Michael McDowell

Personality development following sexual abuse.

Thirty-seven girls and twelve boys who had been sexually abused at an average of 2.6 years previously were traced and reviewed. The nonoffending parents participated in a structured interview and the children were assessed using the Piers-Harris Self-Concept Scale and the Achenbach Child Behavior Checklist. Each child was matched with a child not known to have been sexually abused and these control children underwent a similar psychological assessment. Interviews with the nonoffending parents found that 76% of the children were thought to be less confident than before, 30% had fewer friends, and 20% were more aggressive. Increased sexual awareness was noted in 24%. School teachers reported that 28% still had behavior problems, 17% had repeated a year at school, and a further 17% had deteriorated in their school work. The sexually abused girls had significantly lower self-esteem than the control girls. There was no difference in self-esteem between the control and the sexually abused boys. There was a higher incidence of stranger assault in the boys compared with the girls. The Child Behavior Checklist completed by the parents, the Teacher Report Form, and the Youth Self-Report of the Child Behavior Checklist showed that a highly significant proportion of sexually abused children fell into the clinical range. Sexual abuse appears to have long-term adverse consequences for many of the victims. This may have implications for their ability to relate to others, for the adult friendships they will make, and eventually for the way they will relate to their own children.

From complexity to category: Responding to diagnostic uncertainties of autistic spectrum disorders

Objective: Recent data from Education Queensland has identified rising numbers of children receiving diagnoses of autistic spectrum disorder (ASD). Faced with funding diagnostic pressures, in clinical situations that are complex and inherently uncertain, it is possible that specialists err on the side of a positive diagnosis. This study examines the extent to which possible overinclusion of ASD diagnosis may exist in the presence of uncertainty and factors potentially related to this practice in Queensland.

Diagnosis of autistic spectrum disorders in Queensland: variations in practice.

Objective: For both paediatricians and child psychiatrists, referrals to assess possible autistic spectrum disorders (ASD) are increasing. This study examines current practices of medical specialists in the assessment of these disorders.

Factors associated with medium-term response to psychostimulant medication

Objective: To determine, in a sample of children first prescribed psychostimulants for attention deficit hyperactivity disorder (ADHD) between 1992 and 1994, which child and family factors, components of assessment, and aspects of management, were associated with a favourable treatment response, and with parental satisfaction with management.

Bridging the gap between health and education: Words are not enough

Objectives:  When using specific terminology for childhood developmental disorders, paediatricians make assumptions about what teachers know and believe. If these assumptions are incorrect, collaborative management may be compromised. We surveyed primary school teachers in North Brisbane regarding their beliefs about developmental disorders and their views on collaboration between medical and educational professionals.

Developmental-behavioural problems in general paediatrics

To determine the current role of private general paediatrics in the care of children with problems of development and behaviour.

Public services for children with special needs: Discrimination by diagnosis?

In July 2011, the Australian federal government announced expansion of early intervention funding. Children diagnosed with cerebral palsy, Down syndrome, Fragile X syndrome and hearing and vision impairments are now eligible in addition to the existing funding for children diagnosed with autistic disorders. By deciding who gets the funding according to a set of accepted diagnoses, many children with equivalent if not greater levels of early intervention special need are excluded. In this viewpoint, we consider the fairness of this approach, and argue that while it may make sense from a political point of view, it is hard to justify, and possibly even discriminatory, from clinical, ethical and legal perspectives.

A ‘chronic disorder’ health‐care model for children with complex developmental disorders

Objectives: To conceptualize, develop and evaluate a ‘chronic disorder’ clinical model of health services for children with ‘low‐severity’ developmental disorders assessed and treated within a public Child Development Unit.

A functional analysis of human mirror movements

In this report, an experimental method for investigating the effect of variations in force, amplitude, and frequency of oscillations of the isometric pincer grasp on mirror movements (MM) is described. Normal adults (N = 24) were used as experimental subjects. The magnitude of MM was greater at relatively high static force levels maintained by the passive hand (26% of maximum volitional force or MVF) than at low force levels (4% MVF) in the passive hand. By contrast, the magnitude of MM was smaller at relatively large (20.5% MVF) than at small (9.5% MVF) mean force levels of the active hand when the static force in the passive hand as well as the amplitude and range of oscillation frequencies of the active hand were held constant. The magnitude of MM relative to active hand oscillation was smaller when the active hand oscillated around a relatively large amplitude (22% of MVF) than when it did so around a small amplitude (8% of MVF) at constant mean force levels and oscillation frequencies. The absolute magnitude of MM was not affected by this change in oscillation amplitude. In all experiments, the magnitude of MM was consistently less at relatively high than at low frequencies of oscillation in the active hand. Intrinsic variables of motor control have a major effect on the inducation and modulation of MM, and their contribution may be as great as that of subject variables. The present results differed substantially from those of others who have used similar experimental paradigms. The major difference was the direction of change in power transfer from the active to the passive hand with changes of force in the active hand. Possible reasons for these differences are discussed.

Eclecticism in health services for developmental disorders

Abstract: The term ‘eclectic’, as applied to health care for children with developmental disorders, portrays an individualized, adaptive service response to local constraints and pressures. While this may appear appropriate for the local setting, the end result is a broad diversity of health care approaches. This paper discusses three separate processes that interact at a local level, increasing the likelihood of an eclectic local model of health care for this population of children. The first process draws from the direct clinical work. Variable training, knowledge and skills among health care providers, in combination with differing beliefs around the nature of the problems and their management leads to health care which directly reflects the attributes of the local clinicians. A separate, second process fuelling variability is the differing models of departmental responsibility across Australia – which Government departments fund which aspect of care for children with disabilities. The final process relates to funding streams for health care. State public health, federal Medicare and private insurance all support health services for children with disabilities, with the financial incentives (budgets compared to fee‐for‐service) driving a divergence of practice. This paper concludes that the external political, administrative and financial frameworks within which health care is constructed will continue to promote clinical eclecticism to a degree that would probably be considered unacceptable in other areas of child health care. The solution can only arise from within the clinical work itself, with greater clarity of understanding around the nature of the disorders, the outcomes for which health care takes responsibility, and an increasing focus on an evidence based set of approaches towards achieving these.