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PEDIATRICS Vol. 111 No. 2 February 2003, pp. 262-269

Childhood Behavior Disorders and Injuries Among Children and Youth: A Population-Based Study

Context. While an association between pediatric behavioral disorders and injuries is generally acknowledged, no studies have measured the risk for injury in the context of a large, population-based study that is free of cohort biases.

Objectives. To examine the association between childhood behavior disorders ([CBDs] as indicated by prescription for methylphenidate [MPH]) and a variety of injury outcomes, and to evaluate the risk for injury among these children after controlling for known demographic correlates.

Design. Population-based database analysis of all children in British Columbia (BC) under the age of 19 as of December 31, 1996; comparison of those who had been prescribed MPH and therefore placed in the CBD group (n = 16 806) and those who were not (n = 1 010 067). Demographic information collected was as follows: age, sex, measures of socioeconomic status, and region of residence.

Outcome Measures. Common types of childhood injury in BC: International Classification of Diseases, Ninth Revision N-codes (fractures, open wounds, poisoning/toxic effect, concussion, intracranial, burns) and E-codes (falls, postoperative complications, motor vehicle accidents, struck by object, adverse effects of drugs, suffocation, drowning).

Data Source. BC Linked Health Data Set and the BC Triplicate Prescription Program.

Results. After controlling for known demographic correlates, odds for injury was greater among those treated with MPH and presumed to have a behavioral disorder, when injury was characterized either by type (1.67; 99% confidence interval: 1.54–1.81) or cause (1.52; 99% confidence interval: 1.40–1.66) of injury. This increased risk extended to unexpected categories of injury such as postoperative complications and adverse effects of drugs.

Conclusions. Children with CBDs have >1.5 times the odds of sustaining injuries of a variety of types from a variety of causes, even after controlling for known demographic correlates, than those without behavioral disorders. The risks for these children extend beyond those that might be directly associated with impulsivity and overactivity. Injury prevention strategies aimed at this group of children and youth would be beneficial. Policy-makers should account for increased risk of a wide variety of injuries in this group of children and youth.

Jamie C. Brehaut, PhD*, Anton Miller, MBChB, FRCPC{ddagger},§, Parminder Raina, PhD{ddagger},||,¶,# and Kimberlyn M. McGrail, MPH||,**

* Ottawa Health Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada
{ddagger} Centre for Community Health and Health Evaluation Research, Children’s and Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada
§ Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
|| Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada
British Columbia Injury Research and Prevention Unit, Vancouver, British Columbia, Canada
# Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
** Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada

Key Words: methylphenidate • attention-deficit/hyperactivity disorder • behavior disorders • injury • children • database analysis

Abbreviations: ADHD, attention-deficit/hyperactivity disorder • CBDs, child behavior disorders • SES, socioeconomic status • BCLHD, British Columbia Linked Health Dataset • CHSPR, Centre for Health Services and Policy Research • MSP, Medical Services Plan • CI, confidence interval • RR, relative risk.

Received for publication Dec 21, 2001; Accepted Jul 1, 2002.




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