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Zumbach-Basu J, Rademacher A, Koglin U, Bender D, Lösel F. Longitudinal relations of prematurity and fetal growth restrictions with hyperactivity/inattention and aggression/delinquency. Pediatr Res 2024:10.1038/s41390-024-03297-y. [PMID: 38898109 DOI: 10.1038/s41390-024-03297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/25/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND It is the aim of this study to analyze the longitudinal relationship between premature birth and low birth weight and the reciprocal influence between hyperactive/inattentive behavior and aggressive/delinquent behavior problems in children from early to late childhood. METHODS This study contains data from the German Erlangen-Nuremberg Development and Prevention Study. It applies prospective longitudinal path analyses on data obtained from postnatal pediatric assessments as well as later psychosocial behavior assessments by teachers and parents on N = 667 children, out of which n = 83 children (12.44%) were born preterm/small for gestational age. RESULTS The results show direct effects of birth complications at the beginning of preschool on hyperactivity/inattentiveness (teacher rating: ß = 0.28; p = 0.017; parent rating: ß = 0.32; p = 0.005), but not on aggression/delinquency (teacher rating: ß = 0.002; p = 0.427; parent rating: ß = 0.12; p = 0.324). Reciprocal effects between aggression/delinquency and hyperactivity/inattentiveness were stable at the end of elementary school, but not at the end of preschool across informants. CONCLUSION Our results support a differentiated view on the potential development of behavior problems after birth complications and the demand for early prevention measures. IMPACT STATEMENT Our results extend to the existing body of research by providing insight into the longitudinal effects of prematurity and fetal growth restrictions on hyperactive and aggressive/delinquent behavioral problems throughout a rather long period of development in childhood. The results show direct effects of birth complications on the development of hyperactivity for boys, but not for girls across informants. No direct effects of birth complications on aggression/delinquency are found. Our findings speak against too simple views on behavioral consequences of birth complications and thus can relieve too anxious parents, however close monitoring of the behavioral development of respective children is indicated.
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Affiliation(s)
- Jelena Zumbach-Basu
- Department of Forensic Psychology, Psychologische Hochschule Berlin, Germany, Am Koellnischen Park 2, 10179, Berlin, Germany
| | - Annika Rademacher
- I. School of Education and Social Science, Department of Special Needs Education and Rehabilitation, Psychology in Special Needs Education and Rehabilitation, Carl von Ossietzky Universität Oldenburg, Ammerlaender Heerstrasse 114-118, 26129, Oldenburg, Germany.
| | - Ute Koglin
- I. School of Education and Social Science, Department of Special Needs Education and Rehabilitation, Psychology in Special Needs Education and Rehabilitation, Carl von Ossietzky Universität Oldenburg, Ammerlaender Heerstrasse 114-118, 26129, Oldenburg, Germany
| | - Doris Bender
- Department of Psychology, Friedrich-Alexander-University Erlangen-Nuremberg, Bismarckstr. 6, 91054, Erlangen, Germany
| | - Friedrich Lösel
- Institute of Criminology, Cambridge University & Department of Psychology, Friedrich-Alexander-University Erlangen-Nuremberg, Sidgwick Avenue Cambridge CB3 9DA & Bismarckstr, 1, 91054, Erlangen, Germany
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Garcia-Rosales A, Cortese S, Vitoratou S. Measurement invariance of Attention Deficit/Hyperactivity Disorder symptom criteria as rated by parents and teachers in children and adolescents: A systematic review. PLoS One 2024; 19:e0293677. [PMID: 38394179 PMCID: PMC10889893 DOI: 10.1371/journal.pone.0293677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/17/2023] [Indexed: 02/25/2024] Open
Abstract
This systematic review aimed to establish the extent to which each Attention Deficit/Hyperactivity Disorder (ADHD) symptom criterion is being assessed without being influenced (biased) by factors such as informant, sex/gender, and age. Measurement invariance (MI) testing using confirmatory factor analysis (CFA) is the prime statistical method to ascertain how these factors may affect the measurement and colour the perception or interpretation of symptom criteria. Such effects (non-invariance) can be operationalised in the form of altered association of a symptom criterion with the measured trait (expressed via variations in CFA loadings which represent the weight of each symptom criterion) due to the factor(s) and/or artificially alter the probability of endorsement of a particular symptom criterion (expressed via variations in the CFA threshold(s) representing how mild or severe a given symptom is). Based on a pre-registered protocol (CRD42022276105), we searched PubMed, Global Health, Embase and PsycInfo up to 21-02-23 for studies that included MI assessments on specific ADHD symptom criteria in individuals aged 0-18 years old, using parental and/or teacher report. Self-reports were excluded, given the poor reliability of self-report in ADHD. All included studies met specific COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. Results were synthesised in tabular form, grouping results by factors (e.g. informant) from 44 studies retained. Most comparisons indicated both metric (same loadings) and scalar invariance (same thresholds) with regard to informant, gender, age, temporal (repeated assessments) and co-morbidity. Therefore, the available evidence supports the current diagnostic criteria. However, findings could have been improved by systematic reporting of the direction of bias and its effect size. There appears to be a bias towards reporting MI instead of non-invariance. More studies in the literature are needed where the amalgamation of information provided by different informs and the association of specific symptoms with comorbidity are analysed.
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Affiliation(s)
- Alexandra Garcia-Rosales
- MRC Social Genetic Developmental and Psychiatry Centre, King’s College London, Institute of Psychiatry, Psychology, and Neurosciences, London, United Kingdom
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King’s College, London, United Kingdom
- Universidad Autónoma de Madrid, Madrid, Spain
- Kensington & Chelsea Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Samuele Cortese
- School of Psychology, Centre for Innovation in Mental Health (CIMH), Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York, New York, United States of America
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Horizon Centre, CAMHS West, Solent NHS Trust, Southampton, United Kingdom
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King’s College, London, United Kingdom
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Chen YC, Gui ZH, Bao WW, Liang JH, Zhang SX, Zhao Y, Jiang N, Chen YJ. Chronic exposure to indoor air pollutants in association with attention-deficit/hyperactivity disorder symptoms in Chinese schoolchildren: A cross-sectional study. Neurotoxicology 2023; 94:182-190. [PMID: 36509211 DOI: 10.1016/j.neuro.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/17/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND While increasing studies confirmed the adverse effects of indoor air pollution (IAP) on cardiopulmonary systems, less is known about the impact of IAP on child's brain. OBJECTIVE To explore the associations between multiple indoor air pollutants exposures and attention-deficit/hyperactivity disorder (ADHD) symptoms in Chinese schoolchildren. METHODS We invited 8630 individuals aged 6-12 years from an ongoing school-based cohort study across Guangzhou from April to May 2019. There are 7495 and 7245 children were respectively evaluated on the parent- and teacher-rated Conner's Rating Scale-Revised, and 7087 children were assessed on both versions. Indoor air pollutants exposures including cooking oil fumes, incense burning, home renovation, and secondhand smoke, were measured using a questionnaire reported by parents and children, and further converted into an index. Generalized linear mixed-effects models were performed to evaluate the associations between indoor air pollutants exposures and ADHD index and the presence of ADHD symptoms. RESULTS As reported by parents, 321 (4.3%) children had ADHD symptoms. Each of the four pollutants was positively associated with higher ADHD index and higher odds of ADHD symptoms. Children exposed to 1, 2, and ≥ 3 types of indoor air pollutants had higher ADHD index and higher odds of ADHD symptoms than those non-exposed children. For parent-reported ADHD symptoms, the odds ratios ranged from 1.24 [95% confidence interval (CI): 0.92-1.67] to 2.73 (95% CI: 1.86-4.01). These associations were consistent in parent- and teacher-reported ADHD symptoms, and the combination of both. CONCLUSION Indoor air pollutants exposures were positively associated with higher prevalence of children's ADHD symptoms assessed by whether parents or teachers.
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Affiliation(s)
- Yi-Can Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Zhao-Huan Gui
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Wen-Wen Bao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Shu-Xin Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Yu Zhao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Nan Jiang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
| | - Ya-Jun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China.
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Empirically based dimensions of externalizing symptoms in children and adolescents: a multitrait-multisource approach. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractThe present study sought to refine knowledge about the structure underlying externalizing dimensions. From a “top-down” ICD/DSM-based perspective, externalizing symptoms can be categorized into attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD). From a “bottom-up” developmental theory-based perspective, disruptive behaviors can be meaningfully described as aggressive (AGG) and rule-breaking (RB) behaviors. We analyzed five large data sets comprising externalizing symptom ratings obtained with a screening instrument using different sources (parents, teachers, self-ratings) from different samples. Using confirmatory factor analyses, we evaluated several factor models (unidimensional; correlated factors; bifactor (S-1) models) derived from an ICD/DSM- and theory-based perspective. Our optimally fitting models were assessed for measurement invariance across all sources, sample settings, and sex. Following several model-based criteria (model fit indices; factor loadings; omega statistics; model parsimony), we discarded our models stepwise and concluded that both the ICD/DSM-based model with three correlated factors (ADHD, ODD, CD) and the developmental theory-based model with three correlated factors (ADHD, AGG, RB) displayed a statistically sound factor structure and allowed for straightforward interpretability. Furthermore, these two models demonstrated metric invariance across all five samples and across sample settings (community, clinical), as well as scalar invariance across sources and sex. While the dimensions AGG and RB may depict a more empirically coherent view than the categorical perspective of ODD and CD, at this point we cannot clearly determine whether one perspective really outperforms the other. Implications for model selection according to our model-based criteria and clinical research are discussed.
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Martel MM, Goh PK, Lee CA, Karalunas SL, Nigg JT. Longitudinal attention-deficit/hyperactivity disorder symptom networks in childhood and adolescence: Key symptoms, stability, and predictive validity. JOURNAL OF ABNORMAL PSYCHOLOGY 2021; 130:562-574. [PMID: 34472891 PMCID: PMC8480395 DOI: 10.1037/abn0000661] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The current study visualized attention-deficit/hyperactivity disorder (ADHD) symptom networks in a longitudinal sample of participants across childhood and adolescence with exploratory examination of age and gender effects. Eight hundred thirty-six children ages 7-13 years were followed annually for 8 years in total. Across parent and teacher report, results suggested "is easily distracted" and "difficulties sustaining attention" as central symptoms across three testing points (i.e., Year 1, Year 3, and Years 5-8 collapsed). "Difficulties following instructions" and "intrudes/interrupts" also emerged as parent-reported central symptoms. Assessment of network structure across the three testing points suggested global robustness of relations among ADHD symptoms from midchildhood into early adolescence. However, relations among symptoms that cause problems in school settings (i.e., being easily distracted) were stronger in teacher-reported than parent-reported networks. When aggregated into a sum score, central symptoms during Year 1 predicted total difficulties related to mental health problems 5 years later just as well as all 18 symptoms. Central symptoms of ADHD may be useful as screeners of future emotional and behavioral difficulties. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Jungersen CM, Lonigan CJ. Do Parent and Teacher Ratings of ADHD Reflect the Same Constructs? A Measurement Invariance Analysis. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021; 43:778-792. [DOI: 10.1007/s10862-021-09874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Garcia-Rosales A, Vitoratou S, Faraone SV, Rudaizky D, Banaschewski T, Asherson P, Sonuga-Barke E, Buitelaar J, Oades RD, Rothenberger A, Steinhausen HC, Taylor E, Chen W. Differential utility of teacher and parent-teacher combined information in the assessment of Attention Deficit/Hyperactivity Disorder symptoms. Eur Child Adolesc Psychiatry 2021; 30:143-153. [PMID: 32246275 PMCID: PMC7864845 DOI: 10.1007/s00787-020-01509-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Consistent research findings indicate that parents and teachers observe genuinely different Attention Deficit/Hyperactivity Disorder (ADHD) behaviours in their respective settings. OBJECTIVE To evaluate the utility of information provided by teacher informant assessments (INFAs) of ADHD symptoms, and the implications of aggregation algorithms in combing parents' information, i.e. using 'or-rule' (endorsement by either one informant) versus 'and-rule' (endorsement by both informants). METHOD Teacher ratings on Conners scales and clinical data from parental accounts on 1383 probands and their siblings from the IMAGE study were analysed. The psychometric properties of teacher and combined ratings using the item response theory model (IRT) are presented. Kappa coefficients, intraclass correlations and linear regression were employed. RESULTS First, teacher endorsement of symptoms is located in a narrow part of the trait continuum close to the average levels. Symptoms exhibit comparable perception in the measurement of the trait(s) with similar discrimination ability and information (reliability). Second, the IRT properties of the 'or-rule' ratings are predominantly influenced by parent-INFAs; and the 'and-rule' ratings predominantly by teacher-INFAs ratings. Third, parent-teacher INFAs agreement was low, both for individual items (κ = 0.01-0.15) and for dimensional scores (r = 0.12-0.16). The 'or-rule' captured milder expressions of ADHD symptoms, whereas the 'and-rule' indexed greater severity of ADHD. CONCLUSIONS Parent and teacher-INFAs provide different kinds of information, while both are useful. Teacher-INFA and the 'and-rule' provide a more accurate index of severity than an additive symptom count. Parent-INFA and the 'or-rule' are more sensitive for detecting cases with milder ADHD.
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Affiliation(s)
- Alexandra Garcia-Rosales
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK.
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK.
- Universidad Autónoma de Madrid, Madrid, Spain.
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Daniel Rudaizky
- Centre for the Advancement of Research on Emotion, School of Psychological Sciences, University of Western Australia, Perth, Australia
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Philip Asherson
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Edmund Sonuga-Barke
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert D Oades
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
- Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Child and Adolescent Mental Health Center, Capital Region Psychiatry, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Southern Denmark University, Odense, Denmark
| | - Eric Taylor
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Wai Chen
- Complex Attention and Hyperactivity Disorders Service (CAHDS), Child and Adolescent Health Service (CAHS), Department of Health Western Australia, Crawley, Australia
- Faculty of Health and Medical Sciences, Paediatrics, University of Western Australia, Crawley, Australia
- Centre for Child & Adolescent Related Disorders, Graduate School of Education, University of Western Australia, Crawley, Australia
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Vitoratou S, Garcia-Rosales A, Banaschewski T, Sonuga-Barke E, Buitelaar J, Oades RD, Rothenberger A, Steinhausen HC, Taylor E, Faraone SV, Chen W. Is the endorsement of the Attention Deficit Hyperactivity Disorder symptom criteria ratings influenced by informant assessment, gender, age, and co-occurring disorders? A measurement invariance study. Int J Methods Psychiatr Res 2019; 28:e1794. [PMID: 31310449 PMCID: PMC7649942 DOI: 10.1002/mpr.1794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/29/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aims to ascertain whether the differences of prevalence and severity of attention deficit hyperactivity disorder (ADHD) are true or whether children are perceived and rated differently by parent and teacher informant assessments (INFAs) according to gender, age, and co-occurring disorders, even at equal levels of latent ADHD traits. METHODS Use of latent trait models (for binary responses) to evaluate measurement invariance in children with ADHD and their siblings from the International Multicenter ADHD Gene data. RESULTS Substantial measurement noninvariance between parent and teacher INFAs was detected for seven out of nine inattention (IA) and six out of nine hyperactivity/impulsivity (HI) items; the correlations between parent and teacher INFAs for six IA and four HI items were not significantly different from zero, which suggests that parent and teacher INFAs are essentially rating different kinds of behaviours expressed in different settings, instead of measurement bias. However, age and gender did not affect substantially the endorsement probability of either IA or HI symptom criteria, regardless of INFA. For co-occurring disorders, teacher INFA ratings were largely unaffected by co-morbidity; conversely, parental endorsement of HI symptoms is substantially influenced by co-occurring oppositional defiant disorder. CONCLUSIONS Our findings suggest general robustness of Diagnostic and Statistical Manual of Mental Disorders ADHD diagnostic items in relation to age and gender. Further research on classroom presentations is needed.
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Affiliation(s)
- Silia Vitoratou
- Psychometrics and Measurement Lab, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Alexandra Garcia-Rosales
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK.,Psychiatry Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Edmund Sonuga-Barke
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert D Oades
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Göttingen, Germany
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland.,Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Child and Adolescent Mental Health Center, Capital Region Psychiatry, Copenhagen, Denmark.,Department of Child and Adolescent Psychiatry, Southern Denmark University, Odense, Denmark
| | - Eric Taylor
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Wai Chen
- MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK.,Complex Attention and Hyperactivity Disorders Service (CAHDS), Specialised Child and Adolescent Mental Health Services (CAMHS), WA Department of Health, Perth, Western Australia, Australia.,Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health and Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Western Australia, Australia
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