Ontario Child Health Study Research Articles

From attention‐deficit/hyperactivity disorder to medical stimulant use to the diversion of prescribed stimulants to non‐medical stimulant use: connecting the dots

To describe the connections among the likelihood of attention deficit/hyperactivity disorder (ADHD), medical and non-medical methylphenidate and amphetamine use and the diversion of prescribed methylphenidate in the general adolescent population. Cross-sectional self-reported anonymous data from the 2002 Student Drug Use Survey in the Atlantic Provinces. The Atlantic provinces of Canada. A total of 12,990 students participated. The outcomes were a positive ADHD screening test, medical and non-medical use of methylphenidate, medical and non-medical use of amphetamine and the giving and selling of methylphenidate medication by students with a prescription. The Ontario Child Health Study Hyperactivity Scale was used to screen for ADHD. The prevalence of a positive ADHD screening test was 6% with no significant gender difference. The prevalence of medical and non-medical methylphenidate use and medical and non-medical amphetamine use was 2.0%, 6.6%, 1.2% and 8.7%, respectively. A positive ADHD screening test was independently predictive of these four patterns of use. About 26% of students with prescribed methylphenidate gave or sold some of their medication. Students in a class where at least one student had given or sold some of their prescribed pills had a 1.52-fold increased risk of non-medical methylphenidate use than their counterparts in classes where no giving or selling had taken place. Connections were demonstrated at the population level between ADHD, medical methylphenidate use, the diversion of prescribed methylphenidate and the non-medical use of methylphenidate. The appropriate assessment and management of ADHD are essential to minimize both the risk of diversion and of substance use associated with unrecognized or untreated ADHD.

Neighborhood and Family Influences on Educational Attainment: Results from the Ontario Child Health Study Follow‐Up 2001

This study uses multilevel models to examine longitudinal associations between contextual influences (neighborhood and family) assessed in 1983 in a cohort of 2,355 children, 4-16 years of age, and educational attainment in 2001. Variation in educational attainment in 2001 attributable to between-neighborhood and between-family differences was 8.17% and 36.88%, respectively. The final model explained 33.64% of the variance in educational attainment, with unique variances of 14.53% for neighborhood and family-level variables combined versus 10.94% for child-level variables. Among the neighborhood and family-level variables, indicators of status (5.29%) versus parental capacity/family process (4.03%) made comparable predictions to attainment while children from economically disadvantaged families did not benefit educationally from living in more affluent areas.

Canadian Researchers Celebrate Country's Neuroscience Legacy

Canadian Researchers Celebrate Country's Neuroscience Legacy

Childhood and Early Adult Predictors of Risk of Incident Back Pain: Ontario Child Health Study 2001 Follow-up

Musculoskeletal disorders of the back and spine are a leading cause of disability in working-age populations. There is limited information on the potential consequences of childhood socioeconomic and health status on the risk of incident back pain in early adulthood. The authors describe factors associated with having had a first episode of back pain during the past year in the Ontario Child Health Study, a prospective cohort study of children who were aged 4-16 years at the time of enrollment in 1983 and were resurveyed in 2001. Respondents reporting a first episode of back pain (n=143) were compared with respondents who had never experienced back pain (n=896). The annual incidence of a first episode of back pain in this sample of young adults was 74.7/1,000. Following adjustment for age, sex, childhood conditions, childhood health status, and measures of early adult health, behavior, socioeconomic status, and work environment, the risk of incident back pain was associated with both low (odds ratio (OR)=1.86, 95% confidence interval (CI): 1.14, 3.03) and moderate/high (OR=1.85, 95% CI: 1.07, 3.02) levels of psychological distress, current heavy smoking (OR=1.85, 95% CI: 1.10, 3.10), lower levels of parental education in childhood (OR=1.72, 95% CI: 1.06, 2.80), and emotional or behavioral disorders in childhood (OR=1.87, 95% CI: 1.02, 3.41). The associations of low childhood socioeconomic status and childhood emotional and behavioral disorders with risk of incident back pain in early adulthood are important findings with implications for better understanding the etiology of soft-tissue disorders.

440: Childhood Health Status and Inter-Generational Socioeconomic Mobility in the Ontario Child Health Study

440: Childhood Health Status and Inter-Generational Socioeconomic Mobility in the Ontario Child Health Study

Improving access to mental health services for youth and parents.

Improving access to mental health services for youth and parents.

Differential-maternal parenting behavior: estimating within- and between-family effects on children.

This study examined the impact of differential-maternal parenting behavior, evaluated as a family-level experience, on children's emotional-behavioral problems. Data come from 3 child development studies: 2,128 four- to sixteen-year-olds (Ontario Child Health Study), 7,392 four- to eleven-year-olds (National Longitudinal Study of Children and Youth), and 1,992 three- to fourteen-year-olds (National Longitudinal Study of Youth). In 2 of 3 studies, there was consistent evidence that differential-maternal parenting behavior had an adverse impact on all siblings as a group, over and above parenting directed at individual siblings. The strength of association was sensitive to the type of maternal parenting behavior, dimension of child maladjustment, and respondent perspective (stronger for hostile/negative parenting, child externalizing problems, and mother assessments of child emotional-behavioral problems).

‘Attention deficits and subclinical epileptiform discharges: are EEG diagnostics in ADHD optional or essential?’

Developmental Medicine & Child NeurologyVolume 46, Issue 7 p. 501-502 Free Access ‘Attention deficits and subclinical epileptiform discharges: are EEG diagnostics in ADHD optional or essential?’ Katja Becker MD, Corresponding Author Katja Becker MD Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim Department of Child and Adolescent Psychiatry and Psychotherapy Central Institute of Mental Health Mannheim, Germany E-mail: kbecker@zi-mannheim.deSearch for more papers by this authorJudith K Sinzig MD, Judith K Sinzig MD Department of Child and Adolescent Psychiatry and Psychotherapy, University of CologneSearch for more papers by this authorMartin Holtmann MD, Martin Holtmann MD Department of Child and Adolescent Psychiatry and Psychotherapy, JW Goethe-University, Frankfurt/MainSearch for more papers by this author Katja Becker MD, Corresponding Author Katja Becker MD Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim Department of Child and Adolescent Psychiatry and Psychotherapy Central Institute of Mental Health Mannheim, Germany E-mail: kbecker@zi-mannheim.deSearch for more papers by this authorJudith K Sinzig MD, Judith K Sinzig MD Department of Child and Adolescent Psychiatry and Psychotherapy, University of CologneSearch for more papers by this authorMartin Holtmann MD, Martin Holtmann MD Department of Child and Adolescent Psychiatry and Psychotherapy, JW Goethe-University, Frankfurt/MainSearch for more papers by this author First published: 13 February 2007 https://doi.org/10.1111/j.1469-8749.2004.tb00514.xCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Dunn DW., Austin JK., Harezlak J., Ambrosius WT. (2003)ADHD and epilepsy in childhood. Dev Med Child Neurol 45: 50– 54. 2 Noeker M., Haverkamp F. (2003) Neuropsychological deficiencies as a mediator between CNS dysfunction and inattentive behaviour in childhood epilepsy. Dev Med Child Neurol 45: 717– 718.(Letter). 3 Holtmann M., Becker K., Kentner-Figura B., Schmidt MH. (2003) Increased frequency of rolandic spikes in ADHD children. Epilepsia 44: 1241– 1244. 4 Hemmer SA., Pasternak JF., Zecker SG., Trommer BL. (2001) Stimulant therapy and seizure risk in children with ADHD. Pediatr Neurol 24: 99– 102. 5 Szatmari P., Offord DR., Boyle MH. (1989) Ontario Child Health Study: prevalence of attention deficit disorder with hyperactivity. J Child Psychol Psychiatry 30: 219– 230. 6 Halperin JM. (1991) The clinical assessment of attention. Int J Neurosci 58: 171– 182. 7 Dulcan M. (1997) Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 36 (Suppl. 10): 85– 121. 8 Deonna T., Zesiger P., Davidoff V., Maeder M., Mayor C., Roulet E. (2000) Benign partial epilepsy of childhood: a longitudinal neuropsychological and EEG study of cognitive function. Dev Med Child Neurol 42: 595– 603. 9 Weglage J., Demsky A., Pietsch M., Kurlemann G. (1997) Neuropsychological, intellectual, and behavioral findings in patients with centrotemporal spikes with and without seizures. Dev Med Child Neurol 39: 646– 651. 10 Baglietto MG., Battaglia FM., Nobili L., Tortorelli S., De Negri E., Caleva MG., Veneselli E., De Negri M. (2001) Neuropsychological disorders related to interictal epileptic discharges during sleep in benign epilepsy of childhood with centrotemporal or Rolandic spikes. Dev Med Child Neurol 43: 407– 412. Citing Literature Volume46, Issue7July 2004Pages 501-502 ReferencesRelatedInformation

Neuropsychological profiles of adolescents with ADHD: effects of reading difficulties and gender.

Executive function, particularly behavioral inhibition, has been implicated as a core deficit specific to Attention-Deficit/Hyperactivity Disorder (ADHD) whereas rapid naming has been implicated as a core deficit specific to reading disabilities (RD). Females may be less impaired in executive function although adolescent females with ADHD have yet to be studied. Neuropsychological profiles of four adolescent groups aged 13-16 with equal female representation were investigated: 35 ADHD, 12 RD, 24 ADHD+RD, and 37 normal controls. A semi-structured interview (K-SADS-PL), the Conners Rating Scales and the Ontario Child Health Study Scales were used to diagnose ADHD. RD was defined as a standard score below 90 on at least one of the following: Reading or Spelling of the WRAT3 or Word Attack or Word Identification of the WRMT-R. The WISC-III, Rapid Automatized Naming, Stroop and Stop tasks were used as measures of cognitive and executive function. The two ADHD groups (ADHD, ADHD+RD) showed deficits in processing speed, naming of objects, poor behavioral inhibition and greater variability in reaction times whereas the two RD groups (RD, RD+ADHD) showed verbal working memory deficits and slower verbal retrieval speed. Only the comorbid group was slower with naming of numbers and colors and had slower reaction times. Regression analyses indicated that incongruent color naming (Stroop) and variability in go reaction time were the best predictors of hyperactive/impulsive ADHD symptoms whereas variability in go reaction time and processing speed were the best predictors of inattentive ADHD symptoms. Speed of letter naming and verbal working memory accounted for the most variability in composite achievement scores. No gender differences were found on any of the cognitive tests. This study challenges the importance of behavioral inhibition deficits in ADHD and that naming deficits are specific to RD. Further investigation into cognitive deficits in these groups is required.

Home ownership and the emotional and behavioral problems of children and youth.

This study examined the impact of home ownership on the emotional-behavioral problems of children and youth ages 4 to 16 years. Data came from two large-scale general population surveys conducted in the province of Ontario in 1983, the Ontario Child Health Study (N = 3,325) and the National Longitudinal Study of Children and Youth (N = 12,592). Results showed an inverse association between home ownership and ratings of emotional-behavioral problems. The net effects of home ownership expressed in standard units dropped from the .20 to .43 range for teacher and parent ratings to the .07 to .17 range, after controlling for socioeconomic variables. Furthermore, the concentration of home ownership in neighborhoods was not associated with ratings of child problem behavior in either study. Projects aimed at supporting home ownership among low-income families may provide a means for improving the emotional and behavioral functioning of disadvantaged children.

ADHD and Accident Proneness

ADHD and Accident Proneness

Validity of the Brown ADD scales: an investigation in a predominantly inattentive ADHD adolescent sample with and without reading disabilities.

The Brown ADD Scale for Adolescents is widely used in clinical settings, yet, no published studies have investigated divergent and concurrent validity and specificity and sensitivity to inattentive ADHD symptomatology. Ninety-eight participants (13 to 16 years) were classified as ADHD/I and/or reading disabled (RD) using Kiddie Schedule for Affective Disorder and Schizophrenia (K-SADS), Conners' Rating Scales (CRS-R), and Ontario Child Health Study Scales (OCHSS), WRAT3, and WRMT-R. The results were: 29 ADHD/I; 12 RD, 16 ADHD/I with RD; and, 41 controls. The RD group was included to evaluate specificity. The Brown was administered but not used in classification. The ADHD groups scored higher on the Brown subscales compared with the other two groups. The recommended cutoffs resulted in high rates of false negatives but few false positives; this suggests good specificity but poor sensitivity. There were moderate correlations among the Brown, CRS-R, and OCHSS. The Brown can be useful in screening out ADHD; however, its low sensitivity precludes its usefulness in diagnosing ADHD.

The role of permanent income and family structure in the determination of child health in Canada.

We use data from the Ontario Child Health Study (OCHS) to provide the first Canadian estimates of how the empirical association between child health and both low-income and family status (lone-mother versus two-parent) changes when we re-estimate the model with pooled data. Two waves of data provide a better indication of the family's long-run level of economic resources than does one wave. Our measures of health status include categorical indicators and the health utility score derived from the Health Utilities Index Mark 2 (HUI2) system. Consistent with findings from other countries, we find that most outcomes are more strongly related to low-average income (in 1982 and 1986) than to low-current income in either year. Unlike some previous research, we find the quantitative impact of low-income on child health to be modest to large. Lone-mother status is negatively associated with most outcomes, but the lone-mother coefficients did not change significantly when we switched from low-current income to low-average income. This implies that the lone-mother coefficient in single cross-sections is not just a proxy for low-permanent income.

Highly somatizing young adolescents and the risk of depression.

To determine if high levels of somatization symptoms in 13- to 16-year-olds from the general population predict risk of major depression and other psychiatric disorders 4 years later. Cohort study, using interview and self-report survey data from the 1983 Ontario Child Health Study (OCHS) and 1987 OCHS Follow-up. The study population included 1015 13- to 16-year-olds from the general community within Ontario. Baseline levels of somatization and emotional disorder were measured by the Survey Diagnostic Instrument, a checklist based on DSM-III criteria. Data were also collected for a range of sociodemographic factors, as well as the presence of chronic health problems. Major depression, anxiety disorders, and substance abuse and dependency at follow-up were measured using a self-administered questionnaire derived from the Diagnostic Interview Schedule. Bivariate and multiple logistic regression techniques were used to assess the relationship between high levels of somatization symptoms (>90th percentile) and later emotional morbidity, with adjustment for potential confounding factors, including gender and baseline disorders. Highly somatizing adolescents are at increased risk of major depression 4 years later, an association that is not explained by detectable emotional disorder at baseline or gender differences between groups. There is an important interaction between somatization and emotional disorder in predicting risk of major depression. It is primarily the group of 13- to 16-year-olds not recognized as being emotionally disordered at the initial OCHS survey in which somatization symptoms increased risk of later depression. The young teen with high levels of somatic complaints had as much risk of later depression as his/her peer with more typical symptoms of emotional disorder. Highly somatizing adolescents were also more likely to describe panic attacks at 4-year follow-up. There was no increased risk of substance abuse/dependency in the highly somatizing group or in generalized anxiety. High levels of somatic symptoms identified in young adolescents in the community represent a significant risk factor for major depression 4 years later, particularly in those individuals who do not present with more typical symptoms of emotional disorder. To detect the emergence of this serious emotional morbidity, adequate follow-up and continuity of care for these challenging patients are needed.

What does early antisocial behaviour predict? A follow-up of 4- and 5-year-olds from the Ontario Child Health Study.

To examine the predictive accuracy of antisocial behaviours among 4- and 5-year-old children for problem behaviours 4 years later (ages 8 and 9 years). Data from the Ontario Child Health Study (1983) and Follow-up (1987) are used. Predictive accuracy is conceptualized using positive predictive value (PPV) and sensitivity. The predictive accuracy of early antisocial behaviors for the 1987 outcomes is examined overall, by gender, by variable thresholds of predictor and outcome be gender, and by using contextual variables alone or in combination with antisocial behaviour recorded in 1983. Resulting: The predictive accuracy of 1983 antisocial behaviour for 1987 outcome is generally modest and differs by gender (better for boys for externalizing disorder [PPV = 41%, sensitivity = 57%]; better for girls for internalizing disorder [PPV = 13%, sensitivity = 80%]; better for boys for conduct problems [PPV = 54%, sensitivity = 21%]¿. Using either gender-specific thresholds or gender-neutral thresholds does not alter predictive accuracy in a consistent way, nor does the use of a single contextual variable. Use of a cumulative risk index increases PPV but decreases sensitivity. The predictive accuracy of antisocial behaviour in 4-and 5-years-old children over 4 years in a nonclinical community population is limited. The clinical, research, and policy implications of this work are discussed.

A checklist and structured lay interview had low agreement but comparable validity for childhood psychiatric disorders

Boyle MH, Offord DR, Racine YA , et al. Adequacy of interviews vs checklists for classifying childhood psychiatric disorder based on parent reports. Arch Gen Psychiatry1997 Sep; 54 : 793...

Adequacy of interviews vs checklists for classifying childhood psychiatric disorder based on parent reports.

The advantages and disadvantages of lay-administered structured interviews and self-administered problem checklists for estimating prevalence and associated features of childhood psychiatric disorder have attracted little comment. This article compares the scientific adequacy of these 2 instruments for classifying DSM-III-R categories of childhood psychiatric disorder in general population samples. Study data are from parental assessments of 251 children aged 6 to 16 years participating in a 2-stage measurement evaluation study. Reliability and validity were compared between the Diagnostic Interview for Children and Adolescents (the structured interview in the study) and the revised Ontario Child Health Study scales (the self-administered problem checklist used in the study). Reliability estimates based on the kappa statistic were comparable for the 2 instruments and ranged from 0.21 (conduct disorder) to 0.70 (depression) on the lay interview and from 0.17 (depression) to 0.61 (oppositional defiant disorder) on the self-administered checklist. Validity coefficients tended to favor the checklist categories, but only marginally. On balance, differences in reliability and validity were small between the 2 instruments. These differences would appear to have no discernible impact on the knowledge about prevalence and associated features of disorder generated by use of such instruments in general population surveys.

What if we could eliminate child poverty? The theoretical effect on child psychosocial morbidity.

The aim of this study was to examine the attributable risk of low income for child psychosocial morbidity. Data on 1,996 6- to 16-year-old participants from the Ontario Child Health Study, a province-wide cross-sectional study done in 1983, were used. Out-comes measured included psychiatric disorders, poor school performance, chronic health problems, and social impairment. The attributable risk for low income and child psychosocial morbidity was generally small except among selected disorders in younger children. The implications of these findings are discussed.

Factors predicting use of mental health and social services by children 6-16 years old: Findings from the Ontario Child Health Study.

Correlates of mental health and social service utilization are examined based on Ontario Child Health Study data. Findings indicate that psychiatric disorder as a predictor of service use may be confounded by school performance and parental use of services, thus calling into question the extent to which program planning should be based on prevalence rates of child psychiatric disorder. Children from low-income families tend to make greater use of available services, suggesting that programs need to be tailored more specifically to their needs.

Pathways into the Work Force: Antecedents of School and Work Force Status

The study aim was to identify risk factors for specific pathways into the work force using data from the Ontario Child Health Study Follow-up. Potential predictor variables were derived from data collected in 1983 on adolescents aged 13 to 16 years. The subjects were followed up 4 years later and the school/work force outcome was determined. Bivariate and multivariate statistical analyses were used to identify variables with a strong independent association with this outcome. Subjects in the work force were four times more likely than those attending school to have come from a low-income family and at least two times more likely to have a family background of low maternal education, to have failed a grade, or to have used substances heavily during early adolescence. Subjects with two or more of these risk factors were likely to be in part-time work or unemployed. Preventive interventions should be targeted at children from poor families, or who fail at school, or show early onset of substance abuse and other deviant behaviors. Studies are needed to further elucidate the relationship between these risk factors and pathways into the work force and beyond.