PCH EXPAAND - a prospective randomised control trial to comprehensively assess risk factors in children and adolescents who present with deliberate self-harm and evaluate the efficacy of therapeutic intervention at the time of acute mental health crisis: Enabling improved understanding and responsiveness to our patients

Rates of deliberate self-harm (DSH) in children and adolescents (C&A) have increased in prevalence, severity and chronicity, and this problem is now considered a major public health issue that is associated with high personal and societal costs, as well as high service burden. While DSH has been increasingly studied across lifespan, particularly high rates of DSH in C&A are poorly understood. These knowledge gaps call for an opportunity to gain better understanding of the psychopathology responsible for vicious cycle of DSH and to develop better and more efficacious evidence based treatments. We present the protocol for WA-based study at Perth Children's Hospital (PCH) EXPAAND project that stands for EXploring Psychiatric and Attentional risk factors in children and Adolescents Needing intervention for Deliberate self-harm. More specifically, EXPAAND screens for dissociative symptoms and assesses Alexithymia, Substance Use Disorder, Attention Deficit /Hyperactivity Disorder (ADHD), Sluggish Cognitive Tempo, all - identifiable and treatable conditions that could elevate the risk of DSH by different causal pathways.
This RCT study is being delivered in three parts. We assess the rates of these psychiatric and attention conditions in C&A with DSH at PCH Emergency Department across a 14-month period. We then investigate the statistical relationship between DSH behaviour and identified conditions in addition to specific psychosocial and trauma factors that we also screen for. The project includes pharmacological treatment for ADHD if detected. Finally, we deliver and evaluate the therapeutic arm of the study: a manualized brief psychotherapeutic intervention, known as Therapeutic Assessment (Ougrin et al., 2010).