The Development of Elder-Governed Adjuvant Cultural Therapy for Aboriginal and/or Torres Strait Islander Young People With Mental Health Conditions.

A 10-year review of the 2008 Council of Australian Governments' (COAG) Close the Gap Strategy identified the lack of involvement of Indigenous people in developing policies as a key reason health disparities persist. It also posits that disconnection from Country and culture have been crucial factors. Physical and mental health cannot be separated from spiritual health and well-being amongst Indigenous Australians. This article describes the co-development of a cultural enrichment research study with Indigenous Elders, health service leaders, and community members that places culture at the centre of care to augment traditional Western mental health management. The study has been overseen and nurtured from its inception by a governance board of Traditional Custodian Elders and an Advisory Group of Indigenous health workers. Qualitative data were collected through community 'zoom-yarns' between an Indigenous research assistant and 44 community members during COVID-19 lockdowns. These yarns were analysed through an innovative, constructivist, multi-perspectival discursive grounded theory method. Findings have led to an Elder-governed adjuvant cultural therapy which is currently being trialled and will be evaluated using the same multi-perspectival discursive grounded theory research methodology. One third of all Indigenous Australians now live in capital cities, so developing models to bring culture and Country into urban health facilities are becoming increasingly important. The Indigenous-led research approach outlined in this paper suggests a model for engaging Indigenous communities that mainly distrust Western research and have been failed by Western mental health care. It has the potential to shape future policy.

Exploring the association of Indigeneity, social adversity status and externalizing symptoms in children and adolescents.

OBJECTIVE: The relationship between Indigeneity, social adversity status and externalizing symptoms is complex and unclear. This study investigates how Indigeneity, social adversity status and externalizing symptoms are related in young people. METHODS: A total of 132 Indigenous and 247 non-Indigenous young people aged 6-16 years were recruited from a hospital mental health outpatient service. Normality plots with statistics for social adversity status and parent-reported externalizing symptoms were completed for the two groups, matched for age, gender, mental disorder symptom severity, symptom-linked distress and impairment. Standard multiple regression was used to examine how Indigeneity moderates the relationship between social adversity status and parent-reported externalizing symptoms. A scatterplot investigated the association between Indigeneity and social adversity status in young people with parent-reported externalizing symptoms. RESULTS: The distributions of the two groups and (1) social adversity status and (2) parent -reported externalizing symptoms were non-normal but acceptable for a moderator analysis. Indigeneity and social adversity status made independent significant positive contributions to externalizing symptoms. In contrast the interaction between Indigeneity and social adversity status made a nonsignificant negative trend to externalizing symptoms. A scatterplot revealed Indigeneity moderated the link between social adversity status and externalizing symptoms. CONCLUSIONS: High social adversity status is linked to externalizing symptoms in non-Indigenous young people but despite higher social adversity, Indigenous young people don't necessarily externalize. Potential protective resilience factors for externalizing symptoms in the Indigenous young people need to be ascertained and nurtured. Future systematic investigations of the contribution of these protective factors to Indigenous referral pathways and management are needed. It is also crucial that increased social adversity status is addressed and managed in all young people, regardless of Indigeneity.

Country and community vs poverty and conflict: Teasing apart the key demographic and psychosocial resilience and risk factors for Indigenous clinic-referred children and adolescents.

OBJECTIVE: Indigenous young people are known to have adverse demographic and psychosocial factors affecting worse mental health outcomes and some household factors aiding resilience. In Australia, there has been no exploration of these factors in clinically referred Indigenous young people assessed in a culturally appropriate way. METHODS: A total of 113 Indigenous children and adolescents, 217 non-Indigenous young people, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched, and 112 typically developing participants, age- and gender-matched were recruited. Cultural validity and reliability of the impairing symptoms in Indigenous young people were determined. Key demographic and psychosocial factors were compared across the three groups. RESULTS: The Indigenous clinical group differed significantly from the other two groups that did not differ on three possibly protective measures examined. Key demographic and psychosocial risk factors in the Indigenous group differed significantly from the non-Indigenous clinical group which in turn differed from the typically developing participants. The three groups exhibited a progressively increased magnitude of difference. CONCLUSIONS: It remains imperative to nurture features that provide protection and enhance resilience for Indigenous young people and their communities. Indigenous status is linked to significant demographic and psychosocial disadvantage over and above that conferred by clinical impairment and its management. It is crucial that these features are managed and/or advocated for with those demographic and psychosocial factors of the greatest magnitude dealt with first. Future systematic investigations of the contribution of these key factors to mental health referral pathways, assessment and management are needed.

Distinct Neural Profiles of Frontoparietal Networks in Boys with ADHD and Boys with Persistent Depressive Disorder.

Working memory deficits are common in attention-deficit/hyperactivity disorder (ADHD) and depression-two common neurodevelopmental disorders with overlapping cognitive profiles but distinct clinical presentation. Multivariate techniques have previously been utilized to understand working memory processes in functional brain networks in healthy adults but have not yet been applied to investigate how working memory processes within the same networks differ within typical and atypical developing populations. We used multivariate pattern analysis (MVPA) to identify whether brain networks discriminated between spatial versus verbal working memory processes in ADHD and Persistent Depressive Disorder (PDD). Thirty-six male clinical participants and 19 typically developing (TD) boys participated in a fMRI scan while completing a verbal and a spatial working memory task. Within a priori functional brain networks (frontoparietal, default mode, salience), the TD group demonstrated differential response patterns to verbal and spatial working memory. The PDD group showed weaker differentiation than TD, with lower classification accuracies observed in primarily the left frontoparietal network. The neural profiles of the ADHD and PDD differed specifically in the SN where the ADHD group's neural profile suggests significantly less specificity in neural representations of spatial and verbal working memory. We highlight within-group classification as an innovative tool for understanding the neural mechanisms of how cognitive processes may deviate in clinical disorders, an important intermediary step towards improving translational psychiatry.

Whose place? Lessons from a case study of a guardianship determination for an Australian Indigenous child.

Whose values matter when considering which environment is healthier for a child whose guardianship is contested? The biological mother from a remote Australian Aboriginal community, who voluntarily relinquished her but has now requested her return? The foster mother who has cared for her in a metropolitan centre in another State of Australia, thousands of kilometres away? The welfare professionals who also live in that city? Or the child herself, who left her birth home and community five years earlier at the age of two? Drawing on a case study of a seven-year old Aboriginal girl, the authors argue that non-Indigenous values trumped Indigenous values without the realisation of key players who were empowered to make such determinations. The article uses Manuel DeLanda's neo-assemblage theory to consider the range of processes that exert themselves to shape place-values and social identity in colonised nations. It will also draw on Erik Erikson's and Lev Vygotsky's theories of psychosocial development to consider competing sets of values that raised feelings of dissonance within the child. Beliefs about what makes a place health-giving are revealed to be complex in colonised nations. Despite policy and legislative changes to better support Aboriginal people and their right to difference, non-Indigenous professionals can continue to be driven by an unrecognised systemic racism. While place-values are not, of course, the only (or perhaps even the most significant) consideration in guardianship determinations, this article will argue they can play a significant and covert role.

Key demographic and mental disorder diagnostic differences between Australian First Nations and non-First Nations clinic-referred children and adolescents assessed in a culturally appropriate and safe way.

OBJECTIVE: Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized Diagnostic and Statistical Manual mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues. METHODS: In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6-16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. Diagnostic and Statistical Manual mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of Diagnostic and Statistical Manual mental disorder diagnoses between the two clinical groups. RESULTS: Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14-7.69) among the First Nations compared to the non-First Nations clinical group. CONCLUSION: Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured.

Irritability and Inattention Not Sad Low Mood Predict Impulsiveness in Children and Adolescents With Major Depressive Disorder and Persistent Depressive Disorder.

ABSTRACT: The specific relationships between impulsiveness, inattention, sad, low mood, and irritability have not been systematically examined in young people with major depressive disorder with and without persistent depressive disorder. The relationships are important to clarify because these symptom dimensions may increase suicidal risk in children and adolescents with these depressive disorders. A total of 313 medication-naive young people (aged 6-16 years) with active major depressive disorder (MDD) alone, persistent depressive disorder (DD) alone, and comorbid MDD and DD were identified. "Inattention," "sad/unhappy," and "irritable" mood were identified by parent standardized questionnaire. Standard multiple regression was used to investigate how well inattention, sad/unhappy, and irritable mood predict impulsiveness. Inattention (32% of the variance, increased) and irritable mood (5% of the variance, increased) both made independent significant contributions to impulsiveness, whereas sad/unhappy mood did not. Decreasing irritability via more targeted and comprehensive management approaches may ameliorate impulsiveness in young people with these depressive disorders.

Gender Variance in Children and Adolescents with Neurodevelopmental and Psychiatric Conditions from Australia.

Gender variance is a broad term used to describe gender non-conforming behaviors. Past studies have used the parental response to Child Behavior Checklist (CBCL) Item 110, which asks whether a child "Wishes to be of opposite sex" as an indicator of gender variance. The population prevalence of gender variance in children and adolescents using this metric was found to be 1.2% in birth-assigned females and 0.4% in birth-assigned males (Achenbach & Rescorla, 2001). However, in those referred for psychiatric evaluation, it was higher (5.4% of birth-assigned females and 2.8% of birth-assigned males) (Achenbach & Rescorla, 2001). The aim of this study was to use the CBCL to estimate the prevalence of gender variance among children and adolescents with neurodevelopmental and psychiatric conditions and assess whether this was higher compared to controls. The response to the CBCL and the child's neurodevelopmental and/or psychiatric diagnosis were extracted from the clinical notes of 1553 children and adolescents referred to an outpatient psychiatry clinic in Australia. This was compared to data from 181 control participants as well as to the CBCL standardization sample of 1605 controls. Of the 1553 young people, whose mean age was 10.9 years, gender variance was reported in 3.1% compared to 1.7% in local control participants (p > .05) and 0.7% in the CBCL controls (p < .0001). Rates varied depending upon the underlying diagnosis (ASD 5.2%; ADHD 2.5%, intellectual disability 4.7%; depression 2.6%; and anxiety 4.7%). In this way, our findings support past observations that young people with neurodevelopmental and psychiatric conditions have high rates of gender variance.

ROC Analyses of Relevant Conners 3-Short Forms, CBCL, and TRF Scales for Screening ADHD and ODD.

Receiver operating characteristic curve analysis was used to examine and compare the diagnostic accuracy of the Conners 3-Parent Short Form (C 3-P(S)), and the Conners 3-Teacher Short Form (C 3-T(S)) inattention and hyperactivity/impulsivity scales, and the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) attention problems scales, to distinguish those with and without attention deficit/hyperactivity disorder (ADHD). It also examined and compared the diagnostic accuracy of the C 3-P(S) and C 3-T(S) Aggression (AG) scales, and the CBCL and TRF Aggressive Behavior (AB) scales, to distinguish those with and without oppositional defiant disorder (ODD). The study used archival data (N = 150-261) involving a large group of clinic-referred children aged between 6 and 11 years who had been interviewed for clinical diagnosis of ADHD and ODD using the Anxiety Disorders Interview Schedule for Children (ADISC-IV) as the reference standard, and then administered one or more of the screening measures. The findings provided empirical support for the use of the C 3-P(S) and CBCL for identifying ADHD and ODD, with the CBCL aggressive behavior scale having better ability to detect ODD. The implications of the findings for using the screening scales for diagnoses of ADHD and ODD are discussed.

Irritability, Depressed Mood, Inattention and Spatial Working Memory in Children and Adolescents with Major Depressive Disorder With/Without Persistent Depressive Disorder.

The specific relationships between sad/low mood, irritability, inattention and spatial working memory (SWM) have not been systematically examined in young people with major depressive disorder with and without persistent depressive disorder. 313 medication naïve young people (aged 6-16 years) with active major depressive disorder (MDD) alone, persistent depressive disorder (DD) alone and comorbid active MDD and DD were identified. Standard multiple regression was used to investigate how well SWM components-Spatial Span, Strategy and Between Search Errors (BSE)-predict 'sad/unhappy', 'irritable' mood and 'Inattention'. Spatial Span (4% of the variance-decreased), Strategy and BSE (both 1% of the variance increased) all made independent significant contributions to 'Inattention' while having no independent association with 'sad/unhappy' or 'Irritable' mood. These findings support the independence of depressive cognitive impairment from the two main components of depressive mood. Improving SWM and attention via targeted management approaches may aid young people with these depressive disorders.

Parent- and child-reported anxiety disorders differentiating major depressive disorder and dysthymic disorder in children and adolescents.

OBJECTIVE: To date, specific parent- and child-defined anxiety disorders associated with dysthymic disorder (DD; DSM-5 persistent depressive disorder equivalent) with and without major depressive disorder (MDD) have not been investigated in children and adolescents. METHOD: In a cross-sectional study, we compared point prevalence rates of parent- and child-reported anxiety disorders in DD alone (N = 154), MDD alone (N = 29), comorbid DD and MDD (N = 130) and anxiety disorders alone (N = 126) groups. RESULTS: DD alone and MDD alone did not differ with respect to comorbid anxiety disorders from parent and child reports, while parent-reported panic disorder (PD) was significantly increased in the DD and MDD group compared to the other three groups as was child-reported post-traumatic stress disorder (PTSD) compared to the MDD alone and anxiety disorders alone groups. In contrast, specific phobia (SpPh) was significantly increased in the anxiety disorders alone group compared to the DD and MDD group. CONCLUSION: The findings suggest that specific fear-related anxiety disorders, especially parent-reported PD and child-reported PTSD, may aid the early recognition of DD and MDD.

Spatial working memory performance in children and adolescents with major depressive disorder and dysthymic disorder.

BACKGROUND: Spatial working memory (SWM) is known to be impaired in children with Major depressive disorder (MDD), and, separately, Dysthymic disorder (DD) (DSM V persistent depressive disorder equivalent). Yet, it remains unclear whether MDD or DD is associated with worse SWM impairment, whether DD adds to the SWM impairments evident in MDD and whether these findings are evident in children as well as adolescents with MDD and DD. METHODS: The association of SWM and its strategy and spatial span components is explored in carefully defined children and adolescents (age 6-16 years) with MDD alone (N = 29), MDD and DD (N = 130), DD alone (N = 154) compared to healthy typically developing participants (N = 107), controlling for age, gender, full scale IQ and social adversity status. The relationship between SWM and its strategy and span components and anxious/depressed and inattentive symptoms were also examined. RESULTS: MDD was associated with worse SWM impairment than DD and there was no evidence of an additive effect of MDD and DD on SWM, strategy and spatial span deficits. Further, these findings were age-independent. LIMITATIONS: The data presented are cross sectional and limited to SWM deficits in MDD and/or DD. CONCLUSIONS: This study concurs with and extends current influential models about the cognitive effects of MDD and DD. Clinical implications and future research directions are discussed.

Correlated Trait-Correlated Method Minus One Analysis of the Convergent and Discriminant Validity of the Conners 3 Short Forms.

This study used the correlated trait-correlated method minus one model to examine the convergent and discriminant validity of the scales of the Conners 3 Short [C 3 (S)]. The C 3 (S) scales in the analysis were inattention (IN), hyperactivity/impulsivity (HY), learning problems (LP; learning problems/executive functioning from the teacher version), aggression (AG), and peer relations (PR, only for parent and teacher versions). A total of 529 adolescents and children (75% males, mean age = 11.75 years, SD = 2.97 years) provided self-ratings, and were also rated by their mothers and teachers. The findings indicated no support for the convergence of IN and HY across the three respondents. In contrast, there was convergence for LP, AG, and PR. There was support for the discriminant validity of the traits, except between IN and HY. The findings are discussed in relation to the convergent and discriminant validity of the C 3 (S) measures, and the clinical use of the C 3 (S).

Brain Imaging of the Cortex in ADHD: A Coordinated Analysis of Large-Scale Clinical and Population-Based Samples.

OBJECTIVE: Neuroimaging studies show structural alterations of various brain regions in children and adults with attention deficit hyperactivity disorder (ADHD), although nonreplications are frequent. The authors sought to identify cortical characteristics related to ADHD using large-scale studies. METHODS: Cortical thickness and surface area (based on the Desikan-Killiany atlas) were compared between case subjects with ADHD (N=2,246) and control subjects (N=1,934) for children, adolescents, and adults separately in ENIGMA-ADHD, a consortium of 36 centers. To assess familial effects on cortical measures, case subjects, unaffected siblings, and control subjects in the NeuroIMAGE study (N=506) were compared. Associations of the attention scale from the Child Behavior Checklist with cortical measures were determined in a pediatric population sample (Generation-R, N=2,707). RESULTS: In the ENIGMA-ADHD sample, lower surface area values were found in children with ADHD, mainly in frontal, cingulate, and temporal regions; the largest significant effect was for total surface area (Cohen's d=-0.21). Fusiform gyrus and temporal pole cortical thickness was also lower in children with ADHD. Neither surface area nor thickness differences were found in the adolescent or adult groups. Familial effects were seen for surface area in several regions. In an overlapping set of regions, surface area, but not thickness, was associated with attention problems in the Generation-R sample. CONCLUSIONS: Subtle differences in cortical surface area are widespread in children but not adolescents and adults with ADHD, confirming involvement of the frontal cortex and highlighting regions deserving further attention. Notably, the alterations behave like endophenotypes in families and are linked to ADHD symptoms in the population, extending evidence that ADHD behaves as a continuous trait in the population. Future longitudinal studies should clarify individual lifespan trajectories that lead to nonsignificant findings in adolescent and adult groups despite the presence of an ADHD diagnosis.

Psychometric Properties of the Autism Spectrum Quotient: Children's Version (AQ-Child).

Confirmatory factor analysis (CFA) and exploratory and factor analysis (EFA) aimed to determine the optimum Autism Spectrum Quotient-Children (AQ-Child) model. Initial CFA of parent ratings of the AQ-Child for 404 clinic-referred children with ADHD, aged between 4 and 11 years, revealed mixed/moderate support for the implied AQ-Child five-factor model and the past statistically supported four-factor model (Auyeung et al., J Autism Dev Disord 38:1230-1240, 2008). Interestingly, EFA findings indicated most support for a four-factor model, with factors reflecting "mind-reading", "social skills", "attention to details", and "imagination". The items loading in these factors were different from those proposed originally for similar factors (Auyeung et al., J Autism Dev Disord 38:1230-1240, 2008). The factors in the model showed acceptable internal consistency-reliability and discriminant validity. Clinical and research implications are discussed.

A case-control genome-wide association study of ADHD discovers a novel association with the tenascin R (TNR) gene.

It is well-established that there is a strong genetic contribution to the aetiology of attention deficit hyperactivity disorder (ADHD). Here, we employed a hypothesis-free genome-wide association study (GWAS) design in a sample of 480 clinical childhood ADHD cases and 1208 controls to search for novel genetic risk loci for ADHD. DNA was genotyped using Illumina's Human Infinium PsychArray-24v1.2., and the data were subsequently imputed to the 1000 Genomes reference panel. Rigorous quality control and pruning of genotypes at both individual subject and single nucleotide polymorphism (SNP) levels was performed. Polygenic risk score (PGRS) analysis revealed that ADHD case-control status was explained by genetic risk for ADHD, but no other major psychiatric disorders. Logistic regression analysis was performed genome-wide to test the association between SNPs and ADHD case-control status. We observed a genome-wide significant association (p = 3.15E-08) between ADHD and rs6686722, mapped to the Tenascin R (TNR) gene. Members of this gene family are extracellular matrix glycoproteins that play a role in neural cell adhesion and neurite outgrowth. Suggestive evidence of associations with ADHD was observed for an additional 111 SNPs (⩽9.91E-05). Although intriguing, the association between DNA variation in the TNR gene and ADHD should be viewed as preliminary given the small sample size of this discovery dataset.

Item Response Theory Analysis of the Anxiety and Mood Disorders in Clinic-Referred Children.

There is evidence that the major anxiety and depressive disorders could reflect a single underlying internalization factor. For a group of 1,031 clinic-referred children, the study examined support for this factor, and used the two-parameter logistic model to examine the item response theory properties of the disorders in this factor. For the set of anxiety and depressive disorders, confirmatory factor analysis supported a one-factor model. The two-parameter logistic model analysis indicated that all the internalizing disorders in this factor were strong discriminators of the internalizing dimension. Also, they measured more of the internalizing dimension and with more precision in the upper half of the trait continuum. There was also support for the convergent validity of the internalizing dimension, in that it had large-to-medium effect size correlations with internalizing scores of other measures. The implications of the findings for clinical practice and clinical classification are discussed.

Validity of the ADHD Bifactor Model in General Community Samples of Adolescents and Adults, and a Clinic-Referred Sample of Children and Adolescents.

OBJECTIVE: This study examined the bifactor models of ADHD in three groups: adolescents from the general community ( n = 214), adults from the general community ( n = 366), and a clinic sample ( n = 245). METHOD: For the adolescent sample, mothers provided ratings of the ADHD symptoms, and their teachers provided ratings for Emotional Symptoms, Conduct Problems, Hyperactivity, Peer Problems, and Prosocial Behavior. For the adult sample, all adults completed self-ratings of the ADHD symptoms and measures for depression, anxiety, and stress. For the clinic-referred sample, mothers provided ratings of the ADHD symptoms, and they were diagnosed for ADHD, Conduct Disorder/Oppositional Defiant Disorder, anxiety disorders, and depression disorders. RESULTS: The findings for all samples supported the bifactor model, and there were differences in the way the general and specific factors correlated with the external variables. CONCLUSION: The findings support the validity of the bifactor model.

White matter microstructure in boys with persistent depressive disorder.

BACKGROUND: Persistent depressive symptoms in children and adolescents are considered a risk factor for the development of major depressive disorder (MDD) later in life. Previous research has shown alterations in white matter microstructure in pediatric MDD but discrepancies exist as to the specific tracts affected. The current study aimed to improve upon previous methodology and address the question whether previous findings of lower fractional anisotropy (FA) replicate in a sample of children with persistent depressive disorder characterized by mild but more chronic symptoms of depression. METHODS: White matter microstructure was examined in 25 boys with persistent depressive disorder and 25 typically developing children. Tract specific analysis implemented with the Diffusion Tensor Imaging - ToolKit (DTI-TK) was used to probe fractional anisotropy (FA) in eleven major white matter tracts. RESULTS: Clusters within the left uncinate, inferior fronto-occipital and cerebrospinal tracts showed lower FA in the clinical group. FA in the left uncinate showed a negative association with self-reported symptoms of depression. CONCLUSIONS: The results demonstrate lower FA in several white matter tracts in children with persistent depressive disorder. These findings support the contention that early onset depression is associated with altered white matter microstructure, which may contribute to the maintenance and recurrence of symptoms.