Abstract
BackgroundIndividual neurodevelopmental disorders are associated with premature mortality. Little is known about the association between multiple neurodevelopmental markers and premature mortality at a population level. The ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) approach considers multiple neurodevelopmental parameters, assessing several markers in parallel that cluster, rather than considering individual diagnostic categories in isolation.ObjectivesTo determine whether childhood neurodevelopmental markers, including reduced intellectual functioning, are associated with all-cause premature mortality.Methods and proceduresIn a general population cohort study (n = 12,150) with longitudinal follow up from childhood to middle age, Cox proportional hazard models were used to study the associations between childhood neurodevelopmental markers (Rutter B scale and IQ) and premature all-cause mortality.Outcomes and resultsThe cognitive measures and 21 of the 26 Rutter B items were significantly associated with premature mortality in bivariate analyses with hazard ratios from 1.24 (95% CI 1.05–1.47) to 2.25 (95% CI 1.78–2.90). In the final adjusted model, neurodevelopmental markers suggestive of several domains including hyperactivity, conduct problems and intellectual impairment were positively associated with premature mortality and improved prediction of premature mortality.ConclusionsA wide range of neurodevelopmental markers, including childhood IQ, were found to predict premature mortality in a large general population cohort with longitudinal follow up to 60–65 years of age.ImplicationsThese findings highlight the importance of a holistic assessment of children with neurodevelopmental markers that addresses a range of neurodevelopmental conditions. Our findings could open the door to a shift in child public mental health focus, where multiple and/or cumulative markers of neurodevelopmental conditions alert clinicians to the need for early intervention. This could lead to a reduction in the risk of broad health outcomes at a population level.
Highlights
A wide range of neurodevelopmental markers, including childhood intelligence quotient (IQ), were found to predict premature mortality in a large general population cohort with longitudinal follow up to 60–65 years of age. These findings highlight the importance of a holistic assessment of children with neurodevelopmental markers that addresses a range of neurodevelopmental conditions
Several studies have already demonstrated associations between individual neurodevelopmental disorders and premature mortality: Autism spectrum disorder (ASD) [1], Attention Deficit Hyperactivity Disorder (ADHD) [2], Conduct Disorder [3, 4], and Intellectual Disability [5] are all associated with an increased risk of premature death
The ESSENCE approach highlights that it is rare for one neurodevelopmental problem to occur in isolation, that individual symptoms are markers for the likely presence of additional neurodevelopmental problems, that markers of neurodevelopmental disorders can cross diagnostic boundaries, that clinical presentations can change throughout the life course and that “sub-clinical” markers across a range of diagnostic areas might be more important for predicting health outcomes than individual diagnoses
Summary
Several studies have already demonstrated associations between individual neurodevelopmental disorders and premature mortality: Autism spectrum disorder (ASD) [1], Attention Deficit Hyperactivity Disorder (ADHD) [2], Conduct Disorder [3, 4], and Intellectual Disability [5] are all associated with an increased risk of premature death. Despite these disorders being conceptualised as separate entities, comorbidity is “a rule rather than an exception” [6] and the broad range of symptoms of neurodevelopmental disorders are known to have a common genetic underpinning [7]. The ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) approach considers multiple neurodevelopmental parameters, assessing several markers in parallel that cluster, rather than considering individual diagnostic categories in isolation
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