Neurodevelopmental multimorbidity and educational outcomes of Scottish schoolchildren: A population-based record linkage cohort study.
Neurodevelopmental multimorbidity and educational outcomes of Scottish schoolchildren: A population-based record linkage cohort study.
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DOI：
10.1371/journal.pmed.1003290
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发表时间：
2020-10
期刊：
影响因子：
15.8
通讯作者：
Pell JP
中科院分区：
文献类型：
--
作者：
Fleming M;Salim EE;Mackay DF;Henderson A;Kinnear D;Clark D;King A;McLay JS;Cooper SA;Pell JP
神经发育条件通常共存于儿童，但与成人相比，儿童多发性硬化症在研究和临床实践中引起的关注较少。我们以前报道过，接受注意力缺陷多动障碍（ADHD）和抑郁症治疗的儿童有更多的缺课和被排除在外，额外的支持需求，成绩较差，失业率增加。他们也更有可能有共存的条件，包括自闭症和智力残疾。我们调查了苏格兰学龄儿童神经发育多发性硬化症（≥2种疾病）的患病率及其与同龄人相比的教育结果。我们回顾性地链接了6个苏格兰范围的数据库，分析了2009年至2013年期间在苏格兰学校就读的766，244名4至19岁（平均值= 10.9）儿童（390，290 [50.9%]男孩; 375，954 [49.1%]女孩）。儿童分布在所有贫困的五分之一中（最贫困到最贫困：22.7%、20.1%、19.3%、19.5%、18.4%）。大多数（96.2%）是白色种族。我们确定自闭症谱系障碍（ASD）和智力残疾的记录，额外的支持需要和多动症和抑郁症，通过相关的兑现处方。我们在4，789名（0.6%）儿童中发现了神经发育性多发性硬化（≥2种），ASD和智力残疾是最常见的组合。在调整社会人口（性别，年龄，种族，贫困）和产妇（产妇年龄，产妇吸烟，性别-妊娠特定的出生体重百分位数，胎龄，5分钟Apgar评分，分娩方式，产次）因素，多胎与增加学校缺勤和排斥，失业，考试成绩较差。疾病数量（0、1、≥2）与最后3个结局之间存在明显的剂量关系。与没有条件的儿童相比，有1个条件的儿童和有2个或更多条件的儿童缺勤率更高（1种疾病校正的发病率比[IRR] 1.28，95% CI 1.27-1.30，p < 0.001，2种或2种以上疾病校正的IRR 1.23，95% CI 1.20-1.28，p < 0.001），更大的排斥（调整后IRR 2.37，95% CI 2.25-2.48，p < 0.001和调整后IRR 3.04，95% CI 2.74-3.38，p < 0.001），成绩较差（调整后比值比[OR] 3.92，95% CI 3.63-4.23，p < 0.001和调整后OR 12.07，95% CI 9.15-15.94，p < 0.001），失业率增加（调整OR 1.57，95% CI 1.49-1.66，p < 0.001和调整OR 2.11，95% CI 1.83-2.45，p < 0.001）。在进一步调整共病的身体状况和额外的支持需求后，协会仍然存在。同时存在的抑郁症是缺勤的最大驱动力，同时存在的多动症是排斥的最大驱动力。缺乏正式的初级保健诊断是一个局限性，因为从处方中确定抑郁症和多动症忽略了接受替代治疗或不接受治疗的受影响儿童，并且可以为其他适应症开具一些抗抑郁药。围绕单一条件构建临床实践和培训可能会使神经发育多Morphosis儿童处于不利地位，我们观察到与1个条件和没有条件的儿童相比，他们的教育成果显着较差。Michael Fleming及其同事调查了患有抑郁症、注意缺陷多动障碍、自闭症或智力残疾的儿童的教育结果。患有神经发育疾病的儿童在学校会遇到困难。多种神经发育状况通常共存。我们调查了苏格兰学童神经发育多发性硬化症的患病率及其与同龄人相比的教育成果。我们将苏格兰范围内的健康和教育数据联系在一起，以确定2009年至2013年期间在苏格兰上学的儿童中的神经发育多发病。我们确定了接受抑郁症、注意缺陷多动障碍（ADHD）、自闭症和智力残疾治疗的儿童，并将合并症定义为同时存在2种或2种以上这些疾病。与没有条件的儿童相比，有1个条件的儿童以及有2个或更多这些条件的儿童，经历了更多的学校缺勤和排斥，考试成绩较差，失业率上升。围绕单一条件构建临床实践和培训可能会使患有多Morphine的儿童处于不利地位，我们在研究中观察到，与患有1种条件和没有条件的儿童相比，他们的教育成果不良的风险显着增加。
Neurodevelopmental conditions commonly coexist in children, but compared to adults, childhood multimorbidity attracts less attention in research and clinical practice. We previously reported that children treated for attention deficit hyperactivity disorder (ADHD) and depression have more school absences and exclusions, additional support needs, poorer attainment, and increased unemployment. They are also more likely to have coexisting conditions, including autism and intellectual disability. We investigated prevalence of neurodevelopmental multimorbidity (≥2 conditions) among Scottish schoolchildren and their educational outcomes compared to peers. We retrospectively linked 6 Scotland-wide databases to analyse 766,244 children (390,290 [50.9%] boys; 375,954 [49.1%] girls) aged 4 to 19 years (mean = 10.9) attending Scottish schools between 2009 and 2013. Children were distributed across all deprivation quintiles (most to least deprived: 22.7%, 20.1%, 19.3%, 19.5%, 18.4%). The majority (96.2%) were white ethnicity. We ascertained autism spectrum disorder (ASD) and intellectual disabilities from records of additional support needs and ADHD and depression through relevant encashed prescriptions. We identified neurodevelopmental multimorbidity (≥2 of these conditions) in 4,789 (0.6%) children, with ASD and intellectual disability the most common combination. On adjusting for sociodemographic (sex, age, ethnicity, deprivation) and maternity (maternal age, maternal smoking, sex-gestation–specific birth weight centile, gestational age, 5-minute Apgar score, mode of delivery, parity) factors, multimorbidity was associated with increased school absenteeism and exclusion, unemployment, and poorer exam attainment. Significant dose relationships were evident between number of conditions (0, 1, ≥2) and the last 3 outcomes. Compared to children with no conditions, children with 1 condition, and children with 2 or more conditions, had more absenteeism (1 condition adjusted incidence rate ratio [IRR] 1.28, 95% CI 1.27–1.30, p < 0.001 and 2 or more conditions adjusted IRR 1.23, 95% CI 1.20–1.28, p < 0.001), greater exclusion (adjusted IRR 2.37, 95% CI 2.25–2.48, p < 0.001 and adjusted IRR 3.04, 95% CI 2.74–3.38, p < 0.001), poorer attainment (adjusted odds ratio [OR] 3.92, 95% CI 3.63–4.23, p < 0.001 and adjusted OR 12.07, 95% CI 9.15–15.94, p < 0.001), and increased unemployment (adjusted OR 1.57, 95% CI 1.49–1.66, p < 0.001 and adjusted OR 2.11, 95% CI 1.83–2.45, p < 0.001). Associations remained after further adjustment for comorbid physical conditions and additional support needs. Coexisting depression was the strongest driver of absenteeism and coexisting ADHD the strongest driver of exclusion. Absence of formal primary care diagnoses was a limitation since ascertaining depression and ADHD from prescriptions omitted affected children receiving alternative or no treatment and some antidepressants can be prescribed for other indications. Structuring clinical practice and training around single conditions may disadvantage children with neurodevelopmental multimorbidity, who we observed had significantly poorer educational outcomes compared to children with 1 condition and no conditions. Michael Fleming and colleagues investigate educational outcomes among children with comorbid depression, attention deficit hyperactivity disorder, autism, or intellectual disability. Children with neurodevelopmental conditions experience difficulties at school. Multiple neurodevelopmental conditions commonly coexist together. We investigated prevalence of neurodevelopmental multimorbidity in Scottish schoolchildren and their educational outcomes compared to peers. We linked Scotland-wide health and education data together to identify neurodevelopmental multimorbidity among children attending school in Scotland between 2009 and 2013, inclusive. We identified children treated for depression, attention deficit hyperactivity disorder (ADHD), autism, and intellectual disability and defined comorbidity as 2 or more of those conditions existing together. Compared to children with no conditions, children with 1 condition, and children with 2 or more of these conditions, experienced increased school absenteeism and exclusion, poorer exam attainment, and increased unemployment. Structuring clinical practice and training around single conditions may disadvantage children with multimorbidity, who we observed in our study to have significantly increased risk of poor educational outcomes compared to children with 1 condition and no conditions.
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影响因子：
7.7
作者：
Fleming M;Fitton CA;Steiner MFC;McLay JS;Clark D;King A;Mackay DF;Pell JP
通讯作者：
Pell JP
影响因子：
4.4
作者：
Kraut AA;Langner I;Lindemann C;Banaschewski T;Petermann U;Petermann F;Mikolajczyk RT;Garbe E
通讯作者：
Garbe E
影响因子：
6.6
作者：
Gardarsdottir, H.;Heerdink, E. R.;Egberts, A. C. G.
通讯作者：
Egberts, A. C. G.
影响因子：
24.3
作者：
Fleming, Michael;Fitton, Catherine A.;Pell, Jill P.
通讯作者：
Pell, Jill P.
影响因子：
3.9
作者：
Alabaf, Setareh;Gillberg, Christopher;Anckarsater, Henrik
通讯作者：
Anckarsater, Henrik