Socioemotional and behavioural difficulties in children with chronic physical conditions: analysis of the Longitudinal Study.. 2023 David-Wilathgamuwa

[Andy]

Full title: Socioemotional and behavioural difficulties in children with chronic physical conditions: analysis of the Longitudinal Study of Australian Children

Objectives
To examine the prevalence of socioemotional and behavioural difficulties (SEBDs) in children with chronic physical conditions (CPCs) and to analyse how this prevalence varied with the type and number of CPCs and the age of the child.

Design
Cross-sectional study of a secondary data analysis of the Longitudinal Study of Australian Children.

Setting
An Australian nationally representative sample of general population of children.

Participants
15 610 children-waves aged 6–14 years.

Intervention/exposure
Children reported to have at least 1 of the 21 CPCs by their parents.

Main outcome measures
Clinically relevant SEBDs were defined using standardised cut-offs of the parent-administered Strengths and Difficulties Questionnaire.

Results
Children with a CPC have significantly increased odds of total, internalising and externalising SEBDs than those without (total SEBDs, adjusted odds rartio or OR 3.13, 95% CI 2.52 to 3.89), controlling for sex, age, socioeconomic status and parental mental health status. The highest prevalence of total SEBDs was found in children with chronic fatigue (43.8%), epilepsy (33.8%) and day wetting (31.6%). An increasing number of comorbid CPCs was associated with a rising prevalence of SEBDs. On average, 24.2% of children with at least four CPCs had SEBDs. These children had 8.83-fold increased odds (95% CI 6.9 to 11.31) of total SEBDs compared with children without a CPC. Age was positively related to the odds of SEBDs.

Conclusion
Children with a CPC have a significantly increased risk of having SEBDs than those without. These findings highlight the need for routine assessment and integrated intervention for SEBDs among children with CPCs.

Paywall, https://adc.bmj.com/content/early/2023/04/25/archdischild-2022-325069

 

[Hutan]

University of New South Wales

Does anyone have access to this?

They appear to regard 'chronic fatigue' as a condition rather than a symptom - would be interesting to know how they define that.

 

[Hutan]

This study worked with longitudinal data, which potentially could be extremely useful.

The SDQ has the item pertaining to “complaints of headaches, stomach aches or sickness” that may be symptoms of a chronic illness such as chronic fatigue. We carried out a sensitivity anal- ysis removing this item from the SDQ total score for children with chronic fatigue, frequent headaches, and recurrent pain. We found minimal difference in this sensitivity analysis (online supplemental file 2).

I expect the SDQ has other items that overlap with the symptoms someone with ME/CFS has. There's also probably a problem with the definition of 'chronic fatigue' as a condition - the underlying problem could be all sorts of things.

Our study has shown that not only severe clinical conditions such as epilepsy were associated with a high prevalence of SEBDs (33.8%) but also CPCs perceived as less clinically severe (eg, chronic fatigue, day wetting and soiling) were associated with a higher preva- lence of SEBDs. These ‘less severe’ conditions are not adequately represented in clinical research.

Just to explain the 'children-waves' thing - children in the longitudinal study are assessed every two years. The data from one assessment is referred to as a 'wave'. So, most children in the study would have contributed two lots of data. For each, whether the child had a chronic physical condition and whether they had a socioemotional and behavioural difficulty in a wave was assessed. It's a bit of a weird approach, as they were producing data points that are not independent of each other - the two observations for each child - that surely must have created statistical issues. I don't know how they handled those. I find it a bit hard to be completely sure what they did.

I find that Table 1 rather poorly done. It doesn't tell us a lot. See for example, for Aboriginal and Torres Strait Islanders - they accounted for 2% of the children waves with no chronic physical condition - but that doesn't tell us what percentage of these children have no chronic physical condition. Aboriginal and Torres Strait Island children account for 3.1% of children-waves with at least one chronic physical condition, but again, that's not a very helpful way to present what could be incredibly useful data.

 

[Hutan]

It should be noted that evidence-based treatment of physical symptoms can improve mental health; however, physical health treatment alone is not adequate for all children.28 Meta-analysis has shown brief cognitive behavioural therapy may reduce psychiatric symptoms of children with long-term physical health conditions.29 Brief, transdiagnostic mental health assessment and tailored treatment for children with long-term physical health conditions and their families may also reduce mental health difficulties.30 Further, integrated patient-centred models of care have demonstrated promise to address both mental health needs and improve physical health symptoms, especially for patients with high comorbidity.28

This appears to be the underlying rationale for the study - the prescription of CBT for all. Along with what comes across as a rather begrudging note that evidence-based treatment of physical symptoms can also help mental health.

The common sense notion that health care providers should take into account the child's environment and be aware of the possibility of emotional and behavioural difficulties that might be part of the child's health condition or might be a result of the condition isn't really given any helpful elaboration in this study. It would have been much more useful, for example, to have taken single health conditions and reported exactly what 'socioemotional and behavioural' issues were common, and then think about why, and whether specific things can be done to prevent or treat those.

I'm not sure how reliable the data is, when, for example there is a physical condition called 'Frequent headaches' and a socioemotional and behavioural condition of 'complaints of headaches, stomach aches or sickness', but only 18% of the children-waves with 'frequent headaches' have 'complaints of headaches, stomach aches or sickness'. Yes, they did do a sensitivity analysis that involved taking that item out, but we are told that analysis is in a supplementary file.

 

[bobbler]

University of New South Wales

Does anyone have access to this?

They appear to regard 'chronic fatigue' as a condition rather than a symptom - would be interesting to know how they define that.

Good point. I can't read the full text and either way I find this really very potentially worrying at the likelihood that either the article itself doesn't look into whether the difficulties are externally caused by the very paradigm they are likely to push a child into (and ergo increase harm) having influenced their surroundings and ergo daily treatment, and even if not the fact most skim-read and then gel with what they want to believe unless this difference of 'situational cause - in this case the misinformation and related abuse and unkind behaviour not the illness being the cause' is underlined

I can see how this will mislead and be used for the opposite treatment than would like be helpful - which is psychology, scientific psychology taking in hand all of these touchpoints a child with chronic fatigue or ME/CFS is having to put up with treating them badly. Just like you'd have proper equality courses for any other issue or minority where micro or macro-aggressions and lack of adapting to needs was happening. Instead of pretending the issue is the person being harmed by quite unusual and counterintuitive to empathy paradigms e.g. if someone is exhausted telling them what? I mean there is probably enough to deal with if you just think about ensuring their friends 'get' the issue and are kind about it. But that would require modelling from a good system too.

I don't know regarding the situational context for those with chronic fatigue, given maybe it could be a different ilness and maybe it is just people who've been dumped into that bracket and are yet to be diagnosed with something else like ME/CFS, given it is basically a broader criteria with no guarantee anyone has bothered with exclusions in what we know about most health systems.

And I know the killer of the ME/CFS misinformation is that what causes huge pain and harm and makes people's survival impossible on a daily basis is what is promoted widely for others to do to us from all angles - and is yet to be corrected in all the touchpoints that come at us daily. It's immoral and I can't help but assume intention after all this time personally that it might be hoped it would drive people to utter sadness and madness because that isn't a Maslow's survivable world in any sense, so whoever invented it I don't know how they continue to justify it as anything other than anti-everything sustainable to health and wellbeing. For a start these people aren't stupid and know they treat people horribly and they end up feeling worse that's why they are doing this sort of research. And it ain't psychology if you aren't identifying the proper cause and beginning with the situational (not the internal)

And for that reason it probably can't be good for a condition that also just hasn't been investigated well, where there are people who it doesn't work (given if there is any evidence it'll be lowest common denominator so who knows which persons it worked a bit for then that was divided across all for a minescule divided affect that could be claimed for all).

So I really worry how divisively this will be used if said individuals get chucked under people with the same belief-issues - because psychology after all needs to match cause with treatment, and I can see a strong likelihood the cause is potentially being intensified as the treatment where someone with psychosomatic beliefs is involved there?

 

[Hutan]

Child SEBDs were identified using the parent-reported Strengths and Difficulties Questionnaire (SDQ). The SDQ is a 25-item questionnaire that measures SEBDs in children aged 4–17 years. The SDQ has five subscales, including emotional problems, conduct problems, hyperactivity, peer problems and prosocial behaviour. The items from all subscales, except the prosocial behaviour subscale, combine to give a total SDQ score ranging from 0 to 40.17

The clinical cut-off for each subscale was determined using normative data of the SDQ in Australia.18 A child was identified to have SEBDs if the total SDQ score was ≥17. We grouped the four SDQ subscales into internalising (sum of peer and emotional subscales scores) and externalising (sum of hyper- activity and conduct subscales scores) subscales.19 The clinical cut-off for internalising difficulties was 9/20 and that for exter- nalising difficulties was 10/20.18

Here's a version of the scale here:
https://www.sdqinfo.org/py/sdqinfo/b3.py?language=Englishqz(Austral)
It is, as so many of these scales are, rather underwhelming. There is an item 'good attention span, sees work through to the end'. Also 'rather solitary, prefers to play alone'.