Children's Health Policy Centre

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The Children's Health Policy Centre is an interdisciplinary research group in the Faculty of Health Sciences at Simon Fraser University. It focuses on improving social and emotional wellbeing for all children, and on the public policies needed to reach these goals. Its work complements the mission of the Faculty of Health Sciences to advance the health of populations locally, nationally and globally.

Helping children with ADHD

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2017
Abstract: 

Background: An estimated 2.5% of children experience attention-deficit/hyperactivity disorder (ADHD). Effective interventions can substantially improve the wellbeing of these young people.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for children with ADHD. Applying our inclusion criteria to the 88 studies identified from our searches, we accepted six RCTs.

Results: Substantial research supports the effectiveness of parent training interventions — which teach positive behavioural strategies — for treating childhood ADHD. The evidence supporting child Cognitive-Behavioural Therapy (CBT) and Behavioural Therapy (BT) is also particularly strong, spanning many studies. Positive evidence on Neurofeedback is also starting to emerge. The medications methylphenidate, dextroamphetamine and atomoxetine all have strong evidence of success over multiple RCTs. Two RCTs on guanfacine showed some evidence of success; however, both had significant ties to the drug’s manufacturer.

Conclusions: For childhood ADHD, practitioners can offer a range of good options, such as parent training as well as child CBT and behavior therapy. These psychosocial treatments have the benefit of showing benefits months after the intervention ends. Still, some children may require appropriate medications to effectively manage their ADHD. Any young person prescribed a medication for ADHD needs regular monitoring for both benefits and side effects.

Supporting LGBTQ+ youth

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2017
Abstract: 

Background: Young people who are lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) often face added challenges growing up, including homelessness, violence and an unequal burden of mental health concerns. Consequently, there is a strong need to intervene to ensure these inequities are addressed.

Methods: We used systematic review methods to identify studies assessing interventions aimed at supporting LGBTQ+ youth. Applying our inclusion criteria to the 22 studies identified from our searches, we accepted five observational studies.

Results: Many schools in North America are implementing positive practices and policies to support LGBTQ+ youth. Effective interventions include supporting gay-straight alliances, enacting policies against homophobic bullying, and training staff.

Conclusions: When discrimination against LGBTQ+ youth is addressed, there can be many positive benefits, including reduced substance use, suicidal ideation and suicide attempts by LBGTQ+ youth. Gay-straight alliances and policies against homophobic bullying may have benefits that extend beyond LGBTQ+ youth, including reducing drinking for all students. By encouraging and supporting LGBTQ+ youth, practitioners and policy-makers can assist all young people, regardless of gender identity or sexual orientation.

Preventing childhood depression

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2017
Abstract: 

Background: There is substantial evidence that many cases of childhood depression can be prevented with effective interventions.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for depressed children and youth. Applying our inclusion criteria to the 81 studies identified from our searches, we accepted seven RCTs.

Results: Our review found a strong body of evidence indicating that Cognitive-Behavioural Therapy (CBT) is effective in preventing childhood depression. We identified six CBT preventive interventions that proved successful in rigorous evaluations. They included the programs Coping with Stress, Family Group CBT, Icelandic Prevention, Taking Action, and Teen Talk and the book Feeling Good. Interpersonal Therapy also proved successful.

Conclusions: CBT should be the first choice for preventing childhood depression. Notably, all the successful prevention programs were delivered in groups, making it possible to reach many more youth than with individual interventions. As well, among the effective CBT programs with documented success in preventing depression in adolescents, the CBT-based Coping with Stress stood out, with three rigorous RCTs showing the program prevents depression.

Helping children with depression

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2017
Abstract: 

Background: For children who develop depression, timely and effective treatments are essential — to minimize both symptoms and distress, and to help them return to healthy lives.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for depressed children and youth. Applying our inclusion criteria to the 99 studies identified from our searches, we accepted 14 RCTs.

Results: Cognitive-Behavioural Therapy (CBT) stood out as a robust treatment for childhood depression, whether delivered individually, in groups, or by computer. As well, the medications clomipramine, escitalopram and fluoxetine reduced symptoms but were also associated with significant side effects.  

Conclusions: Strong evidence suggests CBT is the best among the psychosocial interventions for depression and comes with no side effects. All children with depression should offered this intervention. Among the medications, the evidence is most robust for fluoxetine. Any young person prescribed an antidepressant needs regular monitoring for both benefits and side effects.

Preventing problematic substance use among youth

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019
Abstract: 

Background: Risk and protective factors for substance use disorders do not occur equally among young people. We identify factors that influence the development of substance use disorders as well as programs with the best potential for helping young people at risk.    

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions aimed to prevent problematic substance use among at-risk youth. Applying our inclusion criteria to the 82 studies identified from our searches, we accepted six RCTs evaluating five prevention interventions.

Results: Three programs made a significant impact on substance use. CHAT reduced the negative consequences of young people’s alcohol and cannabis use. Middle School Success reduced the frequency of girls’ cannabis use. Across the two Preventure RCTs, the program reduced alcohol use and binge drinking frequency, drug use frequency and number of drugs used as well as alcohol use problems. In contrast, Brief Intervention and Strengthening Families did not have a significant impact on substance use. 

Conclusions: Even though many young people experiment with alcohol or cannabis, most do not develop problematic use. For those who are at-risk for their use escalating, there are effective interventions to curtail substance use. Moreover, by investing in effective prevention programs, unnecessary costs for young people, their families and society can be avoided.

Preventing youth substance misuse: Programs that work in schools

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: Substance misuse comes with great costs for individuals and for society, including compromised mental and physical health, loss of productivity, reduced quality of life, increased justice and health care costs, and even premature disability and death. The most effective and humane way to avert these costs is to prevent substance misuse from occurring by intervening early with young people.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating school-based interventions designed to prevent adolescent substance.  Applying our inclusion criteria to the 152 studies identified from our searches, we accepted eight RCTs.

Results: Two programs — Unplugged and Project PATHS — showed success in preventing substance misuse. Unplugged provided youth with information on the effects of substances and taught them skills, including being assertive and resisting peer pressure. Project PATHS focused on positive adolescent development by teaching problem-solving and building family relationships. Both programs were delivered by teachers.

Conclusions: Compelling evidence shows that substance misuse prevention programs can be successfully delivered in schools by school staff. By investing in these programs, it is possible to avert needless suffering.

Treating substance misuse in young people

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: At any given time, an estimated 2.4% of Canadian youth use alcohol or drugs at a level that qualifies for a substance use disorder diagnosis, with alcohol and cannabis problems being the most common. Given that substance use disorders take a tremendous toll on young people and can become entrenched, effective interventions need to be provided early in life.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to treat adolescent substance use disorders.  Applying our inclusion criteria to the 104 studies identified from our searches, we accepted eight RCTs.

Results: The following seven community-based treatments showed evidence of success: Adolescent Cannabis Check-Up, Case Management, Cognitive Behavioural Therapy (CBT), Community Reinforcement, Ecologically Based Family Therapy, Motivational Interviewing and Multidimensional Family Therapy. Of these, CBT, Multidimensional Family Therapy and Motivational Interviewing had particularly strong evidence of effectiveness, with positive outcomes from multiple RCTs.

Conclusions: There are many effective interventions for treating youth substance misuse. By intervening at this early point in the lifespan, it is possible to avert far more serious problems later in life.

Preventing child maltreatment

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: All children need safety, stability and nurturing in order to flourish. Yet many children experience maltreatment, including neglect, emotional abuse, exposure to intimate partner violence, physical abuse or sexual abuse. Consequently, effective interventions to prevent maltreatment are crucial.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to prevent child maltreatment.  Applying our inclusion criteria to the 43 studies identified from our searches, we accepted three RCTs.

Results: We found strong evidence showing two programs — Child FIRST and Nurse-Family Partnership (NFP) — were successful in preventing child maltreatment. NFP, which targets key risk factors for maltreatment, including socio-economic disadvantage resulted particularly strong benefits, including reducing families’ involvement with child protective services as well as reducing child behaviour problems and improving mothers’ life circumstances. 

Conclusions: The success of NFP and Child FIRST provides evidence that child maltreatment can be prevented.

Helping children who have been maltreated

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2018
Abstract: 

Background: Child maltreatment is an avoidable form of adversity that puts children at risk for negative mental health and life course outcomes making prevention imperative. Nevertheless, when maltreatment has occurred, interventions can help reduce harm for children while also supporting parents.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for children who have been maltreated. Applying our inclusion criteria to the 68 studies identified from our searches, we accepted seven RCTs.

Results: Six interventions showed benefits. Promoting First Relationships reduced child apprehensions due to maltreatment and improved children’s behaviour and emotional responses. Child-Parent Psychotherapy increased children’s “secure attachment” to their mothers and improved their behaviour. Project Support reduced physical abuse among children exposed to intimate partner violence and improved children’s behaviour and emotional well-being. Multisystemic Therapy reduced re-abuse and out-of-home placements; it also reduced child posttraumatic stress, dissociation, and other emotional and behavioural problems. Fostering Healthy Futures reduced placement changes as well as child dissociation and emotional distress. Finally, It’s My Turn Now reduced children’s posttraumatic stress symptoms.

Conclusions: The best way to help children flourish is to support families to meet children’s basic needs, including preventing maltreatment. When children have been mistreated, practitioners should intervene before mental health symptoms develop given that emotional or behavioural problems can be prevented. Finally, children who have been maltreated and then develop emotional or behavioural symptoms need to receive effective interventions as quickly as possible.

Helping youth with bipolar disorder

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019
Abstract: 

Background: Although bipolar disorder is rare in young people, effective treatments are critical for those experiencing it.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for youth with bipolar disorder. Applying our inclusion criteria to the 50 studies identified from our searches, we accepted 12 RCTs.

Results: Among the five medications assessed, aripiprazole and lithium stood out. Aripiprazole significantly reduced disorder severity and manic symptoms while improving overall functioning. Lithium also reduced manic symptoms while improving overall functioning. Still, both had significant side effects. Among the three psychosocial interventions assessed — Multifamily Psychoeducational Psychotherapy, Child and Family-Focused Cognitive-Behavioural Therapy, and Family-Focused Therapy — all showed benefit. In contrast, the dietary supplement flax oil was not effective.

Conclusions: Most young people with bipolar disorder will need medication to manage this condition. Aripiprazole and lithium should be considered first, given their effectiveness and their regulatory approval. The three effective psychosocial treatments should also be considered as an adjunct to medication.