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Head circumference and child ADHD symptoms and cognitive functioning: results from a large population-based cohort study

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Abstract

The aim of this study is to understand the association between prenatal, newborn and postnatal head circumference (HC) and preschool neurodevelopment in a large population-based birth cohort. The INMA project followed 1795 children from 12 weeks of pregnancy to preschool years. HC measurements were carried out prospectively, and following a standardized protocol during pregnancy (12, 20 and 34 weeks), birth, and child ages of 1–1.5 and 4 years old; and z-scores were further estimated. Prenatal head growth was assessed using conditional z-scores between weeks 12–20 and 20–34. Several neuropsychological tests [MSCA (cognition), CPT (attention)] and behavioral rating scales [DSM-IV-ADHD, CAST (autism), CPSCS (social competence)] were carried out during the last follow-up (5 years old). Multivariable models adjusted for family and child characteristics were applied to analyze associations between HC and neurodevelopment. In fully adjusted models, prenatal HC and head growth showed little or no associations with the neurodevelopment outcomes. Independent associations were observed between HC z-scores at birth, 1–1.5 years and 4 years and MSCA global cognitive scores and DSM-IV inattention symptoms. Specifically, z-score at birth was positively associated with general cognitive scores [β 1.22, 95% confidence interval (CI) 0.59, 1.85], and we observed a protective association with ADHD-DSM-IV total symptoms, mean ratio (MR) 0.85 (0.75, 0.96). Prenatal HC and head growth measurements gave little information about child cognitive abilities and behavior at preschool years. However, HC at birth and early childhood was positively associated with a range of neuropsychological outcomes, including protective associations with ADHD symptoms.

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Abbreviations

ASC:

Autism spectrum conditions

ASD:

Autism spectrum disorder

BSID:

Bayley scales of infant development

CAST:

Childhood autism spectrum test

CI:

Confidence interval

CPT:

Conner’s kiddie continuous performance test

CPSCS:

California preschool social competence scale

CBCL:

Child behavior check list

DSM-IV-ADHD:

Attention-deficit/hyperactivity disorder criteria of the diagnostic and statistical manual of mental disorders, fourth edition form list

ELBW:

Extremely low birth weight

FDR:

False discovery rate

HC:

Head Circumference

INMA:

Infancia y medio ambiente [environment and childhood]

SD:

Standard deviation

MSCA:

McCarthy scales of children’s abilities

MR:

Mean ratio

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Acknowledgements

We would like to thank all the participants of the INMA Project for their collaboration as well as the project investigators at each cohort center as well as the coordination centers. A full roster of the INMA Project investigators can be found at http://www.PROYECTOINMA.org/. Wilma Zijlema did English edits in the manuscript.

Funding

Sabadell: This work was supported by grants from the Spanish Ministry of Health [FIS-PI041436]; Instituto de Salud Carlos III [Red INMA G03/176 and CB06/02/0041 and predoctoral grant PFIS 2010, Register FI10/00399]; the Generalitat de Catalunya-CIRIT [1999SGR 00241]; the EU sixth framework project NEWGENERIS [FP6-2003-Food-3-A-016320]; Fundació Roger Torné, and Fundació La Mataró de TV3 (Project No. 090430 & No. 20162210). This study has been funded by Instituto de Salud Carlos III through the projects “CP14/00108 & PI16/00261” (co-funded by European Regional Development Fund “A way to make Europe”). Asturias: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176 and CB06/02/0041), FISS-PI042018, FISS-PI09/02311, FISS-PI1302429, Obra Social Cajastur/Fundación Liberbank and Universidad de Oviedo. Guipuzkoa: This study was funded by grants from Instituto de Salud Carlos III (FIS-PI06/0867 and FIS-PS09/00090), Department of Health of the Basque Government (2005111093 and 2009111069), and the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001). Valencia: This study was funded by grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1, Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, and CP11/00178), and the Conselleria de Sanitat Generalitat Valenciana; all in Spain. FIS-DENAMIC: PI/11/02038. Jordi Julvez holds a Miguel Servet contract (MS14/00108) awarded by the Spanish Institute of Health Carlos III (Ministry of Economy and Competitiveness). This study was also funded by grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, 17/00663, and CP11/00178), Alicia Koplowitz Foundation 2017, and the Conselleria de Sanitat Generalitat Valenciana; all in Spain.

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Ferrer, M., García-Esteban, R., Iñiguez, C. et al. Head circumference and child ADHD symptoms and cognitive functioning: results from a large population-based cohort study. Eur Child Adolesc Psychiatry 28, 377–388 (2019). https://doi.org/10.1007/s00787-018-1202-4

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