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Eapen V, Črnčec R, Pick AX, Tsao O, Lai R, Lee J, Sowman PF. Comprehensive behavioural intervention for tics: a neurophysiological intervention. J Integr Neurosci 2022; 21:89. [PMID: 35633170 DOI: 10.31083/j.jin2103089] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Gilles de la Tourette Syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by motor and vocal tics. While Comprehensive Behavioural Intervention for Tics (CBIT) is an effective, non-pharmacological treatment for patients with GTS, the underlying neurophysiological basis of this intervention has not been investigated. METHODS To investigate the clinical effectiveness of CBIT in reducing tic severity in young people with GTS and explore neurophysiological mechanisms associated with clinical change. RESULTS There was a significant overall improvement in tic severity of large effect size. The Cortical Silent Period (CSP) to motor evoked potential (MEP) ratio (CSP/MEP ratio) increased after the intervention with a small effect size. Other neurophysiological measures of inhibition were not significantly related to the change in tic severity. CONCLUSIONS Alongside significant clinical improvements, these results suggest a role for motor cortical Gamma-aminobutyric acid (GABA)-ergic inhibitory circuitry in the neurophysiological changes underlying CBIT treatment. These findings need to be replicated in larger studies using control samples.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, 2052 Sydney, Australia.,Academic Unit of Child Psychiatry, South Western Sydney Local Health District and Ingham Institute, 2170 Sydney, Australia
| | - Rudi Črnčec
- Pnerith Therapy Centre, Penrith, 2750 Sydney, Australia
| | - Anna Xenia Pick
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia
| | - Owen Tsao
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia
| | - Richard Lai
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia
| | - Janette Lee
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia.,Sydney Children's Hospital, Randwick, 2031 Sydney, Australia
| | - Paul F Sowman
- School of Psychological Sciences, Macquarie University Australia, 2113 Sydney, Australia
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Eapen V, McPherson S, Karlov L, Nicholls L, Črnčec R, Mulligan A. Social communication deficits and restricted repetitive behavior symptoms in Tourette syndrome. Neuropsychiatr Dis Treat 2019; 15:2151-2160. [PMID: 31440054 PMCID: PMC6666375 DOI: 10.2147/ndt.s210227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/27/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Autism spectrum disorders (ASD) have been found to occur more frequently in individuals with Tourette syndrome (TS) than in the general population. Similarities exist between ASD and TS clinically, which suggests a potential relationship between the two conditions. Purpose: The purpose of this study was to explore the occurrence of autism-related features in ASD and TS, focusing on areas of overlap and difference. Patients and methods: This study examined the nature and extent of autistic traits as measured by the Social Communication Questionnaire (SCQ) in a sample with a diagnosis of TS, a sample diagnosed to have ASD, and a normative general population sample. Results: The TS sample had significantly higher mean SCQ scores than the general population, but generally lower scores than the ASD sample. The group differences in mean SCQ scores between the TS and ASD sample were significant except in the domain of restricted repetitive behaviours (RRB). Conclusion: This suggests that ASD traits occur commonly in the TS population, with a significant overlap in certain clinical features. This was especially the case for complex movements or repetitive behaviours, which may represent either: i) a shared phenotype which is subclinical, ii) a phenocopy where some clinical symptoms mimic each other, or iii) a co-morbidity. Awareness of this association can be useful in identifying these symptoms as part of the comprehensive assessment of TS and addressing these to improve the overall clinical outcomes in these patients.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry , University of New South Wales, Sydney, NSW, Australia
| | - Sarah McPherson
- Medical Oncology, The Canberra Hospital, Canberra, ACT, Australia
| | - Lisa Karlov
- School of Psychiatry , University of New South Wales, Sydney, NSW, Australia
| | - Laura Nicholls
- School of Psychiatry , University of New South Wales, Sydney, NSW, Australia
| | - Rudi Črnčec
- Penrith Therapy Centre, Penrith, NSW, Australia
| | - Aisling Mulligan
- Department of Child and Adolescent Psychiatry, University College Dublin, Dublin, Ireland
- Dublin North City and County Child and Adolescent Mental Health Service, Health Services Executive, Dublin, Ireland
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Mathew NE, Burton KLO, Schierbeek A, Črnčec R, Walter A, Eapen V. Parenting preschoolers with autism: Socioeconomic influences on wellbeing and sense of competence. World J Psychiatry 2019; 9:30-46. [PMID: 30915270 PMCID: PMC6422881 DOI: 10.5498/wjp.v9.i2.30] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 05/29/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous research suggests that parents raising a child with autism experience higher levels of psychological distress than parents of typically developing children and parents of children with other developmental disorders. Little is known, however, about the intersection between the effects of socioeconomic status (SES) on the wellbeing and sense of parental competency of parents of pre-schoolers with autism and how it relates to child symptom severity.
AIM To examine the relationship between their child’s symptom severity, SES, as measured by neighbourhood advantage and occupational status, on the psychological wellbeing and perceived parenting competence among parents of preschoolers with autism.
METHODS Parents of 117 preschool-aged children with a diagnosis of autism spectrum disorder (ASD), 107 mothers and 54 fathers, completed questionnaires about their child’s symptoms of ASD and functioning, their own perceptions of their wellbeing and parental competence on entry to an early intervention program in Sydney, Australia. Parents also provided demographic information pertaining to their occupation, level of education attained and address (postcode). All children were also assessed for their severity of symptoms using the Autism Diagnostic Observation Schedule. The Australian Socioeconomic Index of occupational status as a measure of familial SES and the Index of Relative Socio-economic Advantage and Disadvantage as a measure of neighbourhood advantage were used to examine the impact of SES on parental sense of competence and wellbeing.
RESULTS Compared to normative populations, both mothers and fathers in our sample reported significantly higher levels of parenting sense of efficacy but lower levels of interest in the parenting role. Mothers also displayed higher levels of satisfaction. Both mothers and fathers displayed higher levels of depression than normative populations with mothers also reporting greater levels of stress and anxiety. Child symptom severity was associated with maternal parenting competency with these relationships amplified among mothers with higher familial SES and who lived in areas of greater neighbourhood advantage. Increased adaptive functioning was associated with better maternal wellbeing, particularly among mothers who lived in areas of greater neighbourhood advantage. Contrastingly, paternal parenting competence was generally not influenced by child adaptive functioning or symptom severity, although for those in higher familial SES brackets, children’s symptom severity and maladaptive symptoms were negatively related to paternal sense of parenting efficacy. There was a trend towards moderate relationships between lower familial SES and greater depression, stress and anxiety among fathers, but no relationship with their child’s ASD symptom severity or functioning.
CONCLUSION SES differentially impacts wellbeing and sense of parenting competence and its relationship to the impact of child symptoms for mothers and fathers of preschoolers with autism.
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Affiliation(s)
- Nisha E Mathew
- School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
| | - Karen L O Burton
- School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
| | - Anne Schierbeek
- Vrije Universiteit Amsterdam, De Boelelaan, Amsterdam 1081 HV, The Netherlands
| | - Rudi Črnčec
- School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
| | - Amelia Walter
- School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, South West Sydney Local Health District, Liverpool Hospital, ICAMHS, Mental Health Centre (Level L1), Locked Bag 7103, Liverpool NSW 1871, Australia
| | - Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney NSW 2052, Australia
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, South West Sydney Local Health District, Liverpool Hospital, ICAMHS, Mental Health Centre (Level L1), Locked Bag 7103, Liverpool NSW 1871, Australia
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Sierakowski A, Eapen V, Črnčec R, Smoleniec J. Developmental and behavioral outcomes of uncomplicated monochorionic diamniotic twins born in the third trimester. Neuropsychiatr Dis Treat 2017; 13:1373-1384. [PMID: 28579783 PMCID: PMC5449110 DOI: 10.2147/ndt.s122739] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Relatively little is known about the neurodevelopmental and behavioral outcomes of monochorionic diamniotic (MCDA) twin pregnancies where there are no antenatal complications peculiar to monochorionicity or prematurity. METHODS Twenty-two MCDA twins (44 children) with an average age of 4.3 years, and with no antenatal complications detected by 28 weeks of gestation, were recruited from a feto-maternal unit database. Parents completed a battery of neurodevelopmental and behavioral assessment questionnaires. RESULTS Eighteen children (41%) were identified as having developmental or behavioral concerns, predominantly of mild severity, which in turn were associated with a lower birth weight of medium effect size (Cohen's d=0.59). CONCLUSION MCDA twins delivered in the third trimester with no antenatal monochorionic complications in the first two trimesters appear to be at risk for subtle neurodevelopmental difficulties, associated with a lower birth weight. Ongoing developmental surveillance of these children during preschool-age is indicated for early identification and intervention.
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Affiliation(s)
| | - Valsamma Eapen
- School of Psychiatry, University of New South Wales.,Academic Unit of Infant, Child and Adolescent Psychiatry, Ingham Institute, Liverpool Hospital, South Western Sydney Local Health District
| | - Rudi Črnčec
- School of Psychiatry, University of New South Wales.,Academic Unit of Infant, Child and Adolescent Psychiatry, Ingham Institute, Liverpool Hospital, South Western Sydney Local Health District
| | - John Smoleniec
- Division of Women's and Children's Health, University of New South Wales, Sydney.,Department of Maternal-Fetal Medicine, Liverpool Hospital, Liverpool, NSW, Australia
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Woolfenden S, Eapen V, Jalaludin B, Hayen A, Kemp L, Dissanyake C, Hendry A, Axelsson E, Overs B, Eastwood J, Črnčec R, McKenzie A, Beasley D, Murphy E, Williams K. Prevalence and factors associated with parental concerns about development detected by the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort. BMJ Open 2016; 6:e012144. [PMID: 27609853 PMCID: PMC5020845 DOI: 10.1136/bmjopen-2016-012144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks; identify associated risk factors; and examine documentation of the PEDS at well-child checks. DESIGN, PARTICIPANTS A prospective birth cohort of 2025 children with 50% of those approached agreeing to participate. Demographic data were obtained via questionnaires and linked electronic medical records. Telephone interviews were conducted with parents to collect PEDS data. PRIMARY AND SECONDARY OUTCOMES Multiple logistic regression analyses identified risk factors for moderate or high developmental risk on the PEDS. A Cumulative Risk Index examined the impact of multiple risk factors on developmental risk and documentation of the PEDS at the well-child checks. RESULTS Of the original cohort, 792 (39%) had 6-month, 649 (32%) had 12-month and 565 (28%) had 18-month PEDS data. Parental concerns indicating moderate or high developmental risk on the PEDS were 27% (95% CI 24 to 30) at 6 months, 27% (95% CI 24 to 30) at 12 months and 33% (95% CI 29 to 37) at 18 months. Factors associated with moderate or high developmental risk were perinatal risk (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); maternal Middle Eastern or Asian nationality (OR 6 months: 1.6 (95% CI 1.1 to 2.4)), (OR 12 months: 1.7 (95% CI 1.1 to 2.7)); and household disadvantage (OR 6 months: 1.5 (95% CI 1.0 to 2.2). As the number of risk factors increased the odds increased for high or moderate developmental risk and no documentation of the PEDS at well-child checks. CONCLUSIONS Children with multiple risk factors are more likely to have parental concerns indicating developmental vulnerability using the PEDS and for these concerns to not be documented.
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Affiliation(s)
- Susan Woolfenden
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Epidemiology Group, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynn Kemp
- School of Nursing and Midwifery, University of Western Sydney, Penrith South DC, New South Wales, Australia
| | - Cheryl Dissanyake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, South Australia, Australia
| | - Alexandra Hendry
- Early Years Research Group, Ingham Institute, Sydney South West Local Health District, Sydney, New South Wales, Australia
| | - Emma Axelsson
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bronwyn Overs
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
| | - John Eastwood
- Community Paediatrics, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rudi Črnčec
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne McKenzie
- Sydney South West Local Health District, Australia,Sydney, New South Wales, Australia
| | - Deborah Beasley
- Office of Kids and Families (NSW Health), North Sydney, New South Wales, Australia
| | - Elisabeth Murphy
- Office of Kids and Families (NSW Health), North Sydney, New South Wales, Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, South Australia, Australia
- Developmental Medicine, Royal Children's Hospital, Melbourne, South Australia, Australia
- Murdoch Children's Research Institute, Melbourne, South Australia, Australia
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Hakeem A, Črnčec R, Asghari-Fard M, Harte F, Eapen V. Development and validation of a measure for assessing gender dysphoria in adults: The Gender Preoccupation and Stability Questionnaire. Int J Transgend 2016. [DOI: 10.1080/15532739.2016.1217812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Woolfenden S, Eapen V, Axelsson E, Hendry A, Jalaludin B, Dissanayake C, Overs B, Descallar J, Eastwood J, Einfeld S, Silove N, Short K, Beasley D, Črnčec R, Murphy E, Williams K. Who is our cohort: recruitment, representativeness, baseline risk and retention in the "Watch Me Grow" study? BMC Pediatr 2016; 16:46. [PMID: 27013220 PMCID: PMC4806415 DOI: 10.1186/s12887-016-0582-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/14/2014] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background The “Watch Me Grow” (WMG) study examines the current developmental surveillance system in South West Sydney. This paper describes the establishment of the study birth cohort, including the recruitment processes, representativeness, follow-up and participants’ baseline risk for future developmental risk. Methods Newborn infants and their parents were recruited from two public hospital postnatal wards and through child health nurses during the years 2011–2013. Data was obtained through a detailed participant questionnaire and linked with the participant’s electronic medical record (EMR). Representativeness was determined by Chi-square analyses of the available clinical, psychosocial and sociodemographic EMR data, comparing the WMG participants to eligible non-participants. Reasons for non-participation were also elicited. Participant characteristics were examined in six, 12, and 18-month follow-ups. Results The number of infants recruited totalled 2,025, with 50 % of those approached agreeing to participate. Reasons for parents not participating included: lack of interest, being too busy, having plans to relocate, language barriers, participation in other research projects, and privacy concerns. The WMG cohort was broadly representative of the culturally diverse and socially disadvantaged local population from which it was sampled. Of the original 2025 participants enrolled at birth, participants with PEDS outcome data available at follow-up were: 792 (39 %) at six months, 649 (32 %) at 12 months, and 565 (28 %) at 18 months. Participants with greater psychosocial risk were less likely to have follow-up outcome data. Almost 40 % of infants in the baseline cohort were exposed to at least two risk factors known to be associated with developmental risk. Conclusions The WMG study birth cohort is a valuable resource for health services due to the inclusion of participants from vulnerable populations, despite there being challenges in being able to actively follow-up this population.
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Affiliation(s)
- Susan Woolfenden
- Sydney Children's Hospitals Network, Sydney, Australia. .,University of New South Wales, Sydney, Australia.
| | - Valsamma Eapen
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, Australia.,School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Emma Axelsson
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, Australia.,School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Alexandra Hendry
- Early Years Research Group, Ingham Institute, Sydney South West Local Health District, Sydney, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,Epidemiology Group, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Bronwyn Overs
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, Australia.,School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,Community Paediatrics, South Western Sydney Local Health District, Sydney, Australia
| | - Stewart Einfeld
- Centre for Disability Research and Policy, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Natalie Silove
- Sydney Children's Hospitals Network, Sydney, Australia.,School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Kate Short
- University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia.,Speech Pathology Unit, Liverpool Hospital, Sydney, Australia
| | | | - Rudi Črnčec
- Academic Unit of Child Psychiatry, South West Sydney Local Health District (AUCS), Sydney, Australia.,School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, Australia
| | | | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Sydney, Australia.,Developmental Medicine, Royal Children's Hospital, Sydney, Australia.,Murdoch Children's Research Institute, Sydney, Australia
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Abstract
OBJECTIVE Tourette syndrome is often associated with attention deficit hyperactivity disorder, obsessive compulsive disorder and other co-morbidities, the presence of which can reduce health-related quality of life. The relationship between the number and type of co-morbidities and tic severity upon health-related quality of life has been insufficiently examined in Tourette syndrome populations and not at all in the Australian context. We hypothesised that an increased number of co-morbid diagnoses would be inversely related to health-related quality of life and that the presence of attention deficit hyperactivity disorder and obsessive compulsive disorder in particular would negatively impact health-related quality of life. METHOD In all, 83 people with a previously established diagnosis of Tourette syndrome, who responded to a letter of invitation sent to the Tourette Syndrome Association of Australia past-member database, formed the study sample. Participants completed the Gilles de la Tourette Syndrome-Quality of Life Scale and a short form of the National Hospital Interview Schedule to assess tics and related behaviours. RESULTS Participants with pure-Tourette syndrome had significantly better health-related quality of life than those with Tourette syndrome and three or more co-morbid diagnoses. Few differences were observed between the pure-Tourette syndrome and Tourette syndrome and one or two co-morbid diagnoses groups. Analysis of the impact of individual co-morbid disorders and Tourette syndrome symptoms on health-related quality of life indicated that attention deficit hyperactivity disorder exerted a significant negative effect, as did the presence of complex tics, especially coprolalia and copropraxia. When these variables were examined in multiple regression analysis, number of co-morbidities and the presence of coprophenomena emerged as significant predictors of health-related quality of life. CONCLUSION While tics are the defining feature of Tourette syndrome, it appears to be the presence of co-morbidities, attention deficit hyperactivity disorder, in particular, and coprophenomena that have the greater impact on health-related quality of life. This has implications for symptom-targeting in the treatment of Tourette syndrome since all available treatments are symptomatic and not disease modifying.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS) & Ingham Institute, Liverpool, NSW, Australia
| | - Corina Snedden
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Rudi Črnčec
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS) & Ingham Institute, Liverpool, NSW, Australia
| | - Anna Pick
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Perminder Sachdev
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
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Abstract
The significant changes in DSM 5 as these relate to a number of the child psychiatric disorders are reviewed by several authors in this special issue: In this paper we address some of the changes in the conceptual organisation of DSM 5 and specifically focus on anxiety and related disorders. In the case of child and adolescent psychiatry, the most notable feature is that the chapter on Disorders Usually First Diagnosed in infancy, Childhood or Adolescence has been deleted. Instead, a new chapter in DSM 5 describes Neurodevelopmental Disorders which typically manifest early in development. Further, an expectation had been built that DSM would be based on the latest data in neuroscience and that a clear direction towards a mixed dimensional and categorical approach would be evident. This has been the case with some disorders and a notable example is the removal of Obsessive Compulsive Disorder (OCD) from the Anxiety Disorder chapter and placement with other related disorders that share similar neurobiology and treatment response. In this regard, the addition in DSM 5 of a new specifier "tic-related" to OCD is worth noting as there is emerging evidence that differential treatment response exists when tics are associated with OCD. The same situation applies to tics with ADHD, thus presenting the argument for a dimensional approach to Tic Spectrum Disorder (TSD) incorporating categories such as those with tics only, tics with OCD, tics with ADHD etc. to be given due consideration in the future. Another important change that clinicians in the field of child psychiatry will no doubt notice is the demise of the multiaxial classification. Instead, DSM 5 has moved back to a nonaxial documentation of diagnosis with separate notations for important psychosocial and contextual factors as well as level of functioning and disability. Clinicians are urged, however, to continue to recognise the need to understand how symptoms and behaviours might have arisen and assess relevant contextual factors such as the family relationships, quality of care, any history of abuse, and so on. Further, the move to harmonise DSM 5 with the structure of ICD 11 (scheduled for release in 2015) should make understanding and familiarising oneself with the two major classificatory systems easier in the future.
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Affiliation(s)
- Valsamma Eapen
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS), Liverpool Hospital, Mental Health Centre (Level 1: ICAMHS), Locked Bag 7103, Liverpool BC, NSW 1871, Australia; School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, Australia.
| | - Rudi Črnčec
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS), Liverpool Hospital, Mental Health Centre (Level 1: ICAMHS), Locked Bag 7103, Liverpool BC, NSW 1871, Australia; School of Psychiatry & Ingham Institute, University of New South Wales, Sydney, Australia
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10
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Eapen V, Woolfenden S, Williams K, Jalaludin B, Dissanayake C, Axelsson EL, Murphy E, Eastwood J, Descallar J, Beasley D, Črnčec R, Short K, Silove N, Einfeld S, Prior M. "Are you available for the next 18 months?" - methods and aims of a longitudinal birth cohort study investigating a universal developmental surveillance program: the 'Watch Me Grow' study. BMC Pediatr 2014; 14:234. [PMID: 25241772 PMCID: PMC4190387 DOI: 10.1186/1471-2431-14-234] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal developmental surveillance programs aimed at early identification and targeted early intervention significantly improve short- and long-term outcomes in children at risk of developmental disorders. However, a significant challenge remains in providing sufficiently rigorous research and robust evidence to inform policy and service delivery. This paper describes the methods of the 'Watch Me Grow' study that aims to maximise accurate early detection of children with developmental disorders through a partnership formed between policy makers, service providers and researchers. METHODS/DESIGN A mixed methods study design was developed consisting of: (1) a qualitative study of parents and health service providers to investigate barriers and enablers of developmental surveillance; (2) recruitment of a birth cohort and their longitudinal follow-up to 18 months of age to: a) assess risk factors for not accessing existing developmental surveillance programs and b) estimate the prevalence of children identified with developmental risk; (3) comparison of surveillance outcomes with a reference standard at 18 months of age to assess the diagnostic test accuracy of existing and alternative developmental surveillance tools; and (4) comparison of developmental surveillance models to inform policy recommendations. Data linkage will be used to determine the uptake and representativeness of the study participant group versus non-participants. DISCUSSION The Watch Me Grow study is expected to provide a collaborative opportunity to enhance universal developmental surveillance for early accurate identification of developmental risk. This will also provide quality evidence about identification of developmental risk and access to services to be embedded in existing practice with linkages to policy development.
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Affiliation(s)
- Valsamma Eapen
- />Academic Unit of Child Psychiatry South Western Sydney Local Health District (AUCS), Sydney, Australia
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
- />Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Susan Woolfenden
- />Sydney Children’s Hospitals Network, Sydney, Australia
- />University of New South Wales, School of Women’s and Children’s Health, Sydney, Australia
| | - Katrina Williams
- />Department of Paediatrics, University of Melbourne, Melbourne, Australia
- />Developmental Medicine, Royal Children’s Hospital, Melbourne, Australia
- />Murdoch Childrens Research Institute, Melbourne, Australia
| | - Bin Jalaludin
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />Centre for Research, Evidence Management and Surveillance, Sydney and South Western Sydney Local Health Districts, Sydney, Australia
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Cheryl Dissanayake
- />Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Emma L Axelsson
- />Academic Unit of Child Psychiatry South Western Sydney Local Health District (AUCS), Sydney, Australia
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
- />Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | - John Eastwood
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />Community Paediatrics, South Western Sydney Local Health District, Sydney, Australia
| | - Joseph Descallar
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />South Western Sydney Clinical School, South Western Sydney Local Health District, University of New South Wales, Sydney, Australia
| | | | - Rudi Črnčec
- />Academic Unit of Child Psychiatry South Western Sydney Local Health District (AUCS), Sydney, Australia
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
| | - Katherine Short
- />Ingham Institute for Applied Medical Research, Sydney, Australia
- />University of New South Wales, School of Women’s and Children’s Health, Sydney, Australia
- />Speech Pathology Unit, Liverpool Hospital, Liverpool, Australia
| | - Natalie Silove
- />School of Psychiatry and Ingham Institute, University of New South Wales, Sydney, Australia
- />Sydney Children’s Hospitals Network, Sydney, Australia
- />Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Stewart Einfeld
- />Centre for Disability Research and Policy, Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Margot Prior
- />School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Matthey S, Črnčec R, Hales A, Guedeney A. A DESCRIPTION OF THE MODIFIED ALARM DISTRESS BABY SCALE (m-ADBB): AN INSTRUMENT TO ASSESS FOR INFANT SOCIAL WITHDRAWAL. Infant Ment Health J 2013. [DOI: 10.1002/imhj.21407] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stephen Matthey
- University of Sydney; Sydney South West Local Health District, and University of New South Wales
| | - Rudi Črnčec
- Sydney South West Local Health District and University of New South Wales
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Eapen V, Črnčec R, Walter A. Exploring Links between Genotypes, Phenotypes, and Clinical Predictors of Response to Early Intensive Behavioral Intervention in Autism Spectrum Disorder. Front Hum Neurosci 2013; 7:567. [PMID: 24062668 PMCID: PMC3769633 DOI: 10.3389/fnhum.2013.00567] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 06/06/2013] [Accepted: 08/26/2013] [Indexed: 12/27/2022] Open
Abstract
Autism spectrum disorder (ASD) is amongst the most familial of psychiatric disorders. Twin and family studies have demonstrated a monozygotic concordance rate of 70-90%, dizygotic concordance of around 10%, and more than a 20-fold increase in risk for first-degree relatives. Despite major advances in the genetics of autism, the relationship between different aspects of the behavioral and cognitive phenotype and their underlying genetic liability is still unclear. This is complicated by the heterogeneity of autism, which exists at both genetic and phenotypic levels. Given this heterogeneity, one method to find homogeneous entities and link these with specific genotypes would be to pursue endophenotypes. Evidence from neuroimaging, eye tracking, and electrophysiology studies supports the hypothesis that, building on genetic vulnerability, ASD emerges from a developmental cascade in which a deficit in attention to social stimuli leads to impaired interactions with primary caregivers. This results in abnormal development of the neurocircuitry responsible for social cognition, which in turn adversely affects later behavioral and functional domains dependent on these early processes, such as language development. Such a model begets a heterogeneous clinical phenotype, and is also supported by studies demonstrating better clinical outcomes with earlier treatment. Treatment response following intensive early behavioral intervention in ASD is also distinctly variable; however, relatively little is known about specific elements of the clinical phenotype that may predict response to current behavioral treatments. This paper overviews the literature regarding genotypes, phenotypes, and predictors of response to behavioral intervention in ASD and presents suggestions for future research to explore linkages between these that would enable better identification of, and increased treatment efficacy for, ASD.
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Affiliation(s)
- Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney, South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Rudi Črnčec
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Amelia Walter
- Academic Unit of Child Psychiatry South West Sydney, South Western Sydney Local Health District, Liverpool, NSW, Australia
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Abstract
This study examined the errors made by clinicians when scoring the Edinburgh Postnatal Depression Scale (EPDS). This measure has items with reverse scoring that may increase the likelihood of errors being made. Four hundred ninety-six EPDS forms from client files in four clinical services were examined for item scoring errors and addition errors. Clinicians (N = 22) from the four services were also surveyed as to what rate of errors they expected the study would find and what rate would be unacceptable. Errors of either type were present in between 13.4 and 28.9% of forms across the four sites. These error rates were greater than most of the surveyed clinicians expected and were at a level that was considered by most to be problematic. However, the error rates did not have a meaningful impact on the rates of women scoring above various cutoff scores often used with the EPDS. The EPDS is often incorrectly scored by practitioners at a level that is of concern to clinicians of these services. Clinical teams should adopt the use of scoring templates and a double adding-up procedure when using measures such as the EPDS as a way that may reduce such scoring errors.
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Affiliation(s)
- Stephen Matthey
- South Western Sydney Local Health District, Sydney, Australia.
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14
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Malloch S, Shoemark H, Črnčec R, Newnham C, Paul C, Prior M, Coward S, Burnham D. Music therapy with hospitalized infants-the art and science of communicative musicality. Infant Ment Health J 2012; 33:386-399. [PMID: 28520171 DOI: 10.1002/imhj.21346] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infants seek contingent, companionable interactions with others. Infants in a Neonatal Intensive Care Unit (NICU), while receiving care that optimizes their chances of survival, often do not have the kind of interactions that are optimal for their social development. Live music therapy (MT) with infants is an intervention that aims for contingent, social interaction between therapist and infant. This study, with a limited numbers of infants, examined the effectiveness of an MT intervention in the NICU at The Royal Children's Hospital Melbourne. Two groups of late pre-term and full-term infants were recruited to the study; one was given MT and the other was not. A healthy group of infants not given MT served as an additional control. The effect of MT was indexed using two measures reflecting infant social engagement: the Neurobehavioral Assessment of the Preterm Infant (NAPI) and the Alarm Distress Baby Scale (ADBB). Results suggest that the MT intervention used at The Royal Children's Hospital Melbourne supports infants' neurobehavioral development. In particular, hospitalized infants who received MT were better able to maintain self-regulation during social interaction with an adult, were less irritable and cried less, and were more positive in their response to adult handling, when compared with infants who did not receive the intervention. These are important prerequisites for social interaction and development. Further and larger scale research using MT with this population is indicated.
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Affiliation(s)
| | - Helen Shoemark
- Murdoch Childrens Research Institute and The Royal Children's Hospital, Melbourne
| | - Rudi Črnčec
- MARCS Auditory Laboratories, University of Western Sydney
| | - Carol Newnham
- Parent-Infant Research Institute, Austin Medical Centre, Melbourne
| | - Campbell Paul
- The Royal Children's Hospital, Melbourne and Murdoch Childrens Research Institute
| | | | - Sean Coward
- MARCS Auditory Laboratories, Univeristy of Western Sydney
| | - Denis Burnham
- MARCS Auditory Laboratories, Univeristy of Western Sydney
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15
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Matthey S, Črnčec R. Comparison of two strategies to improve infant sleep problems, and associated impacts on maternal experience, mood and infant emotional health: a single case replication design study. Early Hum Dev 2012; 88:437-42. [PMID: 22115988 DOI: 10.1016/j.earlhumdev.2011.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 10/17/2011] [Accepted: 10/26/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Infant sleep problems (ISP) are common and have known effects on parental mood. There is debate as to whether treatment strategies may impact on the infant's emotional health. AIMS To compare the effectiveness of two treatment strategies for ISP on the infant's sleep, maternal mood, and the infant's emotional health. The two strategies are 1) systematic ignoring with minimal check ('SI-mc': commonly known as 'controlled crying'), and 2) a new, but similar, method where parents feign sleep inside the infant's room before intervening (parental presence with minimal check: 'PP-mc'). DESIGN Participants were randomised to one of the two conditions. Measures were taken at baseline, then three weeks and four months post-intervention. SUBJECTS Data were collected from 16 families with infants aged 6-18 months who were seeking professional help with their infant's sleep difficulties. OUTCOME MEASURES Measures of infant sleep, maternal experiences and mood, and infant emotional health were collected. RESULTS Both treatments were effective, with a third to a half of families reporting decreased ISP by 3 week post intervention, and nearly all reporting decreased ISP by follow-up. Similarly, most mothers in both treatments reported improvements to their experiences or mood, and there was no discernable disruption to infant emotional health. CONCLUSIONS These findings support previous research into the effectiveness of SI-mc. The study also expands the research into the effectiveness of parental presence by showing that with the inclusion of the minimal check component, which may be preferred by both parents and clinicians over non-responding to the crying infant, the strategy is as effective as SI-mc.
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Affiliation(s)
- Stephen Matthey
- Infant, Child and Adolescent Mental Health Service, South Western Sydney Local Health Network, Australia.
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Abstract
Interest in the measurement of parenting confidence in research and clinical contexts has grown considerably in recent decades, particularly in the area of health care. Psychometric and technical characteristics of scales assessing this construct suitable for the parents of children aged 0–12 years were reviewed in this research. In so doing, information is provided that will assist clinicians and researchers in selecting a measure suitable to their needs. Thirty-six instruments assessing parenting confidence were located. Two dominant approaches to item selection were evident: (1) general items suitable for a range of child ages, or (2) task-specific items suitable for parents of a child of a particular age. Psychometrically, most scales possessed adequate reliability data, although validity data for many scales was limited. In addition, only two of the instruments, both with general items, had stratified normative data. Scales appropriate for a range of research purposes and some clinical applications are available. Further research is necessary to provide normative data for task-specific parenting confidence scales.
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18
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Črnčec R, Barnett B, Matthey S. Development of an instrument to assess perceived self-efficacy in the parents of infants. Res Nurs Health 2008; 31:442-53. [DOI: 10.1002/nur.20271] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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