Charlotte Waddell

Child Psychiatric Epidemiology and Canadian Public Policy-Making: The State of the Science and the Art of the Possible

Epidemiological studies have characterized the high burden of suffering that child psychiatric disorders cause—14% of children (1.1 million in Canada) have clinically important disorders at any given time. In this review, we summarize the recent research and discuss several unresolved scientific issues that must be addressed to make epidemiology more useful to policy-makers. We then discuss implications for policy-making to improve childrens mental health outcomes. Overall, given the high prevalence rates, increasing clinical services alone will not suffice; rather, a multifaceted mix of strategies is required.

A Public Health Strategy to Improve the Mental Health of Canadian Children

Mental health problems are the leading health problems that Canadian children currently face after infancy. At any given time, 14% of children aged 4 to 17 years (over 800 000 in Canada) experience mental disorders that cause significant distress and impairment at home, at school, and in the community. Fewer than 25% of these children receive specialized treatment services. Without effective prevention or treatment, childhood problems often lead to distress and impairment throughout adulthood, with significant costs for society. Childrens mental health has not received the public policy attention that is warranted by recent epidemiologic data. To address the neglect of childrens mental health, a new national strategy is urgently needed. Here, we review the research evidence and suggest the following 4 public policy goals: promote healthy development for all children, prevent mental disorders to reduce the number of children affected, treat mental disorders more effectively to reduce distress and impairment, and monitor outcomes to ensure the effective and efficient use of public resources. Taken together, these goals constitute a public health strategy to improve the mental health of Canadian children.

Validating the Repetitive Behavior Scale-Revised in Young Children with Autism Spectrum Disorder.

This study examined the factor structure of the Repetitive Behavior Scale-Revised (RBS-R) in a sample of 287 preschool-aged children with autism spectrum disorder (ASD). A confirmatory factor analysis was used to examine six competing structural models. Spearman’s rank order correlations were calculated to examine the associations between factor scores and variables of interest. The 3- and 5-factor models were selected as preferable on the basis of fit statistics and parsimony. For both models, the strongest correlations were with problem behavior scores on the Child Behavior Checklist and repetitive behavior scores on the ADI-R. Developmental index standard scores were not correlated with factors in either model. The results confirm the utility of the RBS-R as a measure of repetitive behaviors in young children with ASD.

Phenotypic Overlap Between Core Diagnostic Features and Emotional/Behavioral Problems in Preschool Children with Autism Spectrum Disorder

This study examined the phenotypic overlap between core diagnostic features and emotional/behavioral problems in a sample of 335 preschool children with autism spectrum disorder (ASD). Results from principal component analysis (2 components; 49.70% variance explained) suggested substantial phenotypic overlap between core diagnostic features and emotional/behavioral problems. Component I, Emotional Behavioral Repetitive Problems, was independent of the children’s intellectual, adaptive functioning, and structural language abilities. Component II, Social Communication Deficits, was negatively related to the children’s intellectual, adaptive functioning, and structural language abilities. Both components were positively related to parental stress. This exploratory study contributes to our understanding of the ASD phenotype and provides further support for including emotional/behavioral problems as part of the clinical characterization of children with ASD.

Influence of reporting effects on the association between maternal depression and child autism spectrum disorder behaviors.

BACKGROUND Maximizing measurement accuracy is an important aim in child development assessment and research. Parents are essential informants in the diagnostic process, and past research suggests that certain parental characteristics may influence how they report information about their children. This has not been studied in autism spectrum disorders (ASD) to date. We aimed, therefore, to investigate the possible effect that maternal depression might have on a mothers reports of her childs ASD behaviors. Using structural equation modeling, we disaggregated shared from unique variation in the association between latent variable measures of maternal depression and ASD behaviors. METHODS Data were obtained from a study of preschoolers aged 2-4 newly diagnosed with ASD (n = 214). Information from a parent questionnaire, a semi-structured parent interview, and a semi-structured observational assessment was used to develop a latent variable measure of child ASD behaviors. Mothers reported on their own depression symptoms. We first modeled the covariance between maternal depression and child ASD behavior. Then, to quantify unique variation, we added covariance terms between maternal depression and the residual variation associated with the individual measures of child ASD behaviors. RESULTS The model demonstrated excellent fit to the underlying data. Maternal self-report of depression symptoms exhibited a significant association with the unique variance of the questionnaire report but not with the latent variable measure of child ASD behavior. A gradient pattern of association was demonstrated between maternal depression and the unique variance of the ASD measures: most strongly for the maternal questionnaire report, more weakly for the maternal semi-structured interview, and to a trivial extent for the observational interview. CONCLUSIONS Parental depression may influence reporting of ASD behaviors in preschoolers. Shared method effects may also contribute to bias. This finding highlights the importance of obtaining multimethod reports of child ASD symptoms.

Factor analysis of the Parenting Stress Index‐Short Form with parents of young children with autism spectrum disorders

The primary purpose of this study was to examine the underlying factor structure of the Parenting Stress Index‐Short Form (PSI‐SF) in a large cohort of parents of young children with autism spectrum disorder (ASD). A secondary goal was to examine relationships between PSI‐SF factors and autism severity, child behavior problems, and parental mental health variables that have been shown to be related to parental stress in previous research. A confirmatory factor analysis (CFA) was used to examine the three‐factor structure described in the PSI‐SF manual [Abidin, 1995 ]: parental distress, parent–child dysfunctional interaction, and difficult child. Results of the CFA indicated that the three‐factor structure was unacceptable when applied to the study sample. Thus, an exploratory factor analysis was conducted and suggested a six‐factor model as the best alternative for the PSI‐SF index. Spearmans correlations revealed significant positive correlations with moderate to large effect sizes between the revised PSI‐SF factors and autism severity, externalizing and internalizing child behaviors, and an index of parent mental health. The revised factors represent more narrowly defined aspects of the three original subscales of the PSI‐SF and might prove to be advantageous in both research and clinical applications. Autism Res 2011,4:336–346.

Conduct disorder : Practice parameters for assessment, treatment, and prevention

These practice parameters summarize the current scientific research evidence about conduct disorder in children and youth in order to provide information about effective practices for assessment, treatment, and prevention. The target audiences for these parameters include families, policymakers, and frontline workers, such as social workers, psychologists, police, teachers, physicians, and others who work with children and youth with conduct disorder in Canada.

Rethinking evidence-based practice for children’s mental health

“Efficiency is concerned with doing things right. Effectiveness is doing the right things.” Drucker, 1993 Typically, evidence-based practice (EBP) refers to health practitioners applying the best currently available research evidence in the provision of health services. In other words, EBP challenges practitioners to “do things right” and to “do the right things”. EBP originated in medicine, where an estimated 10 000 new randomised controlled trials (RCTs) are published every year but where an estimated 20%–40% of services still do not reflect the best research evidence.1 Related disciplines such as psychology have also embraced the EBP movement to bridge research and practice in order to improve outcomes for people with mental disorders.2 In children’s mental health, high levels of unmet service need suggest a strong role for EBP. At any given time 14% of children experience mental disorders that cause significant distress and impair their functioning, yet only 25% of these children receive specialised mental health treatment services.3 It is also clear that children’s mental health services often fail to reflect the best available research evidence, leading researchers to argue that EBP is an ethical imperative if we are to improve children’s mental health.4,5 Despite being widely advocated, EBP has nevertheless proved difficult to implement. To some extent implementation barriers are a result of a restricted focus on interventions designed to change simple behaviours performed by individual practitioners, such as prescribing by physicians. These interventions have had only modest effects and need to be integrated with larger organisational and system changes that support EBP.1 However, a greater challenge may be posed by controversies about EBP’s narrow definitions of “evidence,” particularly when applied in mental health.6 Here, we discuss the controversies with regard to implementing EBP in children’s mental health. We illustrate the issues based …

Investigating the measurement properties of the Social Responsiveness Scale in preschool children with Autism Spectrum Disorders

The purpose of this study was to examine the measurement properties of the Social Responsiveness Scale in an accelerated longitudinal sample of 4-year-old preschool children with the complementary approaches of categorical confirmatory factor analysis and Rasch analysis. Measurement models based on the literature and other hypothesized measurement models which were tested using categorical confirmatory factor analysis did not fit well and were not unidimensional. Rasch analyses showed that a 30-item subset met criteria of unidimensionality and invariance across item, person, and over time; and this subset exhibited convergent validity with other child outcomes. This subset was shown to have enhanced psychometric properties and could be used in measuring social responsiveness among preschool age children with Autism Spectrum Disorders.

Impact of personal and social resources on parenting stress in mothers of children with autism spectrum disorder

This study examined the longitudinal associations between child behavior problems, coping strategies, social resources, and parenting stress in mothers of young children with autism spectrum disorder. Participants were 283 mothers who completed self- and child-report measures at the time of diagnosis and 2 years later. Hierarchical multiple regression was conducted to predict overall parenting stress. At diagnosis, the final model indicated that high levels of social support and mothers’ use of active engaged coping strategies were associated with lower levels of parenting stress. Conversely, high levels of child externalizing behavior problems, family dysfunction, and mothers’ use of disengaged coping strategies were associated with higher parenting stress. Two years later, high levels of parenting stress at diagnosis predicted increased parenting stress. In addition, high or increasing levels of social support predicted a decrease in parenting stress, while high or increasing levels of family dysfunction predicted increased stress. Finally, increased use of disengaged coping strategies and decreased use of active coping strategies over time predicted higher levels of parenting stress. Results are discussed in terms of their implications for the provision of targeted supports that are designed to enhance the personal and social resources available to mothers of children with autism spectrum disorder.