One in six school-aged children now have a probable mental health disorder -- up from one in nine in 2019. Services for children and young people’s mental health are stretched more than ever before, such that maximising resources and their effectiveness is a key priority. The success of mental health interventions can be optimised by improving our understanding of how an intervention translates into events that lead to improved outcomes. Parent and child behaviours are the primary intervention targets for children’s mental health, yet little is known about how parent-child dynamics change during, or because of, an intervention, or the extent to which they remain modified in the longer term. We aim to address this gap, with specific focus on children’s disruptive behaviour as one of the most common reasons for children to receive mental health services.

To examine the effect of mental health interventions on two-way processes between parents and children, we will take a novel approach using data from ALSPAC. We plan to link data on Mental Health Services use with individual-level data on parents and children. We will consider two-way parent-child relationships as a function of intervention by examining these processes before and after mental health service provision within families, as well as by examining potential moderation of change in these processes by comparing families receiving mental health service provision and those not.

Researchers at the University of Bristol and University College London (UCL)

Mental health

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This project builds on an earlier ALSPAC project which undertook magnetic resonance imaging (MRI) scans of about 400 participants at ages 20 and 26. Using these scans we will investigate developmental trajectories for psychiatric disorders to illuminate possible interactions between the brain, behaviour, genetics and environmental exposures. Findings from the earlier project will be used as a starting point to investigate ALSPAC’s wealth of data that enables comprehensive research into autistic traits within the general population and associations with other psychiatric conditions.

Research has shown that autism is linked to increased risk for psychotic experiences. This project will assess exposure to psychotic experiences and autistic traits and subsequent behavioural and neurobiological outcomes. Autism and its associated traits can often be diagnosed early in development so perinatal exposures such as parental health and birth trauma will be important to consider.

Our aims are to explore (1) via magnetic resonance imaging measures, any biological relationships between autistic traits and psychotic experiences, and (2) the developmental trajectories of autistic traits and to model the impact of biological and environmental factors.

It is important to follow the development of autistic traits so that changes to psychosocial outcomes can be monitored and targeted for potential intervention. This research will enhance our understanding of behavioural and biological pathology associated with autism and any links to other psychiatric conditions.

Researchers at University College London (UCL)

Education, primary & secondary health care

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The original Children of the 90s have had their lung function measured at the ages of 8, 15 and 24 years. This has been used to find four different trajectories of lung function: persistently high, normal, below average, and persistently low. It is known that below normal lung function trajectories are associated with chronic obstructive pulmonary disease, cardiovascular disease and all-cause mortality. It is therefore important that we find and target any modifiable risk factors for these lower trajectories.

In this project we are looking at back at the general practice and hospital records of G1 participants to identify if childhood respiratory disease is associated with below normal lung function trajectories. We will also assess the severity of any respiratory disease, in particular asthma, by looking at previous prescriptions of steroids, antibiotics, and inhalers as well as emergency admissions to hospital.

Researchers at Bristol Medical School’s Academic Respiratory Unit

Primary and secondary physical health records

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This project will look at the genetic underpinnings of neurodevelopmental traits such as cognitive ability and social and communication difficulties, and the genetics of related conditions such as autism, intellectual disability, and ADHD. It is known that both common and rare genetic variants influence these traits.

In this project, we will use the data in ALSPAC on cognitive development, behaviour, and educational achievement of ALSPAC children at different ages to investigate the joint impact of rare and common genetic variants on cognitive development and neurodevelopmental traits over time, and whether these are modified by the environmental factors and parents’ behaviour.

We will also look at genetic effects on mental health and educational attainment, as well as behavioural and personality traits relevant to reproductive success. We will contribute data to the Autism Sequencing Consortium (ASC), a leading international collaborative group working on deciphering autism genetics and its relation to cognition and brain development.

We plan to combine ALSPAC data with other datasets of similar nature from the ASC, to identify new genes underlying autism, understand genetic differences between autistic individuals who have different co-morbidities and understand sex differences in autism.

Researchers at the Wellcome Sanger Institute

Education, mental health & physical health records

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In any two year period, almost one quarter of children were exposed to maternal mental illness. Mother’s mental health problems are associated with problems in children’s cognitive development, physical and mental health. We also know that exposure to intimate partner violence (IPV) and parental substance misuse during childhood increases the risk of negative mental health outcomes. There is some evidence that parental mental health problems may reduce children’s resilience to the impact of IPV. However, we do not yet fully understand the relationships between IPV, parental mental health and children’s mental health. We also know little about factors that promote resilience in children exposed to IPV.

Using ALSPAC we plan to:

1. Better understand the relationships between interparental violence, parental substance misuse, parental mental health and how they relate to children’s mental health

2. Explore the mechanisms promoting resilience in children exposed to interparental violence

Researchers at the University of Bristol & University College London (UCL)

Mental health & physical health records

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Eating disorders (including Anorexia Nervosa (AN) Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Other Specified Feeding and Eating Disorders (OSFED)) are severely impairing and have the highest mortality of any psychiatric condition. Prevalence of eating disorders in the general population is around 5% but up to a third of young women and one fifth of young men report disordered eating behaviours (e.g. fasting, purging, binge-eating, excessive exercise) that are impacting their lives. However, very little research has been conducted into the association between disordered eating behaviours (often reported on questionnaires) and eating disorder diagnoses (confirmed by medical records), or on factors that lead to a lack of eating disorder diagnosis in individuals who report disordered eating behaviours consistent with diagnostic criteria.

Furthermore, associations with potential risk factors such as socioeconomic position (SEP) are inconsistent for self-reported eating disorder symptoms and eating disorder diagnoses. Whilst some studies have found that lower SEP is associated with higher self-reported eating disorder traits, these findings are not universal. For example, a large national study in USA found no association between SEP and eating disorders. In addition, studies which have looked at rates of diagnosis and hospitalisation (rather than self-reported symptoms) have found that higher family SEP is associated with increased risk of eating disorders. However, it is not clear that higher SEP is a cause of eating disorders. An alternative explanation is that children from higher SEP backgrounds find it easier to access services, and this may be why there are higher rates of diagnosis in this group.

This project will look broadly at the association between disordered eating captured by questionnaire reports and eating disorder diagnoses from linked medical records. Firstly, we will assess whether individuals with disordered eating reported on questionnaires also have an eating disorder medical diagnosis. Secondly, we will explore what factors are associated with obtaining an eating disorder diagnosis in the whole sample and in those reporting diagnostic level disordered eating behaviours via questionnaire. We will also examine associations for socioeconomic position with disordered eating symptoms and eating disorder diagnosis in the ALSPAC cohort and with other population-based cohorts. Finally, we will examine similarities in outcomes for individuals who report disordered eating on questionnaires and those with a diagnosis of eating disorders.

This project aims to better understand the association between disordered eating (self-reported on questionnaires) and eating disorder diagnoses (via linked medical data).

1. Investigate whether individuals reporting disordered eating on questionnaires at age 13, 16, 18 and 24 years have received an eating disorder diagnosis (linked medical records)

2. Identify characteristics associated with lack of eating disorder diagnosis (medical records) in individuals reaching diagnostic level frequency of disordered eating behaviours on questionnaires (age 13, 16, 18 and 24 years)

3. Compare associations between socioeconomic position and disordered eating symptoms with associations between socioeconomic position and eating disorder diagnosis. We will use data from ALSPAC, along with two other large population studies from Denmark and Sweden (DNBC, MoBa).

4. Investigate similarities and differences in social, educational and medical outcomes for individuals with self-reported disordered eating compared with medical record diagnoses of eating disorders.

Researchers at the University of Bristol

Mental health

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Research has discovered that on any given day in England, 28.5% of young people experience mental health problems, and that as little as one in four of them receive formal support for these problems. There is a lack of knowledge of what happens to those young people not receiving mental health services. For those individuals receiving mental health services, mental health problems have been shown to limit economic, vocational, and social functioning. International studies suggest that 50 to 70% of young people who receive services for their mental health problems continue to experience these problems in adulthood.

The proposed project will learn from cohort data which young people are less likely to receive professional support for their mental health problems and what the characteristics are of those young people not receiving mental health services for their problems. It will also be determined how many young people who do not receive mental health services for their problems continue to experience mental health problems in young adulthood and how resilient these young people were during the COVID pandemic.

The feedback provided by Young People will help direct the course of the project. While researchers from the University of Southampton will share the findings with the academic community, YOUNGMINDS will spread the word about our research and findings to their members and followers, young people, mental health service providers and policy makers using a variety of different media. Output activities will increase awareness and promote discussion among the stakeholder groups and ease the way for more effective mental health support for young people

Our aim is to:

(1) Enhance our understanding of the social, economic, psychological factors associated with the development and progression of mental health problems for those young people not accessing formal mental health services

(2) Explore characteristics of those young people not receiving professional services for their mental health problems and determine if they have access to informal support.

(3) Examine resilience during unpredictable challenging times (COVID pandemic) for those young people not receiving menal health services for their mental health problems

(4) Employ a statistical technique that is novel to the field of mental health research to adjust for missing data

Researchers at the University of Southampton

Education, Mental health

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Mental health problems are globally prevalent, and made worse by Covid-19. There is a growing recognition of the roles of economic circumstances in determining mental health, however, it remains unclear how the economic circumstances at various levels (individual and household; local areas; and national) manifest differently on mental health through different channels.

This project aims to map out the relationship between mental health and economic variables at the individual/household levels, evaluate the effects of social and economic policies on mental health, and identify factors at local area levels in affecting mental health directly and making policies more effective at improving mental health.

The project will also combine your information from Children of the 90s with data from school and hospital records to find out how economic shocks affect mental health. The researchers will also examine the mechanisms through which economic shocks affect mental health, including educational attainment and socio- emotional development. 

Professor Eugenio Proto, Alec Cairncross Professor of Applied Economics and Econometrics at the University of Glasgow Dr Anwen Zhang, Senior Lecturer in Economics at the University of Glasgow

KS1, KS2, KS3, KS4, KS5

Primary & secondary health care records

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Self-harm in young people is a major problem with as many as 1-in-6 adolescents reporting having self-harmed at some point in their lives. Recent studies also suggest that levels of self-harm are rising, particularly for young women. Young people who self-harm seem to be more likely to struggle in a number of ways in early adulthood, including being more likely to have a mental health problem, and to use alcohol and illegal drugs. It is also the strongest known risk factor for suicide, which is the most common cause of death among this age group. 

GPs have a key role to play in the early identification and management of self-harm as most young people consult with a GP relatively regularly. It is currently unclear whether young people who self-harm are not visiting their GP, or whether they are visiting their GP for other reasons and their self-harm is not being picked up. This project will use information you have given to Children of the 90s in questionnaires and at focus clinics, along with GP records to answer this question, and find out how young people who report self-harm to their GP are different from those who do not. This will help identify whether there are particular groups of young people who may be in need of help but are not accessing it. The researchers will also use the information contained in GP records to develop a prediction tool for self-harm. This will help GPs to identify which young people are most likely to have self-harmed, so that they can provide help earlier. 

The project will also combine your information from Children of the 90s with data from hospital records to find out how many people who were self-harming at 16 present to hospital for self-harm when they are older. The researchers will also look at what factors influence this. Self-harm can be very serious, and often people who present to hospital have tried to end their lives. Early identification of those who are most likely to present is therefore really important to facilitate timely access to interventions and help to prevent loss of life.

Dr Lydia Speyer, Lecturer in Developmental Psychology at Lancaster University

KS1, KS2, KS3, KS4, KS5

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Approximately 10-20% of children and adolescents experience socio-emotional difficulties severe enough to merit a diagnosis of a mental health disorder. More than 40% of these youth develop at least one other mental illness throughout their life. A developmental perspective that investigates the interrelations between different domains of socio-emotional development from early life to adulthood can offer important insights into why socio-emotional difficulties commonly co-occur.

Using state-of-the-art longitudinal statistical techniques, this project aims to significantly advance our understanding of the mechanisms underlying co-occurring socio-emotional difficulties. It will illuminate the roles of both genetics and psychosocial factors, including the role of educational achievement in linking different socio-emotional difficulties together using robust study designs that consider a range of confounders and providing the best available evidence yet on the causal mechanisms underlying the co-occurrence of socio-emotional difficulties.

As well as informing preventions and interventions, this will contribute to better, more comprehensive theories of the developmental roots of mental health.

Researchers at the University of Bristol and Exeter University

Primary & secondary health care records

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Problematic menstrual symptoms, such as pain, heavy bleeding, and irregular cycles, impact a high proportion of women and people who menstruate and are associated with multiple adverse physical and mental health outcomes, as well as reduced attendance and productivity at school/work. Despite this, little research has sought to identify the causes and risk factors associated with such menstrual symptoms. Socioeconomic disadvantage is one factor that has been associated with worse menstrual symptoms; however, the current evidence is mixed and unable to understand causality. It is possible that socioeconomic position (SEP) causally impacts menstrual symptoms due to early life stressors and associated lifestyle factors adversely impacting the development of the brain, the nervous system, and hormone production systems. Additionally, menstrual symptoms could negatively impact SEP through their impacts on school and work thus restricting the ability of women suffering with such symptoms to reach their fully academic and career potential. Therefore, this project aims to understand the causal, bidirectional relationship between SEP and menstrual symptoms by combining observational and genetic methods in multiple UK-based cohorts. Robust evidence that SEP and menstrual symptoms are causally related may support the need for additional support or treatment for individuals from disadvantaged backgrounds and/or provide rationale for improving school and work environments to enable women to better manage problematic menstrual symptoms.

Aim(s) and objective(s) -

Aim 1: Describe the prevalence of menstrual symptoms throughout adolescence and early adulthood, and in the period following childbirth.

Aim 2: Describe the genetic architecture of menstrual symptoms and the genetic correlations between different menstrual symptoms.

Aim 3: Explore the causal effect of SEP on menstrual symptoms, observationally and genetically.

Aim 4: Explore the causal effect of menstrual symptoms on SEP, observationally and genetically. 

Researchers at the University of Bristol and Exeter University

 Education

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Handedness refers to the preferential use of one hand over the other. Ambidexterity refers to the ability to perform the same action equally well with both hands. The frequency of left handedness in modern western cultures is approximately 10% and is greater in males than females. At the level of the brain, handedness is associated with the lateralization of language (i.e. which side of the brain is involved in language) and potentially to other cognitive traits such as reading ability.

Using data from the Children of 90s study, the aims of this project are to:

(1) Investigate the relationship between handedness and other measures of laterality (i.e. foot and eye preference)

(2) Investigate the relationship between genes and measures of handedness and laterality

(3) Investigate how handedness and other measures of laterality relate to reading ability, intelligence, academic performance in school and other measures of cognition

Researchers at the University of Queensland in collaboration with researchers from the University of Bristol and Queensland Institute of Medical Research

 School records and grades

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Do official records and self-reports of offending identify the same individuals? And does this depend on the context and/or individual characteristics? These are critical questions at the heart of crime and violence research. Official records and self-reports represent the two primary methods for measuring offending. However, official records only capture the “tip of the iceberg” as not all crimes are reported to the police. Additionally, there is bias in which individuals and which offences are decided to be recorded as criminal incidents by the police, and there are examples of misidentification errors. On the other hand, self-reports of offending via confidential questionnaires or interviews can introduce different biases, including social desirability (e.g., response falsification), recall error, and selection bias – as individuals who have engaged in criminal activity are less likely to respond to research surveys and interviews.

 Few studies have compared the two measures of offending, with most of these coming from the US. While this evidence suggests that both measures generally agree, self-reports identify higher rates of criminal offending and a significant proportion of individuals with criminal records fail to self-report. The strength of agreement between official records and self-report has been found to vary by crime types and sociodemographic groups. Cultural context may also represent an important factor influencing the agreement between official records and self-reports given known discrepancies in the prevalence of crime and violence in low- and middle-income countries (LMIC) compared to high-income countries (HIC). However, due to a lack of studies with both official records and self-reports of crime from countries outside of the US, the role of national context is poorly understood.

 In this study, we aim to advance the evidence on the agreement between official records and self-reports of crime using two well-matched birth cohort studies from a LMIC (Brazil) and HIC (Britain) context. We will examine whether the agreement between the two sources differs cross-nationally, and the role of other previously examined factors (e.g., crime type, sociodemographics) in influencing the strength of agreement between self-report and official records. 

Researchers at University of Bristol and the Human Development & Violence (DOVE) Research Centre, Federal University of Pelotas, Brazil

Avon and Somerset Police data

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Most research on youth criminal behaviour and recidivism (the tendency for an offender to reoffend) focuses on risk factors, and the literature often describes protective effects of the lack of a risk factor. However, the absence of a risk factor is not inherently protective and a deeper understanding of protective factors is useful in designing public health interventions. Protective factors explored in the literature are: social and emotional support, family support and connectedness, engagement in religious activities, school connectedness, and educational attainment. While there is some initial evidence suggesting these factors are protective against crime and/or promote desistance, this evidence is limited and much of it comes from adult samples and samples outside the UK. This project will use ALSPAC data to examine the role of early life and educational factors in protecting young people from offending, and in promoting desistance.

Aim(s) and objective(s)

1. Identify social and/or educational factors that protect against youth criminal behaviour (police record prior to age 18 years).

2. Identify social and/or educational factors that promoting desistance from crime among young adults (<30 years) who have a crime record in youth.

Researchers at University of Bristol

Education & Avon and Somerset Police data

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Colour blindness (CVD) is a congenital condition affecting 8% of men (0.4% of women). Depending on type and severity, affected individuals have significant difficulties discriminating a wide range of colours facing wide-ranging challenges on a day-to-day basis (e.g. interpreting colour-coded information at the workplace or recreational environments). A growing impact is expected in educational settings due to an increasing reliance on colour resources in schools. Unfortunately, a study using a birth cohort from 1958 (Cumberland et al, 2004) has reported a lack of impact of colour blindness on Maths and reading ability but fails to account for the increase in colour in classrooms in recent years. The publication led to the cessation of CVD school screening in 2009, preventing children from accessing more appropriate resources.
In contrast, a number of authors have argued that CVD can increase difficulties experienced in a range of school subjects including Sciences, Maths, Art, PE and Geography as such subjects may use colour to explain concepts, give instructions and require it in problem solving tasks. Alongside any academic implications, CVD has been found to have an effect on social, psychological and emotional outcomes. For example CVD children may experience teasing from classmates. We here propose to investigate the potential impacts of CVD on education and emotional outcomes in a more recent context.

Researchers at Newcastle University

Education data

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Several studies have demonstrated that sleep during the early years (i.e. prior to formal school entry) can predict later language skills, cognition and wellbeing during childhood and adolescence. However, these studies have typically only examined a few sleep parameters with mixed findings. Moreover, research exploring the effects on later mental wellbeing have used broad definitions of ‘sleep problems’, making it difficult to conclude which sleep problems are important. This research will investigate the effects of sleep in early years of childhood on critical cognitive and wellbeing outcomes in later life, specifically how sleep relates to later language skills, mental wellbeing, and cognitive abilities and academic achievement.

Researchers at the University of York and Lancaster

Education data

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Exposure to air pollution and road transport noise in pregnancy and early life may affect mental health and cognitive function that have long-term effects into adult life. However, it is unclear how important this is as there are few studies on the impact of very early life exposures to environmental pollution.

This project will apply and extend existing models of noise and air pollution exposure to estimate road traffic noise exposure, nitrogen dioxide (NO2) and particulate matter (PM10) in the prenatal, infancy, early childhood, mid-childhood, and adolescent periods of the ALSPAC prospective cohort data, to undertake secondary analyses examining the long-term effects of road traffic noise exposure and air pollution exposure across childhood on the development of children’s mental health and cognitive/social development.

Researchers at the University of Leicester

Air pollution, geodata, education data

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Children who are maltreated, or whose parents experience domestic abuse, have a higher risk of worse educational outcomes, physical health, and mental health. Yet most people who experience maltreatment or parental domestic abuse are unknown to public services. This means opportunities to support them may be missed.

In Children of the 90s, both parents and young people have provided detailed data on domestic abuse and child maltreatment. This has shown that both domestic abuse and child maltreatment are linked with a higher risk of depression, anxiety, and other health problems, as well as a higher risk of not obtaining good GCSE results. Yet the data have also shown promising factors that could break the link between domestic abuse and mental health.

By linking Children of the 90s data with GP and hospital records, we hope to show how many people who report child maltreatment in the Children of the 90s questionnaires are missed in health care records, and whether these differences are systematic. We will also be able to look at the health care attendance of children and young people exposed to domestic abuse and child maltreatment to see who attends, with what presentations, and at what ages. This might give us clues as to whether there are important signs in medical records of children and young people who would benefit from being asked about their family circumstances, to see if they would benefit from additional support. 

Researchers at the University of Bristol and University College London

Health records and hospital visits

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Development in the early childhood years lays the foundation for future learning and skill development. As most children grow up within a family, it is their parents that have the greatest influence on their early development. Parents pass on their genes, manage the home environment, and make the majority of family decisions. They choose to spend time with their children, to spend money on their children by providing toys, books, and educational experiences, and they shape the home environment. The choices that parents make influence the development of their children’s academic and ‘soft’ skills (such as grit and self-control). Recent research has highlighted the importance of soft skills for long-term economic outcomes. Good self-control, for example, helps academically able pupils to achieve – it is hard to achieve good exam results without self-control, even with a high IQ. In the same way, it is difficult to improve job skills (and gain promotion) without grit, no matter how naturally talented. The foundations for building these (and other) vital soft skills are laid by parents during their offspring’s early childhood. Our study will use the Children of the 90s' data to explore how parental choices and practices during infancy influence children’s educational outcomes, and whether and how this differs according to the educational and occupational background of the parents and grandparents of the Children of the 90s children. We will use the Children of the Children of the 90s (COCO90s) data to document the relative importance of  education and occupation for outcomes across four generations.

Education data

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In all studies participant drop out is a frequent and inevitable problem that can lead to statistical analysis results that don’t accurately reflect the results that would have been found had all participants remained in the study. We may therefore produce flawed conclusions as a result of the participant drop out. To combat this we use a method called multiple imputation to try to correct for the missing data. This method uses variables from the statistical analysis model and additional variables, called auxiliary variables, that are predictive of missing data. These auxiliary variables are often essential for removing bias in multiple imputation analyses, but are frequently missing themselves. We aim to apply simulations (where we repeatedly run mathematical models under different scenarios) and additionally a real data example using data from the Children of the 90s study to assess how missing data in auxiliary variables can impact multiple imputation analyses.

Education data

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Heart disease and dementia represent two of the most common causes of disability and death in the world today. Although distinct conditions, growing evidence suggests that similar risk factors may underlie both diseases and that prevention strategies designed to protect the heart may also benefit the brain. Scientists and doctors have long known that the heart disease process starts very early in life, and that poor health choices can result in early changes to the heart and blood vessels virtually from birth which may increase the risk of a heart attack in later life. Growing evidence now suggests that the same may apply to dementia, with its occurrence in late-life possibly also occurring as the result of decades of damage to the brain sustained across the lifespan. How early this damage starts, however, remains unclear. This study aims to use the wealth of brain imaging, cognitive testing, and educational data contained within ALSPAC to investigate whether factors which are known to cause damage to the heart and blood vessels in early life are also associated with early changes within the brain and differences in thinking and memory skills as young people transition into adulthood.

Education data

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Mercury is a toxic metal released into the environment through natural and industrial processes. There is evidence that humans can be exposed to trace quantities of mercury through diet – such as fish, meat, and vegetables, air and water pollution, tea consumption, and use of traditional medicines. Other factors appear to be predictors of mercury levels, such as our age, ethnicity, socioeconomic status, and occupation. Over time, harmful quantities can accumulate within our bodies and this has been linked to poorer cardiovascular, renal, and reproductive health.

Although dietary consumption of fish is assumed to be a primary source of mercury in humans, there has been little research into the relative importance of all these different factors. By quantifying how much each of the above sources or predictors affects the levels of mercury we are exposed to, we can make stronger conclusions about what the key risk factors are for mercury exposure.

This study aims to evaluate the link between potential predictors of mercury levels, and mercury found in blood samples taken during pregnancy in ALSPAC. This will include comparing to anonymised residential area, to assess whether there is evidence of geographic variation perhaps caused by local air quality. 

Those who provided maternal blood samples for metal analysis.

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Disordered sleep is commonly reported in autism from a young age, as are symptoms of mental illness. Mental health and sleep are closely related within the general population but the nature of the association between sleep and mental health problems in autism is poorly understood. More generally, the underlying causes of sleep problems in autism are unknown. As a result, current treatments for sleep problems are largely ineffective in autistic people, and they also face severe consequences of mental ill health, such as high rates of suicidality and in-patient care. We aim to characterise the relationship between sleep problems and mental ill health (and identify factors underpinning these sleep problems) in young people with autism and in people with autistic traits. We will focus specifically on childhood and adolescence as this comprises the typical age-range of onset for problems in both sleep and mental health. Our approach to answering these questions will involve statistical modelling of longitudinal data on sleep and mental health in the ALSPAC cohort. Ultimately we hope that new knowledge from this work will inform future interventions for sleep and mental health in autistic children and adolescents.

Primary care and special education data

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A growing body of evidence has shown that exposure to air pollution is associated with higher blood pressure/hypertension, cardiovascular events, and cardiovascular mortality. However, few studies have assessed the impact of air pollution on cardiovascular health in younger individuals.

A meta-analysis of cross-sectional and longitudinal studies has shown that an increase in PM2.5 was associated with higher carotid intima-media thickness (CIMT). Even though there is a growing body of evidence on the association between air pollution and cardiovascular outcomes later in life, very little is known in younger individuals [3]. A study carried out with young adults (mean age 28, SD 1.0) showed that nitrogen dioxide (NO2), but not PM2.5, was associated with increased pulse wave velocity (PWV).

It is also possible that the associations between air pollution and cardiovascular health outcomes differ according to intermediate factors, such as body mass index (BMI). A study with 158 individuals aged 17-22 years found that a 1 standard deviation (SD) change in long-term NO2 exposure was associated with 11.3mg/dL higher total cholesterol and 9.4mg/dL higher low-density lipoprotein cholesterol (LDL-C), and these associations were stronger amongst obese participants, suggesting that obesity might exacerbate the effects of air pollution.

The aim of this study is to assess the long-term associations of air pollution with several measures of cardiovascular health in young adults (i.e. central and peripheral blood pressure, heart rate, PWV and CIMT) and explore possible effect modifications by BMI in these associations.

Air pollution geodata

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Blood pressure tracks from childhood to adulthood, and elevated blood pressure in childhood or adolescence is associated with several intermediate markers of cardiovascular disease (CVD) and with CVD events and mortality in adulthood. There is a growing body of evidence showing that ambient environmental exposures, such as air pollution, noise and many characteristics of the built environment are associated with high blood pressure/hypertension in adulthood, and some associations with blood pressure have also been observed in children.

Early-life, especially prenatal and early postnatal, is a period of rapid development and particularly vulnerable to environmental factors, and adverse exposures in this period could lead to long-term health effects, including higher risk of CVD. Some studies have shown associations between prenatal ambient environmental factors and blood pressure in children, including some measures of the built environment (e.g., facility density, facility richness and building density), noise, temperature, and air pollution. Investigating whether early-life ambient environmental factors are also associated with changes in blood pressure in different developmental periods will further contribute to the understanding of the importance of environmental exposures to the risk of hypertension across the life-course.

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we aim to assess the association of a range of ambient environmental exposures in early-life with changes in systolic (SBP) and diastolic blood pressure (DBP) during three developmental periods: childhood, adolescence, and early adulthood. We will also seek to replicate the associations found in ALSPAC in other independent European cohorts part of the LongITools project (Generation R, EDEN, PANIC and NFBC 1986).

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Key modifiable risk factors for hyperglycaemia/diabetes include unhealthy diet, lack of physical activity and overweight/obesity. These are, in part, determined by the built environment, which comprises components such as walkability index, accessibility, population density, land use mix, and food environment. Most of the research assessing the association between built environment and glycaemic traits assesses type 2 diabetes mellitus (T2DM) in adulthood as an endpoint. Very few studies have assessed the association between the built environment and glucose and insulin-related traits in children/adolescents.

The association between air pollution and glucose and insulin-related traits has been more widely studied. Exposures to PM10 and PM2.5 have been associated with higher fasting blood glucose, and several meta-analyses have shown that air pollution is associated with the prevalence and incidence of T2DM. Air pollution, more specifically NO2 and PM10, has also been associated with insulin levels and insulin resistance, and some of these associations have been observed in childhood.

There is also evidence for associations between noise and higher prevalence and incidence of T2DM. To the best of our knowledge, no studies have assessed noise and glucose and insulin-related traits in childhood/adolescence.

This study aims to assess the associations of built environment, air pollution and noise with longitudinal changes in glucose, glycated haemoglobin, insulin and insulin resistance from childhood to early adulthood using data from European prospective studies.

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There is inconsistent evidence of an association between prenatal exposure to air pollution and adiposity in childhood. Some studies suggest positive associations, possibly with stronger magnitude in boys, some find no association, and others find inverse associations between prenatal air pollution and adiposity in childhood. Most studies have been relatively small (<3,500 participants) and assess adiposity at a single time point.

The potential mechanisms linking air pollution to adiposity are still uncertain. Maternal exposure to air pollution may affect fetal growth, and intrauterine growth restriction will influence later-life adiposity. Inflammation is another hypothesised mechanism of the association between prenatal air pollution and offspring adiposity, and this might also be part of the fetal growth pathway.

Using data from three birth cohorts (ALSPAC, BiB and Generation R), this project will assess the association of different measures of air pollution (PM10, PM2.5, NO2 and NO) during pregnancy with fetal growth, trajectories of adiposity in childhood, and maternal and offspring inflammation. We will also explore possible sensitive windows by assessing trimester-specific associations, and whether associations differ by sex. If associations of air pollution with fetal growth, inflammation and childhood adiposity are evident, we will explore and quantify possible mediation by fetal growth and inflammation in the association between prenatal air pollution and childhood adiposity.

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Our project aims to estimate the prevalence and distribution, in terms of geography and socioeconomic status, of lead exposure in England and its costs in terms of children’s wellbeing and development. While scholars and practitioners believe lead exposure to be widespread in England, a dearth of data on this issue has so far hindered policymaking. We will perform a secondary data analysis, building on international evidence to project exposure burden in England. ALSPAC data provide unique measurements of lead levels for a small area in the 1990s that will inform our estimates nationwide.

Address and geodata

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All the commonly used drugs that produce general anaesthesia have been shown to increase brain cell death in young laboratory animals and lead to abnormal function later on. Mounting concern about the potentially toxic effects of anaesthetic drugs on the young brain has led to 76 studies since 1990 which have attempted to measure the brain development and functioning of humans who were given general anaesthetics for surgery or procedures in early childhood. Aspects of brain development which have been examined include measures of intelligence, movement and co-ordination, behaviour, language and speech, literacy and numeracy. Other measures have included academic achievement in school and diagnoses of learning disability, autism and attention deficit hyperactivity disorder (ADHD).

Unfortunately, these human studies are frequently limited quality, with: too few children (on average 130 cases), no method to account for other causes of adverse brain development which could bias the results, no information on the duration and type of general anaesthetic drugs given and not specifically designed to assess children's brain development. Their results are conflicting and somewhat difficult to interpret. At present, it remains uncertain whether anaesthetic drugs are harming young children’s brains. The definitive results of a single clinical trial specifically designed to address this important question are not due for several years. In the meantime, the number of published review articles, commentaries, consensus statements and statements by regulatory bodies continues to grow. The United States Food and Drug Association urges careful consideration of the risks and benefits of a general anaesthetic in young children and pregnant women undergoing anaesthesia which may last longer than three hours or require multiple procedures.

Our project will determine whether there is evidence of impaired long-term brain development in ALSPAC data, specifically those children who had general anaesthetics for surgery or procedures before the age of four. We anticipate that the detailed information recorded about these children and their parents, as well as the quality of assessment of their brain development throughout childhood and adolescence, will allow us to better investigate this important issue than previous human studies have been able to do. We also propose to collect new information from childrens' medical records in order to describe the types and duration of general anaesthetics which were given in the early 1990s for different surgeries or unpleasant procedures. This will help us to determine whether increased duration of anaesthesia is associated with additionally worse brain development, and will allow us to place the findings of the ALSPAC study in context with changes to paediatric anaesthetic practice in the last two decades, as well as enhancing the utility of the ALSPAC resource to future anaesthetic research.

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People with intellectual disability (also called learning disabilities) have difficulties in understanding new or complex information, in learning new skills and a reduced ability to cope independently, which started before adulthood. People with intellectual disability often have poor long-term outcomes and inequalities compared to the general population. This includes reduced access to and effectiveness of health care, difficulties in education and employment, and higher chances of early death.

Many causes of intellectual disability are genetic in nature. Others are influenced by the environment before (pregnancy) or around the time of their birth (the perinatal period), and in childhood. The Children of the 90s study provides the opportunity to explore how our genes and early life environment can influence the risk of developing an intellectual disability. This project will use information you have given to Children of the 90s in questionnaires and at focus clinics as well as data from GP records and hospital visits to investigate the causes and consequences of having an intellectual disability.

Our first project will look at whether there is a link between mother’s substance use (such as alcohol and tobacco) in pregnancy and the child’s risk of intellectual disability. These substances are known to influence the development of the fetus in the womb, but whether they cause problems like intellectual disability is not known. Understanding such a link is important, as it may help guide policy and help pregnant women make informed choices about the risks of substance use in pregnancy. In the future, we will be interested in understanding the role of other factors in the development of intellectual disability, and also aim to understand the longer term outcomes of having intellectual disability.

1. Department for Education and local authority records on children who had a statement of special educational needs

2. Health records (from your GP, hospital visits and community mental healthcare providers) about diagnoses of intellectual disability

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Eczema (also known as atopic dermatitis) affects 20% of children and up to 10% of adults, and is becoming more common globally. Eczema is a challenging disease characterised by itch, sleeplessness, discomfort, stress and stigma for sufferers, but it looks very different and the disease takes different courses in different people, and no single treatment for it works for everyone. This suggests that there may be different diseases, all of which get called eczema, but which may in fact be clinically distinguishable subtypes with different prognoses and treatment needs.

We want to find out whether this is true, and to do this we will look for groups of children where the course of disease and other clinical characteristics such as immunological profile, demographics and other comorbid diseases are very similar within group, but different across groups. This will help us characterise these subtypes and in future lead to better estimates of whether the disease will resolve on its own or require medical intervention, and eventually better and more personalised treatment recommendations.

This study is currently investigating eczema subtypes with an approach called latent class analysis using data from children in the original ALSPAC cohort. We would like to expand on this by looking at linked primary care electronic health records, in order to 1) see if we can replicate our findings using data collected in real-world settings, 2) add to the characterisation of subtypes with additional information not contained in the cohort collections, and 3) do an exploratory analysis to see if phenotypes can be derived based solely on data from electronic health records.

1. Data from mother and child questionnaires (all years) with information about eczema

2. Linked primary care records relating to eczema

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