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Wednesday, December 07, 2022

Autism, ADHD and school absence are risk factors for self-harm – Nation World News

summary: The risk of self-harm in emergency rooms is three times higher for boys with ASD than for those not on the autism spectrum. Additionally, researchers found a fourfold increase in self-harm behaviors for both men and women with ADHD. Children with less than 80% school attendance also had a threefold higher risk of self-harm behavior.

Source: King’s College London

The research, led by King’s College London and South London and the Maudsley NHS Foundation Trust, has analyzed factors associated with self-harm in more than 111,000 adolescents aged 11-17 years.

published in BMC Medicine The study found that the risk of self-harm in hospital emergency departments was nearly three times higher for boys with autism spectrum disorder (ASD) than boys without ASD.

Attention deficit hyperactivity disorder (ADHD) was a strong predictor of self-harm for both boys and girls, with a nearly fourfold increased risk of self-harm among those with ADHD.

Absence from school was also associated with an increased risk of self-harm: for youth whose attendance was below 80 percent, the risk of self-injury was three times higher.

Partially funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Center and the Wellcome Trust, this is the first long-term investigation of adolescent self-harm and ASD in England using linked school and hospital data. The research provides valuable insight into those groups most at risk, which represents an important step in developing preventive strategies for self-harm.

Dr Johnny Downs, Consultant Child and Adolescent Psychiatrist in South London and Maudsley and NIHR Clinician Scientist at the Department of Child and Adolescent Psychiatry, King’s College London, and senior author on the paper, said:

“By combining these large-scale datasets, we have been able to understand which groups of youth may be most vulnerable to self-harm. Importantly we are using local data so this has direct implications for the NHS Trust where I work and could improve our targeting of mental health interventions within schools in South London. Another important aspect of this study is that any region of England can use the same approach, as school and hospital data already exist and can be combined.”

Self-harm is common among teenagers and research shows that 1 in 5 self-harm. About 12 percent of teen self-harm episodes are seen in emergency departments and it is young people who are most likely to be at risk of suicide.

The researchers linked hospital attendance data to educational data to measure self-harm. It examined educational factors such as school attendance, special educational needs and free school meal status, as well as data on mental health service use.

The study assessed data on 113,286 youth from four South London boroughs collected between 2009-2013.

By analyzing data from the national student database on whether children with ASD were assigned special educational needs, the study showed that boys with ASD had a higher risk of self-harm than boys without ASD. . This pattern was not observed in girls with ASD, but in general the risk of self-harm was higher in girls than boys (1.5% compared to 0.3% in boys).

Emily Simonoff, Professor of Child and Adolescent Psychiatry at King’s College London, and Theme Lead for Child Mental and Neurodevelopmental Disorders at the NIHR Maudsley Biomedical Research Centre, who is a co-author on the paper, said:

“We know that autistic adults have higher rates of premature death, including increased rates of suicide. Self-harming behaviors, such as those discovered in the current study, are precursors to more serious suicide attempts. Therefore, early detection and proactive intervention are very important when self-harm first appears.

“Autistic people often have more difficulty controlling their emotions, which can contribute to higher levels of distress and, due to the communication impairments experienced by many autistic people, professionals may be concerned with the distress they are experiencing. Can’t appreciate the level and severity of these behaviors.”

The study also found that teens who attended mental health services for ADHD had a four times higher risk of self-harm than those who did not attend services for ADHD. School exclusion and absenteeism were also identified as risk factors.

Joint first author Dr Emily Widnal who conducted research at King’s and is now a senior research associate in public health at the University of Bristol, said: “Our research has shown that adolescents spend more time away from school, either due to exclusion or absenteeism. The middle class has an increased risk of self-harm compared to young people who are in school most of the time.

“Linking educational data to mental health data plays an important role in answering questions of public health research into child and adolescent mental health and can help identify where more support is needed in schools.”

It Shows A Sad Boy
Attention deficit hyperactivity disorder (ADHD) was a strong predictor of self-harm for both boys and girls, with a nearly fourfold increased risk of self-harm among those with ADHD. Image is in public domain

The study also revealed findings that may require further research to pinpoint possible underlying mechanisms. For example, a finding that girls with ASD had no higher risk of self-harm than those without ASD could be explained by the lower diagnosis of ASD in girls.

The study also found that people who spoke English as a second language had a lower risk of self-harm than those who spoke English as their mother tongue.

Dr Downs commented, “Taken at face value the results suggest that young people who are residents of London but are non-native English speakers have fewer mental health problems.”

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It Shows The Mind

“But there may be other effects at work which could mean that these young people are harming themselves and not rendering services or expressing their distress through other means, such as substance abuse. “

The study used the Clinical Record Interactive Search (CRIS) platform to analyze clinical e-records from South London and Maudsley NHS Foundation Trust. CRIS was developed by NIHR Maudsley BRC.

About this ASD and ADHD research news

Author: Ryan Jewell
Source: King’s College London
contact: Ryan Jewell – King’s College London
image: Image is in public domain

Basic Research: open access.
“Autism spectrum disorder as a risk factor for adolescent self-harm: a retrospective cohort study of 113,286 young people in the UK” by Johnny Downs et al. BMC Medicine


Summary

Autism spectrum disorder as a risk factor for adolescent self-harm: a retrospective cohort study of 113,286 youth in the UK

background

Individuals with autism spectrum disorder (ASD) have a particularly high risk of suicide and suicide attempts. Presentation to hospital with self-harm is one of the strongest risk factors for subsequent suicide. We describe the use of a novel data linkage between regularly collected education data and child and adolescent mental health data to examine whether the general population of adolescents with ASD presenting emergency care with self-harm higher risk than .

methods

A retrospective cohort study was conducted on a population aged 11–17 living in four South London boroughs between January 2009 and March 2013, participating in state secondary schools identified in the National Student Database (NPD). Exposure data on ASD status was obtained from NPD. We used Cox regression to model time for first self-harm presentation to the emergency department (ED).

result

One thousand and twenty adolescents presented with ED with self-harm, and 763 were matched to NPD. The sample for analysis included 113,286 adolescents (2.2% with ASD). For boys only, there was an increased risk of self-harm associated with ASD (adjusted hazard ratio 2 79, 95% CI 1 40–5 57, P<0·01). Several other factors were also associated with a higher risk of self-harm, including school absence, exclusion from school, and being in foster care.

conclusion

This study provides evidence that ASD in boys, and other educational, social and clinical factors, are risk factors for emergency presentation with self-harm in adolescents. These findings are an important step in developing early recognition and prevention programs.

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