Search

Background: The aim of this study was to investigate the demographic, clinical characteristics, and service systems of patients with autism spectrum disorder (ASD) and/or intellectual disability presenting to a large paediatric hospital emergency department (ED) with behaviours of concern (BOC) over a two-year period. Method: Retrospective audit of ED presentations with BOC in patients with ASD and/or intellectual disability from 1 January 2019 to 31 December 2020, at the Royal Children's Hospital, Melbourne, Australia. Results: There were 124 presentations (84 patients) in 2019 and 129 presentations (82 patients) in 2020. The mean age was 11.7 years. 55% arrived by ambulance, 24% required physical restraint, and 26% required sedation. Re-presentation was predicted by single-parent household, child protection involvement, and requirement of an interpreter. Conclusions: Children and adolescents with ASD and/or intellectual disability regularly present to ED with BOC. New models of care are required to better support this highly vulnerable patient group.

Children and adolescents (henceforth "children") with both attention-deficit/hyperactivity disorder (ADHD) and anxiety experience greater difficulties than children with either alone, though qualitative methodologies are yet to be used to understand the challenges this population experiences. We aimed to explore parent-reported daily impacts of co-occurring anxiety in children with ADHD (ages 8–13 years). Participants were enrolled in an Australian trial evaluating an adapted anxiety intervention and were eligible if their child met diagnostic criteria for ADHD plus separation, social, and/or generalized anxiety disorder. A baseline measure of life impacts associated with child anxiety captured situations parents reported were difficult, due to their child's anxiety. Reflexive thematic analysis of free-text responses (N = 203) facilitated new insights via inductively generating key themes. Three overarching themes highlighted (1) child difficulties with everyday situations and processes due to their anxiety; (2) the nature of the child's anxiety being pervasive and unrelenting; and (3) the strain placed on the child's family system. This study enhances understanding of daily impacts associated with co-occurring anxiety and ADHD and may contribute to an improved understanding of support needs. Results reiterate the need to identify co-occurring difficulties in children with ADHD and support both children and their families. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Children and adolescents with autism spectrum disorder and/or intellectual disability often present to emergency departments with behaviours of concern: irritability, aggression and self‐injurious behaviour. The objective of this study was to design, implement and evaluate a new model of care to support these patients and their families following presentation to reduce the need for re‐presentation.We designed and evaluated a new model of care for these patients, comprising consultations with a developmental paediatrician and a child psychiatrist, referral to a specialist behavioural service and 6 weeks of care coordination by a clinical nurse consultant. Using a quality improvement framework, iterative improvements were made to the model via a series of plan–do–study–act cycles. Re‐presentation rates were compared with a control group of patients who presented with behaviours of concern but were not recruited into the study. Participating families and treating clinicians were surveyed at 2 and 6 weeks post‐enrolment to gather qualitative feedback about their experience of the model.A total of 31 families participated in the study. Three‐ and 6‐month re‐presentation rates were 48.7% and 36.3% lower than the control group. Qualitative evaluation of the model by both families and clinicians was positive. The model was feasible and acceptable. Families reported feeling heard and understood, and that the intervention was helpful and provided a positive path forwards.The findings suggest that a simple model of care can be successfully implemented and provide meaningful benefits for families of children with behaviours of concern, including reduced crisis‐oriented help‐seeking. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) is consistently associated with poor school-level outcomes. Although school engagement is recognized as a protective factor associated with increased academic achievement, school retention/completion, and student well-being in the general population, little research has focused on school engagement in children with ADHD. Aims: To explore a model of the relationships between ADHD symptoms at age 7, student-teacher closeness and conflict at age 10, and emotional engagement with school at age 10 and 12. Sample: Participants were 498 grade one children (mean age = 7.3), recruited from 43 socio-economically diverse government primary schools in Melbourne. Follow-up occurred at 36 months (mean age = 10.5) and 54 months (mean age = 12.0). Methods: Data were drawn from a controlled community-based longitudinal study examining the long-term effects of ADHD on children's behaviour, learning, and day-to-day living. Data were collected via direct assessment and child, parent, and teacher surveys. Results: Path analysis revealed a significant, negative relationship between ADHD symptoms and emotional engagement with school, which was partially mediated by student-teacher conflict. This remained significant after controlling for differences in ADHD status (ADHD, high-risk, or control group), ADHD medication use, and socio-economic status. Conclusions: These findings highlight the negative impact of ADHD symptoms on children's emotional engagement with school. Given the role of student-teacher conflict in mediating this relationship, interventions aiming to reduce conflict in the student-teacher relationship may promote school engagement for students with ADHD, with potential to improve longer-term outcomes.

Objective: To compare family functioning over time for elementary school children with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 179) and subthreshold ADHD (ST-ADHD; N = 86), to children without ADHD (Control; N = 212). Method: ADHD was assessed using the Conners 3 ADHD Index and Diagnostic Interview Schedule for Children IV. At baseline, 18-month follow-up and 36-month follow-up, parents completed measures assessing a range of family functioning domains. Results: At baseline, the ADHD group reported higher psychological distress, less parenting self-efficacy, less parenting consistency, and more stressful life events; and both groups reported poorer family quality of life (QoL) and greater parenting anger. Trajectories were largely similar to controls (i.e., stable over time), but unlike controls, ADHD and ST-ADHD groups showed lessening parent-partner support and parenting warmth, respectively; and both groups showed worsening aspects of family QoL. Conclusion: Families of children with ADHD and ST-ADHD report persistently poor or worsening family functioning; highlighting a need for tailored psycho-social supports. [ABSTRACT FROM AUTHOR]