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Kerimofski KL, Panton KR, Pestell CF. Australian psychologists' knowledge, confidence, and practices in fetal alcohol spectrum disorder diagnostic assessment. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:653-666. [PMID: 38316430 DOI: 10.1111/acer.15275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure (PAE). There are many documented barriers to FASD diagnostic assessment, including a limited number of trained clinicians. This study aimed to establish baseline levels of Australian psychologists' knowledge and practices in FASD assessment to develop training and improve future diagnostic capacity. METHODS An online survey was completed by 106 Australian psychologists. The survey elicited respondents' demographics, knowledge about FASD, confidence in various aspects of assessment and perceived future training needs. RESULTS Respondents reported a broad understanding of the FASD diagnostic term and potential harm of prenatal alcohol exposure (PAE). However, most respondents were not confident in their ability to conduct the psychometric assessments that provide a diagnostic assessment of FASD or ask about PAE. There was a significant positive correlation between the number of correct knowledge items and the psychologists' confidence in conducting FASD assessments. The clinical neuropsychologists demonstrated significantly greater knowledge and confidence in applying FASD diagnostic criteria and assessing PAE than school, clinical, and other psychologists. Most psychologists were more confident in their ability to apply the diagnostic criteria for other neurodevelopmental disorders. CONCLUSIONS Recognition of FASD is growing in Australia, however, further work is required to improve clinicians' understanding of and confidence in completing FASD assessments. Most participants indicated a preference for online training to learn more about FASD assessment.
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Affiliation(s)
- Katherine L Kerimofski
- School of Psychological Science, University of Western Australia (WA), Crawley, Western Australia, Australia
| | - Kirsten R Panton
- School of Psychological Science, University of Western Australia (WA), Crawley, Western Australia, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of Western Australia (WA), Crawley, Western Australia, Australia
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Jewell E, Dunleavy B, Faitakis M, Pun JW, Moss S, Pei J, Mela M, Flannigan K, Tremblay M, McLachlan K. Screening and identification of fetal alcohol spectrum disorder in criminal legal settings: A realist review. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:208-270. [PMID: 38660916 DOI: 10.1002/cbm.2336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 03/13/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Screening for fetal alcohol spectrum disorder (FASD) has been identified as a promising approach to improve recognition, understanding and effective response to the unique needs of those with FASD in criminal legal settings. However, to date, there has been limited synthesis of relevant screening tools, indicators, or implementation considerations in this context. AIMS The present review aimed to synthesise evidence and develop a conceptual framework for understanding how, when, why, for whom and by whom FASD screening tools, items and/or indicators and characteristics serve to accurately identify people with FASD in criminal legal contexts, with consideration of individual and system needs relevant to effective implementation and response. METHODS A preregistered search was conducted using a modified realist review framework for both peer-reviewed articles and grey literature. Included sources were available in English, which focused on individuals with prenatal alcohol exposure and/or FASD with criminal legal involvement and offered new empirical evidence. Sources were reviewed using the Quality Control Tool for Screening Titles and Abstracts by Second Reviewer framework, extracted using a structured coding form and narratively synthesised. RESULTS The search yielded 52 sources, 11 FASD screening tools designed for or applied in criminal legal settings and 38 potential FASD indicators or characteristics relevant to identifying people who may have FASD in criminal legal settings, organised into six conceptually related domains. There was limited evidence supporting the psychometric properties of screening tools across populations or settings, though growing evidence highlights the promise of some instruments. Although few studies characterised potential considerations to be made when implementing a screening tool or approach, both system and individual level needs related to recognising and effectively responding to FASD in criminal legal contexts were identified, and findings revealed strong support among legal and clinical professionals regarding the need for FASD screening in these settings. CONCLUSIONS Findings of this review can be used to inform the development, selection, implementation and evaluation of FASD screening tools in criminal legal settings and underscore a continued need for enhanced resources, policy and cross-sectoral response to better support the needs of people with FASD in the criminal legal contexts.
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Affiliation(s)
- Emma Jewell
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
- Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Bianka Dunleavy
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Martina Faitakis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Jessica W Pun
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Sarah Moss
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | | | - Mansfield Mela
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Kaitlyn McLachlan
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
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Kent N, Hayes N, Young S, Vanderpeet C, Shanley D, Harris K, Pestell C, Elliott E, Reid N. Exploring resource implications and models of care for assessment and diagnosis of fetal alcohol spectrum disorder: A scoping review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2022-2032. [PMID: 38226761 DOI: 10.1111/acer.15198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 01/17/2024]
Abstract
Previous reviews have examined annual mean costs of care for individuals with fetal alcohol spectrum disorder (FASD), costs of the health burden, costs to the justice system, productivity losses for caregivers, and both the monetary and nonmonetary costs of reduced quality of life. However, because there have been no published reviews focused on understanding the resource implications and specific service features for the assessment and diagnostic process for FASD, the current scoping review investigated the available evidence on these topics. Eligible studies were identified through a systematic search of six databases and included if they contained information on the potential costs or models of care associated with undertaking an assessment for FASD. Data were charted, underwent content analysis, and were reported according to the PRISMA extension for scoping reviews. Eleven studies were included in the final qualitative synthesis. The primary patient costs were attributed to the lengthy time required for diagnosis (up to 47 h). The primary service costs were attributed to costs of clinicians and support personnel and the involvement of multidisciplinary teams in the assessment process. Estimates of the specific dollar values of diagnostic costs were limited and varied between studies. Several models of care were explored, primarily in Canadian clinics, which aimed to capitalize on available services to improve accessibility and patient care and reduce service costs. This study provides important preliminary insights into the resource implications and models of care involved in the diagnostic assessment of FASD. However, the low number of available studies and variability in available data highlight the need for formal costing studies and detailed information gathering on available models of care to inform future clinical practice and policy development.
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Affiliation(s)
- Nykola Kent
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nicole Hayes
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sophia Young
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Chelsea Vanderpeet
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Dianne Shanley
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Katrina Harris
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Australian Childhood Foundation, Abbotsford, Victoria, Australia
| | - Carmela Pestell
- Australian Childhood Foundation, Abbotsford, Victoria, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Westmead, Sydney, New South Wales, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
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Reid N, Kent N, Hewlett N, Bagley K, Tsang TW, Goldsbury S, Williams R, Akison L, Holland L, Vanderpeet C, Doyle M, Boaden N, Hayes N. Factors to be considered as part of a holistic assessment for fetal alcohol spectrum disorder: A scoping review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2007-2021. [PMID: 38226745 DOI: 10.1111/acer.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 01/17/2024]
Abstract
We undertook a scoping review to identify the factors outside of current fetal alcohol spectrum disorder (FASD) diagnostic criteria to be considered as part of a holistic assessment process. This included physical, social, cultural, mental health and wellbeing factors to inform targeted recommendations and supports to improve outcomes for individuals with FASD. Evidence from this review will be used to inform the revision of the Australian Guide to the Diagnosis of FASD. Six electronic databases were searched. Studies were eligible if they included factors outside of the diagnostic criteria that cover dysmorphology, growth restriction, neurodevelopmental impairments. Data charting and content analysis were performed to synthesize the results. One hundred twenty-one studies were included that spanned 12 key areas These included physical health, sleep, adverse postnatal experiences, substance use/other risk-taking behaviors, contact with the criminal justice system, mental health, First Nations cultural considerations, transition to adult roles, involvement with the out-of-home care system, feeding and eating, strengths/interests/external resources and incontinence. Areas to be considered as part of a holistic assessment and diagnostic process spanned individual, family, and system level factors. Results provide guidance for clinicians on the wide range of factors that could influence long-term health, development, and wellbeing for individuals with prenatal alcohol exposure and FASD. In practice, this guidance can be used to inform an individualized assessment process to facilitate tailored recommendations and supports to best meet the complex needs of individuals living with FASD and their families.
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Affiliation(s)
- Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nykola Kent
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Nicole Hewlett
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- The First Nations Cancer & Wellbeing Research Team, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Kerryn Bagley
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
| | - Sarah Goldsbury
- Māori/Indigenous Health Innovation, University of Otago Christchurch, Christchurch, New Zealand
| | - Robyn Williams
- Curtin Medical School, Curtin University, Bentin, Western Australia, Australia
| | - Lisa Akison
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Lorelle Holland
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Chelsea Vanderpeet
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Michael Doyle
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nirosha Boaden
- School of Social Work, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole Hayes
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Queensland University of Technology, Brisbane, Queensland, Australia
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Hewlett N, Hayes L, Williams R, Hamilton S, Holland L, Gall A, Doyle M, Goldsbury S, Boaden N, Reid N. Development of an Australian FASD Indigenous Framework: Aboriginal Healing-Informed and Strengths-Based Ways of Knowing, Being and Doing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20065215. [PMID: 36982125 PMCID: PMC10049125 DOI: 10.3390/ijerph20065215] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 05/27/2023]
Abstract
Aboriginal culture intuitively embodies and interconnects the threads of life that are known to be intrinsic to human wellbeing: connection. Therefore, Aboriginal wisdom and practices are inherently strengths-based and healing-informed. Underpinned by an Indigenist research methodology, this article presents findings from a collaboration of Aboriginal and non-Aboriginal peoples to develop an Australian Fetal Alcohol Spectrum Disorder (FASD) Indigenous Framework during 2021 to 2023. The FASD Indigenous Framework unfolds the changes that non-Aboriginal clinicians and Aboriginal peoples each need to make in their respective ways of knowing, being and doing in order to facilitate access to healing-informed, strengths-based and culturally responsive FASD knowledge, assessment, diagnosis and support services among Aboriginal peoples. Drawing on the Aboriginal practices of yarning and Dadirri, written and oral knowledges were gathered. These knowledges were mapped against Aboriginal cultural responsiveness and wellbeing frameworks and collaboratively and iteratively reflected upon throughout. This article brings together Aboriginal wisdom (strengths-based, healing-informed approaches grounded in holistic and integrated support) and Western wisdom (biomedicine and therapeutic models) in relation to FASD. From a place of still awareness (Dadirri), both forms of wisdom were drawn upon to create Australia's first FASD Indigenous Framework, a new practice in the assessment and diagnosis of FASD, which offers immense benefit to equity, justice, support and healing for Aboriginal families with a lived experience of FASD.
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Affiliation(s)
- Nicole Hewlett
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Lorian Hayes
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Robyn Williams
- Curtin Medical School, Curtin University, Perth, WA 6000, Australia
| | - Sharynne Hamilton
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Lorelle Holland
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Alana Gall
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | - Michael Doyle
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sarah Goldsbury
- Māori/Indigenous Health Innovation, University of Otago Christchurch, Christchurch 8013, New Zealand
| | - Nirosha Boaden
- Faculty of Social Work, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
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Dawe S, Eggins E, Betts J, Webster H, Pomario T, Doak J, Chandler-Mather N, Hatzis D, Till H, Harnett P, Wood A, Shelton D. An investigation of the utility of the Australian Guide to the diagnosis of fetal alcohol spectrum disorder in young children. Alcohol Clin Exp Res 2023; 47:486-500. [PMID: 36810987 DOI: 10.1111/acer.15012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Early diagnosis of children with fetal alcohol spectrum disorder (FASD) assists in implementing critical early support. The challenge lies in having a diagnostic process that enables valid and reliable assessment of domains of functioning in young children, with the added complexity that many children will also have co-occurring exposure to childhood adversity that is likely to impact these domains. METHODS The aim of this study was to test a diagnostic assessment of FASD in young children using the Australian Guide to the Diagnosis of FASD. Ninety-four children (aged 3 to 7 years) with confirmed or suspected prenatal alcohol exposure were referred to two specialist FASD clinics for assessment in Queensland, Australia. RESULTS There was a significant risk profile with 68.1% (n = 64) children having had contact with child protection services, and most children living in kinship (n = 22, 27.7%) or foster (n = 36, 40.4%) care. Forty-one percent of the children were Indigenous Australians. The majority (64.9%, n = 61) of children met criteria for FASD, 30.9% were classified as "At Risk" for FASD (n = 29), and 4.3% received no FASD diagnosis (n = 4). Only 4 (4%) children were rated as severe for the brain domain. Over 60% of children (n = 58) had two or more comorbid diagnoses. Sensitivity analyses indicated that the removal of comorbid diagnoses in the Attention, Affect Regulation, or Adaptive Functioning domains resulted in a change in 7 of 47 cases (15%) to an "At Risk" designation. CONCLUSIONS These results highlight the complexity of presentation and the extent of impairment in the sample. The use of comorbid diagnoses to substantiate a "severe" designation in specific neurodevelopmental domains raises the question of whether there were false-positive diagnoses. The complexity of determining causal relationships between exposure to PAE and early life adversity on developmental outcomes continues to be a challenge in this young population.
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Affiliation(s)
- Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Elizabeth Eggins
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Joseph Betts
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Heidi Webster
- Child Development Service, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Tania Pomario
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Doak
- School of Psychology, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ned Chandler-Mather
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Denise Hatzis
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Haydn Till
- Child Development Service, Gold Coast Hospital, Gold Coast, Queensland, Australia
| | - Paul Harnett
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Queensland, Australia
| | - Andrew Wood
- School of Psychology, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Doug Shelton
- Child Development Service, Gold Coast Hospital, Gold Coast, Queensland, Australia
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Reid N, Shanley DC, Logan J, White C, Liu W, Hawkins E. International Survey of Specialist Fetal Alcohol Spectrum Disorder Diagnostic Clinics: Comparison of Diagnostic Approach and Considerations Regarding the Potential for Unification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15663. [PMID: 36497738 PMCID: PMC9737886 DOI: 10.3390/ijerph192315663] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Fetal alcohol spectrum disorder (FASD) is a prevalent neurodevelopmental condition. Despite FASD being recognized as a clinical disorder there is no globally agreed set of diagnostic criteria. Accurate and timely diagnosis of FASD is imperative to inform clinical care, optimize outcomes for individuals accessing assessments and their families, as well as for research and prevention strategies. To inform movement towards a unified approach, the present study aimed to capture an international perspective on current FASD diagnostic criteria, as well as potential barriers and facilitators to unification. An online survey was created using REDCap and sent to clinics identified and contacted via internet searches. Quantitative data were presented using descriptive statistics and open-ended questions analysed using content analysis. The survey captured information about each clinic's current diagnostic approach, whether they would support a unified method, and the barriers and facilitators for a consistent international FASD diagnostic approach. Fifty-five (37.4%) of 147 FASD clinics identified worldwide participated. The majority (n = 50, 90.9%) of respondents supported a unified approach. Content analysis identified a lack of collaboration as a key barrier, while strong leadership in guideline creation and implementation emerged as a central facilitator. These barriers and facilitators can be used to guide future collaborative efforts towards implementing consistent diagnostic criteria.
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Affiliation(s)
- Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Dianne C. Shanley
- School of Applied Psychology, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Jayden Logan
- Child Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Codi White
- School of Applied Psychology, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Wei Liu
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Erinn Hawkins
- School of Applied Psychology, Griffith University, Gold Coast, QLD 4222, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD 4222, Australia
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