"Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol.

BACKGROUND: The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) - developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents' mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the 'care-as-usual' group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and 'warm hand over' by a 'service navigator' to ensure their needs are met. METHODS: Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the 'care-as-usual' or 'intervention' group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. CONCLUSIONS: Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. TRIAL REGISTRATION: The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819 ) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Predictors of developmental surveillance completion at six months of age in south western Sydney.

BACKGROUND: While developmental surveillance programs promote early identification of child developmental problems, evidence has indicated suboptimal uptake. This study aimed to identify predictors of developmental surveillance completion at 6 months postpartum. METHODS: Questionnaires were administered to the parents of 510 infants who were born in south western Sydney, Australia over a 22-month period. Attendance for developmental screening and completion of the Parents' Evaluation of Developmental Status (PEDS) at 6 months postpartum were modelled separately using multivariable logistic regression. RESULTS: Developmental surveillance attendance was predicted by higher levels of maternal education, annual income and being informed about checks. PEDS completion at 6 months of age was predicted by higher income and being informed, as well as being married, employed, speaking English at home, full-term birth and the professional status of the practitioner completing the check. CONCLUSIONS: Barriers to developmental surveillance included low socioeconomic status, linguistic diversity and possible gaps in parental knowledge and professional education. Developmental surveillance rates may be increased by the addition of targeted parental and professional support within current universal frameworks.

Gilles de la Tourette syndrome in a cohort of deaf people.

We present six patients with Gilles de la Tourette syndrome (TS) who are also deaf. TS has been observed previously, but rarely reported in deaf people, and to date, so called "unusual" phenomenology has been highlighted. TS occurs almost worldwide and in all cultures, and the clinical phenomenology is virtually identical. In our cohort of deaf patients (we suggest another culture) with TS, the phenomenology is the same as in hearing people, and as in all other cultures, with classic motor and vocal/phonic tics, as well as associated phenomena including echo-phenomena, pali-phenomena and rarer copro-phenomena. When "words" related to these phenomenon (e.g. echolalia, palilalia, coprolalia or mental coprolalia) are elicited in deaf people, they occur usually in British Sign Language (BSL): the more "basic" vocal/phonic tics such as throat clearing are the same phenomenologically as in hearing TS people. In our case series, there was a genetic predisposition to TS in all cases. We would argue that TS in deaf people is the same as TS in hearing people and in other cultures, highlighting the biological nature of the disorder.

Developmental vulnerability--don't investigate without a model in mind.

Children who are developmentally vulnerable are at risk of a difficult start to school, and ongoing educational challenges which may adversely impact on long term health outcomes. Clinicians, researchers and service providers need a thorough understanding of both risk and protective factors and their complex interplay to understand their impact on early childhood development, in order to plan effective and comprehensive prevention and interventions strategies. In this opinion piece we recommend that investigation of developmental vulnerability should only proceed if underpinned by both a theoretical model through which the interaction between risk and protective factors may be investigated, and analytical models that are appropriate to assess these impacts.

Pathogenetic model for Tourette syndrome delineates overlap with related neurodevelopmental disorders including Autism.

Tourette syndrome (TS) is a highly heritable neuropsychiatric disorder characterised by motor and vocal tics. Despite decades of research, the aetiology of TS has remained elusive. Recent successes in gene discovery backed by rapidly advancing genomic technologies have given us new insights into the genetic basis of the disorder, but the growing collection of rare and disparate findings have added confusion and complexity to the attempts to translate these findings into neurobiological mechanisms resulting in symptom genesis. In this review, we explore a previously unrecognised genetic link between TS and a competing series of trans-synaptic complexes (neurexins (NRXNs), neuroligins (NLGNs), leucine-rich repeat transmembrane proteins (LRRTMs), leucine rich repeat neuronals (LRRNs) and cerebellin precursor 2 (CBLN2)) that links it with autism spectrum disorder through neurodevelopmental pathways. The emergent neuropathogenetic model integrates all five genes so far found to be uniquely disrupted in TS into a single pathogenetic chain of events described in context with clinical and research implications.

Prevalence and correlates of conduct disorder among inmates of juvenile detention centres, United Arab Emirates.

The prevalence of conduct disorder was assessed in 77 young people in 4 juvenile detention centres in the United Arab Emirates (UAE). The prevalence of conduct disorder was 24.7%, and recidivism, as indicated by repeat admissions to the centres, was found to be associated with conduct disorder. Having a diagnosis of conduct disorder was associated with a lower educational and occupational level of the father, as well as living with a single parent or relatives. Among UAE nationals, conduct disorder was also associated with having a mother who was a non-UAE national.

Prevalence and correlates of conduct disorder among inmates of juvenile detention centres, United Arab Emirates

The prevalence of conduct disorder was assessed in 77 young people in 4 juvenile detention centres in the United Arab Emirates [UAE]. The prevalence of conduct disorder was 24.7%, and recidivism, as indicated by repeat admissions to the centres, was found to be associated with conduct disorder. Having a diagnosis of conduct disorder was associated with a lower educational and occupational level of the father, as well as living with a single parent or relatives. Among UAE nationals, conduct disorder was also associated with having a mother who was a non-UAE national

Familial predictors of childhood shyness: a study of the United Arab Emirates population.

OBJECTIVES: Phobic anxiety disorders generally breed true. In this regard, family studies have suggested an association between childhood shyness and maternal social phobia. In this study, the relationship between childhood shyness and maternal social anxiety was examined. SUBJECTS AND METHODS: 203 5-year-old children from an Arabian Gulf community and their mothers were evaluated. The children were assessed in stage 1 using the shyness scale of Stevenson-Hinde and Glover and the Preschool Behavior Checklist (PBCL), while mothers completed the Liebowitz Social Anxiety Scale. In the second stage, blind clinical interviews were carried out to ascertain the diagnosis of psychiatric diagnoses, if any, using DSM-IV criteria. RESULTS: 27% of the children were identified as shy using the shyness scale of Stevenson-Hinde and Glover and 19% scored above the cutoff for behavioral disturbance on the PBCL. Child shyness was associated with female gender and maternal social anxiety as indicated by scores on the Liebowitz Social Anxiety Scale, while an inverse relationship was noted with behavioral disturbance. The odds of the child having a high shyness score was increased if the mother had social anxiety (odds ratio = 2.14) and the child lived in a family that was 'not socially active' (odds ratio = 1.42). CONCLUSION: Our initial findings suggest that there may be a complex interaction between maternal social anxiety and family sociability in childhood shyness. Prospective longitudinal work is indicated.

Correlation between hypertension and income distribution among United Arab Emirates population.

To determine the correlation between hypertension and income distribution among United Arab Emirates (UAE) population. Case-control study matched for age, sex, nationality and education. The survey included 500 hypertensive adults aged 20-65 years ascertained from Primay Health Care (PHC) Clinics along with a randomly selected sample of 500 control subjects from the community. Face-to-face interviews were done where data were gathered on socio-demographic-economic status (SES) and lifestyle habits. Hypertension was defined according to WHO criteria as having Systolic Blood Pressure (SBP) > or = 140 mm Hg and/or Diastolic Blood Pressure (DBP) > or = 90 mm Hg and/or being on antihypertensive treatment. The survey was carried out in urban and semi-urban PHC Clinics. A total of 818 subjects were included in this study from a sample of 1000; 409 cases and 409 controls. There were 422 males and 396 females in this study, with 255 UAE nationals and 438 expatriates. Hypertension was found to be significantly higher among the low income group (35.2% vs. 24.9% controls, p = 0.002; while mean SBP in the low income group was 130.2 +/- 17.6 vs. 128.0 +/- 17.4 controls, p = 0.022). Among males, smoking and alcohol consumption were higher among the group with low income level but only smoking showed significant difference (p value = 0.016). Activity level was higher among the low income groups. This study supports the importance of socio-economic factors as an income distribution effect on life-style habits and hypertension.

Screening for language delay in the United Arab Emirates.

BACKGROUND: Developmental language delay (DLD) is frequent among two- and three-year-olds but little is known about this condition in the Arabian Peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in the United Arab Emirates (UAE). The findings regarding the prevalence and psychosocial correlates of DLD are reported here. METHODS: A total of 694 children, representative of the UAE 3-year-old population were screened using the Denver Developmental Screening Test (DDST) and the language screening procedure as used by Westerlund and Sundelin. RESULTS: Of the 694 children screened for DLD at 3 years of age, 69 children (9.9%; CI 7.8-12.4) were found to have delays in the language sector of DDST. A total of 45 (6.5%; CI 4.3-8.7) were identified as having general language disability, both in comprehension and expression as per the language screening procedure. Language delay was found to be associated with rural living, mother being from a different nationality, non-involvement of domestic help in child care, family history of language delay, obstetric and perinatal problems and presence of behavioural problems in the child. Using stepwise multiple logistic regression analysis, two factors emerged as important with regard to general language delay, which were previous non-UAE nationality of the mother and total monthly income of the family. CONCLUSION: The pattern and correlates of DLD found in this survey are in line with those reported by other surveys, but some unique socio-cultural risk factors specific to this community were identified. The implications of these findings to screening and referral for further evaluation and intervention are discussed.

Clinical features and associated psychopathology in a Tourette syndrome cohort.

OBJECTIVE: This study explored in detail the association between tic symptomatology, related clinical variables, and psychopathology in 91 consecutive adult TS subjects from a UK clinic. METHODS: Consecutive patients from a specialized Tourette clinic who met the DSM-III criteria for TS were evaluated using standardized rating scales for Tourette syndrome and other psychopathology. RESULTS: The male female ratio in our cohort was 1.8:1. Significantly more males had an earlier age at onset of TS and history of birth complications. Obsessive compulsive behaviors in the patient was positively correlated with presence of attention deficit hyperactivity disorder and self-injurious behaviors. With regard to adult psychopathology, principal components factor analysis yielded two factors, 'obsessionality' and 'anxiety/depression', which accounted for 72% of the variance. CONCLUSION: Our results support the high occurrence of anxiety, depression and obsessionality in adult TS subjects.

Some risk factors for hypertension in the United Arab Emirates.

A case-control study evaluated the relationship between hypertension and socioeconomic and lifestyle factors in Al-Ain city. The survey included 426 hypertensive adults aged 20-65 years attending urban and semi-urban clinics and a randomly selected sample of 436 normotensive controls. Hypertension among cases was higher for men, age 40-49 years, non-UAE nationals, urban living, currently married, having children, illiterate, administrative/professional job, living in traditional house and low income. There were significant differences between cases and controls with regard to obesity, raised cholesterol level, low physical activity and family history of heart disease, kidney disease or diabetes. Multivariate logistic regression analysis revealed that obesity, medium/high income, history of diabetes, low physical activity and having 3+ children were significantly associated with hypertension.

Some risk factors for hypertension in the United Arab Emirates

A case-control study evaluated the relationship between hypertension and socioeconomic and lifestyle factors in Al-Ain city.The survey included 426 hypertensive adults aged 20-65 years attending urban and semi-urban clinics and a randomly selected sample of 436 normotensive controls. Hypertension among cases was higher for men, age 40-49 years, non-UAE nationals, urban living, currently married, having children, illiterate, administrative/professional job, living in traditional house and low income. There were significant differences between cases and controls with regard to obesity, raised cholesterol level, low physical activity and family history of heart disease, kidney disease or diabetes. Multivariate logistic regression analysis revealed that obesity, medium/high income, history of diabetes, low physical activity and having 3+ children were significantly associated with hypertension

Psychosocial correlates of paediatric cancer in the United Arab Emirates.

To study the psychosocial factors and illness variables associated with children's and parents' perceptions of and ways of coping with cancer, in 38 childhood cancer patients aged 5-15 years, coping was studied in relation to sociodemographic variables and self-perception in terms of competence, behaviour and self-worth. Less optimal coping was found to be associated with poor family communications and lack of sharing/expression of emotions ( P=0.005), presence of behavioural and emotional problems in the child ( P=0.008) and parental lack of hope ( P=0.001). No association was found with gender, parental education or occupation, socioeconomic status, or child's self-perception including global estimation of self-worth. Furthermore, none of the illness variables was found to be associated with coping. Awareness about health-related issues was found to be strongly associated with parental education ( P=0.000). Our findings suggest that parental hope and both social and family communication are integral to helping patients and families cope with the illness experience.

Epilepsy in children with cerebral palsy.

OBJECTIVES: To study the occurrence, associated factors, nature and prognosis of seizures in children with cerebral palsy (CP). DESIGN: A prospective, descriptive, hospital-based, case-control study. SETTING: Tertiary level University Teaching Hospitals in the Al Ain Medical District, United Arab Emirates. PATIENTS: Fifty-six children with CP and seizures seen in the neurodevelopmental clinics at Al Ain and Tawam University Hospitals during the period of 1997-1999 were studied (group 1). Two control groups of 35 children with CP without seizures (group 2) and 50 children with seizures but no CP (group 3) were also studied. RESULTS: Spastic tetraplegia was the commonest type of CP associated with seizures whereas spastic diplegia was the commonest variety of CP in group 2. Most children with CP had an early onset of seizures within the first year of life as against those without CP. The children in group 1 had a higher incidence of neonatal seizures (42.9% vs. 29.4% in group 2 and 0% in group 3), presence of significant developmental delay (98.2% vs. 20.0% in group 3), occurrence of significant abnormalities on brain imaging (94.6% vs. 19.6% in group 3) and a need for use of more than 1 antiepileptic drug (66.1% vs. 30.0% in group 3). Over half of children in the study group presented with generalized tonic clonic seizures; the electroencephalogram (EEG) showed focal epileptic discharges with or without secondary generalization in 39.3%. The overall outcome of seizures in children with CP was poor needing prolonged course of anticonvulsant medications, polytherapy and higher incidence of refractory seizures and admissions for status epilepticus compared to the control group. CONCLUSIONS: Cerebral palsy is associated with a higher incidence of seizure disorders, which, in a majority, has its onset in the neonatal period; brain imaging showed abnormal pathology in most affected children, which possibly accounts for the tendency to more refractory seizures in these children.

Prevalence and correlates of childhood fears in Al-Ain, United Arab Emirates.

The prevalence of fear was explored in 340 adolescents in Al-Ain, United Arab Emirates. More than 50% reported feeling extremely frightened of 6 out of 60 fear items surveyed. These items were: someone dying in the family (66.5%), parents getting divorced (65.3%), the devil (63.8%), breaking a religious law (61.5%), being kidnapped (53.2%) and being adopted (49.9%). The level of fear showed a significant positive correlation with female gender, parental death/divorce, living with a single parent/relatives, living in low income families and an adverse home environment. Nearly half of the children reported that the fear caused considerable distress and interfered with daily activities.

Childhood behavioural disturbance in a community sample in Al-Ain, United Arab Emirates.

The prevalence of behavioural and emotional problems was evaluated among 620 United Arab Emirates nationals aged 6-18 years using the Rutter Parent Questionnaire. Of these children, 11.8% scores above the cut-off point indicating behavioural disturbance. The prevalence of conduct problems was greater among boys, while emotional problems were more common among girls. Certain unspecified chronic life difficulties, parental distress in relation to their children, family history of psychiatric illness and alcohol or drug use in a family member were associated with behavioural disturbance, but no significant association was found with gender, socioeconomic status, family size or recent life events. Our findings suggest that behavioural disturbance exists among a substantial number of school-aged children in the community.

Prevalence of tics and Tourette syndrome in an inpatient adult psychiatry setting.

OBJECTIVE: Given the widely recognized genetic basis for Gilles de la Tourette syndrome (TS) and the suggestion that the putative TS gene(s) may be expressed as or associated with a variety of psychiatric illnesses, this study was undertaken to assess the prevalence of tics and TS in a psychiatric inpatient population. DESIGN: Cross-sectional study. SETTING AND PATIENTS: 200 consecutive adult patients who were admitted to the psychiatric wards of University College London Teaching Hospitals. OUTCOME MEASURES: TS and related behaviours, as assessed by the comprehensive semi-structured National Hospital Interview Schedule. RESULTS: None of the 200 patients had definite TS, but 2 were observed to have motor tics; 10 had a history of tics (present for less than a year), and 7 reported a family history of tics. Thus, 19 (9.5%) inpatients qualified for inclusion in a broadly defined TS diathesis. These rates are significantly lower than those reported in a similar community based epidemiological study of adolescents (p = 0.018). CONCLUSIONS: Our findings do not support the theory that TS and related behaviours are over-represented among adult inpatients with psychiatric illnesses.

Childhood behavioural disturbance in a community sample in Al-Ain, United Arab Emirates

The prevalence of behavioural and emotional problems was evaluated among 620 United Arab Emirates nationals aged 6-18 years using the Rutter Parent Questionnaire. Of these children, 11.8% scores above the cut-off point indicating behavioural disturbance. The prevalence of conduct problems was greater among boys, while emotional problems were more common among girls. Certain unspecified chronic life difficulties, parental distress in relation to their children, family history of psychiatric illness and alcohol or drug use in a family member were associated with behavioural disturbance, but no significant association was found with gender, socioeconomic status, family size or recent life events. Our findings suggest that behavioural disturbance exists among a substantial number of school-aged children in the community