Predictors of and barriers to service use for children at risk of ADHD: longitudinal study.

Many children with, or at risk of, ADHD do not receive healthcare services for their difficulties. This longitudinal study investigates barriers to and predictors of specialist health service use. This is a 5-year follow-up study of children who participated in a cluster randomised controlled trial, which investigated school-level interventions (provision of books with evidence-based information and/or feedback of names of children) for children at risk of ADHD. 162 children who had high levels of ADHD symptoms at age 5 (baseline) were followed up at age 10 years. Using baseline data and follow-up information collected from parents and teachers, children who had and had not used specialist health services over the follow-up period were compared and predictors (symptom severity, comorbid problems, parental perception of burden, parental mental health, and socio-demographic factors) of specialist service use investigated. The most common parent-reported barrier reflected lack of information about who could help. Amongst children using specialist health services who met criteria for ADHD at follow-up, 36% had been prescribed stimulant medication. Specialist health service use was associated with each one-point increase in teacher-rated symptoms at baseline [inattention symptoms (adjusted OR = 1.40; 95% CI 1.12-1.76) and hyperactivity/impulsivity symptoms (adjusted OR = 1.23; 95% CI 1.05-1.44)]. Parental mental health problems were also independently associated with service use (for each one-point increase in symptoms, adjusted OR = 1.41; 95% CI 1.04-1.91). Severity of teacher-rated ADHD symptoms in early school years is a determinant of subsequent service use. Clinicians and teachers should be aware that parental mental health problems are independently associated with service use for children at risk of ADHD.

The Development of a School-Based Measure of Child Mental Health.

Early detection of child mental health problems in schools is critical for implementing strategies for prevention and intervention. The development of an effective measure of mental health and well-being for this context must be both empirically sound and practically feasible. This study reports the initial validation of a brief self-report measure for child mental health suitable for use with children as young as 8 years old ("Me & My School" [M&MS]). After factor analysis, and studies of measurement invariance, 2 subscales emerged: emotional difficulties and behavioral difficulties. These 2 subscales were highly correlated with corresponding constructs of the Strengths and Difficulties Questionnaire (SDQ) and showed correlations with attainment, deprivation, and educational needs similar to ones obtained between these demographic measures and the SDQ. Results suggest that this school-based self-report measure is psychometrically sound, and has the potential of contributing to school mental health surveys, evaluation of interventions, and recognition of mental health problems within schools.

Academic Outcomes Following a School-Based RCT for ADHD: 6-Year Follow-Up.

Objective: For children with high levels of ADHD symptoms, to investigate the impact of early school-based interventions on academic outcomes in mid-childhood. Method: A 6-year follow-up of 4- to 5-year-olds (N = 52,075) whose schools participated in a cluster randomized controlled trial for children at risk of ADHD. School-level interventions involved the provision of a booklet with evidence-based information (book) and/or feedback of names (identification) of children with high levels of ADHD symptoms. At ages 10 to 11 years, outcome measures were scores in English and mathematics tests. Results: For children with high levels of ADHD symptoms, the interventions had no impact on academic outcomes. When all children were analyzed, the book intervention had a positive impact on mathematics. Baseline inattention was associated with poorer academic outcomes, whereas impulsiveness was associated with better academic outcomes. Conclusion: The provision of evidence-based information about helping children with ADHD at school may have wider academic benefits.

Clustered randomised controlled trial of two education interventions designed to increase physical activity and well-being of secondary school students: the MOVE Project.

OBJECTIVE: To assess the effectiveness of 2 interventions in improving the physical activity and well-being of secondary school children. DESIGN: A clustered randomised controlled trial; classes, 1 per school, were assigned to 1 of 3 intervention arms or a control group based on a 2×2 factorial design. The interventions were peer-mentoring and participative learning. Year 7 children (aged 11-12) in the peer-mentoring intervention were paired with year 9 children for 6 weekly mentoring meetings. Year 7 children in the participative learning arm took part in 6 weekly geography lessons using personalised physical activity and Global Positioning System (GPS) data. Year 7 children in the combined intervention received both interventions, with the year 9 children only participating in the mentoring sessions. PARTICIPANTS: 1494 year 7 students from 60 schools in the North of England took part in the trial. Of these, 43 students opted out of taking part in the evaluation measurements, 2 moved teaching group and 58 changed school. Valid accelerometry outcome data were collected for 892 students from 53 schools; and well-being outcome data were available for 927 students from 52 schools. MAIN OUTCOME MEASURES: The primary outcomes were mean minutes of accelerometer-measured moderate-to-vigorous intensity physical activity per day, and well-being as evaluated by the KIDSCREEN-27 questionnaire. These data were collected 6 weeks after the intervention; a 12-month follow-up is planned. RESULTS: No significant effects (main or interaction) were observed for the outcomes. However, small positive differences were found for both outcomes for the participative learning intervention. CONCLUSIONS: These findings suggest that the 2 school-based interventions did not modify levels of physical activity or well-being within the period monitored. Change in physical activity may require more comprehensive individual behavioural intervention, and/or more system-based efforts to address wider environmental influences such as family, peers, physical environment, transport and educational policy. TRIAL REGISTRATION NUMBER: ISRCTN82956355.

Rasch analysis of inattentive, hyperactive and impulsive behaviour in young children and the link with academic achievement.

The Attention Deficit Hyperactivity Disorder (ADHD) criteria from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders were used to assess a large sample of children at the end of their first year at school in England. These data were explored using Rasch measurement and the measures for the items together with their frequencies are reported. The data were further analysed in three ways: a) The results were compared with a previous similar analysis of college students. b) A principal components analysis of the item residuals from the Rasch analysis was conducted. c) The measures were linked to reading and mathematics attainment assessed at three different time points. The exploration supported previous work and theoretical positions, and in doing so raised issues about the appropriateness of the use of the criteria across all ages. It also suggested that one of the currently recognised ADHD sub-types could be further sub-divided into verbal and physical hyperactivity. The links to academic achievement raised questions about the integrity of the currently recognised ADHD sub-types and the paper calls for further investigations.

Impact of early school-based screening and intervention programs for ADHD on children's outcomes and access to services: follow-up of a school-based trial at age 10 years.

OBJECTIVES: To investigate the impact of early school-based screening and educational interventions on longer-term outcomes for children at risk for attention-deficit/hyperactivity disorder (ADHD) and the predictive utility of teacher ratings. DESIGN: A population-based 5-year follow-up of a randomized, school-based intervention. SETTING: Schools in England. PARTICIPANTS: Children between 4 and 5 years of age with high teacher-rated hyperactivity/inattention scores. Follow-up data were collected on 487 children in 308 schools. INTERVENTIONS: Following screening, using a 2 x 2 factorial design, schools randomly received an educational intervention (books about ADHD for teachers), the names of children with high hyperactivity/inattention scores between ages 4 and 5 years (identification), both educational intervention and identification, or no intervention. OUTCOME MEASURES: Parent-rated hyperactivity/inattention, impairment in classroom learning, and access to specialist health services for mental health or behavioral problems. RESULTS: None of the interventions were associated with improved outcomes. However, children receiving the identification-only intervention were twice as likely as children in the no-intervention group to have high hyperactivity/inattention scores at follow-up (adjusted odds ratio, 2.11; 95% confidence interval, 1.12-4.00). Regardless of intervention, high baseline hyperactivity/inattention scores were associated with high hyperactivity/inattention and specialist health service use at follow-up. CONCLUSIONS: We did not find evidence of long-term, generalizable benefits following a school-based universal screening program for ADHD. There may be adverse effects associated with labeling children at a young age.

The relationship between birthweight, weight gain in infancy, and educational attainment in childhood.

Previous studies have examined the relationship between low weight gain (failure to thrive) in infancy and later cognitive ability, but no study to date appears to have examined the relationship between weight gain in infancy across the 'normal' range and later cognitive ability. We report results for a large prospective birth cohort of the relationship between weight gain in infancy and educational attainment at age 10. Routinely recorded weights from child health clinic records for an annual birth cohort of 3418 children born with gestation >36 weeks were collected, as well as gestation in weeks, birthweight and the postcode, for which the Townsend Deprivation Score was identified. At 10 years of age, those attending schools within the Newcastle Education Authority were given a picture vocabulary and a non-verbal ability test, and tests of educational attainment in maths and reading. These were successfully linked to the infant weight data for 2294 (63%) of the children, and complete growth data were available for 1724 (47%) of the children who had completed at least one educational test. There was a significant positive relationship between weight gain in infancy and picture vocabulary, adjusted for economic deprivation, gestational age and birthweight, but not with any of the other outcomes. There was a statistically significant association between birthweight and all four outcomes, which was positive up to about one SD above average birthweight, and negative above. In this population, the association between early growth and cognitive outcomes is stronger for growth before birth, postnatal weight gain having a relatively minor impact.