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McLennan JD. How are we doing as a journal? A request for feedback. J Can Acad Child Adolesc Psychiatry 2024; 33:2. [PMID: 38449722 PMCID: PMC10914149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
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McLennan JD, Gonzalez A, MacMillan HL, Afifi TO. Routine screening for adverse childhood experiences (ACEs) still doesn't make sense. Child Abuse Negl 2024:106708. [PMID: 38388325 DOI: 10.1016/j.chiabu.2024.106708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/23/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
When a serious health or social problem is identified as both prevalent and in need of attention, a common response is to propose that various systems implement routine identification, such as universal screening. However, these well-intentioned responses often fail to consider the key requirements necessary to determine whether benefits outweigh harms. Unfortunately, this continues to be the case for calls to implement routine screening for Adverse Childhood Experiences (ACEs). Persistent evidence gaps for this type of screening include the lack of any randomized controlled trials demonstrating that ACEs screening programs lead to any benefits. Rather than being informed by established screening principles, the calls to proceed with ACEs screening appear to rely on the assumption that simply identifying risk factors can lead to beneficial outcomes that outweigh any risk of harms. This may reflect a gap in understanding that patterns identified at the population level (e.g., that more ACEs are associated with more health and social problems) cannot be directly translated to practices at the level of the individual. This commentary does not question the importance of ACEs; rather it identifies that directing limited resources to screening approaches for which there is no evidence that benefits outweigh harms is problematic. Instead, we advocate for the investment in high-quality trials of prevention interventions to determine where best to direct limited resources to reduce the occurrence of ACEs, and for the prioritization of evidence-based treatment services for those with existing health and social conditions, whether or not they are attributed to ACEs.
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Affiliation(s)
- John D McLennan
- Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada.
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, Offord Centre for Child Studies, McMaster University, Hamilton, Canada.
| | - Harriet L MacMillan
- Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, Faculty of Health Sciences, Offord Centre for Child Studies, McMaster University, Hamilton, Canada.
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
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McLennan JD. A follow-up on the "Best Interests of the Child". J Can Acad Child Adolesc Psychiatry 2023; 32:275-276. [PMID: 38034411 PMCID: PMC10686223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- John D McLennan
- Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary
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McLennan JD. Is the journal a place for debates? J Can Acad Child Adolesc Psychiatry 2023; 32:144-145. [PMID: 37534115 PMCID: PMC10393353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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McLennan JD, Dufe K, Afifi TO, MacMillan HL, Warriyar K V V. Do parenting behaviors intended as discipline vary by household religious affiliation in Cameroon? Child Abuse Negl 2023; 143:106299. [PMID: 37392514 DOI: 10.1016/j.chiabu.2023.106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Religious affiliation may account for some variance in parenting behaviors used for disciplinary intent. However, most reported studies of this relationship are limited to high-income countries focused on Christianity. OBJECTIVE This study aimed to determine whether parenting behaviors vary by religion in a low- and middle-income country between Protestant, Catholic, and Muslim groups. It was hypothesized that Protestant households would have higher odds of select parenting behaviors. PARTICIPANTS & SETTINGS Data from the 2014 Cameroonian Multiple Indicator Cluster Survey, containing a nationally representative household sample, were used. METHODS Adult caregivers in selected households with a child aged 1-14 years of age participated in interviews containing a standardized disciplinary measure asking about the exposure of one randomly selected child to a series of parent behaviors in the preceding month. RESULTS Of the 4978 households, 41.6 % were Catholic, 30.9 % Protestant and 27.6 % Muslim. Spanking was the most common of the six types of physical punishments across groups with no association with household religion. In contrast, children in Protestant households had higher odds of being hit with an object compared to the other two groups, but only for younger children. Children in Protestant households also had higher odds of exposure to a combined approach, i.e., use of physical, psychological, and non-violent parent behaviors. CONCLUSIONS This study advances the examination of the potential influence of household religion on parenting behavior, however further inquiry is needed to examine these patterns in other settings with additional indices of religiosity and disciplinary beliefs.
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Affiliation(s)
- John D McLennan
- Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada.
| | - Kewir Dufe
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Harriet L MacMillan
- Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, Faculty of Health Sciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada.
| | - Vineetha Warriyar K V
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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McLennan JD. Aiming to broaden understanding of issues raised in articles in this journal. J Can Acad Child Adolesc Psychiatry 2023; 32:66-67. [PMID: 37181446 PMCID: PMC10168618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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McLennan JD, Fulford C, Hrycko S, Cobigo V, Tahir M. Service Use Patterns by Children With Down Syndrome in a Canadian Region. Intellect Dev Disabil 2023; 61:79-88. [PMID: 36706005 DOI: 10.1352/1934-9556-61.1.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 10/17/2022] [Indexed: 05/16/2023]
Abstract
Children with Down syndrome require services from different sectors over time to optimize health and development, however, there is little information on longitudinal, cross-sector service use. Parents of children with Down syndrome attending a Canadian children's hospital participated in semistructured interviews covering life-time multiple sector service use. Five key service patterns were identified: (1) primary care physicians playing a circumscribed role; (2) a marked shift in public habilitative service receipt from development agencies in the preschool years to exclusive school delivery after school entry; (3) families obtaining private services to address gaps from public sector services; (4) a prominent role for parents to identify additional services; and (5) service variability as a function of timing and severity of medical comorbidity.
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Affiliation(s)
- John D McLennan
- John D. McLennan, Department of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Casey Fulford
- Casey Fulford, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sophia Hrycko
- Sophia Hrycko, Children's Hospital of Eastern Ontario & Department of Psychiatry, University of Ottawa, ON, Canada
| | - Virginie Cobigo
- Virginie Cobigo, Children's Hospital of Eastern Ontario & Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Munazza Tahir
- Munazza Tahir, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
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McLennan JD. What are the missing competencies in psychiatry residency training? J Can Acad Child Adolesc Psychiatry 2023; 32:2-3. [PMID: 36776926 PMCID: PMC9879038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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McLennan JD. Persons. J Can Acad Child Adolesc Psychiatry 2022; 31:114. [PMID: 35919905 PMCID: PMC9275368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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McLennan JD. Finding the "Right" Balance in this Clinical Journal. J Can Acad Child Adolesc Psychiatry 2022; 31:50-51. [PMID: 35614955 PMCID: PMC9084374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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McLennan JD. Challenged to Continue to Grapple about Cannabis and Mental Health Practice. J Can Acad Child Adolesc Psychiatry 2022; 31:2-3. [PMID: 35251191 PMCID: PMC8862602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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McLennan JD, Pérez Agramonte M, Mosquea Hernández M. A mixed method inquiry of early complementary feeding of infants in the Dominican Republic. Appetite 2021; 170:105873. [PMID: 34923031 DOI: 10.1016/j.appet.2021.105873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/02/2022]
Abstract
Exclusive breastfeeding (EBF) is infrequent and decreasing over time in the Dominican Republic. This study aimed to identify patterns of, and women's rationale for, early complementary feeding. Mothers of children under 12 months of age living in a low-resource peri-urban community had three opportunities to contribute: (i) responding to feeding questions embedded in a standardized questionnaire used at a well-baby clinic (n = 101), (ii) participating in focus groups (n = 31), and (iii) engaging in home-based, semi-structured individual interviews (n = 25). Quantitative questionnaire data were analyzed to identify feeding practices as a function of child age. Textual data from the individual interviews and focus groups were systematically reviewed and coded to identify key constructs through a qualitative descriptive approach. The majority (>86%) of mothers reported breastfeeding at all monthly age bands up to six months. However, EBF was rare, with more than half reporting use of other milks and other foods by the infants' second and fifth month, respectively. Overarching themes to explain early complementary feeding from the qualitative data can be broadly captured by the complementary perceptions that there are problems with relying on breastfeeding alone and that there are benefits to early complementary feeding in the early months of an infant's life. EBF was experienced as (A) insufficient, (B) not always available, (C) sometimes not safe, (D) having potentially negative effects on the mother, and (E) bringing challenges. Complementary feeding was identified as helpful in addressing each of these concerns. Although mothers typically endorsed breastmilk as the preferable and best option for infant feeding, this did not translate into EBF and was not presented as contradictory to the use and perceived benefits of early complementary feeds.
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Affiliation(s)
- John D McLennan
- Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, and Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada.
| | - Miki Pérez Agramonte
- Hospital Dr. Elías Santana, Los Alcarrizos, Santo Domingo Oeste, Dominican Republic
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McLennan JD. Inpatient Child Psychiatry Research: Time to be more Experimental. J Can Acad Child Adolesc Psychiatry 2021; 30:224-225. [PMID: 34777505 PMCID: PMC8561859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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McLennan JD. What are the Bounds of Child and Adolescent Psychiatry? J Can Acad Child Adolesc Psychiatry 2021; 30:148-149. [PMID: 34381506 PMCID: PMC8315221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Braunberger P, McLennan JD. Arguments for Keeping Child & Adolescent Psychiatry Focused on Persons Under 18 Years of Age. J Can Acad Child Adolesc Psychiatry 2021; 30:217-222. [PMID: 34381517 PMCID: PMC8315220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Child and adolescent psychiatrists and their associations are grappling with the idea of restructuring their subspecialty to including transitional age youth (TAY), sometimes operationalized as persons 18-25 years of age. This consideration is currently before the Canadian Academy of Child and Adolescent Psychiatry (CACAP). This essay identifies several concerning and potentially harmful consequences of widening the age range of child and adolescent psychiatry. A key concern is the consequential and substantial increase in the population mandate which will significantly dilute already strained and limited child and adolescent psychiatry resources. Furthermore, the nature of some of the needs of TAY may preferentially divert resources away from younger patients. The change in age range will also disrupt existing partnerships which facilitate multidisciplinary care and needed efficiencies for the child and adolescent population, such as close working ties with pediatrics and schools. This is not to say that there may not be merit in child and adolescent psychiatrists contributing to the care of TAY, just as our members already contribute to other areas of mental health outside our immediate mandate. However, to advance such a mandate change, a threshold of evidence of a net beneficial impact including a systematic evaluation of potential harms and opportunity costs is needed. Unfortunately, such an assessment has not yet occurred and therefore a mandate and name change is premature. We recommend a much more deliberate evaluation of the role child and adolescent psychiatrists and their associations might play in contributing to the needs of TAY.
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Affiliation(s)
- Peter Braunberger
- St Joseph's Care Group Thunder Bay, Northern Ontario School of Medicine, and Telemental Health, The Hospital for Sick Children, Toronto, Ontario
| | - John D McLennan
- Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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McLennan JD. Paying Attention to the Measures Used in Psychiatric Research and Services. J Can Acad Child Adolesc Psychiatry 2021; 30:66-67. [PMID: 33953758 PMCID: PMC8056961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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McLennan JD. Wondering about the psychiatrist's role in smoking cessation from inpatients to whole populations. J Can Acad Child Adolesc Psychiatry 2021; 30:2. [PMID: 33552166 PMCID: PMC7837523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Johnson D, McLennan JD, Heron J, Colman I. The relationship between profiles and transitions of internalizing and externalizing symptoms in children and suicidal thoughts in early adolescence. Psychol Med 2020; 50:2566-2574. [PMID: 31576782 DOI: 10.1017/s0033291719002733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adolescence is a high-risk period for the onset of suicidal thoughts and behaviors. Identification of preceding patterns of internalizing and externalizing symptoms that are associated with subsequent suicidal thoughts may offer a better understanding of how to prevent adolescent suicide. METHODS Data from the National Longitudinal Survey of Children and Youth, a prospective population-based Canadian cohort, contained Child Behavior Checklist items which were used to examine profiles and transitions of internalizing and externalizing symptoms in children, aged 6-11 years (n = 8266). The association between these profiles/transitions and suicidal thoughts in adolescents was examined using multivariate logistic regression modeling. RESULTS Latent profile analyses identified four measurement invariant profiles of internalizing and externalizing symptoms at ages 6/7 and 10/11: (1) low on all symptoms, (2) moderate on all symptoms, (3) high on all symptoms, and (4) high on hyperactivity/inattention and internalizing. Recurrent (homotypic or heterotypic) and increasing symptoms from 6/7 to 10/11 were associated with suicidal thoughts in adolescence, compared to those with stable low symptoms. Those with decreasing symptoms from 6/7 to 10/11 were not at increased risk of suicidal thought in adolescence. CONCLUSIONS While patterns of recurrent symptoms were associated with suicidal thoughts, a similar association was observed between profiles at age 10/11 years and suicidal thoughts. This suggests that the recent assessments of mental health symptoms in children may be as sufficient a predictor of adolescent suicidal thought as transition profiles.
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Affiliation(s)
- Dylan Johnson
- University of Ottawa, School of Epidemiology and Public Health
| | - John D McLennan
- University of Calgary, Department of Pediatrics
- Children's Hospital of Eastern Ontario-Research Institute
| | - Jon Heron
- University of Bristol, Bristol Medical School, Population Health Sciences, Centre for Academic Mental Health
| | - Ian Colman
- University of Ottawa, School of Epidemiology and Public Health
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McLennan JD. Navigating To What? Are We Getting Children and Families to Effective Mental Health Services? J Can Acad Child Adolesc Psychiatry 2020; 29:212-213. [PMID: 33184563 PMCID: PMC7595258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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McLennan JD, Bahadur A, Cobigo V, Hrycko S, Fulford C. Cross-sector service use patterns among children with developmental disabilities in a district in Canada. J Appl Res Intellect Disabil 2020; 34:546-555. [PMID: 33070429 DOI: 10.1111/jar.12821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of information about cross-sector service use by children with developmental disabilities despite their need for services from multiple sectors. METHODS Responses to service use questions from a parent-completed survey on school-aged children who attended clinics specific for those with developmental disabilities at a Canadian children's hospital were examined. RESULTS School meetings were the most common of three professional meeting types attended in the last 12 months (64.9%) for the sample of 205 children. Recreational services were the most common of five service types received in the same time period (79.0%). Using ordinal logistic regression models, a higher number of behavioural difficulties was the only variable consistently related to indices of more meeting types (school, physician, other) attended and more service types received (recreation, respite, etc.). CONCLUSIONS The service relationship with behavioural problems, and not socio-demographic variables, is consistent with a needs-based oriented delivery system.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Virginie Cobigo
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, ON, Canada.,School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sophia Hrycko
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Casey Fulford
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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McLennan JD. The Ethically Questionable Lack of Research Evaluation of What We Deliver in the Child and Youth Mental Health Service System. J Can Acad Child Adolesc Psychiatry 2020; 29:130-131. [PMID: 32774396 PMCID: PMC7391872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Charach A, Mohammadzadeh F, Belanger SA, Easson A, Lipman EL, McLennan JD, Parkin P, Szatmari P. Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis. J Can Acad Child Adolesc Psychiatry 2020; 29:76-105. [PMID: 32405310 PMCID: PMC7213917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 10/19/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Primary care practitioners determine access to care for many preschool children with mental health (MH) problems. This study examined rates of mental health (MH) problem identification in preschoolers within primary healthcare settings, related service use, and MH status at follow-up. The findings may inform evidence-based policy and practice development for preschool MH. METHOD For this systematic review, MEDLINE®, EMBASE®, PsycInfo®, and ERIC ® were searched from inception to March 7, 2018 for reports in which a screening measure was used to identify MH problems in children aged 24-72 months, seen in primary and community health care settings. Meta-analyses, using random effects models to provide pooled estimates, were used when three or more studies examined identification rates. Findings on service use and persistence of disorders are summarized. RESULTS Thirty-five publications representing 21 studies met the inclusion criteria. MH problems were identified in 17.6% of preschoolers (95% Confidence Interval (CI): 11.1-24.1), Q = 4.9, p > 0.1 by primary/community healthcare practitioners. Psychiatric diagnoses were identified in 18.4% of preschoolers (95% CI: 12.3 - 24.4), Q= 1.6, p > 0.1. Based on three studies, parents of 67-72% of identified children received advice and 26-42% received specialist referrals. In the subset of studies examining persistence of MH disorders, 25-67% of identified children had MH disorders after one to three years. CONCLUSION While the identification rate by primary/community practitioners is similar to the diagnostic rate, these may not consistently be the same children. Substantial variability in management and outcomes indicate need for more rigorous evaluation of primary care services for this population.
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Affiliation(s)
- Alice Charach
- Department of Psychiatry, University of Toronto Faculty of Medicine, and The Hospital for Sick Children, Toronto, Ontario
| | - Forough Mohammadzadeh
- Department of Psychiatry, The Hospital for Sick Children, Toronto, and Qvella Corporation, Richmond Hill, Ontario
| | - Stacey A Belanger
- Département de Pédiatrie, Faculté de Médicine, Université de Montréal and CHU Sainte Justine, CIRENE (Centre Intégré du Réseau en Neurodéveloppement de L'Enfant), Montréal, Quebec
| | - Amanda Easson
- Department of Psychology, University of Toronto and Rotman Research Institute, Baycrest Center for Geriatric Care, Toronto, Ontario
| | - Ellen L Lipman
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences McMaster University, McMaster Children's Hospital and Offord Centre for Child Studies, Hamilton Ontario
| | - John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario, and Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Patricia Parkin
- Department of Pediatrics, University of Toronto Faculty of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, and The Hospital for Sick Children, Toronto, Ontario
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto Faculty of Medicine, The Hospital for Sick Children, and The Centre for Addiction and Mental Health, Toronto, Ontario
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McLennan JD. Deliberately Chipping Holes in the Wall: A Modest Goal for the Journal. J Can Acad Child Adolesc Psychiatry 2020; 29:56-57. [PMID: 32405307 PMCID: PMC7213914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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McLennan JD, MacMillan HL, Afifi TO. Questioning the use of adverse childhood experiences (ACEs) questionnaires. Child Abuse Negl 2020; 101:104331. [PMID: 31887655 DOI: 10.1016/j.chiabu.2019.104331] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 05/15/2023]
Abstract
Adverse childhood experiences (ACEs) are increasingly recognized as important predictors of poor health outcomes. In response, there is increasing application of ACEs questionnaires in clinical practice and population health surveys. Such efforts are often justified as approaches to identify ACEs, components of trauma-informed care, and/or measures to determine prevalence within epidemiological research. Unfortunately, such measures are often used without evaluating the strengths and limitations of the measures themselves. One of the most commonly used ACEs questionnaires is a ten-question version (ACEs-10), that is composed of two clusters - one asking about different types of child maltreatment, and the other asking select questions about household challenges. Unfortunately, both this questionnaire and its derivatives have substantial drawbacks that warrant careful consideration about their use. Problems include limited item coverage, collapsing of items and response options, a simplistic scoring approach, and the lack of psychometric assessment. These deficiencies are inconsistent with the standards expected for use of measures in healthcare services and research. Given these deficiencies, we recommend that these limitations are addressed before further use of ACEs-10, and its derivatives, for either clinical or research purposes.
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Affiliation(s)
- John D McLennan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario, Canada.
| | - Harriet L MacMillan
- Departments of Psychiatry & Behavioural Neurosciences, and Pediatrics, McMaster University, Hamilton, Ontario, Canada; Offord Centre for Child Studies, Hamilton, Ontario, Canada.
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
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McLennan JD, Macmillan HL, Afifi TO, McTavish J, Gonzalez A. Problems with the recommendation to implement ACEs screening. Paediatr Child Health 2020; 25:64-65. [PMID: 33390738 PMCID: PMC7757773 DOI: 10.1093/pch/pxz129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- John D McLennan
- Department of Pediatrics, University of Calgary, Calgary, Alberta
- Children’s Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario
| | - Harriet L Macmillan
- Department of Pediatrics, McMaster University, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Offord Centre for Child Studies, Hamilton, Ontario
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Jill McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Offord Centre for Child Studies, Hamilton, Ontario
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Offord Centre for Child Studies, Hamilton, Ontario
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McLennan JD. Deprescribing in a Youth with an Intellectual Disability, Autism, Behavioural Problems, and Medication-Related Obesity: A Case Study. J Can Acad Child Adolesc Psychiatry 2019; 28:141-146. [PMID: 31798652 PMCID: PMC6863577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Vlad, not his real name, a 15 year old boy with an autism spectrum disorder and intellectual disability, was referred for psychiatric consultation due to aggression and other behavioural problems. He presented for initial psychiatric consultation on five psychotropic medications with associated severe obesity. A systematic deprescribing and cross-tapering plan was implemented, removing all five psychotropic medications (which included olanzapine and quetiapine) and introducing ziprasidone. These changes were associated with a 44.8kg weight loss with no behavioral deterioration and overall lower rates of aggression. Vlad's case may typify important deficiencies in the service system which create a context that allows for aggressive psychotropic polypharmacy without apparent concomitant increase in sophistication of behavioral management design and support, while also tolerating substantial treatment adverse effects (e.g., medication induced severe obesity) within a member of a vulnerable population (e.g., a youth with developmental disability in care). Suggestions to address some of these contextual factors are outlined.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario
- Department of Pediatrics, University of Calgary, Alberta
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McLennan JD, Braunberger P. Advocacy-Related Information Distortion: The Case of Fetal Alcohol Spectrum Disorders. Can J Psychiatry 2019; 64:660-661. [PMID: 31288558 PMCID: PMC6699033 DOI: 10.1177/0706743719862991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Peter Braunberger
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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McLennan JD, MacMillan HL, Afifi TO, McTavish J, Gonzalez A, Waddell C. Routine ACEs screening is NOT recommended. Paediatr Child Health 2019; 24:272-273. [PMID: 31241059 DOI: 10.1093/pch/pxz042] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John D McLennan
- Department of Pediatrics, University of Calgary, Calgary, Alberta.,Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario
| | - Harriet L MacMillan
- Department of Pediatrics, McMaster University, Hamilton, Ontario.,Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario.,Offord Centre for Child Studies, Hamilton, Ontario
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Jill McTavish
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario.,Offord Centre for Child Studies, Hamilton, Ontario
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario.,Offord Centre for Child Studies, Hamilton, Ontario
| | - Charlotte Waddell
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia
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Javaheri KR, McLennan JD. Adherence to Antipsychotic Adverse Effect Monitoring Among a Referred Sample of Children with Intellectual Disabilities. J Child Adolesc Psychopharmacol 2019; 29:235-240. [PMID: 30810348 DOI: 10.1089/cap.2018.0167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Despite frequent use of antipsychotic medications to target severe behavioral problems among children with intellectual disabilities (ID), there is little information as to the extent to which adverse effect monitoring is in place for this population. The aim of this pilot study was to determine the extent to which monitoring for adverse effects was documented in health records of a cohort of children with ID who had been prescribed antipsychotic medication. METHODS Data were available on all children referred to a mental health clinic at a children's hospital in Canada who had ID and behavioral difficulties with intake appointments between September 1, 2016 and November 30, 2017. Charts of all those on antipsychotic medications were reviewed for a 12-week period to determine the extent to which adverse effect monitoring was documented using the parameters stipulated by the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA), including laboratory, anthropometric, and neurological measures. RESULTS The database was composed of 47 patients of whom 25 were on antipsychotics (56% boys; mean age 13 [SD 3] years). The most commonly used antipsychotic was risperidone (48%). The extent of adherence to the guidelines was (1) 96% for weight, height, and body mass index; (2) 84% for extrapyramidal symptom screening; (3) 80% for blood pressure; (4) 64% for abdominal girth and liver enzymes; (5) 60% for fasting plasma glucose; and (6) 56% for fasting lipids. Only 20% had all core recommended parameters documented. CONCLUSIONS There were significant gaps in adverse effect monitoring in this cohort. Examination of variation in larger samples from multiple clinical services are required to determine the extent of this quality care gap. Several barriers to adherence are proposed with suggested solutions.
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Affiliation(s)
| | - John D McLennan
- 2 Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.,3 Department of Pediatrics, University of Calgary, Calgary, Canada
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McLennan JD, Braunberger P. Caution Is Needed When Adding Etiology to Mental Disorder Criteria: The Case of Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure. J Am Acad Child Adolesc Psychiatry 2018; 57:818-819. [PMID: 30392619 DOI: 10.1016/j.jaac.2018.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/06/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been cautiously restrictive in incorporating etiological variables into diagnostic criteria. This etiologically agnostic approach seems appropriate given the lack of evidence for single dominant causal factors for most mental disorders. Moving toward an etiologically based diagnostic system was, however, articulated as one of the research goals for DSM-5.1 Unfortunately, the threshold of evidence justifying inclusion of an etiology in the criteria of a mental disorder in the DSM has not, to our knowledge, been explicitly articulated. Nevertheless, DSM-5 proposes a new exception with the introduction of "Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure" (ND-PAE) in the chapter on "Conditions for Further Study."2 Criteria for this new diagnosis include (A) "more than minimal exposure to alcohol during gestation…," (B) "impaired neurocognitive functioning as manifested by one or more…" from a list of five domains, and (C) impaired self-regulation (p.798).2 The basis for an exception for this particular etiologic variable, prenatal alcohol exposure (PAE), along with the implied hypothesis that it is causal for this cluster of neurobehavioral abnormalities, is not detailed in the DSM-5.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario and University of Ottawa, Ontario, Canada.
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Abstract
The term dual diagnosis can refer to the co-occurrence of an intellectual disability and a mental disorder. While such a term may have some advocacy rationale aimed at facilitating improved mental health care for those with intellectual disabilities, it is proposed that the construct has flawed underpinnings, and its application may problematize mental health service delivery. A core concern is the promotion of categorical diagnostic models, whereas dimensional models may more accurately reflect underlying continuums for both cognitive and mental health challenges. A categorical diagnostic approach may also contribute to questionable dichotomization of mental health difficulties in persons with intellectual disabilities into "problem or challenging behaviours" versus "mental disorders." Organizing services based on beliefs that such distinctions and categorical classifications are accurate may contribute to unnecessary and inappropriate fractionation of interventions and create additional service barriers for a vulnerable population. It is proposed that the term dual diagnosis be abandoned and replaced by systematic use of a dimensional approach to help facilitate assessment, intervention evaluation, and equitable service access.
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Affiliation(s)
- John D. McLennan
- Children’s Hospital of Eastern Ontario-Research Institute and the University of Ottawa, Ottawa, Ontario, Canada
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McLennan JD. Video-conferencing Telehealth Linkage attempts to Schools to Facilitate Mental Health Consultation. J Can Acad Child Adolesc Psychiatry 2018; 27:137-141. [PMID: 29662525 PMCID: PMC5896527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 11/10/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Telehealth to schools may be a strategic approach to expand child mental health service delivery, however, there are only a few published examples. This report describes video-conferencing telehealth linkage attempts to schools to facilitate mental health consultation. METHODS A series of synchronous video-conferencing linkage strategies were attempted to connect a mental health consultation service to multiple schools in a Canadian setting. Consultation to support the implementation of the Daily Report Card, for students with attentional and behavioural problems, was the core content of this pilot linkage attempt. RESULTS Synchronous video conference consultations were successfully delivered to six elementary schools across three school districts. Two of three linkage strategies were functional. One used existing health centre-based telehealth units to connect to school-based dedicated tablets with a video collaboration app and reliance on existing school Wi-Fi. A second used existing laptops in both the health and school system linked through a communication platform. A third connection, using 3G/4G hotspots to obviate the need to access school Wi-Fi, was deemed too expensive in this setting. CONCLUSION The potential to use existing computer hardware to connect mental health providers and schools could facilitate scale-up. However, it is unknown whether mental health systems and school sectors will invest in such linkages and reorganize core mental health services to be delivered in this way.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
- Department of Pediatrics, University of Calgary, Calgary, Alberta
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Charach A, Bélanger SA, McLennan JD, Nixon MK. Screening for disruptive behaviour problems in preschool children in primary health care settings. Paediatr Child Health 2018; 22:478-493. [PMID: 29601056 DOI: 10.1093/pch/pxx128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Disruptive behaviour problems in preschool children are significant risk factors for, and potential components of, neurodevelopmental and mental health disorders. Some noncompliance, temper tantrums and aggression between 2 and 5 years of age are normal and transient. However, problematic levels of disruptive behaviour, specifically when accompanied by functional impairment and/or significant distress, should be identified because early intervention can improve outcome trajectories. This position statement provides an approach to early identification using clinical screening at periodic health examinations, followed by a systematic mental health examination that includes standardized measures. The practitioner should consider a range of environmental, developmental, family and parent-child relationship factors to evaluate the clinical significance of disruptive behaviours. Options within a management plan include regular monitoring, accompanied by health guidance and parenting advice, referral to parent behaviour training as a core evidence-based intervention, and referral to specialty care for preschool children with significant disruptive behaviours, developmental or mental health comorbidities, or who are not responding to first-line interventions.
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Affiliation(s)
- Alice Charach
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario.,Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario
| | | | - John D McLennan
- Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario
| | - Mary Kay Nixon
- Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario
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Charach A, Bélanger SA, McLennan JD, Nixon MK. Screening for disruptive behaviour problems in preschool children in primary health care settings. Paediatr Child Health 2018; 23:83. [DOI: 10.1093/pch/pxx198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McLennan JD, Sparshu S. Returning to Stimulants in Children with Treatment Resistant ADHD: A Case Series. J Can Acad Child Adolesc Psychiatry 2018; 27:50-56. [PMID: 29375634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To present a case series of children retrialed on stimulants after initial poor stimulant responses given the paucity of information on the usefulness of this strategy. METHODS Health records from an ADHD medication service were obtained for six children who: (i) were medication naïve at service entry; (ii) had trials of at least one stimulant from each stimulant class; (iii) subsequently received a non-stimulant ADHD medication; and, (iv) were then retried on stimulants. RESULTS Initial stimulant discontinuation was a function of adverse effects and/or limited symptom improvement. Minimal response and/or adverse effects to non-stimulants contributed to the decision to retry stimulants. Final ADHD symptom ratings by parents and teachers were significantly better than baseline for this cohort. Three were discharged on stimulants, two as monotherapy. CONCLUSION Further study is required to develop evidence-based treatment algorithms for treatment resistant ADHD. Retrying a stimulant may be one option.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario-Research Institute; Department of Psychiatry, University of Ottawa; Department of Pediatrics, University of Calgary
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Charach A, Bélanger SA, McLennan JD, Nixon MK. Le dépistage des comportements perturbateurs en première ligne chez les
enfants d’âge préscolaire. Paediatr Child Health 2017; 22:485-493. [PMCID: PMC5804786 DOI: 10.1093/pch/pxx129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Chez les enfants d’âge préscolaire, les comportements perturbateurs sont d’importants facteurs de risque et des éléments potentiels de troubles du neurodéveloppement et de la santé mentale. Entre l’âge de deux et cinq ans, il est normal d’observer des comportements transitoires comme un certain défaut de se conformer, des crises de colère et de l’agressivité. Cependant, il est important de dépister les comportements perturbateurs problématiques, particulièrement lorsqu’ils s’accompagnent d’une atteinte fonctionnelle ou d’une détresse marquée, car une intervention précoce peut améliorer le pronostic. Le présent document de principes décrit une démarche pour diagnostiquer rapidement ce type de comportements grâce au dépistage clinique lors des examens de santé réguliers, suivis d’un examen de la santé mentale qui inclut des mesures standardisées. Le praticien devrait envisager une série de facteurs liés à l’environnement, au développement, à la famille et à la relation parent-enfant pour évaluer la signification clinique des comportements perturbateurs. Parmi les plans de prise en charge possibles, soulignons un suivi régulier conjugué à des conseils sur la santé et sur les habiletés parentales, l’orientation vers une formation sur les comportements destinée aux parents (une intervention fondamentale fondée sur des données probantes) et l’orientation des enfants d’âge préscolaire vers des soins spécialisés lorsqu’ils présentent des comportements perturbateurs importants, qu’ils ont des comorbidités touchant le déve loppement ou la santé mentale ou qu’ils ne répondent pas aux interventions de première ligne.
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Affiliation(s)
- Alice Charach
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles
du développement, Ottawa (Ontario)
- Académie canadienne de psychiatrie de l’enfant et de l’adolescent, Ottawa
(Ontario)
| | - Stacey Ageranioti Bélanger
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles
du développement, Ottawa (Ontario)
| | - John D McLennan
- Académie canadienne de psychiatrie de l’enfant et de l’adolescent, Ottawa
(Ontario)
| | - Mary Kay Nixon
- Académie canadienne de psychiatrie de l’enfant et de l’adolescent, Ottawa
(Ontario)
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McLennan JD. “Johnny, how did you end up on five psychotropic medications?”. CMAJ 2017; 189:E1265-E1266. [DOI: 10.1503/cmaj.170165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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McLennan JD, Braunberger P. A Critique of the New Canadian Fetal Alcohol Spectrum Disorder Guideline. J Can Acad Child Adolesc Psychiatry 2017; 26:179-183. [PMID: 29056979 PMCID: PMC5642456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/24/2017] [Indexed: 06/07/2023]
Abstract
A new Fetal Alcohol Spectrum Disorder (FASD) guideline was published in the Canadian Medical Association Journal in 2016. This is relevant to the mental health field as mental health symptoms and psychiatric disorders are often identified as associated with and/or part of FASD presentations. Unfortunately, the new guideline has not advanced understanding of the interface between FASD and mental health problems; rather it may contribute to additional confusion. For example, a new recommendation to include additional mental health symptoms, such as anxiety and affect dysregulation, as manifestations contributing to a diagnosis of FASD is particularly concerning given the paucity of evidence supporting this assertion and the potential to distort delivery of mental health interventions for mental health problems. In addition, the guideline recommendation for introducing an "at risk for FASD" designation is not without risk. An appeal is made for greater scrutiny in the construction of diagnostic criteria and guidelines and for a more careful delineation of causal relationships and comorbidities to better inform the delivery of evidence-based mental health care.
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Affiliation(s)
- John D. McLennan
- Scientist, Children’s Hospital of Eastern Ontario – Research Institute; Research Chair in Child and Adolescent Psychiatry, Department of Psychiatry, University of Ottawa; Adjunct Associate Professor, Department of Pediatrics, University of Calgary
| | - Peter Braunberger
- Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, Ontario
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Charach A, McLennan JD, Bélanger SA, Nixon MK. Screening for Disruptive Behaviour Problems in Preschool Children in Primary Health Care Settings. J Can Acad Child Adolesc Psychiatry 2017; 26:172-178. [PMID: 29056978 PMCID: PMC5642455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Disruptive behaviour problems in preschool children are significant risk factors for, and potential components of, neurodevelopmental and mental health disorders. Some non-compliance, temper tantrums and aggression between two and five years of age are normal and transient. However, problematic levels of disruptive behaviour, specifically when accompanied by functional impairment and/or significant distress, should be identified because early intervention can improve outcome trajectories. This position statement provides an approach to early identification using clinical screening at periodic health examinations, followed by a systematic mental health examination that includes standardized measures. The practitioner should consider a range of environmental, developmental, family and parent-child relationship factors to evaluate the clinical significance of disruptive behaviours. Options within a management plan include regular monitoring accompanied by health guidance and parenting advice, referral to parent behaviour training as a core evidence-based intervention, and referral to specialty care for preschool children with significant disruptive behaviours, developmental or mental health comorbidities, or who are not responding to first-line interventions.
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Affiliation(s)
- Alice Charach
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee
- Canadian Academy of Child and Adolescent Psychiatry
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McLennan JD. It's More Complicated than Myth Busting: Parents Deciding About Stimulant Use for their Children. J Can Acad Child Adolesc Psychiatry 2017; 26:68-69. [PMID: 28747928 PMCID: PMC5510934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- John D. McLennan
- Scientist, Children’s Hospital of Eastern Ontario – Research Institute; Research Chair in Child and Adolescent Psychiatry, Department of Psychiatry, University of Ottawa; Adjunct Associate Professor, Department of Pediatrics, University of Calgary
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McLennan JD. Changes over time in early complementary feeding of breastfed infants on the island of Hispaniola. Rev Panam Salud Publica 2017; 41:e39. [PMID: 31391818 PMCID: PMC6660860 DOI: 10.26633/rpsp.2017.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
Abstract
Objective. To describe and contrast early complementary feeding (ECF) over time in breastfed infants in the Dominican Republic (DR) and Haiti, the two countries that share the island of Hispaniola. Methods. Secondary data analysis was conducted on cross-sectional data from Demographic and Health Surveys administered at four different time-points in both countries between 1994 and 2013. Extracted samples were composed of breastfed infants < 6 months of age whose caregivers had responded to dietary questions on food consumption in the previous 24 hours. Results. Plain water was the most frequently consumed complementary substance in both countries. However, the prevalence of water consumption increased in the DR over time, whereas in Haiti it decreased. Milk (non-breast) use was also common and followed a similar pattern as water over time in the two countries. Expanded use of water and milk in the DR are the major contributors to its drop in exclusive breastfeeding (EBF) rates over time. Whereas in Haiti, a reduction in a broader array of liquids and semi-solids/solids overtime appears to have contributed to its markedly improved EBF rates. Conclusion. Determining contributors to the differential trends in water and milk (non-breast) use between these two countries may identify targets for addressing the persistent gaps in EBF on the island of Hispaniola.
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Affiliation(s)
- John D McLennan
- Children's Hospital of Eastern Ontario Research Institute and University of Ottawa Children's Hospital of Eastern Ontario Research Institute and University of Ottawa OttawaOntario Canada Children's Hospital of Eastern Ontario Research Institute and University of Ottawa, Ottawa, Ontario, Canada
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McLennan JD. Understanding attention deficit hyperactivity disorder as a continuum. Can Fam Physician 2016; 62:979-982. [PMID: 27965331 PMCID: PMC5154646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To review research findings that consider whether attention deficit hyperactivity disorder (ADHD) is a discrete entity or whether it is more consistent with an extreme end-of-trait distribution in the population and to then grapple with the potential clinical implications. QUALITY OF EVIDENCE Peer-reviewed publications in the past 5 years, drawing from diverse fields (taxonomy, epidemiology, genetics, neurobiology, and neuropsychology), were identified through searches in MEDLINE and PsycINFO. MAIN MESSAGE Accumulating research findings are most consistent with a predominately dimensional rather than a qualitatively distinct existence for ADHD. This does not negate the clinical needs of those who have substantial ADHD symptom clusters, nor the risks that such symptoms entail. However, the lack of discontinuity in the distribution of such traits in the population creates great uncertainty as to what thresholds should prompt explicit intervention. CONCLUSION The implications of this pattern of findings might include the need to de-emphasize categorical conceptualizations of ADHD, produce evidence to better inform risk-benefit ratios of interventions along a spectrum of symptom and functional severity, and more coherently triage and arrange service delivery on the basis of symptom and functional severity rather than artificial diagnostic categorizations.
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Affiliation(s)
- John D McLennan
- Child psychiatrist at the Children's Hospital of Eastern Ontario in Ottawa, a scientist at the Children's Hospital of Eastern Ontario Research Institute, Research Chair in Child & Adolescent Psychiatry at the University of Ottawa, and Adjunct Associate Professor at the University of Calgary in Alberta.
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McLennan JD, MacMillan HL. Routine primary care screening for intimate partner violence and other adverse psychosocial exposures: what's the evidence? BMC Fam Pract 2016; 17:103. [PMID: 27488658 PMCID: PMC4972945 DOI: 10.1186/s12875-016-0500-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Family physicians and other primary care practitioners are encouraged or expected to screen for an expanding array of concerns and problems including intimate partner violence (IPV). While there is no debate about the deleterious impact of violence and other adverse psychosocial exposures on health status, the key question raised here is about the value of routine screening in primary care for such exposures. DISCUSSION Several characteristics of IPV have led to consideration for routine IPV screening in primary care and during other healthcare encounters (e.g., emergency room visits) including: its high prevalence, concern that it may not be raised spontaneously if not prompted, and the burden of suffering associated with this exposure. Despite these factors, there are now three randomized controlled trials showing that screening does not reduce IPV or improve health outcomes. Yet, recommendations to routinely screen for IPV persist. Similarly, adverse childhood experiences (ACEs) have several characteristics (e.g., high frequency, predictive power of such experiences for subsequent health problems, and concerns that they might not be identified without screening) suggesting they too should be considered for routine primary care screening. However, demonstration of strong associations with health outcomes, and even causality, do not necessarily translate into the benefits of routine screening for such experiences. To date, there have been no controlled trials examining the impact and outcomes - either beneficial or harmful - of routine ACEs screening. Even so, there is an expansion of calls for routine screening for ACEs. While we must prioritize how best to support and intervene with patients who have experienced IPV and other adverse psychosocial exposures, we should not be lulled into a false sense of security that our routine use of "screeners" results in better health outcomes or less violence without evidence for such. Decisions about implementation of routine screening for psychosocial concerns need similar rigorous debate and scrutiny of empirical evidence as that recommended for proposed physical health screening (e.g., for prostate and breast cancer).
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Affiliation(s)
- John D McLennan
- Departments of Pediatrics, Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Harriet L MacMillan
- Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Abstract
Iron is often initiated for children with low hemoglobin values in the absence of other indicators of iron deficiency in low-resource settings. Unfortunately, there are few reports describing outcomes from such an approach outside of clinical trials. This study examined outcomes of an anemia screening and treatment service in a low-resource community in the Dominican Republic. Complete blood counts (CBC) and receipt of iron supplementation were extracted from health records of young children participating in a well-baby clinic in the targeted community. Of the 265 children screened, 68.7% had hemoglobin values <11.0 g/dl; 61.5% of these anemic children had follow-up CBCs. While 72.3% of those with follow-up CBCs picked-up some iron supplements, only 21.4% had a follow-up hemoglobin ≥11.0 g/dl. Amount of iron given was not related to change in hemoglobin at follow-up. More follow-up monitoring of quality and impact of community care is required with associated evidence-informed benchmark targets.
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Affiliation(s)
- John D McLennan
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA
| | - MacGregor Steele
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA
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Wagner DJ, McLennan JD. An Alternative Approach to Scoring the MTA-SNAP-IV to Guide Attention-Deficit/Hyperactivity Disorder Medication Treatment Titration towards Symptom Remission: A Preliminary Consideration. J Child Adolesc Psychopharmacol 2015; 25:749-53. [PMID: 26682996 DOI: 10.1089/cap.2015.0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Multimodal Treatment Study for Attention-Deficit/Hyperactivity Disorder Swanson, Nolan, and Pelham, Version IV (MTA-SNAP-IV) is a common rating scale to measure attention-deficit/hyperactivity disorder (ADHD) symptoms during medication treatment. Relying on the traditional scoring approach for this instrument to identify symptom remission, however, may leave a child with significant residual symptoms. The objective of this study was to examine an alternative scoring approach for this instrument to identify the extent of residual symptoms for children completing ADHD medication treatment. METHODS Parent and teacher ratings on the ADHD symptom component of the MTA-SNAP-IV were extracted from medical records of 80 children completing medication treatment at a specialty clinic in Canada. Data were scored in two ways. 1) Traditional scoring based on assigning a value ranging from 0 to 3 for response options: "Not at all," "Just a little," "Pretty much," or "Very much," for each symptom and then determining a mean across items, and 2) alternative scoring based on assigning values of 0, 0, 0.5, and 1 across the same response options and summing the total across items. Symptom remission based on the former is defined as a mean value ≤ 1, and for the latter it is defined as a summed value equal to 0. RESULTS Children were significantly less likely to be classified as symptom remitted under the alternative scoring method based on parent, teacher, and combined parent-teacher ratings. Using the alternative scoring approach, residual symptoms were identified for 25%, 39%, and 70% of children classified as symptom remitted (under traditional scoring rules) by parents, teachers, and parents/teachers combined, respectively. CONCLUSIONS Potential "residual" ADHD symptoms were identified in many children attaining symptom remission using the traditional scoring approach; however, further scrutiny of this alternative scoring approach is required. Although it may improve the ability to detect residual symptoms that could signal the need for further intervention to achieve symptom remission, it may increase the risk of over treatment.
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Affiliation(s)
- Daniel J Wagner
- 1 Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario, Canada
| | - John D McLennan
- 2 Department of Pediatrics, Psychiatry and Community Health Sciences, Cumming School of Medicine. University of Calgary , Calgary, Alberta, Canada
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Aman DD, McLennan JD. Inequities in Receipt of Iron and Vitamin A Supplements, and Anthelmintic Medications by Young Children in the Dominican Republic. J Health Care Poor Underserved 2015; 26:1207-22. [PMID: 26548674 DOI: 10.1353/hpu.2015.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gaps in the receipt of micronutrients and anthelmintic medications by children in low-and middle-income countries undermine efforts to reduce the burden of vitamin A and iron deficiencies, and soil transmitted helminthiases. This study aimed to identify the extent of equitable receipt of these interventions in the Dominican Republic (DR) using indices of need and socioeconomic status with data derived from the DR 2007 Demographic and Health Survey. Receipt of anthelmintic medication, iron, and vitamin A were reported for 55.0% (last six months), 30.3% (last seven days), and 24.0% (last six months) of young children, respectively. No relationships were found between indices of need and receipt of any of the interventions using bivariate and multivariate analysis. However, receipt of each intervention was related to higher maternal education, and iron was additionally related to greater family wealth. Systematic efforts to improve equitability of receipt of these core child health interventions are needed.
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McLennan JD. Persisting without Evidence is a Problem: Suicide Prevention and Other Well-Intentioned Interventions. J Can Acad Child Adolesc Psychiatry 2015; 24:131-132. [PMID: 26379726 PMCID: PMC4558985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/08/2015] [Indexed: 06/05/2023]
Affiliation(s)
- John D. McLennan
- Cumming School of Medicine, Departments of Pediatrics, Psychiatry, and Community Health Sciences, University of Calgary, Calgary, Alberta
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McLennan JD. Alcohol-exposed? Next. CMAJ 2015; 187:cmaj.150041. [PMID: 25918171 PMCID: PMC4467938 DOI: 10.1503/cmaj.150041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- John D McLennan
- Child Psychiatry Consultant, Cumming School of Medicine, University of Calgary, Calgary, Alta
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McLennan JD, Steele M. Extent of microcytic anemia among children in a low-income, peri-urban community in the Dominican Republic using different cut-points. J Trop Pediatr 2015; 61:86-91. [PMID: 25505156 DOI: 10.1093/tropej/fmu071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Response to anemia in low-resource settings may entail presumptive iron treatment for those with Hemoglobin (Hb) levels falling below certain cut points. This study aimed to inform an anemia screening and treatment service in a low-income community in the Dominican Republic by determining (i) the prevalence of anemia in young children attending this service using different Hb cut points and (ii) the extent of microcytosis using different recommended cut points for the mean corpuscular volume (MCV). Using the WHO recommended cut point of <11.0 g/dl, 69.9% of 292 children would be classified as anemic, while using a more conservative cut point, <10.0 g/dl, 34.6% would be identified. Depending on the Hb cut point and which of two age-based MCV cut points are used, the prevalence of microcytosis within the anemic subsamples ranged from 23.5% to 80.2%. With increasing availability of complete blood counts in low resource settings (vs. Hb only), more sophisticated management algorithms are necessary to guide primary care efforts.
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Affiliation(s)
- John D McLennan
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA
| | - MacGregor Steele
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, CANADA
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