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Aims: ADHD (attention‐deficit/hyperactivity disorder) affects 5% of children on average. Despite the high need to access services for ADHD treatment, not all children with ADHD utilise healthcare services equally. This study aims to systematically synthesise evidence of equity and equality in health service use/costs and health‐related quality of life (HRQoL)/wellbeing of children with ADHD across socioeconomic (SES) classes. Methods: The literature search was conducted across seven databases (Academic Search complete, MEDLINE Complete, PsycINFO, ERIC, Global Health, CINAHL and EconLit). The search was limited to peer‐reviewed articles published to 23rd January 2023 in English and focused on children. Study quality was assessed using the Critical Appraisal Skills Program (CASP), Joanna Briggs Institute (JBI) and Mixed Methods Appraisal Tool (MMAT) checklists. Results: 25 out of 1207 articles were eligible for inclusion. The results showed that SES was associated with different types of healthcare utilisation. Only three studies were found on HRQoL/well‐being. Children with ADHD from low SES families had lower HRQoL than children from high SES families. Conclusion: This study found that a social gradient exists in both healthcare service use and children's HRQoL among those with ADHD. [ABSTRACT FROM AUTHOR]

Background: Low language abilities are known to be associated with significant adverse long‐term outcomes. However, associations between low language and health‐related quality of life (HRQoL) are unclear. We aimed to (a) examine the association between low language and HRQoL from 4 to 13 years and (b) classify the children's trajectories of HRQoL and language and examine the association between language and HRQoL trajectories. Methods: Data were from an Australian community‐based cohort of children. HRQoL was measured at ages 4–13 years using the parent‐reported Pediatric Quality of Life Inventory 4.0. Language was assessed using the Clinical Evaluation of Language Fundamentals (CELF)‐Preschool 2nd edition at 4 years and the CELF‐4th edition at 5, 7 and 11 years. Multivariable linear regression and mixed effect modelling were used to estimate cross‐sectional and longitudinal associations between low language and HRQoL from 4 to 13 years. A joint group‐based trajectory model was used to characterize associations between HRQoL and language trajectories over childhood. Results: Children with low language had substantially lower HRQoL than children with typical language from 4 to 13 years. Higher language scores were associated with better HRQoL, particularly in social and school functioning. Three HRQoL trajectories were identified: stable‐high (51% of children), reduced with slow decline (40%) and low with rapid decline (9%). Children with low language were less likely to follow a stable‐high HRQoL trajectory (40%) while 26% and 34% followed the reduced with slow decline and low with rapid decline trajectories, respectively. Conclusions: Children with low language experienced reduced HRQoL from 4 to 13 years. More than half had declining trajectories in HRQoL highlighting the need to monitor these children over time. Interventions should not only aim to improve children's language ability but also address the wider functional impacts of low language. [ABSTRACT FROM AUTHOR]

Background: Early childhood is an important time to establish eating behaviours and taste preferences, and there is strong evidence of the association between the early introduction of sugar‐sweetened beverages and obesity and dental caries (tooth decay). Dental caries early in life predicts lifetime caries experience, and worldwide expenditure for dental caries is high. Methods: Questionnaire data from the Splash! longitudinal birth cohort study of young children in Victoria, Australia was used to examine beverage consumption and parental feeding behaviours of young children, aiming to provide contemporary dietary data and assess consistency with the Australian dietary guidelines. Results: From 12 months of age, the proportion of children drinking sugar‐sweetened beverages consistently increased with age (e.g. fruit juice consumed by 21.8% at 12 months and 76.7% at 4 years of age). However, the most common beverages for young children are milk and water, consistent with Australian dietary guidelines. In relation to other risk factors for dental caries, at 6 months of age children were sharing utensils, and at 12 months three quarters of carers tasted the child's food before feeding. Conclusions: The increasing consumption of sugar‐sweetened beverages and prevalence of other risk factors for dental caries and obesity through early childhood continues to be a problem despite efforts to raise awareness of these issues with parents. [ABSTRACT FROM AUTHOR]

Background: Low language (LL) is a common childhood condition affecting 7–17% of children. It is associated with life‐long adverse outcomes and can affect various aspects of a child's life. However, the literature on its impact on health‐related quality of life (HRQoL), service use and costs are limited. To date, there has been no systematic review of the overall economic burden of LL. A systematic review regarding the economic burden of LL is important for clinical, educational, policy decision‐making and theoretical aspects. We adopted the term 'low language' to refer to children whose language performance falls below well‐recognized cut‐points regardless of known or unknown aetiology. Aims: To review the literature systematically on how LL is associated with HRQoL, service utilization and costs. Methods & Procedures: A systematic search was conducted across various databases, including MEDLINE, Embase, PsycINFO, CINAHL, up to July 2017. Data on study design, population and outcomes were extracted and screened by two pairs of reviewers with the revision of other experts in the panel on any discrepancies. The Effective Public Health Practice Project tool was used to assess the risk of bias of the included studies. The findings of the included studies were summarized in a narrative synthesis. Outcomes & Results: We identified 22 relevant articles, of which 12 reported HRQoL and 11 reported service utilization and costs associated with LL. Preference‐based instruments, which include the relative importance attached to different aspects of HRQoL, were less employed in the literature. Most studies found poorer HRQoL in children with LL compared with their peers. About half the families having children with LL did not actively seek professional help, and many families felt they did not receive sufficient services when needed. Healthcare costs associated with LL were substantial. Non‐healthcare costs were largely unexplored. Conclusions & Implications: LL was associated with reduced children's HRQoL, higher service use and costs. Under‐servicing was evident in children with LL. LL also imposed large costs on the healthcare system. Further research is required to examine (1) the overall HRQoL of children with LL, in particular studies using and testing the performance of preference‐based instruments; and (2) the service use and costs specific to LL, especially non‐healthcare costs. [ABSTRACT FROM AUTHOR]

Background: We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and cost‐effective when delivered by pediatricians or psychologists in community settings. Methods: Translational, cluster‐randomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5–13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep–wake phase disorder, or were experiencing sleep‐related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies. Results: In an intention‐to‐treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost‐effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months. Conclusions: A low‐cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial. [ABSTRACT FROM AUTHOR]

Time use could profoundly affect adolescents' health-related quality of life (HRQL). Ideally, overall time use patterns would be considered, because activities within a 24-hour day are inherently correlated (more in one activity means less in another). This review focused on the associations of (i) overall time use patterns and (ii) components of time use patterns with HRQL in adolescents.Conclusion: More physical activity, less screen time and more/adequate sleep, in isolation, are associated with better profile-based HRQL subscales. Greater understanding of adolescents' overall time use patterns and HRQL is, therefore, a priority for policy development. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between mothers' health-related quality of life (HRQoL) and child behaviour problems at age 2 years. To investigate whether the relationship between maternal HRQoL and child behaviour problems is independent of maternal mental health.Methods: Cross-sectional survey nested within a population-level, cluster randomised trial, which aims to prevent early child behaviour problems. One hundred and sixty mothers of 2-year-old children, in nine local government areas in Victoria, Australia. HRQoL was measured using the Assessment of Quality of Life 6D and child behaviour was measured using the child behaviour checklist (CBCL/1.5-5 years). Maternal mental health was measured using the Depression Anxiety Stress Scale. Data were collected at child age 2 years; demographic data were collected at child age 8 months.Results: HRQoL was lower for mothers with children that had borderline/clinical behaviour problems compared to those with children without problems (mean difference -0.14, 95% confidence interval (CI): -0.16 to -0.12, P < 0.001). The finding did not markedly change when adjusting for household income, financial security, child gender, child temperament and intervention group status at child age 8 months (mean difference -0.12, 95% CI: -0.15 to -0.09, P < 0.001), but did attenuate when additionally adjusting for concurrent maternal mental health (mean difference -0.03, 95% CI: -0.05 to -0.02, P < 0.001).Conclusions: Child behaviour problems were associated with lower maternal HRQoL. Child behaviour problems prevention programmes could consider this association with maternal HRQoL and be designed to improve and report both mothers' and their child's health and wellbeing. [ABSTRACT FROM AUTHOR]

Aim: We aim to describe health service (HS) use in the first 6 months post-partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms.Methods: Participants were 781 infants and mothers in Melbourne, Australia. Mothers reported infant feeding, sleeping and crying problems, depressive symptoms and health service use. Costs were valued in 2012 Australian dollars.Results: The most common services used were maternal child health nurses, general practitioners (GP) and allied health. Infant feeding problems were associated with increased costs for services relevant to infant behaviour including maternal child health nurses (P = 0.007), GP (P = 0.008) and paediatricians (P = 0.03). Maternal depressive symptoms were associated with increased costs for services relevant to depressive symptoms including parenting centres (P = 0.04), GP (P = 0.004), psychiatrists (P = 0.02) and psychologists (P = 0.001). Mothers who completed high school had higher service costs for infant problems than those with lower education (P = 0.02). Single mothers had higher costs for services used for their depressive symptoms than partnered mothers (P < 0.001). Mothers with English as a second language had lower service costs for their depressive symptoms (P = 0.02).Conclusions: Infant feeding problems and maternal depressive symptoms are associated with higher costs for health services relevant to these conditions. Cost-effective strategies to manage these conditions are needed with accessibility being ensured for mothers who are experiencing social adversity. [ABSTRACT FROM AUTHOR]

Aim: Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity.Methods: Participants: Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children.Outcome: Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays.Predictor: biennial BMI measurements over the same period.Results: Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years.Conclusions: Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood. [ABSTRACT FROM AUTHOR]

Aim We studied infants and children with and without special health care needs ( SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. Methods Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 ( n = 5107) and 4-5 ( n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. Outcome measure: Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. Results At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. Conclusions SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system. [ABSTRACT FROM AUTHOR]

Emotionally Focused Therapy (EFT) is an empirically validated relational therapy that recognizes the complexity of couple's therapy and supports the need for specialized training of therapists. Until now, there has been little research on effective methods for EFT supervision and no systematic model for conducting EFT supervision. The findings of a qualitative study of certified EFT therapists' experiences with EFT supervision and training are presented in this study, along with a systematic model of EFT supervision. The model of EFT supervision is based on the findings of this study, relevant research regarding effective clinical supervision, and the authors' experiences with EFT supervision. This model of EFT supervision is isomorphic to the clinical practice of EFT, in that it is theoretically grounded in attachment theory and emphasizes experiential and emotionally based processes. [ABSTRACT FROM AUTHOR]

Medical Education 2010: 44: 706–715 Objectives This study aimed to describe the application, feasibility and outcomes of using simulated patients (SPs) to increase the skills of general practitioners (GPs) delivering a behavioural intervention to reduce childhood overweight and mild obesity. Methods Five female actors were trained as SPs. A total of 67 GPs from 46 general practices in Melbourne, Victoria, Australia, conducted two simulated consultation visits regarding healthy lifestyle family behaviour change, during which they practised their skills and received formative feedback. The GPs and SPs rated GP performance immediately after each consultation. Subsequently, 139 parents of overweight or obese 5–9-year-old children rated GP performance during real-life consultations. Other measures included child body mass index (BMI) Z-scores (at baseline and at a 9-month follow-up) and GP-reported levels of comfort and competence and the perceived value of SP visits. Results Simulated patient ratings, but not GP self-ratings, of GP performance predicted both parent ratings of real-life consultations (Spearman’s rho 0.39 for correlation with SP rating at Visit 1) and subsequent reductions in BMI Z-scores between baseline and follow-up (Visit 1, rho − 0.45; Visit 2, rho − 0.46). GP levels of comfort and competence were maintained during and after the SP visits. A total of 95% of GPs rated simulated consultations as useful, although only 18% said they would pay for them. Conclusions Simulated patient assessment may predict real patient feedback and clinical outcomes, helping to identify doctors who require further training in behaviour change techniques. Randomised controlled trials may establish whether SPs actually raise skills or improve outcomes. [ABSTRACT FROM AUTHOR]

Objective. To examine the relationship between overweight/obesity in children, socioeconomic status and ethnicity/cultural background. Design. Cross-sectional survey of children aged 4-13 years. Setting. A total of 23 primary (elementary) schools in an inner urban municipality of Melbourne, Australia. Participants. A total of 2685 children aged 4-13 years and their parents. Main exposure measures. Ethnicity/cultural background - maternal region of birth; socioeconomic position (SEP) indicators - maternal and paternal educational attainment, family employment status, possession of a healthcare card, ability to buy food, indicator of disadvantage (Socioeconomic Index for Areas, SEIFA) score for school; parental weight status. Main outcome measure. Prevalence of overweight/obesity. Results. Prevalence of overweight/obesity approached 1 in 3 (31%) in this sample. Prevalence of overweight/obesity was greater for children of both North Africa and Middle Eastern background and children of Southern, South Eastern and Eastern European background compared with children of Australian background. This difference remained after adjusting for age, sex, height, clustering by school, SEP indicators and parental weight status; odds ratio, OR=1.57 (95% confidence interval, CI 1.12-2.19) and 1.88 (95%CI 1.24-2.85), respectively. Conclusions. There is a clear independent effect of ethnicity above and beyond the effect of socioeconomic status on overweight and obesity in children. Further research is required to explore the mediators of this gradient. [ABSTRACT FROM AUTHOR]

Background: The role of the δ-opioid receptor in ethanol drinking has remained unclear despite the use of traditional pharmacological and correlational approaches. The results of several studies suggest that pharmacological blockade of these receptors results in decreases in ethanol drinking behavior, but an approximately equal number of reports have failed to observe an effect of δ-receptor antagonism on ethanol drinking. It is clear that alternative approaches to understanding opioid-receptor involvement in ethanol drinking are needed. Methods: In this study, ethanol drinking was examined in δ-opioid receptor knockout (KO) mice by using first a two-bottle-choice test, then an operant self-administration paradigm and a second two-bottle-choice test, in that order. In addition, because KO mice were previously shown to display enhanced anxiety-like behavior relative to wild-type (WT) mice, the effect of ethanol self-administration on anxiety-like responses was determined. Results: δ KO mice initially showed no evidence of a preference for ethanol in the first two-bottle-choice drinking test; however, after an experience of operant self-administration of ethanol, a preference for ethanol developed in the second two-bottle-choice test. KO mice also showed a preference for ethanol over water and self-administered more ethanol than WT mice in the operant self-administration paradigm. The ethanol self-administered in this procedure was sufficient to reverse the innate anxiety-like response observed in this strain. Conclusions: δ KO mice showed a greater preference for ethanol and consumed more ethanol than their WT counterparts, suggesting that a decrease in δ-receptor activity is associated with increased ethanol-drinking behavior. It is hypothesized that δ receptors may influence ethanol self-administration at least partly through an effect of these receptors on anxiety-like behavior. [ABSTRACT FROM AUTHOR]

Objective: To review systematically inpatient compared to outpatient care for the treatment of anorexia nervosa and other eating disorders. Method: Search of electronic databases, references and contact with experts to identify randomized controlled trials (RCTs), case–control studies and case series. Study quality was assessed and data extracted by two independent researchers. Results: Two RCTs and seven case series were identified. Unpublished 5-year follow-up data from one RCT showed a (non-statistically significant) improvement in percentage well in the outpatient compared to the inpatient group, but no difference in mortality. Case series were difficult to interpret because of the inherent biases – follow-up varied from 1.5 to 11.7 years and showed wide variations in outcome. Discussion: There is no evidence that inpatient treatment is more (or less) effective than outpatient treatment for people with anorexia nervosa in the long term. Short-term emergency inpatient treatment of the consequences of eating disorders may still be necessary. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

A model is proposed in which a neurovirulent, microglial-passaged, Simian immunodeficiency virus (SIV) is used m produce central nervous system (CNS) pathology and behavioral deficits in rhesus monkeys reminiscent of those seen in humans infected with human immunodeficiency virus (HIV), The time course of disease progression was characterized by using functional measures of cognition and motor skill, as well as neurophysi010giC monitoring. Concomitant assessment of immunological and virological parameters illustrated correspondence between impaired behavioral performance and viral pathogenesis. Convergent results were obtained from neuropathological findings indicative of significant CNS disease, In ongoing Studies, this SIV model is being used to explore the behavioral sequelae of immunodeficiency virus infection, the viral and host factors leading to neurologic dysfunction, and to begin testing potential therapeutic agents. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses a prospective study of Australian cohort of children which describes the use of services for childhood communication disorders, out-of-pocket costs to families and costs to the health system using data from the Early Language in Victoria Study.