Use of medication by young people with attention-deficit/hyperactivity disorder

The document attached has been archived with permission from the editor of the Medical Journal of Australia (26 April 2007). An external link to the publisher’s copy is includedObjectivesTo examine the prevalence of psychotropic medication use by children with attention-deficit/hyperactivity disorder (ADHD) and children without ADHD. To identify factors associated with stimulant use by children in the community.DesignA representative, multistage probability sample of Australian households was conducted in 1998. Parents completed questionnaires assessing children's mental health problems and health-related quality of life. They also completed a structured interview to identify children's psychiatric disorders and their use of medications during the previous six months.ParticipantsParent or main caregiver of 3597 children aged 6-17 years.Main outcome measuresRates of use of stimulants (dexamphetamine and methylphenidate), antidepressants and clonidine by children.ResultsOverall, 1.8% of children (95% CI, 1.5%-2.3%) were receiving stimulant medication. Of those with ADHD, 12.6% (95% CI, 9.8%-16.1%) were being treated with stimulants, 2.3% (95% CI, 1.3%-4.3%) with antidepressants, and 1.9% (95% CI, 1.0%-3.7%) with clonidine. Among children without ADHD, 0.5% (95% CI, 0.3%-0.8%) were receiving stimulant medication. This represented 22.9% (95% CI, 14.6%-34.0%) of all the children who were receiving stimulants. Variables significantly associated with stimulant use were being male, having ADHD, attending a paediatrician, and having higher scores on the Aggressive Behaviour and Attention Problems scales on the Child Behaviour Checklist.ConclusionsAbout 13% of Australian children with ADHD, and a substantial number of children without ADHD, are taking stimulants. The question of whether Australian children are being undertreated or overtreated with stimulant medication depends on the criteria used to assess the appropriateness of stimulant use. Additional information is needed to clarify when stimulants should be used to treat ADHD.Michael G. Sawyer, Joseph M. Rey, Brian W. Graetz, Jennifer J. Clark and Peter A. Baghurs

Genetic and clinical contributions to cerebral palsy: A multi-variable analysis

All authors are contributors to the Australian Collaborative Cerebral Palsy Research Group The definitive version is available at www.wileyonlinelibrary.comAimThis study aims to examine single nucleotide polymorphism (SNP) associations with cerebral palsy in a multi-variable analysis adjusting for potential clinical confounders and to assess SNP-SNP and SNP-maternal infection interactions as contributors to cerebral palsy.MethodsA case control study including 587 children with cerebral palsy and 1154 control children without cerebral palsy. Thirty-nine candidate SNPs were genotyped in both mother and child. Data linkage to perinatal notes and cerebral palsy registers was performed with a supplementary maternal pregnancy questionnaire. History of known maternal infection during pregnancy was extracted from perinatal databases.ResultsBoth maternal and fetal carriage of inducible nitric oxide synthase SNP rs1137933 were significantly negatively associated with cerebral palsy in infants born at less than 32 weeks gestation after adjustment for potential clinical confounders and correction for multiple testing (odds ratio 0.55, 95% confidence interval 0.38-0.79; odds ratio 0.57, 95% confidence interval 0.4-0.82, respectively). Analysis did not show any statistically significant SNP-SNP or SNP-maternal infection interactions after correction for multiple testing.ConclusionsMaternal and child inducible nitric oxide synthase SNPs are associated with reduced risk of cerebral palsy in infants born very preterm. There was no evidence for statistically significant SNP-SNP or SNP-maternal infection interactions as modulators of cerebral palsy risk.Michael E O’Callaghan, Alastair H MacLennan, Catherine S Gibson, Gai L McMichael, Eric A Haan, Jessica L Broadbent, Peter A Baghurst, Paul N Goldwater, Gustaaf A Dekker and for the Australian Collaborative Cerebral Palsy Research Grou

Resilience and its association with depression, emotional and behavioural problems, and mental health service utilisation among refugee adolescents living in South Australia

Extent: 9p.Background. Despite the frequency of traumatic or stressful events experienced by refugee children and adolescents prior to migration and following resettlement, the majority do not experience mental health problems emphasising the critical nature of resilience. While a host of factors deemed to be protective of mental health in young refugees have been identified, there has been little research exploring the role of resilience as a distinct psychological construct. This study aimed to explore the nature of psychological resilience in refugee adolescents and the relationship between resilience and depression, other emotional and behavioural problems, and mental health service uptake. Method. One hundred and seventy multiethnic refugee adolescents aged 13–17 from South Australia were administered a survey comprising the Connor-Davidson Resilience Scale (CD-RISC), Children’s Depression Inventory (CDI), and Strengths and Difficulties Questionnaire (SDQ). Results. Females tended to have higher resilience, as did those adolescents who had been living in Australia longer. Adolescents suffering from depressive symptoms or other emotional or behavioural problems had lower resilience. There was little evidence of an association between resilience scores and exposure to trauma or service utilisation. Discussion. Fostering resilience may be critical to efforts to prevent or reduce mental health problems in refugee adolescents.Tahereh Ziaian, Helena de Anstiss, Georgia Antoniou, Peter Baghurst, and Michael Sawye

Resource factors for mental health resilience in early childhood: An analysis with multiple methodologies

Extent: 23p.Background: Given that relatively little is known about the development of resilience in early childhood, this longitudinal study aimed to identify preschool resource factors associated with young children’s mental health resilience to family adversity. Methods: A community sample of 474 young Australian children was assessed in preschool (mean age 4.59 years, 49% male), and again two years later after their transition into formal schooling. At each assessment, standard questionnaires were used to obtain ratings from both parents and teachers about the quality of children’s relationships with parents and teachers, children’s self-concept and self-control, mental health (Strengths and Difficulties Questionnaire), and family adversities (including stressful life events and socioeconomic disadvantage). Results: Greater exposure to cumulative family adversities was associated with both greater teacher- and parent-reported child mental health difficulties two years later. Multiple methodologies for operationalizing resilience were used to identify resources associated with resilient mental health outcomes. Higher quality child–parent and child-teacher relationships, and greater child self-concept and self-control were associated with resilient mental health outcomes. With the exception of child-teacher relationships, these resources were also prospective antecedents of subsequent resilient mental health outcomes in children with no pre-existing mental health difficulties. Child–parent relationships and child self-concept generally had promotive effects, being equally beneficial for children facing both low- and high-adversity. Child self-control demonstrated a small protective effect on teacher-reported outcomes, with greater self-control conferring greater protection to children under conditions of high-adversity. Conclusions: Findings suggest that early intervention and prevention strategies that focus on fostering child-adult relationship quality, self-concept, and self-control in young children may help build children’s mental health and their resilience to family adversities.Lauren R Miller-Lewis, Amelia K Searle, Michael G Sawyer, Peter A Baghurst and Darren Hedle

Weight Gain in Early Life Predicts Risk of Islet Autoimmunity in Children With a First-Degree Relative With Type 1 Diabetes

OBJECTIVE—In a prospective birth cohort study, we followed infants who had a first-degree relative with type 1 diabetes to investigate the relationship between early growth and infant feeding and the risk of islet autoimmunity

Indicators of university–industry knowledge transfer performance and their implication for universities: evidence from the United Kingdom

The issue of what indicators are most appropriate in order to measure the performance of universities in knowledge transfer (KT) activities remains relatively under-investigated. The main aim of this paper is to identify and discuss the limitations to the current measurements of university-industry KT performance, and propose some directions for improvement. We argue that university-industry KT can unfold in many ways and impact many stakeholders, and that, especially in highly differentiated university systems, choosing indicators focused on a narrow range of activities and impacts might limit the ability of universities to accurately represent their KT performance. Therefore, KT indicators should include a variety of activities and reflect a variety of impacts, so as to allow comparability between different institutions and avoid the creation of undesirable behavioural incentives. To illustrate these issues empirically, we discuss the case of the United Kingdom’s Higher Education –Business and Community Interaction (HE-BCI) survey

Stressful life events and cancer risk

In a prospective cohort study in Denmark of 8736 randomly selected people, no evidence was found among 1011 subjects who developed cancer that self-reported stressful major life events had increased their risk for cancer

Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis

Lead is a confirmed neurotoxin, but questions remain about lead-associated intellectual deficits at blood lead levels < 10 μg/dL and whether lower exposures are, for a given change in exposure, associated with greater deficits. The objective of this study was to examine the association of intelligence test scores and blood lead concentration, especially for children who had maximal measured blood lead levels < 10 μg/dL. We examined data collected from 1,333 children who participated in seven international population-based longitudinal cohort studies, followed from birth or infancy until 5–10 years of age. The full-scale IQ score was the primary outcome measure. The geometric mean blood lead concentration of the children peaked at 17.8 μg/dL and declined to 9.4 μg/dL by 5–7 years of age; 244 (18%) children had a maximal blood lead concentration < 10 μg/dL, and 103 (8%) had a maximal blood lead concentration < 7.5 μg/dL. After adjustment for covariates, we found an inverse relationship between blood lead concentration and IQ score. Using a log-linear model, we found a 6.9 IQ point decrement [95% confidence interval (CI), 4.2–9.4] associated with an increase in concurrent blood lead levels from 2.4 to 30 μg/dL. The estimated IQ point decrements associated with an increase in blood lead from 2.4 to 10 μg/dL, 10 to 20 μg/dL, and 20 to 30 μg/dL were 3.9 (95% CI, 2.4–5.3), 1.9 (95% CI, 1.2–2.6), and 1.1 (95% CI, 0.7–1.5), respectively. For a given increase in blood lead, the lead-associated intellectual decrement for children with a maximal blood lead level < 7.5 μg/dL was significantly greater than that observed for those with a maximal blood lead level ≥7.5 μg/dL (p = 0.015). We conclude that environmental lead exposure in children who have maximal blood lead levels < 7.5 μg/dL is associated with intellectual deficits

Lead exposure in adult males in urban Transvaal Province, South Africa during the apartheid era

Human exposure to lead is a substantial public health hazard worldwide and is particularly problematic in the Republic of South Africa given the country’s late cessation of leaded petrol. Lead exposure is associated with a number of serious health issues and diseases including developmental and cognitive deficiency, hypertension and heart disease. Understanding the distribution of lifetime lead burden within a given population is critical for reducing exposure rates. Femoral bone from 101 deceased adult males living in urban Transvaal Province (now Gauteng Province), South Africa between 1960 and 1998 were analyzed for lead concentration by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Of the 72 black and 29 white individuals sampled, chronic lead exposure was apparent in nearly all individuals. White males showed significantly higher median bone lead concentration (ME = 10.04 µg·g−1), than black males (ME = 3.80 µg·g−1) despite higher socioeconomic status. Bone lead concentration covaries significantly, though weakly, with individual age. There was no significant temporal trend in bone lead concentration. These results indicate that long-term low to moderate lead exposure is the historical norm among South African males. Unexpectedly, this research indicates that white males in the sample population were more highly exposed to lead