Children with persistent conduct problems who dropout of treatment

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach. The overall dropout rate was 36%. Dropout occurred significantly less frequently in the CBT group. The dropout group was associated with mothers who were younger and less educated, a poorer rating by the clinicians at the last meeting, parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks. In the second study we used a naturalistic follow-up design. Forty-six children were included. The overall dropout rate was 48%. Again, the children who defaulted were rated by clinicians as less likely to have improved and dropout was also  significantly associated with parental perception of a less organised treatment. In both studies dropout usually occurred after assessment and at the early phase of treatment.

Persistence and subtype stability of ADHD among substance use disorder treatment seekers

OBJECTIVE: To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. METHOD: In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners' Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. RESULTS: Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. CONCLUSION: ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

The development of a screening questionnaire for childhood cruelty to animals

Childhood cruelty to animals may be a marker of poor prognosis amongst conduct disordered children. However, other than semistructured interviews with parents or children, there are no screening instruments for this behavior. The aim of this study was to develop such an instrument. In the first phase of the study, a parent-report questionnaire, Children's Attitudes and Behaviors Towards Animals (CABTA) was designed and piloted on 360 elementary school children, enabling community norms and a factor structure for the instrument to be derived. In the second phase, the questionnaire was completed by the parents of a small sample of children (N= 17) to establish its test-retest reliability. In the third phase of the study, the CABTA was completed by the parents of 19 children who had been diagnosed with either a Disruptive Behavioral Disorder or Attention Deficit Hyperactivity Disorder, and the results were compared with the outcome of a semistructured interview with parents regarding their child's behavior toward animals. The results of the various phases of the study indicated that the CABTA consists of two factors, Typical and Malicious Cruelty to animals, and is a reliable and valid tool for detecting childhood cruelty to animals. Possible use and adaptations of the CABTA as a screening instrument in clinical and community samples are discussed.

Does the Triple P-Positive Parenting Program provide value for money?

Objective: The aim of the present study was to investigate the economic case for the implementation of the Triple P-Positive Parenting Program on a population basis in Queensland, Australia, in order to reduce the prevalence of conduct disorder in children. Method: Threshold analysis was undertaken together with a limited cost-effectiveness analysis. Results: The Triple P-Positive Parenting Program is a dominant intervention; that is, it costs less than the amount it saves, until the reduction in prevalence falls below 7% where net costs become positive. Conclusions: Triple P is likely to be a worthwhile use of limited health funds. The economic case is promising, but further research is required to confirm the study results.

Parenting style as a moderator of the effect of temperament on adolescent externalising and internatlising behaviour problems

The direct and interactive effects of temperament and parenting were examined in the prediction of early adolescent externalising behaviour problems (conduct disorder and hyperactivity), internalising problems (depression and anxiety), and substance use, using data on 1,402 13- and 14-year-olds. Significant direct effects were found for four temperament factors (negative reactivity, task persistence, activity, and approach), and four parenting factors (warmth, power assertion, physical punishment, and monitoring). For those high in persistence, low in negative reactivity, or low in activity, problem outcomes were generally very rare, regardless of parenting. Prevalence of behaviour problems was generally elevated among those low in persistence, high in negative reactivity, or high in activity, even in cases where parenting was high in positive qualities such as warmth and monitoring. Prevalence of certain behaviour problems was substantially elevated when low persistence, high negative reactivity, or high activity occurred in combination with lower parental warmth or lower monitoring. The results suggest that parenting can play an important moderating role in the relationship of particular temperament characteristics to behavioural problems. [Author abstract]

Differences in dropout between diagnoses in child and adolescent mental health services

Dropout from treatment is a significant problem in child and adolescent mental health services, and findings regarding the role of possible contributing factors are inconsistent. It is argued that this inconsistency may be the result of the confounding effects of different definitions of dropout, and different dropout rates for different diagnoses. A file review of 520 new cases over a 12-month period in a large Child and Adolescent Mental Health Service in Melbourne, Australia was performed. Information was collected about the intake, parents, family, child, diagnoses and treatment. A significant relationship was found between diagnosis and dropout rate, with clients experiencing family problems or conduct disorder and ADHD being more likely to dropout, and those experiencing negative life events, anxiety disorders or those not having a diagnosis being less likely to dropout. These findings offer potential directions for services to consider specific strategies for retaining their clients. Possible reasons for these findings, methodological issues and future research directions are discussed.

Childhood cruelty to animals : a tri-national study

Childhood cruelty to animals is a symptom of conduct disorder that has been linked to the perpetration of violence in later life. Research has identified several factors associated with its etiology, including social factors. However, no cross-cultural studies on this phenomenon have been reported. This study investigated childhood cruelty to animals in Japan, Australia and Malaysia. Parents of 1,358 children between the ages of 5 and 13 years completed the Children’s Attitudes and Behaviours towards Animals questionnaire (CABTA) which assesses Typical and Malicious Cruelty to animals. Analyses revealed no overall differences between children from these countries on either scale. However, younger boys were more likely to be cruel than younger girls in each country, and younger children in Australia and Japan were more likely to be cruel that older children in those countries. The findings are discussed in relation to previous research, and recommendations for future studies are suggested.

The relationship between divorce and children with AD/HD of different subtypes and comorbidity: results from a clinically referred sample

This study investigated the relationship between divorce and thesymptom profile of children with attention deficit/hyperactivity disorder(AD/HD). The files of 1,201 children from a pediatric practicein Sydney, Australia were used in this study. Children wereaged 6 to 18 years, and were diagnosed with either the inattentiveor combined type of AD/HD. Results show that 213 children hadparents who were divorced. Children with the combined type, andespecially boys with comorbid conduct disorder/oppositional defiantdisorder (CD/ODD) were more common in the divorced group,and children of the inattentive type with comorbid learning disabilitieswere overrepresented in nondivorced families. Results suggestthat divorce is associated with disruptive behavior patterns inchildren with AD/HD. The importance of including marital status asan important correlate in AD/HD treatment outcomes is discussed.

Evaluation of an early intervention program for childhood conduct problems

Treatment outcomes of an early intervention program for childhood conduct problems were evaluated. Results provided support for the longitudinal effectiveness of the program in reducing conduct problems, social difficulties, and psychosocial impairment for young primary school aged children. Children's experience and expression of anger also reduced across the program's duration. The portfolio presents four case studies whose results provide further support for Exposure and Response Prevention (ERP) as an effective and clinically useful treatment for paediatric OCD in everyday clinical contexts.

The relationship between coronary heart disease (CHD) and major depressive disorder (MDD) : key mechanisms and the role of quality of life

Various trials have been conducted evaluating depression management programs for patients with Coronary Heart Disease (CHD). However, to date, the most effective way to manage this co-morbidity in the real world setting remains unclear. To better understand the past successes and failures of previous trials and subsequently develop suitable interventions that target key components of health related quality of life (HRQOL) such as mental, physical and vocational functioning, we first need to understand the mechanisms underpinning the relationship between the two conditions. This paper will draw on the key literature in this field as identified by psychiatric, medical and social sciences databases (Cochrane Central Register of Controlled Trials, PubMed, OVID, Medline) available up to January 2012, with the aim to conduct a narrative review which explores: the aetiological relationship between depression and CHD; its association with HRQOL; the relationship between CHD, depression and vocational functioning; and the impact of depression treatment on these outcomes. Key recommendations are made regarding the management of this prevalent co-morbidity in clinical settings.

A longitudinal examination of burden and psychological distress in carers of people with an eating disorder

Purpose
Eating disorders are chronic conditions that require ongoing, high level care. Despite the chronic nature of eating disorders, to date, previous research examining eating disorder carer burden and psychological distress has been cross-sectional only. Therefore, the current study aimed to conduct a preliminary longitudinal examination of the predictors of carer burden and psychological distress for carers of those with an eating disorder.
Methods
A self-report, quantitative questionnaire approach was utilised. Forty-two carers completed three self-report questionnaires over a period of 9 months (initial, 4½ and 9 months) assessing carer burden, psychological distress, carer needs, expressed emotion, coping strategies and social support.
Results
Maladaptive coping, expressed emotion and carer needs were significant longitudinal predictors of carer burden. Carer psychological distress could not be predicted longitudinally.
Conclusions
In order to reduce carer burden, interventions should test whether reducing maladaptive coping strategies, expressed emotion and addressing carer needs lead to lower carer burden and distress.

Black and white is always grey-the power of the police to conduct a strip search in Victoria

The performance of a strip search by a police officer is a serious interference with the liberty and dignity of an individual. However, it is considered by police to be an important part of their law enforcement armory and one that is increasingly necessary to utilise to assist in the investigation and prosecution of drug-related crimes. This article considers the troublesome issue of whether and in what circumstances the common law may extend to police the power to conduct a strip search. In addition, there is an examination of the statutes and regulations that purportedly give police in Victoria the power to strip search with particular attention given to ss 81 and 82 of the Drugs, Poisons and Controlled Substances Act 1981 (Vic).

Analysis of zinc transporter, hZnT4(Slc30A4), gene expression in a mammary gland disorder leading to reduced zinc secretion into milk

Zinc deficiency, causing impaired growth and development, may have a nutritional or genetic basis. We investigated two cases of inherited zinc deficiency found in breast-fed neonates, caused by low levels of zinc in the maternal milk. This condition is different from acrodermatitis enteropathica but has similarities to the "lethal milk" mouse, where low levels of zinc in the milk of lactating dams leads to zinc deficiency in pups. The mouse disorder has been attributed to a defect in the ZnT4 gene. Little is known about the expression of the human orthologue, hZnT4 (Slc30A4). Sequence analysis of cDNA, real-time PCR and Western blot analysis of hZnT4, carried out on control cells and cells from unrelated mothers of two infants with zinc deficiency, showed no differences. The hZnT4 gene was highly expressed in mouthwash buccal cells compared with lymphoblasts and fibroblasts. The hZnT4 protein did not co-localise with intracellular free zinc pools, suggesting that hZnT4 is not involved in transport of zinc into vesicles destined for secretion into milk. This observation, combined with phenotypic differences between the "lethal milk" mouse and the human disorder, suggests that the "lethal milk" mouse is not the corresponding model for the human zinc deficiency condition.

A Look at Corporate Code of Conduct Legislation

Over recent years, there has been a growing perception among civil society in the developed world that multinational corporations are engaged in socially and environmentally exploitative practices that they would never get away with, or even attempt, in their home countries. Whether right or wrong, that perception and its political and economic ramifications have driven a global movement for more responsible corporate behavior. As part of that global movement, three common law jurisdictions—the United States, Australia and the United Kingdom—have seen legislation introduced to enforce standards of practice for multinational corporations based in those countries in respect of their overseas activities. None of those Bills has yet passed into law, but they are worthy of analysis as attempts to transform hitherto amorphous concepts like 'corporate social responsibility' into concrete legislation. This article compares and critically analyses the three Bills, making recommendations as to how they could be improved, with particular emphasis on the need to forge stronger links between the legislative provisions and international human rights law.