Children's Mental Health Research Quarterly

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Children's mental health: The numbers and the needs

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2022-05
Abstract: 

Background: Estimates of the number of children affected by mental disorders and the percent of them receiving treatment interventions are essential to guide planning for public mental health services.

Methods: We interpret findings from our recent systematic review and meta-analysis on the prevalence and impact of childhood mental disorders.

Results: We identified 14 high-quality epidemiological studies meeting all of our inclusion criteria, including representative sampling and use of rigorous diagnostic measures. This resulted in the inclusion of nearly 62,000 children aged four to 18 years from 11 high-income countries. Our meta-analysis found that 12.7% of children met diagnostic criteria for a mental disorder at any given time. Additionally, our analysis found that among children with mental disorders, only 44.2% received any services for these conditions.

Conclusions: Data show that there are serious mental health service shortfalls which represent a violation of children’s rights and prevent children from flourishing. We present a population health strategy to help address these deficits.

Document type: 
Article

Helping children with obsessive-compulsive disorder

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2022
Abstract: 

Background: An estimated 0.3% of children meet diagnostic criteria for obsessive-compulsive disorder (OCD) at any given time and are in need of treatment. Our previous systematic review, conducted nearly a decade ago, identified cognitive-behavioural therapy (CBT), fluoxetine and sertraline as effective interventions. We set out to update our review to identify any additional interventions for treating childhood OCD.

Methods:  We used systematic review methods to find recently published randomized controlled trials (RCTs) evaluating treatments for childhood OCD. We accepted 12 new RCTs, assessing both psychosocial interventions and medications, including innovative ways of delivering CBT.

Results: There is strong evidence for using a variety of forms of CBT to treat childhood OCD, including in person with children alone and with their families as well as by phone or online. Positive Family Interaction Therapy also proved to be a helpful supplement to CBT among families with indicators predictive of a limited response to CBT alone. In contrast, the medications riluzole and d-cycloserine failed to produce benefits.

Conclusions: All children diagnosed with OCD need timely access to effective treatment. CBT should be a starting point for treatment, with fluoxetine and sertraline being considered with careful monitoring when CBT does not succeed.

Childhood bullying: Time to stop

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Childhood bullying can lead to serious consequences, including subsequent mental health problems such as anxiety, depression and suicidality. We therefore set out to identify if there were any effective antibullying programs.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating antibullying programs for children. After applying our rigorous inclusion criteria, we accepted eight RCTs – evaluating six school-based programs and two clinic-based interventions.

Results: Four school-based programs – Youth Matters, Roots of Empathy, Bullies and Dolls, and Media Heroes – were successful at reducing at least one form of bullying. Integrative Family Therapy, a clinical intervention, was also effective at reducing bullying by teenage boys.

Conclusions: There are effective antibullying interventions that can be delivered in elementary, middle and secondary schools. So programs can start early, reaching more children to prevent the harms that come with bullying. Additionally, some young people may benefit from the help of a mental health practitioner to address bullying and other aggressive behaviours.

Fighting racism

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Racism has a profound impact on children well-being. In fact, researchers have found links between experiencing racial discrimination and mental health concerns, including depression, anxiety and conduct problems. We therefore set out to identify effective interventions for reducing racism in children.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating interventions to reduce racism. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating 11 interventions.

Results: Two interventions showed promising outcomes. Books that recounted close friendships between non-refugee and refugee children resulted in children having more positive attitudes towards refugees.  As well, history lessons focused on Black American’s contributions to society and their experiences of racism resulted in children having more positive attitudes towards Black people and increased their valuing of racial fairness. 

Conclusions: Two brief interventions had a positive impact on children’s attitudes towards people of colour. They offer a helpful starting point for ongoing efforts to create more equitable experiences for all children. 

File(s): 

Treating posttraumatic stress disorder in children

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Posttraumatic stress disorder (PTSD) affects approximately 0.1% of children who have been exposed to serious adversities. We therefore set out to identify effective interventions for treating childhood PTSD.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions for children who had diagnosed with PTSD. After applying our rigorous inclusion criteria, we accepted five RCTs – evaluating three psychosocial interventions and one medication.

Results: Prolonged Exposure for Adolescents and KIDNET, both based on cognitive-behavioural therapy (CBT), showed significant benefits for children, including reduction of PTSD diagnoses, symptoms, and overall functioning compared to controls. In contrast, D-cycloserine failed to show benefit for children compared to controls. In a head-to-head trial, Eye Movement Desensitization and Reprocessing (EMDR) and CBT both reduced PTSD diagnoses and symptoms, with EMDR outperforming CBT in reducing diagnoses by parent-report at one-year follow-up.

Conclusions: Preventing childhood adversities is priority. But when a child develops PTSD, access to effective treatment is crucial. CBT was effective in reducing diagnoses and/or symptoms across four RCTs in our systematic review. 

File(s): 

Helping children cope with trauma

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021
Abstract: 

Background: Experiencing adverse experiences during childhood can lead to the development of mental disorders. We therefore set out to identify that effectively help children who have experienced trauma.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating prevention interventions for children after serious adverse experiences. After applying our rigorous inclusion criteria, we accepted five RCTs – evaluating three psychosocial interventions delivered to children who had been maltreated, and one medication for children who had sustained physical injuries.

Results: It’s My Turn Now, Fostering Healthy Futures, and Multisystemic Therapy showed benefits for children who had a history of maltreatment, including reducing symptoms of mental disorders. In contrast, Propranolol failed to show benefit for children who had sustained injuries.

Conclusions: Preventing childhood adversities wherever possible is crucial and recognizes children’s rights to safety. Yet it is possible to prevent mental health symptoms from developing even after children have experienced serious adversity.

Helping young people with psychosis

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Psychotic disorders are associated with a high degree of impairment making early intervention crucial for youth. We therefore set out to identify effective psychosis interventions for young people.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating treatment interventions. After applying our rigorous inclusion criteria, we accepted eight RCTs – evaluating five different medications and three psychosocial interventions.

Results: Aripiprazole and olanzapine showed benefits in two trials each, although both led to adverse events that require close monitoring. Cognitive Remediation Therapy, Computer-Assisted Cognitive Remediation and the Think Program showed secondary benefits of improved cognitive skills and reduced emergency room visits which can be helpful when used along with antipsychotic medications.

Conclusions: Antipsychotics should be used prudently, after careful assessment and diagnosis, and psychosocial interventions should be offered as well. Further research is needed on early interventions to help young people with psychosis.

Psychosis: Is prevention possible?

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Controversy persists about whether or not it is possible to prevent psychotic disorders. We set out to identify if there were any effective interventions that prevent psychosis among youth.

Methods: We used systematic review methods to identify randomized controlled trials (RCTs) evaluating prevention interventions. After applying our rigorous inclusion criteria, we accepted three RCTs –  evaluating one supplement and two psychosocial interventions with youth found to be at high-risk for psychosis.

Results: Omega-3 polyunsaturated fatty acid (PUFA) supplements reduced psychosis diagnoses and symptoms use and improved overall functioning over six years follow-up. Two other interventions – Auditory Cognitive Training and Family-Focused Treatment – did not produce significant benefits post-intervention.

Conclusions: More studies are needed to replicate results for PUFAs. As well, additional research is needed to develop psychosocial interventions that may help high-risk youth. Given the high burdens and costs associated with psychosis, prevention remains an important goal for youth and families.

Mental health treatment: Reaching more kids

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Nearly 70% of children who are in need of specialized mental health services do not access them. We set out to identify effective self-delivered interventions as a way to help bridge the gap between those in need and those being serviced.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating self-delivered treatments. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating five treatment interventions.

Results: Three self-directed family interventions reduced anxiety diagnoses and symptoms for school age children. One self-directed parenting intervention reduced ADHD diagnoses for school age children. Additionally, one self-directed youth invention reduced depression symptoms for adolescents.

Conclusions: Strong research evidence supports the use of self-directed treatments to address three common childhood mental disorders. Greater use of these interventions can expand the number of children who are reached with effective treatments.

Prevention: Reaching more kids

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2020
Abstract: 

Background: Effective prevention programs are particularly crucial to reduce the number of children in need of mental health treatment services. Yet despite growing research evidence on effective programs, prevention efforts remain modest in many jurisdictions.  Given the high levels of unmet needs, reaching more children is a priority. One approach is to identify prevention options that are more self-directed and less reliant on direct provision by practitioners, such as online programming and self-help tools.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating self-directed prevention interventions. Applying our inclusion criteria, we accepted eight RCTs evaluating seven prevention interventions.

Results: The seven self-directed interventions prevented or reduce symptoms of the five most common childhood mental concerns — anxiety, ADHD, problematic substance use, behaviour problems and depression. These interventions assisted children and youth across a range of ages, from the preschool years to the teens.

Conclusions: Strong research evidence supports the use of self-directed prevention interventions as part of the continuum of care for the most common childhood mental health concerns. Including these types of interventions in overall service planning can enable providers to reach many more children, youth and families, in turn potentially lowering the need for treatment. Comprehensive children’s mental health plans should therefore include these kinds of prevention programs.