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Aitken M, Plamondon A, Krzeczkowski J, Kil H, Andrade BF. Systematic Integration of Multi-Informant Externalizing Ratings in Clinical Settings. Res Child Adolesc Psychopathol 2024; 52:635-644. [PMID: 37787879 DOI: 10.1007/s10802-023-01119-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 10/04/2023]
Abstract
Best practice clinical assessment of externalizing problems often necessitates collection of information from parents, youth themselves, and teachers. The present study tested the predictive validity of a psychometrically-driven scoring procedure to integrate multi-informant, dimensional ratings of externalizing problems. Participants were 2264 clinic-referred youth ages 6-18. Parents, teachers, and youth completed questionnaire ratings of externalizing problems (hyperactivity-inattention, conduct problems, and oppositionality-defiance) prior to an initial clinical appointment. The predictive validity of simple (highest informant rating; and all informant ratings separately) and more complex (latent S-1 bifactor model with specific informant factors; and moderated nonlinear factor analysis accounting for child age and sex) methods of informant integration was tested in predicting impairment, comorbidity, and number of clinical encounters. A simple model, in which all informant ratings were included, showed the best predictive validity across outcomes, performing as well or better than the use of the highest informant ratings or more complex latent variable models. The addition of child age and sex as moderators in the factor model did not improve predictive validity. Each informant (parent, teacher, and youth) contributes important information to the prediction of clinically-relevant outcomes. There is insufficient evidence at present to suggest that complex latent variable models should be favored over simpler models that preserve each informant's ratings.
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Affiliation(s)
- Madison Aitken
- Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Department of Psychology, York University, Toronto, Canada.
| | - André Plamondon
- Département des Fondements et Pratiques en Éducation, Université Laval, Québec, Canada
| | - John Krzeczkowski
- Department of Health Sciences, Brock University, Saint Catherine's, Canada
| | - Hali Kil
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Brendan F Andrade
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Higgins B, Jones L, Devraj K, Kilduff C, Moosajee M. 'It would help people to help me': Acceptability of digital phenotyping among young people with visual impairment and their families. Digit Health 2024; 10:20552076231220804. [PMID: 38188864 PMCID: PMC10771050 DOI: 10.1177/20552076231220804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives To explore the acceptability of an eHealth App for vision-related monitoring and symptom reporting among young people with a visual impairment and their parents. Methods Qualitative investigation using virtual semi-structured focus groups (via Zoom software) of seven young participants with a genetic eye disorder including inherited retinal disease and structural eye abnormalities (e.g. microphthalmia), and 7 parents; all recruited from ocular genetic clinics at Moorfields Eye Hospital. Audio transcripts were analysed using thematic analysis. Results Data were coded into six key themes: (1) increased involvement in care, (2) opportunity for less hospital-centric care, (3) better representation of visual impairment in a real-world setting, (4) trust in a reputable service provider, (5) harnessing data for health purposes and (6) intended purpose of the app. Both young people and their families were accepting of an eHealth app and felt they would be empowered by greater involvement in their care plan, if privacy of the data was retained, and information was managed correctly. While parents endorsed the opportunity for mental health tracking, young people were hesitant towards its inclusion. Conclusion In summary, there was overall acceptability of an eHealth app among young people with a visual impairment and their parents. These findings will help to maximise the effective integration of digital phenotyping when monitoring and supporting young people experiencing sight loss.
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Affiliation(s)
- Bethany Higgins
- Institute of Ophthalmology, University College London, London, UK
- Division of Optometry and Vision Sciences, City, University of London, London, UK
| | - Lee Jones
- Institute of Ophthalmology, University College London, London, UK
- Research Directorate, BRAVO VICTOR, London, UK
| | - Kishan Devraj
- Institute of Ophthalmology, University College London, London, UK
| | | | - Mariya Moosajee
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- The Francis Crick Institute, London, UK
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3
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Bazier A, O'Laughlin L, Feinstein J. Parent attributions and attention deficit/hyperactivity disorder knowledge as predictors of specific help-seeking interests. Clin Child Psychol Psychiatry 2024; 29:353-367. [PMID: 37923559 DOI: 10.1177/13591045231205972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Many children diagnosed with attention deficit/hyperactivity disorder (ADHD) do not receive appropriate services following diagnosis. Although information about ADHD is widely available and abundant, sometimes conflicting information may impede parent help-seeking. The present study examined parent knowledge of ADHD and attributions of child behavior as predictors of interest in formal and informal help seeking at the point of child evaluation for possible ADHD. Participants (89 caregivers of children ages 5-12) completed a measure of ADHD knowledge, rated attributions of child behavior in response to vignettes depicting ADHD symptoms, and indicated their interest in a range of formal and informal services that could be recommended following the child's evaluation. Parents reported strongest interest in academic services followed by medication, child focused therapy, and informal services (e.g., seeking information about ADHD). Family income, ADHD knowledge and attributions that child behavior will persist over time were associated with all types of help-seeking interest except academic services. Perceptions of child control over behavior predicted greater interest in medication. Findings suggest that increasing parent knowledge of ADHD and exploring parent goals and preferences for treatment may increase service utilization for children following assessment/diagnosis of ADHD.
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Affiliation(s)
- Ashley Bazier
- Department of Psychiatry, IU School of Medicine, Indianapolis, IN, USA
- Psychology Department, Indiana State University, Terre Haute, IN, USA
| | - Liz O'Laughlin
- Psychology Department, Indiana State University, Terre Haute, IN, USA
| | - Jessica Feinstein
- Psychology Department, Indiana State University, Terre Haute, IN, USA
- Akron Children's Hospital, Akron, OH, USA
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Levine RS, Smith K, Wagner NJ. The Impact of Callous-Unemotional Traits on Achievement, Behaviors, and Relationships in School: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:1546-1566. [PMID: 35438469 DOI: 10.1007/s10578-022-01344-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/16/2022] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
Abstract
Disruptive behavior disorders (DBDs) are associated with significant academic, behavioral, and relationship challenges in the school setting. Children with co-occurring DBDs and callous-unemotional (CU) traits show a distinct pattern of early starting, chronic, and aggressive disruptive behavior and are resistant to traditional DBD interventions. There is growing evidence that CU traits have important consequences for children's school functioning. The purpose of this systematic review is to synthesize research on CU traits in school with a focus on academics, relationships, and behavior. We searched PsycINFO, PubMed, and Education Full-Text to identify 37 empirical studies that met inclusionary criteria. Findings suggest that CU traits are associated with poor academic performance, high levels of aggression and conduct problems, and difficulty forming relationships at school, often above and beyond the impact of DBDs alone. Findings and future directions are discussed including how the current study can support key stakeholders in promoting the success of students with elevated CU traits.
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Affiliation(s)
- Rebecca S Levine
- Education Studies, University of California, San Diego, La Jolla, Oakland, California, USA
| | - Kelly Smith
- Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, Massachusetts, USA
| | - Nicholas J Wagner
- Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, Massachusetts, USA.
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Jackson ST, Jaeger AJ, Del Vecchio T. Predictors of help-seeking behavior in mothers of preschoolers. Clin Child Psychol Psychiatry 2023; 28:1495-1508. [PMID: 36876474 DOI: 10.1177/13591045231160644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Mental health difficulties in the preschool years require early intervention, but preschool children are underserved in mental healthcare. One explanation might be that parents do not seek services because their problem recognition, or labeling, ability is lacking. While previous research demonstrates that labeling is positively associated with help-seeking, interventions aimed at improving help-seeking by improving labeling are not always successful. Parental perceptions of severity, impairment, and stress also predict help-seeking, but have not been examined alongside labeling. Thus, it is unclear how much they add to the parental help-seeking process. The present study simultaneously examined labeling and parental perceptions of severity, impairment, and stress on help-seeking. Participants (82 adult mothers of children ages 3-5 years) read vignettes describing preschool-aged children with symptoms of depression, anxiety, and ADHD, and answered a series of questions to assess their labeling and likelihood of help-seeking for each of the problems presented. Help-seeking was found to be positively associated with labeling (r = .73; r = .60), severity (r = .66), impairment (r = .31), and stress (r = .25). Furthermore, severity, impairment, and stress predicted endorsements of help-seeking above and beyond what was predicted by labeling alone (R2 change = .12; χ2 (3) = 20.03, p < .01). These results underscore the importance of parental perceptions of children's behavior to the help-seeking process.
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Arpin E, de Oliveira C, Siddiqi A, Laporte A. Beyond the mean: Distributional differences in earnings and mental health in young adulthood by childhood health histories. SSM Popul Health 2023; 23:101451. [PMID: 37434657 PMCID: PMC10331842 DOI: 10.1016/j.ssmph.2023.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Research on the long-term effects of health in early life has predominantly relied on parametric methods to assess differences between groups of children. However, this approach leaves a wealth of distributional information untapped. The objective of this study was to assess distributional differences in earnings and mental health in young adulthood between individuals who suffered a chronic illness in childhood compared to those who did not using the non-parametric relative distributions framework. Using data from the Panel Study of Income Dynamics, we find that young adults who suffered a chronic illness in childhood fare worse in terms of earnings and mental health scores in adulthood, particularly for individuals reporting a childhood mental health/developmental disorder. Covariate decompositions suggest that chronic conditions in childhood may indirectly affect later outcomes through educational attainment: had the two groups had similar levels of educational attainment, the proportion of individuals with a report of a chronic condition in childhood in the lower decile of the relative earnings distribution would have been reduced by about 20 percentage points. Findings may inform policy aimed at mitigating longer run effects of health conditions in childhood and may generate hypotheses to be explored in parametric analyses.
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Affiliation(s)
- Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON, M5T 3M6, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
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Arpin E, de Oliveira C, Siddiqi A, Laporte A. The "Long-arm" of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data. Econ Hum Biol 2023; 50:101257. [PMID: 37348288 DOI: 10.1016/j.ehb.2023.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 06/24/2023]
Abstract
The objective of this study was to investigate the relationship between health conditions in childhood (ages 4-11), and health and socioeconomic outcomes in adulthood (ages 21-33). This study takes advantage of a new linkage between the National Longitudinal Survey of Children and Youth (NLSCY) and administrative tax data from the T1 Family File (T1FF) from Statistics Canada. The NLSCY includes rich longitudinal information on child development, while the T1FF includes administrative tax information on each child in adulthood (e.g., income, social assistance). The primary measures of child health relate to the diagnosis of a chronic condition, affecting the child's physical or mental/developmental health. The results suggest that mental/developmental health conditions in childhood more negatively influence adult health and socioeconomic conditions, compared to physical health conditions. Interaction models reveal modest heterogenous effects; for example, there is some evidence of a cushioning effect from higher household income in childhood, as well as an exacerbating negative effect from lower birth weight for mental/developmental health conditions. Using a covariate decomposition approach to explore underlying pathways, the results reveal that associations between health in early life and outcomes in adulthood are partially explained by differences in cognitive skills (i.e., mathematics test scores) in adolescence (ages 16-17). Results may encourage policy investments to mitigate the occurrence of health conditions in childhood and to ensure timely access to educational supports and health services for children with chronic conditions.
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Affiliation(s)
- Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada.
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON M6J 1H4, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON M5T 3M6, Canada; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada
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8
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Studts CR, Jacobs JA, Bush ML, Lowman J, Westgate PM, Creel LM. Behavioral Parent Training for Families With Young Deaf or Hard of Hearing Children Followed in Hearing Health Care. J Speech Lang Hear Res 2022; 65:3646-3660. [PMID: 35985319 PMCID: PMC9802658 DOI: 10.1044/2022_jslhr-22-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE It is well established that individuals with a communication disability, including being deaf or hard of hearing (DHH), experience inequities in health services and outcomes. These inequities extend to DHH children's access to psychosocial evidence-based interventions (EBIs). Behavioral parent training is an EBI that can be used to improve caregiver and child outcomes. Despite being supported by decades of effectiveness research, this EBI is rarely accessed by, or studied with, caregivers of DHH children. The purpose of this article is to describe a program of stakeholder-engaged research adapting and assessing behavioral parent training with caregivers of young DHH children followed in hearing health care, aimed at reducing inequities in access to this EBI. METHOD The first section briefly summarizes the literature on disruptive behavior problems in young children, with a focus on preschool-age DHH children. The evidence base for behavioral parent training is described. Next, the gaps in knowledge and practice regarding disruptive behaviors among DHH children are highlighted, and the potential integration of behavioral parent training into the standard of care for this population is proposed. CONCLUSIONS Young DHH children who use hearing aids and/or cochlear implants experience disruptive behavior problems at rates at least as high as typically hearing children, but their access to EBIs is limited, and behavioral parent training programs tailored to this population have not been rigorously tested. Caregivers and hearing health care service providers affirm the potential benefits of behavioral parent training and were partners in adapting this EBI. This research highlights several principles and approaches essential for reducing inequities and improving the quality of life not only for DHH children and their families but also for individuals with communication disabilities more broadly: engagement of key stakeholders in research, collaboration across disciplines, and using implementation science methods and models to design for implementation, dissemination, and sustainment. Presentation Video: https://doi.org/10.23641/asha.21215900.
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Affiliation(s)
- Christina R. Studts
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora
| | - Julie A. Jacobs
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Matthew L. Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington
| | - Joneen Lowman
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | | | - Liza M. Creel
- Department of Health Management and Systems Sciences, University of Louisville, KY
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Abstract
OBJECTIVE Many children at risk for negative outcomes related to untreated attention deficit hyperactivity disorder (ADHD) do not receive necessary mental healthcare. Parents' mental health-seeking behavior is important in the early identification of ADHD and preventing comorbidities with ADHD. Parents may experience some barriers that may delay or stop parents from seeking mental healthcare for their children. METHOD This systematic review summarized existing evidence of parents' barriers to seeking mental healthcare for their children at risk of ADHD. RESULTS This review included 21 studies that address different parental barriers under the three levels of the social-ecological model, including individual, interpersonal, and community levels. CONCLUSION Raising parents' awareness of the process of seeking mental healthcare has the potential to help identify children at risk for ADHD earlier. Developing psychoeducational intervention that improves parents' seeking behavior and reduces barriers toward seeking mental healthcare is needed.
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Luo J, Raat H, Franse CB, Bannink R, Bai G, van Grieken A. Correlates of help-seeking by parents for the socioemotional development of their 3-year-old children: a longitudinal study. BMJ Open 2022; 12:e052595. [PMID: 35017243 PMCID: PMC8753387 DOI: 10.1136/bmjopen-2021-052595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Timely parental help-seeking regarding their child's socioemotional development is associated with a lower rate and lower severity of psychosocial problems in later life. This study aimed to examine the correlates of parental help-seeking for the socio-emotional development of 3-year-old children. DESIGN Retrospective cohort study. SETTING Community-based survey in Rotterdam. PARTICIPANTS Of 2305 parents and their 2-year-old children at baseline, 1507 who completed follow-up questionnaires were included in the analyses when children were 3 years old. OUTCOME MEASURES Parental help-seeking regarding their child's socioemotional development and types of formal and informal help sources (eg, general practitioner, internet) used in the past 12 months were measured. Hierarchical logistic regression models were applied to identify factors correlates of parental help-seeking among 13 predisposing, enabling and need factors according to Andersen's behavioural model. RESULTS In total, 22.6% of parents reported help-seeking in the past 12 months for socioemotional development of their 3-year-old child; 6.8% addressed formal help sources and 17.5% addressed informal help sources. General practitioner (2.7%) and family (12.5%) were the most frequently used formal and informal sources, respectively. In the full model, predisposing factors associated with higher odds of parental help-seeking were child's other western ethnic background (OR=1.66, 95% CI 1.02 to 2.68) and parental age ≤29 years old (OR=1.71, 95% CI 1.01 to 2.92). No associated factors were found among enabling factors. The need factors associated with higher odds of parental help-seeking were having previous help-seeking (OR=2.52, 95% CI 1.83 to 3.48) and discussing child's socioemotional development in the well-child visit (OR=2.47, 95% CI 1.73 to 3.53). CONCLUSIONS Predisposing and need factors were associated with parental help-seeking for socioemotional development of 3-year-old children. The findings can be used to further develop support for parents accessing adequate information, prevention and anticipatory care with regards to the child's socio-emotional development.
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Affiliation(s)
- Jie Luo
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carmen Betsy Franse
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Guannan Bai
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Amy van Grieken
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Duarte CS, Lovero KL, Sourander A, Ribeiro WS, Bordin IAS. The Child Mental Health Treatment Gap in an Urban Low-Income Setting: Multisectoral Service Use and Correlates. Psychiatr Serv 2022; 73:32-38. [PMID: 34106744 DOI: 10.1176/appi.ps.202000742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To efficiently target capacity-building efforts for child mental health services in low- and middle-income countries (LMICs), it is critical to define how care is structured across sectors and individual-level factors. METHODS In a community-based sample of 1,408 children and adolescents (ages 6-15 years) from Itaboraí, Brazil, the authors assessed need and service use across four care systems (mental health specialty, health, welfare, and informal). Individual-level factors included child gender and age, maternal perception of child mental health need, paternal absence, maternal education, and maternal anxiety and depression. RESULTS The mental health treatment gap was 88%, with only 12% of children with psychiatric problems using mental health services. Children with mental health problems were more likely than those without these problems to use health and other sectors of care and to use services in more than one sector of care. Overall, 46% of the children with any clinical mental health problems and 31% of those with only internalizing problems were identified by their mothers as having a mental health need. Among those with clinical mental health problems, factors associated with mental health service use were being a boy and paternal absence but not mental health problem type or maternal awareness. CONCLUSIONS Closing the child mental health treatment gap in urban settings in LMICs where resources are scarce will likely require system-level changes, such as engagement of diverse service sectors of care. Interventions need to target increased maternal awareness about mental health problems and encourage provision of mental health services to girls.
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Affiliation(s)
- Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Kathryn L Lovero
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Andre Sourander
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Wagner S Ribeiro
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
| | - Isabel A S Bordin
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York City (Duarte, Lovero, Sourander); Care Policy and Evaluation Centre, London School of Economics and Political Science, London (Sourander); Department of Child Psychiatry, University of Turku, Turku, Finland (Ribeiro); Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil (Bordin)
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Sawrikar V, Diaz AM, Tully L, Hawes DJ, Moul C, Dadds MR. Bridging the gap between child mental health need and professional service utilisation: Examining the influence of mothers' parental attributions on professional help-seeking intentions. Eur Child Adolesc Psychiatry 2022; 31:239-251. [PMID: 33211203 PMCID: PMC8837521 DOI: 10.1007/s00787-020-01682-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
There is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers' attributions about their child's problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers' anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (β = .19, p = .002) but not parental self-efficacy (β = - .01, p = .865) in the general sample, while positively associated with child-responsible attributions (β = .20, p = .009) and negatively associated with parental self-efficacy (β = - .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.
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Affiliation(s)
- Vilas Sawrikar
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia. .,Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Antonio Mendoza Diaz
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia ,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Lucy Tully
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - David J. Hawes
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Caroline Moul
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Mark R. Dadds
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
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13
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Baweja R, Soutullo CA, Waxmonsky JG. Review of barriers and interventions to promote treatment engagement for pediatric attention deficit hyperactivity disorder care. World J Psychiatry 2021; 11:1206-1227. [PMID: 35070771 PMCID: PMC8717033 DOI: 10.5498/wjp.v11.i12.1206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common and impairing behavioral health disorder, impacting over 5% of children worldwide. There are multiple evidence-based pharmacological and psychosocial treatments for ADHD, and greater service utilization is associated with improved acute and long-term outcomes. However, long-term outcomes are suboptimal as multimodal treatments are often not accessed and most care ends prematurely. This narrative review discusses barriers to engagement for children and adolescents with ADHD and their families as well as interventions to overcome these barriers. Families face a variety of structural and attitudinal barriers, ranging from cost and access to stigma and low self-efficacy to successfully implement change. There are multiple interventions that may enhance engagement with ADHD care including psychoeducation, integration of behavioral services in general medical settings, telehealth as well as specific adaptations to existing ADHD treatments, such as the use of motivational interviewing or shared decision making. Integration of behavioral health into general medical settings and telehealth have been found in controlled studies to increase access by reducing both structural and attitudinal barriers. Adding motivational interviewing, shared decision making and other engagement interventions to evidence-based ADHD treatments has been found to reduce attitudinal barriers that translates into improved participation and satisfaction while enhancing outcomes. However, little is known about how to promote extended engagement with ADHD services even though a chronic care model for ADHD is recommended.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
| | - Cesar A Soutullo
- Louis A. Faillace, MD Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX 77054, United States
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA 17033, United States
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14
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Zifkin C, Montreuil M, Beauséjour MÈ, Picard S, Gendron-Cloutier L, Carnevale FA. An exploration of youth and parents' experiences of child mental health service access. Arch Psychiatr Nurs 2021; 35:549-555. [PMID: 34561072 DOI: 10.1016/j.apnu.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/12/2021] [Accepted: 06/12/2021] [Indexed: 11/28/2022]
Abstract
Youth experience an increased prevalence of mental health issues, while access to timely and quality services remains problematic. This study examined the experiences of adolescents and their parents surrounding mental health care access. A 4-month focused ethnography was conducted at a mental health clinic for adolescents experiencing difficulties with emotional regulation. Findings revealed major barriers to service access, including a lack of knowledge, information, and guidance, long wait times, and stigma. Facilitators to access included social support, having a contact person, and good rapport with healthcare providers. The study highlights the importance of timely mental health service access for adolescents and provides insights for the improvement of service accessibility.
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Affiliation(s)
- Cleo Zifkin
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada
| | - Marjorie Montreuil
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada; Douglas Hospital Research Centre, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada.
| | - Marie-Ève Beauséjour
- Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada
| | - Stéphane Picard
- Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada
| | - Lauranne Gendron-Cloutier
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada
| | - Franco A Carnevale
- Ingram School of Nursing, McGill University, 680, rue Sherbrooke Ouest, Montreal, Quebec H3A 2M7, Canada; Douglas Mental Health University Institute, 6875 boul. LaSalle, Verdun, Québec H4H 1R3, Canada; Department of Pediatrics, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada; Counselling Psychology, McGill University, Montreal, Quebec, Canada
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15
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Diaz-Stransky A, Rowley S, Zecher E, Grodberg D, Sukhodolsky DG. Tantrum Tool: Development and Open Pilot Study of Online Parent Training for Irritability and Disruptive Behavior. J Child Adolesc Psychopharmacol 2020; 30:558-566. [PMID: 33035067 PMCID: PMC7699014 DOI: 10.1089/cap.2020.0089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: Parent management training is an effective treatment for disruptive behavior disorders but it is often underutilized in clinical settings. Access to care is limited due to logistical barriers as well as limited service availability. This study examines in an open trial the acceptability, feasibility, and clinical effects of a digital parent management training intervention that includes videoconference coaching, called "Tantrum Tool." Methods: Fifteen children, ages 3-9 years, participated in an open trial of an 8-week intervention. The primary symptom measure was the Disruptive Behavior Rating Scale (DBRS), and the secondary outcome measure was the Affective Reactivity Index (ARI) completed by the primary caregiver before and after treatment. Results: Treatment retention was high (80%), and parents reported a high level of satisfaction with the program. There was a significant reduction in the mean DBRS score from 13.5 ± 5.5 at baseline to 7.3 ± 3.4 at endpoint, p < 0.001. There was also a significant reduction in the mean ARI irritability score from 7.2 ± 2.6 at baseline to 3.75 ± 2.1 at endpoint, p < 0.01. Conclusions: This open pilot study supports the feasibility and acceptability of a digital parent training program for young children with disruptive behavior. Findings provide preliminary support for a clinically meaningful reduction of both disruptive behavior and irritability. Using the Tantrum Tool to deliver online treatment for children could increase access to first-line treatments for disruptive behavior and irritability in young children. ClinicalTrials.gov: NCT03697837.
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Affiliation(s)
- Andrea Diaz-Stransky
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.,Address correspondence to: Andrea Diaz-Stransky, MD, Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Sonia Rowley
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eitan Zecher
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Grodberg
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Denis G. Sukhodolsky
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.,Denis G. Sukhodolsky, PhD, Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06519, USA
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16
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Wallisch A, Little L, Dean E, Dunn W. Parent concerns: Differentiating developmental diagnoses in young children. Res Dev Disabil 2020; 103:103684. [PMID: 32454302 DOI: 10.1016/j.ridd.2020.103684] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Screening guidelines recommend listening closely to parent concerns to aid in the identification of children with disabilities, since parent concerns may be predictive of an eventual child diagnosis. METHODS We performed a secondary analysis to examine the extent to which specific parent concerns differentiated six diagnostic categories (i.e., ASD, ASD + ADHD, Disruptive Impulse-Control and Conduct Disorder, developmental delays, and speech and language disorders) among 503 children 36-72 months of age. Data was drawn for a large diagnostic center in the Midwest. RESULTS We performed multinomial logistic regression with parent concerns differentiating six diagnostic categories. Results indicated that parent concerns preceding a diagnostic evaluation significantly differ among children with various diagnoses. CONCLUSION Parent concerns often aligned with core diagnostic criteria; regardless of a parent's knowledge of diagnostic criteria, their observations of child behavior are exceptionally insightful.
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Affiliation(s)
- Anna Wallisch
- University of Kansas, 444 Minnesota Avenue #300, 66101, Kansas City, KS, USA.
| | | | - Evan Dean
- University of Kansas Medical Center, Kansas City, KS, USA
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17
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Ingoglia C. When Enough is Still Not Enough. J Behav Health Serv Res 2020; 47:1-3. [DOI: 10.1007/s11414-019-09681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Johnston OG, Derella OJ, Gold MA, Burke JD. Preliminary Validation of the Parental Help-Seeking Stage of Change Measure for Child Behavior Problems. Child Youth Care Forum 2020; 49:223-46. [DOI: 10.1007/s10566-019-09525-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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