Katrina Williams

Royal Melbourne Hospital, Melbourne, Victoria, Australia

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Publications (48)110.2 Total impact

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    ABSTRACT: Since the Journal of Paediatrics and Child Health was first published, there has been substantial change in the field of autism spectrum disorders (ASDs) with an exponential increase in the amount of funded and published research. In this paper, we focus on regression in children with ASD, a phenomenon that remains poorly understood. We discuss the implications of what we know about regression in ASD for the way we think about ASD more broadly and for paediatric practice.
    Journal of Paediatrics and Child Health 01/2015; 51(1). DOI:10.1111/jpc.12805 · 1.19 Impact Factor
  • 11/2014; 11(2):60-69. DOI:10.9782/2159-4341-17.2.60
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    ABSTRACT: Universal developmental surveillance programs aimed at early identification and targeted early intervention significantly improves short- and long-term outcomes in children at risk of developmental disorders. However, a significant challenge remains in providing sufficiently rigorous research and robust evidence to inform policy and service delivery. This paper describes the methods of the 'Watch Me Grow' study that aims to maximise accurate early detection of children with developmental disorders through a partnership formed between policy makers, service providers and researchers.
    BMC Pediatrics 09/2014; 14(1):234. DOI:10.1186/1471-2431-14-234 · 1.92 Impact Factor
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    ABSTRACT: Parental concerns about their children's development can be used as an indicator of developmental risk. We undertook a systematic review of the prevalence of parents' concerns as an indicator of developmental risk, measured by the Parents' Evaluation of Developmental Status (PEDS) and associated risk factors.
    BMC Pediatrics 09/2014; 14(1):231. DOI:10.1186/1471-2431-14-231 · 1.92 Impact Factor
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    ABSTRACT: Context: There is evidence that OSA in children can be associated with acute and chronic effects on the cardiovascular system due to repetitive episodes of apnea and hypoxemia. Objective: To assess whether there is an association between OSA and echocardiographic findings in children and whether that association persists after adenotonsillectomy. Data sources: A literature search was conducted based on PUBMED, EMBASE and LILACS. Study selection: Children with USA and children who did not have USA, who were aged <= 12 years. Data extraction: Two reviewers extracted data independently; the risk of bias was assessed by examining the selected sample, the recruitment method, completeness of follow up, and blinding. Results: Seven studies met all the inclusion criteria and methodological requirements. There was a significant difference with elevated mean pulmonary arterial pressure levels in OSA participants compared to those without OSA at preoperative assessment [mean difference (MD) 8.67; confidential interval (CI) 95% 6.09, 11.25]. OSA participants showed a statistically significant increased interventricular septum (IVS) thickness (mm) [MD 0.60; CI 95% 0.09, 1.11]; and right ventricular (RV) dimension (cm/m) [MD 0.19; CI 95% 0.10, 0.28]. There was also a significant increase in right ventricular (RV) dimension (cm/m) [MD 0.10; Cl 95% 0.05, 0.14] in OSA children. Conclusion: There is moderate quality evidence regarding possible association between USA and right heart repercussions. More prognosis studies are needed, to allow the combination of results in a meta-analysis.
    International Journal of Pediatric Otorhinolaryngology 07/2014; 78(10). DOI:10.1016/j.ijporl.2014.07.021 · 1.32 Impact Factor
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    ABSTRACT: Response to early intervention programs in autism is variable. However, the factors associated with positive versus poor treatment outcomes remain unknown. Hence the issue of which intervention/s should be chosen for an individual child remains a common dilemma. We argue that lack of knowledge on "what works for whom and why" in autism reflects a number of issues in current approaches to outcomes research, and we provide recommendations to address these limitations. These include: a theory-driven selection of putative predictors; the inclusion of proximal measures that are directly relevant to the learning mechanisms demanded by the specific educational strategies; the consideration of family characteristics. Moreover, all data on associations between predictor and outcome variables should be reported in treatment studies.
    Frontiers in Pediatrics 06/2014; 2:58. DOI:10.3389/fped.2014.00058
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    ABSTRACT: Continuing from part 1, part 2 of the autism spectrum disorders review explores clinical practice and service delivery aspects of autism spectrum disorders including current assessment approaches in Australia, family-centred models of care, and key service structure and delivery issues. Treatments including behavioural interventions, established and emergent medication, and complementary and alternative therapies are discussed. The key role of paediatricians as both individual child and family care providers and advocates, as well as agents of service reform in Australia, is evident. Much still needs to be done.
    Journal of Paediatrics and Child Health 01/2014; 50(5). DOI:10.1111/jpc.12456 · 1.19 Impact Factor
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    ABSTRACT: This review paper describes our current perspective of autism spectrum disorders (ASD), taking into account past, current and future classification systems and the evolving definitions of ASD. International prevalence rates from 1965 to 2012 are presented and key issues, including whether there is an epidemic of autism and what this means in terms of thinking about possible causes of autism, are discussed. Also discussed is the need for high quality national data collection in Australia and the evidence, and lack of evidence, for the many theoretical causes of ASD. The lack of robust classification of autism along with limited high quality evidence base about its prevalence and possible causes leaves ample space for future discoveries.
    Journal of Paediatrics and Child Health 01/2014; 50(5). DOI:10.1111/jpc.12451 · 1.19 Impact Factor
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    ABSTRACT: Camarata (2014) provides a comprehensive summary of the current state of the research on early identification and intervention for children with autism spectrum disorders (ASD). Extending on the foundations provided by Camarata, this commentary discusses the value of a diagnosis of ASD and questions whether there is sufficient evidence on which to base continuing calls for early identification and ASD-specific intervention. Gaps are highlighted in the evidence base, suggestions made about how to fill those gaps, and an alternative framework is proposed for achieving best outcomes for children with early developmental problems of the type seen in ASD and their families.
    International Journal of Speech-Language Pathology 12/2013; DOI:10.3109/17549507.2013.861870 · 1.18 Impact Factor
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    ABSTRACT: AIM: This study describes the presentations made to the Sydney Children's Hospital (SCH) Emergency Department (ED) by local Aboriginal and Torres Strait Islander (Aboriginal) children with particular reference to children who present frequently or whose presentation was preventable. METHODS: Data from the SCH ED Information System were extracted for all presentations made by children who identified as Aboriginal, aged between 0-15 years, who presented between 2005-2008. Presentations were coded according to the presenting problem, diagnosis, outcome, and whether the presentations were potentially preventable. Preventable presentations include those presentations considered to be avoidable and those that could have been managed by a local primary care or community service. RESULTS: There were 1252 presentations to the SCH ED by 453 Aboriginal children aged 0-15 years. More than 50% of children presented more than once. Seventy-nine children presented more than five times. Nearly 45% of presentations were coded as potentially preventable. CONCLUSIONS: A significant proportion of ED presentations were potentially preventable with the use of culturally appropriate and accessible local community and primary health care services and better referral pathways back to these services. Community engagement is required to raise awareness of common presentations and to look at strategies to prevent common problems both occurring and presenting to the ED. This will enhance the health of urban Aboriginal children.
    Journal of Paediatrics and Child Health 05/2013; 49(9). DOI:10.1111/jpc.12225 · 1.19 Impact Factor
  • Journal of Paediatrics and Child Health 03/2013; 49(9). DOI:10.1111/jpc.12171 · 1.19 Impact Factor
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    ABSTRACT: AIM: We developed a questionnaire to assess social development (SIQ) in preschool children. Social development is often not included in medical assessment, though it may assist in early identification of autism spectrum disorder (ASD). METHODS: Parents of 108 children with ASD, speech and language disorders, or 'developmental concerns', recruited from a clinical developmental assessment and community child health service, completed the SIQ, and also a Childhood Autism Rating Scale (CARS) assessment. Receiver Operator Characteristic (ROC) curves were generated to assess the performance of different questionnaire score thresholds in correctly identifying children with a CARS score of 30 or more. Logistic regression models were used to identify the questions which had the most predictive value for a CARS score of 30 or more. RESULTS: An SIQ score of 14 or more correctly identified children with a CARS ≥30 with a sensitivity of 85%, specificity 85%, positive likelihood ratio (LR) 8.3 and negative LR 0.2. Two questions were identified as most predictive of ASD. CONCLUSIONS: The SIQ may assist clinicians in assessing social development and in making decisions about referral for autism assessment. Evaluation of the SIQ at the point of entry to a clinical service is needed.
    Journal of Paediatrics and Child Health 01/2013; 49(2). DOI:10.1111/jpc.12092 · 1.19 Impact Factor
  • Katrina Williams, Mike South
    Journal of Paediatrics and Child Health 01/2013; 49(1):75-7. DOI:10.1111/jpc.12070 · 1.19 Impact Factor
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    ABSTRACT: Aims:  The study aims to assess the sensitivity and specificity of the Australian Developmental Screening Test (ADST) in a clinical setting in detecting developmental concerns that warrant further assessment or treatment. Methods:  Clients referred to an inner Sydney Community Health Centre with developmental concerns were initially assessed using the ADST, followed within 12 weeks by an assessment using the Griffiths Mental Developmental Scales (GMDS) as the gold standard. Results:  Of the 65 eligible children, 46 (71%) had results indicating further assessment (42) or follow-up (4) was needed (using the criteria recommended in the ADST manual). However, of these only 21 (46%) had an abnormal GMDS. This gave a sensitivity of 95% but a specificity of only 52%. New threshold criteria for further assessment were developed and applied to three age groups. If children aged under 2 years are assessed using the standard ADST threshold, and children 2 years or older are assessed using the new ADST cut-off, then the tool has a sensitivity of 95%, a specificity of 82%, a positive likelihood ratio of 5.24 (95% CI 2.78, 9.88) and negative likelihood ratio of 0.06 (0.01, 0.40). Conclusions:  Modified criteria for the ADST developed in this study showed good specificity and sensitivity for detection of developmental problems in this population, referred because of developmental concerns. Further testing to see if these new criteria perform well in a different population is now needed.
    Journal of Paediatrics and Child Health 11/2012; 48(11):1004-9. DOI:10.1111/j.1440-1754.2012.02588.x · 1.19 Impact Factor
  • Katrina Williams, Mimi Tang
    Journal of Paediatrics and Child Health 10/2012; 48(10):942-3. DOI:10.1111/j.1440-1754.2012.02574.x · 1.19 Impact Factor
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    ABSTRACT: An important step toward improvement of the conduct of pediatric clinical research is the standardization of the ages of children to be included in pediatric trials and the optimal age-subgroups to be analyzed. We set out to evaluate empirically the age ranges of children, and age-subgroup analyses thereof, reported in recent pediatric randomized clinical trials (RCTs) and meta-analyses. First, we screened 24 RCTs published in Pediatrics during the first 6 months of 2011; second, we screened 188 pediatric RCTs published in 2007 in the Cochrane Central Register of Controlled Trials; third, we screened 48 pediatric meta-analyses published in the Cochrane Database of Systematic Reviews in 2011. We extracted information on age ranges and age-subgroups considered and age-subgroup differences reported. The age range of children in RCTs published in Pediatrics varied from 0.1 to 17.5 years (median age: 5; interquartile range: 1.8-10.2) and only 25% of those presented age-subgroup analyses. Large variability was also detected for age ranges in 188 RCTs from the Cochrane Central Register of Controlled Trials, and only 28 of those analyzed age-subgroups. Moreover, only 11 of 48 meta-analyses had age-subgroup analyses, and in 6 of those, only different studies were included. Furthermore, most of these observed differences were not beyond chance. We observed large variability in the age ranges and age-subgroups of children included in recent pediatric trials and meta-analyses. Despite the limited available data, some age-subgroup differences were noted. The rationale for the selection of particular age-subgroups deserves further study.
    PEDIATRICS 06/2012; 129 Suppl 3:S161-84. DOI:10.1542/peds.2012-0055J · 5.30 Impact Factor
  • Katrina Williams, Catherine Marraffa
    Journal of Paediatrics and Child Health 06/2012; 48(6):534-6. DOI:10.1111/j.1440-1754.2012.02491.x · 1.19 Impact Factor
  • PEDIATRICS 06/2012; 129 Suppl 3:S153-60. DOI:10.1542/peds.2012-0055I · 5.30 Impact Factor
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    ABSTRACT: Clinicians are increasingly using electronic sources of evidence to support clinical decision-making; however, there are multiple demands on clinician time, and summarised and synthesised evidence is needed. Clinical Answers (CA) have been developed to address this need; the CA is a synthesised evidence-based summary that supports point-of-care clinical decision-making. The aim of this paper is to report on a survey used to test and improve the CA format. An online survey was sent to pediatricians via e-mail and posted on a child health clinical standards website. Quantitative data analysis consisted primarily of descriptive statistics; qualitative data analysis consisted of content analysis. Eighty-three pediatricians responded to the survey. Most respondents found the CA useful or very useful (93%) and agreed or strongly agreed that the layout was effective and allowed them to quickly locate critical information (82%). Quantitative and qualitative data suggested that respondents thought there should be less detail in the linked figures and tables (p = 0.0002), but overall respondents seemed to think there was an appropriate level of detail in most sections of the CA. Based on the quantitative and qualitative survey responses, major and minor modifications to the CA format were implemented, such as removing forest plots, adding links in each addendum to bring the user back to the front page, and adding an 'Implications for practice' section to the CA. Findings suggest that CAs will be a useful tool for pediatricians; thus, the research team has now begun creating CAs to assist busy clinicians in their day-to-day clinical practice by providing high-quality information for decision-making at the point-of-care.
    BMC Pediatrics 03/2012; 12:34. DOI:10.1186/1471-2431-12-34 · 1.92 Impact Factor
  • Mike South, Katrina Williams
    Journal of Paediatrics and Child Health 03/2012; 48(3):279-80. DOI:10.1111/j.1440-1754.2012.02436.x · 1.19 Impact Factor

Publication Stats

327 Citations
110.20 Total Impact Points

Institutions

  • 2012–2015
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
    • The Royal Children's Hospital
      • Department of Developmental Medicine
      Melbourne, Victoria, Australia
  • 2011–2014
    • University of Melbourne
      Melbourne, Victoria, Australia
    • Liverpool Hospital
      Liverpool, New South Wales, Australia
  • 2010–2011
    • University of New South Wales
      Kensington, New South Wales, Australia
  • 2006–2010
    • Sydney Children's Hospital
      Sydney, New South Wales, Australia
  • 2005–2010
    • Children's Hospital at Westmead
      • Children's Hospital at Westmead Clinical School
      Sydney, New South Wales, Australia
  • 2007
    • Bond University
      • School of Health Sciences
      Gold Coast, Queensland, Australia