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BackgroundIn youth at clinical high-risk for psychosis, elevated cortisol levels predict subsequent onset of psychotic disorder. However, it is unclear whether cortisol alterations are evident at an earlier clinical stage and promote progression of psychosis expression. The present study aimed to address this issue by investigating whether cortisol levels in childhood were associated with the emergence of attenuated psychotic symptoms in early adulthood. In exploratory analyses, we examined whether cortisol and psychosocial stress measures interacted in predicting attenuated psychotic symptoms.MethodsA sample of children (N=109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. Attenuated psychotic symptoms were assessed at T2 using the Prodromal Questionnaire (PQ).ResultsDiurnal cortisol (β = 0.915, 95% CI: 0.062, 1.769) and daily stressors (β = 0.379, 95% CI: 0.034, 0.723) at T1 were independently associated with total PQ scores at T2 after accounting for demographic factors and prior psychopathology. Exploratory analyses indicated a significant interaction between diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081, 1.405), with the highest predicted T2 total PQ scores occurring when both diurnal cortisol and daily stressors were increased.ConclusionsOur findings suggest that daily stressors and elevations in diurnal cortisol in late childhood/early adolescence increases risk for developing attenuated psychotic symptoms. These findings emphasise the importance of assessing environmental and biological risk factors for psychosis during neurodevelopmentally vulnerable time-periods.

Maltreated children are vulnerable to adverse mental health outcomes. Information about how children’s mental health needs vary according to different levels of child protection contact (potentially culminating in out-of-home care [OOHC]) is valuable for the effective provision of services. This study aimed to examine associations between different levels of contact with child protection services before the age of 10 years and self-reported mental health difficulties at age 11 years. Participants (n = 26,960) were drawn from the New South Wales Child Development Study, a multiagency, multigenerational, longitudinal record linkage study that combines administrative records with cross-sectional survey data. We examined associations between four levels of child protection response (non-threshold reports, unsubstantiated reports, substantiated reports, OOHC; each relative to no report) and six domains of self-reported mental health difficulties (including internalising and externalising symptoms, and psychotic-like experiences). All levels of contact with child protection services were associated with increased odds of mental health difficulties in all domains. Children who had been placed in OOHC and children with substantiated reports had the highest odds of reporting clinical levels of mental health difficulties; 48.1% of children with an OOHC placement and 45.6% of those with substantiated child protection reports showed clinical levels of mental health difficulties in at least one domain. Children with child protection reports that were unsubstantiated, or determined not to meet the threshold for risk-of-significant harm, were also at increased risk of mental health difficulties in middle childhood. These findings underscore the importance of early detection and intervention for all children at risk of maltreatment.

Early life exposure to infectious diseases confers risk for adult psychiatric disorders but relatively few human population studies have examined associations with childhood mental disorder. Here we examined the effects of exposure to maternal infection during pregnancy, and child infectious diseases in early childhood (birth to age 4 years), in relation to first mental disorder diagnosis (age 5–13 years). The study sample comprised 71,841 children represented in a population cohort of children in New South Wales, Australia, followed from birth to early adolescence via linkage of administrative registers. Childhood exposure to infectious disease was determined during the prenatal period (i.e., maternal infection during gestation), and in early childhood (between birth and age 4 years) using the NSW Ministry of Health Admitted Patients data collection. Days to first diagnosis with a mental disorder was determined from recorded diagnoses between age 5–13 years in the NSW Ministry of Health's Admitted Patients, Emergency Department and Mental Health Ambulatory data collections. While crude hazard ratios for both prenatal infection and childhood infection exposures indicated significantly earlier diagnosis with mental disorders associated with both of these risk factors, only childhood infection exposure was associated with higher adjusted hazard ratios (aHR) for any diagnoses (aHR = 1.21, 95% CI = 1.11–1.32), externalising disorders (aHR = 1.45, 95% CI 1.18–1.79) and developmental disorders (aHR = 1.82, 95% CI 1.49–2.22) when the effects of maternal and early childhood (age < 5 years) mental disorders were taken into account. Exposure to infectious diseases during early childhood, but not prenatal infection exposure, appears to be associated with earlier diagnosis of mental disorders in childhood.

BACKGROUND: For adults with psychosis, international guidelines recommend individual and family based cognitive behavioural therapy interventions. Recommendations are extended to children and adolescents, based on adult research. It is also recommended that psychological interventions are offered for childhood presentations of psychotic-like or Unusual Experiences (UE), in the absence of a formal diagnosis, when these are Distressing (UEDs). Cognitive models underpinning these interventions require testing in adolescent populations, to further refine therapies. We address this need, by testing for the first time, the application of the adult cognitive model of psychosis to adolescent UEDs. METHODS: We used baseline data from the Coping with Unusual ExperienceS (CUES+) randomised controlled trial for 122 clinically referred adolescents (12-18 years) with self-reported UEDs. Known psychological mechanisms of adult cognitive models of psychosis; negative life events, affect (anxiety and depression), reasoning (jumping to conclusions bias), and schemas were investigated using multiple linear regression models, alongside variables particularly associated with the development and severity of adolescent UEDs and UE type (dissociation, externalising/behavioural problems, managing emotions). RESULTS: The psychological mechanisms of adult cognitive models of psychosis explained 89% of the total variance of adolescent UED severity, F (10, 106) = 99.34, p < .0005, r2 = 0.89, with schemas as the principal significant contributor. Variance explained 40 - 72% across each of the UE types (paranoia, hallucinations, delusions, paranormal thinking and grandiosity). CONCLUSIONS: Findings suggest that the psychological components of adult cognitive models of psychosis, particularly schemas, are also implicated in adolescent UEDs.

There is known to be considerable overlap among the victims and perpetrators of crime. However, the extent of this overlap early in life among children and young adolescents is not clear. We examined the sociodemographic profiles of young people who had early contact with police regarding a criminal incident as a person of interest, victim and/or witness, as well as the patterns of multiple police contact types from birth to 13 years of age. Data were drawn from a longitudinal, population-based sample of 91,631 young people from New South Wales, Australia. Among the 10.6% (n = 9677) of young people who had contact with police, 14.4% (n = 1393) had contact as a person of interest and as a victim and/or witness on two or more separate occasions. The most common first contact type was as a victim/witness, but those children with a first contact as a person of interest were most likely to have at least one further contact. Young people with both types of police contact were younger at first police contact, were more likely to reside in a socioeconomically disadvantaged area, and to be recorded as having an Aboriginal and/or Torres Strait Islander background. Our findings demonstrate that, by 13 years of age, 1 in 10 young people had been in early contact with police and that a minority have contact with the police as both a person of interest and a victim/witness. These young people may represent a particularly disadvantaged group in the community who are likely to be at risk of future adversity, including repeated contact with the criminal justice system.

Children with disabilities are known to have high rates of contact with child protection services. However, little is known about child protection contacts for a broader group of children with special healthcare needs (SHCN; i.e., special needs or other impairments of concern that affect learning). This study examined the characteristics of contact with child protection services (prior to the age of 6 years) for children with SHCN identified at school entry using the 2009 Australian Early Development Census, using administrative data from more than 65,000 children in the New South Wales Child Development Study. Child protection contacts prior to age 6 years were more prevalent among children with SHCN compared with those without; in particular, children with SHCN had higher odds of a history of exposure to neglect and physical abuse, and higher odds of being placed in out-of-home care, compared with their typically developing peers. Understanding the characteristics of child protection contacts among children with SHCN, with consideration of factors that may influence their patterns of contact with these and other human services agencies, will inform the development of appropriate social policy initiatives to fulfil Australia’s obligations under the United Nations Convention on the Rights of the Child.

Parental history of offending and/or mental illness are risk factors for child maltreatment. However, limited research has directly contrasted the role of maternal versus paternal criminal offending or mental health problems in contributing to earlier contact with the child protection system. In this study we examined the relative contributions of these risk factors in relation to the time to the offspring’s first report to child protection services, or first placement in out of home care (OOHC), using administrative records for a population sample of 71,661 children. Prior paternal offending had a greater independent effect on time to the offspring’s first contact with child protection services (HR = 2.27 [95% CI = 2.14-2.40]) than maternal offending (HR = 1.75 [95% CI = 1.63 -1.87]) or maternal mental disorder diagnosis (HR = 1.66 [95% CI = 1.57 -1.77]). By contrast, prior maternal offending (HR = 2.58 [95% CI = 2.26-2.95]) and mental disorder diagnosis (HR = 2.33 [95% CI = 2.05-2.63]) had a greater effect on earlier placement in OOHC, relative to prior paternal offending (HR = 1.59 [95% CI = 1.35 -1.88]) and mental disorder diagnosis (HR = 1.06 [95% CI = 0.94 -1.19]). These findings demonstrate the potential benefits of coordinated government responses across multiple agencies to identify vulnerable children and families who might benefit from early interventions or support services.

Background: Mismatch negativity (MMN) and P3a amplitude reductions are robust abnormalities of sensory information processing in schizophrenia, but they are variably present in different profiles of risk (family history vs. clinical high risk) for the disorder. This study aimed to determine whether these abnormalities characterize children presenting replicated risk factors for schizophrenia, using longitudinal assessment over the ages of 9–16 years in children with multiple replicated antecedents of schizophrenia (ASz) and with family history of schizophrenia (FHx), relative to typically developing (TD) peers. Methods: A total of 105 children (52 female) sampled from the community were assessed at ages 9–12 years and approximately 2 and 4 years later. Linear mixed models were fitted to MMN and P3a peak amplitudes and latencies, with intercept and slope estimates from 32 ASz and 28 FHx children compared with those of 45 TD peers. Results: In ASz relative to TD children, MMN amplitude initially increased and then prominently decreased during adolescence. Both ASz and FHx children had greater P3a amplitude than TD children at 11 years, which decreased with age, in contrast to P3a amplitude increasing during adolescence in TD youths. MMN abnormalities were specific to ASz children who continued to present symptoms during follow-up. Conclusions: Age-dependent MMN and P3a abnormalities demarcate adolescent development of ASz and FHx from TD children, with auditory change detection abnormalities specific to ASz children with continuing symptoms and attention-orienting abnormalities characterizing both ASz and FHx risk profiles. Follow-up is required to determine whether these abnormalities index vulnerability for schizophrenia or an illness nonspecific developmental delay.

Adult psychosocial difficulties, including psychiatric disorders, are often preceded by childhood psychosocial vulnerabilities, presenting critical windows of opportunity for preventative intervention. The present study aimed to identify longitudinal patterns (representing transitions between profiles) of childhood socio-emotional and cognitive vulnerability in the general population from early to middle childhood, in relation to key risk factors (e.g. parental mental illness and offending). Data were drawn from the New South Wales Child Development Study, which combines intergenerational multi-agency administrative records with cross-sectional assessments using data linkage methods. We analysed data from childhood assessments of socio-emotional and cognitive functioning at two time points (ages 5–6 and 10–11 years) that were linked with administrative data from government departments of health, child protection, and education for 19,087 children and their parents. Latent profile analyses were used to identify socio-emotional and cognitive profiles at each time point, and latent transition analyses were used to determine the probability and potential moderators of transition between profiles at each age. Three developmental profiles were identified in early childhood, reflecting typically developing, emotionally vulnerable, and cognitively vulnerable children, respectively; two profiles were identified in middle childhood, reflecting typically developing and vulnerable children. Child’s sex, child protection services contact, parental mental illness, and parental offending influenced children’s transitions between different vulnerability profiles, with the strongest effects for parental mental illness and child protection contact. Early detection of vulnerable children and factors promoting resilience are important steps in directing future health and social policy, and service planning for vulnerable children.

Objectives: To examine associations between being the subject of child protection reports in early childhood and diagnoses of mental disorders during middle childhood, by level of service response. Design, setting, participants: Retrospective analysis of linked New South Wales administrative data, 2001–2016, for a population cohort of children (mean age in 2016, 13.2 years; SD, 0.37 years) enrolled in the longitudinal NSW Child Development Study (NSW-CDS), wave 2 linkage. Main outcome measures: Associations between being the subject of a child protection report (any, and by level of child protection response) during early childhood (birth to 6 years of age) and diagnoses of mental disorders during middle childhood (6–14 years). Results: 13 796 of 74 462 children in the NSW-CDS (18.5%) had been the subjects of reports to child protection services during early childhood: 1148 children had been placed in out-of-home care at least once, and 1680 had been the subjects of substantiated risk-of-significant-harm reports but were not placed in care, while 9161 had non-substantiated reports, and 1807 had reports of facts that did not reach the threshold for significant harm. After adjusting for sex, socio-economic disadvantage, perinatal complications, and parental mental illness, early childhood contact with protection services was associated with increased frequency of being diagnosed with a mental disorder during middle childhood (adjusted odds ratio [aOR], 2.72; 95% CI, 2.51–2.95). The frequency was highest for children who had been placed in out-of-home care (aOR, 5.25; 95% CI, 4.46–6.18). Conclusion: Childhood-onset mental disorders are more frequently diagnosed in children who come to the attention of child protection services during early childhood, particularly in children placed in out-of-home care.

Background: Longitudinal data on health costs associated with physical and mental conditions are not available for children reported to child protection services. Objective: To estimate the costs of hospitalization for physical and mental health conditions by child protection status, including out-of-home-care (OOHC) placement, from birth until 13-years, and to assess the excess costs associated with child protection contact over this period. Participants and setting: Australian population cohort of 79,285 children in a multi-agency linkage study. Methods: Costs of hospitalization were estimated from birth (if available) using Round 17, National Hospital Cost Data Collection (2012-13; deflated to 2015-16 AUD). Records of the state child protection authority determined contact status. Data were reported separately for children in OOHC. Hospital separations were classified as mental disorder-related if the primary diagnosis was recorded in ICD-10 Chapter V (F00-F99). Results: Hospital separations were more common in children with child protection contact. Physical health care costs per child decreased with age for all children, but were significantly higher for children with contact. Mental health costs per child were always significantly higher for children with contact, with marked increases at 3 ≤ 4 years and 8 ≤ 9 years. Point estimates of annual costs per child were always highest for children with an OOHC placement. The net present value of the excess costs was $3,224 per child until 13- years, discounted at 5 %. Conclusions: Children in contact with child protection services show higher rates and costs for physical and mental health hospitalizations in each of their first 13 years of life.

Background: Maltreated children are at risk of poor educational outcomes, but also experience greater individual, family, and neighbourhood adversities that may obscure an understanding of relationships between child protection involvement and educational attainment. Objective: To examine associations between child protection involvement and 3rd- and 5th-grade reading and numeracy attainment, while controlling multiple other adversities. Participants and Setting: Participants were 56,860 Australian children and their parents from the New South Wales Child Development Study with linked multi-agency records. Methods: Multinomial logistic regressions examined associations between level of child protection involvement (Out-Of-Home Care [OOHC] placement; substantiated Risk Of Significant Harm [ROSH]; unsubstantiated ROSH; non-ROSH; and no child protection report) and standardised tests of 3rd- and 5th-grade reading and numeracy. Fully adjusted models controlled demographic, pregnancy, birth, and parental factors, and early (kindergarten) developmental vulnerabilities on literacy and numeracy, and other developmental domains (social, emotional, physical, communication). Results: All children with child protection reports were more likely to attain below average, and less likely to attain above average, 3rd- and 5th-grade reading and numeracy, including children with reports below the ROSH threshold. Children with substantiated ROSH reports who were not removed into care demonstrated the worst educational attainment, with some evidence of protective effects for children in OOHC. Conclusions: A cross-agency response to supporting educational attainment for all children reported to child protection services is required, including targeted services for children in OOHC or with substantiated ROSH reports, and referral of vulnerable families (unsubstantiated and non-ROSH cases) to secondary service organisations (intermediate intervention).

Objectives: Childhood psychotic-like experiences (PLEs) increase risk for concurrent and future psychiatric disorders but are common in the population. Strategies are needed to identify vulnerable individuals who may benefit from monitoring or targeted intervention. This study aimed to delineate profiles of childhood PLEs that might be differentially associated with other psychopathologies, and multiple psychopathology. Design: Cross-sectional, online self-report survey. Methods: Participants were 27,000 Australian children from a population cohort (13,416 girls; mean age 11.91 years) who completed an online self-report questionnaire assessing PLEs (hallucinations and delusions) and Emotional, Peer Relationship, Conduct, and Hyperactivity–Inattention psychopathology. Latent class analysis differentiated classes of children showing different patterns of PLE responses, and multinomial logistic regression determined the association between the PLE classes and the various psychopathologies, adjusted for demographic covariates and the other psychopathologies. Results: Five latent profiles of PLE responses were characterized as follows: None (27.4% of children), Minor (29.7%), Moderate (11.8%), Hallucinatory (21.0%), and Strong (10.2%). These classes showed distinct associations with other psychopathologies (odds ratios between 1.27 and 4.58), and dose–response relationships indicated increasing likelihood of multiple psychopathology for the Hallucinatory and Strong classes (odds ratio = 21.87 for ≥3 psychopathologies in the Strong class). Conclusions: Tailored interventions that address the particular needs of these different classes of individuals may be warranted. Practitioner points: Children aged 11–12 years who report psychotic-like experiences (PLEs) can be classified into five different PLE profiles based on self-reported questionnaire responses, which may reflect different pathological processes. These PLE profiles show different patterns and magnitudes of increa

The 25-item Strengths and Difficulties Questionnaire (SDQ) is a popular screening instrument that assesses childhood psychopathology and prosocial behaviour. While the value of acquiring multi-informant perspectives in the assessment of childhood psychopathology is recognised, the use of the self-report version of the questionnaire is recommended only for children aged 11 years and older. This study aimed to evaluate the psychometric comparability of self-report on the SDQ by children aged 9–10 years relative to children aged 11 years using item response modelling. Item response models were used in a community sample of 7959 children to investigate the structure, item characteristics, and age differences related to self-report by children aged 9–10 years (n = 6004), relative to children aged 11 years (n = 1955), on the SDQ. Internalizing, externalizing, and prosocial factors explained the covariance of the questionnaire items. There were statistically significant age-related differences on only two items (the “worries” and “distractible” items), but these differences were small in magnitude and did not affect the precision of measurement of the SDQ. Self-report by children aged 9 and 10 years on the SDQ is psychometrically comparable to reports by children aged 11 years after controlling for differences in latent severity. This work expands the utility of the self-report SDQ to children aged as young as 9 years.

Contact with the police, as the first contact with the criminal justice system for young people and children, may signify individuals who are vulnerable to later adverse social and health outcomes. However, little is known about how often children have contact with police or for what reason. In this paper, we provide a demographic profile of the prevalence and reasons for police contact among a representative, longitudinal, population-based sample of 91,631 young people in New South Wales, Australia. By 13 years of age, almost one in six (15.6%) children had contact with police as a victim, person of interest and/or witness on at least one occasion. The most common reason for contact with police was in relation to an assault. There was considerable overlap among children who had been in contact with police on more than one occasion for different reasons, with those having police contact as a person of interest or witness being seven times more likely to have also been in contact with police as a victim in a separate incident, than children not known to police. We show that contact with the police is surprisingly common among children and suggest that early interventions for children in contact with police might prevent a range of adverse outcomes not limited to criminal offending.

Premorbid motor dysfunction is one of the earliest of developmental antecedents identified among individuals who develop schizophrenia in adulthood. However, among individuals with schizophrenia, premorbid motor dysfunction is not apparent at all stages of childhood development and may reduce with increasing age. Currently, little is known about the trajectories of motor development during adolescence among youth at-risk for the disorder. One hundred and one participants were assessed repeatedly, at approximately 24-month intervals (time 1, aged 9–12 years; time 2, 11–14 years; and time 3, 13–16 years), on the Purdue Pegboard assessment, comprising four subtests: Dominant Hand (DH), Non-Dominant Hand (NDH), Both Hands (BH), and Assembly. Fine motor and coordination skills development between ages 9–16 years was compared between youth characterised by a triad of developmental antecedents of schizophrenia (ASz, N = 32); youth with at least one affected relative with schizophrenia/schizoaffective disorder (FHx; N = 26); and typically developing youth without antecedents or family history (TD, N = 43). Longitudinal mixed models for repeated measures indicated significant motor skills improvements with age in TD youth on the Assembly subtest only. Relative to TD youth, we found evidence for developmental deficits (i.e., dysfunction that emerged early and remained stable) among ASz youth on DH and BH subtests, and among FHx youth on the Assembly subtest. ASz youth were characterised by a developmental delay on the Assembly subtest (i.e., initial performance decrement in middle childhood that caught up with peers’ performance during adolescence). These divergences from normative motor development may reflect differences in structural and functional neural correlates.

Purpose: Previous research found sustained high levels of mental health service use among adults who experienced bullying victimization during childhood. This could be due to increased psychopathology among this group, but other factors, such as self-perception as having a mental health problem, might contribute to increased service use. Additionally, the relationship between informal help-seeking for mental health problems and bullying victimization is incompletely understood. Methods: The present study examined associations between the frequency of bullying victimization and both formal service use and informal help-seeking for mental health problems independent from psychopathology. Data on bullying victimization, service use, informal help-seeking for mental health problems, psychopathology, and self-labelling as a person with mental illness were collected among 422 young people aged 13–22 years. Results: In logistic regression models, controlling for past and current psychopathology and using no bullying victimization as the reference category, we identified a greater likelihood of mental health service use among persons who experienced frequent bullying victimization, as well as a greater likelihood of seeking informal help among persons who experienced occasional victimization. Increased self-identification as a person with mental illness completely mediated the positive association between frequent bullying victimization and mental health service use. Conclusions: Our findings suggest that services to support persons who experienced frequent bullying victimization should focus on improving empowerment and self-perception. Additionally, there might be unserved need for formal support among those who experienced occasional bullying victimization.

Prior investigations indicate that the five core personality dimensions (the “Big Five”) are measurable by middle childhood. The aim of this research was to examine the psychometric properties of a short-form self-report measure of the Big Five personality dimensions in children that would be suitable for administration online in large population-based studies. Twen-ty-five questionnaire items in English, derived from the 65-item Big Five Questionnaire for Children in Italian (Barbaranelli, Caprara, Rabasca, & Pastorelli, 2003), were completed online by 27,415 Australian children in Year 6 (mean age 11.92 years). An item response theory approach evaluated the psychometric properties and resolved a 20-item short-form questionnaire. Exploratory and confirmatory factor analyses supported the Big Five structure. Construct validity was demonstrated via correlations between Big Five scores and the Strengths and Difficulties Questionnaire subscales (Goodman, 2001). The 20 items provide a brief, reliable, and valid child self-report measure of the Big Five personality dimensions.

Objectives Children whose parents have a history of criminal offending may be at risk of higher rates of emergency department (ED) presentation, along with other adverse health outcomes. We used data from a large, population-based record linkage project to examine the association between maternal and paternal criminal offending and the incidence of ED presentations among child offspring. Methods Data for 72 772 children with linked parental records were drawn from the New South Wales Child Development Study. Information on parental criminal offending (spanning 1994-2016) and child ED presentations (spanning 2005-2016; approximately ages 2-12 years) was obtained from linked administrative records. Cox proportional hazards regression analyses were conducted to examine the association between parental offending and the incidence of children's ED presentations for any reason and for physical injury, while accounting for important covariates. Results Child rates of ED presentation, particularly for physical injury, were higher among those with parental history of criminal offending, after adjusting for covariates. The magnitude of the association was higher for paternal criminal offending (ED presentation for any reason: HR=1.44 (95% CI 1.41 to 1.48); physical injury: HR=1.70 (95% CI 1.65 to 1.75)) than maternal criminal offending (any reason: HR=0.99 (95% CI 0.95 to 1.03); physical injury: HR=1.05 (95% CI 1.00 to 1.10)). Conclusion Children of parents, particularly of fathers, with a history of criminal offending have an increased incidence of ED presentation, including for potentially avoidable physical injury. These findings require replication and further research to understand the mechanisms underlying these associations.

Objective This study examined associations between chronic physical health conditions (identified from hospital records) that are subject to school health care plans, and children’s emotional, behavioral, and social functioning during early (~5 years of age) and middle childhood (~11 years). Methods Participants were 21,304 Australian children from a representative longitudinal population cohort derived by multi-agency record linkage. Hospital presentations (admitted patients and emergency department) identified children with asthma (n = 1,573), allergies and anaphylaxis (n = 738), type 1 diabetes (n = 59), epilepsy (n = 87), and any of these conditions (n = 2,275), relative to 19,029 children without these presentations. Logistic regression analyses determined associations between these exposures and (i) emotional, behavioral, social, and overall vulnerabilities reported by teachers (early childhood) and children (middle childhood), and (ii) self-reported lack of sources of support (middle childhood). Results Prevalence of any condition in hospital records was 7.5% by early childhood, and 10.7% by middle childhood. Relative to peers without these presentations, small increases in risk of overall problems, and selected emotional, behavioral, and social problems, were apparent for children with any condition, and asthma specifically, in early and middle childhood. Large and pervasive effects were apparent for epilepsy, limited small effects in middle childhood only for allergies and anaphylaxis, and no increases in risk associated with type 1 diabetes examined in middle childhood. No condition was associated with increased risk of lacking supports. Conclusions Children with hospital records of chronic conditions, particularly epilepsy and asthma, might benefit from school-based care plans that integrate their physical and mental health support needs.

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Although parental criminal offending is a recognized risk factor for conduct problems among offspring, its impact on the continuity and discontinuity of children’s behavioural and emotional difficulties during the early development is less well known. We used data from a large, population-based record-linkage project to examine the relationship between parental offending and the continuity and discontinuity of children’s conduct, attentional, and emotional difficulties from early to middle childhood while also considering the role of timing of the parental offending exposure. Method: Data for 19,208 children and their parents were drawn from the New South Wales Child Development Study. Multinomial regression analyses tested associations between mother’s and father’s history and timing of any and violent offending, and patterns of continuity or discontinuity in offspring emotional, conduct, and attentional difficulties between ages 5 and 11 years. Results: Maternal and paternal offending each conferred a significantly increased risk of all the patterns of developmental difficulties, including those limited to age 5 only (remitting problems), to age 11 only (incident problems), and to difficulties present at both ages 5 and 11 years (persisting problems). Greatest odds were observed for persisting conduct problems. Paternal offending that continued through early and middle childhood had the greatest association with child difficulties, while the timing of maternal offending had a less prominent effect on child developmental difficulties. Conclusion: Parental offending is a strong risk factor for early and pervasive behavioural and emotional problems in offspring, and may be a key indicator of high risk for later antisocial behaviour.

The intergenerational transmission of criminality is well established. However, few intergenerational studies in Australia have examined the link between parents’ offending and their children’s behaviour. Even fewer have used large enough samples to examine serious maternal offending. This study uses a sample of over 21,000 Australian children and their parents to determine the prevalence and co-occurrence of offending among mothers and fathers, and the relationship between parental offending and children’s conduct problems at age 11. The study found that parental offending increases a child’s likelihood of conduct problems, and the offending most strongly associated with child conduct problems is maternal violent offending. It also found that the intergenerational transmission of antisocial behaviour begins early, highlighting the importance of intervention for at-risk children and programs targeted at mothers as well as fathers.

Background: Childhood maltreatment is associated with early childhood developmental vulnerabilities. However, the extent to which higher levels of child protection responses confer benefit to developmental competencies, and the impact of earlier timing of first reports in relation to early childhood vulnerability remains unclear. Objective: We examined associations between early developmental vulnerabilities and (1) the highest level of child protection response (where OOHC was deemed the highest response among other types of reports/responses), and (2) the developmental timing of the first child protection report. Participants and Setting: Participants included 67,027 children from the New South Wales Child Development Study, of whom 10,944 were reported to child protection services up to age 5 years. Methods: A series of Multinomial Logistic Regressions were conducted to examine focal associations. Results: Children with substantiated maltreatment reports showed the strongest odds of vulnerability on three or more developmental domains (adjusted OR = 4.90; 95% CI = 4.13–5.80); children placed in OOHC showed slightly better physical, cognitive and communication competencies (adjusted ORs from 1.83 to 2.65) than those with substantiated reports that did not result in OOHC placements (adjusted OR from 2.77 to 3.67), when each group was compared to children with no child protection reports. Children with first maltreatment reports occurring in the first 18 months of life showed the strongest likelihood of developmental vulnerabilities on three or more developmental domains (adjusted OR = 3.56; 95% CI = 3.15–4.01) relative to children with no child protection reports. Conclusion: Earlier reports of maltreatment may signal the need for targeted remediation of early developmental competencies to mitigate early developmental difficulties.

Background: Cross-agency administrative data can improve cost-effective triage systems for child protection and other human service delivery. Objective: To determine the minimum set of cross-agency indicators that could accurately classify placement in out-of-home-care (OOHC)before age 13–14 years. Participants and setting: Participants were 72,079 Australian children (mean age = 13.16 years; SD = 0.37; 51.4% male)and their parents, for whom linked administrative records spanning the years 1994–2016 were available for analysis within the ‘New South Wales Child Development Study’. Methods: First, a series of logistic regression analyses were conducted to examine associations between cross-agency (health, justice, education)risk indicators and membership of the sub-cohort of 1239 children who had an OOHC placement prior to age 13–14 years, relative to (1)the sub-cohort of 55,473 children who had no previous contact with child protection services, and (2)the sub-cohort of 15,367 children who had been reported to child protection services but had no record of OOHC placement. We then explored the classification characteristics associated with a smaller combination of risk factors, and the utility of specific familial risk factors, for classifying membership of the OOHC subgroup. Results: A combination of six risk indicators evident before OOHC placement can classify children placed in OOHC with approximately 95% accuracy, and the presence of at least four of these risk indicators provides excellent specificity (99.6%). Conclusions: A combination of risk factors observable in administrative datasets held by multiple government agencies may be used to target support services to prevent entry into OOHC for children from vulnerable families.

Objective: We examined associations between developmental vulnerability profiles determined at the age of 5 years and subsequent childhood mental illness between ages 6 and 13 years in an Australian population cohort. Methods: Intergenerational records from New South Wales (NSW) Government Departments of Health and Child Protection spanning pre-birth to 13 years of age were linked with the 2009 Australian Early Development Census records for 86,668 children. Mental illness indices for children were extracted from health records between 2009 and 2016 (child’s age of 6–13 years). Associations between mental disorder diagnoses and membership of early childhood risk groups, including those with established ‘special needs’ (3777, 4.3%) at school entry, or putative risk classes delineated via latent class analysis of Australian Early Development Census subdomains – referred to as ‘pervasive risk’ (N = 3479; 4.0%), ‘misconduct risk’ (N = 5773; 6.7%) or ‘mild generalised risk’ (N = 9542; 11%) – were estimated using multinomial logistic regression, relative to children showing ‘no risk’ (N = 64,097; 74%). Poisson regression models estimated the relative risk of a greater number of days recorded with mental health service contacts among children in each Australian Early Development Census risk group. Adjusted models included child’s sex, socioeconomic disadvantage, child protection contacts and parental mental illness as covariates. Results: The crude odds of any mental disorder among children aged 6–13 years was increased approximately threefold in children showing pervasive risk or misconduct risk profiles at the age of 5 years, and approximately sevenfold in children with special needs, relative to children showing no risk; patterns of association largely remained after adjusting for covariates. Children with special needs and the misconduct risk class used mental health services over a greater number of days than the no risk class. Conclusion: Patterns of early childhood

This paper describes the development of a brief school-based instrument designed for use in research and in educational practice. The Survey of School Promotion of Emotional and Social Health differentiates states of high, moderate, and low implementation of whole-school policies and practices that promote the emotional and social health of students. The instrument measures the extent to which a school has implemented policies and practices in four health-promoting domains: (a) creating a positive school community, (b) teaching social and emotional skills, (c) engaging the parent community, and (d) supporting students experiencing mental health difficulties. Responses were gathered via an online survey of Principals in almost 600 Australian primary schools in New South Wales. Preliminary psychometric properties of the instrument, and the development of an implementation index using latent class analysis, are described. The final 13-item version of the survey has broad applicability for use by researchers and evaluators for comparative and multivariate analyses. School leadership may find it useful as a brief tool to guide the identification of target areas for whole-school improvement across the four important health-promoting domains.

Background: Fetal exposure to infectious and noninfectious diseases may influence early childhood developmental functioning, on the path to later mental illness. Here, we investigated the effects of in utero exposure to maternal infection and noninfectious diseases during pregnancy on offspring developmental vulnerabilities at age 5 years, in the context of estimated effects for early childhood exposures to infectious and noninfectious diseases and maternal mental illness. Methods: We used population data for 66,045 children from an intergenerational record linkage study (the New South Wales Child Development Study), for whom a cross-sectional assessment of five developmental competencies (physical, social, emotional, cognitive, and communication) was obtained at school entry, using the Australian Early Development Census (AEDC). Child and maternal exposures to infectious or noninfectious diseases were determined from the NSW Ministry of Health Admitted Patients Data Collection (APDC) and maternal mental illness exposure was derived from both APDC and Mental Health Ambulatory Data collections. Multinomial logistic regression analyses were used to examine unadjusted and adjusted associations between these physical and mental health exposures and child developmental vulnerabilities at age 5 years. Results: Among the physical disease exposures, maternal infectious diseases during pregnancy and early childhood infection conferred the largest associations with developmental vulnerabilities at age 5 years; maternal noninfectious illness during pregnancy also retained small but significant associations with developmental vulnerabilities even when adjusted for other physical and mental illness exposures and covariates known to be associated with early childhood development (e.g., child's sex, socioeconomic disadvantage, young maternal age, prenatal smoking). Among all exposures examined, maternal mental illness first diagnosed prior to childbirth conferred the greatest odds

© Copyright 2018, Mary Ann Liebert, Inc. Though the positive association between a connection to the natural environment and well-being is well established, few studies have examined this association in children, and none have explored whether this relationship remains when accounting for other factors that affect well-being, such as social supports, attention, and empathic skills. The current study aims to address this gap. Data are drawn from the New South Wales Child Development Study (NSW-CDS) and comprise a representative sample of 26,848 children who completed a self-report survey of mental health and well-being when aged approximately 11 years. Multiple regression analysis indicated that, after adjusting for covariates (i.e., social supports, empathy, attention, socioeconomic status, and sex), connection to nature was positively, albeit weakly, associated with two indicators of well-being: self-satisfaction and prosocial behavior. Social supports had the strongest relationship with self-satisfaction, while empathy had the strongest relationship with prosocial behavior. Based on our findings, and that of previous research, we suggest that developing a connection to nature can slightly improve well-being and may complement or augment other well-being and education-based programs. Future research should examine whether the relationship between connection to nature and well-being is influenced by proximity to green spaces, experiences of nature, and age.

This study examined the structure of the Best Start Kindergarten Assessment (Best Start) of literacy and numeracy, with the aim of confirming a two-factor measure of attainment at school entry comparable in structure to standardised measures of literacy and numeracy administered in later school years. Administrative data from the 2009 Best Start were obtained from the New South Wales Department of Education for 37,734 children aged ∼5 years (i.e. as they entered their first year of compulsory schooling) as part of the New South Wales Child Development Study. Exploratory and confirmatory factor analyses were performed on the 11 Best Start scales using a split half methodology, with the findings supporting a two-factor solution underpinning literacy and numeracy attainment. The availability of this two-factor Best Start measure of literacy and numeracy at school entry, which precedes the repeated national assessments conducted later in the primary and high school years, facilitates research to examine pathways of academic performance over time.

Background: Among adults with schizophrenia, evidence suggests that premorbid deficits in different cognitive domains follow distinct developmental courses during childhood and adolescence. The aim of this study was to delineate trajectories of adolescent cognitive functions prospectively among different groups of youth at-risk for schizophrenia, relative to their typically developing (TD) peers. Method: Using linear mixed models adjusted for sex, ethnicity, parental occupation and practice effects, cognitive development between ages 9 and 16 years was compared for youth characterised by a triad of well-replicated developmental antecedents of schizophrenia (ASz; N = 32) and youth with a least one affected relative with schizophrenia or schizoaffective disorder (FHx; N = 29), relative to TD youth (N = 45). Participants completed measures of IQ, scholastic achievement, memory and executive function at three time-points, separated by approximately 24-month intervals. Results: Compared to TD youth, both ASz and FHx youth displayed stable developmental deficits in verbal working memory and inhibition/switching executive functions. ASz youth additionally presented with stable deficits in measures of vocabulary (IQ), word reading, numerical operations, and category fluency executive function, and a slower rate of growth (developmental lag) on spelling from 9 to 16 years than TD peers. Conversely, faster rates of growth relative to TD peers (developmental delay) were observed on visual and verbal memory, and on category fluency executive function (ASz youth only) and on matrix reasoning (IQ) and word reading (FHx youth only). Conclusions: These differential patterns of deviation from normative adolescent cognitive development among at-risk youth imply potential for cognitive rehabilitation targeting of specific cognitive deficits at different developmental phases.

Background: Maternal smoking during pregnancy and parental offending are both linked to adverse offspring outcomes. Few studies have examined how these exposures together influence diverse offspring outcomes in early childhood. Aims: To examine associations between quantity of prenatal maternal smoking and frequency of maternal offending and offspring behavioural and cognitive outcomes at age 5 years. Methods: Over 66,000 Australian children (mean age 5.6 years) were drawn from an intergenerational data linkage study. Unadjusted and adjusted logistic regressions were conducted for the two key exposures (maternal prenatal smoking and mother having at least two criminal convictions) and offspring behavioural and cognitive vulnerabilities. Population attributable fractions (PAFs) were also estimated for each outcome for the two exposures. Results: Prenatal smoking and maternal offending were, separately and together, associated with most of the developmental vulnerabilities examined, even after adjusting for other familial and prenatal risk factors. PAFs for prenatal smoking ranged from 5.3% to 15.8%, and PAFs for maternal offending ranged from 3.4% to 11.8% across the offspring outcomes. Conclusions: Maternal smoking during pregnancy and maternal offending were uniquely associated with a range of offspring vulnerabilities, but mothers who smoked during pregnancy tended to experience multiple problems that should also be considered as indicators of child vulnerabilities. While early behavioural difficulties were evident in these children, it was striking that they were also likely to have cognitive vulnerabilities. Early intervention to support cognitive development in these children may minimise their risk of academic underachievement, long-term disadvantage, and even offending.

Background The intergenerational risk for mental illness is well established within diagnostic categories, but the risk is unlikely to respect diagnostic boundaries and may be reflected more broadly in early life vulnerabilities. We aimed to establish patterns of association between externalising and internalising vulnerabilities in early childhood and parental mental disorder across the full spectrum of diagnoses.Methods A cohort of Australian children (n = 69 116) entering the first year of school in 2009 were assessed using the Australian Early Development Census, providing measures of externalising and internalising vulnerability. Parental psychiatric diagnostic status was determined utilising record-linkage to administrative health datasets.Results Parental mental illness, across diagnostic categories, was associated with all child externalising and internalising domains of vulnerability. There was little evidence to support interaction by parental or offspring sex.Conclusions These findings have important implications for informing early identification and intervention strategies in high-risk offspring and for research into the causes of mental illness. There may be benefits to focusing less on diagnostic categories in both cases.

This study examined associations between maltreatment and early developmental vulnerabilities in a population sample of 68,459 children (Mage = 5.62 years, SD =.37) drawn from the Australian state of New South Wales, using linked administrative data for the children and their parents (collected 2001–2009). Associations were estimated between (a) any maltreatment, (b) the number of maltreatment types, and (c) the timing of first reported maltreatment and vulnerability and risk status on multiple developmental domains (i.e., physical, social, emotional, cognitive, and communication). Pervasive associations were revealed between maltreatment and all developmental domains; children exposed to two or more maltreatment types, and with first maltreatment reported after 3 years of age, showed greater likelihood of vulnerability on multiple domains, relative to nonmaltreated children.

Background: Childhood 'unusual experiences' (such as hearing voices that others cannot, or suspicions of being followed) are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS). Unusual experiences that are distressing or have adverse life impact (UEDs) are associated with a range of current and future emotional, behavioural and mental health difficulties. Recommendations for psychological intervention are based on evidence from adult studies, with some support from small, pilot, child-specific evaluations. Research is needed to ensure that the recommendations suit children as well as adults. The CUES+ study (Coping with Unusual ExperienceS for 12-18 year olds) aims to find out whether cognitive behaviour therapy for UEDs (CBT-UED) is a helpful and cost-effective addition to usual community care for 12-18 year olds presenting to United Kingdom National Health Service Child and Adolescent Mental Health Services in four London boroughs. Methods: The CUES+ study is a randomised controlled trial comparing CBT-UED plus routine care to routine care alone. CBT-UED comprises up to 16 sessions, including up to 12 individual and up to four family support meetings, each lasting around 45-60min, delivered weekly. The primary outcome is emotional distress. Secondary outcomes are change in UEDs, risk events (self-harm, attendance at emergency services, other adverse events) and health economic outcomes. Participants will be randomised in a 1:1 ratio after baseline assessment. Randomisation will be stratified by borough and by severity of mental health presentation: 'severe' (an identified psychotic or bipolar disorder) or any 'other' condition. Outcomes will be assessed by a trained assessor blind to treatment condition at 0, 16 and 24weeks. Recruitment began in February, 2015 and is ongoing until the end of March, 2017. Discussion: The CUES+ study will contribute to the curren

© 2017, The Royal Australian and New Zealand College of Psychiatrists 2017. Objective: Detecting the early emergence of childhood risk for adult mental disorders may lead to interventions for reducing subsequent burden of these disorders. We set out to determine classes of children who may be at risk for later mental disorder on the basis of early patterns of development in a population cohort, and associated exposures gleaned from linked administrative records obtained within the New South Wales Child Development Study. Methods: Intergenerational records from government departments of health, education, justice and child protection were linked with the Australian Early Development Census for a state population cohort of 67,353 children approximately 5 years of age. We used binary data from 16 subdomains of the Australian Early Development Census to determine classes of children with shared patterns of Australian Early Development Census–defined vulnerability using latent class analysis. Covariates, which included demographic features (sex, socioeconomic status) and exposure to child maltreatment, parental mental illness, parental criminal offending and perinatal adversities (i.e. birth complications, smoking during pregnancy, low birth weight), were examined hierarchically within latent class analysis models. Results: Four classes were identified, reflecting putative risk states for mental disorders: (1) disrespectful and aggressive/hyperactive behaviour, labelled ‘misconduct risk’ (N = 4368; 6.5%); (2) ‘pervasive risk’ (N = 2668; 4.0%); (3) ‘mild generalised risk’ (N = 7822; 11.6%); and (4) ‘no risk’ (N = 52,495; 77.9%). The odds of membership in putative risk groups (relative to the no risk group) were greater among children from backgrounds of child maltreatment, parental history of mental illness, parental history of criminal offending, socioeconomic disadvantage and perinatal adversities, with distinguishable patterns of association for some covariates. Conclu

© 2017, Springer-Verlag Berlin Heidelberg. Purpose: To examine the impact of parental criminal offending, both paternal and maternal, on offspring aggression at age 5 years, while also considering key risk factors, including parental mental illness, child’s sex, and socioeconomic disadvantage. Methods: The sample comprised 69,116 children, with linked parental information, from the New South Wales Child Development Study, a population-based multi-agency, multi-generational record linkage study that combines information from a teacher-reported cross-sectional survey of early childhood development at age 5 years (the 2009 Australian Early Development Census; AEDC) with data obtained via administrative records from multiple sources (e.g., health, crime, education, and welfare). Hierarchical logistic regression analyses were conducted to determine the effects of maternal and paternal criminal court appearances (frequency and type of offending), and mental health service contacts, on offspring aggression measured in the AEDC. Results: Having a parent with a history of offending was significantly associated with high levels of offspring aggression in early childhood. The strength of association was greatest when parents were involved in frequent (≥6 offences: adjusted odds ratio [aOR] range = 1.55–1.73) and violent (aOR range = 1.49–1.63) offending. Both maternal and paternal offending remained significant predictors of offspring aggression after accounting for parental mental illness, and associations were similar in magnitude for maternal and paternal offending histories. Conclusions: Parental history of severe criminal offending increased the risk of high levels of aggression in offspring during early childhood, highlighting the need for intervention with families during this key developmental period.

Background: Parental criminal offending is an established risk factor for offending among offspring, but little evidence is available indicating the impact of offending on early childhood functioning. We used data from a large Australian population cohort to determine associations between exposure to parental offending and a range of developmental outcomes at age 5 years. Method: Multi-generation data in 66 477 children and their parents from the New South Wales Child Development Study were combined using data linkage. Logistic and multinomial regressions tested associations between any and violent offending histories of parents (fathers, mothers, or both parents) obtained from official records, and multiple measures of early childhood developmental functioning (social, emotional-behavioural, cognitive, communication and physical domains) obtained from the teacher-reported 2009 Australian Early Development Census. Results: Parental offending conferred significantly increased risk of vulnerability on all domains, particularly the cognitive domain. Greater risk magnitudes were observed for offending by both parents and by mothers than by fathers, and for violent than for any offending. For all parental offending exposures, vulnerability on multiple domains (where medium to large effects were observed) was more likely than on a single domain (small to medium effects). Relationships remained significant and of comparable magnitude following adjustment for sociodemographic covariates. Conclusions: The effect of parental offending on early childhood developmental outcomes is pervasive, with the strongest effects on functioning apparent when both parents engage in violent offending. Supporting affected families in early childhood might mitigate both early developmental vulnerability and the propensity for later delinquency among these offspring.

Purpose The Middle Childhood Survey (MCS) was designed as a computerised self-report assessment of children's mental health and well-being at approximately 11 years of age, conducted with a population cohort of 87 026 children being studied longitudinally within the New South Wales (NSW) Child Development Study. Participants School Principals provided written consent for teachers to administer the MCS in class to year 6 students at 829 NSW schools (35.0% of eligible schools). Parent or child opt-outs from participation were received for 4.3% of children, and MCS data obtained from 27 808 children (mean age 11.5 years, SD 0.5; 49.5% female), representing 85.9% of students at participating schools. Findings to date Demographic characteristics of participating schools and children are representative of the NSW population. Children completed items measuring Social Integration, Prosocial Behaviour, Peer Relationship Problems, Supportive Relationships (at Home, School and in the Community), Empathy, Emotional Symptoms, Conduct Problems, Aggression, Attention, Inhibitory Control, Hyperactivity-Inattention, Total Difficulties (internalising and externalising psychopathology), Perceptual Sensitivity, Psychotic-Like Experiences, Personality, Self-esteem, Daytime Sleepiness and Connection to Nature. Distributions of responses on each item and construct demarcate competencies and vulnerabilities within the population: most children report mental health and well-being, but the population distribution spanned the full range of possible scores on every construct. Future plans Multiagency, intergenerational linkage of the MCS data with health, education, child protection, justice and early childhood development records took place late in 2016. Linked data were used to elucidate patterns of risk and protection across early and middle child development, and these data will provide a foundation for future record linkages in the cohort that will track mental and physical health, social

Background. Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined. Method. This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathways to care (i.e. processes associated with help-seeking and health service contact) among people experiencing first-episode psychosis or at clinically defined increased risk of developing psychotic disorder. Forty studies were identified through searches of electronic databases (CINAHL, EMBASE, Medline, PsycINFO, Sociological Abstracts) from 1996 to 2016, supplemented by reference searches and expert consultations. Data synthesis involved thematic analysis of qualitative findings, narrative synthesis of quantitative findings, and a meta-synthesis combining these results. Results. The meta-synthesis identified six themes in relation to stigma on pathways to care among the target population: 'sense of difference', 'characterizing difference negatively', 'negative reactions (anticipated and experienced)', 'strategies', 'lack of knowledge and understanding', and 'service-related factors'. This synthesis constitutes a comprehensive overview of the current evidence regarding stigma and pathways to care at early stages of psychotic disorders, and illustrates the complex manner in which stigma-related processes can influence help-seeking and service contact among first-episode psychosis and at-risk groups. Conclusions. Our findings can serve as a foundation for future research in the area, and inform early intervention efforts and approaches to mitigate stigma-related concerns that currently influence recognition of early difficulties and contribute to delayed help-seeking and access to care.

© 2017 Elevated C-reactive protein (CRP), a non-specific biomarker of systemic bodily inflammation, has been associated with more pronounced cognitive impairments in adults with psychiatric disorders, particularly in the domains of memory and executive function. Whether this association is present in early life (i.e., the time at which the cognitive impairments that characterise these disorders become evident), and is specific to those with emerging psychiatric disorders, has yet to be investigated. To this end, we examined the association between salivary CRP and cognitive function in children aged 11–14 years and explored the moderating effect of psychopathology. The study utilised data from an established longitudinal investigation of children recruited from the community (N = 107) that had purposively over-sampled individuals experiencing psychopathology (determined using questionnaires). CRP was measured in saliva samples and participants completed assessments of cognition (memory and executive function) and psychopathology (internalising and externalising symptoms and psychotic-like experiences). Linear regression models indicated that higher salivary CRP was associated with poorer letter fluency (β = −0.24, p = 0.006) and scores on the inhibition (β = −0.28, p = 0.004) and inhibition/switching (β = −0.36, p < 0.001) subtests of the colour-word interference test, but not with performance on any of the memory tasks (working, visual, and verbal memory tasks). Results were largely unchanged after adjustment for psychopathology and no significant interactions between CRP and psychopathology were observed on any cognitive measure. Our findings provide preliminary evidence that elevated salivary CRP is associated with poorer cognitive function in early life, but that this association is not moderated by concurrent psychopathology. These findings have implications for early intervention strategies that attempt to ameliorate cognitive deficits associated with emerging

© 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) Aim: Childhood infectious diseases can be associated with later physical and psychological ill health, and the effects of this association may be evident during early childhood development. This study aimed to examine the effects of hospitalisation for early life infection on early childhood development. Methods: Hospital admission data for infection were obtained from the New South Wales Ministry of Health Admitted Patient Data Collection for 87 026 children, for whom the Australian Early Development Census (AEDC) was completed in their first year of formal schooling (age approximately 5 years). The AEDC provides estimates of each child's level of functioning on five domains of development spanning social and emotional skills, communication skills, numeracy and literacy and physical health. Multinomial logistic regressions were used to determine the relationship between exposure to hospital admissions for infectious disease prior to age 4 years and vulnerability on the AEDC. Models were adjusted for the effects of potential confounding factors related to the perinatal period, exposure to maltreatment and family characteristics. Results: Single and multiple hospitalisation(s) for infections were consistently associated with increased likelihood of being developmentally vulnerable on all AEDC domains, with odds ratios ranging from 1.02 to 1.28, after adjustment for confounding factors. Conclusions: This study demonstrates a pervasive effect of early life infections that require hospital admission on multiple aspects of early child development, even after adjustment for potential confounding factors. Relatively, severe infection during early childhood constitutes a risk factor for developmental vulnerability by the time of entry to school.

Purpose: The London Child Health and Development Study (CHADS) is a prospective, longitudinal investigation of children, sampled from the general community aged 9–11 years and assessed biennially, who present premorbid risk markers for schizophrenia. The study aims to characterise developmental trajectories of psychological, cognitive, and biological functioning in at-risk children and identify potential targets for early preventative intervention. This review summarises CHADS findings, discusses these in the context of recent theory regarding aetiology and prevention of schizophrenia, and highlights challenges to be addressed with future research. Methods: We review (1) epidemiological information on the prevalence and correlates of developmental antecedents of schizophrenia in the general child population, (2) evidence of psychosocial, cognitive, and biological dysfunctions in at-risk children presenting multiple antecedents of schizophrenia and at-risk children with a family history of schizophrenia, and (3) related findings from an associated sample of help-seeking children receiving intervention. Results: Community-based screening of 9–11-year olds identified ~9 % with a triad of antecedents of schizophrenia [including psychotic-like experiences (PLEs)] who are putatively at-risk of psychosis; these children reported greater exposure and responsivity to stressors, impairments in general intelligence and specific cognitive functions, brain structure and function abnormalities, and neuromotor dysfunction. Preliminary evidence suggests distressing PLEs are a viable target for cognitive-behavioural intervention in at-risk children. Conclusions: Intervention in early, premorbid phases of illness might alleviate current difficulties and avert future schizophrenia using benign treatments. The CHADS programme has identified several markers that may index early pathophysiology and constitute potential targets for preventative intervention.

Purpose: The initial aim of this multiagency, multigenerational record linkage study is to identify childhood profiles of developmental vulnerability and resilience, and to identify the determinants of these profiles. The eventual aim is to identify risk and protective factors for later childhood-onset and adolescent-onset mental health problems, and other adverse social outcomes, using subsequent waves of record linkage. The research will assist in informing the development of public policy and intervention guidelines to help prevent or mitigate adverse longterm health and social outcomes. Participants: The study comprises a population cohort of 87 026 children in the Australian State of New South Wales (NSW). The cohort was defined by entry into the first year of full-time schooling in NSW in 2009, at which time class teachers completed the Australian Early Development Census (AEDC) on each child (with 99.7% coverage in NSW). The AEDC data have been linked to the children's birth, health, school and child protection records for the period from birth to school entry, and to the health and criminal records of their parents, as well as mortality databases. Findings to date: Descriptive data summarising sex, geographic and socioeconomic distributions, and linkage rates for the various administrative databases are presented. Child data are summarised, and the mental health and criminal records data of the children's parents are provided. Future plans: In 2015, at age 11 years, a self-report mental health survey was administered to the cohort in collaboration with government, independent and Catholic primary school sectors. A second record linkage, spanning birth to age 11 years, will be undertaken to link this survey data with the aforementioned administrative databases. This will enable a further identification of putative risk and protective factors for adverse mental health and other outcomes in adolescence, which can then be tested in subsequent record linkages.

Adolescent internalizing and externalizing psychopathology is strongly associated with adult psychiatric morbidity, including psychotic disorders. This study examined whether internalizing or externalizing trajectories (continuity/discontinuity of symptoms) from middle childhood were associated with adolescent psychotic-like experiences (PLEs). Prospective data were collected from a community sample of 553 children (mean age = 10.4 years; 50% male) and their primary caregivers. Participants completed questionnaire reports of internalizing and externalizing psychopathology and PLEs at baseline, and again approximately 2 years later. Logistic regression was used to examine the association of adolescent PLEs with four trajectories of internalizing and externalizing psychopathology (persistent, incident, remitting, and none), controlling for a range of potential confounders and sampling bias. Significant associations were identified between adolescent PLEs and the incident internalizing (adjusted odds ratio [adj. OR] = 2.96; 95% confidence interval [CI] = 1.60-5.49) and externalizing psychopathology (adj. OR = 2.14; 95% CI = 1.11-4.14) trajectories, as well as the persistent internalizing (adj. OR = 1.90; 95% CI = 1.13-3.18) and externalizing (adj. OR = 1.81, 95% CI = 1.02-3.19) trajectories. Children with remitting psychopathology trajectories were no more likely to present later PLEs than those who never experienced psychopathology. While for many individuals symptoms and illness remit during development without intervention, this study provides important insights regarding potential targets and timing for delivery of early intervention and prevention programs.