A Pilot Study for Understanding the Perceptions of Australian General Practitioners Regarding Psychopharmacology for Children With Autism Spectrum Disorders.

BACKGROUND: General practitioners (GPs) are increasing involved in the care of children with autism spectrum disorders (ASDs), and prescribe and/or manage psychotropic medications for these children. Few published reports of perceptions of GPs regarding use of these medications exist in the literature. OBJECTIVE: Qualitative analysis of comments by 177 GPs regarding psychopharmacology use in children with ASDs. METHODS: A postal questionnaire survey containing both close- and open-ended questions was conducted in New South Wales, Australia. RESULTS: Respondent GPs were more likely to be females graduated from Australian medical schools and reported an interest either in child or in mental health. The respondents demonstrated good understanding of the issues surrounding psychopharmacology use in children with ASD based on contemporary literature on this topic. The main themes included concerns regarding medication safety, evidence for their use, and role of these medications as an adjuvant to behavior management. GPs reported a lack of experience of these medications, and would often prescribe only under the supervision of specialists. GPs with greater confidence and involvement with children of ASDs prescribed more medications; whereas GP reporting more concerns with regard to medications prescribed less. CONCLUSION: Respondent GPs have good understanding of psychotropic medications but need support from specialists for managing these medications in children with ASDs. Future larger studies should explore the utility of collaborative models of care for GPs to work in close partnerships with specialists.

A Framework for Developing a Curriculum Regarding Autism Spectrum Disorders for Primary Care Providers.

INTRODUCTION: The prevalence of Autism Spectrum Disorders (ASDs) has increased and varies across age groups. Thus there is an increasing need for educational opportunities for General Practitioners (GPs) and other Primary Care providers to help in early identification and referral to specialist services. An earlier survey of GPs in New South Wales (Australia) demonstrated two broad domains for educational activities: (1) a general knowledge (important for early identification and referral) and (2) surveillance (important for ongoing management). AIM: To seek further evidence to these domains and synthesize the important contents for educational programs for GPs. MATERIALS AND METHODS: We conducted a (1) Confirmatory Factor Analysis (CFA) on our original survey data and (2) systematic review of the literature to identify important educational topics, using a life cycle approach. RESULTS: CFA and literature review support theoretical framework of two domains. Alerts and red flags for ASDs, knowledge of simple surveillance tools, communication of diagnosis with parents, referral pathways particularly to speech pathologists before a formal diagnosis is confirmed, and appreciation of vulnerabilities for identifying supports were important in the general knowledge domain, while supporting the families through transition points such as from pre-school to school entry, secondary school and adolescence, role of psychopharmacology such as medications for sleep issues, and for common co-morbidities of anxiety were important in the surveillance dimension. CONCLUSION: GP supervisors and medical and nursing educators can use findings from this paper for developing structured learning activities for training primary health care workforce regarding ASD's.

An Exploratory Survey for Understanding Perceptions, Knowledge and Educational Needs of General Practitioners (GSs) Regarding Autistic Disorders in New South Wales (NSW), Australia.

AIM: A survey was conducted to ascertain General Practitioners (GPs') perceptions, knowledge and educational needs regarding autistic disorders in childhood. METHODS: A concurrent mixed method approach was used for data collection and analysis. Exploratory factor analysis (EFA) of the data was done and groups were compared using appropriate statistical tests. RESULTS: There was more response from female GPs, Australian medical graduates and those with an interest in mental and /or child health. Variability was noted in how GPs perceived their competence and knowledge of autistic disorders. About 60% correctly believed that an early-individualised treatment programme was evidence based. Knowledge was inversely related to the number of years in practice and enhanced by personal involvement with children of these disorders and awareness of community resources. Parallel analysis of knowledge scale revealed a "general knowledge" dimension loading items helpful for early identification and referral and a "surveillance" dimension helpful for ongoing involvement of GPs for management of children with ASDs. CONCLUSIONS: Although further development and refinement of knowledge questionnaire using these dimensions for primary care physicians are needed these are relevant target areas for education.

Efficacy of the bell and pad alarm therapy for nocturnal enuresis.

AIM: (i) To determine the efficacy of bell and pad alarm therapy as an initial and relapse treatment for nocturnal enuresis; (ii) to explore risk factors for treatment failure; and (iii) to explore risk factors for relapse within 12 months of successful bell and pad alarm therapy. METHODS: A 22-item questionnaire was sent to 240 children who received bell and pad alarm therapy in a 6-year period via a community centre. The questionnaire recorded demographic characteristics of the child, length of the first bell and pad alarm therapy, outcome of initial treatment and relapse information. RESULTS: The initial response and relapse rates of bell and pad alarm therapy were 84 and 30%, respectively. Female gender, absence of diurnal symptoms and willingness to use alarm therapy were associated with better treatment outcomes. Treatment success was associated with shorter treatment length. The success rate of repeating alarm therapy after relapse was 78%, with an average length of treatment of 10 weeks. CONCLUSION: The bell and pad alarm therapy is an effective treatment for nocturnal enuresis both as initial therapy and after relapse. The association between patient characteristics and treatment response found in our study may help inform clinicians of likely treatment outcomes, and identify those who may need a different approach.