Preventing preschool mental health problems: Population-based cluster randomized controlled trial

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Objective Prevention of child behavior problems may reduce later mental health problems. We compared the effectiveness, at the population level, of an efficacious targeted prevention program alone or following a universal parenting program. Method Three arm, cluster randomized controlled trial. 1353 primary caregivers and healthy eight-month-old babies recruited July 2010 to January 2011 from well-child centers (randomization unit). Primary outcome: Child Behavior Checklist (CBCL) externalizing and internalizing scales* at child age three and 4.5 years. Secondary outcomes: Parenting Behavior Checklist* and over-involved/protective parenting (primary caregiver report). Secondary caregivers completed starred measures at age three. Results Retention was 76% and 77% at ages three and 4.5 years, respectively. At three years, intention-to-treat analyses found no statistically significant differences (adjusted mean difference (95% CI; p-value)) for externalizing (Targeted versus Usual Care -0.2 (-1.7 to 1.2; p= 0.76); Combined versus Usual Care 0.4 (-1.1 to 1.9; p=0.60)) or internalizing behavior problems (Targeted versus Usual Care 0.2 (-1.2 to 1.6; p= 0.76); Combined versus Usual Care 0.4 (-1.1 to 2.0; p=0.58)). Primary outcomes were similar at 4.5 years. At three years, primary and secondary caregivers reported less over-involved/protective parenting in both the Combined and Targeted versus Usual Care arm; secondary caregivers also reported less harsh discipline in the Combined and Targeted versus Usual Care arm. Mean program costs per family were $A218 (Targeted arm) and A$682 (Combined arm). Conclusion When translated to the population level by existing staff, pre-existing programs appeared ineffective in improving child behavior, alone or in combination, but improved parenting

Behavioural sleep problems in children with attention-deficit/hyperactivity disorder (ADHD): protocol for a prospective cohort study

Introduction Children with attention-deficit/hyperactivity disorder (ADHD) commonly experience behavioural sleep problems, yet these difficulties are not routinely assessed and managed in this group. Presenting with similar symptoms to ADHD itself, sleep problems are complex in children with ADHD and their aetiology is likely to be multifactorial. Common internalising and externalising comorbidities have been associated with sleep problems in children with ADHD; however, this relationship is yet to be fully elucidated. Furthermore, limited longitudinal data exist on sleep problems in children with ADHD, thus their persistence and impact remain unknown. In a diverse sample of children with ADHD, this study aims to: (1) quantify the relationship between sleep problems and internalising and externalising comorbidities; (2) examine sleep problem trajectories and risk factors; and (3) examine the longitudinal associations between sleep problems and child and family functioning over a 12-month period.Methods and analysis A prospective cohort study of 400 children with ADHD (150 with no/mild sleep problems, 250 with moderate/severe sleep problems) recruited from paediatric practices across Victoria, Australia. The children\u27s parents and teacher provide data at baseline and 6-month and 12-month post enrolment.Key measures Parent report of child\u27s sleep problem severity (no, mild, moderate, severe); specific sleep domain scores assessed using the Child Sleep Habits Questionnaire; internalising and externalising comorbidities assessed by the Anxiety Disorders Interview Schedule for Children IV/Parent version.Analyses Multiple variable logistic and linear regression models examining the associations between key measures, adjusted for confounders identified a priori.Ethics and dissemination Ethics approval has been granted. Findings will contribute to our understanding of behavioural sleep problems in children with ADHD. Clinically, they could improve the assessment and management of sleep problems in this group. We will seek to publish in leading paediatric journals, present at conferences and inform Australian paediatricians through the Australian Paediatric Research Network.<br /

Assessment and management of tic disorders and Tourette syndrome by Australian paediatricians

AIM: The diagnosis and management of tic disorders and Tourette syndrome (TS) can be challenging. A better understanding of current approaches by paediatricians is important to inform research and education to improve patient outcomes. We aimed to investigate current assessment and management practices for tics/TS by Australian paediatricians. METHODS: An online survey was sent to members of the Australian Paediatric Research Network. Primary outcomes of interest included assessment processes, referrals, behavioural interventions and pharmacological management. Four scenarios were presented to elicit information regarding treatment of different types of cases. RESULTS: Of 340 eligible paediatricians, 139 (41%) responded, with 116 (84%) reporting that they diagnose and manage tics/TS as part of their practice. Questionnaires were used more to identify comorbidities (43%) than to quantify tics (12%). Referrals were most likely to be made to psychologists. Medication was considered important in the management of TS by 45% of respondents, with clonidine identified as the first-choice medication by 69%. There was wide variation in both the pharmacological and behavioural management strategies reported. CONCLUSIONS: There is substantial practice variation among Australian paediatricians in the assessment and management of patients referred with tics/TS. This may reflect insufficient evidence regarding best practice, as well as limited training in this area. There is a need for improved education of Australian paediatricians in the assessment and management of tics/TS, as well as further research to identify optimal treatments

The effect of cold and hot reformation process to mechanical properties of deformed automobile chassis material

Vehicles are damaged as a result of traffic accidents. Chassis and body parts of damaged vehicles are reformed by using cold and hot deformation methods. High-strength low alloy (HSLA) steel material coated (galvanised) with S320GD+Z quality (DIN EN 10326) zinc, which is used in chassis production, was used in this study. Steel sheet materials were damaged. Damaged automotive chassis material was reformed with cold and hot reformation processes. Tensile, notch impact, bending and hardness tests were applied to the reference material which were not deformed and materials to which reformation process was applied. In the light of obtained results, the effect of reformation process on mechanical properties of automotive sheet was determined

Cryptococcal parotid involvement: an uncommon localization of Cryptococcus neoformans

We describe a cryptococcal infection localized in the parotid gland of an otherwise healthy 72-year-old woman. The patient presented with a painful, approximately 4.5 cm diameter mass in the anterior region of her right ear. Her symptoms were mild and uncharacteristic. The patient had previously fallen on her face in her garden, causing the loss and breakage of her dentures. Since the soil of the garden contained chicken droppings, it is quite likely that the oral prothesis became contaminated on contacting the soil. The fungus probably entered the parotid gland through the traumatization of the posterior lateral wall of her oral cavity by her broken denture. Numerous intra- and extracellular cryptococcal yeast cells were observed in both histopathological and mycological slide preparations. The yeastlike fungus was recovered in cultures inoculated with tissue collected through three biopsies of her parotid region. The isolates were identified as Cryptococcus neoformans by classical mycology methods and found to be susceptible, in vitro, to fluconazole, amphotericin B and flucytosine. Fluconazole treatment (400 mg/d, for 6 months) was started and the patients facial swelling resolved and the pain significantly reduced within 5 weeks of the initiation of treatment. While fungal infection of the parotid gland have been reported, to our knowledge, this is the first description of a non-disseminated primary parotid infection due to C. neoformans

Utility-based quality of life in mothers of children with behaviour problems: a population-based study

Objectives: 1. To examine the relationship between mothers’ health-related quality of life (HRQoL) and child behaviour problems at age 2 years. 2. To investigate whether the relationship between maternal HRQoL and child behaviour problems is independent of maternal mental health. Methods: Design: Cross-sectional survey nested within a population-level, cluster randomised trial which aims to prevent early child behaviour problems. Participants: 1160 mothers of two year old children, in nine Local Government Areas in Victoria, Australia. Measures: HRQoL was measured using the Assessment of Quality of Life (AQoL-6D) and child behaviour was measured using the Child Behavior Checklist (CBCL/1.5-5 years). Maternal mental health was measured using the Depression Anxiety Stress Scale (DASS). Data were collected at child age 2 years; demographic data were collected at child age 8 months. Results: HRQoL was lower for mothers with children that had borderline/clinical behaviour problems compared to those with children without problems (mean difference -0.14, 95% CI: -0.16 to -0.12, p<0.001). The finding did not markedly change when adjusting for household income, financial security, child gender, child temperament and intervention group status at child age 8 months (mean difference -0.12, 95% CI: -0.15 to -0.09, p<0.001), but did attenuate when additionally adjusting for concurrent maternal mental health (mean difference -0.03, 95% CI: -0.05 to -0.02, p<0.001). Conclusions: Child behaviour problems were associated with lower maternal HRQoL. Child behaviour problems prevention programmes could consider this association with maternal HRQoL and be designed to improve and report both mothers’ and their child’s health and wellbeing.We would like to acknowledge Professor Daniel Shaw, Bibi Gerner, Amelia Hicks, Daisy Grinter, Amy Loughman and Kate Lycett for their help to commence this study in 2010, and their contribution to data collection and intervention delivery. We would also like to thank all the maternal child health nurses from the nine participating LGAs (City of Casey, Bayside City Council, Darebin City Council, Hobsons Bay City Council, City of Port Phillip, Mornington Peninsula Shire, Manningham City Council, Knox City Council and Yarra Ranges Shire Council) and the families taking part. We would like to thank the parenting experts at the Parenting Research Centre who co-facilitate the Toddlers Without Tears parenting groups. Murdoch Childrens Research Institute research is supported by the Victorian Government's Operational Infrastructure Support Programme and funded by Australian National Health and Medical Research Council (NHMRC) Partnership 46525 and community partners: Victorian Department of Education and Early Childhood, Victorian Department of Health and the Municipal Associations of Victoria. The researchers acknowledge support of the Australian NHMRC for salary support through Early Career Fellowship 1035100 (LG), Career Development Awards 607351 (HH) and 546405 (MW) and Capacity Building Grants 425855 (LG) and 436914 (HH, JB and OU). OU is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health in England

Prevalence and Predictors of Medication Use in Children with Attention-Deficit/Hyperactivity Disorder: Evidence from a Community-Based Longitudinal Study

This is the author accepted manuscript. The final version is available from Mary Ann Liebert via the DOI in this recordObjectives: To determine, in a community-based sample of primary school-aged children meeting diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), (1) the proportion of children with ADHD treated with medication; (2) predictors of medication use; and (3) the association between medication use and psychological service utilization. Methods: Grade 1 children with ADHD were recruited through 43 schools in Melbourne, Australia, using a two-stage screening and case confirmation procedure. Parent report of medication treatment, clinician diagnosis, and psychological service use were collected at ages 7 and 10 years. Medication use was analyzed by ADHD subtype. Predictors of medication treatment examined included ADHD symptom severity and persistence, externalizing comorbidities, poor academic performance, and social disadvantage. Unadjusted and adjusted logistic regression were used to identify the predictors of medication status. Results: One hundred seventy-nine children with ADHD were recruited. At baseline, 17.3% had been clinically diagnosed with ADHD, increasing to 37.7% at age 10 years. At baseline, 13.6% were taking ADHD medications, increasing to 25.6% at age 10. Children with the combined and hyperactive-impulsive subtypes were more likely to be taking medication than those with inattentive subtype (age 7: p = 0.002; age 10: p = 0.03). ADHD symptom severity (Conners 3 ADHD Index) at baseline was concurrently and prospectively associated with medication use at both ages (both p = 0.01), and ADHD symptom severity at age 10 was also associated with medication use at age 10 (p = 0.01). Baseline area-level disadvantage was associated with medication use at age 7 (p = 0.04). At 10 years, children receiving medication were more likely, compared with those who were not, to be receiving psychological services (p = 0.001). Conclusions: In this study, only a minority of children meeting diagnostic criteria for ADHD were diagnosed clinically or treated with ADHD medication by age 10. The strongest predictors of medication treatment were ADHD symptom severity and area disadvantage.Australian National Health and Medical Research Council (NHMRC)Collier FoundationMurdoch Children’s Research Institute (MCRI)National Institute for Health Research (NIHR

Family functioning in children with ADHD and subthreshold ADHD: A 3-year longitudinal study

This is the author accepted manuscript.Data availability: To access research materials related to this study, please email corresponding author.Objective: To compare family functioning over time for elementary school children with Attention-Deficit/Hyperactivity Disorder (ADHD; N=179) and subthreshold ADHD (ST ADHD; N=86), to children without ADHD (Control; N=212). Method: ADHD was assessed using the Conners 3 ADHD Index and Diagnostic Interview Schedule for Children IV. At baseline, 18-month follow-up and 36-month follow-up, parents completed measures assessing a range of family functioning domains. Results: At baseline, the ADHD group reported higher psychological distress, less parenting self-efficacy, less parenting consistency, and more stressful life events; and both groups reported poorer family quality of life (QoL) and greater parenting anger. Trajectories were largely similar to controls (i.e., stable over time), but unlike controls, ADHD and ST-ADHD groups showed lessening parent-partner support and parenting warmth, respectively; and both groups showed worsening aspects of family QoL. Conclusion: Families of children with ADHD and ST ADHD report persistently poor or worsening family functioning; highlighting a need for tailored psycho-social supports.Australian National Health & Medical Research Council (NHMRC)Victorian Government Operational Infrastructure SchemeMurdoch Children’s Research InstituteNational Institute for Health and Care Research (NIHR)La Trobe Universit

ADHD at age 7 and functional impairments at age 10

This is the author accepted manuscript. The final version is available from the American Academy of Pediatrics via the DOI in this recordBackground and Objectives Attention-Deficit/Hyperactivity Disorder (ADHD) cohort studies have typically involved clinical samples, and have usually recruited children across wide age ranges, limiting generalizability across complexity and developmental stage. We compared academic, emotional-behavioral and social functioning at age 10, and predictors of outcomes, in a nonreferred cohort of children recruited at age 7, between full syndrome (FS) ADHD, subthreshold (ST) ADHD and non-ADHD controls. Methods This was a prospective, cohort study with a 3 year follow-up period. Children were recruited from 43 socio-economically diverse schools in Melbourne, Australia. Multi-informant outcomes at age 10 were academic functioning (Wide Range Achievement Test-4; Social Skills Improvement System), emotional-behavioral functioning (Strengths and Difficulties Questionnaire (SDQ) Total)) and social functioning (SDQ Peer Problems). Outcomes were compared across the groups using adjusted random effects linear regression analyses. Results 477 children (62% male) were recruited at mean (SD) age 7.3 years (0.4). There were 179 FS participants, 86 ST and 212 controls. Sample retention was 78.2% at 3-year follow-up. Both the FS and ST groups were functioning worse than controls on almost all outcome measures. The best predictors of outcome for children with ADHD were working memory (academic outcome, p<0.001), ADHD symptom severity (emotional-behavioral outcome, parent: p <0.001, teacher: p<0.01), and autism spectrum disorder symptoms (emotional-behavioral outcome, parent p=0.003; social outcome, parent p=0.001). Conclusions Children with FS and ST ADHD at age 7 experience persisting functional impairments across domains at age 10. The predictors identified at age 7 present potential targets for intervention to ameliorate impairments