External Publications Using GUI Data

Objectives
To examine the associations between preeclampsia and longitudinal child developmental and behavioural outcomes using data from a nationally representative study of children living in Ireland.

Methods
We used maternal-reported data from the Growing Up in Ireland longitudinal study of children. Data on preeclampsia and preeclampsia + small for gestational age (SGA) were collected when children were 9-months old. Data on child development and behavioural outcomes were collected at 9-months using the Ages and Stages Questionnaire (ASQ), and at 3 years, 5 years and 7–8 years using the Strengths and Difficulties Questionnaire (SDQ). Multivariate logistic regression analysis was used to examine the association between preeclampsia exposure and failure of ASQ domains, and abnormal SDQ domains. Linear spline multilevel models were used to examine the association between preeclampsia and preeclampsia + SGA and repeated measures of SDQ. All models controlled for several perinatal and sociodemographic factors.

Results
A total of 10,692 children were included in the study at baseline, representing a weighted total of 70,791. Multivariate logistic regression suggested that preeclampsia was not associated with failing any ASQ domain. Preeclampsia was associated with abnormal SDQ cut-off of emotional (≥ 5) and hyperactivity (≥ 7) domains at age 5 years only. In the linear spline model, mean SDQ score was higher at each time point in exposed groups.

Conclusions for Practice
While we did not find strong evidence of associations between preeclampsia and child developmental and behavioural outcomes overall, some associations between preeclampsia-exposure and subtle behavioural issues did persist. Further research is needed to replicate these findings, and determine the clinical significance of changes in SDQ scores.

Background
There is growing concern around youth mental health. A population health approach to improve mental health must address, among other issues, economic insecurity, access to housing and education, harm reduction from substance use. As a universal public health intervention, increasing physical activity at a population level may have an important role in our approach. The aim of this study was to examine the longitudinal association between physical activity patterns between childhood and early adolescence and emotional-behavioural difficulties in later adolescence.

Methods
This study was based on data from the ′98 Child cohort of the Growing Up in Ireland Study. Participants were categorized according to physical activity levels at ages 9 and 13. Emotional-behavioural difficulties at age 17 were measured using the parent-reported Strengths and Difficulties Questionnaire. Logistic regression was used to examine the association between physical activity and emotional-behavioural outcomes.

Results
Among 4618 participants included in the regression model, those categorized as Inactive (n=1607) or Reducer (n=1662) were more than twice as likely to have emotional-behavioural difficulties at age 17 compared with those who were Active [adjusted odds ratio (AOR) 2.1, 95% CI 1.46–3.01, P<0.001; AOR 1.93, 95% CI 1.34–2.76, P<0.001, respectively]. Among those with emotional-behavioural difficulties at baseline (n=525), those categorized as Active had 2.3-fold reduced odds for emotional-behavioural problems at age 17 compared with those who were Inactive (AOR 0.43, 95% CI 0.23–0.78, P=0.006).

Conclusions
Increasing physical activity among adolescents is a safe and sustainable public health intervention associated with improved mental health.

The first 1000 days of life are a period of unique sensitivity and plasticity during which critical cognitive abilities are formed. Routine developmental screening tools aim to identify infants who would benefit from early intervention. While these tools have been validated for detecting children with more severe neurodevelopmental disorders, their ability to identify the larger proportion with below average cognitive function has not been sufficiently explored. The aim of this study was to examine the validity of the Ages and Stages Questionnaire (ASQ), for identifying children with later below average cognitive function.

The study population (n=8260) is formed from two national cohort studies, the Growing Up in Ireland (GUI) Infant cohort (n=7,444) and the Cork BASELINE cohort (n=816). The ASQ was completed at 8 months and 24-27 months respectively. Cognitive assessments were performed at age 5. Those scoring <1 standard deviation (SD) below the mean were categorised as below average cognitive function. Applying the currently used onward referral criterion (one fail in any domain) the sensitivity, specificity, positive and negative predictive values of the 8- and 24-27- month ASQ for detecting children with later below average cognitive function were calculated.

In the GUI cohort n=905 participants (12.5%) had scores <1SD below the mean on the Picture Similarities Scale. In the BASELINE cohort n=101 participants (13.4%) had an IQ <1SD below the cohort mean. Applying the currently used onward referral criterion (failing in any one domain in the ASQ), the sensitivity of the 8-month ASQ for detecting children scoring <1SD below the mean on the Picture Similarities Scale at age 5 was 16.4% (95% CI 14.0-19.0). The specificity was 92.0% (95% CI 91.3-92.6), with a positive predictive value (PPV) of 22.6% (95% CI 19.5-26.0) and a negative predictive value (NPV) of 88.5% (95% CI 87.7%-89.2%).

In the BASELINE cohort n=468 participants completed the 24-month ASQ and n=316 the 27-month ASQ. Applying the same onward referral criterion to the 24- and 27- month ASQ combined, the sensitivity for detecting those with an IQ <1SD below the cohort mean was 20.8% (95% CI 13.6-30.2) and the specificity was 91.1% (95% CI 88.6-93.2).

The ASQ has a low sensitivity for identifying children with below average cognitive function at age 5. The findings of this study suggest that if we are to intervene early in the developmental trajectory for children with below average cognitive function alternative methods of identifying high risk infants are needed.

Children with below average cognitive function represent a substantial yet under-researched population for whom academic and social demands, which increase in complexity year by year, pose significant challenge. Effects on emotional-behavioural development (EBD) are not well understood. The aim of this study was to compare trajectories of EBD for children with and without below average cognitive function. The underlying hypothesis was that trajectories of EBD would differ between groups, with divergence occurring as children are subject to increasingly complex cognitive demands.

Participants consist of 7,000 children and caregivers who completed the Growing Up in Ireland survey at age 3,5 and 9 years. Cognitive function was measured at age 3 using the Picture Similarities Scale. A t-score 1-2 standard deviations below the mean was categorised as below average cognitive function (n=767), and scores above this categorised as average cognitive function (n=6418). EBD was measured using the Strengths and Difficulties Questionnaire (SDQ) at age 3,5 and 9. Repeated measures ANOVA was used to examine the difference between the overall group means across the repeated measures of SDQ, the SDQ change over time, and the interaction between cognitive group and change over time. Further analysis of trajectories was performed using latent growth curve analysis.

Compared to those with average cognitive function, a significantly higher proportion of children with below average function were male (61.8% v 38.2%, χ2 (1, N=7134) = 42.07 p<0.001), born to a single parent family (22.4% v 14.7%, χ2 (1, N=7134) = 23.15 p<0.001), and had a parent who smoked (35.6% v 25.8%, χ2 (1, N=7134) = 33.23 p<0.001). Children with below average cognitive function had significantly higher mean total SDQ scores at all ages. Repeated measures ANOVA demonstrated a significant group-by-time interaction effect (F(2,7182)=4.649, p=0.010). The mean difference (MD) in SDQ between cognitive groups increased over time (MD Age 3:0.87, 95% confidence interval (CI) 0.53-1.21, Age 9 MD:1.49,95% CI 1.08-1.91). For those with average or above cognitive function the overall SDQ decreased between age 3-9 (MD: -0.49 95% CI -0.65—0.33). This decrease was not seen for those with below average function, who had a non-statistically significant increase in SDQ between age 3-9.

Children with below average cognitive function experience higher and worsening mean SDQ scores throughout childhood. A scalable method of early identification of children at risk for below average cognitive function should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes.

The incidence of adiposity in the early years of life has outgrown the prevalence in older children and adolescents globally; however, the factors influencing weight gain are predominantly studied in adults. This study examines the relationship between changing economic conditions during the Irish recession and child weight in a nationally representative sample of 10,011 Irish children studied at 9 months, 3 years and 5 years old. This study is the first to use longitudinal anthropometric measurements to estimate the impact of direct parental unemployment on children’s weight. Fixed effect logistic regression is used to examine the effects of parental unemployment on weight using the Growing up in Ireland infant cohort from 2008 to 2013. Weight and length/height measured by trained interviewers and child growth charts are used to quantify children’s weight status according to BMI-for-age and weight-for-age measures. For BMI-for-age, the probability of a child being classified as overweight/obese is 8 percentage points higher if either parent experiences unemployment. A sensitivity analysis of weight-for-age indicates that the probability is of similar magnitude across several alternative growth charts and definitions of adiposity (the WHO standard, British Growth Reference, and Centers for Disease Control). The analysis is repeated, cross-sectionally, for physical activity and diet to clarify mechanisms of effect. The probability of a child consuming healthy food and physical activity with an implied cost is lower if either parent becomes unemployed. A focus on overweight/obesity in the early years is of crucial importance as if current trends are not addressed, a generation of children may grow up with a higher level of chronic disease.

To date, studies using cross-sectional methodologies make up a majority of the literature surrounding children with autism spectrum disorders and participation in physical activity and screen time. Longitudinal studies are needed to examine how physical activity and screen time behaviors co-develop for children with and without an autism spectrum disorder. To address this research gap, this study compared how physical activity and screen time levels changed over time (9 to 18 years of age) between youth with autism spectrum disorder and youth with neurotypical development. Data on the levels of moderate-to-vigorous physical activity, light physical activity, television-, and video game-based screen time, collected as a part of the “Growing up in Ireland” study, were compared between youth with autism spectrum disorder and a propensity-matched sample of youth with neurotypical development (n = 88 per group; 176 in total). Robust regression analyses indicated that children with autism spectrum disorder became less active over time compared to children with neurotypical development and that video game screen time also differed significantly between the groups when children were 9 years old. These findings elucidate important disparities present between these groups of children during pivotal developmental times.

The COVID-19 lockdown and closure of schools, clinics, and community-based services put children with autism spectrum disorders (ASDs) and other developmental disabilities (DDs) at increased risk of negative outcomes. This study aimed to investigate parents’ perceptions of their children’s behavioural outcomes during the COVID-19 lockdown, parents’ satisfaction with services during this time, and willingness to engage in telehealth. A cross-sectional study was conducted in Ireland. Parents (n = 89) completed an online questionnaire that included the strengths and difficulties questionnaire (SDQ-P). Results demonstrated that children with ASD/DDs were vulnerable to negative outcomes including hyperactivity, emotional symptoms, problems with peers and fewer prosocial behaviors. Children’s behavioral outcomes (‘current sample’, n = 89) were also compared with pre-COVID-19 data taken from the Growing Up in Ireland Study (‘GUI sample’, n = 327). The current sample exhibited significantly more behavioral difficulties than the pre-COVID GUI sample (p < 0.001). For the current sample, scores on each of the five SDQ subscales were significantly associated with a total impact score, and parents reported dissatisfaction with support services provided and willingness to engage in behavioral telehealth. Commitment is required to identify barriers to services faced by families in Ireland and to address the need for adapted behavior support services during periods of emergency.

Keywords: COVID-19; intellectual disabilities; developmental disabilities; autism; behavior; behavioral support

This study investigated trajectories of concomitant internalising, externalising, and peer problems, and associated risk factors for group-membership, using a person-centered approach to better understand heterogeneity in subgroups identified. A cohort of 7,507 children in Ireland was followed from infancy to late childhood (50.3%, males; 84.9% Irish). The parent-version of the Strengths and Difficulties Questionnaire was used when children were 3, 5, 7 and 9 years of age. Information on antecedent risk factors was collected when children were 9 months. Group-based multi-trajectory modelling and multinomial logistic regression were used. Six subgroups of children with distinct profiles were identified, evidencing both homotypic and heterotypic comorbidity. No support of a ‘pure’ internalising, externalising or peer problems group was found in any identified trajectory group. Difficulties in one problem domain indicated the presence of difficulty in another problem domain for all children in elevated groups. Risk factors associated with group-membership were complex, with only three common factors across elevated groups: prenatal exposure to smoking, maternal education, and maternal stress. Specific risk factors for group-membership included low birth weight, sex, maternal age, maternal depression, family composition, social class, medical card status and quality of attachment. Despite some overlap in predictors, the combination of predictors specific to each group would suggest tailored programming. For children with the most acute problems, programming targets should include families with boys, born with low birth weight, exposed to smoking prenatally, with mothers who have lower levels of education, postnatal depression, increased stress and fewer financial resources.

Background
Childhood adversity (CA) is commonly associated with an increased risk of subsequent psychopathology. It is important to identify potential mediators of this relationship which can allow for the development of interventions. In a large population-based cohort study we investigated the relationship between CA and late adolescent psychopathology and early adolescent candidate mediators of this relationship.

Methods
We used data from three waves (n = 6039) of Cohort 98′ of the Growing up in Ireland Study (age 9, 13 and 17). We used doubly robust counterfactual analyses to investigate the relationship between CA (reported at age-9) with psychopathology (internalizing and externalizing problems), measured using the Strengths and Difficulties Questionnaire at age-17. Counterfactual and traditional mediation was used to investigate the mediating effects of the parent-child relationship, peer relations, self-concept, computer usage and physical activity.

Results
CA was associated with an increased risk of internalizing and externalizing problems at age-17. Parent-child conflict mediated 35 and 42% of the relationship between CA and late adolescent externalizing problems and internalizing problems, respectively. Self-concept and physical activity mediated an additional proportion of the relationship between CA and internalizing problems. These results were robust to unmeasured confounding.

Conclusions
Parent-child conflict explains more than a third of the relationship between CA and later psychopathology. Self-concept and physical activity explain the additional proportion of the relationship between CA and internalizing problems. This suggests that these factors may be good targets for intervention in young people who have experienced CA to prevent subsequent psychopathology.

Keywords
Childhood adversity, parent-child conflict, psychopathology, self-concept and physical activity

This collection brings together various cutting-edge and accessible perspectives and insights into the rich, complex and intriguing stage of life that is childhood. Contributions here relate specifically to the Irish context, with many seamless connections also made to the universal themes of childhood and their relevance within the international context. The chapters are organised into four themes: (1) Children and families in education and special education settings; (2) Childrenâ (TM)s environment and play spaces; (3) Childrenâ (TM)s voice in research, classrooms and non-traditional settings; and (4) Childrenâ (TM)s experiences in STEM education. Across the chapters, the authors identify current best practices and place them within the overall context of current trends in research into childhood. There is a complementary balance of theoretical and practical knowledge presented throughout the volume. Given the variety of perspectives and contributions presented here, it will be of interest to those working in professional practice, such as educators, psychologists, sociologists, and the more general public, including parents and policymakers.

The study examines whether and why parental job loss may stifle early child development, relying on cohort data from the population of children born in Ireland in 2007–2008 (N = 6,303) and followed around the time of the Great Recession (2008–2013). A novel approach to mediation analysis is deployed, testing expectations from models of family investment and family stress.

Parental job loss exacerbates problem behavior at ages 3 and 5 (.05–.08 SDs), via the channels of parental income and maternal negative parenting. By depressing parental income, job loss also hampers children’s verbal ability at age 3 (.03 SDs). This is tied to reduced affordability of formal childcare, highlighting a policy lever that might tame the intergenerational toll of job loss.

In many countries, information on the prevalence of persistent speech and language disorders in early childhood is sparse due to the lack of nationally representative samples and longitudinal studies. Secondary analysis of data collected on over 7500 Irish children at ages 5 and 9 years, found that the prevalence of speech and language difficulties reported by the primary caregivers of Irish children decreased from one in six at age 5 to one in 12 at age 9. However, one in 20 children were reported to have difficulties at both ages. Regression analysis compared children with difficulties at both age 5 and age 9 to those who had been reported to have them at age 5 but no longer had such difficulties at age 9. Children with speech and language difficulties at both age 5 and age 9 were more likely to have two or more developmental impairments as well as current or past hearing impairments. Teachers and parents also reported a greater number of social-emotional difficulties. Family characteristics did not differ significantly across the two groupings. At best, up to one third of the children at ages 5 and 9 with speech and language difficulties had two or more contacts with a speech and language therapists in the preceding 12 month period. Increased support to these children, their parents and teachers would seem to be warranted.

Keywords
speech difficulties, language difficulties, children, longitudinal, national, survey, Ireland, speech and language therapy

Using data from Ireland’s national longitudinal study of children, this paper employs a capabilities approach to disability to understand how individual characteristics as well as home and school environmental factors at age 9 relate to academic and socio-emotional outcomes of students with special educational needs (SEN) at age 17. Results suggest that young people with SEN register both lower average scores and make less academic progress between the age of 9 and their national lower secondary examination, with the exception of young people with a physical SEN. Both home and school environmental factors at 9 years have long-term associations with the academic outcomes of young people with SEN, after controlling for individual characteristics and prior academic achievement. Home and school environmental factors had less consistent associations with the socio-emotional outcomes of young people with SEN. By using rigorous nationally representative longitudinal data, this paper offers a more holistic understanding of the development of young people with SEN. The paper also provides important evidence that a more inclusive approach for supporting students with additional needs, their parents, and their schools is needed.

Keywords
Special educational needs, capabilities approach, academic achievement, socio-emotional outcomes, Growing Up in Ireland

While the role parents play in supporting young people is well established, support from other caring adults also becomes important during adolescence, particularly when young people are facing problems in their lives. The goal of this paper is to reflect on youth support seeking when facing problems, exploring differences between youth who seek support from parents only and those who seek support from parents and other non-parental adults. This paper outlines the findings of a secondary analysis of data from the third wave of the Growing up in Ireland child cohort at 17/18 years, collected from primary caregivers and youth. From 6126 young people in the national sample, 91.3% answered the selective question about the type of adult support they seek. Of this cohort, 36% of young people seek support from a parent and 48% go to a parent and another adult. Comparing these groups, there are significant differences found in both their individual and contextual characteristics, with better outcomes for youth with additional non-parental adult support, including using active coping strategies, better self-esteem, and identity resolution. While the findings indicate that non-parental adults have a positive influence in different areas of youth well-being, further research is required to better understand the ways in which support from non-parental adults helps young people in their transition to adulthood.

Keywords
Supportive adults, natural mentors, youth, transition to adulthood, parenting

Large-scale international migration continues apace. From a health-care services perspective, it is important to understand the influence of migrant heritage on utilization, to allocate resources appropriately and facilitate equity. However, the differences in utilization across different migrant groups remain poorly understood, particularly so for paediatric populations. This paper contributes to filling this gap in knowledge, examining the health-care contact of children for whom their primary caregiver is foreign-born, using longitudinal data from two nationally representative surveys. The study setting is Ireland, which provides an interesting case as a small, open European country, which for the first-time experienced net inward migration in the past two decades. For both cohorts, panel regression models, adjusting for socioeconomic and health indicators, demonstrated lower utilization of general practitioner (GP) services for children of caregivers from ‘less-advanced, non-Anglosphere, non-European Union (EU)’ nations, relative to native-born counterparts. Relatively lower attendances at Emergency Departments and hospital nights were also observed for this group, as well as for children born to EU (non-UK) caregivers. The insights provided are instructive for policymakers for which immigration is a substantial phenomenon in current and future population demographics.

Children, particularly those of preschool ages (below 3 years), spend the majority of time indoors in the family home. Home conditions can impact upon occupant’s health, with energy poverty identified as a public health concern in Europe and internationally. Children growing up in energy poor homes may be especially vulnerable to health impacts, though the area is relatively understudied. This study addresses a gap in understanding, examining the effect of household energy poverty on the health of resident children using longitudinal data from two cohorts – an Infant Cohort (aged 9 months to 5 years) and a Child Cohort (aged 9 years to 17–18 years), growing up in Ireland.

Panel logistic regression models adjust for a range of covariates including socioeconomic and household information as well as smoking in the household. For the Infant Cohort, household energy poverty was associated with a 1.41 times higher odds of child respiratory illness (p = 0.003; 95% Confidence Interval (CI) 1.12–1.77), and 1.47 times the odds of child wheezing (p < 0.001; 95% CI 1.25–1.74). The odds of a young child being rated as very healthy was lower (point estimate: 0.85, p = 0.011; 95% CI 0.75–0.96). For older children, the relationships were not statistically significant. The risk that energy poverty presents for the health of young children merits continued policy attention.

Objective
To explore whether the associations between developmental delays in the first year of life and psychosocial outcomes in preschool children are affected by participation in organized sport.

Study design
Data were obtained from the infant cohort of the Growing Up in Ireland project. Parents reported on child development (Ages and Stages Questionnaire) at age 1 year, psychosocial characteristics (Strengths and Difficulties Questionnaire) at ages 3 and 5 years, and engagement in organized sport at age 5 years. Data were analyzed using mixed models.

Results
At age 1 year, 15% of the cohort was classified as having developmental delays. These children exhibited more behavioral difficulties (0.55, ±0.27; mean difference, ±95% confidence limits [CL]) (P < .0001) and fewer prosocial behaviors (−0.54, ±0.11) (P < .0001) at age 3 years. For boys in this group, engagement in sport was associated with a significant decrease in behavioral difficulties between ages 3 and 5 years (−0.44, ±0.39) (P = .03). Compared with those classified as lacking regular engagement (ie, never engaging, or engaging <1 hour/week), the relative effect of sport on changes in behavioral difficulties for boys with developmental delays was statistically significant (0.70, ±0.59) (P = .02). Participation in sport was not associated with significant changes in behavioral difficulties for girls, or a significant change in prosocial behaviors for boys or girls.

Conclusions
Regular participation in sport by boys could attenuate some of the behavioral difficulties associated with early development. Lack of opportunities for engaging in sport could negatively affect boys’ behavioral regulation in the preschool period.