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BACKGROUND: This systematic review aimed to explore the effects of sport and physical activity on behaviour and emotional problems, mental health and psychosocial well-being of children and adolescents with intellectual disability. METHOD(S): Five databases were searched systematically (ERIC, MEDLINE, PsycINFO, SportDISCUS and SCOPUS), up to 28 February 2021. Thirty-two studies met criteria for inclusion. RESULT(S): Studies in this review included case studies (n = 15), treatment trials (n = 14), cross sectional studies (n = 2) and a cohort study (n = 1). Evidence was positive, though high risk of bias in treatment trials (7 of 14 rated high) meant generalisability of results was limited. CONCLUSION(S): The available evidence suggests a positive relationship between physical activity and improved behaviour and emotional problems, mental health and psychosocial well-being; however, more robust randomised controlled trials are required to confirm this.Copyright © 2021 John Wiley & Sons Ltd.

BACKGROUND: Behaviour and emotional problems are highly prevalent in children with autism spectrum disorder (ASD). In typically developing children, attachment quality acts as a risk/protective factor for behavioural outcomes and adjustment, warranting investigation in children with ASD. METHOD(S): We investigated the relationship between attachment and child behaviour and emotional problems in children with ASD and comorbid intellectual disability. Data were collected from parent-child dyads where children were diagnosed with ASD and ID (n = 28) or other developmental disabilities (n = 20). RESULT(S): Children with ASD had higher levels of behaviour and emotional problems and more attachment difficulties than children with other developmental disabilities. Poorer attachment quality contributed uniquely to the variance in child behaviour and emotional problems. CONCLUSION(S): Interventions targeting behaviour and emotional problems in children with ASD may benefit from an attachment model which addresses the child's difficulty in using caregivers as a coregulatory agent of emotions.Copyright © 2019 John Wiley & Sons Ltd.

OBJECTIVE: The purpose of this study was to examine the feasibility and effectiveness of a suicide prevention smartphone application. METHOD(S): Thirty-six non-Aboriginal Australians aged between 16 and 42 years (67% female) were recruited from a tertiary mental health service where they were receiving treatment for suicide risk. Participants were asked to use the BeyondNow safety planning smartphone application to manage their suicide safety plan during a 2-month trial, as an adjunct to treatment as usual. A survey battery designed to measure feasibility and effectiveness of the smartphone app plus treatment as usual intervention was completed at baseline and follow-up. RESULT(S): A vast majority of participants used the app to view and edit their safety plans and reported that the app was easy to use. A reduction was observed in participant severity and intensity of suicide ideation, and suicide-related coping increased significantly. No significant changes were observed in suicide resilience. CONCLUSION(S): The BeyondNow safety planning smartphone application was shown to be feasible and effective as an adjunct to mental health treatment among patients at risk of suicide.Copyright © 2018 The Authors. Suicide and Life-Threatening Behavior published by Wiley Periodicals, Inc. on behalf of American Association of Suicidology.

Background: The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID. Method(s): Parents of 83 young people with ID aged 4-17 years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour. Result(s): The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off. Conclusion(s): The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information.Copyright © 2017 MENCAP and Intern

This study assessed the psychometric properties of two visual analogue scales of irritability, known as the Cranky Thermometers (CT), in both an Australian community secondary-school sample (N = 164) and a sample of adolescents with a depressive disorder (N = 127). The first scale Cranky Now measures current irritability, and the second, Cranky Two Weeks, measures peak irritability within the last two weeks. CT scores were significantly higher in adolescents with major depressive disorder than in the school sample and showed improvement following treatment for depression. Positive associations were found between CT and irritability scores as determined by Kiddie Schedule for Affective Disorders and Schizophrenia (not irritable, sub-threshold, threshold irritability) and Affective Reactivity Index scores. Results suggest that the CTs are rapidly administered, have promising psychometric properties and demonstrate utility in measuring irritability in clinical and community settings.Copyright © 2018

Background: Among children with intellectual disabilities, children with autism spectrum disorder (ASD) have higher rates of behaviour and emotional problems than those without ASD. Parent training programmes, such as Stepping Stones Triple P (SSTP), have been shown to reduce child behaviour and emotional problems. This study aimed to evaluate whether the community-based SSTP programme produced comparable outcomes for children with and without ASD (i.e. whether having ASD moderated the treatment outcome effect). Method(s): A subsample of 365 families who took part in the Stepping Stones Triple P (SSTP) programme was analysed, including children with an intellectual or developmental disability aged 2-10 years. Parents reported whether their child had been diagnosed with ASD and completed socio-demographic information and measures assessing child behaviour and emotional problems, and parenting style pre-, postintervention, and at 12-month follow-up. Result(s): Although the children with ASD (n = 230) had significantly higher rates of behaviour and emotional problems at all-time points compared to the children without ASD (n = 135), both groups demonstrated significant decreases in behaviour and emotional problems post-treatment. These gains were maintained at 12-month follow-up for overall behaviour and emotional problems, disruptive behaviours, self-absorbed behaviours and communication disturbance. There was however a small increase in anxiety at 12-month follow-up for children without ASD only. Additionally, there was a continued decrease in social relating problems for the children with ASD, but not for those without ASD. A similar pattern of improvement and maintenance was found for parenting skills (consistency, coercive and positive encouragement) between the parents of children with and without ASD. Conclusion(s): Overall, the community-based SSTP programme demonstrated a comparable effectiveness in reducing child behaviour and emotional problems and maintaini

This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.

This paper aims to synthesise the literature on attachment in children with Autism Spectrum Disorder (ASD), highlighting gaps in current research and applications for clinical practice. The research databases PsycINFO, Ovid Medline, and the Cochrane Library were searched for the terms "autism" and "attachment". Forty papers investigating attachment in children with ASD were identified and narratively reviewed. Seven samples were identified that reported attachment classifications using the Strange Situation Paradigm, with an average of 47% of children with ASD classified as secure (n = 186). With research to date concluding that children with ASD can form secure attachments, studies are now looking at risk and protective factors in the development of attachment, correlates of attachment, attachment disorders in children with ASD, and attachment-based interventions for children with ASD. Many of these studies are preliminary investigations with contradictory findings reported, highlighting important directions for future research.Copyright © 2016

Background: Service responses to behaviour phenotypes include care by expert clinicians, syndrome-specific clinics, disability-specific mental health services and generic mental health services. While these services contribute to care, they are often of limited accessibility. Method(s): We describe a population-wide public health intervention aimed at increasing the accessibility of services to the target population. Stepping Stones Triple P (SSTP) is a public health intervention of known efficacy in reducing behaviour problems when delivered to parents of children aged 0-12 with mixed developmental disabilities. Result(s): The strategy we discuss involves enhancing SSTP with modules for specific causes of developmental disabilities including Down, Fetal Alcohol, Fragile X, Prader-Willi and Williams syndromes. Conclusion(s): We propose that enhancing SSTP with syndrome specific modules will increase the accessibility of support to families who have a child with a specific behaviour phenotype. We suggest that future research should confirm the public health impact of the modified SSTP programme using the RE-AIM framework.Copyright © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd

Objective: Oxidative stress, inflammation and heavy metals have been implicated in the aetiology of autistic disorder. N-acetyl cysteine has been shown to modulate these pathways, providing a rationale to trial N-acetyl cysteine for autistic disorder. There are now two published pilot studies suggesting efficacy, particularly in symptoms of irritability. This study aimed to explore if N-acetyl cysteine is a useful treatment for autistic disorder. Method(s): This was a placebo-controlled, randomised clinical trial of 500 mg/day oral N-acetyl cysteine over 6 months, in addition to treatment as usual, in children with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of autistic disorder. The study was conducted in Victoria, Australia. The primary outcome measures were the Social Responsiveness Scale, Children's Communication Checklist-Second Edition and the Repetitive Behavior Scale-Revised. Additionally, demographic data, the parent-completed Vineland Adaptive Behavior Scales, Social Communication Questionnaire and clinician-administered Autism Diagnostic Observation Schedule were completed. Result(s): A total of 102 children were randomised into the study, and 98 (79 male, 19 female; age range: 3.1-9.9 years) attended the baseline appointment with their parent/guardian, forming the Intention to Treat sample. There were no differences between N-acetyl cysteine and placebo-treated groups on any of the outcome measures for either primary or secondary endpoints. There was no significant difference in the number and severity of adverse events between groups. Conclusion(s): This study failed to demonstrate any benefit of adjunctive N-acetyl cysteine in treating autistic disorder. While this may reflect a true null result, methodological issues particularly the lower dose utilised in this study may be confounders.Copyright © The Royal Australian and New Zealand College of Psychiatrists.

Changes to the DSM-5 Autism Spectrum Disorder (ASD) criteria raised concerns among parents and practitioners that the criteria may exclude some children with Pervasive Developmental Disorder (PDD). Few studies have examined DSM-5 sensitivity and specificity in children less than 5 years of age. This study evaluated 185 children aged 20-55 months with DSM-IV PDD or developmental delay. Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) data was assigned to DSM-5 subdomains. Children displaying the required symptomatology were classified with DSM-5 ASD. DSM-IV clinical diagnoses were compared to DSM-5 classifications. Using combined ADI-R/ADOS information, sensitivity was.84 and specificity was.54. Comorbid behaviour and emotional problems were significantly lower in children with PDD that did not meet DSM-5 criteria.Copyright © 2016, Springer Science+Business Media New York.

Longitudinal research has demonstrated that social outcomes for adults with autism are restricted, particularly in terms of employment and living arrangements. However, understanding of individual and environmental factors that influence these outcomes is far from complete. This longitudinal study followed a community sample of children and adolescents with autism into adulthood. Social outcomes in relation to community inclusion and living skills were examined, including the predictive role of a range of individual factors and the environment (socio-economic disadvantage). Overall, the degree of community inclusion and living skills was restricted for the majority, and while childhood IQ was an important determinant of these outcomes, it was not the sole predictor. The implications of these findings in relation to interventions are discussed.Copyright © 2014, Springer Science+Business Media New York.

The literature on the association between behavioural and emotional problems and ageing in adults with Down syndrome (DS) without dementia is limited and has generally not reported on a wide range of behavioural and emotional problems. This research aimed to extend the field by examining the associations between age and a wide spectrum of behavioural and emotional problems in adults with DS without dementia. A preliminary analysis of the association between potential covariates and behavioural and emotional problems was also undertaken. Parents and caregivers completed a questionnaire on behavioural and emotional problems for 53 adults with DS aged between 16 and 56 years. Twenty-eight adults with DS and their caregivers were part of a longitudinal sample, which provided two time points of data approximately four years apart. Additionally, 25 participants with DS and their caregivers were from a cross sectional sample, which provided one time point of data. Random effects regression analyses were used to examine the patterns in item scores for behavioural and emotional problems associated with age.No significant associations between age and the range or severity of any behavioural and emotional items were found. This suggested a more positive pattern for ageing adults with DS than has been previously described. Given that behavioural and emotional problems were not associated with age, investigation into other factors that may be associated with the behavioural and emotional difficulties for adults with DS is discussed. © 2014 Elsevier Ltd.

Cognitive behavioural therapy is currently the treatment of choice for anxious school-refusing students; however, response rates in adolescents are lower than in children. Antidepressant medications have been shown to be efficacious in the treatment of the anxiety and depressive disorders that may underlie school refusal. This study investigated whether a combination of cognitive behavioural therapy (CBT) and fluoxetine (FLX) would be superior to CBT alone in adolescents exhibiting school refusal. Sixty-two adolescents with school refusal and an anxiety disorder were randomly allocated to CBT, CBT+FLX or CBT and placebo (PLA). The primary outcome measure was proportion of school attendance over the last month. Mean attendance at baseline was 15%. Average school attendance after 12 weeks of treatment was 55% for CBT, 53% for CBT+FLX and 42% for CBT+PLA. These findings suggest that fluoxetine did not augment CBT in the treatment of school refusal in the short term. Side effects of treatment were not significantly different between treatment groups and overlapped substantially with anxiety symptoms. This presentation will present a range of outcomes from this trial from post-treatment and 6- and 12-month follow-up assessments and discuss their implications for the management of school refusal.

Background: This study describes the mental illness and psychosocial outcomes of adolescents who experienced a depressive disorder and identifies predictors of full remission and recurrence. Method(s): 140 adolescents with major depressive disorder, dysthymic disorder, or depressive disorder NOS were offered psychosocial and!or antidepressant treatment across two clinical trials. Three to nine years later (mean 5.7 years), 111 adolescents and young adults completed self-, parent- and clinician- reported measures of psychopathology and psychosocial functioning in a naturalistic follow-up study. The Structured Clinical Interview for DSM-IV Axis I Disorders was used to determine the presence or absence of depressive disorder as well as other Axis I Disorders. Result(s): By the follow-up assessment, most adolescents made a full remission from their index depressive disorder (926%). Recurrence of depressive disorder (524%) during the follow-up period was common, as was the experience of other disorders including anxiety, substance abuse and eating disorders. Time to full remission and recurrence did not vary between baseline types of depressive disorder. Self-reported depressive symptoms and anxiety disorder were associated with failure to achieve full remission while socio-economic status, self-reported self-efficacy and depressive symptoms were associated with recurrence of depressive disorder. Limitation(s): Due to different treatment starting times, the length of the follow up period varied by up to 5.2 years. Conclusion(s): Adolescents who experience depressive disorder are at high risk of ongoing mental illness and psychosocial impairment. Predictors of the course of depressive disorder may be of use in determining which adolescents may require more intensive intervention. © 2013 Elsevier BV. All rights reserved. © 2013 Elsevier B.V. All rights reserved.

Autism and Asperger's disorder (AD) are characterised by impairments in social interaction, stereotypic behaviours or restricted interests. Although currently listed as distinct clinical disorders, the validity of their distinction remains controversial. This study examined gait in children with autism and AD. Eleven children with high-functioning autism and eleven children with AD completed a series of walking tasks. Results indicated distinct movement disturbance; these findings are discussed in light of seminal papers in this field by Vilensky et al. (Arch Neurol 38:646-649, 1981) and Hallett et al. (Arch Neurol 50:1304-1308, 1993) who interpret the gait of individuals with autism using parkinsonian and cerebellar-ataxia patient models, respectively. Distinctions in gait patterns implicating perhaps unique motor circuit disturbances support the hypothesis that autism and AD may have unique neurodevelopmental trajectories. © Springer Science+Business Media, LLC 2011.

Objective: The aim of the study was to investigate the specificity of sleep problems in children with autism and further explore the currently unclear association between sleep problems and daytime behaviour. Methodology: The Pervasive Developmental Disorder (PDD) group consisted of 31 children with autism and 7 children with Asperger's Disorder ranging in age from 44 to 152 months. The control group consisted of 36 children ranging in age from 63 to 171 months. The children were matched on age and gender, and group-matched on IQ level. A sleep diary was completed by parents over a 2- week period, in addition to several behaviour questionnaires. Result(s): Results showed that children in the PDD group exhibited qualitatively and quantitatively different sleep patterns to nonautistic control children. Conclusion(s): The findings were discussed in light of current literature concerning circadian rhythm dysfunction, social difficulties, and abnormal melatonin levels in children with autism.

This study examined whether repetitive behaviours were a differentiating feature of autism in children aged less than 51 months. The study also examined the relationship between age (chronological and developmental) and repetitive behaviours in young children with autism. Standardised developmental and diagnostic assessments were conducted on 55 children aged between 22 and 51 months, consisting of 40 developmentally delayed children with DSM-IV-TR Autistic Disorder and 15 developmentally delayed children without Autistic Disorder. Results indicated that several measures of repetitive behaviour, particularly more complex high-level ones, were significantly positively associated with the probability of receiving a diagnosis of autism. No significant relationships were found between developmental age and the presence of repetitive behaviours in children with autism, but younger chronological age was associated more with simple or low-level repetitive behaviours. © Steinkopff Verlag 2006.

This study is a preliminary analysis of part of a major longitudinal multidisciplinary program examining psychopathology in young people with intellectual disability. The aim is to assess potential behavioural risk factors for injury in a representative community sample of 571 children and adolescents aged 4-18 years in 5 health regions in the state of New South Wales, Australia. Results show the prevalence of potential injury risk behaviours to be significantly higher in the study group than for young people representative of the general community. Sex differences in prevalence of these behaviours in the study group appear minimal. Behavioural injury risk patterns in the study group tend to reflect those seen in younger aged children in the general community. These findings suggest that children and adolescents with intellectual disability display behaviours which may increase their risk for injury.

Objective: A new instrument, the Adolescent Depression Treatment Satisfaction Questionnaire (ADTSQ) was devised to measure the consumer satisfaction of depressed adolescents and their parents. The objectives of the paper were to present the psychometric properties of the ADTSQ and to investigate the relative consumer satisfaction with cognitive-behavioural therapy (CBT), sertraline (SRT) and a combined treatment of CBT and SRT (COMBINED) for the treatment of adolescent depression. In addition, participants were asked to rank their most preferred treatment from the following approaches: medication, individual counselling, group program and family therapy. Method(s): Thirty-eight adolescents with a unipolar depressive disorder and 37 parents who participated in a randomized clinical trial of CBT versus SRT versus COMBINED completed the ADTSQ following the completion of acute treatment. Result(s): The ADTSQ was found to have high internal consistency and exploratory factor analysis detected three underlying factors. High levels of consumer satisfaction were reported by both adolescents and parents in all three treatments. Those treated with CBT treatments reported higher levels of skill acquisition than those treated with SRT. Of the four treatment approaches, most parents and adolescents rated individual counselling as their first preference. Conclusion(s): The ADTSQ is a useful measure of consumer satisfaction for depressed adolescents and their parents. CBT, SRT and COMBINED were shown to have high consumer satisfaction with CBT's higher skills training content reflected in the participants' reports. Individual counselling was perceived as the most favourable choice of treatment for adolescent depression. Although limitations associated with the measurement of consumer satisfaction and of the study are acknowledged, it is recommended that the inclusion of consumer satisfaction measures be considered in clinical trials that examine treatment efficacy.

Autism is a neurodevelopmental disorder with a specific pattern of behavioural, communication and social problems. Additional mental health problems are often poorly understood and undetected. This study investigates the level and pattern of emotional and behavioural problems in young people with autism compared with children with intellectual disability (ID). Subjects were 381 young people with autism and a representative group of 581 Australian young people with ID aged 4-18 years. Parents/carers provided details of the emotional and behavioural problems of their child using the Developmental Behaviour Checklist (DBC-P). Young people with autism were found to suffer from significantly higher levels of psychopathology than young people with ID. The implications of this finding are discussed. © Springer Science+Business Media, Inc. 2006.

Unhappiness and transient feelings of depression are common normal experiences for many children. Persistent depressive illness occurs in about 2 per cent of children and seriously affects social, educational and emotional development. Treatment usually requires family therapy and behavioural and psychotherapeutic measures. Antidepressant medication has an occasional role in cases with a biological basis.

Cognitive-behavior therapy is frequently used in the treatment of school refusal, a challenging problem for mental health professionals and school authorities. We review the clinical and research support for the efficacy of cognitive-behavior therapy using recently published guidelines for determining the level of evidentiary support for psychosocial interventions. Although cognitive-behavior therapy appears to be a useful treatment for school refusal, further research is needed before it can be considered as having 'well-established' empirical status. Several other important methodological and theoretical issues are emphasized. (C) 2000 Elsevier Science Ltd.

Child sexual abuse is a highly prevalent problem that frequently occasions the onset of post-traumatic stress disorder in the victimized youngster. This selective review addresses recent advances in the assessment and treatment of sexually abused children with post-traumatic stress disorder. Firstly, we outline the diagnostic criteria for post-traumatic stress disorder and significant moderating variables in the development of post-traumatic stress disorder. Secondly, we address the clinical assessment of post-traumatic stress disorder in sexually abused children, recommending a developmentally sensitive, multi-informant approach. Thirdly, we consider a family-wide cognitive-behavioural treatment framework for sexually abused children with post-traumatic stress disorder that involves both child and non-offending caregivers. Fourthly, we examine the results of recent evaluation studies supportive of cognitive-behavioural therapy in the treatment of sexually abused children. Lastly, we consider conclusions for clinical practice and directions for future research.

Objective: Adolescents accessing inpatient psychiatric services typically have severe and complex disturbance. The aim of the present study was to provide a comprehensive description of an adolescent inpatient sample by examining their psychiatric diagnosis, symptomatology and functioning and associated parental mental health, family functioning and cultural and socioeconomic factors. Few studies have described all these factors and existing studies have reported varying results. Method(s): Participants were 88 adolescents (37 male) aged 12-18 years (mean=15.4 years) consecutively recruited through a small number of case clinicians from a regional metropolitan public inpatient unit over a 5 year period. Adolescents and parents participated in clinical interviews and completed psychometric measures. Case clinicians provided diagnostic information. Result(s): In contrast to previous studies, adolescents were from a cross-section of socioeconomic backgrounds. Results showed a high rate of comorbid Axis I diagnoses with depressive disorders the most common principal diagnosis. Two-thirds of adolescents experienced clinical levels of internalizing problems. Clinical levels of thought disturbance and externalizing problems were reported for most adolescents, although adolescents self-reported fewer of these symptoms. Educational and social difficulties were common. A salient result was the high level of family dysfunction reported by multiple informants. Most parents reported minimal personality or psychological disturbance but results contradicted other studies and may reflect response bias. In a preliminary finding, non-English-speaking background and low socioeconomic status were associated with a psychosis-related principal diagnosis. Conclusion(s): Findings indicate the multiplicity of issues facing adolescent inpatients including psychiatric symptoms, impaired personal and family functioning and family cultural and background factors. Treatment that focuses on only

Autism is characterized by impairments in three areas: (i) reciprocal social interaction; (ii) communication; and (iii) repetitive and stereotyped patterns of interest and behaviour. Despite the finding that parents notice abnormalities and problems with their child's development at a very early age, research shows that diagnoses are often made at an age beyond that recommended for the commencement of early intervention. This paper reviews the range of studies that have sought to elucidate the early features of autism in young, preschool children. Impairments in the capacity for reciprocal social interaction involving preverbal, verbal and non-verbal communication, and play and symbolic behaviour are the key features indicative of autism in infants and preschool children.

The aim of the current study was to investigate the manifestation of repetitive behaviour profiles in young children with a Pervasive Developmental Disorder. The sample consisted of 137 developmentally delayed children with a DSM-IV-TR Pervasive Developmental Disorder (PDD) and 61 developmentally delayed children without a PDD. An exploratory factor analytic investigation using 12 ADI-R repetitive behaviour items from parent report of children with a PDD reported the emergence of two factors. The first factor consisted of higher-level, "insistence on sameness" behaviours, and the second of lower-level, repetitive "sensory-motor" behaviours. This factor structure was also applicable to a more general group of young children with developmental delay, regardless of their diagnosis. Correlational analyses highlighted contrasting relationships between developmental variables and the different repetitive behaviour factors. These relationships were different for children with a PDD and those without a PDD. The findings have potential implications for the early assessment and diagnosis of PDDs in young children. © 2009 Springer Science+Business Media, LLC.

Autism and Asperger's disorder (AD) are neurodevelopmental conditions that affect cognitive and social-communicative function. Using a movement-related potential (MRP) paradigm, we investigated the clinical and neurobiological issue of 'disorder separateness' versus 'disorder variance' in autism and AD. This paradigm has been used to assess basal ganglia/supplementary motor functioning in Parkinson's disease. Three groups (high functioning autism [HFA]: 16 males, 1 female; mean age 12y 5mo [SD 4y 4mo]; AD: 11 males, 2 females; mean age 13y 5mo [SD 3y 8mo]; comparison group: 13 males, 8 females; mean age 13y 10mo [SD 3y 11mo]) completed a cued motor task during electroencephalogram recording of MRPs. The HFA group showed reduced peak amplitude at Cz, indicating less activity over the supplementary motor area during movement preparation. Although an overall significant between-group effect was found for early slope and peak amplitude, sub-analysis revealed that the group with AD did not differ significantly from either group. However, it is suggested that autism and AD may be dissociated on the basis of brain - behaviour correlations of IQ with specific neurobiological measures. The overlap between MRP traces for autism and Parkinson's disease suggests that the neurobiological wiring of motor functioning in autism may bypass the supplementary motor area/primary motor cortex pathway.

OBJECTIVE: To evaluate cognitive-behavioral therapy, antidepressant medication alone, and combined CBT and antidepressant medication in the treatment of depressive disorders in adolescents. METHOD(S): Seventy-three adolescents (ages 12-18 years) with a primary diagnosis of DSM-IV major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified were randomly allocated to one of three treatments. Treatment outcome measures were administered before and after acute treatment, and at a 6-month follow-up. Depression diagnosis was the primary outcome measure; secondary measures were self- and other report and clinician rating of global functioning. The trial was conducted at three community-based clinics between July 2000 and December 2002. Data analyses used an intent-to-treat strategy. RESULT(S): Following acute treatment, all treatment groups demonstrated statistically significant improvement on outcome measures (depressive diagnosis, Reynolds Adolescent Depression Scale, Revised Children's Manifest Anxiety Scale, Suicidal Ideation Questionnaire), and improvement was maintained at follow-up. Combined cognitive-behavioral therapy and antidepressant medication was not found to be superior to either treatment alone. Compared with antidepressant medication alone, participants receiving cognitive-behavioral therapy alone demonstrated a superior acute treatment response (odds ratio = 6.86; 95% confidence interval 1.12-41.82). Although cognitive-behavioral therapy was found to be superior to antidepressant medication alone for the acute treatment of mild to moderate depression among youth, this may have stemmed from the relatively low dose of sertraline used. CONCLUSION(S): All treatments led to a reduction in depression, but the advantages of a combined approach were not evident. ©2006 by the American Academy of Child and Adolescent Psychiatry.

Child sexual abuse is a prevalent form of child maltreatment that frequently occasions severe disturbance including posttraumatic stress disorder. This review focuses on recent cognitive-behavioural treatment initiatives designed specifically for sexually abused children, and the extent to which they are empirically supported. Our review draws on case studies, open clinical trials, multiple baseline investigations and randomized clinical trials. At first glance, the research findings are encouraging for the efficacy and acceptability of cognitive-behaviour therapy. However, more conservative conclusions are reached when stringent criteria are applied regarding evidentiary support for psychosocial interventions. Directions for future research are also explored.

This review explores advances in the behavioural assessment and treatment of childhood headaches. Behavioural assessment procedures are outlined including the behavioural interview, self-report questionnaires, self-monitoring and caregiver observations. We conclude that behavioural treatment strategies are effective in the management of childhood headaches, although most of the research support appears to be limited to relaxation training and biofeedback. Nonetheless, the behavioural assessment and treatment of childhood headaches appears to be a promising clinical and research direction.

Many children experience chronic headaches, particularly migraine and tension headaches. These can be quite debilitating for the child and produce much concern from caregivers and health professionals. Following a discussion of pathophysiology and epidemiological findings, we emphasize the need for nonpharmacological interventions for chronic headaches. This review explores advances in the behavioral assessment and treatment of childhood headaches. We outline behavioral assessment procedures, including the behavioral interview, headache questionnaires, self-monitoring, caregiver observations, and psychophysiological recording. Treatment typically encompasses relaxation training, biofeedback, assertion training; and cognitive therapy. Parental involvement is also one emphasized component in behavioral approaches to treatment. Our review suggests that behavioral treatment strategies are effective in the management of childhood headaches, although most of the research support appears limited to relaxation training and biofeedback. Nonetheless, behavioral assessment and treatment of childhood headaches appears to be a promising clinical and research direction.

Study design: Representative community cross-sectional self-report survey of adults with spinal cord injury (SCI). Objective(s): To establish semantic translation and validation of the Swedish scales - the Spinal Cord Lesion Coping Strategies Questionnaire and the Spinal Cord Lesion Emotional Wellbeing Questionnaire. Setting(s): Adults on the Victorian traumatic SCI register and attendees of the nontraumatic outpatient clinic were invited to participate. Method(s): Instruments were forward and backward translated to establish semantic equivalence. Principle components analyses were undertaken. Correlation and logistic regression analyses were conducted to demonstrate validity of the instruments using both positive (high quality of life) and negative (depression and anxiety) psychological outcomes. Result(s): The final sample consisted of 443 adults with SCI living in the community. Both instruments demonstrated acceptable psychometric properties. Univariate correlation analyses showed most of the new scale components displayed medium to large relationships in the expected direction with the psychological outcomes and the other subscales. Health status and helplessness were significant predictors of both the positive and negative psychological outcomes in the logistic regression analyses. Acceptance was significantly related to the positive outcome only. Female and incomplete tetraplegia categories were significantly and positively related to depression only. Conclusion(s): Notwithstanding a few issues with some of the subscales, the results support the usefulness of these easy to use instruments and point to ways for further development of the scales. © 2008 International Spinal Cord Society All rights reserved.

Background. The Bethlem Scale was designed as a validated measure of mother-infant adjustment in mother-baby units. Method. A multi-centre trial was conducted to investigate aspects of the reliability, validity and clinical usefulness of the Bethlem Mother-infant Interaction Scale within five in-patient psychiatric mother-baby units. Results. This revealed good inter-rater, test-retest and inter-item reliability. Correlations of the scale items with psychiatrist's ratings and changes in scoring over time suggest reasonable validity, despite some design problems with individual items. Conclusion. Mother-infant interaction scales may have an important role in improving the quality of care for mothers and their babies in the psychiatric setting. The development of a more extensive scale, the Monash Mother-infant Interaction Scale, is discussed.

The aim of this study was to examine executive functioning, in particular, attentional set-shifting deficits in high-functioning autism (n = 12) and Asperger's disorder (n = 12). A large or global digit composed of smaller or local digits was presented during each trial. The participants indicated the presence of 1s or 2s by pressing the appropriate button. These targets could appear globally or locally. Relative to IQ, sex and age matched controls, reaction time to global targets in individuals with autism was retarded when the previous target appeared locally. This deficiency in shifting from local to global processing, however, was not observed in individuals with Asperger's disorder. The theoretical and neurobiological significance of this dissociation in executive functioning in these clinically related disorders was explored.

This study aimed to determine whether there were differences in behavioural and emotional disturbance (psychopathology) between children and adolescents with high-functioning autism and Asperger syndrome. Subjects consisted of 75 children and adolescents with high-functioning autism and 52 with Asperger's disorder (DSM-IV diagnoses). Psychopathology was measured using the Developmental Behaviour Checklist. Analysis of covariance (ANCOVA) controlling for the effects of age and cognitive level was used to determine whether the groups differed in their levels of psychopathology. It was found that children and adolescents with Asperger's disorder presented with higher levels of psychopathology than those with high-functioning autism, were more disruptive, antisocial and anxious, and had more problems with social relationships. The implications of these findings are discussed.

There is now a growing body of research examining movement difficulties in children diagnosed with high functioning autism (HFA) and Asperger's disorder (AD). Despite this, few studies have investigated the kinematic components of movement that may be disrupted in children diagnosed with these disorders. The current study investigated rapid aiming movements in 19 individuals diagnosed with HFA, 20 individuals diagnosed with AD and 18 typically developing (TD) controls. A novel touchscreen version of a Fitts' aiming task was administered that required participants to make 10 reciprocal aiming movements between targets. Task difficulty was manipulated by varying the size and distance between targets. Movement time in the HFA and AD groups was comparable to TD controls. Children with HFA displayed more constant and variable error across repeated aiming attempts compared to the TD group that may be attributed to deficits in feedforward online refinement of movement. These findings are in accordance with previous gait, ocular motor, upper limb and neuroimaging studies that suggest that the cerebellum may underlie movement disturbance in individuals diagnosed with HFA. Additionally, differences in the nature of upper limb motor disturbance in HFA may serve as a useful future adjunct to clinical measures. © 2011 Elsevier Ltd.

The Developmental Behaviour Checklist (DBC) was developed to assess psychopathology in children with intellectual disabilities. A cut-off point between 'non-cases' and 'cases' was determined by comparison of the total scores with psychiatric clinical assessment. This paper describes a method aimed at determining the types of psychiatric problems in those regarded as 'cases'. Factor analysis with varimax rotation carried out on a sample of 1093 subjects extracted six factors. Standardized factor scores were calculated for each subject in a community sample (n = 450), and the only or the dominant positive score was determined for each of the 'cases'. Over 80% of 'cases' could be allotted to one condition. Only a small number had none, or three or more conditions. The same procedure was replicated on a validation sample (n = 448) with even more satisfactory results. Differences in the prevalence of the six conditions by sex, age and level of mental retardation were ascertained. The validity and clinical relevance of this method are discussed.

Gait abnormalities have been widely reported in individuals with autism and Asperger's disorder. There is controversy as to whether the cerebellum or the basal-ganglia frontostriatal regions underpin these abnormalities. This is the first direct comparison of gait and upper-body postural features in autism and Asperger's disorder. Clinical and control groups were matched according to age, height, weight, performance, and full scale IQ. Consistent with Hallet's (1993) cerebellar-gait hypothesis, the autistic group showed significantly increased stride-length variability in their gait in comparison to control and Asperger's disorder participants. No quantitative gait deficits were found for the Asperger's disorder group. In support of Damasio and Maurer's (1982) basal-ganglia frontostriatal-gait hypothesis, both clinical groups were rated as showing abnormal arm posturing, however, only the Asperger's group were rated as significantly different from controls in terms of head and trunk posturing. While DSM-IV-TR suggests that Asperger's disorder, but not autism, is associated with motoric clumsiness, our data suggest that both clinical groups are uncoordinated and lacking in motor smoothness. Gait differences in autism and Asperger's disorder were suggested to reflect differential involvement of the cerebellum, with commonalities reflecting similar involvement of the basal-ganglia frontostriatal region. © Steinkopff Verlag 2006.

Few studies have focused on the validity of the ADI-R and ADOS in the assessment of preschool children with developmental delay. This study aimed to evaluate the diagnostic validity of the ADI-R and the ADOS in young children. Two-hundred and nine children aged 20-55 months participated in the study, 120 of whom received a diagnosis of autism. ADI-R and ADOS diagnostic classifications were compared to consensus clinical diagnoses. Children with a clinical diagnosis of autism scored significantly higher on all algorithm domains of the ADI-R and ADOS. The ADOS performed better than the ADI-R in comparison to consensus clinical diagnosis. Characteristics of the ADI-R and ADOS false positive and false negative cases are explored. Further research is recommended in terms of examining which items of the ADI-R best predict a diagnosis of autism for very young children with developmental problems. © 2007 Springer Science+Business Media, LLC.