Showing papers in "Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent in 2012"

Maternal Stress during Pregnancy, ADHD Symptomatology in Children and Genotype: Gene-Environment Interaction

Abstract: Objective Case control studies suggest a relationship between maternal stress during pregnancy and childhood ADHD. However, maternal smoking, parenting style and parental psychiatric disorder are possible confounding factors. Our objective was to control for these factors by using an intra-familial design, and investigate gene-environment interactions.

A review of executive function deficits and pharmacological management in children and adolescents.

Abstract: Objective: To review both the functions and dysfunction of the executive system (ES) focusing on the extent of executive function (EF) deficits in most psychiatric disorders in children and adolescents and the possibility of such deficits acting as markers for pharmacological management.

Media Use and Health Outcomes in Adolescents: Findings from a Nationally Representative Survey

Abstract: OBJECTIVE: Examine the association between quantity of media use and health outcomes in adolescents. METHOD: Multiple logistic regression analyses were conducted with the Canadian Community Health Survey 1.1 (youth aged 12-19 (n=9137)) to determine the association between hours of use of television/videos, video games, and computers/Internet, and health outcomes including depression, alcohol dependence, binge drinking, suicidal ideation, help-seeking behaviour, risky sexual activity, and obesity. RESULTS: Obesity was associated with frequent television/video use (Adjusted Odds Ratio (AOR) 1.10). Depression and risky sexual behaviour were less likely in frequent video game users (AOR 0.87 and 0.73). Binge drinking was less likely in frequent users of video games (AOR 0.92) and computers/Internet (AOR 0.90). Alcohol dependence was less likely in frequent computer/Internet users (AOR 0.89). CONCLUSIONS: Most health outcomes, except for obesity, were not associated with using media in youth. Further research into the appropriate role of media will help harness its full potential. Language: en

Multiple Health-Risk Behaviour and Psychological Distress in Adolescence

Abstract: Adolescent mental health is a concern in Canada, with approximately 5% of male youth and 12% of female youth aged 12–19 years having experienced at least one major depressive episode (Canadian Mental Health Association, 2010). Medications that are used to treat mental illness are often associated with weight gain (Allison et al., 2009), and therefore may contribute to the increased risk of being overweight or obese in later life. A recent review found longitudinal-based evidence suggesting a 1.90- to 3.50-fold increased risk of being overweight in later life for childhood and adolescent depressive symptoms (Liem, Sauer, Oldehinkel, & Stolk, 2008). In younger populations who are not undergoing medical treatment, other modifiable health-risk behaviours, such as smoking and physical inactivity, may contribute to the increased risk of being over-weight or obese in later life (Centers for Diseases Control and Prevention, 2005). These health-risk behaviours often begin during adolescence and extend into adulthood, and have been postulated to have negative implications on long-term health (Centers for Diseases Control and Prevention, 2005). The relationship between mental health and health-risk behaviours is well-recognized in the adult population who suffer from severe mental illness (SMI), such as major depression and schizophrenia (Allison et al., 2009). Rates of obesity, substance abuse, and physical inactivity are disproportionately higher in persons with SMI than in the general population (Allison et al., 2009; Jerome et al., 2009; Kalman, Morissette, & George, 2005). Poor nutrition is also a concern. Compared to the general population, individuals diagnosed with SMI often consume fewer daily servings of fruits, vegetables, and fiber, skip breakfast more frequently, and consume more sugar and fat (Brown, Birtwistle, Roe, & Thompson, 1999). Among adolescents, skipping breakfast, inadequate consumption of fruits and vegetables, and daily consumption of sugar-sweetened beverages are related to higher weight status (Deshmukh-Taskar et al., 2010; Malik, Schulze, & Hu, 2006). However, our understanding of the relationship between adolescent mental health and health-risk behaviours is limited (e.g., Brooks, Harris, Thrall, & Woods, 2002; Katon et al., 2010; Mistry, McCarthy, Yancey, Lu, & Patel, 2009; Paxton, Valois, Watkins, Huebner, & Wazner Drane, 2007). Previous studies have found that adolescents with depressive symptoms are more likely to smoke, use alcohol and drugs, exhibit unhealthy diets, spend more time in sedentary behaviour, and have a higher prevalence of obesity (Brooks et al., 2002; Katon et al., 2010; Paxton et al., 2007). This link is particularly evident among female adolescents (Mistry et al., 2009). More research is needed to establish the relationship between adolescent mental health and modifiable health-risk behaviours. One model that may be useful for understanding the relationship between adolescent mental health and health-risk behaviours is the multiple affective behaviour change (M-ABC) model (Taylor, 2010). According to this model, a reciprocal relationship exists between mood and the engagement in mood-regulating behaviours (i.e., substance use, high energy snacking, and sedentary behaviour). Specifically, during temporary or more prolonged periods of negative mood and stress there may be a greater tendency to engage in health behaviours that may enhance mood and affect. Some individuals may use alcohol or nicotine to regulate their mood; others may engage in brief bouts of physical activity. These mood-regulating behaviours, in turn, have a direct influence on weight status. The M-ABC model provides a framework for designing multiple health behaviour change interventions as well as for identifying potential moderators of the relationship between mood and multiple health behaviours. Additionally, the M-ABC model provides researchers with the opportunity to examine any moderators of the relationships between mood, multiple health behaviours, and obesity. However, prior to rigorous model testing, more research is needed to determine whether the relationships identified in the M-ABC model can be applied to adolescents. The current study extends the previous research on adolescent mental health and health-risk behaviours by providing a Canadian examination of adolescent mental health symptoms, specifically psychological distress, and health-risk behaviours using a conceptual framework (i.e., the MABC model; Taylor, 2010). Furthermore, this study extends current research by examining a broader range of dietary behaviours in the context of adolescent mental health and health-risk behaviours. For example, skipping breakfast has been associated with less favorable nutrient intake profiles and greater adiposity in adolescence (Deshmukh-Taskar et al., 2010), while associations are also commonly found between greater intakes of sugar-sweetened beverages and weight gain and obesity (Malik et al., 2006). It was hypothesized that psychological distress would be associated with female sex, low parental education, overweight/obesity, older age, physical inactivity, screen-time behaviour, use of alcohol, tobacco, and cannabis, irregular consumption of breakfast, fruits and vegetables, and daily consumption of soft drinks. Identifying modifiable predictors of overweight and obesity in adolescence could lead to more effective targeted prevention strategies, and therefore, a decreased likelihood of developing physical and mental illness later in life (Liem et al., 2008).

Mental health problems in children with prader-willi syndrome.

Abstract: Background Prader-Willi Syndrome (PWS) is a genetically determined neurodevelopmental disorder, which occurs in approximately one in 22000 births. Aims This study aimed to investigate psychiatric characteristics of children diagnosed with PWS compared with an age-, gender- and IQ-matched control group. The parents of children with PWS were assessed for psychological distress in comparison to the parents of the control group. Methodological limitations identified in previous studies were addressed in the present study. Methods Psychiatric problems were evaluated in a sample of children with genetically confirmed PWS and an age- and IQ-matched control group using the Child Behaviour Checklist 6-18. Parental psychological distress for both groups was evaluated with the Brief Symptom Inventory. Results Children with PWS had more severe somatic, social, and thought problems, and were more withdrawn-depressed in comparison to controls. Borderline difficulties were detected for the affective, somatic, and attention deficit-hyperactivity CBCL DSM-orientated subscales in the PWS group. Parents of PWS children, in comparison to controls, had more somatization, phobic anxiety, obsessive-compulsive, and anxiety problems. Conclusions PWS represents a complex psychological disorder with multiple areas of disturbances.

Spirituality and Religion in Youth Suicide Attempters' Trajectories of Mental Health Service Utilization: The Year before a Suicide Attempt.

Abstract: OBJECTIVE: Youth suicide attempters are high-risk for suicide. Many have untreated mental disorders and are not receiving services. It is crucial to understand potential influences associated with service use. Spirituality/religion are one influence in youths' mental health service trajectories. This study explored youths' experiences of spirituality/religion as it relates to their help-seeking the year before their suicide attempt. METHOD: Fifteen youth (aged 14-18) who made a suicide attempt(s) one to two years prior were consecutively recruited through the Depressive Disorders Program of a psychiatric hospital and interviewed using a mixed-methods design, including an adapted psychological autopsy method. RESULTS: THREE THEMES EMERGED: religious community members acted as a bridge, step, or provider to mental health services; religious/spiritual discourses were encountered within services; and many youths reported changes in spirituality/religious beliefs the year before their suicide attempt. CONCLUSIONS: Spirituality/religion can have a role in these youths' service trajectories. How this confers protection or challenges needs to be clarified. Our findings can inform policies supporting training religious leaders about suicide intervention to foster coordination with mental health services, and service-providers in judiciously approaching spiritual/religious themes in suicide prevention. Language: en

Referral Patterns and Training Needs in Psychiatry among Primary Care Physicians in Canadian Rural/Remote Areas

Abstract: Objectives: This study examined the referral patterns of rural/remote primary care physicians (PCPs) as well as their needs and interests for further training in child/adolescent mental health.

Review of the pharmacotherapy of irritability of autism.

Abstract: Objective: To review the randomized controlled trial data regarding pharmacotherapy of irritability of autism.

Non-suicidal self-injury and suicidal behaviour in children and adolescents accessing residential or intensive home-based mental health services.

Abstract: OBJECTIVE: There is a dearth of Canadian research with clinical samples of youth who self-harm, and no studies could be located on self-harm in children and youth accessing residential or intensive home-based treatment. The purposes of this report were to explore the proportion and characteristics of children and youth identified as self-harming at admission by clinicians compared to youth not identified as self-harming, compare self-harming children to adolescents, and to compare caregiver ratings of self-harm at intake to clinician ratings at admission. METHOD: This report was developed from a larger longitudinal, observational study involving 210 children and youth accessing residential and home-based treatment and their caregivers in partnership with five mental health treatment centres in southwestern Ontario. Agency data were gleaned from files, and caregivers reported on symptom severity at 12 to 18 months and 36 to 40 months post-discharge. RESULTS: Fifty-seven (34%) children and youth were identified as self-harming at admission. The mean age was 11.57 (SD 2.75). There were statistically significant differences on symptom severity at intake between those identified as self-harming and those not so identified; most of these differences were no longer present at follow up. Children were reported to have higher severity of conduct disorder symptoms than adolescents at intake, and there was some consistency between caregiver-rated and clinician-rated self-harm. Children were reported to engage in a wide range of self-harming behaviours. CONCLUSION: These findings suggest that youth who were identified as self-harming at admission have elevated scores of symptom severity, self-harm can occur in young children and while many improve, there remains a concern for several children and youth who did not improve by the end of service. Children engage in some of the same types of self-harm behaviours as adolescents, and they also engage in behaviours unique to children. Language: en

Understanding Bipolar Disorder: A Developmental Psychopathology Perspective

Abstract: Cicchetti, A Developmental Psychopathology Perspective on Bipolar Disorder. Part I: Phenomenology and Diagnosis. Meyer, Carlson, Development, Age of Onset, and Phenomenology in Bipolar Disorder. Youngstrom, A Developmental Psychopathology Perspective on the Assessment and Diagnosis of Bipolar Disorder. Luby, Belden, Tandon, Bipolar Disorder in the Preschool Period: Development and Differential Diagnosis. Part II: Onset, Prognosis, and Course. Diler, Birmaher, Miklowitz, Clinical Presentation and Longitudinal Course of Bipolar Spectrum Disorders in Children and Adolescents. Alloy, Abramson, Urosevic, Nusslock, Jager-Hyman, Course of Early-onset Bipolar Spectrum Disorders During the College Years: A Behavioral Approach System Dysregulation Perspective. Goldberg, A Developmental Perspective on the Course of Bipolar Disorder in Adulthood. Part III: Etiology/Risk and Protective Mechanisms. Willcutt, McQueen, Genetic and Environmental Vulnerability to Bipolar Spectrum Disorders. Fleck, Cerullo, Nandagopal, Adler, Patel, Strakowski, DelBello, Neurodevelopment in Bipolar Disorder: A Neuroimaging Perspective. Alloy, Abramson, Walshaw, Keyser, Gerstein, Adolescent-onset Bipolar Spectrum Disorders: A Cognitive Vulnerability-stress Perspective. McClure-Tone, Social Cognition and Cognitive Flexibility in Bipolar Disorder. Post, Miklowitz, The Role of Stress in the Onset, Course, and Progression of Bipolar Illness and its Comorbidities: Implications for Therapeutics. Part IV: Treatment. Kowatch, Strawn, DelBello, Developmental Considerations in the Pharmacological Treatment of Youths with Bipolar Disorder. Thase, Pharmacotherapy for Adults with Bipolar Depression. Miklowitz, Goldstein, Family-based Approaches to Treating Bipolar Disorder in Adolescence: Family-focused Therapy and Dialectical Behavior Therapy. Mendenhall, Fristad, Psychoeducational Psychotherapy for Children with Bipolar Disorder. Part V: First-person Accounts. Hinshaw, Growing Up in a Family with Bipolar Disorder: Personal Experience, Developmental Lessons, and Overcoming Stigma.

Prevention of substance use in children/adolescents with mental disorders: a systematic review.

Abstract: OBJECTIVE: WE CONDUCTED A SYSTEMATIC REVIEW TO ANSWER THE QUESTION: Among youth ≤18 years of age with a mental disorder, does substance use prevention compared to no prevention result in reduced rates of substance use/abuse/disorder (SUD)? The review was requested by the Ontario Ministry of Health and Long-term Care through the Canadian Institutes for Health Research Evidence on Tap program. METHODS: A four-step search process was used: Search 1 and 2: Randomized controlled trials (RCTs) that evaluated a SUD prevention intervention in individuals with a mental disorder who were: 1) ≤18 years; or, 2) any age. Search 3: Observational studies of an intervention to prevent SUD in those with mental disorder. Search 4: RCTs that evaluated a SUD primary prevention skills-based intervention in high-risk youth ≤18 years. RESULTS: Searches 1 and 2: one RCT conducted in youth was found; Search 3: two observational studies were found. All three studies reported statistically significant reductions in substance use. Search 4: five RCTs were found with mixed results. Methodological weaknesses including inadequate study power may explain the results. CONCLUSIONS: Little is known about effective interventions to prevent SUD in youth with a mental disorder. Effective SUD primary prevention programs exist and should be evaluated in this high-risk group.

The effects of gender on adolescent suicide in Ontario, Canada

Abstract: OBJECTIVE: Identify patterns of suicide amongst male and female adolescents aged 11-18 years in Ontario. METHOD: All 370 adolescent suicides in Ontario between January 2000 and November 2006 were analyzed. Previous attempts, history of psychiatric treatment, location committed and method of suicide were assessed. Data was analyzed using 2-tailed t-tests and chi-square without Yates' correction. RESULTS: Male adolescent suicide was twice as common as female suicide. Males were more likely to use violent methods (p=0.0352) and females were more likely to have a history of a previous suicide attempt (p=0.0001). CONCLUSIONS: While most of the data agree with previous studies in adult populations, the ratio of male to female suicides was much lower in our adolescent population. Language: en

Partnership at the forefront of change: documenting the transformation of child and youth mental health services in quebec.

Abstract: OBJECTIVE The Quebec Plan d'action en sante mentale (PASM) (Mental Health Action Plan) reform, a major transformation of the province's mental health care system, has put primary care rather than hospital-based care at the forefront of mental health service delivery. This study documents perceptions of changes in child and youth mental health (CYMH) services following the reform, as well as facilitators and obstacles to collaboration and partnership in CYMH services, and the specific challenges related to collaboration and partnership when servicing multi-ethnic populations. METHODS This qualitative participatory research study collected data using semi-structured individual interviews, focus groups and participant observation in community-based health and social service institutions. Thematic analysis was performed. RESULTS The reform process encountered challenges in building a common culture of care within and between institutions, while collaboration and partnership evolved in a positive direction throughout the study. Study results highlighted the importance of fostering communication at all levels. Collaboration and partnership was facilitated by opportunities for clinical discussions, dialogue on models of care, harmonizing administrative and clinical priorities, and involving key actors and structures. The results revealed difficulties in implementing multidisciplinary work and in negotiating partners' responsibilities. Quality of partnership and collaboration appeared particularly crucial in providing optimal care to vulnerable families, including migrants. CONCLUSION The PASM reform involved a major and challenging transformation in CYMH services. Continuous dialogue through time and leadership sharing appeared promising to foster this transformation.

Efficacy of Methylphenidate in ADHD Children across the Normal and the Gifted Intellectual Spectrum.

Abstract: Grizenko et al █ Abstract Objective: This study evaluates whether attention-deficit/hyperactivity disorder (ADHD) children with a borderline intelligence quotient (IQ) (70≤FSIQ<80), normal IQ (80≤FSIQ<120) and high IQ (FSIQ≥120) respond differently to psychostimulant treatment. Method: 502 children, aged 6 to 12 years, with an IQ range from 70 to 150 participated in a two-week, double-blind, placebo-controlled, crossover methylphenidate (MPH) trial. Results: In addition to differences in socioeconomic background and parental education, higher IQ children were found to present with less severe symptoms. No significant differences were found with regards to treatment response. Conclusion: ADHD children within the normal and high levels of intellectual functioning all respond equally to psychostimulant treatment, and that proper medication management is necessary for all children with the disorder.

Mental Health in Inuit Youth from Nunavik: Clinical Considerations on a Transcultural, Interdisciplinary, Community-oriented Approach

Abstract: Objective: This paper discusses the organization of mental health care for youth in Nunavik and considers how best to adapt care to the sociocultural and geographical specificities of this region.

Childhood depression revisited: indicators, normative tests, and clinical course.

Abstract: Until four or five decades ago, the clinical consensus about childhood depression was that it did not, and perhaps could not, occur (Lefkowitz & Burton, 1978; Rie, 1966; Rochlin, 1965; Wolfenstein, 1966). In fact, prior to 1960, childhood depression was rarely mentioned in the literature (Cytryn, 2003; Tisher, 2007). A number of studies and conceptualizations have since reversed this view (Burks & Harrison, 1962; Cytryn, Cytryn, & Rieger, 1967; Glaser, 1967; Kovacs & Beck, 1977; Sandler & Jaffe, 1965; Toolan, 1962). Notably, though, some authors have conceded that childhood depression was often not directly observable. Glaser (1967) and Lesse (1974) argued that depression in childhood was present, but masked by behaviours such as oppositional behaviour, aggressiveness, and bed-wetting, which were sometimes referred to as “depressive equivalents” (also see Cytryn & McNew, 1972; Toolan, 1962). Currently, the existence of childhood depression is widely accepted (Tisher, 2007). Since this evolution in the thinking about childhood affective disorder, a number of assessment instruments have been developed to test for childhood depression. For example, the Children’s Depressive Rating Scale (CDRS, an instrument to be used by clinicians; Poznanski, Cook, & Carroll, 1979), the Children’s Depression Scale (CDS, self- or parent report; Tisher & Lang, 1983), and the Children’s Depression Inventory (CDI, also self-report; Kovacs, 1992). Perhaps the most widely used is the CDI, which was developed as a downward extension of the well-known test for adults, the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). It seems then, that depression has been firmly located in childhood. However, there are a number of weaknesses in the underpinnings of the arguments supporting this contention.

The family as partner in child mental health care: problem perceptions and challenges to collaboration.

Abstract: Objective: The development of the health and social care system has made it increasingly specialized, decentralized and professionalized. Accordingly, demands of efficient approaches to collaboration and integration of services for children, adolescents and their family networks have emerged. The aim of this article is to present and analyze findings from a review of the literature on parents as collaboration partners with professionals.

Clinical Characteristics of Depressed Youths in Child Psychiatry.

Abstract: Objective To describe the clinical characteristics of depressed children and adolescents according to age groups and sex. Methods A retrospective chart review study was conducted on 75 youths aged 6-17 years referred for depressive disorders to child psychiatry in 2002-2003. Descriptive statistics and tests of association were completed to compare boys aged 6-11 years, boys aged 12-17 years and girls aged 12-17 years. Results One out of two youths has repeated a school year. About 60% of depressed boys aged 6-11 years are referred to child psychiatry services for behavioral difficulties and 71% of boys in this age group have a depressive disorder comorbid with disruptive behavior disorder. Adolescent boys and girls are more likely to present internalized symptoms than children. However, suicidal ideation is as widespread in children (71%) as in adolescent population, both boys (72%) and girls (85%). Parent-child relational problems are observed in the majority of the sample with a higher prevalence among adolescent girls. Conclusion : It is as important to assess depressive symptoms and suicidal ideation among young boys with behavioral difficulties as in adolescent boys and girls. Family functioning is important to consider in evaluating and treating youth.

Assessment and Treatment of Pediatric Eating Disorders: A Survey of Physicians and Psychologists

Abstract: █ Abstract Objective: Studies show that primary care clinicians struggle with the assessment and treatment of eating disorders in adults. There are no known studies examining current practices of clinicians with respect to eating disorders in children and adolescents. The following study describes the key practices of primary care clinicians in Ontario, Canada, around the screening, assessment, and treatment of eating disorders in children and adolescents. Method: A 24-item survey was developed to obtain information from family physicians and psychologists about presenting complaints and current practices related to the assessment and treatment of eating disorders. Results: Findings of this study suggest that despite discipline-specific differences, a large proportion of clinicians do not routinely screen for eating disorders, and when eating disorders are assessed and treatment is initiated, family members are not routinely involved in the process. Conclusion: In Ontario, primary care clinicians may benefit from more training and support to better identify and treat children and adolescents with eating disorders. In particular, clinicians may require additional training around screening, multi-informant assessment methods, as well as appropriate therapy techniques.

An international perspective on youth mental health: the role of primary health care and collaborative care models.

Abstract: Mental health problems make a significant contribution to morbidity and mortality in youth worldwide. Suicide is the third highest cause of death in young people and neuropsychiatric disorders, including specifically depression, schizophrenia and alcohol abuse, are the leading cause of disability in young people in all regions (Gore, 2011; Patton et al., 2009; World Health Organization, 2004). If poor mental health during adolescence and early adulthood goes unrecognized, it increases their vulnerability to poor psychological functioning in the immediate and long term, and leads to lost economic productivity and increased costs to society. Yet, in many countries only a small minority of young people with mental health problems are able to access appropriate resources for recognition, support, care and treatment (Morris et al., 2011). Health services for adolescents and youth who are at risk but who do not yet exhibit clinical symptoms are even more inadequate (Knitzer, 2000). The World Health Organization (WHO) urges governments in both high-income and low- and middle-income countries to scale up services for mental health by making available an optimal mix of services comprised of informal community care, primary care services, community mental health services and specialized inpatient facilities (WHO, 2001; 2012). The WHO also emphasizes the critical importance of integrating mental health into general health facilities, moving away from historical models of vertical mental health systems largely relying on psychiatric hospital-based approaches to treatment, which are often ineffective and fraught with human rights violations. It encourages provision of youth mental health care at the primary health care level, close to communities and with young peoples’ active engagement in monitoring the quality of care (WHO and World Organization of Family Doctors, 2008; WHO, 2005). There are many potential advantages of including youth mental health in health care services at the primary health care level. Primary care mental health services facilitate the early identification and treatment of mental disorders and have the potential to dramatically increase and equalize access to care. Primary health care professionals are best placed to adopt holistic and ecological approaches to care which acknowledge the frequent coexistence and close relationship between physical and mental ill health, and ensure the engagement and empowerment of available resources within families, schools and communities. Health workers can establish trusting and long-term relationships with youth and prevent mental health problems by promoting healthy lifestyles, providing anticipatory guidance and offering timely interventions for common behavioural, emotional and social problems. Primary care workers have a knowledge of community resources and health, social and education services, and can better respond to the specific needs of local communities (Kramer & Garralda, 2000). From an economic perspective, primary care services are usually the most affordable option for both users and governments. Primary-care worker-generated referrals are usually more appropriate and better directed, thus minimizing waste of scare financial and human resources. Youth with mental health concerns avoid the indirect costs associated with seeking specialist care in distant locations. Furthermore, mental health services delivered close to communities minimize stigma and discrimination, and foster respect of human rights (WHO and World Organization of Family Doctors, 2008). Research on scaling up mental health services has identified a number of common barriers to mainstreaming youth mental health care into primary care services. They include inadequate skills and competences of primary health care providers to perform mental health promotion, prevention and care tasks, unclear job tasks, and excessive workload (Eaton et al., 2011). Fragmentation of services among diverse levels of the health care system and among different community-based services across sectors (e.g. social, educational, occupational, juvenile justice and rehabilitation services) is another major challenge reported by health professionals in primary care services. As a consequence, youth at risk or with mental disorders encounter difficulties in finding appropriate comprehensive responses to their complex and multi-layered needs. Finally, a low utilization of available services by youth compounds the problem (Osher, 2002). Making available clinical classifications and protocols for the management of mental disorders to primary care providers is not sufficient to overcome the above mentioned barriers or to promote the effective integration of mental health care services and to scale up services for mental health in primary care settings. Increasing evidence from health system research documents that deep transformational changes at the policy level, in health systems organization and management, and training and management of human resources is required (Jenkins & Strathdee, 2000; Kakuma et al., 2011). Among other health system organizational innovations, the adoption of collaborative practices is being proposed as a key ingredient of community-based health care system responses. In collaborative models, general practitioners retain primary responsibility of care but professionals with complementary skills (traditionally mental health professionals) work as part of a package of care, liaising with both patient and health worker to increase the overall effectiveness of care. Collaborative approaches are based on a strong partnership between first line health workers and other professionals with diverse expertise and mandates, who work together to meet users’ needs. They imply task shifting and task sharing among a multidisciplinary team of professionals. Collaborative approaches increase the feasibility of assessment and management of mental disorders by busy health workers in community-based settings, while also promoting provision of good quality and comprehensive mental health care. The adoption of collaborative care models may result in increased service uptake by adolescents and youth, as they tend to prefer receiving care by general health practitioners and in non-specialized (and hence less stigmatizing) health settings (Kramer & Garralda, 2000; Bower, 2002; Bower, Garralda, Kramer, Harrington, & Sibbald, 2001). The WHO recently launched a program—the Mental Health Gap Action Program (mhGAP)—aiming specifically at scaling up mental health services by integrating mental health into primary health care. It adopts a life-cycle approach and targets adolescents and youth, among other age groups (WHO, 2008). The program provides technical guidance for mainstreaming mental health in primary care settings, simple evidence-base guidelines for assessment and management of mental disorders by non-specialist health care providers, and training materials for clinical staff at various levels (WHO, 2010). The implementation of mhGAP at the primary health care level implies the establishment of structured collaboration mechanisms with mental health specialists, schools, social and rehabilitation services. Management tasks of primary care workers include liaising with social services and community resources, providing advice to teachers, and providing skills training to parents. Policy makers, planners, clinical staff and service users are actively engaged in the adaptation of the proposed model to the local context and health system organization. An important preliminary step in the adaptation process is the analysis of available local needs and resources (i.e. community needs, organization of services, available human resources and skills mix), followed by the redefinition of tasks, a planning of appropriate capacity building targeting different cadres and according to specific competence gaps and roles (including the provision of supportive supervision and consultations), and the establishment of a mechanism for collaborative practice. The program is currently being pilot tested in several countries. The evaluation of these demonstration projects will contribute to increase the evidence on outcomes of youth mental health care provision at primary health care settings through collaborative care models.

Attention deficit hyperactivity disorder (ADHD) in children, seasonal photoperiods, nocturnal movements and diurnal agitation.

Abstract: OBJECTIVE: The main purpose of this study was to verify that the shortening photoperiods of winter contribute to increasing the nocturnal and diurnal agitation of children with ADHD and that lengthening photoperiods diminish it. METHOD: To verify this hypothesis we chose a location where daylight times drop drastically in the fall--Edmonton (Canada). The study's sample was fifteen children, varying in age from 7 to 9 years (M=8.13 years old). The participants were divided into two clinical groups and one control group. The first clinical group was made up of five (n=5) children diagnosed with ADHD and treated with psychostimulants. The second clinical group was made up of five (n=5) children with ADHD not treated with psychostimulants. The control group was composed of five (n=5) children showing no signs of ADHD or psychopathologies. The intensity of diurnal agitation linked to ADHD was evaluated by teachers using the French version questionnaire (SWAN-F) at T1 (first day of experiment). The children's nocturnal movements were evaluated using actimetry. Their sleep quality was measured with a sleep agenda. These last two measurements were carried out for five consecutive days when the length of the photoperiod was at its shortest (end of December). The same procedures were repeated at the end of June (T2), when the photoperiod was at its maximum. RESULTS: The principal results support the study's hypothesis and show a significant baseline difference (p=0.008) between the nocturnal motor movements of the ADHD children and those of the control children. CONCLUSIONS: According to these results, this type of research should be reproduced in other Nordic countries and should include a larger sample group of children diagnosed with ADHD. Language: en

Effectiveness of Day Treatment for Disruptive Behaviour Disorders: What is the Long-term Clinical Outcome for Children?

Abstract: OBJECTIVE: The present study investigates the clinical long-term outcomes (2½ to 4 years post-discharge) of children aged 12 and under with a primary diagnosis of a Disruptive Behaviour Disorder (DBD) who attended a short-term day treatment program using best-practice treatment strategies. This study compared children's admission, discharge, and follow-up test scores on standardized measures of behaviour and functioning, as rated by parents. METHOD: Measures of clinical symptoms in the children and parent report of stress were used. To test for treatment effects across time, two repeated-measures ANOVAs were calculated. RESULTS: There was significant treatment change across time points on measures of social problems, externalizing symptoms, levels of aggression, intensity of problems, and symptoms of ADHD. CONCLUSIONS: Children with DBD who attended a short-term day treatment program using best-practice treatment strategies showed significant improvement in their behaviour at home. These improvements were relatively long lasting. The current study lends support to the effectiveness of day treatment and the idea that severe DBD can be treated using multi-modal, intensive, and evidence-based treatment techniques resulting in long-term change. Language: en

Stress and Relief: Parents Attending a Respite Program

Abstract: Objective The objectives of this study were to examine changes in stress among parents of children with special needs in a respite service and consider parental experience of the service. Methods Families who were enrolled in a ten-month centre-based respite program were invited to participate in the evaluation. Change in parent stress, indexed by the Parent Stress Index-Short Form (PSI-SF), was determined. These results were compared with findings from exploratory qualitative interviews with a subset of parents and a small comparison group who also completed the PSI-SF. Results At baseline, 69% of parents (n=45) had high total stress scores on the PSI-SF. No significant improvements were detected on parent stress over time or differences from improvements in the comparison group. In contrast, the subgroup of parents (n=10) who participated in the qualitative interviews described substantial benefits from the respite program including a sense of relief and having time for other activities. Conclusions It is proposed that the respite program may have provided a temporary break to parents thereby bestowing a sense of relief, but was not adequate to impact on more chronic stress patterns, suggesting that these are related but separate constructs and experiences.

Health Information Preference among Youth and Caregivers related to Second-Generation Antipsychotic Treatment.

Abstract: Objective: To determine the health information-seeking preferences of youth with mental health challenges and their caregivers, focusing on health literacy needs related to second-generation antipsychotics (SGAs). Methods: One hundred fifty two youth and 158 caregivers attending outpatient psychiatry clinics at BC Children’ s Hospital between February 2009 and December 2010 completed a SGA health literacy survey. Results: Youth and caregivers placed emphasis on understanding the benefits and side effects of SGA-treatment, along with strategies to prevent potential side effects. While psychiatrists were viewed as a crucial source of information by both groups, pharmacists were an under-utilized resource by youth. Both youth and caregivers preferred brochures from healthcare providers, websites, and support groups to access health information; however, preferences diverged among other activities. Specifically, youth favoured practical, “hands-on” programs such as cooking and exercise classes, whereas caregivers showed greater interest in didactic presentations and conferences. Sex differences were observed in receptiveness towards certain programs and resources. Conclusions: The findings from this study support the inclusion of caregivers and youth of both sexes with mental health conditions in the future development of educational resources related to medications such as SGAs. Health literacy strategies need to be multi-faceted, and utilize mixed methods to ensure broad reach and applicability.

Trichotillomania, bipolar disorder and white matter hyperintensities in a six-year old girl.

Abstract: A six-year-old girl was referred to our child psychiatry outpatient clinic by the Pediatric Neurology Unit with a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) and trichotillomania. She had neither eyebrows nor eyelashes. The clinical picture was of irritability, frequent tantrums, and aggressive behaviour. During the following year she presented several brief episodes of intense mood changes, which typically started with night-time onset trichotillomania and sleep disturbance. The episodes lasted no longer than five days and recurred within one or two months. A diagnosis of pediatric bipolar disorder (BD) was made after the first months of clinical follow-up. An MRI showed focal white matter hyperintensities (WMH) in T2.