Brett McDermott

Posttraumatic stress disorder and general psychopathology in children and adolescents following a wildfire disaster.

Objective: To report on the use of the Post Traumatic Stress Disorder Reaction Index (PTSD-RI) and the Strengths and Difficulties Questionnaire (SDQ) in identifying children and adolescents who may require psychological interventions following exposure to a wildfire disaster. Method: Six months after a wildfire disaster, we conducted a school-based program to screen for wildfire-related events, such as exposure to and perception of threat, posttraumatic stress disorder (PTSD), and general psychopathology. Results: The screening battery was completed by 222 children (mean age 12.5 years, SD 2.48; range 8 to 18 years). Severe or very severe PTSD was reported by 9.0% of students, while 22.6% scored in the abnormal range on the Emotional Symptoms subscale of the SDQ. Younger children and individuals with greater exposure to and perception of threat experienced higher levels of PTSD and general psychopathology. Female students reported a greater perception of threat but did not report higher levels of PTSD or other symptoms. Conclusions: Screening was well received by students, parents, and staff and proved feasible in the postdisaster environment. The PTSD-RI and SDQ demonstrated different individual risk associations and functioned as complementary measures within the screening battery. The identification of children at greatest risk of mental health morbidity enabled service providers to selectively target limited mental health resources.

Adolescents' Perceived Weight Associated With Depression in Young Adulthood: A Longitudinal Study

Objective: The objective of this study is to examine whether adolescents’ measured BMI and self‐ or mothers perception of weight status at age 14 are associated with depression at age 21.

Postdisaster emotional distress, depression and event‐related variables: findings across child and adolescent developmental stages

Objective: Developmental approaches have not been widely used in child and adolescent posttraumatic stress disorder research, and little is known about developmental differences in response to postdisaster trauma. Our objective was to investigate postdisaster depression and emotional distress psychopathology across a broad child and adolescent developmental range. Method: Six months following a bushfire disaster, 2379 grade 4–12 school students completed an extensive self-report battery, which included the Impact of Event Scale and the Birleson Depression Inventory. Generalized linear models were constructed to model the effects of multiple covariates on continuous outcome measures of depression and emotional distress. Results: Significant independent predictors of persisting depressive symptoms were increased symptoms of emotional distress; increased symptoms of anxiety; evacuation experience; and school grade. Significant independent predictors of emotional distress were persisting depressive symptoms; perception of threat to self or to parents; evacuation experience; and school grade. Gender was not a significant predictor in either the depression or emotional distress multivariate models. Complex, non-linear relationships between depression, emotional distress and school grade were found. Conclusion: This study suggests that important developmental differences in postdisaster psychological responses exist across a broad spectrum of developmental stages in children.

Fetal growth and subsequent mental health problems in children aged 4 to 13 years.

To test the hypothesis that children with suboptimal fetal growth have significantly poorer mental health outcomes than those with optimal growth, a population random sample survey of children aged 4 to 16 years in Western Australia in 1993 was conducted. The Child Behavior Checklist (Achenbach 1991a) and the Teacher Report Form (Achenbach 1991b) were used to define mental health morbidity. Survey data for 1775 children aged 4 to 13 years were available for linkage with original birth information. The percentage of expected birth weight (PEBW) was used as the measure of fetal growth. Children below the 2nd centile of PEBW who had achieved only 57% to 72% of their expected birthweight given their gestation at delivery were at significant risk of a mental health morbidity (OR 2.9, 95% CI 1.18, 7.12). In addition, they were more likely to be rated as academically impaired (OR 6.0, 95% CI 2.25, 16.06) and to have poor general health (OR 5.1, 95% CI 1.69, 15.52).

Parental Anxiety in the Treatment of Childhood Anxiety: A Different Story Three Years Later

This study reports on the results of a long-term follow-up of 60 (29 girls and 31 boys, all of Caucasian ethnicity) children and adolescents diagnosed with an anxiety disorder and treated 3 years earlier with child-focused cognitive behavior therapy (CBT) or child-focused CBT plus parental anxiety management (PAM). Sixty-seven children aged 7 to --14 years were assigned to either the “child anxiety only” or the “child + parental anxiety” condition based on parents’ trait anxiety scores. Within conditions, participants were randomly assigned to one of the two treatment conditions. Results indicated that at follow-up, parental anxiety did not represent a risk factor for childrens treatment outcome. In addition at follow-up, children who received the combined CBT + PAM intervention (regardless of parental anxiety status) were significantly more likely to be anxiety diagnosis free compared with children who received the child-focused CBT intervention only.

Posttraumatic stress disorder and emotional problems in children following motor vehicle accidents: An extended case series

Objective: The prevalence of posttraumatic stress disorder (PTSD) and general psychopathology in children following motor vehicle accidents (MVA) was investigated. Method: Twenty-six subjects aged 8–13 years presenting to an emergency department following an MVA were assessed 3 months after the accident using a standard clinical psychiatric assessment, a structured research interview and self- and parent-report questionnaires. Results: A higher prevalence of psychopathology was seen in the sample compared with community controls. Self-report of PTSD symptoms revealed 22% subjects in the moderate or severe PTSD range and 35% of mild severity. There was significant concordance between self-report PTSD scores and a clinical diagnosis of PTSD. Perception of threat and the internalising subscale on the Child Behaviour Checklist were significantly correlated with PTSD scores. Conclusions: PTSD and other symptoms of emotional distress are common following MVAs. The clinical and public health implications are discussed, and areas for further research highlighted.

Parent and child report of family functioning in a clinical child and adolescent eating disorders sample

Objective: To investigate parent and self-report of family dysfunction in children and adolescents with eating disorders. Further, to investigate family functioning differences across the eating disorders diagnostic groups; anorexia nervosa, eating disorders not otherwise specified (EDNOS) and bulimia nervosa, and between the restricting and binge-purge eating disorders behavioural subtypes. Methods: The Family Adjustment Device General Functioning Scale (FAD-GFS) was administered to 100 children and their parents who presented consecutively at an eating disorders assessment clinic. DSM-IV eating disorders diagnoses in this group included 42 children diagnosed with anorexia nervosa, 26 with EDNOS, 12 with bulimia nervosa and 20 diagnosed as having no eating disorder. Results: Both the parent and child FAD-GFS report demonstrated high internal consistency supporting the suitability of this instrument for research with this sample. Parent and child reports were moderately positively correlated. Total scores for all eating disorders diagnostic categories were significantly higher than community norms. Anorexia nervosa, EDNOS and bulimia nervosa groups did not significantly differ on parent or child reports. FAD-GFS profiles for restricters and binge-purgers suggest higher levels of family dysfunction in the families of binge purgers. Conclusions: The FAD-GFS has suitable psychometric properties for use as a summary instrument with young people diagnosed with an eating disorder. However, more informative instruments assaying a greater range of constructs, especially in the impulsive, dyscontrol domain, are required to investigate differences among eating disorders diagnostic groups and behavioural subtypes.

Predictors of maternal misclassifications of their offspring's weight status: a longitudinal study

Background:Very little is known about the factors influencing parental misclassifications of a childs weight status. The aim of this study is to examine the predictors of maternal misclassifications of their adolescent offsprings weight status.Methods:A mother–child linked analysis was carried out using 14-year follow-up data from a population-based prospective birth cohort of 2650 children (52% males) who were participants in the Mater-University Study of Pregnancy in Brisbane (Australia) in 1981. Offsprings observed height and weight and maternal perception of offspring weight were reported when they were 14 years old and predictors were prospectively recorded either at first clinical visit of mothers or at 5 or 14 years follow-up. Maternal misclassifications were defined combining observed body mass index (BMI) categories and maternal perceptions of their offsprings weight status.Results:We found that maternal misclassification of childs weight status was common and included misclassifications both to higher and lower weight categories. Forty percent of mothers of overweight children misclassified their child as normal or underweight, more so in males than females. Fifteen percent of mothers of normal weight children misclassified their child as underweight, again more so in males than females. The main independent predictors of maternal misclassifications of child weight status were gender, child dissatisfaction with appearance, shape, size and weight, dieting to lose weight, general health status, maternal BMI and family meals. Gender, child dissatisfaction, dieting and maternal overweight were especially associated with misclassifications of overweight children.Conclusions:This study identified a number of maternal, child and family factors associated with maternal misclassifications of child weight status. Although relevant for clinical practice, further study is needed, however, to evaluate the benefits and harms of promoting increasing parental and child awareness of the childs weight status at a population level.

Vulnerability factors for disaster-induced child post-traumatic stress disorder: the case for low family resilience and previous mental illness

Objective: The aim of the present study was to investigate whether parent report of family resilience predicted childrens disaster-induced post-traumatic stress disorder (PTSD) and general emotional symptoms, independent of a broad range of variables including event-related factors, previous child mental illness and social connectedness. Methods: A total of 568 children (mean age = 10.2 years, SD = 1.3) who attended public primary schools, were screened 3 months after Cyclone Larry devastated the Innisfail region of North Queensland. Measures included parent report on the Family Resilience Measure and Strengths and Difficulties Questionnaire (SDQ)–emotional subscale and child report on the PTSD Reaction Index, measures of event exposure and social connectedness. Results: Sixty-four students (11.3%) were in the severe–very severe PTSD category and 53 families (28.6%) scored in the poor family resilience range. A lower family resilience score was associated with child emotional problems on the SDQ and longer duration of previous child mental health difficulties, but not disaster-induced child PTSD or child threat perception on either bivariate analysis, or as a main or moderator variable on multivariate analysis (main effect: adjusted odds ratio (ORadj) = 0.57, 95% confidence interval (CI) = 0.13–2.44). Similarly, previous mental illness was not a significant predictor of child PTSD in the multivariate model (ORadj = 0.75, 95%CI = 0.16–3.61). Conclusion: In this post-disaster sample children with existing mental health problems and those of low-resilience families were not at elevated risk of PTSD. The possibility that the aetiological model of disaster-induced child PTSD may differ from usual child and adolescent conceptualizations is discussed.

Comparing different modes of delivery: A pilot evaluation of a family-focused, cognitive-behavioral intervention for anxiety-disordered children

Cognitive behavior therapy delivered by trained clinicians has been shown to be an effective treatment for childhood anxiety. However, the prevalence of anxiety disorders in children and adolescents, combined with the practical and psychological obstacles that often prevent families from accessing professional help, mean that alternative ways of reaching prospective clients must be explored. This pilot study aims to compare the relative efficacy of two different modes of delivering a family-focused, cognitive-behavioral intervention for children with an anxiety disorder. The two modalities compared were: a parent-delivered program (bibliotherapy) and a clinician-delivered program (individual therapy). Twenty-seven children aged between 7 and 14, together with their parents, were randomly assigned to one of the two conditions listed above. Results at post-treatment showed a significant improvement for children in both treatment conditions in terms of diagnostic status, number of diagnoses and severity of primary diagnosis at follow-up. Children in the bibliotherapy condition demonstrated a significant improvement over time in terms of child- and parent-reported anxiety levels. No differences were found between the two treatment conditions on any outcome measure. These results were maintained at 3- and 6-month follow-up. Although a pilot study, these data suggest that a bibliotherapy format of the intervention described may have potential merit. The implications for service delivery are discussed, as are the limitations of this research.