Novel insights into somatic comorbidities in children and adolescents across psychiatric diagnoses: an explorative study

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Muskens, Wietske A. Ester, Helen Klip, Martine van Dongen-Boomsma, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2840534/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Sep, 2023 Read the published version in Child Psychiatry & Human Development → Version 1 posted 3 You are reading this latest preprint version Abstract Many children with psychiatric disorders display somatic symptoms, although these are frequently overlooked. As somatic morbidity early in life negatively influences long-term outcomes, it is relevant to assess comorbidity. However, studies of simultaneous psychiatric and somatic assessment in children are lacking. The aim of this study was to assess the prevalence of somatic comorbidities in a clinical sample of children and adolescents with psychiatric disorders in a naturalistic design. Data were assessed from 276 children with various psychiatric disorders (neurodevelopmental disorders, affective disorders, eating disorders and psychosis) aged 6–18 years. These data were collected as part of routine clinical assessment, including physical examination and retrospectively analyzed. For a subsample (n = 97), blood testing on vitamin D3, lipid spectrum, glucose and prolactin was available. Results of this cross-sectional study revealed that food intake problems (43%) and insomnia (66%) were common. On physical examination, 20% of the children were overweight, 12% displayed obesity and 38% had minor physical anomalies. Blood testing (n = 97) highlighted vitamin D3 deficiency (< 50 nmol/L) in 73% of the children. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. The main somatic comorbidities in this broad child- and adolescent psychiatric population consisted of (1) problems associated with food intake, including obesity and vitamin D3 deficiency and (2) sleeping problems, mainly insomnia. Child and adolescent psychiatrists need to be aware of potential somatic comorbidities and may promote a healthy lifestyle. child and adolescent psychiatry somatic comorbidity physical health insomnia obesity vitamin D deficiency Figures Figure 1 Introduction “The mind is the body and the body is the mind”. This statement that opposes the Cartesian dualism [1] is supported by the high co-occurrence and relationship between somatic and psychiatric conditions [2, 3]. Various studies, mainly based on the adult population, show that the pathways between psychiatric and somatic disorders are complex, bidirectional and share common risk factors [2].Associations between somatic and specific psychiatric conditions are partially found in research investigating children. For example, children with a diagnosis of autism spectrum disorder (ASD) and/ or attention deficit hyperactivity disorder (ADHD) frequently display obesity and neurologic disorders while children withdiabetes type I or asthma show mood and anxiety disorders [4-9] As such, increased awareness of the co-occurrence of somatic and psychiatric health issues is warranted [2-9]. However, little is known about the prevalence of somatic disorders in the daily child psychiatric practice. Although many children with psychiatric disorders appear to display comorbid somatic symptoms, these are frequently overlooked [10-12]. In general, patients with psychiatric disorders are more likely to develop somatic comorbidities [2, 3]. Vice versa, somatic disorders may cause, enhance or camouflage psychiatric symptoms [2]. Of major concern is that most psychiatric disorders arise during childhood [13] and that many somatic comorbidities in children with psychiatric disorders continue into adulthood [12]. Therefore, it is crucial, from a preventive perspective, to investigate somatic risk factors and comorbidities in children with psychiatric disorders to develop guidelines that integrate physical and mental health to improve outcomes. Most data on somatic comorbidities in child and adolescent psychiatry are confined to neurodevelopmental disorders (NDD), especially ASD and ADHD. A systematic review showed a broad range of somatic comorbidities in NDD [14]. Likewise, children with chronic somatic disorders show an increased risk of NDD [15, 16]. As NDD may also indicate underlying genetic syndromes with an increased risk of somatic and psychiatric vulnerability, multidisciplinary healthcare are recommended in these children [14]. In addition, the awareness that lifestyle factors may also relate to psychiatric disorders has grown rapidly [17].Results from a recent meta-analysis indicated that an unhealthy lifestyle in patients with psychiatric diagnoses contributes to adverse somatic health outcomes [18]. This also appears relevant for children with psychiatric disorders, although large-scale longitudinal studies of lifestyle factors in children with psychiatric diagnoses are sparse [18]. A recent register based study of children and adolescents showed associations between a wide range of psychiatric and somatic diagnoses across all types of conditions and across all ages [12]. However, ASD was not included in that study while several demographic variables, such as socioeconomic factors were not accounted for. Thus far, data of somatic comorbidities in children and adolescents with broader psychiatric diagnoses are relatively sparse and allow no firm conclusions due to limited numbers of participants and/ or a lack of robust methodological design [4, 19, 20]. As such, a clear picture about the impact of somatic comorbidities in child psychiatric services is missing. Here, we performed an observational, cross-sectional study to assess the prevalence of somatic comorbidities in a sample of children and adolescents with various psychiatric disorders using a standardized somatic assessment in a naturalistic design. We hypothesize that somatic comorbidities are widespread in children and adolescents with psychiatric disorders. Materials and Methods As part of an ongoing explorative assessment on somatic comorbidity and lifestyle in children and adolescents with psychiatric disorders, we retrospectively reviewed documents and medical records from patient files between March 2020 and December 2020, including physical and laboratory measurements at diagnostic assessment carried out between October 2017 and March 2020 at the child hospital of Karakter University Centre – Radboud University Hospital. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Study sample The study sample included children and adolescents aged 6-18 with psychiatric disorders based on DSM-IV-TR and/ or DSM 5 (since 1 January 2018 used in the Netherlands) [21, 22]. Psychiatric disorders were classified into four categories based on primary diagnosis: (1) neurodevelopmental disorders (ASD, ADHD, Tourette syndrome), (2) affective disorders (unipolar depression, bipolar disorder, dysthymia/ persistent depressive disorder, disruptive mood dysregulation disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, separation anxiety disorder, social phobia), (3) eating disorders (anorexia nervosa, bulimia nervosa) and (4) psychosis (first psychosis, schizophrenia). Insomnia criteria are also based on DSM-IV-TR and DSM 5 criteria [21, 22]. Karakter UC provides psychiatric care for children and adolescents with an average or high intelligence level. Participants were required to have a minimum average estimated intelligence (IQ > 70). Estimated intelligence was based on either clinical functioning (e.g., good functioning at school) or by assessing an intelligence test (Wechsler Intelligence Scale for Children, if available [23]). Children who were supplemented with vitamin D3 at the moment of assessment were excluded from the study (n = 3). Measures Psychiatric assessment Prior to the first appointment, questionnaires were analyzed on child’s ethnicity, parent’s educational level and family history. Ethnicity of the child was based on the parental country of birth. If both parents were non-Dutch, mother’s ethnicity determined the ethnicity of the child. Parents' educational level was determined by the highest completed education (primary school, secondary school and higher education). During the first appointment, a psychologist and child and adolescent psychiatrist interviewed the child and caregivers. Next, a mental state and physical examination was carried out by the child and adolescent psychiatrist or a nurse practitioner, supervised by a child and adolescent psychiatrist. Consensus diagnoses were established by a multidisciplinary team consisting of two independent child and adolescent psychiatrists, psychologists and two nurse practitioners. Physical and laboratory assessment Physical examination included measurement of weight, height, blood pressure, heart rate, inspection of minor physical anomalies (MPA) and signs of non-self-injury behavior. MPAs are subtle, abnormal morphological features, such as deviations in morphology of the head, eyes, ears, mouth, hands, and feet [24]. Non-self-injury behavior (NSSI) consists of behaviors such as self-cutting, scratching, hitting or banging, carving, and scraping often seen as inadequate coping behavior to regulate overwhelming distress [25]. The prevalence of children being underweight, overweight or obese was defined by the cut-off values of BMI references per age group according to the International Obesity Task Force [26]. Blood pressure was measured with an oscillometric device, widely used to screen initial blood pressure in a clinical setting. In the United States and Europe, the diagnosis of persistent childhood hypertension is made when repeated blood pressure values on three separate visits are above the 95th percentile for the age, gender and height of the patient or above 130/80 mmHg. Blood testing included vitamin D3, glucose, prolactin levels and lipid profiles. Indications for blood testing were based on available clinical guidelines [27]. Blood specimens were processed at a local laboratory from which references were used to interpret the results of the laboratory findings. For vitamin D3 references from the American Academy of Pediatrics Committee on Nutrition and The Institute of Medicine corresponded to a serum 25-hydroxyvitamin D level of at least 50 nmol/liter [28]. Data analysis Patient baseline characteristics were reported using frequency distributions for the categorical variables and mean ± standard deviation for the continuous variables when normally distributed. Otherwise, the median and interquartile range was reported. The prevalence of somatic comorbidities was presented as a frequency distribution for the different diagnostic groups and the total group. A fisher exact test was used if the expected cell frequencies were smaller than five. A p-value < 0.05 (two-sided) was considered statistically significant in descriptive statistics. Sub-analyses were done with different variables (gender, age, primary diagnosis, medication, and educational level of caregivers) to determine their influence on the results of the somatic examination and laboratory findings. All analyses were conducted using SPSS version 24 (IBM Corporation, Armonk, NY). Results As shown in figure 1, 278 children were referred to the psychiatric hospital in the previously stated time frame. Two were not diagnosed with a psychiatric disorder and were therefore not included. Laboratory measurements were available for 97 children. Table 1 presents the baseline demographic and clinical characteristics of the participants. Of the 276 patients, 145 were male (52.5%) with a mean age of 12.9 years (range 6-18, SD 3.5). A total of 93.1% of the children were of Dutch ancestry (North European), 3.6% of the children were adopted and 40.9% of parents had separated or divorced. In terms of parental education, 116 parents (42.0%) reportedly completed higher education, 104 parents (37.7%) completed secondary education only; and 39 parents (14.1%) completed primary education. Positive family history of psychiatric disorders was present in 65.6% of the children. Exposure to stressful life events of the child was conveyed by parents in 56.1% of the children. The two most common primary diagnoses were NDD (63%) and affective disorders (29%). In the NDD group, 24 children did have ADHD and 149 ASD as primary diagnosis; for affective disorders, 43 children did have a depressive disorder and 37 an anxiety disorder as primary diagnosis. A total of 149 children were treated with one type of psychotropic drug or a combination of drugs (54.0%) at the time of somatic assessment. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. Table 1. Description of the study population (n = 276) n % Age 6-11 year 88 31.9% 12-14 year 72 26.1% 15-18 year 116 42.0% Gender Male 145 52.5% Female 131 47.5% Stressful life events Yes 155 56,2% No 121 43,8% Primary psychiatric diagnosis Neurodevelopmental disorder 173 62.7% Affective disorder 80 29.0% Eating disorder 12 4.3% Psychosis 11 4.0% Psychotropic medication Yes 149 54,0% No 127 46,0% If yes, Antipsychotics 96 64.4% Stimulants 35 23.5% Antidepressants 17 11.4% Mood stabilizers 1 0.7% Educational level primary caregivers Primary education 39 14.1% Secondary and lower vocational education 104 37.7% University degree, higher professional education 116 42.0% Information is missing 17 6.2% Family history of psychiatric diagnosis Negative 90 32.6% Positive 181 65.6% Information is missing 5 1.8% Table 2 presents the somatic comorbidities for the total group and the four primary psychiatric diagnoses groups. Questionnaires and somatic interviews of the child and caregivers displayed insomnia (n=182; 66%) and problematic food behavior, including selective eating, food neophobia, limited intake or hyperphagia (n= 119; 43%) as major complaints in the total group. Of note, insomnia frequency rates were high for all psychiatric diagnoses (55-91%). The physical assessment indicated that 19.9% of the children were overweight and 12.0% obese, according to BMI. Overweight and obese ranges were similar across psychiatric diagnoses (overweight 20-27%; obese 12-18%), except for children with eating disorders. For children using antipsychotic medication, 25.0% of the children were overweight and 13.5% obese. Minor physical anomalies were present in 52.6% of the children with NDD and in 54.5% of the children with psychosis, compared to 8.8% in children with affective disorders and absent in children with eating disorders. Signs of non-self-injury behavior were noticed in 44 children (16.1%). Measurement of height (2≤sd≥2) was not significant between the different diagnosis groups. Prevalence rates of hypertension were low across all diagnostic groups and not significant. In total, hypertension was measured in seven children (2.5%). Low blood pressure (systolic <90mmHg) was measured in twelve children (4%). Alcohol and/ or drug abuse was mentioned by 20 adolescents (7%; not significant). Two children with NDD had a history of epileptic seizures and were treated by a child neurologist. Table 2 Primary diagnosis in relation to somatic comorbidity in the study population Total NDD Affective Disorder Eating Disorder Psychosis p-value * (n = 276) (n=173) (n = 80) (n = 12) (n = 11) n % n % n % n % n % Insomnia Absent 94 34.1% 78 45.1% 15 18.8% 0 0% 1 9.1% <0.01 Present 182 65.9% 95 54.9% 65 81.3% 12 100% 10 90.9% Eating behavior problems Absent 157 56.9% 102 59.0% 48 60.0% 1 8.3% 6 54.5% <0.01 Present 119 43.1% 71 41.0% 32 40.0% 11 91.7% 5 45.5% BMI category Underweight a 35 12.7% 13 7.5% 8 10.0% 11 91.7% 3 27.3% <0.01 Normal 153 55.4% 104 60.1% 45 56.3% 1 8.3% 3 27.3% Overweight b 55 19.9% 35 20.2% 17 21.3% 0 0.0% 3 27.3% Obese b 33 12.0% 21 12.1% 10 12.5% 0 0.0% 2 18.2% MPA Absent 169 61.2% 79 45.7% 73 91.3% 12 100% 5 45.5% <0.01 Present 104 37.7% 91 52.6% 7 8.8% 0 0% 6 54.5% Missing 3 1.1% 3 1.7% 0 0.0% 0 0% 0 0.0% Signs of non-self-injury behavior Absent 230 83.9% 153 89.5% 65 81.3% 6 50.0% 6 54.5% <0.01 Present 44 16.1% 18 10.5% 15 18.8% 6 50.0% 5 45.5% Alcohol/ drugs abuse Absent 256 92.8% 161 93.1% 73 91.3% 12 100% 10 90.9% NS Present 20 7.2% 12 6.9% 7 8.8% 0 0% 1 9.1% Height Height ≤ 2SD 10 3.6% 7 4.0% 2 2.5% 1 8.3% 0 0% NS Normal 253 91.7% 155 89.6% 76 95.0% 11 91.7% 11 100% Height ≥ 2SD 12 4.3% 10 5.8% 2 2.5% 0 0.0% 0 0% Missing 1 0.4% 1 0.6% 0 0.0% 0 0.0% 0 0% Blood pressure Low 12 4.3% 8 4.6% 2 2.5% 2 16.7% 0 0.0% NS Normal 253 91.7% 159 91.9% 75 93.8% 9 75.0% 10 90.9% High c 7 2.5% 4 2.3% 1 1.3% 1 8.3% 1 9.1% Missing 4 1.4% 2 1.2% 2 2.5% 0 0.0% 0 0.0% NDD=Neuro Developmental Disorder. BMI=Body Mass Index. MPA= Minor Physical Anomalies. NS= Not Significant. SD=Standard Deviation a Underweight: BMI ≤5th percentile. b Overweight, obese: according to the International Obesity Task Force[26]. c Blood pressure high: measured 3 times * Chi squared test. A p-value < 0.05 (two-sided) was considered statistically significant. Table 3 presents the laboratory findings of a subsample (n=97). Vitamin D3 deficiency <50 nmol/ L was present in 71 children (73.2%) and highly prevalent across all diagnoses (NDD 68.1%, affective disorders 79.5%, eating disorder 100% and psychosis 62.5%). Dyslipidemia (cholesterol, triglycerides, LDL-cholesterol and non-HDL cholesterol) was found in three children (3.1%); high levels of prolactin (> 500 mE/L) in four children (all of them using risperidone). For hyperprolactinemia, there was no macroprolactin in these four children. None of the children on antipsychotics had increased glucose levels. Table 3 Laboratory findings of a subsample of children (n = 97) Total NDD Affective Disorder Eating Disorder Psychosis p-value* (n = 97) (n=47) (n = 39) (n = 3) (n = 8) n % n % n % n % n % Vitamin D3 >50nmol/L 23 23.7% 15 31.9% 8 20.5% 0 0% 3 37.5% NA 500 mE/L 4 4.1% 3 6.4% 1 2.6% 0 0% 0 0% Lipid spectrum a Normal 94 96.9% 46 97.9% 37 94.9% 3 100% 8 100% NA Dyslipidemia a 3 3.1% 1 2.1% 2 5.1% 0 0% 0 0% Glucose Normal 96 99.0% 47 100% 38 97.4% 3 100% 8 100% NA < 5.6mmol/l 1 1.0% 0 0% 1 2.6% 0 0% 0 0% NDD=Neuro Developmental Disorder N/A= not applicable due to small numbers in multiple columns a Lipid spectrum comprised levels of cholesterol, triglycerides (TG), low-density lipoprotein (LDL) high-density lipoprotein (HDL) according to reference values for children. b Dyslipidemia was defined as total cholesterol >5.2 mmol/L (200 mg/dl), LDL > 3.4 mmol/L (130 mg/dl), HDL 1.7 mmol/L (150 mg/dl), or a combination thereof. *Chi squared test Discussion This study found high somatic comorbidities in a large naturalistic sample of 276 children with broad psychiatric diagnoses, including NDD, affective disorders, eating disorders and psychosis. The primary somatic comorbidities were 1) problems associated with food intake, including overweight, obesity and vitamin D3 deficiency and 2) sleeping problems, mainly insomnia. Our findings indicate that somatic comorbidities are widespread in children and adolescents with psychiatric disorders. Assessing various somatic comorbidities in a sample consisting of several child psychiatric disorders, allowed to see its broad variation including problems with weight, problems related to food intake, vitamin D3 deficiency (<50nmol/l), insomnia and minor physical anomalies. With respect to problems in weight 12.0% of our sample was obese compared to 2.5% in the general Dutch population in the same period of this study [29]. Similarly, the percentage of overweight was 19.9%, compared to 14.2% of children in the general Dutch population [29]. These percentages increased for children using antipsychotic medication (25% for overweight children and 13.5% for obese children). These findings are consistent with previous studies. For example, in children with NDD, prevalence rates of overweight vary between 11-34% (our study 20.2%), and for obese children, between 12-23% (our study 12.2%) [4,5, 30-32]. A recent meta-analysis indicated that obese children are more at risk for depression than normal-weight children with a prevalence of 10.4% [33]. In the opposite direction, our results displayed a prevalence of 12.5% of obesity among children with depression and anxiety disorders (affective disorders). Likewise, the same symptoms related to lifestyles, such as sedentary habits, disordered sleep, insufficient physical activity and dysregulated food consumption, are common in obese children and children with affective disorders [34]. For an optimal development of children, it is essential to be aware of these symptoms and to address both psychiatric and somatic conditions. As obesity is an important risk factor for cardiovascular disease during later life, it is important to be aware of the risk factors in children, such as some types of medication, the psychiatric disorder itself, genetic variations with obesity and lifestyle related factors [35]. Furthermore, our study showed a prevalence of vitamin D3 deficiency (<50nmol/l) in the whole group of children with psychiatric disorders of 73%. This is much higher compared to reported 30% in the general population of Dutch children [36]. Vitamin D3 deficiency is associated with a range of adverse somatic and psychiatric outcomes (cardiovascular, diabetes, cancer, depression, NDD, psychosis and dementia) and might be a risk factor for impaired brain development [37, 38]. Reversely, vitamin D3 deficiency could be due to unhealthy lifestyle such as poor diet quality, being overweight and reduced exposure to sunlight by an imbalance between indoor and outdoor activities, which may be more common in children with psychiatric disorders [39, 40]. Additionally, a recent study revealed an inverse association between BMI and vitamin D3 levels in children with ASD and internalizing disorders [41], which is in line with studies in the general population [42, 43]. However, the underlying associations of vitamin D3 deficiency in somatic and psychiatric disorders are still poorly understood and questions for supplementation and lifestyle intervention remain. The second main finding is the high rate of insomnia in our population (66% ) compared to primary school-aged children (5-30%) and adolescents (4-13%) in the general population [44]. Insomnia is the most common sleep disorder in children and is primarily characterized by difficulty initiating or maintaining sleep and/or poor sleep quality, which results in significant impairments in daytime functioning [45, 46]. Sleep problems are complex and viewed as part of neurologic and psychiatric disorders (e.g., ASD, affective disorders, epilepsy, psychosis, migraine) [45-47]. For some psychiatric disorders sleep problems are also part of the criteria itself (e.g., depression and anxiety disorders) [46]. Several studies show that estimates of insomnia are higher in pediatric populations with psychiatric diagnoses, including ADHD, ASD, anxiety and depression which is in line with our findings [47, 48]. For instance, our study found that insomnia in children with NDD was comparable with the existing literature (50-80%) [47, 49, 50]. Also, for insomnia in children with affective disorders, similar rates are found: in our study 81% compared to 75 - 90% for depression and anxiety in previous studies [46, 48, 51]. Notably, in case of insomnia, the symptoms of depression or anxiety disorder are even more severe [46, 48, 51]. In addition, cognitive behavioral therapy for insomnia provides a non-pharmacological option for improving sleep in psychiatric patients [18]. This is also relevant for children with psychiatric disorders in which the relationship between sleep and behavioral interventions has not been fully elucidated. The clinical assessment further showed a high rate of minor physical anomalies (MPA) in children with NDD (53%) and psychosis (55%), which is also consistent with the literature [52, 53]. While a single MPA is not uncommon in the general population, a greater number of MPAs is associated with somatic comorbidities and underlying genetic variations [54]. As such, careful analysis of the combination of NDD, childhood psychosis, somatic comorbidities and MPA requires an simultaneous assessment to consider referral to a clinical geneticist [14]. Besides the physical outcomes, 66% of the children in our study did have a primary caregiver with a psychiatric diagnosis and 56% had been exposed to stressful life events (SLE; divorce of caregivers, death of caregiver, serious illness to family members, physical and/or sexual abuse, bullying at school). The Netherlands Mental Health Survey and Incidence Study [55] revealed an estimation of 350 Dutch children in 10.000 residents with a caregiver with a psychiatric diagnosis; the National Survey of Children's Health in the United States estimated that 7.2% of the US children had at least one caregiver with poor mental health [56]. For SLE, there is no single definition of what an SLE is and the impact may vary per event and child [57]. The reported prevalence of SLEs in children is high and varies between studies [58, 59]. Poor mental health among primary caregivers and exposure to SLE are associated with poor mental and physical health in children across the lifespan [56- 59]. Unfortunately, accurate and timely somatic assessment in children with psychiatric disorders can be challenging due to atypical presentation of symptoms, difficulties in describing and/or expressing subjective experiences or symptoms and insufficient expertise about somatic comorbidities in this population [11]. In line with our study, Agnafors et al (2019) showed associations between a wide range of psychiatric and somatic disorders across all types of conditions and across all ages in a register-based study [12]. This warrants the question to implement simultaneous assessment of somatic and psychiatric symptoms in children and adolescents with psychiatric diagnoses. Among the strengths of our study is the extensive assessment of the somatic comorbidities of a relatively large number of children and adolescents with different psychiatric disorders. This showed a broad variation of comorbidities, underscoring the importance of routine somatic assessment in children with psychiatric disorders. Second, the somatic and psychiatric assessment was performed with great scrutiny and based on the assessment of two clinical experts (independent child and adolescent psychiatrists) and the psychiatric diagnoses were based on an evaluation by a multidisciplinary team. Additionally, the somatic assessments were carried out in a standardized way, allowing consistent and reliable collection of data. Third, we ran additional analyses with different variables to determine the influence of these variables (gender, age, medication and SES) on the physical examination and laboratory findings. There are also several limitations regarding this study. First, lack of a matched control group may limit the specificity of our findings. However, prevalence rates from children from the general population were available.. Given the remarkable differences with this norm population, our general concerns about the high rates of somatic concerns in children with psychiatric disorders appear valid. Second, all children in this study were recruited in a child psychiatric center, which may introduce ascertainment/selection bias. A third limitation is that, although we have included children with various child psychiatric disorders, the number of patients in some specific diagnostic categories was small(e.g. psychosis and eating disorders), not allowing additional analyses to explore potential relationships between specific diagnosis and somatic comorbidities. A fourth limitation is the cross-sectional design which does not allow for further exploration of intricate relationships between psychiatric and somatic concerns over time. We recommend that future studies investigating physical health in child and adolescent psychiatric populations collect longitudinal data in large samples of children and typically developing peers, including those with intellectual disabilities. At a broader public health level, research is required into the effectiveness of interventions that promote a healthy lifestyle, especially in child psychiatric population. Also, the role of vitamin D3 in psychiatric and somatic diseases needs further exploration, for instance, how it relates to other health factors (such as BMI, age, gender, diet, ethnicity, season, etc.), but also what the effects of supplementation are in relation to diagnosis. Furthermore, research of underlying genetic variation may provide deeper insight into patient (sub)groups more susceptible to mental and physical health problems than others. Ultimately, this may guide personalized treatment approaches. In conclusion, the findings of this study underscore the high prevalence of somatic comorbidity in children and adolescents with psychiatric disorders and highlight the importance of standardized somatic screening in this group. The primary somatic comorbidities, including higher-than-healthy weight, vitamin D3 deficiency and sleep problems, may be strongly related to lifestyle factors and future studies may need to address this. As such, the findings of this study suggest that mental health professionals may need to asses and treat somatic comorbidities or refer for adequate treatment. Clinicians must address mental and physical health, to ensure maximal well-being and the best possible outcomes for children and adolescents with psychiatric illnesses. Declarations Statements and Declarations Funding/Support : No funding was secured for this study Competing Interests : The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Availability of data and material: The datasets generated and/or analyzed during the current study are not publicly available due to ethical restrictions and personal data protection. However, reasonable requests for patient level data should be made to the corresponding author and will be considered after discussion with the ethical board. As far as possible, we intend to include all relevant data in the manuscripts. Code availability : Not applicable Ethics approval : The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. Data collection was part of a routine clinical procedure and retrospectively analyzed. Informed consent: Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin. Consent for publication : Not applicable Contributors' Statement JM conceptualized and designed the study, collected, coordinated, and supervised data collection, performed the statistical analyses, drafted the initial manuscript, and revised the manuscript. WE provided input into the analyses and interpretation and revised the manuscript critically. HK supervised the statistical analyses and interpretation, and commented on the manuscript. 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Arch Pediatr Adolesc Med 159:231–237 Diagnostic and Statistical Manual of Mental Disorders (2000) 4th rev. edition, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington, DC Diagnostic (2013) and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association, Washington, DC Beaujean AA, Woodhouse N (2020) Wechsler Intelligence Scale for Children (WISC). The Wiley Encyclopedia of Personality and Individual Differences Myers L, Anderlid BM, Nordgren A, Willfors C, Kuja-Halkola R, Tammimies K, Bölte S Minor physical anomalies in neurodevelopmental disorders: a twin study.Child Adolesc Psychiatry Ment Health. 2017 Nov28;11:57. doi: 10.1186/s13034-017-0195-y Brown RC, Plener PL (2017 Mar) Non-suicidal Self-Injury in Adolescence. Curr Psychiatry Rep 19(3):20. 10.1007/s11920-017-0767-9 Talma H, Schönbeck Y, Bakker B, Hirasing RA, van Buuren S (2010) [Growth diagrams 2010: manual for measuring and weighing of children and the use of growth diagrams] Dutch. TNO Kwaliteit van Leven, Leiden Ruijter AD (2012) The Dutch knowledge centre for child and adolescent psychiatry.Neuropsychiatrie De L'enfance Et De L'adolescence, 60 Ross AC, Manson JE, Abrams SA et al (2011 Jan) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96(1):53–58 Public Health (2020) Healy S, Aigner CJ, Haegele JA (2018) Prevalence of overweight and obesity among US youth with autism spectrum disorder.Autism Egan AM, Dreyer ML, Odar CC, Beckwith M, Garrison CB (2013) Obesity in young children with autism spectrum disorders: prevalence and associated factors. Child Obes 9:125–131 Kamal Nor N, Ghozali AH, Ismail J (2019 Feb) Prevalence of Overweight and Obesity Among Children and Adolescents With Autism Spectrum Disorder and Associated Risk Factors. Front Pediatr 20:7:38 Sutaria S, Devakumar D, Yasuda SS, Das S, Saxena S (2019 Jan) Is obesity associated with depression in children? Systematic review and meta-analysis. Arch Dis Child 104(1):64–74 Chao, Wadden AM, T.A., Berkowitz RI (2019) Obesity in Adolescents with Psychiatric Disorders. Curr Psychiatry Rep 21, 3 (2019) van der Valk ES, van den Akker ELT, Savas M et al (2019 Jun) A comprehensive diagnostic approach to detect underlying causes of obesity in adults. Obes Rev 20(6):795–804 Voortman T, van den Hooven EH, Heijboer AC et al (2015) Vitamin D Deficiency in School-Age Children Is Associated with Sociodemographic and Lifestyle Factors. J Nutr 145:791–798 Holick MF (2017) The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord 18:153–165 Balachandar R, Pullakhandam R, Kulkarni B, Sachdev HS (2021) Relative Efficacy of Vitamin D2 and Vitamin D3 in Improving Vitamin D Status: Systematic Review and Meta-Analysis. Nutrients. Sep 23;13(10):3328 Guessous I (2015) Role of Vitamin D deficiency in extraskeletal complications: predictor of health outcome or marker of health status?.BioMed research international,563403 Föcker M, Antel J, Ring S et al (2017 Sep) Vitamin D and mental health in children and adolescents. Eur Child Adolesc Psychiatry 26(9):1043–1066 Muskens J, Klip H, Zinkstok JR et al (2022 Sep) Vitamin D status in children with a psychiatric diagnosis, autism spectrum disorders, or internalizing disorders. Front Psychiatry 14:13:958556 Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB (2015) Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev 16:341–349 Taylor SN (2020) Vitamin D in toddlers, preschool children, and adolescents. Ann Nutr Metab 76(Suppl 2):30–41 Ma ZR, Shi LJ, Deng MH (2018) Efficacy of cognitive behavioral therapy in children and adolescents with insomnia: a systematic review and meta-analysis.Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas, 51(6), e7070 Nunes ML, Bruni O (2015 Nov-Dec) Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach. J Pediatr (Rio J) 91(6 Suppl 1):S26–35 Roth T (2007) Insomnia: definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine: JCSM : official publication of the American Academy of Sleep Medicine. 3(5 Suppl):S7–S10 Blackmer AB, Feinstein JA (2016) Management of sleep disorders in children with neurodevelopmental disorders: a review. Pharmacotherapy 36(1):84–98 Fang H, Tu S, Sheng J, Shao A (2019) Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. J Cell Mol Med 23(4):2324–2332 Banaschewski T, Bruni O, Fuentes J et al (2021) Practice Tools for Screening and Monitoring Insomnia in Children and Adolescents with Autism Spectrum Disorder.J Autism Dev Disord van der Heijden KB, Stoffelsen RJ, Popma A, Swaab H (2018 Jan) Sleep, chronotype, and sleep hygiene in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and controls. Eur Child Adolesc Psychiatry 27(1):99–111 Kahn M, Sheppes G, Sadeh A (2013 Aug) Sleep and emotions: bidirectional links and underlying mechanisms. Int J Psychophysiol 89(2):218–228 Angkustsiri K, Krakowiak P, Moghaddam B et al (2011 Nov) Minor physical anomalies in children with autism spectrum disorders. Autism 15(6):746–760 Vanteemar S, Sreeraj JC, Puzhakkal B, Holla et al (2021) Cross-diagnostic evaluation of minor physical anomalies in psychiatric disorders. J Psychiatr Res 142:54–62 ISSN 0022-3956, Leppig KA, Werler MM, Cann CI, Cook CA, Holmes LB (1987 Apr) Predictive value of minor anomalies. I. Association with major malformations. J Pediatr 110(4):531–537 de Graaf R, Ten Have M, van Gool C, van Dorsselaer S (2012) Results from NEMESIS-2]. Tijdschr Psychiatr 54(1):27–38 Dutch. Prevalentie van psychische aandoeningen en trends van 1996 tot 2009; resultaten van NEMESIS-2 [Prevalence of mental disorders, and trends from 1996 to 2009 Wolicki SB, Bitsko RH, Cree RA et al (2021) Mental Health of Parents and Primary Caregivers by Sex and Associated Child Health Indicators. ADV RES SCI 2:125–139 Novais A, Monteiro S, Roque S, Correia-Neves M, Sousa N How age, sex and genotype shape the stress response.Neurobiol Stress. 2016 Nov23;6:44–56 Fang Y, Raat H, Windhorst DA et al The Association between Stressful Life Events and Emotional and Behavioral Problems in Children 0–7 Years Old: The CIKEO Study.Int J Environ Res Public Health. 2022 Jan31;19(3):1650 Vanaelst B, Huybrechts I, De Bourdeaudhuij I, Bammann K, Hadjigeorgiou C, Eiben G, Konstabel K, Michels N, Molnar D, Moreno LA et al (2012) Prevalence of negative life events and chronic adversities in european pre- and primary-school children: Results from the idefics study. Arch Public Health 70:26 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Sep, 2023 Read the published version in Child Psychiatry & Human Development → Version 1 posted Editor assigned by journal 23 Apr, 2023 Submission checks completed at journal 21 Apr, 2023 First submitted to journal 20 Apr, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2840534","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":193888210,"identity":"0970980a-d99f-4a1c-a90d-42b0dea12949","order_by":0,"name":"Jet B. Muskens","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYBACxgYQeQCI2dtArARStPAcA2uRINIukBaJNCK1MDdwp0n+OGOTJz/zWeLnipq0On7pA4wfPubgcxjvNmmeG2nFBrfTDkueOZYjIdmXwCw5cxsBLQwfDidukE5vkGxgq5AwOMPAxsxLQIvkjw//E+fPPN78s+FfhYQ9MVokeG4cSGy4wXZMsrEtR8KAh5CWZt7N1jxnkhM3nElLs2zsS5OccYaxGa9fDNt7N978ccwucX77MeObDd+S+fl7mA9++IhPSzM2x+JWDwTyeGVHwSgYBaNgFIAAAN1yUgDbBaE8AAAAAElFTkSuQmCC","orcid":"","institution":"Karakter Child and Adolescent Psychiatry University Centre","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jet","middleName":"B.","lastName":"Muskens","suffix":""},{"id":193888212,"identity":"20fb7a8b-030e-4951-a07b-ee4d5645d40e","order_by":1,"name":"Wietske A. Ester","email":"","orcid":"","institution":"Sarr Autism Rotterdam, Youz Child and Adolescence Psychiatry","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wietske","middleName":"A.","lastName":"Ester","suffix":""},{"id":193888214,"identity":"6687a95a-1148-449c-a363-ed93cebfc696","order_by":2,"name":"Helen Klip","email":"","orcid":"","institution":"Karakter Child and Adolescent Psychiatry University Centre","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Helen","middleName":"","lastName":"Klip","suffix":""},{"id":193888216,"identity":"e7a0dd2d-589c-4fd0-af38-7b19623d1e5a","order_by":3,"name":"Martine van Dongen-Boomsma","email":"","orcid":"","institution":"Karakter Child and Adolescent Psychiatry University Centre","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Martine","middleName":"van","lastName":"Dongen-Boomsma","suffix":""},{"id":193888218,"identity":"e48b3f41-74c6-4cf0-9344-80e1ba3fd248","order_by":4,"name":"Wouter G. Staal","email":"","orcid":"","institution":"Radboud University Nijmegen Medical Centre","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wouter","middleName":"G.","lastName":"Staal","suffix":""}],"badges":[],"createdAt":"2023-04-20 09:44:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2840534/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2840534/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10578-023-01587-w","type":"published","date":"2023-09-01T15:10:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":36276073,"identity":"eade01de-6966-43fd-88b3-affa041aef58","added_by":"auto","created_at":"2023-04-25 13:35:01","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":192681,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of study inclusion of the study population.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2840534/v1/9d3403669d4c3cdff20090f7.jpeg"},{"id":42782376,"identity":"a634d19d-e808-4684-a7de-1ea59970a3bd","added_by":"auto","created_at":"2023-09-07 15:16:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":297530,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2840534/v1/255457f3-9951-4371-9ea4-a94ca593124b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Novel insights into somatic comorbidities in children and adolescents across psychiatric diagnoses: an explorative study","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u0026ldquo;The mind is the body and the body is the mind\u0026rdquo;. This statement that opposes the Cartesian dualism [1] is supported by the high co-occurrence and relationship between somatic and psychiatric conditions [2, 3]. Various studies, mainly based on the adult population, show that the pathways between psychiatric and somatic disorders are complex, bidirectional and share common risk factors [2].Associations between somatic and specific psychiatric conditions are partially found in research investigating children. For example, children with a diagnosis of autism spectrum disorder (ASD) and/ or attention deficit hyperactivity disorder (ADHD) frequently display obesity and neurologic disorders while children withdiabetes type I or asthma show mood and anxiety disorders [4-9] As such, increased awareness of the co-occurrence of somatic and psychiatric health issues is warranted [2-9]. However, little is known about the prevalence of somatic disorders in the daily child psychiatric practice. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough many children with psychiatric disorders appear to display comorbid somatic symptoms, these are frequently overlooked [10-12]. In general, patients with psychiatric disorders are more likely to develop somatic comorbidities [2, 3]. Vice versa, somatic disorders may cause, enhance or camouflage psychiatric symptoms [2]. Of major concern is that most psychiatric disorders arise during childhood [13] and that many somatic comorbidities in children with psychiatric disorders continue into adulthood [12]. Therefore, it is crucial, from a preventive perspective, to investigate somatic risk factors and comorbidities in children with psychiatric disorders to develop guidelines that integrate physical and mental health to improve outcomes.\u003c/p\u003e\n\u003cp\u003eMost data on somatic comorbidities in child and adolescent psychiatry are confined to neurodevelopmental disorders (NDD), especially ASD and ADHD. A systematic review showed a broad range of somatic comorbidities in NDD [14]. Likewise, children with chronic somatic disorders show an increased risk of NDD [15, 16]. As NDD may also indicate underlying genetic syndromes with an increased risk of somatic and psychiatric vulnerability, multidisciplinary healthcare are recommended in these children [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition, the awareness that lifestyle factors may also relate to psychiatric disorders has grown rapidly [17].Results from a recent meta-analysis indicated that an unhealthy lifestyle in patients with psychiatric diagnoses contributes to adverse somatic health outcomes [18]. This also appears relevant for children with psychiatric disorders, although large-scale longitudinal studies of lifestyle factors in children with psychiatric diagnoses are sparse [18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA\u0026nbsp;recent register based study of children and adolescents showed associations between a wide range of psychiatric and somatic diagnoses across all types of conditions and across all ages [12]. However, ASD was not included in that study while several demographic variables, such as socioeconomic factors were not accounted for. Thus far, data\u0026nbsp;of somatic comorbidities in children and adolescents with broader psychiatric diagnoses are relatively sparse and allow no firm conclusions due to limited numbers of participants and/ or a lack of robust methodological design [4, 19, 20]. As such, a clear picture about the impact of somatic comorbidities in child psychiatric services is missing.\u003c/p\u003e\n\u003cp\u003eHere, we performed an observational, cross-sectional study to assess the prevalence of somatic comorbidities in a sample of children and adolescents with various psychiatric disorders using a standardized somatic assessment in a naturalistic design. We hypothesize that somatic comorbidities are widespread in children and adolescents with psychiatric disorders.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eAs part of an ongoing explorative assessment on somatic comorbidity and lifestyle in children and adolescents with psychiatric disorders, we retrospectively reviewed documents and medical records from patient files between March 2020 and December 2020, including physical and laboratory measurements at diagnostic assessment carried out between October 2017 and\u0026nbsp;March 2020\u0026nbsp;at the child hospital of Karakter University Centre \u0026ndash; Radboud University Hospital.\u0026nbsp;The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy sample\u003c/p\u003e\n\u003cp\u003eThe study sample included children and adolescents aged 6-18 with psychiatric disorders based on DSM-IV-TR and/ or DSM 5 (since 1 January 2018 used in the Netherlands) [21, 22]. Psychiatric disorders were classified into four categories based on primary diagnosis: (1) neurodevelopmental disorders (ASD, ADHD, Tourette syndrome), (2) affective disorders (unipolar depression, bipolar disorder, dysthymia/ persistent depressive disorder, disruptive mood dysregulation disorder,\u0026nbsp;generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, separation anxiety disorder, social phobia), (3) eating disorders (anorexia nervosa, bulimia nervosa) and (4) psychosis (first psychosis, schizophrenia).\u0026nbsp;\u0026nbsp;Insomnia criteria are also based on DSM-IV-TR and DSM 5 criteria [21, 22]. Karakter UC provides psychiatric care for children and adolescents with an average or high intelligence level.\u0026nbsp;Participants were required to have\u0026nbsp;a minimum average estimated intelligence (IQ \u0026gt; 70). Estimated intelligence was based on either clinical functioning (e.g., good functioning at school) or by assessing an intelligence test (Wechsler Intelligence Scale for Children, if available \u0026nbsp;[23]).\u0026nbsp;Children who were supplemented with vitamin D3 at the moment of assessment were excluded from the study (n = 3).\u003c/p\u003e\n\u003cp\u003eMeasures\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePsychiatric assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePrior to the first appointment, questionnaires were analyzed on child\u0026rsquo;s ethnicity, parent\u0026rsquo;s educational level and family history.\u0026nbsp;Ethnicity of the child was based on the parental\u0026nbsp;country of birth. If both parents were non-Dutch, mother\u0026rsquo;s\u0026nbsp;ethnicity determined the ethnicity of the child.\u0026nbsp;Parents\u0026apos; educational level was determined by the highest completed education (primary school, secondary school and higher education).\u003c/p\u003e\n\u003cp\u003eDuring the first appointment, a psychologist and child and adolescent psychiatrist interviewed the child and caregivers. \u0026nbsp;Next, a mental state and physical examination was carried out by the child and adolescent psychiatrist or a nurse practitioner, supervised by a child and adolescent psychiatrist.\u0026nbsp;Consensus diagnoses were established by a multidisciplinary team consisting of two independent child and adolescent psychiatrists, psychologists and two nurse practitioners.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePhysical and laboratory assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePhysical examination included measurement of weight, height, blood pressure, heart rate, inspection of minor physical anomalies (MPA) and signs of non-self-injury behavior. MPAs are subtle, abnormal morphological features, such as deviations in morphology of the head, eyes, ears, mouth, hands, and feet\u0026nbsp;[24].\u0026nbsp;Non-self-injury behavior (NSSI) consists of behaviors such as self-cutting, scratching, hitting or banging, carving, and scraping often seen as inadequate coping behavior to regulate overwhelming distress [25].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of children being underweight, overweight or obese was defined by the cut-off values of BMI references per age group according to the International Obesity Task Force [26]. Blood pressure was measured with an oscillometric device, widely used to screen initial blood pressure in a clinical setting. In the United States and Europe, the diagnosis of persistent childhood hypertension is made when repeated blood pressure values on three separate visits are above the 95th percentile for the age, gender and height of the patient or above 130/80 mmHg.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBlood testing included vitamin D3, glucose, prolactin levels and lipid profiles. Indications for blood testing were based on available clinical guidelines [27].\u0026nbsp;Blood specimens were processed at a local laboratory from which references were used to interpret the results of the laboratory findings. For vitamin D3 references from the American Academy of Pediatrics Committee on Nutrition and The Institute of Medicine corresponded to a serum 25-hydroxyvitamin D level of at least 50 nmol/liter [28].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatient baseline characteristics were reported using frequency distributions for the categorical variables and mean \u0026plusmn; standard deviation for the continuous variables when normally distributed. Otherwise, the median and interquartile range was reported. The prevalence of somatic comorbidities was presented as a frequency distribution for the different diagnostic groups and the total group. A fisher exact test was used if the expected cell frequencies were smaller than five. A p-value \u0026lt; 0.05 (two-sided) was considered statistically significant in descriptive statistics. Sub-analyses were done with different variables (gender, age, primary diagnosis, medication, and educational level of caregivers) to determine their influence on the results of the somatic examination and laboratory findings. All analyses were conducted using SPSS version 24 (IBM Corporation, Armonk, NY).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs shown in figure 1, 278 children were referred to the psychiatric hospital in the previously stated time frame. Two were not diagnosed with a psychiatric disorder and were therefore not included. Laboratory measurements were available for 97 children.\u003c/p\u003e\n\u003cp\u003eTable 1 presents the baseline demographic and clinical characteristics of the participants. Of the 276 patients, 145 were male (52.5%) with a mean age of 12.9 years (range 6-18, SD 3.5). A total of 93.1% of the children were of Dutch ancestry (North European), 3.6% of the children were adopted and 40.9% of parents had separated or divorced. In terms of parental education, 116 parents (42.0%) reportedly completed higher education, 104 parents (37.7%) completed secondary education only; and 39 parents (14.1%) completed primary education. Positive family history of psychiatric disorders was present in 65.6% of the children. Exposure to stressful life events of the child was conveyed by parents in 56.1% of the children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe two most common primary diagnoses were NDD (63%) and affective disorders (29%). In the NDD group, 24 children did have ADHD and 149 ASD as primary diagnosis; for affective disorders, 43 children did have a depressive disorder and 37 an anxiety disorder as primary diagnosis. A total of 149 children were treated with one type of psychotropic drug or a combination of drugs (54.0%) at the time of somatic assessment. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDescription of the study population (n = 276)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003e6-11 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e31.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003e12-14 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e26.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003e15-18 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e42.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e52.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e47.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003eStressful life events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e56,2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e43,8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary psychiatric diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eNeurodevelopmental disorder\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e62.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eAffective disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e29.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eEating disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e4.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003ePsychosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e4.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003ePsychotropic medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e54,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e46,0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eIf yes,\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eAntipsychotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e64.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eStimulants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e23.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eAntidepressants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e11.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eMood stabilizers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e0.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003eEducational level primary caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e14.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary and lower vocational education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e37.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eUniversity degree, higher professional education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e42.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eInformation is missing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e6.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\n \u003cp\u003eFamily history of psychiatric diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e32.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e65.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.97464342313788%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"43.42313787638669%\" valign=\"top\"\u003e\n \u003cp\u003eInformation is missing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45958795562599%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.142630744849445%\" valign=\"top\"\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 presents the somatic comorbidities for the total group and the four primary psychiatric diagnoses groups. Questionnaires and somatic interviews of the child and caregivers displayed insomnia (n=182; 66%) and problematic food behavior, including selective eating, food neophobia, limited intake or hyperphagia (n= 119; 43%) as major complaints in the total group. Of note, insomnia frequency rates were high for all psychiatric diagnoses (55-91%).\u003c/p\u003e\n\u003cp\u003eThe physical assessment indicated that 19.9% of the children were overweight and 12.0% obese, according to BMI. Overweight and obese ranges were similar across psychiatric diagnoses (overweight 20-27%; obese 12-18%), except for children with eating disorders. For children using antipsychotic medication, 25.0% of the children were overweight and 13.5% obese. Minor physical anomalies were present in 52.6% of the children with NDD and in 54.5% of the children with psychosis, compared to 8.8% in children with affective disorders and absent in children with eating disorders. Signs of non-self-injury behavior were noticed in 44 children (16.1%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMeasurement of height (2\u0026le;sd\u0026ge;2) was not significant between the different diagnosis groups. Prevalence rates of hypertension were low across all diagnostic groups and not significant. In total, hypertension was measured in seven children (2.5%). Low blood pressure (systolic \u0026lt;90mmHg) was measured in twelve children (4%). \u0026nbsp;Alcohol and/ or drug abuse was mentioned by 20 adolescents (7%; not significant). Two children with NDD had a history of epileptic seizures and were treated by a child neurologist.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"13\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePrimary diagnosis in relation to somatic comorbidity in the study population\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.95447409733124%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.2276295133438%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.773940345368917%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.930926216640502%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNDD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.459968602825745%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAffective\u0026nbsp;Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.459968602825745%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eEating Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.087912087912088%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePsychosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.105180533751962%\" rowspan=\"3\"\u003e\n \u003cp\u003ep-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.65284974093264%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.753022452504318%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"12.953367875647668%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 276)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12607944732297%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n=173)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.607944732297064%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.607944732297064%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.298791018998273%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.782608695652176%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.869565217391305%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.217391304347826%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.695652173913044%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.695652173913044%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.391304347826087%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.826086956521739%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\n \u003cp\u003eInsomnia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e34.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e45.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e18.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e65.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e54.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e81.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e90.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eEating behavior problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e56.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e59.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e60.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e54.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.476190476190474%\" valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.714285714285714%\" valign=\"top\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e43.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.714285714285714%\" valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e41.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e40.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.904761904761905%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047619047619047%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\n \u003cp\u003eBMI category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eUnderweight\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e12.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e7.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e10.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e55.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e60.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e56.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eOverweight\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e19.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e20.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e21.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eObese\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e12.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e12.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e12.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\n \u003cp\u003eMPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e61.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e45.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e91.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e37.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e52.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e8.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e54.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e1.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSigns of\u0026nbsp;non-self-injury behavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e83.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e89.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e81.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e54.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.476190476190474%\" valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.714285714285714%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e16.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.714285714285714%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e10.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e18.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e50.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.904761904761905%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047619047619047%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol/ drugs abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e92.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e93.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e91.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e90.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.476190476190474%\" valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.714285714285714%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e7.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.714285714285714%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e6.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e8.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.904761904761905%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\" valign=\"top\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047619047619047%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eHeight \u0026le; 2SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e3.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e4.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e2.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e89.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e95.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eHeight \u0026ge; 2SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e4.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e5.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e2.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\n \u003cp\u003eBlood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e4.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e4.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e2.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e91.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e93.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e75.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e90.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e2.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e2.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e1.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.061611374407583%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.323854660347552%\" valign=\"top\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e1.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.739336492890995%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e1.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e2.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.265402843601896%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.897314375987362%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109004739336493%\" valign=\"top\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.162717219589258%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"13\" valign=\"top\"\u003e\n \u003cp\u003eNDD=Neuro Developmental Disorder.\u0026nbsp;BMI=Body Mass Index. MPA= Minor Physical Anomalies. NS= Not Significant. SD=Standard Deviation\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eUnderweight: BMI \u0026le;5th percentile.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003eOverweight, obese: according to the International Obesity Task Force[26].\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ec\u003c/sup\u003e\u003csup\u003e\u0026nbsp;\u0026nbsp;\u003c/sup\u003eBlood pressure high: measured 3 times\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003eChi squared test. A p-value \u0026lt; 0.05 (two-sided) was considered statistically significant.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 presents the laboratory findings of a subsample (n=97). Vitamin D3 deficiency \u0026lt;50 nmol/ L was present in 71 children (73.2%) and highly prevalent across all diagnoses \u0026nbsp;(NDD 68.1%, affective disorders 79.5%, eating disorder 100% and psychosis 62.5%). Dyslipidemia (cholesterol, triglycerides, LDL-cholesterol and non-HDL cholesterol) was found in three children (3.1%); high levels of prolactin (\u0026gt; 500 mE/L) in four children (all of them using risperidone). For hyperprolactinemia, there was no macroprolactin in these four children. None of the children on antipsychotics had increased glucose levels.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"14\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eLaboratory findings of a subsample of children (n = 97)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.901081916537867%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.901081916537867%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNDD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.437403400309119%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAffective Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.437403400309119%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eEating Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.055641421947449%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePsychosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" rowspan=\"3\"\u003e\n \u003cp\u003ep-value*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.707482993197278%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.095238095238095%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.095238095238095%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n=47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.585034013605442%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.585034013605442%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.26530612244898%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e(n = 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.707482993197278%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.1020408163265305%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.8231292517006805%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.272108843537415%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.8231292517006805%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.761904761904762%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.8231292517006805%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.761904761904762%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.8231292517006805%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.442176870748299%\" valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.8231292517006805%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.17006802721088435%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003eVitamin D3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;50nmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e23.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e31.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e20.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;50 nmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e73.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e68.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e79.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e62.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003eProlactinaemia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e95.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e93.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e97.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt; 500 mE/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e4.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e6.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e2.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003eLipid spectrum\u003csup\u003ea\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e96.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e97.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e94.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003eDyslipidemia\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e3.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e2.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003eGlucose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e99.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e97.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 5.6mmol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e1.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e2.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.001545595054097%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.146831530139103%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.636785162287481%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.7913446676970635%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.327666151468315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.945904173106646%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.109737248840804%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.119010819165378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1545595054095827%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"14\" valign=\"top\"\u003e\n \u003cp\u003eNDD=Neuro Developmental Disorder\u0026nbsp;N/A= not applicable due to small numbers in multiple columns\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eLipid spectrum comprised levels of cholesterol,\u003csup\u003e\u0026nbsp;\u0026nbsp;\u003c/sup\u003etriglycerides (TG),\u003csup\u003e\u0026nbsp;\u003c/sup\u003elow-density lipoprotein (LDL) \u003csup\u003e\u0026nbsp;\u003c/sup\u003ehigh-density lipoprotein (HDL) according to reference values for children.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eb\u0026nbsp;\u003c/sup\u003eDyslipidemia was defined as total cholesterol \u0026gt;5.2\u0026nbsp;mmol/L (200\u0026nbsp;mg/dl), LDL\u0026nbsp;\u0026gt;\u0026nbsp;3.4\u0026nbsp;mmol/L (130\u0026nbsp;mg/dl), HDL \u0026lt;0.9\u0026nbsp;mmol/L (35\u0026nbsp;mg/dl), or triglycerides \u0026gt;1.7\u0026nbsp;mmol/L (150\u0026nbsp;mg/dl), or a combination thereof.\u003c/p\u003e\n \u003cp\u003e*Chi squared test\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found high somatic comorbidities in a large naturalistic sample of 276 children with broad psychiatric diagnoses, including NDD, affective disorders, eating disorders and psychosis. The primary somatic comorbidities were 1) problems associated with food intake, including overweight, obesity and vitamin D3 deficiency and 2) sleeping problems, mainly insomnia. Our findings indicate that somatic comorbidities are widespread in children and adolescents with psychiatric disorders. Assessing various somatic comorbidities in a sample consisting of several child psychiatric disorders, allowed to see its broad variation including problems with weight, problems related to food intake, vitamin D3 deficiency (\u0026lt;50nmol/l), insomnia and minor physical anomalies.\u003c/p\u003e\n\u003cp\u003eWith respect to problems in weight 12.0% of our sample was obese compared to 2.5% in the general Dutch population in the same period of this study [29]. Similarly, the percentage of overweight was 19.9%, compared to 14.2% of children in the general Dutch population [29]. These percentages increased for children using antipsychotic medication (25% for overweight children and 13.5% for obese children). These findings are consistent with previous studies. For example, in children with NDD, prevalence rates of overweight vary between 11-34% (our study 20.2%), and for obese children, between 12-23% (our study 12.2%) [4,5, 30-32].\u003c/p\u003e\n\u003cp\u003eA recent meta-analysis indicated that obese children are more at risk for depression than normal-weight children with a prevalence of 10.4% [33]. In the opposite direction, our results displayed a prevalence of 12.5% of obesity among children with depression and anxiety disorders (affective disorders). Likewise, the same symptoms related to lifestyles, such as sedentary habits, disordered sleep, insufficient physical activity and dysregulated food consumption, are common in obese children and children with affective disorders [34]. For an optimal development of children, it is essential to be aware of these symptoms and to address both psychiatric and somatic conditions. As obesity is an important risk factor for cardiovascular disease during later life, it is important to be aware of the risk factors in children, such as some types of medication, the psychiatric disorder itself, genetic variations with obesity and lifestyle related factors [35].\u003c/p\u003e\n\u003cp\u003eFurthermore, our study showed a prevalence of vitamin D3 deficiency (\u0026lt;50nmol/l) in the whole group of children with psychiatric disorders of 73%. This is much higher compared to reported 30% in the general population of Dutch children [36]. Vitamin D3 deficiency is associated with a range of adverse somatic and psychiatric outcomes (cardiovascular, diabetes, cancer, depression, NDD, psychosis and dementia) and might be a risk factor for impaired brain development [37, 38]. Reversely, vitamin D3 deficiency could be due to unhealthy lifestyle such as poor diet quality, being overweight and reduced exposure to sunlight by an imbalance between indoor and outdoor activities, which may be more common in children with psychiatric disorders [39, 40]. Additionally, a recent study revealed an inverse association between BMI and vitamin D3 levels in children with ASD and internalizing disorders [41], which is in line with studies in the general population [42, 43]. However, the underlying associations of vitamin D3 deficiency in somatic and psychiatric disorders are still poorly understood and questions for supplementation and lifestyle intervention remain.\u003c/p\u003e\n\u003cp\u003eThe second main finding is the high rate of insomnia in our population (66% ) compared to primary school-aged children (5-30%) and adolescents (4-13%) in the general population [44]. Insomnia is the most common sleep disorder in children and is primarily characterized by difficulty initiating or maintaining sleep and/or poor sleep quality, which results in significant impairments in daytime functioning [45, 46]. Sleep problems are complex and viewed as part of neurologic and psychiatric disorders (e.g., ASD, affective disorders, epilepsy, psychosis, migraine) [45-47]. For some psychiatric disorders sleep problems are also part of the criteria itself (e.g., depression and anxiety disorders) [46].\u003c/p\u003e\n\u003cp\u003eSeveral studies show that estimates of insomnia are higher in pediatric populations with psychiatric diagnoses, including ADHD, ASD, anxiety and depression which is in line with our findings [47, 48]. For instance, our study found that insomnia in children with NDD was comparable with the existing literature (50-80%) [47, 49, 50]. Also, for insomnia in children with affective disorders, similar rates are found: in our study 81% compared to 75 - 90% for depression and anxiety in previous studies [46, 48, 51]. Notably, in case of insomnia, the symptoms of depression or anxiety disorder are even more severe [46, 48, 51]. In addition, cognitive behavioral therapy for insomnia provides a non-pharmacological option for improving sleep in psychiatric patients [18]. This is also relevant for children with psychiatric disorders in which the relationship between sleep and behavioral interventions has not been fully elucidated.\u003c/p\u003e\n\u003cp\u003eThe clinical assessment further showed a high rate of minor physical anomalies (MPA) in children with NDD (53%) and psychosis (55%), which is also consistent with the literature [52, 53]. While a single MPA is not uncommon in the general population, a greater number of MPAs is associated with somatic comorbidities and underlying genetic variations [54]. As such, careful analysis of the combination of NDD, childhood psychosis, somatic comorbidities and MPA requires an simultaneous assessment to consider referral to a clinical geneticist [14].\u003c/p\u003e\n\u003cp\u003eBesides the physical outcomes, 66% of the children in our study did have a primary caregiver with a psychiatric diagnosis and 56% had been exposed to stressful life events (SLE; divorce of caregivers, death of caregiver, serious illness to family members, physical and/or sexual abuse, bullying at school).\u0026nbsp;\u003cem\u003eThe Netherlands Mental Health Survey and Incidence Study\u003c/em\u003e [55]\u003cem\u003e revealed \u003c/em\u003ean estimation of 350 Dutch children in 10.000 residents with a caregiver with a psychiatric diagnosis; the National Survey of Children's Health in the United States estimated that 7.2%\u0026nbsp;of the US children had at least one caregiver with poor mental health [56]. For SLE, there is no single definition of what an SLE is and the impact may vary per event and child [57]. The reported prevalence of SLEs in children is high and varies between studies [58, 59]. Poor mental health among primary caregivers and exposure to SLE are associated with poor mental and physical health in children across the lifespan [56- 59].\u003c/p\u003e\n\u003cp\u003eUnfortunately, accurate and timely somatic assessment in children with psychiatric disorders can be challenging due to atypical presentation of symptoms, difficulties in describing and/or expressing subjective experiences or symptoms and insufficient expertise about somatic comorbidities in this population [11]. In line with our study, Agnafors et al (2019) showed associations between a wide range of psychiatric and somatic disorders across all types of conditions and across all ages in a register-based study [12]. This warrants the question to implement simultaneous assessment of somatic and psychiatric symptoms in children and adolescents with psychiatric diagnoses.\u003c/p\u003e\n\u003cp\u003eAmong the strengths of our study is the extensive assessment of the somatic comorbidities of a relatively large number of children and adolescents with different psychiatric disorders. This showed a broad variation of comorbidities, underscoring the importance of routine somatic assessment in children with psychiatric disorders. Second, the somatic and psychiatric assessment was performed with great scrutiny and based on the assessment of two clinical experts (independent child and adolescent psychiatrists) and the psychiatric diagnoses were based on an evaluation by a multidisciplinary team. Additionally, the somatic assessments were carried out in a standardized way, allowing consistent and reliable collection of data. Third, we ran additional analyses with different variables to determine the influence of these variables (gender, age, medication and SES) on the physical examination and laboratory findings.\u003c/p\u003e\n\u003cp\u003eThere are also several limitations regarding this study. First, lack of a matched control group may limit the specificity of our findings. However, prevalence rates from children from the general population were available.. Given the remarkable differences with this norm population, our general concerns about the high rates of somatic concerns in children with psychiatric disorders appear valid. Second, all children in this study were recruited in a child psychiatric center, which may introduce ascertainment/selection bias. A third limitation is that, although we have included children with various child psychiatric disorders, the number of patients in some specific diagnostic categories was small(e.g. psychosis and eating disorders), not allowing additional analyses to explore potential relationships between specific diagnosis and somatic comorbidities. A fourth limitation is the cross-sectional design which does not allow for further exploration of intricate relationships between psychiatric and somatic concerns over time.\u003c/p\u003e\n\u003cp\u003eWe recommend that future studies investigating physical health in child and adolescent psychiatric populations collect longitudinal data in large samples of children and typically developing peers, including those with intellectual disabilities. At a broader public health level, research is required into the effectiveness of interventions that promote a healthy lifestyle, especially in child psychiatric population. Also, the role of vitamin D3 in psychiatric and somatic diseases needs further exploration, for instance, how it relates to other health factors (such as BMI, age, gender, diet, ethnicity, season, etc.), but also what the effects of supplementation are in relation to diagnosis. Furthermore, research of underlying genetic variation may provide deeper insight into patient (sub)groups more susceptible to mental and physical health problems than others. Ultimately, this may guide personalized treatment approaches.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the findings of this study underscore the high prevalence of somatic comorbidity in children and adolescents with psychiatric disorders and highlight the importance of standardized somatic screening in this group. The primary somatic comorbidities, including higher-than-healthy weight, vitamin D3 deficiency and sleep problems, may be strongly related to lifestyle factors and future studies may need to address this. As such, the findings of this study suggest that mental health professionals may need to asses and treat somatic comorbidities or refer for adequate treatment. Clinicians must address mental \u003cem\u003eand\u003c/em\u003e physical health, to ensure maximal well-being and the best possible outcomes for children and adolescents with psychiatric illnesses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatements and Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding was secured for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to ethical restrictions and personal data protection. However, reasonable requests for patient level data should be made to the corresponding author and will be considered after discussion with the ethical board. As far as possible, we intend to include all relevant data in the manuscripts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.\u0026nbsp;Data collection was part of a routine clinical procedure and\u0026nbsp;retrospectively analyzed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWritten informed consent to participate in this study was provided by the participants\u0026rsquo; legal guardian/next of kin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributors\u0026apos; Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJM conceptualized and designed the study, collected, coordinated, and supervised data collection, performed the statistical analyses, drafted the initial manuscript, and revised the manuscript. WE provided input into the analyses and interpretation and revised the manuscript critically. HK supervised the statistical analyses and interpretation, and commented on the manuscript. MvD and JZ critically revised the manuscript for important content.WS conceptualized the study, supervised data analysis, and critically revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThibaut F (2018 Mar) The mind-body Cartesian dualism and psychiatry. Dialogues Clin Neurosci 20(1):3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDruss BG, Walker ER (2011) Mental disorders and medical comorbidity. 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ADV RES SCI 2:125\u0026ndash;139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNovais A, Monteiro S, Roque S, Correia-Neves M, Sousa N How age, sex and genotype shape the stress response.Neurobiol Stress. 2016 Nov23;6:44\u0026ndash;56\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFang Y, Raat H, Windhorst DA et al The Association between Stressful Life Events and Emotional and Behavioral Problems in Children 0\u0026ndash;7 Years Old: The CIKEO Study.Int J Environ Res Public Health. 2022 Jan31;19(3):1650\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanaelst B, Huybrechts I, De Bourdeaudhuij I, Bammann K, Hadjigeorgiou C, Eiben G, Konstabel K, Michels N, Molnar D, Moreno LA et al (2012) Prevalence of negative life events and chronic adversities in european pre- and primary-school children: Results from the idefics study. Arch Public Health 70:26\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"child and adolescent psychiatry, somatic comorbidity, physical health, insomnia, obesity, vitamin D deficiency","lastPublishedDoi":"10.21203/rs.3.rs-2840534/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2840534/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMany children with psychiatric disorders display somatic symptoms, although these are frequently overlooked. As somatic morbidity early in life negatively influences long-term outcomes, it is relevant to assess comorbidity. However, studies of simultaneous psychiatric and somatic assessment in children are lacking. The aim of this study was to assess the prevalence of somatic comorbidities in a clinical sample of children and adolescents with psychiatric disorders in a naturalistic design. Data were assessed from 276 children with various psychiatric disorders (neurodevelopmental disorders, affective disorders, eating disorders and psychosis) aged 6\u0026ndash;18 years. These data were collected as part of routine clinical assessment, including physical examination and retrospectively analyzed. For a subsample (n\u0026thinsp;=\u0026thinsp;97), blood testing on vitamin D3, lipid spectrum, glucose and prolactin was available. Results of this cross-sectional study revealed that food intake problems (43%) and insomnia (66%) were common. On physical examination, 20% of the children were overweight, 12% displayed obesity and 38% had minor physical anomalies. Blood testing (n\u0026thinsp;=\u0026thinsp;97) highlighted vitamin D3 deficiency (\u0026lt;\u0026thinsp;50 nmol/L) in 73% of the children. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. The main somatic comorbidities in this broad child- and adolescent psychiatric population consisted of (1) problems associated with food intake, including obesity and vitamin D3 deficiency and (2) sleeping problems, mainly insomnia. Child and adolescent psychiatrists need to be aware of potential somatic comorbidities and may promote a healthy lifestyle.\u003c/p\u003e","manuscriptTitle":"Novel insights into somatic comorbidities in children and adolescents across psychiatric diagnoses: an explorative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-25 13:34:57","doi":"10.21203/rs.3.rs-2840534/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2023-04-23T10:22:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-04-21T09:09:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child Psychiatry \u0026 Human Development","date":"2023-04-20T09:34:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ece07c23-c4cd-4d14-ad47-ac8bd4d35c56","owner":[],"postedDate":"April 25th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T15:15:28+00:00","versionOfRecord":{"articleIdentity":"rs-2840534","link":"https://doi.org/10.1007/s10578-023-01587-w","journal":{"identity":"child-psychiatry-and-human-development","isVorOnly":false,"title":"Child Psychiatry \u0026 Human Development"},"publishedOn":"2023-09-01 15:10:14","publishedOnDateReadable":"September 1st, 2023"},"versionCreatedAt":"2023-04-25 13:34:57","video":"","vorDoi":"10.1007/s10578-023-01587-w","vorDoiUrl":"https://doi.org/10.1007/s10578-023-01587-w","workflowStages":[]},"version":"v1","identity":"rs-2840534","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2840534","identity":"rs-2840534","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}