Using natural experiments and animal models to study causal hypotheses in relation to child mental health problems

Thapar, Anita; Rutter, Michael

doi:10.1002/9781118381953.ch12

Cited by 14 publications

(24 citation statements)

References 119 publications

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“…38,52,53 In relation to prenatal smoking and stress, quasi-experimental designs suggest most or all of the association with offspring ADHD, unlike with offspring birth weight, is explained by unmeasured confounds. 54,55,56,57,58 Environmental toxins, specifically in utero or early childhood exposure to lead, organophosphate pesticides and polychlorinated biphenyls are risk factors (see detailed review in 38 Psychosocial risks, such as low income, family adversity and harsh/hostile parenting, whilst robustly causal for certain psychiatric disorders, are also correlates rather than proven causes of ADHD. Longitudinal studies, 59 treatment trials 60 and a study of children adopted away at birth 61 suggest that observed negative mother-child relationships (even in unrelated mothers) arise as a consequence of early child ADHD symptoms (reverse causation) and improve with treatment.…”

Section: Environment and Gene-environment Interplaymentioning

confidence: 99%

Attention deficit hyperactivity disorder

2016

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The causes of ADHD are complex and multifactorial, with genetics, early environment and gene-environment interplay all being involved. No single risk factor is either necessary or sufficient to explain its occurrence. ADHD is highly heritable, and multiple types of genetic variants appear to be involved. None are diagnostic. Early environmental factors (e.g. diet, pre-and perinatal factors, toxins and psychosocial risks) have also been extensively investigated but whilst correlations have been found between many environmental influences and ADHD, it is difficult to prove definite causes. Later, potentially modifiable factors might influence its course and outcomes and more research is needed on this. Clinical assessment should be detailed and go beyond asking about diagnostic items. There are specific guidelines for the stepwise management of ADHD, and when follo i g these, the se e it of s pto s a d a i di idual's i u sta es a d medical history should be taken into account. If ADHD medications are prescribed, it should be in conjunction with behavioural interventions. ADHD medication needs to be regularly reviewed. ADHD in many respects behaves like a chronic medical disorder. For many individuals, multimodal interventions that are carefully adjusted over time will be important. A developmental approach to assessment and treatment is necessary, taking into account how presentation and risks change over time.

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Section: Environment and Gene-environment Interplaymentioning

confidence: 99%

Attention deficit hyperactivity disorder

2016

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“…prenatal and early life environmental enrichment, social influences) that optimise neurodevelopmental outcomes and this is an important area for future research. Longitudinal observational designs will remain important but other methods then are required to test causal hypotheses (as discussed extensively elsewhere 61 ).…”

Section: Change In Predominant Manifestationmentioning

confidence: 99%

Neurodevelopmental disorders

Thapar

Cooper

Rutter

2017

The Lancet Psychiatry

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518

388

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Neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder, although most commonly considered in childhood, can be lifelong conditions. In this Personal View that is shaped by clinical experience and research, we adopt a conceptual approach. First, we discuss what disorders are neurodevelopmental and why such a grouping is useful. We conclude that both distinction and grouping are helpful and that it is important to take into account the strong overlap across neurodevelopmental disorders. Then we highlight some challenges in bridging research and clinical practice. We discuss the complexity of clinical phenotypes and the importance of the social context. We also argue the importance of viewing neurodevelopmental disorders as traits but highlight that this is not the only approach to use. Finally, we consider developmental change across the life-span. Overall, we argue strongly for a flexible approach in clinical practice that takes into consideration the high level of heterogeneity and overlap in neurodevelopmental disorders and for research to link more closely to what is observed in real-life practice.

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“…Fourth, cross‐cohort comparisons of populations affected and unaffected by a universal change in risk can overcome the problem of selection effects, and therefore sometimes provide conditions approximating a ‘natural experiment’ (Costello et al., ; Shadish, Cook, & Campbell, ; Thapar & Rutter, ). Causal inferences are stronger where there are multiple populations or subpopulations who experienced a clearly defined change in an environmental condition at different times, or where there otherwise equivalent affected and unaffected groups (Shadish et al., ).…”

Section: What Can Time Trends Studies Tell Us About the Aetiology Of mentioning

confidence: 99%

“…It is also clear that individuals differ in how they respond to environmental stress. For all these reasons, robust conclusions about causal risk factors require convergent data using a variety of different study designs (Thapar & Rutter, ).…”

Section: What Can Time Trends Studies Tell Us About the Aetiology Of mentioning

confidence: 99%

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Annual Research Review: Secular trends in child and adolescent mental health

Collishaw

2014

Child Psychology Psychiatry

597

482

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Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.

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Using natural experiments and animal models to study causal hypotheses in relation to child mental health problems

Cited by 14 publications

References 119 publications

Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder

Neurodevelopmental disorders

Annual Research Review: Secular trends in child and adolescent mental health

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