Early Intervention For Borderline Personality Disorder In Youth: A Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$709,932.00
Summary
Borderline Personality Disorder (BPD) is a severe mental disorder involving instability of emotions, impulse control, self-concept and interpersonal relationships. BPD arises during adolescence and has a suicide rate of 10%. This study investigates the most effective form of early intervention for BPD that improves the daily lives of individuals and reduces poor outcomes, such as deliberate self-harm. The findings will inform the dissemination of early intervention for BPD in the health system.
Parent Education For The Treatment Of Severe Behaviour Problems In Children With Developmental Disabilities
Funder
National Health and Medical Research Council
Funding Amount
$116,220.00
Summary
Approximately 40% of children with developmental disabilities have severe behaviour problems (e.g., aggression, self-injury, property destruction, and extreme tantrums) (Einfeld and Tonge, 1996). The care of a child with such problems represents a significant burden to parents and society. One of the most promising treatments is functional communication training (FCT), which aims to reduce problem behaviours by improving the child's communication skills. Numerous studies have demonstrated the ef ....Approximately 40% of children with developmental disabilities have severe behaviour problems (e.g., aggression, self-injury, property destruction, and extreme tantrums) (Einfeld and Tonge, 1996). The care of a child with such problems represents a significant burden to parents and society. One of the most promising treatments is functional communication training (FCT), which aims to reduce problem behaviours by improving the child's communication skills. Numerous studies have demonstrated the effectiveness of FCT (Mirenda, 1997). Wacker et al. (1998) have shown that parents can be taught to use FCT, but these parents received individual consultations, which would seem to limit its practicality. Preliminary results from our current APEX grant suggest that parents can learn to implement this treatment in a group format, which is more practical from a public health perspective. However, it is currently unknown if group training is as effective as individual consultation. In the present application, we aim to compare these two ways of teaching parents how to use FCT. From a total sample of 36, the parents of 18 children will be randomly assigned to the group training format and 18 to the individual format. All parents will receive 12 hours of training on how to use FCT, either as part of a group of 3 families (mothers and-or fathers) in the clinic or on a one-to-one basis in the family home. Pre, post, and follow-up measures of problem behaviours will be used to address the research question: Is group training as effective as individual consultation? If so, we would have demonstrated a more practical way of teaching parents how to implement this evidence-based treatment for child behaviour problems.Read moreRead less
Parenting Style As A Mediator Of Psychosocial Risk Factors And Childhood Externalizing Behaviour Problems
Funder
National Health and Medical Research Council
Funding Amount
$113,160.00
Summary
It is imperative that effective interventions be developed and evaluated for children with externalising disorders (e.g. oppositional disorder, attention deficit order and conduct disorder). The prevalence of these problems in the community is high, the prognosis of children is poor, and externalising problems are passed on across successive generations in the same family. Childhood externalising problems are also one of the most costly behavioural disorders for society. Many studies have examin ....It is imperative that effective interventions be developed and evaluated for children with externalising disorders (e.g. oppositional disorder, attention deficit order and conduct disorder). The prevalence of these problems in the community is high, the prognosis of children is poor, and externalising problems are passed on across successive generations in the same family. Childhood externalising problems are also one of the most costly behavioural disorders for society. Many studies have examined the nature and course of externalising problems in older children and adolescents. However, little attention has been paid to the early onset of externalising disorders amongst preschool and early school-age children. Whilst the relationships between family risk factors (e.g. marital discord and maternal depression), parental management styles and children's behaviour problems are widely recognised, the exact nature and direction of these relationships remains largely unknown. This proposal will provide new information about the mechanism through which family risk factors such as marital discord or parental distress influence the onset and persistence of externalising problems in young children, via their effects on parents' behaviour management techniques. This information can then be used to instruct early intervention efforts for parents and families of children at risk of developing externalising behaviour problems.Read moreRead less
Severe Malaria In Children In Papua New Guinea: A Longitudinal Study Of Pathophysiology, Management And Outcome
Funder
National Health and Medical Research Council
Funding Amount
$484,808.00
Summary
The features of severe infection in children living in tropical countries may not allow differentiation between malaria and bacterial-viral causes. This can create significant problems with deciding on appropriate management. In addition, the main complications of malaria such as coma, increased acid levels in the blood and anaemia are not well understood. We plan to characterise infections in Papua New Guinean children in detail and explore mechanisms behind important malarial complications.
If Childhood Primary Snoring Resolves, Do Neurocognition And Behaviour Also Improve?
Funder
National Health and Medical Research Council
Funding Amount
$568,067.00
Summary
Sleep breathing disorders (SBD) are common and affect around 10% of all children. Previous research however has shown that sleep disorders are often not recognised or considered important enough to report to general practitioners. Thus, the true incidence of sleep disorders in Australian children is not known. Nevertheless, even the mildest SBD, primary snoring, has been associated with significant deficits in daytime learning, memory, intelligence, attention and problematic behaviour. In severe ....Sleep breathing disorders (SBD) are common and affect around 10% of all children. Previous research however has shown that sleep disorders are often not recognised or considered important enough to report to general practitioners. Thus, the true incidence of sleep disorders in Australian children is not known. Nevertheless, even the mildest SBD, primary snoring, has been associated with significant deficits in daytime learning, memory, intelligence, attention and problematic behaviour. In severe cases of childhood SBD (i.e. sleep apnoea syndrome), removal of the tonsils and adenoids has been shown to improve the learning and behaviour problems. Thus there is increasing pressure on doctors to treat primary snoring in children with surgery to improve their intellectual functioning. However, recent evidence in children has shown that snoring may resolve naturally in up to 50% of cases over one to two years. In addition to the risks of surgery, the large number of children who may have a natural resolution of snoring suggestst that the pressure to treat primary snoring in may not be justified. This study will be the first to determine the prevalence of childhood snoring and associated problems in the Australian community. We also aim to discover whether snoring and the associated intellectual deficits persist over time during childhood. We will identify frequent snorers and healthy non-snorers in children aged 5-10 years old, using parental questionnaires. We will then study 75 snorers and 75 non-snorers in more detail, monitoring them with overnight sleep studies and questionnaires 2 years apart, to see if snoring, intellectual function and behavioural problems persist over time. This information will improve the health of Australian children by determining the prevalence of childhood SBD and persistence of associated deficits such as in learning, memory and behaviour.Read moreRead less
Effects Of Lead And Socio-cultural Factors On Cognition And Behaviour Of Children In Port Pirie And Broken Hill
Funder
National Health and Medical Research Council
Funding Amount
$394,825.00
Summary
The effect of lead on children's 'intelligence' is controversial. Poorer IQ scores in children with higher exposure to lead, have been found reasonably consistently, - but there is disagreement on whether lead exposure is simply a common ASSOCIATE of poor IQ, or whether it actually CAUSES deficits. In 1994, the NHMRC prudently recommended a graded series of interventions to be implemented, depending on the proprtion of children in the community with blood lead concentrations in specific categori ....The effect of lead on children's 'intelligence' is controversial. Poorer IQ scores in children with higher exposure to lead, have been found reasonably consistently, - but there is disagreement on whether lead exposure is simply a common ASSOCIATE of poor IQ, or whether it actually CAUSES deficits. In 1994, the NHMRC prudently recommended a graded series of interventions to be implemented, depending on the proprtion of children in the community with blood lead concentrations in specific categories above 10 ug lead -100 ml of blood. The choice of this figure (10 ug-dl) was more pragmatic than scientific; there being very little data on the health effects of exposures below 10 ug-dl available at that time. A recent analysis of pooled data from past studies has now suggested there may be very large effects on child IQ at blood lead concentration BELOW 10 ug-dl. Health authorities will soon be lobbied intensely to spend vast sums on new lead abatement programs. Cities like Port Pirie and Broken Hill (where cooperative programs have achieved such significant reductions in lead exposure that a high percentage of their children now have blood lead levels below 10 ug-dl), will be forced to examine expensive options to avoid closure of the industries which provide their economic backbones, if this analysis proves to be correct. Our proposal argues that before committing to new and costly abatement programs, there is an urgent need to augment our evidence-base by conducting a new study ofchildren with lead exposures below 10 ug-dl, using more modern measures of intelligence. The study will pay closer attention to some of the socio-cultural and inherited determinants of child IQ which may have confounded the lead-IQ association in past studies, and will supplement IQ assessments (which are now considered to derive from a very old and narrow view of intelligence) with new tools for measuring 'intelligence' that may be less socio-culturally dependent.Read moreRead less
A Randomised Control Trial Of Medical Treatment Versus The Placement Of The Lap Band In Severely Obese Adolescents.
Funder
National Health and Medical Research Council
Funding Amount
$481,905.00
Summary
There has been a substantial rise in the number of overweight and obese adolescents in our community. While prevention of obesity is the ultimate goal, effective stratagies for the management of obese adolescents must be sought. Unfortunately there are few studies that have focused on this problem in adolescents and success has been very limited. Modern obesity surgery is the only reliable method of achieving and sustaining major weight loss in severely obese (body mass index > 35 kg-m2) adul ....There has been a substantial rise in the number of overweight and obese adolescents in our community. While prevention of obesity is the ultimate goal, effective stratagies for the management of obese adolescents must be sought. Unfortunately there are few studies that have focused on this problem in adolescents and success has been very limited. Modern obesity surgery is the only reliable method of achieving and sustaining major weight loss in severely obese (body mass index > 35 kg-m2) adults and there are now several small studies that demonstrate its effectiveness in adolescents. Modern obesity surgery involving the keyhole placement of an adjustable band around the very upper part of the stomach has proven to be safe and effective and requires one 24 hr stay in hospital. In this collaborative study, involving the Monash University Centre for Obesity Research and Education and the Royal Children's Hospital, we propose to formally test, for the first time, the effectiveness of a weight loss program that includes adjustable band surgery, and compare this with a comprehensive best care behavioral program, over a period of 2-years in severely obese adolescents. We estimate that suitable subjects will come from the top 1% for body mass index in our community. After thorough assessment 50 suitable candidates with ages ranging from 14 to 18 years will be randomly allocated to one of the two treatment programs. The intensity of each program will be similar. A broad range of measues including: weight, health status, physical disability, psychological status, body image and quality of life, will be performed before and at completion of the 2-year programs. In addition we will compare the complications, compliance and cost of the two programs. This study will help us assess and compare the effectiveness of the 2 programs and provide vital information regarding the role of modern keyhole obesity surgery for the management of severely obese adolescents.Read moreRead less