A pilot feasibility and acceptability trial of an internet indicated prevention program for perfectionism to reduce eating disorder symptoms in adolescents.

PURPOSE: Perfectionism is a transdiagnostic risk factor for eating disorders. Treating perfectionism can reduce symptoms of eating disorders. No research has examined an indicated prevention trial using internet-based Cognitive-Behavioural Therapy for Perfectionism (ICBT-P) in adolescent girls at elevated risk for eating disorders. Our aim was to conduct a preliminary feasibility trial using a co-designed ICBT-P intervention. It was hypothesised that a higher proportion of participants in the ICBT-P condition would achieve reliable and clinically significant change on perfectionism, eating disorders, anxiety and depression, compared to waitlist control. METHODS: Twenty-one adolescent girls with elevated symptoms of eating disorders (M age = 16.14 years) were randomised to a 4-week online feasibility trial of a co-designed ICBT-P prevention program or waitlist control. Qualitative surveys were used to gain participant perspectives. RESULTS: The ICBT-P condition had a higher proportion of participants achieve reliable change and classified as recovered on perfectionism and symptoms of eating disorders and anxiety, compared to waitlist control. Qualitative findings indicated that 100% of participants found the program helpful. CONCLUSION: The results indicate ICBT-P is a feasible and acceptable program for adolescent girls with elevated eating disorder symptoms. Future research is required to examine outcomes in a randomised controlled trial. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort or case-control analytic studies. TRIAL REGISTRATION NUMBER: This trial was prospectively registered with Australian and New Zealand Clinical Trials Registry (ACTRN12620000951954P) on 23/09/2020.

Understanding eating disorder symptoms in adolescents: testing a cognitive-behavioural model of eating disorders in a community sample.

Clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties are associated with eating disorder symptoms in clinical samples. The aim of the current study was to test a model including clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties to understand eating disorder symptoms in an adolescent community sample. Adolescents (N = 446, M age = 16.25 years, SD = 1.64; 74.2% female) completed measures of clinical perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms. Path analysis indicated clinical perfectionism, self-esteem, mood intolerance, and interpersonal difficulties were all directly associated with symptoms of eating disorders, and that clinical perfectionism was indirectly associated with eating disorders through self-esteem, mood intolerance, and interpersonal difficulties. The results indicate the cognitive-behavioural model of eating disorders can be applied to adolescents in the community with symptoms of eating disorders. Directional causality between constructs should be established to understand whether increased clinical perfectionism, and reduced self-esteem, mood intolerance, and interpersonal difficulties are vulnerabilities to the development and maintenance of eating disorders.

Corporal punishment of children in Australia: The evidence-based case for legislative reform.

OBJECTIVE: Across all of Australia's states and territories, it is legal for a parent or carer to hit their child. In this paper, we outline the legal context for corporal punishment in Australia and the argument for its reform. METHODS: We review the laws that allow corporal punishment, the international agreements on children's rights, the evidence on the effects of corporal punishment, and outcomes of legislative reform in countries that have changed their laws to prohibit corporal punishment. RESULTS: Legislative reform typically precedes attitude changes and reductions in the use of corporal punishment. Countries with the most ideal outcomes have instigated public health campaigns educating the population about law reform while also providing access to alternative non-violent discipline strategies. CONCLUSIONS: Extensive evidence exists demonstrating the adverse effects of corporal punishment. When countries change legislation, educate the public about these effects, and provide alternative strategies for parents, rates of corporal punishment decrease. IMPLICATIONS FOR PUBLIC HEALTH: We recommend law reform in Australia to prohibit corporal punishment, a public health campaign to increase awareness of corporal punishment and its effects, provision of access for parents to alternative evidence-based strategies to assist in parenting, and a national parenting survey to monitor outcomes.

Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families.

Parents can be essential change-agents in their children's lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.

A behavioural activation intervention to increase engagement with life and wellbeing in older adults: Study protocol for a randomised controlled trial.

BACKGROUND: Meaningful activity engagement is a critical element of ageing well. Interventions designed to increase activity engagement tend to be activity-specific and do not always meet the needs of older adults with diverse interests and capacities. Behavioural activation (BA) provides a promising person-centred framework for promoting engagement in valued activities. This study will examine the effectiveness of a behavioural activation-based intervention for promoting engagement with life and wellbeing among older adults. METHOD: Participants will be randomly allocated to one of two conditions (BA intervention, Active Control) and take part in a six-week intervention that consists of one-on-one weekly sessions of up to one hour to be administered either via telephone or online video conferencing with a trained facilitator. This study will recruit 120 + participants aged 65 + who score at or below the median on a test of life engagement. Participants will complete questionnaires of primary and secondary measures both pre-program, one-week and three months post-program. Participants will also complete a daily diary questionnaire during the fourth and fifth weeks of the intervention. The primary outcome measure is the Life Engagement Test, and secondary outcome measures include assessments of subjective wellbeing, psychological wellbeing, mental health, self-reported health, social engagement, loneliness and life satisfaction. DISCUSSION: The outcomes from this study will provide evidence as to whether a BA based approach represents an effective method for promoting engagement with life and wellbeing among older community-dwelling adults. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (Reg no. ACTRN 12621001192875). Trial retrospectively registered 6th September, 2021.

Parental Adjustment Scale: Validation of a brief, five-item measure of parental adjustment for use with families of typically developing children and children with developmental and/or intellectual disabilities in Australia.

BACKGROUND: Explores the validity of the five-item parental adjustment scale, a subscale of the previously validated Parenting and Family Adjustment Scales. AIM: The aim was to assess the factor structure and convergent validity of a measure of parental adjustment within parents of typically developing children and parents of childiren with developmental and/or intellectual disabilities. METHODS AND PROCEDURES: Cross-sectional survey data was analysed from Australian parents of children aged 2-12 years who were typically developing children (N = 683) and had developmental and/or intellectual disabilities (N = 756). Confirmatory factor analyses and multi-group structural equation modelling examined if the factor structure performed similarly across the two populations. Convergent validity was assessed. OUTCOMES AND RESULTS: The confirmatory factor analysis supported the hypothesised one-factor structure for the parental adjustment scale in both populations. Partial measurement invariance confirmed that the scale was structurally consistent within both parent groups. The convergent validity was supported by significant correlations with the DASS-21 in the disability population and the K10 in the typically developing population. CONCLUSIONS AND IMPLICATIONS: This brief, easily administered, five-item scale demonstrates strong potential in assessing parental adjustment, within both parents of typically developing children and parents of children with developmental and/or intellectual disabilities.

A review of Australian Government funding of parenting intervention research.

OBJECTIVES: Parenting is central to children's optimal development and accounts for a substantial proportion of the variance in child outcomes, including up to 40% of child mental health. Parenting is also one of the most modifiable, proximal, and direct factors for preventing and treating a range of children's problems and enhancing wellbeing. To determine the effectiveness of new approaches to parenting intervention, and to evaluate how to optimise reach and uptake, sufficient funding must be allocated for high quality research. METHOD: We reviewed funding awarded by the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) for parenting intervention research during 2011-2020. RESULTS: Parenting intervention research received 0.25% of the NHMRC and ARC research budgets. CONCLUSIONS: There is a substantial mismatch between the funding of parenting intervention research and the impact of improved parenting on short- and long-term child outcomes. To rectify this, it is critical that Australian Government funding schemes include parenting interventions as priority areas for funding. IMPLICATIONS FOR PUBLIC HEALTH: Changes in allocation of funding to parenting research will support the establishment of evidence for the effective development, implementation and dissemination of parenting interventions to maximise health outcomes for children and their families.

Mechanisms of Change in Population-Based Parenting Interventions for Children and Adolescents.

OBJECTIVE: Developing an effective population-level system of evidence-based parenting support capable of shifting (at a population level) rates of child maltreatment and social, emotional, and behavioral problems in children requires an integrated theory of change. This paper presents a systems-contextual model of change and identifies modifiable mechanisms that can potentially explain population-level changes in parenting and child outcomes. METHOD: Using the Triple P-Positive Parenting Program as an exemplar of a tiered, multi-level system of evidence-based parenting interventions, we discuss the putative mechanisms of change necessary to produce change in child behavior, parenting, practitioner behavior, and organizational changes to support the sustained implementation of an intervention. RESULTS: A model of change is proposed that blends theoretical perspectives derived from social learning theory, self-regulation theory, applied behavior analysis, cognitive behavior principles, developmental theory, and principles derived from the fields of public health, implementation science, and economics to explain change in the behavior at the community wide level. Different types of interventions targeting different populations and mechanisms are used to illustrate how sustainable change in child and parent outcomes can be achieved. CONCLUSIONS: Evidence supporting specific mechanisms and moderators of intervention effects are discussed as well as directions for future research on mechanisms.

A pilot study of a new bereavement program for children: Lionheart Camp for Kids.

We assessed the acceptability and effectiveness of a new childhood bereavement service known as Lionheart Camp for Kids. Using a pre-post-follow-up design, data pertaining to 12 bereaved children (aged 5-12 years) and their primary caregivers were obtained. Results showed that caregivers reported decreases in children's peer relationship problems, improvements in parental consistency, and reductions in coercive parenting, and there was a trend toward lower self-reported grief by the children. Caregivers were highly satisfied with the program. There is a need for a wait-list or randomized controlled trial over a longer time period to determine the full benefits of the camp.

Unguided low intensity cognitive behaviour therapy for anxiety and depression during the COVID-19 pandemic: A randomised trial.

The COVID-19 pandemic has had a severe impact on mental health worldwide, with increased rates of anxiety and depression widely documented. The aim of this study was to examine unguided low intensity cognitive behaviour therapy for anxiety and depression during the pandemic. A sample of 225 individuals in Australia and the United Kingdom (M age 37.79, SD = 14.02, range 18-80 years; 85% female) were randomised into intervention or waitlist control. The intervention group demonstrated significant decreases in anxiety (d = 0.36 [0.18, 0.54]) and depression (d = 0.28 [0.11, 0.45]) compared to controls. The majority of participants (96%) rated the intervention as useful, and most (83%) reported they spent 30 min or less reading the guide, with 83% agreeing the intervention was easy to read. The results indicate that low intensity cognitive behaviour therapy has efficacy in reducing anxiety and depression during the COVID-19 pandemic. There is an urgent need to disseminate low intensity psychological therapies to improve mental health in this challenging time.

An examination of the transdiagnostic cognitive-behavioural model of eating disorders in adolescents.

OBJECTIVE: The validity of the transdiagnostic cognitive-behavioural model of eating disorders has been examined in adults, however there is limited examination in adolescents with eating disorders. The present study examined the direct and indirect relationships between eating disorder symptoms and the four maintaining processes: perfectionism, low core self-esteem, mood intolerance, and interpersonal difficulties. METHOD: Using a correlational cross-sectional design, adolescents with eating disorders (N = 270; anorexia nervosa [restricting; 35.9%]; anorexia nervosa [binge purge; 8.1%]; bulimia nervosa [9.3%]; atypical anorexia nervosa [27.4%]; bulimia nervosa [of low frequency and/or limited duration; 3%]; purging [1.1%]; and unspecified feeding or eating disorders [15.2%]) completed measures of perfectionism, self-esteem, mood intolerance, interpersonal difficulties, and eating disorder symptoms as part of the intake assessment to an eating disorders program. RESULTS: Path analysis revealed that low self-esteem and mood intolerance were directly associated with eating disorder symptoms. Perfectionism was indirectly associated with eating disorder symptoms through self-esteem and mood intolerance. DISCUSSION: The findings provide partial support for the transdiagnostic model of eating disorders in an adolescent clinical sample. In particular, core low self-esteem and mood intolerance were found to be pertinent in adolescents with eating disorders. A limitation of the current study was the use of cross-sectional data. Future research should examine the transdiagnostic model with the use of longitudinal data. Furthermore, future research is required to examine potential differences in the way the maintaining mechanisms operate between adolescents and adults with eating disorders and the implications for treatment.

Guided Internet-delivered cognitive behaviour therapy for perfectionism in a non-clinical sample of adolescents: A study protocol for a randomised controlled trial.

BACKGROUND: Perfectionism is elevated across a range of psychopathologies and has been shown to impede treatment outcomes. There is also evidence suggesting elevated perfectionism may contribute to the onset and maintenance of non-suicidal self-injury. There is a growing body of evidence suggesting that Internet-delivered cognitive-behavioural therapy for perfectionism reduces perfectionism and symptoms of psychological disorders and that reductions are maintained at 3-month and 6-month follow-up. There may also be reductions in non-suicidal self-injury, although no study has investigated this potential benefit. Given that associations between perfectionism and psychopathology are observed across both adults and adolescents, the need for the development of interventions targeting adolescents is essential for early intervention and prevention. METHODS: The present study will employ a randomised controlled trial to examine the efficacy of 8-week guided Internet-delivered cognitive-behavioural therapy for perfectionism in adolescents compared to a waitlist control group. The primary outcome is perfectionism, and secondary outcomes include symptoms of psychological disorders, well-being, and non-suicidal self-injury. Outcomes will be assessed at pre-intervention, post-intervention, 1-month follow-up, 3-month follow-up, and 6-month follow-up. A minimum of 240 participants will be recruited online through social media, Australian universities, and schools across Australia. Generalised linear mixed models will be used to test for changes in outcomes between the intervention group and the waitlist control. DISCUSSION: The outcomes of this trial will contribute to the literature on perfectionism and psychopathology in adolescents, as well as the efficacy of guided Internet-delivered interventions for adolescents. TRIAL REGISTRATION: The trial was registered on the 20th of June 2019 at the Australia New Zealand Clinical Trials Registry (ACTRN12619000881134). TRIAL STATUS: This is protocol version 1.0. Participant recruitment began on 31 July 2019 and is still actively running with an anticipated completion date in the fourth quarter of 2020.

School-based intervention to address self-regulation and executive functioning in children attending primary schools in remote Australian Aboriginal communities.

Executive functioning and self-regulation influence a range of outcomes across the life course including physical and mental health, educational success, and employment. Children prenatally exposed to alcohol or early life trauma (ELT) are at higher risk of impairment of these skills and may require intervention to address self-regulation deficits. Researchers partnered with the local Aboriginal health organization and schools to develop and pilot a manualized version of the Alert Program® in the Fitzroy Valley, north Western Australia, a region with documented high rates of fetal alcohol spectrum disorder and ELT. This self-controlled cluster randomized trial evaluated the effect of an 8-week Alert Program® intervention on children's executive functioning and self-regulation skills. Following parent or caregiver consent (referred to hereafter as parent), 271 students were enrolled in the study. This reflects a 75% participation rate and indicates the strong community support that exists for the study. Teachers from 26 primary school classrooms across eight Fitzroy Valley schools received training to deliver eight, one-hour Alert Program® lessons over eight-weeks to students. Student outcomes were measured by parent and teacher ratings of children's behavioral, emotional, and cognitive regulation. The mean number of lessons attended by children was 4.2. Although no significant improvements to children's executive functioning skills or behavior were detected via the teacher-rated measures as hypothesized, statistically significant improvements were noted on parent-rated measures of executive functioning and behavior. The effectiveness of future self-regulation programs may be enhanced through multimodal delivery through home, school and community based settings to maximize children's exposure to the intervention. Despite mixed findings of effect, this study was an important first step in adapting and evaluating the Alert Program® for use in remote Australian Aboriginal community schools, where access to self-regulation interventions is limited.

Exploring Compassion from the Perspective of Health Care Professionals Working in Palliative Care.

Background: Despite the body of literature regarding the varying definition of compassion, there appears a lack of literature pertaining to the meaning of compassion from the perspective of health care professionals working in palliative care settings. Objective: The study aimed to explore how health care professionals working in palliative care settings view and/or understand the construct of compassion. Methods: A qualitative approach using semistructured interviews was used. Interviews were conducted with eighteen health care professionals working in pediatric, adult, and aged palliative care settings. Interviews transcripts were thematically analyzed. Results: Thematic analysis identified four main interrelated themes and supplementary subthemes. Health care professionals working in palliative care settings identified their perception of the (1) meaning of compassion, (2) importance of providing compassionate care, (3) barriers to providing compassionate care, and (4) facilitating compassionate care. Conclusions: This study presents a novel understanding of the components of compassion from the perspective of health care professionals working in palliative care. While there is need for future research, important areas of improvement include increased resourcing, reducing time pressures, and education within palliative care settings. This will enable the fostering of compassionate care to patients, as well as enhanced well-being both professionally and personally for health care providers delivering such care.

Self-Regulation Approach to Training Child and Family Practitioners.

Evidence-based psychotherapies or programs (EBPs) exist for most mental health disorders that occur in childhood; however, the majority of children with a mental health disorder do not receive such treatments. This research-practice gap has been attributed to a range of factors that complicate the delivery of EBPs in everyday practice. While most suggestions to bridge this gap have focused on how to develop EBPs that will have a better fit for the clinical settings in which they will ultimately be deployed, a useful adjunct is to enhance practitioners' capacity to flexibly deliver EBPs to manage these factors. We propose that the extent to which a practitioner is able to change their own behaviour in response to cues and information about the current needs of their clients, and do so while maintaining the integrity of an EBP, may be a function of practitioners' self-regulatory capacity. In this conceptual paper, we describe a model of self-regulation that can be applied to child and family practitioners. We argue that practitioners with greater self-regulatory capacity are more likely to take up EBPs, sustain their use of them and have superior outcomes with clients. We draw on our experience in disseminating a system of parenting support to illustrate how practitioners' self-regulatory capacity can be enhanced while simultaneously receiving training in an EBP. Advantages and disadvantages of a self-regulatory approach to training are discussed and directions for future research are offered.

An evaluation of an integrated fluency and resilience program for early developmental stuttering disorders.

PURPOSE: The temperament construct of effortful control, an index of self-regulation and resilience, has been found to be predictive of stuttering severity in children and is a potential indicator of clinical prognosis. Evidence supports early intervention for preschool stuttering, and the successful effect of parents as agents of change in their children's stuttering therapy. However, no previous studies have trained parents to improve self-regulation in their children as a component of stuttering therapy. This study aimed to explore the effects of addressing self-regulation, as a component of stuttering treatment, on child fluency as well as parent and child psychosocial outcomes. METHODS: This study implemented a preliminary parent administered resilience component in conjunction with stuttering therapy for children who stutter, and compared outcomes to a cohort of children who stutter who received stuttering therapy only. Twenty-eight children who stutter were randomly allocated to one of the two treatment groups. Dependent variables tested pre- and post-treatment included stuttered speech severity, parenting practices, and child resilience indicators. Outcomes were compared between groups at post treatment. RESULTS: Stuttered speech severity decreased in both treatment groups. A reduction in behavioural and emotional problems, and increase in resilience was observed in the children who stutter whose parents received the additional resilience component of therapy. Furthermore, a significant improvement in parenting practices was demonstrated in this group. No significant changes in emotional and behavioural problems in children or parents were observed in the group of children who received fluency therapy only. CONCLUSION: Results demonstrate that implementation of the resilience component was successful in positively shifting parenting practices and increasing behavioural resilience in children who stutter. This has clinical implications for successfully managing fluency while concurrently targeting the concomitant behavioural and emotional impacts of the disorder on both children and parents, potentially a key future prognostic indicator of the maintenance of fluency outcomes.

Study protocol for a self-controlled cluster randomised trial of the Alert Program to improve self-regulation and executive function in Australian Aboriginal children with fetal alcohol spectrum disorder.

INTRODUCTION: While research highlights the benefits of early diagnosis and intervention for children with fetal alcohol spectrum disorders (FASD), there are limited data documenting effective interventions for Australian children living in remote communities. METHODS AND ANALYSIS: This self-controlled cluster randomised trial is evaluating the effectiveness of an 8-week Alert Program school curriculum for improving self-regulation and executive function in children living in remote Australian Aboriginal communities. Children in grades 1-6 attending any of the eight participating schools across the Fitzroy Valley in remote North-West Australia (N ≈ 363) were invited to participate. Each school was assigned to one of four clusters with clusters randomly assigned to receive the intervention at one of four time points. Clusters two, three and four had extended control conditions where students received regular schooling before later receiving the intervention. Trained classroom teachers delivered the Alert Program to students in discrete, weekly, 1-hour lessons. Student outcomes were assessed at three time points. For the intervention condition, data collection occurred 2 weeks immediately before and after the intervention, with a follow-up 8 weeks later. For control conditions in clusters two to four, the control data collection matched that of the data collection for the intervention condition in the preceding cluster. The primary outcome is change in self-regulation. FASD diagnoses will be determined via medical record review after the completion of data collection. The results will be analysed using generalised linear mixed modelling and reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Western Australia (WA) (RA/4/1/7234), WA Aboriginal Health Ethics Committee (601) and WA Country Health Service (2015:04). The Kimberley Aboriginal Health Planning Forum Research Sub-Committee and WA Department of Education also provided approval. The results will be disseminated through peer-reviewed journals, conference presentations, the media and at forums. TRIAL REGISTRATION NUMBER: ACTRN12615000733572; Pre-results.

Building Bridges Triple P: Pilot study of a behavioural family intervention for adolescents with autism spectrum disorder.

BACKGROUND: Many parents of adolescents with autism spectrum disorder (ASD) report that they are ill-equipped to support their children's behaviour, and these youths are known to be at substantially greater risk of emotional or behavioural problems compared to their typically developing peers. There is a need for an efficient and tailored parenting program for parents of adolescents with ASD that includes guidance on how to best support these youths' development and well-being. AIMS: The current study examined the feasibility of Building Bridges Triple P (BBTP), an eight-week (11.5 h) parenting program specifically targeted to the needs of parents of adolescents with a developmental disability. METHODS: A pretest-posttest single group design was used to evaluate the feasibility and acceptability of BBTP, and the potential of the program to have desired intervention effects, with nine parents of adolescents with ASD. RESULTS: After participating in BBTP, parents reported significant reductions in their adolescent's behaviour problems, increased parenting confidence, decreased lax and overreactive responding, and decreased symptoms of depression and stress. These effects were mostly observed at post-test but were more pronounced at 3-month follow-up. Parents reported that they were satisfied with the content and format of BBTP. CONCLUSIONS: Results provide preliminary support for the feasibility and acceptability of BBTP, and that the program has a number of desired intervention effects.

Parenting and family adjustment scales (PAFAS): validation of a brief parent-report measure for use with families who have a child with a developmental disability.

BACKGROUND: Children with a developmental disability are three to four times more likely than their typically developing peers of developing significant emotional and behavioural problems. There is strong evidence to suggest that individual biological and psychological factors interact with family functioning to precipitate and perpetuate these problems. AIMS: This study examined the psychometric properties of a brief measure, the Parent and Family Adjustment Scales (PAFAS) for use with parents of children with a developmental disability. METHODS: A sample of 914 parents of children (M=6.27years) with a developmental disability participated in the study. Disabilities included Autism Spectrum Disorder and Intellectual Disability RESULTS: A confirmatory factor analysis supported a 16-item, four factor model of PAFAS Parenting, and an 11-item, three factor model of PAFAS Family Adjustment. The Parenting Scale measures parental consistency, coercive practices, use of encouragement and the quality of parent-child relationship. The Family Adjustment Scale measures parental emotional adjustment and partner and family support in parenting. CONCLUSIONS: The current study indicated that the PAFAS demonstrates promise as a brief measure of multiple domains of family functioning important for families who have a child with a developmental disability.