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  • 1. Boman, Krister K.
    et al.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Long-term outcomes of childhood cancer survivors in Sweden: a population-based study of education, employment, and income2010In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 116, no 5, p. 1385-1391Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies of different national populations were indispensable for estimating the impact of illness-related disability on social outcomes in adult childhood cancer survivors. The effects of childhood cancer on educational attainment, employment, and income in adulthood in a Swedish setting were studied. METHODS: The study population was a national cohort of 1.46 million Swedish residents, including 1716 survivors of childhood cancer diagnosed before their 16th birthday, followed up in 2002 in registries at >25 years of age. Main outcomes were educational attainment, employment, and net income. Markers of persistent disability were considered, and outcomes were analyzed with multivariate linear and logistic regression models adjusted for age, sex, and socioeconomic indicators of the childhood households. RESULTS: Non-central nervous system (CNS) cancer survivors had similar education, employment, and income as the general population in adjusted models, whereas survivors of CNS tumors more often had no more than basic (< or =9 years) education (relative risk [RR], 1.80 [95% confidence interval (95% CI), 1.45-2.23]), less often attained education beyond secondary school (RR, 0.69 [95% CI, 0.58-0.81]), and less often were employed (RR, 0.85 [95% CI, 0.77-0.94]). Predicted net income from work was lower in CNS tumor survivors (P <.001) than in the general population, even after the exclusion of individuals who received economic disability compensation. CONCLUSIONS : CNS tumor survivors had poorer social outcomes compared with the general population, whereas outcomes for survivors of other childhood cancers were similar to the general population. Established late effects highlighted the importance of improved, safer pediatric CNS tumor treatment protocols and surveillance that identified individual needs for preventive and remedial measures.

  • 2. Dalen, Monica
    et al.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindblad, Frank
    Odenstad, Anna
    Rasmussen, Finn
    Vinnerljung, Bo
    Educational attainment and cognitive competence in adopted men: A study of international and national adoptees, siblings and a general Swedish population2008In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 30, no 10, p. 1211-1219Article in journal (Refereed)
    Abstract [en]

    Internationally and nationally adopted young men were recently reported to have lower than average scores on intelligence tests at military conscription, compared with non-adopted conscripts in Sweden. In this study we used the Swedish national registers to analyse how this lower cognitive competence influences the educational attainment of adoptees. Intelligence test scores at conscription were analysed in relation to educational attainment at follow-up at 25-34 years in male international (n = 2.314) and national (n = 1.153) adoptees, compared with the general population in the same birth cohorts.

    Korean adoptees more often had obtained a post-secondary education compared with the general population while Non-Korean and national adoptees less often had such an education at follow-up. The international adoptees had a better chance than the general population to complete a post-secondary level and a lower risk to remain at a basic level when their cognitive competence, as measured by intelligence test scores, had been accounted for. This effect was quite similar in biological children in families of international adoptees who had the best test scores, in the Korean adoptees who had slightly better test scores than the general population, and in the Non-Korean adoptees who had considerably lower test scores. National adoptees had similar outcomes in these respects as the general population when test scores had been accounted for. Higher age at adoption was associated with a lower educational attainment in the Non-Korean but not in the Korean adoptees, an effect that was attenuated when test scores were accounted for.

    We conclude that a lower than average cognitive competence did influence the educational attainment of the Non-Korean international and the Swedish-born adoptees in this study. international but not national adoptees had attained a higher educational level than predicted from their scores on intelligence tests. This education promoting effect was similar in the Korean adoptees, who had high test scores in comparison with the general population, and the Non-Korean adoptees who had comparatively low test scores.

  • 3. Ekeus, Cecilia
    et al.
    Lindström, Karolina
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Rasmussen, Finn
    Hjern, Anders
    Preterm birth, social disadvantage, and cognitive competence in Swedish 18- to 19-year-old men2010In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 125, no 1, p. e67-e73Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim was to study the impact of a range of gestational ages (GAs) on cognitive competence in late adolescence and how this effect is modified by contextual social adversity in childhood. METHODS: This was a register study based on a national cohort of 119664 men born in Sweden from 1973 to 1976. Data on GA and other perinatal factors were obtained from the Medical Birth Register, and information on cognitive test scores was extracted from military conscription at the ages of 18 to 19 years. Test scores were analyzed as z scores on a 9-point stanine scale, whereby each unit is equivalent to 0.5 SD. Socioeconomic indicators of the childhood household were obtained from the Population and Housing Census of 1990. The data were analyzed by multivariate linear regression. RESULTS: The mean cognitive test scores decreased in a stepwise manner with GA. In unadjusted analysis, the test scores were 0.63 stanine unit lower in men who were born after 24 to 32 gestational weeks than in those who were born at term. The difference in global scores between the lowest and highest category of socioeconomic status was 1.57. Adjusting the analysis for the childhood socioeconomic indicators decreased the effect of GA on cognitive test scores by 26% to 33%. There was also a multiplicative interaction effect of social adversity and moderately preterm birth on cognitive test scores. CONCLUSIONS: This study confirms previous claims of an incremental association of cognitive competence with GA. Socioeconomic indicators in childhood modified this effect at all levels of preterm birth.

  • 4. Ekéus, Cecilia
    et al.
    Hjern, Anders
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Vinnerljung, Bo
    Teenage childbirth among female international adoptees: a national cohort study2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 6, p. 1054-1056Article in journal (Refereed)
  • 5. Ekéus, Cecilia
    et al.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Hjern, Anders
    Short stature, smoking habits and birth outcome in international adoptees in Sweden2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 12, p. 1309-14Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate short stature and smoking habits as risk factors for birth outcome in international adoptees in comparison with non-adopted mothers. DESIGN: Prospective cohort study. SETTING: Nationwide study in Sweden. POPULATION: Two study groups were identified from mothers who were born 1968-1979 and gave birth during 1982-2001-3,610 mother-child dyads with a mother adopted from a non-European country and 336,992 mother-child dyads with a mother born in Sweden. METHOD: Register study. OUTCOME MEASURES: Pre-eclampsia, instrumental delivery, preterm delivery, small for gestational age (SGA), Apgar score, cephalhematoma and perinatal mortality and birth weight. RESULTS: Short stature and smoking were more common in international adoptees compared with non-adopted, odds ratios (ORs) 29.07 (95% C.I.: 25.29-33.42) and 1.39 (1.27-1.52), respectively. International adoptees had a slightly increased risk for instrumental delivery (OR: 1.42; 1.32-1.54) and preterm delivery (<37 weeks) (OR: 1.39; 1.24-1.56) and there was a slightly increased risk for SGA (OR: 1.24; 1.01-1.52) in their offspring. However, when we adjusted for maternal height, preterm delivery was the only outcome that remained statistically significant. Adjustment for smoking habits had marginal effects on all outcomes. CONCLUSION: The short stature of international adoptees increased their risk for delivery and birth complications in a predictable manner, but otherwise outcomes were very similar to the general population. No special obstetric monitoring is indicated by adoption status in itself.

  • 6.
    Elmelid, Andrea
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Stickley, Andrew
    Natl Ctr Neurol & Psychiat, Natl Inst Mental Hlth, Dept Child & Adolescent Mental Hlth, Kodaira, Tokyo, Japan.;Sodertorn Univ, Stockholm Ctr Hlth Soc Transit SCOHOST, Huddinge, Sweden.;Univ Tokyo, Grad Sch Med, Dept Human Ecol, Tokyo, Japan..
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Schwab-Stone, Mary
    Yale Univ, Sch Med, Ctr Child Study, New Haven, CT 06520 USA..
    Henrich, Christopher C.
    Georgia State Univ, Dept Psychol, Atlanta, GA 30302 USA..
    Ruchkin, Vladislav
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Yale Univ, Sch Med, Ctr Child Study, New Haven, CT 06520 USA..
    Depressive symptoms, anxiety and academic motivation in youth: Do schools and families make a difference?2015In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 45, p. 174-182Article in journal (Refereed)
    Abstract [en]

    This longitudinal study aimed to examine the association between depressive and anxiety symptoms and academic motivation by gender, and whether positive school and family factors would be associated with academic motivation, in spite of the presence of such symptoms. Study participants were predominantly economically disadvantaged youths aged 13-15 years in a Northeastern US urban public school system. The Social and Health Assessment (SAHA) served as the basis for a survey undertaken in 2003 and 2004 with information being used from students who participated at both time points (N = 643). Multiple linear regression analyses showed that depressive symptoms were negatively associated with academic motivation, while anxiety was positively related to academic motivation in both genders. Teacher support, school attachment and parental control were positively related to academic motivation even in the presence of internalizing problems. The negative association of depressive symptoms with academic motivation may be potentially decreased by attachment to school.

  • 7.
    Elmund, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindblad, Frank
    National Institute for Psychosocial Medicine, Department of Public Health Sciences, Division of Psychosocial Factors and Health, Karolinska Institutet, Stockholm, Sweden.
    Vinnerljung, Bo
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Intercountry adoptees in out-of-home care: A national cohort study2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 3, p. 437-442Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate risks of placements in out-of-home care for non-European adoptees. Methods: Intercountry adoptees born outside Europe 1973-1984 (n = 16 522) were compared with same age peers from the majority population (n = 1 026 523) using national demographic and child welfare registers. Multivariate analyses were performed using logistic regression models, and odds ratios (OR) for different forms of out-of-home care placements were calculated. Results: After adjustments for socio-demographic background variables, the OR:s for placements of intercountry adoptees in residential care from age 10 were 5.1 (95% Cl 4.6-5.8) and 3.0 (95% Cl 2.6-3.6) for placements in foster care from age 10. For placements in all forms of out-of home care up to age 10, the odds were on par with the majority population. Higher child age at adoption, origin from Latin America, single parent adoption and maternal age above 35 at birth of the child were identified as significant predictors of out-of-home care from age 10. Conclusion: Intercountry adoptees emerge as a risk group for placements in out-of home care during adolescence, especially for entries into residential care (in Sweden usually triggered by persistent behaviour problems).

  • 8.
    Gupta Löfving, Sandra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Stickley, Andrew
    Schwab-Stone, Mary
    Ruchkin, Vladislav
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Community violence exposure and severe posttraumatic stress in suburban American youth: risk and protective factors2015In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 50, no 4, p. 539-547Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The psychological effects of community violence exposure among inner-city youth are severe, yet little is known about its prevalence and moderators among suburban middle-class youth. This study aimed to assess the prevalence of community violence exposure among suburban American youth, to examine associated posttraumatic stress and to evaluate factors related to severe vs. less severe posttraumatic stress, such as co-existing internalizing and externalizing problems, as well as the effects of teacher support, parental warmth and support, perceived neighborhood safety and conventional involvement in this context.

    METHOD: Data were collected from 780 suburban, predominantly Caucasian middle-class high-school adolescents in the Northeastern US during the Social and Health Assessment (SAHA) study.

    RESULTS: A substantial number of suburban youth were exposed to community violence and 24 % of those victimized by community violence developed severe posttraumatic stress. Depressive symptoms were strongly associated with higher levels and perceived teacher support with lower levels of posttraumatic stress.

    CONCLUSION: Similar to urban youth, youth living in suburban areas in North American settings may be affected by community violence. A substantial proportion of these youth reports severe posttraumatic stress and high levels of comorbid depressive symptoms. Teacher support may have a protective effect against severe posttraumatic stress and thus needs to be further assessed as a potential factor that can be used to mitigate the detrimental effects of violence exposure.

  • 9. Hjern, Anders
    et al.
    Ekeus, Cecilia
    Rasmussen, Finn
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Educational achievement and vocational career in twins: a Swedish national cohort study2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 6, p. 591-596Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate how being born and raised as a twin is associated with IQ, educational achievement and vocational career.

    Methods: Register study in a national birth cohort, complemented with a siblings study. The study population included 13 368 individuals born and raised as twins and 837 752 singletons, including 3019 siblings of twins, in the Swedish birth cohorts of 19731981. Our outcome measures were mean grade points on a five point scale from ninth grade of primary school at 1516 years, IQ tests on a nine grade point scale from male conscripts at 1819 years, highest completed education, disability benefits, work income and employment at 2735 years of age.

    Results: Twins had slightly better mean grade point averages in ninth grade; +0.08 (95% CI 0.040.11) and more often had completed a university education in young adulthood; OR 1.16 (1.021.21) compared with singleton siblings, despite male twins having a slightly lower IQ at military conscription compared with male singletons. Employment rates, mean income and disability benefits were similar in twins and singletons.

    Conclusions: Twins have slightly better educational careers and similar vocational careers compared with those born as singletons.

  • 10.
    Hjern, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindberg, Lene
    Lindblad, Frank
    Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9- to 14-year follow-up2006In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 189, no Nov, p. 428-432Article in journal (Refereed)
    Abstract [en]

    Background: Earlier studies have indicated poor long-term outcomes for patients with anorexia nervosa. Aims: To study health and social outcomes of adolescent in-patients with anorexia nervosa in relation to prognostic factors. Method: A register study based on socio-economic and health data was conducted for a national cohort of female residents in Sweden born between 1968 and 1977, including 748 in-patients with anorexia nervosa. Results: At follow-up 9-14 years after hospital admission, 8.7% of patients with anorexia nervosa had persistent psychiatric health problems demanding hospital care and 21.4% were dependent on society for their main income; the stratified relative risks were 5.8 (95% CI 4.7-7.6) and 2.6 (2.3-3.0) respectively, compared with the general female population. The mortality rate for patients with anorexia nervosa was 1.2% and the stratified risk ratio for maternity was 0.6 (95% CI 0.5-0.7). Long duration of hospital care and psychiatric comorbidity were predictors of persistent psychiatric problems and financial dependency on society. Conclusions: The outcome in this cohort of adolescent in-patients with anorexia nervosa was considerably better than that reported in previous studies.

  • 11. Hjern, Anders
    et al.
    Vinnerljung, Bo
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Santé et adaptation sociale chez de jeunes adultes adoptés à l’international en Suède: Que peuvent nous apprendre les registres nationaux ?2009In: Adoption: un lien pour la vie / [ed] Chomilier J, Duyme M, Marseille: Éditions Solal , 2009Chapter in book (Other academic)
  • 12. Hjern, Anders
    et al.
    Weitoft, G R
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Social adversity predicts ADHD-medication in school children: a national cohort study2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 6, p. 920-924Article in journal (Refereed)
    Abstract [en]

    Aims: To test the hypothesis that psychosocial adversity in the family predicts medicated ADHD in school children. Method: ADHD-medication during 2006 was identified in the Swedish Prescribed Drug Register in national birth cohorts of 1.1 million 6-19 year olds. Logistic regression models adjusted for parental psychiatric disorders were used to test our hypothesis. Results: There was a clear gradient for ADHD medication with level of maternal education, with an adjusted odds ratio of 2.20 (2.04-2.38) for the lowest compared with the highest level. Lone parenthood and reception of social welfare also implied higher risks of ADHD-medication with adjusted ORs of 1.45 (1.38-1.52) and 2.06 (1.92-2.21) respectively. Low maternal education predicted 33% of cases with medicated ADHD and single parenthood 14%. Conclusions: Social adversity in the family predicts a considerable proportion of ADHD-medication in school children in Sweden.

  • 13.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Allen, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Nilsson, Kent W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Polymorphisms in the FK506 binding protein 5 gene are associated with attention deficit hyperactivity disorder and diurnal cortisol levels2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 9, p. 910-915Article in journal (Refereed)
    Abstract [en]

    AIM: Previous studies have shown an association between childhood attention deficit hyperactivity disorder (ADHD) and a down-regulated hypothalamus-pituitary-adrenal axis (HPA-axis) with low diurnal cortisol levels. Given the role of the FK506 binding protein 5 (FKBP5) as an important regulator of the negative feedback system of the HPA-axis, we set out to investigate possible associations between single nucleotide polymorphisms (SNPs) in FKBP5 in relation to ADHD and diurnal cortisol levels.

    METHODS: Children with ADHD (n=81) and healthy comparisons (n=88) collected saliva four times during a regular school day for radioimmunoassay analysis of cortisol and for genotyping of five SNPs in FKBP5 (rs9296158, rs1360780, rs9470080, rs7748266 and rs9394309).

    RESULTS: We found associations between SNP genotypes and ADHD as well as between genotypes and diurnal cortisol levels. One of these SNPs, rs9470080, was significantly associated with both ADHD and lower cortisol levels.

    CONCLUSION: This study contributes to previous findings on a down-regulated HPA-axis in children with ADHD by demonstrating an association between ADHD, lower cortisol levels and SNPs of the FKBP5-gene. The relevance of these findings for the development and shaping of ADHD symptoms need to be approached in larger samples, preferably also taking stress reactivity into consideration.

  • 14.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hogmark, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Nilsson, Kent W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Effects of stimulants and atomoxetine on cortisol levels in children with ADHD2013In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 209, no 3, p. 740-741Article in journal (Refereed)
    Abstract [en]

    Children with attention deficit hyperactivity disorder (ADHD) have lower diurnal cortisol levels than non-ADHD comparison subjects. Aiming at elucidating the effects of medications used to treat ADHD, we investigated saliva cortisol in children with ADHD: 20 without medication, 147 on methylphenidate, and 21 on atomoxetine. The only significant finding was that children on atomoxetine had higher cortisol levels at bedtime than unmedicated children.

  • 15.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Ctr Neurodev Disorders KIND, Dept Womens & Childrens Hlth, Pediat Neuropsychiat Unit, Stockholm, Sweden.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Valladares, Eliette
    Ctr Res & Intervent Hlth, Leon, Nicaragua.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Associations between psychiatric symptoms and cortisol levels in Nicaraguan young school-age children2016In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 240, p. 376-380Article in journal (Refereed)
    Abstract [en]

    The regulation of the Hypothalamus-Pituitary-Adrenal axis (HPA-axis) with its end product cortisol seems to be affected in several psychiatric disorders. Although findings are not conclusive, internalizing symptoms have primarily been associated with higher diurnal cortisol levels and externalizing symptoms with lower cortisol levels. In this study on nine-year-olds in Nicaragua (n=111), we investigated associations between child psychiatric symptoms, using the Child Behavior Check List (CBCL), and saliva cortisol levels collected in the morning and afternoon, also adjusting for potential confounders. In line with previous findings, internalizing symptoms were significantly associated with higher morning, but not afternoon cortisol levels. Surprisingly, externalizing symptoms were also significantly associated with higher morning cortisol levels. Possibly, this association between externalizing symptoms and cortisol levels may be characteristic of early ages, representing a higher exposure to external stressors. The study highlights the need for prospective studies, following the development of the HPA-axis and its association with psychiatric symptoms.

  • 16.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Valladares, E
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    High maternal cortisol levels during pregnancy are associated with more psychiatric symptoms in offspring at age of nine: A prospective study from Nicaragua2015In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 71, p. 97-102Article in journal (Refereed)
    Abstract [en]

    Maternal exposure to stress or adversity during pregnancy has been associated with negative health effects for the offspring including psychiatric symptoms. Programming of the hypothalamic-pituitary-adrenal (HPA) axis has been suggested as one mediating process. In order to investigate possible long term effects of stressors during pregnancy, we followed 70 children and their mothers from pregnancy up to nine years aiming to investigate if maternal cortisol levels and distress/exposure to partner violence were associated with child psychiatric symptoms and child cortisol levels at follow-up. Maternal distress was evaluated using The Self Reporting Questionnaire, exposure to partner violence by an instrument from WHO and child psychiatric symptoms with Child Behavior Checklist (CBCL). We adjusted the analyses for gestational week, gender, SES, perinatal data and maternal distress/exposure to partner violence at child age of nine years. Elevated maternal cortisol levels during pregnancy, as a possible marker of maternal stress load, were correlated with higher CBCL-ratings, especially concerning externalizing symptoms. Maternal cortisol levels during pregnancy were not associated with child cortisol levels at child age of nine years. Maternal distress and exposure to partner violence during pregnancy were neither associated with child psychiatric symptoms nor child cortisol levels. To conclude, intrauterine exposure to elevated cortisol levels was associated with higher ratings on offspring psychopathology at nine years of age. The lack of association between maternal cortisol levels during pregnancy and child cortisol levels does not support the hypothesis of fetal programming of the HPA-axis, but reliability problems may have contributed to this negative finding.

  • 17.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Early psychosocial adversity and cortisol levels in children with attention-deficit/hyperactivity disorder2013In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 22, no 7, p. 425-432Article in journal (Refereed)
    Abstract [en]

    Previous studies suggest a different regulation of the hypothalamus-pituitary-adrenal axis (HPA-axis) with lower diurnal cortisol levels, especially in the morning, in children with attention-deficit/hyperactivity disorder (ADHD) compared with controls. Since exposure to foetal and childhood psychosocial adversity has been associated with both ADHD and HPA-axis functioning, such exposures may explain these low cortisol levels in ADHD via early programming of the HPA-axis. Thus, our main aim was to retrospectively study foetal and early childhood exposures to psychosocial adversity in children with ADHD and to relate these exposures to cortisol levels. Saliva samples were collected during a regular weekday in children, 6-17 years old, with clinically confirmed ADHD (n = 197) and non-affected comparisons (n = 221) for radioimmunoassay analysis of cortisol. Parental rating scales were used for categorising subtypes of ADHD and degree of exposure to adversity. Children with ADHD had more reports of at least one rated foetal adversity (p = 0.041) and childhood adversity (p < 0.001) than comparisons. The association between low morning cortisol levels and ADHD-symptoms remained when analyses were adjusted for adversities, age, sex, sampling time and symptoms of oppositional defiant disorder. No relation was found between exposures to foetal/childhood adversity and cortisol levels except for a positive relation between childhood adversity and cortisol morning increase in children with ADHD. The hypothesis that early adversity may influence the HPA-axis, leading to lower cortisol levels in children with ADHD, was not supported by our findings.

  • 18.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Nilsson, Kent W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    The Pressure-Activation-Stress scale in relation to ADHD and cortisol2015In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, no 2, p. 153-161Article in journal (Refereed)
    Abstract [en]

    The Pressure–Activation–Stress (PAS) scale is a self-report questionnaire for children concerning perceived stress. To explore behavioral and physiological correlates, we investigated if scores discriminate between a group prone to perceive high levels of stress [children with attention-deficit/hyperactivity disorder (ADHD)] and a healthy school sample, and if they are associated with diurnal cortisol levels. The PAS scale was filled in at home by children (11–17 years) with clinically confirmed ADHD (n = 102) and non-affected comparisons (n = 146). Saliva samples were collected four times during a regular school day for radioimmunoassay analysis of cortisol. Subtypes and severity of ADHD symptoms were determined using parental rating scales. Children with ADHD scored higher on the PAS scale than a school sample. The PAS scores were similar over ages in the ADHD group while they increased with age in the healthy group. Female sex was associated with higher stress in both groups but no gender interaction was found. No association was found between PAS scores and cortisol levels in neither group. Children in the ADHD group had a lower ratio of cortisol levels/perceived stress on all sampling occasions, built up both by the higher PAS scores and the lower cortisol levels in children with ADHD. The higher PAS scores in children with ADHD support the validity of the scale. The lack of association between PAS scores and diurnal cortisol levels is intriguing and illustrates the complexity of the stress concept. Stress-related fragility seems to accompany ADHD during childhood.

  • 19.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Hogmark, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Cortisol levels in children with Attention-Deficit/Hyperactivity Disorder2012In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 46, no 11, p. 1398-1405Article in journal (Refereed)
    Abstract [en]

    Regulation of the Hypothalamus-Pituitary-Adrenal axis (HPA-axis) and its end product cortisol differs among persons with certain psychiatric disorders when compared with controls. Some reports concern Attention-Deficit/Hyperactivity Disorder (ADHD) but findings are inconclusive. In this study we collected four saliva samples during a regular weekday in children, 6-17 years old, with ADHD (n = 201) and non-affected comparisons (n = 221). Saliva cortisol was measured with radioimmunoassay technique. Clinical data were collected for diagnostic information. Subtypes and severity of symptoms were determined using parental rating scales. Children with ADHD had lower saliva cortisol levels than comparisons at waking up Median = 9.1 versus 12.7 nmol/L (p < .001), 30 min later Median = 15.8 versus 20.1 nmol/L (p < .001) and before going to bed Median = 0.8 versus 1.0 nmol/L (p = .015). No difference was found for the afternoon sample. When the study group was split into three different age groups similar results were found only for children above 10 years of age. Subtype of ADHD or co-occurring symptoms did not affect the cortisol levels. Degree of severity of ADHD symptoms was not associated with cortisol levels in the study group, other than a weak negative correlation between the afternoon sample and hyperactivity symptoms. The low cortisol levels in children with ADHD may indicate a dysregulation of the HPA-axis, for instance a down-regulation or a phase delay of the diurnal curve. The low levels may be related to the under-arousal possibly underlying several of the core symptoms of ADHD.

  • 20.
    Isaksson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Department of Women’s and Children’s Health, Pediatric Neuropsychiatry Unit, Center for Neurodevelopmental Disorders.
    Ruchkin, Vladislav
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Yale Child Study Center, Yale University USA; Säter Psychiatric Clinic.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Unseen and Stressed? Gender Differences in Parent and Teacher Ratings of ADHD Symptoms and Associations With Perceived Stress in Children With ADHD.2016In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In this study, we investigate the differences between parent and teacher ADHD ratings, and how these ratings relate to perceived stress in children with ADHD.

    METHOD: Ratings by parents and teachers with the Swanson, Nolan and Pelham ADHD symptom rating scale (SNAP-IV) were collected from children with a clinical diagnosis of ADHD (n = 137). Also, information on medication was collected. Children (≥11 years of age; n = 64) were invited to complete the Pressure-Activation-Stress scale.

    RESULTS: Among girls, but not boys, teacher ratings were significantly lower than parental ratings on all symptom scales. Lower teacher ratings on hyperactivity symptoms were associated with higher levels of perceived stress.

    CONCLUSION: The findings suggest a potential gender bias in ratings among teachers. Underrated, and hence underidentified, ADHD problems in the school setting seem to increase the perception of stress in the sense of pressure for both girls and boys.

  • 21. Ivarsson, Malena
    et al.
    Anderson, Martin
    Akerstedt, Torbjorn
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    The Effect of Violent and Nonviolent Video Games on Heart Rate Variability, Sleep, and Emotions in Adolescents With Different Violent Gaming Habits2013In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 75, no 4, p. 390-396Article in journal (Refereed)
    Abstract [en]

    To study cardiac, sleep-related, and emotional reactions to playing violent (VG) versus nonviolent video games (NVG) in adolescents with different gaming habits. Methods: Thirty boys (aged 13-16 years, standard deviation=0.9), half of them low-exposed (<= 1 h/d) and half high-exposed (>= 3 h/d) to violent games, played a VG/NVG for 2 hours during two different evenings in their homes. Heart rate (HR) and HR variability were registered from before start until next morning. A questionnaire about emotional reactions was administered after gaming sessions and a sleep diary on the following mornings. Results: During sleep, there were significant interaction effects between group and gaming condition for HR (means [standard errors] for low-exposed: NVG 63.8 [2.2] and VG 67.7 [2.4]; for high-exposed: NVG 65.5 [1.9] and VG 62.7 [1.9]; F(1,28)=9.22, p=.005). There was also a significant interaction for sleep quality (low-exposed: NVG 4.3 [0.2] and VG 3.7 [0.3]); high-exposed: NVG 4.4 [0.2] and VG 4.4 [0.2]; F(1,28)=3.51, p=.036, one sided), and sadness after playing (low-exposed: NVG 1.0 [0.0] and VG 1.4 [0.2]; high-exposed: NVG 1.2 [0.1] and VG 1.1 [0.1]; (F(1,27)=6.29, p=.009, one sided). Conclusions: Different combinations of the extent of (low versus high) previous VG and experimental exposure to a VG or an NVG are associated with different reaction patterns-physiologically, emotionally, and sleep related. Desensitizing effects or selection bias stand out as possible explanations.

  • 22. Ivarsson, Malena
    et al.
    Anderson, Martin
    Åkerstedt, Torbjörn
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Playing a violent television game affects heart rate variability2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 1, p. 166-172Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how playing a violent/nonviolent television game during the evening affects sympathetic and parasympathetic reactions during and after playing as well as sleep quality during the night after playing. SUBJECTS AND METHODS: In total, 19 boys, 12-15 years of age, played television games on two occasions in their homes and participated once without gaming. Heart rate, heart rate variability (HRV) and physical activity were measured during gaming/participating and the night to follow using a portable combined heart rate and movement sensor. A sleep diary and questionnaires about gaming experiences and session-specific experiences were filled in. Criteria for Selection of Games: Violent game involves/rewards direct physical violence (no handguns) against another person, and nonviolent game involves/rewards no violence; same game design ('third-person game'); conducted in the same manner; no differences concerning motor activity; similar sound and light effects; no sexual content, violence against women or racial overtones. RESULTS: During violent (vs. nonviolent) gaming, there was significantly higher activity of the very low frequency component of the HRV and total power. During the night after playing, very low frequency, low frequency and high frequency components were significantly higher during the violent (vs. nonviolent) condition, just as total power. There were no significant differences between the three conditions (violent/nonviolent/no gaming) with respect to an index reflecting subjectively perceived sleep difficulties. Nor was there any difference between violent and nonviolent condition for any single sleep item. CONCLUSION: Violent gaming induces different autonomic responses in boys compared to nonviolent gaming--during playing and during the following night--suggesting different emotional responses. Subjectively perceived sleep quality is not influenced after a single gaming experience. Future studies should address the development of the autonomic balance after gaming over longer time than a night, physiological adaptation to frequent gaming and potential gender differences.

  • 23. Ivarsson, Malena
    et al.
    Anderson, Martin
    Åkerstedt, Torbjörn
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Playing a violent television game does not affect saliva cortisol2009In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, no 6, p. 1052-1053Article in journal (Refereed)
  • 24.
    Jablonska, B.
    et al.
    Stockholm Centre for Public Health, Sweden.
    Lindberg, L.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Stress Research Institute, Stockholm University, Sweden.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden.
    Ethnicity, socio-economic status and self-harm in Swedish youth: a national cohort study2009In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 39, no 1, p. 87-94Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have shown an elevated risk for self-harm in adolescents from ethnic minorities. However, potential contributions to this risk from socio-economic factors have rarely been addressed. The main aim of this article was to investigate any such effects. METHOD: A national cohort of 1009 157 children born during 1973-1982 was followed prospectively from 1991 to 2002 in Swedish national registers. Multivariate Cox analyses of proportional hazards were used to estimate the relative risk of hospital admission for self-harm. Parental country/region of birth was used as proxy for ethnicity. RESULTS: Youth with two parents born outside Sweden (except those from Southern Europe) had higher age- and gender-adjusted hazard ratios (HRs) of self-harm than the majority population (HR 1.6-2.3). The HRs decreased for all immigrant groups when socio-economic factors were accounted for but remained significantly higher for immigrants from Finland and Western countries and for youth with one Swedish-born and one foreign-born parent. CONCLUSIONS: Socio-economic factors explain much of the variation by parental country of birth of hospital admissions for self-harm in youth in Sweden.

  • 25. Jablonska, Beata
    et al.
    Lindberg, Lene
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Rasmussen, Finn
    Östberg, Viveca
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    School performance and hospital admissions due to self-inflicted injury: a Swedish national cohort study2009In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 38, no 5, p. 1334-1341Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Self-inflicted injury in youth has increased in many Western countries during recent decades. Education is the most influential societal determinant of living conditions in young people after early childhood. This study tested the hypothesis that school performance predicts self-inflicted injury. METHODS: A national cohort of 447 929 children born during 1973-77 was followed prospectively in the National Patient Discharge Register from the end of their ninth and last year of compulsory school until 2001. Multivariate Cox analyses of proportional hazards were used to test hypotheses regarding grades in ninth grade as predictors of hospital admission due to self-inflicted injury. RESULTS: The risk of hospital admission because of self-inflicted injury increased steeply in a step-wise manner with decreasing grade point average. Hazard ratios were 6.2 (95% confidence interval 5.5-7.0) in those with the lowest level of grade point average compared with the highest. The risks were similar for women and men. Adjustment for potential socio-economic confounders in a multivariate proportional hazards regression analysis attenuated this strong gradient only marginally. CONCLUSION: School performance is a strong factor for predicting future mental ill-health as expressed by self-inflicted injury.

  • 26. Jablonska, Beata
    et al.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Östberg, Viveca
    Lindberg, Lene
    Rasmussen, Finn
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    A national cohort study of parental socioeconomic status and non-fatal suicidal behaviour-the mediating role of school performance2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, p. 17-Article in journal (Refereed)
    Abstract [en]

    Background: A link between low parental socioeconomic status and mental health problems in offspring is well established in previous research. The mechanisms that explain this link are largely unknown. The present study investigated whether school performance was a mediating and/or moderating factor in the path between parental socioeconomic status and the risk of hospital admission for non-fatal suicidal behaviour.

    Methods: A national cohort of 447 929 children born during 1973-1977 was followed prospectively in the National Patient Discharge Register from the end of their ninth and final year of compulsory school until 2001. Multivariate Cox proportional hazards and linear regression analyses were performed to test whether the association between parental socioeconomic status and non-fatal suicidal behaviour was mediated or moderated by school performance.

    Results: The results of a series of multiple regression analyses, adjusted for demographic variables, revealed that school performance was as an important mediator in the relationship between parental socioeconomic status and risk of non-fatal suicidal behaviour, accounting for 60% of the variance. The hypothesized moderation of parental socioeconomic status-non-fatal suicidal behaviour relationship by school performance was not supported.

    Conclusions: School performance is an important mediator through which parental socioeconomic status translates into a risk for non-fatal suicidal behaviour. Prevention efforts aimed to reduce socioeconomic inequalities in non-fatal suicidal behaviour among young people will need to consider socioeconomic inequalities in school performance.

  • 27.
    Jonsson, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Natl Board Hlth & Welf, Stockholm, Sweden.
    Johanson, Josefin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Nilsson, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Natl Board Hlth & Welf, Stockholm, Sweden.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Adverse effects of psychological therapy: An exploratory study of practitioners' experiences from child and adolescent psychiatry2016In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 21, no 3, p. 432-446Article in journal (Refereed)
    Abstract [en]

    The scientific knowledge about adverse effects of psychological therapies and how such effects should be detected is limited. It is possible that children and adolescents are particularly vulnerable and need specific support in order to express adverse effects. In this exploratory study, we used a qualitative approach to explore practitioners' experiences of this phenomenon. Fourteen practitioners providing psychological therapy within the Child and Adolescent Psychiatric Service were interviewed. Qualitative content analysis was applied to the data. Four overarching categories brought up by the practitioners were identified: vagueness of the concept (reflecting that the concept was novel and hard to define), psychotherapist-client interaction (encompassing aspects of the interaction possibly related to adverse effects), consequences for the young person (including a range of emotional, behavioural and social consequences) and family effects (e.g. professional complications and decreased autonomy for the parent). Professional discussions on these issues could improve psychological therapy for children and adolescents. Based on our findings and previous research, we propose three basic aspects to consider when adverse effects are detected and managed in this context: typology (form, severity and duration), aetiology (hypothesis about the causes) and perspective (adverse effects seen from the points of view of different interested parties).

  • 28.
    Karlsson, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Stickley, Andrew
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Schwab-Stone, Mary
    Ruchkin, Vladislav
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Risk and protective factors for peer victimization: a 1-year follow-up study of urban American students2014In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 23, no 9, p. 773-781Article in journal (Refereed)
    Abstract [en]

    This study examined whether internalizing problems, parental warmth and teacher support were associated with adolescents' experience of future peer victimization in school. Data were drawn from two rounds of the longitudinal Social and Health Assessment (SAHA). Study subjects comprised 593 US urban adolescents (aged 13.8 ± 0.8 years; 56 % female). Results showed that there was a substantial degree of continuity in peer victimization over a 1-year period. The presence of internalizing (anxiety, depressive and somatic) symptoms at baseline was associated with an increased risk of peer victimization over time. Both parental warmth and teacher support were uniquely associated with a lower risk for peer victimization. Implications of these findings for prevention efforts are discussed.

  • 29.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Alternativhypotesen - ett hjälpmedel eller en fallgrop?2009In: Juridisk publikation, ISSN 2000-2920, Vol. 1, no 1, p. 93-118Article in journal (Refereed)
  • 30.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Är hovrätters bevisprövning konsekvent?2010In: Svensk Juristtidning, ISSN 0039-6591, no 4, p. 344-357Article in journal (Refereed)
  • 31.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Backman, L.
    Åkerstedt, T.
    Immigrant girls perceive less stress2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 7, p. 889-893Article in journal (Refereed)
    Abstract [en]

    AIM: To develop a new stress scale and use it for investigating impact of ethnicity on perception of stress. SUBJECTS AND METHODS: One thousand one hundred and twenty-four students (grades 6-9) from 14 schools filled in a questionnaire at school with questions about age, sex, use of language at home (proxy for cultural background), stress and stressors. Factor analysis and analysis of variance were used to analyze the data. RESULTS: Two-stress dimensions were identified, 'pressure'(7 items, Cronbach's alpha 0.862) and 'activation'(4 items, Cronbach's alpha 0.767). Scores on the two scales and a separate 'stress' item were higher in girls and increased with grade. Use of another language than Swedish at home showed a significant effect only for activation, with lower scores in girls. The interaction effect between sex and language was significant for all variables and was due mainly to lower stress in girls using another language than Swedish at home. CONCLUSION: This new stress scale has some promising qualities like a condensed format, basis in a specific stress concept and formulated to be as age and culture independent as possible. Immigrant girls seem to perceive less stress than Swedish born girls, which opens up for questions about protective mechanisms.

  • 32.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Backman, Lena
    Lundin, Anders
    Åkerstedt, Torbjörn
    Sleep, stress and eating attitudes predict concentration at school2011In: Salud (i) Ciencia, ISSN 1667-8982, E-ISSN 1667-8990, Vol. 18, no 2, p. 142-146Article in journal (Refereed)
    Abstract [en]

    Background: Sleep, stress and eating habits may affect concentration in school. These factors are probably interrelated, but have never been studied together as predictors of concentration. The purpose of this study, based on secondary analysis of previously collected data, was to evaluate if/how low sleep quality, perceived stress and negative attitudes to eating at school predict self-reported concentration difficulties in school in 11-15-year-olds.

    Methods: 1 124 students (grades 6-9) from 14 schools (a representative sample from a metropolitan area) filled in a questionnaire at school with questions about socio-demographic data, sleep, perceived stress, school eating attitudes and concentration in school.

    Results: Logistic regression analysis with mutual adjustment for all predictors, as well as for grade and gender yielded an odds ratio (OR) for the stress component "pressure" of 3.05 (95% confidence interval [CI] = 2.73-4.38), OR = 1.70 (1.20-2.42) for school eating attitude, and OR = 2.57 (1.78-3.71) for difficulties sleeping.

    Conclusion: Sleep, stress, and eating attitudes independently seem to predict perceived problems of concentration in school, suggesting that a multi-focus approach of life-style patterns may be suitable when trying to improve students' ability to concentrate in school.

  • 33.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Dalén, Monica
    Rasmussen, Finn
    Vinnerljung, Bo
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    School performance of international adoptees better than expected from cognitive test results2009In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 18, no 5, p. 301-308Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate school performance of international adoptees in relation to their cognitive competence. METHOD: From the population of all male Swedish residents born 1973-1976, registered in the census 1985 and with complete test scores from military conscription, the following study groups were identified: Korean adoptees (n = 320), non-Korean adoptees (n = 1,125), siblings (children born by adoptive parents, n = 190) and Swedish majority comparisons (n = 142,024). Global scores from intelligence tests at conscription were compared with grade points from the last compulsory school year (year 9). Linear and logistic regression was applied in statistical analyses. RESULTS: The mean grade points in theoretical subjects were lower in non-Korean adoptees than in the majority population, but when global test scores from military conscription were adjusted for, outcomes were significantly better, equal for physics, than in the majority population. The grade points of Korean adoptees were higher than in the majority population and the same held true after adjusting for global test scores. When SES was taken into account, the risk of poor school performance (only completed lower subject levels) increased in non-Korean adoptees compared to models only adjusted for age and sex. CONCLUSION: Male international adoptees generally perform better in school than expected by their cognitive competence. A cognitive evaluation is important in the assessment of adoptees with learning difficulties.

  • 34.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Eickhoff, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Forslund, Anders H
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Isaksson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Gustafsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Fasting blood glucose and HbA1c in children with ADHD2015In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 226, no 2-3, p. 515-516Article in journal (Refereed)
    Abstract [en]

    Reports of hypocortisolism and overweight in pediatric ADHD motivate an investigation of blood glucose regulation in this group. Fasting blood glucose and HbA1c were investigated in 10 children (10-15 years) with ADHD and 22 comparisons. Fasting blood glucose was similar in both groups. HbA1c values were higher in the ADHD-group. BMI-SDS was also higher in the ADHD-group but did not predict HbA1c. The results suggest an association between ADHD and an altered blood glucose homeostasis.

  • 35.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Adaptation of International Adoptees in Sweden.2009In: International adoptees: School Performance, Educational Attainment and Social Adjustment / [ed] M. Dalen & A-L. Rygvold, Oslo: University of Oslo , 2009, p. 61-68Chapter in book (Other academic)
  • 36.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    ADHD after fetal exposure to maternal smoking2010In: Nicotine & tobacco research, ISSN 1462-2203, E-ISSN 1469-994X, Vol. 12, no 4, p. 408-415Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Smoking during pregnancy has been reported to be associated with a twofold to fourfold increased risk of attention-deficit hyperactivity disorder (ADHD) in the offspring. Genetic and socioeconomic confounders may contribute to this association. The aim of this study was to investigate the association between fetal exposure to maternal smoking during pregnancy and ADHD, taking such potential confounders into consideration. METHODS: A register study in a population of 982,856 children, 6-19 years of age, born at term, and residents in Sweden in 2006 was conducted. Logistic regression was used to calculate odds ratios (ORs) of maternal smoking habits during pregnancy on ADHD medication in the 927,007 study subjects where maternal smoking habits were available from the Medical Birth Register in the presence of socioeconomic and parental psychiatric morbidity confounders. To adjust the analysis also for genetic confounding, we used a within-mother between-pregnancy approach in offspring of 26,292 mothers with inconsistent smoking habits (smoking/non-smoking) between pregnancies. RESULTS: The OR for ADHD medication in offspring of mothers who smoked >or=10 cigarettes/day was 2.86 (2.66-3.07) in the entire study population after adjustment for sex and age, while this same exposure yielded an OR of only 1.26 (0.95-1.58) when two pregnancies of the same mother were analyzed in a within-subjects design. DISCUSSION: Smoking during pregnancy has a strong association with ADHD in the offspring in the general Swedish population, but this risk is primarily explained by genetic and socioeconomic confounding.

  • 37.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Isaksson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Heiskala, Viktor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Koposov, Roman
    Ruchkin, Vladislav
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Comorbidity and Behavior Characteristics of Russian Male Juvenile Delinquents With ADHD and Conduct Disorder2015In: journal of attention disorders, ISSN 1557-1246Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the previously suggested hypothesis that those with comorbid ADHD and Conduct Disorder (CD) diagnoses differ from other antisocially involved youth in terms of higher rates of violent behavior, impulsiveness, and psychopathic traits.

    METHOD: Three hundred eighty juvenile incarcerated delinquents from Northern Russia were assessed by means of semi-structured psychiatric interview and by student and teacher self-reports.

    RESULTS: The study has demonstrated higher rates of psychiatric disorders and of comorbidity, as well as more complicated substance abuse and disruptive behaviors in those with combined ADHD-CD diagnosis, as compared with CD only, ADHD only, and no CD no ADHD groups. The results regarding psychopathic traits were inconclusive.

    CONCLUSION: The group with combined ADHD-CD diagnosis is more severely disturbed, both as concerns psychiatric comorbidity and more severe aggressive and disruptive behaviors. However, there is only limited evidence supporting a higher prevalence of psychopathic traits in this group.

  • 38.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Lainpelto, Katrin
    Sexual Abuse Allegations by Children with Neuropsychiatric Disorders2011In: Journal of Child Sexual Abuse, ISSN 1053-8712, E-ISSN 1547-0679, Vol. 20, no 2, p. 182-195Article in journal (Refereed)
    Abstract [en]

    All Swedish court cases from 2004 and 2006 concerning alleged child sexual abuse (sexual harassment excluded) were identified through criminal registers. Fourteen cases (one boy) concerned a child with a neuropsychiatric disorder. The diagnostic groups were mental retardation (10 cases), autism (three cases), and ADHD (one case). Psychiatric experts were engaged in only two cases. When experts were involved, the courts focused on credibility issues. When the courts applied neuropsychiatric arguments in the absence of an expert, they used developmental arguments. When the authors found that significant neuropsychiatric issues were not discussed by the court it concerned interpretations of symptoms and developmental standpoints. The results illustrate the complexity and pitfalls of drawing conclusions about associations between symptoms and personality characteristics on one side and accuracy of sexual abuse allegations on the other. Moreover, the results highlight the importance of a high quality system for providing courts with adequate neuropsychiatric knowledge.

  • 39.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Lainpelto, Katrin
    When superior courts reach different conclusions in the same child sexual abuse cases – is there a lesson to be learned?2008In: Journal of Investigative Psychology and Offender Profiling, ISSN 1544-4759, E-ISSN 1544-4767, Vol. 5, no 3, p. 171-187Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to analyse Swedish child sexual abuse cases from 1989 to 2004 characterised by the following: (1) conviction in first trial in a court of appeal; (2) the Supreme Court later accepted a petition for a new trial; and (3) acquittal in second trial in the same court of appeal (with new judges). The study was conducted to determine what criteria were used for evaluating psychological child-related information and how they were applied. Eight argument themes were identified in the reasoning of the courts: (1) ability to perceive, remember, and communicate about experiences in a reliable way; (2) influence before first forensic interview; (3) influence during forensic interview/s; (4) motives for disclosing/retracting; (5) statement characteristics; (6) disclosure process; (7) behaviour and/or emotions related to investigations/interviews; and (8) psychological symptoms. The arguing of the courts was classified as belonging to one of three categories for each argument theme: (1) supporting/challenging the allegations; (2) opposing a conceivably supportive/challenging argument; and (3) indifferent. In six of the nine cases, arguments belonging to the same theme were presented in both court proceedings. Diametrically opposite conclusions were reached in 15 of 20 of these examples and same conclusion in one case. The evaluation method/s seemingly underlying the child psychological arguments of the courts may have a low reliability.

  • 40. Lindblad, Frank
    et al.
    Lindberg, Lene
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Anorexia nervosa in young men: A cohort study2006In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 39, no 8, p. 662-666Article in journal (Refereed)
    Abstract [en]

    Objective: The current study investigates the background and outcome of anorexia nervosa (AN) in young men. Method: All (N = 61) men, born in 1968-1977 with hospital care in Sweden between 1987 and 1992 due to AN, were compared with the general population. Information about socioeconomic background, health-related outcome (hospital care for AN, other psychiatric diagnoses, abuse of alcohol/drugs and/or suicide attempt), and social outcome (major income from sick leave/sick pension or >= 6 months social welfare, living with birth parents, and living with child and partner; education level) was taken from national registers.

    Results: On a group level, the findings suggest some differences between male patients with AN and the male population without AN concerning social background, capacity to support oneself, and living with partner and child. Mental ill-health outcome was almost the same for men with AN as for the general population.

    Conclusion: Male gender in AN - on a group level - suggests a good psychiatric prognosis.

  • 41.
    Lindblad, Frank
    et al.
    Division of Psychosocial Factors and Health, Karolinska Institutet.
    Lindberg, Lene
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Improved survival in adolescent patients with anorexia nervosa: a comparison of two Swedish national cohorts of female inpatients2006In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 163, no 8, p. 1433-1435p. 1433-1435Article in journal (Refereed)
    Abstract [en]

    Objective: The authors examined two cohorts of female inpatients with anorexia nervosa a decade apart to determine whether there had been any changes in terms of survival. Method: The Swedish National Registers, which contain information about hospital discharges and deaths for the entire population, were used to investigate differences in mortality. Subjects born between 1958 and 1967 and hospitalized due to anorexia nervosa between 1977 and 1981 (N=564) were compared with subjects born between 1968 and 1977 and hospitalized due to anorexia nervosa between 1987 and 1991 (N=554). The cohorts were followed from first hospital admission until 1992 and 2002, respectively. Results: Twenty-five deaths (4.4%) were recorded within the cohort hospitalized between 1977 and 1981, and seven deaths (1.3%) occurred in the cohort hospitalized between 1987 and 1991. The hazard ratio of death for the 1977—1981 cohort relative to the 1987—1991 cohort was 3.7. Conclusions: Mortality among female patients with anorexia nervosa in hospital care in Sweden has decreased dramatically, which is probably related to the introduction of specialized care units.

  • 42.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Lindgren, Carl
    Välfärdslandets gåta: Varför mår barnen inte lika bra som de har det?2009 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 43.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Ringbäck Weitoft, G.
    Hjern, A.
    Maternal and paternal psychopathology increases risk of offspring ADHD equally2011In: Epidemiology and Psychiatric Sciences, ISSN 2045-7960, E-ISSN 1827-4331, Vol. 20, no 4, p. 367-372Article in journal (Refereed)
    Abstract [en]

    Background. Parental psychopathology may increase the risk of attention-deficit hyperactivity disorder (ADHD) in the offspring. The aim of this study was to analyze if/how gender influences the association between parental psychiatric/addictive disorders and ADHD medication in the offspring.

    Methods. Register study in national birth cohorts of 1.1 million 6-19-year-olds. In this population, 7960 individuals with ADHD medication were identified in the Swedish Prescribed Drug Register during 2006. Data on parental psychiatric/addictive disorders and suicide death were obtained through linkages to national registers. Logistic regression was used for analyses with multiple adjustments for socio-economic, regional and demographic confounders.

    Results. Parental diagnosis related to illicit drugs was associated with the highest odds ratios (ORs) of ADHD medication (OR: similar to 3.5-4), followed by suicide attempt/death (OR: similar to 3-3.5), alcohol (OR: similar to 2.5-3), affective disorder (OR: similar to 2.5) and psychosis (OR: similar to 2-2.5). The ORs were of similar magnitudes for maternal and paternal psychopathology and did not vary by the gender of the offspring. Adjusting for social characteristics decreased the ORs substantially and in the same way regarding fathers' and mothers' possible influence on the risk of ADHD in children.

    Conclusions. Neither parental nor offspring gender seems to influence the link between parental addictive/psychiatric disorder and offspring ADHD.

  • 44.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Signell, Sonja
    Degrading attitudes related to foreign appearance: Interviews with Swedish female adoptees from Asia2008In: Adoption & Fostering: The Quarterly Journal of British Agencies for Adoption & Fostering, ISSN 0308-5759, E-ISSN 1740-469X, Vol. 32, no 3, p. 46-59Article in journal (Refereed)
    Abstract [en]

    Seventeen adopted young women from South Korea and Thailand (age 25–35 years) were interviewed about their experiences of degrading attitudes related to their geographic origin and physical appearance. Prejudices related to sexuality displayed four themes – exoticassociations, availability, strong libido and exploitation –corresponding to prevailing Western sexualised cultural stereotypes about Asian women. Prejudices specific to adoption included expected gratitude and indiscriminate friendliness. The experiences usually involved recurring rather than single incidents and several women reported that they had adversely influenced their well-being and quality of life. Many had developed strategies for coping with such attitudes, usually from men.

  • 45.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Vinnerljung, Bo
    von Borczyskowski, Annika
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Adopción internacional en Suecia: Salud mental y adaptación social en adolescentes y jóvenes2008In: Infancia y Aprendizaje, ISSN 0210-3702, E-ISSN 1578-4126, Vol. 31, no 2, p. 211-231Article in journal (Refereed)
    Abstract [en]

    The paper summarises results from five studies exploring psychosocial outcomes for international adoptees in Sweden. Cohorts of international adoptees were identified in national Swedish registers. The study groups were compared with: 1) general population, 2) national adoptees, 3) immigrants, 4) children on welfare, and 5) birth children of the adoptive parents. The international adoptees had around three-fold excess risks of hospitalisation due to psychiatric problems and suicidal behaviour in models adjusted for age, sex and the adoptive family's social prerequisites. The risk of suicidal behaviour was also high in national adoptees, but lower than that of foster children who had even higher risks. Educational attainment was on par with the general population. Age at adoption over 4 years was related to a poorer outcome. In conclusion, international adoptees are more vulnerable than non-adoptees.

  • 46.
    Lindblad, Frank
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Weitoft, Gunilla Ringbäck
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    ADHD in international adoptees: a national cohort study2010In: European child & adolescent psychiatry, ISSN 1435-165X, Vol. 19, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    Several investigators have reported an increased frequency of attention/hyperactivity symptoms in international adoptees, though population-based studies are lacking. In this national cohort study, we aimed to determine the prevalence of ADHD medication in international adoptees in Sweden, in comparison to the general population. A further purpose was to study gender, age at adoption and region of origin as predictors of ADHD medication in international adoptees. The study population consisted of all Swedish residents born in 1985-2000 with Swedish-born parents, divided into 16,134 adoptees, and a comparison population of 1,326,090. ADHD medications were identified in the Swedish Prescribed Drug Register during 2006. Logistic regression was used to calculate the odds ratios. The rates of ADHD medication were higher in international adoptees than in the comparison population for both boys (5.3 vs. 1.5% for 10-15-year olds) and girls (2.1 vs. 0.3% for 10-15-year olds). International adoptees from all regions of birth more often consumed ADHD medication compared with the majority population, but the age and sex adjusted odds ratios were particularly high for adoptees from Eastern Europe, Middle East/Africa and Latin America. Adjusting for maternal education and single parenthood increased the odds ratios even further. The risk also increased with higher age at adoption. Adoptees from Eastern Europe have a very high risk for ADHD medication. A structured identification and support programme should be tailored for this group. Adoptees from other regions have a more moderately increased risk, which should be communicated to adoptive parents and to professionals who care for adoptees in their clinical practice.

  • 47.
    Lindgren, Carl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    The enigma of the welfare state: excellent child health prerequisites - poor subjective health2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 6, p. 803-807Article in journal (Refereed)
    Abstract [en]

    The rate of subjective health complaints among Swedish children is increasing by age and over time, and more so than among children in other Scandinavian countries. In contrast, the somatic health and prerequisites for wellbeing are excellent. This paradoxical situation, The Enigma of the Welfare State, is the focus of this viewpoint. We argue that one important background factor may be late adverse effects of the welfare society itself and some of its inherent values. We have identified several possible pathways. We have given them names of diseases - on the society level - like health obsession, stress panic, welfare apathy and hyper-individualism. Together with other factors such as a dysfunctional school and an unsatisfactory labour market for youth, these diseases are involved in an interplay that is constantly inducing anxiety and low self-esteem. Conclusion: The gradually deteriorating self-reported health among Swedish youth may, to some degree, be explained as a late adverse effect of the welfare society itself and its inherent values.

  • 48. Lindström, Karolina
    et al.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hjern, Anders
    Preterm Birth and Attention-Deficit/Hyperactivity Disorder in Schoolchildren2011In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 127, no 5, p. 858-865Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Previous studies have demonstrated an increased risk for attention-deficit/hyperactivity disorder (ADHD) in follow-up studies of preterm survivors from NICUs. In this study we analyzed the effect of moderate as well as extreme preterm birth on the risk for ADHD in school age, taking into account genetic, perinatal, and socioeconomic confounders. METHODS: Register study in a Swedish national cohort of 1 180 616 children born between 1987 and 2000, followed up for ADHD medication in 2006 at the age of 6 to 19 years. Logistic regression was used to test hypotheses. A within-mother-between-pregnancy design was used to estimate the importance of genetic confounding in a subpopulation of offspring (N = 34 334) of mothers who had given birth to preterm (<= 34 weeks) as well as term infants. RESULTS: There was a stepwise increase in odds ratios for ADHD medication with increasing degree of immaturity at birth; from 2.1 (1.4-2.7) for 23 to 28 weeks' gestation, to 1.6 (1.4-1.7) for 29 to 32 weeks', 1.4 (1.2-1.7) for 33 to 34 weeks', 1.3 (1.1-1.4) for 35 to 36 weeks', and 1.1 (1.1-1.2) for 37 to 38 weeks' gestation compared with infants born at 39 to 41 weeks' gestation in the fully adjusted model. The odds ratios for the within-mother-between-pregnancy analysis were very similar. Low maternal education increased the effect of moderate, but not extreme, preterm birth on the risk for ADHD. CONCLUSION: Preterm and early term birth increases the risk of ADHD by degree of immaturity. This main effect is not explained by genetic, perinatal, or socioeconomic confounding, but socioeconomic context modifies the risk of ADHD in moderately preterm births.

  • 49. Lindström, Karolina
    et al.
    Lindblad, Frank
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hjern, Anders
    Psychiatric morbidity in adolescents and young adults born preterm: a Swedish national cohort study2009In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 123, no 1, p. e47-e53Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Increasing numbers of infants born preterm survive into adulthood. Previous studies have reported increased levels of neurologic and cognitive disabilities in these children. In this study, we analyzed the effect of having been born preterm on psychiatric morbidity. METHODS: A Swedish national cohort of 545628 individuals born in 1973-1979 was followed up in the national registers during 1987-2002. Multivariate Cox analysis of proportional hazards was used to estimate the hazard ratios of hospital admissions for psychiatric disorders and alcohol/illicit drug abuse. RESULTS: There was a stepwise increase in psychiatric hospital admissions with an increasing degree of preterm birth. A total of 5.2% of children born at 24 to 28 weeks' gestation and 3.5% born at 29 to 32 weeks' gestation had been hospitalized because of a psychiatric disorder. The hazard ratios for psychiatric disorders were 1.68 in the group of very preterm children (gestational weeks 24-32), 1.21 in the moderately preterm group (gestational weeks 33-36), and 1.08 in the early term group (gestational weeks 37-38) after adjustment for socioeconomic confounders. Moderately preterm and early term birth accounted for 85% of the risk attributed to preterm/early term birth. The effect of preterm birth was greater in households with low socioeconomic status. CONCLUSION: Preterm birth carries some risk for psychiatric disorders requiring hospitalization in adolescence and young adulthood (ages 8-29 years). Even if this risk increases with degree of preterm birth, most subjects are moderately preterm, a group in need of more attention in research and secondary prevention.

  • 50. Odenstad, A.
    et al.
    Hjern, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindblad, Finn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Rasmussen, F.
    Vinnerljung, B.
    Dalén, M.
    Does age at adoption and geographic origin matter? A national cohort study of cognitive test performance in adult inter-country adoptees2008In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 38, no 12, p. 1803-1814Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Inter-country adoptees run risks of developmental and health-related problems. Cognitive ability is one important indicator of adoptees' development, both as an outcome measure itself and as a potential mediator between early adversities and ill-health. The aim of this study was to analyse relations between proxies for adoption-related circumstances and cognitive development. Method: Results from global and verbal scores of cognitive tests at military conscription (mandatory for all Swedish men during these years) were compared between three groups (born 1968-1976): 746 adoptees born in South Korea, 1548 adoptees born in other non-Western countries and 330 986 non-adopted comparisons in the same birth cohort. Information about age at adoption and parental education was collected from Swedish national registers. RESULTS: South Korean adoptees had higher global and verbal test scores compared to adoptees from other non-European donor countries. Adoptees adopted after age 4 years had lower test scores if they were not of Korean ethnicity, while age did not influence test scores in South Koreans or those adopted from other non-European countries before the age of 4 years. Parental education had minor effects on the test performance of the adoptees - statistically significant only for non-Korean adoptees' verbal test scores - but was prominently influential for non-adoptees. CONCLUSIONS: Negative pre-adoption circumstances may have persistent influences on cognitive development. The prognosis from a cognitive perspective may still be good regardless of age at adoption if the quality of care before adoption has been 'good enough' and the adoption selection mechanisms do not reflect an overrepresentation of risk factors - both requirements probably fulfilled in South Korea.

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