Does group-based parent support during the transition to parenthood affect child socio-emotional problems and health care utilization? A randomized controlled trial.

As government-funded universal programs for new parents continue to expand, it is critical to investigate their short- and longer-term effects. The level of knowledge, especially on the effect of group-based interventions, is sparse. This study is the second report from a large trial of a widely implemented universal group-based parenting program in Denmark and includes outcomes on child socio-emotional problems and use of health services. A sample of 1701 unborn children from families representative within the area, were randomized to intervention or care as usual beginning November 2014. From these families, 1268 mothers and 999 partners (mean age 29.4 and 31.19, respectively; 6% migration background) filled in the Ages and Stages Questionnaire. Intention-to-treat-analyses showed fewer socio-emotional problems in the intervention group (between-group difference - 2.34, 95% CI [0.40, 4.30], d = - 0.13) as reported by mothers, but not partners, when children were 10 months old. This finding was transitory (no longer significant at 19 months). No effects were found on health care utilization. The previous report from this trial showed no effects on measures of parenting. In total, these findings serve the purpose of adjusting future expectations to the size and type of effect to be gained from a universal parent program in a resourceful setting. We conclude that even if the Family Startup Program (DK: Familieiværksætterne) 2 was liked, well implemented, and well attended by the parents, the positive effect on children's socio-emotional problems, was too modest to be the argument that can carry the weight of policy going forward. PUBLIC SIGNIFICANCE STATEMENT: This study examined the effects of the Family Startup Program (DK: Familieiværksætterne), a universal, group-based program to support parents during the transition to parenthood. Results showed a modest transitory preventive effect on children's socio-emotional problems and no effects on health care utilization. These findings adjust down previous expectations to the size and type of effects to be gained from universal group-based parent support in a well-resourced setting.

Early-Life Injuries and the Development of Attention-Deficit/Hyperactivity Disorder.

Objective: To estimate phenotypic and familial association between early-life injuries and attention-deficit/hyperactivity disorder (ADHD) and the genetic contribution to the association using polygenic risk score for ADHD (PRS-ADHD) and genetic correlation analyses.Methods: Children born in Denmark between 1995-2010 (n = 786,543) were followed from age 5 years until a median age of 14 years (interquartile range: 10-18 years). Using ICD-10 diagnoses, we estimated hazard ratios (HRs) and absolute risks of ADHD by number of hospital/emergency ward-treated injuries by age 5. In a subset of ADHD cases and controls born 1995 to 2005 who had genetic data available (n = 16,580), we estimated incidence rate ratios (IRRs) for the association between PRS-ADHD and number of injuries before age 5 and the genetic correlation between ADHD and any injury before age 5.Results: Injuries were associated with ADHD (HR = 1.61; 95% CI, 1.55-1.66) in males (HR = 1.59; 1.53-1.65) and females (HR = 1.65; 1.54-1.77), with a dose-response relationship with number of injuries. The absolute ADHD risk by age 15 was 8.4% (3+ injuries) vs 3.1% (no injuries). ADHD was also associated with injuries in relatives, with a stronger association in first- than second-degree relatives. PRS-ADHD was marginally associated with the number of injuries in the general population (IRR = 1.06; 1.00-1.14), with a genetic correlation of 0.53 (0.21-0.85).Conclusions: Early-life injuries in individuals and their relatives were associated with a diagnosis of ADHD. However, even in children with the most injuries, more than 90% were not diagnosed with ADHD by age 15. Despite a low positive predictive value and that the impact of unmeasured factors such as parental behavior remains unclear, results indicate that the association is partly explained by genetics, suggesting that early-life injuries may represent or herald early behavioral manifestations of ADHD.

Discontinuity in care: Practice closures among primary care providers and patient health care utilization.

We evaluate the consequences for patients of being matched to a new primary care provider due to practice closures. Using an event study and population-level data of patients and providers in Denmark, we find that the transition between providers is smooth; among re-matched patients, there is little change in primary care utilization at the extensive margin. Second, we document a 17% increase in fee-for-service per visit and a large increase in the probability that the patient initiates drug therapy targeting chronic and underdiagnosed diseases (hypertension, hyperlipidemia, and diabetes). Additionally, the re-matched patients are more likely to be admitted to inpatient care for these diseases. The increase in therapeutic initiation is not primarily because the new providers are relatively predisposed to prescribing these drugs. Instead, it appears that when patients match to new providers, there is a consequential reassessment of patients' medical needs which leads to the initiation of new treatment.

Group-based parent support during the transition to parenthood: Primary outcomes from a randomised controlled trial.

RATIONALE: Theory suggests that when parents believe in their ability to positively influence their children, the children are at lower risk of poor developmental outcome. For this reason, parents' sense of competence is a common target in early parenting interventions. OBJECTIVE: This study assessed effects on parents' sense of competence, parenting stress, and symptoms of depression from a widely implemented universal and group-based parenting program. METHODS: In total, 1701 families were enrolled and randomised to one of two conditions a) participation in Family Start up Program (FSP), currently implemented at large scale in Denmark, or b) Care as Usual (CAU). FSP aims to empower new parents through knowledge and network. CAU is the public pre- and post-natal care available to families in both conditions. Recruitment was conducted between November 24, 2014, and February 1, 2017 at Aarhus University Hospital, from all incoming pregnant women within one of the larger Danish municipalities. In total, 4313 families were assessed for eligibility. Data were analysed as intention-to-treat and with n = 1255 (74%) mothers and n = 984 (60%) partners who responded at 10 months postpartum. RESULTS: When randomised to the FSP, 92% of the mothers and 94% of the partners received the intervention attending an average of 8.4 [SD = 3∙4] and 7.9 [SD = 3∙3] group meetings, respectively. The program evaluation data indicated that parents were satisfied with the program. We found no mean differences between FSP and CAU in parental sense of competence, parental stress, or symptoms of depression at 10 months in mothers or partners. CONCLUSION: The intervention did not influence parents' sense of competence even if the parents attended and liked the group meetings. This highlights the need for refinement of either the intervention approach or the expectation to its outcome. ClinicalTrials.gov ID: NCT02294968.

Maternity ward crowding, procedure use, and child health.

This paper studies the impact of day-to-day variation in maternity ward crowding on medical procedure use and the health of infants and mothers. Exploiting data on the universe of Danish admissions to maternity wards in the years 2000-2014, we first document substantial day-to-day variation in admissions. Exploiting residual variation in crowding, we find that maternity wards change the provision of medical procedures and care on crowded days relative to less crowded days, and they do so in ways that alleviate their workload. We find very small and precisely estimated effects of crowding on child and maternal health. Thus our results suggest that, for the majority of uncomplicated births, maternity wards in Denmark can cope with the observed inside-ward variation in daily admissions without detectable health risks.

The prevalence of intimate partner violence among couples signing up for universally offered parent preparation.

BACKGROUND: Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and the unborn child. Nevertheless, IPV is seldom addressed in the context of parent preparation. AIM: This study aimed to map the prevalence, direction, and severity of IPV in a sample of expectant couples signing up for universally-offered parent preparation. METHOD: A total of 1726 Danish couples expecting their first child provided data on physical and psychological IPV by completing the Family Maltreatment measure during the second trimester of pregnancy. RESULTS: In 18.5% of the couples, at least one partner reported psychological or physical IPV acts during the past year. In more than 8% of couples, one or both partners reported acts and impacts above the ICD-11 threshold for clinically-significant IPV (CS-IPV) during the past year (3.6% physical CS-IPV, 5.3% psychological CS-IPV, and 0.8% both physical and psychological CS-IPV). Among couples with physical IPV below the clinical threshold, pregnant-woman-to-partner (50%) and bidirectional (38.2%) IPV were more common than partner-to-pregnant-woman IPV (11.8%). Among couples with physical CS-IPV, pregnant-woman-to-partner (36.1%), partner-to-pregnant-women (29.1%) and bidirectional (34.4%) forms were equally common. Among couples with psychological IPV, pregnant-woman-to-partner (54.9%) and partner-to-pregnant-woman (39.6%) IPV were more common than bidirectional IPV (5.5%). DISCUSSION: The prevalence of violence was markedly higher in this study compared with previous reports from the Nordic region and highlights a previous oversight of a substantial and clinically significant level of pregnant-woman-to-partner IPV-as well as the reverse. Data from this study call for IPV to be addressed in universally offered parent preparation programs.

First-time mothers' confidence mood and stress in the first months postpartum. A cohort study.

OBJECTIVES: The aims were to describe first-time mothers' confidence, mood and stress 2 and 6 months postpartum and to investigate the extent to which the tools measuring maternal confidence and maternal mood used alone or together at 2 months postpartum predict first-time maternal confidence, mood and stress 6 months postpartum. DESIGN: A cohort including 513 first-time mothers' self-reported questionnaires concerning three scales: The Karitane Parenting Confidence Scale (KPCS), the Edinburgh Postnatal Depression Scale (EPDS), and the Parental Stress Scale (PSS) collected 2 and 6 months postpartum. Descriptive statistic, simple and multiple linear regression analysis were used. RESULTS: First-time mothers' with confidence scores below the clinical cut-off (KPCS <40) fell significantly from 25% to 14% (p < 0.001), symptoms of depression above the clinical cut-off (EPDS ≥ 8) fell significantly from 16% to 12% (p < 0.001), and parental stress as a mother fell significantly from a mean of 32.88 to 30.98 (p < 0.001). The KPCS assessed at 2 months postpartum was the strongest predictor for both maternal confidence (R2 = 0.38) and parental stress (R2 = 0.26) 6 months postpartum. CONCLUSION: The results support the assumption that parenthood is a complicated period for first-time mothers characterised by low confidence, symptoms of depression and high stress which improve over time for the majority of mothers. The KPCS at 2 months postpartum was the strongest predictor of the measures used. Further research is needed to identify parents who are struggling, especially for health professionals' whose role is to support parents in their parenthood the first period after birth.

Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study.

BACKGROUND: Supporting early mother-infant relationships to ensure infants' future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities. METHODS: This quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis. RESULTS: The levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93-10.09) compared with 7.62 (95%CI;7.03-8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96-10.14) compared with 7.83 (95%CI;7.19-8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88-9.99) in the intervention group compared with 7.73 (95%CI;7.13-8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13-33.94) compared with 35.29 (95%CI;34.07-36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22-41.98) compared with 40.10 (95%CI;39.65-40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE. CONCLUSION: The findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method. TRIAL REGISTRATION: This study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447 .

Allometric trajectories of body and head morphology in three sympatric Arctic charr (Salvelinus alpinus (L.)) morphs.

A study of body and head development in three sympatric reproductively isolated Arctic charr (Salvelinus alpinus (L.)) morphs from a subarctic lake (Skogsfjordvatn, northern Norway) revealed allometric trajectories that resulted in morphological differences. The three morphs were ecologically assigned to a littoral omnivore, a profundal benthivore and a profundal piscivore, and this was confirmed by genetic analyses (microsatellites). Principal component analysis was used to identify the variables responsible for most of the morphological variation of the body and head shape. The littoral omnivore and the profundal piscivore morph had convergent allometric trajectories for the most important head shape variables, developing bigger mouths and relatively smaller eyes with increasing head size. The two profundal morphs shared common trajectories for the variables explaining most of the body and head shape variation, namely head size relative to body size, placement of the dorsal and pelvic fins, eye size and mouth size. In contrast, the littoral omnivore and the profundal benthivore morphs were not on common allometric trajectories for any of the examined variables. The findings suggest that different selective pressures could have been working on traits related to their trophic niche such as habitat and diet utilization of the three morphs, with the two profundal morphs experiencing almost identical environmental conditions.

ARE HEALTH VISITORS' OBSERVATIONS OF EARLY PARENT-INFANT INTERACTIONS RELIABLE? A CROSS-SECTIONAL DESIGN.

Health visitors need competences to promote healthy early parent-infant relationships. The aims of this study were to explore whether there are differences between groups of health visitors with and without additional parenting program education in terms of their knowledge of infant-parent interaction and their observation and assessment skills of such interactions. The cross-sectional study included 36 health visitors' certified Marte Meo therapists and 85 health visitors without additional parenting program education. Health visitors' observation skills were measured assessing five video-recorded mother-infant interactions. A questionnaire was used to measure their intention, self-efficacy, and knowledge. More certified Marte Meo therapists than health visitors without additional parenting program education reported a significantly higher mean level of knowledge of the early relationship, 6.42 (95% CI; 6.18-6.66) versus 5.05 (95% CI; 4.86-6.10), p = .04; and more certified Marte Meo therapists than health visitors without additional parenting program education reported a higher mean level of knowledge of infant self-regulation, 2.44 (95% CI; 2.18-2.71) versus 1.83 (95% CI; 1.62-2.03), p < .001. In the latter group, 54% (95% CI; 0.43-0.64) reported a significantly higher need for further education versus 22% (95% CI; 0.11-0.39), p = .001. Compared to health visitors without any parenting program education, health visitors certified as Marte Meo therapists reported a significantly higher frequency of correct assessment of mothers' sensitivity in two of five video-recordings, with 77.78% (95% CI; 0.61-0.87) compared to 45.88% (95% CI; 0.35-0.57) in Video 3, p = .001, and 69.44% (95% CI; 0.52-0.82) compared to 49.41% (95% CI; 0.39-0.60) in Video 4, p = .04, respectively. The results of the present study support the use of video-based education of health visitors to increase their knowledge of and skills in assessing parent-infant interactions. Randomized controlled trials are needed to determine whether the improved level of health visitors' knowledge and observation skills may be assigned to participation in the Marte Meo education program.

Playing the Fertility Game at Work: An Equilibrium Model of Peer Effects.

We study workplace peer effects in fertility decisions using a game theory model of strategic interactions among coworkers that allows for multiple equilibria. Using register-based data on fertile-aged women working in medium sized establishments in Denmark, we uncover negative average peer effects. Allowing for heterogeneous effects by worker type, we find that positive effects dominate across worker types defined by age or education. Negative effects dominate within age groups and among low-education types. Policy simulations show that these estimated effects make the distribution of where women work an important consideration, beyond simply if they work, in predicting population fertility.

Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study.

BACKGROUND: Injuries represent the largest disease burden and most common cause of death in children. Attention deficit hyperactivity disorder (ADHD) is associated with increased mortality, with accidents being the most common cause of death in ADHD. However, it is not known whether pharmacological treatment has any modifying effect on the risk of injuries in children and adolescents with ADHD. METHODS: Using Danish national registers, we followed a cohort of 710 120 individuals, including 4557 individuals diagnosed with ADHD before age 10 years. Using a quasi-experimental, difference-in-difference design, we estimated the odds ratios (ORs) for injuries and the mean change in prevalence rates of injuries and emergency ward visits before and after treatment, with matched untreated children with ADHD at the same age serving as controls. FINDINGS: Children with ADHD were more likely to sustain injuries, compared with children without ADHD, at age 10 years (adjusted OR=1·29, 95% CI 1·22-1·37) and at age 12 years (adjusted OR=1·30, 1·23-1·37). From age 5 to 10 years, the prevalence of injuries in children with ADHD who were treated with ADHD drugs decreased from 19% to 14%, compared with a prevalence of about 17% in non-treated children with ADHD. This corresponded to an adjusted difference-in-difference reduction in prevalence of injuries at age 10 years of 31·5% (8·2-54·8) and 43·5% (18·1-69·0) at age 12 years due to treatment. Pharmacological treatment also reduced the prevalence of emergency ward visits at age 10 years (28·2%, 6·3-50·1) and age 12 years (45·7%, 25·8-65·7). INTERPRETATION: Children with ADHD had an increased risk of injuries compared with other children. Treatment with ADHD drugs reduced the risk of injuries by up to 43% and emergency ward visits by up to 45% in children with ADHD. Taken together with previous findings of accidents being the most common cause of death in individuals with ADHD, these results are of major public health importance. FUNDING: The Lundbeck Foundation, the Danish Council for Independent Research, Centre For Integrated Register-based Research at Aarhus University, the Region of Southern Denmark Research Foundation, and Wørzner's Foundation.

The Family Startup Program: study protocol for a randomized controlled trial of a universal group-based parenting support program.

BACKGROUND: Inadequate parenting is an important public health problem with possible severe and long-term consequences related to child development. We have solid theoretical and political arguments in favor of efforts enhancing the quality of the early family environment in the population at large. However, little is known about effect of universal approaches to parenting support during the transition to parenthood. This protocol describes an experimental evaluation of group based parenting support, the Family Startup Program (FSP), currently implemented large scale in Denmark. METHODS/DESIGN: Participants will be approximately 2500 pregnant women and partners. Inclusion criteria are parental age above 18 and the mother expecting first child. Families are recruited when attending routine pregnancy scans provided as a part of the publicly available prenatal care program at Aarhus University Hospital, Skejby. Families are randomized within four geographically defined strata to one of two conditions a) participation in FSP or b) Treatment As Usual (TAU). FSP aims to prepare new families for their roles as parents and enhance parental access to informal sources of support, i.e. social network and community resources. The program consists of twelve group sessions, with nine families in each group, continuing from pregnancy until the child is 15 months old. TAU is the publicly available pre- and postnatal care available to families in both conditions. Analyses will employ survey data, administrative data from health visitors, and administrative register based data from Statistics Denmark. All data sources will be linked via the unique Danish Civil Registration Register (CPR) identifier. Data will be obtained at four time points, during pregnancy, when the child is nine months, 18 months and seven years. The primary study outcome is measured by the Parenting Sense of Competence scale (PSOC) J Clin Child Psychol 18:167-75, 1989. Other outcomes include parenting and couple relationship quality, utility of primary sector service and child physical health, socio-emotional and cognitive development. DISCUSSION: The protocol describes an ambitious experimental evaluation of a universal group-based parenting support program; an evaluation that has not yet been made either in Denmark or internationally. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02294968. Registered November 14 2014.

Consequences of ADHD medication use for children's outcomes.

This paper estimates effects of early ADHD medication use on key human capital outcomes for children diagnosed with ADHD while using rarely available register based data on diagnoses and prescription drug purchases. Our main identification strategy exploits plausible exogenous assignment of children to hospitals with specialist physicians, while our analysis of health outcomes also allows for an individual level panel data strategy. We find that the behavior of specialist physicians varies considerably across hospitals and that the prescribing behavior does affect the probability that a given child is treated. Results show that children diagnosed with ADHD in pharmacological treatment have fewer hospital contacts if treated and that treatment to some extent protects against criminal behavior.

Cardiovascular safety of stimulants in children with attention-deficit/hyperactivity disorder: a nationwide prospective cohort study.

OBJECTIVE: The purpose of this study was to determine whether stimulant users are at higher risk of a later cardiovascular event than are non-users, examining this association in both a national cohort and a population-based sample of children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD). We also aim to examine a possible dose-response relationship in such an association. METHODS: We conducted a longitudinal, prospective cohort study of all children born in Denmark between 1990 and 1999. Within this cohort, children with ADHD were identified. Data from national health registers on psychiatric and somatic diagnoses, stimulant prescriptions, cardiovascular risk factors, pre- and perinatal and sociodemographic covariates in all children and their parents were merged, using the unique personal identification number. Hazard ratios (HR) for cardiovascular events were estimated using Cox regression, adjusted for other known risk factors. RESULTS: In the total population (n=714,258 contributing a total of 6,767,982 person-years) use of stimulants increased the risk of a cardiovascular event; adjusted HR=1.83 (1.10-3.04). In children with ADHD (n=8300) stimulant treatment also increased the risk of a cardiovascular event (adjusted HR=2.20 [2.15-2.24]), with a complex time-dependent dose-response relationship. CONCLUSIONS: This is the first nationwide cohort study of the cardiovascular safety of stimulants in children and adolescents, and it represents, to our knowledge, the longest prospective follow-up study. Cardiovascular events were rare but twice as likely in stimulant users as in non-users, both in the total national population and in children with ADHD. We found a complex, time- and dose-dependent interrelationship between cardiovascular adverse events and stimulant treatment in children and adolescents. Our results suggest a safety signal with an increased risk of cardiovascular disease associated with stimulant treatment in children and adolescents, even after adjusting for a number of potential confounders.

Gender and injuries predict stimulant medication use.

OBJECTIVE: The purpose of this article was to examine whether injuries in early childhood and gender predict prescriptions of stimulant medication in three groups of children: With attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other psychiatric disorders (OPD). METHODS: This was a population-based study with prospective and complete follow-up of children with ADHD (n=11,553), ASD (n=9698), and OPD (n=48,468), of whom 61%, 16%, and 3%, respectively, were treated with stimulants. For all 69,719 individual children data on psychiatric diagnoses, injuries, and drug prescriptions were obtained from national registers and merged. RESULTS: Having sustained an injury before 5 years of age increased the likelihood of later stimulant treatment, in children with ADHD (odds ratio [OR]=1.09; 95% confidence interval [CI]=1.01-1.21), ASD (OR=1.19; 95% CI=1.02-1.40), and OPD (OR=1.24; 95% CI=1.08-1.42), with each injury increasing the likelihood by 3%, 10%, and 7%, respectively. Head injury did not increase the likelihood of later stimulant treatment. Within each of the three groups, ADHD, ASD, and OPD boys were more likely than girls to receive stimulant medication, OR=1.17 (95% CI=1.07-1.28); OR=1.71 (95% CI=1.47-2.01), and OR=2.41 (95% CI=2.16-2.71), respectively. CONCLUSIONS: To our knowledge, this is the first prospective study assessing early life predictors of later ADHD medication in children with a psychiatric disorder, taken from a national cohort with complete follow-up of all cases. We found that the number of injuries prior to diagnosis was associated with initiation of stimulant treatment in all three groups of patients. In addition, male gender predicted treatment with ADHD medications. Our results suggest that the number of injuries early in life prior to diagnosis is associated with stimulant treatment, and may serve as a proxy for the level of later severity of ADHD symptoms, as it is universally associated with pharmacological treatment for ADHD.

Common Danish standards in prescribing medication for children and adolescents with ADHD.

Assessing whether symptoms of attention-deficit hyperactivity disorder (ADHD) in children are age-inappropriate is essential. Hence, comparing children within one school grade is problematic and the risk of applying relative standards is inherent. Being young-for-grade increases the likelihood of receiving medication in countries with high prevalence of ADHD medication. We test the same hypothesis in a cohort of 418,396 children and find no difference between children who are young-for-grade and old-for-grade. The Danish system, with its restrictive approach to medication and clear diagnostic guidelines seems to have avoided a systematic bias of ADHD medication in young children reported in other countries.

Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study.

OBJECTIVE: The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylphenidate, dexamphetamine, and atomoxetine in children and adolescents, within three diagnostic groups: 1) autism spectrum disorder (ASD), 2) attention-deficit/hyperactivity disorder (ADHD), and 3) other psychiatric disorders. METHODS: Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 (n=852,711). Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylphenidate, dexamphetamine, and atomoxetine were extracted from the registers. Prescriptions were also stratified by duration (<6 months. vs.≥ 6 months). RESULTS: Sixteen percent of 9698 children and adolescents with ASD (n=1577), 61% of 11,553 children and adolescents with ADHD (n=7021) and 3% of 48,468 children and adolescents with other psychiatric disorders (n=1537) were treated with one or more ADHD medications. There was a significant increase in prescription rates of these medications for all three groups. From 2003 to 2010, youth 6-13 years of age with ASD, ADHD, and other psychiatric disorders had 4.7-fold (4.4-4.9), 6.3-fold (6.0-6.4), and 5.5-fold (5.0-5.9) increases, respectively, in prescription rates of ADHD medications. CONCLUSION: This is the largest study to date assessing stimulant treatment in children and adolescents with ASD, and is the first prospective study quantifying the change over time in the prevalence of treatment with ADHD medications in a population-based national cohort of children and adolescents with ASD. The prevalence of stimulant treatment in youth with ASD of 16% is consistent with earlier studies. The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark. This increase is not limited to only those with ADHD, but includes others with neuropsychiatric disorders, including ASD. The risks and benefits of this practice await further study.

The importance of children's ADHD for parents' relationship stability and labor supply.

Children with attention-deficit/hyperactivity disorder (ADHD) have much worse long-term outcomes than other children. This paper uses Danish register-based data on children born from 1990 to 1997 to investigate the significance of children's ADHD for parents' outcomes. We observe 172,299 pairs of parents from 1990 to 2007 of which 2457 have a firstborn child diagnosed with ADHD and 169,842 have a firstborn child without ADHD. Ten years after the birth of the child, parents of children diagnosed with ADHD have a 75% higher probability of having dissolved their relationship and a 7-13% lower labor supply. Parents of children with ADHD are, however, particularly disadvantaged in terms of socioeconomic background and mental health. We explain about half of the gaps in partnership stability and labor supply when these factors are taken into consideration, but a statistically and economically significant gap remains to be explained. Additionally, we find that the receipt of a diagnosis to some extent moderates the influence of underlying ADHD on partnership stability. Still, our study concludes that poor child health in terms of ADHD reduces parental socioeconomic status (SES) by lowering their labor supply (and earnings) and reducing relationship stability.

The toll of fertility on mothers' wellbeing.

Using multiple births as source of variation, we study the impact of fertility on the overall wellbeing of mothers. First, using US Census data for the year 1980, we study the impact of number of children on family arrangements, welfare participation and poverty status. Second, using the National Health Interview Survey (NHIS) for the period 1982-2003, we study the impact on a series of health risk factors. The findings reveal, first, that an increase in family size increases the likelihood of marital breakdown. Second, we find evidence that mothers facing an increase in family size are not only more likely to live with other family members such as grandparents, aunts and uncles, they are also more likely to receive help from welfare programs. Third, consistent with an increase in welfare participation, families (mothers) are more likely to fall below the poverty line, and they face a reduction in total family income. The results using NHIS confirm a negative impact of fertility on marriage stability and an increase in welfare participation measured by the likelihood of using Medicaid and for some samples a reduction in the take-up of private health insurance. Finally, we find evidence that a shock in fertility increases the likelihood of mothers suffering from high blood pressure and becoming obese.