| 1. |
- Tillman, Karin K., 1977-, et al.
(författare)
-
Academic Achievement in children with orofacial clefts-a nationwide study in Sweden
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate if academic achievement among children with nonsyndromic orofacial clefts (OFC) differs compared to nonaffected children.Methods: A register-based cohort of all children born with Cleft lip (CL), Cleft Lip and Palate (CLP) and Cleft Palate only (CPO) in Sweden between 1973 and 2004, with records in the Swedish school grade register (SGR) (n=6286), was compared to a matched community cohort (n=61352). Outcome measures were academic achievements in mathematics and Swedish in school years 3, 5, 6, 9 and upper secondary school, all subjects’ grades in schoolyear 9, and university degree. Binomial-, ordinal logistic-, linear-, and binary logistic regression were used, and a number of covariates were adjusted for.Results: In the third school year, children with CLP and CPO demonstrated lower odds of passing the mathematics’ national standard tests (NSTs) (CLP; aOR 0.72, 95% CI 0.54-0.95 and CPO; aOR 0.54, 95% CI 0.418-0.697). CPO was associated with lower odds of passing Swedish NST (OR 0.54, 95% CI 0.40-0.72). In the ninth school year, students with CLP and CPO had lower grades in mathematics (CLP; aOR 0.87, 95% CI 0.78-0.97 and CPO; aOR 0.81, 95% CI 0.73-0.91), lower average percentile grade (CLP; coefficient -2.71, 95% CI (- 4.07)-(-1.36) and CPO; -3.23, 95% CI (-4.715)-(-1.736)) and CLP also presented lower Swedish grades (aOR 0.89, 95 % CI 0.80-0.99). At upper secondary school, students with CLP and CPO had lower grades in mathematics (CLP; aOR 0.85, 95% CI 0.75-0.98 and CPO; aOR 0.87, 95% CI 0.76-0.999). Only individuals with CPO had reduced odds of graduating from university (aOR 0.81, 95% CI 0.665-0.983).Conclusions: Our findings of worse academic achievements in children with OFC throughout the educational system emphasize the need to screen children with clefts for learning difficulties to provide additional support in school.
|
|
| 2. |
- Tillman, Karin K., 1977-, et al.
(författare)
-
Bilateral orofacial clefts confer increased risk of psychiatric morbidity relative to unilateral clefts
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundNonsyndromic orofacial clefts (OFC) are associated with neurodevelopmental disorders. The aim of this study was to compare children with bilateral clefts with unilateral clefts regarding psychiatric disorders.MethodsWe utilized data on all children born in Sweden between 1973 and 2012 with unilateral cleft lip (UCL), bilateral cleft lip (BCL), unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). We performed Cox regression analyses with direct comparisons between bilateral and unilateral clefts compared to matched community cohorts and adjusted for confounders.ResultsChildren with BCL showed risk increases for any psychiatric disorder (aHR 2.13, 95% CI 1.04-4.36), including intellectual disability (aHR 5.31, 95% CI 1.29-21.78) compared to UCL. Children with BCLP demonstrated risk increases for any psychiatric disorder (aHR 1.55, 95% CI 1.20-2.01), including speech and language disorders (aHR 1.99, 95% CI 1.00-3.97), neurodevelopmental disorders (aHR 1.66, 95% CI 1.11-2.47) and other psychiatric disorders (aHR 1.54, 95% CI 1.11-2.15), such as personality disorders (aHR 5.76, 95% CI 2.13- 15.55) compared to UCLP.ConclusionsThis large nationwide register study shows for the first time that individuals with bilateral clefts demonstrate elevated risks of psychiatric disorders compared to unilateral clefts.
|
|
| 3. |
- Tillman, Karin K.
(författare)
-
Craniofacial malformations and psychiatric disorders from a neurodevelopmental perspective
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Orofacial clefts (OFC) and craniosynostosis (CS) are the two most common craniofacial malformations. Of note, craniofacial abnormalities share some overlapping risk factors with psychiatric disorders. Thus, this thesis aimed to study psychiatric and educational outcomes in this group.In study I and III we examined psychiatric outcomes among children with nonsyndromic OFC stratified on cleft lip (CL), cleft lip and palate (CLP), cleft palate only (CPO), unilateral and bilateral CL and CLP. In study II we studied associations between nonsyndromic CS (NSCS) and psychiatric disorders. Study IV assessed national standardised tests in Swedish and mathematics, school grades and university degrees in children with CL, CLP and CPO. Children with craniofacial malformations were identified through the Swedish National Patient Register and compared to a cohort from the general population that was matched for month and year of birth, sex and county of birth. In addition, children with craniofacial malformations were compared to their unaffected siblings.Individuals with OFC presented risk increases for intellectual disability, language disorders, psychosis, autism spectrum disorder, attention-deficit/hyperactivity disorder and behavioural disorders in childhood. CPO showed the most robust associations, followed in descending order by CLP and CL. Nonaffected siblings had a lower risk of psychiatric disorders. Females generally had higher risks for psychiatric comorbidity (Study I).Children with bilateral clefts had higher risk increases for psychiatric disorders compared to children with unilateral clefts. We also found that females with bilateral CLP showed higher risks for intellectual disability and neurodevelopmental disorders compared to males with bilateral CLP (Study III).Risk increases for any psychiatric disorder including intellectual disability, language disorders, other neurodevelopmental disorders and other psychiatric disorders, were seen in individuals with NSCS. In the crude analyses full siblings with NSCS, as compared to nonaffected siblings, were more likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorders and other neurodevelopmental disorders. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders. Females displayed borderline higher risk increases than males (Study II).Finally, children with OFC had lower school performance almost throughout the educational years, especially in mathematics. Lower academic achievement was most evident in children with OFC without a concurrent psychiatric disorder. In the ninth school year and upper secondary school female academic outcomes were more negatively affected than male academic outcomes (Study IV).In summary, craniofacial malformations were associated with increased risks for multiple psychiatric disorders and lower academic achievement.
|
|
| 4. |
|
|
| 5. |
- Tillman, Karin K., et al.
(författare)
-
Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts
- 2018
-
Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567 .- 1527-5418. ; 57:11, s. 876-883
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type.METHOD: A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n = 7,842) was compared to a matched cohort (n = 78,409) as well as to their unaffected siblings (n = 9,637). The risk of psychiatric diagnoses, suicide attempts, and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models.RESULTS: Children with cleft lip (CL) had a significantly higher risk of any psychiatric disorder, intellectual disability, and language disorders; children with cleft lip and palate (CLP) had, in addition, an increased risk of autism spectrum disorder (ASD). Children with cleft palate only (CPO) had risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and also for psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD, or ADHD compared to their siblings with OFC.CONCLUSION: Children with nonsyndromic clefts had a significantly higher risk of neurodevelopmental disorders. This risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.
|
|
| 6. |
- Tillman, Karin K., et al.
(författare)
-
Nonsyndromic craniosynostosis is associated with increased risk for psychiatric disorders
- 2020
-
Ingår i: Plastic and reconstructive surgery (1963). - : Ovid Technologies (Wolters Kluwer Health). - 0032-1052 .- 1529-4242. ; 146:2, s. 355-365
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis.METHODS: The authors reviewed a register-based cohort of all individuals born with nonsyndromic craniosynostosis in Sweden between 1973 to 1986 and 1997 to 2012 (n = 1238). The nonsyndromic craniosynostosis cohort was compared with a matched community cohort (n = 12,380) and with unaffected full siblings (n = 1485). The authors investigated the risk of psychiatric disorders, suicide attempts, and suicides by using Cox regression adjusted for perinatal and somatic factors, season and birth year, sex, parental socioeconomic factors, and parental psychiatric disorders.RESULTS: Children with nonsyndromic craniosynostosis had a higher risk of any psychiatric disorder (adjusted Cox-derived hazard ratio, 1.70; 95 percent CI, 1.43 to 2.02), including intellectual disability (adjusted Cox-derived hazard ratio, 4.96; 95 percent CI, 3.20 to 7.70), language disorders (adjusted Cox-derived hazard ratio, 2.36; 95 percent CI, 1.57 to 3.54), neurodevelopmental disorders (adjusted Cox-derived hazard ratio, 1.30; 95 percent CI, 1.01 to 1.69), and other psychiatric disorders (adjusted Cox-derived hazard ratio, 1.43; 95 percent CI, 1.11 to 1.85). Full siblings with nonsyndromic craniosynostosis were more likely, in the crude analyses, to be diagnosed with any psychiatric disorder, including intellectual disability, language disorders, and neurodevelopmental disorders compared with nonaffected siblings. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders.CONCLUSIONS: Children with nonsyndromic craniosynostosis demonstrated higher risks of any psychiatric disorder compared with children without nonsyndromic craniosynostosis. This risk cannot fully be explained by familial influences (i.e., genetic or environmental factors).CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
|
|
