(No outline received).

This project will investigate how well parents and health professionals can identify developmental problems in preschool children, using the ALSPAC study, a total birth cohort of 14,138 children born in 1991-2.

We will test whether parents are the first to identify impairments in their children and whether questionnaires can be an effective method of selecting children for further professional assessment in the pre-school period.

(No proposal form received).

This project aimed to examine whether skeletal development in childhood is programmed by early life factors, by studying the relationship between maternal diet as assessed by food frequency questionnaire (FFQ), other determinants of maternal nutrition such as smoking and exercise, and bone mass acquisition in childhood. The latter was assessed by measuring total body bone mineral content (BMC), bone area and bone mineral density (BMD) by performing total body DXA scans in 7000 children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort at age nine. Regional development at sites such as the spine, upper and lower limbs was also evaluated. In further studies, we aimed to explore the mechanisms involved in any such programming effect by examining the role of genetic factors by studying associations between DXA parameters and single nucleotide polymorphisms (SNPs) in different genes.

Our proposal was to create a resource for the study of lifestyle and body composition through puberty bycollecting and calibrating data on diet, activity and body composition within the Avon Longitudinal Study ofParents and Children (ALSPAC). The specific aims of the proposal were to:

1. Code dietary diaries collected at age 10+
2. Code activity diaries collected at age 10+
3. Perform total body dual energy X-ray absorptiometry (DXA) scans at age 11+
4. Perform calibration studies using magnetic resonance imaging (MRI) and deuterium dilution at age 11+
5. Collect and code dietary diaries at age 13+
6. Collect and code activity diaries at age 13+
7. Perform total DXA scans at age at age 13+
8. Perform calibration studies using MRI and deuterium dilution at age 13+
9. Calibrate the diet diary measures using repeat diaries, overnight urine collection and activity measures at age 13+

Though universally documented, sex differences in antisocial disorders remain poorly understood, and existing theory and evidence couses heavily on males. This proposal outlines an integrated programme of studies - spanning early childhood to the adult years - designed to test psychosocial influences on sex differences, and to provide the basis for a life-course perspective on antisocial behaviour in girls. Building on collaborations with three ongoing UK and US epidemiology/longitudinal studies the programme tests: (i) influences on the emergence of sex differences in early childhood; (ii) contrasting developmental models for the onset and persistance of girls' antisocial behaviour in childhood and adolescence, and for continuities to problems in psychosocial functioning in adult life; and (iii) biological and psychosocial risks for the development of depressive co-morbidity in early adolescence, and for the onset and recurrence of low mood in adult life.

We have developed techniques to study endothellal function non-invasively in children and young adults. This programme of work will study how genetic and early enviromental factors affect endothellal function and other markers of early arterial disease (such as arterial stiffness) in a large population of pre-pubertal children undergoing long-term follow-up. Long-term follow-up will also show how these arterial changes progress during puberty and when later risk factors such as smoking are enocuntered.

With regards to children with cerebral palsy, very little information about attainment of urinary continence is available. The long-term physical, psychosocial and financial burden of incontinence in the cerebral palsy patient is considerable and in order for the paediatrician to begin addressing these important issues further information regarding the normal attainment of bladder control in children with cerebral palsy has to be established. This is the aim of this study.

METHODS

The original study:

The data in this study originate from a previously published population based study (Scrutton and Baird 1997) which established a cohort of children with bilateral cerebral palsy born from 1989 to 1992 (inclusive) to mothers resident at the time of birth within the geographically defined area of the South East Thames Regional Health Authority (SETRHA) in south east England in order to monitor the children's hip development up to the age of 5 years using serial hip X-rays. It is for this reason that children with hemiplegic cerebral palsy are not included. The South East Thames Health Region at the time had a population of 3.65 million with 205 958 live births during the study period. A comparison of epidemiological data between SETRHA and England and Wales showed similarities between the two. For original methods of recruitment, details of ethical permission and consent, and diagnosis of cerebral palsy the reader is referred to the original paper (Scrutton and Baird 1997).

Present study:

For the purposes of this study, a questionnaire containing details of the child's attainment of bowel and bladder control by day and night, as well as parental concerns or presence of abnormal bladder and bowel symptoms, was used. This questionnaire was administered by physiotherapists to the parents of the children sometime after their third birthdays together with other information required for the original study at that time. The parents/carers were asked to post the questionnaire back to the investigators in a self-addressed envelope. Almost all were returned between the third and fourth birthdays, although one was returned at 5 years. After 5 years of age, a visit was carried out by the original authors, mostly in the child's home together with the parents. A number of parameters were obtained during this visit including confirmation of the diagnosis of cerebral palsy, the nature of the motor disorder including distribution (quadriplegia, diplegia, double hemiplegia and paraplegia) and type (hypertonia, ataxia, involuntary movements, hypotonia and ataxic diplegia after Hagberg 1985), learning level (as ascertained from other medical or educational sources), severity of disability and the age of attainment of bladder and bowel control by day and night. For funding and practical reasons these visits were carried out between 7 to 9 years of age. A closing visit questionnaire, including further continence data was completed some time after the age of 14 years (up to age 19 years) in this cohort, in a similar manner to the above. Whilst the stated aim of this study is to establish the age of attainment of bladder control in subjects with cerebral palsy, data on bowel control have been analysed simultaneously for two reasons: availability and therefore ease of analysis together with bladder data, and the fact that bowel and bladder control are physiologically and developmentally linked, and have been shown by previous authors to follow each other sequentially (Stein and Susser 1967, Largo and Stutzle 1977, Crawford 1989).

Definitions:

Cerebral palsy has been taken to mean all non-progressive disorders of movement and posture caused by a defect or lesion in the brain by 15 months chronological age, and not part of another syndrome which has a motor component. Those with syndromes including a high risk of skeletal or joint anomalies and children whose disorder had no clinical trunk or lower-limb involvement were also excluded. Each child's paediatrician provided written confirmation of the diagnosis at 5 years of age.

Bladder and bowel control was defined as being reliably continent with socially acceptable toileting even if help was required.

Definitions of learning level, severity of disability and type (Hagberg 1989)/distribution of motor disorder are defined and classified according to the Gross Motor Function Classification System (GMFCS).

RESULTS

The results of bladder and bowel continence attainment will be presented in a longitudinal manner together with details of any abnormal patterns which will be discussed. The data collected at three years and eight years of age have already been analysed and analysis of the data available at 16-19 years of age is currently awaited. The only available control comparison group is a series of international studies which are for the large part retrospective, cross-sectional and not population based and neither are they collected from a British population with a similar birth date.

We wish to investigate the measurement of borderline personality disorder (BPD) within the 11-12 year-old cohort of the ALSPAC data. Specifically, we intend to employ item response theory (IRT) methods on the BPD symptom criteria. IRT constitutes a latent trait approach to psychological measurement, modeling the probability of endorsing a given item (e.g., presence of affective instability) as a function of an individual's standing on the underlying construct (e.g., BPD).

The basic unit of IRT is the item characteristic curve (ICC), which depicts visually the relationship between the construct and a person's response to an item (Embretson & Reise, 2000). The shape of this curve is influenced by at least two parameters: difficulty and discrimination. The difficulty parameter represents the point at which the probability of endorsing an item is 50%. The discrimination parameter is the slope of the ICC at the value of the difficulty parameter. These parameters will provide important information for evaluating the performance of each BPD criterion, such as the level of BPD needed to meet the criterion and the degree to which it differentiates among higher and lower levels of BPD (Feske, Kirisci, Tarter, & Pilkonis, 2007).

Most applications of IRT require that the construct being measured is unidimensional. Several factor analytic investigations of the BPD criteria in adults have supported a unidimensional structure (Aggen, Neale, Roysamb, Reichborn-Kjennerud, & Kendler, 2009; Feske et al., 2007; Fossati, Maffei, Bagnato, Donati, Namia, & Novella, 1999), while others have reported a structure sufficiently unidimensional for IRT purposes (Johansen, Karterud, Pedersen, Gude, & Falkum, 2004; Sanislow et al., 2002), as evidenced by high factor intercorrelations (Embretson & Reise, 2000). To date, only one study (Becker, McGlashan, & Grilo, 2006) has conducted factor analysis of the BPD criteria in a youth sample, the results of which did not reveal a unidimensional structure. However, this study employed principle component analysis with orthogonal rotation and, thus, did not report the magnitude of factor intercorrelations. Taken together, these studies provide reason to believe that the BPD criteria may be sufficiently unidimensional to employ a traditional IRT-based model. However, in the event that the BPD criteria are not unidimensional in the ALSPAC data, multidimensional or categorical confirmatory factor analysis will be employed.

In order to investigate our aims, we will need the CI-BPD data that correspond to each of the 9 DSM-IV symptom criteria, including the questions used to inform judgment of whether the symptom was present.