The effects of a course of intranasal oxytocin on social behaviors in youth diagnosed with autism spectrum disorders: A randomized controlled trial

Background There is increasing interest in oxytocin as a therapeutic to treat social deficits in autism spectrum disorders (ASD). The aim of this study was to investigate the efficacy of a course of oxytocin nasal spray to improve social behavior in youth with ASD. Methods In a double-blind, placebo-controlled trial across two Australian university sites between February 2009 and January 2012, 50 male participants aged between 12 and 18 years, with Autistic or Asperger's Disorder, were randomized to receive either oxytocin (n = 26) or placebo (n = 24) nasal sprays (either 18 or 24 International Units), administered twice-daily for 8 weeks. Participants were assessed at baseline, after 4- and 8-weeks of treatment, and at 3-month follow-up. Primary outcomes were change in total scores on the caregiver-completed Social Responsiveness Scale and clinician-ratings on the Clinical Global Impressions-Improvement scale. Secondary assessments included caregiver reports of repetitive and other developmental behaviors and social cognition. Clinical trial registration: Australian New Zealand Clinical Trials Registry www.anzctr.org.au ACTRN12609000513213. Results Participants who received oxytocin showed no benefit following treatment on primary or secondary outcomes. However, caregivers who believed their children received oxytocin reported greater improvements compared to caregivers who believed their child received placebo. Nasal sprays were well tolerated and there was no evidence of increased side effects resulting from oxytocin administration. Conclusions This is the first evaluation of the efficacy for a course of oxytocin treatment for youth with ASD. Although results did not suggest clinical efficacy, further research is needed to explore alternative delivery methods, earlier age of intervention, and the influence of caregiver expectation on treatment response.

Positive youth development in the United States: History, efficacy, and links to moral and character education

This paper reviews specific conceptual frameworks and focuses on the evidence from evaluations of program applications delivered prior to age 21 that have the common aim of encouraging Positive Youth Development.

Spirituality, religion and youth: an introduction

 This chapter introduces the concepts of religion and spirituality, particularly as these relate to young people. It reviews some of the major changes that are occurring in contemporary society and how these changes are reflected in the types of religions and spiritualties that young people are practicing. The processes of globalization, international migration, and the mass media provide more choice and increase uncertainty. In this context, the chapter examines some case studies to illustrate how some young people are embracing these choices and uncertainty, practicing Witchcraft as a religion and finding spiritual meaning in dance parties such as raves. In contrast, other young people find various forms of fundamentalisms attractive because they offer certainty in the face of unsettling and insecure times. Finally we discuss the rise of Pentecostalism in Africa and the issue of religious teaching in secular schools.

Toward a clinically meaningful taxonomy of violent offenders: the role of anger and thinking styles

Violent offender rehabilitation programs aim to reduce the risk of re-offending in known offenders by addressing a range of different treatments needs, often with core intervention targets of improving anger regulation and altering antisocial beliefs and thinking styles. Such programs have proven efficacy in reducing recidivism for some, but not all, violent offenders, and little is known about the effects of these programs on different offender types. This study investigates whether subtypes of violent offenders can be meaningfully identified and considers how this influences short-term treatment outcomes. Cluster analysis identified three distinctive violent offender groups within a sample of 305 male offenders who had been assessed for participation in a violent offender rehabilitation program. An "unregulated" group had high levels of anger experience and expression and low levels of anger control, and held beliefs that were strongly supportive of a criminal lifestyle. A "regulated" group demonstrated levels of anger and beliefs supporting criminal activity that were not in a range that warranted treatment. Finally, an "overregulated" group was assessed as the group at highest risk of violent re-offending and had low levels of anger experience and expression and an absence of beliefs supporting criminal activity. The unregulated group appeared to gain the most benefit from treatment, although it had the highest levels of criminal thinking and problematic anger. These findings nonetheless offer support for the hypothesis that violent offender treatment programs may be optimally effective when targeted at particular types of offenders.

Youth mental health first aid: a description of the program and an initial evaluation

BACKGROUND: Adolescence is the peak age of onset for mental illness, with half of all people who will ever have a mental illness experiencing their first episode prior to 18 years of age. Early onset of mental illness is a significant predictor for future episodes. However, adolescents and young adults are less likely than the population as a whole to either seek or receive treatment for a mental illness. The knowledge and attitudes of the adults in an adolescent's life may affect whether or not help is sought, and how quickly. In 2007, the Youth Mental Health First Aid Program was launched in Australia with the aim to teach adults, who work with or care for adolescents, the skills needed to recognise the early signs of mental illness, identify potential mental health-related crises, and assist adolescents to get the help they need as early as possible. This paper provides a description of the program, some initial evaluation and an outline of future directions.

METHODS: The program was evaluated in two ways. The first was an uncontrolled trial with 246 adult members of the Australian public, who completed questionnaires immediately before attending the 14 hour course, one month later and six months later. Outcome measures were: recognition of schizophrenia or depression; intention to offer and confidence in offering assistance; stigmatising attitudes; knowledge about adolescent mental health problems and also about the Mental Health First Aid action plan. The second method of evaluation was to track the uptake of the program, including the number of instructors trained across Australia to deliver the course, the number of courses they delivered, and the uptake of the YMHFA Program in other countries.

RESULTS: The uncontrolled trial found improvements in: recognition of schizophrenia; confidence in offering help; stigmatising attitudes; knowledge about adolescent mental health problems and application of the Mental Health First Aid action plan. Most results were maintained at follow-up. Over the first 3 years of this program, a total of 318 instructors were trained to deliver the course and these instructors have delivered courses to 10,686 people across all states and territories in Australia. The program has also spread to Canada, Singapore and England, and will spread to Hong Kong, Sweden and China in the near future.

CONCLUSIONS: Initial evaluation suggests that the Youth Mental Health First Aid course improves participants' knowledge, attitudes and helping behaviour. The program has spread successfully both nationally and internationally.

BMI and healthcare cost impact of eliminating tax subsidy for advertising unhealthy food to youth

INTRODUCTION: Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. METHODS: We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. RESULTS: We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. CONCLUSIONS: Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.

Contact lens fitting and training in a child and youth population

PURPOSE: To determine the ease with which children and youths without previous soft contact lens (SCL) experience were able to handle, care for, adapt and be fitted with SCLs. METHODS: 179 children aged 8-16 were recruited. Study visits included: screening and training visits, 1-week and 3-month follow-ups. During the training visit, the time taken to demonstrate proficiency in lens insertion and removal and care was recorded. A second training visit was scheduled if necessary. RESULTS: Nine children did not complete the screening visit and eight discontinued during the study. Of those eight, seven discontinued during the first week and one before the 3-month visit. Of those recruited, 90.5% (162/179) were successfully fitted and completed the study. A majority of children were dispensed with lenses at the first training visit (94.6%, 162/171). The mean training time for all children was 30min. There were no statistically significant differences in the number of lenses required to fit or instruction time by age group (p>0.05) or gender (p>0.05). Nine participants (5.3%, 9/171) required a second training visit with four still unable to handle lenses (2.3%, 4/171). By the 1-week visit 13.2% (22/167) of participants either lost or tore lenses, no subsequent lost or torn lenses occurred. No serious adverse events occurred during the study. CONCLUSION: Children and youths with no previous contact lens experience were easily fitted, able to successfully wear and care for lenses. The results of this study should encourage practitioners to recommend SCLs as a vision correction option.

Objectively measured physical activity and sedentary time in youth: The International children's accelerometry database (ICAD)

Background: Physical activity and sedentary behaviour in youth have been reported to vary by sex, age, weight status and country. However, supporting data are often self-reported and/or do not encompass a wide range of ages or geographical locations. This study aimed to describe objectively-measured physical activity and sedentary time patterns in youth. Methods: The International Children's Accelerometry Database (ICAD) consists of ActiGraph accelerometer data from 20 studies in ten countries, processed using common data reduction procedures. Analyses were conducted on 27,637 participants (2.8-18.4 years) who provided at least three days of valid accelerometer data. Linear regression was used to examine associations between age, sex, weight status, country and physical activity outcomes. Results: Boys were less sedentary and more active than girls at all ages. After 5 years of age there was an average cross-sectional decrease of 4.2 % in total physical activity with each additional year of age, due mainly to lower levels of light-intensity physical activity and greater time spent sedentary. Physical activity did not differ by weight status in the youngest children, but from age seven onwards, overweight/obese participants were less active than their normal weight counterparts. Physical activity varied between samples from different countries, with a 15-20 % difference between the highest and lowest countries at age 9-10 and a 26-28 % difference at age 12-13. Conclusions: Physical activity differed between samples from different countries, but the associations between demographic characteristics and physical activity were consistently observed. Further research is needed to explore environmental and sociocultural explanations for these differences.

Interrogating conceptions of “vulnerable youth” in theory, policy and practice

Young people who are considered ‘vulnerable’ or ‘at risk’ are a particular target of various policies, schemes and interventions. But what does vulnerability mean? Interrogating Conceptions of “Vulnerable Youth” explores this question in relation to various policy fields that are relevant to young people, as well for how this plays out in practice and how it is experienced by young people themselves. What makes this book unique is that most authors had the opportunity to jointly explore these issues during a two-day workshop, and their chapters are informed by their cross-agency and cross-discipline discussions, making for a nuanced and thoughtful set of contributions. This collection is highly recommended for researchers and research students in the social sciences, as well as professional staff working in youth policy and youth services, in government departments and in NGOs. “Those who are most vulnerable should receive our greatest moral attention. However, the translation of generalised moral principles into effective policy and programs has never been easy. Political interests have invariably intervened, leading to complex debates about how vulnerability should be defined, classified, measured and represented. In recent years, these debates have become further complicated, as nation-states around the world have preached austerity. This timely book suggests that the responsibility for protecting the vulnerable cannot be left to individuals, but demands collective action, through institutions such as education, health and welfare. It examines some of the ways in which public policies and programs represent those who are vulnerable, involving a range of assumptions about the social, economic and political conditions that produce their vulnerabilities.” From the Foreword by Professor Fazal Rizvi

The relationship between exposure to violence and anger in Thai adolescents

Youth violence is a serious public health problem in Thailand, and yet is poorly understood and is thought to vary considerably between metropolitan and rural areas. This article reports the findings of a cross-sectional study involving 1,170 technical college students who completed self-report questionnaires assessing the frequency of violent acts, antisocial behavior, and angry emotion. There were no differences in self-reported violent activities between metropolitan and rural participants, but those attending colleges in the metropolitan areas reported more acts involving weapons. Scores on the measure of anger expression predicted physical and verbal assault, specifically punching and name calling, suggesting that the implementation of interventions which help students to improve control over anger may be a useful violence prevention approach.

Youth Depression Alleviation-Augmentation with an anti-inflammatory agent (YoDA-A): protocol and rationale for a placebo-controlled randomized trial of rosuvastatin and aspirin

AIM: There is growing support for the role of inflammation and oxidative stress in the pathophysiology of major depressive disorder (MDD). This has led to the development of novel strategies targeting inflammation in the treatment of depression. Rosuvastatin and aspirin have well-documented, anti-inflammatory and antioxidant properties. The aim of the Youth Depression Alleviation: Augmentation with an anti-inflammatory agent (YoDA-A) study is to determine whether individuals receiving adjunctive anti-inflammatory agents, aspirin and rosuvastatin experience a reduction in the severity of MDD compared with individuals receiving placebo. METHODS: YoDA-A is a 12-week triple-blind, randomized controlled trial funded by the National Health and Medical Research Council, Australia. Participants aged 15-25, with moderate-to-severe MDD, are allocated to receive either 10 mg/day rosuvastatin, 100 mg/day aspirin, or placebo, in addition to treatment as usual. Participants are assessed at baseline and at weeks 4, 8, 12 and 26. The primary outcome is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 12. RESULTS: The study is planned to be completed in 2017. At date of publication, 85 participants have been recruited. CONCLUSION: Timely and targeted intervention for youth MDD is crucial. Given the paucity of new agents to treat youth MDD, adjunctive trials are not only pragmatic and 'real-world', but additionally aim to target shortfalls in conventional medications. This study has the potential to first provide two new adjunctive treatment options for youth MDD; aspirin and rosuvastatin. Second, this study will serve as proof of principle of the role of inflammation in MDD.

Program outcomes in youth justice outcomes: the PLUS+ program review

This report provides a methodology to assess the outcomes of rehabilitation programs that are delivered to young offenders in South Australia. A method of assessing change is described that can be applied across a number of different programs, but is illustrated in relation to one particular program, the PLUS+ program. PLUS+ is a group-based cognitive skills program which employs cognitive-behavioural methods of problem-solving, skills-training, and self-management to rehabilitate young offenders. It is one of the most intensive and best established programs to have been implemented in South Australia. Based on a review of this program a number of recommendations are made to enhance the future delivery and evaluation of PLUS+.