Publications by authors named "Antonio Mendoza Diaz"

14 Publications

  • Page 1 of 1

Speaking Softly and Listening Hard: The Process of Involving Young Voices from a Culturally and Linguistically Diverse School in Child Health Research.

Int J Environ Res Public Health 2021 05 28;18(11). Epub 2021 May 28.

Population Child Health, School of Women's and Children's Health, Faculty of Medicine, UNSW, Sydney 2031, Australia.

The involvement of young people in the planning of research continues to be rare, particularly for young people from culturally and linguistically diverse communities. This paper describes our experience in establishing a Youth Research Advisory Group (YRAG) in South West Sydney (SWS), including barriers and successful strategies. One hundred and fifteen students between school Years 7 and 12 (ages 11-18) took part in at least one of five sessions between 2019 and 2021. In total, we carried out 26 YRAG sessions, with between five and 30 students in each. Sessions focused on mapping the health priorities of the participants and co-developing research project proposals related to their health priorities. Our work with students revealed that their main areas of concern were mental health and stress. This led to material changes in our research strategy, to include "Mental Health" as a new research stream and co-develop new mental health-related projects with the students. Important strategies that enabled our research included maintaining flexibility to work seamlessly with organisational and individual preferences, and ensuring our processes were directed by the schools and-most importantly-the students themselves. Strategies such as maintaining an informal context, responding rapidly to student preference, and regularly renegotiating access enabled us to engage with the students to deepen our understanding of their experiences.
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http://dx.doi.org/10.3390/ijerph18115808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198054PMC
May 2021

A Multistate Trial of an Early Surveillance Program for Autism Within General Practices in Australia.

Front Pediatr 2021 23;9:640359. Epub 2021 Apr 23.

Cooperative Research Centre for Living With Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia.

The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, which in turn can have a cumulative effect over the life course. The current protocol describes a multi-site, cluster randomized control trial comparing a developmental surveillance pathway for autism to usual care, using opportunistic visits to general practitioners (GPs). Units of randomization are GP clinics across two Australian states (New South Wales and Victoria), with thirty clinics within each state, each of which will aim to recruit approximately forty children aged between ~18- and 24-months, for a total of ~2,400 participants. Children will be randomized to two clusters; namely, an autism surveillance pathway (ASP) or surveillance as usual (SaU). The screening process for the ASP arm involves primary and secondary screenings for developmental concerns for autism, using both parent and GP reports and observations. Children in both arms who show signs of developmental concerns for autism will be offered a full developmental assessment by the research team at 24 months of age to determine the efficacy of developmental surveillance in successfully identifying children with autism. The trial is registered with ANZCTR (ACTRN12619001200178) and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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http://dx.doi.org/10.3389/fped.2021.640359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102783PMC
April 2021

School-based integrated healthcare model: how Our Mia Mia is improving health and education outcomes for children and young people.

Aust J Prim Health 2021 Mar 18. Epub 2021 Mar 18.

Integrating healthcare into education settings represents a promising model to address complex health problems in disadvantaged communities through improving access to health and social services. One such example of an effective school-based health hub is the Our Mia Mia (OMM) Wellbeing Hub, located in a primary school in Nowra and servicing a community experiencing significant socioeconomic disadvantage. The efficacy of OMM rests on its success in facilitating access to services by removing the barriers of cost and transport and establishing connection to community. The OMM fosters collaborations between health professionals and educators to coordinate holistic treatment and implement appropriate student supports in a timely manner. The support of key individuals and groups, in addition to the flexibility of the model, has allowed the hub to pivot and adapt to meet the changing needs of its community, particularly as challenges pertaining to bureaucracy, financial sustainability and community mistrust have presented themselves. Future directions for the OMM hub, and the possibility of adapting and translating school-based healthcare delivery models in other disadvantaged communities, is discussed.
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http://dx.doi.org/10.1071/PY20177DOI Listing
March 2021

Impact of the COVID-19 pandemic on the well-being of children with neurodevelopmental disabilities and their parents.

J Paediatr Child Health 2021 05 10;57(5):631-636. Epub 2021 Jan 10.

School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.

Aims: To examine the impact of COVID-19 pandemic on child mental health and socio-emotional and physical well-being (including sleep, diet, exercise, use of electronic media; care giver perceptions of symptoms of child neurodevelopmental disability [NDD] and comorbidities), and care giver mental health and well-being, social support and service use.

Methods: An online cross-sectional self-report survey was distributed via disability service providers and support groups. Care givers of children aged 2-17 years with a NDD were invited to respond to questions on child symptom severity and well-being, parent well-being and service access and satisfaction.

Results: Overall, 302 care givers (94.7% female) completed the survey. Average child age was 9.7 years and 66.9% were male. Worsening of any child NDD or comorbid mental health symptom was reported by 64.5% of respondents and 76.9% reported child health and well-being was impacted by COVID-19. Children were viewing more television and digital media (81.6%), exercising less (68.0%), experiencing reduced sleep quality (43.6%) and had a poorer diet (32.4%). Almost one fifth (18.8%) of families reported an increase in the dosage of medication administered to their child. Parents reported COVID-19 had impacted their own well-being (76.1%). Over half of respondents were not satisfied with services received during COVID-19 (54.8%) and just 30% reported that telehealth works well for their child.

Conclusion: Targeted interventions are required to address worsening child neurodevelopmental disability, mental health symptoms and poor diet, sleep and exercise patterns. Improved access to telehealth services is indicated, as is further research on barriers and enablers of effective telehealth services.
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http://dx.doi.org/10.1111/jpc.15285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014782PMC
May 2021

A systematic review on the intersection of attention-deficit hyperactivity disorder and gaming disorder.

J Psychiatr Res 2021 01 11;133:212-222. Epub 2020 Dec 11.

University of New South Wales, Faculty of Medicine, School of Psychiatry, 1 Campbell Street, Liverpool, NSW, 2170, Australia.

Introduction: Studies of Gaming Disorder (GD) consistently identify co-morbidity with various psychiatric disorders including major depression, obsessive compulsive disorder and anxiety disorders. One of the strongest associations has been with Attention Deficit Hyperactivity Disorder (ADHD). We present a systematic review of this association by pooling and integrating available evidence.

Methods: PubMed, EMBASE, PsychInfo and CINHAHL were searched for articles that reported a quantitative association between GD and ADHD and its dimensions, using equivalent search terms. Quality appraisal was done using criteria adapted from the Critical Appraisal Skills Package (CASP) checklists.

Results: 1028 articles were identified, of which 29 studies were included for systematic review (n = 56650 participants). Most of these studies were observational in nature, and were of moderate quality, with deficits particularly in the domains of generalisability and confounding. Community surveys (n = 18) of purposive samples constituted the majority, with fewer clinic-based samples (n = 11). While ADHD symptoms were consistently associated with GD, More frequent associations were displayed with inattention associations with GD than other ADHD subscales. There were no conclusive findings regarding the type of game on severity of either condition, or on completion of treatment.

Conclusions: The findings suggest an association between ADHD and GD, although the direction of the relationship is unclear. This has implications for clinical practice, policy and research. We recommend that ADHD is screened for when evaluating IGD as part of routine practice."
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http://dx.doi.org/10.1016/j.jpsychires.2020.12.026DOI Listing
January 2021

Bridging the gap between child mental health need and professional service utilisation: Examining the influence of mothers' parental attributions on professional help-seeking intentions.

Eur Child Adolesc Psychiatry 2020 Nov 19. Epub 2020 Nov 19.

School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.

There is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers' attributions about their child's problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers' anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (β = .19, p = .002) but not parental self-efficacy (β =  - .01, p = .865) in the general sample, while positively associated with child-responsible attributions (β = .20, p = .009) and negatively associated with parental self-efficacy (β =  - .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.
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http://dx.doi.org/10.1007/s00787-020-01682-6DOI Listing
November 2020

Mapping the Specific Pathways to Early-Onset Mental Health Disorders: The "Watch Me Grow for REAL" Study Protocol.

Front Psychiatry 2020 19;11:553. Epub 2020 Jun 19.

Faculty of Science, School of Psychology, University of Sydney, Sydney, NSW, Australia.

Background: From birth, the human propensity to selectively attend and respond to critical super-stimuli forms the basis of future socio-emotional development and health. In particular, the first super-stimuli to preferentially engage and elicit responses in the healthy newborn are the physical touch, voice and face/eyes of caregivers. From this grows selective attention and responsiveness to emotional expression, scaffolding the development of empathy, social cognition, and other higher human capacities. In this paper, the protocol for a longitudinal, prospective birth-cohort study is presented. The major aim of this study is to map the emergence of individual differences and disturbances in the system of social-Responsiveness, Emotional Attention, and Learning (REAL) through the first 3 years of life to predict the specific emergence of the major childhood mental health problems, as well as social adjustment and impairment more generally. A further aim of this study is to examine how the REAL variables interact with the quality of environment/caregiver interactions.

Methods/design: A prospective, longitudinal birth-cohort study will be conducted. Data will be collected from four assessments and mothers' electronic medical records.

Discussion: This study will be the first to test a clear developmental map of both the unique and specific causes of childhood psychopathology and will identify more precise early intervention targets for children with complex comorbid conditions.
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http://dx.doi.org/10.3389/fpsyt.2020.00553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319093PMC
June 2020

The Clinical Assessment of Prosocial Emotions (CAPE 1.1): A multi-informant validation study.

Psychol Assess 2020 Apr 12;32(4):348-357. Epub 2019 Dec 12.

School of Psychology.

Support for the clinical importance of callous and unemotional (CU) traits has grown considerably in recent years, yet tools for the assessment of CU traits in clinical settings have largely been limited to questionnaires. This study examined the validity of the Clinical Assessment of Prosocial Emotions (CAPE 1.1), a newly developed clinician-rating measure of CU traits in children and adolescents. Participants were children aged 3 to 15 years ( = 82; 75% male) who were referred for treatment of conduct problems. Diagnoses of conduct disorder and oppositional defiant disorder were formulated based on semistructured diagnostic interviews prior to treatment. The CAPE 1.1 was scored based on structured interviews administered jointly to mothers and fathers and was validated with questionnaire measures of CU traits and other correlates of CU traits from multiple informants. Evidence of criterion validity was found in significant associations between CAPE 1.1 scores and questionnaire measures of CU traits completed by mothers, fathers, and teachers. Evidence of construct validity was found in significant associations between CAPE 1.1 scores and established correlates of CU traits, including severity of oppositional defiant disorder/conduct disorder symptoms indexed via diagnostic interview with parents, teacher ratings of proactive aggression, and reports of affective empathy by mothers and fathers. These findings provide support for the clinical utility of the CAPE 1.1 and its inclusion as part of a comprehensive assessment of children and adolescents with conduct problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pas0000792DOI Listing
April 2020

Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study.

J Med Internet Res 2019 08 2;21(8):e14127. Epub 2019 Aug 2.

Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.

Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students.

Objective: We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype.

Methods: A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype.

Results: We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype's 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking.

Conclusions: Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries.
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http://dx.doi.org/10.2196/14127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6696860PMC
August 2019

Therapist-assisted online treatment for child conduct problems in rural and urban families: Two randomized controlled trials.

J Consult Clin Psychol 2019 Aug 17;87(8):706-719. Epub 2019 Jun 17.

Royal Far West.

Objective: We examined the relative efficacy of an online versus face-to-face (FTF) parenting intervention for reducing the severity of child conduct problems and related parent and child outcomes in 2 randomized controlled trials.

Method: In Study 1, rural families ( = 133) with a child 3-9 years of age with a full or subclinical primary diagnosis of oppositional defiant or conduct disorder traveled to Sydney, Australia for a comprehensive assessment and randomization to receive either AccessEI, a 6-10 week online therapist-assisted parenting program, or FTF treatment, whereby they received the same program presented FTF during a 1-week treatment. To control for unavoidable treatment dosage differences in the first study, Study 2 was conducted in which urban families ( = 73) with a child aged 3 to 14 years meeting similar criteria as Study 1 were randomized to receive AccessEI versus FTF treatment.

Results: In both studies, improvements in severity of child diagnoses and maternal measures of child behavior showed very large effect sizes for both treatments at posttreatment and 3-month follow-up and did not differ across treatment conditions. There were moderate effect sizes for improvements in parent mental health and no differences across treatment conditions.

Conclusions: It is concluded that the effects of the therapist-assisted online parenting interventions for the treatment of child conduct problems were similar to a FTF intervention, providing evidence for the effectiveness of an accessible treatment for rural and remote families. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000419DOI Listing
August 2019

Why is this Happening? A Brief Measure of Parental Attributions Assessing Parents' Intentionality, Permanence, and Dispositional Attributions of Their Child with Conduct Problems.

Child Psychiatry Hum Dev 2019 06;50(3):362-373

University of Sydney, Sydney, Australia.

We present and evaluate a new self-report measure of parental attributions developed for assessing child causal and dispositional attributions in parenting interventions. The Parent Attribution Measure (PAM) ascribes attributions along first-order dimensions of intentionality, permanence, likeability, and disposition, and a higher-order Total Scale. The psychometric analyses involved participants drawn from populations of clinical (n = 318) and community-based families (n = 214) who completed questionnaires assessing parental attributions, parenting behaviours, parental depression, parental feelings about the child, and child behavioural problems. Confirmatory factor analysis indicated that a 3-factor hierarchical structure provided a close fitting model. The model with intentionality, permanence, and disposition (consolidating likeability and disposition) dimensions as first-order factors grouped under a higher-order general factor was validated in independent samples and demonstrated sound psychometric properties. The PAM presents as a brief measure of parental attributions assessing parents' intentionality, permanence, and dispositional attributions of their child with conduct problems.
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http://dx.doi.org/10.1007/s10578-018-0844-2DOI Listing
June 2019

Intergenerational Stability of Callous-Unemotional Traits.

Child Psychiatry Hum Dev 2018 Jun;49(3):480-491

Child Behavior Research Clinic, School of Psychology, University of Sydney, Sydney, NSW, Australia.

This study investigated the stability of callous and unemotional (CU) traits across generations by assessing self-report assessments of psychopathy factors in parents and their relationship to children's CU traits in a clinical sample: 223 boys (M age = 7.65) and 83 girls (M = 7.35) referred for treatment of disruptive behavior disorders. First, we expanded previous findings showing a positive relationship between maternal psychopathy scores and CU traits in boys. Second, we tested whether parental psychopathy scores predicted CU traits in children over and above general indicators of mental health risk: parental psychopathology, parental warmth, and harsh parenting. Fathers' psychopathy factor 1 was uniquely related to CU traits. In contrast, the relationship between mothers' psychopathy factor 2 and children's CU traits disappeared when maternal warmth was included. Gender differences suggested these results are most applicable to boys. These findings support the intergenerational stability of psychopathy factor 1 between children and their fathers.
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http://dx.doi.org/10.1007/s10578-017-0766-4DOI Listing
June 2018

Genetic Regulation of Maternal Oxytocin Response and Its Influences on Maternal Behavior.

Neural Plast 2016 31;2016:5740365. Epub 2016 Oct 31.

Sydney Child Behaviour Research Clinic, School of Psychology, University of Sydney, Sydney, NSW, Australia.

We interrogated the genetic modulation of maternal oxytocin response and its association with maternal behavior using genetic risk scores within the oxytocin receptor (OXTR) gene. We identified a novel SNP, rs968389, to be significantly associated with maternal oxytocin response after a challenging mother-infant interaction task (Still Face Paradigm) and maternal separation anxiety from the infant. Performing a multiallelic analysis across OXTR by calculating a cumulative genetic risk score revealed a significant gene-by-environment (G × E) interaction, with OXTR genetic risk score interacting with adult separation anxiety to modulate levels of maternal sensitivity. Mothers with higher OXTR genetic risk score and adult separation anxiety showed significantly reduced levels of maternal sensitivity during free play with the infant. The same G × E interaction was also observed for the extended OXTR cumulative genetic risk score that included rs968389. Moreover, the extended cumulative OXTR genetic risk score itself was found to be significantly associated with maternal separation anxiety as it specifically relates to the infant. Our results suggest a complex montage of individual and synergistic genetic mediators of maternal behavior. These findings add to specific knowledge about genetic regulation of maternal oxytocin response in relation to maternal adjustment and infant bonding through the first few months of life.
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http://dx.doi.org/10.1155/2016/5740365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107871PMC
August 2017

Individual Differences in Childhood Behavior Disorders Associated With Epigenetic Modulation of the Cortisol Receptor Gene.

Child Dev 2015 Sep-Oct;86(5):1311-20. Epub 2015 Jul 7.

The University of New South Wales.

Behavioral/emotional difficulties in children are the first sign of mental health problems. These problems are however, heterogeneous. A domain that may identify homogenous subgroups is hypothalamic-pituitary-adrenal function. This study tested whether epigenetic regulation of glucocorticoid receptor gene could explain the co-occurrence of anxiety problems in children with behavior problems. Four- to 16-year-old clinically referred children (N = 241) were measured for psychiatric symptoms, methylation of target CpG sites in blood or saliva, and morning cortisol levels in those who gave blood. Increased methylation of promoter 1F CpG sites was associated with higher vulnerability to co-occurring internalizing symptoms and morning cortisol. The results support increasing optimism that epigenetic regulation of key neuroendocrine systems might help explain hitherto unfathomable individual differences in susceptibility to psychiatric symptom profiles.
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http://dx.doi.org/10.1111/cdev.12391DOI Listing
June 2016
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