John Mathai

Children with persistent conduct problems who dropout of treatment.

Abstract Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach. The overall dropout rate was 36%. Dropout occurred significantly less frequently in the CBT group. The dropout group was associated with mothers who were younger and less educated, a poorer rating by the clinicians at the last meeting, parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks. In the second study we used a naturalistic follow-up design. Forty-six children were included. The overall dropout rate was 48%. Again, the children who defaulted were rated by clinicians as less likely to have improved and dropout was also significantly associated with parental perception of a less organised treatment. In both studies dropout usually occurred after assessment and at the early phase of treatment.

Use of the Strengths and Difficulties Questionnaire as an outcome measure in a child and adolescent mental health service

Objective: To examine the usefulness of the Strengths and Difficulties Questionnaire (SDQ) as an outcome measure for patients referred to a child and adolescent mental health service (CAMHS). Methods: This was a prospective study of new CAMHS attendees. Questionnaires were completed by clinicians, parents, teachers and children (if aged 11 years or older) at initial attendance and after approximately 6 months. Results: At 6-month follow up, positive change was detected on the SDQ. There was a significant reduction in the ‘total difficulties’ score as rated by parents, teachers and children. This positive change corresponded to a significant reduction in the clinician-rated Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scores. Furthermore, there were lowered levels of perceived difficulties and burden on the SDQ impact supplement, and a decrease in the overall impact score. Conclusion: The SDQ is a useful outcome measure. The HoNOSCA and SDQ complement each other because they provide measures of change from the clinician, the parent and the child.

The Strengths and Difficulties Questionnaire (SDQ) as a screening measure prior to admission to a Child and Adolescent Mental Health Service (CAMHS)

Abstract The objective of this study was to evaluate the usefulness of the Strengths and Difficulties Questionnaire (SDQ) as a routine measure to screen for emotional and behavioural disorders in children and adolescents referred to a community child and adolescent mental health service (CAMHS). Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were also utilised and the correlation between the two instruments was examined. The study was conducted with 130 consecutive new CAMHS attendees. Clinicians, parents, teachers and children (if aged 11 years or older) completed questionnaires at initial attendance. According to parents, 85% of children and adolescents referred exhibited moderate to severe behavioural/emotional problems, and 82% had a SDQ impact score in the abnormal range. Teachers’ ratings generally indicated less severe problems. Teachers rated 60% of the children in the moderate to severe range and 61% had an impact score in the abnormal range. Selfreports from the older-aged children showed that 67% rated themselves to be in the moderate to severe range. Fifty two percent rated themselves in the abnormal range for impact. Moderate inter-test (HoNOSCA and SDQ) and inter-rater (SDQ) correlations were found. The findings are consistent with similar studies conducted in the U.K. In conclusion, the SDQ is sensitive in detecting emotional and behavioural problems and may be utilised to screen referrals at intake.

Children who are cruel to animals: a revisit

Objective: There is a paucity of research regarding children who are cruel to animals (CTA). Previous studies have suggested that being CTAis linked with recurrent aggression in adulthood. In this report, children with persistent conduct problems who are CTA are examined. Method: Aclinic-referred sample of 141 children and a community sample of 36 children between the ages of 5–12 were assessed using a test battery of questionnaires for parents, teachers and the child on mental health symptoms, self-perception, demographics and psychosocial factors. Forty of the clinic-referred children and one of the community group were rated by their parents as sometimes or definitely cruel to animals. The CTA, non-CTAand community samples were compared. Results: The CTA group had more conduct symptoms compared with the non-CTA group. However, the older CTA group unexpectedly reported a higher self-esteem compared with the non-CTA group. There was no significant difference between the two clinic-referred groups in gender, attention deficit hyperactivity disorder and internalising symptoms, and psychosocial factors. Conclusion: Being CTA is possibly a marker of a subgroup of conduct disorder which has a poor prognosis.

Spiritual history of parents of children attending a child and adolescent mental health service

Objective: To conduct a survey of the importance of spirituality in parents of children referred to a child and adolescent mental health service. Method: A questionnaire consisting of five questions was completed by 70 parents. Results: The vast majority of parents reported spirituality to be of some importance and more than half believed that therapists should consider their spiritual beliefs in the management of their childs problems. Conclusion: Professional Colleges need to actively address this area and educate their members on the importance of including a spiritual history in assessment and treatment protocols.

Pilot study investigating the effect of intercessory prayer in the treatment of child psychiatric disorders.

OBJECTIVE To investigate whether intercessory prayer had an effect on the outcomes of a group of children with psychiatric conditions, using a triple blind randomized study design. CONCLUSION This study was unable to show any additional benefits for patients who received intercessory prayer compared to those who received treatment as usual.

Patients who do well and who do less well in an inpatient adolescent unit

Objective: The primary aim of the study was to investigate whether patient characteristics such as age, sex, length of inpatient stay and reason for admission were related to positive or negative treatment outcome at an adolescent inpatient unit. Method: This study employed a prospective cohort design in the form of a clinical audit. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) pre- and post-admission scores were compared for the whole sample and across diagnoses. Results: While there was a significant reduction overall in symptoms following an inpatient stay, patient characteristics and reason for admission were not related to outcomes at a statistically significant level. Conclusions: This inpatient unit generally functions as a short stay unit and as a result it is difficult to draw any meaningful conclusions as to what sort of patient would benefit most from an admission to the unit.

Comparison of mental health symptoms between children attending developmental/behavioural paediatric clinics and child and adolescent mental health service.

Aim:  Australian paediatricians are being referred many children with severe and complex behavioural presentations. Australian paediatricians are being referred many children with severe and complex behavioural presentations. The aim of this study was to compare patients seen in the developmental/behavioural paediatric clinic (DBP) with those seen in the community child and adolescent mental health service (CAMHS) of a paediatric teaching hospital. We hypothesised that the burden of emotional‐behavioural symptoms of children referred to these two services would be similar.

Evaluation of Outcome in Child and Adolescent Mental Health Services: Children with Persistent Conduct Problems

This article focuses on the evaluation of outcome in child and adolescent mental health services. We examined the outcomes of 46 children with persistent conduct problems by gathering at baseline and six months information from multiple informants on multiple domains including the functioning of the child, risk factors, and parents’ and children’s perceptions of the treatment process. A statistically significant reduction in oppositional/conduct symptoms was reported six months after the initial clinical contact. However, the majority of the group still scored within the clinical range. The various outcome measures are correlated to only a mild to moderate degree. Teachers did not notice the same degree of change at school, despite the changes noticed by parents. Symptom improvement and satisfaction with a service are two separate issues. Parents’ satisfaction was related to their perception of the therapist and the therapy offered. Their satisfaction was high if they perceived that the therapist was able to communicate well, show care and concern, and if the therapy was perceived as organized. Much can be learned from a comprehensive outcome measurement system within a mental health service.

Use of the Strengths and Difficulties Questionnaire in Identifying Emotional and Behavioural Problems in Children of Parents with a Mental Illness in Australia

Abstract Thirty six children of parents who attended the adult outpatient service in the Werribee Mercy Mental Health Program were screened for possible emotional and behavioural problems using the Strengths and Difficulties Questionnaire. The proportion of children identified with difficulties was 50 percent, much higher than in the general population. Fifty eight percent of the children had chronic problems and the difficulties were perceived to be moderate to severe in 53 percent of the sample. The burden of these difficulties on the family was also high. Despite this, only a small proportion of children were then referred for further assessment and treatment. More psycho-education for both clinicians in the adult service and for parents is required. Difficulties in recruitment resulted in low numbers for this study. There continues to be difficulty in parents consenting for their children to be assessed.