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Behavioural difficulties in early childhood and risk of adolescent injury
  1. Amrita Bandyopadhyay1,2,
  2. Karen Tingay3,
  3. Ashley Akbari2,4,
  4. Lucy Griffiths4,5,
  5. Helen Bedford5,
  6. Mario Cortina-Borja6,
  7. Suzanne Walton5,
  8. Carol Dezateux7,
  9. Ronan A Lyons1,2,4,
  10. Sinead Brophy1,2,4
  1. 1 National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, United Kingdom
  2. 2 Administrative Data Research UK, Swansea University Medical School, Swansea, United Kingdom
  3. 3 Office for National Statistics, Cardiff Road, Newport, Wales, UK
  4. 4 Health Data Research UK, Swansea University Medical School, Swansea, United Kingdom
  5. 5 Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, UCL, London, UK
  6. 6 Clinical Epidemiology, Nutrition and Biostatistics, UCL Great Ormond Street Institute of Child Health, London, UK
  7. 7 Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  1. Correspondence to Amrita Bandyopadhyay, Swansea University Medical School, Swansea SA2 8PP, UK; A.Bandyopadhyay{at}


Objective To evaluate long-term associations between early childhood hyperactivity and conduct problems (CP), measured using Strengths and Difficulties Questionnaire (SDQ) and risk of injury in early adolescence.

Design Data linkage between a longitudinal birth cohort and routinely collected electronic health records.

Setting Consenting Millennium Cohort Study (MCS) participants residing in Wales and Scotland.

Patients 3119 children who participated in the age 5 MCS interview.

Main outcome measures Children with parent-reported SDQ scores were linked with hospital admission and Accident & Emergency (A&E) department records for injuries between ages 9 and 14 years. Negative binomial regression models adjusting for number of people in the household, lone parent, residential area, household poverty, maternal age and academic qualification, child sex, physical activity level and country of interview were fitted in the models.

Results 46% of children attended A&E or were admitted to hospital for injury, and 11% had high/abnormal scores for hyperactivity and CP. High/abnormal or borderline hyperactivity were not significantly associated with risk of injury, incidence rate ratio (IRR) with 95% CI of the high/abnormal and borderline were 0.92 (95% CI 0.74 to 1.14) and 1.16 (95% CI 0.88 to 1.52), respectively. Children with borderline CP had higher injury rates compared with those without CP (IRR 1.31, 95% CI 1.09 to 1.57).

Conclusions Children with high/abnormal hyperactivity or CP scores were not at increased risk of injury; however, those with borderline CP had higher injury rates. Further research is needed to understand if those with difficulties receive treatment and support, which may reduce the likelihood of injuries.

  • longitudinal data linkage
  • routine data
  • Strengths and Difficulties Questionnaire
  • hospital admission
  • A&E attendance

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  • Contributors RAL and SB designed the study. AB prepared and analysed the data within the SAIL Databank with support from Mario Cortina-Borja, Karen Tingay and Lucy Griffiths. AB and SB wrote the manuscript and all authors contributed to critically appraising and reviewing the manuscript. All authors approved the final manuscript.

  • Funding This work was supported by the Wellcome Trust (grant no 087389/B/08/Z), Farr Institute of Health Informatics Research from the Medical Research Council (MR/K006584/1 and MR/K006525/1), Health Data Research UK (grant ref: NIWA1), Administrative Data Research – UK (ES/S007393/1), National Centre for Population Health and Wellbeing Research and Asthma UK Centre for Applied Research (AUK-AC-2012-01).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for the fourth survey of the MCS was received from the Northern and Yorkshire Research Ethics Committee (07/MRE03/32). This study was approved by the SAIL Information Governance Review Panel in Wales and the Public Benefit and Privacy Panel for Health and Social Care in Scotland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

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