Copenhagen Child Cohort Research Articles

Functional Somatic Symptoms and Consultation Patterns in 5- to 7-Year-Olds

To investigate the frequency of and factors linked to medical consultation for functional somatic symptoms (FSS) among 5- to 7-year-old children. We assessed 1327 children from the Copenhagen Child Cohort 2000 for FSS at ages 5 to 7 years. Register data on past health care use in general practice were compared between children with and those without parent-reported medical consultation for FSS at the age of 5 to 7 years: respective consulters (n = 96) and nonconsulters (n = 211) and children without FSS (n = 1019). Degree of parental worries about the child's symptoms and parent-reported symptom characteristics and associated impacts were compared between consulters and nonconsulters. Among 308 children with FSS, 31.1% were consulters. Being a consulter was significantly associated with multisymptomatic presentation, parental worries about the symptoms, symptom impact, and a higher past health care use in general practice. Multiple logistic regression analysis controlled for gender, comorbid physical disease, and symptom severity revealed that the number of face-to-face contacts in general practice during the child's first 4 years of life predicted being an consulter for FSS at 5 to 7 years (odds ratio 1.03, 95% confidence interval 1.00-1.06; odds ratio interpreted per unit change in number of contacts). This study adds to our understanding of health care use for FSS in childhood by highlighting the influence of parents' early consultation patterns with their child and the influence of parental perceptions of their child's health and FSS-related impact on pediatric health care use for FSS. Management of health care use in children with FSS should address these aspects.

Flow patterns on spectral‐domain optical coherence tomography reveal flow directions at retinal vessel bifurcations

To study intravascular characteristics of flowing blood in retinal vessels using spectral-domain optical coherence tomography (SD-OCT). Examination of selected arterial bifurcations and venous sites of confluence in 25 healthy 11-year-old children recruited as an ad hoc subsample from the population-based, observational Copenhagen Child Cohort 2000 study. The blood stream in retinal arteries maintains a figure-of-8 SD-OCT profile consistent with a laminar flow in concentric sheets and a parabolic velocity distribution up to the point of divergence at arterial bifurcations. In contrast, the blood stream at the site of confluence of two retinal veins remains divided into two parallel sets of sheets with separate velocity distribution for a downstream distance of at least four trunk vessel diameters. Consequently, retinal trunk vessels near bifurcations/confluences have distinctly different internal SD-OCT profiles, a figure-of-8 pattern in arteries and a figure figure-of-88 in veins that can be used to distinguish between the two vessel types. This study verified the hypothesis that directions of blood flow at dichotomous vascular branchings can be determined using SD-OCT. This feature may assist the identification of flow reversal near sites of vascular occlusion, the analysis of blood flow near vascular malformations and the segmentation of retinal SD-OCT images.

Combined infant regulatory problems and early maternal psychiatric illness predict risk of functional somatic symptoms in later childhood

Commentary on Rask CU, Ørnbøl E, Olsen EM, et al. Infant behaviors are predictive of functional somatic symptoms at ages 5–7 years: results from the Copenhagen Child Cohort CCC2000. J...

Infant Behaviors Are Predictive of Functional Somatic Symptoms at Ages 5-7 Years: Results from the Copenhagen Child Cohort CCC2000

To investigate infancy predictors of impairing functional somatic symptoms (FSS) at child ages 5-7 years with a focus on problems with feeding, sleep, and tactile reactivity. This study is part of a longitudinal birth cohort study, Copenhagen Child Cohort CCC2000. Child health, development, and functioning were assessed by community health nurses at 4 home visits from birth to age 10 months. FSS at ages 5-7 years were measured by the Soma Assessment Interview in 1327 children. Sociodemographic data and information on maternal psychiatric illness were obtained from the Danish National Registers. Multiple logistic regression analysis controlled for maternal psychiatric illness and annual household income revealed that combined infancy regulatory problems (ie, at least 2 of 3 problems of feeding, sleeping, or tactile reactivity during the first 10 months of living) predicted impairing FSS at 5-7 years (aOR = 2.9, 95% CI: 1.3-6.6). Maternal psychiatric illness during the child's first year of living was also associated with later child FSS (aOR = 7.1, 95% CI: 1.8-27.8). Regulatory problems may be an early marker of disturbed sensory reactivity in young children, which together with maternal psychiatric problems, point to possible early risk mechanisms of impairing FSS in childhood.

Parental-Reported Health Anxiety Symptoms in 5- to 7-Year-Old Children: The Copenhagen Child Cohort CCC 2000

Hypochondriasis, now often designated as health anxiety, is important in terms of prevalence, levels of suffering, and health services cost in adults. Whereas the DSM-IV-TR suggests that the condition primarily begins in adulthood, retrospective reports point to a possible origin in childhood with onset as early as preschool age. However, little research has addressed health anxiety in children. In the present study we explored parental-reported health anxiety symptoms (HAS) and their association with physical and mental health in a population-based sample of 5- to 7-year-old children. Parents of 1323 children (49.7% boys), recruited from the birth cohort: Copenhagen Child Cohort CCC 2000, completed questionnaires regarding their child's HAS, and physical and mental health. Associations were examined using multiple logistic regression analyses adjusted for concurrent chronic physical disease. HAS were present in 17.6% and present 'a lot' (categorized as considerable HAS) in 2.4% of the children. Children with considerable HAS demonstrated more physical health problems and internalizing disorders than children with no or non-considerable HAS, but in the majority (71.9%) no associated chronic physical disease or other mental disorder was reported. In a subsample of children with functional somatic symptoms (FSS), impairing FSS were more likely among children who reported HAS. The findings suggest that HAS present as primary complaints early in life and are associated with impairing child health problems in the area of FSS and internalizing disorders. These aspects may be important to understand and also to prevent the development of severe health anxiety.

Eating Patterns in a Population-Based Sample of Children Aged 5 to 7 Years: Association With Psychopathology and Parentally Perceived Impairment

There is still a lack of research on childhood eating patterns and their correlates in relation to psychopathology and parentally perceived impact in general population samples. We aimed to determine which eating patterns were more likely to be identified as problematic by parents, and their impact and association with childhood psychopathology (emotional, behavioral, and pervasive developmental disorders) in a general population child cohort. We collected data as part of the 5- to 7-year-old follow-up of a randomly derived subsample of the Copenhagen Child Cohort 2000. Of the eligible 2912, 1327 (45.6%) children and parents participated in the study. Parents were interviewed using a composite instrument assessing eating behaviors and their impact. Associations with contemporaneous psychopathology were determined using logistic regression. Five eating patterns were identified (good eating/overeating, picky eating, slow/poor eating, delayed eating behaviors, and snacking behaviors); among these, picky eating and slow/poor eating were described as a problem by more than half of parents and they also had high impact. Picky eating was associated with psychopathology across disorders. Emotional undereating was associated with emotional and functional somatic symptoms. A quarter of parents described at least one eating behavior as a problem. Eating behaviors in a general population cohort were differentially associated with impact and psychopathology. Picky eating was highlighted among other behaviors as having negative correlates. Better knowledge of how childhood eating behaviors impact on children and their association with psychopathology will aid adequate assessment and treatment.

313 The Prevalence and Risk Factors of Mental Health Disorders in a Danish General Population Study of Children 5-7-Years of Age

Objective: To estimate the prevalence, cooccurrence and risk factors of mental health disorders in 5-7 year-old children in the general population.Materials and Methods: The study is a 5-7 years follow-up of the Danish birth cohort The Copenhagen Child Cohort, CCC2000, including 6,090 children from the general population. The cohort was screened for mental health problems by questionnaires to parents and pre-school teachers (Strengths and Difficulties Questionnaire, SDQ). Screen positive children and a random sample of 1330 children were assessed by diagnostic interviews administered to parents and questionnaires to pre-schoolteachers (Developmental and Well-being Assessment, DAWBA). Data on peri-natal adversities, sociodemographic risk factors and hospital admissions were obtained from Danish National Registers.Results: The overall prevalence of mental health disorders in 5-7 years-old children was 4.4% (95%CI: 3.3-5.5). Emotional disorders were found in 2.0% children, behavioural disorders in 1.5% (95%CI: 0.9-2.2) and hyperkinetic disorder in 0.9% (95%CI: 0.4-1.4). The prevalence of pervasive developmental disorders was 1.0 (95%CI: 0.5-1.5). Nearly a third had co-occurrence of mental health diagnoses and the relative risk of having a mental health disorder was significantly higher in boys compared to girls:1.8 (95%CI:1.1 - 3.1).Preliminary results on early risk factors and predictors of mental health problems between birth and 7 years in CCC 2000 will be presented at the congress.

315 The Ccc2000 Birth Cohort: Patterns of Functional Somatic Symptoms and Eating Behaviours in 5-7-Year-Old Children

Background and aims: The spectrum of functional somatic symptoms (FSS) and their relation with regulatory disturbances such as feeding/eating problems in childhood has received little attention. In this study, we analyze the prevalence of FSS and their associations with eating behaviours in 5-7-year-old children. Methods: FSS and eating behaviours were measured in 1,327 children, at 5-7 years of age, from a random sample of the Copenhagen Child Cohort 2000. Parents were interviewed using 1) the Soma Assessment Interview on diverse FSS in children and 2) the Childhood Eating Assessment Inventory, a composite instrument derived from existing instruments and assessing different eating behaviours and their impact. Results: In total, the 1-year prevalence of any FSS was 23.2%, and impairing FSS were found in 4.4%. Problematic eating behaviour in the child was reported by a quarter of the parents. Functional somatic symptoms were significantly associated with picky eating and emotional undereating (χ2=4.6, p< 0.05; χ2= 4.9, p< 0.05 respectively) but not with the other common eating behavioural constructs such as good appetite, poor/slow eating, delayed eating behaviour and snacking. Conclusions: Functional somatic symptoms (FSS) and problematic eating behaviours are frequent complaints in the child population at age 5-7 years. The association between FSS and specific eating behaviours point to a common underlying cause for expression of distress in a subgroup of children with a likely need of clinical intervention.

The need for a long-term perspective in child and adolescent psychiatry

When taking care of our patients and families in daily clinical practice, it is difficult to not solely be directed at acute, short-term improvements. Typically, patients are being referred to our clinical services at a time when symptoms of mental disorders have already led to significant impairments on important areas such as social, academic, and family functioning. Then, obviously, we try to put effective interventions in place that aim to decrease symptoms as well as reduce impairments. Indeed, we now have several treatments in the field of child and adolescent psychiatry with a solid evidence base [1]. Well-researched examples include the use of stimulant medications for attention-deficit/hyperactivity disorder (ADHD), risperidone [2] and aripiprazole [3] for irritability in autism spectrum disorders, and behavioral parent training [4] for children with disruptive behavior problems. Ideally, however, in addition to addressing the acute needs of our pediatric patients, our interventions should be truly aimed at preparing our children for a better life in the long run. Will the interventions we apply contribute to the better functioning of our patients as adults? The long-term results of the Multimodal Treatment study of ADHD (MTA) [5] have been complex, but clearly demonstrate that there is not a simple relationship between impressive acute treatment effects of well-monitored stimulant medication and effects over the long run. Fortunately, the Treatment for Adolescents with Depression Study (TADS) [6] that investigated the effectiveness of fluoxetine, cognitive-behavioral therapy, and their combination in adolescents with major depressive disorder was able to demonstrate persistent benefits of treatments over 1 year of naturalistic follow-up. This issue of European Child and Adolescent Psychiatry contains several articles that deal with the long-time perspective in our field. Gevensleben et al. [7] report on the long-term follow-up of their randomised controlled trial of neurofeedback versus a control treatment (a computerized attention skills training) in children with ADHD and demonstrated that behavioral improvements through neurofeedback were actually maintained at a 6-month follow-up. Longitudinal cohort studies are a classic way to investigate the long-term effects of important environmental factors for children’s development. Elberling et al. [8] longitudinally studied the influence of perinatal and socioeconomic data, and data on child mental illness diagnosed in preschool years on psychosocial function at 5–7-year follow-up, in the Copenhagen Child Cohort, which involves more than 6,000 children. Several markers of socioeconomic disadvantages were found to be associated with mental health problems at 5–7 years of age. In another large-scale longitudinal cohort study in Norway in this issue, Lien et al. [9] showed that internalizing mental health problems among adolescent girls were significantly associated with atopic conditions 3 years earlier, thus demonstrating that atopy may have long-lasting effects on mood and anxiety levels. Finally, a truly long-term perspective on our field is provided by a wonderful overview by the most eminent long-term leader and pioneer of child and adolescent psychiatry. Professor Sir Michael Rutter gives a unique perspective on the developments from the mid-twentieth century onwards, ending with a look ahead to the most important opportunities and challenges as well as the hazards that need to be avoided.

Risk factors for weight faltering in infancy according to age at onset

The aim of this study was to identify risk factors for failure to thrive (FTT) or weight faltering according to age of onset. The study is part of a Danish longitudinal population study of early risk mechanisms in child psychiatric disorders, The Copenhagen Child Cohort, which consists of a birth cohort of 6090 children born during the year 2000 and followed prospectively from birth. Weight faltering/FTT was defined as slow conditional weight gain, and divided into subtypes according to age of onset in the first year of life: birth to 2 weeks, 2 weeks to 4 months, and 4-8 months. Regardless of the age of onset, slow weight gain was found to be strongly associated with feeding problems, but the risk factors involved differed according to age of onset. Thus, onset within the first weeks of life clearly differed from faltering later on, the former being strongly associated with low birthweight and gestational age, with single parenthood and with mother having smoked during pregnancy. Onset between 2 weeks and 4 months was associated with congenital disorders and serious somatic illness, and with deviant mother-child relationship, whereas, onset between 4 and 8 months seemed to represent a group of children with feeding problems arising de novo in otherwise healthy children. In conclusion, weight faltering in infancy is clearly associated with contemporary measured feeding problems, but the risk mechanisms involved differ in early vs. late onset.

The prevalence of SDQ-measured mental health problems at age 5–7 years and identification of predictors from birth to preschool age in a Danish birth cohort: The Copenhagen Child Cohort 2000

The objective of the study is to investigate the prevalence, distribution and predictors of mental health problems in 5-7-year-old Danish children in the general population. This study is a 5-7-year follow-up study of a birth cohort of 6,090 children, the Copenhagen Child Cohort 2000. The extended version of the Strengths and Difficulties Questionnaire (SDQ) was answered by parents and pre-school teachers. Data from Danish national registers included perinatal data, socioeconomic data and data on child mental illness diagnosed at hospital in preschool age. Register data from the first year of life was obtained from 99.7% of the children in the cohort. Of 5,898 eligible children, 3,501 participated in the SDQ assessment (59%). The overall estimated 6-month prevalence of mental health problems was 4.8% (95% CI 4.1-5.6). Conduct problems were found in 3.0% (95% CI 2.4-3.6), problems of hyperactivity/inattention in 0.7% (95% CI 0.4-1.0) and emotional problems in 1.5% (95% CI 1.1-1.9). Boys showed a higher risk of having mental health problems as compared to girls: risk ratio 2.0 (95% CI 1.5-2.8). Several markers of socioeconomic disadvantages were associated with mental health problems at 5-7 years of age. In conclusion, the 6-month prevalence of SDQ-measured mental health problems was relatively low in Danish children when compared with findings from several European countries, but was in line with findings from other studies in Nordic countries. The lower prevalence might reflect differences in psychosocial risk load and environmental stress given the social and cultural context.

Functional somatic symptoms and associated impairment in 5–7-year-old children: the Copenhagen Child Cohort 2000

Research on somatisation or functional disorders, characterised by the subjective report of physical symptoms in the absence of clear physical pathology, in young children is limited. This study investigates the distribution, types and co-occurrence of parent-reported functional somatic symptoms (FSS) and their impairment in a population-based sample of Danish 5-7-year-old children. Data were obtained from a 5-7-year follow-up of the Copenhagen Child Cohort 2000. The entire study population included 3,000 randomly sampled children from the cohort. Among these FSS measures were obtained for 1,327 children. The newly introduced parent interview, the soma assessment interview, was used to assess the child's FSS. Impairing symptoms were defined as FSS that caused substantial discomfort, impairment of everyday life, absence from day-care or school and/or help-seeking in the health care system. The 1-year prevalence of any FSS was 23.2% (N = 308) and higher in girls than boys (27.6 vs. 18.8%, P < 0.0001). Impairing FSS were found in 4.4% (N = 58). Pain complaints, i.e. limb pain, headache and abdominal pain, were the most frequently reported FSS. Among the 308 children with FSS, 66 (21.4%) presented with two or more of these functional pain complaints, while 15 (4.9%) had all three types. The findings indicate that FSS are common health complaints in 5-7-year-old children. A subgroup with impairing FSS with a likely need of clinical intervention was identified. This suggests that a somatisation pattern may start early in life and call for future studies to include associated impairment in the investigation of childhood FSS.

Parenting, Development Problems Predict Mental Illness in Infants

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessParenting, Development Problems Predict Mental Illness in InfantsJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:4 Jul 2008https://doi.org/10.1176/pn.43.13.0017aIf a child is a terrible sleeper or eater during the first months of life it does not mean that he or she is going to experience poor mental health during the second year.But if the child's relationship with its parents during the first few months is disturbed, mental health problems in the second year might be the outcome.These are some of the implications to emerge from a study headed by Anne Mette Skovgaard, M.D., an associate professor of health sciences at Denmark's University of Copenhagen. Results appeared in the May Journal of Child Psychology and Psychiatry.In 2000 Skovgaard and her colleagues launched a longitudinal study called the Copenhagen Child Cohort (CCC 2000) to investigate developmental psychopathology prospectively from birth in a general population. The study included 6,090 children, or 9 percent of children born in Denmark that year. The researchers then randomly selected 306 children from the cohort for this leg of the study. Out of the 306, 210 participated.Various instruments were used to evaluate the 210 children's development during the first 10 months of life as well as the quality of parenting they experienced during this time. And once the children reached 1.5 years of age, clinical observations and videotape recordings were used in combination with standardized measures to diagnose mental health disturbances according to the ICD and Diagnostic Classification Zero to Three. Out of the 210 subjects, 73 were found to have an eating disorder, a sleeping disorder, or other disorder.Finally, Skovgaard and her colleagues found that there were links between a child's development and parenting experiences during the first 10 months of life and its mental health at 1.5 years of age.Delays in cognitive functioning, poor language development, and aberrations in social communication during the first 10 months of life significantly predicted any psychiatric disorder and especially a neurodevelopmental one at 1.5 years of age. Moreover, being an unwanted child or being abused by a parent significantly predicted a relationship disturbance at 1.5 years of age. And eating problems that started after age 6 months significantly predicted an eating disorder at 1.5 years of age.However, eating problems that started before 6 months of age did not significantly predict a psychiatric disorder at 1.5 years of age; nor did sleeping problems from birth to 10 months.Thus, it looks as if certain factors that a child experiences during his or her first year of life can impact mental health during the second year of life, Skovgaard and her team concluded. Further research in this growing field of infant and toddler psychiatry will lead to innovative ways to treat and prevent mental illness in the very young, the researchers said.An abstract of “Predictors (0-10 Months) of Psychopathology at Age One-and-a-HalfYears—A General Population Study in the Copenhagen Child Cohort CCC 2000” is posted at<www.blackwell-synergy.com/loi/jcpp>.▪ ISSUES NewArchived

Predictors (0–10 months) of psychopathology at age 1½ years – a general population study in The Copenhagen Child Cohort CCC 2000*

Epidemiological studies of mental health problems in the first years of life are few. This study aims to investigate infancy predictors of psychopathology in the second year of life. A random general population sample of 210 children from the Copenhagen Child Birth Cohort CCC 2000 was investigated by data from National Danish registers and data collected prospectively from birth in a general child health surveillance programme. Mental health outcome at 1(1/2) years was assessed by clinical and standardised measures including the Child Behavior Check List 1(1/2)-5 (CBCL 1(1/2)-5), Infant Toddler Symptom Check List (ITSCL), Checklist for Autism in Toddlers (CHAT), Bayley Scales of Infant Development (BSID II), Mannheim Eltern Interview (MEI), Parent Child Early Relational Assessment (PC ERA) and Parent Infant Relationship Global Assessment Scale (PIR-GAS), and disordered children were diagnosed according to the International Classification of Diseases (ICD-10) and Diagnostic Classification Zero to Three (DC: 0-3). Deviant language development in the first 10 months of life predicted the child having any disorder at 1(1/2) years, OR 3.3 (1.4-8.0). Neuro-developmental disorders were predicted by deviant neuro-cognitive functioning, OR 6.8 (2.2-21.4), deviant language development, OR 5.9 (1.9-18.7) and impaired social interaction and communication, OR 3.8 (1.3-11.4). Unwanted pregnancy and parents' negative expectations of the child recorded in the first months of the child's life were significant predictors of relationship disturbances at 1(1/2) years. Predictors of neuro-developmental disorders and parent-child relationship disturbances can be identified in the first 10 months of life in children from the general population.

Can a general health surveillance between birth and 10 months identify children with mental disorder at 1½ year?

Mental health surveillance in infancy was studied in an existing child health surveillance programme with child psychiatric disorder at 1(1/2) year as the outcome. Children considered of concern by community health nurses were cases in a case control study nested in the Copenhagen Child Cohort (CCC 2000). Outcome was mental health status at 1(1/2) year assessed by clinical and standardised strategies, including videotape recordings, parent interviews and the instruments: CBCL 1(1/2)-5, ITSCL, CHAT, Bayley Scales of Infant Development II, PC ERA and PIR-GAS. The positive predictive value of concern in the first 10 months of living was 24% (CI 17.0-31.9), the negative predictive value was 85% (CI 77.9-89.6) and the sensitivity was 56% (CI 42.4-69.0). Concern about development was significantly associated with the child having a neuro-developmental disorder at 1(1/2) year, and concern about mother-child relationship was associated with emotional, behavioural, eating, and sleeping disturbances. A general health surveillance program seems to have potentials to identify infants at risk for mental health problems provided standardised measures and specific training of the involved health professionals.

Editorial

Editorial

The prevalence of mental health problems in children 1½ years of age – the Copenhagen Child Cohort 2000

The Copenhagen Child Cohort, CCC 2000, was established to investigate developmental psychopathology prospectively from birth in a general population. A random sample of 211 children from the CCC 2000 was investigated when the children were 1(1/2) years of age. The prevalence and associates of mental health problems and psychopathology were studied by clinical and standardised strategies, including videotape recordings, parent interviews and the following instruments: The Child Behavior Check List 1(1/2)-5 (CBCL 1(1/2)-5), The Infant Toddler Symptom Check List (ITSCL), Checklist for Autism in Toddlers (CHAT), Bayley Scales of Infant Development II (BSID II), The Parent Child Early Relationship Assessment (PC ERA) and Parent Infant Relationship Global Assessment Scale (PIR-GAS). Mental health problems according to International Classification of Diseases (ICD-10) and Diagnostic Classification Zero to Three (DC 0-3) diagnoses were found in 16-18% of 1(1/2)-year-old children. Most common were disturbances of emotion, behaviour and eating and the DC 0-3 diagnosis of regulatory disorder. Parent-child relationship disturbances were found in 8%. High psychosocial risk was significantly associated with emotional and behavioural disorders (OR 3.1 95% (1.2-8.1)) and disturbed parent-child relationship (OR 5.0 95% (1.6-16.0)). The strongest association of risk was found between relationship disorders and emotional and behavioural disorders (OR 11.6 95% (3.8-37.5)). The prevalence and distribution of psychopathology in 1(1/2)-year-old children seem to correspond to the distributions among older children. Disturbances in parent-child relationship have a key position in the risk mechanisms in early child psychopathology.