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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 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).

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.

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.

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 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.

Objectives Health care guidelines recommend psychological interventions for childhood unusual experiences that are associated with distress or adverse functional impact (UEDs), based on adult, rather than child-specific, evidence. We report the first randomized controlled evaluation of the acceptability and potential clinical utility of cognitive behavioural therapy for childhood UEDs (CBT-UED). Design Pilot randomized controlled trial. Methods Participants aged 8–14 years were recruited from referrals to community services for children with emotional/behavioural problems and screened for self-reported UEDs. Results Of around 1,000 referrals over 36 months, 304 (30%) were identified to the research team, 174 (57%) were successfully contacted, 110 (63%) consented to screening, 96 (87%) attended a screening assessment, and 51 (53%) reported UEDs. Forty-nine (96%) consented to randomization to either CBT-UED (9–12 weekly sessions of 40–50 min, adjunctive to usual care, n = 24) or treatment-as-usual/waitlist control (TAU/WL, n = 25). Childhood internalizing emotional symptoms (e.g., feeling ‘nervous’/'scared’/’tearful’/’worried’/'sick’; proposed primary outcome), UEDs, depression, anxiety, and childhood psychopathology (secondary outcomes) were measured at baseline, at 12 weeks, and, where therapy was ongoing but incomplete (

Out-of-school suspension is associated with adverse educational, justice, health, and welfare outcomes. Little research has focussed on suspensions from primary (elementary) school, despite early exclusions representing high-risk events for poor outcomes. This study aimed to identify early life predictors of primary school suspensions in a sample of 34,855 Australian children using linked education, health, child protection, and justice records for children and their parents. Associations between 26 sociodemographic, pregnancy/birth, child, and parent factors (measured prior to 3rd grade) and subsequent suspensions, issued during the 3rd through 6th grades (ages ~8–11 years), were examined in bivariate and multivariable logistic regressions. In the fully adjusted model, 18 factors were associated with suspension, with the largest effects for male gender, child protection services contacts, and aggressive behaviour. Identification of students at risk of early suspension using multi-sector information available at school entry may assist educators and policymakers to deliver preventative interventions.

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 45–60 min, 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 24 weeks. Recruitment began in February, 2015 and is ongoing until the end of March, 2017. Discussion The CUES+ study will contribute to the currently limited child-specific evidence base for psychological interventions for UEDs occurring in the context of psychosis or any other mental health presentation. Trial registration International Standard Randomised Controlled Trials, ID: ISRCTN21802136. Prospectively registered on 12 January 2015. Protocol V3 31 August 2015 with screening amended. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2326-4) contains supplementary material, which is available to authorized users.

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. Conclusion: Patterns of early childhood developmental vulnerabilities may provide useful indicators for particular mental disorder outcomes in later life, although their predictive utility in this respect remains to be established in longitudinal follow-up of the cohort.

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: 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. Funding: QUT Project 2018001348 (ARC FT170100294)

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.

Psychotic-like experiences (PLEs) are perceptual and thought disturbances that, although common among children, increase risk for future psychopathology, particularly if persistent. Clinical interviews are too time-consuming and costly to administer at a population level, but the criterion validity of a brief questionnaire for screening community samples of children as young as 9 years for PLEs has not been established. This study aimed to test the criterion (concurrent and predictive) validity of the Psychotic-Like Experiences Questionnaire for Children (PLEQ-C). The PLEQ-C (9-item self- and 10-item parent-report versions) was administered to 139 children aged 9–12 years and their caregivers recruited from Greater London, UK. Children additionally completed a diagnostic interview assessing hallucinations and delusions and three further PLEQ-C assessments at approximately 24-month intervals. Concordance of child- and caregiver-reports of PLEs on questionnaire (PLE-Q) was low. Self-reports of any PLE-Q demonstrated good sensitivity (73.3%), specificity (78.5%), positive and negative predictive values (PPV: 72.1%; NPV: 79.5%) for any PLE determined by interview (PLE-I), whereas caregiver-reports of any PLE-Q performed poorly (sensitivity 51.7%, specificity 78.5%, PPV 64.6%, NPV 68.1%). Multinomial regression analyses indicated that children reporting any PLE-Q at screening were at significantly increased risk of reporting PLEs on multiple assessments during adolescence relative to no PLEs, closely replicating the pattern and magnitude of effects (large-to-very large) obtained for children with any PLE-I. The PLEQ-C offers a valid, brief, feasible, and cost-effective means of community screening to identify children who present with PLEs and could be assessed with clinical interview.

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 increased risk for other types of psychopathology, and multiple psychopathology, suggesting that they present different treatment needs. Cross-sectional investigation of the associations between PLE profiles and other psychopathologies limits any conclusions as to the causal direction of these relationships. Multi-informant reports of psychopathology were unavailable.

This cohort study examines the behavioral, developmental, and other factors underlying the first exposure of school-aged children to the criminal justice system in Australia., Key Points Question Are children with mental health problems that were identified at school entry at greater risk of police contact for any reason, ie, as a person of interest, survivor of crime, or witness? Findings In this cohort study of 79 801 children followed up from their first year of full-time schooling to 13 years of age, the incidence of early police contact was twice the rate in children with teacher-assessed emotional or behavioral problems at school entry compared with those without such problems. The elevated incidence rates were found for police contact as a person of interest, survivor of crime, or witness. Meaning Results of this study suggest that the association between mental illness and increased risk of criminal justice system contact in adulthood and adolescence extends to early childhood., Importance In adulthood and adolescence, mental health vulnerability is known to be associated with risk of criminal justice system contact as both a perpetrator and survivor of crime, but whether this association is apparent early in child development is unknown. Prevention of poor outcomes, including repeated contact with the criminal justice system, relies on the identification of vulnerability early in life and at the start of such contact. Objective To ascertain whether children with emotional or behavioral problems and general developmental vulnerabilities are at an increased risk of subsequent contact with police as a person of interest, a survivor of crime, or a witness. Design, Setting, and Participants This cohort study used routinely collected data from the New South Wales Child Development Study in Australia. The cohort was composed of children who entered full-time schooling in New South Wales in 2009, had complete data for the emotional maturity domain of the Australian Early Development Census, and had no police contact before January 1, 2009. The children in the cohort were followed up until the age of 13 years. Data were analyzed from October 17, 2019, to May 13, 2020. Exposures Emotional or behavioral problems and developmental risk profiles derived from the teacher-rated Australian Early Development Census. Main Outcomes and Measures Incidence rates of police contact (as a person of interest, survivor of crime, or witness) were derived from the New South Wales Police Force Computerised Operational Policing System. Results A total of 79 801 children (40 584 boys [50.9%]; 2009 mean [SD] age, 5.2 [0.37] years) were included. Children with teacher-identified emotional or behavioral problems at school entry had an incidence rate of police contact (for any reason) that was twice that of children without such problems (unadjusted hazard ratio [HR], 2.14; 95% CI, 1.94-2.37). Contact with police as a survivor of crime was most commonly recorded (7350 [9.2%]), but the strength of the association was greatest between emotional or behavioral problems and police contact as a person of interest (unadjusted HR, 4.75; 95% CI, 3.64-6.19). Incidence of police contact as a person of interest was high for children with a pervasive developmental risk profile (unadjusted HR, 13.80; 95% CI, 9.79-19.45). Conclusions and Relevance This study found an association of emerging emotional or behavioral problems and developmental vulnerabilities with increased risk of police contact for any reason among young children, suggesting that this well-known association in adults and adolescents can be identified at an earlier developmental stage. These findings support primary and secondary interventions to prevent police contact early in life and to target the earliest contacts with the criminal justice and educational systems.

BackgroundParental 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.MethodMulti-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.ResultsParental 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.ConclusionsThe 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.

Highlights • We determined the extent of gender-specific intergenerational antisocial behavior. • Gender-specific associations were not larger than associations across-gender. • The largest associations were between mothers' and daughters' antisocial behavior.

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.

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.

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 developmental vulnerability are associated with subsequent onset of mental disorders and have the potential to inform interventions to mitigate the risk for mental disorders in later childhood and adolescence.

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. Twenty-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. Read More: https://guilfordjournals.com/doi/10.1521/pedi_2018_32_380

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. 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. 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. 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.

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.

Increasing evidence suggests that the intergenerational transmission of antisocial behaviour begins from the earliest childhood developmental periods. This chapter presents findings on the role of parental offending on offspring developmental vulnerability in early childhood. Data were drawn from the New South Wales Child Development Study, a large Australian population-based, multi-agency, intergenerational study that utilises administrative record linkage of data from multiple sources (i.e., criminal justice, health, welfare, and education). The present chapter focuses on the associations between parental criminal offending and offspring outcomes at age 5 years as measured by the Australian Early Development Census (AEDC). The AEDC is a teacher-reported cross-sectional assessment that captured 99.9 per cent (N = 87,026) of the eligible New South Wales children entering kindergarten in the state of New South Wales in 2009, indexing early childhood developmental functioning across five domains (physical health and wellbeing, social competence, emotional maturity, language and cognitive development, and communication and general knowledge). Results showed that both maternal and paternal offending were associated with offspring vulnerability on all five of the AEDC domains as well as on the aggression subdomain, even after accounting for other important risk factors (e.g., child sex, socio-economic disadvantage). Findings suggest that the effects of parental offending may be pervasive in early childhood, with multiple developmental outcomes affected, especially cognitive functioning. A second record linkage was conducted in 2016 to bring data up to age 12 years for the children, and we plan to conduct follow-up studies with the cohort into adulthood using successive waves of record linkage.

The New South Wales Child Development Study (NSW-CDS) was established to enable a life course epidemiological approach to identifying risk and protective factors for childhood and adolescent-onset mental health problems, and other adverse outcomes (e.g. educational underachievement, welfare dependence, criminality). The study methodology entails repeated waves of record linkage for a population of Australian children in the state of NSW, funded by competitive funding awards (see Funding), and conducted in partnership with multiple NSW government departments. Table 1 summarizes the study phases (waves of record linkage) and measurements...

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 of developmental vulnerability at age 5 years. Conclusions Prenatal exposure to infectious or noninfectious diseases appear to influence early childhood physical, social, emotional and cognitive developmental vulnerabilities that may represent intermediate phenotypes for subsequent mental disorders.

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.

BackgroundThe 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.MethodsA 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.ResultsParental 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.ConclusionsThese 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 (M-age=5.62years, 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. Refereed/Peer-reviewed

Background: 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. Methods: Item response models were used in a community sample of 7,959 children to investigate the structure, item characteristics, and age differences related to self-report by children aged 9-10 years (n=6,004), relative to children aged 11 years (n=1,955), on the SDQ. Results: 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. Conclusions: 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.

BackgroundPituitary volume enlargements have been observed among individuals with first-episode psychosis. These abnormalities are suggestive of hypothalamic–pituitary–adrenal (HPA) axis hyperactivity, which may contribute to the development of psychosis. However, the extent to which these abnormalities characterize individuals at elevated risk for schizophrenia prior to illness onset is currently unclear, as volume increases, decreases and no volume differences have all been reported relative to controls. The current study aimed to determine whether antipsychotic-naive, putatively at-risk children who present multiple antecedents of schizophrenia (ASz) or a family history of illness (FHx) show pituitary volume abnormalities relative to typically developing (TD) children. An additional aim was to explore the association between pituitary volume and experiences of psychosocial stress.MethodASz (n = 30), FHx (n = 22) and TD (n = 32) children were identified at age 9–12 years using a novel community-screening procedure or as relatives of individuals with schizophrenia. Measures of pituitary volume and psychosocial stress were obtained at age 11–14 years.ResultsNeither ASz nor FHx children showed differences in pituitary volume relative to TD children. Among FHx children only, pituitary volume was negatively associated with current distress relating to negative life events and exposure to physical punishment.ConclusionsThe lack of pituitary volume abnormalities among ASz and FHx children is consistent with our previous work demonstrating that these children are not characterized by elevated diurnal cortisol levels. The findings imply that these biological markers of HPA axis hyperactivity, observed in some older samples of high-risk individuals, may emerge later, more proximally to disease onset.

Health care guidelines recommend psychological interventions for childhood unusual experiences that are associated with distress or adverse functional impact (UEDs), based on adult, rather than child-specific, evidence. We report the first randomized controlled evaluation of the acceptability and potential clinical utility of cognitive behavioural therapy for childhood UEDs (CBT-UED).Pilot randomized controlled trial.Participants aged 8-14 years were recruited from referrals to community services for children with emotional/behavioural problems and screened for self-reported UEDs.Of around 1,000 referrals over 36 months, 304 (30%) were identified to the research team, 174 (57%) were successfully contacted, 110 (63%) consented to screening, 96 (87%) attended a screening assessment, and 51 (53%) reported UEDs. Forty-nine (96%) consented to randomization to either CBT-UED (9-12 weekly sessions of 40-50 min, adjunctive to usual care, n = 24) or treatment-as-usual/waitlist control (TAU/WL, n = 25). Childhood internalizing emotional symptoms (e.g., feeling 'nervous'/'scared'/'tearful'/'worried'/'sick'; proposed primary outcome), UEDs, depression, anxiety, and childhood psychopathology (secondary outcomes) were measured at baseline, at 12 weeks, and, where therapy was ongoing but incomplete (12 sessions) at 12 weeks, at end-of-treatment (EOT). Twenty-two CBT-UED participants (92%) attended ≥5 sessions. Forty-four participants (90%) completed 12-week assessments (CBT-UED, n = 21/24, 88%; TAU/WL, n = 23/25, 92%). Preliminary findings were encouraging for emotional symptoms and UEDs, but otherwise mixed.Retention, screening, and consent rates were as anticipated; recruitment took longer than planned. Trial procedures were acceptable to young people, their families, and clinicians. Therapy exceeded 12 weeks, but was well-received, with no serious adverse events attributed to participation. Further evaluation is needed.Around half of 8- to 14-year-olds in Child and Adolescent Mental Health Services reported distressing unusual experiences. An age-adapted cognitive behavioural intervention appears feasible, and safe to deliver, with the potential to augment standard care. This is a pilot study, and further evaluation is needed. Longer term outcomes should be a focus of future evaluation.

The interrelationship between stigma and help-seeking is under-researched among children and adolescents. This study explored stigma in relation to pathways to care among young people putatively in an early stage of increased risk of developing psychotic disorders. “Pathways to care” was defined as help-seeking and support from informal and formal resources, and increased risk was determined through the presence of persistent psychotic-like experiences and internalizing/externalizing psychopathology. Twenty-nine qualitative interviews were analyzed using thematic analysis. We defined the superordinate theme in these data as “conditional disclosure,” a concept reflecting the rules and prerequisites that influenced how/whether participants sought help. Through parallels between these findings and established stigma theory, we examined how these conditions could be interpreted as influenced by stigma. Our findings demonstrate the influence of stigma on young people’s perceptions of a range of pre-clinical symptoms, and on how they seek support for these symptoms.

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 and educational/occupational outcomes into adolescence and early adulthood. Refereed/Peer-reviewed

Background Individuals with established psychosis are characterised by a distinct pattern of hypothalamic-pituitary-adrenal (HPA) axis dysfunctions which include both elevated daytime cortisol levels and a blunted cortisol awakening response (CAR). Whilst these patterns of dysfunction have also been observed among those at elevated risk for the disorder, longitudinal studies are scarce. As such, the relevance of these HPA axis abnormalities for the progression of psychopathology in high-risk populations is unknown. Utilising data from a well-characterised, longitudinal cohort of youth at elevated risk for schizophrenia and their typically-developing peers (The Child Health and Development Study), we aimed to investigate the extent to which HPA axis function determined in childhood is a significant predictor of putative prodromal status and psychopathology in late adolescence/early adulthood. Methods The sample comprised high-risk individuals who presented either multiple antecedents of schizophrenia (developmental delays, psychopathology, and psychotic-like experiences: ASz=21) or a family history of illness (FHx=13), and typically-developing youth with neither antecedents nor a family history (TD=36). Participants were recruited at age 9–12 years using a community screening method and assessed biennially throughout adolescence. At the age 11–14 years assessment phase, participants collected salivary cortisol samples in their home environment which were used to determine diurnal cortisol secretion and the CAR. At the age 17–21 years assessment phase, participants completed measures of prodromal symptoms (Prodromal Questionnaire: PQ), depression (Quick Inventory of Depressive Symptomatology questionnaire: QIDS), and anxiety (Social Interaction Anxiety Scale: SIAS). Established PQ thresholds were used to identify participants who met probable prodromal status. Logistic and linear regression analyses were used to examine the extent to which salivary cortisol measures at age 11–14 years predicted probable prodromal status and continuous psychopathology measures at 17–21 years, respectively. Results Relative to the TD group, ASz youth were characterised by higher depression (B=0.24, p=0.05) and disorganised symptoms (B=0.36, p=0.007) at 17–21 years whilst FHx youth obtained higher scores on the PQ general symptoms scale (B=0.24, p=0.048). Analyses performed in the total sample indicated that the CAR was negatively associated with depression symptoms (B=-0.28, p=0.006) and PQ negative symptoms (B=-0.30, p=0.004) at age 17–21 years. Positive associations were observed between diurnal cortisol and positive (B=0.41, p=0.02), disorganised (B=0.30, p=0.04), and general (B=0.29, p=0.03) PQ symptoms. Diurnal cortisol levels were also significantly associated with probable prodromal status at follow-up (OR=1.04, p=0.04). No significant interactions were observed between group status and salivary cortisol levels in any model. After adjustment for potential confounders (age, follow-up time, sex, BMI, and pubertal status), the CAR continued to show significant associations with both depression (p=0.006) and PQ negative symptoms (p=0.007) whilst only a statistical trend was observed for the relationship between diurnal cortisol levels and positive symptoms (p=0.055). Discussion The current study is the first to examine the extent to which HPA axis function can predict development of prodromal symptoms in a high-risk cohort. Our finding that more abnormal HPA axis function (i.e., a decreased CAR and higher diurnal cortisol) at age 11–14 years is associated with both prodromal and depression symptoms at age 17–21 has important implications for aetiological theories and for clinical practice.

Social withdrawal is a robust childhood risk factor for later schizophrenia. The aims of this paper were to assess the evidence for childhood social withdrawal among adults with schizophrenia and, comparatively, in children aged 9-14 years who are putatively at-risk of developing schizophrenia. We conducted a meta-analysis, including cohort and case-control studies reporting social withdrawal measured by the Child Behavior Checklist (CBCL) in adults with schizophrenia vs. controls. Further, an experimental study compared CBCL withdrawal scores from typically-developing children with scores from two groups of putatively at-risk children: (i) children displaying a triad of replicated antecedents for schizophrenia, and (ii) children with at least one first- or second-degree relative with schizophrenia or schizoaffective disorder. Six studies met inclusion criteria for the meta-analysis (N = 3828), which demonstrated a large effect of increased childhood social withdrawal in adults with schizophrenia (standardized mean difference [SMD] score = 1.035, 95% CI = 0.304-1.766, p = 0.006), with no indication of publication bias, but considerable heterogeneity (I(2) = 91%). Results from the experimental study also indicated a large effect of increased social withdrawal in children displaying the antecedent triad (SMD = 0.743, p = 0.001), and a weaker effect in children with a family history of schizophrenia (SMD = 0.442, p = 0.051). Childhood social withdrawal may constitute a vulnerability marker for schizophrenia in the presence of other antecedents and/or genetic risk factors for schizophrenia.

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.

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. Refereed/Peer-reviewed

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 long-term 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. Refereed/Peer-reviewed

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 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 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.

Aims.Childhood maltreatment and a family history of a schizophrenia spectrum disorder (SSD) are each associated with social-emotional dysfunction in childhood. Both are also strong risk factors for adult SSDs, and social-emotional dysfunction in childhood may be an antecedent of these disorders. We used data from a large Australian population cohort to determine the independent and moderating effects of maltreatment and parental SSDs on early childhood social-emotional functioning.Methods.The New South Wales Child Development Study combines intergenerational multi-agency data using record linkage methods. Multiple measures of social-emotional functioning (social competency, prosocial/helping behaviour, anxious/fearful behaviour; aggressive behaviour, and hyperactivity/inattention) on 69 116 kindergarten children (age ~5 years) were linked with government records of child maltreatment and parental presentations to health services for SSD. Multivariable analyses investigated the association between maltreatment and social-emotional functioning, adjusting for demographic variables and parental SSD history, in the population sample and in sub-cohorts exposed and not exposed to parental SSD history. We also examined the association of parental SSD history and social-emotional functioning, adjusting for demographic variables and maltreatment.Results.Medium-sized associations were identified between maltreatment and poor social competency, aggressive behaviour and hyperactivity/inattention; small associations were revealed between maltreatment and poor prosocial/helping and anxious/fearful behaviours. These associations did not differ greatly when adjusted for parental SSD, and were greater in magnitude among children with no history of parental SSD. Small associations between parental SSD and poor social-emotional functioning remained after adjusting for demographic variables and maltreatment.Conclusions.Childhood maltreatment and history of parental SSD are associated independently with poor early childhood social-emotional functioning, with the impact of exposure to maltreatment on social-emotional functioning in early childhood of greater magnitude than that observed for parental SSDs. The impact of maltreatment was reduced in the context of parental SSDs. The influence of parental SSDs on later outcomes of maltreated children may become more apparent during adolescence and young adulthood when overt symptoms of SSD are likely to emerge. Early intervention to strengthen childhood social-emotional functioning might mitigate the impact of maltreatment, and potentially also avert future psychopathology.

Background: Over half of children in the general population report unusual or “psychotic-like” experiences (PLEs). The development of a later at-risk mental state is associated with persistent, distressing, PLEs, which are appraised negatively and hard to cope with. We have designed a novel, manualized, cognitive behavioural intervention for children aged 9 to 14 years, which aims to reduce emotional problems, improve coping and resilience, and help children manage PLEs, before an identifiable psychosis risk develops. We report on the feasibility, acceptability and clinical impact of the intervention. Method: Four children who reported PLEs and emotional problems in a community survey completed the intervention, and gave detailed feedback. Clinical outcomes were assessed before, during, and after therapy. Results: Emotional problems, PLE frequency, and PLE impact all decreased during the intervention. Child and therapist satisfaction with the treatment was high. Conclusions: It is feasible, acceptable and helpful to offer psychological interventions to children who report emotional distress and PLEs, prior to the emergence of clear risk factors. Our intervention has the potential to increase resilience to the development of future mental health problems. A larger, randomized controlled evaluation is underway.

Background Latent liability for schizophrenia (schizotypy) is expressed in various combinations of cognitive, psychological, and behavioural characteristics evident in the general population. Historical models propose that distinct classes of individuals expressing different forms of schizotypy may represent manifestations of differential levels of genetic and environmental risk for schizophrenia (or related illness). However, there has been little investigation of developmental models of schizotypy in childhood. Here, we sought to delineate latent profiles of schizotypy among children aged 11–12 years, and to examine associations between emerging schizotypal profiles and parental history of mental illness (as a proxy for genetic risk), early life trauma, and childhood contact with health services for mental illness up to age 13 years. Methods Latent profiles of schizotypy were distinguished among 22,137 children (mean age=11.9 years) for whom intergenerational records of health service contact for mental illness and child protection reports were linked to the Middle Childhood Survey (MCS) within the NSW Child Development Study.1 Selected MCS items were used to index schizotypy across six domains (Unusual Experiences, Cognitive Disorganisation, Impulsive Non-conformity, Introversion, Dysphoria and Self-Other disturbance). Using Latent Profile Analyses (LPA), four groups emerged according to patterns of expression across these domains; membership of three putative schizotypy groups were examined in relation to the likelihood of being exposed to childhood maltreatment and parental mental illness, and the child’s own mental illness up to age 13 years, relative to the no risk group. Results Four classes emerged from the LPA: (1) ‘schizotypy’ (n=1323; 6%); (2) ‘dysphoric pseudo-schizotypy’ (n=4261, 19%); (3) ‘introverted pseudo-schizotypy’ (n=4473; 20%) and; (4) ‘no psychopathology’ (no-risk, n=12,080; 55%). Children in the schizotypy group had the greatest odds of being the subject of a child protection report (OR=2.9, 95% CI 2.6–3.3) and in contact with health services for mental illness by age 13 years (OR=2.7, 95% CI 2.2–3.3), relative to the no-risk group. The odds of child protection reports and childhood mental disorders were smaller, yet significantly increased, among dysphoric pseudo-schizotypy (ORs=1.9 and 1.8, respectively) and introverted pseudo-schizotypy (ORs=1.7 and 1.4, respectively), relative to the no-risk group. Parental mental illness exposure was greatest among the schizotypy (OR=2.3, 95% CI 2.0–2.6) subgroup, and was also increased in dysphoric pseudo-schizotypy (OR=1.6, 95% CI 1.5–1.8) and introverted pseudo-schizotypy (OR=1.4, 95% CI 1.3–1.5), relative to the no-risk group. Discussion We provide evidence for distinct subtypes of children expressing different forms of schizotypy among a large Australian sample from the general population. The subgroup of children labeled ‘schizotypy’ (6%) characterized by high levels of cognitive disorganisation, impulsive non-conformity, introversion, and self-other disturbance may be at highest risk for developing schizophrenia or other mental illness in adulthood, and had a greater likelihood of childhood maltreatment and parental mental illness history, than other ‘pseudo-schizotypy’ groups. Reference 1. Carr, V.J., Harris, F., Raudino, A., Luo, L., Kariuki, M., Liu, E., Tzoumakis, S., Smith, M., Holbrook, A., Bore, M., Brinkman, S.A., Lenroot, R.K., Dix, K., Dean, K., Laurens, K.R., Green, M.J. (2016) Cohort Profile: The New South Wales Child Development Study (NSW-CDS) – An Australian multi-agency, multi-generational, longitudinal record linkage study. 6:e009023 doi:10.1136/bmjopen-2015–009023.

Background Much anti-stigma work suggests that reducing stigma and improving mental health literacy could also improve access to care and support for people with psychotic disorders. This is important given that increasing help-seeking, especially during the early stages of psychosis could reduce the substantial delays to care experienced by people with psychotic disorders. Little is known about levels of personal stigma and mental health literacy among young people at-risk of psychotic disorders, whether there are differences between young people with and without elevated risk for psychosis and how this is associated with actual help-seeking for individuals at-risk of developing psychotic disorders. Methods We interviewed participants from two existing, ongoing prospective cohorts in the UK and in Brazil. Participants were initially recruited from primary schools. Both samples represent enriched community cohorts (including a greater than average proportion of young people at risk of developing psychotic disorders) in Greater London (n=407) and a similar cohort of young people in Brazil (n=1,500). Participants were presented a vignette depicting a young person with early psychosis symptoms and asked about: recognition of the disorder; intended help-seeking; beliefs about interventions and prevention, stigmatising attitudes and whether they knew someone with a similar problem. We also collected detailed clinical data on psychiatric symptoms (via SDQ [Strengths and Difficulties Questionnaire] in the UK and DAWBA [Development and Well-Being Assessment] in Brazil), presence of psychotic-like experiences, and use of mental health services and personal experiences of seeking support for a mental disorder. Results Findings on the relationship between personal stigma and mental health literacy in relation to psychotic disorders, intended help-seeking and actual mental health service use, will be presented among young people with and without risk of developing psychotic disorders in the UK and Brazil. Discussion Reducing personal stigma and improving mental health literacy among young people at risk of psychosis who do not yet use clinical services could be important for future help-seeking. Future research should investigate the impact of anti-stigma interventions among young people with and without risk of developing psychotic disorders and how this facilitates help-seeking and support for this vulnerable group.

Background Stigma and discrimination are proposed as critical factors contributing to the underuse of mental health services amongst young people, however these influences remain understudied. Existing research on stigma experienced by young people has focused on individuals in contact with mental health services or with a psychiatric diagnosis. Using a community sample, this study investigates subjective accounts of stigma during the early stages of mental health difficulties with regards to how disclosure and coping are considered, and how help-seeking is approached. Methods In-depth semi-structured individual interviews were conducted with young people from a Greater London, UK, community cohort. Purposive sampling criteria were used to recruit participants who reported early psychopathology of a persisting nature (emotional and/or behavioural difficulties at a clinical level, and psychotic-like symptoms), thus representing young people at-risk of developing psychiatric disorder. 29 young people aged 12-18 years took part in the study. Thematic analysis was used to analyse the interview data. Results In-depth semi-structured individual interviews were conducted with young people from a Greater London, UK, community cohort. Purposive sampling criteria were used to recruit participants who reported early psychopathology of a persisting nature (emotional and/or behavioural difficulties at a clinical level, and psychotic-like symptoms), thus representing young people at-risk of developing psychiatric disorder. 29 young people aged 12-18 years took part in the study. Thematic analysis was used to analyse the interview data. Discussion “Conditional disclosure” is central to how young people cope with their difficulties. Often stigma-related concerns in particular contributed to restricted disclosure, in this way delaying young people’s initial help-seeking when difficulties emerge.

Background The extent to which poor academic achievement is associated with later schizophrenia is unclear. The aim of the present study was to update our prior meta-analyses which examined academic achievement in youth aged 16 years or younger who later developed schizophrenia or schizophrenia spectrum disorders (SSD) and those who did not (Dickson et al, 2012, Psychological Medicine, 42, 743–755). We also conducted a new meta-analysis on published studies that reported on general academic achievement in youth at-risk for schizophrenia/SSD aged 16 years or younger compared to typically developing youth Methods In addition to the five studies included in our earlier meta-analyses, a further three prospective investigations of birth or genetic high-risk cohorts were identified that reported results using objective measures of general academic achievement and of mathematics achievement for individuals who did and did not develop schizophrenia/SSD in adulthood. For our new meta-analysis we identified a total of seven studies that met the following inclusion criteria: (1) written in English; (2) objective measure of general academic achievement consisting of scores on least two core academic subjects (i.e., literacy and mathematics) at age 16 years or younger; (3) results provided for youth at high risk for developing schizophrenia/SSD in adulthood by virtue of having at least one first-degree relative with the disorder or reporting psychotic like-experiences (PLEs); and (4) sufficient data to calculate effect sizes. Results Meta-analyses showed that by age 16 years, individuals who later developed schizophrenia/SSD presented with significantly poorer general academic achievement (d=-0.26) and mathematics achievement (d=-0.21). Findings also indicated that during adolescence, youth with a family history of schizophrenia/SSD and youth reporting PLES were characterised by significantly lower general academic achievement than healthy peers (d=-0.39; d=-0.53, respectively). Discussion These results show that poor academic achievement precedes illness onset, and may represent an easily identifiable non-specific marker of biological, psychological and social risk processes underpinning the development of schizophrenia/SSD.

Background Intervention aimed at preventing schizophrenia may be most effective if targeted at specific, but modifiable, functional impairments that present during childhood. We have developed a novel method of screening community samples aged 9 to 12 years to identify children who present a triad of putative antecedents of schizophrenia (ASz), defined as 1) speech and/or motor development lags/problems; 2) internalizing, externalizing, and/or peer-relationship problems in the clinical range; and 3) psychotic-like experiences. This study examined whether ASz children display brain function abnormalities during error processing that are similar to those exhibited by adults with schizophrenia. Methods Twenty-two ASz children and 26 typically developing (TD) children with no antecedents of schizophrenia completed an error-inducing Go/NoGo task during event-related potential recording. Group differences were examined in the amplitude and latency of four event-related potential components: the initial error-related negativity (ERN) and later error-positivity (Pe) elicited on false-alarm responses to NoGo trials, and the corresponding initial correct response negativity (CRN) and later correct response positivity (Pc) elicited during processing of correct responses to Go trials. Results Relative to TD children, ASz children were characterized by reduced ERN amplitude but unaffected CRN, Pe, and Pc amplitudes. No group differences were observed in the latency of any component. Conclusions Children presenting a triad of putative antecedents of schizophrenia show error-processing dysfunction mimicking that observed in adults with schizophrenia using the same Go/NoGo paradigm. The ASz children displayed specific early error-processing deficits rather than a generalized deficit in self-monitoring.

Numerous studies have described attenuated event-related potential (ERP) component amplitudes in schizophrenia (e.g., P300, Mismatch Negativity (MMN), Error Negativity/Error-Related Negativity (Ne/ERN)). Functional magnetic resonance imaging (fMRI) studies have typically shown decreased recruitment of diverse brain areas during performance of tasks that elicit the above ERP components. Recent research suggests that phase-resetting of slow-oscillations (e.g., in the delta and theta bands) underlies the potentials observed in ERP averages. Several studies have reported that slow-oscillations are increased in amplitude in people with schizophrenia at rest. Few studies have examined event-related low-frequency oscillations in schizophrenia. We examined event-related evoked and induced delta and theta activity in 17 people with schizophrenia and 17 healthy controls in two go/no-go task variants. We analyzed stimulus-related and response-related oscillations associated with correct-hits, correct-rejects and false-alarms. Our results reveal a pattern of reduced delta and theta activity for task-relevant events in schizophrenia. The findings indicate that while low-frequency oscillations are increased in amplitude at rest, they are not coordinated effectively in schizophrenia during various information processing tasks including target-detection, response-inhibition and error-detection. This slow-oscillation coordination abnormality may help explain the decreased recruitment of brain areas seen in fMRI studies.