What are the clinical and educational risk factors for poor academic outcomes in children with Autistic Spectrum Disorder?

导致自闭症谱系障碍儿童学业成绩不佳的临床和教育风险因素有哪些？

• 批准号: MR/L017105/1
• 负责人: Johnny Downs
• 金额: $ 28.07万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2014
• 资助国家: 英国
• 起止时间: 2014 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FL017105%2F1
• 关键词: What; clinical; educational; risk; factors

Approximately 1% of UK school age children have an Autistic Spectrum Disorder (ASD). Children with ASD typically have longstanding difficulties using language, engaging in every day social interactions and having a general, flexible interest in the world around them. ASD is commonly diagnosed in the first years of primary school. The majority of children who receive an ASD diagnosis will go on to have difficulties throughout their school life, often leaving with no qualifications. This puts them at a significant disadvantage as adults and at greater risk for a host of mental and physical health problems. An important objective for UK child mental health specialists, teachers and researchers is to reduce these educational failings for children with ASD whilst at school, to ensure they have better skills and opportunities in later life.In the UK, specialist Child and Adolescent Mental Health Services (CAMHS) commonly provide ASD assessments and offer treatment. CAMHS services also treat common childhood mental health conditions including anxiety, depression, conduct and hyperactivity disorders. Children without ASD who suffer these disorders often have considerable difficulties achieving their potential at school. Fortunately there are a number of effective mental health treatments including medications that can help non ASD children get back on track. These treatments increase their chances of attending school, not getting into trouble and passing exams.Children with ASD also suffer from these disorders and at much greater rates (up to 70% in some studies) than typically developing children. ASD combined with other mental health disorders presents as a much more complex condition to manage and may significantly impact educational performance. Currently there is little evidence available to inform clinicians on how best to treat the common co-occurring conditions associated with ASD. Pharmacological treatments, developed primarly in non ASD children, may not have the same effect in improving educational performance for ASD children. Pharmacological treatments (for example stimulants, anti-depressants and anti-psychotics) are being increasingly used by CAMHS to help manage common co-occurring disorders in children with ASD. At present, little is known which disorders or additional symptoms lead clinicians to prescribe these medications to children with ASD. Also, very few experimental trials are conducted in children with ASD that are adequately designed to measure the long term effect of treatment, therefore their influence on longer term educational outcomes like overall school attendance, exclusion rates or final exam results remains unclear. With robust confidentiality and data protection measures in place, electronic health records(EHRs) can provide rich data to investigate the gaps in current knowledge. They can be used to determine which childhood factors lead to impaired educational performance in ASD, and how they may be modified by treatment. For this proposal, I will use EHRs via the Clinical Record Interactive Search system(CRIS) and link the records with the National Pupil Database(NPD). CRIS was developed by King College London to allow researchers to retrieve in depth information from the anonymised case notes of over 34,000 CAMHS patients. The NPD is a database managed by the Department for Education and contains all children academic records since enrolment in state school from 2002. As the fellowship applicant, under the supervision of Professor Hotopf and Dr Hayes at Kings College London, and Professor Ford at the University of Exeter, I will study whether additional mental health difficulties impact on educational performance and whether treatments that may reduce these difficulties could improve academic outcomes.

大约1%的英国学龄儿童患有自闭症谱系障碍（ASD）。患有ASD的儿童通常在使用语言，参与日常社交互动以及对周围世界的普遍，灵活的兴趣方面存在长期困难。ASD通常在小学的第一年被诊断出来。大多数接受ASD诊断的儿童在整个学校生活中都会遇到困难，通常没有资格离开。这使他们作为成年人处于明显的不利地位，并面临更大的精神和身体健康问题的风险。英国儿童心理健康专家、教师和研究人员的一个重要目标是减少ASD儿童在学校的教育失败，确保他们在以后的生活中拥有更好的技能和机会。在英国，儿童和青少年心理健康服务专家（CAMHS）通常提供ASD评估和治疗。CAMHS服务还治疗常见的儿童心理健康状况，包括焦虑，抑郁，行为和多动症。患有这些疾病的没有ASD的儿童通常在学校实现他们的潜力有相当大的困难。幸运的是，有许多有效的心理健康治疗方法，包括可以帮助非ASD儿童回到正轨的药物。这些治疗增加了他们上学的机会，不惹麻烦和通过考试。ASD儿童也患有这些疾病，并且比正常发育的儿童患病率高得多（在一些研究中高达70%）。ASD与其他心理健康疾病相结合，是一种更复杂的疾病，可能会显着影响教育表现。目前，几乎没有证据可以告知临床医生如何最好地治疗与ASD相关的常见并发症。主要在非ASD儿童中开发的药物治疗在改善ASD儿童的教育表现方面可能没有相同的效果。CAMHS越来越多地使用药物治疗（例如兴奋剂，抗抑郁药和抗精神病药）来帮助管理ASD儿童常见的并发症。目前，尚不清楚哪些疾病或其他症状导致临床医生为ASD儿童开这些药物。此外，很少有实验性试验在ASD儿童中进行，这些试验被充分设计用于测量治疗的长期效果，因此它们对长期教育结果的影响，如整体入学率，排除率或期末考试结果仍不清楚。通过强大的保密和数据保护措施，电子健康记录（EHR）可以提供丰富的数据来调查当前知识的差距。它们可用于确定哪些儿童因素导致ASD的教育表现受损，以及如何通过治疗进行修改。对于这个建议，我将通过临床记录交互式搜索系统（CRIS）使用EHR，并将记录与国家学生数据库（NPD）链接。CRIS由伦敦国王学院开发，允许研究人员从超过34,000名CAMHS患者的匿名病例记录中检索深入信息。NPD是由教育部管理的数据库，包含自2002年进入公立学校以来所有儿童的学习记录。作为奖学金申请人，在伦敦国王学院的霍托夫教授和海斯博士以及埃克塞特大学的福特教授的监督下，我将研究额外的心理健康困难是否会影响学习成绩，以及可能减少这些困难的治疗是否会改善学业成绩。

项目成果

Reviewing a Decade of Research Into Suicide and Related Behaviour Using the South London and Maudsley NHS Foundation Trust Clinical Record Interactive Search (CRIS) System.

• DOI: 10.3389/fpsyt.2020.553463
• 发表时间: 2020
• 期刊: Frontiers in psychiatry
• 影响因子: 4.7
• 作者: Bittar A;Velupillai S;Downs J;Sedgwick R;Dutta R
• 通讯作者: Dutta R

Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis.

• DOI: 10.1016/j.drugalcdep.2016.04.036
• 发表时间: 2016-07-01
• 期刊: Drug and alcohol dependence
• 影响因子: 4.2
• 作者: Bogdanowicz KM;Stewart R;Chang CK;Downs J;Khondoker M;Shetty H;Strang J;Hayes RD
• 通讯作者: Hayes RD

Toward Learning Machines at a Mother and Baby Unit.

• DOI: 10.3389/fpsyg.2020.567310
• 发表时间: 2020
• 期刊: Frontiers in psychology
• 影响因子: 3.8
• 作者: Boman M;Downs J;Karali A;Pawlby S
• 通讯作者: Pawlby S

Guidance for researchers wanting to link NHS data using non-consent approaches: a thematic analysis of feedback from the Health Research Authority Confidentiality Advisory Group.

希望使用非同意方法链接NHS数据的研究人员的指南：卫生研究当局机密咨询小组反馈的主题分析。

• DOI: 10.23889/ijpds.v5i1.1355
• 发表时间: 2020-10-02
• 期刊: International journal of population data science
• 作者: Cross L;Carson LE;Jewell A;Heslin M;Osborn D;Downs J;Stewart R
• 通讯作者: Stewart R

The association between early childhood onset epilepsy and attention-deficit hyperactivity disorder (ADHD) in 3237 children and adolescents with Autism Spectrum Disorder (ASD): a historical longitudinal cohort data linkage study.

• DOI: 10.1007/s00787-022-02041-3
• 发表时间: 2023-11
• 期刊: EUROPEAN CHILD & ADOLESCENT PSYCHIATRY
• 影响因子: 6.4
• 作者: Carson, Lauren;Parlatini, Valeria;Safa, Tara;Baig, Benjamin;Shetty, Hitesh;Phillips-Owen, Jacqueline;Prasad, Vibhore;Downs, Johnny
• 通讯作者: Downs, Johnny