Adult Life Outcomes Research Articles

Health Literacy and Quality of Life in Young Adults From The Belgian Crohn's Disease Registry Compared to Type 1 Diabetes Mellitus.

Background and Aims: The management of chronic inflammatory bowel diseases in youth is challenging. We aimed to determine health literacy (HL), quality of life (QoL) and clinical outcomes in young adults from the BELgian CROhn's disease registry (BELCRO) in comparison to type 1 diabetes mellitus (DM) as a control.Methods: In this prospective and observational study, young adults with Crohn's disease (CD) diagnosed < 18 years and with > 5 years disease duration and a comparable group of patients with DM completed validated HL, QoL and work productivity and activity impairment questionnaires (HLS-EU-Q16, EQ-5D-5L and WPAI). HL was scored as sufficient (13–16), problematic (9–12) or inadequate (0–8). QoL was dichotomized into “no problems” (EQ-5D level 1) or “problems” (EQ-5D levels 2 to 5). Non-parametric (Mann-Whitney U) analyses and Spearman correlations were performed.Results: A total of 52 CD (median [IQR] age of 25.0 [23.8-27.0], 64% male) and 50 DM (age 20.0 [19.0-22.0], 50% male) patients were included. HL was 14.0 [11.0-16.0] for CD and 14.0 [11.3-14.8] for DM (p = 0.6) with similar proportions of sufficient (60 vs. 68%, p = 0.4), problematic (34 vs. 26%, p = 0.3) and inadequate HL (both 6%, p = 1). Although QoL was comparable for CD and DM (77.0 [68.8-82.0] vs. 75.0 [65.0-80.0] %, p =0.4), CD had a trend for higher pain/discomfort (50 vs. 32%, p = 0.06). HL and QoL correlated in CD (r = 0.6, p < 0.001) and DM patients (r = 0.6, p < 0.001). Fewer CD patients with recent hospitalization/surgery had sufficient HL (31 vs. 69%, p = 0.01) and had lower QoL (70.0 [60.0-77.0] vs. 80.0 [70.0-85.0], p = 0.04) compared to those without.Conclusions: Selected young Belgian adults suffering from CD for >5 years have similar and sufficient HL compared to DM patients. However, CD patients requiring hospitalization/surgery have lower HL, which indicates the need for targeted educational programs.

The role of psychiatry in championing positive life outcomes for children and adults with neurodevelopmental disorders and their families.

Children and adults with neurodevelopmental disorders make up an estimated 10% of the population. Addressing health inequalities and poorer life outcomes is essential to deliver better quality care. Two parent-carers working in national roles in England suggest ways to increase understanding and work together in coproduction to achieve this.

Immune Thrombocytopenia (ITP): Current Limitations in Patient Management.

Primary immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by isolated thrombocytopenia caused by increased platelet destruction and impaired platelet production. First-line therapies include corticosteroids, intravenous immunoglobulin, and anti-D immunoglobulin. For patients who are refractory to these therapies, those who become corticosteroid dependent, or relapse following treatment with corticosteroid, options include splenectomy, rituximab, and thrombopoietin-receptor agonists, alongside a variety of additional immunosuppressive and experimental therapies. Despite recent advances in the management of ITP, many areas need further research. Although it is recognized that an assessment of patient-reported outcomes in ITP is valuable to understand and guide treatment, these measures are not routinely measured in the clinical setting. Consequently, although corticosteroids are first-line therapies for both children and adults, there are no data to suggest that corticosteroids improve health-related quality of life or other patient-related outcomes in either children or adults. In fact, long courses of corticosteroids, in either children or adults, may have a negative impact on a patient’s health-related quality of life, secondary to the impact on sleep disturbance, weight gain, and mental health. In adults, additional therapies may be needed to treat overt hemorrhage, but unfortunately the results are transient for the majority of patients. Therefore, there is a need to recognize the limitations of current existing therapies and evaluate new approaches, such as individualized treatment based on the probability of response and the size of effect on the patient’s most bothersome symptoms and risk of adverse effects or complications. Finally, a validated screening tool that identifies clinically significant patient-reported outcomes in routine clinical practice would help both patients and physicians to effectively follow a patient’s health beyond simply treating the laboratory findings and physical symptoms of ITP. The goal of this narrative review is to discuss management of newly diagnosed and refractory patients with ITP, with a focus on the limitations of current therapies from the patient’s perspective.

Raising a new generation in a postcolonial era through decolonised early childhood development and care services

This article draws on the literature in development economics, psychology and sociology to explicate how decolonised early childhood education and care services can reverse the metacolonial cognition lingering in the postcolonial era. In particular, the author shows that colonial institutions persist even after formal colonisation has ended through the application of de facto power. Self-knowledge developed during early childhood impacts adult socio-economic life outcomes. Thus, decolonising early childhood development and care by ensuring positive representations of self will improve self-perceptions and self-awareness. The implications for practice and policy are discussed within the context of deploying decolonised early childhood development and care services to raise a new generation of confident Africans to accelerate the development of the continent and regions with similar histories of colonisation.

Effect of Maternal Factors on Low Birth Weight Baby in a Medical College of Kolkata

Background: Low birth weight is a major determinant of mortality, morbidity and disability in infancy and childhood and also has a long-term impact on health outcomes in adult life. Objectives: The present study was undertaken with the objectives of assessment of occurrence of low birth weight babies delivered in NRS Medical College &amp; Hospital and to find out the role of different sociodemographic and pregnancy related factors influencing low birth weight. Method: A descriptive, observational study was conducted in the postnatal ward of the Hospital. All mothers who delivered during the study period were interviewed and relevant record was reviewed. Results: 38% of the babies had low birth weight. Proportion of teenage mothers were higher in case of low birth weight babies compared to the mothers of normal birth weight babies ( 27.7% Vs 17% ). 72.3% of the LBW babies were from family with per capita income &lt; Rs 3000/- compared to 37.7% normal birth weight babies. 67.7% of mothers of low birth weight babies had last child birth within 3years compared to 33% of normal babies. 10.7% of the mothers of LBW babies had &lt;3 ANC visits compared to 1.8% in other group. 22.6% of the mothers consumed &lt;100 Folifer tablets and 23.1% smoked tobacco during the antenatal period who delivered LBW babies compared to 1.8% and 2.8% respectively in their counterparts. Conclusion: Magnitude of low birth weight is still high and various unfavourable socio-demographic, antenatal and obstetric factors increased the risk of delivering low birth weight baby.

Young Adults With Developmental Language Disorder: A Systematic Review of Education, Employment, and Independent Living Outcomes.

Purpose Research on developmental language disorder (DLD) in adulthood has increased rapidly in recent years. However, to date, there has been no systematic literature review on this topic, thereby limiting the possibility to have a comprehensive overview of publications in this field. Method Following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature review. A literature search was undertaken in four databases, from 2005 to 2018. We selected articles with original data related to life outcomes of young adults with and without DLD, all aged between 18 and 34 years, in three life areas: education, employment, and independent living. Methodological characteristics of the studies were analyzed. Results Fifteen articles were selected with longitudinal designs. In every life area, young adults with DLD were compared to their typically developing peers to identify their strengths and weaknesses. The predictive role of language abilities was also examined. Conclusions Outcomes within each life area are heterogeneous. Nevertheless, similarly to young children and adolescents, young adults with DLD face numerous challenges. Although language abilities partly predict some of these outcomes, much of the variance remains unaccounted for and some outcomes are unrelated to this predictor. This systematic literature review has implications for researchers and practitioners to identify promising avenues for research, interventions, and policy development. Supplemental Material https://doi.org/10.23641/asha.13022552.

Prenatal exposure to fine particulate matter and fetal growth: a cohort study from a velocity perspective

BackgroundReduced growth velocity before birth increases the risk of adverse health outcomes in adult life. However, until recently, there has been a lack of studies demonstrating the impact of prenatal PM2.5 exposure on fetal growth velocity. MethodsThe current study was embedded in a previous cohort built between January 1, 2014, and April 30, 2015, in Shanghai First Maternity and Infant Hospital, China, in 6129 eligible singleton pregnancies. The PM2.5 concentration was estimated by an inverse distance weighted method according to the residential addresses of the participants. Repeated fetal biometry measurements, including head circumference (HC), abdominal circumference (AC), femur length (FL), and biparietal diameter (BPD), were measured through ultrasound between 14 and 41 gestational weeks. A principal component analysis through conditional expectation for sparse longitudinal data was used to estimate the corresponding velocities. ResultsA total of 22782 ultrasound measurements were conducted among 6129 participants with a median of 2 and a maximum of 9 measurements. With each 10 μg/m3 increase in cumulative PM2.5 exposure, the velocity of HC, AC FL and BPD decreased by 0.12 mm/week, 0.17 mm/week, 0.02 mm/week and 0.02 mm/week, respectively, on average. The results of the Generalized Functional Concurrent Model showed that the velocity decreased significantly with PM2.5 exposure between 22 and 32 gestational weeks, which might be the potential sensitive exposure window. ConclusionsThere are negative associations between prenatal exposure to PM2.5 and fetal growth velocity, and the late second trimester and early third trimester might be the potential sensitive window.

Atrial arrhythmias and patient-reported outcomes in adults with congenital heart disease: An international study

Atrial arrhythmias (ie, intra-atrial reentrant tachycardia and atrial fibrillation) are a leading cause of morbidity and hospitalization in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD. The purpose of this study was to assess the impact of atrial arrhythmias on PROs in adults with CHD and explore geographic variations. Associations between atrial arrhythmias and PROs were assessed in a cross-sectional study of adults with CHD from 15 countries spanning 5 continents. A propensity-based matching weight analysis was performed to compare quality of life, perceived health status, psychological distress, sense of coherence, and illness perception in patients with and those without atrial arrhythmias. A total of 4028 adults with CHD were enrolled, 707 (17.6%) of whom had atrial arrhythmias. After applying matching weights, patients with and those without atrial arrhythmias were comparable with regard to age (mean 40.1 vs 40.2 years), demographic variables (52.5% vs 52.2% women), and complexity of CHD (15.9% simple, 44.8% moderate, and 39.2% complex in both groups). Patients with atrial arrhythmias had significantly worse PRO scores with respect to quality of life, perceived health status, psychological distress (ie, depression), and illness perception. A summary score that combines all PRO measures was significantly lower in patients with atrial arrhythmias (-3.3%; P = .0006). Differences in PROs were consistent across geographic regions. Atrial arrhythmias in adults with CHD are associated with an adverse impact on a broad range of PROs consistently across various geographic regions.

Pathophysiology and consequences of arterial stiffness in children with chronic kidney disease

Changes in arterial structure and function are seen early in the course of chronic kidney disease (CKD) and have been causally associated with cardiovascular (CV) morbidity. Numerous potential injuries encompassing both traditional and uremia-specific CV risk factors can induce structural arterial changes and accelerate arterial stiffening. When the buffering capacity of the normally elastic arteries is reduced, damage to vulnerable microcirculatory beds can occur. Moreover, the resultant increase to cardiac afterload contributes to the development of left ventricular hypertrophy and cardiac dysfunction. Adult studies have linked arterial stiffness with increased risk of mortality, CV events, cognitive decline, and CKD progression. Pulse wave velocity (PWV) is currently the gold standard of arterial stiffness assessment but its measurement in children is challenging due to technical difficulties and physiologic aspects related to growth and poor standardization between algorithms for calculating PWV. Nevertheless, studies in pediatric CKD have reported increased arterial stiffness in children with advanced CKD, on dialysis, and after kidney transplantation. Development of arterial stiffness in children with CKD is closely related to mineral-bone disease and hypertension, but other factors may also play a significant role. The clinical relevance of accelerated arterial stiffness in childhood on cardiovascular outcomes in adult life remains unclear, and prospective studies are needed. In this review we discuss mechanisms leading to arterial stiffness in CKD and its clinical implications, along with issues surrounding the technical aspects of arterial stiffness assessment in children.

An Investigation of Coping Strategies Used by College Students With Intellectual Disability

Abstract Attending college can lead to many benefits including better outcomes in adult life for college graduates. This concept is applicable to all students, including students with intellectual disability who are attending institutions of higher education programs to refine social, academic, employment, and independent living skills. Similar to their typical peers, students with intellectual disability enrolled in postsecondary education programs endure levels of stress that result in the application of coping strategies necessary to navigate various social domains of college life, including romantic relationships, friendships, roommate relationships, and social media interactions. The present study utilizes survey and interview data to examine which coping strategies are used by college students with mild intellectual disability. When faced with stressful situations, almost one-third of study participants chose Planful Problem Solving as their first choice coping strategy in the Romantic domain, and almost half of respondents used it to deal with stressful situations related to Friendships. More than a third of college students with intellectual disability chose Confrontive Coping as their preferred strategy in the Roommate and Social Media domains. Findings are consistent with previous research, which suggests that young adults with intellectual disability use Problem-Focused strategies most frequently when dealing with stressful situations. Implications for research and practice are also presented and discussed.

Children’s vulnerability to natural disasters: Evidence from natural experiments in Bangladesh

Both developed and developing countries face natural disasters, but it is the poor in developing countries, particularly women and children, that are most affected by those disasters in terms of loss of lives and livelihoods. If the predictions of climate change models bear out, Bangladesh could be affected by frequent and severe natural disasters such as rising sea levels leading to floods, cyclones, etc. Natural disasters adversely affect employment opportunities and earnings of the most vulnerable households. Loss of employment and earnings can affect the nutritional intake of children in regions affected by natural disasters. Since nutritional status in the early ages of 0–60 months of a child can potentially impact outcomes in adult life including education and earnings, hindrances that affect nutritional supply and result in low nutritional intake can have adverse lifetime effects on children. Consequently, the frequency and severity of natural disasters due to climate change have intergenerational effects. In this study, we examine the effects of natural disasters – specifically, cyclones Sidr and Aila - on children’s nutritional status in Bangladesh. We estimate the nutritional status of children below 60-months age who had been exposed to those extreme events in November 2007 and May 2009. Results show that children exposed to such extreme climate events, while in-utero and newborn stages, suffer a significant reduction in height for age Z-score and are more likely to be stunted and underweight. This is particularly important as height for age Z-score is regarded as a critical measure of the long-term consequences of nutritional intake. Our findings suggest that extreme climate events such as super cyclones can potentially exert detrimental effects on nutritional status indicator that is an important measure of the long-term nutrition intake.

Adult correlates of adverse childhood experiences in Ukraine

BackgroundThe impact of adverse childhood experiences (ACEs) on adult life outcomes is well-documented by a considerable body of research. This study investigates the relationship between ACEs and both physical and mental health outcomes in a nationally representative sample of Ukrainian adults. ObjectiveThe aim of this study was to analyze whether ACEs are associated with lifetime physical and mental health outcomes in a nationally representative sample of Ukrainian adults. Participants and Setting In 2002, the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was administered to a national probability sample of Ukrainian adults (n = 4725). MethodsAssociations between ACEs and later life physical and mental health outcomes are examined using logistic regression models. ResultsACEs were significantly correlated with poor later life mental and physical health. Participants with three or more ACEs were most likely to have chronic pain, cardiovascular disease, other disease, depressive disorders, anxiety disorders, substance abuse disorders, and all disability metrics analyzed. Adjusted odds ratios for these models ranged from 1.80 to 3.81. Additionally, we found a large association between the number of ACES and later negative health outcomes. ConclusionsOur results indicate that in Ukraine, ACEs have a strong negative effect on later life mental and physical health. Further research is needed to explore specific ACEs and examine potential mediators such as social support in the relationship between ACEs and health outcomes.

Is amblyopia associated with school readiness and cognitive performance during early schooling? Findings from the Millennium Cohort Study.

Amblyopia is a neurodevelopmental condition causing reduced vision, for which programmes of whole population child vision screening exist throughout the world. There is an ongoing debate about the value of screening due to the lack of evidence about meaningful functional impacts of amblyopia. Our objective was to determine whether amblyopia is associated with school readiness and early cognitive performance. Data from the prospective Millennium Cohort Study of children born in the United Kingdom in 2000-01 and followed-up to age 7 years (n = 13,967). Using parental self-report on eye conditions and treatment coded by clinical reviewers, participants were grouped into no eye conditions, strabismus alone, refractive amblyopia, or strabismic/mixed (refractive plus strabismic) amblyopia. The outcomes were poor school readiness using Bracken School Readiness Assessment <25th percentile (age 3); and cognitive tests and their age-related trajectories using British Ability Scale II Naming Vocabulary (ages 3/5) and Pattern Construction (ages 5/7). Multivariable analyses showed that compared to children without any eye conditions, only those with strabismic/mixed amblyopia had an increased risk of poor school readiness (OR = 2.04, 95%CI 1.09-3.82). Small differences in mean scores for NV and PC of children with amblyopia (all types) compared to those without any eye condition were not clinically significant (>10 points) irrespective of whether treatment had already started. The age-related cognitive trajectories of children with amblyopia did not differ from those without any eye conditions for either NV (p = 0.62) or PC (p = 0.51). These associations are at population rather than individual level, so it might be that some individuals with amblyopia did experience significant adverse outcomes that are not captured by summary statistics. Amblyopia is not significantly associated with adverse cognitive performance and trajectories in early schooling and there is no evidence that this is due to a mediating effect of treatment. Although amblyopia combined with strabismus is associated with poor school readiness, this is not translated into poor cognitive performance. These novel findings may explain the lack of association reported between amblyopia and educational outcomes in adult life and suggest that the impact of amblyopia on education is not of itself a justification for whole population child vision screening aimed at detecting this disorder.

Modeling Determinants of Low Birth Weight for Under Five-Children in Ethiopia

Low birth weight (LBW) is a major determinant of morbidity, mortality and disability in infancy and childhood and has a long-term impact on health outcomes in adult life. This study was aimed to model LBW using marginal and generalized linear mixed models as well as identify the potential risk factors of LBW in Ethiopia. Data was taken from the 2011 Ethiopian demographic and health survey, which is a nationally representative survey of children in the 0–59 month age groups. Two model families, generalized estimating equation and alternating logistic regression models from marginal model family, and generalized linear mixed model from cluster specific model family were used for the analysis. The result showed that 34.8% of children were born with LBW. Alternating logistic regression model was best fits the data for population-averaged effects of the given factors on birth weight than generalized estimating equation model. Generalized linear mixed model with two random intercepts was the best model to evaluate within and between regional heterogeneity of birth weight. Both the best-fitted models gave the same conclusion that sex, wealth status, age, antenatal care, marital status, vaccination, anemia and mother education level were the determinant factors of LBW. This study contributes to the understanding of the individual and collective effect of maternal, socio-economic and child related factors influencing infant birth weight in Ethiopia.

“I don’t want to be a patient”: Peer mentoring partnership fosters communication for autistic university students

Background: Despite recognition of the benefits of post-school education in improving life outcomes for autistic adults their university completion rates remain low.Aim: To explore the experiences of undergraduate autistic university students participating in specialist peer mentoring (SPM) to identify active ingredients in the peer mentoring process and to examine the impact of SPM on social communication.Material and method: A total of 30 (8 female; M age = 22.3; SD = 6.7) undergraduate autistic university students engaged in SPM participated in this study. A quantitative pre-test post-test design examined changes in autistic traits. In parallel, the experiences of participating in SPM were explored through semi-structured interviews.Results: Improvements were noted at post-test on the Social Responsiveness Scale-2 total score p = 0.02), and its Social Communication, (p = 0.03) and Social Motivation (p = 0.03) sub-scales. Four themes emerged from the interviews: Developing Partnership and Understanding, Modelling and Practising Communication, Psychological Support and Grading and Planning Skills.Conclusions: These results indicated that the mentor-mentee partnership was a crucial active ingredient of SPM. This partnership appeared to modify social cognition and motivation for autistic university students through modelling and practising communication.Significance: These results demonstrate that SPM can support participation at university for autistic university students.

Cognitive, Psychiatric, and Quality of Life Outcomes in Adult Survivors of Extracorporeal Membrane Oxygenation Therapy: A Scoping Review of the Literature.

To perform a scoping literature review of cognitive, psychiatric, and quality of life outcomes in adults undergoing extracorporeal membrane oxygenation for any indication. We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO from inception to June 2019. Observational studies, clinical trials, qualitative studies, and case series with at least 10 adult subjects were included for analysis. Outcomes of interest consisted of general or domain-specific cognition, psychiatric illness, and quality of life measures that included both mental and physical health. Study selection, data quality assessment, and interpretation of results were performed by two independent investigators in accordance with the PRISMA statement. Twenty-two articles were included in this review. Six described cognitive outcomes, 12 described psychiatric outcomes of which two were qualitative studies, and 16 described quality of life outcomes. Cognitive impairment was detected in varying degrees in every study that measured it. Three studies examined neuroimaging results and found neurologic injury to be more frequent in venoarterial versus venovenous extracorporeal membrane oxygenation, but described a variable correlation with cognitive impairment. Rates of depression, anxiety, and post-traumatic stress disorder were similar to other critically ill populations and were related to physical disability after extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survivors' physical quality of life was worse than population norms but tended to improve with time, while mental quality of life did not differ significantly from the general population. Most studies did not include matched controls and instead compared outcomes to previously published values. Extracorporeal membrane oxygenation survivors experience cognitive impairment, psychiatric morbidity, and worse quality of life compared with the general population and similar to other survivors of critical illness. Physical disability in extracorporeal membrane oxygenation patients plays a significant role in psychiatric morbidity. However, it remains unclear if structural brain injury plays a role in these outcomes and whether extracorporeal membrane oxygenation causes secondary brain injury.

Regional Inequalities, Childhood Socioeconomic Conditions and Adult Life Outcomes — Evidence from Pakistan

The circumstances during early years of life wieldasignificant impact on adult life outcomes by influencing and altering the cognitive, social and personality development of individuals. While these, in turn, are determined largely by the parental socioeconomic status which, in great part, depends on prosperity of the regions within which they dwell. This study assessed the relationship among regional inequalities, its influence on early life conditions and the consequent transmission toadult life in the shape of socioeconomic outcomes. For this purpose, secondary data on Pakistans regional, economic and sociodemographic indicators was utilized. Results confirmed the significance of regional disparities over living conditions at the start of life and lifelongsocioeconomic outcomes. A just spread of the economic pie among the regions can improve socioeconomic and living conditions at individual level. This can have favorable implications in the shape of healthy and productive adults.

Investigation and Treatment of High Blood Pressure in Young People: Too Much Medicine or Appropriate Risk Reduction?

Hypertension among young people is common, affecting 1 in 8 adults aged between 20 and 40 years. This number is likely to increase with lifestyle behaviors and lowering of hypertension diagnostic thresholds. Early-life factors influence blood pressure (BP) although the mechanisms are unclear; BP tracks strongly within individuals from adolescence through to later life. Higher BP at a young age is associated with abnormalities on heart and brain imaging and increases the likelihood of cardiovascular events by middle age. However, diagnosis rates are lower, and treatment is often delayed in young people. This reflects the lack of high-quality evidence that lowering BP in young adults improves cardiovascular outcomes later in life. In this review, we evaluate the current evidence regarding the association between BP in young adult life and adverse cardiovascular outcomes later in life. Following this, we discuss which young people with raised BP should be investigated for secondary causes of hypertension. Third, we assess the current models to assess cardiovascular risk and show a lack of validation in the younger age group. Fourth, we evaluate the evidence for lifestyle interventions in this age group and demonstrate a lack of persistence in BP lowering once the initial intervention has been delivered. Fifth, we address the pros and cons of drug treatment for raised BP in young people. Finally, there are unique life events in young people, such as pregnancy, that require specific advice on management and treatment of BP.

The long-term outcomes of a cohort of adolescents and adults from Greece with autism spectrum disorder

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disorder. Although it is a lifelong condition, treatments and services can improve a person’s symptoms and ability to function. Research on the outcomes in adolescence and adult life and on the associated factors is limited. The objective of the present study is to examine the outcomes as well as the contributing factors in adolescents and adults diagnosed with ASD in Greece.MethodParticipants included 69 parents of individuals diagnosed with ASD in their childhood. Interviews were conducted with the parents, and archived medical and psychological records were collected. Participants had been diagnosed in the Child and Adolescent Unit of the 3d Psychiatric Clinic of the AHEPA Hospital in Thessaloniki, Greece between 1990 and 2007.ResultsThe overall outcome was poor in most of cases (22.6% “very poor” and 24.5% “poor”); however, a substantial number had “good” (18.9%) or “very good” (22.6%) outcomes. Severity of initial diagnosis (χ2 = 65.956, DF = 8, p < 0.001), presence of comorbid disorders in childhood (χ2 = 14,085, DF = 4, p < 0.007), current comorbidity (χ2 = 15.834, DF = 4, p = 0.003), and certain developmental milestones [early acquisition of language skills (χ2 = 16.991, DF = 8, p = 0.030)] were positively correlated with adult outcomes.ConclusionsOverall outcomes in the Greek sample were consistent with international studies. It seems that important contributing factors are comorbidity and especially overall lower cognitive function (intellectual disability), but further research is needed as well as enhanced adult-oriented research and intervention programs.

Adolescent boys' physical fighting and adult life outcomes: Examining the interplay with intelligence.

Although it is well known that adolescent delinquent behavior is related to poor outcomes in adulthood, longitudinal research on specific acts of delinquency and their interplay with important individual characteristics in predicting future outcomes is scarce. We aimed to examine how physical fighting-one of the most common acts of violent delinquency among adolescent boys-is related to adult life success in several domains, and how intelligence influences these associations. The study used data from 1,083 boys that participated in the population-based longitudinal Young in Norway Study, following adolescents from 1992 to 2015, by combining self-reports at four time points with comprehensive information from registers. Results showed that adolescent boys' physical fighting was associated with poor adult outcomes in the domains of employment, education, and criminal behavior. Associations remained significant even after controlling for conduct problems in general-which isolated the effects of fighting from other delinquent acts-as well as from a variety of other potential confounders. Detailed analyses on the interplay of physical fighting and intelligence showed that some parts of the associations between adolescent boys' fighting and several adverse adult outcomes could be ascribed to lower intelligence among the fighters. Moreover, intelligence moderated the relationship between physical fighting and adult education. Adolescent fighting was not related to educational attainment among boys with high intelligence, whereas boys with lower intelligence experienced detrimental effects of adolescent fighting. The analyses show the importance of considering adolescent boys' physical fighting as a potential risk factor for future social marginalization.