Evolutionary motor biases and cognition in children with and without autism

Evolution has endowed vertebrates with a divided brain that allows for processing of critical survival behaviours in parallel. Most humans possess a standard functional brain organisation for these ancient sensory-motor behaviours, favouring the right hemisphere for fight-or-flight processes and the left hemisphere for performing structured motor sequences. However, a significant minority of the population possess an organisational phenotype that represents crowding of function in one hemisphere, or a reversal of the standard functional organisation. Using behavioural biases as a proxy for brain organisation, results indicate that reversed brain organisation phenotype increases in populations with autism and is associated with weaker cognitive abilities. Moreover, this study revealed that left-handedness, alone, is not associated with decreased cognitive ability or autism. Rather, left-handedness acts as a marker for decreased cognitive performance when paired with the reversed brain phenotype. The results contribute to comparative research suggesting that modern human abilities are supported by evolutionarily old, lateralised sensory-motor processes. Systematic, longitudinal investigations, capturing genetic measures and brain correlates, are essential to reveal how cognition emerges from these foundational processes. Importantly, strength and direction of biases can act as early markers of brain organisation and cognitive development, leading to promising, novel practices for diagnoses and interventions.</p

Development and evaluation of an educational intervention in youth mental health for primary care practitioners.

Objectives: Irish adolescents have one of the highest rates of suicide and self-harm in the European Union. Although primary care has been identified as an opportune environment in which to detect and treat mental health problems in adolescents, lack of training among primary care professionals (PCPs) is a barrier to optimum identification and treatment. We describe the development and evaluation of an educational intervention on youth mental health and substance misuse for PCPs. Methods: Thirty general practitioners and other PCPs working in the Mid-West region participated in an educational session on youth-friendly consultations, and identification and treatment of mental ill-health and substance use. Learning objectives were addressed through a presentation, video demonstration, small-group discussions, role play, question-and-answer sessions with clinical experts, and an information pack. Following the session, participants completed an evaluation form assessing knowledge gain and usefulness of different components of the session. Results: 71% of participants were involved in the provision of care to young people. 55% had no previous training in youth mental health or substance abuse. Participants rated knowledge gains as highest with regard to understanding the importance of early intervention, and primary care, in youth mental health. The components rated as most useful were case studies/small group discussion, the ‘question-and-answer session’ with clinical experts, and peer interaction. Conclusions: The educational session outlined in this pilot was feasible and acceptable and may represent an effective way to train professionals to help tackle the current crisis in youth mental health

Towards early intervention for youth mental health in primary care: a qualitative study of service provider perspectives in two deprived urban areas

Aims: Early intervention in youth mental health is increasingly viewed as easier, cheaper and more effective than traditional approaches to care. GPs, as the healthcare professional most often consulted by young people, have a central role in early detection of youth mental health and addiction disorders. However, international data suggests many young people have concerns bringing these issues to their GP, and GPs themselves experience difficulty identifying and treating mental health issues. The aim of this study is to gain an understanding of the experience of youth mental health and addiction treatment in two deprived urban areas to inform future early intervention practice development. Methods: Semi-structured interviews were recorded with 37 healthcare professionals. Inductive thematic analysis was carried out using QSR NVivo 9. Results: ‘Context’ suggests youth mental health issues are considerably influenced by wider societal context and local factors (e.g. family). Intervention suggests many barriers and enablers to helping young people, be that at the identification, treatment, or engagement stages of intervention. Conclusions: Many factors influence how a young person develops, seeks help for, and engages with treatment for mental and substance use disorders. This knowledge is useful in developing interventions in primary care that are specific to deprived urban areas

The role of context in youth mental health and addiction issues: a qualitative study on social deprivation in Limerick City and Dublin South Inner City

Introduction: Youth mental health (YMH) and addiction issues are a core component of the problems facing those living in urban areas of social deprivation in Ireland, in particular South Inner City Dublin and Limerick City 1,2. These local contexts, with histories of drug addiction, violence, family dissolution, suicide and gang-related criminality lend themselves to promote further criminal and addictive behaviour, as well as increased stress and decreased protective factors such as social support and education. Early intervention is considered a ‘best buy’ in mental health, but the current Irish system struggles to engage with young people and offer them appropriate treatment

Towards early intervention for youth mental health in primary care: a qualitative study in two deprived urban areas

Towards early intervention for youth mental health in primary care: a qualitative study in two deprived urban area

Primary care and youth mental health in Ireland:qualitative study in deprived urban areas

Background: Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15–24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people’s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals’ experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16–25 years) in primary care in deprived urban settings in Ireland. Methods: The chosen method for this qualitative study was inductive thematic analysis which involved semistructured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres. Results: We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care’s longitudinal nature as a key asset in promoting treatment engagement. Conclusions: Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people’s experience and developing complex interventions that promote early intervention are priorities. (350 words

Early intervention for youth mental health and substance use disorders: the role of the GP

In Ireland, psychological morbidity has been reported in 21-27% of young adults, while the rate of youth suicide is the fourth highest of 26 European Union countries. The challenge of youth mental health for primary care is especially evident in socio-economically disadvantaged areas where risk factors for mental health problems are especially common. Mental health care in primary care has been defined as “the provision of basic preventive and curative mental health care at the first point of contact of entry into the health care system” (WHO, 2001). However despite frequent interaction with general practice, young people may be reluctant to contact general practitioners (GPs), or even recognise them as a source of help when distressed. Health professionals also face many challenges when trying to identify the mental and substance use disorders, including fear of ‘over-medicalising’ young lives and misinterpreting depression as a normal response to the wider psychosocial context of a young person’s life