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Introduction: This study investigates the cumulative effects of adverse childhood experiences (ACEs) on adult depression, anxiety, and stress in Abu Dhabi, controlling for demographic factors, lifestyle, and known health and mental health diagnoses. Methods: Utilizing a cross-sectional design and self-report measures, the research aims to fill a critical gap in understanding the specific impacts of ACEs in the UAE. Based on a multi-site, cross-sectional community sample of 697 residents of Abu Dhabi. Results: The findings reveal significant variances in current screening values for depression, anxiety, and stress attributable to ACEs after controlling for demographic factors, lifestyle risk factors, and adult diagnoses of health and mental health conditions. Discussion: The results underline the lifelong impact of ACEs and reinforce the importance of early identification and intervention. In particular, the implications for policy and practice in understanding and mitigating ACEs long-term effects on mental health are considered.

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BACKGROUND: Childhood asthma is a prevalent condition with potential impact on adult life. RESEARCH QUESTION: In a 60-year follow-up study of adults with a history of severe childhood asthma, what are the potential differences in characteristics between individuals with persistent asthma and asthma remission in adulthood? STUDY DESIGN AND METHODS: Danish adults with a history of childhood asthma and a 4-month stay in at an asthma care facility in Kongsberg, Norway (1950-1979) in childhood were included. Recruitment was carried out through social media and personal invitation letters. Participants completed questionnaires and underwent spirometry, bronchial provocation, and bronchodilator reversibility and blood tests. Asthma remission was defined as no use of asthma medication and no asthma symptoms within the past 12 months, with the remaining participants being classified as having current asthma. RESULTS: Among 1,394 eligible participants, 232 participants completed the follow-up. Ninety percent had current asthma, of whom 26% reported exacerbations in the past year. Only 16% of all the participants were managed in secondary care. Common comorbidities were allergic rhinitis (60%), hypertension (21%), eczema (16%), and cataract (8%). Compared with participants in remission, participants with persistent asthma showed higher total IgE (P = .03) and both lower FEV1 % predicted (P = .03) and FEV1 to FVC ratio (P < .001), as well as numerically higher fractional exhaled nitric oxide and blood eosinophil count. INTERPRETATION: Our 60-year follow-up study of adults with a history of severe childhood asthma revealed that nine of 10 participants still had current asthma. Persistent asthma was associated with lower lung function and higher levels of type 2 inflammatory biomarkers compared with asthma remission.

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In 1969, my sister Christianne was born late preterm with a genetic disorder and given a very pessimistic prognosis. I will describe, from a family perspective, some lifecourse lessons about neurodiversity using the World Health Organization International Classification Model of Functioning (WHO-ICF). This model emphasizes that, in communicating about the complexity of outcomes of disability, attention must be paid to facilitators and barriers for optimizing health, functioning in daily life, and participation in the community. I will describe several developmental lifecourse lessons learned in negotiating fragmented systems of health, education, and community care. I will suggest ways to improve physician-parent communication, focusing on enablement to decrease a family's sense of isolation and despair. I have benefitted from my parents' archives, discussions with all my seven sisters (including Christianne), and discussions with my brother and sister-in law. They all have provided invaluable feedback from a family perspective during Christianne's lived lifecourse journey with neurodiversity.

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Employment, social relationships, and autonomy are priorities to people with intellectual and developmental disabilities (IDDs). However, few validated measures exist to systematically assess these key adult outcomes in this population. This research includes first steps to develop self- and proxy report measures of life outcomes for adults with IDDs-the Relationships, Employment, Autonomy, and Life Satisfaction (REALS). A literature search identified existing adult outcome measures, and comparison of their domains informed initial conceptual model development. External consultants revised the model, and items were generated. Autistic adults (n = 15), adults with other IDDs (n = 7), caregivers of autistic adults (n = 13), and caregivers of adults with other IDDs (n = 10) completed in-depth cognitive interviews to assess comprehension of items and response categories, factors influencing how participants respond to items, and the inclusiveness of the item pool. A final conceptual model was generated with three subdomains (social relationships, employment, and autonomy), including assessment of life satisfaction within each domain. Cognitive interviews revealed that response set restructuring and item-level revisions were needed to capture the complexity of adult life and make the measure more accessible across a range of abilities. This study developed a conceptual model of relationships, work, and autonomy specific to adults with IDDs. Future work will involve collecting data from 800 + self-reporters with IDDs and 800 + caregivers of adults with IDDs to conduct psychometric analyses. Improving measurement in this area is critical to better understanding the needs of adults with IDDs and improving services available to them.

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BACKGROUND: Childhood outcomes following preterm birth are widely published, however long-term adult outcomes are less well described. We aimed to determine the quality of life and burden of co-morbidities experienced by preterm-born young adults in Western Australia. METHODS: A retrospective observational study was conducted. Participants born at 23-33 weeks gestation cared for at King Edward Memorial Hospital during 1990 and 1991 were recruited from a historical birth cohort. Participants completed general, medical and reproductive health questionnaires. Results were compared with contemporaneous cohort data and/or population statistics. RESULTS: Questionnaires were received from 73 young adults aged 28 to 30 years. The majority of respondents completed high school (94.5 %), were employed fulltime (74.0 %) and had close friends and family relationships. Almost all the participants considered their health to be good (94.0 %) and participated in light exercise (90.0 %). Increased hypertension, hypercholesterolaemia, asthma, neuropsychiatric conditions and visual impairment were reported. Depression Anxiety and Stress Scale (DASS-21) scoring identified increased mild anxiety. Increased consultation with healthcare workers and use of prescription medications were reported. CONCLUSION: The group of preterm-born adults surveyed reported a good quality of life, supportive interpersonal relationships and they provided significant contributions to society. They did report increased medical and psychological conditions than the general population.

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There is a wealth of literature characterizing social difficulties in autism spectrum disorder (ASD). However, little work has replicated longitudinal findings from typical development that adolescent social competence predicts positive adult outcomes in ASD. The current study examined social competence trajectories from 2 to 26 and the utility of three social competence measures collected in adolescence in predicting work, residential status, friendship, and romantic outcomes in a longitudinal cohort (n = 253) of ASD. Using group-based trajectory modeling, we identified two patterns of social competence development: a low trajectory characterized by slow linear gains throughout childhood and plateauing in adulthood, and a high trajectory characterized by steeper linear gains in childhood followed by decline in adulthood. Regression models indicated one social competence measure, Vineland Social-AE scores, significantly predicted employment, residential status, and friendships in adulthood. One other social competence measure, SSQ total scores, also significantly predicted friendship in adulthood. Only nonverbal IQ at 9 predicted the likelihood of having ever had a romantic relationship. These findings highlight the role of social competence in both atypical and typical development and suggest the social impairments associated with ASD do not necessarily impact all realms of social functioning equally.

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Movements designed to engage youth in tobacco control have been an important part of tobacco prevention for decades. Today, young people are increasingly diverse, and their primary issues of concern are gun control, racism, mental health, and climate change. To engage today's young people, tobacco control programs need to draw connections between youth's identities, top issues, and tobacco. UpRISE is a social justice youth tobacco control movement that engages diverse youth in identifying the root causes of youth nicotine use. In 2018-2019, 21 youth-serving organizations and schools hosted youth coalitions. Coalitions engaged in a six-session workbook called "Getting to the root cause," and adults were provided training and reflective supervision. Pre/post surveys with youth participants (n = 180) and end-of-year interviews with adult facilitators (n = 22) were used to assess outcomes. The primary outcomes were supportive adult relationships, youth voice in decision-making, anti-tobacco industry attitudes and beliefs, psychological empowerment, critical consciousness, and global belief in a just world. Quantitative measures of supportive adult relationships, youth voice in decision-making, psychological empowerment, and anti-tobacco industry attitudes and beliefs all increased significantly over time (p < .0001, p < .0001, p < .0001, p = .0034, respectively). Critical consciousness and global belief in a just world did not change significantly. During interviews, adults reported learning how: to engage in youth-adult partnerships, the tobacco industry abused its power, to engage in critical reflection about power. Adults also felt empowered. UpRISE may be a promising approach to increase racially diverse youth's engagement in social justice-oriented tobacco control efforts that advance equity.

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INTRODUCTION: This 33-year study examined associations between self-control development in adolescence and forgivingness, i.e., the dispositional tendency to forgive others, in middle adulthood. METHODS: Participants were 1350 adults aged 45 years (50.6% female). Self-control was measured yearly from age 12 to 16, while forgivingness was measured at age 45. RESULTS: Results indicated significant individual differences in level and change of self-control across the adolescent years and an average mean-level increase. Individual differences in level and change in self-control were independently associated with forgivingness in middle adulthood. Individuals who either entered adolescence with higher self-control, and/or increased in self-control during the adolescent years, reported higher scores in forgivingness at age 45 compared to peers. This pattern held even after controlling for gender, socioeconomic status (SES), and conduct problems in adolescence. CONCLUSION: The current findings demonstrate that developmental processes in adolescence are important for individual differences in the dispositional tendency to forgive others in adulthood.

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Little is known about work readiness skills among autistic adults. This study sought to address this by examining work readiness skills and their relation to vocational outcomes among 281 autistic young adults. It also examined perceived barriers and facilitators to employment as articulated by a subset of autistic adults. Results revealed a variegated work readiness profile. Stronger work readiness skills (particularly work style/adaptability) were associated with more favorable vocational outcomes. Autistic participants articulated both barriers and facilitators to employment related to the autism phenotype, job search/work readiness, and workplace education. These findings indicate the need for research on phenotype-driven vocational rehabilitation strategies as well as workplace psychoeducation/accommodations to support vocational outcomes for autistic adults.

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We examine the impact of health and economic conditions at birth on the adult outcomes of child immigrants using the Children of Immigrants Longitudinal Study. Our sample consists of children from 39 countries who were brought to the United States before the age of 13. We estimate immigrant outcomes as a function of the infant mortality rate (IMR) and GDP per capita of their home country in the year of birth, controlling for birth-year, year-of-arrival and country-of-birth fixed effects, as well as demographic characteristics. IMR has a significant negative impact on English reading ability and GPA in middle school. IMR significantly decreases first job prestige, years of schooling, working hours and log earnings. Some of these effects appear to be working through the lower middle school GPA. IMR does not influence self-rated health or labor market participation in adulthood, and there is no statistically significant relationship between GDP per capita and adult outcomes. Detrimental effects of IMR are significantly lower for children who arrived younger and whose parents have high school degree or above. Our estimates are of economic significance: the impact of being born in 1975 versus 1976 in Nicaragua in terms of the impact of IMR on earnings is equal to the gender effect on earnings. Our results cannot be explained by selection on observables: the pre-migration characteristics of children and parents are not associated significantly with the health and economic conditions at birth. Also, several tests show that our results cannot be explained by potential selection on unobservables.

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OBJECTIVE: This study tested the "intervention as prevention" hypothesis: that treatment of childhood psychopathology in the community might reduce risk for adult psychopathology. METHOD: Analyses were based on a prospective, population-based study of 1,420 children followed up to 8 times during childhood (ages 9-16 years; 6,674 observations) about psychiatric status and specialty mental health services use. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants) to assess adult psychopathology. RESULTS: Participants with a childhood psychiatric disorder who used childhood specialty mental health services were at similar risk for adult emotional (odds ratio [OR] = 0.7; 95% CI = 0.3-1.4, p = .29) disorders and at higher risk for adult substance disorders (OR = 2.1; 95% CI = 1.1-4.2, p = .03) as compared those with a childhood disorder who did not use services. The risk for substance disorders was driven by children with behavioral disorders (OR = 3.6; 95% CI = 1.6-8.1, p = .002). Sensitivity analyses suggest that an unmeasured confounder would have to have an E value of 3.26 or risk ratio of 1.92 to alter this finding. Higher "dose" of services use (defined at 6+ visits) was not associated with improved outcomes. CONCLUSION: Community services use may reduce psychopathology within childhood, but they do not necessarily prevent adult psychiatric problems. These findings are consistent with the notion of mental health problems as chronic conditions that often begin in childhood but that may recur in different forms across the lifespan even when treated.

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Current evidence suggests that multiple pathways of "early-starting" conduct problems exist, including persisting and declining trajectories. Since relatively little is known about the early onset-declining pathway, this study examined the long-term outcomes of different childhood conduct problem trajectories in a disproportionately high-risk sample (N = 754). Parents reported on children's conduct problems at six time points (kindergarten to grade 7). At age 25, psychosocial outcomes were assessed across five domains (psychopathology, substance use, risky sexual behavior, antisocial behavior, and adaptive outcomes). Four childhood conduct problem trajectories were identified: extremely high increasing (EHI; 3.7%), high stable (HS; 22.0%), moderate decreasing (MD; 38.8%), and low decreasing (LD; 35.5%). The EHI and HS groups displayed the poorest psychosocial functioning at age 25, whereas the LD group exhibited the most positive adjustment. Although individuals in the MD group displayed relatively positive adjustment on some outcomes, they displayed more psychopathology and lower well-being in adulthood than the LD group. These findings suggest that there are diverse pathways of early-starting conduct problems, and that all early starters are at risk for later maladjustment. However, the degree and type of risk is related to the severity of conduct problems throughout childhood.

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Borderline personality disorder symptoms (BPDsx) in mothers have been linked to psychopathology in their offspring. However, it is still unclear whether BPDsx in fathers influences offspring psychopathology and, if so, how this risk transmission may occur. A total of 448 father-mother-offspring triads completed a longitudinal study following children from birth until age 20 and included self-report questionnaires and clinical interviews when children were 15 and 20 years old. Results revealed that paternal BPDsx were predictive of youth BPDsx and internalizing symptoms, even after controlling for maternal BPDsx. Chronic family stress was a significant mediator of the relationship between paternal BPDsx and offspring BPDsx, internalizing symptoms, and externalizing symptoms. Fathers' expressed emotion and child temperament were not significant mediators. Although offspring sex predicted youth outcomes, it was not a significant moderator of the association between paternal BPDsx and offspring symptoms. Finally, controlling for comorbid paternal disorders weakened the association between paternal BPDsx and youth psychopathology.

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LAY ABSTRACT: Previous research has shown that relatively few adults with autism have a paid job or live on their own. However, outcomes also vary a lot and may depend on many different factors. In this study, we examined the level of functioning and happiness of 917 adults with autism (425 men and 492 women) aged 18-65 years. Most of them were of average to high intellectual ability. Over 6 years, we measured whether they had a paid job, close friendships and lived on their own (i.e. their objective functioning). We also measured how happy they felt. Objectively, most autistic adults did fairly to very well. Those with better objective outcomes (e.g. those with paid work) also tended to be happier. Most adults improved in objective functioning and happiness over 6 years. Participants with a lower intellectual ability, more autism traits, mental health problems and younger age had poorer objective outcomes. Participants with more autism traits and mental health problems were less happy. Autistic men and women functioned at similar levels and were equally happy. We found important factors that predict a better (or worse) outcome for autistic adults. Overall, compared with some previous research, our findings give a more positive picture of the outcomes for autistic adults with average to high intellectual abilities.

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Objective: Our objective was to examine developmental trajectories of co-occurring psychopathology symptoms from childhood to young adulthood in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), individuals with Autism Spectrum Disorder (ASD), and typically developing (TD) individuals. Method: We assessed co-occurring psychopathology symptoms in 61 individuals with ADHD, 26 with ASD, and 40 TD individuals at baseline (T1; Mage = 11.72, 64% boys), 2-year follow up (T2; Mage = 13.77), and 10-year follow up (T3; Mage = 21.35). We analyzed trajectories of internalizing behaviors, externalizing behaviors, and total problems with linear mixed models. Results: From T1 to T3, the ADHD group displayed a small decline in internalizing behaviors (d = -0.49) and large declines in externalizing behaviors (d = -0.78) and total problems (d = -0.71). The ASD group displayed large declines in internalizing behaviors (d = -0.79), externalizing behaviors (d = -0.80), and total problems (d = -0.89). From T1 to T2, the decline in externalizing behaviors and total problems were significantly smaller in the ADHD group compared with the ASD group. The ADHD and the ASD group displayed more co-occurring symptoms compared with the TD group at T3. Conclusion: Individuals with ADHD and ASD, respectively, displayed declines in co-occurring symptoms from childhood to young adulthood. Individuals with ASD displayed an earlier decline compared with individuals with ADHD. Compared with TD individuals, individuals with ADHD and ASD, respectively, continued to display elevated levels of co-occurring symptoms in young adulthood.

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LAY ABSTRACT: Alcohol use and misuse are associated with a variety of negative physical, psychological and social consequences. The limited existing research on substance use including alcohol use in autistic adults has yielded mixed findings, with some studies concluding that autism reduces the likelihood of substance use and others suggesting that autism may increase an individual's risk for substance misuse. This study investigated demographic and psychological predictors of alcohol use and misuse in a sample of 237 autistic adults. An online survey was used to obtain data on demographic information, autistic traits, depression, generalised anxiety, social anxiety, mental well-being, social camouflaging and alcohol use. The sample was divided into three groups (non-drinkers, non-hazardous drinkers and hazardous drinkers) in order to investigate associations between alcohol use and demographic factors, autistic traits, mental health variables and social camouflaging. Our results demonstrated a U-shaped pattern among autistic adults, with non-drinkers and hazardous drinkers scoring higher than non-hazardous drinkers on levels of autistic traits, depression, generalised anxiety and social anxiety. Autistic non-drinkers were less likely to be male and had more autistic traits. Gender and level of autistic traits may be the most significant factors in predicting alcohol use in the autistic community.

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BACKGROUND: Studies of autistic children suggest that restricted eating, reduced physical activity, and sleep disorders are common; however, no studies attempt to broadly describe the diet, exercise, and sleep patterns of autistic adults or consider relationships between lifestyle behaviors and the widely reported increased risks of obesity and chronic conditions. To address this, the authors developed the largest study of lifestyle patterns of autistic adults and assessed their relationships to body mass index, health outcomes, and family history. METHODS: We administered an anonymized, online survey to n = 2386 adults (n = 1183 autistic) aged 16-90 years of age. We employed Fisher's exact tests and binomial logistic regression to describe diet, exercise, and sleep patterns; mediation of seizure disorders on sleep; body mass index (BMI); relationships of lifestyle factors to BMI, cardiovascular conditions, and diabetic conditions; and sex differences among autistic adults. RESULTS: Autistic adults, and particularly autistic females, exhibit unhealthy diet, exercise, and sleep patterns; they are also more likely to be underweight or obese. Limited sleep duration and high rates of sleep disturbances cannot be accounted for by epilepsy or seizure disorders. Lifestyle factors are positively related to higher risk of cardiovascular conditions among autistic males, even more than family history. LIMITATIONS: Our sample may not be representative of all autistic and non-autistic people, as it primarily comprised individuals who are white, female, have a high school education or higher, and reside in the UK. Our sampling methods may also exclude some individuals on the autism spectrum, and particularly those with moderate to severe intellectual disability. This is a cross-sectional sample that can test for relationships between factors (e.g., lifestyle factors and health outcomes) but cannot assess the direction of these relationships. CONCLUSIONS: Autistic adults are less likely to meet minimal health recommendations for diet, exercise, and sleep-and these unhealthy behaviors may relate to excess risk of cardiovascular conditions. Although the present study can only provide preliminary, correlational evidence, our findings suggest that diet, exercise, and sleep should be considered and further investigated as key targets for reducing the now widely reported and dramatically increased risks of health comorbidity and premature death among autistic individuals compared to others. Physicians should work cooperatively with patients to provide health education and develop individualized strategies for how to better manage challenges with diet, exercise, and sleep.

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INTRODUCTION: Autism spectrum disorder is a highly heterogeneous diagnosis. When a child is referred to autism services or receives a diagnosis of autism spectrum disorder it is not known what their potential adult outcomes could be. We consider the challenge of making predictions of an individual child's long-term multi-facetted adult outcome, focussing on which aspects are predictable and which are not. METHODS: We used data from 123 adults participating in the Autism Early Diagnosis Cohort. Participants were recruited from age 2 and followed up repeatedly through childhood and adolescence to adulthood. We predicted 14 adult outcome measures including cognitive, behavioral and well-being measures. Continuous outcomes were modeled using lasso regression and ordinal outcomes were modeled using proportional odds regression. Optimism corrected predictive performance was calculated using cross-validation or bootstrap. We also illustrated the prediction of an overall composite formed by weighting outcome measures by priorities elicited from parents. RESULTS: We found good predictive performance from age 9 for verbal and non-verbal IQ, and daily living skills. Predictions for symptom severity, hyperactivity and irritability improved with inclusion of behavioral data collected in adolescence but remained modest. For other outcomes covering well-being, depression, and positive and negative affect we found no ability to predict adult outcomes at any age. Predictions of composites based on parental priorities differed in magnitude and precision depending on which parts of the adult outcome were given more weight. CONCLUSION: Verbal and non-verbal IQ, and daily living skills can be predicted well from assessments made in childhood. For other adult outcomes, it is challenging to make meaningful predictions from assessments made in childhood and adolescence using the measures employed in this study. Future work should replicate and validate the present findings in different samples, investigate whether the availability of different measures in childhood and adolescence can improve predictions, and consider systematic differences in priorities.

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Social support promotes resilience to adverse childhood events, but little is known about the role of natural mentors-caring, nonparental adults-in the lives of childhood abuse survivors. The current study draws from a large, longitudinal, nationally representative sample (Add Health) to examine the prevalence and characteristics of natural mentoring relationships for adolescents with a history of caregiver childhood abuse, and the extent to which these relationships are associated with psychological and health outcomes in adulthood. Among the sample (n = 12,270), 28.82% and 4.86% reported caregiver childhood physical and sexual abuse, respectively. Youth who reported caregiver childhood physical abuse were more likely than those who did not endorse abuse to report having a natural mentor, but their mentoring relationships were characterized by lower interpersonal closeness, shorter duration, and less frequent contact. Exposure to caregiver childhood abuse was associated with adverse outcomes during adulthood, including antisocial behavior, physical health limitations, and suicidality; the presence of a natural mentor did not buffer the negative impact of trauma on adult outcomes. However, longer mentoring relationships during adolescence buffered the strength of the association between both caregiver physical and sexual abuse during childhood and suicidality during early adulthood.

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OBJECTIVE: Depression is common, impairing, and the leading cause of disease burden in youths. This study aimed to identify the effects of childhood/adolescent depression on a broad range of longer-term outcomes. METHOD: The analysis is based on the prospective, representative Great Smoky Mountains Study of 1,420 participants. Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview up to 8 times in childhood (age 9-16 years; 6,674 observations; 1993-2000) for DSM-based depressive disorders, associated psychiatric comorbidities, and childhood adversities. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric outcomes and functional outcomes. RESULTS: In all, 7.7% of participants met criteria for a depressive disorder in childhood/adolescence. Any childhood/adolescent depression was associated with higher levels of adult anxiety and illicit drug disorders and also with worse health, criminal, and social functioning; these associations persisted when childhood psychiatric comorbidities and adversities were accounted for. No sex-specific patterns were identified. However, timing of depression mattered: individuals with adolescent-onset depression had worse outcomes than those with child-onset. Average depressive symptoms throughout childhood and adolescence were associated with more adverse outcomes. Finally, specialty mental health service use was protective against adult diagnostic outcomes. CONCLUSION: Early depression and especially persistent childhood/adolescent depressive symptoms have robust, lasting associations with adult functioning. Some of these effects may be attenuated by service use.

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