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Biomedical subjects

D R Offord

Publications and source records attributed to D R Offord.

At least 55 records · Page 3Linked to original sources
PubMed1994

Conduct disorder: long-term outcomes and intervention effectiveness.

OBJECTIVE: To review the literature on conduct disorder in two areas: long-term outcome and the effects of interventions. METHOD: The sources of the articles for review were computer searches, but the articles were selected for this review to illustrate key findings in the long-term outcome area and to review critically four intervention strategies to prevent or treat conduct disorder, namely, parent- and family-targeted programs, social-cognitive programs, peer and school-based programs, and community programs. RESULTS: Conduct problems in childhood predict the same increased rates of psychiatric disorder overall in men and women but the patterns are different: for externalizing disorders, the prediction is stronger in men and for internalizing disorders, the prediction is stronger in women. In the intervention domain, the literature provides limited evidence of the effectiveness of either primary or secondary prevention. CONCLUSIONS: Prospective studies of community samples of children provide the best opportunity to understand more thoroughly the adult outcomes of conduct disorder. Because of the heavy burden of suffering of conduct disorder, and the limited effectiveness of clinical interventions, there is a compelling argument in favor of an increased emphasis on primary prevention efforts.

Adolescent↗
PubMed1994

Primary prevention of child physical abuse and neglect: a critical review. Part I.

This paper (Part I) and its companion paper (Part II) provide an overview of the primary prevention of child maltreatment. Part I reviews the effectiveness of interventions aimed at the primary prevention of child physical abuse and neglect. Prospective controlled trials published between January 1979 and May 1993 were systematically identified. The quality of each study was determined using criteria which assessed methodological rigor. Interventions aimed at the prevention of physical abuse and neglect were classified into six main categories within the broad group of perinatal and early childhood programs. While many of these programs did not show a reduction in physical abuse or neglect, there is evidence that extended home visitation can prevent physical abuse and neglect among disadvantaged families.

Adolescent↗
PubMed1994

Primary prevention of child sexual abuse: a critical review. Part II.

This paper (Part II) and the previous paper (Part I) provide an overview of the primary prevention of child maltreatment. Part II focuses on the effectiveness of interventions aimed at the primary prevention of child sexual abuse. It includes prospective controlled trials published between January 1979 and May 1993. These studies were systematically identified and the quality of each trial was determined using criteria which assessed methodological rigor. Interventions aimed at the prevention of sexual abuse were classified into eight main categories based on the method of intervention. All programs had education as the primary focus. There is evidence that educational programs can improve safety skills and knowledge of children about sexual abuse but no study has produced data that education actually reduces the occurrence of sexual abuse.

Adolescent↗
PubMed1993

Evaluation of the Diagnostic Interview for Children and Adolescents for use in general population samples.

This article presents evaluative data on the use of the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) to classify DSM-III-R disorders in the general population. Data for the analyses came from a probability sample (N = 251) of parent-child/adolescent dyads aged 6 to 16 separately administered the DICA-R on two occasions, 10- to 20 days apart, by trained lay interviewers and child psychiatrists. Data are presented on prevalence, test-retest reliability, parent-child/adolescent agreement, and trained lay interviewer-child psychiatrist agreement. High prevalences of oppositional defiant disorder derived from parent assessments and overanxious disorder and dysthymia derived from adolescent assessments suggest that these disorders may be overidentified. Interview data provided by 6- to 11-year olds to classify the internalizing disorders were too unreliable to be useful. Agreement between parent-child/adolescent dyads was generally low while agreement between trained lay interviewers-child psychiatrists was generally high.

Adolescent↗
PubMed1993

The outcome of adolescent depression in the Ontario Child Health Study follow-up.

Outcome data from a longitudinal community-based study are presented for 652 adolescents who had a major depressive syndrome (MDS), conduct disorder (CD), both disorders, or neither disorder at the study inception. In general, it was found that both MDS and CD carried with them significant psychiatric and psychosocial morbidity 4 years later. Statistical comparisons between the MDS and CD groups were not significant for any outcome but were suggestive of distinct outcomes for these two disorders. Findings for the "mixed" MDS and CD group are presented and the nosological status of this group is discussed.

Adolescent↗
PubMed1993

Follow-up of psychiatric and educational morbidity among adopted children.

OBJECTIVE: The purpose of this study is to evaluate longitudinally the strength of association between adoptive status and psychiatric and educational morbidity and substance use. METHOD: This study makes use of data from the 1983 Ontario Child Health Study and 1987 follow-up. This community survey of children (4- to 16-years-old in 1983, 8- to 20-years-old in 1987) included a subpopulation of adopted children. The primary outcomes measured were psychiatric disorder, poor school performance, and substance use. RESULTS: Adoption, identified in 1983, in boys was a significant marker for psychiatric disorder in 1987. Adoption was not a significant risk indicator for educational morbidity or substance use in 1987. In the multivariate analyses, adoptive status demonstrated no independent influence on 1987 educational morbidity or substance use. However, adoptive status, in the presence of poor school performance in 1983, was a significant risk indicator for psychiatric disorder in 1987. CONCLUSIONS: Adopted children did not do significantly worse than nonadopted children over time in terms of educational morbidity or substance use, but adopted boys demonstrated a significantly increased risk of psychiatric disorder versus nonadopted boys.

Adolescent↗
PubMed1993

Evaluation of the revised Ontario Child Health Study scales.

This article describes the development and evaluation of the revised Ontario Child Health Study (OCHS) scales to measure conduct disorder, oppositional disorder, attention-deficit hyperactivity disorder, overanxious disorder, separation anxiety and depression based on DSM-III-R symptom criteria. Problem checklist assessments were obtained from parents and teachers of children aged 6-16 and youths aged 12-16 drawn from: (1) a general population sample (N = 1751); and (2) a mental health clinic sample (N = 1027) in the same industrialized, urban setting. Evaluation of the revised OCHS scales indicates that they possess adequate psychometric properties and provide an efficient means to obtain measurements of childhood psychiatric disorder, in general population studies, that correspond to DSM-III-R classification of disorder.

Adolescent↗
PubMed1993

Predicting substance use in early adolescence based on parent and teacher assessments of childhood psychiatric disorder: results from the Ontario Child Health Study follow-up.

This article examines relationships between psychiatric disorder, poor school performance, family dysfunction and low family income in a cohort of 8-12-year-olds and use of tobacco, marijuana and hard drugs 4 years later. Conduct disorder assessed by teachers predicted use of alcohol and hard drugs, while low family income and poor school performance predicted use of tobacco. Neither attention-deficit disorder nor emotional disorder was related to adolescent substance use. Although behavioural deviance in childhood is associated with adolescent substance use, it has limited potential for identifying groups at risk in the general population for purposes of preventing substance use in later years.

Adolescent↗
PubMed1993

Familial aggregation of emotional and behavioral problems of childhood in the general population.

OBJECTIVE: This study sought to evaluate the existence and implications of familial aggregation of emotional and behavioral problems of childhood in a general population sample. METHOD: The children included in the study were chosen with the use of a sampling technique that identified households in which there were two or more children aged 4-16 years living at home at the time of the survey. Ratings on checklists of emotional and behavioral problems were obtained from parents, teachers of children in elementary school, and the children themselves if they were adolescents aged 12-16. Children were classified as having problems if their scores on scales of conduct, attention deficit, or emotional problems were in the top 10% of the distribution of scores from any informant. RESULTS: There was evidence for familial aggregation of these problems, particularly conduct and emotional problems. However, this was largely derived from the parents' reports of symptoms, not the teachers' or adolescents' reports. The degree of familial aggregation varied according to certain sibship characteristics and patterns of comorbidity. CONCLUSIONS: Familial aggregation of emotional and behavioral problems does exist in a community population and is not simply an artifact of clinic attendance.

Adolescent↗
PubMed1993

Evaluation of the original Ontario Child Health Study scales.

This article presents evaluative information on the use of the original Ontario Child Health Study scales to serve as original-level measures of conduct disorder, hyperactivity and emotional disorder among children in the general (non clinic) population. Problem checklist assessments were obtained from parents and teachers of children aged six to 16 and youth aged 12 to 16 drawn from a general population (n = 1,751); and a mental health clinic sample (n = 1,027) in the same industrialized, urban setting. The results showed that the original OCHS scales possess adequate psychometric properties to be used as original-level measures of disorder. Correlations between individual items and their hypothesized scales were very strong, indicating convergent validity, while correlations between the same items and other (non hypothesized) scales were lower, indicating discriminant validity. Item analyses indicated that individual scale items possess both convergent and discriminant validity. Although the scales were skewed to the positive end of the continuum, they demonstrated good internal consistency (all estimates > or = 0.74) and test-retest (all estimates > or = 0.65) reliability. Finally, three different validity analyses confirmed hypotheses about how the original OCHS scales should perform if they provide useful measures of disorder.

Adolescent↗
PubMed1992

Ontario child health study: social and school impairments in children aged 6 to 16 years.

This study reports on informant-specific prevalence rates and the relationship with psychiatric disorder of social and school impairments in a community sample of children, 6 to 16 years of age, in Ontario. Prevalence rates ranged from less than 1% to over 18% depending on informant, and there was a low level of agreement between informants. Although impairments were strongly related to psychiatric disorder, there were many children with impairments and no psychiatric disorder or psychiatric disorder with no impairments. Implications of these results are discussed.

Adolescent↗
PubMed1992

Outcome, prognosis, and risk in a longitudinal follow-up study.

This study reports the results of a 4-year follow-up of a community sample of children who were ages 4 to 12 in 1983 at the first wave of data collection. Results on outcomes revealed that conduct disorder showed the greatest stability especially from late childhood to early adolescence. In multivariate analyses, both family dysfunction and problems getting along with others significantly predicted the persistence of one or more psychiatric disorders 4 years later, and low income predicted one or more psychiatric disorders among children free of disorder 4 years earlier. The implications of the results for the child psychiatric field, especially prevention, are discussed.

Adolescent↗
PubMed1992

Predicting substance use in late adolescence: results from the Ontario Child Health Study follow-up.

OBJECTIVE: The purpose of this study was to evaluate the relationship between use of tobacco, alcohol, marijuana, and hard drugs (substance use) and psychiatric disorder in early adolescence and substance use in late adolescence. METHOD: Adolescents included in the study were identified by means of a household sampling frame and participated in the Ontario Child Health Study in 1983 and the follow-up in 1987. There were 726 12-16-year-olds (369 boys and 357 girls) in 1983 who had complete information in 1987. Data on substance use were collected from adolescents by using a structured, self-administered questionnaire. Data on psychiatric disorder were collected in 1983 from both adolescents and their parents by using problem checklists to assess conduct disorder, attention deficit disorder, and emotional disorder. RESULTS: Prior substance use in 1983 was associated strongly with subsequent use in 1987. Among the psychiatric disorders assessed in 1983, only conduct disorder made an independent contribution to predicting use of marijuana (relative odds = 3.46) and other hard drugs (relative odds = 6.82) in 1987, after prior use of these substances and coexisting attention deficit and emotional disorders were controlled. Corresponding estimates of attributable risk (the expected contribution of exposure to conduct disorder to the development of substance use) were 5.7% and 11.1%, respectively. CONCLUSIONS: Although a statistically significant relationship existed between conduct disorder in early adolescence and use of marijuana and hard drugs in late adolescence, the potential is limited for preventing substance use in the general population by treating conduct disorder early on.

Adolescent↗
PubMed1992

Psychiatric disorders in adopted children: a profile from the Ontario Child Health Study.

Studies of clinical populations suggest that adopted children are overrepresented among children using mental health facilities, whereas studies using non clinical populations of adopted children have reached mixed conclusions about whether or not there is an increased psychological risk associated with adoption. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years, which included a subpopulation of adopted children, were used to: 1. profile the characteristics of adoptive families; 2. examine the strength of adoptive status as a marker for psychiatric and educational morbidity; and 3. determine the extent to which adoptive status has an independent relationship with psychiatric and educational morbidities. The findings were: 1. adoptive mothers were significantly older than non adoptive mothers, but otherwise adoptive families did not differ significantly from non adoptive families, 2. adoption in boys, but not in girls, was a significant marker for psychiatric disorder and poor school performance; adoption in adolescent girls was a significant marker for substance use; and 3. multivariate analyses demonstrated no independent effect of adoption on psychiatric disorder or poor school performance; for adolescents, adoptive status did have an independent relationship with substance use for girls. The implications of these findings will be discussed.

Achievement↗
PubMed1991

Ontario Child Health Study follow-up: evaluation of sample loss.

This article presents an analysis of sample loss in a 4-year follow-up of children aged 4 to 12 who participated in the Ontario Child Health Study in 1983. Of the 1,617 children participating in the original Ontario Child Health Study, 1,172 (72.5%) were located and enlisted at follow-up in 1987. Based on wave-one assessments, nonparticipants at follow-up tended to have higher levels of psychopathology and family risk variables. Respondents were matched with nonparticipants and differentially weighted to compensate for selective loss. In comparing estimates based on actual (observed) and weighted responses in the follow-up sample, it was found that the effects of sample loss depended on the analytical focus. Evaluations of outcome of disorder and risk for disorder were not affected by sample loss. Evaluation of variables that predict persistence of disorder (prognosis) was affected by a bias toward the null.

Bias↗