Characteristics of conduct—disordered children and their families: A review

Kalgal Burnbona: An Integrated Model of Care Between the Health and Education Sector

Introduction

Kalgal Burnbona is a framework developed for applying school-based integrated care (SBIC) across Sydney Local Health District (SLHD).

Description

Kalgal Burnbona is an innovative and integrative framework developed to provide holistic, integrated, multidisciplinary child and family centred care to school-aged children from priority populations within SLHD, such as those belonging to the Aboriginal community. The expected outcomes include improved health, behavioural, education and social outcomes. This article contextualises the development of the Kalgal Burnbona framework from its beginnings as a pilot site called Ngaramadhi Space (NS) within the Healthy Homes and Neighbourhoods (HHAN) initiative, through to its evolution to an integrated partnership between the New South Wales (NSW) health and education sector. An example of how the framework can be implemented in other settings within SLHD is described.

Discussion

A tiered approach to integrated care across SLHD is postulated based on evidence from a mixed methods evaluation of NS and in line with the Rainbow Model of Integrated Care (RMIC). Kalgal Burnbona is an example of a community-driven response through collaborative partnerships to improve health, education and social outcomes. The framework described provides structure for multisector teams to work within, recognising that each community and school has its own history and needs.

Conclusion

The Kalgal Burnbona model can be scaled up to serve a wider network of students across SLHD. The initial successes of the model, which include improving access and engagement for children with unmet physical health, mental health and social needs while being accepted by communities provide evidence for policy changes and advocacy that centre on collaborative cross-sector partnerships.

What does the term childhood behavioural disorders mean in the context of Aboriginal culture within Australia? Part 2: Historical and social context

Childhood behavioural disorders (CBDs) are a common reason for referral to paediatric services and are associated with negative individual and societal outcomes. This article addresses how childhood became a distinct entity and how historical changes shaped its definition. Thereafter, the evolution of diagnostic criteria for CBD and associated limitations will be summarised. This will be followed by a discussion about Aboriginal culture, and the impact of colonisation on social and emotional well-being. This will provide a contextual frame for understanding how social and cultural context influences diagnoses of CBD in Aboriginal children. From this, a conversation about the journey moving forward will begin.

Can We Manage Behavioral Problems through the Development of Children's Social-Emotional Regulated Behavior? Longitudinal Study of a Preschool Program

Behavioral problems are early indicators of antisocial behavior and should be targeted from a preventive perspective from early childhood. The purpose of the study was to analyze the effectiveness of the AC1 preschool program that develops social-emotional skills that facilitate the adjustment and regulation of the person. A total of 102 children aged 3–4 years old participated in the research, 52 belonging to the experimental group and 49 to the control group. Program-trained skills (ROAC-3), social skills (PKBS-2), and externalizing problems (CBCL C-TRF) were assessed in the pre- and post-intervention phase. Data analysis was carried out using a generalized linear mixed model analysis (GLMM). The results show that the children in the experimental group scored higher on the variables trained by the program and on social skills than those in the control group. They also obtained lower scores in the observed externalizing problems. The effect of the program was high in the emotion identification and expression, communication skills, prosocial behaviors (sharing and helping), problem-solving, and social interaction. Social-emotional learning in early childhood is essential for the prevention of behavioral problems to facilitate the development of adjusted and regulated behavior. Thus, preschool programs could play a key role.

Poly-substance use and sexual risk behaviours: a cross-sectional comparison of adolescents in mainstream and alternative education settings

BACKGROUND

Surveys of young people under-represent those in alternative education settings (AES), potentially disguising health inequalities. We present the first quantitative UK evidence of health inequalities between AES and mainstream education school (MES) pupils, assessing whether observed inequalities are attributable to socioeconomic, familial, educational and peer factors.

METHODS

Cross-sectional, self-reported data on individual- and poly-substance use (PSU: combined tobacco, alcohol and cannabis use) and sexual risk-taking from 219 pupils in AES (mean age 15.9 years) were compared with data from 4024 pupils in MES (mean age 15.5 years). Data were collected from 2008 to 2009 as part of the quasi-experimental evaluation of Healthy Respect 2 (HR2).

RESULTS

AES pupils reported higher levels of substance use, including tobacco use, weekly drunkenness, using cannabis at least once a week and engaging in PSU at least once a week. AES pupils also reported higher levels of sexual health risk behaviours than their MES counterparts, including: earlier sexual activity; less protection against sexually transmitted infections (STIs); and having 3+ lifetime sexual partners. In multivariate analyses, inequalities in sexual risk-taking were fully explained after adjusting for higher deprivation, lower parental monitoring, lower parent-child connectedness, school disengagement and heightened intentions towards early parenthood among AES vs MES pupils. However, an increased risk (OR = 1.73, 95% CI 1.15, 2.60) of weekly PSU was found for AES vs MES pupils after adjusting for these factors and the influence of peer behaviours.

CONCLUSION

AES pupils are more likely to engage in health risk behaviours, including PSU and sexual risk-taking, compared with MES pupils. AES pupils are a vulnerable group who may not be easily targeted by conventional population-level public health programmes. Health promotion interventions need to be tailored and contextualised for AES pupils, in particular for sexual health and PSU. These could be included within interventions designed to promote broader outcomes such as mental wellbeing, educational engagement, raise future aspirations and promote resilience.

Reciprocal associations between early adolescent antisocial behavior and depressive symptoms: A longitudinal study in Victoria, Australia and Washington State, United States

PURPOSE

Reciprocal prospective associations between adolescent antisocial behavior and depressive symptoms were examined.

METHODS

Seventh grade students (average age 13 years; N=2,314/2,348) were surveyed (T1), and then followed-up 12 (T2) and 24 months (T3) later, using the same methods in Washington State and Victoria, Australia.

RESULTS

Negative binomial regressions showed antisocial behavior (T1, T2) did not prospectively predict depressive symptoms (T2, T3). T1 multivariate predictors for T2 depressive symptoms included female gender (incident rate ratio [IRR] = 1.70), prior depressive symptoms (IRR = 1.06), alcohol use (IRR = 1.13), family conflict (IRR = 1.13), antisocial peers (IRR = 1.08) and bullying victimization (IRR = 1.06). Depressive symptoms (T1, T2) did not predict antisocial behavior (T2, T3). T1 multivariate predictors for T2 antisocial behavior included female gender (IRR = .96), age (IRR = .97), prior antisocial behavior (IRR = 1.32), alcohol use (IRR = 1.04), antisocial peers (IRR = 1.11) and academic failure (IRR = 1.03).

CONCLUSIONS

Depressive symptoms and antisocial behaviors showed considerable predictive stability in early adolescence but were not reciprocally related. Prevention and intervention strategies in adolescence may benefit by targeting common predictors such as alcohol, peer interactions and early symptoms for depression and antisocial behavior.

Within-individual versus between-individual predictors of antisocial behaviour: A longitudinal study of young people in Victoria, Australia

In an influential 2002 paper, Farrington and colleagues argued that to understand 'causes' of delinquency, within-individual analyses of longitudinal data are required (compared to the vast majority of analyses that have focused on between-individual differences). The current paper aimed to complete similar analyses to those conducted by Farrington and colleagues by focusing on the developmental correlates and risk factors for antisocial behaviour and by comparing within-individual and between-individual predictors of antisocial behaviour using data from the youngest Victorian cohort of the International Youth Development Study, a state-wide representative sample of 927 students from Victoria, Australia. Data analysed in the current paper are from participants in Year 6 (age 11-12 years) in 2003 to Year 11 (age 16-17 years) in 2008 (N = 791; 85% retention) with data collected almost annually. Participants completed a self-report survey of risk and protective factors and antisocial behaviour. Complete data were available for 563 participants. The results of this study showed all but one of the forward- (family conflict) and backward-lagged (low attachment to parents) correlations were statistically significant for the within-individual analyses compared with all analyses being statistically significant for the between-individual analyses. In general, between-individual correlations were greater in magnitude than within-individual correlations. Given that forward-lagged within-individual correlations provide more salient measures of causes of delinquency, it is important that longitudinal studies with multi-wave data analyse and report their data using both between-individual and within-individual correlations to inform current prevention and early intervention programs seeking to reduce rates of antisocial behaviour.

Students' experiences of school suspension

ISSUE ADDRESSED

School inclusion and academic attainment are key social determinants of health. Students who have been suspended from school are more likely to disengage from school and consequently not receive the health promoting benefits of social inclusion and academic achievement. This study sought to explore the experiences of students who have been previously suspended (i.e. had experienced school exclusion).

METHODS

Seventy-four previously suspended adolescents from five schools in the state of Victoria, Australia, completed a written questionnaire. Students reported their understanding of the process of being suspended; what they did and with whom they spent the day(s) of suspension; and their perceptions of their return to school post-suspension.

RESULTS

While suspended, a minority of suspended students received adult supervision and most suspended students participated in benign leisure activities. Upon return to school, students reported diminished teacher assistance and found that suspension did not help resolve the underlying issues that lead to the suspension.

CONCLUSIONS

Removal of a student displaying problem behaviours from the classroom may provide temporary relief to the school community but suspended students report minimal benefits from suspension. Suspension removes the potential pro-social normative influences of school and provides an opportunity to establish antisocial peer networks. Suspended students appear to perceive a stigma upon their return to school, further diminishing an already tenuous school relationship. So what? School suspension exposes disadvantaged students to several negative social determinants of health. Students displaying problem behaviours would benefit from interventions that maintain the student's relationship with school. Should suspension be necessary, schools could assist by ensuring that suspended students receive appropriate adult supervision and a formal reintegration to school to promote social inclusion and academic attainment, two recognised key determinants of health.

Reassessing the Effects of Early Adolescent Alcohol Use on Later Antisocial Behavior: A Longitudinal Study of Students in Victoria, Australia and Washington State, United States

The effect of early adolescent alcohol use on antisocial behavior was examined at one- and two-year follow-up in Washington, United States and Victoria, Australia. Each state used the same methods to survey statewide representative samples of students (N = 1,858, 52% female) in 2002 (Grade 7 [G7]), 2003 (Grade 8 [G8]), and 2004 (Grade 9 [G9]). Rates of lifetime, current, frequent, and heavy episodic alcohol use were higher in Victoria than Washington State, whereas rates of five antisocial behaviors were generally comparable across states. After controlling for established risk factors, few associations between alcohol use and antisocial behavior remained, except that G7 current use predicted G8 police arrests and stealing and G9 carrying a weapon and stealing; G7 heavy episodic use predicted G8 and G9 police arrests; and G7 lifetime use predicted G9 carrying a weapon. Hence, risk factors other than alcohol were stronger predictors of antisocial behaviors.

Language and internalizing and externalizing behavioral adjustment: developmental pathways from childhood to adolescence

Two independent prospective longitudinal studies that cumulatively spanned the age interval from 4 years to 14 years used multiwave designs to investigate developmental associations between language and behavioral adjustment (internalizing and externalizing behavior problems). Altogether 224 children, their mothers, and teachers provided data. Series of nested path analysis models were used to determine the most parsimonious and plausible paths among the three constructs over and above stability in each across age and their covariation at each age. In both studies, children with poorer language skills in early childhood had more internalizing behavior problems in later childhood and in early adolescence. These developmental paths between language and behavioral adjustment held after taking into consideration children's nonverbal intellectual functioning, maternal verbal intelligence, education, parenting knowledge, and social desirability bias, as well as family socioeconomic status, and they applied equally to girls and boys.

Developmental Pathways among Adaptive Functioning and Externalizing and Internalizing Behavioral Problems: Cascades from Childhood into Adolescence

A developmental cascade describes a longitudinal cross-domain unique relation. Here, a 3-wave multivariate design and developmental cascade analysis were used to investigate pathways among adaptive functioning and externalizing and internalizing behavioral problems in a community sample of 134 children seen at 4, 10, and 14 years. Children, mothers, and teachers provided data. Nested path analytic models tested the plausible cascades among the three domains apart from their covariation at each age and rank-order stability across age. Adaptive functioning in early adolescence was predicted by early childhood adaptive functioning and externalizing behavioral problems, with both effects mediated by late childhood adaptive functioning and internalizing behavioral problems; externalizing behavioral problems in early adolescence were predicted by early childhood internalizing behavioral problems with the effect mediated by late childhood externalizing behavioral problems. These developmental cascades obtained independent of child intelligence; child age and maternal education and social desirability were also considered but were not related to any outcome variables. The findings suggest that strategically timed and targeted interventions designed to address young children's behavioral problems may return investment in terms of an enhanced epidemiology of adaptively functioning teens.

Social competence, externalizing, and internalizing behavioral adjustment from early childhood through early adolescence: developmental cascades

This study used a three-wave longitudinal design to investigate developmental cascades among social competence and externalizing and internalizing behavioral adjustment in a normative sample of 117 children seen at 4, 10, and 14 years. Children, mothers, and teachers provided data. A series of nested path analysis models was used to determine the most parsimonious and plausible cascades across the three constructs over and above their covariation at each age and stability across age. Children with lower social competence at age 4 years exhibited more externalizing and internalizing behaviors at age 10 years and more externalizing behaviors at age 14 years. Children with lower social competence at age 4 years also exhibited more internalizing behaviors at age 10 years and more internalizing behaviors at age 14 years. Children who exhibited more internalizing behaviors at age 4 years exhibited more internalizing behaviors at age 10 years and more externalizing behaviors at age 14 years. These cascades among social competence and behavioral adjustment obtained independent of child intelligence and maternal education and social desirability of responding.

The Strengthening Families Program 10-14: influence on parent and youth problem-solving skill

The aim of this paper is to report the results of a preliminary examination of the efficacy of the Strengthening Families Program (SFP) 10-14 in improving parent and youth problem-solving skill. The Hypotheses in this paper include: (1) youth and parents who participated in SFP would have lower mean scores immediately (T2) and 6 months (T3) post intervention on indicators of hostile and negative problem-solving strategies; (2) higher mean scores on positive problem-solving strategies; and (3) youth who participated in SFP would have higher mean scores at T2 and at T3 on indicators of individual problem solving and problem-solving efficacy than youth in the comparison group. The dyads were recruited from elementary schools that had been stratified for race and assigned randomly to intervention or comparison conditions. Mean age of youth was 11 years (SD = 1.04). Fifty-seven dyads (34-intervention&23-control) were videotaped discussing a frequently occurring problem. The videotapes were analysed using the Iowa Family Interaction Rating Scale (IFIRS) and data were analysed using Dyadic Assessment Intervention Model. Most mean scores on the IFIRS did not change. One score changed as predicted: youth hostility decreased at T3. Two scores changed contrary to prediction: parent hostility increased T3 and parent positive problem solving decreased at T2. SFP demonstrated questionable efficacy for problem-solving skill in this study.

Risk factors of abuse of parents by their ADHD children

It is interesting that there is scant research of abuse of parents by their children and no study was found on the abuse of parents by their attention deficit hyperactivity disorder (ADHD) children. Seventy-four children and adolescents suffering from ADHD and their parents were interviewed. The diagnoses were made according to DSM-IV diagnostic criteria. A questionnaire was developed to assess the children's abuse toward parents. More than half of the parents are suffering from at least one of the forms of abuse by their ADHD children. Scores of parental abuse were not related to gender. Different types of abuse correlated with oppositional defiant disorder (ODD), tic, and separation anxiety disorder (SAD). Fathers' and mothers' age, the level of education, and type of occupation were not risk factors of the abuse scores. ODD and mother's major depressive disorder were predictors of the abuse. There was a very disturbing high rate of abuse by children against parents. There is an interrelation of different forms of abuse. This study contributes to increasing awareness on the abuse of parents by their ADHD children.

Pilot evaluation of parent-child interaction therapy delivered in an Australian community early childhood clinic setting

OBJECTIVE

Parent-child interaction therapy (PCIT) is a short-term, evidence-based parent training intervention used widely in the treatment of behaviourally disordered preschool-aged children. Outcome studies have shown PCIT to be associated with lasting improvements in child and sibling behaviours and in the interactional styles, stress levels, confidence, and psychological functioning of parents. To date, however, all outcome studies have been conducted in university research clinic settings, and therefore understanding about the effectiveness of PCIT applied in a real-world setting has been limited. The present study evaluated the effectiveness of PCIT delivered to families in an Australian community-based early childhood clinic.

METHOD

Participants included 43 families with children aged 19-52 months who were referred for treatment of disruptive child behaviours and who completed PCIT treatment at the Karitane Toddler Clinic, in Sydney, Australia. Parents provided pre- and post-treatment ratings of child behaviours, parental stress, parental psychopathology and parental attitudes to therapy.

RESULTS

At the end of the programme, clinically and statistically significant improvements were seen in child behaviours and parental well-being, and parents reported high levels of satisfaction with treatment.

CONCLUSIONS

Implications for the implementation of PCIT programmes in community-based settings are discussed and areas of further research are identified.

Rates of student-reported antisocial behavior, school suspensions, and arrests in Victoria, Australia and Washington State, United States

BACKGROUND

Few methodologically rigorous international comparisons of student-reported antisocial behavior have been conducted. This paper examines whether there are differences in the frequency of both antisocial behavior and societal responses to antisocial behavior in Victoria, Australia and Washington State, United States. These 2 states were chosen due to their similarities on sociodemographic characteristics and their differences in policy frameworks around problem behavior including antisocial behavior and substance use.

METHODS

State representative samples of students (N = 5769) in school grades 5, 7, and 9 in Victoria and Washington State completed a modified version of the Communities That Care self-report survey of behavior and societal responses to behavior. Chi-square analyses compared frequencies of antisocial behavior, school suspensions, and police arrests in the 2 states. Multivariate logistic regression analyses were conducted for each outcome measure to examine the effect of state, controlling for sample design, clustering of students within schools, age, socioeconomic status, and urbanicity.

RESULTS

Few state differences in student-reported antisocial behavior were found, although frequencies varied across behavior type and grade level. Differences in societal responses were observed across grade levels with grade 5 Washington students reporting higher rates of school suspension. Older Washington students reported more arrests.

CONCLUSIONS

Rates of student antisocial behavior appear similar in these 2 states in Australia and the United States. However, youth in the United States relative to Australia may experience greater societal consequences for problem behavior. Further research is required to examine the impact of these consequences on subsequent behavior.

The effect of school suspensions and arrests on subsequent adolescent antisocial behavior in Australia and the United States

PURPOSE

To examine the effect of school suspensions and arrests (i.e., being taken into police custody) on subsequent adolescent antisocial behavior such as violence and crime, after controlling for established risk and protective factors in Victoria, Australia and Washington State, United States (U.S.).

METHODS

This article reports on analyses of two points of data collected 1 year apart within a cross-national longitudinal study of the development of antisocial behavior, substance use, and related behaviors in approximately 4000 students aged 12 to 16 years in Victoria, Australia and Washington State, U.S. Students completed a modified version of the Communities That Care self-report survey of behavior, as well as risk and protective factors across five domains (individual, family, peer, school, and community). Multivariate logistic regression analyses investigate the effect of school suspensions and arrests on subsequent antisocial behavior, holding constant individual, family, peer, school, and community level influences such as being female, student belief in the moral order, emotional control, and attachment to mother.

RESULTS

At the first assessment, school suspensions and arrests were more commonly reported in Washington, and school suspensions significantly increased the likelihood of antisocial behavior 12 months later, after holding constant established risk and protective factors (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.1, p < .05). Predictors of antisocial behavior spanned risk and protective factors across five individual and ecological areas of risk. Risk factors in this study were pre-existing antisocial behavior (OR 3.6, CI 2.7-4.7, p < .001), association with antisocial peers (OR 1.8, CI 1.4-2.4, p < .001), academic failure (OR 1.3, CI 1.1-1.5, p < .01), and perceived availability of drugs in the community (OR 1.3, CI 1.1-1.5, p < .001). Protective factors included being female (OR 0.7, CI 0.5-0.9, p < .01), student belief in the moral order (OR 0.8, CI 0.6-1.0, p < .05), student emotional control (OR 0.7, CI 0.6-0.8, p < .001), and attachment to mother (OR 0.8, CI 0.7-1.0, p < .05).

CONCLUSIONS

School suspensions may increase the likelihood of future behavior. Further research is required to both replicate this finding and establish the mechanisms by which school suspensions exert their effects.

Child and family predictors of therapy outcome for children with behavioral and emotional problems

This study investigated the characteristics of 106 children primarily referred for externalizing behavior problems and their families, and assessed the prediction of treatment outcome following a standardized short-term, cognitive behavioral group program. Exploring Together comprised a children's group (anger management, problem-solving and social skills training), a parents' group (parenting skills training, dealing with parents' personal, relationship and family-of-origin issues), and a combined children's and parents' group (to target parent-child interactions). The main predictors of reductions in externalizing and internalizing behaviors at home following treatment were children's pre-existing levels of these behavioral and emotional problems (children with higher levels improved most), and positive parent-child interaction. Higher pre-existing levels of behavioral and emotional problems and low levels of attention problems predicted greater improvement in post-treatment school behaviors. Implications of the findings for improving interventions for childhood behavioral and emotional problems are discussed.

Learning, Enjoying, Growing, Support model: an innovative collaborative approach to the prevention of conduct disorder in preschoolers in hard to reach rural families

OBJECTIVE

To develop, implement and evaluate a pilot program targeting rural families with preschool aged children at risk of conduct disorder.

DESIGN

A prospective single group repeated measures design.

SETTING

Communities in four local government areas in the Mid Western Area Health Service, New South Wales.

SUBJECTS

A total of 33 families were referred to the program through community services where they were established clients.

INTERVENTIONS

The Learning, Enjoying, Growing, Support model comprised a parenting program (Incredible Years; Kids Challenge and Change); a children's social skills program (Playing and learning to Socialise) and a transition to school component. Group programs were run simultaneously over 5-10 weeks.

MAIN OUTCOME MEASURES

Measures of positive parenting and child problem behaviour and social skills were conducted on referral, and at completion of the program.

RESULTS

There was a self-reported increase in utilisation of all positive parenting skills with significant increases in rewarding (median score on referral: 4 (range: 4-6); at completion of program 6 (4-6); (P = 0.02)) and ignoring (2 (0-6) to 3 (1-8); (P = 0.02)). Children increased their levels of social skills. Significant improvement was reported in cooperation: (median score: 24 (18-33) to 27 (19-33); (P = 0.02)); interaction (24 (6-9) to 26 (11-32); (P = 0.03)) and independence(25 (16-33) to 28 (20-33); (P = 0.008)). There was a downward trend in problem behaviour exhibited with a significant reduction in internalising behaviour (median score 19 (3-30) to 12 (0-32); (P = 0.04)).

CONCLUSIONS

The positive impact of the model on parenting skills and child behaviour is promising and communities are continuing to run the programs. We recommend a broader adoption through rural communities.

Major depression and conduct disorder in youth: associations with parental psychopathology and parent-child conflict

BACKGROUND

This study examined conduct disorder (CD) and major depression (MDD) in adolescents in relationship to parent-child conflict and psychopathology in their parents.

METHOD

Participants were drawn from a population-based sample of twins and their families. Affected participants had lifetime diagnoses of CD and/or MDD; controls had no history of either disorder.

RESULTS

The presence of CD or MDD in an adolescent was related to increased rates of maternal MDD and paternal antisocial behavior. Both CD and MDD in adolescents were directly associated with high parent-child conflict. This association appeared unrelated to whether the father had a history of antisocial behavior; however, the association between mother-child conflict and psychopathology in the child was related to the mother having a history of MDD as well.

CONCLUSION

The implications of these findings for the complex relationship between parental diagnoses, child diagnoses, and parent-child conflict are discussed.

Mental health of adolescents in custody: the use of the "Adolescent Psychopathology Scale" in a Tasmanian context

OBJECTIVE

To investigate the incidence of mental health problems based on the DSM-IV [1] among adolescents in custody in Tasmania, using the Adolescent Psychopathology Scale (APS) [2].

METHODS

The APS was administered to 50 adolescents admitted consecutively to a youth detention centre in Tasmania, Australia, using a structured interview format.

RESULTS

In this sample 46% scored positively for a mood disorder, 36% for posttraumatic stress disorder (PTSD), and 32% for an anxiety disorder excluding PTSD.

CONCLUSIONS

Tasmania is no exception to the rule that adolescents in custody have a high proportion of mental health problems. This study confirmed findings of previous studies that detained adolescents had a roughly equivalent level of mental health problems as young people referred to mental health services and five times more than adolescents in the community. Therefore, all detained adolescents should be assessed for mental health problems as their risk is equivalent to that of young people referred to mental health services in the community. Youth detention centres are able to provide significant opportunities for individual therapy and group programmes for young people with mental health problems. However, to achieve a realization of this potential, detention facilities need to develop philosophies and procedures, which facilitate the development of therapeutic, as opposed to "punishing", environments.