Developing Preschool Language Surveillance Models - Cumulative and Clustering Patterns of Early Life Factors in the Early Language in Victoria Study Cohort.

BACKGROUND: Screening and surveillance of development are integral to ensuring effective early identification and intervention strategies for children with vulnerabilities. However, not all developmental skills have reliable screening processes, such as early language ability. METHOD: We describe how a set of early life factors used in a large, prospective community cohort from Australia are associated with language abilities across the preschool years, and determine if either an accumulation of risk factors or a clustering of risk factors provide a feasible approach to surveillance of language development in preschool children. RESULTS: There were 1,208 children with a 7-year language outcome. The accumulation of early life factors increased the likelihood of children having low language skills at 7-years. Over a third of children with typical language skills (36.6%) had ≤ two risks and half of the children with low language (50%) had six or more risks. As the number of factors increases the risk of having low language at 7-years increases, for example, children with six or more risks had 17 times greater risk, compared to those with ≤ two risks. Data collected from 1,910 children at 8- to 12-months were used in the latent class modeling. Four profile classes (or groups) were identified. The largest group was developmentally enabled with a supportive home learning environment (56.2%, n = 1,073). The second group was vulnerable, both developmentally and in their home learning environment (31.2%, n = 596); the third group was socially disadvantaged with a vulnerable home learning environment (7.4%, n = 142); the final group featured maternal mental health problems and vulnerable child socio-emotional adjustment (5.2%, n = 99). Compared to developmentally enabled children, the risk of low language at 7-years was greater for children in the three other groups. CONCLUSION: The cumulative and cluster risk analyses demonstrate the potential to use developmental surveillance to identify children within the first years of life who are at risk of language difficulties. Importantly, parent-child interaction and the home learning environment emerged as a consistent cluster. We recommend they be adopted as the common focus for early intervention and universal language promotion programs.

Experience of stress in parents of children with ADHD: A qualitative study.

Purpose: Qualitative research aimed at understanding the stress of parents of children with ADHD is limited and few interventions have been designed to directly target their stress. The study aim was to explore the stress of parents of children with ADHD using qualitative methodology.Methods: Thirteen parents of children with ADHD participated in two focus groups. Open-ended questions explored parents' experiences of stress. Focus groups were recorded, transcribed, and coded using thematic analysis. Parents also completed the Parenting Stress Index-Short Form.Results: Four primary themes were identified: The child's behaviour feels like a "wrecking ball"; Coping with the "war at home"; A divided family: "relationships don't survive"; and Craving support: "it's goddamn hard work". Five of eleven participants who completed the PSI-SF scored in the clinically significant range indicating levels of stress that require professional support.Conclusions: Parents attribute their high stress to their children's behaviour, unmet needs for support, and social stigma. Parents request support to enable them to cope and appear to represent a clinical population who require mental health care and support themselves. Future interventions directly targeting the stress of parents of children with ADHD may provide wide-ranging benefits for their children and families.

Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial.

OBJECTIVE: To examine whether behavioural strategies designed to improve children's sleep problems could also improve the symptoms, behaviour, daily functioning, and working memory of children with attention deficit hyperactivity disorder (ADHD) and the mental health of their parents. DESIGN: Randomised controlled trial. SETTING: 21 general paediatric practices in Victoria, Australia. PARTICIPANTS: 244 children aged 5-12 years with ADHD attending the practices between 2010 and 2012. INTERVENTION: Sleep hygiene practices and standardised behavioural strategies delivered by trained psychologists or trainee paediatricians during two fortnightly consultations and a follow-up telephone call. Children in the control group received usual clinical care. MAIN OUTCOME MEASURES: At three and six months after randomisation: severity of ADHD symptoms (parent and teacher ADHD rating scale IV-primary outcome), sleep problems (parent reported severity, children's sleep habits questionnaire, actigraphy), behaviour (strengths and difficulties questionnaire), quality of life (pediatric quality of life inventory 4.0), daily functioning (daily parent rating of evening and morning behavior), working memory (working memory test battery for children, six months only), and parent mental health (depression anxiety stress scales). RESULTS: Intervention compared with control families reported a greater decrease in ADHD symptoms at three and six months (adjusted mean difference for change in symptom severity -2.9, 95% confidence interval -5.5 to -0.3, P=0.03, effect size -0.3, and -3.7, -6.1 to -1.2, P=0.004, effect size -0.4, respectively). Compared with control children, intervention children had fewer moderate-severe sleep problems at three months (56% v 30%; adjusted odds ratio 0.30, 95% confidence interval 0.16 to 0.59; P<0.001) and six months (46% v 34%; 0.58, 0.32 to 1.0; P=0.07). At three months this equated to a reduction in absolute risk of 25.7% (95% confidence interval 14.1% to 37.3%) and an estimated number needed to treat of 3.9. At six months the number needed to treat was 7.8. Approximately a half to one third of the beneficial effect of the intervention on ADHD symptoms was mediated through improved sleep, at three and six months, respectively. Intervention families reported greater improvements in all other child and family outcomes except parental mental health. Teachers reported improved behaviour of the children at three and six months. Working memory (backwards digit recall) was higher in the intervention children compared with control children at six months. Daily sleep duration measured by actigraphy tended to be higher in the intervention children at three months (mean difference 10.9 minutes, 95% confidence interval -19.0 to 40.8 minutes, effect size 0.2) and six months (9.9 minutes, -16.3 to 36.1 minutes, effect size 0.3); however, this measure was only completed by a subset of children (n=54 at three months and n=37 at six months). CONCLUSIONS: A brief behavioural sleep intervention modestly improves the severity of ADHD symptoms in a community sample of children with ADHD, most of whom were taking stimulant medications. The intervention also improved the children's sleep, behaviour, quality of life, and functioning, with most benefits sustained to six months post-intervention. The intervention may be suitable for use in primary and secondary care.Trial registration Current Controlled Trials ISRCTN68819261.

Anxiety in children with attention-deficit/hyperactivity disorder.

OBJECTIVES: Although anxiety is common in children with attention-deficit/hyperactivity disorder (ADHD), it is unclear how anxiety influences the lives of these children. This study examined the association between anxiety comorbidities and functioning by comparing children with ADHD and no, 1, or ≥2 anxiety comorbidities. Differential associations were examined by current ADHD presentation (subtype). METHODS: Children with diagnostically confirmed ADHD (N = 392; 5-13 years) were recruited via 21 pediatrician practices across Victoria, Australia. Anxiety was assessed by using the Anxiety Disorders Interview Schedule for Children-IV. Functional measures included parent-reported: quality of life (QoL; Pediatric Quality of Life Inventory 4.0), behavior and peer problems (Strengths and Difficulties Questionnaire), daily functioning (Daily Parent Rating of Evening and Morning Behavior), and school attendance. Teacher-reported behavior and peer problems (Strengths and Difficulties Questionnaire) were also examined. Linear and logistic regression controlled for ADHD severity, medication use, comorbidities, and demographic factors. RESULTS: Children with ≥2 anxiety comorbidities (n = 143; 39%) had poorer QoL (effect size: -0.8) and more difficulties with behavior (effect size: 0.4) and daily functioning (effect size: 0.3) than children without anxiety (n = 132; 36%). Poorer functioning was not observed for children with 1 anxiety comorbidity (n = 95; 26%). Two or more anxiety comorbidities were associated with poorer functioning for children with both ADHD-Inattentive and ADHD-Combined presentation. CONCLUSIONS: Children with ADHD demonstrate poorer QoL, daily functioning and behavior when ≥2 anxiety comorbidities are present. Future research should examine whether treating anxiety in children with ADHD improves functional outcomes.

A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial.

OBJECTIVE: To assess the effectiveness of a parent-focused intervention on infants' obesity-risk behaviors and BMI. METHODS: This cluster randomized controlled trial recruited 542 parents and their infants (mean age 3.8 months at baseline) from 62 first-time parent groups. Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge, skills, and social support around infant feeding, diet, physical activity, and television viewing. Control group parents received 6 newsletters on nonobesity-focused themes; all parents received usual care from child health nurses. The primary outcomes of interest were child diet (3 × 24-hour diet recalls), child physical activity (accelerometry), and child TV viewing (parent report). Secondary outcomes included BMI z-scores (measured). Data were collected when children were 4, 9, and 20 months of age. RESULTS: Unadjusted analyses showed that, compared with controls, intervention group children consumed fewer grams of noncore drinks (mean difference = -4.45; 95% confidence interval [CI]: -7.92 to -0.99; P = .01) and were less likely to consume any noncore drinks (odds ratio = 0.48; 95% CI: 0.24 to 0.95; P = .034) midintervention (mean age 9 months). At intervention conclusion (mean age 19.8 months), intervention group children consumed fewer grams of sweet snacks (mean difference = -3.69; 95% CI: -6.41 to -0.96; P = .008) and viewed fewer daily minutes of television (mean difference = -15.97: 95% CI: -25.97 to -5.96; P = .002). There was little statistical evidence of differences in fruit, vegetable, savory snack, or water consumption or in BMI z-scores or physical activity. CONCLUSIONS: This intervention resulted in reductions in sweet snack consumption and television viewing in 20-month-old children.

Psychosocial predictors of 4-year BMI change in overweight and obese children in primary care.

OBJECTIVE: This study aimed to determine whether (1) initial and/or (2) changes in psychosocial functioning predict body mass index (BMI) z-score change over 4 years in overweight/mildly obese 5- to 9-year old children presenting to primary care. DESIGN AND METHODS: Eligible participants (n = 258) were overweight/mildly obese children (IOTF criteria) recruited into the LEAP2 trial (ISRCTN52511065) from 3,958 children visiting general practitioners in Melbourne, Australia from May 2005 to July 2006. Predictors were change scores calculated from repeated measures of parent- and child-reported child health-related quality of life (PedsQL) and self-esteem; child-reported desire to be thinner; and parent-reported child weight concern. Outcome was measured BMI z-score change from baseline to 4 years. RESULTS: The 189 respondents (61% female; 73% retention) showed little mean change in BMI z-score (-0.08) but wide variation (standard deviation 0.50, range -1.32 to 1.20). Only one baseline measure (better parent-reported PedsQL School Functioning) predicted improving BMI z-score. However, parents and children consistently reported that changes in psychosocial functioning (i.e., PedsQL Social and Global Self-esteem) were inversely related to BMI z-score change scores. The strongest predictors of decreases in BMI z-scores were changes in child-reported body-image variables, i.e., improvements in Physical Appearance Self-esteem (ß =0.40, 95% CI -0.98 to -0.15, P < 0.01) and declines in Desire to be Thinner (ß = 0.33, 95% CI 0.04 to 0.23, P < 0.01). CONCLUSIONS: At presentation to primary care, it seems unlikely that targeting the psychosocial factors measured in this study would influence BMI z-score change in overweight/mildly obese children. Subsequent change in psychosocial well-being covaries with BMI z-score change and may have important adolescent ramifications; the causal directions for these associations require further research.

Physical activity and 3-year BMI change in overweight and obese children.

OBJECTIVES: Targeting physical activity (PA) is a mainstay in obesity treatment, but its BMI benefits are poorly quantified. We studied long-term predictive PA-BMI relationships in overweight/obese children presenting to primary care. METHODS: Three-year follow-up of 182 overweight/obese 5- to 10-year-olds recruited from 45 Melbourne general practices. PREDICTOR: 7-day accelerometry (counts per minute, cpm). OUTCOMES: change in BMI z score, BMI category, and clinically significant BMI improvement (z score change ≥0.5). ANALYSIS: Linear and logistic regression. RESULTS: Mean (SD) baseline and 3-year BMI z scores were 1.8 (0.6) and 1.8 (0.7), and mean (SD) activity scores 334 (111) and 284 (104) cpm, respectively. Baseline activity did not predict BMI change. However, for every 100 cpm increase in change in activity over 3 years, BMI z score fell by 0.11 (95% confidence interval [CI] 0.03-0.20; P = .006). There were also trends toward greater odds of staying in the same, versus moving to a higher, BMI category (odds ratio 1.85, 95% CI 0.99-3.46) and clinically significant BMI improvement (odds ratio 1.96, 95% CI 0.90-4.27; P = .09). Change in percentage time spent in moderate-vigorous (P = .01), but not sedentary (P = .39) or light (P = .59), activity predicted reduced BMI z score. CONCLUSIONS: Sustained increase in moderate-vigorous PA predicts reducing BMI z score over 3 years in overweight/obese children presenting to primary care. However, the small BMI change associated with even the largest activity changes may explain disappointing BMI outcomes of brief primary care interventions targeting PA.

Why families choose not to participate in research: feedback from non-responders.

AIM: Subjects who did not respond to an invitation to participate in a community-based randomised controlled trial for childhood obesity in Melbourne, Australia were approached to investigate reasons for non-participation. METHODS: Between January and September 2007, 305 families were sent a brief questionnaire and invited to take part in the current study. Thirty-seven questionnaires were returned and 12 parents agreed to a follow-up interview. Questionnaire data were quantitatively analysed. The interviews were conducted via the telephone and provided detailed qualitative information on non-participation. RESULTS: Lack of time was cited as a main reason for non-participation. Different aspects of time were discussed including lack of time to dedicate to a topic seen as low priority, overestimated perception of time for study commitments and the inappropriate timing of the request. Other major reasons for non-participation included risk of negative experiences and the impact of the initial contact with the study. CONCLUSIONS: This study illustrates the experiences of potential participants during the recruitment process, their perceptions of study commitments and how their previous experiences impact on their decision to participate in research. These findings provide insight into the decision not to participate in health research and could be used to modify recruitment procedures for future health research as a way of improving the recruitment experience for potential participants as well as enhancing recruitment rates.

Preventing mental health problems in children: the Families in Mind population-based cluster randomised controlled trial.

BACKGROUND: Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to determine the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care). METHODS/DESIGN: Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months.Participants were families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care.The interventions comprises (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems.Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective. DISCUSSION: This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed. TRIAL REGISTRATION: ISRCTN61137690.

Using simulated patients to develop doctors' skills in facilitating behaviour change: addressing childhood obesity.

OBJECTIVES: This study aimed to describe the application, feasibility and outcomes of using simulated patients (SPs) to increase the skills of general practitioners (GPs) delivering a behavioural intervention to reduce childhood overweight and mild obesity. METHODS: Five female actors were trained as SPs. A total of 67 GPs from 46 general practices in Melbourne, Victoria, Australia, conducted two simulated consultation visits regarding healthy lifestyle family behaviour change, during which they practised their skills and received formative feedback. The GPs and SPs rated GP performance immediately after each consultation. Subsequently, 139 parents of overweight or obese 5-9-year-old children rated GP performance during real-life consultations. Other measures included child body mass index (BMI) Z-scores (at baseline and at a 9-month follow-up) and GP-reported levels of comfort and competence and the perceived value of SP visits. RESULTS: Simulated patient ratings, but not GP self-ratings, of GP performance predicted both parent ratings of real-life consultations (Spearman's rho 0.39 for correlation with SP rating at Visit 1) and subsequent reductions in BMI Z-scores between baseline and follow-up (Visit 1, rho-0.45; Visit 2, rho-0.46). GP levels of comfort and competence were maintained during and after the SP visits. A total of 95% of GPs rated simulated consultations as useful, although only 18% said they would pay for them. CONCLUSIONS: Simulated patient assessment may predict real patient feedback and clinical outcomes, helping to identify doctors who require further training in behaviour change techniques. Randomised controlled trials may establish whether SPs actually raise skills or improve outcomes.

Study protocol: the sleeping sound with attention-deficit/hyperactivity disorder project.

BACKGROUND: Up to 70% of children with Attention-Deficit/Hyperactivity Disorder (ADHD) experience sleep problems including difficulties initiating and maintaining sleep. Sleep problems in children with ADHD can result in poorer child functioning, impacting on school attendance, daily functioning and behaviour, as well as parental mental health and work attendance. The Sleeping Sound with ADHD trial aims to investigate the efficacy of a behavioural sleep program in treating sleep problems experienced by children with ADHD. We have demonstrated the feasibility and the acceptability of this treatment program in a pilot study. METHODS/DESIGN: This randomised controlled trial (RCT) is being conducted with 198 children (aged between 5 to 12 years) with ADHD and moderate to severe sleep problems. Children are recruited from public and private paediatric practices across the state of Victoria, Australia. Upon receiving informed written consent, families are randomised to receive either the behavioural sleep intervention or usual care. The intervention consists of two individual, face-to-face consultations and a follow-up phone call with a trained clinician (trainee consultant paediatrician or psychologist), focusing on the assessment and management of child sleep problems. The primary outcome is parent- and teacher-reported ADHD symptoms (ADHD Rating Scale IV). Secondary outcomes are child sleep (actigraphy and parent report), behaviour, daily functioning, school attendance and working memory, as well as parent mental health and work attendance. We are also assessing the impact of children's psychiatric comorbidity (measured using a structured diagnostic interview) on treatment outcome. DISCUSSION: To our knowledge, this is the first RCT of a behavioural intervention aiming to treat sleep problems in children with ADHD. If effective, this program will provide a feasible non-pharmacological and acceptable intervention improving child sleep and ADHD symptoms in this patient group. TRIAL REGISTRATION: Current Controlled Trials ISRCTN68819261. ISRCTN: ISRCTN68819261.

Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial.

OBJECTIVE: To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children. DESIGN: Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment. SETTING: 45 family practices (66 general practitioners) in Melbourne, Australia. PARTICIPANTS: 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score >or=3.0) were excluded. INTERVENTION: Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials. Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI. RESULTS: Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention - control) at 6 and 12 months were, for BMI, -0.12 (95% CI -0.40 to 0.15, P=0.4) and -0.11 (-0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (-4 to 52, P=0.09) and 11 (-26 to 49, P=0.6); and, for nutrition score, 0.2 (-0.03 to 0.4, P=0.1) and 0.1 (-0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm. CONCLUSIONS: Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia. TRIAL REGISTRATION: ISRCTN 52511065 (www.isrctn.org).

Economic evaluation of a primary care trial to reduce weight gain in overweight/obese children: the LEAP trial.

BACKGROUND: A common policy response to the childhood obesity epidemic is to recommend that primary care physicians screen for and offer counseling to the overweight/obese. As the literature suggests, this approach may be ineffective; it is important to document the opportunity costs incurred by brief primary care obesity interventions that ultimately may not alter body mass index (BMI) trajectory. METHODS: Live, Eat and Play (LEAP) was a randomized controlled trial of a brief secondary prevention intervention delivered by family physicians in 2002-2003 that targeted overweight/mildly obese children aged 5 to 9 years. Primary care utilization was prospectively audited via medical records, and parents reported family resource use by written questionnaire. Outcome measures were BMI (primary) and parent-reported physical activity and dietary habits (secondary) in intervention compared with control children. RESULTS: The cost of LEAP per intervention family was AU $4094 greater than for control families, mainly due to increased family resources devoted to child physical activity. Total health sector costs were AU $873 per intervention family and AU $64 per control, a difference of AU $809 (P < .001). At 15 months, intervention children did not differ significantly in adjusted BMI or daily physical activity scores compared with the control group, but dietary habits had improved. CONCLUSIONS: This brief intervention resulted in higher costs to families and the health care sector, which could have been devoted to other uses that do create benefits to health and/or family well-being. This has implications for countries such as the United States, the United Kingdom, and Australia, whose current guidelines recommend routine surveillance and counseling for high child BMI in the primary care sector.

What do GPs get out of participating in research? - experience of the LEAP trial.

BACKGROUND: Maximising the health of our communities requires a strong foundation of clinical research. Undertaking community based clinical research requires an understanding of what motivates practitioners to participate in research and how they experience the process. It has been suggested that a primary care sector with a strong research culture and evidence base is crucial to getting evidence into practice, yet general practice research has been criticised for ignoring clinical research. This article examines why a group of general practitioners took part in clinical research. METHODS: Participants completed surveys before and after involvement in the Live, Eat and Play (LEAP) study, a randomised controlled trial to reduce childhood overweight. RESULTS: Thirty-four GPs enrolled in LEAP and completed the baseline survey; 30 delivered the intervention and 29 completed all surveys. Sixtyone percent (17) of the GPs agreed that their expectations of their participation in the project had been met. Twenty-eight of 29 GPs stated they would participate in similar research if asked again. Responses to open ended questions indicated that the most highly valued reason for participating in research was to learn new clinical skills, update knowledge and reflect on practice. DISCUSSION: General practitioners were driven to participate in research by altruism, the desire to update their knowledge and clinical skills, and the opportunity to reflect on their practice rather than the promise of 'rewards' such as quality assurance and continuing medical education points.

Are general practitioners equipped to detect child overweight/obesity? Survey and audit.

AIM: To ascertain the extent to which general practitioners (GPs) routinely weigh, measure and calculate body mass index (BMI) in children, and to assess the accuracy and accessibility of their anthropometric equipment. METHODS: A convenience sample of 34 GPs from 29 primary care family medical practices in Melbourne, Australia, completed a questionnaire regarding their routine anthropometric practice for 5-10-year-old children and perceived role in managing childhood overweight and obesity. Practice audits (April-June 2002) assessed the accuracy and accessibility of anthropometric equipment. RESULTS: Forty-four per cent of GPs reported regularly weighing children; 38% regularly measured children's height. Only one regularly calculated children's BMI. Formal training in child anthropometry and servicing of anthropometric equipment was rare. The majority of equipment was accessible. Stadiometers on average measured the height of a 'short' pole (true height 92.68 cm) as 92.52 cm (SD = 0.8), and measured the height of a 'tall' pole (true height 157.64 cm) as 157.55 cm (SD = 0.9). On average, calibration weights of 20 kg and 80 kg were recorded as 19.7 kg (SD = 0.6) and 79.2 kg (SD = 1.5) respectively. Despite these shortcomings, these GPs generally felt they played a key role in managing overweight in children. CONCLUSIONS: Self-reported practice by these GPs falls well short of 2003 National Health and Medical Research Council guidelines recommending bi-annual measuring of all children in the primary care setting. The variability of anthropometric equipment audited could result in widely discrepant BMI values, leading to serious misclassification of many children's weight status.

Weighty matters--an approach to childhood overweight in general practice.

BACKGROUND: In Australia, childhood obesity now rivals asthma as the most prevalent chronic child health condition. The past 2 decades have shown a rapidly rising prevalence of childhood overweight and obesity with no sign that this trajectory will plateau. Primary care is increasingly recognised as a forum in which to address this growing public health issue. OBJECTIVE: This article discusses the epidemiology of childhood overweight and obesity in Australia and their associated physical and psychosocial morbidities. It discusses the current evidence base and resources for the definition, investigation and management of childhood obesity and outlines an approach in the primary care setting. It also reports a recently developed general practitioner delivered intervention to reduce overweight in primary school aged children--the Live, Eat and Play (LEAP) project. DISCUSSION: Clear clinical practice guidelines for the assessment and management of overweight and obesity in childhood in primary care now exist. The feasibility of these guidelines, and the availability of resources required to deliver them, is not yet clear. The LEAP project proposes an effective intervention delivered by general practitioners to address this vital and complex issue.

Can Australian general practitioners tackle childhood overweight/obesity? Methods and processes from the LEAP (Live, Eat and Play) randomized controlled trial.

BACKGROUND: General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown. OBJECTIVES: To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5- to 9-year-old children. METHODS: A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross-sectional body mass index (BMI) survey of 5- to 9-year-old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution-focused behaviour change consultations over 12 weeks. RESULTS: General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation. CONCLUSIONS: Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family-based primary care approach is beneficial, harmful or ineffective.

Does parents' evaluation of developmental status at school entry predict language, achievement, and quality of life 2 years later?

OBJECTIVE: We studied the accuracy of the Parents' Evaluation of Developmental Status (PEDS) at school entry in predicting academic, language, and health-related quality of life (HRQoL) outcomes 2 years later. DESIGN/METHOD: Prospective population study in elementary schools in Melbourne, Australia. Base Population. A total of 1591 school entry children who participated in a separate cross-sectional study. Cases. One hundred seventy-three children randomly selected from those with significant parental developmental concerns. Controls. One hundred twenty-nine children without significant parental development concerns. Predictors (1997). Parents completed all 10 PEDS items; teachers completed 5 PEDS items. Outcomes (1999). The PEDS and the Child Health Questionnaire (parents) and the Comprehensive Inventory of Basic Skills-Revised and the Renfrew Action Picture Test of language (children). Odds ratios (ORs) were calculated for low outcome scores, defined as >1.0 standard deviation below the mean or <16th centile. RESULTS: At outcome, case parents reported more "significant" concerns on the PEDS than did control parents (65% vs 26%, OR 5.3), but mean language and academic scores were only slightly lower for case children. Parent-reported self-help and school skills concerns predicted low language (ORs 2.1-2.8) and academic (ORs 1.3-6.6) scores. Teacher concerns about early school skills predicted low academic scores (ORs 3.7-4.7). However, sensitivity and specificity values were modest. Baseline developmental concerns predicted poor scores on a number of domains of HRQoL 2 years later. CONCLUSIONS: Although individual developmental concerns at school entry variably predict later academic and language scores, sensitivity and specificity values would not support use of the PEDS as a stand-alone screen to detect later problems.

The relationship between friendship factors and adolescent girls' body image concern, body dissatisfaction, and restrained eating.

OBJECTIVE: This study examined whether poorer friendship relations predict weight concerns and dietary restraint in adolescent girls. METHOD: Questionnaires were administered to 131 Year 9 and Year 10 girls to assess the relationship between acceptance by friends, perceived social support, friendship intimacy, and perceived impact of thinness on male (PITOF-M) and female (PITOF-F) friendships on the one hand, and body image concern, body dissatisfaction, and restrained eating on the other. RESULTS: Friendship variables contributed significantly to the prediction of body image concern, body dissatisfaction, and restrained eating. The largest unique contribution to prediction was from the PITOF-M. Poor acceptance by friends significantly predicted the PITOF-M and PITOF-F. Whereas heavier girls were more likely to believe being thinner would improve their friendships, they did not experience poorer friendships. DISCUSSION: Results suggest sociocultural risk factors for disordered eating and underline the importance of perceived peer affiliation on girls' body image concern and dieting.