Neurodevelopmental disorders (ESSENCE): – Early detection and outcome in adulthood
Valdemar Landgren gives us an overview of his doctoral studies which focus on ESSENCE in adulthood.
What is your professional background Valdemar?
I graduated from medical school in Gothenburg in 2014, and am a specialising in adult psychiatry and work at Skaraborg Hospital. The research projects in my thesis are done in collaboration with researchers affiliated with the Gillberg Neuropsychiatry Centre, but they have all been conducted locally at Skaraborg Hospital.
What are your research interests?
I am interested in how ESSENCE is expresses itself in adulthood, as well as treatments, nosology and mechanisms at the intersection of internal medicine and psychiatry.
You are a PhD student at GNC, what is your project about?
There is a lot of material on children with ESSENCE, but significantly less about the outcome in adulthood. Two of the sub-projects therefore follow children with ESSENCE into adulthood. In the first study, we met with adopted children when they were 18-28 years old and who were diagnosed with Fetal Alcohol Spectrum Disorders as children. The second study was on ADHD with motor coordination disorder (DCD), previously referred to as DAMP. The participants were followed up in national registers when they were 30-31 years old. The third study examined predictors in childhood of outcome in adulthood for this group. In my fourth study, we are examing the prevalence of ESSENCE in Swedish school children today, and the reliability of the ESSENCE-Q parent questionnaire which aims at identifying children with difficulties. All of these projects are population-based, making the groups more representative of the conditions than, for example, a clinic-based study.
You have recently published your first article on Fetal Alcohol Syndrome. What were the main findings?
Despite adoption to a favourable environment, participants continued to have significant disabilities and psychiatric problems as adults. As a group, stunted growth (height) persisted into adulthood and notably, the general aptitude regarding IQ of the participants was lower in adulthood than in childhood. It may therefore be particularly important to reassess the cognitive abilities of children with FASD when they become adults, which places different demands on their ability to lead independent lives.
You have also published your second article on ADHD and DCD? Can you give us a brief summary of what it is about and your findings?
This study consisted of participants with ADHD and DCD, as well as an original comparison group and a register-based comparison group where we looked at outcomes in national registers when the participants were 30-31 years old. We primarily looked at a composite measure consisting of need for psychiatric medication, presence of psychiatric diagnosis, disability pension, criminal conviction. Although it was more prevalent in those with ADHD+DCD, almost half of the group had none of the outcomes. It was also notable that only 10% had received treatment with central stimulants, whereas they were much more likely to have received treatment for depression and anxiety.
The third article was also about ADHD and DCD. What did it show?
We were looking to see if there were clinical clues that predicted how they would fare as adults, because in the first study there was a big difference in outcomes between the participants. To examine this, we used a survey when the children were 9 years old to find predictors of outcomes when the participants were adults. When not limiting the studies to ADHD symptoms, but also including co-occurring difficulties in motor skills, defiance, behaviour, autistic traits and depression their symptoms could explain about 40% of the variance in outcome. We also looked at how the symptoms related to each other. Problems with behaviour and defiance are common in ADHD and were correlated. They are therefore often grouped as disruptive problems. Motor difficulties, which are rarely examined in ADHD studies, were most strongly associated with depressed mood when participants were children, as well as work ability in adulthood, but did not correlate to the same extent with the severity of ADHD. This underscores that motor difficulties are associated with children's well-being and warrant targeted interventions directly, as well as contributing prognostic information beyond maladaptive behaviors in the long term.
What are you working on now and in the future in terms of research?
Last year my research was in a low-intensity phase, as I was mostly working clinically in adult psychiatry. From this winter onwards I am alternating between parental leave and research until I defend my doctoral thesis on 23 September 2022. We are in the final phase of data collection for a school-based broad student health survey, which is the basis of the fourth part of the thesis. This work examines the ESSENCE-Q’s reliability (a questionnaire on early developmental abnormalities) completed by parents predicts clinical ESSENCE problems when children are 10 years old.
What has been the highlight of your research career so far?
In parallel with my dissertation I had the privilege of participating in Christoffer Rahm's research which in many ways breaks new ground in the research field of paedophilia. Christoffer Rahm also became my co-supervisor. I have also appreciated the chats I have had with researchers I have looked up to a lot, such as Christopher Gillberg, Ken Jones and Max Fink. Although research is ultimately about the research itself, it's great to get answers to questions "straight from the horse's mouth" from experts, as it can tell you more than can fit into a scientific manuscript. It has also served to inspire. I will never forget the visit to Max Fink's home in New York!
Which aspects of your doctoral studies do you enjoy the most? What is most difficult?
I enjoy most aspects of research, from planning to data collection, analysis, presentation, writing... Although data entry can get very boring! I have been give ample research time by my employer during my PhD, but maintaining the opportunity to do research after my PhD seems to be difficult, even though it is something I want.
Still keeping his football career alive and hoping for a normal long season without crowd restrictions due to the pandemic!