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Summary of Abstracts Submitted by Keynote & State of the Art Speakers Speaker: Tom Anders Topic: Children are they our future? Summary: Hunger, trauma, insecurity, physical illness, witness to violence, incarceration, absent or inadequate education, and mental disorder are only some of the conditions to which our children are exposed, both in developed and developing countries. Ironically, these conditions exist at a time when research has provided many new insights into what optimal brain development requires, and how genetic influences interact with environmental forces to shape personality and affect behaviour. This presentation highlights the roles that mental health professionals must play in advocating for the well-being and future of the children of the world.
Speaker: Vicki Anderson Topic: Social problems following acquired brain injuries in childhood Summary: Children who suffer brain injuries are at risk of long-term consequences that span a range of domains, including physical disability, cognitive impairment and behavioural and social dysfunction. While much is now understood about physical and cognitive sequelae, social and behavioural problems remain less well defined. Frequently, families describe their child as ‘different’ after brain injury – more aggressive, impulsive, emotional, and socially withdrawn and isolated. This address proposes a model of social and behavioural dysfunction following early brain injury, incorporating biological, psychological, and environmental parameters. This model is considered in the context of longitudinal research data, as well as case-based illustrations.
Speaker: Colette ChilandTopic: Racism and nurturing Summary: Although the concept of a human “race” is illusory, racism itself is cruelly real. This presentation suggests ways in which to combat racism. Firstly, it is proposed that religious imperialism must be overcome. Multilingualism should be developed, whilst the acculturation of migrants must be encouraged. The second proposal relates to nurturing and educating children appropriately – teaching children anti-racist beliefs; educating them about the laws that criminalise racism and revisionist/negationist behaviour; and exposing them to a greater social mix in schools. Psychological work on projections that lead to the manufacturing of scapegoats is essential too. Finally, diversity (which begins with showing respect towards women, and then towards every human) is to be welcomed. This address concludes by stating that such aims encompass our work in the field of child and adolescent psychiatry.
Speaker: Mark R. Dadds Topic: The developmental psychopathology of aggression: From genes to mental models Summary: Aggressive behaviour problems in young children are the first sign of risk for later mental health problems. Explanations of child aggression and antisocial behaviour have traditionally focused on pathways via poor parenting and family dysfunction. There is evidence that more extreme and chronic forms may also be driven by child temperamental characteristics relating to deficits in amenability to socialisation practices and empathic responding. This address presents results from several large studies looking at the measurement of antisocial and empathic traits in young children, their genetic bases, their relationship to other measures of adjustment in the child and family, and their influences on treatment strategies. A model that highlights the ways child characteristics interact with parenting strategies to magnify or diminish risk for antisocial behaviour is presented. It is concluded that traditional parenting interventions can be fine-tuned to best respond to measurable variations in child temperament.
Speaker: Peter Fonagy Topic: Research on social cognition and the widening scope of mentalisation based treatments Summary: Research on social cognition has opened a new chapter in psychodynamic psychotherapies for children and adolescents. Accumulating evidence suggests a connection between the robustness of social cognition and the quality of attachment relationships with the primary caregiver. Deficits in social cognition have repeatedly been identified in relation to a range of mental disorders characteristic of childhood and adolescence. In line with these discoveries, therapeutic techniques have evolved with their roots in a psychodynamic framework that directly address problems of social cognition in an attachment context provided by the therapeutic relationship. This presentation reviews research in social cognition, in addition to outlining therapeutic approaches for infants, middle childhood and adolescents, that focus on age- and diagnosis-specific methods for strengthening mentalising capacities.
Speaker: Ian Goodyer Topic: Juvenile depressions: Their nature, characteristics, and outcome Summary: Unipolar depression occurs across the lifespan, with a predominant emergence during adolescence. Longitudinal studies show that the outcomes into early adult life are highly variable. Approximately 60% of these will recur, and approximately a third of these will be unresponsive to treatment and run a chronic course. The latter are more likely to be males with severe presentations and a history of substance abuse. Aetiological studies have substantially clarified the role of abnormal psychological processes in the onset and maintenance of an episode during the adolescent years. It is also apparent that the neural systems which subserve mood and cognitive processing are structurally and functionally different to those of individuals who have never been depressed. This presentation expands upon these findings, in addition to discussing both research and clinical strategies that are required to improve our understanding and treatments of these disorders.
Speaker: Larry Greenhill Topic: Drug safety for psychotropic medications for children and adolescents Summary: Drug safety for psychotropic medications used in children and adolescents have become a global concern. Starting with the banning of most antidepressants for use in youth by the United Kingdom's MHRA, the United States Food and Drug Administration (FDA) have defined new dangers for commonly used psychotropics for children and adolescents. These have included increased suicidality following treatment with antidepressants and with atomoxetine; concerns about rare, serious, and unexpected cardiovascular events in those youth treated chronically with psychostimulants; and new instances of psychosis in children treated with psychostimulants. In some instances, black box warnings have been inserted at the top of the drug package insert, whilst in other instances, a MedGuide has been packaged with each unit of medication. However, while protecting the public safety, the new warnings do not include a thorough and conservative estimate of the actual risk. The objective of this presentation is to expose the participant to a careful review of the evidence for these troubling adverse events, and to examine the reasons for recalibrating of the agency's level of concern about psychotropics for youth.
Speaker: David A. Hay Topic: Genes, environment, gene-environment interaction: Where will the genetics of child psychopathology be in 2010? Summary: The last few years have seen enormous changes in our approaches to the role of genetic determinants of child and adolescent psychopathology. Whilst research has revealed that no specific genes are of large effect, the role of particular genes is consistently found across different conditions (e.g., ADHD and reading difficulties). Hence, rather than genes for behavioural disorders, perhaps we should be thinking about genes for particular symptoms, shared by several diagnoses? Complementary to these advances, a gene-environment interaction model is proposed (i.e., “nature via nurture”). This address concludes with three predicted main prospects for the next few years beyond advances in these gene and gene-environment interaction approaches, namely: 1) the nexus of genetics and diagnosis; 2) psychopharmacogenetics; and 3) genetics means the family. That is, finding a highly heritable childhood disorder should mean greater scrutiny of the parents and other adult relatives, in addition to consideration of their own psychopathology, when it comes to implementing behavioural intervention programs.
Speaker: Scott W. Henggeler Topic: Multisystemic Therapy (MST): Clinical overview, outcomes, and bases of success Summary: Multisystemic Therapy is an intensive family- and community-based treatment that has been applied to a wide range of serious clinical problems presented by youths and their families (e.g., chronic and violent criminal behaviour, substance abuse, sexual offending, psychiatric emergencies, child maltreatment, and serious health care problems). Across these clinical populations, the overarching goals of MST programs are to decrease rates of antisocial behaviour and other clinical problems, improve functioning, and reduce the need for out-of-home placements. This address explores randomised trials investigating the efficacy of MST among violent and substance-abusive juvenile offenders, reporting significant treatment effects and positive outcomes.
Speaker: James F. Leckman Topic: Primary parental preoccupation: Circuits, genes, and the crucial role of the environment Summary: Parental caregiving includes a set of highly conserved behaviours and mental states that may reflect both an individual's genetic endowment and the early experience of being cared for as a child. This review first examines the mental and behavioural elements of early parental caregiving in humans. Second, we consider what is known about the neurobiological substrates of maternal behaviours in mammalian species, including some limited human data. Third, we briefly review the evidence that specific genes encode proteins that are crucial for the development of the neural substrates that underlie specific features of maternal behaviour. Fourth, we review the emerging literature on the "programming" role of the intrauterine environment, and postnatal caregiving environment in shaping subsequent maternal behaviour. We conclude that there are critical developmental windows during which the genetically determined microcircuitry of key limbic-hypothalamic-midbrain structures are susceptible to early environmental influences, and that these influences powerfully shape an individual's responsivity to psychosocial stressors and their resiliency or vulnerability to various forms of human psychopathology later in life.
Speaker: Professor Frank Oberklaid Topic: Children's mental health: New paradigms urgently needed Summary: Mental Health is an issue that has finally arrived on the policy agenda. While there is a belated appreciation of the prevalence of mental health problems and its costs not only to society, but also to individuals and families; a number of issues and barriers remain to be addressed. These include tensions between the treatment of individual children and a population focus on promotion, prevention, and early intervention; making the most effective and efficient use of scarce secondary and tertiary consultative services; developing new community-based service models with links to other professional groups; evolving training programs to include new knowledge and ensure evidence based professional practice; and establishing meaningful collaborations with paediatricians. This presentation canvasses some of these issues using Australian data, in addition to drawing on ongoing work (from the Centre for Community Child Health) in developing new service models and strategies which effectively refocus existing services for young children and their families.
Speaker: Professor George Patton Topic: Puberty’s changing relevance for mental health Summary: The effects of puberty on health and well-being are profound and paradoxical. It marks a transition in risks for depression and other mental disorders, psychosomatic syndromes, substance abuse, and antisocial behaviours among youth. These trends coincide with a growing mismatch between biological and social maturation, and the emergence of more dominant youth cultures, which have propelled many adolescents into earlier initiation of sexual activity and substance use. This presentation draws upon examples from the Victorian Adolescent Health Cohort Study and the International Youth Development Study, focusing on the effects of puberty on mental health and behaviour. The adult sequelae of mental health problems which emerge at puberty are discussed, in addition to implications for preventive and clinical intervention at and around the adolescent period.
Speaker: Helmut Remschmidt Topic: How effective are our treatments? Results and problems of treatment evaluation in child and adolescent psychiatry Summary: The purpose of this presentation is to review a multicomponent treatment model in children and adolescents with psychopathological disorders. Five treatment components (individual therapy with the patient, functional therapies, parent and family oriented interventions, other environmental interventions, and psychotropic medication) were applied to a large sample of patients with different psychopathological disorders in outpatient, day patient, and inpatient settings. Treatment evaluation was assessed via patient, parent, and therapist reports on measures of symptoms, treatment evaluation, and quality of life. Treatment success and corresponding effect sizes are reported. It is concluded that the findings of this naturalistic study can be used to improve empirically based treatment procedures under realistic clinical conditions. Speaker: Joseph M. Rey Topic: Psychotropic drugs and young hearts: A deadly mixture? Summary: Concerns about the association of stimulant drugs with sudden death in children surfaced recently, prompting extensive discussion in the lay media and professional literature. This caused anxiety among patients, parents, clinicians, and regulatory authorities. Other psychotropic drugs, such as tricyclic antidepressants, are known to be cardiotoxic. This presentation reviews the evidence about the cardiotoxicity of psychotropic drugs widely used in children and adolescents, in addition to sudden cardiac death in young people. Implications for clinical practice are discussed.
Speaker: Professor Matthew R. Sanders Topic: The role parenting interventions in the prevention and treatment of child psychopathology Summary: This presentation examines the role of parenting and family interaction in the development and management of child psychopathology. Research evidence derived from the Triple P-Positive Parenting Program is presented, to support the adoption of a public health approach to the delivery of parenting difficulties. Main findings from several recently completed randomised trials examining the effects of media interventions, primary care and workplace interventions targeting parenting are presented. Intensive parenting programs for high-risk families are discussed, as are predictors, mediators and moderators of intervention effects.
Speaker: Professor Fiona Stanley Topic: Essential ingredients for a civil society: Putting young people back in the centre Summary: In spite of Australia’s relative economic prosperity and increasing levels of national wealth, our youth have not shared in the benefits resulting from this prosperity. The societal changes that have occurred over the past thirty years are having a devastating affect on those who are least prepared to deal with the harshness of society. We have consequently seen increases in problems affecting children and youth, and little improvement in the social inequalities that exist in Australia. Adolescent mental health problems are increasing, growing numbers of young people are obese or have developed an eating disorder, and Australia still ranks in the highest third of countries with respect to suicide. Data from the Western Australian Aboriginal and Child Health Survey shows that current systems are failing Indigenous people, and there have been no improvements in their health (including their mental health) or education levels since the 1960s. This presentation concludes by emphasising the need to act collaboratively to build a civil society for our children.
Speaker: Hans Steiner Topic: Anger, aggression and violence: The neuroscience and developmental psychopathology of crime Summary: The field of developmental psychiatry has neglected the study of the science, taxonomy, and treatment of aggression and its psychopathology. In response to this gap, this presentation summarises recent literature, and reports on several ongoing studies in the California Department of Juvenile Justice. The findings provide evidence to suggest that two highly relevant subforms of aggression can now be distinguished, namely: “Hot” and “Cold”, which are supported by different neuro-architectures, and subsequently respond to differential treatment methods. This presentation concludes with a discussion as to the application of these new insights, emphasising the potential to construct more effective interventions and programs to serve these youths.
Speaker: Tuula TamminenTopic: Infant mental health services in different parts of the worldSummary: One of the most rapidly developing areas in the field of psychiatry during the past few decades has been the expertise on infant mental health. Research projects, prevention and promotion programs, and specialised services have been created across the world. The World Association for Infant Mental Health recently conducted a world-wide survey, screening the existing services and programs for infants and toddlers. Building on the results of this survey, the needs for further development in the field of infant mental health are presented.
Speaker: Bruce Tonge Topic: The psychopathology of intellectual disability Summary: Comorbid severe mental health problems complicating intellectual disability (ID) are a common and costly public health problem. The Australian Child to Adult Development study (ACAD) has examined the course of psychopathology in a representative cohort of children with ID, as well as samples of children with Fragile X, Williams, Prader Willi and Down syndromes and children with Autism over a 14-year period. Levels of behavioural and emotional disturbance remain high into young adulthood. A biopsychosocial model of psychopathology is evident, as there are specific behavioural phenotypes are associated with known genetic disorders. Gender has little impact on psychopathology, but the level of ID influences presenting symptoms. Parental mental health and care, social networks, life events and family functioning are associated with mental health outcomes. The findings provide a solid basis for mental health promotion and service delivery in this vulnerable population.
Speaker: Charles Zeanah Topic: Infant mental health: Models and approaches Summary: The science of early development and our understanding of the impact of early experiences on later social, emotional, and cognitive development has grown dramatically in the past three decades. Because of increasingly compelling and far-reaching data, there is increasing interest and concern about the quality of the infant's earliest experiences, and how those experiences shape the child's later development. The unique focus of infant mental health interventions is most often the caregiver-infant relationship, rather than the traditional approach of focusing either on the child or caregiver. Because a relationship approach to assessment and treatment is new, the development of evidence-based approaches is just emerging. Nevertheless, there are overarching goals across the continuum of services: (1) enhancing the ability of caregivers to nurture young children more effectively, (2) minimising/averting suffering, and ensuring that families in need of more intensive services can obtain them, and (3) expanding the ability of non-family caregivers to identify, address, and prevent social-emotional problems in early childhood. This address summarises the model that guides infant mental health, in addition to illustrating specific approaches.
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