This annual report - Taranaki District Health Board

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A diagnosis of conduct disorder according to DSM-IV requires the presence of at least three of the following inthe previous year and at least one in the previous six months:often lies to obtain goods or favours or to avoid obligations (i.e. “cons” others)often bullies, threatens, or intimidates othersoften initiates physical fightshas broken into someone else’s house, building, or carhas stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking andentering; forgery)has used a weapon that can cause serious physical harm to others (e.g. a bat, broken bottle, knife, gun)has been physically cruel to peoplehas been physically cruel to animalshas stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)has forced someone into sexual activityhas deliberately engaged in fire setting with the intention of causing serious damagehas deliberately destroyed others’ property (other than by fire setting)often stays out at night despite parental prohibitions, beginning before age 13 yearshas run away from home overnight at least twice while living in a parental or parental surrogate home (oronce without returning for a lengthy period)is often truant from school, beginning before age of 13 yearsThe same provisos regarding frequency, severity and developmental age apply as they do to ODD and, if ayoung person is over 18, they must not meet the criteria for Anti-social personality disorder.Conduct disorders can be divided into two sub-types, based on age of onset: A childhoodonsettype (if at least one criterion characteristic of Conduct Disorder was present prior toage 10 years) and an adolescent-onset Type (absence of any criteria characteristic ofConduct Disorder prior to age 10 years) [402].The prognosis for early-onset conduct disorders is generally poor, with outcomes inadulthood including alcoholism, drug abuse, criminality, domestic abuse and psychiatricdisorders (including anti-social personality disorder) [423,424].EpidemiologyThere have now been a number of community surveys of mental disorders in children andyouth in the U.K. and the U.S. which may be considered methodologically rigorousbecause they applied DSM-IV criteria and included both direct structured interviews withchildren and reports about children’s symptoms and functioning from parents or primarycaregivers. A recent review of these studies found a median 12-month prevalence ofdisruptive behaviour disorders (i.e. ODD or CD) of 6% with a range from 5 to 14 % [315].Conduct disorder has consistently been found to be much more prevalent in boys withmany studies finding prevalence 3–4 times higher in boys than in girls. Some, but not all,studies have found a higher prevalence of ODD in boys.In New Zealand, the Christchurch longitudinal study (of children born in 1977) reported theprevalence of Conduct Disorder at 14–15 years as being 14.1% for Māori and 3.5% fornon-Māori while the Dunedin longitudinal study (of children born between April 1972 andMarch 1973) reported the prevalence of conduct disorder at 17–18 years as being 13.6%for Māori and 7.7% for non-Māori [425].Earlier onset of disruptive behaviour disorders is associated with more aggressivebehaviours and worse outcomes. Youths with CD commonly also have ADHD and boyswho have a diagnosis of ADHD are more likely to have early onset behaviour disorders.There is also a strong association between mood and anxiety disorders and disruptivebehaviour disorders [315].TreatmentPoor quality parenting is an important precursor of childhood-onset conduct problems. It ischaracterised by low levels of parental involvement and supervision, and inconsistent andpunitive discipline, and it interacts with parental risk factors such as mental illness,substance abuse, disrupted family life, unemployment and low socio-economic status andwith risk factors in children including difficult temperament, low verbal intelligence,impulsivity and deficits in processing social information. Despite the cumulative effects ofIn-Depth Topic: Mental Health Issues in Children - 380
multiple risk factors, there is increasing evidence that improving parenting skills can resultin improvements in children’s behaviour and parental mental health [426].In general, treatment programmes are more effective for children under the age of 12 andparent management training programmes for 3–7 year olds are the interventions mostlikely to produce substantial reductions in rates of child conduct problems [427].Parenting programmesThere is now a very considerable literature relating to parenting programmes for theprevention and treatment of conduct disorders. As an entry point into this literature,readers who require more detailed information than is provided here might like to use theConduct Problems Best Practice Report by the Advisory Group on Conduct problems forthe Ministry of Social Development [427].There are two main varieties of parenting programmes: behavioural and relationship,although many combine elements of both. The aim of relationship programmes is to assistparents to understand both their own and their child’s emotions and behaviour, and toimprove parent-child communication. Behavioural programmes aim to teach parents theskills to address the causes of problem behaviour and strategies such as ignoring badbehaviour and praising co-operative behaviour, building a relationship with their childthrough child-led play, and setting boundaries with ‘time out’ for infringements [428].A 2009 systematic review by Dretzke et al. reviewed 57 randomised controlled trials ofparenting programmes for the treatment of children with conduct problems [424]. Mostinterventions included in the trials were focussed on the parents alone and were deliveredover 10 or fewer sessions. Only four trials were considered to be of good quality. Thereview authors performed a meta-analysis of 24 trials which found that parentingprogrammes significantly reduced parent-reported intensity and frequency of behaviourproblems (intensity SMD -0.67, 95% CI -0.91 to -0.42; frequency SMD -0.62, 95% CI -0.85to -0.40) and they concluded that parenting programmes are an effective treatment forchildren with conduct problems. However, they reported that there was insufficientevidence to determine which types of programme were most likely to be effective, mainlybecause the studies that compared programmes tended to compare programmes thatwere different in several key characteristics making it impossible to determine whichparticular programme features might be associated with better outcomes.A 2012 Cochrane review assessed the effectiveness and cost-effectiveness ofbehavioural and cognitive-behavioural group-based parenting interventions for improvingchild conduct problems (in children aged 3–12 years), parenting skills and parental mentalhealth [426]. Noting that previous reviews had combined results from both group-basedand individual-based programmes and included programmes that were delivered tochildren with comorbidities (other disorders in addition to conduct problems) as well as tochildren with conduct disorders alone, the authors of this review elected to use morestringent criteria in determining which studies to include in their review. Thirteen trials (10RCTs and 3 quasi-randomised trials) were included together with two economicevaluations based on two of the trials. The review authors concluded that behavioural andcognitive-behavioural group-based parenting interventions were both effective and costeffective in the short term for improving child conduct problems, parenting skills andparental mental health but that further research is needed on long term outcomes.Nine of the thirteen studies in the 2012 Cochrane review evaluated the Incredible YearsIntervention which is being widely used in New Zealand in programmes delivered byGroup Special Education, CAMHS and contracted NGOs [429].A preliminary evaluation of the efficacy and cultural acceptability of these programmes inthe New Zealand context has been carried out by Fergusson et al., using data provided bythe Ministry of Education [430]. This study used data gathered from 214 parents (ofchildren aged from 2½ to 8 years) who had attended an Incredible Years Basic ParentProgramme for at least nine sessions and it compared pre- and post-test scores on theEyberg Child Behaviour Inventory (ECBI) Problem and Intensity Scales [431] and theSocial Competence Scale [432] and also assessed parent satisfaction with theIn-Depth Topic: Mental Health Issues in Children - 381
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Cover Artwork: Long-tailed Blue But
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LIST OF FIGURESFigure 1. Gross Dome
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Figure 41. Number of Students Invol
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Figure 85. Proportion of Babies Bor
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Figure 127. Relationship Between th
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Table 21. Policy Documents Relevant
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Table 108. Proportion of Young Peop
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INTRODUCTION AND OVERVIEWIntroducti
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three then reviews mental health is
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Table 1. Overview of the Determinan
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Stream Indicator New Zealand Distri
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47MACROECONOMICINDICATORS
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Expenditure-based Measure of GDPThe
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Gini Coefficient: The Lorenz curve
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CHILD POVERTY AND LIVING STANDARDSI
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After Housing Costs (AHC)Relative P
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Figure 8. Proportion of Dependent C
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14 Items (Enforced Lacks) are inclu
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Local Policy Documents and Evidence
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Other Relevant New Zealand Evidence
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UNEMPLOYMENT RATESIntroductionIn th
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Figure 12. Unemployment Rates by Ag
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Unemployment Rates by Qualification
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Figure 18. Quarterly Unemployment R
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CHILDREN RELIANT ON BENEFIT RECIPIE
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Table 4. Number of Children Aged 0-
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Table 5. Number of Children Aged 0-
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YOUNG PEOPLE RELIANT ON BENEFITSInt
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Table 7. Number of Young People Age
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New Zealand Distribution by Ethnici
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Figure 25. Young People Aged 16-24
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Table 10. Number of Young People Ag
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HOUSEHOLD COMPOSITION91
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Data Source and MethodsDefinitionPr
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Figure 29. Proportion of Children A
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Robertson J, et al. 2006. Review of
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Canadian National Occupancy Standar
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Figure 33. Proportion of Children a
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Other Relevant EvidenceMarmot Revie
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Note 2: The number of new school en
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Figure 36. Proportion of New Entran
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Sylva K, et al. 2004 The Effective
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Table 15. Enrolments in Māori Medi
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Table 16. Number of Students (Māor
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Local Policy Documents which Consid
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HIGHEST EDUCATIONAL ATTAINMENT AT S
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Figure 43. Highest Educational Atta
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Figure 46. Highest Educational Atta
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SENIOR SECONDARY SCHOOL RETENTION A
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Participation in Tertiary Education
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Midland Region Distribution and Tre
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The following section uses informat
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Figure 54. Age-Standardised Rates o
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Figure 56. Age-Standardised School
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TRUANCY AND UNJUSTIFIED ABSENCESInt
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Figure 60. Total Unjustified Absenc
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Figure 63. Total Unjustified Absenc
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Table 22. The National Immunisation
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Figure 64. Immunisation Coverage by
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Figure 67. Immunisation Coverage by
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Figure 71. Immunisation Coverage at
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Soares-Weiser K, et al. 2012. Vacci
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Briss PA, et al. 2000. Reviews of e
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Data Sources and MethodsIndicatorPr
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Figure 75. Proportion of New Zealan
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Proportion Receiving Core Contacts
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Figure 81. Proportion of Babies who
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The B4 School CheckThe B4 School Ch
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Other Relevant EvidenceThe Scottish
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185SUBSTANCE USE
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Notes on InterpretationNote 1: The
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Maternal Smoking at First Registrat
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Table 32. Number of Cigarettes Smok
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National Institute for Health and C
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2. Proportion of babies born to mot
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Table 37. Number of Cigarettes Smok
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Figure 93. Proportion of Year 10 St
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Figure 95. Proportion of Year 10 St
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TOBACCO USE IN YOUNG PEOPLEIntroduc
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Figure 96. Daily Smoking Rates in Y
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2009 New Zealand Tobacco Use Survey
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Source of Tobacco in the Last Month
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Carson KV, et al. 2011. Community i
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Other Relevant PublicationsMāori A
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Other Cochrane Systematic Reviews o
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ALCOHOL-RELATED HOSPITAL ADMISSIONS
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Figure 100. Alcohol-Related Hospita
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Table 45. Listed External Causes of
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Shults RA, et al. 2009. Effectivene
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Mortality from conditions with a so
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Table 50. Mortality from Conditions
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Figure 105. Hospital Admissions for
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Table 55. Hospital Admissions for C
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Table 57. Hospital Admissions for C
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Midland Region Distribution by Caus
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INFANT MORTALITY AND SUDDEN UNEXPEC
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New Zealand Distribution and Trends
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Figure 111. Total Infant Mortality,
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Table 62. Neonatal and Post Neonata
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Table 65. Neonatal and Post Neonata
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Distribution by Ethnicity, NZ Depri
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Figure 116. Sudden Unexpected Death
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Vennemann M, et al. 2007. Do immuni
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276
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with a review of interventions aime
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deprivation in some parts of the wo
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who delay a second pregnancy by two
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Family ViolenceDefinitions and New
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need for multidisciplinary interven
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6 days to determine gestational age
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In New Zealand, information on fact
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post intervention. Engagement in ed
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antenatal care, including two nutri
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throughout pregnancy, birth and the
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Alcohol and Other DrugsNational and
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Zealand had a number of specialist
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in one Cochrane review [274] (see p
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interventions to treat antenatal de
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In ConclusionWhile it is hoped that
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308
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Data Source and MethodsDefinition1.
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Other Systematic ReviewsLouwers ECF
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INJURIES ARISING FROM ASSAULT IN YO
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New Zealand Distribution by Age and
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Flood M & Fergus L. 2008. An Assaul
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Page 340 and 341: Data Source and MethodsDefinition1.
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Page 352 and 353: oader contextual influences on the
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Page 356 and 357: Williams SB, et al. 2009. Screening
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Page 368 and 369: IN-DEPTH TOPIC: MENTAL HEALTH ISSUE
Page 370 and 371: this [350]. The review stated that
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Page 374 and 375: Social Workers in SchoolsIn 2011 th
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Page 390 and 391: ACCESS TO MENTAL HEALTH SERVICES: L
Page 392 and 393: Table 97. Children and Young People
Page 394 and 395: Midland Region DistributionChildren
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Page 400 and 401: Numbers Accessing Services by Diagn
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Page 412 and 413: Midland Region DistributionAmongst
Page 414 and 415: Local Policy Documents and Evidence
Page 416 and 417: Fletcher A, et al. 2008. School Eff
Page 418 and 419: New Zealand Distribution and Trends
Page 420 and 421: Figure 138. Mortality from Suicide
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Page 424 and 425: Ougrin D & Latif S. 2011. Specific
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Guide to Community Preventive Servi
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information on all of the events oc
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3. In addition, some providers admi
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as in the majority of the analyses
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APPENDIX 5: THE NATIONAL MORTALITYC
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As a result of these changes, there
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2. Research also suggests that ethn
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APPENDIX 8: POLICE AREA BOUNDARIESF
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Figure 142. Police Area Boundaries
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3. The condition exhibits a socioec
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REFERENCES1. Children's Commissione
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33. Mackay R. 2005. The Impact of F
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71. Ministry of Health. 2011. Immun
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107. ASH New Zealand. 2011. Nationa
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141. Child and Youth Mortality Revi
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175. Pihama L. 2011. Overview of M
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208. King-Hele S, Webb RT, Mortense
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244. Nelson Marlborough District He
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274. Ramsay J, Carter Y, Davidson L
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306. Jewkes R. 2002. Intimate partn
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347. Heflinger CA, Hinshaw SP. 2010
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376. Ministry of Education. 2012. W
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410. Ministry of Health. 2001. New
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443. Zeanah PD, Bailey LO, Berry S.
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480. Weinberg MK, Olson KL, Beeghly
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