Children's Mental Health Research Quarterly

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Promoting positive behaviour in children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2015
Abstract: 

Background: For some children challenging behaviours, including defiance and aggression, start to impede their development and well-being. We set out to determine whether early interventions could assist these young people.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for preventing child behaviour disorders, including oppositional defiant disorder and conduct disorder. Applying our inclusion criteria to the 166 studies identified from our searches, we accepted 13 RCTs.

Results: We found five programs — Chicago Parent Program, Fast Track, Incredible Years, Nurse-Family Partnership, and Parent Management Training — that had positive behavioural outcomes. All either focused primarily on parenting or included parents to a substantial degree. Additionally, Fast Track and Nurse-Family Partnership were also shown to be cost-effective.

Conclusions: It is possible to avert behavioural problems early in a child’s development before they become entrenched. Doing so comes with substantial long-term benefits to children, families and society.

Helping children with behaviour problems

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016
Abstract: 

Background: An estimated 2.4% of children experience oppositional defiant disorder (ODD), which is characterized by argumentative behaviours and frequent losses of temper. Conduct disorder (CD), which includes aggression and other serious rule violations, affects approximately 2.1% of young people. 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 behavioural disorders. Applying our inclusion criteria to the 82 studies identified from our searches, we accepted eight RCTs.

Results: We identified one parenting program — Incredible Years — that reduced ODD diagnoses. We also found two programs child and family programs that were effective. Project Support reduced CD/ODD diagnosis while Multidimensional Treatment Foster Care reduced symptoms of delinquency. While the medication quetiapine reduced behaviour problems, it was associated with significant side effects.

Conclusions: Given the effectiveness of psychosocial interventions in addressing clinically significant behaviour problems, they should always be offered to families first. Interventions need to include parents and teach effective parenting techniques, such as paying attention to good behaviour as well as using praise and rewards. Medication should be used as a last resort for children with behavioural disorders.

Preventing anxiety for children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016
Abstract: 

Background: Anxiety disorders area the most common mental health concern that young people experience. Because of the frequency of these disorders and the considerable distress they cause, effective prevention efforts are greatly needed.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for preventing anxiety disorders in children and youth. Applying our inclusion criteria to the 57 studies identified from our searches, we accepted five RCTs.

Results: Our review found two Cognitive-Behavioural Therapy (CBT) based interventions that successfully prevented anxiety disorders: Coping and Promoting Strength and Dutch Anxiety Prevention. These findings add to the well-established body of evidence showing the effectiveness of CBT in preventing childhood anxiety disorders.

Conclusions: CBT should be the first choice for preventing childhood anxiety. By expanding prevention efforts, more young people can be reached before anxiety disorder develop and well before these disorders become needlessly entrenched.

Helping childhood with anxiety

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016
Abstract: 

Background: Approximately 3% of children meet diagnostic criteria for an anxiety disorder. There are effective interventions to help these young people.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for children and youth with anxiety disorders. Applying our inclusion criteria to the 95 studies identified from our searches, we accepted nine RCTs.

Results: Our review found a strong body of evidence indicating that Cognitive-Behavioural Therapy (CBT) is effective in treating childhood anxiety disorders. We identified eight CBT programs that reduced child anxiety diagnosis or disorder severity including: Cool Kids, Coping Cat, Friends, One-Session Treatment, Parent Education Program, Skills for Academic and Social Success, Strongest Families and Timid to Tiger.  We also found two medications – venlafaxine and sertraline – that reduced diagnosis; both, however, produced significant side effects.

Conclusions: CBT should be the first choice for treating childhood anxiety. CBT has proven evidence of success in treating all types of anxiety disorders among children as young as three. Medications should only be considered when children have not benefitted from CBT. When medications are used, they require ongoing monitoring.

Promoting self-regulation and preventing ADHD symptoms

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2016
Abstract: 

Background: Some children experience challenges with self-regulation and begin to display symptoms of attention-deficit/hyperactivity disorder (ADHD). We set out to determine whether early interventions could assist these young people.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for preventing ADHD symptoms. Applying our inclusion criteria to the 90 studies identified from our searches, we accepted nine RCTs.

Results: We found four programs — Legacy for Children, Incredible Years, Incredible Years + Child Literacy Program, and SAFE Children — that prevented one or more symptoms of ADHD. All focused on parents of young, at-risk children, teaching them skills to promote positive child development. 

Conclusions: It is possible to prevent ADHD symptoms and promote children’s self-regulation skills. Effective programs should be offer during the preschool and early school years to help avert symptoms from they become entrenched.

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.