The authors compared service-use patterns and factors associated with service use for 279 boys and 119 girls who met the criteria for attention-deficit/hyperactivity disorder (ADHD), as defined in the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition ( DSM-IV).The participants had been identified from a nationally representative sample of Australian youth. Boys and girls with ADHD did not differ in their rates of service use, the types of services they attended (school/education or health-based services), the types of help they received, and the main problems for which they received help, with the exception that boys had higher rates of medication use. However, the factors associated with service use were not uniform across gender. For boys, problems with schoolwork or grades and number of ADHD symptoms were the main predictors of service use,whereas for girls the main predictor was the presence of depressive disorders.These findings suggest there are gender differences in the factors associated with service use among children with ADHD that are likely to have implications for assessment and treatment of the disorder.

OBJECTIVE:To examine gender differences among children meeting symptom criteria for DSM-IV attention-deficit/hyperactivity disorder (ADHD) identified in a nationally representative sample of Australian children.METHOD:From 2,404 children aged 6 to 13 years, 225 boys and 99 girls with ADHD symptoms were identified using the parent version of the Diagnostic Interview Schedule for Children and compared on parent reports of children's behavioral problems and impairment.RESULTS:When ADHD types were collapsed into a single group, boys and girls did not differ on core symptoms, comorbidity, and impairment with the exception that girls rated higher on somatic complaints and boys had poorer school functioning. However, gender patterns were found to vary across ADHD type on impairment measures of social problems, schoolwork difficulties, and self-esteem, with boys being generally rated as more impaired in the combined and hyperactive-impulsive groups but equally or less impaired in the inattentive group.CONCLUSIONS:The findings suggest the possibility of gender-specific risks associated with high levels of inattentive and hyperactive-impulsive symptoms indicating that ADHD subtype membership should be considered when conducting ADHD gender comparisons.

Objective: To compare the health-related quality of life (HRQL) between children aged 6-17 years with one of three mental disorders (attention-deficit/hyperactivity disorder, major depressive disorder, or conduct disorder), a physical disorder, and those with none of these disorders. Method: Parent reports describing the HRQL, mental disorders, and physical disorders of a national sample of 3,597 children and adolescents in Australia, aged 6-17 years (response rate = 70%), were obtained by means of a structured diagnostic interview and questionnaires. Results: After controlling for age, gender, and family structure, children with mental disorders were reported to have a significantly worse HRQL in several domains than children with no disorder. In many areas they were reported to have a worse HRQL than children with physical disorders. Parents also reported that the problems of children with mental disorders interfered significantly with the daily lives of children, parents, and families. Conclusions: The findings are consistent with previous studies which have reported that adults with mental disorders have substantial impairment in their HRQL. The findings suggest that children with a mental disorder require help in many areas of their lives. Achieving this will require an integrated approach to health care delivery rather than the current distinction between physical and mental health services.

OBJECTIVES:To examine the prevalence of psychotropic medication use by children with attention-deficit/hyperactivity disorder (ADHD) and children without ADHD. To identify factors associated with stimulant use by children in the community. DESIGN:A representative, multistage probability sample of Australian households was conducted in 1998. Parents completed questionnaires assessing children's mental health problems and health-related quality of life. They also completed a structured interview to identify children's psychiatric disorders and their use of medications during the previous six months. PARTICIPANTS:Parent or main caregiver of 3597 children aged 6-17 years. MAIN OUTCOME MEASURES:Rates of use of stimulants (dexamphetamine and methylphenidate), antidepressants and clonidine by children. RESULTS:Overall, 1.8% of children (95% CI, 1.5%-2.3%) were receiving stimulant medication. Of those with ADHD, 12.6% (95% CI, 9.8%-16.1%) were being treated with stimulants, 2.3% (95% CI, 1.3%-4.3%) with antidepressants, and 1.9% (95% CI, 1.0%-3.7%) with clonidine. Among children without ADHD, 0.5% (95% CI, 0.3%-0.8%) were receiving stimulant medication. This represented 22.9% (95% CI, 14.6%-34.0%) of all the children who were receiving stimulants. Variables significantly associated with stimulant use were being male, having ADHD, attending a paediatrician, and having higher scores on the Aggressive Behaviour and Attention Problems scales on the Child Behaviour Checklist. CONCLUSIONS:About 13% of Australian children with ADHD, and a substantial number of children without ADHD, are taking stimulants. The question of whether Australian children are being undertreated or overtreated with stimulant medication depends on the criteria used to assess the appropriateness of stimulant use. Additional information is needed to clarify when stimulants should be used to treat ADHD.

OBJECTIVE:This paper describes the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing.METHOD:The aims of the study, critical decisions in planning for the study, progress to date and key issues which influenced the course of the study are described.RESULTS:The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing is the largest study of child and adolescent mental health conducted in Australia and one of the few national studies to be conducted in the world. Results from the study will provide the first national picture of child and adolescent mental health in Australia.CONCLUSIONS:Large-scale epidemiological studies have the potential to provide considerable information about the mental health of children and adolescents. However, having a clear set of aims, ensuring that the scope of the study remains within manageable proportions and paying careful attention to the details of fieldwork are essential to ensure that high-quality data is obtained in such studies.

OBJECTIVE:To examine the discriminant validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes in a nationally representative sample of Australian youths.METHOD:The Diagnostic Interview Schedule for Children, including the symptom-specific impairment questions, was administered to 3,597 parents of children aged 6 to 17 years (response rate = 70%). Parents also completed questionnaires assessing children's emotional and behavioral problems and quality of life.RESULTS:Current DSM-IVADHD prevalence was 7.5% (6.8% with impairment) with inattentive types being more common than hyperactive-impulsive and combined types. ADHD was more prevalent among young males and was linked to social adversity, particularly for combined types. Compared with non-ADHD controls, all three ADHD subtypes were rated as having more emotional and behavioral problems and lower psychosocial quality of life, with combined types consistently rated the most impaired. Combined types received higher ratings than hyperactive-impulsive and inattentive types on externalizing behavior problems, disruption to family activities, and symptom-specific impairments with schoolwork and peer-related activities. Inattentive types were rated as having lower self-esteem, more social and school-related problems, but fewer externalizing problems than hyperactive-impulsive types.CONCLUSION:These findings support the view of DSM-IVADHD subtypes as distinct clinical entities with impairments in multiple domains.

Purpose: To identify and compare perceived supportive and nonsupportive behaviors exhibited by family members and friends toward adolescents with cystic fibrosis (CF), and to examine the relationships between supportive and nonsupportive behaviors and adolescents' psychological adjustment.Method: Participants were 35 adolescents with CF attending the Women's and Children's Hospital in South Australia. Perceived supportive and nonsupportive behaviors were assessed using an adapted version of the Chronic Disease Support interview. The psychological adjustment of the adolescents was assessed using the Youth Self Report Form. Repeated-measures analyses of variance were performed to compare the support provided by family members and friends. Multiple regression analyses assessed the contribution of supportive and nonsupportive behaviors for the prediction of psychological adjustment.Results: Family members provided more tangible support than friends who, conversely, provided more companionship support. Overall, family members scared higher than friends on ratings for supportive behaviors. No differences were observed between family members and friends on ratings for nonsupportive behaviors. Rating of nonsupportive behaviors for family members was found to be the strongest predictor of psychological adjustment.Conclusions: Family members and friends provide different types of support. Family members provide more tangible help with treatment tasks and adolescents provide more companionship. Overall, this study demonstrated the importance of addressing nonsupportive as well as supportive behaviors when investigating the impact of support on the psychological adjustment of adolescents with a chronic illness. (C) Society for Adolescent Medicine, 1999.

Objective: To describe initial results from the Child and Adolescent Component of the National Survey of Mental Health and Well-Being.Method: A multistage sampling scheme was used to obtain a representative sample of 4509 children and adolescents aged 4 to 17 years from across Australia. The number of children and adolescents sampled was in proportion to the size of the target populations within each state and territory, distributed proportionately across metropolitan and non-metropolitan areas (within the exception of the Northern Territory). Information about child and adolescent mental health problems was obtained from the parents and from adolescents aged 13–17 years using the Child Behaviour Checklist and the Youth Self Report. Parents also completed the Diagnostic Interview Schedule for Children (DISC-IV). The latter instrument was used to identify children and adolescents with Depressive Disorders, Attention Deficit Hyperactivity Disorder and Conduct Disorder. These disorders were chosen for assessment by diagnostic interview because of their public health significance for child and adolescent mental health in Australia. The health-related quality of life of children and adolescents was assessed using the Child Health Questionnaire (CHQ) which has parallel versions designed for independent completion by parents and children aged 10 years or older. The CHQ was completed by parents of 6–17 year olds and by adolescents aged 13–17 years. The questionnaire could not be used with children under the age of 6 years because assessment in several areas is based on children's school functioning and in some states of Australia, children aged four or five years have not commenced school. Information about adolescent health-risk behaviors, suicidal ideation and suicidal behaviour was obtained from the 13 to 17 year olds using the Youth Risk Behaviour System Questionnaire developed by Centers for Disease Control and Prevention in North America. Parents also completed a standard questionnaire designed to obtain information about services used by the children and adolescents during the six months prior to the study.Results: Three sets of results will be reported in the symposium. First, the prevalence of mental health problems experience by children and adolescents and the health-related quality of life of children with mental health problems will be described. Second, rates of health risk behaviors, suicidal ideation and suicidal behaviour amongst children and adolescents with mental health problems will be presented. Third, patterns of service utilisation exhibited by children and adolescents with mental health problems and barriers to service use will be reported.Conclusion: This is the first presentation at a national conference of results from the Child and Adolescent Component of the National Survey of Mental Health and Well-Being. It will provide the opportunity for professionals to learn of the initial findings from this national study and to discuss the results with the research group responsible for the study.