Recent Submissions

  • The feasibility of a strategy for the remote recruitment, consenting and assessment of recent referrals: a protocol for phase 1 of the On-Line Parent Training for the Initial Management of ADHD referrals (OPTIMA)

    Daley, David; French, Blandine; Glazebrook, Cris; Groom, Madeleine J.; Hall, Charlotte L.; Sayal, Kapil (2022)
    BACKGROUND: In the UK, children with high levels of hyperactivity, impulsivity and inattention referred to clinical services with possible attention-deficit/hyperactivity disorder (ADHD) often wait a long time for specialist diagnostic assessment. Parent training (PT) has the potential to support parents during this difficult period, especially regarding the management of challenging and disruptive behaviours that often accompany ADHD. However, traditional face-to-face PT is costly and difficult to organise in a timely way. We have created a low-cost, easily accessible PT programme delivered via a phone app, Structured E-Parenting Support (STEPS), to address this problem. The overall OPTIMA programme will evaluate the efficacy and cost-effectiveness of STEPS as a way of helping parents manage their children behaviour while on the waitlist. To ensure the timely and efficient evaluation of STEPS in OPTIMA, we have worked with children's health services to implement a remote strategy for recruitment, screening and assessment of recently referred families. Part of this strategy is incorporated into routine clinical practice and part is OPTIMA specific. Here, we present the protocol for Phase 1 of OPTIMA-a study of the feasibility of this remote strategy, as a basis for a large-scale STEPS randomised controlled trial (RCT). METHODS: This is a single arm observational feasibility study. Participants will be parents of up to 100 children aged 5-11 years with high levels of hyperactivity/impulsivity, inattention and challenging behaviour who are waiting for assessment in one of five UK child and adolescent mental health or behavioural services. Recruitment, consenting and data collection will occur remotely. The primary outcome will be the rate at which the families, who meet inclusion criteria, agree in principle to take part in a full STEPS RCT. Secondary outcomes include acceptability of remote consenting and online data collection procedures; the feasibility of collecting teacher data remotely within the required timeframe, and technical difficulties with completing online questionnaires. All parents in the study will receive access to STEPS. DISCUSSION: Establishing the feasibility of our remote recruitment, consenting and assessment strategy is a pre-requisite for the full trial of OPTIMA. It can also provide a model for future trials conducted remotely.
  • Conduct disorders in children and adolescents

    Baker, Karen (2016)
    Conduct disorders in children and adolescents are the most common mental health difficulty presenting to child health professionals. A working knowledge of these conditions is helpful for all health professionals dealing with children. This review describes their prevalence and aetiology, as well as relevant evidenced-based interventions crucial to successful management.
  • A comparison of adults with antisocial personality traits with and without childhood conduct disorder

    Perdikouri, Marianna; Huband, Nick (2007)
    Background: Antisocial personality disorder (ASPD) in DSM-IV is unique among personality disorder diagnoses in requiring the individual to satisfy a number of childhood criteria in addition to relevant traits exhibited in adulthood. We examined the validity of this childhood requirement.; Methods: Personality disordered individuals assessed using the International Personality Disorder Examination and exhibiting a sufficient number of adult antisocial traits to meet criterion A of DSM-IV were subdivided into those who exhibited antisocial traits in both adulthood and childhood and those who had such traits in adulthood only. The two groups were then compared on a number of historical, clinical, and self-report measures.; Results: Thirty individuals meeting both childhood and adult criteria (ASPD) were compared with 39 meeting adult antisocial criteria only (ASS). Few differences were found between the two groups on the measures examined, although those in the ASPD group appeared more severe and had higher anger scores on the STAXI-2 psychometric test.; Conclusions: This failure to find clinically important differences between the two groups is in agreement with previous reports and needs to be taken into account in future revisions of ASPD in DSM.;
  • The relationship between childhood conduct disorder and adult antisocial behavior is partially mediated by early-onset alcohol abuse

    Khalifa, Najat; Duggan, Conor; Howard, Richard C. (2012)
    Early-onset alcohol abuse (EOAA) was previously found to both mediate and moderate the effect of childhood conduct disorder (CD) on adult antisocial behavior (ASB) in an American community sample of young adults (Howard, R., Finn, P. R., Gallagher, J., & Jose, P. (2011). Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behavior. Journal of Forensic Psychiatry and Psychology. Advance online publication. doi:10.1080/14789949.2011.641996). This study tested whether this result would generalize to a British forensic sample comprising 100 male forensic patients with confirmed personality disorder. Results confirmed that those in whom EOAA co-occurred with CD showed the highest level of personality pathology, particularly Cluster B traits and antisocial/borderline comorbidity. Those with co-occurring CD with EOAA, compared with those showing only CD, showed more violence in their criminal history and greater recreational drug use. Regression analysis showed that both EOAA and CD predicted adult ASB when covariates were controlled. Further analysis showed that EOAA significantly mediated but did not moderate the effect of CD on ASB. The failure to demonstrate an exacerbating effect of EOAA on the relationship between CD and ASB likely reflects the high prevalence of CD in this forensic sample. Some implications of these findings are discussed.
  • Conduct disorders in children and adolescents

    Baker, Karen (2013)
    Conduct disorders in children and adolescents are the most common mental health difficulty presenting to child health professionals. This review describes their prevalence and aetiology, as well as relevant evidenced-based interventions crucial to successful management. © 2012 Elsevier Ltd.
  • Use of services and associated costs for young adults with childhood hyperactivity/conduct problems: 20-year follow-up

    Sayal, Kapil (2014)
    BACKGROUND: Although childhood hyperactivity and conduct problems are associated with difficulties in adulthood, little is known about later service use or public expenditure costs in the UK. AIMS: To describe the use of services and calculate recent (past 6 months) and early adulthood (since the age of 18 years) public expenditure costs incurred by young adults who had hyperactivity and/or conduct problems during childhood. METHOD: A 20-year follow-up of a community sample of 6- to 7-year-old boys (n = 83) with hyperactivity only, conduct problems only, mixed hyperactivity and conduct problems, and no behaviour problems (control). Information was obtained about service use; recent (past 6 months), and early adulthood (since age 18 years) public expenditure costs were calculated. METHOD: A 20-year follow-up of a community sample of 6- to 7-year-old boys (n = 83) with hyperactivity only, conduct problems only, mixed hyperactivity and conduct problems, and no behaviour problems (control). Information was obtained about service use; recent (past 6 months), and early adulthood (since age 18 years) public expenditure costs were calculated. RESULTS: High levels of childhood conduct problems were associated with a two- to threefold increase in early adulthood costs, mainly driven by criminal justice contacts. Although the mixed problems group had the highest recent costs in terms of receipt of benefits and health and social care, they had the lowest criminal justice costs. CONCLUSIONS: High levels of early childhood conduct problems are particularly associated with increased health, social care and criminal justice costs in adulthood.Copyright Royal College of Psychiatrists.
  • Children of parents with substance abuse disorders had higher rates of conduct disorder and substance use

    Baldwin, Laurence (1999)
    [commentary on Merikangas KR, Dierker LC, Szatmari P. Psychopathology among offspring of parents with substance abuse and/or anxiety disorders: A high-risk study. J CHILD PSYCHOL PSYCHIAT 1998 Jul;39:711-20]Question: Are parental substance abuse and anxiety disorders risk factors for psychopathology in offspring? Design: Cohort study. Setting: New Haven, Connecticut USA. Participants: 192 children (mean age 12 y, 51% boys) of 123 white parents (mean age 39 y). There were 77 children of 52 parents with substance abuse disorders, 58 children of 36 parents with anxiety disorders, and 57 children of 35 parents with no history of psychiatric disorders (control group parents). Parents were recruited from alcohol, drug, anxiety, and general treatment settings or by a random procedure. Exclusion criteria were organic mental impairment, schizoaffective disorder, or schizophrenia. Assessment of risk factors: Both parents of each child were independently interviewed for substance abuse and anxiety disorders using the Schedule for Affective Disorders and Schizophrenia, modified to include criteria from the Diagnostic and Statistical Manual of Mental Disorders 3rd edition, revised. Main outcome measures: Diagnoses of psychiatric disorders (modified Kiddie-Schedule for Affective Disorders and Schizophrenia) were assigned by a blinded psychologist who conducted interviews with the child and with the mother. Data on social adjustment and overall functioning (Child Global Assessment Scale, CGAS), smoking (>/=1-2 times/wk), drug use (>/= 1 time), and alcohol use (>/= 1 time) were also collected. Main results: The table summarises the results. No group differences existed for anxiety or affective disorders in children. Children of parents with substance abuse disorders had higher rates of conduct disorder than children of parents with anxiety disorders or with no psychiatric history, and lower overall functioning scores than children of parents with no psychiatric history (p < 0.01). Children of parents with substance abuse disorders and children of parents with anxiety disorders had higher rates of smoking than children of parents with no psychiatric history. Rate of drug use was highest in children of parents with substance abuse disorders, lower in children of parents with anxiety disorders, and lowest in children of control group parents; and a similar non-significant trend was shown for the rate of alcohol use. Conclusion: Children of parents with substance abuse disorders had higher rates of conduct disorder, smoking, and drug use and lower overall functioning than children of parents with no history of psychiatric disorders.