This study investigates practicing clinician and staff perspectives on potential protocol modifications for the “Nasal Irrigation, Oral Antibiotics, and Subgroup Targeting for Effective Management of Acute Sinusitis” (NOSES) study, a pragmatic randomized controlled trial aiming at improving acute rhinosinusitis management. Focus groups with clinicians and staff at the pretrial stage recommended expanding participant age inclusion criteria, incorporating patients with COVID-19, and shortening the supportive care phase. Participants also discussed patient engagement and recruitment strategies. These practical insights contribute to optimizing the NOSES trial design and underscore the value of qualitative inquiries and healthcare stakeholder engagement in informing clinical trial design.

In this study, we examined the prevalence and nature of nonclinical panic attacks in 649 Australian youth and explored the relations between such attacks and measures of social support, stress, anxiety, depression, and fear. Full-blown attacks (attacks involving four or more symptoms with rapid onset) were reported by 104 of the youth (16%). Attacks were reported more frequently by girls than boys; however, age was unrelated to panic-attack status. Heightened levels of anxiety and fear, as well as stress in the family and lack of family support, were related to attack status. Path-analytic procedures supported a working model consisting of stress, social support, and emotional distress as related to panic status. Limitations of the self-report data on panic attacks and the other measures used in this study are acknowledged.

This paper reviews the role and indications for pharmacotherapy of children with school refusal. The psychopharmacological treatment of school refusal is based mainly on evidence of the effectiveness of certain drugs in the treatment of adult disorders. There is some evidence that tricyclic antidepressants and benzobiazepines may be specifically useful in the treatment of school refusal, but further research is warranted. Potentially serious side effects mean that drugs are best confined to cases where psychological treatments have not been effective or where drugs are used briefly as an adjunct to a broader psychological treatment plan. Drugs may also have a role in the specific treatment of comorbid conditions associated with school refusal. Any use of drugs should involve regular reviews to monitor response, compliance, and side effects.

A case study is presented of a 13-year-old adolescent male with a long history of anxious symptoms related to school attendance. At the time of referral to the school refusal clinic, the adolescent had significant difficulty attending school, having attended for only 1 day in the past 3 weeks. A cognitive-behavioural treatment program was conducted over 3 weeks, consisting of seven sessions with the adolescent, seven sessions with his parents, and consultation to school personnel. Treatment focused on the implementation of behaviour management techniques by caregivers as well as teaching anxiety management skills to the adolescent. Positive treatment outcomes included the adolescent's return to full-time attendance at school as well as a decrease in emotional distress. The implications of treatment are discussed in relation to the simultaneous application of behaviour management and anxiety management strategies in the treatment of school refusal.

Despite their significance, childhood anxiety disorders, compared to those of adults, have been neglected by researchers. However, recent years have witnessed increasing research on childhood anxiety disorders. Normative and developmental aspects of fear and anxiety are briefly discussed and we examine the classification and diagnostic reliability of childhood anxiety disorders. In relation to assessment, we focus on some recent research developments on self-report instruments and behavioural avoidance tests. An integrative behavioural treatment model is presented in which the need for age-appropriate intervention is emphasised. Also, data on the social validity of fear reduction procedures are presented. Finally, we outline several directions for future research.

The heterogeneous nature of school refusal has led to much confusion surrounding the conceptualisation of this phenomenon. A number of researchers have developed taxonomic systems in an effort to enhance our understanding of school refusal and to facilitate communication among professionals working in the field. The current paper explores the evolution of these systems and outlines the limitations of each. Non-empirical classificatory systems are reviewed first, followed by empirical systems based on factor analyses and diagnostic profiles. A functional taxonomic system for problematic school attendance is then reviewed. Future research based on sound methodological procedures should aim to examine a broad range of child and family characteristics in order to develop reliable, homogenous subtypes for this population.

Traditionally, mental health professionals and school authorities have found school refusal to be a perplexing and challenging problem. Relevant to an understanding of school refusal, we initially review some important developmental-normative considerations. The clinical features, epidemiology, and etiology of school refusal are also briefly discussed. We then describe a number of behavioural strategies that have been used in the management of school refusal. Finally, we review the research support for the efficacy and acceptability of behavioural strategies in the treatment of school refusal.

Following Bandura's theory, a Self-efficacy Questionnaire for School Situations (SEQ-SS) was developed to assess the cognitions of school refusers. The instrument contains twelve school-related situations which are rated by children according to their belief about their ability to cope with each situation. Factor analysis yielded two reliable factors labelled Academic/Social Stress and Separation/Discipline Stress. Psychometric evaluation also revealed good internal consistency and test-retest reliability. Total self-efficacy scores for 135 school refusers ranged from very low to very high. Self-efficacy was highest with regard to doing school work and lowest with regard to answering peers' questions about absences. The clinical utility of the SEQ-SS is discussed, with implications for the selection of cognitive and behavioural treatment procedures. The application of the instrument in future research is also considered.

This article describes a cognitive-behavioural intervention implemented over 10 sessions with an adolescent girl experiencing school refusal and depression. Treatment focused on the learning of various coping skills to deal with stressful situations at home and school. Following a decision to change schools, a rapid school return was employed. A multimethod, multisource evaluation was used at pretreatment, posttreatment, and follow-up assessments. The data indicated positive treatment outcomes: the adolescent returned to full-time attendance at school and exhibited decreased levels of emotional distress. The treatment gains were maintained at a 3-month follow-up.

This article describes the application of cognitive behavioural therapy to three sexually abused young people. We emphasise developmental influences and the nuances of the therapeutic approach. An exposure-based treatment approach was used with the youths. A multimodal assessment evaluation was conducted at pretreatment and posttreatment, and at a 3-month follow-up. Results on outcome measures indicated a positive therapeutic effect for the youths.

Child sexual abuse is a highly prevalent problem that frequently occasions the onset of posttraumatic stress disorder in the victimised youngster. Given the success of cognitive-behavioral interventions with adult trauma victims, it has been suggested that this treatment approach be applied to sexually abused children. We review the empirical support for the efficacy and acceptability of cognitive-behavioral strategies in the treatment of sexually abused children. Several clinical practice and research issues are also noted.

This overview examines the nature, prevalence, and impact of child sexual abuse. Associations and potential risk factors are identified, thus showing that child sexual abuse is not randomly distributed through the population. Finally, we discuss the ways in which clinicians and researchers have conceptualised the impact of child sexual abuse. A social and developmental model is outlined.

Anxiety is a highly prevalent problem with various manifestations in young children, especially those with an intellectual disability. Many parents of children with disabilities also experience a wide range of health problems, including anxiety, stress and depression. Very few group-based programs for parents of disabled children have been evaluated, and none of the existing research studies specifically address child or parental anxiety. Given the success of cognitive-behavioural interventions for anxious children without disabilities, it is logical that these interventions be applied to anxious intellectually disabled children. This paper presents a rationale for a new parent training-based early intervention program, targeting anxiety in this population of young people.

Accessibility, stigma and adverse effects of self-reliance can hinder the receipt of psychological treatments, especially in people living with chronic illness or disability. The aim of this study was to develop and pilot a flexible online psychological treatment using CBT and positive-psychology based techniques, for individuals with spinal cord injury (SCI) who also lived with depression or both depression and anxiety. A multiple case study approach provided in-principle evidence of the acceptability of the Electronic Personal Administration of Cognitive Therapy: ePACT. Three adults living with SCI completed pre- and post-intervention interviews and multiple modules of ePACT. The interviews used the Structural Clinical Interview for DSM Disorders (SCID/-N/P) for diagnosis and the standardised survey instruments: Depression Anxiety and Stress Scale — short version (DASS-21), Personal Wellbeing Index 4th edition (PWI) and the Spinal Cord Lesion Emotional Wellbeing Questionnaire (SCL EWQ v1 Australia). The results indicated that the online program was acceptable, and they all showed some improvement in symptoms. All participants indicated that they would not have sought face-to-face therapy for reasons of access and stigma. They all had a strong sense of independence and felt this would have been questioned if they sought therapy.

Rett syndrome (RTT) is a severe neurodevelopmental disorder affecting females almost exclusively and is characterized by a wide spectrum of clinical manifestations. Mutations in the X-linked methyl-CpG-binding protein 2 (MECP2) gene have been found in up to 95% of classical RTT cases and a lesser proportion of atypical cases. Recently, mutations in another X-linked gene, CDKL5 (cyclin-dependent kinase-like 5) have been found to cause atypical RTT, in particular the early onset seizure (Hanefeld variant) and one female with autism. In this study we screened several cohorts of children for CDKL5 mutations, totaling 316 patients, including individuals with a clinical diagnosis of RTT but who were negative for MECP2 mutations (n = 102), males with X-linked mental retardation (n = 9), patients with West syndrome (n = 52), patients with autism (n = 59), patients with epileptic encephalopathy (n = 33), patients with Aicardi syndrome (n = 7) and other patients with intellectual disability with or without seizures (n = 54). In all, seven polymorphic variations and four de novo mutations (c.586C>T [p.S196L]; c.58G>C [p.G20R]; c.2504delC [p.P835fs]; deletion of exons 1 - 3) were identified, and in all instances of the latter the clinical phenotype was that of an epileptic encephalopathy. These results suggest that pathogenic CDKL5 mutations are unlikely to be identified in the absence of severe early-onset seizures and highlight the importance of screening for large intragenic and whole gene deletions.