Publications

• Tzoumakis, S., Whitten, T., Laurens, K. R., Dean, K., Harris, F., Carr, V. J., & Green, M. J. (2024). Levels of Involvement with Child Protection Services Associated with Early Adolescent Police Contact as a Victim and Person of Interest. Journal of Interpersonal Violence, 0(0), doi: 10.1177/08862605231223468
  

This study of 71,465 young people showed that different levels of involvement with child protection services (i.e., no risk of significant harm [non-ROSH], unsubstantiated ROSH, substantiated ROSH, and out-of-home care; each relative to no child protection contact) from birth to age 11 years were associated with police contact as a victim and/or person of interest from age 11 to age 14 years. Substantiated ROSH and out-of-home care had the largest associations, which were similar in magnitude across all types of police contact categories. Findings highlight that even children with unsubstantiated child protection reports are at heightened risk of police contact compared to children who are unknown to child protection services, underlining the need to support all families in contact with the child protection system.

• Watkeys, O.J., O’Hare, K., Dean, K. et al. Cumulative comorbidity between neurodevelopmental, internalising, and externalising disorders in childhood: a network approach. Eur Child Adolesc Psychiatry (2024). doi: 10.1007/s00787-023-02312-7

Among a total cohort of 90,269 children, 2,268 children (2.5%) were diagnosed with at least one mental disorder by age 12 years, and 461 (20.3% of the 2,268 children with at least one mental disorder) were diagnosed with two or more different disorders (out of total of 8 groups of mental disorders analysed) before age 12 years (i.e., the accumulation of mental disorder diagnoses is referred to as “cumulative comorbidity”). This study provides one of the first examples of population evidence showing pervasive patterns of cumulative mental disorder comorbidity in childhood. The findings were generated from the use of network analyses which revealed that all mental disorder categories were either directly or indirectly connected, with developmental disorders and child affective and emotional disorders being the most central (interconnected) in the network; mental disorder categories aggregated (weakly) into two “communities” of disorders representing (i) internalising and externalising disorders and (ii) neurodevelopmental and sleep disorders. Our findings suggest that cumulative comorbidity between mental disorders may be an artefact of the categorical approach to psychiatric diagnosis. The findings of the current study may therefore inform the ongoing movement towards dimensional, person-centred approaches to diagnosis and treatment.

• O’Hare K., Watkeys O., Dean K., Laurens K.R., Tzoumakis S., Harris F., Carr V.J., Green M.J. (2024). Childhood Schizotypy and Adolescent Mental Disorder, Schizophrenia Bulletin, 50 (1), 69-77, sbad132, doi: 10.1093/schbul/sbad132
  In this study of 26,837 children, individual patterns of functioning on six domains of ‘schizotypy’ obtained via self-report in middle childhood (age 11 years) were associated with higher likelihood of being diagnosed with specific mental disorders later in adolescence. The concept of ‘schizotypy’ provides a framework for understanding the development of psychotic disorders such as schizophrenia, and potentially other mental disorders, across the lifespan. We determined three profiles of ‘schizotypy’ labelled true schizotypy (representing 6.8% of the sample), affective schizotypy (18.3%) or introverted schizotypy (24.7%) that were compared to children showing virtually no signs of risk at this age. Child members of the true schizotypy group were the only ones at higher likelihood of developing a psychotic disorder in adolescence, but were also more likely to develop other mental disorders, as were children represented in the other schizotypy groups. This research is among few prospective longitudinal examinations of the relationship between schizotypy in childhood and adolescent mental health problems. While the study shows that different profiles of schizotypy in childhood are important correlates of mental disorders in adolescence, they may not be specifically associated with psychotic disorders.  

• Bradley, M., Dean, K., Lim, S., Laurens, K.R., Harris, F., Tzoumakis, S., O'Hare, K., Carr, V.J., Green, M.J. Early life exposure to air pollution and psychotic-like experiences, emotional symptoms, and conduct problems in middle childhood. Soc Psychiatry Psychiatr Epidemiol (2023), doi: 10.1007/s00127-023-02533-w
  
  This study found small, positive associations between air pollution exposure and psychotic-like experiences in middle childhood. In a sample of 19,932 children from the NSW Child Development Study, we examined nitrogen dioxide and particulate matter less than 2.5 μm exposure at two time points (birth and middle childhood), in relation to self-reported psychotic-like experiences, emotional symptoms and conduct symptoms in middle childhood. Inconsistencies in previous research leave uncertainties around the link between air pollution and mental health problems in childhood, as well as the impact of exposure timing. After adjusting for potential confounding factors, we found that exposure to both nitrogen dioxide and particulate matter less than 2.5 μm exposure in middle childhood was associated with concurrent psychotic-like experiences at age 11-12 years, however, no association was found with middle childhood emotional symptoms or conduct problems. This study is the first to examine the relationship between air pollution exposure and childhood psychotic-like experiences and raises questions about the potential mechanisms of action of air pollution on the developing brain. 

• O’Hare K, Watkeys O, Dean K, et al. Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort. Australian & New Zealand Journal of Psychiatry. 2023;0(0). doi:10.1177/00048674231179652
  
  Among 91,597 adolescents followed from birth to 18 years of age in Wave 3 of the NSW Child Development Study, 5.7% (over 5,200 individuals) had at least one incident of self-harm or suicidal ideation recorded by health, police, and/or child protection agencies. The largest proportion of youth with reported self-harm and suicidal ideation were recorded by child protection services, at a younger age of first contact relative to other incidents of self-harm recorded by other human service agencies. Nearly 40% of youth with a health service contact for self-harm or suicidal ideation also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm or suicidal ideation than boys, but not child protection or police services. These findings reinforce the view that suicide prevention is not solely the responsibility of health services; high rates of overlap among different agencies responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.

• Harris, F., Dean, K., Watkeys, O.J., Laurens, K.R., Tzoumakis, S., Carr, V.J., Green., M.J. Conditions of Birth and Early Childhood Developmental Risk for Mental Disorders. Child Psychiatry Hum Dev (2023). doi: 10.1007/s10578-023-01549-2
  
  Distinct patterns of risk factors known at the time of birth are associated with different types of early childhood developmental risk detected at school entry. In a sample of 66,464 children from the NSW Child Development Study, child membership in four distinct ‘developmental risk’ classes at age ~5-6 years was examined in relation to 14 demographic, perinatal and familial factors, revealing two distinct risk patterns of association with early childhood risk. First, membership in the ‘misconduct risk class’ was associated with a distinct pattern of familial risk factors (i.e., maternal history of mental illness, maternal and paternal history of court charges and prenatal child protection notification). Second, membership in the ‘pervasive risk class’ (and to a lesser extent the ‘mild generalised risk class’) was associated with a pattern of perinatal factors (e.g., multiparity, young mother, and maternal smoking during pregnancy). These findings provide new information that can inform targeted service provision for children and families during contact with health and other social services in the first 2000 days, before the patterns of early childhood risk are detectable at the time of school entry.

• O'Hare, K., Watkeys, O., Harris, F., Dean, K., Carr, V.J. and Green, M.J. (2023). Self-harm and suicidal ideation in children and adolescents in contact with child protection services. Medical Journal of Australia, 218(11), 526-527, doi: 10.5694/mja2.51898
  
  In this longitudinal study of more than 91,597 children growing up in NSW, nearly 75% of self-harm and suicidal ideation incidents recorded by health services occurred in young people with child protection contact. Children who had been placed in out-of-home care showed the highest incidence of self-harm and/or suicidal ideation (13.0%), followed by those with substantiated child protection reports (10.4%), those with non-substantiated or non-threshold reports (4.6%), and those with no child protection contact (0.9%). While self-harm and suicidal ideation are known to be more common among young people who are known to child protection services, this is the first Australian study to quantify the cumulative incidence of self-harm and suicidal ideation recorded by health services from ages 0-17 years, among young people with differing levels of child protection contact. Cross-agency preventative interventions may be useful for children exposed to trauma and adversity.  

• O’Hare, K., Tzoumakis, S., Watkeys, O., Katz, I., Laurens, K. R., Butler, M., Harris, F., Carr, V. J., & Green, M. J. (2023). Out-of-home care characteristics associated with childhood educational underachievement, mental disorder, and police contacts in an Australian population sample. Child Abuse & Neglect, 139, doi: 10.1016/j.chiabu.2023.106120
  
  Children in out-of-home care (OOHC) are more likely to experience poor educational achievement, mental health issues, and early contact with the police. However, not all children in OOHC experience these problems equally. In a study of 2,082 children from the NSW-CDS who had at least one OOHC placement before age 13 years, we examined the characteristics of OOHC placements that were associated with these problems. Specifically, unstable placements, frequent maltreatment, placements with foster carers, and longer periods of time spent in care were associated with higher likelihood of experiencing these problems. Although the study did not examine all of the potential factors that could impact the child's well-being, such as characteristics of the child's original home, it can help understand which children in OOHC are most at risk of experiencing these problems. We also discovered that poor education, mental health issues, and police contact were often experienced together, and that different aspects of OOHC placements were linked to different types of problems. This suggests that a comprehensive approach to supporting children placed in out of home care, across education, health, and police agencies, is warranted.

• O’Hare, K., Laurens, K. R., Watkeys, O., Tzoumakis, S., Dean, K., Harris, F., Linscott, R., Carr, V. J., & Green, M. J. (2023). Parental mental disorders and offspring schizotypy in middle childhood: an intergenerational record linkage study. Social Psychiatry and Psychiatric Epidemiology, doi: 10.1007/s00127-023-02455-7
  
  This study found that the offspring of parents who had been diagnosed with a mental disorder were more likely to report particular sets of characteristics (e.g., personality, thinking style, social behaviour, referred to as ‘schizotypy’) in middle childhood (age 11 years) that may signify risk for later mental disorder in these children. In a cohort of over 22,000 children from the general population in the New South Wales Child Development Study (NSW-CDS),those reporting any of three different patterns of ‘schizotypy’ in childhood were more likely to have at least one parent with any of seven different types of mental disorder, but there were not clear links between any specific diagnosis in parents and childhood schizotypy. These findings suggest that intergenerational transmission of risk for mental disorder is largely general, rather than specific to any one particular disorder.

• Carpendale E.J., Green M.J., Williams K.E., Tzoumakis S., Carr V.J., Laurens K.R. (2023). Item Response Theory Analysis of Self-Reported Social-Emotional Learning Competencies in an Australian Population Cohort Aged 11 Years, School Psychology, 38(4), 247-263, doi: 10.1037/spq0000533
  
  This study developed and tested a brief, self-report measure of social-emotional competencies in middle childhood that aligns with the Collaborative for Academic, Social, and Emotional Learning (CASEL) framework used to guide school-based social and emotional learning in Australian schools. The 20-item measure, the Middle Childhood Survey – Social-Emotional Learning (MCS-SEL), assesses students’ skills on the five CASEL competencies: Self-Awareness, Self-Management, Social Awareness, Relationship Skills, and Responsible Decision-Making. The measure was developed using students’ responses to an online survey of mental health and wellbeing (the Middle Childhood Survey) administered at school to ~27,000 6th-grade students from the New South Wales Child Development Study (aged 11-12 years). The MCS-SEL is a tool that school leaders and researchers can use in the classroom to identify students’ social and emotional strengths and support needs, and guide the selection and provision of whole-school social-emotional learning programs to develop these competencies.

• Carpendale E.J., Green M.J., Williams K.E., Tzoumakis S., Carr V.J., Laurens K.R. (2023). Measurement Invariance Across Sex and Language Background of a Self-Report Social-Emotional Learning Questionnaire for Middle Childhood, Child Indicators Research, 16, 1233-1240, doi: 10.1007/s12187-023-10015-3
  
  This study demonstrates that our new measure of social-emotional competencies in middle childhood, the Middle Childhood Survey – Social-Emotional Learning (MCS-SEL), can be used with girls and boys, and with students from English and non-English language backgrounds, to reliably and validly gather Australian students’ own reports of their social-emotional competencies. The study tested the measurement properties of the instrument in two subsamples of 2,000 6th grade students (aged 11-12 years) from the NSW Child Development Study, comprising 1,000 girls and 1,000 boys, and 1,000 students who spoke English as their main language at home and 1,000 students who spoke a language other than English at home. The MCS-SEL measured social-emotional competencies in the same way in each of these groups, meaning that any differences in social-emotional skills identified by the measure reflect true differences in competency levels, rather than differences in measurement. This study confirms the MCS-SEL as a useful tool for educators and researchers to measure Australian students’ social-emotional functioning in the classroom, to identify students’ strengths and needs that might be supported by school-based social-emotional learning programs.

• Athanassiou, U., Green, M. J., Tzoumakis, S., Whitten, T., Laurens, K. R., Harris, F., Carr, V. J., & Dean, K. (2023). Relationships between parental mental illness and/or offending and offspring contact with the police in childhood: findings from a longitudinal record-linkage study. Criminal Behaviour & Mental Health, 33(1), 72-84, doi.org/10.1002/cbm.2274
  
  This study showed that children whose parents have a history of offending and/or mental illness are at increased risk of being in contact with the police early in life. Associations between parental offending and mental illness and offspring police contact from age 5 to 13 years were examined in relation to three types of police contact: ‘person of interest’, ‘victim’ or ‘witness’, as well as ‘any’ police contact, regardless of type. We specifically examined children’s police contact associated with paternal and maternal factors separately, and also “combined” parental risk (i.e. both offending and mental illness among either or both parents). We showed that parental history of offending and mental illness was associated with early police contact among offspring, particularly for police contact as a ‘person of interest’ but also as a ‘victim’ and ‘witness’; further, children of parents with a combined history of offending and mental illness were at highest risk of early police contact. These findings highlight the need for early prevention and intervention programs which respond to the needs of children whose parents have histories of both offending and mental illness.

• O’Hare K., Watkeys O., Badcock, J. C., Laurens K.R., Tzoumakis S., Dean K., Harris F., Carr V.J., Green M.J. (2022) Pathways from developmental vulnerabilities in early childhood to schizotypy in middle childhood, British Journal of Clinical Psychology, 62(1), 228-242, https://doi.org/10.1111/bjc.12405
  
  Pathways from early difficulties with social, emotional, language, motor, and cognitive skills in early childhood (known as ‘developmental vulnerabilities’) through to patterns of characteristics (e.g., personality, thinking style, social behaviour, referred to as ‘schizotypy’) that signify risk of mental disorder were (at least partially) accounted for by educational under-achievement in middle childhood in this longitudinal study. This was revealed in a study of the relationships between developmental vulnerabilities at age ~5 years and educational underachievement at age ~8-10 years among 19,216 children showing different patterns of ‘schizotypy’ self-reported at age ~11 years. The finding that educational underachievement explained some of the relationships between developmental vulnerabilities and schizotypy, suggests that cognitive difficulties in childhood exist on the pathway to mental health difficulties later in life. These findings are important because they show the kinds of vulnerabilities expressed at different stages of the life-course which might be targeted by early intervention programs to prevent the onset of mental illness in later life. 

• O’Hare K., Watkeys O., Whitten T., Dean K., Laurens K.R., Tzoumakis S., Harris F., Carr V.J., Green M.J. (2022) Cumulative Environmental Risk in Early Life: Associations With Schizotypy in Childhood, Schizophrenia Bulletin, sbac160, 29(2), 244-254, doi: 10.1093/schbul/sbac160
  
  This study showed that children exposed to more (cumulative) environmental risk factors in early life were at increased risk of reporting particular sets of characteristics (e.g., personality, thinking style, social behaviour, referred to as ‘schizotypy’) in middle childhood (age 11 years) that may signify risk for later mental disorder.  We examined 19 environmental risk exposures from birth to age 11 years  (e.g., being the victim of a crime, socioeconomic deprivation, maternal pregnancy complications) among 20,599 children, and found that almost all environmental risk factors were associated with at least one of three patterns of ‘schizotypy’ evident in the general population. We also found that when the environmental factors were summed into a cumulative score, they were associated most strongly with a pattern of schizotypy evident in around 6% of children, who may be at high risk for developing psychotic or other mental disorders in later life. These findings suggest that reducing the effects of harmful environmental factors in early life could lower mental health risk among developing children.

• Watkeys, O. J., O’Hare, K., Dean, K., Laurens, K. R., Harris, F., Carr, V. J., & Green, M. J. (2022). Early childhood developmental vulnerability associated with parental mental disorder comorbidity. Australian & New Zealand Journal of Psychiatry, 00048674221116806. doi:10.1177/00048674221116806
  
  Parental mental disorder comorbidity is associated with increased risk of developmental vulnerability among offspring at five years of age. In a cohort of 66,154 children from the New South Wales Child Development Study (NSW-CDS), we investigated the relationships between parental mental disorder comorbidity and offspring developmental vulnerability as assessed by the Australian Early Development Census (AEDC). Both the number of distinct mental disorders experienced by each parent, and specific combinations of the most common forms of parental mental disorder comorbidity, associated with increased likelihood of developmental vulnerability on behavioural and emotional domains, as well as with child membership in developmental risk profiles characterised by vulnerability across multiple AEDC subdomains. Parental mental disorder comorbidity has been linked to increased risk of offspring psychopathology in adolescence and adulthood. Until now, the extent to which parental mental disorder comorbidity is associated with early childhood developmental vulnerability of offspring was unclear. The likelihood of developmental vulnerability in offspring increased with the number of disorders diagnosed in their mothers and fathers. This finding emphasises the need to consider parental mental disorder comorbidity in the provision of early intervention and primary prevention strategies.

• O’Hare K., Watkeys O., Dean K., Laurens K.R., Harris F., Carr V.J., Green M.J. Cumulative environmental risk in early life is associated with mental disorders in childhood. Psychological Medicine, 53(10), 4762-4771. doi:10.1017/S0033291722001702
  
  Children exposed to cumulative environmental risk factors in early life are more likely to present to health services for treatment for mental disorder in later childhood. We examined associations between 16 environmental risk factors occurring in early life (i.e., between the prenatal period to <6 years of age) and later diagnoses of mental disorder recorded in health service data (from age 6 to 13 years), among 71 932 children. Each environmental risk factor was examined individually, and an individual score representing cumulative exposure to multiple risk factors was also examined (i.e., a summed environmental risk score). As a child’s environmental risk score increased, so did the likelihood that they would be diagnosed with a mental disorder between age 6 to 13 years. Thirteen of the 16 environmental factors measured were positively associated with at least one category of mental disorder (including prenatal factors, neighbourhood characteristics and more proximal experiences of trauma or neglect). These findings suggest that no single environmental factor is a necessary or sufficient cause of mental disorder; multifactorial and transdiagnostic approaches are needed to understand the impact of the environment on the development of mental disorders across the life course. In many instances, environmental risk factors are preventable or capable of mitigation by appropriate public policy settings.

• Whitten, T., Green, M. J., Tzoumakis, S., Laurens, K. R., Harris, F., Carr, V. J., & Dean, K. (2022). Early developmental vulnerabilities following exposure to domestic violence and abuse: Findings from an Australian population cohort record linkage study. Journal of Psychiatric Research, 153, 223-228, doi: 10.1016/j.jpsychires.2022.07.012
  
  Children exposed to domestic violence and abuse before the age of five years are more likely to exhibit vulnerability across a broad range of developmental domains at school entry than non-exposed children. The extent of vulnerability does not appear to differ substantially between children who were the victim or witness of domestic violence, or between boys and girls. These findings are based on analyses conducted for 82,501 children drawn from the NSW Child Development Study, with findings suggesting that early contact with police may present an opportunity to identify young children who experience domestic violence and abuse and refer them for appropriate interventions. This work extends prior research in this area which often relies on mother-reported involvement in domestic violence and abuse as a proxy indicator of child exposure; studies using direct measures of child exposure to domestic violence and abuse are scarce, especially among representative population-based samples. The use of police contact records in this study therefore provides a means to more reliably identify children who had been exposed to domestic violence and abuse. The finding that witnesses of domestic violence and abuse had comparable developmental vulnerabilities to victims highlights the importance of extending support services to all young children indirectly involved in domestic violence and abuse.

• O'Hare, K., Watkeys, O., Whitten, T., Dean, K., Laurens, K.R., Harris, F., Carr, V.J., Green, M.J. (2022). Parental and community risk factors for childhood self-harm thoughts and behaviours. Journal of Affective Disorders, 310, 279-283; doi: 10.1016/j.jad.2022.05.050
  
  Thoughts of self-harm and related behaviours in childhood (<14 years) are relatively rare, they appear to be related to intergenerational risk factors including parental mental disorders and parental offending history. While little is known about risk factors for self-harm in the age group studied here, analysis of records for 74,479 children found that 0.2% had experienced self-harm and related behaviours between the age of 3-14 years. Unlike in adolescent samples, community risk factors such as socioeconomic deprivation, remote or regional location, and neighbourhood crime rates were not associated with self-harm thoughts of behaviours in childhood. This research suggests that there may be risk factors that are passed between generations that increase the risk of childhood self-harm.

• Harris F., Dean K., Laurens K.R., Tzoumakis S., Carr V.J., Green M.J. (2022). Regional Mapping of Early Childhood Risk for Mental Disorders in an Australian Population Sample. Early Intervention Psychiatry, 16 (12), 1269-1277, doi: 10.1111/eip.13281
  
  The proportion of children (aged ~5-6 years) at risk of later childhood mental disorders is generally higher in regional and socioeconomically disadvantaged areas than metropolitan areas of New South Wales (NSW). This was evident in local government area-based mapping of the geographical distribution of early childhood risk for mental disorders across the state. We specifically mapped the percentage of children in each region who were identified with distinct classes of risk identified through patterns of early developmental vulnerabilities on the Australian Early Development Census, in a population sample of 82,891 children from the NSW Child Development Study. The identification of geographical areas with a higher proportion of children who are at risk of developing mental disorders has the potential to inform the provision of place-sensitive early intervention services. While spatial trends show a high proportion (≥10%) of the children at risk for mental disorders at age ~5-6 years were predominately located in regional areas, some metropolitan areas of Sydney showed similar high proportions of risk, and conversely some regional and remote areas showed the lowest levels of risk.  These findings suggest the capacity of policymakers to prioritise place-sensitive delivery of early intervention services for children at risk of mental disorders, through information available on an existing national triennial census of children on school entry.

• Green M.J., O'Hare K., Laurens K.R., Tzoumakis S., Dean K., Badcock J.C., Harris F., Linscott R.J., Carr V.J.. (2022). Developmental profiles of schizotypy in the general population: A record linkage study of Australian children aged 11-12 years. British Journal of Clinincal Psychology, 61(3), 836-858, doi: 10.1111/bjc.12363. PMID: 35229307.
  
  This study establishes three distinct childhood profiles of risk for severe mental illness in adulthood, among 22,137 children who completed the Middle Childhood Survey (MCS) when they were aged 11-12 years. The study was based on the theory that risk for schizophrenia in the general population is reflected in patterns of individual characteristics (e.g., personality and thinking style, affect, and social behaviour) collectively referred to as ‘schizotypy’. However, certain combinations of these characteristics may also indicate risk for other types of adult mental disorders. The findings suggest that around 6% of the child population are at high risk for developing schizophrenia or a related psychotic disorder (showing a profile that we referred to as “True Schizotypy”), while another 20% of the population appear to show an attenuated version of the True Schizotypy profile; a different 20% of the child population showed a distinct schizotypy profile that may indicate risk for later affective (mood) or personality disorders. These three profiles of schizotypy emerged in individual patterns of functioning across 6 broad domains, spanning ‘Unusual (perceptual) experiences’, ‘Cognitive Disorganisation’, ‘Impulsive non-conformity’, ‘Introversion’, ‘Dysphoria’, ‘Self-Other Disturbance’. Prior exposure to perinatal and familial adversities including childhood maltreatment, as well as poor early childhood development and academic functioning, was variously associated with each of the schizotypy profiles. There was also a higher proportion of childhood mental disorders already diagnosed among children showing the True Schizotypy profile, relative to the other profiles. The predictive utility of these childhood risk profiles will be determined in follow up studies of these children as they reach adolescence and early adulthood.

• Green, M.J., Watkeys, O., Kariuki, M., Hindmarsh, G., Whitten, T., Dean, K., Laurens, K.R., Harris, F., Carr, V.J. (2022). Forecasting childhood adversities from conditions of birth. Paediatric and Perinatal Epidemiology, 36, 230-242, doi: 10.1111/ppe.12828
  
  Up to a quarter of children at risk of multiple adverse outcomes can be detected at birth. Using data for 72,059 Australian children and their parents, we were able to determine specific combinations of perinatal and familial risk exposures, known at the time of birth, that could accurately predict a range of adverse childhood outcomes up to age 13 years. The presence of five or more risk exposures characterised 12-25% of children with between one and four or more adverse outcomes; children who experienced multiple adverse outcomes were able to be predicted with high certainty from information known at birth. Individual outcomes such as sustained educational underachievement in middle childhood, substantiated childhood maltreatment, and coming to the attention of police were able to be predicted with excellent levels of accuracy from specific sets of risk indicators known at birth. Other individual outcomes such as mental disorder diagnoses and early childhood developmental vulnerability were less accurately predicted by information known at birth. Childbirth presents an optimal time for identifying high-risk families to commence intervention that could avert various childhood health and social adversities. However, cautious application of perinatal health screening for early intervention is warranted. 

• Laurens K.R., Graham L.J., Dix K.L., Harris F., Tzoumakis S., Williams K.E., Schofield J.M., Prendergast T., Waddy N., Taiwo M., Carr V.J., Green M.J. (2022) School-based mental health and early intervention programs in New South Wales, Australia: Mapping practice to policy and evidence. School Mental Health, 15, 582-597, doi: 10.1007/s12310-021-09482-2
  
  Three-quarters of New South Wales primary school principals/leaders reported delivering mental health and wellbeing programs to students, but more than one third of the programs being delivered had not yet been evaluated to determine their effectiveness. As part of the NSW Child Development Study, this paper reports the results of an online survey of 597 NSW primary school principals conducted late in 2015. The study compiled information about the delivery of school-based programs in four health-promoting domains — creating a positive school community; teaching social and emotional skills; engaging the parent community; and supporting students experiencing mental health difficulties — and considered this information in relation to published ratings of the effectiveness of these programs. There was variability in the use of evidence-based programs across the four health-promotion domains, and limitations in the amount of evidence of effectiveness available to support the programs. All Australian schools are now required to deliver a mental health and wellbeing curriculum to students. Our findings indicate a need to provide educators with improved support to identify, implement, and evaluate effective evidenced-based programs that promote student mental health.

• Watkeys, O.J., Dean, K., Laurens, K.R., Harris, F., Carr, V.J., Green, M.J. (2022). Familial clustering of birth risk for adverse childhood outcomes. Journal of Perinatology, 42 (5), 603-610 doi: 10.1038/s41372-021-01264-7
  
  Children exposed to multiple birth and familial risk factors during the perinatal period are significantly more likely to experience adverse outcomes in childhood. These findings were evident in retrospective analyses of linked administrative records (between 2001-2016) for 72,059 children and their parents from the NSW Child Development Study (NSW-CDS). While many early-life risk factors for adverse outcomes in childhood have been identified, these risk factors rarely occur in isolation. The goal of this study was therefore to explore the impact of familial clustering of risk factors on subsequent adverse outcomes for the offspring in early and middle childhood. Four groups of children exposed to distinct combinations of risk factors (known at the time of birth) were identified – No risk, multipara+perinatal risk, young mother+perinatal risk, and pervasive familial risk. Children belonging to any of the three risk groups, particularly the pervasive familial risk group, were significantly more likely to experience developmental vulnerability, academic difficulties, mental disorders, child maltreatment, and contact with police as a victim or person of interest before the age of 13 years. These findings may help to refine the targeting of family-focused intervention strategies during the perinatal period.

• Laurens K.R., Dean K., Whitten T., Tzoumakis S., Harris F., Waddy N., Premdergast T., Taiwo M., Carr V.J., Green M.J. (2021). Early childhood predictors of elementary school suspension: An Australian record linkage study. Journal of Applied Developmental Psychology, 77, 101343; doi: 10.1016/j.appdev.2021.101343.
  
  A broad range of early childhood factors each make individual contributions to a student’s risk of suspension from primary school, including male gender, referral to child protection services, early externalising behaviours, a diagnosed emotional or behavioural problem, socioeconomic disadvantage, pregnancy and birth factors, academic underachievement, physical injury, and parental criminal offending and mental illness. This study analysed multi-agency linked data on 34,855 children from the NSW Child Development Study using multivariate logistic regression, to examine the associations between early childhood factors that were present by the end of 2nd grade (approximately 8 years of age) and suspension from primary school during the 3rd through 6th grades. The study provides information to help identify students at risk of early suspension, so that they can be supported to engage effectively with learning at school. A comprehensive multi-agency response is required, which could include school-based programs supplemented by support from health and social services agencies throughout the early childhood period, including in early childhood settings and during the initial years of school.  

• Green, M.J., Piotroswka, P.J., Tzoumakis, S., Whitten, T., Laurens, K.R., Butler, M., Katz, I., Harris, F. & Carr, V.J. (2021). Profiles of Resilience from Early to Middle Childhood among Children Known to Child Protection Services, Journal of Clinical Child & Adolescent Psychology, doi: 10.1080/15374416.2021.1969652
  
  A significant proportion (~65%) of children known to child protection services show profiles of socio-emotional and cognitive resilience from early to middle childhood. One group of children (54% of those known to child protection services) show a profile of stress-resistance, and a smaller group (13% of those known to child protection services) show a profile of emergent resilience. These findings emerged in latent profile analyses of a NSW cohort of 4,716 children known to child protection services by age 13 years, in which multi-dimensional profiles of resilience were evident in social, emotional and cognitive functioning when assessed at age 5-6 years (Time 1) and age 10-11 years (Time 2). Factors associated with both of the resilience profiles included being female, and personality characteristics of openness and extraversion; other factors associated with stress-resistance, specifically, included higher socioeconomic status, non-Indigenous background, higher perceived support at home and at school, and not having a parent with a history of criminal offending. These findings suggest that a complex interplay between individual, family, and community characteristics confer resilience at critical periods in the life course. Resilience processes have been less studied in this developmental period between early to middle childhood, relative to later periods of adolescence or adulthood.

• Green, M. J., Watkeys, O. J., Whitten, T., Thomas, C., Kariuki, M., Dean, K., Laurens, K.R., Harris, F., Carr, V. J. (2021). Increased incidence of childhood mental disorders following exposure to early life infection. Brain, Behavior, and Immunity, 97, 376-382. doi: 10.1016/j.bbi.2021.08.009
  
  Children who are hospitalised for an infectious condition in early childhood (birth to 4 years) are more likely to be diagnosed with a mental disorder between the ages of 5 and 13 years. This was revealed in a study of 71,841 children in which the effects of both prenatal and early childhood exposure to infection were examined in relation to later diagnosis of mental disorder in childhood. A total of 2,027 children were exposed to maternal infection during the pregnancy period (prenatal exposure) and 16,356 children were exposed to infection in early childhood. While the incidence of any mental health condition, as well as specific internalising, externalising and developmental disorders, were all crudely associated with both prenatal and early childhood infection, only the latter remained significantly associated with mental disorder diagnoses in childhood when other factors were considered (e.g., child’s sex, socioeconomic status, maternal age at child’s birth, maternal smoking during pregnancy). Exposure to infectious diseases during early childhood, but not prenatal infection exposure, appears to be associated with earlier diagnosis of mental disorders in childhood.

• O’Hare, K., Hussain, A., Laurens, K.R. Hindmarsh, H., Carr, V.J., Tzoumakis, S., Harris, F., Green, M.J. (2023). Self-reported mental health of children known to child protection services: an Australian population-based record linkage study. European Child & Adolescent Psychiatry, 32, 101-112, doi: s00787-021-01841-3 (Published online 10 July 2021)
  
  Children who have been in contact with child protection services before age 10 years are more likely to self-report mental health difficulties than their peers with no child protection contact, regardless of the type of child protection contact (i.e., whether the report results in the child being placed in out-of-home care, the report is substantiated but the child remains in home, the report is unsubstantiated, or the report is determined not to meet the threshold for risk-of-significant harm). This finding was revealed in a study of 26,290 children from the NSW-CDS who completed the online self-report Middle Childhood Survey when they were aged 11 years; the children answered questions about difficulties with emotional symptoms, peer relationships, conduct problems, hyperactivity-inattention, prosocial behaviours, and psychotic-like experiences. Relative to their peers, children with child protection were more likely to report difficulties in all these areas of mental health, with 48% of children in out-of-home care and 46% of children with substantiated reports reporting clinical levels of difficulties in at least one mental health domain. These findings highlight the need for mental health supports for all children in contact with child protection services.

• Dean, K., Whitten, T., Tzoumakis, S., Laures, K.R., Harris, F., Carr, V.J., Green, M.J. (2021). Incidence of Early Police Contact Among Children With Emerging Mental Health Problems in Australia, JAMA Network Open, 4(6):e21112057. doi: 10.1001/jamanetworkopen.2021.12057.
  
  Children with emotional or behavioral problems identified at school entry have twice the rate of subsequent police contact of children without such problems. These elevated rates of police contact were evident for all types of contact with police – as a person of interest, survivor of crime, or witness. Using data from the NSW Child Development Study, a cohort of almost 80,000 children were followed from their first year of full-time schooling to 13 years of age, with available linked police contact data and teacher-assessments of developmental vulnerabilities from the Australian Early Development Census. Individuals with mental health problems are well known to have higher rates of contact with the criminal justice system later in life, but this study confirms that the association emerges in early life. Early police contact, for any reason, may represent an opportunity to identify and intervene with vulnerable young people and their families to prevent later adversity. School entry also presents an opportunity to identify children who have emotional, behavioural and other developmental vulnerabilities that put them at increased risk of early justice system contact.

• Athanassiou, U., Whitten, T., Tzoumakis, S., Hindmarsh, G., Laurens, K.L., Harris, F., Carr, V.J., Green, M.J., Dean, K. (2021). Examining the overlap of young people’s early contact with the police as a person of interest and victim or witness. Journal of Criminology, 54(4), 501-520. doi:10.1177/26338076211014594
  
  Young people with multiple types of contact with the police by age 13 years (e.g., as both a person of interest and a victim and/or witness) are more likely to be boys, live in a socioeconomically disadvantaged area, be born to younger mothers or be of Aboriginal and/or Torres Strait Islander background relative to young people who had no contact with the police. The most common first contact type was as a victim/witness but those children with a first contact as a person of interest were most likely to have at least one further contact. This evidence comes from linked NSW Police Force data for 91,631 young people included in Wave 2 of the NSW Child Development Study, in which one in ten young people (10.6%) have had contact with the police for a criminal incident by the age of 13 years as a person of interest, victim or a witness; among these children, 14.4% had been in contact with police as both a person of interest and a victim and/or witness. While there is a known overlap between perpetrators and victims of crime in adulthood, this research provides new evidence about the extent of this overlap early in life among children and young adolescents, and their sociodemographic characteristics. This research can inform targeted early identification and intervention programs that consider a wide range of risk factors to reduce the risk of future adversity, including early and multiple contact with police. 

• Green, M.J., Hindmarsh, G., Harris, F., Laurens, K.L., Tzoumakis, S., Whitten, T., Katz, I., Carr, V.J. (2021). Child protection status and developmental outcomes in early and middle childhood: A data summary from the NSW Child Development Study. http://doi.org/10.26190/8hv3-s740
  
  Children reported to child protection services before the age of 5 years show higher rates of developmental vulnerability, academic under-achievement, self-reported psychopathology, and contact with the police (relative to children not subjected to such reports), in line with a greater level of child protection response. This report was commissioned by the NSW Department of Communities and Justice (DCJ) to improve their policies and practice around identifying and assessing child need, to ensure safety, wellbeing, and positive life outcomes for children in out-of-home care (OOHC). The brief received from DCJ requested information about a diverse array of developmental outcomes among children with substantiated ‘Risk of Significant Harm’ (ROSH) reports or those who had been placed in OOHC. Each developmental outcome in childhood was thus examined with respect to (a) the highest level of child protection response (non-ROSH, non-substantiated ROSH, substantiated ROSH, or OOHC placement); (b) the number of ROSH reports; (c) single or multiple (substantiated) maltreatment types (physical abuse, emotional abuse, sexual abuse, or neglect); (d) the type of substantiated maltreatment (physical abuse, emotional abuse, sexual abuse, or neglect) among those exposed to a single type of maltreatment only; (e) exposure to various other risk factors spanning individual, familial, and contextual factors. There were generally higher rates of adverse developmental outcomes among those with multiple child protection reports and exposed to more than one type of maltreatment. The adverse developmental outcomes of children with child protection reports were augmented by the child’s sex (males overrepresented in poor performing groups), socioeconomic disadvantage, Indigenous status, young maternal age at birth of child, maternal smoking during pregnancy, pre-term birth, parental mental illness, and parental criminal offending. These risk factors are known to be associated with child protection involvement as well as with many adverse health and social outcomes throughout childhood, adolescence, and adulthood. 

• Whitten, T., Dean, K., Li, R., Laurens, K.R., Harris, F., Carr, V.J., Green, M.J. (2021). Earlier contact with child protection services among children of parents with criminal convictions and mental disorders. Child Maltreatment, 26(1), 63-73. doi.org/10.1177/1077559520935204
  
  Having a mother with a mental disorder, or a mother or father with a prior criminal conviction are independently associated with earlier contact with the child protection system and placement in out-of-home care (OOHC). This paper presents findings from 71,661 children and their parents drawn from the NSW-CDS. This study examined the impact of maternal and paternal criminal convictions and mental disorders on the time to offspring’s first contact with the child protection system and/or OOHC placement. Around 20% of mothers and 50% of fathers had a criminal conviction prior to their child’s first contact with the child protection system. By contrast, 23% of mothers and 14.3% of fathers were previously diagnosed with a mental disorder. Having a mother or father with a prior criminal conviction, or a mother with a mental disorder, were each independently associated with earlier first contact with the child protection system and placement in OOHC. The largest effects were for paternal criminal conviction and time to first child protection contact (almost a two-and-a-half times greater incidence), and maternal criminal conviction and time to first OOHC placement (two-and-a-have times greater incidence). These findings demonstrate the potential benefits of coordinated government responses to identify vulnerable children and families who might benefit from inter-agency support services.

• Hindmarsh, G., Laurens, K.R., Katz, I., Butler, M., Harris, F., Carr, V.J., Green, M.J. (2020). Child protection services for children with special healthcare needs: A population record linkage study. Australian Journal of Social Issues (Special Issues: Big Data and Social Policy); 56(2), 223-243. doi:10.1002/ajs4.145.
  
  Child protection contacts prior to age 6 years were more prevalent among children with special healthcare needs (SHCN) compared to their peers without SHCN. This paper presents findings from 65,349 children using administrative data from the New South Wales Child Development Study. We examined the characteristics of contact with child protection services before age 6 years, among children identified with ‘special needs’ or other impairments of concern on the 2009 Australian Early Development Census, in their first year of formal schooling. While children with disabilities are known to have high rates of contact with child protection, little is known about the broader group of children with SHCN. In this study around 30% of children with broad SHCN had contact with child protection services prior to the age 6 years, compared to 16% of children without SHCN. Children with SHCN had higher odds of a history of exposure to neglect and physical abuse, and higher odds of being placed in out-of-home care, compared to their typically developing peers. Understanding the relationship between child protection contact among children with SHCN, will inform the development of appropriate policy initiatives to fulfil Australia’s obligations under the United Nations Convention on the Rights of the Child.

• Tzoumakis, S., Whitten, T., Piotrowska, P., Dean, K., Laurens, K.R., Harris, F., Carr, V.J., Green, M.J. (2020). Gender and the intergenerational transmission of antisocial behaviour. Journal of Criminal Justice, 67. Article number 101670. (First online 4 March, 2020). doi:10.1016/j.jcrimjus.2020.101670
  
  Children of parents with a history of criminal offending are more likely to demonstrate antisocial behaviour. However, few studies have examined whether this relationship is gender-specific. This study examined antisocial behaviour in children at three developmental stages: in early childhood, using the Australian Early Development Census administered at age ~5 years; in middle childhood, using the Middle Childhood Survey administered at age ~11 years; and in early adolescence, at ages 13 to 16 years using police contact data. Participants comprised three population samples from Wave 2 of the NSW-CDS, with 66 135, 21 630 and 71 661 children included in the early childhood, middle childhood and early adolescent groups, respectively. Using inter-agency linked data we found the patterns of intergenerational transmission varies for girls and boys, with stronger associations between parental offending and antisocial outcomes in daughters than sons. The largest effects were demonstrated in early adolescence, where sons and daughters of offending parents were approximately 3 and 4 times more likely to have been in contact with the police, respectively. This research indicates that daughters of offending parents are at particularly high risk of contact with police, and suggests that both boys and girls with offending parents would benefit from targeted intervention programs. 

• Piotrowska, P. J., Whitten, T., Tzoumakis, S., Laurens, K. R., Katz, I., Carr, V. J., Harris, F., Green, M. J. (2020). Transitions between socio-emotional and cognitive vulnerability profiles from early to middle childhood: A population study using multi-agency administrative records. European Child & Adolescent Psychiatry, 29(12), 1659-1670. doi:10.1007/s00787-020-01475-x 
  
  Patterns of social-emotional and cognitive functioning assessed at age 5-6 years and age 10-11 years in a large population-based sample demonstrate that the majority of children (78%) who were developing as expected in early childhood continued to develop as expected in middle childhood. However, a substantial proportion of children who were developmentally vulnerable for social-emotional (42%) and cognitive (41%) functioning in early childhood remained vulnerable in middle childhood, and a smaller group of children (22%) showed decline in social-emotional and cognitive development over time. These findings were generated in a study of 19,087 children and their parents in the NSW-CDS who provided data to examine patterns of socio-emotional and cognitive development during early and middle childhood, and the influence of familial risk factors (child’s sex; socioeconomic disadvantage; child protection contact; parental mental illness and criminal offending) on transitions in these skills over time. Early socio-emotional and cognitive skills are linked to adult mental health and poor educational attainment, under-employment and criminal activity, so it is important to understand how children’s socio-emotional and cognitive vulnerabilities develop and identify factors that influence their development. Around 40% of vulnerable children in early childhood remained vulnerable in middle childhood. Male children, those been in contact with child protection services, or who had a parent with mental illness or involved in criminal offending, were more likely to be represented in the vulnerable group in middle childhood. The early detection of vulnerable children and the factors influencing this vulnerability are important steps in directing future health and social policy, and service planning.

• Whitten, T., Green, M. J., Tzoumakis, S., Laurens, K. R., Harris, F., Carr, V. J., Dean, K. (2020). Children’s contact with police as a victim, person of interest and witness in New South Wales, Australia. Australian & New Zealand Journal of Criminology, 53(3), 387-410. doi:10.1177/0004865819890894
  
  Nearly one in six (15.6%) children have had contact with police by age 13 years – as either a victim, person of interest or witness – according to this Australian population-based study. This paper presents preliminary analyses of linked NSW Police Force data for 91,631 children from Wave 2 of the NSW-CDS. A total of 14,329 de-identified children were recorded as having any contact with the police in NSW as a victim, person of interest or witness. Data of this nature, specifically population estimates on police contacts, are crucial to begin to understand the developmental trajectories of criminal justice system involvement, and associated early-life risk factors. Interestingly, approximately half of the children with police contact as a person of interest (50.6%) or witness (46.6%), also had a separate contact as a victim. Preliminary analyses examining risk factors for police contact identified socioeconomic disadvantage, Aboriginal and Torres Strait Islander background, young maternal age at the child’s birth, and residential remoteness as increasing the risk of children coming into contact. This study provides the first epidemiological study of police contacts in a representative population-based sample of Australian children.

• Laurens, K.L., Islam, F., Kariuki, M., Harris, F., Chilvers, M., Butler, M., Schofield, J., Essery, C., Brinkman, S.A., Carr, V.J., Green, M.J. (2020). Reading and numeracy attainment of children reported to child protection services: A population record linkage study controlling for other adversities. Child Abuse & Neglect, 101, Article number 104326. doi:10.1016/j.chiabu.2019.104326
  
  Children reported to child protection services are more likely than unreported children to attain below average reading and numeracy, and less likely to attain above average national standards. Data from 56,860 children and their parents in the New South Wales Child Development Study were used to examine the associations between different levels of child protection reports (children placed into out of home care, children with substantiated maltreatment who were not placed in to care, and two groups of children with unsubstantiated maltreatment reports, compared to children with no reports) and 3rd - and 5th -grade reading and numeracy attainment on the National Assessment Program-Literacy and Numeracy. We considered the role of multiple other individual, family, and neighbourhood adversities that may confound these relationships. Children with any type of child protection report experienced greater risk of poor reading and numeracy attainment. Maltreated children not placed into care demonstrated the worst reading and numeracy attainment, with some evidence of a potential beneficial effect of care placement for maltreated children. The findings endorse policies that promote collaboration, training, and information sharing between child protection and education systems, as well as other agencies, to support the academic achievement of all vulnerable children with child protection reports, and broader provision of universal and targeted interventions depending on the report level.

• Neil, A.L., Islam, F., Kariuki, M., Laurens, K.R., Katz, I., Harris, F., Carr, V.J., Green, M.J. (2020). Costs for physical and mental health hospitalizations in the first 13 years of life among children engaged with Child Protection Services. Child Abuse & Neglect, 99, Article Number 104280 (First online 26 November, 2019). doi:10.1016/j.chiabu.2019.104280
  
  Children in contact with child protection services show higher rates and costs for physical and mental health hospitalisations in each of their first 13-years of life, with mental health hospitalisations for children with out-of-home-care (OOHC) placement 5-fold greater than children not known to child protection services. The analysis was based on hospital records for a cohort of 79,285 children from the NSW-CDS. Costs were estimated from birth (as available) using Round 17, National Hospital Cost Data Collection. Records of the NSW state child protection authority determined child protection contact status, and mental health hospitalisations comprised hospital separations with a primary mental disorder diagnosis recorded. The use of linked population data provides an effective means of examining health costs associated with childhood maltreatment, for which there is otherwise a limited knowledge base. Using multi-agency linked data analysis we found that mental health costs per child were always significantly higher for children with child protection contact, with critical periods for the onset and/or identification of mental disorders among children known to child protection services. Our findings should support the prioritization of mental health care for children known to child protection services, and provide the first evidence of age-related mental health costs for children placed in OOHC, at critical stages of development.

• Green, M.J., Hindmarsh, G., Kariuki, M., Laurens, K.R., Neil, A., Katz, I., Chilvers, M., Harris, F., Carr, V.J. (2020). Mental disorders in children known to child protection services during early childhood. Medical Journal of Australia, 21(1), 22-28. doi:10.5694/mja2.50392
  
  Children reported to child protection services before the age of 5-6 years are more than twice as likely to be diagnosed with a mental illness before age 13 years, than children not known to child protection services during early childhood. Among these children, those placed in out-of-home-care are at greatest risk of mental health problems, being more than 5 times more likely to be diagnosed with a mental illness by age 13 years. These findings arose from retrospective analysis of 74,462 children for whom linked administrative data was available from 2001–2016, from the NSW Child Development Study (NSW-CDS) Wave 2 data linkage. Among this population, 13,796 children (18.5%) had been the subjects of reports to child protection services before age 5-6 years, and 1,148 children (1.5%) had been placed in out-of-home care in early childhood. These findings follow considerable evidence showing that exposure to child maltreatment is a strong risk factor for adult-onset mental disorders. We provide the first detailed information about the type of mental disorders emerging in childhood following actual maltreatment, as well as children who have been notified to child protection services as being at high risk of future harm. All children who are reported to child protection services during early childhood require specific mental health support and care. 

• Laurens, K.R., Tzoumakis, S., Dean, K., Harris, F., Carr, V.J., Green, M.J. (2020). Population profiles of child-reported psychotic-like experiences, and their differential association with other psychopathologies. British Journal of Clinical Psychology, 59(1), 22-38. doi:10.1111/bjc.12230
  
  Childhood experiences of hallucinations and delusions (psychotic-like experiences) increase risk for concurrent and future psychiatric disorders but are relatively common in the population. For most children, these experiences are benign and transitory, but strategies are needed to identify vulnerable children who may benefit from monitoring or targeted intervention. This study sought to identify patterns of childhood psychotic-like experiences in the general population, and the relationship of particular profiles of responses with other psychopathologies. Participants in the study were 27,000 Australian children from the NSW-CDS population cohort who completed the online self-report Middle Childhood Survey, including items assessing psychotic-like experiences and emotional, peer relationship, conduct, and hyperactivity-inattention psychopathology. Five classes of response patterns to psychotic-like experiences were identified, reflecting None (27.4% of children), Minor (29.7%), Moderate (11.8%), Hallucinatory (21.0%), and Strong (10.2%). The odds of multiple psychopathology were greater in the Hallucinatory and Strong groups.

• Green, M.J., Kariuki, M., Chilvers, M., Butler, M., Katz, I., Burke, S., Tzoumakis, S., Laurens, K.R., Harris, F., Carr, V.C. (2019). Inter-agency indicators of out-of-home-care placement by age 13–14 years: A population record linkage study. Child Abuse & Neglect, 93, 91-102. doi:10.1016/j.chiabu.2019.04.013
  
  This study sought to determine the minimum set of indicators available in cross-agency administrative data that could be used to accurately distinguish children placed in out-of-home-care from the wider group of children known to child protection services, and from the general population unknown to child protection services. Participants comprised a population sample of 72,079 children and their parents, including 1,239 children who had been placed in out-of-home-care, 15,367 children who had been reported to child protection services but had no record of out-of-home-care placement, and 55,473 children who had no previous contact with child protection services (up to age 13–14 years). A combination of six risk indicators was able to classify children placed in out-of-home-care with approximately 95% accuracy. These findings show that several key risk factors available in administrative records held by multiple government agencies may be used to identify vulnerable children, for whom targeted family support services may prevent future out-of-home-care placements.

• Laurens, K.R., Green, M.J., Dean, K., Tzoumakis, S., Harris, F., Islam, F., Kariuki, M., Essery, C.M., Schofield, J.M., Carr, V.J. (2019). Chronic physical health conditions, mental health, and sources of support in a longitudinal Australian child population cohort. Journal of Pediatric Psychology, 44(9), 1083-1096. doi:10.1093/jpepsy/jsz048
  
  This study examined the associations between chronic physical health conditions which are monitored and managed in NSW public schools under Individual Health Care Plans (namely asthma, allergies and anaphylaxis, type 1 diabetes, and epilepsy) and emotional, social, and behavioural difficulties assessed at age 5 years on the teacher-reported Australian Early Development Census, and at age 11 years using the self-report Middle Childhood Survey. Participants were 21,304 children from the NSW-CDS, of whom 7.5% had a hospital record of at least one of these conditions by early childhood (age 5 years), and 10.7% by middle childhood (age 11 years). Relative to peers who had no hospital records of these chronic health conditions, children with any of these health conditions experienced a small increase in selected emotional, behavioural, and social problems, as well as overall (total) problems at both assessment points (age 5 and age 11 years). Despite these difficulties, children identified with chronic health conditions were just as likely as their peers without such conditions to identify feeling supported or connected at home, school, in their community, and with their natural environment.

• Whitten, T., Green, M.J., Yin-Lan, S., Laurens, K.R., Tzoumakis, S.,Kariuki, M., Harris, F., Carr, V.J., Dean, K. (2019). Parental offending and children’s emergency department presentations in New South Wales, Australia. Journal of Epidemiology & Community Health, 73(9), 832-838. doi:10.1136/jech-2019-212392 
  
  This paper examined the incidence of Emergency Department presentations among child offspring of parents with criminal offending records, in a population sample of 72,772 children and their parents drawn from the New South Wales Child Development Study. Rates of Emergency Department presentation, particularly for physical injury, were higher among children with parental history of criminal offending (and greatest for paternal criminal offending), after adjusting for the contribution of other risk factors such as parental mental illness, Aboriginal and/or Torres Strait Islander background, low socioeconomic status, maternal age at birth, and the child's sex. These findings suggest children of parents with a history of criminal offending have an increased risk of childhood presentations to the Emergency Department, including for potentially avoidable physical injury. 

• Rossen, L., Tzoumakis, S., Kariuki, M., Laurens, K.R., Butler, M., Chilvers, M., Harris, F., Carr, V.J., Green, M.J. (2019). Timing of the first report and highest level of child protection response in association with early developmental vulnerabilities in an Australian population cohort. Child Abuse & Neglect, 93, 1-12. doi:10.1016/j.chiabu.2019.04.007
  
  This paper examined associations between early developmental vulnerabilities (at age 5 years) and (1) the highest level of child protection response (where out-of-home-care was deemed the highest response among other types of reports/responses), and (2) the timing of the first child protection report during early development. The sample included 67,027 children drawn from the New South Wales Child Development Study, of whom 10,944 were reported to child protection services up to age 5 years. The results indicated that children with substantiated maltreatment reports showed the strongest odds of vulnerability on three or more developmental domains relative to children with no child protection report (followed by children placed in out-of-home-care, then children with unsubstantiated child protection reports). Children placed in out-of-home-care showed slightly better physical, cognitive and communication competencies than those with substantiated reports that did not result in out-of-home-care placements (when each group was compared to children with no child protection reports). Children with first maltreatment reports occurring in the first 18 months of life showed the strongest likelihood of developmental vulnerabilities on three or more developmental domains relative to children with reports in later years of childhood, when each group was compared to children with no child protection reports. The findings show early reports of maltreatment may signal the need for targeted remediation of early developmental competencies to mitigate early developmental difficulties.

• Green, M.J., Tzoumakis, S., Laurens, K.R., Dean, K., Kariuki, M., Harris, F., Brinkman, S.A., Carr, V.J. (2019). Early developmental risk for subsequent childhood mental disorders in an Australian population cohort. Australian & New Zealand Journal of Psychiatry, 53(4), 304-315. doi:10.1177/0004867418814943
  
  This paper examined associations between developmental vulnerability profiles determined at the age of 5 years, and subsequent childhood mental illness diagnosed between ages 6 and 13 years, in a population sample of 86,668 children from the New South Wales Child Development Study (NSW-CDS) cohort. Membership of putative risk classes in early childhood were delineated via latent class analysis of Australian Early Development Census subdomains, and children designated as those with established ‘special needs’ at school entry were examined as a separate group of interest. The results indicated that the crude odds of being diagnosed with any mental disorder between the ages of 6–13 years was increased approximately threefold in children showing ‘pervasive' risk or ‘misconduct' risk profiles according to their AEDC vulnerability patterns at age 5 years, relative to children showing no AEDC vulnerabilities. The odds of mental illness among children with special needs was increased approximately sevenfold, relative to children showing no AEDC vulnerabilities, before adjusting for other contributing factors (e.g., parental mental illness history, child protection records, socioeconomic status, child’s sex). These findings show that distinct patterns of early childhood developmental vulnerability are associated with subsequent onset of mental disorders, and that AEDC risk profiles have the potential to inform interventions to mitigate the risk for mental disorders in later childhood and adolescence.

• Whitten, T., Laurens, K.R., Tzoumakis, S., Kaggodaarachchi, S., Green, M.J., Harris, F., Carr, V.J., Dean, K. (2019). The influence of parental offending on the continuity and discontinuity of children’s internalizing and externalizing difficulties from early to middle childhood. Social Psychiatry and Psychiatric Epidemiology, 54(8), 965-975. doi:10.1007/s00127-019-01670-5
  
  This study examined the relationship between parental offending and the continuity and discontinuity of children’s conduct, attentional, and emotional difficulties from early to middle childhood while also considering the role of timing of the parental offending exposure. We specifically tested associations between mother’s and father’s history and timing of any and violent offending, and patterns of continuity or discontinuity in offspring emotional, conduct, and attentional difficulties between ages 5 and 11 years, in a population sample of 19,208 children and their parents drawn from the New South Wales Child Development Study (NSW-CDS) cohort. Maternal and paternal offending each conferred increased risk of all patterns of developmental difficulties, including those limited to age 5 only (remitting problems), to age 11 only (incident problems), and difficulties present at both ages 5 and 11 years (persisting problems), with the greatest associations observed between parental offending history and persisting conduct problems. Paternal offending that continued through early and middle childhood had the greatest association with child developmental difficulties, while the timing of maternal offending had a less prominent effect on child developmental difficulties.

• Tzoumakis, S., Burton, M., Carr, V.J., Dean, K., Laurens, K.R., Green, M.J. (2019). Parental offending and children’s conduct problems. Trends & issues in crime and criminal justice No. 571. Canberra: Australian Institute of Criminology. 
  
  This study examined the the link between parental criminal offending history and offspring behaviour in middle childhood, in a population sample of 21,956 children drawn from the NSW Child Development Study (NSW-CDS). Specifically, the prevalence of offending among mothers and fathers was examined in relation to the children’s conduct problems at age 11 years. The findings showed that parental offending history increased the likelihood of conduct problems among offspring, and that maternal violent offending was most strongly associated with conduct problems in middle childhood. The findings suggest that the intergenerational transmission of antisocial behaviour begins early, highlighting the importance of intervention for at-risk children and programs targeted at mothers as well as fathers.

• Dix, K.L., Green, M.J., Tzoumakis, S., Dean, K., Harris, F., Carr, V.J., Laurens, K.R. (2019) The Survey of School Promotion of Emotional and Social Health (SSPESH): A brief measure of the implementation of whole-school mental health promotion. School Mental Health, 11(2), 294-‌308. doi:10.1007/s12310-018-9280-5
  
  This paper describes the development of a brief school-based instrument designed for use in research and in educational practice. The Survey of School Promotion of Emotional and Social Health (SSPESH) measures the extent to which a school has implemented policies and practices in four health-promoting domains: (a) creating a positive school community, (b) teaching social and emotional skills, (c) engaging the parent community, and (d) supporting students experiencing mental health difficulties. The questionnaire can be used to differentiate high, moderate, and low implementation of whole-school policies and practices that promote the emotional and social health of students. To develop the instrument, responses were gathered via an online survey of Principals in almost 600 Australian primary schools in New South Wales during 2015. The paper describes the preliminary psychometric properties of the instrument (reliability, validity), and the development of the implementation index using Latent Class Analysis methods. This brief 13-item survey can be used by researchers and evaluators for comparative and multivariate analyses. School leadership may find it useful as a brief tool to guide the identification of target areas for whole-school improvement across the four important health-promoting domains.