The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being

OBJECTIVE

To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems.

METHOD

The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours.

RESULTS

Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey.

CONCLUSION

Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

The sleep/wake rhythm in children with autism

The sleep patterns of two groups of children with autism, one with moderate to severe intellectual handicap, and one with mild handicap to normal IQ level, were compared with those of children without autism. Parents completed 14 day sleep diaries and questionnaires. Results suggested that at some stage during childhood, particularly under 8 years of age, the majority of children with autism will experience sleep problems. These problems are likely to be severe in many cases and will generally include one or more of: extreme sleep latencies; lengthy periods of night waking, shortened night sleep; and early morning waking. Such problems may have some specificity for autism as they appear to be rare in non-handicapped children and in children with mild degrees of intellectual handicap. It is likely that sleep problems in early childhood are related to the severe social difficulties present in autism and the consequent inability of these children to use social cues to synchronize their sleep/wake cycle. Continued sleep difficulties at older ages and with higher IQ may also be related to arousal and anxiety factors.

Urinary cortisol circadian rhythm in a group of high-functioning children with autism

Previous research has suggested that there may be dysfunction in the control of the hypothalamic-pituitary-adrenal axis in autistic children. Both an abnormal cortisol circadian rhythm and failure to suppress cortisol secretion in response to dexamethasone have been reported. This study investigated the basal urinary cortisol circadian rhythm in a group of high-functioning children with autism and matched controls. No evidence was found for abnormal temporal placement of the circadian rhythm in the autistic group. There was a tendency towards cortisol hypersecretion during the day, predominantly in those autistic children who were integrated into the normal school system. While the temporal parameters of the cortisol circadian rhythm in these children with autism were probably normal, the tendency towards cortisol hypersecretion may indicate an environmental stress response in this group.

The rule learning behavior of reading disabled and normal children as a function of task characteristics and instruction

The purpose of this research was to investigate rule learning in reading disabled (RD) and normal children (chronological age and reading age (RA) match) when required to (a) abstract rules independently, and (b) use rules after instruction. Study 1 required the children to solve problems using shapes and letters. Although there was no difference between groups in the rate of problem solving when children were asked to abstract rules independently, the pattern of errors was different. The RD children made a greater proportion of errors on the negative instance for the more complex problems. In particular, this occurred on the letter task which involved psycholinguistic categorization. After instruction, the RA controls made more errors than the other groups. Study 2 was an analogous pseudoword reading task. Even with statistical adjustment for differences in prior grapheme-phoneme (g-p) rule knowledge, the RD children performed less accurately than the RA controls when they had to abstract rules, although this was restricted to the most difficult rule (rule of e). There was no difference after instruction in rule application, although the pattern of errors and post-test results indicated that the RD children continued to experience decoding difficulty. These results suggest a phonologically based productive deficit which interferes with the learning of g-p rules. This may be part of a more general language deficit which includes psycholinguistic categorization. Despite the severity of this handicap, RD children seem responsive to instruction.

Singing ability after right and left sided brain damage. A research note

Capacity to sing following brain damage was investigated in a series of 15 right sided and 15 left sided lesioned subjects and 15 normal control subjects. All subjects were asked to sing the same well-known song and performance was judged by independent expert musicians using criteria of ability to pitch the melody, accurately produce the rhythm, and overall quality of the production. There was a lack of support for differential effect of right and left cerebral damage on pitch and rhythm aspects of singing, but a generalized effect of brain damage was found.

Temperament and behavioural adjustment in hearing impaired children

Temperament and behavioural adjustment were assessed in 26 hearing impaired pre-school children. By comparison with normally hearing children the clinical group was rated by their mothers as having a more difficult temperament, but no greater level of behaviour problems. Teachers of these children rated them as less well adjusted overall and specifically, more anxious compared with a normative group. Mothers of hearing impaired children showed elevated levels of anxiety, depression and overall problem scores on the General Health Questionnaire and the latter variable was the best predictor of rated behaviour problems in their children. Teacher rating of behaviour problems was best predicted by their rating of the child's temperament. Greater support for mothers of hearing impaired children is suggested as important in preventing behavioural maladjustment in this handicapped group.

Biological and neuropsychological approaches to childhood autism

There is growing conviction that childhood autism is a biologically based disorder. The evidence that has accrued in a variety of areas pertaining to biological abnormality in autism suggests that, with the possible exception of genetic factors, very few data are available that illuminate the autistic disorder specifically. Neurological models which might be useful in guiding further research are discussed and reasons for the slow progress in this important aspect of the study of autism are identified.

Computed tomographic study of children with classic autism

Computed tomographic (CT) scans were obtained for nine autistic boys aged between 9 and 16 years. All were considered to have classic childhood autism of unequivocal diagnosis, with symptoms present from infancy, and were functioning in the borderline or normal level of intelligence. They had performed poorly on tests purported to measure left hemispheric functions. There was no sign of abnormality of any kind on the CT scans or any asymmetry that might be related to lateralized cognitive functions. It is suggested that earlier reported abnormalities are a function of the inclusion of patients with a heterogeneous collection of disorders in the tested sample.

Recognition of abstract and concrete words in a dichotic listening paradigm

A dichotic listening paradigm was used to examine the hypothesis that whilst concrete nouns can be processed equally well by both right and left hemispheres, the left hemisphere is superior in processing abstract nouns. Although simple main effects of word frequency, ear of presentation, sex of subject and concreteness / abstractness were significant and in the expected directions, further fine-grained analyses using in particular the laterality coefficient showed that only about a third of the subjects showed a clear right ear advantage, and that this was not related to any of the independent variables. There was no evidence supporting differential hemispheric processing of concrete and abstract words and it is suggested that methods of data analysis used in this kind of research need to be carefully examined.

Language lateralization in specific reading retarded children and backward readers

In this study, language lateralization in subgroups of disabled readers was investigated using a dichotic monitoring task. The Rutter and Yule classification of specific reading retarded and backward reading groups was used to obtain subgroups of 10 to 12 year old boys with reading difficulties. No abnormalities of language lateralization were shown in either group when compared with controls; all showed the usual right ear advantage on this task. Furthermore neither of the reading disabled groups showed any deficiency in the ability to divide and sustain their attention to the task as shown by a signal detection analysis and comparison of performance over time. It can be claimed with some confidence that in a highly structured task of this nature reading disabled children show no abnormalities in either laterality or attentional processes.

Classification of hyperactive children

Numerical taxonomy was used in an attempt to identify subgroups in a sample of children labelled as hyperactive. In each of two analyses of Conners' questionnaire data (supplied by parents and by teachers), two classes were obtained, apparently differentiated on the basis of rated severity of behavioural symptoms. No aetiologically important differentiating attributes emerged. There was poor agreement between the two data sources. particularly in the classification of the more disordered group; and, over all, teachers perceived the children as less deviant than did parents. Comparison with earlier studies indicated the similarity in behavioural symptoms between this sample and those from other countries. However, the obtained data argued against the existence of a pure hyperactive disorder, since there was virtually no differentiation between conduct problems and items relating more specifically to hyperactivity. Hyperactivity as a diagnostic category appears to have little meaning either aetiologically, or descriptively, or prescriptively.

Cognitive abilities and disabilities in infantile autism: a review

The literature on various aspects of learning and performance in autistic children is reviewed and interpreted as indicating very little that is specific to autism. Inadequate and inconsistent methodology precludes generalizations concerning the nature of the disorder. It is suggested that future research should be particularly concerned with controlling for developmental influences on performance, and with investigation of the higher functioning autistic children who are less governed by retardation factors. The current evidence is considered to support a hypothesis concerning abnormal hemisphere functioning in this group of children.

Hemisphere functioning in autistic children

Recent research in childhood autism has provided support for the hypothesis that a central cognitive deficit involving severe language impairment underlies this disorder. In this study a group of autistic children were tested for handedness and for lateralization of speech function using a dichotic listening task. Contrary to earlier reports there were no left-handed children in the group although a number showed mixed preference. In the dischotic listening task using pairs of single syllable words the autistic group performed similarly to a matched group of normal children in terms of numbers of correct responses but over all did not show the right ear advantage characteristic of the normal children. There was a significant excess of right hemisphere dominance for verbal stimuli amongst the autistic children suggesting that for some at least, language functions had developed in the right hemisphere. Lateralization was shown to be related to presence or absence of speech before the age of 5 years and to IQ level.

Laterality and selective attention in hyperactive children

Laterality and selective attention were investigated in a group of 20 hyperactive children and their matched controls using a dichotic listening task. There was a strong right-ear advantage for both groups indicating that hyperactive children were not different from normal children in hemispheric specialization for verbal stimuli. In the selective attention experiment hyperactive children were again not different from normal children in their ability either to select the input designated as relevant or to resist the distraction of input designated irrelevant. Both groups gave more correct responses from the right ear than from the left ear, and more intrusions from the right ear than from the left. The results do not suggest abnormalities of lateralization for verbal material or indicate the existence of a selective attentional deficit. It is suggested that such reported deficits may be situation or task-specific.

Short-term and serial memory in autistic, retarded, and normal children

Experimental data on memory ability of autistic children is scarce and contradictory. It is suggested that this may in part be the result of failure to control for acquisition of the correct response before memory is tested. In the first experiment reported, acquisition was controlled in a delayed-response visual discrimination task. The performance of autistic children was compared with MA matched normal and retarded controls. Recall deteriorated with increasing delay interval in each group. There were no significant group differences. The second experiment was designed to measure the effects of interference on memory using a serial memory task. No differences were found among groups in rate of learning, although the autistic children improved significantly on the second and longer series. There was no relationship between performance on the STM and the serial memory tasks over the same time intervals for any group. The results are interpreted as supporting the view that when MA and response acquisition level are equated with normal and retarded children in a memory task, autistic children do not show any specific memory deficits.

An epidemiological study of autistic and psychotic children in the four eastern states of Australia

Data on general behavioural and etiological characteristics of a sample of 146 autistic and psychotic children from the four eastern states of Australia are presented. Both inter and intra study comparisons are made with reference to a number of factors considered significant in childhood psychosis. The findings accord with those of similar overseas studies on most factors although methodological and diagnostic differences limit the conclusions. A notable finding was that of an excess of "organic" indications in a sub-group of early onset, severly withdrawn "autistic" chhildren suggesting that further neurological and EEG testing of autistic children is desirable.