Longitudinal associations between childhood and adulthood externalizing and internalizing psychopathology and adolescent substance use.

BACKGROUND: Emotional and behavioral problems are commonly associated with substance use in adolescence but it is unclear whether substance use precedes or follows mental health problems. The aim was to investigate longitudinal associations between externalizing and internalizing psychopathology and substance use in a prospective population study design. METHOD: The sample was the Northern Finland Birth Cohort 1986 Study (NFBC 1986; n = 6349; 3103 males). Externalizing and internalizing mental health problems were assessed at age 8 years (Rutter scales), substance use and externalizing and internalizing problems [Youth Self-Report (YSR)] at age 15-16 years, and hospital diagnoses for internalizing disorders (age 25) and criminal offences (age 20) from nationwide registers in adulthood. RESULTS: Externalizing problems at age 8 were associated with later substance use. After adjustment for sociodemographic factors, parental alcohol use and psychiatric disorders, and earlier externalizing and internalizing problems, substance use predicted criminality, especially among males, with the highest odds ratio (OR) for cannabis use [adjusted OR 6.2, 95% confidence interval (CI) 3.1-12.7]. Early internalizing problems were not a risk for later substance use. Female adolescent cannabis (OR 3.2, 95% CI 1.4-7.3) and alcohol (OR 2.1, 95% CI 1.1-4.2) use predicted internalizing disorders in adulthood. CONCLUSIONS: Externalizing problems precede adolescent substance use in both genders, whereas, among boys, substance use also precedes criminal offences. Internalizing problems may follow substance use in females. These associations were robust even when taking into account previous mental health problems.

Response initiation in young adults at risk for psychosis in the Northern Finland 1986 Birth Cohort.

INTRODUCTION: This is one of the very few studies to investigate the specific executive function/processing speed component of response initiation in subjects at familial risk (FR) for psychosis, and the first such study in subjects at clinical risk (CR) for psychosis. METHODS: Participants (N = 177) were members of the general population-based Northern Finland 1986 Birth Cohort in the following four groups: FR for psychosis (n = 62), CR for psychosis (n = 21), psychosis (n = 25) and control subjects (n = 69). The response initiation of these groups was compared in three different tests: Semantic fluency, Stockings of Cambridge and Spatial working memory. RESULTS: The two risk groups did not differ significantly from control group, but differed from, and outperformed the psychosis group in semantic fluency response initiation. CONCLUSIONS: Response initiation deficits were not evident in a non-help seeking psychosis high-risk sample.

Disruptive behaviour disorder with and without attention deficit hyperactivity disorder is a risk of psychiatric hospitalization.

AIM: To evaluate the psychiatric hospitalization among adolescents diagnosed with disruptive behaviour disorders (DBD) and/or attention deficit hyperactivity disorder (ADHD). METHODS: The sample (N = 457) was drawn from the Northern Finland Birth Cohort 1986. Four groups were formed, based on the K-SADS-PL diagnostic interview procedure: adolescents with DBD (n = 44), ADHD (n = 91), comorbid DBD and ADHD (n = 72) and without either DBD or ADHD (n = 250). Information from the Finnish Hospital Discharge Register (FHDR) was used to evaluate the psychiatric hospitalization among the study subjects. RESULTS: When compared with no diagnosis group, the adolescents with behavioural disorders had an increased risk (adjusted odds ratios: DBD = 4.4, ADHD = 2.2, comorbid DBD & ADHD = 5.6) of having also psychiatric disorder in the FHDR. The onset age of the psychiatric disorders in the FHDR (medians: DBD = 14.9, ADHD = 7.5 and DBD & ADHD = 15.3 years) and the combined length of hospitalization (medians: 25, 50 and 26 days, respectively) differed among adolescents with behavioural disorders compared with those with no diagnosis (median age 12.1 years and length of hospitalization 4 days). CONCLUSION: Adolescents diagnosed with DBD (with and without ADHD) are at high risk of undergoing psychiatric hospitalization during their life.

Sensory Abnormality and Quantitative Autism Traits in Children With and Without Autism Spectrum Disorder in an Epidemiological Population.

Sensory abnormalities (SAs) are recognized features in Autism Spectrum Disorder (ASD), and a relationship between SAs and ASD traits is also suggested in general population. Our aims were to estimate the prevalence of SAs in three different settings, and to study the association between SAs and quantitative autism traits (QAT) using the Autism Spectrum Screening Questionnaire (ASSQ) and a parental questionnaire. In an epidemiological population of 8-year-old children (n = 4397), the prevalence of SAs was 8.3%, in an ASD sample (n = 28), 53.6%, and in a non-ASD sample (n = 4369), 8.0%, respectively. Tactile and auditory hypersensitivity predicted an ASD diagnosis. The ASSQ was able to differentiate children with and without SA. In conclusion, QAT level and SAs were associated in all study samples.

Prevalence of Autism Spectrum Disorder in 7-9-Year-Old Children in Denmark, Finland, France and Iceland: A Population-Based Registries Approach Within the ASDEU Project.

We estimated autism spectrum disorder (ASD) prevalence in 7-9 year-old children in 2015 using data from three nationwide health registry systems (Denmark, Finland, Iceland) and two French population-based regional registries. Prevalence ranged from 0.48% in South-East France to 3.13% in Iceland (South-West France: 0.73%, Finland: 0.77%, Denmark: 1.26%). Male/female ratios ranged from 3.3 in Finland to 5.4 in South-West France. Between 12% (Denmark) and 39% (South-West France) of cases were diagnosed with intellectual disability. The variations in population-based ASD prevalence across four European countries with universal health care practices likely reflect variation in detection, referral and diagnosis practices and autism awareness across these areas. Using established population-based data systems is an efficient approach to monitor ASD prevalence trends over time.

Is prenatal alcohol exposure related to inattention and hyperactivity symptoms in children? Disentangling the effects of social adversity.

BACKGROUND: Studies concerning whether exposure to low levels of maternal alcohol consumption during fetal development is related to child inattention and hyperactivity symptoms have shown conflicting results. We examine the contribution of covariates related to social adversity to resolve some inconsistencies in the extant research by conducting parallel analyses of three cohorts with varying alcohol consumption and attitudes towards alcohol use. METHODS: We compare three population-based pregnancy-offspring cohorts within the Nordic Network on ADHD from Denmark and Finland. Prenatal data were gathered via self-report during pregnancy and birth outcomes were abstracted from medical charts. A total of 21,678 reports concerning inattention and hyperactivity symptoms in children were available from the Strengths and Difficulties Questionnaire or the Rutter Scale completed by parents and/or teachers. RESULTS: Drinking patterns differed cross-nationally. Women who had at least some social adversity (young, low education, or being single) were more likely to drink than those better off in the Finnish cohort, but the opposite was true for the Danish cohorts. Prenatal alcohol exposure was not related to risk for a high inattention-hyperactivity symptom score in children across cohorts after adjustment for covariates. In contrast, maternal smoking and social adversity during pregnancy were independently and consistently associated with an increase in risk of child symptoms. CONCLUSIONS: Low doses of alcohol consumption during pregnancy were not related to child inattention/hyperactivity symptoms once social adversity and smoking were taken into account.

Maternal adiposity prior to pregnancy is associated with ADHD symptoms in offspring: evidence from three prospective pregnancy cohorts.

OBJECTIVES: We examine whether pregnancy weight (pre-pregnancy body mass index (BMI) and/or weight gain) is related to core symptoms of attention deficit hyperactivity disorder (ADHD) in school-age offspring. DESIGN: Follow-up of prospective pregnancy cohorts from Sweden, Denmark and Finland within the Nordic Network on ADHD. METHODS: Maternal pregnancy and delivery data were collected prospectively. Teachers rated inattention and hyperactivity symptoms in offspring. High scores were defined as at least one core symptom rated as 'severe' and two as 'present' (approximately 10% of children scored in this range). Logistic regression and latent class analyses were used to examine maternal pregnancy weight in relation to children's ADHD core symptoms. RESULTS: Teacher rated 12 556 school-aged children. Gestational weight gain outside of the Institute of Medicine guidelines was not related to ADHD symptoms (below recommendations: odds ratio (OR): 0.96; 95% confidence interval (CI): 0.81, 1.14; above recommendations: OR: 0.98; 95% CI: 0.82, 1.16). To examine various patterns of pre-pregnancy BMI and weight gain, we used latent class analysis and found significant associations between classes that included pre-pregnancy overweight or obesity and a high ADHD symptom score in offspring, ORs ranged between 1.37 (95% CI: 1.07, 1.75) and 1.89 (95% CI: 1.13, 3.15) adjusted for gestational age, birth weight, weight gain, pregnancy smoking, maternal age, maternal education, child gender, family structure and cohort country of origin. Children of women who were both overweight and gained a large amount of weight during gestation had a 2-fold risk of ADHD symptoms (OR: 2.10, 95% CI: 1.19, 3.72) compared to normal-weight women. CONCLUSIONS: We show for the first time that pre-pregnancy BMI is associated with ADHD symptoms in children. Our results are of public health significance if the associations are causal and will then add ADHD symptoms in offspring to the list of deleterious outcomes related to overweight and obesity in the prenatal period.

Insulin resistance and lipid levels in adolescents with familial risk for psychosis.

OBJECTIVE: Type 2 diabetes and dyslipidemias co-occur frequently with schizophrenia. It is not known how common they are in adolescents with a familial risk for psychosis. METHOD: The Northern Finland 1986 Birth Cohort consists of 9432 children born alive in the two Northernmost provinces in Finland. At the age of 15/16 they participated in clinical examination including measurements of glucose, lipids and IR, and a questionnaire including items about their diet and physical activity. The Finnish Hospital Discharge Register was used to find out non-organic psychoses in parents during 1972-2000. This familial risk was found out in 54 boys and 68 girls. Their results were compared with other cohort members. RESULTS: No differences were observed in the cardiometabolic risk factors between the study groups. CONCLUSION: Our results suggest that familial risk for psychosis is not directly associated with disturbances of glucose and lipid metabolism among adolescents.

Maternal smoking during pregnancy and delinquency of the offspring: an association without causation?

The aim was to evaluate the association between maternal smoking in pregnancy and delinquency of the offspring in youth and early adulthood. The study population consisted of 5966 male members of the Northern Finland birth cohort of 1966, of whom 355 (6.0%) had committed a crime which led to a criminal record by early 1989, which was taken as an indicator of delinquency. Data collection was started during pregnancy and the development and health of the children was followed up continuously to the age of 14. The incidence of delinquency by the age of 22 was 4.6% among the sons of the mothers who did not smoke during pregnancy and 10.3% among those of the smokers. No clear dose-response gradient was observed, and those stopping smoking during the first trimester of the pregnancy had only a slightly smaller incidence of delinquency than those continuing smoking through pregnancy. The association of maternal smoking with delinquency was studied by controlling a number of social and demographic variables using an approach based on stratification by a confounder score. The adjusted incidence difference between smoking and non-smoking mothers was 4.1% (95% confidence interval [CI] : 2.5-5.8) and the ratio was 1.73 (95% CI : 1.41-2.12). A parallel analysis by logistic regression yielded an estimated odds ratio of 1.74 (95% CI : 1.37-2.11) for the same comparison. Even though the association between maternal smoking and delinquency of the offspring remained after adjustment for the available social and demographic factors, maternal smoking may be symptomatic of a certain lifestyle and norm-breaking behaviour which is likely to increase delinquency in the children rather than being an agent with a direct causal role. This is supported by the lack of any clear dose-response pattern and the minor importance of stopping smoking. Another possibility is that maternal smoking may cause some kind of brain damage which affects the behaviour of the child.

The single parent family and the child's mental health.

The prevalence of psychiatric and psychosomatic disorders in a 1 year birth cohort from northern Finland followed up until 19 years was examined on the basis of hospital records and national registers for subsidies for chronically sick children. Psychiatric disorders were found to occur with higher frequency in children of single parent families, especially those lacking a father during the child's whole life. Childhood enuresis was most frequent in the children who had experienced the divorce of their parents. Discriminant function analysis was used to establish the explanatory value of the family constellation for both psychiatric disorders and enuresis. The other significant explanatory variables for psychiatric disorders were school performance, place of residence and the child's height at 1 year of age, with poor school performance, high population density and short stature increasing the risk. The other significant variables increasing the risk of enuresis were psychiatric disorders, poor school performance, juvenile smoking and small size of dwelling. Disabled children had psychiatric disorders 9 times as frequently as non-disabled ones.

Teenage alcohol drinking and non-standard family background.

The teenage alcohol drinking in 1980 is described in a cohort of 12,058 subjects born in Northern Finland in 1966, with special reference to non-standard families (with one or both parents absent). The percentage of boys (girls) who had been drinking alcohol at the age of 14 years, was 59.1 (58.3)%, being 57.5 (55.6%) in standard, full families and 66.0 (69.0)% in non-standard families. The percentage of having been drunk was 25.2 (25.1)%, or 22.8 (22.1)% in full families and 36.1 (37.1)% in the non-standard families. When adjusted for the maternal age at birth, place of residence, social class and child's status in the family (firstborn or not, only child or not) by means of regression modelling, the risk of alcohol drinking/having been drunk was still increased in non-standard families, especially in cases of divorce or same-sex parental death, the risk differences as compared to the standard family usually being between 10-20%. The results suggest that a non-standard family structure is associated with early juvenile alcohol drinking. Parental loss or absence may constitute one important factor leading to excessive haste in adopting the adolescent culture, including its potentially destructive habits.

Bullying and psychiatric symptoms among elementary school-age children.

OBJECTIVE: The aim of this study was to assess bullying and psychological disturbance among 5,813 elementary school-aged children. METHOD: The data consisted of information given by the parents, teachers, and children themselves (Rutter A2 Scale, Rutter B2 Scale and Children's Depression Inventory). Children involved in bullying (as bullies, bully-victims, and victims) were compared to other children. RESULTS: More boys than girls were found to be involved in bullying. Bully-victims scored highest in externalizing behaviour and hyperactivity, and they themselves reported feelings of ineffectiveness and interpersonal problems. Victims scored highest in internalizing behavior and also psychosomatic symptoms, and they themselves reported anhedonia. Some gender differences in psychiatric symptomatology were also found. Children involved in bullying, especially children who both bullied and were bullied themselves, were psychologically disturbed. More children involved in bullying than others were referred for psychiatric consultation. The probability of being referred was highest among bully-victims (6.5 fold for males and 9.9 for females when compared to children not involved in bullying). CONCLUSIONS: The findings indicate that bullying is a common phenomenon among children who are psychologically disturbed. Bullying also elevates the probability of being referred for psychiatric consultation.

To be born as a twin--risks and sequelae.

About 2.5% of infants born in Finland are twins. Twins have long been objects for genetic studies, which nowadays have large study groups, e.g. twin registers from a whole country. Twins can also be studied from another point of view: the special situation of being a twin, and its consequences on development and mental health. Perinatal mortality and morbidity are higher in twins than in singletons, and accordingly cumulative incidences of various handicaps are higher in twins. The human relationships of twins have their special features from the early beginning. Twins have to share the attention from the parents, and some parents resolve the situation by sharing the twins: "mother's child" and "father's child" may develop. Twins may be dependent on each other, and the inter-twin relationship can also be characterized by dominance-submissiveness. In adolescence, the time of getting independence from the parents, twins have also another task of development: they have to grow up from the co-twin dependence in order to become autonomous adults. In comparison to much bigger twin materials of genetic studies, follow-up studies in birth cohorts have their benefits, too. They give us a good opportunity to research the development of human relationships in twin families and their consequences on both somatic and mental health.

Risk factors and prognosis for psychiatric morbidity in children and adolescents.

Because of the new epidemiological studies during the past two decades our knowledge concerning child and adolescent psychiatric disorders has grown up. There exists data concerning the distribution of different disorders in the community. The development in the methodology of child psychiatric investigation has made it possible to study also the risk factors and prognostic features of child psychiatric disorders. In this paper risk and prognostic factors of various child psychiatric disorders are reviewed. All the findings from studies made in different countries are not suitable as such in Finland. No large scale epidemiological studies concerning the risk and prognostic factors of various child psychiatric disorders are available in Finland. The cohort-66 study offers a possibility to elucidate also these factors.

Long-term outcome of migration in childhood and adolescence.

The effect of migration on the family and on the individual can be divided into three groups: cultural, changes in social environment and changes in the interpersonal relations. When successful adaptation is not achieved, acculturative stress may arise and somatic or mental disorders may develop. The finding of individual differences in people's responses to environmental conditions has led to search for vulnerability factors that increase people's susceptibility to stressors and for buffering influences that serve a protecting function under the same circumstances. The studies on migration should focus on somatic and mental health of the migrants, on achievements at school and at work, on protecting factors at different ages of migration and on the role of language acquisition and of social network on the adaptational process. The focus on this review is in childhood, adolescence and young adulthood.

Munchausen-by-proxy syndrome: countertransference as a diagnostic tool.

The authors report on an unusual reaction in clinicians interviewing known perpetrators of Munchausen-by-proxy syndrome (MBPS): an uncanny, ego-dystonic, and cognitively dissonant sense that the parent could not be the perpetrator, despite all clinical/forensic evidence. The authors suggest that this reaction can have various sources: One may be "as-if" character pathology in the parent, with the capacity to evoke, unconsciously, disbelief in the clinician. Given the poor treatment outcome reported in MBPS perpetrators, the authors suggest that, if confirmed, this finding will lead to more accurate psychiatric diagnosis of the parent, and more informed treatment of this potentially harmful or lethal syndrome.

The growth, development and education of Finnish twins: a longitudinal follow-up study in a birth cohort from pregnancy to nineteen years of age.

The growth, development and vocation of 289 twins in a one year birth cohort beginning during pregnancy and followed up to the age of 19 years was compared with that of 11,623 singletons and two sets of controls matched either by maternal factors only or by these and perinatal morbidity, all from the same cohort. The twins were more often pre-term and small for their gestational age, and had more often suffered from perinatal asphyxia, neonatal hyperbilirubinaemia and hypoglycemia. They had learned to walk without support later than the singletons and the controls matched only by maternal factors, but this difference did not exist between the twins and the controls also matched by perinatal morbidity. The same kind of result was found when studying the number of words spoken at the age of one year and physical growth at the ages of 1 and 14 years. The twins did not differ significantly from the singletons during their compulsory nine years of primary and secondary schooling. According to the national registers of vocational choices, the twins had applied for admission to further education courses less often than the singletons or their controls matched only by maternal factors, but not when compared with the controls also matched by perinatal morbidity. Logistic regression analysis revealed numerous perinatal or environmental factors having an adverse effect on educational achievements, but the twin situation itself was not shown to have adverse effects. About half of the same-sex twin pairs and one seventh of the opposite-sex pairs had chosen the same vocation, compared with just over 10% similarity between the twins and their controls.

[Stress and coping with stress by mothers of children with mild cerebral dysfunctions]. / Stress und Stressbewältigung bei Müttern von Kindern mit leichten zerebralen Dysfunktionen.

Adapting the paradigm developed by Richard Lazarus, parenting stress and coping were studied among mothers of children (n = 42) with Minimal Brain Dysfunction (MBD) and mothers with non-disabled children (n = 42), aged 6 to 9. The children of control mothers were matched by age, sex, social status, and maternal marital status with the MBD children. The mothers of MBD children were found to experience more parenting difficulties, more negatively toned cognitive appraisals of their stakes in parenting and less positive adaptational outcomes than their controls. The mothers of MBD children appraised their mastery lower than their controls. However, family well-being, or self-esteem did not differ between the mothers of MBD children and their controls.

Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study.

Childhood bullying behaviors (bullying and victimization) were studied as risk factors for substance use among Finnish males. The study design was a nationwide prospective general population study, where information was collected in 1989 and 1999. Bullying behaviors and childhood psychopathology at age eight were collected from teachers, parents and boys themselves. At age 18, self-reports of frequent drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or more per day), and illicit drug use during the past six months were obtained from 78% of the boys attending the study at age eight (n=2946). Being frequently victimized at age eight predicted daily heavy smoking, and this was evident even after adjusting for childhood family background, psychopathology at age eight and at age 18, and other forms of substance use. In multivariate analysis, bullying others frequently predicted illicit drug use, while being a victim of bullying associated with a lower occurrence of illicit drug use. Bullying behaviors had no association with frequent drunkenness independent of other factors. Accordingly, being a victim of bullying predisposes in particular to subsequent smoking. Bullying others in childhood can be regarded as an early indicator to illicit drug use later in life. The screening and intervention possibilities in order to recognize the risk group for later health compromising behaviors are emphasized.

Physical activity and fitness in adolescents at risk for psychosis within the Northern Finland 1986 Birth Cohort.

BACKGROUND: Literature regarding physical activity and fitness among subjects at risk for psychosis especially in adolescents is scarce. This study evaluated the level of physical activity and cardio-respiratory fitness among subjects at risk for psychosis in a relatively large birth cohort sample. METHODS: The study population consisted of the Northern Finland Birth Cohort 1986 including 6987 adolescents who self-reported their physical activity by responding to a postal inquiry in 2001-2002 at the age of 15-16 years. Their cardiorespiratory fitness was measured in a clinical examination by a submaximal cycle ergometer test. Vulnerability to psychosis was defined in three ways: having a parent with a history of psychosis, having prodromal symptoms of psychosis measured by PROD-screen questionnaire at the age of 15-16 years or having actually developed psychosis after the field study (in 2002-2005). The Finnish Hospital Discharge Register was used to find out about parental and the individual's own psychosis. RESULTS: Those individuals who developed psychosis were more likely to be physically inactive (OR 3.3; CI 95% (1.4-7.9) adjusted for gender, parental socio-economic status, family structure and parents' physical activity) and to have poor cardiorespiratory fitness (OR 2.2; 95% CI 0.6-7.8 adjusted for parental socio-economic status, family structure and parents' physical activity) compared to those who did not develop psychosis. CONCLUSIONS: Adolescents who would actually develop psychosis had a relatively low level of physical activity compared to their age mates. General recommendations for physical activity would be important for subjects at risk for developing psychosis in order to avoid detrimental effect of physical inactivity on overall health.