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Charlotte Clark + PDW: The prospective association between childhood cognitive ability and somatic s

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Related to, and following on from, a 2009 Chalder study that was discussed here: http://forums.phoenixrising.me/inde...rental-expectations-of-their-childs-iq.22629/

The prospective association between childhood cognitive ability and somatic symptoms and syndromes in adulthood: the 1958 British birth cohort

  1. Eva M Kingma1,
  2. Judith G M Rosmalen1,
  3. Peter D White2,
  4. Stephen A Stansfeld2,
  5. Charlotte Clark2

    http://www.ncbi.nlm.nih.gov/pubmed/24022814
Abstract
Background Cognitive ability is negatively associated with functional somatic symptoms (FSS) in childhood. Lower childhood cognitive ability might also predict FSS and functional somatic syndromes in adulthood. However, it is unknown whether this association would be modified by subjective and objective measures of parental academic expectations.

Methods 14 068 participants from the 1958 British birth cohort, whose cognitive ability was assessed at 11 years. Outcomes were somatic symptoms at 23, 33 and 42 years. Self-reported irritable bowel syndrome (IBS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and operationally defined CFS-like illness were measured at 42 years.

Results Lower cognitive ability at age 11 years was associated with somatic symptoms at ages 23, 33 and 42 years. Adjusting for sex, childhood internalising problems, previous somatic symptoms and concurrent psychological symptoms, childhood cognitive ability remained negatively associated with somatic symptoms at age 23 years (β=−0.060, 95% CI −0.081 to −0.039, p<0.01), 33 years (β = −0.031, 95% CI −0.050 to −0.011, p<0.01), but not with somatic symptoms at 42 years. Overall, we found no clear association between lower childhood cognitive ability and CFS/ME, CFS-like illness and IBS. Associations between cognitive ability and somatic symptoms at 23 years were moderated by low parental social class, but not by subjective indicators of parental academic expectations.

Conclusions Lower childhood cognitive ability predicted somatic symptoms, but not CFS/ME, CFS-like illness and IBS in adulthood. While earlier research indicated an important role for high parental academic expectations in the development of early-life FSS, these expectations do not seem relevant for somatic symptoms or functional somatic syndromes in later adulthood.
So they thought less bright children would be more likely to end up with CFS, and found:

We found an association between higher cognitive ability and self-reported CFS/ME, which was in contrast to our hypothesis. Since the association was only found when additionally adjusting for psychological symptoms and since it was rather small, we might consider this as a chance finding.

I wonder if they'd consider a similarly sized finding to be just chance if it had supported their hypothesis? I'm not sure I remember having ever read a paper where a significant finding in support of the researchers hypothesis was suggested to be a matter of chance.

Their summary of the paper:

What this study adds?
  • This study supports the findings that lower cognitive ability in childhood precedes the development of FSS many years later in adulthood.

  • While earlier research indicated an important role for high parental academic expectations in the development of early-life FSS, these expectations do not seem relevant for somatic symptoms or functional somatic syndromes in later adulthood.

  • Psychological symptoms also play a role in the association between childhood cognitive ability and adulthood somatic symptoms.

  • Further studies of factors that might explain the association between childhood cognitive ability and FSS in adulthood, such as coping strategies and psychological distress, should be conducted to inform preventive interventions for FSS.

Paper was generally tedious, trying to avoid saying 'we don't know what we're talking about, but have lumped together loads of patients under pointless labels to help us sound like experts... here are some weak associations that we can spin a story from'.

The aetiology of FSS is poorly understood, but FSS are known to result from multifactorial processes, including complex interactions between biological, psychological and social vulnerability factors.8–10

'The aetiology of... oh, it's all a load of bollocks. Who do we think we're kidding?'
 
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Bob

Senior Member
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I wonder if they'd consider a similarly sized finding to be just chance if it had supported their hypothesis?
Most unlikely!
But I'm glad that they found no association either way.
What did they possibly hope to achieve by finding an association?

This study concerns me for many reasons, but the main reason is that is makes me think of eugenics.

Their hypothesis could easily be interpreted that children with delayed academic development should be defined as having low IQ and that children with low IQ develop 'functional' (i.e. psychosomatic) illness because they have low IQ.
 
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13,774
Most unlikely!
But I'm glad that they found no association either way.
What did they possibly hope to achieve by finding an association?
This study concerns me for many reasons, but the main reason is that is makes me think of eugenics.

Their hypothesis could easily be interpreted that children with delayed academic development should be defined as having low IQ and that children with low IQ develop 'functional' (i.e. psychosomatic) illness because they have low IQ.

I'd have thought that they'd see it as evidence that the psychosocial strain of low IQ contributes to the development of WTFSS. I doubt that this would then be seen as good reason to increase the financial resources available to people struggling to compete in a modern labour market, but rather, they could be managed into being more 'resilient'.

Actually - I did a rubbish job with my first post. I was in the middle of three things while writing it, and kept getting distracted, and in the end just decided to post what I'd done (missing out the title, and another finding that could be of interest).

They also found no evidence that high parental expectations led to WTFSS.

Parental modifying factors
No significant interactions were found between childhood cognitive ability and the three subjective indicators of parental academic expectations (parental academic expectations as perceived by the child, parental interest reported by the teacher and parental aspirations of the child's future academic performance) in predicting somatic symptoms at age 23, 33 or 42 years.

This is all the sort of thing where, even if weak associations were found, it wouldn't be that interesting. Having a lower IQ or higher parental expectations probably can make life more difficult, and it would be unsurprising if this led to some increase in subjective complaints. Also though, maybe parents with higher expectations are more likely to be able to offer financial support that makes life less difficult? Maybe those with higher IQs who suffer from disabling fatigue are more likely to end up with a diagnosis of CFS? It seems very unlikely that this sort of research could lead to an interesting finding at the moment, and indeed, they seem happy to put their own finding to one side when it conflicts with their hypothesis.
 

barbc56

Senior Member
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How in the world do you define parental expectations?

Great job multitasking!!:thumbsup:


Thanks for the well written post as well as my best laugh of the day.:)
 

Firestormm

Senior Member
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Positively Freudian in design :vomit: :bang-head:

Thanks Esther. You win the 'perseverance in the face of crap' award this week :)

I wonder if we shouldn't have a policy change for 2014. No more publishing on this forum of psychological crap. Perhaps a sub-forum or a ban on Phoenix completely? Rhetorical. Don't answer. No wish to take the thread off piste :ill:
 
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1) People with Functional Somatic Symptoms did worse in school as children.
2 )People with CFS did better in school as children.

Wouldn't this imply that CFS is not a functional disorder? Of course, the BPS morons will never let that thought cross their minds.

That was another thing that bugged me about this paper that I forgot to note.


Candidate mechanisms in adults might include psychological distress, which has been associated with FSS and with clusters of related FSS; that is, functional somatic syndromes or disorders (FSD) in adulthood.

In chronic fatigue syndrome (CFS), a type of FSD, it was shown that parental expectations of the cognitive ability of children with CFS were higher than parental expectations of the cognitive ability of children without CFS.


We found an association between higher cognitive ability and self-reported CFS/ME, which was in contrast to our hypothesis.

Their summary:
What this study adds?
  • This study supports the findings that lower cognitive ability in childhood precedes the development of FSS many years later in adulthood.

So CFS = FSD = cluster of FSS

But (it is claimed) lower cognitive ability in childhood precedes the development of FSS, and they found an association between higher cognitive ability and self-reported CFS. Shouldn't they have spent a bit of time addressing that?

I've read general criticism of epidemiology as a field: that it tends to be used to justify the prejudices of the researchers involved, that loads of papers just hype findings found after looking at loads of variables, and that there are so many things going on in people's lives that are unaccounted for that most reported findings are misleading. On the Virology podcast that used to get posted here, they were pretty critical of epidemiology a few times too. I've not done much reading on this, but it does seem like this sort of work is very difficult to do well, and very easy to do poorly. It does seem like a lot of poor CFS work gets done in this area.

re this paper: They do include quite a lot of provisos in the text... not nearly enough imo.

eg [edit: I wouldn't assume that their references really show what they claims to. The worthless Chlader paper mentioned about was cited uncritically too]:

The question arises as to which mechanisms explain the long-lasting association of lower childhood cognitive ability with somatic symptoms in adulthood. The association may be spurious in that lower cognitive ability in childhood may be confounded by a related but unmeasured variable. If it is aetiologically important, it may be that children with higher cognitive ability develop better coping strategies to deal with stressful situations that prevent them from developing FSS. Previous studies in children showed more internal coping strategies in children with higher cognitive ability.39 As mentioned, lower childhood cognitive ability was associated with psychological distress in early adulthood,38 increasing vulnerability to FSS.

Also, they were just checking numbers of symptoms, and assuming that lots of symptoms were probably FSS:

There were several limitations. It was not clear whether all somatic symptoms were functional.

(Thanks for the kind words... but I really should have focussed a bit more when doing my first post. Tbh, not that interesting a paper, so I kept getting drawn into other things).
 
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WillowJ

คภภเє ɠรค๓թєl
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Or, lower childhood cognitive ability is from early expression of whatever disease. Or, lower childhood cognitive ability (as measured) is related to poverty (e.g. parent doesn't have time to read to the child; nutrition is lacking; etc.) and poverty is also associated to disease (and not just the ones they can't readily identify so call "functional" but also recognizable ones which are not mistaken for functional). But I bet they didn't consider those ideas.
 
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Snow Leopard

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I missed this discussion before.

But basically, the finding of higher (base) cognitive ability of children both replicates a prior study (the one investigating parental expectations) and suggests significant biases in the participation of individuals across different types of studies.

Some people like to claim that prospective studies like this are not subject to such biases, but unless you have very high participation rates, biases inevitably occur.
 
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But basically, the finding of higher (base) cognitive ability of children both replicates a prior study (the one investigating parental expectations) and suggests significant biases in the participation of individuals across different types of studies.

Ta SL. I hadn't thought of linking it to that Chalder study.
 
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I didn't think it was worth starting new threads for these abstracts, but also thought that they may be of interest, and are vaguely related to this thread:

J Pediatr. 2014 Jan 10. pii: S0022-3476(13)01528-X. doi: 10.1016/j.jpeds.2013.12.003. [Epub ahead of print]
Predictors for Persistence of Functional Somatic Symptoms in Adolescents.
Janssens KA1, Klis S2, Kingma EM2, Oldehinkel AJ2, Rosmalen JG2.
Author information
Abstract

OBJECTIVE:
To identify risk factors for persistence of functional somatic symptoms (FSS; ie, somatic symptoms that cannot be sufficiently explained by underlying organic pathology).

STUDY DESIGN:
The first (N = 2230, mean age = 11.1 years [SD 0.6], 50.8% girls), second (N = 2149, mean age = 13.7 years [SD 0.5], 51.0% girls), and third (N = 1816, mean age = 16.3 years [SD 0.7], 52.3% girls) assessment waves of the general population study TRacking Adolescents' Individual Lives Survey were used. FSS were assessed with the Youth Self-Report and the Child Behavior Checklist. Growth mixture models were used to identify different subgroups of adolescents on the basis of the developmental trajectory of their symptoms. Adolescents with persistent symptoms were compared with adolescents with decreasing symptoms with a multivariable logistic regression analysis.

RESULTS:
In our general population cohort, 4.1% of adolescents suffered from persistent FSS. Risk factors for persistent FSS were being a girl (OR 4.69, 95% CI 2.17-10.12), suffering from depressive symptoms (OR 5.35, 95% CI 1.46-16.62), poor self-rated health (OR 1.56, 95% CI 1.02-2.39), and high parent-reported FSS (OR 4.03, 95% CI 1.20-13.54). Anxiety, parental overprotection, school absenteeism, and diversity of symptoms did not predict persistence of FSS.

CONCLUSIONS:
This study identified risk factors for persistence of FSS in adolescents. Future studies might study effects of coping strategies and iatrogenic factors on symptom persistence.

Copyright © 2014 Mosby, Inc. All rights reserved.

http://www.ncbi.nlm.nih.gov/pubmed/24418471

Int J Behav Med. 2013 Jun;20(2):206-12. doi: 10.1007/s12529-012-9251-4.
Predictors of a functional somatic syndrome diagnosis in patients with persistent functional somatic symptoms.
Kingma EM, de Jonge P, Ormel J, Rosmalen JG.
Author information
Abstract

BACKGROUND:
Functional somatic syndromes (FSS) are characterized by the existence of multiple persistent functional somatic symptoms. Not many patients fulfilling the criteria for an FSS, receive a formal diagnosis, and it is unknown which factors explain this discrepancy. Patients that tend to worry and patients that gather more health information may have an increased chance of an FSS diagnosis. We hypothesized that high intelligence and high neuroticism increase the probability of an FSS diagnosis in patients with persistent functional somatic symptoms.

PURPOSE:
This study aims to investigate patient factors that might be important in the process of syndrome labeling.

METHODS:
Our study was performed in a large, representative population cohort (n = 976) in Groningen, The Netherlands, and included two assessment waves. Intelligence was measured using the General Aptitude Test Battery version B 1002-B. Neuroticism was measured using the 12-item neuroticism scale of the Eysenck Personality Questionnaire-Revised. Functional somatic symptoms were measured with the somatization section of the Composite International Diagnostic Interview. Current FSS diagnosis was assessed with a questionnaire. We performed multivariable logistic regression analyses including sum scores of neuroticism, intelligence scores, sex, number of functional somatic symptoms, and age as potential predictors of having an FSS diagnosis.

RESULTS:
From the 976 participants that completed measurements at follow-up, 289 (26.4 %) participants reported at least one persistent functional somatic symptom, and these subjects were included in the main analyses (38.4 % males, mean age of 55.2 years (SD = 10.7), 36-82 years). High numbers of functional somatic symptoms ((OR) = 1.320; 95 % (CI) = 1.097-1.588), female sex (OR = 9.068; 95 % CI = 4.061-20.251), and high intelligence (OR = 1.402; 95 % CI = 1.001-1.963) were associated with an FSS diagnosis, while age (OR = 0.989; 95 % CI = 960-1.019) and neuroticism (OR = 0.956; 95 % CI = 0.872-1.048) were not.

CONCLUSION:
This study suggests that high intelligence, but not high neuroticism, increases the chance of syndrome labeling in patients with persistent functional somatic symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/22836483

Ned Tijdschr Geneeskd. 2012;156(37):A4541.
[How do patients interpret terms for medically unexplained symptoms?].
[Article in Dutch]
Kingma EM, Moddejonge R, Rosmalen J.
Author information
Abstract

OBJECTIVE:
To investigate how primary care patients interpret the existing terminology used to describe medically unexplained symptoms; to contribute to the current academic discussion on unequivocal terminology.

DESIGN:
Descriptive cohort study.

METHODS:
We approached patients in the waiting rooms of two general medical practices in the city of Groningen and in the province of Drenthe. Based on a fictitious case, the patients were asked to assign connotations to a number of possible diagnoses for medically unexplained tiredness. The patients could choose from seven predetermined connotations. Among the diagnoses for medically unexplained tiredness were 'functional fatigue', 'chronic fatigue syndrome', 'psychosomatic tiredness', and 'medically unexplained tiredness'. From the seven connotations, we labeled three connotations as being negative. When patients gave at least one negative connotation to a possible diagnosis, the diagnosis was labeled as 'offensive'.

RESULTS:
A total of 184 patients participated in the study. From the alternative diagnoses for medically unexplained tiredness, 'psychosomatic tiredness' had the most negative connotations: at least one negative connotation for 65 (35%) patients. 'Chronic fatigue syndrome' and 'functional fatigue' had the fewest negative connotations: at least one negative connotation for respectively 17 (9%) and 24 (13%) patients.

CONCLUSION:
The terms 'chronic fatigue syndrome' and 'functional fatigue' were less offensive. Our results could imply that terms for medically unexplained tiredness that refer less to a psychological basis are most acceptable for the patient.

http://www.ncbi.nlm.nih.gov/pubmed/22971428
 

Bob

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After the results from those studies you think the authors would pack up their desperate hypotheses and go home.

For adults, the only predictor for having CFS/FSS is having high intelligence.
Hmm.. Perhaps that's because people with CFS have to diagnose themselves, otherwise they often don't get a diagnosis, so they have to have a degree of academic curiosity? Or because only a particular type of (informed and demanding) patient ends up being noticed by the medical profession and receiving secondary care?

For adolescents two of the predictors are either feeling ill or parents reporting the patient as being ill. Hmm.. So a predictor of illness is 'feeling ill'? Wow, way out. Some cutting edge science going on here! Oh, and another predictor is being a girl. In other words more females have CFS than males. Wow, what a finding. This is mind blowing stuff!

:rolleyes:
 
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For adolescents two of the predictors are either feeling ill or parents reporting the patient as being ill. Hmm.. So a predictor of illness is feeling ill? Wow, way out. Some cutting edge science going on here!

I haven't read the full papers, but it wouldn't surprise me if this were no less ridiculous than it sounds.

A lot of epidemiology seems pretty poorly thought through to me.
 

Bob

Senior Member
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BTW, thanks for posting, @Esther12.

They're actually quite helpful, in a way, because they debunk their own theories and demonstrate that neuroticism, anxiety, parental overprotection, school absenteeism, and diversity of symptoms are not predictors of CFS.

The third paper is even more ridiculous than the other two (which is quite a feat).

(I haven't read the full papers either, and don't intend to.)
 
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There seem to be loads of these sorts of studies with conflicting and minor findings. I probably would be worth us trying to keep track of them a bit better, so we could cite conflicting ones when a particular claim is being presented as evidence based (anyone want to volunteer for a database?)... the whole area seems weak to me.

Unless there are really strong prospective findings then they often look to be constructing stories out of confounds and coincidence.
 
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Just stumbled on this on the funding for this paper - £170,00.

Abstract

This research is examining the causes of chronic fatigue/ME and irritable bowel syndrome in the 1958 British Birth cohort, using data on health, family, education, and occupation gathered in childhood and adulthood before the illness develops. An understanding of the causes of these illnesses will contribute to preventing illness, as well as provide useful information for doctors, care providers, and patients and their families. Chronic fatigue syndrome, also known as ME is a debilitating illness, where the sufferer experiences long-term mental and physical tiredness that seriously affects daily life and activities. Little is known about what causes the illness. Few studies have information about the individual’s life before the illness develops and those that do suggest differing evidence for exercise, childhood illness and childhood depression as causes of chronic fatigue. Studies have also not yet examined whether the causes of chronic fatigue are different to the causes of other similar disorders, such as irritable bowel syndrome. This project is examining factors from childhood and adulthood that are thought to cause the development of chronic fatigue and which may also cause irritable bowel syndrome including childhood and adulthood depression, exercise habits, serious illnesses, neglect, and poor parenting in childhood.
Technical Summary
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating illness characterised by prolonged fatigue lasting over 6 months, accompanied by a wide range of symptoms. CFS/ME typically develops in early to mid adulthood, but little is known about the aetiology of the illness, making prevention and treatment challenging.

Previous studies of preventive and risk markers for CFS/ME are predominantly case control studies limited by small samples, lacking prospective data. These studies suggest that psychological health, childhood adversity and physical inactivity are risk markers for CFS/ME. Prospective studies of preventive and risk markers are few and the findings disparate. Analyses of the 1970 birth cohort found that high levels of exercise in childhood decreased risk and childhood illness increased risk of CFS/ME at age 30; in contrast, similar analyses of the 1946 birth cohort found that high levels of exercise in childhood increased risk and childhood illness showed no associated with CFS/ME at age 53. These findings may reflect differential associations for diagnoses in early versus mid-adulthood but further replication is required to inform prevention strategies.

Prospective studies have yet to examine whether preventive and risk markers are specific for CFS/ME or whether they reflect general markers for functional disorders such as CFS/ME and irritable bowel syndrome (IBS). This two year project will utilize the prospective 1958 British Birth cohort data to develop hypothesis testing models of lifecourse preventive and risk markers of CFS/ME and IBS, examining general and specific markers for CFS/ME and IBS, as well as replicating previous analyses of the 1970 and 1946 cohorts in relation to CFS/ME.

The 1958 Cohort is a prospective study of over 17,000 births, followed up over a 45 year period. This project will focus on health outcomes at 42y (N=11419), and preventive and risk markers from childhood (7y, 11y, 16y) and adulthood (23y, 33y). Hypotheses testing preventive and risk factors relating to psychological health across the lifecourse, childhood adversity, physical inactivity, body mass index, and chronic childhood illness will be tested. Age of onset for CFS/ME and IBS is known enabling pre-morbid factors to be distinguished from post-morbid factors.

This project offers a unique opportunity to test many of the prevailing hypotheses relating to preventive and risk markers of CFS/ME and IBS in a large prospective dataset. Information about markers and the specificity of markers for CFS/ME and IBS will be a useful addition to knowledge for practitioners, care providers and patients.

http://gtr.rcuk.ac.uk/project/3F6FA5EC-12F1-47AE-946C-ECA271FFD78C#tabOutcomes

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Goodwin Laura (2011) Psychopathology and physical activity as predictors of chronic fatigue syndrome in the 1958 british birth cohort: a replication study of the 1946 and 1970 birth cohorts. in Annals of epidemiology
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Goodwin Laura (2013) Life course study of the etiology of self-reported irritable bowel syndrome in the 1958 British birth cohort. in Psychosomatic medicine
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Clark Charlotte (2011) Premorbid risk markers for chronic fatigue syndrome in the 1958 British birth cohort. in The British journal of psychiatry : the journal of mental science
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Goodwin Laura (2011) Psychopathology and physical activity as predictors of chronic fatigue syndrome in the 1958 british birth cohort: a replication study of the 1946 and 1970 birth cohorts. in Annals of epidemiology

Also, £300,000 for this piece of research from Charlotte Clark and Esther Crawley. I hope this is not the sort of work on 'prevention' that @Action for M.E. is involved in:

http://gtr.rcuk.ac.uk/project/92F6B9E6-B13E-4BC5-AD74-F2245F8B5D54