Screening for psychopathology in child welfare: the Strengths and Difficulties Questionnaire (SDQ) compared with the Achenbach System of Empirically Based Assessment (ASEBA)

Whilst children in child welfare suffer more psychopathology than their community peers, only a small percentage of them actually receive mental health care. Previous literature suggested that all children entering child welfare should be screened. This study evaluated whether the Strengths and Difficulties Questionnaire (SDQ) could be used for this purpose. The extended version of the SDQ and the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire were administered to parents and caregivers of 292 children in child welfare. Children older than 11 years also completed the SDQ self-report and the Youth Self Report (YSR). Furthermore, the child’s history of service use was recorded and informants were asked if the actual care was sufficient. Inter-informant correlations for the scores from the SDQ and ASEBA were high and comparable or favoured the use of the SDQ (for parents and caregivers). Internal consistency was satisfactory to good. For all informants, high correlations were found between SDQ and ASEBA. Despite high scores on the SDQ, only 29% of the children had received mental health care. Service use was only correlated with the parent SDQ and the CBCL and TRF. Additional help, as requested by 21% of the parents and 37% of the caregivers, correlated moderately with the SDQ and ASEBA scores. Compared to the total difficulties score, the impact supplement is a better predictor of service use and the informant’s request for additional help. This study illustrates that the Dutch version of the SDQ, similar to the English and German versions, has equal validity as the Dutch ASEBA for screening children. Caution is warranted when the SDQ is the only source of information for referrals to specialized care

The young Van Dyck’s fingerprint : a technical approach to assess the authenticity of a disputed painting

The painting Saint Jerome, part of the collection of the Maagdenhuis Museum (Antwerp, Belgium), is attributed to the young Anthony van Dyck (1613–1621) with reservations. The painting displays remarkable compositional and iconographic similarities with two early Van Dyck works (1618–1620) now in Museum Boijmans van Beuningen (Rotterdam) and Nationalmuseum (Stockholm). Despite these similarities, previous art historical research did not result in a clear attribution to this master. In this study, the work’s authenticity as a young Van Dyck painting was assessed from a technical perspective by employing a twofold approach. First, technical information on Van Dyck’s materials and techniques, here identified as his fingerprint, were defined based on a literature review. Second, the materials and techniques of the questioned Saint Jerome painting were characterized by using complementary imaging techniques: infrared reflectography, X-ray radiography and macro X-ray fluorescence scanning. The insights from this non-invasive research were supplemented with analysis of a limited number of cross-sections by means of field emission scanning electron microscopy coupled with energy dispersive X-ray spectroscopy. The results demonstrated that the questioned painting’s materials and techniques deviate from Van Dyck’s fingerprint, thus making the authorship of this master very unlikely

Accuracy of consumer-based activity trackers as measuring tool and coaching device in patients with COPD and healthy controls

Background Consumer-based activity trackers are used to measure and improve physical activity. However, the accuracy of these devices as clinical endpoint or coaching tool is unclear. We investigated the use of two activity trackers as measuring and coaching tool in patients with Chronic Obstructive Pulmonary Disease (COPD) and healthy age-matched controls. Methods Daily steps were measured by two consumer-based activity trackers (Fitbit Zip, worn at the hip and Fitbit Alta, worn at the wrist) and a validated activity monitor (Dynaport Movemonitor) in 28 patients with COPD and 14 healthy age-matched controls for 14 consecutive days. To investigate the accuracy of the activity trackers as a clinical endpoint, mean step count per patient were compared with the reference activity monitor and agreement was investigated by Bland-Altman plots. To evaluate the accuracy of activity trackers as coaching tool, day-by-day differences within patients were calculated for all three devices. Additionally, consistency of ranking daily steps between the activity trackers and accelerometer was investigated by Kendall correlation coefficient. Results As a measuring tool, the hip worn activity tracker significantly underestimates daily step count in patients with COPD as compared to DAM (mean +/- SD Delta-1112 +/- 872 steps/day; p<0.0001). This underestimation is less prominent in healthy subjects (p = 0.21). The wrist worn activity tracker showed a non-significant overestimation of step count (p = 0.13) in patients with COPD, and a significant overestimation of daily steps in healthy controls (mean +/- SD Delta+1907 +/- 2147 steps/day; p = 0.006). As a coaching tool, both hip and wrist worn activity tracker were able to pick up the day-by-day variability as measured by Dynaport (consistency of ranking resp. r = 0.80; r = 0.68 in COPD). Conclusion Although the accuracy of hip worn consumer-based activity trackers in patients with COPD and wrist worn activity trackers in healthy subjects as clinical endpoints is unsatisfactory, these devices are valid to use as a coaching tool

Key health outcomes for children and young people with neurodisability: qualitative research with young people and parents

OBJECTIVES: To identify key health outcomes, beyond morbidity and mortality, regarded as important in children and young people with neurodisability, and their parents. DESIGN: Qualitative research incorporating a thematic analysis of the data supported by the Framework Approach; the International Classification of Functioning, Disability and Health (ICF) provided a theoretical foundation. SETTING: The study was conducted in community settings. PARTICIPANTS: Participants were 54 children and young people with neurodisability: 50 participated in focus groups, and 4 in interviews; 53 parents participated: 47 in focus groups and 6 in interviews. Children/young people and parents were recruited through different networks, and were not related. RESULTS: Children/young people and parents viewed health outcomes as inter-related. Achievement in some outcomes appeared valued to the extent that it enabled or supported more valued domains of health. Health outcomes prioritised by both young people and parents were: communication, mobility, pain, self-care, temperament, interpersonal relationships and interactions, community and social life, emotional well-being and gaining independence/future aspirations. Parents also highlighted their child's sleep, behaviour and/or safety. CONCLUSIONS: Those responsible for health services for children/young people with neurodisability should take account of the aspects of health identified by families. The aspects of health identified in this study provide a basis for selecting appropriate health indicators and outcome measures

Regional analysis of UK primary care prescribing and adult service referrals for young people with attention-deficit hyperactivity disorder.

BACKGROUND: Approximately 20% of children with attention-deficit hyperactivity disorder (ADHD) experience clinical levels of impairment into adulthood. In the UK, there is a sharp reduction in ADHD drug prescribing over the period of transition from child to adult services, which is higher than expected given estimates of ADHD persistence, and may be linked to difficulties in accessing adult services. Little is currently known about geographical variations in prescribing and how this may relate to service access. AIMS: To analyse geographic variations in primary care prescribing of ADHD medications over the transition period (age 16-19 years) and adult mental health service (AMHS) referrals, and illustrate their relationship with UK adult ADHD service locations. METHOD: Using a Clinical Practice Research Datalink cohort of people with an ADHD diagnosis aged 10-20 in 2005 (study period 2005-2013; n = 9390, 99% diagnosed <18 years), regional data on ADHD prescribing over the transition period and AMHS referrals, were mapped against adult ADHD services identified in a linked mapping study. RESULTS: Differences were found by region in the mean age at cessation of ADHD prescribing, range 15.8-17.4 years (P<0.001), as well as in referral rates to AMHSs, range 4-21% (P<0.001). There was no obvious relationship between service provision and prescribing variation. CONCLUSIONS: Clear regional differences were found in primary care prescribing over the transition period and in referrals to AMHSs. Taken together with service mapping, this suggests inequitable provision and is important information for those who commission and deliver services for adults with ADHD

Young people with attention deficit hyperactivity disorder in transition from child to adult services: a qualitative study of the experiences of general practitioners in the UK

Abstract: Background: Many young people with Attention Deficit Hyperactivity Disorder (ADHD) have impairing symptoms that persist into adulthood, yet only a minority experience continuity of care into adult life. Despite growing emphasis on the primary care role in ADHD management in NICE ADHD and transition guidance, little is known about GPs’ perspectives, which could hamper efforts to improve outcomes for young people leaving children’s services. This study aimed to understand GPs’ experiences of involvement with this group and explore their views on the roles and responsibilities of primary and secondary care in transition, to inform recommendations for policy and practice. Method: Qualitative interview study with GPs across the UK. Semi-structured telephone interviews were carried out with 14 GPs recruited through a linked mapping study, social media, and snowballing; data were analysed using thematic analysis. Results: In the absence of a smooth transition from child to adult services, many GPs became involved ‘by default’. GPs reacted by trying to identify suitable specialist services, and were faced with the decision of whether to continue ADHD prescribing. Such decisions were strongly influenced by perceptions that prescribing carried risks, and concerns over responsibility, particularly where specialist services were lacking. Participants described variation in service availability, and some highlighted tensions around how shared care works in practice. Conclusion: Implementation of NICE guidance is highly variable, with implications for GPs and patients. Risk and responsibility for primary care ADHD prescribing are central concerns that need to be addressed, as is the inclusion of GPs in a planned transition process

Assessing issues of attribution by means of technical research. A disputed Van Dyck reconsidered

Over the past decades, technical study of artworks proved valuable for addressing issues of attribution.[1] By revealing new information about painting materials and techniques, advanced imaging tools and chemical analyses (e.g. Infrared reflectography, Macroscopic X-ray fluorescence and XRF analysis), we challenge and broaden the current interpretative value of technical investigations of artworks.[2-3] However, despite the recurring introduction of improved diagnostic techniques for the study of paintings and the increasing knowledge of painters’ modus operandi, ‘advances in the methodology of attribution seemed to progress at a snail’s pace.’[4] Hence, the main problem in this research field is how to transform technical data into meaningful information favoring or opposing a specific attribution. This issue can be solved by identifying distinctive materials and techniques as markers in a set of reference artworks for a specific master, workshop, school or period.[5] In this study we assess how an object-based methodology can assist in addressing attribution problems. The method was applied to a case study, i.e. the painting Saint Jerome attributed to Anthony van Dyck [6] of the Antwerp Museum Maagdenhuis, which presented useful evidence on the issue of markers. For the painting Saint Jerome, in-depth art historical and archival research did not result in a clear attribution to Van Dyck. Limited information on the painting’s origin and history could be retraced as the earliest written document on the picture’s provenance dates from 1841. Therefore, Van Dyck’s working procedures were studied by systematically gathering available compositional data derived from a set of 37 reference paintings.[7-16] Additionally, the Antwerp painting’s origin, history, iconographic program, formal features, current condition, physical and technical aspects were examined. Hence, the obtained compositional data of the painting could be studied within a broader art historical and technical context to determine whether the identified painting materials and techniques could be used as markers. This holistic approach thus allowed us to simultaneously assess art historical and technical data to systematically refine our observations and conclusions. As such, the selected markers could be determined for the painting under study, allowing a comparison with the working procedures of Van Dyck. In what follows, we elaborate on the results of the proposed object-based methodology applied to the specific case. Based on the identified working procedures of Van Dyck, the layer build-up, chemical composition and microstructure of the painting were determined by chemical analysis and imaging techniques (e.g. IRR, XRR, Portable XRF, FE-SEM-EDX and MA-XRF scanning). From this working procedure, a set of 4markers could be identified opposing the painting’s current attribution to Van Dyck. First, the identified type of support of the painting Saint Jerome, which is plain-weave canvas with a low density, deviates from Van Dyck’s choice of canvas supports. More specifically, he preferred plain and tabby-weave canvas with a high density. Second, the picture is painted on top of a red chalk-based ground with a grey priming. This canvas preparation type differs from Van Dyck’s usage of white and pale colored chalk-based grounds with various types of primings. Third, the identified blue pigment employed in the painting Saint Jeromefor the depiction of the blue drapery is smalt. Van Dyck, however, favored the usage of the organic pigment indigo to construct blue draperies. Fourth, the identified complex method of paint application to depict the flesh tones in the painting Saint Jerome substantially diverges from Van Dyck’s art practice, who models the human flesh in a single layer. In conclusion, the materials and techniques used in the picture Saint Jeromeclearly deviate from Van Dyck’s working process. These findings thus led us to the conclusion that the painting is not by Anthony van Dyck. References: [1]M. W. Ainsworth.Getty Newsletter2005; 20.1: 4.[2]H.Verougstraete, J. Couvert. La Peinture Ancienne et ses Procédés. Copies, réplique, pastiches, Peeters, Leuven, 2006.[3]K. Van der Stighelen, K. Janssens, G. Van der Snickt, M. Alfeld, B. Van Beneden, B. Demarsin, M. Proesmans, G. Marchal, J.Dik.Art Matters. International Journal for Technical Art History2014; 6: 21.[4]M. W. Ainsworth, in Recent Developments in the Technical Examination of Early Netherlandish Painting. Methodology, Limitations & Perspectives, (Eds: M. Faries, R. Spronk), Brepols, Turnhout, 2003, 137.[5]L. Sheldon, G. Macaro, in European Paintings 15th-18thcentury. Copying, Replicating and Emulating, (Ed: E. Hermens), Archetype Publications, London, 2014, 105-112.[6]L. Philippen, in Commissie van Openbare Onderstand Antwerpen. Bestuurlijk Verslag over het Dienstjaar 1931, Commissie van Openbare Onderstand, Antwerp, 1933, 182-189.[7]L. Alba, M. Jover, M. D. Goya, in The Young Van Dyck, (Eds: A. Vergara, F. Lammertse), Thames & Hudson, London, 2013, 337.[8]M. W. Ainsworth, J. Brealey, E. Haverkamp-Begemann, P. Meyers, Art and Autoradiography: Insights into the Genesis of Paintings by Rembrandt, Van Dyck and Vermeer, The Metropolitan Museum of Art,New York,1987.[9]C. Christensen, M. Palmer, M. Swicklik, in Anthony van Dyck, (Ed: J. Sweeney),National Gallery of Art, Washington, 1990-1991,45.[10]L. Depuydt-Elbaum, R. Ghys. Bulletin de l’Institut Royal du Patrimoine Artistique1999-2000; 28: 251.[11]D. Fend. Jahrbuch des Kunsthistorischen Museums Wien2001; 2: 263.[12]C. Fryklund, F. Lammertse, Masterpiece or Copy? Two Versions of Anthony van Dyck’s St Jerome with an Angel, Museum Boijmans van Beuningen, Rotterdam, 2009.[13]M. Grießer. Jahrbuch des Kunsthistorischen Museums Wien2001; 2: 266.[14]A. Roy. National Gallery Technical Bulletin1999; 20: 50.[15]N. Van Hout,in Looking Through Paintings,(Ed: A. Hermens), Archetype Publications,London1998, 199.[16] R. Woudhuysen-Keller, K. Groen. The Hamilton Kerr Institute Bulletin1988; 1: 119

Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study

Background Optimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions. Aims To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition. Method Surveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires. Results Questionnaire response was 79% at baseline and 82% at follow-up. For those aged 17-19, incident rate (range adjusted for non-response) of transition need was 202-511 per 100 000 people aged 17-19 per year, with successful transition of 38-96 per 100 000 people aged 17-19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria. Conclusions As inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences

Seven steps to mapping health service provision: lessons learned from mapping services for adults with Attention-Deficit/Hyperactivity Disorder (ADHD) in the UK.

BACKGROUND: ADHD affects some individuals throughout their lifespan, yet service provision for adults in the United Kingdom (UK) is patchy. Current methods for mapping health service provision are resource intensive, do not map specialist ADHD teams separately from generic mental health services, and often fail to triangulate government data with accounts from service users and clinicians. Without a national audit that maps adult ADHD provision, it is difficult to quantify current gaps in provision and make the case for change. This paper describes the development of a seven step approach to map adult ADHD service provision in the UK. METHODS: A mapping method was piloted in 2016 and run definitively in 2018. A seven step method was developed: 1. Defining the target service 2. Identifying key informants 3. Designing the survey 4. Data collection 5. Data analysis 6. Communicating findings 7. Hosting/updating the service map. Patients and members of the public (including clinicians and commissioners) were involved with design, data collection and dissemination of findings. RESULTS: Using a broad definition of adult ADHD services resulted in an inclusive list of identified services, and allowed the definition to be narrowed to National Health Service (NHS) funded specialist ADHD services at data analysis, with confidence that few relevant services would be missed. Key informants included patients, carers, a range of health workers, and commissioners. A brief online survey, written using lay terms, appeared acceptable to informants. Emails sent using national organisations' mailing lists were the most effective way to access informants on a large scale. Adaptations to the methodology in 2018 were associated with 64% more responses (2371 vs 1446) collected in 83% less time (5 vs 30 weeks) than the pilot. The 2016 map of adult ADHD services was viewed 13,688 times in 17 weeks, indicating effective communication of findings. CONCLUSION: This seven step pragmatic method was effective for collating and communicating national service data about UK adult ADHD service provision. Patient and public involvement and engagement from partner organisations was crucial throughout. Lessons learned may be transferable to mapping service provision for other health conditions and in other locations