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Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes.Prospective cohort study.Australia.A contemporary cohort of emerging adults across Australia (n = 565, mean age = 18.9, range = 18-21 at baseline).Clinician-administered Structured Clinical Interview for DSM-IV Research Version (SCID-IV-RV) assessed for AUD criteria across five interviews, at 6-month intervals over 2.5 years. Tolerance definitions were operationalized using survey-type response (yes/no), clinician judgement (SCID-IV-RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5-year study period (n = 491), and new-onset AUD was operationalized as any new incidence of AUD during the follow-up period (n = 461).The (i) SCID-IV-RV clinician judgement [odds ratio (OR) = 2.50, P = 0.005], (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase (OR = 2.48, P = 0.007) and (iii) 50% increase only (OR = 2.40, P = 0.005) were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow-up time-points than other definitions. However, these definitions were not associated with persistent AUD (Ps 0.05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, P = 0.001; OR = 4.65, P = 0.004) but not associated with new-onset AUD (Ps 0.05).Initial drink and percentage change thresholds appear to improve the efficacy of change-based tolerance as an indicator for new-onset alcohol use disorder diagnosis in self-report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption-based indicators appear to be a better way to measure tolerance than self-reported change-based definitions.

BACKGROUND Many university students have difficulties with sleep, therefore effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. OBJECTIVE This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. METHODS Focus groups were conducted over three stages to examine student views regarding content, format and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. RESULTS 30 participants [1] attended small focus group discussions. Three key themes were identified: 1) program development; 2) help-seeking and 3) student sleep characteristics. Program development subthemes were: program format; program content; and engagement facilitators. Help-seeking subthemes were: when to seek help; where to access help; stigma; and barriers. Student sleep characteristics subthemes were: factors disturbing sleep and consequences of poor sleep. CONCLUSIONS Students emphasized the need for a sleep intervention with an in person and social component, individualized content and ways to monitor their progress. Participants did not think there was stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload and the pressure of multiple demands as key contributors to sleep difficulties.

Background iReadMore is a digital therapy for people with acquired reading impairments (known as alexia) caused by brain injury or neurodegeneration. A phase II clinical trial demonstrated the efficacy of the digital therapy research prototype for improving reading speed and accuracy in people with poststroke aphasia (acquired language impairment) and alexia. However, it also highlighted the complexities and barriers to delivering self-managed therapies at home. Therefore, in order to translate the positive study results into real-world benefits, iReadMore required subsequent design innovation. Here, we present qualitative findings from the co-design process as well as the methodology. Objective We aimed to present a methodology for inclusive co-design in the redesign of a digital therapy prototype, focusing on elements of accessibility and user engagement. We used framework analysis to explore the themes of the communications and interactions from the co-design process. Methods This study included 2 stages. In the first stage, 5 in-person co-design sessions were held with participants living with poststroke aphasia (n=22) and their carers (n=3), and in the second stage, remote one-to-one beta-testing sessions were held with participants with aphasia (n=20) and their carers (n=5) to test and refine the final design. Data collection included video recordings of the co-design sessions in addition to participants’ written notes and drawings. Framework analysis was used to identify themes within the data relevant to the design of digital aphasia therapies in general. Results From a qualitative framework analysis of the data generated in the co-design process, 7 key areas of consideration for digital aphasia therapies have been proposed and discussed in context. The themes generated were agency, intuitive design, motivation, personal trajectory, recognizable and relatable content, social and sharing, and widening participation. This study enabled the deployment of the iReadMore app in an accessible and engaging format. Conclusions Co-design is a valuable strategy for innovating beyond traditional therapy designs to utilize what is achievable with technology-based therapies in user-centered design. The co-designed iReadMore app has been publicly released for use in the rehabilitation of acquired reading impairments. This paper details the co-design process for the iReadMore therapy app and provides a methodology for how inclusive co-design can be conducted with people with aphasia. The findings of the framework analysis offer insights into design considerations for digital therapies that are important to people living with aphasia.

Aims: To estimate change in young people's alcohol consumption during COVID-19 restrictions in Australia in early-mid 2020, and test whether those changes were consistent by gender and level of consumption prior to the pandemic. Design: Prospective longitudinal cohort. Setting: Secondary schools in New South Wales, Tasmania and Western Australia. Participants: Subsample of a cohort (n = 443) recruited in the first year of secondary school in 2010-11. Analysis data included three waves collected in September 2017-July 2018, September 2018-May 2019 and August 2019-January 2020), and in May-June 2020. Measurements: The primary predictors were time, gender and level of consumption prior to the pandemic. Outcome variables, analysed by mixed-effects models, included frequency and typical quantity of alcohol consumption, binge drinking, peak consumption, alcohol-related harm and drinking contexts. Findings: Overall consumption (frequency × quantity) during the restrictions declined by 17% [incidence rate ratio (IRR) = 0.83; 95% confidence interval (CI) = 0.73, 0.95] compared to February 2020, and there was a 35% decline in the rate of alcohol-related harms in the same period (IRR = 0.66; 95% CI = 0.54, 0.79). Changes in alcohol consumption were largely consistent by gender. Conclusions: From a survey of secondary school students in Australia, there is evidence for a reduction in overall consumption and related harms during the COVID-19 restrictions.

BackgroundYoung people may have elevated risk for poorer mental health during the coronavirus disease 2019 (COVID-19) pandemic, yet longitudinal studies documenting this impact are lacking. This study assessed changes in mental health and help-seeking since COVID-19 restrictions in young Australians, including gender differences.MethodsData were drawn from a recent subsample (n = 443; 60% female; Mage = 22.0) of a prospective cohort originally recruited in secondary school to complete annual surveys. The subsample completed an additional COVID-19 survey during COVID-19 restrictions (May–June 2020), which was compared to responses from their latest annual survey (August 2019–March 2020). Mixed effect models with time and gender as the primary predictors were conducted for: (i) scores on the Patient Health Questionnaire Depression 9-item (PHQ-9) and Generalised Anxiety Disorder 7-item (GAD-7) modules assessed before and during COVID-19 restrictions, and (ii) self-reported help-seeking from a health professional in February 2020, and the month preceding May–June 2020.ResultsMean symptom scores increased from before to during COVID-19 restrictions on the PHQ-9 (coefficient: 1.29; 95% CI 0.72–1.86) and GAD-7 (0.78; 95% CI 0.26–1.31), but there was no increase in help-seeking over time (odds ratio 0.50; 95% CI 0.19–1.32). There was no evidence of differential changes by gender.ConclusionsThis study found increases in depression and anxiety symptoms but not greater help-seeking among young Australian adults during the first wave of the pandemic. Increasing availability and awareness of accessible treatment options and psychoeducation is critical, as well as further research into risk and protective factors to help target treatment to this vulnerable age group.

Supply of alcohol to adolescents is associated with increased alcohol consumption and harms including alcohol use disorder (AUD). We aimed to identify: (1) trajectories of alcohol supply to adolescents; (2) sociodemographic characteristics associated with supply trajectory; (3) patterns of alcohol consumption by supply trajectory; and (4) supply trajectory associations with adverse alcohol outcomes.We used Australian longitudinal survey data (N = 1813) to model latent trajectories of parent and peer alcohol supply over five annual follow-ups (Waves 2-6; MWe identified five alcohol supply classes: (1) minimal supply (n = 739, 40.8%); (2) early parent sips, late peer/parent whole drinks (n = 254, 14.0%); (3) late peer/parent whole drinks (n = 419, 23.1%); (4) early parent sips, mid peer/parent whole drinks (n = 293, 16.2%); (5) early peer/parent whole drinks (n = 108, 6.0%). Compared to minimal supply, the other classes were 2.7-12.9 times as likely to binge drink, 1.6-3.0 times as likely to experience alcohol-related harms, and 2.1-8.6 times as likely to report AUD symptoms at age 19.Earlier supply of whole drinks, particularly from peers, was associated with increased risk of early adulthood adverse alcohol outcomes. While minimal supply represented the lowest risk, supplying sips only in early-mid adolescence and delaying supply of whole drinks until late adolescence is likely to be less risky than earlier supply of whole drinks.

BACKGROUND: Different forms of alcohol-related harm (e.g., hangovers, fighting) may confer differential risk of clinically relevant alcohol problems. We examine: (i) patterns of transition in experiencing alcohol-related harms across adolescence; (ii) whether factors in early adolescence predict transition patterns; and (iii) whether transition patterns predict later alcohol use disorder (AUD) symptoms. METHODS: We used a longitudinal Australian cohort (n = 1828) to model latent class transition patterns of alcohol-related harms across three timepoints (Mage = 13.9, 16.8, 18.8 years). Regression models assessed whether child, peer, and parent factors in early adolescence (Mage = 12.9) predicted harms transition patterns and whether these patterns predicted AUD symptoms in early adulthood (Mage = 19.8). RESULTS: Five transition patterns characterized most of the cohort (n ≈ 1609, 88.0%): (i) minimal harms (n ≈ 381, 20.8%); (ii) late physiological harms (n ≈ 702, 38.4%); (iii) early physiological harms (n ≈ 226, 12.4%); (iv) late all harms (n ≈ 131, 7.2%); and (v) gradual all harms (n ≈ 169, 9.2%). With late physiological harms as the reference, females had increased risk of experiencing early physiological harms (relative risk [RR]: 2.15; 99.5% CI: 1.19, 3.90). Late all harms (RR: 1.71; CI: 1.19, 2.47) and gradual all harms (RR: 1.84; CI: 1.37, 2.47) were each associated with increased odds of meeting criteria for AUD, even when patterns of alcohol consumption are considered. CONCLUSIONS: Adolescents display heterogeneous transition patterns across physiological and psychosocial alcohol-related harms. Females are at greater risk of experiencing early physiological harms. Experience of both physiological and psychosocial harms in late adolescence is an important and potentially modifiable precursor to clinically relevant alcohol problems in early adulthood.

Anomia (word-finding difficulties) is the hallmark of aphasia, an acquired language disorder most commonly caused by stroke. Assessment of speech performance using picture naming tasks is a key method for both diagnosis and monitoring of responses to treatment interventions by people with aphasia (PWA). Currently, this assessment is conducted manually by speech and language therapists (SLT). Surprisingly, despite advancements in automatic speech recognition (ASR) and artificial intelligence with technologies like deep learning, research on developing automated systems for this task has been scarce. Here we present NUVA, an utterance verification system incorporating a deep learning element that classifies 'correct' versus' incorrect' naming attempts from aphasic stroke patients. When tested on eight native British-English speaking PWA the system's performance accuracy ranged between 83.6% to 93.6%, with a 10-fold cross-validation mean of 89.5%. This performance was not only significantly better than a baseline created for this study using one of the leading commercially available ASRs (Google speech-to-text service) but also comparable in some instances with two independent SLT ratings for the same dataset., Comment: Under review

The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and agoraphobia symptom severity. Twenty-seven studies were identified. Results from nine randomised controlled trials (RCTs) showed that iCBT outperformed waiting list and information controls for panic (

Anomia (word finding difficulties) is the hallmark of aphasia an acquired language disorder, most commonly caused by stroke. Assessment of speech performance using pijcture naming tasks is therefore a key method for identification of the disorder and monitoring patient’s response to treatment interventions. Currently, this assessment is conducted manually by speech and language therapists (SLT). Surprisingly, despite advancements in ASR and artificial intelligence with technologies like deep learning, research on developing automated systems for this task has been scarce. Here we present an utterance verification system incorporating a deep learning element that classifies ‘correct’/’incorrect’ naming attempts from aphasic stroke patients. When tested on 8 native British-English speaking aphasics the system’s performance accuracy ranged between 83.6% to 93.6%, with a 10 fold cross validation mean of 89.5%. This performance was not only significantly better than one of the leading commercially available ASRs (Google speech-to-text service) but also comparable in some instances with two independent SLT ratings for the same dataset.

Background Alcohol Use Disorder (AUD) is a significant contributor to global disease burden. AUD has a relatively early onset during young adulthood (Teesson et al., 2010). However, compared to AUD in adults, we have relatively little understanding of AUD in adolescents and emerging adults. Methods The RADAR study is a prospective cohort study designed to investigate the emergence of AUD in community-dwelling adolescents and emerging adults across Australia (age range = 18–21 at baseline). At 6 monthly intervals over 2.5 years, participants were interviewed regarding alcohol consumption and alcohol use disorder criteria by clinical psychologists using the SCID-IV-RV. This paper reports the baseline findings of the RADAR cohort. Results Proportions of lifetime criteria endorsement among regular drinkers varied considerably. Tolerance was the most endorsed criterion (50.3%), followed by Social Problems (10.4%) and Larger/Longer (9.0%). The median age of onset for most individual AUD criteria was 18 years of age. 18.4% of our cohort met DSM-5 AUD diagnosis in their lifetime to date, and 16.8% met ICD-11 dependence. When removing Tolerance from the AUD criteria, DSM-5 AUD lifetime prevalence reduced to 11.0%, and ICD-11 AUD lifetime prevalence fell to 7.1% in our cohort. Conclusions Variable rates of criteria endorsement likely reflect both true differences in the experience of AUD criteria and methodological challenges in the assessment of AUD in an emerging adult age group. High rates of tolerance to the effects of alcohol, and relatively low rates of drinking larger/longer than intended are discussed considering methodological challenges in assessing these criteria in young adults.

Aim To compare the efficacy and acceptability of internet-delivered exposure therapy for panic disorder, to multi-component internet-delivered cognitive behavioral therapy (iCBT) that included controlled breathing, cognitive restructuring and exposure. Methods Participants with panic disorder, with or without agoraphobia, were randomized to internet-delivered exposure therapy (n = 35) or iCBT (n = 34). Both programs were clinician guided, with six lessons delivered over eight weeks. Outcomes included panic disorder and agoraphobia symptom severity, as well as depression symptom severity, functional impairment and days out of role. Results Participants in both conditions displayed a large reduction in panic disorder symptom severity (ds >1.30) from pre- to post-treatment. Participants in both conditions displayed medium to large reduction in agoraphobia and depression symptom severity, functional impairment and days out of role. Effects were maintained at three- and six-month follow-up. There was no significant difference between the interventions in clinical outcomes, adherence or treatment satisfaction. Conclusions Internet-delivered exposure therapy appeared to be as acceptable and efficacious as more established iCBT, despite including less strategies. However, a fully powered replication is now needed to compare the two approaches.

IntroductionHarmful alcohol consumption, particularly alcohol use disorder (AUD), is a worldwide health priority, contributing substantially to global morbidity and mortality. The peak age of onset of AUD is 18–24, thus a deeper understanding of the young adult experience is vital if we are to identify modifiable risk factors and intervene early in the developmental course of this disabling disorder. Critical unanswered questions include: How soon after drinking initiation do AUD symptoms begin to emerge? Which symptoms come first? Do the symptoms unfold in a predictable pattern? In what ways do the emerging symptoms interact with individual, peer, family and environmental risk factors to impact on the transition to disorder?Methods and analysisThe proposed RADAR study will examine the prospective development of AUD symptoms over the young adulthood (18–24) years. We will capitalise on an existing cohort of 1911 community-based adolescents who were recruited at age 13 and have completed a baseline and five annual follow-up assessments as part of an observational cohort study. We will interview these adolescents every 6 months between the ages of 19 and 23 to derive monthly histories of both alcohol use and AUD symptomatology, along with a comprehensive battery of risk and protective factor scales hypothesised to predict the emergence and course of AUD. The results of this study will inform the natural history of AUD and will be used to identify specific targets for prevention and early intervention of AUD.Ethics and disseminationEthical approval has already been granted for the study (UNSW HREC 10144). We will disseminate the results of the study through published manuscripts, conferences and seminar presentations. Data used in published manuscripts will be made available through a suitable online repository (eg, Dryad–datadryad.org).