Use of Medicare Benefit Scheme mental health services in young people who experienced self-harm and/or suicidal behaviours: Data from the Young Minds Matter survey

OBJECTIVES

To examine healthcare utilisation patterns in a sample of young people with self-reported experiences of self-harm and/or suicidal behaviours.

METHODS

A national survey examining mental health in a nationally representative sample of young Australians aged 12-17 years, linked to routinely collected healthcare and dispensing data. For respondents that self-reported experience of self-harm, suicidal ideation, suicidal plan and/or suicide attempt, we assessed attendance at a Medicare Benefits Scheme (MBS) subsidised MH service or non-MH general practitioner (GP) attendance at three time periods: 1) ever, 2) in the 12 months prior to completing the survey and 3) after completing the survey until 31 Dec 2015. We also assessed correlates associated with attendance and non-attendance at a MH service.

RESULTS

The study included 311 young people. MH services were attended in the 12 months before the survey by 38.3% with attempted suicide, 28.7% with a suicidal plan, 28.9% with suicidal ideation and 29.4% with self-harm. MH treatment administered by a GP was the most common MH service (25%); followed treatment by psychologist (15%) and psychiatrist (5%). Attendance at a MH service was observed highest alongside more severe self-reported depression.

CONCLUSIONS

Potential underutilisation of MBS MH services by young people with self-harm and/or suicidal behaviours.

Are trajectories of self-regulation abilities from ages 2-3 to 6-7 associated with academic achievement in the early school years?

BACKGROUND

The aim of this study was to estimate the association between two key aspects of self-regulation, 'task attentiveness' and 'emotional regulation' assessed from ages 2-3 to 6-7 years, and academic achievement when children were aged 6-7 years.

METHODS

Participants (n = 3410) were children in the Longitudinal Study of Australian Children. Parents rated children's task attentiveness and emotional regulation abilities when children were aged 2-3, 4-5 and 6-7. Academic achievement was assessed using the Academic Rating Scale completed by teachers. Linear regression models were used to estimate the association between developmental trajectories (i.e. rate of change per year) of task attentiveness and emotional regulation, and academic achievement at 6-7 years.

RESULTS

Improvements in task attentiveness between 2-3 and 6-7 years, adjusted for baseline levels of task attentiveness, child and family confounders, and children's receptive vocabulary and non-verbal reasoning skills at age 6-7 were associated with greater teacher-rated literacy [B = 0.05, 95% confidence interval (CI) = 0.04-0.06] and maths achievement (B = 0.04, 95% CI = 0.03-0.06) at 6-7 years. Improvements in emotional regulation, adjusting for baseline levels and covariates, were also associated with better teacher-rated literacy (B = 0.02, 95% CI = 0.01-0.04) but not with maths achievement (B = 0.01, 95% CI = -0.01-0.02) at 6-7 years. For literacy, improvements in task attentiveness had a stronger association with achievement at 6-7 years than improvements in emotional regulation.

CONCLUSIONS

Our study shows that improved trajectories of task attentiveness from ages 2-3 to 6-7 years are associated with improved literacy and maths achievement during the early school years. Trajectories of improving emotional regulation showed smaller effects on academic outcomes. Results suggest that interventions that improve task attentiveness when children are aged 2-3 to 6-7 years have the potential to improve literacy and maths achievement during the early school years.

Nurse perceptions of family home-visiting programmes in Australia and England

AIMS

Nurse home-visiting programmes are employed to enhance the functioning of disadvantaged mothers and young children. Despite the key role played by nurses, there is little empirical evidence describing the views and experiences of nurses who deliver home-visiting programmes. This study compared the views and experiences of nurses delivering home-visiting programmes in England and South Australia.

METHODS

Participants were 108 nurses delivering the South Australian Family Home Visiting programme (2008-2011), and 44 nurses delivering the Family Nurse Partnership programme in England (2007-2009). Data were collected using a standard questionnaire that was completed by nurses in each country. The questionnaire asked nurses about their level of influence on programme outcomes, approaches they used to retain maternal engagement with the home-visiting programmes, barriers to effective programme delivery and the effectiveness of supervision.

RESULTS

Both groups of nurses considered that their greatest influence was improving mothers' confidence with parenting skills and increasing mothers' knowledge about children's development. Each group identified quality of nurse-mother relationships as the factor most relevant to retaining maternal engagement. Other influential factors were flexibility of timing for visits and the capacity of the programmes to meet specific needs of mothers.

CONCLUSION

There was consistency in the nurses' views about the home-visiting programmes delivered in England and Australia. Future studies should utilise prospective designs to identify the mechanisms by which factors influence the quality of nurse-mother relationships, approaches used by nurses to solve family problems and elements of mother-nurse relationships that have the strongest influence on programme outcomes.

Effectiveness of nurse home-visiting for disadvantaged families: results of a natural experiment

OBJECTIVE

To evaluate the effects of a postnatal home-visiting programme delivered by community health nurses to socially disadvantaged mothers in South Australia.

DESIGN

The intervention group of 428 mothers lived in metropolitan Adelaide and the comparison group of 239 mothers lived in regional towns where the programme was not yet available. All participating mothers met health service eligibility criteria for enrolment in the home-visiting programme. Participants in both groups were assessed at baseline (mean child age=14.4 weeks SD=2.3), prior to programme enrolment, and again when the children were aged 9, 18 and 24 months.

SETTING

State-wide community child health service.

PARTICIPANTS

667 socially disadvantaged mothers enrolled consecutively. 487 mothers (73%) completed the 24-month assessment.

INTERVENTION

Two-year postnatal home-visiting programme based on the Family Partnership Model.

PRIMARY OUTCOME MEASURES

Parent Stress Index (PSI), Kessler Psychological Distress Scale and the Ages and Stages Questionnaire.

RESULTS

Mixed models adjusting for baseline differences were used to compare outcomes in the two groups. The mothers in the home-visiting group reported greater improvement on the PSI subscales assessing a mother's perceptions on the quality of their relationship with their child (1.10, 95% CI 0.06 to 2.14) and satisfaction with their role as parents (0.46, 95% CI -0.15 to 1.07) than mothers in the comparison group. With the exception of childhood sleeping problems, there were no other significant differences in the outcomes across the two groups.

CONCLUSIONS

The findings suggest that home-visiting programmes delivered by community health nurses as part of routine clinical practice have the potential to improve maternal-child relationships and help mothers adjust to their role as parents.

CLINICAL TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12608000275369.

Four-year prospective study of BMI and mental health problems in young children

OBJECTIVE

To investigate prospectively the relationship between BMI and the mental health and health-related quality of life (HRQoL) of young children.

METHODS

In this study we used data from the Longitudinal Study of Australian Children obtained when children were 4 to 5 and 8 to 9 years old. BMI was available for 3363 children at both waves. Mental health problems were assessed by using the Strengths and Difficulties Questionnaire (SDQ), which was completed by parents and teachers. HRQoL was assessed by using the Pediatric Quality of Life Inventory (PedsQL), which was completed by the parents.

RESULTS

Logistic regression models were adjusted for children's age, gender, baseline SDQ or PedsQL scores, and maternal characteristics. A 1-SD increase in BMI in children aged 4 to 5 years was associated with increased odds of scoring in the abnormal range of the SDQ peer problems scale of 1.15 (95% confidence interval [CI]: 1.03-1.28) for parent reports and 1.20 (95% CI: 1.04-1.37) for teacher reports when these children were aged 8 to 9 years. The odds ratio for children who scored above the at-risk cutoff on the parent-reported PedsQL social problems scale was 1.17 (95% CI: 1.06-1.28) for each 1-SD increase at 4 to 5 years of age. There were also increased odds for teacher reports of childhood emotional problems.

CONCLUSIONS

Higher BMI in children aged 4 to 5 years was positively related to poorer peer relationships and teacher-reported emotional problems but not to other childhood mental health problems, in these children at 8 to 9 years of age. Prospective studies are needed to determine if peer problems experienced by children with higher BMI predict subsequent mental health problems in other areas.

Evaluating population-level interventions for young people's mental health: challenges and opportunities

AIM

To identify key issues relevant to the delivery and evaluation of population-level mental health interventions for children and adolescents.

METHODS

The benefits and limitations of clinical, targeted and universal interventions were initially reviewed. Subsequently, experience gained in evaluations of targeted and universal interventions was utilized to identify key challenges that must be addressed by researchers responsible for evaluating population-level interventions and potential solutions to these challenges.

RESULTS

To be effective, population-level interventions must engage large numbers of individuals in community or regional areas. Successfully evaluating population-level interventions delivered in routine services requires a clear agreement about outcomes, use of strong research methodologies, and the availability of adequate research funding. Sustaining service-research partnerships over the several-year life of typical population interventions requires careful attention to these issues. Electronic databases with the capacity to efficiently collect, store and allow retrieval of large amounts of data in electronic format are also an essential component of population-level interventions. Finally, research leaders need high-quality administrative skills to manage research teams responsible for evaluating large-scale population-level interventions delivered at a regional or national level.

CONCLUSION

Population-level interventions have the potential to play an important role in reducing the incidence and prevalence of mental health problems experienced by young people in the community. However, if they are to achieve their full effectiveness, ongoing evaluations are needed.

Comorbidities of overweight/obesity in Australian preschoolers: a cross-sectional population study

OBJECTIVE

To determine relationships between body mass index (BMI) status and indicators of health and morbidity in a nationally-representative population sample of preschool children.

METHODS

Data from the 4-5-year-old cohort in the first wave (2004) of the Longitudinal Study of Australian Children were studied. Main outcome measures were: measured child BMI, categorised as non-overweight, overweight and obese using International Obesity TaskForce cutpoints; parent-reported child global health, health-related quality of life, mental health problems, asthma, sleep problems, injuries, special health care needs, and level of parental concern about the child's weight. Regression methods were used to assess associations with child's BMI status, adjusted for sociodemographic factors.

RESULTS

BMI was available for 4934 (99%) children; 756 (15.3%) were overweight and 258 (5.2%) obese. Compared to non-overweight children, parents of overweight and obese children reported a higher prevalence of special health care needs (adj OR 1.72, 95% CI 1.20 to 2.46), but other health outcomes were similar. Parental concern about the child's weight was low among the overweight (14.4%) and non-overweight (17.8%) children, but rose to 52.7% in the obese. However, parental concern was unrelated to any of the specific health problems studied.

CONCLUSIONS

Despite a high prevalence of overweight/obesity, parents of overweight and obese children reported relatively few additional health burdens over and above those of the non-overweight preschoolers. These findings may shed light on the disparity between strong public concern and parents' expressed lack of concern about overweight/obesity in their own children around the time of school entry.

A two-year prospective study of the health-related quality of life of children with chronic illness--the parents' perspective

The aim of this study was to assess prospectively changes in the health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF). One hundred and twenty-two parents of children aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Parents described their children's HRQL using the Child Health Questionnaire (PF98) at baseline, 6, 12, 18 and 24 months post-baseline. They reported that the general health of children with CF was significantly worse than that of children with asthma and diabetes at baseline. In other domains there were few differences between the HRQL of children in the three groups. In several domains, the HRQL of children with asthma or diabetes improved over the 2 years of the study. This improvement was less evident for children with CF.

Use of health and school-based services in Australia by young people with attention-deficit/hyperactivity disorder

OBJECTIVE

To examine use of health (including psychiatric) and school-based services by children and adolescents who met symptom criteria for attention-deficit/hyperactivity disorder (ADHD), the factors associated with service use, and barriers to service access.

METHOD

The relationship between parents' perceptions of children's need for professional help, the impact of children's problems on children and parents, and services used during the previous 6 months were examined in a national sample of 398 children and adolescents with ADHD symptoms aged 6 to 17 years (70% response rate). Information was obtained from parents who completed the Diagnostic Interview Schedule for Children Version IV and standard questionnaires. Data collection took place between February and May 1998.

RESULTS

Only 28% of those with ADHD symptomatology had attended health or school-based services. Among these, 41% had attended both health and school-based services, 39% had attended only health services, and 20% had attended only school-based services. Sixty-nine percent of parents attending health services wanted additional help. Parental perceptions that children needed professional help, children's functional impairment, the impact of problems on parents, and comorbid depressive or conduct disorders had a significant and independent relationship with service use.

CONCLUSIONS

A minority of children and adolescents with ADHD symptomatology receives professional help for their problems in Australia. Counseling is the most frequent help provided, with many parents wanting additional help beyond that already provided. Factors other than children's ADHD symptomatology have a significant relationship with service attendance. Practical issues, including the cost of services and waiting lists are the most common barriers cited by parents as hindering access to services.

The relationship between health-related quality of life, pain and coping strategies in juvenile idiopathic arthritis

OBJECTIVES

To investigate the relationship between health-related quality of life (HRQL), experience of pain and pain coping strategies in children with juvenile idiopathic arthritis (JIA). To compare reports describing these variables obtained from children and their parents.

METHODS

Participants were 59 children aged 8 to 18 yr with JIA and their parents. Parents and children completed the PedsQL generic core scales and arthritis module, the visual analogue scale of the Varni-Thompson Pediatric Pain Questionnaire, and the Waldron/Varni Pediatric Pain Coping Inventory. Parents rated children's functional disability using the Childhood Health Assessment Questionnaire.

RESULTS

Parents reported significantly lower scores (indicating worse HRQL) than children on five of the eight PedsQL scales rating children's HRQL. Parents and children reported a significant negative relationship between pain levels and the PedsQL scores assessing children's physical, emotional and social functioning. They also reported a significant negative relationship between scores on several pain coping scales and scores on the PedsQL scales. However, the pattern of these relationships varied for reports from parents and children.

CONCLUSIONS

Pain intensity and pain coping strategies have a significant and independent relationship with several domains that comprise the HRQL of children with JIA. However, parents and children have differing perceptions of the nature of these relationships. The differences emphasize the importance of clinicians obtaining information about children's HRQL, pain levels and pain coping strategies from both parents and children.

Health-service use by children with asthma over a 6-month period

OBJECTIVES

The present study aims to describe the use of health services by children with asthma, and examine disease-specific, parental and sociodemographic variables associated with different levels of health-service utilization.

METHODS

Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health-care services for asthma.

RESULTS

At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty-five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P = 0.05 and P = 0.01, respectively); a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P = 0.05 and P = 0.004, respectively).

CONCLUSIONS

Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services.

Validity of DSM-IVADHD subtypes in a nationally representative sample of Australian children and adolescents

OBJECTIVE

To examine the discriminant validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes in a nationally representative sample of Australian youths.

METHOD

The Diagnostic Interview Schedule for Children, including the symptom-specific impairment questions, was administered to 3,597 parents of children aged 6 to 17 years (response rate = 70%). Parents also completed questionnaires assessing children's emotional and behavioral problems and quality of life.

RESULTS

Current DSM-IVADHD prevalence was 7.5% (6.8% with impairment) with inattentive types being more common than hyperactive-impulsive and combined types. ADHD was more prevalent among young males and was linked to social adversity, particularly for combined types. Compared with non-ADHD controls, all three ADHD subtypes were rated as having more emotional and behavioral problems and lower psychosocial quality of life, with combined types consistently rated the most impaired. Combined types received higher ratings than hyperactive-impulsive and inattentive types on externalizing behavior problems, disruption to family activities, and symptom-specific impairments with schoolwork and peer-related activities. Inattentive types were rated as having lower self-esteem, more social and school-related problems, but fewer externalizing problems than hyperactive-impulsive types.

CONCLUSION

These findings support the view of DSM-IVADHD subtypes as distinct clinical entities with impairments in multiple domains.

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being

OBJECTIVE

To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems.

METHOD

The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours.

RESULTS

Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey.

CONCLUSION

Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

The relationship between asthma severity, family functioning and the health-related quality of life of children with asthma

This study compared the health-related quality of life (HRQL) of 236 children with mild or moderate/severe asthma with that of a large representative sample of children in the general community. The study also examined the relationship between the HRQL of children with asthma and their demographic characteristics, asthma severity and family functioning. Children with asthma had a significantly poorer HRQL than other children in the community. Amongst the children with asthma, parents reported that children living in single-parent families had poorer physical health, mental health and social functioning than children in two-parent families. There was a significant relationship between the mental health of children with asthma and family functioning but no significant relationship between their physical health and family functioning. These findings suggest that the domains comprising the HRQL of children with asthma are related to both disease and non-disease factors. A better understanding of these relationships will facilitate the development of new interventions to help children with asthma.

Depression among Australian adolescents

OBJECTIVES

To examine the prevalence and factors associated with depression in Australian adolescents.

DESIGN

A representative, multistage probability sample of Australian households conducted in 1998 (part of the National Survey of Mental Health and Well-being). Adolescents completed self-report questionnaires and parents were interviewed using a lay-administered, structured psychiatric interview and several questionnaires.

PARTICIPANTS

1,490 adolescents aged 13-17 years and their parent or main caregiver.

MAIN OUTCOME MEASURES

Prevalence of depression in adolescents, as reported by parents and by adolescents themselves; demographic factors; health-risk behaviours; and rate of use of support services.

RESULTS

Of the 1,490 adolescents originally sampled, 150 (10%) did not complete responses to questions on depression and were excluded from the analysis. Seventy of the remaining 1340 adolescents (5.2%; 95% CI, 4.0%-6.4%) met criteria for self-reported depression. Agreement between parent- and adolescent-reported depression was poor (kappa=0.27). Adolescent-reported depression was associated with increased suicide plans (odds ratio [OR], 2.83; 95% CI, 1.19-6.70) and attempts (OR, 9.05; 95% CI, 3.49-23.50) in the previous year, use of marijuana 10 or more times in the previous month (OR, 2.88; 95% CI, 1.25-6.64), having conduct disorder (OR, 4.09; 95% CI, 1.23-13.63) and use of school support services (OR, 4.71; 95% CI, 1.82-12.22). Those who used any kind of support service (24/70; 34%) used a mean of 2.9 services (mode, 2; range, 1-5). Three per cent (2/70) of depressed adolescents had been treated with antidepressants.

CONCLUSIONS

Depressed adolescents exhibit higher rates of health-risk behaviours and psychosocial impairment than non-depressed adolescents, but only a small number receive appropriate treatment. Staff working in school-based services should be trained to identify adolescents with depression and facilitate referral for treatment.

The relationship between the quality of life of children with asthma and family functioning

The quality of life of 84 children with asthma, aged 7-12 years, and their family functioning was assessed using standard questionnaires. A significant relationship was found between children's reports of their quality of life and several key dimensions of family functioning. The results suggest that independent of their frequency, the extent to which asthma symptoms upset and bother children varies depending on the level of the functioning of the children's families. Treatment approaches designed to improve family functioning may reduce the extent to which children are bothered by their asthma symptoms and thus improve their quality of life.

Quality of life of mothers and families caring for preterm infants requiring home oxygen therapy: a brief report

OBJECTIVE

To investigate the impact on mothers and families of caring for a premature infant receiving home oxygen therapy (HOT).

METHODS

Standard questionnaires were used to compare the functioning of mothers and families of 10 premature infants receiving HOT, 10 premature infants who were discharged from hospital on HOT but who no longer required it and 20 premature infants who had never required treatment with HOT.

RESULTS

After adjustment for gestational age, chronological age, birthweight and place of residence (urban/rural), the care required by premature infants receiving HOT had a significantly greater impact on their families than the care of infants not receiving HOT. Mothers of premature infants receiving HOT reported significantly less vitality and more mental health problems than mothers of infants not receiving HOT.

CONCLUSIONS

The use of HOT for premature infants may have a significant adverse impact on their mothers and families.

The National Survey of Mental Health and Wellbeing: the child and adolescent component

OBJECTIVE

This paper describes the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing.

METHOD

The aims of the study, critical decisions in planning for the study, progress to date and key issues which influenced the course of the study are described.

RESULTS

The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing is the largest study of child and adolescent mental health conducted in Australia and one of the few national studies to be conducted in the world. Results from the study will provide the first national picture of child and adolescent mental health in Australia.

CONCLUSIONS

Large-scale epidemiological studies have the potential to provide considerable information about the mental health of children and adolescents. However, having a clear set of aims, ensuring that the scope of the study remains within manageable proportions and paying careful attention to the details of fieldwork are essential to ensure that high-quality data is obtained in such studies.

Association between parental perception of children's vulnerability to illness and management of children's asthma

This study examined the relationship between asthma management strategies used by parents and parental perception of children's vulnerability to illness. Home interviews were conducted with 101 parents of children previously hospitalized with asthma. The child vulnerability scale (CVS) was employed to assess parents' perception of their children's vulnerability to illness. The asthma severity index (ASI) was used to measure the frequency and intensity of asthma symptoms experienced by children in the preceding 12 months. Five markers of parental asthma management were assessed: (i) school absences; (ii) visits to the general practitioner (GP); (iii) visits to the emergency room (ER); (iv) hospitalizations; and (v) whether children are using a regular preventer. After controlling for the frequency and intensity of children's asthma symptoms, parents who perceived that their children were more vulnerable to medical illness were significantly more likely to keep their children home from school (P = 0.01), were more likely to take their children to the GP for acute asthma care (P = 0.02), and were more likely to be giving their children regular preventer medication (P = 0.02). In contrast, the use of tertiary pediatric care services was not significantly associated with parental perceptions of their children's vulnerability. The results suggest that parental attitudes and beliefs about the vulnerability of their children to illness were associated with greater use of GP services by parents and more frequent school absences for children. The use of hospital services by parents appeared to be more strongly associated with the actual level of children's asthma symptoms than their vulnerability to illness.

An Australian study of adolescents with cystic fibrosis: perceived supportive and nonsupportive behaviors from families and friends and psychological adjustment

PURPOSE

To identify and compare perceived supportive and nonsupportive behaviors exhibited by family members and friends toward adolescents with cystic fibrosis (CF), and to examine the relationships between supportive and nonsupportive behaviors and adolescents' psychological adjustment.

METHOD

Participants were 35 adolescents with CF attending the Women's and Children's Hospital in South Australia. Perceived supportive and nonsupportive behaviors were assessed using an adapted version of the Chronic Disease Support Interview. The psychological adjustment of the adolescents was assessed using the Youth Self Report Form. Repeated-measures analyses of variance were performed to compare the support provided by family members and friends. Multiple regression analyses assessed the contribution of supportive and nonsupportive behaviors for the prediction of psychological adjustment.

RESULTS

Family members provided more tangible support than friends who, conversely, provided more companionship support. Overall, family members scored higher than friends on ratings for supportive behaviors. No differences were observed between family members and friends on ratings for nonsupportive behaviors. Rating of nonsupportive behaviors for family members was found to be the strongest predictor of psychological adjustment.

CONCLUSIONS

Family members and friends provide different types of support. Family members provide more tangible help with treatment tasks and adolescents provide more companionship. Overall, this study demonstrated the importance of addressing nonsupportive as well as supportive behaviors when investigating the impact of support on the psychological adjustment of adolescents with a chronic illness.

Longitudinal follow-up of the intellectual and academic functioning of children receiving central nervous system-prophylactic chemotherapy for leukemia: a four-year final report

This longitudinal investigation extends our prospective study of the intellectual and academic functioning of children treated for cancer to 4 years after diagnosis. In the longer term, the children who received central nervous system (CNS) chemotherapy experienced greater neurocognitive deficits, particularly in the area of academic achievement, than did the children who did not receive CNS chemotherapy. Specifically, the CNS chemotherapy-treated children scored lower on academic tests of reading at 3 and 4 years after diagnosis. The results suggest that CNS chemotherapy prophylaxis may adversely effect the development of higher-order mental abilities and cognitive skills during the late-effects period and may also impair academic achievement.

Lifetime low-level exposure to environmental lead and children's emotional and behavioral development at ages 11-13 years. The Port Pirie Cohort Study

The Port Pirie Cohort Study is the first study to monitor prospectively the association between lifetime blood lead exposure and the prevalence of emotional and behavioral problems experienced by children. Lead exposure data along with ratings on the Child Behavior Checklist were obtained for 322 11-13-year-old children from the lead smelting community of Port Pirie, Australia. Mean total behavior problem score (95% confidence interval (CI)) for boys whose lifetime average blood lead concentration was above 15 microg/dl was 28.7 (24.6-32.8) compared with 21.1 (17.5-24.8) in boys with lower exposure levels. The corresponding mean scores (95% CI) for girls were 29.7 (25.3-34.2) and 18.0 (14.7-21.3). After controlling for a number of confounding variables, including the quality of the child's HOME environment (assessed by Home Observation for Measurement of the Environment), maternal psychopathology, and the child's IQ, regression modeling predicted that for a hypothetical increase in lifetime blood lead exposure from 10 to 30 microg/dl, the externalizing behavior problem score would increase by 3.5 in boys (95% CI 1.6-5.4), and by 1.8 (95% CI -0.1 to 11.1) in girls. Internalizing behavior problem scores were predicted to rise by 2.1 (95% CI 0.0-4.2) in girls but by only 0.8 (95% CI -0.9 to 2.4) in boys.

Sociodemographic and behavioural determinants of blood lead concentrations in children aged 11-13 years. The Port Pirie Cohort Study

OBJECTIVE

To describe the determinants of blood lead concentration in children with long term environmental exposure to lead.

DESIGN

Prospective cohort study.

SETTING

The lead smelting town of Port Pirie, South Australia, and surrounding townships.

PARTICIPANTS

326 children born in and around Port Pirie, 1979-1982, followed up until age 11-13 years in 1993-1994.

MAIN OUTCOME MEASURES

Blood lead concentrations assessed at birth and at multiple ages up to 11-13 years; average lifetime blood lead concentration.

RESULTS

Mean blood lead concentration rose sharply over the ages 6 to 15 months, reached a maximum around 2 years of age, and declined steadily as the children grew older. There was no difference in blood lead concentration between boys and girls until they reached the age of 11-13 years, when mean blood lead concentration in boys (8.4 micrograms/dL [0.41 mumol/L]) was slightly higher than in girls (7.5 micrograms/dL [0.36 mumol/L]). Residential area and father's employment site were the two variables most strongly predictive of a child's blood lead concentration at the end of primary school. Poorer-quality home environment was also found to be an independent contributor to blood lead concentrations.

CONCLUSIONS

Age-related factors, and possibly recent concerted efforts to decrease entry or re-entrainment of lead into the environment at Port Pirie, have resulted in most children in our study having blood lead concentrations below 10 micrograms/dL (0.48 mumol/L) at the end of their primary school years. Lead exposure during a child's early years remains an important contributor to average lifetime exposure.

Declining blood lead levels and changes in cognitive function during childhood: the Port Pirie Cohort Study

CONTEXT

Many studies have found a significant inverse association between early exposure to environmental lead and cognitive function in childhood. Whether these effects are reversible when exposure is reduced is not clear.

OBJECTIVE

To assess the reversibility of the apparent effects of lead on cognitive abilities in early childhood by testing whether declines in blood lead concentrations beyond the age of 2 years are associated with improvements in cognition.

SETTING

Urban and rural communities surrounding a large lead smelter in Port Pirie, South Australia.

PARTICIPANTS

A total of 375 children followed up from birth to the age of 11 to 13 years.

DESIGN

Long-term prospective cohort study.

MAIN OUTCOME MEASURES

The Bayley Mental Development Index at age 2 years, the McCarthy General Cognitive Index at age 4 years, and IQs from the Wechsler Intelligence Scale (revised version) at ages 7 and 11 to 13 years.

RESULTS

Mean blood lead concentrations in the children decreased from 1.02 pmol/L (21 .2 microg/dL) at age 2 years to 0.38 micromol/L (7.9 microg/dL) at age 1 1 to 13 years, but cognitive scores in children whose blood lead concentration declined most were generally not improved relative to the scores of children whose blood lead levels declined least. Changes in IQ and declines in blood lead levels that occurred between the ages of 7 and 11 to 13 years (r= 0.12, P= .09) suggested slightly better cognition among children whose blood lead levels declined most.

CONCLUSION

The cognitive deficits associated with exposure to environmental lead in early childhood appear to be only partially reversed by a subsequent decline in blood lead level.

The influence of distress on mothers' and fathers' reports of childhood emotional and behavioral problems

This study examined the effect of parental distress on mothers' and fathers' reports of children's emotional and behavioral problems. The subjects were the parents of 696 children aged 10 to 11 or 14 to 15 years living in two-parent families in the community. The study utilized an extended version of the model previously employed by Fergusson, Lynskey, and Horwood (1993) to examine the impact of maternal depression on mothers' reports of children's behavior. In the present study, the extended model was used to assess the impact of distress on reports of childhood externalizing and internalizing problems obtained from both mothers and fathers. The results suggested that distress had little influence on mothers' or fathers' reports of childhood behavior problems. It is concluded that in community studies the size of any bias in mothers' and fathers' reports of childhood behavior problems due to parental distress is likely to be very small and of little clinical significance.

Influence of parental and family adjustment on the later psychological adjustment of children treated for cancer

OBJECTIVE

To examine the relationship between parental adjustment and family adjustment during the period after the children's diagnosis of cancer and the psychological adjustment of children 2 years after their diagnosis.

METHOD

The study used a prospective design. Children aged 2 to 5 years with cancer and their parents and families (n = 38) were assessed immediately after the children's diagnosis and again 2 years after the diagnosis. Path analysis was used to investigate the relationship between parental and family adjustment during the period after diagnosis and the psychological adjustment of the children 2 years after their diagnosis.

RESULTS

Maternal adjustment during the period after the children's cancer was diagnosed had a significant relationship with the children's psychological adjustment 2 years after diagnosis. In contrast, the adjustment of fathers and family adjustment appeared to have a more limited impact on the later psychological adjustment of the children.

CONCLUSION

The level of distress experienced by mothers after the children's diagnosis may have an important influence on the later psychological adjustment of the children. It is possible that this is due to the impact of maternal distress on the capacity of mothers to care for their children during the children's treatment for cancer.

Social skills training for primary school children: a 1-year follow-up study

OBJECTIVE

To evaluate the effectiveness of the Rochester Social Problem Solving Program to reduce emotional and behavioural problems amongst primary school children.

METHODOLOGY

Children in years 3 and 4 at primary school were assessed prior to receiving the program, immediately after the program and 1 year after the program. At each assessment, the functioning of the children who received the program was compared to the functioning of children enrolled in years 3 and 4 at a comparable school who did not receive the program.

RESULTS

The program improved the ability of children to cope with potentially difficult social situations. However, the program did not reduce the prevalence of teacher-reported or mother-reported childhood emotional and behavioural problems.

CONCLUSIONS

School-based social skills programs may be more effective in reducing childhood emotional and behavioural problems if they include components which focus specifically on childhood behaviour problems as well as components focusing on social skills and peer relationships.

Improvement in outcome of children with Wilms' tumour in South Australia over the last 30 years

OBJECTIVE

To evaluate the outcome of children with Wilms' tumour over the last 30 years in South Australia. To compare the outcome of children treated before and after 1982, when standard treatment protocols were introduced.

METHODOLOGY

Management approaches, survival rates and side-effects of treatment were identified from case notes. Pathology slides were reviewed to ensure all children were correctly diagnosed with Wilms' tumour.

RESULTS

Children treated for Wilms' tumour prior to 1982 had an overall survival rate of 54%. Since 1982 there has been a significant improvement in outcome and the current survival rate is now 85%. Children treated since 1982 have also experienced fewer treatment related side-effects than children treated prior to 1982.

CONCLUSIONS

There has been substantial improvement in survival from childhood Wilms' tumour over the past 30 years in South Australia. This is likely to be due to a combination of factors including standardization of treatment, tailoring of treatment to stage and histology, improved perioperative care, enhanced radiological techniques and higher levels of collaboration between relevant specialists.

A prospective study of childhood emotional and behavioural problems in Port Pirie, South Australia

OBJECTIVE

To describe the extent to which emotional and behavioural problems experienced by 5-year-old children living in or around Port Pirie, South Australia, persisted when the children were aged 11-12 years.

METHOD

Childhood emotional and behavioural problems were identified at the age of 5 years using Child Behaviour Checklists completed by mothers. When the children were aged 11-12 years, problems were identified using checklists completed by mothers, children and teachers.

RESULTS

Attention problems, aggressive behaviour and anxious/depressed problems were the most persistent problems over this period of the children's lives. In general, the strongest relationship over time occurred when reports were obtained from mothers on each occasion. A weaker relationship existed between earlier mother-reported problems and later teacher-reported problems, while the relationship between mother-reported problems and later self-reported problems occupied an intermediate position.

CONCLUSION

The course of problems among children in Port Pirie appeared similar to that previously reported for children in Holland and North America. To better understand the aetiology of psychiatric disorders and to plan for effective interventions, more information is needed about the natural course of childhood emotional and behavioural disorders in Australia.

Mental health promotion for young people: a proposal for a tripartite approach

Child and adolescent mental health promotion programmes may be more effective if they include a combination of different approaches to health promotion rather than relying primarily on one approach. A group of complementary approaches that could be combined in a single programme include: (i) a community-wide media campaign to highlight the harmful effects of family discord on the mental health of young people; (ii) a school-based social skills programme to improve the social skills of young people; and (iii) a life skills programme to build the competence of young people "at risk' for developing mental health disorders. The potential value of this particular combination of approaches is discussed with the aim of facilitating the development of innovative new child and adolescent mental health promotion programmes in Australia.

Emotional health of Indonesian adoptees living in Australian families

OBJECTIVE

To compare the prevalence of emotional and behavioural problems in adolescent adoptees from Indonesia living in South Australian families with that of adolescents living in the community and those referred to mental health clinics in South Australia.

METHOD

Thirty-four Indonesian adoptees completed the Youth Self-Report and their adoptive mothers completed the Child Behaviour Checklist. The results on these instruments were compared with the scores of a community sample and a mental health clinic population.

RESULTS

There was a striking similarity between scores on the Youth Self-Report and the Child Behaviour Checklist instruments for the adoption and community groups. Both these groups had significantly fewer problems than adolescents referred to mental health clinics.

CONCLUSIONS

These results indicate that the outcome in terms of emotional and behavioural health for intercountry adoptions between Indonesia and Australia is favourable.

The mental health status of adolescents released from custody: a preliminary study

OBJECTIVE

To describe the prevalence of mental health problems and the social circumstances of young offenders after their release from custody in a juvenile detention centre.

METHOD

The subjects were 37 adolescents from an original sample of 101 adolescents who had been remanded in a juvenile detention centre in Adelaide, South Australia. The adolescents were evaluated at the time of their initial detention in custody and again 1 year later.

RESULTS

The adolescents reported having a large number of social and mental health problems after their release from custody. One year after their release, 32% of the adolescents scored above the recommended 'cut off' score on the Youth Self Report. This represents a rate of disorder three to four times higher than that reported by adolescents in the community and is comparable to the rate reported by adolescents attending mental health clinics.

CONCLUSIONS

Adolescents remanded in juvenile detention centres experience continuing mental health problems after their release from custody. As well, they experience considerable social dysfunction. There is an urgent need for more active therapeutic follow-up of these young people.

Approaches to delivering child and adolescent mental health services: the South Australian experience

Approximately 10% of children and adolescents experience mental health programs, however only a small proportion receive specialised help. Identifying approaches which can provide a balanced and effective service for the large number of children and adolescents with problems is currently a major challenge for child and adolescent mental health services in Australia. In South Australia, following a review in 1983, child and adolescent services were reorganised into two separate but closely related services. This paper draws on experience in South Australia over the last decade to identify approaches which can be employed in six key areas that significantly influence the effectiveness of child and adolescent mental health services. The paper also describes the specific features which were included in the South Australian child and adolescent mental health service to address these issues.

Adherence to recommended medical regimens in childhood and adolescence

OBJECTIVE

Factors that appear to influence treatment adherence among adults have been the focus of considerable research in recent years. However, less research has focused on children's treatment adherence. This paper reviews current knowledge about factors that appear to influence adherence among children and adolescents.

METHODOLOGY

Factors associated with adherence to medical regimens reviewed here include: (i) the psychosocial characteristics of children and their parents; (ii) the nature of the treatment regimen; and (iii) the relationship between health practitioners, parents and paediatric patients.

CONCLUSIONS

Issues for future research include: (i) the adherence of both children and their parents to children's treatment, and the allocation of responsibility for treatment adherence; (ii) the wide range of behaviours involved in regimen adherence should be acknowledge; patients' adherence to one aspect of their regimen should not be considered indicative of their overall adherence; and (iii) longitudinal studies are required to examine the causal relations between patient adherence and its antecedents.

Do adolescents know where to find help for mental health problems? A brief report

OBJECTIVE

Few previous studies have investigated adolescents' knowledge of the services available to provide help with mental health problems. This is an important omission as knowledge about the availability of mental health services may significantly influence the extent to which adolescents with mental health problems receive appropriate help for their difficulties. The purpose of this study was to investigate knowledge of mental health services among socio-economically disadvantaged adolescents.

METHODOLOGY

Students attending the participating high school completed a questionnaire describing mental health services in South Australia.

RESULTS

The results suggest that the adolescents had little knowledge of mental health services and they primarily discussed their problems with other family members or friends. The results also suggest that the adolescents prefer to obtain information about mental health problems from education programmes in schools or on television.

CONCLUSIONS

There is a need to make adolescents and their families more aware of the services available to provide help for mental health problems.

A prospective study of the psychological adjustment of children with cancer

PURPOSE

This paper describes the prevalence of emotional and behavioral problems and the social competencies of forty children with cancer immediately after their diagnosis and one year post-diagnosis.

PATIENTS AND METHODS

At both points of time the problems and competencies of the children with cancer were compared with the problems and competencies of a matched group of children living in the community.

RESULTS

The results suggest that early in their illnesses, younger children with cancer experience more internalising problems than children in the community. However, the younger children with cancer improved significantly in these areas during the year after their diagnosis. As a result, one year after their diagnosis there was little difference in the prevalence of problems amongst the younger children with cancer and the children in the community. The older children with cancer did not appear to have more problems than children in the community at either the first or the second assessment.

CONCLUSIONS

The results of the study draw attention to possible differences in the prevalence of emotional and behavioral problems experienced by younger and older children with cancer. The results also suggest that amongst younger children with cancer the prevalence of problems declines during the year after their initial diagnoses.

The use of alternative therapies by children with cancer

OBJECTIVE

To identify the nature and prevalence of therapies used by children with cancer as alternatives to orthodox medical treatment.

DESIGN

A descriptive study in which the parents of children with cancer completed a questionnaire describing the use of alternative therapies by their children.

SUBJECTS

Children diagnosed with cancer, excluding brain tumours, at the Women's and Children's Hospital, South Australia, from July 1988 to July 1992.

RESULTS

Approximately 46% of the children with cancer had used at least one alternative therapy. In general, parents reported that the therapies were used as an addition to orthodox medical treatment rather than as an alternative. Less than 50% of the parents had discussed the use of the alternative therapies with the children's doctors.

CONCLUSIONS

A substantial proportion of children with cancer use alternative therapies and the use of these therapies is often not discussed with the children's medical practitioners. There is a continuing need to consider how to better provide, within the context of orthodox medical treatment, those elements of their children's care which parents currently seek from alternative therapies.

Emotional and behavioural problems experienced by children living in single-parent families: a pilot study

This study compared the prevalence of emotional and behavioural problems experienced by 10-11 year old and 14-15 year old children living in single-parent and two-parent families in South Australia. The 10-11 year old male children living in single-parent families were found to have significantly more emotional and behavioural problems than 10-11 year old male children living in two-parent families. In particular, the younger male children living in single-parent families experienced more externalizing behaviour problems than younger male children living in two-parent families. It is suggested that paediatricians and general practitioners need to be aware of children who are at particular risk for developing emotional and behavioural problems, and the approaches which may be employed to provide help.

A prospective study of the psychological adjustment of parents and families of children with cancer

This study compared the psychological adjustment of parents and families of children with cancer, with the adjustment of parents and families in the community. In the weeks after their children's diagnoses, the mothers of children with cancer reported significantly more anxiety and insomnia, somatic symptoms and social dysfunction than mothers in the community. These problems had declined by the time of a 1 year follow-up assessment. However, at the follow-up assessment the mothers of children with cancer reported significantly more symptoms of depression and somatic symptoms than mothers in the community. A similar pattern of findings was evident among the fathers although the fathers generally reported less distress than was reported by the mothers. The results also suggest that a year after the children's diagnoses, the families in which there was a child with cancer were functioning less effectively than the families in the community.

Childhood emotional and behavioural problems: a comparison of children's reports with reports from parents and teachers

Paediatricians are often asked to assess children with emotional and behavioural problems and are faced with the dilemma that reports about the children's behaviour obtained from the children, and from their parents and teachers, may differ. This study compares the number of childhood emotional and behavioural problems reported by children living in the community, with the number of problems reported by their parents and teachers. When describing both internalizing and externalizing problems, the children consistently reported that they had more problems than were reported by either their parents or teachers. This pattern was particularly evident with reports from older female children who reported many more internalizing problems than were reported by their parents and teachers. Possible reasons for the differences between reports from children and the other informants are discussed.

Differences between reports from children, parents and teachers: implications for epidemiological studies

This study describes the different prevalences obtained when varying combinations of informants were used to identify emotional and behavioural disorders in a representative sample of 336 children living in two-parent families in the community of Adelaide, South Australia. When different informants were used to identify children with disorders, the estimated prevalences ranged from 3.3 +/- 1.6% to 17.9 +/- 4.1% for younger children, and 6.0 +/- 2.9% to 19.9 +/- 4.9% for older children. Results from the study highlight potential methodological problems which arise in epidemiological studies due to differences between reports from children, parents, and teachers describing childhood emotional and behavioural problems.

The psychological adjustment of offspring of adults with obsessive-compulsive disorder: a brief report

This study describes the prevalence of emotional and behavioural problems in the offspring of parents who are members of the Obsessive-Compulsive Neurosis Support Group in South Australia. The results suggest that the offspring of adults with obsessive-compulsive disorder do not have more problems than other children and adolescents in the community. The study also highlights potential benefits of collaborative research conducted by research groups and self-help organisations.

The effect of computer-assisted interviewing on the clinical assessment of children

This study investigated the effect of providing clinicians with a report from a computer-assisted interview conducted prior to the clinical assessment of children referred to a mental health service. The results suggest that the availability of reports from computer-assisted interviews influenced the type of problems identified by clinicians and the services that they recommended to manage the children's problems. It is suggested that reports from computer-assisted interviews could assist clinicians by collecting a broad range of clinical information describing the problems of clinic-referred children. It is also suggested that considerably more research is needed into the possible benefits of computer technology in child and adolescent mental health services.

Differences between informants' reports describing emotional and behavioural problems in community and clinic-referred children: a research note

This study compared the pattern of reports describing childhood emotional and behavioural problems amongst children in the community with the pattern of reports describing children referred to mental health clinics. Whereas children in the community reported more externalizing and internalizing problems than were reported by their parents, clinic-referred children reported fewer externalizing but more internalizing problems than their parents. The results highlight potential limitations which may arise when reports describing the problems of clinic-referred children are used as the criterion for assessing the clinical significance of reports describing problems amongst children in the community.

The use of a computer-assisted interview to administer the Child Behavior Checklist in a child psychiatry service

This study describes the use of a computer-assisted interview to administer the Child Behavior Checklist to the parents of children referred to a child psychiatry service. The scores from the computer-assisted interview varied little from the scores obtained using the standard written checklist. Information collected by means of computer-assisted interviews with parents and children has the potential to facilitate the diagnostic assessment of individual children with emotional and behavioral problems, to provide a more comprehensive description of the work of child psychiatry services, and to encourage new clinical research by mental health professionals working in child psychiatry services.

The prevalence of emotional and behaviour disorders and patterns of service utilisation in children and adolescents

This study compared the prevalence of emotional and behavioural disorders in children attending schools of different socio-economic class. In addition, the study compared the rate of service utilization by children with and without disorders. Using cutoff scores recommended for use with Australian children, the prevalence of disorders in schools of different socio-economic class ranged from 2.3 +/- 2.2 to 13.9 +/- 5.3 per 100 children, with the highest prevalence being found in the lower socio-economic class schools. Although few children with disorders had been seen in a mental health clinic, advice had been sought from other services with regard to 66% of these children. This high rate of service utilization by children with disorders highlights the key role that general practitioners, school guidance officers and hospital services could play in facilitating the early identification and management of children with emotional and behavioural disorders.

Adolescents in custody: hidden psychological morbidity?

Seventy-eight adolescents admitted to Adelaide's youth remand centre provided social data and completed the Youth Self Report (YSR) checklist. Most came from chaotic social backgrounds and were without education or family support. Nearly 40% of remanded adolescents scored above the recommended cut-off scores of the YSR, a figure four times greater than that found among adolescents living in the community. This figure was comparable with that reported by adolescents attending child psychiatric services in Adelaide.

A controlled crossover trial of fenfluramine in autism

We report a 12 month double-blind randomized crossover trial of fenfluramine in 20 children with the syndrome of autism. On active drug most of the children lost weight and blood serotonin levels fell by an average of 60%. There was a fall in urinary dopamine (DA) and noradrenaline (NA) levels and increased excretion of homovanillic acid (HVA). Some of the children showed improvement in tests of cognitive and language function, although the results did not achieve overall statistical significance. Event-related brain potentials (ERPs) were obtained in seven subjects on an auditory choice reaction time task. Side effects of the drug included irritability and lethargy. Fenfluramine may have a limited place in the management of some patients with autistic disorder.

Early childhood development: a comparative study of beliefs held by adolescents, medical students and mothers

This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can do the least, medical students' estimations lying between those of adolescents and mothers, and mothers estimating that the children can do the most. In addition, medical students were found to change their beliefs during the time that they participated in their paediatric teaching programme. It is suggested that paediatricians and other child health professionals take into account the varying beliefs held by different groups in the community when providing advice or teaching about early child development.