Mindful Parenting Group Intervention for Parents of Children with Anxiety Disorders.

Parenting behaviour and rearing style contribute to the intergenerational relationship between parental and child anxiety. Current psychological interventions for child anxiety typically do not adequately address parental mental health, parenting behaviours or the parent-child relationship. The current pilot study examines the effectiveness of a mindful parenting intervention (MPI) for parents of young children with clinical anxiety. It was hypothesised that the intervention would be associated with improvements in parental stress, mental health, and mindfulness, and a reduction in child clinical anxiety symptoms. Twenty-one parents of children aged 3-7 years diagnosed with anxiety disorders participated in an 8-week group MPI program that aimed to increase their intentional moment to moment awareness of the parent-child relationship. Parental (anxiety, depression, hostility, stress, burden, mindfulness, mindful parenting) and child (anxiety diagnoses, anxiety severity, comorbidities) outcomes were assessed at pre- and post-intervention, and at 3-month follow-up. Parents reported a significant increase in mindful parenting and a significant reduction in parent-child dysfunctional interaction, but no change in mental health symptoms. There was a significant reduction in parent-rated child anxiety symptoms, severity of child anxiety diagnosis and number of comorbid diagnoses at post and 3-month follow-up. Limitations include a lack of waitlist control, small sample size, and participants were largely mothers, from intact families and highly educated. There was attrition of 43% and outcomes were predominantly self-report. MPIs offer a novel and potentially effective method of increasing mindful parenting, decreasing dysfunctional parent-child interactions, reducing parenting stress and might also be an effective early intervention for indirectly decreasing young children's clinical anxiety symptoms. Larger-scale controlled trials of MPIs are needed.

Childhood Anxiety: Prenatal Maternal Stress and Parenting in the QF2011 Cohort.

In this study we examine whether specific 'anxiety-maintaining' parenting behaviors (i.e., overinvolvement and/or negativity) exacerbate the effects of disaster-related prenatal maternal stress (PNMS) on school-age anxiety symptoms. Women (N = 230), pregnant at the time of the 2011 Queensland Floods, reported on their experience of flood-related PNMS (objective hardship, cognitive appraisal, subjective distress). At 4-years, mother-child dyads were coded for maternal overinvolvement and negativity during a challenging task; at 6-years mothers reported on their children's anxiety symptoms and their own mood, N = 83. Results showed no associations between PNMS and 6-year anxiety, nor did parenting moderate these effects. Poorer maternal concurrent mood was associated with greater anxiety symptoms at 6 years (ß = 0.52). Findings suggest maternal concurrent mood, but not exposure to disaster-related PNMS nor 'anxiety-maintaining' parenting behaviors at preschool age, is related to school-age anxiety symptoms.

Suicidality in 12-Year-Olds: The Interaction Between Social Connectedness and Mental Health.

Suicidal thoughts and behaviors (STB) are a leading cause of death in adolescence. To date, most research with youth has focused on risk factors for suicide; and less attention has been paid to resilience factors. This study examined whether positive beliefs and social connectedness moderate associations between mental health symptoms and STB. A community sample of 12-year-olds (N = 60) completed self-report questionnaires on their STB, mental health symptoms, positive beliefs and social connectedness. Nearly 20% of the adolescents reported STB. STB was associated with increased mental health symptoms and lower scores on the resilience measures. A significant moderating effect of social connectedness showed that youth with a combination of poor mental health and high levels of social support exhibited lower levels of STB. There was no significant moderating effect of positive beliefs. These results indicate that social support should be screened for in primary care and incorporated into youth suicide prevention programs.

Neurobiological underpinnings of cyberbullying: A pilot functional magnetic resonance imaging study.

There is a dearth of research that has investigated the neural correlates of cyberbullying, using task-based functional magnetic resonance imaging (fMRI) and, specifically, in a real-time context such as observing cyberbullying scenarios. This article presents pilot data from a novel protocol designed to undertake such research with the overall aim being to elucidate the neurobiological underpinnings of cyberbullying via task-based fMRI (tb-fMRI)) in passive cyberbystanders. Young adults (N = 32, 18 to 25 years old) viewed six negative (cyberbullying) and six neutral stimuli from the Cyberbullying Picture Series (CyPicS) while undergoing tb-fMRI. Our results revealed 12 clusters of significantly greater blood-oxygenation-level-dependent (BOLD) responses (family wise error corrected p FWE < .05) in participants when viewing cyberbullying stimuli compared to neutral stimuli, across a distributed network of regions including left and right middle temporal gyrus, default mode network hubs, left and right posterior cerebellum/vermis, and putamen. Further analysis also revealed greater BOLD response in females compared to males, as well as in those with no prior experience of cyberbullying compared to those with prior experience (despite gender), when viewing the cyberbullying stimuli compared to the neutral stimuli. These results bring us closer to understanding the neurobiological underpinnings that may be associated with cybervictim/bully status and outcomes.

Predicting therapeutic response to oral ketamine for chronic suicidal ideation: a Bayesian network for clinical decision support.

BACKGROUND: The glutamatergic modulator ketamine has been shown to result in rapid reductions in both suicidal ideation (SI) and depressive symptoms in clinical trials. There is a practical need for identification of pre-treatment predictors of ketamine response. Previous studies indicate links between treatment response and body mass index (BMI), depression symptoms and previous suicide attempts. Our aim was to explore the use of clinical and demographic factors to predict response to serial doses of oral ketamine for chronic suicidal ideation. METHODS: Thirty-two participants completed the Oral Ketamine Trial on Suicidality (OKTOS). Data for the current study were drawn from pre-treatment and follow-up time-points of OKTOS. Only clinical and sociodemographic variables were included in this analysis. Data were used to create a proof of concept Bayesian network (BN) model of variables predicting prolonged response to oral ketamine, as defined by the Beck Scale for Suicide Ideation (BSS). RESULTS: The network of potential predictors of response was evaluated using receiver operating characteristic (ROC) curve analyses. A combination of nine demographic and clinical variables predicted prolonged ketamine response, with strong contributions from BMI, Social and Occupational Functioning Assessment Scale (SOFAS), Montgomery-Asberg Depression Rating Scale (MADRS), number of suicide attempts, employment status and age. We evaluated and optimised the proposed network to increase the area under the ROC curve (AUC). The performance evaluation demonstrated that the BN predicted prolonged ketamine response with 97% accuracy, and AUC = 0.87. CONCLUSIONS: At present, validated tools to facilitate risk assessment are infrequently used in psychiatric practice. Pre-treatment assessment of individuals' likelihood of response to oral ketamine for chronic suicidal ideation could be beneficial in making more informed decisions about likelihood of success for this treatment course. Clinical trials registration number ACTRN12618001412224, retrospectively registered 23/8/2018.

Subcortical Volume Correlates of Psychological Distress in Early Adolescence.

The hippocampus and amygdala have justifiably been the focus of much mental health research due to their putative roles in top-down processing control of emotion, fear, and anxiety. However, understanding the causal relationship between these regions and mental illness has been limited as current literature is lacking in the observation of neuro-structural changes preceding first episodes. Here, we report whole and sub-structural hippocampal and amygdala volume correlates of psychological distress in early adolescence. Automated hippocampal subfield and amygdala nuclei segmentation was carried out in 32 participants (12-13 years old) recruited for the Longitudinal Adolescent Brain Study (LABS) who had psychological distress scores measured by the Kessler-10. Partial correlation analyses revealed significant negative association between left whole amygdala volume and psychological distress. Sub-structure analysis revealed that smaller left hippocampal CA1 volume and left basal and accessory basal amygdala nuclei volumes were all significantly associated with higher levels of psychological distress. Four-month follow-up analysis also revealed an association between change in K10 and CA1 volume suggesting a continued relationship between this hippocampal substructure and psychological distress. Grey matter volume of subcortical sub-structures involved within the hippocampal-basolateral amygdala-prefrontal cortex loop are highly correlated and are significantly reduced in adolescents with higher levels of psychological distress, indicating these nuclei and subfields play an important role in the emergence of mental illness.

The 5-HTTLPR polymorphism of the serotonin transporter gene and child's sex moderate the relationship between disaster-related prenatal maternal stress and autism spectrum disorder traits: The QF2011 Queensland flood study.

The 5-HTTLPR polymorphism of the serotonin transporter has been shown to play a role in autism spectrum disorders (ASD). Moreover, disaster-related prenatal maternal stress (PNMS) has also been shown to be associated with ASD. However, no study to date has examined whether these two factors, either individually or in combination, are predictive of ASD traits in the same sample. We hypothesized that children, particularly boys, with the LL genotype exposed to high levels of disaster-related PNMS would exhibit higher levels of ASD traits compared to boys with the LS or SS genotypes and girls regardless of genotype. Genotype and ASD levels obtained using the Australian normed Autism Spectrum Rating Scales - Short Form were available for 105 30-month-old children exposed to varying levels of PNMS following the 2011 Queensland Flood. For boys, higher ASD traits were associated with the 5-HTTLPR LL genotype in combination with either a negative maternal appraisal of the flood, or high levels of maternal composite subjective stress, PSTD-like or peritraumatic dissociation symptoms. For girls, maternal peritraumatic dissociation levels in combination with the 5-HTTLPR LS or SS genotype were associated with higher ASD traits. The present findings are the first to demonstrate that children's genotype moderates effects of disaster-related PNMS on ASD traits, with different pattern according to child sex.

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study.

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social-emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood-related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social-emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.

Disaster in pregnancy: midwifery continuity positively impacts infant neurodevelopment, QF2011 study.

BACKGROUND: Research shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster. METHODS: This prospective cohort study included 115 women who were affected by a sudden-onset flood during pregnancy. They received one of two models of maternity care: MGP or SC. The women's flood-related objective stress, subjective reactions, and cognitive appraisal of the disaster were assessed at recruitment into the study. At 6-months postpartum they completed the Ages and Stages Questionnaire (ASQ-3) on their infants' communication, fine and gross motor, problem solving, and personal-social skills. RESULTS: Greater maternal objective and subjective stress predicted worse infant outcomes. Even when controlling for maternal stress from the flood, infants of mothers who were in the MGP model of maternity care performed better than infants of mothers in SC on two of the five ASQ-3 domains (fine motor and problem solving) at 6-months of age. Furthermore, infants in the SC model were more likely to be identified as at risk for delayed development on these domains than infants in the MGP model of care. CONCLUSIONS: Continuity of midwifery care has positive effects on infant neurodevelopment when mothers experience disaster-related stress in pregnancy, with significantly better outcomes on two developmental domains at 6 months compared to infants whose mothers received standard hospital care.

The role of prenatal maternal stress in the development of childhood anxiety symptomatology: The QF2011 Queensland Flood Study.

It is possible that findings suggesting a link between prenatal maternal stress (PNMS) and anxiety symptoms in offspring are confounded by postnatal and/or shared mother-child heritability effects. Following exposure to a natural disaster, the Queensland Flood Study investigated the unique and additive effects of various types of disaster-related PNMS (objective hardship, cognitive appraisal, and subjective distress) on childhood anxiety symptomatology (internalizing and/or anxiety symptom measures). Timing of flood exposure during pregnancy and child sex were examined as potential moderators. After controlling for maternal psychosocial factors, greater objective hardship as a result of the floods was significantly associated with greater anxiety symptoms (N = 114) and marginally associated with greater internalizing behaviors (N = 115). Earlier timing of the flood in pregnancy was associated with greater anxiety symptoms. No such associations were found between any PNMS measure and teacher-rated child internalizing behaviors (N = 90). Sex and timing did not moderate associations. Our findings suggest that, in isolation, increased maternal hardship due to exposure to an independent stressor, during pregnancy, may have a programming effect on childhood anxiety symptoms.

Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study.

Poor postnatal mental health is a major public health issue, and risk factors include experiencing adverse life events during pregnancy. We assessed whether midwifery group practice, compared to standard hospital care, would protect women from the negative impact of a sudden-onset flood on postnatal depression and anxiety. Women either received midwifery group practice care in pregnancy, in which they were allocated a primary midwife who provided continuity of care, or they received standard hospital care provided by various on-call and rostered medical staff. Women were pregnant when a sudden-onset flood severely affected Queensland, Australia, in January 2011. Women completed questionnaires on their flood-related hardship (objective stress), emotional reactions (subjective stress), and cognitive appraisal of the impact of the flood. Self-report assessments of the women's depression and anxiety were obtained during pregnancy, at 6 weeks and 6 months postnatally. Controlling for all main effects, regression analyses at 6 weeks postpartum showed a significant interaction between maternity care type and objective flood-related hardship and subjective stress, such that depression scores increased with increasing objective and subjective stress with standard care, but not with midwifery group practice (continuity), indicating a buffering effect of continuity of midwifery carer. Similar results were found for anxiety scores at 6 weeks, but only with subjective stress. The benefits of midwifery continuity of carer in pregnancy extend beyond a more positive birth experience and better birthing and infant outcomes, to mitigating the effects of high levels of stress experienced by women in the context of a natural disaster on postnatal mental health.

A trajectory analysis of childhood motor development following stress in pregnancy: The QF2011 flood study.

This prospective, longitudinal cohort study examined the effects of flood-related stress in pregnancy on the trajectory of children's motor development; and the moderating effects of gestational timing of the flood or sex of the child. Women who were pregnant during a severe flood reported on their objective flood-related experiences, emotional reactions, and cognitive appraisal of the disaster. At 2-, 6-, 16-months, 2½- and 4-years postpartum, mothers' assessed their children's fine and gross motor development using the Ages and Stages-3 Questionnaire. High objective flood-exposure, or a negative appraisal, especially in later pregnancy, predicted poorer gross motor skills which rapidly improved across early childhood. Children's fine motor skill was influenced by the sex of the child with improvements in girls' fine motor skills over time, but not boys'. This demonstrates that stress in pregnancy has enduring influences on gross, but not fine, motor skills. Results are discussed in relation to fetal programming and stress appraisal theory.

Infant Neurodevelopment is Affected by Prenatal Maternal Stress: The QF2011 Queensland Flood Study.

Research shows that prenatal maternal stress (PNMS) negatively affects a range of infant outcomes; yet no single study has explored the effects of stress in pregnancy from a natural disaster on multiple aspects of infant neurodevelopment. This study examined the effects of flood-related stress in pregnancy on 6-month-olds' neurodevelopment and examined the moderating effects of timing of the stressor in gestation and infant sex on these outcomes. Women exposed to the 2011 Queensland (Australia) floods in pregnancy completed surveys on their flood-related objective and subjective experiences at recruitment and reported on their infants' neurodevelopment on the problem solving, communication, and personal-social scales of the Ages and Stages-III at 6 months postpartum (N = 115). Interaction results showed that subjective flood stress in pregnancy had significantly different effects in boys and girls, and that at high levels of stress girls had significantly lower problem solving scores than boys. Timing of the flood later in pregnancy predicted lower personal-social scores in the sample, and there was a trend (p < .10) for greater objective flood exposure to predict lower scores. PNMS had no effect on infants' communication skills. In conclusion, differential aspects of maternal flood-related stress in pregnancy influenced aspects of 6-month-olds' neurodevelopment.

Age-related changes in the effects of stress in pregnancy on infant motor development by maternal report: The Queensland Flood Study.

The current study examined the effects of a natural disaster (a sudden onset flood) as a stressor in pregnancy on infant fine and gross motor development at 2, 6, and 16 months of age. Whether the timing of the stressor in pregnancy or sex of the infant moderated the impact of the prenatal maternal stress on motor development was also explored. Mothers' objective experiences of the flood, emotional reactions and distress, and their cognitive appraisal of the event were assessed retrospectively. Infants' fine and gross motor skills were assessed with the Ages and Stages Questionnaire, and results showed age-related changes in the effects of prenatal maternal stress on these domains. At 2 months, higher levels of prenatal maternal stress was positively related to infant motor development, yet at 6 and 16 months of age there was a negative association, particularly if flood exposure occurred later in pregnancy and if mothers had negative cognitive appraisals of the event. Results also showed differential effects of the maternal stress responses to the floods on infants' fine and gross motor development at each age and that infant sex did not buffer these effects. © 2016 Wiley Periodicals, Inc. Dev Psychobiol 58: 640-659, 2016.

QF2011: a protocol to study the effects of the Queensland flood on pregnant women, their pregnancies, and their children's early development.

BACKGROUND: Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care. METHODS/DESIGN: In January 2011 Queensland, Australia had its worst flooding in 30 years. Simultaneously, researchers in Brisbane were collecting psychosocial data on pregnant women for a randomized control trial (the M@NGO Trial) comparing Midwifery Group Practice to standard care. We invited these and other pregnant women to participate in a prospective, longitudinal study of the effects of prenatal maternal stress from the floods on maternal, perinatal and early childhood outcomes. Data collection included assessment of objective hardship and subjective distress from the floods at recruitment and again 12 months post-flood. Biological samples included maternal bloods at 36 weeks pregnancy, umbilical cord, cord blood, and placental tissues at birth. Questionnaires assessing maternal and child outcomes were sent to women at 6 weeks and 6 months postpartum. The protocol includes assessments at 16 months, 2½ and 4 years. Outcomes include maternal psychopathology, and the child's cognitive, behavioral, motor and physical development. Additional biological samples include maternal and child DNA, as well as child testosterone, diurnal and reactive cortisol. DISCUSSION: This prenatal stress study is the first of its kind, and will fill important gaps in the literature. Analyses will determine the extent to which flood exposure influences the maternal biological stress response which may then affect the maternal-placental-fetal axis at the biological, biochemical, and molecular levels, altering fetal development and influencing outcomes in the offspring. The role of Midwifery Group Practice in moderating effects of maternal stress will be tested.

Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention.

Childhood obsessive-compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable "treatment gap" and "quality gap" in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.

Smell and taste of milk during tube feeding of preterm infants: neurodevelopmental follow-up of the randomized TASTE trial, study protocol.

BACKGROUND: The Taste And Smell To Enhance nutrition (TASTE) trial investigated the effects of smell and taste of milk with tube feeding compared to routine care on the growth of preterm infants. There was no difference between groups in growth (weight, head circumference, length) z-scores at discharge from the hospital. Infants in the intervention group had higher head circumference and length z-scores at 36 weeks postmenstrual age, both secondary outcomes. The objective of this follow-up study is to assess 2-year neurodevelopmental and growth outcomes after exposure of preterm infants to the smell and taste of milk with tube feeding compared to routine care. METHODS: This is a neurodevelopmental follow-up study of a two-center, placebo-controlled randomized trial. Infants born before 29 weeks postmenstrual age and/or with a birth weight of less than 1250 g were randomized to smell and taste of milk with each tube feed or routine care. The current follow-up assessed the 2-year neurodevelopmental and growth outcomes of participants of the TASTE trial discharged from the hospital (n = 334). The primary outcome is survival free of any major neurodevelopmental impairment comprising any moderate/severe cerebral palsy (Gross Motor Function Classification System score II-V), Bayley Scales of Infant and Toddler Development, Third/Fourth Edition (Bayley-III/Bayley-4) motor, cognitive, or language scores < -2SD, blindness, or deafness at 2 years of age. Other outcomes include death, breastfeeding within the first year, and respiratory support, oral feeding, and anthropometric parameters at 2 years of age. The Human Research Ethics Committees of Mater Misericordiae Limited and the Royal Women's Hospital approved the TASTE trial including the neurodevelopmental follow-up described in this protocol. DISCUSSION: For patients and their families, the neurodevelopmental outcomes of preterm infants are of utmost importance. Consequently, they should be investigated following any interventional study performed during the newborn period. Furthermore, improved weight gain and head growth in the hospital are associated with better long-term neurodevelopmental outcomes. Smelling and tasting of milk is an uncomplicated and cost-effective intervention that may improve the growth and neurodevelopmental outcomes of preterm infants. Potential limitations affecting this follow-up study, caused by the COVID-19 pandemic, are anticipated and discussed in this protocol. TRIAL REGISTRATION: Name of the registry: Australian and New Zealand Clinical Trials Registry; Registration number: ACTRN12617000583347 ; Registration date: 26 April 2017.

Urinary 1H NMR Metabolomic Analysis of Prenatal Maternal Stress Due to a Natural Disaster Reveals Metabolic Risk Factors for Non-Communicable Diseases: The QF2011 Queensland Flood Study.

Prenatal stress alters fetal programming, potentially predisposing the ensuing offspring to long-term adverse health outcomes. To gain insight into environmental influences on fetal development, this QF2011 study evaluated the urinary metabolomes of 4-year-old children (n = 89) who were exposed to the 2011 Queensland flood in utero. Proton nuclear magnetic resonance spectroscopy was used to analyze urinary metabolic fingerprints based on maternal levels of objective hardship and subjective distress resulting from the natural disaster. In both males and females, differences were observed between high and low levels of maternal objective hardship and maternal subjective distress groups. Greater prenatal stress exposure was associated with alterations in metabolites associated with protein synthesis, energy metabolism, and carbohydrate metabolism. These alterations suggest profound changes in oxidative and antioxidative pathways that may indicate a higher risk for chronic non-communicable diseases such obesity, insulin resistance, and diabetes, as well as mental illnesses, including depression and schizophrenia. Thus, prenatal stress-associated metabolic biomarkers may provide early predictors of lifetime health trajectories, and potentially serve as prognostic markers for therapeutic strategies in mitigating adverse health outcomes.

Diagnostic Accuracy and economic value of a Tiered Assessment for Fetal Alcohol Spectrum Disorder (DATAforFASD): Protocol.

INTRODUCTION: Australian practices for diagnosing fetal alcohol spectrum disorder (FASD) are lengthy and require specialist expertise. Specialist teams are based in urban locations; they are expensive and have prolonged waitlists. Innovative, flexible solutions are needed to ensure First Nations children living in rural/remote communities have culturally appropriate and equitable access to timely diagnosis and support. This study compares the accuracy of rapid assessments (index tests) that can be administered by a range of primary healthcare practitioners to specialist standardised FASD assessments (reference tests). The cost-efficiency of index tests will be compared with reference tests. METHODS AND ANALYSIS: At least 200 children aged 6-16 years at-risk of FASD will be recruited across at least seven study sites. Following standards for reporting diagnostic accuracy study (STARD) guidelines, all children will complete index and reference tests. Diagnostic accuracy statistics (including receiver operating curves, sensitivity, specificity, positive and negative predictive values and likelihood ratios) will identify whether rapid assessments can accurately identify: (1) the presence of an FASD diagnosis and (2) impairment in each neurodevelopmental domain, compared to comprehensive assessments. Direct and indirect healthcare costs for index tests compared to reference tests will be collected in primary healthcare and specialist settings. ETHICS AND DISSEMINATION OF RESULTS: Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/20/QCHQ/63173); Griffith University Human Research Ethics Committee (2020/743). Results will assist in validating the use of index tests as part of a tiered neurodevelopmental assessment process that was co-designed with First Nations community and primary healthcare practitioners. Outcomes will be summarised and provided to participating practitioners and sites, and disseminated to community health services and consumers. Findings will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12622000498796.

Magic memories: young children's verbal recall after a 6-year delay.

This report describes the first prospective study specifically designed to assess children's verbal memory for a unique event 6 years after it occurred. Forty-six 27- to 51-month-old children took part in a unique event and were interviewed about it twice, after 24-hr and 6-year delays. During the 6-year interview, 9 children verbally recalled the event, including 2 who were under 3 years old when the event occurred. This may be the most convincing evidence to date that such early experiences can be verbally recalled after long delays. These data have important implications for current theories of memory development and childhood amnesia and underscore some of the problems associated with evaluating the veracity of early memories under less controlled conditions.