Mental health promotion for young people: a proposal for a tripartite approach

Child and adolescent mental health promotion programmes may be more effective if they include a combination of different approaches to health promotion rather than relying primarily on one approach. A group of complementary approaches that could be combined in a single programme include: (i) a community-wide media campaign to highlight the harmful effects of family discord on the mental health of young people; (ii) a school-based social skills programme to improve the social skills of young people; and (iii) a life skills programme to build the competence of young people "at risk' for developing mental health disorders. The potential value of this particular combination of approaches is discussed with the aim of facilitating the development of innovative new child and adolescent mental health promotion programmes in Australia.

Emotional health of Indonesian adoptees living in Australian families

OBJECTIVE

To compare the prevalence of emotional and behavioural problems in adolescent adoptees from Indonesia living in South Australian families with that of adolescents living in the community and those referred to mental health clinics in South Australia.

METHOD

Thirty-four Indonesian adoptees completed the Youth Self-Report and their adoptive mothers completed the Child Behaviour Checklist. The results on these instruments were compared with the scores of a community sample and a mental health clinic population.

RESULTS

There was a striking similarity between scores on the Youth Self-Report and the Child Behaviour Checklist instruments for the adoption and community groups. Both these groups had significantly fewer problems than adolescents referred to mental health clinics.

CONCLUSIONS

These results indicate that the outcome in terms of emotional and behavioural health for intercountry adoptions between Indonesia and Australia is favourable.

The mental health status of adolescents released from custody: a preliminary study

OBJECTIVE

To describe the prevalence of mental health problems and the social circumstances of young offenders after their release from custody in a juvenile detention centre.

METHOD

The subjects were 37 adolescents from an original sample of 101 adolescents who had been remanded in a juvenile detention centre in Adelaide, South Australia. The adolescents were evaluated at the time of their initial detention in custody and again 1 year later.

RESULTS

The adolescents reported having a large number of social and mental health problems after their release from custody. One year after their release, 32% of the adolescents scored above the recommended 'cut off' score on the Youth Self Report. This represents a rate of disorder three to four times higher than that reported by adolescents in the community and is comparable to the rate reported by adolescents attending mental health clinics.

CONCLUSIONS

Adolescents remanded in juvenile detention centres experience continuing mental health problems after their release from custody. As well, they experience considerable social dysfunction. There is an urgent need for more active therapeutic follow-up of these young people.

Approaches to delivering child and adolescent mental health services: the South Australian experience

Approximately 10% of children and adolescents experience mental health programs, however only a small proportion receive specialised help. Identifying approaches which can provide a balanced and effective service for the large number of children and adolescents with problems is currently a major challenge for child and adolescent mental health services in Australia. In South Australia, following a review in 1983, child and adolescent services were reorganised into two separate but closely related services. This paper draws on experience in South Australia over the last decade to identify approaches which can be employed in six key areas that significantly influence the effectiveness of child and adolescent mental health services. The paper also describes the specific features which were included in the South Australian child and adolescent mental health service to address these issues.

Adherence to recommended medical regimens in childhood and adolescence

OBJECTIVE

Factors that appear to influence treatment adherence among adults have been the focus of considerable research in recent years. However, less research has focused on children's treatment adherence. This paper reviews current knowledge about factors that appear to influence adherence among children and adolescents.

METHODOLOGY

Factors associated with adherence to medical regimens reviewed here include: (i) the psychosocial characteristics of children and their parents; (ii) the nature of the treatment regimen; and (iii) the relationship between health practitioners, parents and paediatric patients.

CONCLUSIONS

Issues for future research include: (i) the adherence of both children and their parents to children's treatment, and the allocation of responsibility for treatment adherence; (ii) the wide range of behaviours involved in regimen adherence should be acknowledge; patients' adherence to one aspect of their regimen should not be considered indicative of their overall adherence; and (iii) longitudinal studies are required to examine the causal relations between patient adherence and its antecedents.

Do adolescents know where to find help for mental health problems? A brief report

OBJECTIVE

Few previous studies have investigated adolescents' knowledge of the services available to provide help with mental health problems. This is an important omission as knowledge about the availability of mental health services may significantly influence the extent to which adolescents with mental health problems receive appropriate help for their difficulties. The purpose of this study was to investigate knowledge of mental health services among socio-economically disadvantaged adolescents.

METHODOLOGY

Students attending the participating high school completed a questionnaire describing mental health services in South Australia.

RESULTS

The results suggest that the adolescents had little knowledge of mental health services and they primarily discussed their problems with other family members or friends. The results also suggest that the adolescents prefer to obtain information about mental health problems from education programmes in schools or on television.

CONCLUSIONS

There is a need to make adolescents and their families more aware of the services available to provide help for mental health problems.

A prospective study of the psychological adjustment of children with cancer

PURPOSE

This paper describes the prevalence of emotional and behavioral problems and the social competencies of forty children with cancer immediately after their diagnosis and one year post-diagnosis.

PATIENTS AND METHODS

At both points of time the problems and competencies of the children with cancer were compared with the problems and competencies of a matched group of children living in the community.

RESULTS

The results suggest that early in their illnesses, younger children with cancer experience more internalising problems than children in the community. However, the younger children with cancer improved significantly in these areas during the year after their diagnosis. As a result, one year after their diagnosis there was little difference in the prevalence of problems amongst the younger children with cancer and the children in the community. The older children with cancer did not appear to have more problems than children in the community at either the first or the second assessment.

CONCLUSIONS

The results of the study draw attention to possible differences in the prevalence of emotional and behavioral problems experienced by younger and older children with cancer. The results also suggest that amongst younger children with cancer the prevalence of problems declines during the year after their initial diagnoses.

The use of alternative therapies by children with cancer

OBJECTIVE

To identify the nature and prevalence of therapies used by children with cancer as alternatives to orthodox medical treatment.

DESIGN

A descriptive study in which the parents of children with cancer completed a questionnaire describing the use of alternative therapies by their children.

SUBJECTS

Children diagnosed with cancer, excluding brain tumours, at the Women's and Children's Hospital, South Australia, from July 1988 to July 1992.

RESULTS

Approximately 46% of the children with cancer had used at least one alternative therapy. In general, parents reported that the therapies were used as an addition to orthodox medical treatment rather than as an alternative. Less than 50% of the parents had discussed the use of the alternative therapies with the children's doctors.

CONCLUSIONS

A substantial proportion of children with cancer use alternative therapies and the use of these therapies is often not discussed with the children's medical practitioners. There is a continuing need to consider how to better provide, within the context of orthodox medical treatment, those elements of their children's care which parents currently seek from alternative therapies.

Emotional and behavioural problems experienced by children living in single-parent families: a pilot study

This study compared the prevalence of emotional and behavioural problems experienced by 10-11 year old and 14-15 year old children living in single-parent and two-parent families in South Australia. The 10-11 year old male children living in single-parent families were found to have significantly more emotional and behavioural problems than 10-11 year old male children living in two-parent families. In particular, the younger male children living in single-parent families experienced more externalizing behaviour problems than younger male children living in two-parent families. It is suggested that paediatricians and general practitioners need to be aware of children who are at particular risk for developing emotional and behavioural problems, and the approaches which may be employed to provide help.

A prospective study of the psychological adjustment of parents and families of children with cancer

This study compared the psychological adjustment of parents and families of children with cancer, with the adjustment of parents and families in the community. In the weeks after their children's diagnoses, the mothers of children with cancer reported significantly more anxiety and insomnia, somatic symptoms and social dysfunction than mothers in the community. These problems had declined by the time of a 1 year follow-up assessment. However, at the follow-up assessment the mothers of children with cancer reported significantly more symptoms of depression and somatic symptoms than mothers in the community. A similar pattern of findings was evident among the fathers although the fathers generally reported less distress than was reported by the mothers. The results also suggest that a year after the children's diagnoses, the families in which there was a child with cancer were functioning less effectively than the families in the community.

Childhood emotional and behavioural problems: a comparison of children's reports with reports from parents and teachers

Paediatricians are often asked to assess children with emotional and behavioural problems and are faced with the dilemma that reports about the children's behaviour obtained from the children, and from their parents and teachers, may differ. This study compares the number of childhood emotional and behavioural problems reported by children living in the community, with the number of problems reported by their parents and teachers. When describing both internalizing and externalizing problems, the children consistently reported that they had more problems than were reported by either their parents or teachers. This pattern was particularly evident with reports from older female children who reported many more internalizing problems than were reported by their parents and teachers. Possible reasons for the differences between reports from children and the other informants are discussed.

Differences between reports from children, parents and teachers: implications for epidemiological studies

This study describes the different prevalences obtained when varying combinations of informants were used to identify emotional and behavioural disorders in a representative sample of 336 children living in two-parent families in the community of Adelaide, South Australia. When different informants were used to identify children with disorders, the estimated prevalences ranged from 3.3 +/- 1.6% to 17.9 +/- 4.1% for younger children, and 6.0 +/- 2.9% to 19.9 +/- 4.9% for older children. Results from the study highlight potential methodological problems which arise in epidemiological studies due to differences between reports from children, parents, and teachers describing childhood emotional and behavioural problems.

The psychological adjustment of offspring of adults with obsessive-compulsive disorder: a brief report

This study describes the prevalence of emotional and behavioural problems in the offspring of parents who are members of the Obsessive-Compulsive Neurosis Support Group in South Australia. The results suggest that the offspring of adults with obsessive-compulsive disorder do not have more problems than other children and adolescents in the community. The study also highlights potential benefits of collaborative research conducted by research groups and self-help organisations.

The effect of computer-assisted interviewing on the clinical assessment of children

This study investigated the effect of providing clinicians with a report from a computer-assisted interview conducted prior to the clinical assessment of children referred to a mental health service. The results suggest that the availability of reports from computer-assisted interviews influenced the type of problems identified by clinicians and the services that they recommended to manage the children's problems. It is suggested that reports from computer-assisted interviews could assist clinicians by collecting a broad range of clinical information describing the problems of clinic-referred children. It is also suggested that considerably more research is needed into the possible benefits of computer technology in child and adolescent mental health services.

Differences between informants' reports describing emotional and behavioural problems in community and clinic-referred children: a research note

This study compared the pattern of reports describing childhood emotional and behavioural problems amongst children in the community with the pattern of reports describing children referred to mental health clinics. Whereas children in the community reported more externalizing and internalizing problems than were reported by their parents, clinic-referred children reported fewer externalizing but more internalizing problems than their parents. The results highlight potential limitations which may arise when reports describing the problems of clinic-referred children are used as the criterion for assessing the clinical significance of reports describing problems amongst children in the community.

The use of a computer-assisted interview to administer the Child Behavior Checklist in a child psychiatry service

This study describes the use of a computer-assisted interview to administer the Child Behavior Checklist to the parents of children referred to a child psychiatry service. The scores from the computer-assisted interview varied little from the scores obtained using the standard written checklist. Information collected by means of computer-assisted interviews with parents and children has the potential to facilitate the diagnostic assessment of individual children with emotional and behavioral problems, to provide a more comprehensive description of the work of child psychiatry services, and to encourage new clinical research by mental health professionals working in child psychiatry services.

The prevalence of emotional and behaviour disorders and patterns of service utilisation in children and adolescents

This study compared the prevalence of emotional and behavioural disorders in children attending schools of different socio-economic class. In addition, the study compared the rate of service utilization by children with and without disorders. Using cutoff scores recommended for use with Australian children, the prevalence of disorders in schools of different socio-economic class ranged from 2.3 +/- 2.2 to 13.9 +/- 5.3 per 100 children, with the highest prevalence being found in the lower socio-economic class schools. Although few children with disorders had been seen in a mental health clinic, advice had been sought from other services with regard to 66% of these children. This high rate of service utilization by children with disorders highlights the key role that general practitioners, school guidance officers and hospital services could play in facilitating the early identification and management of children with emotional and behavioural disorders.

Adolescents in custody: hidden psychological morbidity?

Seventy-eight adolescents admitted to Adelaide's youth remand centre provided social data and completed the Youth Self Report (YSR) checklist. Most came from chaotic social backgrounds and were without education or family support. Nearly 40% of remanded adolescents scored above the recommended cut-off scores of the YSR, a figure four times greater than that found among adolescents living in the community. This figure was comparable with that reported by adolescents attending child psychiatric services in Adelaide.

A controlled crossover trial of fenfluramine in autism

We report a 12 month double-blind randomized crossover trial of fenfluramine in 20 children with the syndrome of autism. On active drug most of the children lost weight and blood serotonin levels fell by an average of 60%. There was a fall in urinary dopamine (DA) and noradrenaline (NA) levels and increased excretion of homovanillic acid (HVA). Some of the children showed improvement in tests of cognitive and language function, although the results did not achieve overall statistical significance. Event-related brain potentials (ERPs) were obtained in seven subjects on an auditory choice reaction time task. Side effects of the drug included irritability and lethargy. Fenfluramine may have a limited place in the management of some patients with autistic disorder.

Early childhood development: a comparative study of beliefs held by adolescents, medical students and mothers

This study examined beliefs about the normal development of preschool children held by adolescents, medical students and mothers. A consistent pattern was identified, with adolescents estimating that young children can do the least, medical students' estimations lying between those of adolescents and mothers, and mothers estimating that the children can do the most. In addition, medical students were found to change their beliefs during the time that they participated in their paediatric teaching programme. It is suggested that paediatricians and other child health professionals take into account the varying beliefs held by different groups in the community when providing advice or teaching about early child development.

Recurrent abdominal pain in childhood. Relationship to psychological adjustment of children and families: a preliminary study

The study investigated the prevalence of emotional and behavioural problems in children with recurrent abdominal pain (RAP), the sensitivity of RAP children to a painful stimulus, and the attitudes shown by RAP mothers to issues of health and illness. Three groups of children were compared including two groups with RAP, one in which an organic cause for the pain was found, and one where no organic cause was identified. The third group consisted of pain-free children from the general community. No consistent patterns of differences was identified between the groups on the measures used. Possible reasons for the findings are discussed and recommendations made for further research in this area.

The burned child--scarred for life? A study of the psychosocial impact of a burn injury at different developmental stages

Several studies examining the psychosocial adjustment of child burn victims have resulted in contradictory conclusions, possibly because of their diverse methodology and poorly defined outcome measures. Using a standardized behaviour rating scale this study found that adolescent burn victims show a markedly poorer psychosocial adjustment when compared with younger burned children. Visible burns, emotional distress in the mother, and multiple home moves were all associated with poorer psychosocial adjustment in adolescence for burned children.