{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T05:02:05Z","timestamp":1777352525376,"version":"3.51.4"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["427862"],"award-info":[{"award-number":["427862"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001804","name":"Canada Research Chairs","doi-asserted-by":"publisher","award":["00153"],"award-info":[{"award-number":["00153"]}],"id":[{"id":"10.13039\/501100001804","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010090","name":"Women and Children's Health Research Institute","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100010090","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010322","name":"Stollery Children\u00e2\u20ac\u2122s Hospital Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100010322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Limited research has examined the neurodevelopmental health of M\u00e9tis children from a functional perspective, which is essential for culturally sensitive service planning, and policy development. This population-based retrospective birth cohort study linked provincial administrative health data of M\u00e9tis and non-M\u00e9tis singleton live births (2006\u20132016) to follow them up to 10 years of age. A random 1:4 sample of non-M\u00e9tis children served as a reference group. Neurodevelopmental disorders and disabilities (NDD\/D) were examined across six functional NDD\/D domains. Prevalence odds ratios (pOR) with 95% confidence intervals (CI) were calculated using logistic regression models, adjusted for maternal and neonatal characteristics. Incidence rates (IR) per 1,000 person-years were estimated, and age-specific IR was modeled using longitudinal Poisson regression, adjusting for covariates. Associations between maternal and neonatal characteristics and NDD\/D incidence among M\u00e9tis children were examined using multivariable longitudinal Poisson regression models, with adjusted incidence rate ratios (IRR) and 95% CI reported. A total of 38,958 singleton live births were included (7,853 M\u00e9tis and 31,105 non-M\u00e9tis). Overall NDD\/D prevalence among M\u00e9tis (3.3%) and non-M\u00e9tis (2.8%) children did not differ significantly after adjustment (adjusted pOR: 1.1, 95% CI: 0.9, 1.3). Learning-cognition was the most prevalent NDD\/D domain. M\u00e9tis children had a higher IR of NDD\/D at age 2 (5.5 vs. 2.8 cases per 1,000 person-years, rate difference: 2.7 [95% CI: 0.8, 4.6]). Among M\u00e9tis children, higher NDD\/D incidence was associated with maternal age younger than 20 or older than 35 years, high pre-pregnancy weight, male sex, preterm birth, and congenital anomalies. While overall NDD\/D prevalence was similar between M\u00e9tis and non-M\u00e9tis children, M\u00e9tis children were more likely to be diagnosed at age 2, suggesting potential differences in early diagnosis, access to care, or underlying risk factors. A functional classification approach of neurodevelopmental health supports culturally responsive early screening and intervention strategies to address these differences.<\/jats:p>","DOI":"10.1371\/journal.pone.0333699","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T17:24:51Z","timestamp":1759512291000},"page":"e0333699","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence and prevalence of neurodevelopmental disorders and disabilities among m\u00e9tis children in Alberta, Canada: A retrospective birth cohort study"],"prefix":"10.1371","volume":"20","author":[{"given":"Stuart","family":"Lau","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesus","family":"Serrano-Lomelin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Hicks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reagan","family":"Bartel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Bradburn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashton","family":"James","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Crawford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3658-2554","authenticated-orcid":true,"given":"Jeffrey A.","family":"Bakal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Colquhoun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Hicks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8019-5466","authenticated-orcid":true,"given":"Rhonda J.","family":"Rosychuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8287-7102","authenticated-orcid":true,"given":"Alvaro","family":"Osornio-Vargas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radha","family":"Chari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9305-7521","authenticated-orcid":true,"given":"Maria B.","family":"Ospina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"pone.0333699.ref001","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2013","edition":"5"},{"key":"pone.0333699.ref002","volume-title":"International statistical classification of diseases and related health problems","author":"World Health Organization","year":"1992","edition":"10"},{"key":"pone.0333699.ref003","unstructured":"World Health Organization. International Classification of Functioning, Disability and Health (ICF). n.d. https:\/\/www.who.int\/standards\/classifications\/international-classification-of-functioning-disability-and-health"},{"issue":"6","key":"pone.0333699.ref004","doi-asserted-by":"crossref","first-page":"468","DOI":"10.3109\/09638288.2012.699580","article-title":"Diagnostic status, functional status and complexity among Canadian children with neurodevelopmental disorders and disabilities: a population-based study","volume":"35","author":"AR Miller","year":"2013","journal-title":"Disabil Rehabil"},{"issue":"2","key":"pone.0333699.ref005","first-page":"9","article-title":"Developing a non-categorical measure of child health using administrative data","volume":"26","author":"RG Arim","year":"2015","journal-title":"Health Rep"},{"issue":"12","key":"pone.0333699.ref006","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1111\/dmcn.13557","article-title":"Children with neurodevelopmental disorders and disabilities: a population-based study of healthcare service utilization using administrative data","volume":"59","author":"RG Arim","year":"2017","journal-title":"Dev Med Child Neurol"},{"key":"pone.0333699.ref007","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ridd.2017.04.004","article-title":"Employment and choice-making for adults with intellectual disability, autism, and down syndrome","volume":"65","author":"KL Bush","year":"2017","journal-title":"Res Dev Disabil"},{"key":"pone.0333699.ref008","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2018010","article-title":"Socioeconomic disparities and difficulties to access to healthcare services among Canadian children with neurodevelopmental disorders and disabilities","volume":"40","author":"S Raouafi","year":"2018","journal-title":"Epidemiol Health"},{"key":"pone.0333699.ref009","volume-title":"2016 Census of Canada: Aboriginal People","author":"Office of Statistics and Information - Demography","year":"2017"},{"issue":"4","key":"pone.0333699.ref010","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1177\/1087054705284246","article-title":"ADHD characteristics in Canadian Aboriginal children","volume":"9","author":"L Baydala","year":"2006","journal-title":"J Atten Disord"},{"issue":"4","key":"pone.0333699.ref011","first-page":"125","article-title":"Autism spectrum disorders, maternal characteristics and obstetric complications among singletons born in Alberta, Canada","volume":"30","author":"I Burstyn","year":"2010","journal-title":"Chronic Dis Can"},{"issue":"5","key":"pone.0333699.ref012","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1111\/dmcn.14776","article-title":"Cerebral palsy in Canadian Indigenous children","volume":"63","author":"Canadian Cerebral Palsy Registry","year":"2021","journal-title":"Dev Med Child Neurol"},{"key":"pone.0333699.ref013","volume-title":"M\u00e9tis Perspectives on Disability Research and the United Nations Convention on the Rights of Persons with Disabilities","author":"M\u00e9tis National Council","year":"2025"},{"key":"pone.0333699.ref014","doi-asserted-by":"crossref","first-page":"2451","DOI":"10.2147\/NDT.S439450","article-title":"Frozen in Time, a Focused Review of Autism Prevalence in Canadian Indigenous Communities","volume":"19","author":"Y Hus","year":"2023","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"11","key":"pone.0333699.ref015","doi-asserted-by":"crossref","first-page":"6455","DOI":"10.3390\/ijerph19116455","article-title":"Canada\u2019s Colonial Genocide of Indigenous Peoples: A Review of the Psychosocial and Neurobiological Processes Linking Trauma and Intergenerational Outcomes","volume":"19","author":"K Matheson","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"7","key":"pone.0333699.ref016","first-page":"381","article-title":"Social determinants of health and the future well-being of Aboriginal children in Canada","volume":"17","author":"ML Greenwood","year":"2012","journal-title":"Paediatr Child Health"},{"issue":"2","key":"pone.0333699.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15353\/cjds.v11i2.886","article-title":"Autism and autism services with Indigenous families and children in the settler-colonial context of Canada: A critical scoping review","volume":"11","author":"AJ Gerlach","year":"2022","journal-title":"Can J Disabil Stud"},{"issue":"3","key":"pone.0333699.ref018","first-page":"406","article-title":"Systematic Review and Meta-Analysis: Prevalence of Neurodevelopmental Disorders Among Indigenous Children","volume":"3","author":"SC Lau","year":"2024","journal-title":"JAACAP Open"},{"key":"pone.0333699.ref019","volume-title":"Focus on Geography Series, 2021 Census - Alberta","author":"Statistics Canada","year":"2022"},{"key":"pone.0333699.ref020","unstructured":"Statistics Canada. The Daily \u2014 Indigenous population continues to grow and is much younger than the non-Indigenous population, although the pace of growth has slowed. 2022. https:\/\/www150.statcan.gc.ca\/n1\/daily-quotidien\/220921\/dq220921a-eng.htm"},{"issue":"9","key":"pone.0333699.ref021","doi-asserted-by":"crossref","first-page":"103044","DOI":"10.1016\/j.jogc.2025.103044","article-title":"Ehawawisit: Sociodemographic and Clinical Characteristics and Perinatal Outcomes of M\u00e9tis Pregnancies in Alberta, Canada","volume":"47","author":"MB Ospina","year":"2025","journal-title":"J Obstet Gynaecol Can"},{"key":"pone.0333699.ref022","unstructured":"Statistics Canada. An update on the socio-economic gaps between Indigenous Peoples and the non-Indigenous population in Canada: Highlights from the 2021 Census. 2023. https:\/\/www.sac-isc.gc.ca\/eng\/1690909773300\/1690909797208"},{"key":"pone.0333699.ref023","unstructured":"Statistics Canada. Indigenous identity population by gender and age: Canada, provinces and territories, census metropolitan areas and census agglomerations. 2023. https:\/\/open.canada.ca\/data\/en\/dataset\/46f1d5c9-0df8-45e9-b4a1-1e7da28b1560\/resource\/eb73f790-8b55-4804-b05a-6c3dc5e301f8"},{"key":"pone.0333699.ref024","volume-title":"The Canadian enhancement of ICD-10","author":"Canadian Institute for Health Information","year":"2001"},{"key":"pone.0333699.ref025","volume-title":"Canadian Classification of Health Interventions - Tabular List","author":"Canadian Institute for Health Information","year":"2012"},{"key":"pone.0333699.ref026","volume-title":"International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision","author":"World Health Organization","year":"1979"},{"issue":"3","key":"pone.0333699.ref027","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/jomf.12021","article-title":"Profiles of Risk: Maternal Health, Socioeconomic Status, and Child Health","volume":"75","author":"JH Hardie","year":"2013","journal-title":"J Marriage Fam"},{"issue":"1","key":"pone.0333699.ref028","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3390\/toxics3010089","article-title":"Multifactorial Origin of Neurodevelopmental Disorders: Approaches to Understanding Complex Etiologies","volume":"3","author":"A De Felice","year":"2015","journal-title":"Toxics"},{"key":"pone.0333699.ref029","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1471-2393-9-14","article-title":"Association of Apgar score at five minutes with long-term neurologic disability and cognitive function in a prevalence study of Danish conscripts","volume":"9","author":"V Ehrenstein","year":"2009","journal-title":"BMC Pregnancy Childbirth"},{"issue":"3","key":"pone.0333699.ref030","doi-asserted-by":"crossref","first-page":"104","DOI":"10.3390\/genes8030104","article-title":"The Epigenetic Link between Prenatal Adverse Environments and Neurodevelopmental Disorders","volume":"8","author":"M Kundakovic","year":"2017","journal-title":"Genes (Basel)"},{"key":"pone.0333699.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/j.jpeds.2021.06.004","article-title":"Long-Term Neurodevelopmental Outcomes after Moderate and Late Preterm Birth: A Systematic Review","volume":"237","author":"L Fern\u00e1ndez de Gamarra-Oca","year":"2021","journal-title":"J Pediatr"},{"issue":"2","key":"pone.0333699.ref032","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1086\/660885","article-title":"The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment","volume":"5","author":"GL Wehby","year":"2011","journal-title":"J Hum Cap"},{"issue":"8","key":"pone.0333699.ref033","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.10236","article-title":"Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric Disorders in the Offspring: A Systematic Review and Meta-analysis","volume":"2","author":"T Zhang","year":"2019","journal-title":"JAMA Netw Open"},{"key":"pone.0333699.ref034","volume-title":"Perinatal health indicators for Canada 2013: A report of the Canadian Perinatal Surveillance System","author":"Public Health Agency of Canada","year":"2013"},{"issue":"1","key":"pone.0333699.ref035","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1186\/s12884-020-2822-5","article-title":"Systematic review of the measurement properties of indices of prenatal care utilization","volume":"20","author":"S Rowe","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0333699.ref036","unstructured":"Alberta Health Services, Alberta Health. 2018. https:\/\/open.alberta.ca\/dataset\/a14b50c9-94b2-4024-8ee5-c13fb70abb4a\/resource\/70fd0f2c-5a7c-45a3-bdaa-e1b4f4c5d9a4\/download\/Official-Standard-Geographic-Area-Document.pdf"},{"key":"pone.0333699.ref037","article-title":"An area-based material and social deprivation index for public health in Qu\u00e9bec and Canada","volume":"103","author":"R Pampalon","year":"2012","journal-title":"Can J Public Health"},{"issue":"2","key":"pone.0333699.ref038","doi-asserted-by":"crossref","DOI":"10.1542\/peds.108.2.e35","article-title":"A new and improved population-based Canadian reference for birth weight for gestational age","volume":"108","author":"MS Kramer","year":"2001","journal-title":"Pediatrics"},{"issue":"5","key":"pone.0333699.ref039","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1197\/jamia.M2716","article-title":"Protecting privacy using k-anonymity","volume":"15","author":"K El Emam","year":"2008","journal-title":"J Am Med Inform Assoc"},{"issue":"4","key":"pone.0333699.ref040","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1080\/00031305.2024.2350445","article-title":"Binomial confidence intervals for rare events: Importance of defining margin of error relative to magnitude of proportion","volume":"78","author":"O McGrath","year":"2024","journal-title":"Am Statist"},{"issue":"10","key":"pone.0333699.ref041","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"EI Benchimol","year":"2015","journal-title":"PLoS Med"},{"issue":"1","key":"pone.0333699.ref042","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s12874-019-0815-8","article-title":"Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement","volume":"19","author":"T Huria","year":"2019","journal-title":"BMC Med Res Methodol"},{"key":"pone.0333699.ref043","unstructured":"National Aboriginal Health Organization M\u00e9tis Centre. Principles of Ethical M\u00e9tis Research. 2017. https:\/\/achh.ca\/wp-content\/uploads\/2018\/07\/Guide_Ethics_NAHOMetisCentre.pdf"},{"key":"pone.0333699.ref044","volume-title":"Indigenous People with Disabilities in Canada: First Nations People Living Off Reserve, M\u00e9tis and Inuit Aged 15 Years and Older","author":"Statistics Canada","year":"n.d"},{"issue":"8","key":"pone.0333699.ref045","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1080\/09687599.2014.923750","article-title":"Under-detection of autism among First Nations children in British Columbia, Canada","volume":"29","author":"A Lindblom","year":"2014","journal-title":"Disabil Soc"},{"issue":"7","key":"pone.0333699.ref046","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1177\/13623613211018649","article-title":"M\u0101ori and autism: A scoping review","volume":"25","author":"J Tupou","year":"2021","journal-title":"Autism"},{"issue":"5","key":"pone.0333699.ref047","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1177\/1362361319894829","article-title":"Indigenous Australians with autism: A scoping review","volume":"24","author":"B Bailey","year":"2020","journal-title":"Autism"},{"issue":"3","key":"pone.0333699.ref048","doi-asserted-by":"crossref","DOI":"10.1111\/nin.12237","article-title":"Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives","volume":"25","author":"T Horrill","year":"2018","journal-title":"Nurs Inq"},{"issue":"3","key":"pone.0333699.ref049","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1111\/j.1741-1130.2006.00076.x","article-title":"Prevalence of pervasive developmental disorders in two Canadian provinces","volume":"3","author":"H Ouellette-Kuntz","year":"2006","journal-title":"J Policy Pract Intellect Disabil"},{"issue":"52","key":"pone.0333699.ref050","doi-asserted-by":"crossref","first-page":"7623","DOI":"10.1016\/j.vaccine.2019.05.027","article-title":"Neurodevelopmental delay: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data","volume":"37","author":"AN Villagomez","year":"2019","journal-title":"Vaccine"},{"issue":"1","key":"pone.0333699.ref051","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3233\/SJI-150864","article-title":"Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for indigenous populations in Canada","volume":"31","author":"J Smylie","year":"2015","journal-title":"Stat J IAOS"},{"issue":"12","key":"pone.0333699.ref052","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1016\/j.jogc.2019.02.126","article-title":"Maternal Area of Residence, Socioeconomic Status, and Risk of Adverse Maternal and Birth Outcomes in Adolescent Mothers","volume":"41","author":"S Amjad","year":"2019","journal-title":"J Obstet Gynaecol Can"},{"issue":"9683","key":"pone.0333699.ref053","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S0140-6736(09)60827-8","article-title":"Indigenous health part 2: the underlying causes of the health gap","volume":"374","author":"M King","year":"2009","journal-title":"Lancet"},{"issue":"1","key":"pone.0333699.ref054","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1097\/DBP.0000000000000002","article-title":"Disparities in Canadian indigenous health research on neurodevelopmental disorders","volume":"35","author":"NC Di Pietro","year":"2014","journal-title":"J Dev Behav Pediatr"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333699","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T17:25:01Z","timestamp":1759512301000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333699"}},"subtitle":[],"editor":[{"given":"Shivanand","family":"Kattimani,","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":54,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333699","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]}}}