphenidate (MPH) prescription in these patients reduces the risk. METHODS We identified 114 486 patients diagnosed with ADHD from Taiwan's National Health Insurance Research Database from 1997 to 2013. Using a Cox regression model, we compared the risk of transport accidents between ADHD and non-ADHD groups and estimated the effect of MPH on accidents. Furthermore, we applied a self-control case-series analysis to compare the risk of accidents during the medication periods with the same patients' non-medication periods. RESULTS Male ADHD patients had a higher risk of transport accidents than non-ADHD individuals (adjusted hazard ratio [aHR] = 1.24, [95% confidence interval (CI) 1.10-1.39]), especially for those comorbid with epilepsy, oppositional defiant disorder/conduct disorder (ODD/CD), and intellectual disabilities (ID). Female ADHD patients showed no relationship, except for comorbid with autism spectrum disorder (ASD) or ID. We found a reduced risk of transport accidents in patients with ADHD with MPH medication than those without MPH, with a plausible dose-response relationship (aHR of 0.23 to 0.07). A similar pattern was found in self-controlled case-series analysis. CONCLUSIONS Male patients with ADHD, especially those comorbid with epilepsy, ODD/CD, or ID, were at high risk of transport accidents. Female patients, when comorbid with ASD or ID, also exhibited a higher risk of accidents. MPH treatment lowered the accident risk with a dose-response relationship.
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Brunkhorst-Kanaan N, Libutzki B, Reif A, Larsson H, McNeill RV, Kittel-Schneider S. ADHD and accidents over the life span - A systematic review. Neurosci Biobehav Rev 2021; 125:582-591. [PMID: 33582234 DOI: 10.1016/j.neubiorev.2021.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/06/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
Studies have demonstrated an increased risk of accidents and injuries in children, adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). However, little is known about how accident risk may alter over the lifespan. Additionally, it would be important to know if the most common types of accidents and injuries differ in ADHD patients over different age groups. Furthermore, there is increasing evidence of an ameliorating effect of ADHD medication on accident risk. Lastly, the underlying risk factors and causal mechanisms behind increased accident risk remain unclear. We therefore conducted a systematic review focusing on the above described research questions. Our results suggested that accident/injury type and overall risk changes in ADHD patients over the lifespan. ADHD medication appeared to be similarly effective at reducing accident risk in all age groups. However, studies with direct comparisons of accident/injuries and effects of medication at different age groups or in old age are still missing. Finally, comorbidities associated with ADHD such as substance abuse appear to further increase the accident/injury risk.
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Affiliation(s)
- Nathalie Brunkhorst-Kanaan
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt/Main, Germany
| | - Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Andreas Reif
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt/Main, Germany
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77 Stockholm, Sweden; Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Rhiannon V McNeill
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97082 Würzburg, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt/Main, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97082 Würzburg, Germany
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12
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Hu JM, Lee CC, Lin TC, Chung CH, Chen CY, Chang PK, Hsiao CW, Sun CA, Tzeng NS, Chien WC. Risk of Colorectal Cancer in Patients With Attention-Deficit Hyperactivity Disorder: A Nationwide, Population-Based Cohort Study. Front Psychiatry 2021; 12:537137. [PMID: 33613335 PMCID: PMC7892783 DOI: 10.3389/fpsyt.2021.537137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The association between attention-deficit hypersensitivity disorder (ADHD) and the risk of developing colorectal cancer (CRC) is, as yet, to be investigated, and thus, we have conducted this nationwide, cohort study to examine the association in patients from Taiwan. Methods: In this study, 798 individuals with newly diagnosed ADHD and 2,394 (1:3) age-, gender-, and index year- matched controls without ADHD were enrolled, between 2000 and 2013, from the Longitudinal Health Insurance Database, a subset of the National Health Insurance Research Database in Taiwan. The cumulative incidence of CRC was assessed in each cohort by the Kaplan-Meier method. The multivariate Cox proportional hazards model was used to estimate the crude, and the adjusted hazards ratios (HRs) with 95% confidence intervals (CIs), was conducted to estimate the association between ADHD and CRC. Results: The Kaplan-Meier analysis revealed that the cumulative incidence of CRC was significantly higher in patients with ADHD than in those without it (log rank test, p < 0.001). After adjustments for age, gender, comorbidities, and other covariates, the ADHD group was associated with an increased risk of CRC in comparison to the non-ADHD group (adjusted HR = 3.458, 95% CI = 1.640-7.293, p < 0.001). In addition, the usage of methylphenidate was not associated with the risk of developing CRC in patients with ADHD. Conclusion: This retrospective cohort study depicts the evidence that ADHD was associated with the increased risk of CRC. Further studies are needed to confirm the association and the underlying mechanisms.
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Affiliation(s)
- Je-Ming Hu
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Cheng Lee
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Artificial Intelligence Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzu-Chiao Lin
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chao-Yang Chen
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Pi-Kai Chang
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Wen Hsiao
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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13
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Padalko A, Cristall N, Gawaziuk JP, Logsetty S. Social Complexity and Risk for Pediatric Burn Injury: A Systematic Review. J Burn Care Res 2020; 40:478-499. [PMID: 30918946 DOI: 10.1093/jbcr/irz059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Social complexity in health outcomes has been attributed to greater risk of injury, adverse health consequences, and early death in a variety of populations. To determine what social complexity factors associated with burn injury in children, a systematic review of the literature was performed. Two different databases (PubMed and SCOPUS) were searched for articles related to environmental and social determinants of burn injury. Selected literature examined social complexity factors to establish the strength of evidence in relation to incidence of burn injury in children. The extent of factors and the most common social complexities were reviewed. The 641 manuscripts found in PubMed and 327 from SCOPUS were initially reviewed for duplication and English language. Subsequently, manuscripts were selected for relevance based on titles followed by abstracts. Forty-seven manuscripts were reviewed in their entirety. The literature supports a relationship between an increased incidence of pediatric burns in lower income families, children with behavioral disorders, fewer years of parental education and children residing in a rural setting. The majority of reports came from Europe followed by Australia, and scattered information from other countries. Social complexity factors in the environment of the child are associated with an increased risk of burn injury in children. The literature supports the influence of lower income, lower parental education, behavioral disorders and living rurally with an increased incidence of injury. By identifying children at increased risk, it is possible to develop targeted burn prevention and education programs to mitigate burn injury.
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Affiliation(s)
- Adam Padalko
- BSc Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nora Cristall
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada
| | | | - Sarvesh Logsetty
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada.,Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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14
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Chen VCH, Chan HL, Wu SI, Lu ML, Dewey ME, Stewart R, Lee CTC. Methylphenidate and mortality in children with attention-deficit hyperactivity disorder: population-based cohort study. Br J Psychiatry 2020; 220:1-9. [PMID: 32662370 DOI: 10.1192/bjp.2020.129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Little is known about methylphenidate (MPH) use and mortality outcomes. AIMS To investigate the association between MPH use and mortality among children with an attention-deficit hyperactivity disorder (ADHD) diagnosis. METHOD This population-based cohort study analysed data from Taiwan's National Health Insurance Research Database (NHIRD). A total of 68 096 children and adolescents aged 4-17 years with an ADHD diagnosis and prescribed MPH between 2000 and 2010 were compared with 68 096 without an MPH prescription, matched on age, gender and year of first ADHD diagnosis. All participants were followed to death, migration, withdrawal from the National Health Insurance programme or 31 December 2013. MPH prescriptions were measured on a yearly basis during the study period, and the association between MPH use and mortality was analysed using a repeated-measures time-dependent Cox regression model. The outcome measures included all-cause, unnatural-cause (including suicide, accident and homicide) and natural-cause mortality, obtained from linkage to the National Mortality Register in Taiwan. RESULTS The MPH group had lower unadjusted all-cause, natural-, unnatural- and accident-cause mortality than the comparison group. After controlling for potential confounders, MPH use was associated with a significantly lower all-cause mortality (adjusted hazard ratio AHR = 0.81, 95% CI 0.67-0.98, P = 0.027), delayed use of MPH was associated with higher mortality (AHR = 1.05, 95% CI 1.01-1.09) and longer MPH use was associated with lower mortality (AHR = 0.83, 95% CI 0.70-0.98). CONCLUSIONS MPH use is associated with a reduced overall mortality in children with ADHD in this cohort study, but unmeasured confounding cannot be excluded absolutely.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi; and Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Lin Chan
- Department of Psychiatry, Chang Gung University, Taoyuan; and Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, Taipei; and Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital & School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Michael E Dewey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Charles Tzu-Chi Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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15
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Yeh JY, Hou TY, Tseng WT, Chen VCH, Yang YH, Kuo TY, Weng JC, Lee CTC, Chen YL, Lee MJ. Association Between Attention Deficit Hyperactivity Disorder and Risk of Burn Injury: A Propensity-Matched Cohort Study. Neuropsychiatr Dis Treat 2020; 16:1249-1255. [PMID: 32494144 PMCID: PMC7231781 DOI: 10.2147/ndt.s242153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/19/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Literature suggests that attention deficit hyperactivity disorder (ADHD) is associated with a high risk of unintentional injury. However, few studies have focused on whether risk of burn injury is relatively high among patients with ADHD. The aim of this study was to investigate whether ADHD affects the risk of burn injury. MATERIALS AND METHODS Individuals aged <18 years with a current diagnosis of ADHD (N = 52,705) and age-, sex-, and other comorbidity-matched controls were selected from Taiwan's National Health Insurance Research Database for the period of January 1996 to December 2013. Burn injury was identified in both groups, and risk was evaluated using Cox proportional hazards models. We also explored the effects of age and sex on the association. RESULTS We determined that patients with ADHD had an increased probability of burn injury compared with the control group (ADHD vs controls, 4.6% vs 2.6%; adjusted hazard ratio [aHR] = 1.78; 95% confidence interval [CI] = 1.66-1.90). The effect of ADHD on burn injury was more prominent among those aged <6 years (aHR = 1.96; 95% CI = 1.75-2.20) relative to those aged ≥6 years (aHR = 1.69; 95% CI = 1.56-1.83). Both sexes had similar risk profiles. CONCLUSION The study findings contribute to the increasing body of evidence that ADHD is associated with proneness to burn injury, particularly in children aged <6 years.
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Affiliation(s)
- Jia-Yin Yeh
- Department of Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan
| | - Tsai-Yu Hou
- Department of Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan
| | - Wei-Ting Tseng
- Department of Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
| | - Jun-Cheng Weng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Charles Tzu-Chi Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Psychology, Asia University, Taichung, Taiwan
| | - Min-Jing Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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16
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Ghirardi L, Chen Q, Chang Z, Kuja-Halkola R, Skoglund C, Quinn PD, D’Onofrio BM, Larsson H. Use of medication for attention-deficit/hyperactivity disorder and risk of unintentional injuries in children and adolescents with co-occurring neurodevelopmental disorders. J Child Psychol Psychiatry 2020; 61:140-147. [PMID: 31625605 PMCID: PMC6980200 DOI: 10.1111/jcpp.13136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is often associated with other neurodevelopmental disorders (NDs) and with risky behaviors and adverse health outcomes, including injuries. Treatment with ADHD medication has been associated with reduced risk of injuries. However, it is unknown whether the association is present in individuals with co-occurring NDs. The aim of the present study was to estimate the association between ADHD medication use and unintentional injuries in Sweden in children and adolescents with ADHD, including those with co-occurring NDs. METHODS Using a linkage of several national registers via the unique personal identification number, we identified individuals with a diagnosis of ADHD and of other NDs, including autism spectrum disorder, intellectual disability, communication disorders, learning disorders and motor disorders. The primary outcome was unintentional injuries. Secondary outcome was traumatic brain injury (TBI). Individuals were followed from January 1st 2006 or their 5th birthday or the date of the first unintentional injury, whichever came last, to December 31st 2013 or their 18th birthday or death, whichever came first. We compared the rate of injuries during periods on-treatment with the rate of injuries during periods off-treatment within the same individual using stratified Cox regression to calculate hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS For children and adolescents with ADHD (N = 9,421) the rate of any unintentional injuries (HR = 0.85; 95% CI = 0.78-0.92) and TBIs (HR = 0.27; 95% CIs = 0.20-0.38) during medicated periods was lower than during non-medicated periods. Similar results were found among individuals with co-occurring NDs (N = 2,986), for unintentional injuries (HR = 0.88; 95% CI = 0.77-1.01) and for TBIs (HR = 0.27; 95% CI = 0.16-0.44). CONCLUSIONS Beneficial effects of ADHD medication may extend beyond reduction of ADHD core symptoms to prevention of unintentional injuries in children and adolescents, including individuals with co-occurring NDs.
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Affiliation(s)
- Laura Ghirardi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Skoglund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
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17
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Tzeng NS, Chung CH, Lin FH, Yeh CB, Huang SY, Lu RB, Chang HA, Kao YC, Yeh HW, Chiang WS, Chou YC, Tsao CH, Wu YF, Chien WC. Risk of Dementia in Adults With ADHD: A Nationwide, Population-Based Cohort Study in Taiwan. J Atten Disord 2019. [PMID: 28629260 DOI: 10.1177/1087054717714057] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between adults with ADHD and the risk of developing dementia. METHOD Utilizing National Health Insurance Research Database of Taiwan, ADHD patients were identified and compared with age- and gender-matched controls (1:3). RESULTS Of the study participants, 37 (5.48%) developed dementia compared with 81 (4.0%) in the control group. Cox proportional hazards regression analysis revealed that the study participants were more likely to develop dementia. The crude hazard ratio (HR) is 3.418 (95% confidence interval [CI] = [2.289, 5.106], p < .001), and adjusted HR is 4.008 (95% CI = [2.526, 6.361], p < .001) in risk of developing dementia after adjusted for age, gender, comorbidities, geographical area of residence, urbanization level of residence, and monthly income. CONCLUSION Adults with ADHD have a 3.4-fold risk of developing dementia, and other large or national data sets should be explored to support the current findings.
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Affiliation(s)
- Nian-Sheng Tzeng
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,2 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- 3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.,4 Department of Medical Research, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,5 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China
| | - Fu-Huang Lin
- 3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chin-Bin Yeh
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - San-Yuan Huang
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ru-Band Lu
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,6 Department of Psychiatry, College of Medicine & Hospital, National Cheng Kung University, Tainan, Taiwan, Republic of China
| | - Hsin-An Chang
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,2 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Chen Kao
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,7 Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hui-Wen Yeh
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,8 Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, Republic of China.,9 Department of Nursing, Kang-Ning University (Taipei Campus), Taipei, Taiwan, Republic of China
| | - Wei-Shan Chiang
- 1 Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,10 Department and Institute of Mathematics, Tamkang University, New Taipei City, Taiwan, Republic of China
| | - Yu-Ching Chou
- 3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chang-Huei Tsao
- 4 Department of Medical Research, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,11 Department and Institute of Microbiology and Immunology, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yung-Fu Wu
- 4 Department of Medical Research, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wu-Chien Chien
- 3 School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.,4 Department of Medical Research, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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18
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Aural and nasal foreign bodies in children - Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations. Int J Pediatr Otorhinolaryngol 2019; 118:165-169. [PMID: 30639970 DOI: 10.1016/j.ijporl.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Foreign body incorporation in children is often a serious situation. Attention deficit hyperactivity disorder (ADHD) could be a risk factor for self-insertion of foreign bodies. Large cohort analyses are missing. METHODS This was a retrospective analysis of patients' records from a health insurance company representing 2.19% of the German population and 1.75% of German children and adolescents. According to the International Classification of Diseases, children in the age range between 1 and 18 years have been screened for foreign bodies in ear, nasal sinus and nostrils as well as for hyperkinetic disorders (F90), disorders of psychological development (F80-F89), and congenital malformations, deformations and chromosomal abnormalities (Q00-Q99). RESULTS In total, 12887 children (6609 male; 6278 female) have been treated in 16929 cases. The majority (n = 10041 (77.9%)) presented with foreign body incorporation on a single occasion. On average, 1.31 cases of foreign body treatment were recorded per child; 14.1% of children with foreign body treatment (FBT) also had a record of hyperkinetic disorder, 52.7% had a disorder of psychological development, and 50.8% a congenital malformation. Mean occurrence of FBT was 174.8 days before the diagnosis of a hyperkinetic disorder but 517.2 days after the diagnosis of a psychological development disorder and 683.1 days after the diagnosis of a congenital malformation, deformation or chromosomal abnormality. CONCLUSION Patients with disorders of psychological development as well as children with congenital malformations are high-risk patients for nasal and aural foreign bodies. The prevalence of a hyperkinetic disorder in patients with FBT is much higher than in the normal population. ADHD is a risk factor for foreign bodies.
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19
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Turgut K, Poyraz MK, Sekmen E, Aydın İ, Algın A, Yavuz E. Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with foreign body ingestion. Am J Emerg Med 2019; 37:2121-2124. [PMID: 30679008 DOI: 10.1016/j.ajem.2019.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Foreign body ingestion is a common condition in children. We aimed to compare the incidence of attention deficit hyperactivity disorder (ADHD) symptoms in children that ingested foreign bodies with healthy children. METHODS The study group consisted of 3- to 17-year-old pediatric patients admitted to the emergency department after foreign body ingestion, and the control group was formed with children having similar demographic and cultural characteristics that presented to the same department for non-traumatic causes. After initial intervention and stabilization, we administered the Conners' Parent Rating Scales-Revised (CPRS-R) to both groups. RESULTS The study group consisted of 53 patients with a mean age of 7.83 ± 4.36 and the control group comprised 47 children with a mean age of 7.72 ± 3.48 years. There were no statistically significant differences between the study and control groups in terms of age, gender, and parental education levels (p > 0.05 for each). The foreign objects most ingested by children were coins (32.1%), followed by needles (15.1%) and beads (9.4%), and all the patients recovered without complications and were discharged. All the CPRS-R subscale scores were significantly higher in the study group than in the control group (p < 0.001). The parental education levels of the study group were not significantly correlated with DSM-IV hyperactivity-impulsivity and DSM-IV total. CONCLUSION We found that the incidence of ADHD symptoms may be high in children referred to emergency services after accidentally ingesting foreign bodies.
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Affiliation(s)
- Kasım Turgut
- Department of Emergency Medicine, Research and Training Hospital, Adiyaman University, Adiyaman, Turkey.
| | - Mehmet Kaan Poyraz
- Department of Emergency Medicine, Research and Training Hospital, Adiyaman University, Adiyaman, Turkey
| | - Ebru Sekmen
- Department of Pediatric Psychiatry, Research and Training Hospital, Adiyaman University, Adiyaman, Turkey
| | - İrfan Aydın
- Department of Emergency Medicine, Research and Training Hospital, Adiyaman University, Adiyaman, Turkey
| | - Abdullah Algın
- Department of Emergency Medicine, Research and Training Hospital, Adiyaman University, Adiyaman, Turkey
| | - Erdal Yavuz
- Department of Emergency Medicine, Research and Training Hospital, Adiyaman University, Adiyaman, Turkey
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20
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Prasad V, West J, Sayal K, Kendrick D. Injury among children and young people with and without attention-deficit hyperactivity disorder in the community: The risk of fractures, thermal injuries, and poisonings. Child Care Health Dev 2018; 44:871-878. [PMID: 30039608 DOI: 10.1111/cch.12591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/23/2018] [Accepted: 06/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Injuries commonly cause morbidity and mortality in children and young people (CYP). Attention-deficit hyperactivity disorder (ADHD) is the commonest neurobehavioural disorder in CYP and is associated with increased injury risk. However, large, population-based estimates of the risk of specific injuries are lacking. We aimed to provide estimates of the risk of fractures, thermal injuries, and poisonings in CYP with and without ADHD. METHODS In this population-based cohort study, we used primary and secondary care medical records from England from the Clinical Practice Research Datalink. There were 15,126 CYP with ADHD frequency-matched to 263,724 without, aged 3-17 years at diagnosis. The risk of (a) fractures, (b) thermal injuries, and (c) poisonings in CYP with ADHD was compared with those without. RESULTS The absolute rate of injury per thousand person-years at risk in CYP with versus without ADHD was fracture 28.9 (95% CI [27.5, 30.3]) versus 18.7 (95% CI [18.5, 19.0]), long bone fracture 17.7 (95% CI [16.7, 18.8]) versus 11.8 (95% CI [11.6, 12.0]), thermal injuries 4.4 (95% CI [3.9, 4.9]) versus 2.2 (95% CI [2.1, 2.3]), and poisonings 6.3 (95% CI [5.7, 6.9]) versus 1.9 (95% CI [1.9, 2.0]). Adjusting for age, sex, geographical region, deprivation, and calendar year, CYP with ADHD had 25% increase in risk of fracture (hazard ratio [HR] = 1.25; 95% CI [1.19, 1.31]), 21% increase in risk of long bone fracture (HR = 1.21; 95% CI [1.13, 1.28]), double the risk of thermal injury (HR = 2.00; 95% CI [1.76, 2.27]), and almost four times the risk of poisoning (HR = 3.72; 95% CI [3.32, 4.17]). CONCLUSIONS CYP with ADHD are at greater risk of fracture, thermal injury, and poisoning compared with those without. Paediatricians and health care professionals should provide injury prevention advice at diagnosis and reviews.
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Affiliation(s)
- Vibhore Prasad
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Joe West
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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21
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Altun H, Altun İ. Risk of mild head injury in preschool children: relationship to attention deficit hyperactivity disorder symptoms. Childs Nerv Syst 2018; 34:1353-1359. [PMID: 29696355 DOI: 10.1007/s00381-018-3808-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/17/2018] [Indexed: 12/31/2022]
Abstract
AIM To investigate whether there is an association between mild head injury (MHI) and attention deficit hyperactivity disorder (ADHD) symptoms in preschool children. METHODS The study included a patient group of 30 children aged 3-6 years with mild head trauma and a control group of 30 healthy and age- and sex-matched children. The symptoms of ADHD were evaluated using the Conners' Parent Rating Scale-Revised Long (CPRS-RL) form. RESULTS The mean age was 4.73 ± 1.13 years in the patient group and 4.65 ± 0.99 years in the control group. No significant differences were determined between the groups in terms of age, gender, parents' age and education (p > 0.05). The total subscale points as reported by the parents of the children with MHI were significantly higher than those for the control group in terms of the following subscales: oppositional, cognitive problems/inattention, hyperactivity, social problems, ADHD index, Conners' Global Index (CGI)-Irritability-Impulsiveness, CGI-Emotional Lability, CGI-Total and DSM-IV ADHD symptoms (p < 0.05). A history of previous trauma treated in emergency services was determined in eight of the 30 patients (26.7%). CONCLUSIONS The findings of this study suggest that preschool children with MHI have more pre-injury ADHD symptoms and oppositional and emotional-behavioural symptoms than healthy children without trauma. Clinicians should screen children with MHI for ADHD symptoms and refer them for treatment when necessary. Evaluation of children presenting with MHI by a child psychiatrist may prevent repetition of injuries.
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Affiliation(s)
- Hatice Altun
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey.
| | - İdiris Altun
- Department of Neurosurgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
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22
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Outpatient rehabilitation resources and medical expenditure in children with attention-deficit hyperactivity disorder in Taiwan. PLoS One 2018; 13:e0199877. [PMID: 29953532 PMCID: PMC6023132 DOI: 10.1371/journal.pone.0199877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 06/15/2018] [Indexed: 11/19/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in children. This study investigated the use of rehabilitation treatment in Taiwan. We selected children aged 3-12 years from the National Health Insurance Research Database from 2008 to 2012 and included them in the analysis. The children who received a diagnosis according to the International Classification of Diseases, Ninth Revision, Clinical Modification were divided into two groups: ADHD and non-ADHD. We used the chi-squared test, independent sample t test, and multiple regression analysis to conduct the analysis. The utilisation of rehabilitation resources was higher in the ADHD group than in the non-ADHD group. The number of school-aged children with ADHD was higher than the number of preschool-aged children (p < 0.001). The highest utilisation of rehabilitation resources was observed in clinics (p < 0.001). In terms of region, Taipei exhibited the highest utilisation of rehabilitation resources, and the East exhibited the lowest resource utilisation (p < 0.001). Prediction of the use of rehabilitation resources, average cost, average frequency of visits, and total annual cost was affected by factors such as the average frequency of rehabilitation use, demographic characteristics, and the hospital characteristics and location (p < 0.001). The number of children with ADHD and rehabilitation use are increasing yearly; however, limitations in payment restrict the growth of rehabilitation resource use in hospitals. Supplementation of rehabilitation resources at clinics accounts for more than 60%, however, the total annual cost is less than what is observed for hospitals (p < 0.001). Policies should be established to aid in the early detection and treatment of children with ADHD to improve treatment outcomes and reduce the family burden and treatment expenditure in the future.
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23
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Risk of poisoning in children and adolescents with ADHD: a systematic review and meta-analysis. Sci Rep 2018; 8:7584. [PMID: 29765117 PMCID: PMC5953942 DOI: 10.1038/s41598-018-25893-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/01/2018] [Indexed: 12/26/2022] Open
Abstract
Poisoning, a subtype of physical injury, is an important hazard in children and youth. Individuals with ADHD may be at higher risk of poisoning. Here, we conducted a systematic review and meta-analysis to quantify this risk. Furthermore, since physical injuries, likely share causal mechanisms with those of poisoning, we compared the relative risk of poisoning and injuries pooling studies reporting both. As per our pre-registered protocol (PROSPERO ID CRD42017079911), we searched 114 databases through November 2017. From a pool of 826 potentially relevant references, screened independently by two researchers, nine studies (84,756 individuals with and 1,398,946 without the disorder) were retained. We pooled hazard and odds ratios using Robust Variance Estimation, a meta-analytic method aimed to deal with non-independence of outcomes. We found that ADHD is associated with a significantly higher risk of poisoning (Relative Risk = 3.14, 95% Confidence Interval = 2.23 to 4.42). Results also indicated that the relative risk of poisoning is significantly higher than that of physical injuries when comparing individuals with and without ADHD (Beta coefficient = 0.686, 95% Confidence Interval = 0.166 to 1.206). These findings should inform clinical guidelines and public health programs aimed to reduce physical risks in children/adolescents with ADHD.
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Sarac N, Sarac B, Pedroza A, Borchers J. Epidemiology of mental health conditions in incoming division I collegiate athletes. PHYSICIAN SPORTSMED 2018; 46:242-248. [PMID: 29322858 DOI: 10.1080/00913847.2018.1427412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study is to examine the epidemiology of mental health conditions in incoming American Division I collegiate athletes. METHODS Pre-participation physical questionnaires from 1118 incoming student athletes at a Division I Institution were collected retrospectively from 2011-2017. Data collected included lifetime history of any mental health condition, musculoskeletal injuries, concussions, and post-concussion depression. History of any mental health condition was evaluated by gender and sport played. It was also evaluated in comparison to musculoskeletal injuries and concussions. RESULTS The lifetime prevalence of any mental health condition was 14.0% for all athletes, 14.2% for male athletes, and 13.6% for female athletes. Individual sports reported a greater prevalence (17.2%) than did team sports (11.8%) (p = 0.010). The prevalence was also higher in contact sports (16.4%) than in non-contact sports (12.5%), although this difference was not statistically significant (p = 0.072). There was a significant association between mental health condition and all four major groups of injuries examined: upper extremity (p = 0.043), lower extremity (p = 0.007), axial skeletal (p < 0.001), and concussions (p = 0.039). Post-concussion depression occurred in 2.0% of all athletes reporting a concussion. CONCLUSION The lifetime prevalence of mental health conditions in this population (14.0%) is far less than estimates in the general population. This observation may be due to a combination of factors including exercise/athletic participation mitigating depressive symptoms, competitive selection, and underreporting. History of a mental health condition may be associated with injury, although causation cannot be determined.
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Affiliation(s)
- Nikolas Sarac
- a The Ohio State University College of Medicine , Columbus , OH , USA
| | - Benjamin Sarac
- a The Ohio State University College of Medicine , Columbus , OH , USA
| | - Angela Pedroza
- b Department of Sports Medicine , The Ohio State University , Columbus , OH , USA
| | - James Borchers
- b Department of Sports Medicine , The Ohio State University , Columbus , OH , USA
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25
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Liao YT, Yang YH, Kuo TY, Liang HY, Huang KY, Wang TN, Lee Y, McIntyre RS, Chen VCH. Dosage of methylphenidate and traumatic brain injury in ADHD: a population-based study in Taiwan. Eur Child Adolesc Psychiatry 2018; 27:279-288. [PMID: 28856464 DOI: 10.1007/s00787-017-1042-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
Abstract
Preventive effect of stimulants on the risk of brain injuries had been reported. The aim of this study is to determine the extent to which methylphenidate (MPH) prescription moderates the risk of traumatic brain injuries (TBI) in individuals with attention-deficit/hyperactivity disorder (ADHD). Individuals with a recent diagnosis of ADHD between January 1997 and December 2013 (n = 163,618) were identified from Taiwan's National Health Insurance Research Database. A total of 124,438 adolescents and children with ADHD and without prior TBI diagnoses were included and evaluated for subsequent TBI. Methylphenidate prescription duration was subgrouped by the annual average cumulative defined daily dose (DDD): 0, >0 to ≤28, > 28 to ≤84, and >84. We identified 11,463 diagnoses of TBI among 124,438 adolescents and children with ADHD. A Cox regression model was used to investigate whether MPH prescription influenced the risk for TBI after adjusting for sex, age, level of urbanization, seizure, autism and sedative-anxiolytics use. A reduced TBI incidence was observed with MPH prescription DDDs > 84. The protective effect of MPH against TBI persisted after adjusting for confounding factors [hazard ratio (HR) = 0.49; 95% confidence interval (CI): 0.47-0.51]. There was also statistically significant difference in risk for TBI in subjects receiving > 0 to ≤28 or >28 to ≤84 DDDs of MPH treatment (HR = 0.88, 95% CI = 0.83-0.92; HR = 0.76, 95% CI = 0.72-0.80, respectively) when compared with subjects not receiving treatment with MPH. Treatment with MPH for greater than 84 DDDs reduced the risk for TBI among children with ADHD.
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Affiliation(s)
- Yin-To Liao
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Ting-Yu Kuo
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hsin-Yi Liang
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-You Huang
- Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, 6-8, West Section, Jiapu Road, Puzi City, 613, Chiayi, Taiwan, ROC.
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26
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Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallón S, Alvarez Zallo N, Luis EO, de Castro-Manglano P, Soutullo C, Arrondo G. Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 84:63-71. [PMID: 29162520 DOI: 10.1016/j.neubiorev.2017.11.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023]
Abstract
A systematic review with meta-analyses was performed to: 1) quantify the association between ADHD and risk of unintentional physical injuries in children/adolescents ("risk analysis"); 2) assess the effect of ADHD medications on this risk ("medication analysis"). We searched 114 databases through June 2017. For the risk analysis, studies reporting sex-controlled odds ratios (ORs) or hazard ratios (HRs) estimating the association between ADHD and injuries were combined. Pooled ORs (28 studies, 4,055,620 individuals without and 350,938 with ADHD) and HRs (4 studies, 901,891 individuals without and 20,363 with ADHD) were 1.53 (95% CI=1.40,1.67) and 1.39 (95% CI=1.06,1.83), respectively. For the medication analysis, we meta-analysed studies that avoided the confounding-by-indication bias [four studies with a self-controlled methodology and another comparing risk over time and groups (a "difference in differences" methodology)]. The pooled effect size was 0.879 (95% CI=0.838,0.922) (13,254 individuals with ADHD). ADHD is significantly associated with an increased risk of unintentional injuries and ADHD medications have a protective effect, at least in the short term, as indicated by self-controlled studies.
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Affiliation(s)
- Maite Ruiz-Goikoetxea
- Servicio de Urgencias Extrahospitalarias, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK; Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK; Department of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.
| | | | - Sara Magallón
- Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain.
| | - Noelia Alvarez Zallo
- Servicio de Urgencias Extrahospitalarias, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Elkin O Luis
- Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain.
| | - Pilar de Castro-Manglano
- Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Cesar Soutullo
- Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Gonzalo Arrondo
- Instituto Cultura y Sociedad (ICS), Grupo Mente-Cerebro, Universidad de Navarra, Pamplona, Spain.
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27
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Hennig T, Jaya ES, Lincoln TM. Bullying Mediates Between Attention-Deficit/Hyperactivity Disorder in Childhood and Psychotic Experiences in Early Adolescence. Schizophr Bull 2017; 43:1036-1044. [PMID: 27803356 PMCID: PMC5581899 DOI: 10.1093/schbul/sbw139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) is known to be linked to psychotic experiences and psychotic disorders in later life, the developmental trajectories that could explain this association are unknown. Using a sample from the prospective population-based Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 8247), we hypothesized that the previously reported association of ADHD combined subtype in childhood and psychotic experiences in early adolescence is mediated by traumatic events and by involvement in bullying. Moreover, we expected this mediation to be specific to ADHD and tested this by comparison with specific phobia. Children with ADHD combined subtype at age 7 were more often involved in bullying at age 10 (OR 3.635, 95% CI 1.973-6.697) and had more psychotic experiences at age 12 (OR 3.362, 95% CI 1.781-6.348). Moreover, children who were involved in bullying had more psychotic experiences (2.005, 95% CI 1.684-2.388). Bullying was a significant mediator between ADHD and psychotic experiences accounting for 41%-50% of the effect. Traumatic events from birth to age 11 were also significantly associated with ADHD combined subtype and psychotic experiences; however, there was no evidence of mediation. Specific phobia was significantly associated with psychotic experiences, but not with bullying. To conclude, bullying is a relevant translating mechanism from ADHD in childhood to psychotic experiences in early adolescence. Interventions that eliminate bullying in children with ADHD could potentially reduce the risk of having psychotic experiences in later life by up to 50%. Clinicians should thus screen for bullying in routine assessments of children with ADHD.
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Affiliation(s)
- Timo Hennig
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
| | - Edo S Jaya
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
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28
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Chien WC, Chung CH, Lin FH, Yeh CB, Huang SY, Lu RB, Chang HA, Kao YC, Chiang WS, Chou YC, Tsao CH, Wu YF, Tzeng NS. The risk of injury in adults with attention-deficit hyperactivity disorder: A nationwide, matched-cohort, population-based study in Taiwan. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 65:57-73. [PMID: 28458048 DOI: 10.1016/j.ridd.2017.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 04/05/2017] [Accepted: 04/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Few studies have investigated the risk of injuries associated with adults with attention-deficit hyperactivity disorder (ADHD), even though several studies have suggested a higher risk of injury in children and adolescents with ADHD. AIMS To investigate the risk of injury in adults with ADHD. METHODS AND PROCEDURES We included 665 adults with ADHD from January 1, to December 31, 2000, and 1995 sex-, age- and index day-matched controls without ADHD from the Longitudinal Health Insurance Database (LHID) subset of the National Health Insurance Research Database in Taiwan. The Cox proportional hazard models were used to analyze the associations between the relevant demographics, and the psychiatric comorbidities and the risk of injury. OUTCOMES AND RESULTS The patients with ADHD had a 143% increased risk of overall injuries than the controls after considering all the confounding factors. In addition, the use of methylphenidate was associated with a 22.6% decrease in the risk of injuries in the patients with ADHD. CONCLUSIONS AND IMPLICATIONS Our findings strongly support that adults with ADHD are at an increased risk of injury, and imply that methylphenidate therapy may attenuate this risk.
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Affiliation(s)
- Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ru-Band Lu
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Clinical Psychology, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan, ROC; Center for Neuropsychiatric Research, National Health Research Institute, Zhunan, Miaoli County, Taiwan, ROC
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Shan Chiang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department and Institute of Mathematics, Tamkang University, New Taipei City, Taiwan, ROC
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yung-Fu Wu
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC.
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29
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Chen VCH, Yang YH, Liao YT, Kuo TY, Liang HY, Huang KY, Huang YC, Lee Y, McIntyre RS, Lin TC. The association between methylphenidate treatment and the risk for fracture among young ADHD patients: A nationwide population-based study in Taiwan. PLoS One 2017; 12:e0173762. [PMID: 28296941 PMCID: PMC5351966 DOI: 10.1371/journal.pone.0173762] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 02/27/2017] [Indexed: 01/10/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is associated with higher risk for fracture. Whether the medical treatment for ADHD would mitigate the risk remains unclear. In this study, we sought to investigate the effect of methylphenidate treatment on risk for fracture, as well the moderational role of treatment duration on the risk of fracture, in a large national sample. Cases less than 18 years old were identified from Taiwan's National Health Insurance Research Database with a new primary diagnosis of ADHD (ICD-9:314) between 1996 and 2013. A total of 6201 cases with ADHD were included as the study cohort. The cases were divided into 3 groups according to the duration of methylphenidate treatment (0, 1-180, and more than 180 days). All groups were followed until the end of 2013 for first diagnoses of fracture (ICD-9 codes 800 to 829). Cox proportional hazards models were applied. Compared to the group without methylphenidate treatment, the risk for fracture was lower among the group treated for more than 180 days. The adjusted hazard ratio was 0.77 (95% Confidence interval: 0.63-0.94). The groups treated for 180 days or fewer had no significant difference in the risk for fracture. In conclusion, methylphenidate treatment was associated with lower risk for fracture among ADHD patients. The association was evident only in the cohort treated for more than 180 days.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
- Department of Medicine, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-To Liao
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ting-Yu Kuo
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hsin-Yi Liang
- Department of Medicine, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-You Huang
- Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tzu-Chin Lin
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
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30
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Lindemann C, Langner I, Banaschewski T, Garbe E, Mikolajczyk RT. The Risk of Hospitalizations with Injury Diagnoses in a Matched Cohort of Children and Adolescents with and without Attention Deficit/Hyperactivity Disorder in Germany: A Database Study. Front Pediatr 2017; 5:220. [PMID: 29114538 PMCID: PMC5660679 DOI: 10.3389/fped.2017.00220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/28/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in children and adolescents worldwide, and children with ADHD have elevated risk of injuries. Our aim was to assess the risk of hospitalizations with injury diagnoses and their various subtypes in children and adolescents with newly diagnosed ADHD compared to those without ADHD, as well as to study sex effects on this risk in the setting of the German health care system. METHODS The German Pharmacoepidemiological Research Database, in which 20 million insured from four statutory health insurances in Germany are included, was used to set up a matched cohort study of 3- to 17-year-old children and adolescents with and without ADHD. We calculated age-specific incidence rates and used Cox regression to obtain hazard ratios (HRs) for hospitalizations with injury diagnoses. We used the injury mortality diagnosis matrix for classification of injuries. RESULTS The matched cohort comprised a total of 75,300 children. The age-specific incidence rates for hospitalization with injury diagnosis for males with ADHD displayed a u-shaped form with highest incidences in the in the age groups 3-6 years [26.2 per 1,000 person-years; 95% confidence interval (CI) 20.5-33.0] and 18-21 years (28.6; 22.4-36.0). Girls with ADHD were less affected in younger age-groups, but the incidence rate for 18-21 year olds was similar to boys with ADHD (26.4; 17.4-38.4). The adjusted HR for children with ADHD was 1.40 (95% CI 1.30-1.49) compared to non-affected children. With respect to nature of injury, ADHD was associated with hospitalization with injury diagnoses of the internal organs, open wounds, and contusions but not with other injuries. With respect to body regions, children with ADHD were more prone to hospitalizations with injuries of the abdomen, traumatic brain injuries, other head injuries, and system-wide injuries such as poisoning and intoxication. No significant associations were seen for the other body regions. Differences between sexes were only seen for system-wide injuries. CONCLUSION Children and adolescents with ADHD are at an increased risk for hospitalizations with diagnoses of injuries compared to non-affected children. Despite differences in health-care systems, the risk increase is at a similar level in Germany as in other countries.
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Affiliation(s)
- Christina Lindemann
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Medical School Hannover, Hannover, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Core Scientific Area 'Health Sciences' at the University of Bremen, Bremen, Germany
| | - Rafael T Mikolajczyk
- Medical School Hannover, Hannover, Germany.,ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Institute for Medical Epidemiology, Biometrics and Computer Science, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Amiri S, Sadeghi-Bazargani H, Nazari S, Ranjbar F, Abdi S. Attention deficit/hyperactivity disorder and risk of injuries: A systematic review and meta-analysis. J Inj Violence Res 2016; 9:95-105. [PMID: 28554188 PMCID: PMC5556632 DOI: 10.5249/jivr.v9i2.858] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/31/2016] [Indexed: 01/12/2023] Open
Abstract
Background: This study systematically reviewed the literature in order to determine the effect of Attention-Deficit Hyperactivity Disorder (ADHD) on injuries and assessed the magnitude of the potential association. Methods: A systematic review of the studies examining the association of ADHD and injuries was carried out across multiple databases. Odds ratios and standardized mean differences were pooled. Results: A total of 35 studies were selected for quantitative analysis. The association of ADHD and injuries was confirmed over the meta-analysis of eligible studies. The odds ratio pooled over all comparative studies was 1.96(95% CI: 1.6-2.4) using random effects model. Pooled odds ratio of 2.1 and 2.17 were calculated respectively when cohort and case-control studies or just cohort studies were included. The pooled odds ratio reduced to 1.8(CI:1.45-2.3) when studies on specific injuries were removed. For studies comparing scores of rating scales, the pooled standardized mean difference was 0.61(95% CI: 0.03-1.2). Conclusions: Those with ADHD are nearly two times more likely to be injured.
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Affiliation(s)
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran.
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Lee YC, Yang HJ, Chen VCH, Lee WT, Teng MJ, Lin CH, Gossop M. Meta-analysis of quality of life in children and adolescents with ADHD: By both parent proxy-report and child self-report using PedsQL™. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51-52:160-172. [PMID: 26829402 DOI: 10.1016/j.ridd.2015.11.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 06/05/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent developmental disorder that seriously and negatively impacts a child's health-related quality of life (HRQOL). However, no meta-analysis has been conducted to examine the magnitude of impact, domains affected and factors moderating the impact. This review included nine studies that compared HRQOL of children or adolescents with ADHD with those with typical development using both child self-reports and parent proxy-reports. Seven among nine studies were meta-analytically synthesized to examine the degree of impact of ADHD on children and adolescents, parent-child discrepancy, and the moderators. The results indicate that ADHD impact a child's or adolescent's HRQOL negatively with a moderate effect in physical and a severe effect in psychosocial (i.e., emotional, social, and school) domains. Parental ratings of overall HRQOL in children or adolescents with ADHD were not significantly different from child's ratings when compared with typically developing children and adolescents. Age was negatively associated with all domains of HRQOL in children and adolescents with ADHD both by parent- and child-ratings, and the strongest effect was found in parental ratings of child's emotional HRQOL, with a moderate correlation. This meta-analysis suggests that HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports, and that interventions may be planned accordingly. Future meta-analysis may explore how measures of HRQOL and other factors including child, parental, familiar and school characteristics influence the impact of ADHD and the parent-child agreement in children and adolescents.
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Affiliation(s)
- Yi-chen Lee
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan; Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hao-Jan Yang
- Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Taiwan; Chang Gung University, Taiwan
| | - Wan-Ting Lee
- Department of Rehabilitation, Occupational Therapy Room, Sing Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ming-Jen Teng
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
| | - Chung-Hui Lin
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan; Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Michael Gossop
- King's College London, Institute of Psychyatry, London, UK
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Sadeghi-Bazargani H, Mohammadi R, Amiri S, Syedi N, Tabrizi A, Irandoost P, Safiri S. Individual-level predictors of inpatient childhood burn injuries: a case-control study. BMC Public Health 2016; 16:209. [PMID: 26931103 PMCID: PMC4774193 DOI: 10.1186/s12889-016-2799-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
Background Burn injuries are considered one of the most preventable public health issue among children; however, are a cause of significant morbidity and mortality in Iran. The aim of this study was to assess individual-level predictors of severe burn injuries among children leading to hospitalization, in East Azerbaijan Province, in North-West of Iran. Methods The study was conducted through a hospital based case–control design involving 281 burn victims and 273 hospital-based controls who were frequency matched on age, gender and urbanity. Both bivariate and multivariate methods were used to analyze the data. Results Mean age of the participants was 40.5 months (95 % CI: 37–44) with the majority of burns occurring at ages between 2 months-13.9 years. It was demonstrated that with increase in the caregiver’s age there was a decrease in the odds of burn injuries (OR = 0.94, 95 % CI: 0.92-0.97). According to the multivariate logistic regression there were independent factors associated with burn injuries including childhood ADHD (OR = 2.82, 95 % CI: 1.68 - 4.76), child’s age (OR = 0.73, 95%CI: 0.67 - 0.80), flammability of clothing (OR = 1.60, 95 % CI: 1.12 - 2.28), daily length of watching television (OR = 1.31, 95 % CI: 1.06 - 1.61), playing outdoors (OR = 1.32, 95 % CI: 1.16 - 1.50) and increment in the economic status (OR = 1.37, 95 % CI: 1.18 - 1.60). Conclusion Major risk predictors of burn injuries among the Iranian population included childhood ADHD, child’s age, watching television, playing outdoors, high economic status and flammable clothing.
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Affiliation(s)
- Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Mohammadi
- WHO Collaborating Center on Community Safety Promotion, Karolinska Institute, Stockholm, Sweden
| | - Shahrokh Amiri
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naeema Syedi
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, South Australia, Australia
| | - Aydin Tabrizi
- Child Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Poupak Irandoost
- Child Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran. .,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Nikolas MA, Elmore AL, Franzen L, O'Neal E, Kearney JK, Plumert JM. Risky bicycling behavior among youth with and without attention-deficit hyperactivity disorder. J Child Psychol Psychiatry 2016; 57:141-8. [PMID: 26610867 PMCID: PMC8771970 DOI: 10.1111/jcpp.12491] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Injury risk from car-bicycle collisions is particularly high among youth with attention-deficit hyperactivity disorder (ADHD). Here, we capitalized on advances in virtual environment technology to safely and systematically examine road-crossing behavior among child cyclists with and without ADHD. METHODS Sixty-three youth (26 with ADHD, 37 non-ADHD controls) ages 10-14 years crossed 12 intersections with continuous cross-traffic while riding a high-fidelity bicycling simulator. Traffic density (i.e., temporal gaps between vehicles) was manipulated to examine the impact of varying traffic density on behavioral indices of road crossing, including gap selection, timing of entry into the roadway, time to spare when exiting the roadway, and close calls with oncoming cars. In addition, parents filled out questionnaires assessing their child's ADHD symptomatology, temperamental characteristics, bicycling experience, and injury history. RESULTS ADHD youth largely chose the same size gaps as non-ADHD youth, although ADHD youth were more likely to select smaller gap sizes following exposure to high-density traffic. In addition, youth with ADHD demonstrated poorer movement timing when entering the intersection, resulting in less time to spare when exiting the roadway. Hyperactivity-impulsivity symptoms were specifically associated with selection of smaller gaps, whereas timing deficits were specifically associated with inattention and inhibitory control. CONCLUSION Findings highlight two related yet potentially dissociable mechanisms that may influence injury risk among youth with ADHD and provide a foundation for development of injury prevention strategies.
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Affiliation(s)
| | | | - Luke Franzen
- Department of Psychology University of Iowa Iowa City IA USA
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35
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Wamithi S, Ochieng R, Njenga F, Akech S, Macharia WM. Cross-sectional survey on prevalence of attention deficit hyperactivity disorder symptoms at a tertiary care health facility in Nairobi. Child Adolesc Psychiatry Ment Health 2015; 9:1. [PMID: 25657818 PMCID: PMC4318353 DOI: 10.1186/s13034-015-0033-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder is the most common childhood neurobehavioral disorder with well documented adverse consequences in adolescence and adulthood, yet 60-80% of cases go undiagnosed. Routine screening is not practiced in most pediatric outpatient services and little information exists on factors associated with the condition in developing countries. METHODS This was a questionnaire based cross-sectional survey whose primary objective was to determine prevalence of attention deficit hyperactivity disorder (ADHD) symptoms in children aged 6-12 years attending a tertiary care hospital Accidents and Emergency unit. Secondary objectives were to: (i) ascertain if physical injury and poor academic performance were associated with ADHD, (ii) compare diagnostic utility of parent-filled Vanderbilt Assessment Scale (VAS) against Statistical Manual of Mental Disorders-IV (DSM-IV) as the gold reference and (iii) establish if there exists an association between ADHD symptoms cluster and co-morbid conditions. RESULTS Prevalence of cluster of symptoms consistent with ADHD was 6.3% (95% CI; 3.72-10.33) in 240 children studied. Those affected were more likely to repeat classes than the asymptomatic (OR 20.2; 95% CI 4.02-100.43). Additionally, 67% of the symptomatic had previously experienced burns and 37% post-traumatic open wounds. The odds of having an injury in the symptomatic was 2.9 (95% CI; 1.01-8.42) compared to the asymptomatic. Using DSM-IV as reference, VAS had a sensitivity of 66.7% (95%; CI 39.03-87.12) and specificity of 99.0% (95% CI; 96.1-99.2). Positive predictive value was 83.0% (95% CI; 50.4-97.3) and negative predictive value 98.0% (CI 95.1-99.1). Oppositional defiant disorder symptoms, anxiety, depression and conduct problems were not significantly associated with ADHD cluster of symptoms. CONCLUSION The study found a relatively high prevalence of symptoms associated with ADHD. Symptomatic children experienced poor school performance. These findings support introduction of a policy on routine screening for ADHD in pediatric outpatient service. Positive history of injury and poor academic performance should trigger further evaluation for ADHD. Vanderbilt assessment scale is easier to administer than DSM-IV but has low sensitivity and high specificity that make it inappropriate for screening. It however provides a suitable alternative confirmatory test to determine who among clinically symptomatic patients requires referral to a psychiatrist.
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Affiliation(s)
- Susan Wamithi
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
| | - Roseline Ochieng
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
| | | | - Samuel Akech
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
| | - William M Macharia
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
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36
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Negative outcomes in attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder. Ir J Psychol Med 2015; 32:307-312. [PMID: 30185252 DOI: 10.1017/ipm.2014.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), the comorbidity of the oppositional defiant disorder (ODD) negatively affects the course of ADHD. The purpose of this study was to compare ADHD-diagnosed children with and without ODD comorbidity in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries. METHODS This study included 109 children diagnosed with ADHD alone and 79 children with the ADHD-ODD comorbidity from a child psychiatry outpatient clinic. The children who participated in the study were aged between 6 and 15 years. Diagnoses of the children were determined by child psychiatrists according to DSM-IV criteria, and the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form was used to support the diagnosis in initial evaluations of children. Forty-six to fifty months after the first admission, parents were questioned regarding all negative outcomes from the time of first diagnosis to the time of the evaluation by phone. RESULTS The groups were compared in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries over a period of 4 years. The ODD-ADHD group was determined to have higher rates of disciplinary punishments at school, smoking, and unintentional injuries compared with the ADHD group. No statistically significant difference was found between the two groups in terms of criminal behaviors and psychoactive substance use. CONCLUSIONS The ODD comorbidity increases the risk of negative outcomes in children diagnosed with ADHD.
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Hergüner A, Erdur AE, Başçiftçi FA, Herguner S. Attention-deficit/hyperactivity disorder symptoms in children with traumatic dental injuries. Dent Traumatol 2014; 31:140-3. [DOI: 10.1111/edt.12153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Arzu Hergüner
- Konya Training and Research Hospital; Child and Adolescent Psychiatry Clinic; Konya Turkey
| | - Aybuke Emire Erdur
- Department of Orthodontis; Selcuk University; Faculty of Dentistry; Konya Turkey
| | | | - Sabri Herguner
- Department of Child and Adolescent Psychiatry; Necmettin Erbakan University; Meram Faculty of Medicine; Konya Turkey
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Ayaz AB, Ayaz M, Şentürk E, Soylu N, Yüksel S, Yulaf Y. Factors related with unintentional injuries in children with newly diagnosed attention-deficit/hyperactivity disorder. Int J Inj Contr Saf Promot 2014; 23:93-98. [PMID: 25358841 DOI: 10.1080/17457300.2014.969279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the present study was to investigate the factors associated with unintentional injury in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). One thousand four hundred and thirty children between the ages of 6 and 18 who were diagnosed with ADHD for the first time in child psychiatry outpatient clinics were included in the present study. The socio-demographic information of the children, their developmental histories, chronic physical health conditions, comorbid psychiatric disorders, and information obtained via the Turgay DSM-IV-based Child and Adolescent Disorders Screening and Rating Scale were examined retrospectively. It was determined that 12.8% of the children (n = 183) experienced unintentional injury. It was established that age, male gender, disruptive behavioural problems, and low education levels among mothers were predictive of unintentional injuries. The results of the present study suggest that behavioural problems accompanying ADHD and comorbid psychiatric disorders are important in terms of unintentional injuries.
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Affiliation(s)
- Ayşe Burcu Ayaz
- Sakarya University Training and Research Hospital Child and Adolescent Psychiatry Department, Sakarya, Turkey
| | - Muhammed Ayaz
- Sakarya University Training and Research Hospital Child and Adolescent Psychiatry Department, Sakarya, Turkey
| | - Ekrem Şentürk
- İzmit Pediatrics Hospital Child and Adolescent Psychiatry Department, Kocaeli, Turkey
| | - Nusret Soylu
- İnönü University Medical Faculty Child and Adolescent Psychiatry Department, Malatya, Turkey
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Garg N, Silverberg JI. Association between childhood allergic disease, psychological comorbidity, and injury requiring medical attention. Ann Allergy Asthma Immunol 2014; 112:525-32. [PMID: 24713577 DOI: 10.1016/j.anai.2014.03.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/17/2014] [Accepted: 03/16/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Children with allergic disease have multiple risk factors for accidental injuries. OBJECTIVE To determine the prevalence of injuries requiring medical treatment in US children with allergic disease. METHODS The authors analyzed data from the 2007 to 2008 National Survey of Children's Health, including a nationally representative sample of 27,556 children 0 to 5 years old. RESULTS The prevalence (95% confidence interval [CI]) of at least 1 allergic disease was 29.4% (28.0-30.8); 6.6% (5.8-7.4) were diagnosed with asthma, 15.0% (14.0-16.0) with eczema, 11.6% (10.6-12.6) with hay fever, and 6.1% (5.4-6.9) with food allergy. Children with allergic disorders had higher odds of at least 1 comorbid psychiatric and behavioral disorder (PBD; survey logistic regression; odds ratio 2.93, 95% CI 2.13-4.03), including attention-deficit/hyperactivity disorder (4.75, 2.89-7.80), depression (6.03, 1.29-28.27), anxiety (5.54, 2.70-11.37), conduct/oppositional defiant disorder (2.97, 1.88-4.70), and learning delay (2.49, 1.70-3.66), but not autism/Asperger disorder (1.89, 0.98-3.64). The prevalence of injury in the past year requiring medical attention was 10.5% (95% CI 9.5-11.4). The association between allergic disease and injury requiring medical attention was mediated in part by a PBD (Sobel test 0.0021, 95% CI 0.0014-0.0029, P < .0001; bootstrapping approach, indirect effects, odds ratio 1.005, 95% CI 1.003-1.007; Baron-Kenny β(yx,m) = 0.04, P < .0001, R(2) = 0.002). However, children with at least 1 allergic disorder (1.74, 1.23-2.46), including eczema (1.59, 1.01-2.50), asthma (1.91, 1.10-3.31), hay fever (2.05, 1.24-3.39), and food allergies (2.00, 1.10-3.67), had higher odds of sustaining injuries even after controlling for comorbid PBDs and medical disorders. CONCLUSION The results suggest that the association between allergic disease and injury is multifactorial, including being secondary to PBD.
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Affiliation(s)
- Nitin Garg
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Jonathan I Silverberg
- Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University, Chicago, Illinois.
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