External Publications Using GUI Data

Aims
Multiple studies have connected parenting styles to children’s internalising and externalising mental health symptoms (MHS). However, it is not clear how different parenting styles are jointly influencing the development of children’s MHS over the course of childhood. Hence, the differential effects of parenting style on population heterogeneity in the joint developmental trajectories of children’s internalising and externalising MHS were examined.

Method
A community sample of 7507 young children (ages 3, 5 and 9) from the Growing Up in Ireland cohort study was derived for further analyses. Parallel-process linear growth curve and latent growth mixture modelling were deployed.

Results
The results indicated that the linear growth model was a good approximation of children’s MHS development (CFI = 0.99, RMSEA = 0.03). The growth mixture modelling revealed three classes of joint internalising and externalising MHS trajectories (VLMR = 92.51, p < 0.01; LMR = 682.19, p < 0.01; E = 0.86). The majority of the children (83.49%) belonged to a low-risk class best described by a decreasing trajectory of externalising symptoms and a flat low trajectory of internalising MHS. In total, 10.07% of the children belonged to a high-risk class described by high internalising and externalising MHS trajectories, whereas 6.43% of the children were probable members of a mild-risk class with slightly improving yet still elevated trajectories of MHS. Adjusting for socio-demographics, child and parental health, multinomial logistic regressions indicated that hostile parenting was a risk factor for membership in the high-risk (OR = 1.47, 95% CI 1.18–1.85) and mild-risk (OR = 1.57, 95% CI 1.21–2.04) classes. Consistent (OR = 0.75, 95% CI 0.62–0.90) parenting style was a protective factor only against membership in the mild-risk class.

Conclusions
In short, the findings suggest that a non-negligible proportion of the child population is susceptible to being at high risk for developing MHS. Moreover, a smaller proportion of children was improving but still displayed high symptoms of MHS (mild-risk). Furthermore, hostile parenting style is a substantial risk factor for increments in child MHS, whereas consistent parenting can serve as a protective factor in cases of mild-risk. Evidence-based parent training/management programmes may be needed to reduce the risk of developing MHS.

In the current study, we investigated the developmental dynamics between positive youth development, being bullied in adolescence, gender, and sociocultural risk factors. Participants were 3,509 males (49%) and 3,656 females (51%) studied longitudinally across the ages of 9, 13, and 17 years in the Growing Up in Ireland study. Using structural equation modeling, we discovered that being bullied in early adolescence was most strongly predicted by having fewer close friends, higher family poverty, and living in neighborhoods with higher levels of disorder. However, the social disadvantage of a young person’s school did not impact being bullied. More positive reports of connection and caring in early adolescence were negatively predicted by neighborhood disorder and family poverty, and being female had positive association with relationships with teachers. Developing confidence, competence, and character in late adolescence was notably related to having fewer experiences of family trauma and transitions in childhood and to having higher levels of rapport with parents in early adolescence. The results highlight the importance of studying relationships and psychological development in sociocultural context.

Background
Poverty is associated with poor outcomes, yet exposure to distinct poverty trajectories in early childhood is not well understood.

Objective
To understand the prevalence of different trajectories of household poverty and their association with mid-childhood and mother indicators of physical health and psychopathology in Ireland.

Methods
We used a nationally representative, prospective cohort (Growing Up in Ireland–Infant Cohort). Household poverty included lowest third income decile, subjective poverty and material deprivation when children were aged 9 months, and 3, 5, 9 years. We used group-based multitrajectory cluster modelling to classify trajectories of poverty. Using multivariable logistic regression, adjusted with separate child and mother confounders, we assessed the association of poverty trajectories from 9 months to 9 years with child outcomes (overweight, any longstanding illness and psychopathology) at age 9 years and the same poverty trajectories over the same 9-year period with mother outcomes (overweight, any longstanding illness and depression).

Results
Of 11 134 participants, 4 trajectories were identified: never in poverty (43.1%), material/subjective>monetary poverty (16.1%), monetary>material poverty (25.6%) and persistent poverty (15.2%). Children in persistent poverty compared with those in never in poverty experienced higher odds of being overweight at 9 years (adjusted OR (aOR) 1.70, 95% CI 1.34, 2.16), having a longstanding illness (aOR 1.51, 95% CI 1.20, 1.91), and psychopathology (aOR 2.06, 95% CI 1.42, 2.99). The outcomes for primary parents (99.7% were mothers) were as follows: having higher odds of being overweight (aOR 1.49, 95% CI 1.16, 1.92), having a longstanding illness (aOR 2.13, 95% CI 1.63, 2.79), and depression (aOR 3.54, 95% CI 2.54, 4.94).

Conclusions
Any poverty trajectory was associated with poorer psychopathology and physical well-being in late childhood for children and their mothers in Ireland.

Background
Poverty is associated with poor outcomes, yet exposure to distinct poverty trajectories in early childhood is not well understood.

Objective
To understand the prevalence of different trajectories of household poverty and their association with mid-childhood and primary-parent(mother) indicators of physical health and psychopathology in Ireland.

Methods
We used a nationally representative, prospective cohort (Growing-up-in-Ireland– Infant-Cohort). Household poverty included lowest third income decile, subjective poverty and material deprivation when children were aged 9-months(m),3,5,9-years(y). We used group based multi-trajectory-cluster-modelling to classify trajectories of poverty. Using multivariate logistic regression, adjusted with separate child and mother confounders, we assessed the association of poverty trajectories from 9m to 9y with child outcomes (overweight, any longstanding illness and psychopathology) at age 9y and the same poverty trajectories over the same 9y period with mother outcomes (overweight, any longstanding illness and depression).

Results
Of 11,134 participants, four trajectories were identified: never-in-poverty (43.1%), material/subjective>monetary-poverty (16.1%), monetary>material-poverty (25.6%), and persistent-poverty (15.2%). Children in persistent-poverty compared with never in poverty experienced higher odds of being overweight at 9y (adjusted odds ratio aOR 1.70,95% CI 1.34, 2.16), having a longstanding illness (aOR 1.51,95% CI 1.20, 1.91) and psychopathology (aOR 2.06,95% CI 1.42, 2.99). The outcomes for primary parent (99.7% were mothers) had higher odds of being overweight (aOR 1.49,95% CI 1.16, 1.92), having a longstanding illness (aOR 2.13,95% CI 1.63, 2.79), and depression (aOR 3.54,95% CI 2.54, 4.94).

Conclusions
Any poverty trajectory was associated with poorer psychopathology and physical wellbeing in late childhood for children and their mothers in Ireland.

What is already known on this subject?
Poverty is understood as having both objective (e.g. low household income) and subjective dimensions (e.g., perception of being poor relative to others, poverty related anxiety). Evidence highlights the association between child poverty exposure and child and mother wellbeing outcomes.

What this study adds?
Our study examined predicted trajectories of multi-dimensional poverty and child and mother outcomes using a large national cohort. We identified that any poverty trajectory in childhood had a higher odds of being associated with poor well-being outcomes.

How this study might affect research, practice or policy?
This study highlights the need for strategies to ameliorate any poverty exposure as all poverty trajectories resulted in poorer wellbeing outcomes. Strategies should be considered to ameliorate any poverty exposure in early childhood (e.g., school based resourcing).

Background
There are no early, accurate, scalable methods for identifying infants at high risk of poor cognitive outcomes in childhood. We aim to develop an explainable predictive model, using machine learning and population-based cohort data, for this purpose.

Methods
Data were from 8858 participants in the Growing Up in Ireland cohort, a nationally representative study of infants and their primary caregivers (PCGs). Maternal, infant, and socioeconomic characteristics were collected at 9-months and cognitive ability measured at age 5 years. Data preprocessing, synthetic minority oversampling, and feature selection were performed prior to training a variety of machine learning models using ten-fold cross validated grid search to tune hyperparameters. Final models were tested on an unseen test set.

Results
A random forest (RF) model containing 15 participant-reported features in the first year of infant life, achieved an area under the receiver operating characteristic curve (AUROC) of 0.77 for predicting low cognitive ability at age 5. This model could detect 72% of infants with low cognitive ability, with a specificity of 66%.

Conclusions
Model performance would need to be improved before consideration as a population-level screening tool. However, this is a first step towards early, individual, risk stratification to allow targeted childhood screening.

Impact
• This study is among the first to investigate whether machine learning methods can be used at a population-level to predict which infants are at high risk of low cognitive ability in childhood.
• A random forest model using 15 features which could be easily collected in the perinatal period achieved an AUROC of 0.77 for predicting low cognitive ability.
• Improved predictive performance would be required to implement this model at a population level but this may be a first step towards early, individual, risk stratification.

Specific pregnancy complications, socioeconomic position and sex have all been independently associated with child mental health outcomes, but their combined effects remain unclear. We examined whether total number of complications experienced in the pregnancy associated with mental health at 5 and 9-years, and whether this varied by sex or adverse social circumstances. Pregnancy complications were self-reported at 9-months post-natally from a list of 16 complications. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when their child was 5 and 9-years. The primary outcome was the SDQ-total and scoring in the clinical range (> 16) was a secondary outcome. We applied generalized linear mixed models to a large nationally representative Irish cohort (GUI; n = 11,134). Analyses were adjusted for sex, adverse social circumstances (at 9-months), and gestational smoking. We included an interaction term between pregnancy complications and each variable respectively in separate models to examine if associations varied by sex or adverse circumstances.

After controlling for covariates, total complications associated with mental health at 5 and 9-years. Each additional pregnancy complication conferred a 10% higher total-SDQ score (exponentiated co-efficient 1.10 [95%CI 1.06–1.14], 1.20 [1.15–1.26], 1.20 [1.12–1.29] and 1.34 [1.21–1.48] for 1, 2, 3 and 4 + complications respectively). For the dichotomised outcome, generally increasing odds for clinical levels of mental health difficulties were observed (OR 1complication = 1.89, 95%CI [1.37–2.59]; OR 2complications = 2.31, 95%CI [1.53–3.50]; OR 3complications = 1.77, 95%CI [0.89–3.52]; OR 4 + complications = 6.88, 95%CI [3.29–14.40]). Females had significantly lower odds of exhibiting clinically significant mental health difficulties than males (OR = 0.43, 95%CI[0.32–0.57]).

There was no evidence that the association between pregnancy complications and child’s mental health varied by sex or social circumstances at 5 or 9-years. Males exposed to numerous pregnancy complications in the context of adverse social circumstances had the highest predicted probability of having mental health difficulties in middle childhood.

To describe response rates and characteristics associated with response to the Pregnancy Risk Assessment Monitoring System study in Ireland (PRAMS Ireland). Using hospital discharge records of live births at a large, urban, obstetric hospital, a sampling frame of approximately 2,400 mother-infant pairs were used to alternately sample 1,200 women. Mothers’ information including name, address, parity, age and infant characteristics such as sex and gestational age at delivery were extracted from records. Modes of contact included an invitation letter with option to opt out of the study, three mail surveys, a reminder letter and text message reminder for remaining non-respondents. Sixty-one per cent of women responded to the PRAMS Ireland survey over a 133 day response period. Women aged <30, single women, multiparous women and women with a preterm delivery were less likely to respond. Women participating in PRAMS Ireland were similar to the national birth profile in 2011 which had a mean age of 32, were 40 % primiparous, 33 % single or never married and had a 28 % caesarean section rate. Survey and protocol changes are required to increase response rates above recommended Centers for Disease Control and Prevention (CDC) thresholds of 65 % within the recommended 90 day data collection cycle. Additional efforts such as stratification and over-sampling are required to increase representativeness among hard to reach groups such as younger, single and multiparous women before expanding the project to an ongoing, national surveillance system in Ireland.

This retrospective cross-sectional paper examines the relationship between maternal smoking during pregnancy and children’s behavioural problems at 9 years of age independent of a wide range of possible confounders. The final sample comprised 7,505 nine-year-old school children participating in the first wave of the Growing Up in Ireland study. The children were selected through the Irish national school system using a 2-stage sampling method and were representative of the nine-year population. Information on maternal smoking during pregnancy was obtained retrospectively at 9 years of age via parental recall and children’s behavioural problems were assessed using the Strengths and Difficulties Questionnaire across separate parent and teacher-report instruments. A quasi-experimental approach using propensity score matching was used to create treatment (smoking) and control (non-smoking) groups which did not differ significantly in their propensity to smoke in terms of 16 observed characteristics. After matching on the propensity score, children whose mothers smoked during pregnancy were 3.5 % (p < 0.001) and 3.4 % (p < 0.001) more likely to score in the problematic range on the SDQ total difficulties index according to parent and teacher-report respectively. Maternal smoking during pregnancy was more strongly associated with externalising than internalising behavioural problems. Analysis of the dose–response relationship showed that the differential between matched treatment and control groups increased with level of maternal smoking. Given that smoking is a modifiable risk factor, the promotion of successful cessation in pregnancy may prevent potentially adverse long-term consequences.

Objective
This study aims to examine the associations between prenatal exposure to maternal smoking, birth weight and persistent offspring psychiatric symptoms. Additionally, we aim to examine whether the relationship between prenatal maternal smoking and persistent offspring psychiatric symptoms is mediated by offspring birth weight.

Methods
This study used the Growing Up in Ireland (GUI) longitudinal cohort. The GUI is a nationally representative longitudinal study of children which consisted of three data collection waves, at ages 9, 13, and 17 years. Logistic regression analysis was used to examine associations between prenatal tobacco exposure, and offspring psychiatric symptoms. Linear regression was used to examine associations between prenatal tobacco exposure and offspring birth weight. We conducted a mediation analysis examining potential etiological pathways linking maternal smoking during pregnancy, offspring birth weight, and later offspring psychiatric symptoms. All analyses were adjusted for confounders including household income, maternal level of education, and family psychiatric history. Additionally, examination of birth weight and subsequent psychiatric symptoms also was controlled for prematurity.

Results
We found that the association between prenatal tobacco exposure and later psychiatric symptoms is mediated by birth weight.

Conclusions
This work provides further evidence that maternal smoking during pregnancy is an important modifiable lifestyle factor that has an impact not just on the physical health of offspring but also their mental wellbeing. Supporting women with structured smoking cessation programs at the earliest stages of pregnancy should be a public health priority.

Multiple factors including the child’s non-linguistic characteristics and caregiving environment can affect language development. Since preterm birth (<37 weeks’ gestation) can negatively affect language development, this study used path analysis to investigate whether the influence of preterm birth on expressive language development at 3 and 5 years of age is mediated by a child’s non-linguistic characteristics (temperament and cognitive, motor, and social-personal abilities), caregiving environment (maternal and paternal stress and depression, mother-child and father-child relationship quality), and interactions between these domains. These analyses were conducted using three waves of data (ages: 9 months, 3 years, 5 years) on 8,712 children (4,300 female; 535 preterm) from a nationally-representative longitudinal study in Ireland. Preterm birth was indirectly (but not directly) associated with expressive language at 3 years of age via cognitive and social-personal abilities (but not motor abilities, mother-child relationship quality, or father-child relationship quality) at 9 months. There was no direct or indirect effect of preterm birth on expressive language at 5 years of age. Preterm birth negatively affected mother-child and father-child relationship quality at 3 years via fussy-difficult temperament and mother’s/father’s stress (but not depression) at 9 months. These findings are discussed with reference to international standards for neonatal care, including the need for long-term developmental monitoring of children born preterm by multidisciplinary healthcare teams, alongside parental supports promoting mental health and confidence in caregiving tasks. Future study recommendations are made to expand the tested models in line with family systems perspectives.

Anecdotal evidence suggests that grandparents provide a substantial amount of childcare support to parents of infants in Ireland yet there has been little attention to the provision of grandparent childcare at policy level. Using nationally representative data on childcare provision in the Republic of Ireland, this study examined the prevalence of grandparent childcare provision for very young children, and associations between this choice of childcare and key infant, family, and community factors. Using archived data from the Infant Cohort of the Growing Up in Ireland study, descriptive data regarding use of grandparents as childcare providers were outlined. A series of bivariate analyses were then conducted to examine the independent association between a range of infant, family, and community variables and use of grandparent childcare. Finally, a multivariate analysis using binomial logistic regression was used to examine the association of each of these variables in a fully adjusted model. The results show that 38.6% of infants experienced non-parental childcare: 12.4% were looked after by grandparents, 15.7% by other home-based carers and 10.5% in childcare centres such as crèches. Grandparents were the cheapest source of childcare but also provided fewer hours on average. Multivariate analysis indicated the importance of parental income, age, and education in choosing grandparental childcare, with younger, less well-off parents using grandparent childcare more than any other type of childcare. The findings suggest that, whether by choice or by economic pressure, grandparents represent a huge resource in terms of providing childcare for infants. Current childcare policy needs to be cognisant of the significant contribution of grandparents in helping families with young children participate in the labour force. Constraints on the amount of care grandparents are able to provide may have knock-on constraints for parents’ participation in the labour force and earnings.

Keywords
Grandparents, Childcare, Policy, Infants, Ireland

Purpose
The purpose of this paper is to explore the factors associated with occupational stress and job satisfaction among Irish primary school principals. A principal’s job has become increasingly demanding and complex in recent decades. However, there is little current research into their levels of stress and job satisfaction, particularly based on nationally representative data. In order to understand how principals perceive their job and how best to support them, new insights into factors contributing to job satisfaction and stress of school principals are warranted.

Design/methodology/approach
The paper draws on an analysis of Growing up in Ireland data, a national representative study of nine-year-old children in Ireland. In order to explore the simultaneous impact of individual and school factors on stress and job satisfaction of principals in Irish primary schools, multivariate analysis was used. Analyses in this paper are based on responses from principals in 898 schools.

Findings
The results of the study indicate that a significant number of primary school principals in Ireland are not very satisfied and feel stressed about their job. Regression analysis revealed that job satisfaction and occupational stress were related to a complex set of personal characteristics, working conditions, school context and teacher climate.

Research limitations/implications
The data are limited to primary school principals. However, this is in itself an advantage since it allows for greater insights into variation across principals in job satisfaction and stress, holding the effect of school level constant.

Originality/value
This is the first study of its kind in the Irish context that explores the simultaneous effect of a number of factors on school principals’ stress and job satisfaction.

Keywords
Job Satisfaction, Ireland, Occupational stress, Primary schools

Drawing on curriculum differentiation theory, this paper discusses exemptions from learning Irish granted to Irish post-primary students. In order to explore the profile of students granted such exemptions, the study utilises data from a national longitudinal study, Growing Up in Ireland. Additional information is provided by administrative data collected by the Department of Education and Skills to show trends in the number of exemptions granted over time. The findings show that factors impacting on being exempt include gender, social class, having a special educational need at primary school and being born outside Ireland.

Keyword(s): post-primary schools, curriculum differentiation, exemptions from Irish, Ireland

Little is known about the link between childhood and adolescent mental health (MH) difficulties and political outcomes in adulthood. This represents an important knowledge gap in understanding early individual-level factors for future political outcomes. Using the Growing up in Ireland cohort, following 8,568 children from nine to 20 years, we examine how different MH difficulties, and co-occurrence, are associated with various political outcomes. The results show childhood/adolescent MH difficulties are important predictors of political outcomes at age 20. Adolescents with chronic co-occurring MH difficulties starting in childhood report a lower interest in politics, lower trust in politicians, are less likely to register to vote, and if voting, are more likely to vote for an anti-establishment party. Adolescents with chronic emotional MH difficulties starting in childhood report a higher likelihood of voting for an anti-establishment party, but also show a higher probability of political activism and low external political efficacy.

Objectives
Migrant youths endure many challenges. Such challenges can be stressful and lead to psychological difficulties. We investigated the relationship between migration, psychopathology and stressful events in children and adolescents. We hypothesised that migrant youths would show higher levels of psychopathology and more stressful life events than non-migrant youths.

Method
Using the Child cohort (Cohort ‘98) of the ‘Growing up in Ireland’ study we investigated psychopathology, as measured by the Strengths and Difficulties questionnaire (SDQ) at age 9 and 13 and stressful life events in migrant and non-migrant youths.

Results
There was no significant difference between the proportion of migrant and non-migrant youths reporting psychopathology in childhood (p>0.05) or adolescence (p>0.05). Analysis of the SDQ subscales revealed that a significantly greater proportion of migrant youths had hyperactivity problems in childhood (p = 0.04) but a greater proportion of non-migrant youths had emotional problems in early adolescence (p = 0.04). We found that migrant youths experienced significantly more stressful life events than their non-migrant counterparts (p<0.01), however, once ‘Moving house/country‘ was removed as a stressor, there was no difference between the groups (p>0.27).

Conclusions
Contrary to our hypothesis, we observed that there were few differences between migrant and non-migrant youths in the levels of psychopathology. Migrant youths experienced a greater number of stressful life events, however, this was attributable to stressors relating to moving. An increased understanding of the factors promoting resilience, as demonstrated by the migrant youths, could aid health professionals and policy makers to effectively tailor interventions for mental health promotion.

Keywords
Early life stress, immigration, migrants, psychopathology

Background
The COVID-19 pandemic has been dubbed the “biggest public health crisis since the Second World War”. In Ireland, schools were closed for 141 days, dramatically altering the day to day lives of children in Ireland. This research aimed to evaluate the overall wellbeing of schoolchildren in Ireland and capture the prevalence and factors contributing to poor mental health.

Methods
A cross-sectional study was performed based on data from the Growing Up in Ireland COVID-19 web survey of the ’08 Infant cohort. Mental Health Inventory-5 scores were used to assess children at risk of mental health disorders. Logistic regression examined associations between various demographic and psychosocial factors and risk of mental health disorders.

Results
This study included 2,867 primary caregiver- child dyads. Almost 25% of 12/13-year-olds were at risk of mental health disorders (MHDs). An adjusted logistic regression model found associations between being at higher risk of MHDs and factors such as reduced physical activity levels (OR 1.35, 95% CI 1.10-1.66), spending less time outdoors (OR 1.48, 95% CI 1.18-1.85), increased screen-time (OR 1.35, 95% CI 1.09-1.67) and increased arguments with PCGs (OR 3.44, 95% CI 2.78-4.27). Having a trusted adult confidante reduced the risk of MHD (OR 0.25, 95% CI 0.14-0.45).

Conclusions
The prevalence of 12/13-year olds at elevated risk of MHD was high, indicating an urgent need for enhancement of child and adolescent mental health services in Ireland. Physical activity, time outdoors and supportive relationships with primary caregivers were positively associated with reduced MHD risk.

Key messages

• Children were impacted by the COVID-19 restriction measures in a way that was disproportionate to their risk.
• To reduce the risk of poor mental health outcomes for a generation of “quarantweens” we need to place children front-andcentre of our response as we recover from COVID-19.

In an effort to promote optimal health in all children, 24-hour movement guidelines that provide specific recommendations for physical activity, screen-time, and sleep have been developed (≥ 1 hour of physical activity, ≤ 2 hours of screen-time, 9-11 hours of sleep). Children who meet the recommendations for these health behaviours are less likely to be obese than those who do not meet them. This study compared the degree to which children with autism spectrum disorder (ASD) and typically developing (TD) children met the newly developed 24-hour movement guidelines. A propensity-score matched sample of 72 children (36 children with ASD, 36 TD children) from the “Growing Up in Ireland” study was included in the analysis. Based on parents’ completion of time-use diaries, fewer children with ASD, compared to TD children, met the recommendations for screentime (58.3% vs. 80.6%, p=0.07, V=0.24) and physical activity (41.7% vs. 69.4%, p=0.03, V=0.28). Children with ASD were most likely to meet two guidelines (44.4%), whereas TD children most commonly met all three guidelines (55.6%). The findings highlight the breadth of health behaviours that require intervention among children with ASD. The current study suggests that examining the movement behaviours that constitute a 24-hour period for children with ASD may be useful to inform interventions to reduce their risk for sub-optimal health.

Keywords: Physical activity; Screen-time; Sleep; Autistic; exercise; sedentary behaviour; health; overweight; obesity

Objective
This study examines the association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity in a large-scale longitudinal study of children, while controlling for a range of psychosocial factors.

Method
Data were obtained from Growing Up in Ireland, a nationally representative and longitudinal study of approximately 6500 children who were assessed at 9 and 13 years of age. Body mass index (BMI) was determined using measured height and weight, ADHD status was determined by parent reports of professional diagnoses and ADHD symptoms were measured using the Strengths and Difficulties Questionnaire (SDQ).

Results
The associations between ADHD status, ADHD symptoms (SDQ) and BMI category at age 9 and 13 years were evaluated using logistic regression. Adjustments were made for child factors (sex, developmental coordination disorder, emotional symptoms, conduct problems, birth weight and exercise) and parental factors (socio-economic status, parental BMI, parental depression, and maternal smoking and alcohol use during pregnancy). Logistic regression indicated that ADHD status was not associated with BMI category at 9 or at 13 years of age, but children with ADHD at 9 years were significantly more likely to be overweight/obese at 13 years than those without ADHD. However, when other child and parental factors were adjusted for, ADHD status was no longer significantly associated with weight status. Female sex, low levels of exercise, overweight/obese parents and prenatal smoking during pregnancy consistently increased the odds of childhood overweight/obesity.

Conclusions
While ADHD and overweight/obesity co-occur in general populations, this relationship is largely explained by a variety of psychosocial factors.

Keywords
ADHD, longitudinal, obesity, overweight, psychosocial