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Association of Externalizing Behavior Disorder Symptoms and Injury Among Fifth Graders

  • David C. Schwebel
    Correspondence
    Address correspondence to David C. Schwebel, PhD, Department of Psychology, University of Alabama at Birmingham, 1300 University Blvd, CH 415, Birmingham Alabama 35294.
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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  • David L. Roth
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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  • Marc N. Elliott
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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  • Susanna N. Visser
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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  • Sara L. Toomey
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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  • Eva M. Shipp
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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  • Jo Anne Grunbaum
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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  • Mark A. Schuster
    Affiliations
    Department of Psychology, University of Alabama at Birmingham (Dr Schwebel); Department of Biostatistics, University of Alabama at Birmingham (Dr Roth); RAND, Santa Monica, Calif (Drs Elliott and Schuster); Centers for Disease Control and Prevention, Atlanta, Ga (Ms Visser and Dr Grunbaum); Division of General Pediatrics, Children’s Hospital Boston and Harvard Medical School, Boston, Mass (Drs Toomey and Schuster); and Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Tex (Dr Shipp)
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      Abstract

      Objective

      Injury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample.

      Methods

      Data were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome was injury frequency. Primary independent variables were ADHD and CD symptoms. Additional covariates included gender, race/ethnicity, and household income. Ordinal logistic regression examined correlates of injury frequency. The interaction between ADHD and CD symptoms also was examined.

      Results

      In bivariate analyses, the odds of injury increased as ADHD symptoms (odds ratio [OR] 1.29; 95% confidence interval [95% CI] 1.18–1.41) and CD symptoms (OR 1.18; 95% CI 1.07–1.31) increased. However, in multivariate analysis, only ADHD symptoms were significantly associated with injury (OR 1.22; 95% CI 1.10–1.35). There was no statistically significant interaction between ADHD and CD symptoms.

      Conclusions

      ADHD symptoms are associated with increased odds of injury in fifth graders. Findings have implications for potential injury prevention strategies for mental health practitioners (for example, cognitive training with at-risk youth), pediatricians (ADHD screening), and parents (improved supervision).

      Keywords

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      References

      1. National Center for Injury Prevention and Control. WISQARS (Web-Based Injury Statistics Query and Reporting System). Available at: http://www.cdc.gov/injury/wisqars/index.html. Accessed November 5, 2010.

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