Abstract
Background: While tracking major physical-health indicators in children is routine, fewer aspects of cognitive health can be efficiently tracked and used for mental-health monitoring. The current study aims evaluates the reliability and predictive utility of a time-efficient cognitive development chart. This chart seeks to identify children and adolescents with high risk for multiple outcomes such as mental health problems, substance-use, and educational difficulties. Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders (HRC), a longitudinal school-based study conducted from 2010-2011 to 2013-2014. Participants were 2,239 children and adolescents, 6 to 17 years of age, who completed the cognitive assessment at baseline. The task used to track cognitive development was the Two Choice Reaction Time task (2C-RT, <3 minutes of duration, computer-based), which assesses accuracy and speed of perceptual decision-making. Mental health, substance-use, and educational outcomes were assessed by validated standardized methods. Key variables were measured at baseline and 3-year follow-up. Predictive utility was assessed using static (deviations from age-expected performance at baseline) and dynamic (deviations from age-expected change in performance over time) indicators. Findings: The reliability of the task parameter was high (intra-class correlation coefficient = 0*8). Static indicators of cognitive development significantly predicted concurrent mental, intellectual and educational difficulties, as well as incident and persistent educational difficulties and substance use in the 3-year follow-up. Dynamic indicators predicted persistent mental health problems. Interpretation: Primary-care physicians and pediatricians need a time-efficient tool for tracking deviations from age-expected cognitive development, which predict multiple unwanted outcomes at the same time. The current tool shows promise. If replicated, future results could support the generation of tools for tracking risk for mental-health, substance-use, and educational difficulties. Funding Statement: Fundacao de Amparo a Pesquisa do Estado de Sao Paulo and Conselho Nacional de Desen-volvimento Cientifico e Tecnologico. Declaration of Interests: ARS, DSP, JRS, JS, AG, JJM and RPF declare no potential conflict of interest. PMP received PhD scholarship from CNPq and receives post-doctoral grant from FAPESP. GAS received research grants from national funding agencies: FAPERGS, CAPES and CNPq. ECM and RAB received research grants from national funding agencies: FAPESP, CAPES, CNPq. RAB also received research grants from Janssen Cilag, Novartis, Roche in the last 5 years. RAB has participated in speaker bureaus for Ache, Janssen, Lundbeck and Novartis and has been a consultant for Janssen, Novartis and Roche. LAR was on speakers’ bureau and/or acted as consultant for Eli-Lilly, Janssen-Cilag, Medice, Novartis, receives authorship royalties from Oxford Press and ArtMed, and has received unrestricted educational and research support from Eli-Lilly, Janssen-Cilag, Shire and Novartis. MSH and JJM declare no potential conflicts of interest concerning this work. Ethics Approval Statement: The Ethics Committee of the Universidade de Sao Paulo and Universidade Federal do Rio Grande do Sul approved the study.
Published Version
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