Katrina Williams

Royal Melbourne Hospital, Melbourne, Victoria, Australia

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Publications (45)100.56 Total impact

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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. · 1.98 Impact Factor
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    ABSTRACT: 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.
    International journal of pediatric otorhinolaryngology. 07/2014;
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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; · 1.25 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; · 1.25 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 01/2014; 2:58.
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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; · 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; · 1.25 Impact Factor
  • Journal of Paediatrics and Child Health 03/2013; · 1.25 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; · 1.25 Impact Factor
  • Katrina Williams, Mike South
    Journal of Paediatrics and Child Health 01/2013; 49(1):75-7. · 1.25 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. · 1.25 Impact Factor
  • Katrina Williams, Mimi Tang
    Journal of Paediatrics and Child Health 10/2012; 48(10):942-3. · 1.25 Impact Factor
  • Katrina Williams, Catherine Marraffa
    Journal of Paediatrics and Child Health 06/2012; 48(6):534-6. · 1.25 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. · 4.47 Impact Factor
  • PEDIATRICS 06/2012; 129 Suppl 3:S153-60. · 4.47 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. · 1.98 Impact Factor
  • Mike South, Katrina Williams
    Journal of Paediatrics and Child Health 03/2012; 48(3):279-80. · 1.25 Impact Factor
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    ABSTRACT: It has been reported that rates of epilepsy and mortality are higher among the population with autism spectrum disorder (ASD) than in the general population. The aim of this systematic review is to provide comprehensive evidence for clinicians, carers, and people with ASD regarding these outcomes. Studies were eligible for inclusion if the main focus of the study involved observation over a period of 12 months or more of an initially defined population (with appropriate diagnostic label). Studies were also required to have at least 30 participants in order to differentiate case series from cohort studies. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effectiveness, MEDLINE, PsycINFO, EMBASE, and CINAHL were searched. The date of the last search was September 2010. The risk of bias of included studies was assessed and a meta-analysis was undertaken. Twenty-one studies were identified, 16 measuring the percentage of participants with epilepsy and five measuring mortality using a standardized mortality ratio. The pooled estimate for the percentage of participants with epilepsy was 1.8% (95% CI 0.4-9.4%) in studies in which the majority did not have an intellectual disability and the mean age was <12 years at follow-up, and 23.7% (95% CI 17.5-30.5%) in studies in which the majority did have an intellectual disability and the mean age at follow-up was more than 12 years. The pooled estimate for the standardized mortality ratio was 2.8 (95% CI 1.8-4.2). The prevalence of epilepsy is higher among the population with ASD than in the general population. People with ASD have a higher risk of mortality than the general population. This has important health promotion implications.
    Developmental Medicine & Child Neurology 02/2012; 54(4):306-12. · 2.68 Impact Factor
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    ABSTRACT: Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disorders, ranging in severity and characterised by early onset of delay and deviance in the development of social interaction, and verbal and nonverbal communication. ASD is associated with restricted and/or stereotyped interests or behaviours. Tricyclic antidepressants (TCAs) block noradrenaline and serotonin reuptake, increasing the availability of these neurotransmitters in the central nervous system. Via their impact on serotonin, TCAs have been used in the treatment of autistic symptoms and comorbidities in individuals with ASD. To determine if treatment with tricyclic antidepressants:1) improves the core features of autism, including restricted social interaction, restricted communication, and stereotypical and repetitive behaviours; 2) improves non-core features such as challenging behaviours; 3) improves comorbid states, such as depression and anxiety; 4) causes adverse effects. We ran the latest searches for this review on 23 May 2011. We searched: Cochrane Central Register of Controlled Trials (CENTRAL), 2011 Issue 2, MEDLINE (1948 to May Week 2, 2011), EMBASE (1980 to 2011 Week 2), PsycINFO (1887 to current), CINAHL (1937 to current). We also searched Dissertation Abstracts International via Dissertation Express, and the metaRegister of Controlled Trials. Randomised controlled trials of any dose, duration and frequency of oral TCAs compared with placebo, in children and adolescents with a diagnosis of ASD, where at least one standardised outcome measure had been used. Two review authors independently selected and appraised the studies for inclusion and risk of bias. All data were continuous. Three studies met the inclusion criteria for this review. Two studies used clomipramine and one used tianeptine. All three trials were small, with between 12 and 32 participants. One of the clomipramine trials involved children and young adults, while the other two trials enrolled only children. Due to heterogeneity in study participant characteristics, the TCA medications investigated and the outcome measures used, we were not able to perform any meta-analysis.In only one of the three studies was there any indication that giving children tianeptine could be effective in the short term. In this study, parents and teachers reported that it reduced irritability, hyperactivity, inadequate eye contact and inappropriate speech, but clinician ratings found no significant impact on these symptoms. There were also significant adverse effects, including increased drowsiness and reduced activity levels in these individuals while being treated with tianeptine. The evidence of the impact of clomipramine in the two studies is contradictory. There was evidence of improvement in autistic symptoms, irritability and obsessive-compulsive disorder type symptoms, but conflicting evidence in relation to hyperactivity across the two studies, and no significant changes found with inappropriate speech. There were also adverse effects reported with the use of clomipramine. Although side effect ratings were not significantly different to placebo, there were significant dropout rates in the clomipramine arm of one study. Clinicians considering the use of TCAs need to be aware of the limited and conflicting evidence of effect and the side effect profile when discussing this treatment option with people who have ASD and their carers. Further research is required before TCAs can be recommended for treatment of individuals with ASD.
    Cochrane database of systematic reviews (Online) 01/2012; 3:CD008372. · 5.70 Impact Factor
  • Katrina Williams, John A Wray, Danielle M Wheeler
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    ABSTRACT: In 1998 secretin, a gastrointestinal hormone, was suggested as an effective treatment for autism spectrum disorders (ASD) based on anecdotal evidence. To assess whether intravenous secretin improves the core features of ASD, other aspects of behaviour or function such as self-injurious behaviour, and the quality of life of affected individuals and their carers. We also assessed whether secretin causes harm. This is an updated version of our review of this topic originally published in 2005. We searched CENTRAL (2010 Issue 1), MEDLINE (1950 to January 2010) , EMBASE (1980 to 2010 Week 2), PsycINFO (1806 to 2010 Week 2), CINAHL (1938 to January 2010), ERIC (1966 to January 2010), Sociological Abstracts (1952 to January 2010). Sociofile and HealthStar were searched in March 2005 when this review was first published, but were not available for this update. Records were limited to studies published since 1998 as this is when secretin was first proposed as a possible treatment for ASD. We searched reference lists of trials and reviews; we also contacted experts and trialists to find unpublished studies. Randomised controlled trials of intravenous secretin compared to a placebo treatment in children or adults diagnosed with ASD, where at least one standardised outcome measure was reported. Sixteen studies met the inclusion criteria but for two of these, conducted by Repligen, the only available multisite data were reported in press releases. All outcome data from the other 14 trials were continuous. Where trials used cross-over designs, we conducted analysis on results from the first treatment phase. Where mean change from baseline was reported, we used this in preference to post-treatment scores for meta-analyses or forest plots. Meta-analysis was able to be attempted for only one outcome (Childhood Autism Rating Scale). Insufficient data were available to conduct sensitivity or subgroup analyses to assess the impact of study quality, clinical differences in the intervention or clinically relevant differences between groups, such as age or presence of gastrointestinal symptoms. Over 900 children were recruited for the secretin trials. Twenty-five established standardised outcome measures were reported to assess core features of ASD, communication, behaviour, visuospatial skills, affect and adverse events. One standardised measure of global impression was also used. No more than four studies used any one outcome measure similarly. When duration from the start of the intervention to outcome assessment was known, outcomes were reported at between three and six weeks. Meta-analysis of data was not possible but there is now consistency of findings, with RCTs of the efficacy of secretin in autism not showing improvements for core features of ASD. There is no evidence that single or multiple dose intravenous secretin is effective and as such currently it should not be recommended or administered as a treatment for ASD. Further experimental assessment of secretin's effectiveness for ASD can only be justified if there is new high-quality and replicated scientific evidence that either finds that secretin has a role in neurotransmission in a way that could benefit all children with ASD or identifies important subgroups of children with ASD who could benefit from secretin because of a proven link between the action of secretin and the known cause of their ASD, or the type of problems they are experiencing.
    Cochrane database of systematic reviews (Online) 01/2012; 4:CD003495. · 5.70 Impact Factor

Publication Stats

193 Citations
100.56 Total Impact Points

Institutions

  • 2012–2014
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
    • The Royal Children's Hospital
      • Department of Developmental Medicine
      Melbourne, Victoria, Australia
    • University of Alberta
      • Department of Pediatrics
      Edmonton, Alberta, Canada
    • Stanford University
      • Division of Infectious Diseases
      Stanford, CA, United States
  • 2011–2014
    • University of Melbourne
      • Department of Paediatrics
      Melbourne, Victoria, Australia
  • 2008–2013
    • Sydney Children's Hospital
      Sydney, New South Wales, Australia
    • The New South Wales Department of Health
      Sydney, New South Wales, Australia
  • 2010–2012
    • University of New South Wales
      Kensington, New South Wales, Australia
  • 2005–2011
    • Children's Hospital at Westmead
      • • Centre for Kidney Research (Clinical)
      • • Children's Hospital at Westmead Clinical School
      Sydney, New South Wales, Australia