Co-occurring Symptom Trajectories and their relation to Sex, Race, Ethnicity and Healthcare Utilization in the Cohort of Young Adolescents in the ABCD Study�

Importance: Co-occurring physical and psychological symptoms during early adolescence may increase vulnerability to symptom persistence into adulthood. Objective: Describe co-occurring Pain, Psychologic and Sleep disturbance Symptom (Pain-PSS) trajectories in a diverse cohort of young adolescents and the impact of symptom trajectory on healthcare utilization Design: Secondary analysis of longitudinal Adolescent Brain Cognitive Development (ABCD) Study� data collected between 2016-2022 Setting: 21 research sites across the U.S. Participants: 11,473 young adolescents (52.5% male; baseline age 9.91 � 0.63 years) with 2-4 complete annual symptom assessments Main outcome and measures: Four-year symptom trajectories were derived from multivariate latent growth curve analyses. Pain, Psychologic (depression and anxiety), and Sleep disturbance Symptoms (Pain-PSS) were measured using subscales from the Child Behavior Checklist and the Sleep Disturbance Scale of Childhood. Medical history and DSM-5 items measured non-routine medical and mental healthcare utilization. Results: Four No Pain-PSS and 5 Pain-PSS trajectories were supported with good/excellent model fit (predicted probabilities 0.87-0.96). Most children (81%) had asymptomatic or low/intermittent/single symptom trajectories. One in 5 had moderate-high co-occurring symptom trajectories that persisted or worsened. Black, Other Race, and Hispanic children had lower relative risk of having moderate-high co-occurring symptom trajectories. Less than half of youth with moderate-high co-occurring symptom trajectories utilized non-routine healthcare, despite higher utilization compared to asymptomatic children (e.g., 49% High Pain/High PSS vs. 27% asymptomatic had non-routine medical care, adj.OR 2.43 [95% CI 1.97, 2.99]; 46% High Pain/High PSS vs. 4% asymptomatic utilized mental health services, adj.OR 26.84 [95% CI 17.89, 40.29]). Black youth were less likely to report non-routine medical (adj.OR 0.61 [95% CI 0.52, 0.71] or mental healthcare (adj.OR 0.68 [95% CI 0.54, 0.87]), while Hispanic youth were less likely than non-Hispanic youth to have utilized mental healthcare (adj.OR 0.59 [95% CI 0.47, 0.73]). Lower household income lowered the odds of non-routine medical care (adj.OR 0.87 [95% CI 0.77, 0.99]) but not mental healthcare. Conclusion/Relevance: One in five young adolescents experienced moderate-high, co-occurring symptom trajectories, but less than half utilized non-routine medical or mental healthcare. Findings suggest a need for innovative and equitable intervention approaches to decrease the potential for symptom persistence during adolescence.