title: Missed opportunities: childhood learning disabilities as early indicators of risk among homeless adults with mental illness in Vancouver, British Columbia.
abstract: OBJECTIVE
  It is well documented that early-learning problems and poor academic achievement adversely impact child development and a wide range of adult outcomes; however, these indicators have received scant attention among homeless adults. This study examines self-reported learning disabilities (LD) in childhood as predictors of duration of homelessness, mental and substance use disorders, physical health, and service utilisation in a sample of homeless adults with current mental illness.
  
  
  METHODS
  This study was conducted using the baseline sample from a randomised controlled trial (RCT).
  
  
  METHODS
  Participants were sampled from the community in Vancouver, British Columbia.
  
  
  METHODS
  The total sample included 497 adult participants who met criteria for absolute homelessness or precarious housing and a current mental disorder based on a structured diagnostic interview. Learning disabilities in childhood were assessed by asking adult participants whether they thought they had an LD in childhood and if anyone had told them they had an LD. Only participants who responded positively to both questions (n=133) were included in the analyses.
  
  
  METHODS
  Primary outcomes include current mental disorders, substance use disorders, physical health, service utilisation and duration of homelessness.
  
  
  RESULTS
  In multivariable regression models, self-reported LD during childhood independently predicted self-reported educational attainment and lifetime duration of homelessness as well as a range of mental health, physical health and substance use problems, but did not predict reported health or justice service utilisation.
  
  
  CONCLUSIONS
  Childhood learning problems are overrepresented among homeless adults with complex comorbidities and long histories of homelessness. Our findings are consistent with a growing body of literature indicating that adverse childhood events are potent risk factors for a number of adult health and psychiatric problems, including substance abuse.   TRIALS REGISTRATION NUMBER:  This trial has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Michelle Louise
authors.initials: ML
authors.lastname: Patterson
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.forename: Charles James
authors.initials: CJ
authors.lastname: Frankish
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers