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Walker CG, Thayer ZM, Marks EJ, Ly KN, Pillai A, Waldie K, Underwood L, Snell RG, Knowles SD, Cha JE, Morton SMB. Association between maternal depression symptoms and child telomere length. J Psychiatr Res 2024; 174:319-325. [PMID: 38685189 DOI: 10.1016/j.jpsychires.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
The biological mechanisms that explain how adverse early life events influence adult disease risk are poorly understood. One proposed mechanism is via the induction of accelerated biological aging, for which telomere length is considered a biomarker. We aimed to determine if maternal depression pre- and post-partum was associated with telomere length in children at 4 years of age (n = 4299). Mothers completed structured questionnaires assessing depression during pregnancy (Edinburgh Depression Scale), at 9 months (Edinburgh Depression Scale), and at 54 months postpartum (Patient Health Questionnaire 9). Regression methods were used to investigate the relationship between telomere length (DNA from saliva) and maternal depression score recorded at each stage. Significant covariates included in the final model were: maternal age at pregnancy; child sex; child ethnicity; gestational age group, and rurality group. Child telomere length was found to be longer if their mother had a higher depression score at both postpartum time points tested (9 months of age; coefficient 0.003, SE = 0.001, P = 0.01, 54 months of age; coefficient 0.003, SE = 0.002, P = 0.02). Although these findings seem paradoxical, increased telomere length may be an adaptive response to early life stressors. We propose several testable hypotheses for these results and to determine if the positive association between depression and telomere length is a developmental adaptation or an indirect consequence of environmental factors.
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Affiliation(s)
- Caroline G Walker
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand.
| | - Zaneta M Thayer
- Department of Anthropology, Dartmouth College, Hanover, NH, USA
| | - Emma J Marks
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand
| | - Kien N Ly
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand
| | - Avinesh Pillai
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand; Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Karen Waldie
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand; School of Psychology, University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand
| | - Russell G Snell
- School of Biological Sciences, Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Sarah D Knowles
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand; Auckland Museum, Auckland, New Zealand
| | - Jane E Cha
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua and Growing Up in New Zealand, University of Auckland, New Zealand
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Underwood L, Kool B, Pillai A, Kingi TK, Morton S, Ameratunga S. Manifold child, family and social variables are associated with injury among New Zealand preschool children. Inj Prev 2023:ip-2023-044869. [PMID: 38050102 DOI: 10.1136/ip-2023-044869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/09/2023] [Indexed: 12/06/2023]
Abstract
AIM Approaches to understanding child injury tend to focus on short-term proximal influences. Previous analyses have found higher rates of injury among Māori and Pacific children in Aotearoa New Zealand (NZ). This study aimed to investigate how combinations of situations and multiple events act across the life-course to either protect preschool children from, or place them at risk of, repeated injuries requiring medical attention. METHODS Longitudinal data were used to identify parent-reported injuries requiring medical attention among 6114 preschool NZ children. The environments experienced by children with multiple and/or severe injury were explored using multivariable analyses. RESULTS Eight percent of children (n=505) experienced 1-3 injuries with at least one hospitalisation or ≥4 injuries (high injury group) from birth to 4.5 years of age. After accounting for antenatal, sociodemographic and psychosocial variables, children of Māori mothers (OR=0.7, 95% CI 0.5 to 0.97) and children of Asian mothers (OR=0.5, 95% CI 0.3 to 0.7) were less likely to be in the high injury group than children of European mothers. After adjusting for maternal ethnicity and child variables (gender, temperament, level of activity and behaviour difficulties), cumulative exposure to factors in four domains was associated with injury category: maternal, family, social and service use. CONCLUSION This study identified social and economic opportunities to lower rates of injury among preschool children, that might reduce associated direct and indirect costs. Our findings in relation to ethnicity go against the standard public rhetoric and provide support for shifting the apportioning of blame for child injury from individuals to wider environmental exposures for which public health and societal solutions are required.
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Affiliation(s)
- Lisa Underwood
- COMPASS, Faculty of Arts, The University of Auckland, Auckland, New Zealand
| | - Bridget Kool
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Te Kani Kingi
- Research and Innovation, Te Whare Wānanga o Awanuiārangi, Whakatane, New Zealand
| | - Susan Morton
- Centre for Longitudinal Research-He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Slykerman RF, Neumann D, Underwood L, Hobbs M, Waldie KE. Age at first exposure to antibiotics and neurodevelopmental outcomes in childhood. Psychopharmacology (Berl) 2023; 240:1143-1150. [PMID: 36930273 PMCID: PMC10101895 DOI: 10.1007/s00213-023-06351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
RATIONALE Viral illnesses in children are common and are frequently treated with antibiotic medication. Antibiotics reduce the diversity and composition of the gut microbiota, leading to poor developmental outcomes. OBJECTIVES To investigate the relationship between age at first exposure to antibiotics and cognitive and behavioural development at 4.5 years while controlling for multiple confounders, including otitis media. METHODS Study participants were 5589 children enrolled in the broadly generalisable Growing Up in New Zealand cohort study, with antibiotic exposure data, maternal antenatal information, and age 4.5-year behaviour and cognitive outcome data. Children were categorised as first exposed to antibiotics according to the following mutually exclusive ages: 0-2 months; 3-5 months; 6-8 months; 9-11 months; 12-54 months or not exposed by 54 months. Developmental outcome measures included the Strengths and Difficulties Questionnaire, Luria hand clap task, and the Peabody Picture Vocabulary Test-III. RESULTS In univariate analysis, there was an evident dose-response relationship where earlier exposure to antibiotics in the first year of life was associated with behavioural difficulties, lower executive function scores, and lower receptive language ability. After adjusting for confounders, pairwise comparisons showed that first antibiotic exposure between birth and 3 months or between 6 and 9 months was associated with lower receptive vocabulary. Antibiotic exposure at any age prior to 12 months was associated with increases in behavioural difficulties scores at 4.5 years. CONCLUSIONS Following adjustment for socioeconomic factors and otitis media, there is evidence that antibiotic exposure during potentially sensitive windows of development is associated with receptive language and behaviour later in childhood.
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Affiliation(s)
- Rebecca F Slykerman
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Denise Neumann
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Growing UP in New Zealand, Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Mark Hobbs
- Growing UP in New Zealand, Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
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Tye C, McEwen FS, Liang H, Woodhouse E, Underwood L, Shephard E, Barker ED, Sheerin F, Higgins N, Steenbruggen J, Bolton PF. Epilepsy severity mediates association between mutation type and ADHD symptoms in tuberous sclerosis complex. Epilepsia 2023; 64:e30-e35. [PMID: 36633094 DOI: 10.1111/epi.17507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
The association between attention-deficit/hyperactivity disorder (ADHD) and tuberous sclerosis complex (TSC) is widely reported, with support for the role of epilepsy, yet the mechanisms underlying the association across development are unclear. The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of TSC. In Phase 1 of the study, baseline measures of epilepsy, cortical tuber load, and mutation were obtained with 125 children ages 0-16 years. In Phase 2, at an average of 8 years later, ADHD symptoms were measured for 81 of the participants. Structural equation modeling revealed an indirect pathway from genetic mutation, to cortical tuber load, to epileptic spasm severity in infancy, to ADHD symptoms in middle childhood and adolescence, in addition to a pathway linking current seizure severity to ADHD symptoms. Findings were retained when intelligence quotient (IQ) was entered as a correlated factor. The findings support a cascading developmental pathway to ADHD symptoms mediated by early-onset and severe epilepsy in the first 2 years of life. This warrants detailed investigation of seizure characteristics and cognitive and behavioral sequelae associated with ADHD from early in life, to further the understanding of the association between ADHD and early-onset epilepsy across syndromic and non-syndromic populations.
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Affiliation(s)
- Charlotte Tye
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona S McEwen
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Holan Liang
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emma Woodhouse
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lisa Underwood
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elizabeth Shephard
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edward D Barker
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fintan Sheerin
- Department of Neuroradiology, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Nicholas Higgins
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Juul Steenbruggen
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patrick F Bolton
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Neumann D, Peterson ER, Underwood L, Morton SMB, Waldie KE. The Association Between Persistence and Change in Behavioral Difficulties During Early to Middle Childhood and Cognitive Abilities at Age 8. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01453-1. [PMID: 36372805 DOI: 10.1007/s10578-022-01453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022]
Abstract
We investigated the association between persistence and change in behavioral difficulties during early to middle childhood and several cognitive outcomes. We observed 3904 8-year-olds enrolled in the longitudinal study Growing Up in New Zealand (50% male/female; 23% Māori, 9% Pacific Peoples, 13% Asian, 2% Middle Eastern/Latin American/African, 9% Other, 43% European). The NIH Toolbox Cognition Battery was used to assess cognitive functioning at 8 years and the Strengths and Difficulties Questionnaire for behavioral difficulties at 4.5 and 8 years. Multivariate logistic regression analyses were conducted, controlling for well-known sociodemographic confounders. Children with persistent or later onset of behavioral difficulties were at higher risk for poorer vocabulary, reading, inhibitory control/attention, episodic memory, working memory and processing speed at age 8 compared to children with no or improved difficulties. Our study supports the importance of addressing both cognitive and behavioral aspects when planning educational programmes and interventions in early and middle childhood.
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Affiliation(s)
- Denise Neumann
- School of Psychology, Faculty of Science, University of Auckland, Private Bag 92019, 1142, Auckland, New Zealand.
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
- School of Population Health, The University of Auckland, Auckland, New Zealand.
| | - Elizabeth R Peterson
- School of Psychology, Faculty of Science, University of Auckland, Private Bag 92019, 1142, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, Faculty of Science, University of Auckland, Private Bag 92019, 1142, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
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Zhang AXD, Liang H, McEwen FS, Tye C, Woodhouse E, Underwood L, Shephard E, Sheerin F, Bolton PF. Perinatal adversities in tuberous sclerosis complex: Determinants and neurodevelopmental outcomes. Dev Med Child Neurol 2022; 64:1237-1245. [PMID: 35366331 DOI: 10.1111/dmcn.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/14/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
AIM To examine the association between perinatal adversities and neurodevelopmental outcome in tuberous sclerosis complex (TSC). METHOD The Tuberous Sclerosis 2000 study is a prospective, longitudinal UK study of TSC. In phase 1, mutation type, TSC family history, tuber characteristics, presence of cardiac rhabdomyomas, seizure characteristics, and intellectual ability were assessed in 125 children affected with TSC (64 females, 61 males; median age 39mo, range 4-254). In phase 2, 88 participants (49 females, 39 males; median age 148mo, range 93-323) were assessed for neurodevelopmental outcomes including intellectual ability, autism spectrum disorder, and attention-deficit/hyperactivity disorder. Perinatal histories of 88 participants with TSC and 80 unaffected siblings were collected retrospectively using the Obstetric Enquiry Schedule and coded with a modified Gillberg Optimality Scale to measure levels of perinatal adversity. Data were analysed using Mann-Whitney U tests, Spearman's rank correlation, and linear regression with robust standard errors. RESULTS Children with familial TSC experienced significantly greater perinatal adversity than unaffected siblings. Perinatal adversity was higher in children with TSC-affected mothers than those with unaffected mothers. There was no significant association between perinatal adversities and neurodevelopmental outcomes after controlling for confounders. INTERPRETATION Maternal TSC is a significant marker of elevated perinatal risk in addition to risks incurred by fetal genotype. Pregnancies complicated by maternal or fetal TSC require higher vigilance, and mechanisms underlying increased perinatal adversity require further research. WHAT THIS PAPER ADDS Higher perinatal adversity is associated with familial tuberous sclerosis complex (TSC). Maternal TSC was associated with higher frequencies of several perinatal risk markers. Paternal TSC was not associated with higher levels of perinatal adversity. Perinatal adversity levels in TSC1 and TSC2 subgroups did not differ significantly. Perinatal adversities were not associated with neurodevelopmental outcomes.
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Affiliation(s)
- Alexa X D Zhang
- Institute of Child Health, University College London, London, UK
| | - Holan Liang
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Great Ormond Street Hospital NHS Trust, London, UK
| | - Fiona S McEwen
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Charlotte Tye
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Lisa Underwood
- Department of Population Health, University of Auckland, Auckland, New Zealand
| | - Elizabeth Shephard
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fintan Sheerin
- Department of Neuroradiology, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | - Patrick F Bolton
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre in Mental Health at the Maudsley, London, UK
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7
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Morton SMB, Napier C, Morar M, Waldie K, Peterson E, Atatoa Carr P, Meissel K, Paine SJ, Grant CC, Bullen P, Fenaughty J, Bird A, Underwood L, Wall C, Exeter D, Prickett K, Kingi TK, Liang R, Fa’alili-Fidow J, Gerritsen S, Marks E, Walker C, Langridge F, Evans R, Neumann D, Grant M, Lai H, Taufa S, Smith A, Cha J. Mind the gap – unequal from the start: evidence from the early years of the Growing Up in New Zealand longitudinal study. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2058026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Susan M. B. Morton
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Carin Napier
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Manisha Morar
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Karen Waldie
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Psychology and the Centre for Brain Research, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Elizabeth Peterson
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Polly Atatoa Carr
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Kane Meissel
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Learning, Development and Professional Practice, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - Sarah-Jane Paine
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cameron C. Grant
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Pat Bullen
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Learning, Development and Professional Practice, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - John Fenaughty
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Counselling, Human Services and Social Work, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - Amy Bird
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- COMPASS, Faculty of Arts, University of Auckland, Auckland, New Zealand
| | - Clare Wall
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Department of Nutrition, School of Medical Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Daniel Exeter
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kate Prickett
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Roy McKenzie Centre for Study of Families and Children School of Government, Victoria University, Wellington, New Zealand
| | - Te Kani Kingi
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Māori Health, Te Whare Wānanga o Awanuiārangi, Whakatāne, New Zealand
| | - Renee Liang
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Jacinta Fa’alili-Fidow
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | - Sarah Gerritsen
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Emma Marks
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Caroline Walker
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Fiona Langridge
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rebecca Evans
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Denise Neumann
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Molly Grant
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Hakkan Lai
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Seini Taufa
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | - Ash Smith
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane Cha
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Chaplin E, Rawat A, Perera B, McCarthy J, Courtenay K, Forrester A, Young S, Hayward H, Sabet J, Underwood L, Mills R, Asherson P, Murphy D. Prisoners with Attention Deficit Hyperactivity Disorder: co-morbidities and service pathways. Int J Prison Health 2021. [DOI: 10.1108/ijph-03-2021-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to examine effective diagnostic and treatment pathways for attention deficit hyperactivity disorder (ADHD) in prison settings given the high prevalence of ADHD and comorbidities in the prison population.
Design/methodology/approach
Two studies were carried out in two separate prisons in London. Firstly, data were collected to understand the prevalence of ADHD and the comorbidities. The second study used quality improvement (QI) methodology to assess the impact of a diagnostic and treatment pathway for prisoners with ADHD.
Findings
Of the prisoners, 22.5% met the diagnostic criteria for ADHD. Nearly half of them were screened positive for autistic traits, with a higher prevalence of mental disorders among prisoners with ADHD compared to those without. The QI project led to a significant increase in the number of prisoners identified as requiring ADHD assessment but a modest increase in the number of prisoners diagnosed or treated for ADHD.
Originality/value
Despite various challenges, an ADHD diagnostic and treatment pathway was set up in a prison using adapted QI methodology. Further research is needed to explore the feasibility of routine screening for ADHD in prison and examine at a national level the effectiveness of current ADHD prison pathways.
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Chaplin E, McCarthy J, Allely CS, Forrester A, Underwood L, Hayward H, Sabet J, Young S, Mills R, Asherson P, Murphy D. Self-harm and Mental Health Characteristics of Prisoners with elevated rates of autistic traits. Res Dev Disabil 2021; 114:103987. [PMID: 34004498 DOI: 10.1016/j.ridd.2021.103987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/09/2021] [Accepted: 05/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prevalence studies among prisoners have found rates of 1-4% for autism spectrum disorder (ASD) or autistic traits. However, little is known about those prisoners with high levels of autistic traits. AIM This aim of this study was to compare the mental health characteristics of prisoners with autistic traits with neurotypical prisoners not screening positive for neurodevelopmental disorders. METHOD The study recruited 240 male prisoners from a London prison and screened for autism spectrum disorder using the Autism Quotient (AQ) 20 and 10, and Autism Diagnostic Observation Schedule (ADOS). The Mini International Neuropsychiatric Interview was used to assess for depression, anxiety, self-harm behavior and suicide. RESULTS Screening using the AQ identified 46 prisoners with significant autistic traits, with 12 meeting the diagnostic threshold for ASD using the ADOS. Those screening positive with autistic traits were significantly more likely to have thought about self-harm and suicide in the past month than neurotypical prisoners and have a comorbid mental disorder. They were also significantly more likely to report having attempted suicide during their lifetime compared to neurotypical peers at a rate of 64.9 % compared to 11.6 % for the neurotypical prisoners. CONCLUSION Prisoners with elevated levels of autistic traits were more likely to report self-harm, suicidal thoughts and were more vulnerable to a range of mental disorders than neurotypical prisoners. There is a need for more evidence on the experience of autistic prisoners to inform how pathways should work to improve health outcomes through increased awareness and access to screening and subsequent diagnosis which currently prisons are currently not set up for.
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Affiliation(s)
- Eddie Chaplin
- London South Bank University Institute of Health and Social Care, United Kingdom.
| | - Jane McCarthy
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | - Lisa Underwood
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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10
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Bird AL, Underwood L, Berry S, Grant CC, Gulliver P, Fanslow J, Atatoa Carr PE, Fa'alili-Fidow J, Morton SMB. Physical Conflict During Pregnancy: A Socioecological, Cross-Cultural Examination of Risk and Protective Factors for New Zealand Women. Violence Against Women 2020; 27:1930-1956. [PMID: 33263502 DOI: 10.1177/1077801220971356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Participants were 5,831 women in their third trimester of pregnancy, part of a large, longitudinal, pre-birth national cohort study. Women reported on their experience of pushing and shoving, throwing or breaking objects within their relationship over the past month. Univariable regression models examined the association of a large number of potential risk and protective factors. Those significant at the univariable level were carried forward into final multivariable analyses, stratified by New Zealand's four main ethnic groups: European, Māori, Pacific, and Asian peoples. Relationship commitment, reduced family cohesion, and perceived stress were associated with increased risk across ethnic groups.
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Affiliation(s)
- Amy L Bird
- University of Waikato, Hamilton, New Zealand
| | | | | | - Cameron C Grant
- University of Auckland, New Zealand.,Starship Children's Hospital, Auckland, New Zealand
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11
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D'Souza S, Underwood L, Peterson ER, Morton SMB, Waldie KE. The Association Between Persistence and Change in Early Childhood Behavioural Problems and Preschool Cognitive Outcomes. Child Psychiatry Hum Dev 2020; 51:416-426. [PMID: 31907733 DOI: 10.1007/s10578-019-00953-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The link between behavioural and cognitive difficulties is well established. However, research is limited on whether persistence and change in behavioural difficulties relates to cognitive outcomes, particularly during preschool. We used a large New Zealand birth cohort to investigate how persistence and change in serious behavioural problems from ages 2 to 4.5 years related to measures of cognitive delay at 4.5 years (n = 5885). Using the Strengths and Difficulties total problems score at each time point, children were categorised as showing no difficulties, improved behaviour, concurrent difficulties, and persistent difficulties. Cognitive measures assessed included receptive language, early literacy ability, and executive control. Our results showed that children with concurrent and persistent behavioural difficulties were at a greater risk of showing delays within specific cognitive domains relative to children with no difficulties and were also more likely to show comorbid delays across multiple cognitive domains.
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Affiliation(s)
- Stephanie D'Souza
- School of Psychology, The University of Auckland, Auckland, New Zealand. .,Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand. .,COMPASS Research Centre, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand.,Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand.,Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand.,School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand.,Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand
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12
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McDaid F, Underwood L, Fa Alili-Fidow J, Waldie KE, Peterson ER, Bird A, D Souza S, Morton S. Antenatal depression symptoms in Pacific women: evidence from Growing Up in New Zealand. J Prim Health Care 2020; 11:96-108. [PMID: 32171352 DOI: 10.1071/hc18102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/23/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pacific women in New Zealand (NZ) have higher rates of antenatal depression than women from other ethnic groups. AIM To identify factors that are significantly associated with depression symptoms in pregnant Pacific women living in NZ. METHODS Data were collected from 5657 pregnant women, 727 of whom identified their ethnicity as Pacific Island. Antenatal depression symptoms were measured using the Edinburgh Depression Scale with scores above 12 indicating elevated antenatal depression symptoms (ADS). RESULTS Pacific women had significantly higher rates of ADS than non-Pacific women, with 23% of pregnant Pacific women experiencing ADS. Factors associated with ADS for Pacific women included age <25 years, moderate to severe nausea during pregnancy, perceived stress, family stress and relationship conflict. Not seeing the importance of maintaining one's Pacific culture and traditions and negative feelings towards NZ culture were also significantly associated with ADS in Pacific women. One in three Pacific women aged <25 years experienced ADS. Pregnant Pacific women without a family general practitioner (GP) before their pregnancy were 4.5-fold more likely to experience ADS than non-Pacific women with a regular GP. DISCUSSION Further attention is required to providing appropriate primary health care for Pacific women of child-bearing age in NZ. Better screening processes and a greater understanding of effective antenatal support for Pacific women is recommended to respond to the multiple risk factors for antenatal depression among Pacific women.
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Affiliation(s)
- Frances McDaid
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, New Zealand
| | - Lisa Underwood
- School of Population Health, University of Auckland, PO Box 18288, Auckland, 1743, New Zealand; and Corresponding author.
| | - Jacinta Fa Alili-Fidow
- Centre for Longitudinal Research, University of Auckland, PO Box 18288, Auckland 1743, New Zealand
| | - Karen E Waldie
- School of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Amy Bird
- School of Psychology, University of Wollongong, Northfields Ave, NSW 2522, Australia
| | - Stephanie D Souza
- COMPASS Research Centre, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Susan Morton
- School of Population Health, University of Auckland, PO Box 18288, Auckland, 1743, New Zealand; and Centre for Longitudinal Research, University of Auckland, PO Box 18288, Auckland 1743, New Zealand
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13
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Tye C, Mcewen FS, Liang H, Underwood L, Woodhouse E, Barker ED, Sheerin F, Yates JRW, Bolton PF. Long-term cognitive outcomes in tuberous sclerosis complex. Dev Med Child Neurol 2020; 62:322-329. [PMID: 31538337 PMCID: PMC7027810 DOI: 10.1111/dmcn.14356] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 01/10/2023]
Abstract
AIM To investigate the interdependence between risk factors associated with long-term intellectual development in individuals with tuberous sclerosis complex (TSC). METHOD The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of individuals with TSC. In phase 1 of the study, baseline measures of intellectual ability, epilepsy, cortical tuber load, and mutation were obtained for 125 children (63 females, 62 males; median age=39mo). In phase 2, at an average of 8 years later, intellectual abilities were estimated for 88 participants with TSC and 35 unaffected siblings. Structural equation modelling was used to determine the risk pathways from genetic mutation through to IQ at phase 2. RESULTS Intellectual disability was present in 57% of individuals with TSC. Individuals without intellectual disability had significantly lower mean IQ compared to unaffected siblings, supporting specific genetic factors associated with intellectual impairment. Individuals with TSC who had a slower gain in IQ from infancy to middle childhood were younger at seizure onset and had increased infant seizure severity. Structural equation modelling indicated indirect pathways from genetic mutation, to tuber count, to seizure severity in infancy, through to IQ in middle childhood and adolescence. INTERPRETATION Early-onset and severe epilepsy in the first 2 years of life are associated with increased risk of long-term intellectual disability in individuals with TSC, emphasizing the importance of early and effective treatment or prevention of epilepsy. WHAT THIS PAPER ADDS Intellectual disability was present in 57% of individuals with tuberous sclerosis complex (TSC). Those with TSC without intellectual disability had significantly lower mean IQ compared to unaffected siblings. Earlier onset and greater severity of seizures in the first 2 years were observed in individuals with a slower gain in intellectual ability. Risk pathways through seizures in the first 2 years predict long-term cognitive outcomes in individuals with TSC.
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Affiliation(s)
- Charlotte Tye
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Social Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Fiona S Mcewen
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Social Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Department of Biological and Experimental PsychologySchool of Biological and Chemical SciencesQueen Mary University of LondonLondonUK
| | - Holan Liang
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Great Ormond Street Hospital NHS TrustLondonUK,Institute of Child HealthUniversity College LondonLondonUK
| | - Lisa Underwood
- Department of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Emma Woodhouse
- Forensic and Neurodevelopmental SciencesInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS TrustLondonUK
| | - Edward D Barker
- Department of PsychologyInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Fintan Sheerin
- Department of NeuroradiologyOxford University Hospital NHS Foundation TrustOxfordUK
| | - John R W Yates
- Department of Medical GeneticsCambridge UniversityCambridgeUK
| | - Patrick F Bolton
- Department of Child & Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Social Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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14
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Kim Y, Bird A, Peterson E, Underwood L, Morton SMB, Grant CC. Maternal Antenatal Depression and Early Childhood Sleep: Potential Pathways Through Infant Temperament. J Pediatr Psychol 2020; 45:203-217. [DOI: 10.1093/jpepsy/jsaa001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Maternal depression is associated with infant and child sleep patterns, and with infant temperament. Here, we examine whether infant temperament mediated an association between maternal antenatal depression and toddler sleep.
Method
Within the prebirth longitudinal cohort Growing Up in New Zealand, symptoms of antenatal and postnatal depression were measured in 5,568 women using the Edinburgh Postnatal Depression Scale (EPDS). Infant temperament was measured at age 9 months using the Very Short Form of Infant Behavior Questionnaire-Revised (IBQ-R VSF). Sleep duration and nighttime awakenings were reported by parents when children were 2 years old.
Results
Independent associations of maternal depression with child sleep patterns at age 2 years, adjusted for maternal demographics, physical health, family relationships, and child health and feeding, were determined using multivariate logistic regression analysis. The odds of having ≥2 nighttime awakenings were increased for children whose mothers had antenatal (1.36, 1.07–1.73) but not postnatal (1.22, 0.88–1.68) or both antenatal and postnatal depression (0.89, 0.56–1.36). There was no association of maternal depression with shorter sleep duration. Two of five dimensions of infant temperament (fear and negative affect) were associated with both antenatal depression scores and increased nighttime awakenings. Mediation analyses controlling for postnatal depression and other predictors of child sleep supported an indirect pathway of antenatal depression to child sleep through infant temperamental negative affectivity.
Conclusion
Antenatal depression is independently associated with more frequent nighttime awakenings in early childhood. Findings support an indirect pathway through infant negative affect characteristics.
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Affiliation(s)
| | - Amy Bird
- University of Waikato
- University of Auckland
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15
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McCarthy J, Chaplin E, Forrester A, Underwood L, Hayward H, Sabet J, Young S, Mills R, Asherson P, Murphy D. Prisoners with neurodevelopmental difficulties: Vulnerabilities for mental illness and self-harm. Crim Behav Ment Health 2019; 29:308-320. [PMID: 31912971 DOI: 10.1002/cbm.2132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/28/2018] [Accepted: 10/03/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Research into neurodevelopmental disorders in adult offenders has tended to be disorder specific, so hindering service planning for a group of offenders with similar vulnerabilities. AIM To examine vulnerabilities for mental illness and self-harming behaviours among male prisoners screening positive for a range of neurodevelopmental difficulties-including but not confined to disorders of intellectual ability, attention deficit hyperactivity, and in the autistic spectrum. METHOD In a cross-sectional study, prisoners who screened positive for neurodevelopmental difficulties were compared to prisoners who screened negative for the same on indicators of suicide-related and self-harm behaviours, mental illness, and substance misuse using the Mini International Neuropsychiatric Interview (MINI). RESULTS Of 87 prisoners who screened positive for neurodevelopmental difficulties, 69 had full MINI mental health data. In comparison with 69 neurotypical men in the same prison, the neurodevelopmental difficulties group was significantly more likely to have thought about self-harm and suicide in the last month and to have significantly higher rates of concurrent mental disorders including psychosis, anxiety, depression, personality disorder, and substance dependency disorders. CONCLUSIONS This is one of the first studies to examine the mental health of adults with neurodevelopmental difficulties in a prison setting. This group, unlike those who meet diagnostic threshold, is not routinely considered by mental health or correctional services. The study found prisoners with neurodevelopmental difficulties showed greater vulnerability to mental disorder and thoughts of suicide and suicide-related behaviours than other prisoners. Accordingly, we recommend routine early screening across the criminal justice system for any neurodevelopmental difficulties to inform decision-making on the most appropriate disposal and support.
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Affiliation(s)
- Jane McCarthy
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eddie Chaplin
- London South Bank University School of Health and Social Care, Ringgold Standard Institution, 103 Borough Road, London, SE1 0AA, United Kingdom of Great Britain and Northern Ireland
| | - Andrew Forrester
- Greater Manchester Mental Health NHS Foundation Trust and South London and Maudsley NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Hannah Hayward
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Jess Sabet
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Susan Young
- Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, United Kingdom of Great Britain and Northern Ireland
- Broadmoor Hospital West London Mental Health Trust, London, RG45 7EG, United Kingdom of Great Britain and Northern Ireland
| | - Richard Mills
- Research Autism, London, United Kingdom of Great Britain and Northern Ireland
| | - Philip Asherson
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Declan Murphy
- King's College London, London, United Kingdom of Great Britain and Northern Ireland
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16
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D'Souza S, Crawford CN, Buckley J, Underwood L, Peterson ER, Bird A, Morton SMB, Waldie KE. Antenatal determinants of early childhood talking delay and behavioural difficulties. Infant Behav Dev 2019; 57:101388. [PMID: 31634704 DOI: 10.1016/j.infbeh.2019.101388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/26/2022]
Abstract
The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.
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Affiliation(s)
- Stephanie D'Souza
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | | | - Jude Buckley
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Amy Bird
- School of Psychology, University of Wollongong, NSW, Australia
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
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17
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Abstract
BACKGROUND Behavioural problems and psychopathology can present from as early as the preschool period. However there is evidence that behavioural difficulties may not be stable over this period. Therefore, the current study was interested in evaluating the persistence and change in clinically relevant behavioural problems during early childhood in a population-based New Zealand birth cohort. METHODS Behaviour was assessed in 5896 children when they were aged 2 and 4.5 years using the Strengths and Difficulties Questionnaire (SDQ). Correlations and mean differences in subscale and total difficulties scores were examined. Scores were then dichotomised into normal/borderline and abnormal ranges to evaluate the persistence and change in significant behavioural problems. Chi-square analyses and ANOVAs were used to determine the association between sociodemographic and birth variables, and preschool behavioural stability. RESULTS Raw scores at ages 2 and 4.5 years were moderately correlated, with most measures showing a small but significant decrease in mean scores over time. The majority of children who showed abnormal behaviour at 2 years improved at 4.5 years (57.9% for total difficulties). However, a notable proportion persisted in their difficulties from 2 to 4.5 years (42.1% for total difficulties). There was a small percentage of children who were categorised as abnormal only at 4.5 years. Children with difficulties at one or both time points had a greater proportion who were the result of an unplanned pregnancy, lived in highly deprived urban areas, and had mothers who were younger, of Māori and Pacific ethnicity and were less educated. CONCLUSIONS Not all children who show early behavioural difficulties persist in these difficulties. Those whose difficulties persist were more likely to experience risk factors for vulnerability relative to children with no difficulties. Results suggest that repeated screening for early childhood behavioural difficulties is important.
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Affiliation(s)
- Stephanie D’Souza
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand
- Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Elizabeth R. Peterson
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Susan M. B. Morton
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Karen E. Waldie
- School of Psychology, University of Auckland, Auckland, New Zealand
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand
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18
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Neumann D, Herbert SE, Peterson ER, Underwood L, Morton SMB, Waldie KE. A longitudinal study of antenatal and perinatal risk factors in early childhood cognition: Evidence from Growing Up in New Zealand. Early Hum Dev 2019; 132:45-51. [PMID: 30974313 DOI: 10.1016/j.earlhumdev.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Poor maternal health, disadvantageous exposures during pregnancy and unfavourable perinatal events are associated with adverse trajectories in offspring cognitive development. AIM To examine longitudinal associations between antenatal maternal, perinatal and maternal health characteristics and children's early cognitive development across executive control, motor ability and receptive language domains. STUDY DESIGN, SUBJECTS AND OUTCOME MEASURES Analyses comprised interview and observational data from 4587 children and their mothers enrolled in the longitudinal Growing Up in New Zealand cohort study. Children's executive control (Luria hand clap task), motor skills (mothers' report) and receptive language ability (Peabody Picture Vocabulary Test) were assessed at age 4.5 years. Multivariate logistic regression analyses were conducted, controlling for sociodemographic factors. RESULTS Smoking pre- and during pregnancy, no folate intake during first trimester and low birth weight were risk factors for poorer executive control. Perceived stress during pregnancy, no folate intake during first trimester and low birth weight were all risk factors for poorer motor ability. Smoking pre-pregnancy, antenatal anxiety and no folate intake during first trimester were risk factors for poorer receptive language ability. CONCLUSION Adverse ante- and perinatal environments are associated with poorer executive control, motor and receptive language abilities in early childhood. Improving maternal education and support especially for more disadvantaged mothers during pregnancy may reduce the potential deleterious impact of adverse ante- and perinatal conditions on children's early cognition.
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Affiliation(s)
- Denise Neumann
- School of Psychology, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Sarah E Herbert
- School of Psychology, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Elizabeth R Peterson
- School of Psychology, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand; Department of Psychological Medicine, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Karen E Waldie
- School of Psychology, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Auckland, Private Bag 92019, Auckland, New Zealand.
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19
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D'Souza S, Waldie KE, Peterson ER, Underwood L, Morton SMB. Antenatal and Postnatal Determinants of Behavioural Difficulties in Early Childhood: Evidence from Growing Up in New Zealand. Child Psychiatry Hum Dev 2019; 50:45-60. [PMID: 29860616 DOI: 10.1007/s10578-018-0816-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Behavioural difficulties during early childhood have significant implications for multiple outcomes later in life. Child behavioural difficulties at 2 years of age (N = 6246) were assessed by mothers enrolled in a longitudinal, population-based New Zealand cohort study. 10.1% of children had total difficulties scores in the abnormal range on the preschool version of the Strengths and Difficulties Questionnaire. After controlling for maternal education, poverty, and child's birth age/weight, several antenatal and postnatal maternal health and family risk factors were significant for: (i) emotional problems (antenatal maternal perceived stress, lack of periconceptional folate, and moderate to severe maternal postnatal anxiety); (ii) hyperactivity-inattention (antenatal maternal perceived stress, mothers' antenatal exposure to secondhand smoke, moderate to severe maternal postnatal anxiety, and low maternal self-evaluation); (iii) conduct problems and total difficulties (antenatal maternal perceived stress, verbal inter-parental conflict and low maternal self-evaluation). The identification of risk and protective factors associated with early childhood difficulties are vital for guiding intervention and prevention efforts.
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Affiliation(s)
- Stephanie D'Souza
- School of Psychology, Faculty of Science, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, Faculty of Science, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. .,Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
| | - Elizabeth R Peterson
- School of Psychology, Faculty of Science, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.,School of Population Health, The University of Auckland, Auckland, New Zealand
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20
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Schoeps A, Peterson ER, Mia Y, Waldie KE, Underwood L, D'Souza S, Morton SMB. Prenatal alcohol consumption and infant and child behavior: Evidence from the Growing Up in New Zealand Cohort. Early Hum Dev 2018; 123:22-29. [PMID: 30036725 DOI: 10.1016/j.earlhumdev.2018.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND High levels of alcohol exposure during pregnancy can damage developing brains and influence child behavior and learning. AIM To examine the effects of lower levels of alcohol and very early exposure to alcohol on infant temperament and child behavior. STUDY DESIGN, SUBJECTS, AND OUTCOME MEASURES The Growing Up in New Zealand study involves a prospective birth cohort of 6822 pregnant women of whom 6156 provided information on their child's temperament using the Infant Behavior Questionnaire-Revised (IBQ-R VSF) at 9 months and their child's behavior using the Strengths and Difficulties Questionnaire at 2 years. RESULTS A series of adjusted linear regression models controlling for socio-demographic factors found alcohol consumption during pregnancy was most consistently related to Lower Positive Affect, Affiliation/Regulation, and Orienting Capacity temperament scores. Mothers who stopped drinking after becoming aware of their pregnancy, but had an unplanned pregnancy (hence may have a baby exposed to alcohol for longer), also reported infants with lower Orienting Capacity, Affiliation/Regulation, and Fear temperament scores compared to those that did not drink. Children whose mothers drank four or more drinks per week during pregnancy were more likely to report their child as having conduct problems, with higher total difficulties scores at age 2. CONCLUSIONS Alcohol consumption during pregnancy has a negative effect especially on infant temperament, even if small amounts of alcohol are consumed. Our findings have implications for men and women who drink, medical professionals, and for the availability of contraception to those who drink, but do not plan to get pregnant.
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Affiliation(s)
- Anja Schoeps
- Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
| | - Elizabeth R Peterson
- School of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Yasmine Mia
- School of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Karen E Waldie
- School of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Stephanie D'Souza
- School of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, University of Auckland, Private Bag 92019, Auckland, New Zealand; School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Rossen F, Newcombe D, Parag V, Underwood L, Marsh S, Berry S, Grant C, Morton S, Bullen C. Alcohol consumption in New Zealand women before and during pregnancy: findings from the Growing Up in New Zealand study. N Z Med J 2018; 131:24-34. [PMID: 30048430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To examine alcohol consumption before and during pregnancy in the mothers of a contemporary sample of New Zealand children. METHOD Analysis of data from the antenatal assessment of 6,822 women enrolled in the Growing Up in New Zealand study, using logistic regression models to examine associations between maternal alcohol use and maternal demographics, pregnancy planning and parity. RESULTS Seventy-one percent of women drank alcohol before becoming pregnant, 23% during and 13% after the first trimester. The odds of drinking alcohol before pregnancy were significantly higher for younger women who were European or Māori with an unplanned pregnancy and in their first pregnancy; during the first trimester, higher for women who were European or Māori with no secondary school qualification, in their first pregnancy, with an unplanned pregnancy; and in the second and third trimesters, higher for European or Māori women aged 30 and over, in their first pregnancy. CONCLUSIONS Drinking is common in New Zealand women before pregnancy, particularly among European and Māori women. Some women consume small amounts of alcohol and some engage in heavy drinking in pregnancy. Both are a risk for fetal harm. Population-wide and targeted measures are needed to reduce consumption overall and provide support to specific population groups.
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Affiliation(s)
- Fiona Rossen
- School of Population Health, The University of Auckland, Auckland
| | - David Newcombe
- School of Population Health, The University of Auckland, Auckland
| | - Varsha Parag
- National Institute for Health Innovation, The University of Auckland, Auckland
| | - Lisa Underwood
- Growing Up in New Zealand, and Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland
| | - Samantha Marsh
- National Institute for Health Innovation, The University of Auckland, Auckland
| | - Sarah Berry
- Growing Up in New Zealand, and Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland
| | - Cameron Grant
- Department of Paediatrics, The University of Auckland, Auckland
| | - Susan Morton
- Growing Up in New Zealand, and Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland
| | - Chris Bullen
- National Institute for Health Innovation, The University of Auckland, Auckland
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D'Souza S, Waldie KE, Peterson ER, Underwood L, Morton SMB. The Strengths and Difficulties Questionnaire: Factor Structure of the Father-Report and Parent Agreement in 2-Year-Old Children. Assessment 2017; 26:1059-1069. [PMID: 29214848 DOI: 10.1177/1073191117698757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is limited research on the preschool version of the Strengths and Difficulties Questionnaire (SDQ), and comparisons between mothers and fathers as informants and whether the factor structure shows measurement invariance across parents is lacking. Our study involved mothers (n = 6,246) and fathers (n = 3,759) of 2-year-old children from the Growing Up in New Zealand birth cohort. Confirmatory factor analysis was used to evaluate the factor structure of the SDQ and test for measurement invariance across mothers and fathers. For fathers, we found support for a modified five-factor model that accounts for a positive construal method effect. Internal consistency was good for measures except peer problems. Full measurement invariance of this modified model was found across mothers and fathers, and parents showed moderate agreement in their SDQ ratings (0.34 ≤ r ≤ 0.44). More research is needed on whether mother- and father-reports differ in sensitivity when screening for early childhood psychiatric disorders.
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Affiliation(s)
- Stephanie D'Souza
- 1 School of Psychology, The University of Auckland, Auckland, New Zealand.,2 Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- 1 School of Psychology, The University of Auckland, Auckland, New Zealand
| | | | - Lisa Underwood
- 2 Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- 2 Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.,3 School of Population Health, The University of Auckland, Auckland, New Zealand
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Chaplin E, McCarthy J, Underwood L, Forrester A, Hayward H, Sabet J, Mills R, Young S, Asherson P, Murphy D. Characteristics of prisoners with intellectual disabilities. J Intellect Disabil Res 2017; 61:1185-1195. [PMID: 29154489 DOI: 10.1111/jir.12441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 07/31/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Previous studies have found high rates of intellectual disabilities (ID) in prison. However, little is understood about prisoners with ID. This study aimed to identify prisoners with ID and compare their characteristics with prisoners without neurodevelopmental disorders with regard to demographic profile, mental health, suicide risk and offences. METHOD This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ID and mental disorder. RESULTS The study identified 18 prisoners as having ID. Participants with ID were less likely to be from a black or minority ethnic background, be over 35 years of age or have any qualifications. They were more likely to have been single, homeless or unemployed before coming into prison. Prisoners with ID were significantly more likely to have mental health problems and 25% had thought about suicide in the last month and 63% had attempted suicide in the past. Prisoners with ID were also more likely to be housed in the vulnerable prisoners' wing and significantly more likely to have committed robbery than other prisoners. CONCLUSIONS The findings confirm the presence of significant numbers of people with ID with high levels of mental illness in a male prison. Services across the CJS are required for this group, specifically, there is a need for raised awareness among those working in prison about ID and improved skills to recognise offenders with ID and address major gaps in current healthcare provision in prison.
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Affiliation(s)
- E Chaplin
- Mental Health and Intellectual Disabilities Research and Policy Unit, London South Bank University, London, UK
| | - J McCarthy
- Mental Health and Intellectual Disabilities Research and Policy Unit, London South Bank University, London, UK
| | - L Underwood
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - A Forrester
- Offender Health Research Network, University of Manchester
| | - H Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J Sabet
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - S Young
- Department of Medicine, Imperial College London, London, UK
| | - P Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - D Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Underwood L, Waldie K. The effect of paternal depression on depressive symptoms in adolescent offspring. Lancet Psychiatry 2017; 4:889-890. [PMID: 29153627 DOI: 10.1016/s2215-0366(17)30432-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa Underwood
- Centre for Longitudinal Research, University of Auckland, Auckland 1743, New Zealand.
| | - Karen Waldie
- School of Psychology, University of Auckland, Auckland 1743, New Zealand
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Underwood L, Morton SMB, Waldie KE. Assessing Depression Among New Fathers-Reply. JAMA Psychiatry 2017; 74:855-856. [PMID: 28658467 DOI: 10.1001/jamapsychiatry.2017.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lisa Underwood
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand2School of Population Health, University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, University of Auckland, Auckland, New Zealand
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Derks O, Heinrich M, Brooks W, Sterkenburg P, McCarthy J, Underwood L, Sappok T. The Social Communication Questionnaire for adults with intellectual disability: SCQ-AID. Autism Res 2017; 10:1481-1490. [DOI: 10.1002/aur.1795] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/09/2017] [Accepted: 03/20/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Olivia Derks
- Department of Clinical Child and Family Studies; Vrije Universiteit; Amsterdam The Netherlands
| | - Manuel Heinrich
- Department for Psychiatry, Psychotherapy and Psychosomatics; Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstr. 79; Berlin 10365 Germany
- Department of Education and Psychology, Division of Clinical Psychological Intervention; Freie Universität Berlin; Germany
| | - Whitney Brooks
- TEACCH Autism Program; University of North Carolina; Chapel Hill NC
| | - Paula Sterkenburg
- Department of Clinical Child and Family Studies; Vrije Universiteit; Amsterdam The Netherlands
| | - Jane McCarthy
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry; Psychology and Neuroscience, King's College London; London United Kingdom
| | - Lisa Underwood
- Forensic and Neurodevelopmental Sciences; Institute of Psychiatry, Psychology and Neuroscience, King's College London; London United Kingdom
- School of Population Health, University of Auckland; Auckland New Zealand
| | - Tanja Sappok
- Department for Psychiatry, Psychotherapy and Psychosomatics; Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstr. 79; Berlin 10365 Germany
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Underwood L, Waldie KE, Peterson E, D’Souza S, Verbiest M, McDaid F, Morton S. Paternal Depression Symptoms During Pregnancy and After Childbirth Among Participants in the Growing Up in New Zealand Study. JAMA Psychiatry 2017; 74:360-369. [PMID: 28199455 PMCID: PMC5470399 DOI: 10.1001/jamapsychiatry.2016.4234] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Antenatal and postnatal depression are known to be common and associated with poor outcomes for women and their children. There is little evidence on depression symptoms among men during the perinatal period. OBJECTIVE To identify characteristics associated with depression symptoms among men whose partners were pregnant and subsequently gave birth. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort study provided data from a demographically diverse sample of 3523 New Zealand men who completed interviews during their partner's pregnancy and 9 months after the birth of their child. Participants were drawn from a cohort whose partners were pregnant women with a due date between April 25, 2009, and March 25, 2010, who were enrolled in the Growing Up in New Zealand study. Data analysis was conducted from September 1, 2015, to January 8, 2016. MAIN OUTCOMES AND MEASURES Depression symptoms were measured using the Edinburgh Postnatal Depression Scale and the 9-item Patient Health Questionnaire; elevated depression symptoms were defined as scores higher than 12 and 9, respectively. RESULTS The mean (SD) age of the participants at the antenatal interview was 33.20 (6.25) years (range, 16-63 years). Elevated antenatal paternal depression symptoms affected 82 fathers (2.3%) and were associated with perceived stress (odds ratio [OR], 1.38; 95% CI, 1.30-1.47) and fair to poor health during their partner's pregnancy (OR, 2.06; 95% CI, 1.18-3.61). Elevated postnatal paternal depression symptoms affected 153 (4.3%) of fathers and were associated with perceived stress in pregnancy (OR, 1.12; 95% CI, 1.08-1.17), no longer being in a relationship with the mother 9 months after childbirth (OR, 6.36; 95% CI, 2.28-17.78), having fair to poor health at 9 months (OR, 3.29; 95% CI, 2.10-5.16), being unemployed at 9 months (OR, 1.86; 95% CI, 1.11-3.10), and a history of depression (OR, 2.84; 95% CI, 1.69-4.78). CONCLUSIONS AND RELEVANCE Expectant fathers were at risk of depression symptoms if they felt stressed or were in poor health. Rates of elevated depression symptoms were higher during the postpartum period and were associated with adverse social and relationship factors. Identifying fathers most at risk of depressive symptoms and when best to target interventions (antenatal or postnatal) may be beneficial to men and their families.
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Affiliation(s)
- Lisa Underwood
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,Center for Longitudinal Research–He Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Karen E. Waldie
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,School of Psychology, University of Auckland, Auckland, New Zealand
| | - Elizabeth Peterson
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,School of Psychology, University of Auckland, Auckland, New Zealand
| | - Stephanie D’Souza
- Center for Longitudinal Research–He Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand,School of Psychology, University of Auckland, Auckland, New Zealand
| | - Marjolein Verbiest
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Frances McDaid
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Morton
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,Center for Longitudinal Research–He Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand
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Underwood L, Waldie KE, D’Souza S, Peterson ER, Morton SMB. A Longitudinal Study of Pre-pregnancy and Pregnancy Risk Factors Associated with Antenatal and Postnatal Symptoms of Depression: Evidence from Growing Up in New Zealand. Matern Child Health J 2016; 21:915-931. [DOI: 10.1007/s10995-016-2191-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Purpose
– The purpose of this paper is to determine the extent of autism spectrum disorder (ASD) traits among prisoners. The authors tested the hypotheses that ASD traits would: be continuously distributed among prisoners; be unrecognised by prison staff; and predict whether a prisoner met diagnostic criteria for ASD.
Design/methodology/approach
– ASD traits were measured among 240 prisoners in a male prison in London, UK using the 20-item Autism Quotient (AQ-20). Further diagnostic assessment was carried out using the Autism Diagnostic Observation Schedule. Results were compared with ASD data from the 2007 Psychiatric Morbidity Survey.
Findings
– There were 39 participants with an AQ-20 score=10; indicating significant autistic traits. The distribution of ASD traits among participants appeared to be normal and was not significantly higher than the rate found in a population-based sample from England.
Originality/value
– Few studies have explored ASD traits among prisoners. The authors identified high levels of unrecognised ASD traits among a group of male prisoners, many of whom went on to meet diagnostic criteria for ASD. The study highlights the need for specialist assessment within the criminal justice system for individuals with neurodevelopmental disorders including ASD. The authors discuss the process of carrying out an ASD assessment project in a prison.
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Abstract
Purpose
– The purpose of this paper is to provide a brief, descriptive overview of Tuberous Sclerosis Complex (TSC) research with particular reference to studies on Autism Spectrum Disorder (ASD).
Design/methodology/approach
– A search of electronic databases was carried out to identify English language articles on TSC. The literature was explored in more detail with a focus on neurodevelopmental disorders associated with TSC such as ASD.
Findings
– The review included 3,679 references. The earliest articles identified were published in the early twentieth century. Since then research on TSC has advanced rapidly and is being carried out worldwide. Just 62 studies have focused on ASD in TSC, although the number of publications is increasing over time.
Research limitations/implications
– More research on ASD in TSC is needed to benefit those affected by TSC and the broader ASD scientific community.
Practical implications
– Practitioners working with children and adults with ASD should be aware of the wider health issues experienced by those with genetic conditions such as TSC. Similarly, clinicians working with those who have TSC should be aware of the high prevalence of ASD in the group and implications for the way they work with their patients.
Originality/value
– This is the first paper to map and characterise the scientific literature on TSC. There remains a focus on the biomedical aspects of TSC with fewer studies on psychosocial/educational or family impacts. The review concludes with recommended research questions for the future.
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McCarthy J, Chaplin E, Underwood L, Forrester A, Hayward H, Sabet J, Young S, Asherson P, Mills R, Murphy D. Characteristics of prisoners with neurodevelopmental disorders and difficulties. J Intellect Disabil Res 2016; 60:201-6. [PMID: 26486964 DOI: 10.1111/jir.12237] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/22/2015] [Accepted: 09/17/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Previous studies have found high rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) within the criminal justice system (CJS). However, little is understood about prisoners with neurodevelopmental disorders and difficulties (NDD) or their needs. This study aimed to identify prisoners with NDD and compare their characteristics with prisoners without NDD on a range of socio-demographic and social functioning measures. METHOD This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ADHD, ASD and ID. RESULTS The study identified 87 prisoners who screened positive for one or more type of NDD. Participants with NDD were significantly younger and more likely to be single [(odds ratio) OR = 2.1], homeless (OR = 3.4) or unemployed (OR = 2.6) before they came into prison. They also had poorer educational achievements that those without NDD. Over 80% of those with NDD had a previous conviction or imprisonment. CONCLUSIONS The findings confirm the presence of significant numbers of people with NDD in a male prison. Services across the CJS are required for this group; specifically, there is a need for raised awareness among those working in the CJS to improve the recognition of offenders with NDD. Services in the community need to work with individuals with NDD who are at risk of offending, targeting those who are homeless, unemployed and have poor employment opportunities.
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Affiliation(s)
- J McCarthy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - E Chaplin
- London South Bank University, London, United Kingdom
| | - L Underwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - A Forrester
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - H Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - J Sabet
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - S Young
- Department of Medicine, Imperial College London, United Kingdom
| | - P Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - R Mills
- Research Autism, London, United Kingdom
| | - D Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Waldie KE, Peterson ER, D'Souza S, Underwood L, Pryor JE, Carr PA, Grant C, Morton SMB. Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand. J Affect Disord 2015; 186:66-73. [PMID: 26231443 DOI: 10.1016/j.jad.2015.06.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/03/2015] [Accepted: 06/10/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depression during pregnancy has significant implications for pregnancy outcomes and maternal and child health. There is a need to identify which family, physical and mental health factors are associated with depression during pregnancy. METHODS An ethnically and socioeconomically diverse sample of 5664 pregnant women living in New Zealand completed a face-to-face interview during the third trimester. Antenatal depression (AD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Maternal demographic, physical and mental health, and family and relationship characteristics were measured. The association between symptoms of AD and maternal characteristics was determined using multiple logistic regression. RESULTS 11.9% of the participating women had EPDS scores (13+) that indicated probable AD. When considering sociodemographic predictors of AD symptoms, we found that women from non-European ethnicities, specifically Pacific Islander, Asian and other, were more likely to suffer from AD symptoms. Greater perceived stress during pregnancy and a diagnosis of anxiety both before and during pregnancy were also associated with greater odds of having AD according to the EPDS. LIMITATIONS The women were in their third trimester of pregnancy at the interview. Therefore, we cannot discount the possibility of recall bias for questions relating to pre-pregnancy status or early-pregnancy behaviours. CONCLUSIONS AD is prevalent amongst New Zealand women. Ethnicity, perceived stress and anxiety are particularly associated with a greater likelihood of depression during pregnancy. Further attention to supporting maternal mental health status in the antenatal period is required.
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Affiliation(s)
- Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand.
| | | | - Stephanie D'Souza
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Jan E Pryor
- Roy McKenzie Centre for the Study of Families, Victoria University, New Zealand
| | - Polly Atatoa Carr
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Cameron Grant
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
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Abstract
Purpose
– The purpose of this paper is to provide a summary of English policy and legislation which impacts on the health outcomes and social inclusion for adults with autism.
Design/methodology/approach
– A descriptive review of national policy for England was undertaken using key internet search engines such as Google.
Findings
– In spite of innovative legislation and policy relating to autism across England, there are still wide discrepancies in both service models and provision relating to autism. More work is required to communicate what autism services should look like along with greater awareness training for professionals working with adults with autism to ensure reasonable adjustments are occurring across public services.
Originality/value
– This paper outlines current key policy and legislation in England relating to autism.
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Abstract
Purpose
– Diagnosing autism spectrum disorder (ASD) is important over the whole life span. Standardized instruments may support the assessment process. The purpose of this paper is to describe English- and German-screening tools for ASD.
Design/methodology/approach
– PubMed was used to search for published tools and evidence on their diagnostic validity.
Findings
– Searches identified 46 screening tools for ASD. Most are designed for children, while only few measures are available for adults, especially those with additional intellectual disabilities. Many instruments are under-researched, although a small number such as the Modified Checklist for Autism in Toddlers and the SCQ have been widely examined in a variety of populations.
Originality/value
– The study identified and described a number of ASD screeners that can support clinicians or researchers when deciding whether to carry out a more comprehensive ASD assessment.
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Underwood L, Jermy M. Determining optimal pacing strategy for the track cycling individual pursuit event with a fixed energy mathematical model. Sports Eng 2014. [DOI: 10.1007/s12283-014-0153-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McCarthy J, Underwood L, Tsakanikos E, Craig T, Howlin P, Bouras N. EPA-0297 – Predictors of challenging behaviour among mental health service users with intellectual disability and autism spectrum disorders. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)77741-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bonell S, Underwood L, Radhakrishnan V, McCarthy J. Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation. J Intellect Disabil Res 2012; 56:902-909. [PMID: 22044491 DOI: 10.1111/j.1365-2788.2011.01494.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London. METHOD A two-round Delphi process was utilised. White British and Black or Black British service users from a specialist community-based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale. RESULTS Twenty-four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication. CONCLUSIONS People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.
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Affiliation(s)
- S Bonell
- South London and Maudsley NHS Foundation Trust, London, UK.
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Underwood L, McCarthy J, Tsakanikos E, Howlin P, Bouras N, Craig TKJ. Health and Social Functioning of Adults With Intellectual Disability and Autism. Journal of Policy and Practice in Intellectual Disabilities 2012. [DOI: 10.1111/j.1741-1130.2012.00343.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Underwood L, Schumacher J, Burette-Pommay J, Jermy M. Aerodynamic drag and biomechanical power of a track cyclist as a function of shoulder and torso angles. Sports Eng 2011. [DOI: 10.1007/s12283-011-0078-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tsakanikos E, Underwood L, Sturmey P, Bouras N, McCarthy J. Psychometric properties of the Disability Assessment Schedule (DAS) for behavior problems: an independent investigation. Res Dev Disabil 2011; 32:653-658. [PMID: 21208774 DOI: 10.1016/j.ridd.2010.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 12/06/2010] [Indexed: 05/30/2023]
Abstract
The present study employed the Disability Assessment Schedule (DAS) to assess problem behaviors in a large sample of adults with ID (N=568) and evaluate the psychometric properties of this instrument. Although the DAS problem behaviors were found to be internally consistent (Cronbach's α=.87), item analysis revealed one weak item ('Objectional habits') with item-total biserial correlation of only .20. An exploratory factor analysis revealed two main factors. The first factor consisted of items relating to disruptive/distractive problems. The second factor consisted of items relating to antisocial/delinquent problems. Disruptive/distractive problems were specifically associated with low ID level. Antisocial/delinquent behaviors were specifically associated with male gender, schizophrenia, hospital admission and troubles with police. For patients who had both disruptive/distractive problems and antisocial/delinquent behaviors, personality disorders and autism were more frequent, where as anxiety and depression were less frequent. On the basis of the obtained results, two new DAS subscales for assessing challenging behavior were proposed. Both subscales had good levels of internal consistency, as well as face and criterion validity. Overall, the new DAS subscales were shown to have acceptable psychometric properties and have therefore potential for use in both research and clinical practice.
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Affiliation(s)
- Elias Tsakanikos
- Estia Center, Institute of Psychiatry, King's College London, UK.
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Arshad S, Winterhalder R, Underwood L, Kelesidi K, Chaplin E, Kravariti E, Anagnostopoulos D, Bouras N, McCarthy J, Tsakanikos E. Epilepsy and intellectual disability: does epilepsy increase the likelihood of co-morbid psychopathology? Res Dev Disabil 2011; 32:353-357. [PMID: 21084171 DOI: 10.1016/j.ridd.2010.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 10/15/2010] [Indexed: 05/30/2023]
Abstract
Although epilepsy is particularly common among people with intellectual disability (ID) it remains unclear whether it is associated with an increased likelihood of co-morbid psychopathology. We therefore investigated rates of mental health problems and other clinical characteristics in patients with ID and epilepsy (N = 156) as compared to patients with ID but no epilepsy (N = 596). All participants were consecutive referrals to specialist mental heath services. Specialist clinicians agreed on the mental health diagnoses by applying ICD-10 clinical criteria using information gained from interviews with key informants and the patients. Bivariate and multivariate analyses showed that patients with epilepsy were more likely to live in residential housing and have severe ID in line with previous evidence. However, the presence of epilepsy was not associated with an increased likelihood of co-morbid psychopathology. On the contrary, rates of mental health problems, including schizophrenia spectrum, personality and anxiety disorders, were significantly lower among patients with epilepsy. The results are discussed in the context of mood-stabilizing and other psychotropic effects of anti-epileptic drugs in adults with ID and epilepsy, as well as possible diagnostic overshadowing.
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Affiliation(s)
- Saadia Arshad
- Estia Centre, Institute of Psychiatry, King's College London, 66 Snowsfields, London SE1 3SS, UK
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Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L. Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Med 2010; 8:38. [PMID: 20579335 PMCID: PMC2908553 DOI: 10.1186/1741-7015-8-38] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 06/25/2010] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Psychological therapies provided in primary care are usually briefer than in secondary care. There has been no recent comprehensive review comparing their effectiveness for common mental health problems. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders. METHODS Meta-analysis and meta-regression of randomized controlled trials of brief psychological therapies of adult patients with anxiety, depression or mixed common mental health problems treated in primary care compared to primary care treatment as usual. RESULTS Thirty-four studies, involving 3962 patients, were included. Most were of brief cognitive behaviour therapy (CBT; n = 13), counselling (n = 8) or problem solving therapy (PST; n = 12). There was differential effectiveness between studies of CBT, with studies of CBT for anxiety disorders having a pooled effect size [d -1.06, 95% confidence interval (CI) -1.31 to -0.80] greater than that of studies of CBT for depression (d -0.33, 95% CI -0.60 to -0.06) or studies of CBT for mixed anxiety and depression (d -0.26, 95% CI -0.44 to -0.08). Counselling for depression and mixed anxiety and depression (d -0.32, 95% CI -0.52 to -0.11) and problem solving therapy (PST) for depression and mixed anxiety and depression (d -0.21, 95% CI -0.37 to -0.05) were also effective. Controlling for diagnosis, meta-regression found no difference between CBT, counselling and PST. CONCLUSIONS Brief CBT, counselling and PST are all effective treatments in primary care, but effect sizes are low compared to longer length treatments. The exception is brief CBT for anxiety, which has comparable effect sizes.
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Affiliation(s)
- John Cape
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London NW1 0PE, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Craig Whittington
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London Medical School, 2nd floor, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, UK
| | - Paul Wallace
- Research Department of Primary Care and Population Health, University College London Medical School, 2nd floor, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW, UK
| | - Lisa Underwood
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK
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Hemmings C, Underwood L, Bouras N. What should community services provide for adults with psychosis and learning disabilities? A comparison of the views of service users, carers and professionals. ACTA ACUST UNITED AC 2009. [DOI: 10.1108/17530180200900027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hemmings CP, Tsakanikos E, Underwood L, Holt G, Bouras N. Clinical predictors of severe behavioural problems in people with intellectual disabilities referred to a specialist mental health service. Soc Psychiatry Psychiatr Epidemiol 2008; 43:824-30. [PMID: 18488127 DOI: 10.1007/s00127-008-0370-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 04/25/2008] [Indexed: 11/24/2022]
Abstract
Associations between demographic and clinical variables and severe behavioural problems in people with intellectual disabilities were examined in a cross-sectional survey of 408 adults consecutively referred to a specialist mental health service. Severe behavioural problems were present in 136 (33.3%) of the sample. The demographic and clinical predictors of severe behavioural problems in this sample were identified by logistic regression. Age and gender were not associated with severe behavioural problems. The presence of severe ID independently predicted the presence of severe behavioural problems. Schizophrenia spectrum disorders and personality disorders independently predicted the presence of severe behavioural problems, whereas the presence of an anxiety disorder independently predicted their absence. There is an increasing evidence base of relationships between mental disorders and behavioural problems in people with ID although the pattern of these relationships remains unclear.
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Affiliation(s)
- Colin P Hemmings
- Estia Centre, Institute of Psychiatry, King's College London, London, UK.
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Finn DA, Snelling C, Fretwell AM, Tanchuck MA, Underwood L, Cole M, Crabbe JC, Roberts AJ. Increased Drinking During Withdrawal From Intermittent Ethanol Exposure Is Blocked by the CRF Receptor Antagonist d-Phe-CRF(12?41). Alcohol Clin Exp Res 2007; 31:939-49. [PMID: 17403068 DOI: 10.1111/j.1530-0277.2007.00379.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies in rodents have determined that intermittent exposure to alcohol vapor can increase subsequent ethanol self-administration, measured with operant and 2-bottle choice procedures. Two key procedural factors in demonstrating increased alcohol intake are the establishment of stable alcohol self-administration before alcohol vapor exposure and the number of bouts of intermittent vapor exposure. The present studies provide additional behavioral validation and initial pharmacological validation of this withdrawal-associated drinking procedure. METHODS Studies at 2 different sites (Portland and Scripps) examined the effect of intermittent ethanol vapor exposure (3 cycles of 16 hours of ethanol vapor+8 hours air) on 2-hour limited access ethanol preference drinking in male C57BL/6 mice. Separate studies tested 10 or 15% (v/v) ethanol concentrations, and measured intake during the circadian dark. In one study, before measuring ethanol intake after the second bout of intermittent vapor exposure, mice were tested for handling-induced convulsions (HICs) indicative of physical dependence on ethanol. In a second study, the effect of bilateral infusions of the corticotropin-releasing factor (CRF) receptor antagonist D-Phe-CRF(12-41) (0.25 microg/0.5 microL) into the central nucleus of the amygdala (CeA) on ethanol intake was compared in vapor-exposed animals and air controls. RESULTS Intermittent ethanol vapor exposure significantly increased ethanol intake by 30 to 40%, and the mice had higher blood ethanol concentrations than controls. Intra-amygdala infusions of D-Phe-CRF(12-41) significantly decreased the withdrawal-associated increase in ethanol intake without altering ethanol consumption in controls. Following the second bout of intermittent vapor exposure, mice exhibited an increase in HICs, when compared with their own baseline scores or the air controls. CONCLUSIONS Intermittent alcohol vapor exposure significantly increased alcohol intake and produced signs of physical dependence. Initial pharmacological studies suggest that manipulation of the CRF system in the CeA can block this increased alcohol intake.
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Affiliation(s)
- Deborah A Finn
- Portland Alcohol Research Center, Oregon Health & Science University, Portland, Oregon; Veterans Affairs Medical Center, Oregon, USA.
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Yee D, Pearcey R, Dundas G, Hanson J, Mackenzie M, Robinson D, Underwood L, Field C, Urtasun R, Pervez N, Fallone G. 170 Comparison of tomotherapy versus four-field pelvic box altered fractionation radiotherapy treatment plans for locally advanced squamous cell carcinoma of the cervix. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Robinson D, Murray B, Underwood L, Halls S, Roa W. Escalated median dose for pituitary macroadenomas using intensity-modulated radiation therapy. Med Dosim 2004; 29:26-30. [PMID: 15023390 DOI: 10.1016/j.meddos.2003.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2003] [Accepted: 10/08/2003] [Indexed: 11/25/2022]
Abstract
Three-dimensional conformal radiotherapy (3D CRT) has become an established treatment for pituitary macroadenomas. This study is an investigation into the possible dosimetric advantages of intensity-modulated radiotherapy for such critically located tumors. Three consecutive patients with pituitary macroadenoma previously treated with 3D CRT were replanned with inverse-planned IMRT using Helax-TMS (V.6.0, Helax AB, Uppsala, Sweden. Fusion of computed tomography (CT) with postoperative magnetic resonance imaging (MRI) was performed within the planning system to define the gross tumor volume (GTV), planning target volume (PTV), and normal structures including the optic chiasm. Dose-volume histograms (DVHs) for the 3D CRT plans were then compared with those of the corresponding prospective IMRT plans. Both techniques maintained critical structure doses below tolerance levels while maintaining a minimum dose of 45 Gy to 100% of the PTV. While IMRT plans deliver consistently more heterogeneous dose distributions to the PTV, the median PTV dose is elevated in the IMRT plans compared with the 3D CRT plans. For critically located tumors like these pituitary macroadenomas, IMRT allows escalation of the median dose to the tumor without an accompanying loss in critical structure sparing or creating unacceptable cold spots within the PTV.
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Affiliation(s)
- D Robinson
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.
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