This project investigated the diagnosis and psychostimulant treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD) in Manitoba children. These rates were considered according to sex, age, socioeconomic status (SES), geographical region, and comorbidity with learning disabilities (LD) and behavioral disturbances (BD). Data came from the Manitoba Population Health Research Data Repository, a comprehensive collection of administrative, registry, survey and other databases. The research population included all children aged 0 to 19 years in Manitoba (n = 319,506) with a diagnosis of ADHD (n= 9,233), during two Fiscal years (2003/2004 and 2004/2005). The term “gradient” refers to the relationship between SES and health and emphasizes the idea that the change in outcomes is gradual and occurs across the full range of SES. Results from this study indicate that region of residence (urban versus rural) and comorbid BD moderate the SES gradient, as low income, urban dwelling children with a comorbid diagnosis of BD had the highest rates of ADHD diagnoses and prescriptions. Furthermore, whereas age did not moderate the SES gradient, the crude rates indicated that the SES gradient for ADHD diagnoses and prescriptions was most pronounced in urban children 0 to 13 years of age. Otherwise, all main effects tested (sex, age, socioeconomic status, geographical region, and comorbid BD and LD) were significant in both the diagnosis and prescription models for ADHD. Policy considerations that arise out of this study include more stringent diagnostic and prescription treatment practices, additional support resources for children who are most at risk of having ADHD, and increased information about alternate treatment implementation for ADHD. / February 2008

This project investigated the diagnosis and psychostimulant treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD) in Manitoba children. These rates were considered according to sex, age, socioeconomic status (SES), geographical region, and comorbidity with learning disabilities (LD) and behavioral disturbances (BD). Data came from the Manitoba Population Health Research Data Repository, a comprehensive collection of administrative, registry, survey and other databases. The research population included all children aged 0 to 19 years in Manitoba (n = 319,506) with a diagnosis of ADHD (n= 9,233), during two Fiscal years (2003/2004 and 2004/2005). The term “gradient” refers to the relationship between SES and health and emphasizes the idea that the change in outcomes is gradual and occurs across the full range of SES. Results from this study indicate that region of residence (urban versus rural) and comorbid BD moderate the SES gradient, as low income, urban dwelling children with a comorbid diagnosis of BD had the highest rates of ADHD diagnoses and prescriptions. Furthermore, whereas age did not moderate the SES gradient, the crude rates indicated that the SES gradient for ADHD diagnoses and prescriptions was most pronounced in urban children 0 to 13 years of age. Otherwise, all main effects tested (sex, age, socioeconomic status, geographical region, and comorbid BD and LD) were significant in both the diagnosis and prescription models for ADHD. Policy considerations that arise out of this study include more stringent diagnostic and prescription treatment practices, additional support resources for children who are most at risk of having ADHD, and increased information about alternate treatment implementation for ADHD.

This project investigated the diagnosis and psychostimulant treatment rates of Attention Deficit/Hyperactivity Disorder (ADHD) in Manitoba children. These rates were considered according to sex, age, socioeconomic status (SES), geographical region, and comorbidity with learning disabilities (LD) and behavioral disturbances (BD). Data came from the Manitoba Population Health Research Data Repository, a comprehensive collection of administrative, registry, survey and other databases. The research population included all children aged 0 to 19 years in Manitoba (n = 319,506) with a diagnosis of ADHD (n= 9,233), during two Fiscal years (2003/2004 and 2004/2005). The term “gradient” refers to the relationship between SES and health and emphasizes the idea that the change in outcomes is gradual and occurs across the full range of SES. Results from this study indicate that region of residence (urban versus rural) and comorbid BD moderate the SES gradient, as low income, urban dwelling children with a comorbid diagnosis of BD had the highest rates of ADHD diagnoses and prescriptions. Furthermore, whereas age did not moderate the SES gradient, the crude rates indicated that the SES gradient for ADHD diagnoses and prescriptions was most pronounced in urban children 0 to 13 years of age. Otherwise, all main effects tested (sex, age, socioeconomic status, geographical region, and comorbid BD and LD) were significant in both the diagnosis and prescription models for ADHD. Policy considerations that arise out of this study include more stringent diagnostic and prescription treatment practices, additional support resources for children who are most at risk of having ADHD, and increased information about alternate treatment implementation for ADHD.

The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantly correlated with lifetime ADHD diagnosis. Given the high lifetime prevalence of ADHD in Manitoba young adults, significant socioeconomic correlates for diagnosis, and multitude of adverse health and social outcomes in this population, further investigation into the trajectory of this relatively unexplored population is recommended. Furthermore, continued measurement of the provision and success of additional resources will ultimately be necessary for enhancing the health status of all Canadian adults living with ADHD.

The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantly correlated with lifetime ADHD diagnosis. Given the high lifetime prevalence of ADHD in Manitoba young adults, significant socioeconomic correlates for diagnosis, and multitude of adverse health and social outcomes in this population, further investigation into the trajectory of this relatively unexplored population is recommended. Furthermore, continued measurement of the provision and success of additional resources will ultimately be necessary for enhancing the health status of all Canadian adults living with ADHD.

Les comorbidités de l'autisme constituent une composante essentielle de son hétérogénéité clinique et étiologique. Nous faisons l'hypothèse qu'elles sont un meilleur indice étiologique que la clinique comportementale du syndrome autistique. Notre première étude explore ainsi les premiers signes d'inquiétude spontanée des parents d'enfants autistes, à partir de 459 questionnaires ouverts. Elle indique que ceux-Ci repèrent très précocement un ensemble de symptômes non spécifiques des interactions sociales qui devraient être inclus dans la description d'un phénotype autistique complexe. La seconde étude liste l'ensemble des facteurs de risque pré, péri, néonatals auxquels on assigne un effet significatif, bien que modéré, sur l'autisme. La troisième étude a permis de réaliser un descriptif détaillé de l'ensemble des causes majeures, dans un échantillon clinique épidémiologique de 183 enfants présentant un autisme typique. Les 36 diagnostics génétiques retrouvés représentent 58% de l'ensemble des causes ce qui laisse proportion significative de troubles neurodéveloppementaux d'origine environnementale ou cryptogènique. La plupart des diagnostics sont rares et reflètent bien l'hétérogénéité étiologique de l'autisme, sans qu'il soit exclu que certaines causes ne convergent vers des mécanismes physiopathologiques communs. Les différences cliniques, génétiques et environnementales que nous identifions entre un autisme syndromique (avec comorbidités) et non syndromique valident l'hypothèse que les comorbidités contribuent à distinguer les étiologies et fournissent des informations pratiques sur le pronostique, une thérapeutique ciblée ou un diagnostic plus précoce. / Successive definitions of autism did not reduce the extent of its clinical heterogeneity. This limits progress in understanding its etiological basis and the implementation of targeted therapeutic strategies. Comorbid disorders with autism are a complex issue because their frequency is one of the core features of clinical heterogeneity. We hypothesize that they are a better etiological clue than behavioral clinical syndromes. Our first study explores the initial instinctive concerns of parents of autistic children based on 459 open-Labelled questionnaires. Parents identify a set of symptoms comorbid to autism at a very early stage in their child's development The second study lists all the pre, peri and neonatal risk factors which have a significant, although moderate, effect on autism. .The third study lists in great detail all of the major causes of autism in a clinical epidemiological sample of 183 children with a typical autism. The 36 genetic diagnoses represent 58% of all causes which leaves a significant proportion of neurodevelopmental disorders of environmental or cryptogenic origin. The clinical, genetic and environmental differences that we identified between a non-Syndromic and syndromic autism (with comorbidities) validate the hypothesis that comorbidities are linked to a more general dysfunction and contribute to distinguishing the etiologies and provide practical information on the prognosis. A dimensional approach which includes comorbid disorders is prone to establish a fine-Grained taxonomy that point to distinct etiopathological processes.

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