Bruce Tonge
Monash University, Psychiatry, Emeritus
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ABSTRACT School refusal is differentiated from other attendance problems such as truancy and school withdrawal. It is characterised by the child's emotional upset at the prospect of going to school, parental awareness of and... more
ABSTRACT School refusal is differentiated from other attendance problems such as truancy and school withdrawal. It is characterised by the child's emotional upset at the prospect of going to school, parental awareness of and antipathy toward the problem, and an absence of significant antisocial behaviour in the child. The child's emotional upset is frequently associated with an anxiety disorder, but it may also be associated with a mood disorder. School refusal affects approximately 1% of school children across the primary and secondary school levels. Severe and prolonged school refusal jeopardises the young person's social, emotional and academic development, and may be associated with mental health problems in adulthood. A first step in management involves efficient identification and the assessment of contributing and maintaining factors. Clinical outcome studies support the efficacy of cognitive behavioural therapy (CBT). The psychosocial approach encompassed in CBT incorporates anxiety management training with the young person, behaviour management training with parents and consultation with school personnel. Pharmacological treatments are commonly employed although empirical support for their use is limited. Tricyclic antidepressants and selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors are the more commonly used agents, with the latter having fewer associated adverse effects. It is suggested that the first line of treatment should be CBT, with simultaneous or subsequent pharmacological treatment contingent upon the response to CBT.
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Research Interests: Psychology and Medicine
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The impact of television on children and child development and on the practice of child psychiatry is reviewed. Evidence from research is that children learn from watching television and the programs they see can change their behaviour.... more
The impact of television on children and child development and on the practice of child psychiatry is reviewed. Evidence from research is that children learn from watching television and the programs they see can change their behaviour. Programs with violent and aggressive themes tend to make children more aggressive and disobedient. Cultural sex-role and social stereotypes depicted on the television can also influence children's perceptions of society. Programs specifically designed for different age groups of children which depict pro-social behaviour are likely to lead children to become more friendly, co-operative and self-controlled. The use of television in child psychiatric clinical work supervision and research, and its potential to reduce the psychological trauma experienced by children in the legal proceedings of child abuse cases is discussed. More research is needed to determine the content and intervening variables that effect the acquisition of both positive and negative behaviour from television and enhance its promotion of mental health.
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The number of smartphone- and tablet-applications, or apps, for health and wellbeing continues to grow at a rapid pace. This scoping study identified articles reporting on the use of apps by and with individuals with autism. Professionals... more
The number of smartphone- and tablet-applications, or apps, for health and wellbeing continues to grow at a rapid pace. This scoping study identified articles reporting on the use of apps by and with individuals with autism. Professionals and parents of children with autism also completed a questionnaire as part of stakeholder consultation. Of the 40 studies identified, 28 reported on the use of apps specifically designed for autism, with clearly the most frequently being the communication support app Proloquo2Go. Other uses include assistance in the teaching and maintenance of social and life skills as well as faciliation in the delivery of behavioral interventions. Stakeholders confirmed the importance of apps to assist communication. While empirical data are available on the effectiveness of apps for augmentative and alternative communication, areas for further research include the functionality and effectiveness of apps for delivery of behavioral interventions and educational games for individuals with autism.
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The creation of subcategories of anxiety disorders of childhood or adolescence in the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) (APA, 1980) and 3rd edition,... more
The creation of subcategories of anxiety disorders of childhood or adolescence in the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) (APA, 1980) and 3rd edition, revised (DSM-III-R) (APA, 1987), has provided a heuristic framework and stimulus for research on anxiety disorders of childhood. This approach to the subcategorization of psychopathological disorders in childhood has not been free of criticism, particularly from Great Britain, where childhood psychiatric disorders are divided into two broad categories: conduct disorders and emotional disorders (which include anxiety states) (Hersov, 1985a). The proponents of this approach have argued that there is insufficient evidence to justify a further subcategorization of emotional disorders and the further specification of anxiety disorders (Hersov, 1985a; Rutter & Shaffer, 1980). However, the new International Classification of Disorders, 10th edition (ICD-10) [World Health Organization (WHO), 1992, pp. 273–276], specifies three types of anxiety disorders within the group of emotional disorders with a set specific to childhood, namely, separation anxiety, phobic anxiety, and social anxiety. It qualifies this categorization, though, with the statement that “emotional disorders of childhood are less clearly demarcated into supposedly specific entities.”
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To survey the attitudes of Australian medical students to determine their views about the relative attractiveness of psychiatry as a career compared with other specialties, and against findings from a North American study. We surveyed 655... more
To survey the attitudes of Australian medical students to determine their views about the relative attractiveness of psychiatry as a career compared with other specialties, and against findings from a North American study. We surveyed 655 first-year medical students attending six Australian Universities. Responses indicated that Australian medical students view psychiatry as distinctly less 'attractive' than other career options, as reported in the North American sample. In comparison with other disciplines, psychiatry was regarded as more interesting and intellectually challenging, but also as lacking a scientific foundation, not being enjoyable and failing to draw on training experiences. Our findings suggest that psychiatry has an image problem that is widespread, reflecting community perceptions and the specialist interests of medical students on recruitment. If psychiatry is to improve its 'attractiveness' as a career option, identified image problems need to be corrected and medical student selection processes re-considered.
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Objective:The aim of the study was to investigate the specificity of sleep problems in children with autism and further explore the currently unclear association between sleep problems and daytime behaviour.Methodology:The Pervasive... more
Objective:The aim of the study was to investigate the specificity of sleep problems in children with autism and further explore the currently unclear association between sleep problems and daytime behaviour.Methodology:The Pervasive Developmental Disorder (PDD) group consisted of 31 children with autism and 7 children with Asperger’s Disorder ranging in age from 44 to 152 months. The control group consisted of 36 children ranging in age from 63 to 171 months. The children were matched on age and gender, and group‐matched on IQ level. A sleep diary was completed by parents over a 2‐week period, in addition to several behaviour questionnaires.Results:Results showed that children in the PDD group exhibited qualitatively and quantitatively different sleep patterns to nonautistic control children.Conclusions:The findings were discussed in light of current literature concerning circadian rhythm dysfunction, social difficulties, and abnormal melatonin levels in children with autism.
Research Interests: Autism, Medicine, Paediatrics, Melatonin, Humans, and 13 moreChild, Female, Sleep disorders, Male, Sleep, Pervasive Developmental Disorder, Questionnaires, Paediatrics & Child Health, Neuropsychological Tests, Autistic disorder, Child preschool, Child behavior disorders, and Paediatrics and reproductive medicine
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... Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine, 2002; 347(5): 314-321. 28 Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism.... more
... Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine, 2002; 347(5): 314-321. 28 Hviid A, Stellfeld M, Wohlfahrt J, Melbye M. Association between thimerosal-containing vaccine and autism. JAMA, 2003; 290(13): 1763-1766. ...
Research Interests: Psychology and Autism
Children with ID often suffer the added handicap of emotional and behavioural disorder which seriously compromises their adjustment and causes significant extra burden and cost for their parents and the community. A comprehensive... more
Children with ID often suffer the added handicap of emotional and behavioural disorder which seriously compromises their adjustment and causes significant extra burden and cost for their parents and the community. A comprehensive biopsychosocial assessment of the child and family provides the context for understanding psychopathological symptoms and the basis for a best practice management plan incorporating psychological, educational, family, and perhaps pharmacological interventions.
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Research Interests: Psychology and Truancy
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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... more
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.
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A A A A Avril Br vril Br vril Br vril Br vril Brer er er er ereton and Bruce T eton and Bruce T eton and Bruce T eton and Bruce T eton and Bruce Tonge onge onge onge onge WHAT IS AUTISM? Autism is a syndrome consisting of a set of... more
A A A A Avril Br vril Br vril Br vril Br vril Brer er er er ereton and Bruce T eton and Bruce T eton and Bruce T eton and Bruce T eton and Bruce Tonge onge onge onge onge WHAT IS AUTISM? Autism is a syndrome consisting of a set of developmental and behavioural features that must be present for the condition to be diagnosed. The core features of autism include impairment in three main areas of functioning: • • • • • social interaction; • • • • • communication; • • • • • patterns of behaviour, interests and activities (which become restricted, repetitive and stereotyped). Kanner first described these core features in his paper of 1943, in which 11 children with 'autistic disturbances of affective contact' showed a distinctive pattern of symptoms: • • • • • inability to relate to people and situations; • • • • • failure to use language for the purpose of communication; • • • • • obsessive desire for the maintenance of sameness in the environment. The DSM–IV diagnostic system (A...
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This is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Attention Deficit Hyperactivity Disorder (ADHD). The objective here was to... more
This is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Attention Deficit Hyperactivity Disorder (ADHD). The objective here was to use a comprehensive scoping review approach to identify the concepts of functional ability and disability used in the scientific ADHD literature and link these to the nomenclature of the ICF-CY. Systematic searches were conducted using Medline/PubMed, PsycINFO, ERIC and Cinahl, to extract the relevant concepts of functional ability and disability from the identified outcome studies of ADHD. These concepts were then linked to ICF-CY by two independent researchers using a standardized linking procedure. Data from identified studies were analysed until saturation of ICF-CY categories was reached. Eighty studies were included in the final analysis. Concepts contained in these studies were linked to 128 ICF-CY categories. Of these categories, 68 were considered to be particularly relevant to ADHD (i.e., identified in at least 5 % of the studies). Of these, 32 were related to Activities and participation, 31 were related to Body functions, and five were related to environmental factors. The five most frequently identified categories were school education (53 %), energy and drive functions (50 %), psychomotor functions (50 %), attention functions (49 %), and emotional functions (45 %). The broad variety of ICF-CY categories identified in this study underlines the necessity to consider ability and disability in ADHD across all dimensions of life, for which the ICF-CY provides a valuable and universally applicable framework. These results, in combination with three additional preparatory studies (expert survey, focus groups, clinical study), will provide a scientific basis to define the ICF Core Sets for ADHD for multi-purpose use in basic and applied research, and every day clinical practice.
Research Interests: Psychology, Assessment, Focus Groups, Adolescent, Medicine, and 15 moreDSM, Activities of Daily Living, Humans, Child, Female, Male, Child Psychiatry, Diagnostics, Medline, Clinical Sciences, ICD, Disability Evaluation, Surveys and Questionnaires, Attention deficit disorder with hyperactivity, and Outcome Assessment Health Care
In 'The Winter's Tale' Shakespeare has an old shepherd say: "I would there were no age between ten and twenty three, or that youth would sleep out the rest; for there's nothing in between but getting wenches with... more
In 'The Winter's Tale' Shakespeare has an old shepherd say: "I would there were no age between ten and twenty three, or that youth would sleep out the rest; for there's nothing in between but getting wenches with child, wronging the ancientry, stealing and fighting." Shakespeare highlights that the risks and crises of adolescence are development of adult sexuality; separation from parents (the 'ancientry') and development of independence; and the expression of (and coping with) aggressive feelings. I would add a fourth task: formation of an identity and development of the adult mind.
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Schizophrenia is associated with changes in the structure and functioning of a number of key brain systems, including prefrontal and medial temporal lobe regions involved in working memory and declarative memory, respectively. Imaging... more
Schizophrenia is associated with changes in the structure and functioning of a number of key brain systems, including prefrontal and medial temporal lobe regions involved in working memory and declarative memory, respectively. Imaging techniques provide an unparalleled window into these changes, allowing repeated assessments across pre- and post-onset stages of the disorder and in relation to critical periods of brain development. Here we review recent directions in structural and functional neuroimaging research on schizophrenia. The view emerging from this work is that schizophrenia is fundamentally a disorder of disrupted neural connectivity, the sources of which appear to be genetic and environmental risk factors influencing brain development both prenatally and during adolescence.
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Dear Sir, McConaghy’s provocative article arouses a particular dilemma-whether to accord his viewpoint any recognition by responding to the article, or to ignore it as not being worthy of debate. However, we are prompted by a sense of... more
Dear Sir, McConaghy’s provocative article arouses a particular dilemma-whether to accord his viewpoint any recognition by responding to the article, or to ignore it as not being worthy of debate. However, we are prompted by a sense of real concern to write in response to three issues associated with McConaghy’s article. Firstly, McConaghy’s view of the scientific method and its application to this area of human behaviour cannot go unchallenged. His central theme is a vilification of Bowlby and others on the basis of their supposed lack of adherence to a rigid testing of the null hypothesis. His arguments are hardly tenable when they are so poorly supported by his selective and limited use of dated material. Further, it is clearly arguable as to whether the study of linear relationships, which McConaghy espouses, has special relevance to the field of human behaviour. Complex, multi-variate factors influence human development. These factors are far more likely to be explicated by an approach which recognises the inter-dependence as well as the plasticity and diversity of human interactions. Secondly, we accept the need to critically appraise concepts such as attachment and bonding, and to continually question their application to clinical, educational and legislative actions. However, we cannot concur with McConaghy in his apparently biased rejection of these concepts’ contribution to the positive changes that are occurring in many areas of child care. The history of childhood is liberally strewn with the record of adults’ rejection of children’s needs for recognition, nurture and continuity of psychological parenting. McConaghy, under the guise of ‘scientific debate’, adds his voice to this record of rejection. A markedly different attitude pervades Rutter’s scholarly article on ‘separation experiences: A new look at an old topic’ in The Journal of’ Paediatrics
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Research Interests: Psychology, Clinical Psychology, Cognitive Science, Autism, Evidence Based Medicine, and 13 moreMedicine, Humans, Child, Behavior Therapy, Empirical Research, Autism Spectrum Disorder, Clinical Sciences, Patient Centered Care, Guidance and Counseling Intervention Programs, Parent‐child Relations, Autistic disorder, Antipsychotic agents, and Child behavior disorders
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... Clayton, Victoria, Australia Neville King Monash University. ... abused before the age of 16 (Baker and Duncan, 1985), while an Australian study of almost 1000 tertiary students found that 13% recalled sexual experiences with an adult... more
... Clayton, Victoria, Australia Neville King Monash University. ... abused before the age of 16 (Baker and Duncan, 1985), while an Australian study of almost 1000 tertiary students found that 13% recalled sexual experiences with an adult before the age of 12 (Goldman and Goldman ...
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Background: Children with anxiety, attention deficit hyperactivity, and disruptive behaviour disorders are frequently seen in general practice and often present with somatic complaints, comorbidity and complex family relationships.... more
Background: Children with anxiety, attention deficit hyperactivity, and disruptive behaviour disorders are frequently seen in general practice and often present with somatic complaints, comorbidity and complex family relationships. Objective: This article presents an approach to assessment including useful clinical questions, case diagnostic criteria and recommendations on psychometric tools for general practice. Discussion: Key management principles including psychological and pharmacological approaches are outlined, and a multidisciplinary approach incorporating specialist care is recommended.
Research Interests: Australia, Family Practice, Medicine, Comorbidity, Anxiety, and 15 moreClinical Practice, Humans, Child, Female, Pubmed, Male, Mental Disorders, Conduct Disorder, Clinical Sciences, Psychotropic Drugs, ANXIETY, Multidisciplinary Approach, Child preschool, Attention deficit disorder with hyperactivity, and mass Screening
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Background: Mental disorders affect young people disproportionately and are increasing in prevalence. Knowledge about depression in adolescents and skill in its management lags behind that for adults. Depression is the most common mental... more
Background: Mental disorders affect young people disproportionately and are increasing in prevalence. Knowledge about depression in adolescents and skill in its management lags behind that for adults. Depression is the most common mental disorder and untreated depression is associated with significant adverse effects. Depression is also a major predictor of suicidal behaviour and suicide. The role of the general practitioner in the treatment of adolescent depression is of considerable public health and clinical importance. Objective: The aim of this paper is to highlight the major differences between adolescent and adult depression in relation to detection, assessment and treatment. Discussion: The new Commonwealth Government's Better Outcomes in Mental Health Initiatives and Incentives provide an opportunity for GPs to improve their knowledge and skills in the detection, assessment and treatment of mental disorders. It is hoped that this paper will encourage GPs to include the topic of adolescent depression in their learning objectives.
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Although school refusal is not a common problem, it causes extreme turmoil in families and affects psychological and social development of the growing child. Causes for school refusal are diverse. Careful assessment to clarify the... more
Although school refusal is not a common problem, it causes extreme turmoil in families and affects psychological and social development of the growing child. Causes for school refusal are diverse. Careful assessment to clarify the function of the school refusal is critical for successful intervention. Effective management strategies have been developed and are described in more detail in a recent book by King, Ollendick, and Tonge.
Research Interests: Anxiety Disorders, Australia, Family Practice, Medicine, Schools, and 13 moreHumans, Child, Female, Pubmed, Male, Separation Anxiety, Clinical Sciences, Public health systems and services research, Guidance and Counseling Intervention Programs, School Refusal, Child preschool, Family Characteristics, and Age distribution
Background: Adolescent depression is mainly managed in primary care. However, there are many problems associated with access to general practice and detection, assessment and treatment of youth depression by general practitioners.... more
Background: Adolescent depression is mainly managed in primary care. However, there are many problems associated with access to general practice and detection, assessment and treatment of youth depression by general practitioners. Clinical guidelines recommend the use of cognitive behavioural therapy (CBT) in treating adolescent depression. Stage 1 of the 'Time for a Future' project involved establishing a new service in Geelong, Victoria, 'The Clockwork Young People's Health Service'. The service aimed to address the barriers to optimal management of adolescent depression. Objective: This article aims to outline Stage 2 of the Time for a Future project which involved training of 'Clockwork' GPs and other practitioners in CBT skills. Discussion: The training program was well received by 68 community and Clockwork GPs, who reported significant changes in their confidence to detect, assess and treat adolescent depression. Ten GPs from Clockwork were a small but important subset of the study because the Clockwork model overcame many of the structural barriers that deter optimal management of adolescent depression by GPs. When real and perceived barriers were addressed concurrently with training, further positive outcomes were possible.
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Background: Depression is a common disorder, increasing in prevalence in all ages. Research on the effective treatment of adolescent depression is lacking. Concern is growing about the recent increase in general practitioner prescribing... more
Background: Depression is a common disorder, increasing in prevalence in all ages. Research on the effective treatment of adolescent depression is lacking. Concern is growing about the recent increase in general practitioner prescribing of antidepressants and reports that selective serotonin reuptake inhibitors (SSRIs) may precipitate suicidal behaviour in adolescents. Objective: This article discusses the importance of recognising and treating adolescent depression, methodological issues in research and recommendations for SSRI prescribing by Australian GPs. Discussion: The lack of access to the mental health services and harmful effects of untreated adolescent depression are a cause for concern. On the balance of current information, the only SSRI Australian GPs may prescribe for the treatment of depression in adolescents is fluoxetine, and then only where cognitive behavioural therapy has failed or the depression is life threatening. The key to successful antidepressant drug treatment in adolescents is frequent review to monitor response, compliance and side effects.