Factors associated with dropout and diagnosis in child and adolescent mental health services

Objective: Dropout from child and adolescent mental health services has ramifications for children, families and the services themselves. Understanding the factors that are associated with dropout for different diagnoses has the potential to assist with tailoring of services to reduce dropout. The aim of the current study was to identify such factors.

Method: A file audit was conducted for all referrals to a child and adolescent mental health service over a 12 month period, yielding 520 subjects for analysis (264 male, 256 female, mean age = 12.6 years). Parent, child and service variables of interest were recorded as were diagnoses, which were categorized into 25 superordinate categories.

Results: Almost 50% of subjects dropped out of treatment. Factors associated with dropout varied across diagnosis, and no factor was associated with dropout for all diagnoses.

Conclusion: There are differences in the factors that were associated with dropout for different disorders. This is a useful finding in terms of understanding and preventing dropout in child and adolescent mental health settings, but more research is needed.

Childhood motor skill proficiency as a predictor of adolescent physical activity

Purpose
Cross-sectional evidence has demonstrated the importance of motor skill proficiency to physical activity participation, but it is unknown whether skill proficiency predicts subsequent physical activity.

Methods
In 2000, children's proficiency in object control (kick, catch, throw) and locomotor (hop, side gallop, vertical jump) skills were assessed in a school intervention. In 2006/07, the physical activity of former participants was assessed using the Australian Physical Activity Recall Questionnaire. Linear regressions examined relationships between the reported time adolescents spent participating in moderate-to-vigorous or organized physical activity and their childhood skill proficiency, controlling for gender and school grade. A logistic regression examined the probability of participating in vigorous activity.

Results
Of 481 original participants located, 297 (62%) consented and 276 (57%) were surveyed. All were in secondary school with females comprising 52% (144). Adolescent time in moderate-to-vigorous and organized activity was positively associated with childhood object control proficiency. Respective models accounted for 12.7% (p = .001), and 18.2% of the variation (p = .003). Object control proficient children became adolescents with a 10% to 20% higher chance of vigorous activity participation.

Conclusions
Object control proficient children were more likely to become active adolescents. Motor skill development should be a key strategy in childhood interventions aiming to promote long-term physical activity.

Family circumstance and adolescent dietary behaviours

The available information on the contribution of family circumstance to adolescent dietary behaviours is inconsistent. Indicators of family circumstance may impact adolescent behaviours by influencing their daily home environment. This study examined cross-sectional and longitudinal relationships between indicators of family circumstance and (i) breakfast skipping and (ii) consumption of snack food, fast food, fruits and vegetables among adolescents. Dietary behaviour was assessed using a web-based survey completed by 1884 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline and 2 years later. Five indicators of family circumstance (parental marital status, maternal education, maternal employment status, number of brothers and number of sisters) were assessed with a questionnaire completed by parents at baseline only. Logistic regression was used to examine cross-sectional associations between indicators of family circumstance and dietary behaviours. Multinomial logistic regression was used to examine associations between indicators of family circumstance and 2-year change in dietary behaviours. Individual indicators of family circumstance were differentially associated with adolescent dietary behaviours. Cross-sectional and longitudinal associations differed for adolescent boys and girls highlighting the importance of assessing specific dietary behaviours and food types individually by gender. This study highlights the complexity of the relationships between family circumstance and adolescent dietary behaviours. Future research needs to assess the efficacy of strategies promoting maternal nutritional knowledge on the dietary behaviours of adolescents.

Electronic media use and adolescent health and well-being : cross-sectional community study

Objective : To describe time adolescents spend using electronic media (television, computer, video games, and telephone); and to examine associations between self-reported health/well-being and daily time spent using electronic media overall and each type of electronic media.

Methods : Design–Cross-sectional data from the third (2005) wave of the Health of Young Victorians Study, an Australian school-based population study. Outcome Measures–Global health, health-related quality of life (HRQoL; KIDSCREEN), health status (Pediatric Quality of Life Inventory 4.0; PedsQL), depression/anxiety (Kessler-10), and behavior problems (Strengths and Difficulties Questionnaire). Exposure Measures–Duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity Recall for Children and Adolescents (MARCA) computerized time-use diary. Analysis–Linear and logistic regression; adjusted for demographic variables and body mass index z score.

Results : A total of 925 adolescents (mean ± standard deviation age, 16.1 ± 1.2 years) spent, on average, 3 hours 16 minutes per day using electronic media (television, 128 minutes per day; video games, 35; computers, 19; telephone, 13). High overall electronic media use was associated with poorer behavior, health status, and HRQoL. Associations with duration of specific media exposures were mixed; there was a favorable association between computer use (typing/Internet) and psychological distress, whereas high video game use was associated with poorer health status, HRQoL, global health, and depression/anxiety. Television and telephone durations were not associated with any outcome measure.

Conclusions : Despite television's associations with obesity, time spent in other forms of media use appear more strongly related to adolescent health and well-being. This study supports efforts to reduce high video game use and further exploration of the role of computers in health enhancement.

Is restricting tobacco sales the answer to adolescent smoking?

Background: Enforcement of legislation restricting retail access to tobacco is increasingly relied on to reduce adolescent smoking rates. In 1996, health authorities in the Northern Sydney Health Area began monitoring tobacco retailer compliance (PROOF program) with staged purchase attempts by adolescents below the legal age (18 years).

Methods: Repeat cross-sectional surveys before (1995) and after (2000) the introduction of PROOF monitored changes in adolescent smoking behaviour. Students aged 12 to 17 years from 11 Northern Sydney metropolitan public secondary schools were surveyed for self-reported smoking and tobacco purchasing behavior in 1995 (n = 5,206) and 2000 (n = 4,120).

Results: Between 1996 and 2000, 545 retailer compliance checks found 34% unlawfully sold cigarettes to minors and 28% of these repeated the offence. Nine prosecutions resulted. Modelling revealed a significant association between the intervention and never having smoked (adjusted OR = 1.16, 95% CI = 1.01–1.33) although there was no significant association with being a current smoker. The odds of being a smoker were greater for students from coeducational schools, with this effect being modified by gender.

Conclusions: There was no reduction in adolescent smoking with active enforcement of tobacco access laws despite an apparent increase in students who reported never to have smoked.

Social control, self-control and psychosocial problems in adolescent males

‘Psychosocial problems’ are psychological problems that are regarded as resulting from the interaction between the adaptive capacities of individuals and the demands of their physical and social environments. Many different factors have been theoretically proposed, and empirically established, as predictors of a range of psychosocial problems in adolescents. However, a problem exists in that this literature appears to lack an integrative framework that has validity across the range of problems that are observed. The purpose of the current research is to propose and test a model that draws together three clusters of factors that are useful in predicting the incidence of adolescent psychosocial problems. These are family structural background factors, family functioning variables and control beliefs. Data were collected from 155 adolescent males aged between 12 and 19 by a single concurrent and retrospective self-report questionnaire. This included data about the respondent (age, involvements with mental health or juvenile justice agencies) and family structural background factors (days per week worked by mother/father, occupational status for mother/father, residential mobility, number of persons in the family home). The questionnaire also incorporated the Parental Bonding Instrument (Parker, Tupling & Brown, 1979) to quantify the levels of perceived parental care and overprotection, and an adaptation of the Parental Discipline Style Scale (Shaw & Scott, 1991), to assess punitive, love withdrawing and inductive discipline practices. In addition, the (Low) Self-control Scale (Grasmick, Tittle, Bursick & Arneklev, 1993) and the Locus of Control of Behaviour Scale (Craig, Franklin, & Andrews, 1984) were used to collect data concerning adolescents’ perceived behavioural self-control and locus of control. Finally, selected sub-scales of the Child Behavior Checklist Youth Self-Report (Achenbach, 1991b) were used to collect data on the incidence of social withdrawal, somatisation, anxiety and depression, aggression and delinquency among the respondents, and in aggregated form, the incidence of ‘total problems’ and internalising and externalising behaviours. Results indicated family structural background factors, family functioning variables and control beliefs possess limited predicted validity and that the usefulness of the proposed model varies between specific psychosocial problems. Family functioning variables were generally stronger predictors than family structural background factors, particularly for internalising behaviours. Of these, levels of parental care and overprotection were generally the strongest predictors. Perceived self-control and locus of control were also generally strong predictors, but were particularly powerful with respect to externalising behaviours. The strength of predictive relationships was observed to vary between specific internalising and externalising behaviours, suggesting that individual difference variables not assessed in the current research were differentially influential. Finally, the parental and individual characteristics that predicted maximal levels of adjustment (defined in terms of minimal levels of internalising and externalising behaviours) were explored and the correlates of various parenting style typologies (Parker et al., 1979) were investigated. These results strongly confirmed the importance of family functioning and control beliefs with respect to the prediction of internalising, externalising and well-adjusted behaviours. In all analyses, substantial proportions of the variance in the incidence of problem behaviours remain unexplained. The findings are examined in relation to previous research focused on (familial) social control and (individual) self-control with respect to psychosocial problems in adolescents. In addition, methodological considerations are discussed and the implications of the findings for clinical and community interventions to address problem behaviours, and for further study, are explored.

Longitudinal evaluation of a risk-factor model for adolescent suicidality

This research developed two best-fitting structural equation models of risk factors for adolescent depression and suicidality: a core model, which included parenting factors, gender, depression, and suicidality, and an extended model, which also encompassed personality traits (Introversion and Impulsivity) and mood factors (Anxiety and Anger). Further, this research investigated the consistency of model fit across time (Le., 1 month & 12 months) and samples, and explored the effectiveness of the ReachOut! Internet site as a psychoeducational prevention strategy for adolescent depression and suicidality. Gender, age, and location differences were also explored. Participants were 185 Year-9 students and 93 Year-10 students aged 14 - 16 years, from seven secondary schools in regional and rural Victoria. Students were given a survey which included the Parental Bonding Instrument (Parker, Tupling, & Brown, 1979), the Millon Adolescent Personality Inventory (Millon, Green, & Meagher, 1982), the Profile of Mood States Inventory (McNair & Lorr, 1964), items on suicidal behaviour including some questions from the Revised Adolescent Suicide Questionnaire (Pearce & Martin, 1994), and questions on loss and general demographics. Results supported an indirect model of risk factors, with family factors directly influencing personality factors, which in turn influenced mood factors, including depression, which then influenced suicidality. At the theoretical level, results supported Attachment Theory (Bowlby, 1969), demonstrating that perceived parenting styles that are warm and not overly controlling are more conducive to an adolescent's emotional well-being than are parenting styles that are cold and controlling. Further, results supported Millon's theory of personality (1981), demonstrating that parenting style influences a child's personality. Short-term intervention effects from the internet site were a decrease in Introversion for the full sample, and decreased Inhibition and Suicidality for a high-risk subgroup. Long-term age effects were decreased Inhibition and increased Anxiety for the fall sample. There was also a probable intervention effect for Depression for the high-risk subgroup. No location differences for the risk factors were found between regional and rural areas.

Adolescent girls in physical education and sport : an analysis of influences on participation

This study investigates the influences on participation in physical activity of thirty adolescent girls from a metropolitan secondary school in Victoria. It seeks to understand how they perceived, experienced and explained their involvement or non involvement in both competitive and non competitive physical activity during four years of their secondary schooling. Participants experienced physical education as both a single sex group in Years 7 and 9 and a coeducational group in Years 8 and 10. They were exposed to a predominantly competitive curriculum in Years 7 to 9 and a less structured, more social, recreational program in Year 10. These experiences enabled them to compare the differences between class structures and activity programs and identify the significant issues which impacted on their participation. Large Australian population studies have revealed that fewer girls participated in sport and regular physical activity than boys. An important consequence is that girls miss out on the health benefits associated with participating in physical activity. Other research has found adolescence is the time that girls drop out of competitive sport. However, an important issue is whether girls who drop out of competitive sport cease to be involved in any physical activity. There are some studies which have reported good participation rates by adolescent girls in non competitive, recreational forms of physical activity and the possibility exists that they may drop out of competitive and into non competitive physical activity. This study primarily utilises a qualitative approach in contrast to previous studies which have largely relied upon the use of surveys and questionnaires. Whilst quantitative research has provided useful information about the bigger picture, there are limitations caused by reliance on the researchers' own interpretations of the data. Additionally there is no opportunity for any clarification and explanation of findings and trends by the respondents themselves. The current study utilized qualitative individual and collective interviews in three stages. Questions were asked in the broad areas of coeducation and single sex classes, preferences for competitive or recreational activity and body image issues. Some quantitative information focusing on nature and extent of current activity patterns was also gathered in the first stage. Thirty Year 10 girls participated in individual first interviews. Nine selected girls then took part in the second (individual) and third (collective) interview stages. Results revealed three groups based on the nature of physical activity involvement: [1] competitive activity group, [2] social activity group and [3] transition group. The transition group represented those who were in the process of withdrawing from competitive sport to take up more non competitive, recreational activity. The most significant difference between groups was skill level. On the whole those entering adolescence with the highest skill levels, such as those in the competitive group, were the most confident and relished competing against others. The social group was low in skill and confidence and had predominantly negative experiences in physical education and sport because their deficiencies were plainly visible to all. Similarly, a lack of skill improvement relative to those of 'better performers' affected the interest and confidence levels of those in the transition group. Boys' domination in coeducational classes through verbal and physical intimidation of the less competent and confident girls and exclusion of very competent girls was a major issue. Social and transition group members demonstrated compliance with boys' power by hanging back and sitting out of competitive activities. Conversely, the competitive group resisted boy's attempts to dominate but had to work hard to demonstrate their athletic capabilities in order to do so. Body image issues such as the skimpy physical education and sport uniform along with body revealing activities such as swimming and gymnastics, heightened feelings of self-consciousness and embarrassment for most girls. When strategies were adopted by social and transition group members to avoid any body exposure or physical humiliation, participation levels were subsequently affected. However, where girls felt confident about their physical abilities and body image, they were able to ignore their unflattering uniforms and thus participation was unaffected. Specific teaching practices such as giving more attention to boys, for example by segregating the sexes in mixed classes to focus attention on boys, reinforced stereotypical notions of gender and contributed to the inequities for girls in physical education. The competitive group were frustrated with having to prove themselves as capable as boys in order to receive greater teacher attention. The transition group rejected teacher's attempts to coerce them into participating in the inter school sports program. The social group believed that teachers viewed and treated them less favourably than others because of their limited skills. Girls were not passive in the face of these obstacles. Rather than give up physical activity they disengaged from competitive sport and took up other forms of activity which they had the confidence to perform. These activity choices also reflected their expanding social interests such as spending time with male and female friends outside school and increased demands on their time by study and part time work commitments. This study not only highlighted the diversity and complexity of attitudes and behaviours of girls towards physical activity but also demonstrated that they display agency in making conscious, sensible decisions about their physical activity choices. Plain Language Summary of Thesis Adolescent girls in physical education and sport; An analysis of influences on participation by Julia Whitty Submitted for the degree of Master of Applied Science Deakin University Supervisor: Dr Judy Ann Jones This study investigates the influences on participation in physical activity of thirty adolescent girls from a metropolitan secondary school in Victoria in order to understand how girls' perceived, experienced and explained their involvement or non involvement in both competitive and non competitive physical activity. Qualitative individual and collective interviews were conducted. Questions focussed on attitudes about coeducation and single sex classes, preferences for competitive or recreational activity and feelings about body image. Some quantitative information about the nature and extent of current activity patterns was also gathered in the first stage. Thirty Year 10 girls participated in individual first interviews. Nine selected girls then took part in the second (individual) and third (collective) interview stages. Results revealed three clearly different groups based on the nature of physical activity involvement (1) Competitive, (2) Social and (3) Transition (those in the process of withdrawing from competitive sport to take up more non competitive, recreational activity). The major difference between groups was skill level. Those entering adolescence with the highest skill levels were more competent and confident in the coeducational and competitive sport setting. Other significant issues included boys' domination, body image and teaching behaviours and practices.

Prevention of body concerns and risk behaviours in adolescent boys

Overall, this thesis was designed to explore the nature of adolescent boys' body image, the effects of body image on body change strategies and psychological adjustment, and the factors that influence body image. The first study examined body image in 362 adolescent boys. Body image was considered in terms of attitudes to different body parts and attributes, including, lower, middle and upper body, as well as weight, shape and muscles. The relationships between Body Mass Index (BMI), body image, sociocultural messages, psychological adjustment and body change strategies, including strategies to decrease weight and increase muscles using food and exercise, drive for thinness, bulimic attitudes and behaviour, excessive exercise, food supplements to lose weight, increase muscles and steroids, were also investigated. Multiple regression analyses were used to examine the role of body image, sociocultural messages and psychological adjustment to predict satisfaction with different body attributes and body change strategies. The findings from study one led to the development of a program aimed at preventing the development of unhealthy attitudes and behaviours among adolescent boys. Study two involved the implementation and evaluation of this prevention program. One hundred and twenty one boys participated in the program. The program was based on social-cognitive theory, and included a focus on accepting differences and the development of self-esteem. The boys who participated in the program indicated some change in existing attitudes and showed less development of risk behaviours relative to the control group. The implications of the findings from this thesis in relation to future research, as well as the prevention of adolescent boys' body image problems are discussed.

There's a black boy dead and a migloo holding a gun : death, Aboriginality and history in Australian adolescent literature

This essay is concerned with the extent to which the attitudes and ideologies of colonial discourse continue to influence contemporary signifying practices in Australian adolescent historical fiction. Under scrutiny are three novels which take issue with the violent aspects of colonisation when so many members of the Indigenous population either died or were forcibly displaced: Melissa Lucashenko’s Killing Darcy, Gary Crew’s No Such Country and Mark Svendsen’s Poison Under Their Lips. Although these texts share a desire to interrogate monolithic versions of Australia’s history, it is argued that such motivations offer no guarantee that the implied audience is positioned to come to an understanding of perspectives belonging to ex-centric Others.

Patterns of physical activity for adolescent girls in Fiji and Tonga

Behavioural patterns are determined in part by sociocultural factors such as values, expected behaviours and sociopolitical organisation. This paper presents the patterns of physical activity reported by Tongan and Fijian females aged 12-18 years and possible explanations for these patterns. The paper draws on interviews conducted in a wider study of adolescents patterns of eating, physical activity and body size in Tonga, Fiji, New Zealand and Australia. The study examined sociocultural factors that could promote or protect against obesity from the perspective of adolescents in order to develop culturally-appropriate strategies for healthy lifestyles. Twenty four indigenous Fijian and 24 Tongan females aged 12-18 years were interviewed by females who were fluent in participants first languages. Researchers from Australia, Tonga and Fiji analysed the data separately and then together in order to capture cultural nuances and enhance cultural validity. This analysis revealed similarities and differences in both cultural groups. Limitations to physical activity identified by Tongan and Fijian girls included the time spent in household chores and parental restrictions.Fijian girls also identified concern about personal safety as a constraint. These findings are examined in relation to sociocultural factors that appear to limit opportunities for young females to be physically active.