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Biomedical subjects

E S Luk

Publications and source records attributed to E S Luk.

14 recordsLinked to original sources
PubMed2001

Children with persistent conduct problems who dropout of treatment.

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach. The overall dropout rate was 36%. Dropout occurred significantly less frequently in the CBT group. The dropout group was associated with mothers who were younger and less educated, a poorer rating by the clinicians at the last meeting, parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks. In the second study we used a naturalistic follow-up design. Forty-six children were included. The overall dropout rate was 48%. Again, the children who defaulted were rated by clinicians as less likely to have improved and dropout was also significantly associated with parental perception of a less organised treatment. In both studies dropout usually occurred after assessment and at the early phase of treatment.

Adolescent↗
PubMed2001

Abnormal executive function in attention deficit hyperactivity disorder: the effect of stimulant medication and age on spatial working memory.

OBJECTIVE: This study sought to examine the factors associated with spatial working memory and the use of strategies to impairments in spatial working memory in children with attention deficit hyperactivity disorder (ADHD). The developmental trajectories for spatial working memory in medicated and medication naïve children with ADHD were investigated. In addition, the effect of psychostimulant medication on deficits in spatial working memory was examined. METHOD: A cross-sectional study compared performance between 21 psychostimulant medicated children with ADHD, 27 medication naïve children with ADHD and 26 matched control subjects on computerized tests of spatial memory and spatial working memory. RESULTS: Compared with the controls, performance in medication naïve children with ADHD was significantly worse on the spatial working memory task. There was no difference in performance between the medicated children with ADHD and the control subjects on this same task, despite the ongoing symptoms of ADHD in the former group. The pattern of normal and abnormal performance in the ADHD groups was age-independent. CONCLUSIONS: Deficits in executive functions related to spatial working memory do occur in children with ADHD, although the magnitude of these deficits is not related to the child's age or the level of ADHD symptoms. These deficits were not present in the current sample of children who were receiving psychostimulant medication.

Age Factors↗
PubMed2001

Better mental health services for young people: responsibility, partnerships and projects.

OBJECTIVE: This paper argues that adolescent psychiatry is best linked with child psychiatry and opposes separate youth mental health programmes for 12-25-year-olds. It reports on the current status of services and considers how adult mental health services (AMHS) can improve services for young adults (18-25-year-olds). METHOD: Factors in development, psychopathology, prevention, training and service systems are reviewed to suggest that current child and adolescent mental health service systems (CAMHS) are appropriate for 0-17-year-olds. Improvements in CAMHS are described from a Victorian perspective, including the model of specialist clinical programmes or teams for specific patient populations. Mechanisms are outlined for AMHS to better assist young adults from 18 to 25 years of age. RESULTS: The model of clinical projects or clinical programme teams, developed in partnership with primary health and others, is a suitable vehicle to help AMHS to improve clinical services to their young adult populations. These may be funded from a variety of sources, including re-engineering existing service resources. CONCLUSIONS: Such developments complement the work of specialist research units and build local competencies. More programme development and evaluation is needed, which will require the support of the College and State and Commonwealth Mental Health Branches.

Adolescent↗
PubMed2001

The development of a screening questionnaire for childhood cruelty to animals.

Childhood cruelty to animals may be a marker of poor prognosis amongst conduct disordered children. However, other than semistructured interviews with parents or children, there are no screening instruments for this behavior. The aim of this study was to develop such an instrument. In the first phase of the study, a parent-report questionnaire, Children's Attitudes and Behaviors Towards Animals (CABTA) was designed and piloted on 360 elementary school children, enabling community norms and a factor structure for the instrument to be derived. In the second phase, the questionnaire was completed by the parents of a small sample of children (N = 17) to establish its test-retest reliability. In the third phase of the study, the CABTA was completed by the parents of 19 children who had been diagnosed with either a Disruptive Behavioral Disorder or Attention Deficit Hyperactivity Disorder, and the results were compared with the outcome of a semistructured interview with parents regarding their child's behavior toward animals. The results of the various phases of the study indicated that the CABTA consists of two factors. Typical and Malicious Cruelty to animals, and is a reliable and valid tool for detecting childhood cruelty to animals. Possible use and adaptations of the CABTA as a screening instrument in clinical and community samples are discussed.

Adolescent↗
PubMed2000

Attention deficit hyperactivity disorder: current progress and controversies.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a common chronic and disabling condition in children. This paper reviews the taxonomic issues and the major comorbid conditions, neurobiological correlates, treatment and public health issues associated with ADHD. METHOD: Pertinent recent papers are reviewed from the psychological and psychiatric literature. RESULTS: The two major taxonomies now define a similar group of children with ADHD of a combined type/hyperkinetic disorder. Advances in the understanding and treatment of ADHD demonstrate the complex multidimensional links between neurobiology, psychology and behaviour. Careful assessment of individual factors in treatment planning and ongoing monitoring of psychostimulant medication treatment in the longer term are recommended. CONCLUSIONS: There is much still to learn about ADHD, and increased levels of clinical research and treatment resources are required.

Anxiety Disorders↗
PubMed2000

Collaboration between general practitioners and a child and adolescent mental health service.

OBJECTIVE: The aim of this project was to develop a collaborative working relationship between general practitioners and a child and adolescent mental health service (CAMHS). METHODS: The project focused on changing the policies and culture within CAMHS to be more GP aware and inclusive. The project also provided GPs with an accredited training package on common mental health problems. The impact of the project was determined through pre and post project surveys and interviews with GPs and mental health workers (case managers) respectively. RESULTS: There was a two-fold increase in communication between the two sectors and a 120% increase in shared care arrangements. There was a 144% improvement in GPs' perceptions of the helpfulness of public CAMHS. DISCUSSION: Implications for future collaboration are discussed. The results of this pilot study are encouraging and warrant replication and validation using standardised instruments. CONCLUSION: To create, enhance and extend the working relationships between GPs and public CAMHS requires strategies for change in both sectors.

Adolescent↗
PubMed1999

Children who are cruel to animals: a revisit.

OBJECTIVE: There is a paucity of research regarding children who are cruel to animals (CTA). Previous studies have suggested that being CTA is linked with recurrent aggression in adulthood. In this report, children with persistent conduct problems who are CTA are examined. METHOD: A clinic-referred sample of 141 children and a community sample of 36 children between the ages of 5-12 were assessed using a test battery of questionnaires for parents, teachers and the child on mental health symptoms, self-perception, demographics and psychosocial factors. Forty of the clinic-referred children and one of the community group were rated by their parents as sometimes or definitely cruel to animals. The CTA, non-CTA and community samples were compared. RESULTS: The CTA group had more conduct symptoms compared with the non-CTA group. However, the older CTA group unexpectedly reported a higher self-esteem compared with the non-CTA group. There was no significant difference between the two clinic-referred groups in gender, attention deficit hyperactivity disorder and internalising symptoms, and psychosocial factors. CONCLUSION: Being CTA is possibly a marker of a subgroup of conduct disorder which has a poor prognosis.

Aggression↗
PubMed1999

Attention deficit hyperactivity disorder: anxiety phenomena in children treated with psychostimulant medication for 6 months or more.

OBJECTIVE: The intermediate- to long-term use of psychostimulant medication has unclear benefits on the core symptoms of attention deficit hyperactivity disorder (ADHD) and delayed onset affective symptom side effects which can mimic these core ADHD symptoms. 'ADHD and anxiety' has also been associated with a poor response to short-term psychostimulant medication treatment. In addition, it is unclear whether 'ADHD and anxiety' should be defined from the child's and/or the parent's perspective. We propose that anxiety will be increased in children with ADHD who are treated with psychostimulant medication in the intermediate- to long-term who are identified by clinicians as poor responders. METHOD: Twenty children with ADHD who were medicated for 6 months or more and who had ongoing core symptoms of ADHD were compared to 20 age- and IQ-matched children with ADHD who were medication-naïve. Chi-squared tests were performed on the categorical dependent variables and independent t-tests on the dependent continuous variables. RESULTS: Anxiety is significantly increased in children with ADHD treated with psychostimulant medication in the intermediate- to long-term who are noted by clinicians to have ongoing core symptoms of ADHD. This statistically significant finding is evident with both categorical and dimensional measures of anxiety from the child's perspective. CONCLUSIONS: The recognition of anxiety and its management in children with ADHD is generally poorly understood. In this particular group of children with ADHD, anxiety may be a side effect of intermediate- to long-term psychostimulant medication and/or a potential marker for a poor response to intermediate- to long-term psychostimulant medication treatment.

Anxiety↗
PubMed1998

Comparison of treatments of persistent conduct problems in primary school children: a preliminary evaluation of a modified cognitive-behavioural approach.

OBJECTIVE: Treatment for persistent conduct problems in primary school children was developed using a modification of cognitive-behavioural therapy (MCBT). Its effectiveness was evaluated by comparing it with conjoint family therapy (FT) and eclectic therapy (ET). METHOD: Children with persistent conduct problems were randomly assigned to one of three treatment groups. They were assessed prior to treatment and then 6 months after. Measures included symptoms of the child; parents' mental health; stress of parenting; family functioning; and parental relationship. In addition, parents' and children's perception of the therapy were assessed and a treatment record was developed to track the treatment process. RESULTS: Thirty-two children were recruited for the study. No statistically significant differences were found in terms of effectiveness between the three groups. In terms of parents' perception of the therapy, there was no difference on the perception of the qualities of the therapists, but on the perception of therapy MCBT was considered to be higher in cognitive-behavioural orientation. CONCLUSION: Further research using a larger sample is required to evaluate MCBT. The study supports the idea that controlled treatment studies can be carried out within busy mental health services.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed1998

Attention deficit hyperactivity disorder and anxiety: is there an association with neurodevelopmental deficits?

OBJECTIVE: The co-occurrence of attention deficit hyperactivity disorder (ADHD) and anxiety is a well-established clinical observation. However, its status as a clinical construct is debated. We review the prevalence of 'ADHD and anxiety', its definitions, and its clinical correlates and we hypothesise that neurodevelopmental deficits may be increased in 'ADHD and anxiety'. METHOD: The authors identified empirical studies in the psychiatric and psychological literature. The search categories included hyperactivity, attention deficit hyperactivity disorder, attention deficit disorder and anxiety. RESULTS: 'ADHD and anxiety' is considerably more common in clinical than epidemiological samples. There are a range of definitions which address the situational variation in both ADHD and anxiety symptoms and the use of categorical and continuous variables to define them. Yet the nature of the anxiety is still unclear. It is associated with a poor response to psychostimulant medication treatment, and alternative pharmacotherapy approaches have been suggested. There is a controversy about whether neurodevelopmental deficits are associated with hyperactivity alone, or anxiety, or both. CONCLUSIONS: 'ADHD and anxiety' is important clinically because it is common and less responsive to psychostimulant medication. Important research issues include its heterogeneity which necessitates the collection of parent, teacher, and child self-reports of symptoms' presence or absence and the hypothesis that neurodevelopmental deficits may be increased in this group of children.

Antidepressive Agents↗
PubMed1997

Continuing the debate on a separate adolescent psychiatry.

OBJECTIVE: This paper continues the debate, started by George Patton, that a separate adolescent psychiatry is required since many psychotic illnesses begin in late adolescence, and adolescent mental health needs have not been well met by child or adult psychiatry. METHOD: Epidemiological studies are used to illustrate that there are many continuities, as well as discontinuities, in the natural history of psychiatric disorders throughout the life cycle. The paper comments on rational service planning, which requires data on the outcomes of different treatment approaches. It goes on to explore the implications of a separate adolescent psychiatry for service delivery, including how current service boundaries and the training of psychiatrists might need to change. RESULTS AND CONCLUSIONS: An argument is mounted that psychiatrists should take a whole life perspective, rather than further fragment the specialty. In most Australian States, recent reviews of child and adolescent mental health services are likely to result in increased funding for services to adolescents. Adult psychiatry needs to attend more to the requirements of older adolescents, and greater collaboration is recommended between psychiatry services for children and adults. The authors argue for diversity of approaches, and consider that moves towards separate adolescent mental health services may not always be appropriate.

Adolescent↗
PubMed1996

Establishing the constructs of childhood behavioral disturbances in a Chinese population: a questionnaire study.

The behavioral problems of Chinese children were examined in a questionnaire study of a representative sample of 3,069 seven-year-old Chinese schoolboys in Hong Kong using Rutter's questionnaires for completion by parents and teachers. Separate robust dimensions of hyperactivity, antisocial, and neurotic behaviors were evident. The correlations among different dimensions were similar to those reported in the West. Short-term longitudinal analysis suggested that these dimensions were stable over time and that antisocial behaviors might develop in hyperactive children. The finding highlights the necessity of differentiating the hyperactive domain from the antisocial one. A significant source effect was found in all three dimensions. Chinese schoolboys had nearly two times the level of questionnaire-rated hyperactivity compared with school boys in the West; but it is premature to conclude that hyperactivity is more common in Chinese schoolboys in Hong Kong. Cross-cultural differences in adults' expectations and tolerance remain a plausible explanation.

Caregivers↗
PubMed1996

Situational versus pervasive hyperactivity in a community sample.

Groups of home and school situational hyperactive primary schoolboys identified from the community were compared with pervasive hyperactive and non-hyperactive controls on a wide range of measures. The hyperactive groups tended to persist in the same category over a half-year period. Both situational hyperactive groups had lower measured activity levels than the pervasive hyperactive group and only the latter differed from non-hyperactive controls. Home hyperactivity was characterized by poor family relationships and was not distinguishable from non-hyperactive home-antisocial controls. School hyperactive boys had specific correlates of low intelligence, motor clumsiness, poor reading and academic abilities. Pervasive hyperactive subjects differed from both situational groups in showing a higher percentage of delayed language development. While home hyperactivity has dubious identity, the distinct pattern of external correlates in school and pervasive hyperactivity speak for the need to regard these as separate entities.

Attention Deficit Disorder with Hyperactivity↗