Disparities in the prevalence of ADHD diagnoses, suspicion, and medication use between Flanders and Québec from the lens of the medicalization process.

The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses and medication use has increased over time around the world, but significant regional differences remain. This paper aims to determine and explain disparities in ADHD prevalence and medication use among school-aged children in two distinct school systems, in Flanders (Belgium) and Québec (Canada). We present detailed descriptive and comparative analyses of data from 35 schools, 114 teachers, and 1046 parents (children) that were collected as part of a comparative international project. The data concern teacher and parent suspicions, teachers' ratings of ADHD-related behaviors in children, teachers' views of medication use, and teachers' beliefs about ADHD. The results show that, compared with Flanders, Québec had significantly more children diagnosed with ADHD and more frequent suspicions of ADHD in children by teachers and parents. We refer to the conceptual, institutional, and interactional levels of medicalization to interpret our findings and conclude that social and cultural readings of children's behaviors differ greatly between regions. Medicalization of children's behaviors is more common in Québec than in Flanders.

Relative Age Effect in Attention Deficit/Hyperactivity Disorder at Various Stages of the Medicalization Process.

Diagnosis and pharmacological treatment of ADHD are more common among the youngest children in a classroom, born in the months immediately preceding the school entry cutoff date. The mechanisms behind this phenomenon, called the relative age effect (RAE), are not yet well understood. Nearly all hypotheses involve the school system, various teachers' actions, and concern children's immaturity. However, most previous studies have been based on reports of health professionals' diagnoses and prescriptions found in official databases rather than on reports of teachers' behavior identification or suspicion of ADHD, despite their being at the first stages of the medicalization process. Our study overcomes this limitation by using reports of parents' and teachers' behavior identification or suspicion of ADHD within a three-level multilevel survey design, comprising 1294 children, 130 teachers, and 17 elementary public schools. The goal of our study was to investigate whether RAE stems (1) from adults' judgement of the child's expression of immaturity or (2) from the consequences associated with the child's double burden of being immature and exhibiting ADHD behaviors. Our multilevel analyses put forward the first hypothesis only, supporting the medicalization of immaturity. RAE in ADHD seems mostly initiated by teachers' pre-diagnostic actions toward younger children.

Depressive symptoms in higher education students during the COVID-19 pandemic: the role of containment measures.

BACKGROUND: Students are a vulnerable group for the indirect impact of the COVID-19 pandemic, particularly their mental health. This paper examined the cross-national variation in students' depressive symptoms and whether this can be related to the various protective measures implemented in response to the initial stage of the COVID-19 outbreak. METHODS: Student data stem from the COVID-19 International Student Well-being Study, covering 26 countries during the first wave of the COVID-19 pandemic. Country-level data on government responses to the COVID-19 pandemic were retrieved from the Oxford COVID-19 Tracker. Multilevel analyses were performed to estimate the impact of the containment and economic support measures on students' depressive symptoms (n = 78 312). RESULTS: School and workplace closures, and stay-at-home restrictions were positively related to students' depressive symptoms during the COVID-19 pandemic, while none of the economic support measures significantly related to depressive symptoms. Countries' scores on the index of these containment measures explained 1.5% of the cross-national variation in students' depressive symptoms (5.3%). This containment index's effect was stable, even when controlling for the economic support index, students' characteristics, and countries' epidemiological context and economic conditions. CONCLUSIONS: Our findings raise concerns about the potential adverse effects of existing containment measures (especially the closure of schools and workplaces and stay-at-home restrictions) on students' mental health.

Gender, work-family conflict and depressive symptoms during the COVID-19 pandemic among Quebec graduate students.

The increasing mental health inequalities between women and men following the COVID-19 crisis represent a major public health concern. Public health measures to mitigate the pandemic could severely impact populations with high prevalence of mental health problems such as graduate students. We aimed to document the gendered experience of the lockdown and its association with depressive symptoms among graduate students in Quebec. We contrast two hypotheses: whether inequalities in depressive symptoms between women and men could be linked to their differential exposure or vulnerability to work, family and study conditions, with the mediating role of work-to-family interference (WIF) and family-to-work interference (FIW). This observational study used path analysis to test our hypotheses using a cross-sectional data collected from 1,790 graduate students from three universities in Quebec. The exposure hypothesis received more support. Women reported more stress regarding new teaching methods, which was associated directly with more depressive symptoms, and indirectly through WIF. Women were more worried about COVID-19, which was associated with more depressive symptoms, and indirectly through WIF and FIW. However, women reported less FIW and more emotional support, both respectively associated with less depressive symptoms. The policy measures taken after the COVID-19 were not gender-neutral. This study demonstrates the importance of taking the potentially gendered effects of policies into consideration, and points to mitigating actions that can forestall the exacerbation of gendered inequalities in mental health.

The children's eating attitudes test: French validation of a short version.

PURPOSE: Disordered eating attitudes and behaviors (DEAB) in childhood have been prospectively associated with eating disorders and obesity in adolescence. Therefore, evaluating DEAB in children with a reliable, sensitive and well-adapted scale is very important. The Children's Eating Attitudes Test (ChEAT) is one of the most popular measuring tools for DEAB in children, but no French version is available. Moreover, while completion time is an important factor to be considered when working with children, only one recent study proposed a shorter version of the ChEAT. Taking the previous works of Murphy and colleagues (2019) as a starting point, the current study aimed to provide the first French-speaking validated 14-item short version of the ChEAT. METHODS: A sample of 1092 boys and girls aged between 8 and 12 years old were recruited in two urban areas in the province of Quebec, Canada. They completed the ChEAT, and their height and weight were measured at school. Factorial structure and internal consistency were assessed. RESULTS: After the initial factorial analysis, two "vomiting (or purging)" items were yielded as problematic and were thus removed from the analysis. The remaining 12 items provided a good fit to the data and a good internal consistency. Moreover, the factorial structure was proved to be invariant across sexes. CONCLUSION: This study is the first to provide a French assessment of DEAB in elementary school children. The French short version of the ChEAT provided a quick and reliable assessment for DEAB with non-clinical children population and could be used as a screening tool, even though no cut-off was established yet. LEVEL OF EVIDENCE: Cross-sectional, descriptive study, Level V.

Appearance Esteem Trajectory According to Three Different Sources of Support Among Adolescents Over a School Year.

Although social support has been linked to body satisfaction, there has been little research on the effect of differential sources of support on the trajectory of appearance esteem over time. To address this gap, this study explored changes in adolescents' appearance esteem to perceived social support over one year. Data were collected from 339 Canadian adolescents (54.57% females) in Grade 7 (Mage = 12.05) and Grade 10 (Mage = 15.14). Multilevel growth modeling revealed that perceived social support from fathers was not associated with appearance esteem, whereas mothers' support had the strongest effect on appearance esteem, consistently over time. Friends' support was also related to an increase in the appearance esteem trajectory, but only for older students. Overall, this prospective study provides a better understanding of the unique contribution of three different sources of social support during adolescence for preventing negative appearance esteem, beyond the effects of other related variables.

The Paths to Children's Disordered Eating: The Implications of BMI, Weight-Related Victimization, Body Dissatisfaction and Parents' Disordered Eating.

Background: Being the target of peer victimization is frequent among children categorized as overweight and obese and is thought to play a central role in disordered eating behavior development. In accordance with a previous theoretical model, this cross-sectional study aimed to replicate among children the mediating role of weight-related victimization from peers and body dissatisfaction in the association between body mass index (BMI) and children's disordered eating attitudes and behaviors (CDEAB), while also taking into account the contribution of parents' disordered eating attitudes and behaviors (PDEAB). Methods: Participants were 874 children aged between 8 and 12 years old who were recruited in elementary schools. Height and weight were measured and used to calculate BMI. Self-reported questionnaires were used to measure weight-related victimization, body dissatisfaction, CDEAB and PDEAB. Results: For both girls and boys, a path analysis showed no direct effect of BMI on CDEAB, but a significant indirect effect was found, indicating that weight-related victimization and body dissatisfaction mediated this relationship. In addition, the indirect effect of weight-related victimization and body dissatisfaction remained significant even when controlling for PDEAB. Conclusion: While weight itself appears to be insufficient to explain CDEAB, weight-related victimization may lead children to see their weight as problematic and develop disordered attitudes and behaviors toward eating. This suggests that weight-related victimization from peers and body dissatisfaction must be taken seriously and that preventive and intervention efforts must be pursued.

Witnessing violence in early secondary school predicts subsequent student impairment.

BACKGROUND: Past research suggests that adolescents who witness violence are at risk of adjustment problems. However, few studies have implemented a longitudinal design and have accounted for direct experiences of victimisation and other major confounders. This prospective study examines the relationship between witnessing school violence and subsequent impairment and whether such associations depend on the kind of violence witnessed. METHODS: 3936 adolescents from Quebec (Canada) were followed from ages 12 through 15 years. Linear regression tested associations between witnessing school violence at age 13 and subsequent antisocial behaviour (drug use, delinquency), emotional distress (social anxiety, depressive symptoms) and academic adjustment (school achievement, engagement) at age 15. We compared the relative contribution of differing forms of witnessing school violence versus being victimised directly. RESULTS: General school violence predicted later impairment. The adjusted associations between indirectly experiencing violence as a bystander and subsequent impairment were comparable to those of direct victimisation. Witnessing covert and major violence was associated with drug use and delinquency. Witnessing minor violence was associated with increases in drug use, social anxiety, depressive symptoms and decreases in school engagement. CONCLUSIONS: Almost all students witnessed school violence, which predicted impairment. Witnessing violence was associated with risk of subsequent adjustment problems 2 years later. Directly experienced victimisation showed a comparable magnitude of risk. This suggests that when it comes to symptoms of conduct disorder, witnessing violence might have the same impact as experiencing it directly. Witnessing earlier covert and major violence predicted social impairment whereas minor violence predicted psychological and academic impairment.

Individual, social, and family factors associated with high school dropout among low-SES youth: Differential effects as a function of immigrant status.

BACKGROUND: In most Western countries, the individual, social, and family characteristics associated with students' dropout in the general population are well documented. Yet, there is a lack of large-scale studies to establish whether these characteristics have the same influence for students with an immigrant background. AIMS: The first aim of this study was to assess the differences between first-, second-, and third-generation-plus students in terms of the individual, social, and family factors associated with school dropout. Next, we examined the differential associations between these individual, social, and family factors and high school dropout as a function of students' immigration status. SAMPLE: Participants were 2291 students (54.7% with an immigrant background) from ten low-SES schools in Montreal (Quebec, Canada). METHOD: Individual, social, and family predictors were self-reported by students in secondary one (mean age = 12.34 years), while school dropout status was obtained five or 6 years after students were expected to graduate. RESULTS: Results of logistic regressions with multiple group latent class models showed that first- and second-generation students faced more economic adversity than third-generation-plus students and that they differed from each other and with their native peers in terms of individual, social, and family risk factors. Moreover, 40% of the risk factors considered in this study were differentially associated with first-, second-, and third-generation-plus students' failure to graduate from high school. CONCLUSION: These results provide insights on immigrant and non-immigrant inner cities' students experiences related to school dropout. The implications of these findings are discussed.

Well-being, gender, and psychological health in school-aged children.

BACKGROUND: Despite being a well-documented phenomenon, gender differences in psychological health complaints in adolescence are poorly understood. The purpose of this study was to test factors related to well-being as explanatory factors of gender differences in psychological complaints (feeling low, irritability or bad temper, nervousness, and sleeping difficulties) in adolescence. METHODS: This study was based on the 9(th) Health Behaviour in School-aged Children (HBSC) study, conducted in 2010 in the Wallonia-Brussels Federation, Belgium, on 9-24 year olds. Using logistic regression analyses, we studied gender differences in psychological complaints through well-being factors (life satisfaction, self-confidence, helplessness, and body image), across age categories, and examined the variation of female excess after taking into account each factor. RESULTS: The four well-being factors together explained more than half of the female excess in feeling low. However, there were still significant gender differences in feeling low for children over 13. Among 13 to 15-year-olds, there were no gender differences in irritability after adjustment. An important decrease in gender differences in nervousness was observed in the multivariate analyses, although there was still significant female excess in nervousness increasing from 13 years old. After full adjustment, only gender differences in sleeping difficulties among 13-15-year-olds remained significant. For all psychological complaints studied, self-confidence caused the most important decrease in gender difference. CONCLUSIONS: This study showed that factors related to well-being could mediate the association between gender and psychological complaints, and pointed to the importance of taking into account well-being factors in the analyses of the aetiology of gender differences in psychological complaints. However, our results suggested that future research should explore additional explanations for gender differences in psychological complaints.

Body Mass Index Accuracy in Preadolescents: Can We Trust Self-Report or Should We Seek Parent Report?

OBJECTIVES: To assess the accuracy of self- and parent-report of weight, height, and body mass index (BMI) in children between 8 and 12 years of age and to determine whether self- or parent-report should be preferred for preadolescents' subjective measures. STUDY DESIGN: Through at-home questionnaires, 875 preadolescent children (44% boys; 56% girls) and their parents (N = 821) were asked to report the children's weight and height. Objective weight and height were measured at school by trained interviewers. RESULTS: Correlations between objective, self-reported, and parent-reported measures were strong for weight, height, and BMI, but children and parents generally underestimated the children's weight by about 1 kg, their height by less than 1 cm, and their BMI by less than 0.25 kg/m(2). The magnitude of the underestimation varied by age, sex, and BMI category, with older children, girls, and children in the overweight and obese BMI categories underestimating their weight to a greater extent. Weight estimates provided by girls' parents tended to be lower than the real values more often than those of boys' parents. CONCLUSIONS: Children and parents are likely to misreport children's weight, height, and BMI. For most youths aged 8 years of age and older, self-report appears as accurate as parent-report and could, therefore, be used interchangeably.

Heterogeneity of sex-stratified BMI trajectories in children from 8 to 14 years old.

OBJECTIVE: Describe and predict sex-stratified trajectories of weight change in youths transitioning from childhood to adolescence. METHODS: Using an accelerated longitudinal design, 461 children between 8 and 12 years old at baseline were followed over three years. Body mass index was calculated from self-reported height and weight. Latent class growth analysis was used to identify BMI trajectories and multinomial logistic regressions, to predict group membership. RESULTS: A four-group heterogeneous trajectory model emerged for boys and girls alike. Characteristics of the trajectories differed between sexes and no obesity group was found for boys. Sociocultural factors, such as media influence, body dissatisfaction, weight victimization, awareness of thin-ideal standards and related pressures were important correlates of trajectory membership. CONCLUSION: BMI trajectories during preadolescence are stable over time for heavier children. Body image concerns and weight stigmatization stand out as important factors in the prediction of developmental weight trajectories and could therefore be integrated in weight gain prevention programs for children of all weights as well as in weight management interventions for overweight and obese children.

Prevalence of prescribed attention-deficit hyperactivity disorder medications and diagnosis among Canadian preschoolers and school-age children: 1994-2007.

OBJECTIVE: To describe trends in the prevalence of prescribed attention-deficit hyperactivity disorder (ADHD) medication by Canadian preschoolers and school-age children and to compare these with trends in the prevalence of the ADHD diagnosis between 1994 and 2007. METHODS: Subjects participated in the National Longitudinal Survey on Children and Youth, a Canadian prospective survey collecting data biennially. Three cross-sectional samples of nonreferred children, aged 3 to 9 years and representative of Canadian children for 1994-1995 (n = 12 595), 2000-2001 (n = 13 904), and 2006-2007 (n = 14 655), were selected for the analyses. Information on prescribed medications and ADHD diagnosis was reported by each child's parents. Prevalence was estimated at each cycle, taking the child's age and sex into account. RESULTS: The estimated prevalence of prescribed medications and ADHD diagnosis in Canada was generally low (less than 3%), but higher for boys (less than 4%) and school-age children (less than 5%). Preschoolers' prevalence of both prescribed medications and ADHD diagnosis stayed stable between 1994 and 2007 (1% or less), while that of school-age children increased nearly 2-fold. Boys' prevalence was higher than that of girls, but girls show the steepest increase over time, up to 2.1-fold. The association between prescribed medications and ADHD diagnosis has strengthened during the 2000s: a greater number of medications were used for children with ADHD (from 43% in 2000 to 59% in 2007) while off-label use of prescribed medications decreased among school-age children. CONCLUSIONS: The upward trend in the prevalence of prescribed ADHD medications and ADHD diagnosis currently observed in contemporary societies is also occurring in Canada, except with preschoolers.

Depressive symptoms in the Belgian population: disentangling age and cohort effects.

OBJECTIVE: Although the association between age and depression has been previously demonstrated, uncertainty remains because of the confounding relationship existing between age and cohort. A study by Yang (J Health Soc Behav 48(1):16, 2007) has evidenced important cohort effects and age-by-cohort interactions in depressive symptoms among US citizens. A crucial limitation, however, is that this study confines itself to elderly population. The objective of the present study is to bring further clarification to the association between age, cohort membership and depressive symptoms, by analyzing a sample with a wider age range. METHODS: The Panel Study of Belgian Households is a prospective longitudinal survey, following adults ages 25-74, annually from 1992 to 2002. Missing data were replaced using multiple imputation, allowing for a complete dataset (N = 7,000) at each wave. Respondents were classified into one of five birth cohorts: 1918-1927; 1928-1937; 1938-1947; 1948-1957; 1958-1967. Frequency of depressive symptoms was reported using a modified version of the Health and Daily Living form. Growth curve modeling was used to determine the effect of age and cohort on depression trajectory. RESULTS: All cohorts differed significantly from one another, with recent cohorts always obtaining the highest mean HDL-depression score. The intensity of depressive symptoms increases linearly with age, but significant age-by-cohorts interactions were detected, indicating that the relationship between age and depression varies across cohorts. No evidence of a WW2 effect was found. CONCLUSION: The association between age and depression has to take cohort membership into account. Cohort replacement effects explain the increase in depression in Belgium.