Highlights in child mental health research: July 2022

Highlights

• A systematic review was conducted to identify the evidence-based protective factors related to resilience among children, adolescents and young adults at risk of several exposures (such as traumatic experiences, victim of violence, poverty, substance abuse, mental health problems, immigrant or criminal behaviour).
• In this paper, resilience is described as the capacity to cope with adversity in contexts of high risk or difficulties.
• Based on the identified protective factors, the authors developed the “Individual and Environmental Resilience Model”. This model describes the protective facts that mitigate negative outcomes in the face of adverse events.

Key findings

• 31 qualitative, quantitative and mixed methods studies were included in the review. It included studies from several countries and one from Australia. Population groups included children and young people from 7-24 years of age.
• Over 60 protective factors were identified. These were categorised into domains under the two identified dimensions of resilience: Individual skills and Environmental.
• The five domains under Environmental included: cultural, community, school, peers and family.
• The five domains of Individual skills included emotional, behavioural, cognitive, biological and communication.

Implications

• This research has synthesised existing research on the topic of resilience, which is often described as an important factor in child mental health.
• It also provides a theoretical framework to explore what specific factors in relation to resilience are protective and can be drawn upon when developing strength-based initiatives and intervention for young people at risk.

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Highlights

• Anxiety disorders are among the most commonly reported mental health problems in children and young people. Child focussed cognitive behavioural therapy (CBT) is an effective treatment for child anxiety, however this level of intervention is time and resource intensive.
• This systematic review and meta-analysis aimed to investigate the efficacy of parent-only interventions in reducing symptoms of anxiety disorders in school-aged children.

Key findings

• 29 papers were included in the review. Seven papers were from Australia or included Australian participants. 23 of the studies evaluated a CBT intervention directed at parents.
• There was significant improvement in anxiety symptoms with parent-only interventions compared to a ‘control’ group of children with anxiety who are on the waitlist for treatment.
• There was no significant difference in anxiety outcomes when comparing parent only with parent-child, or child-only interventions, anxiety symptoms were reduced in all intervention types.
• There was a difference between how parents and children reported mental health outcomes as a result of the treatment. A significant treatment effect was only found for parent-rated outcomes.
• Parent-only interventions may be effective in reducing symptoms of child anxiety disorders, with improvements in symptoms generally maintained at follow up. However, no clear evidence was found for a superior type, duration or format of intervention.

Implications

• The findings suggest that efficient, low intensity interventions delivered to parents may lead to positive outcomes for children.
• Although the study found an improvement in symptoms of anxiety with treatment when compared to control groups, the findings suggest there can be a difference between what the parents perceive as an improvement in the child’s mental health compared to the child.
• This may be a particularly important alternative to resource and time intensive child-focused cognitive behavioural therapy (CBT).

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Highlights

• Children with a refugee background have been documented to have higher levels of depression.
• This article highlights the factors that improve outcomes for refugee children and the risk and protective factors for depression based on the literature.
  

Key findings

• Ten of the 16 studies included for qualitative synthesis showed a significant reduction in depression symptomology. One of the included studies was Australian.
• Interventions included those that address the individual context (e.g. narrative exposure therapy), address the family context and address the community context (e.g. at health care centre, community centre or at schools).
• Coping strategies were considered protective against the development of depressive symptoms at the individual level. Risk factors for depressive symptoms included: child sex (males experienced higher levels of stressful events, females experienced higher rates of depression), age (older children at higher risk of depression), genetics and poor nutrition.
• At the family level, family instability, caregiver mental health, and caregiver education and literacy were all risk factors, whilst family stability and unity were protective factors.
• At the community level, risk factors included exposure to violence in their community of origin or new community and acculturation stress factors. Protective factors included participation in community activities and social support outside of the family.
• Major findings suggest that interventions including caregivers, involving the child’s community, addressing multiple contexts, and that are culturally informed may improve outcomes.

Implications

• Implementation of interventions within school systems provides an effective environment to foster several protective factors and implement interventions across contexts.
• Social support and connectedness reoccur as a protective factor across contexts and as an effective means to decrease depression in refugee youth.
• Due to the unique experiences of refugee children, practitioners should seek out culturally appropriate and contextually adapted interventions to address depression in refugee children.
• Interventions that address multiple contexts demonstrate effectiveness in reducing depression. Practitioners should consider intervening at different ecological levels (individual, family and community)
• Service providers should facilitate accessibility of external resources for caregivers to bolster their well-being and thereby improve depressive symptoms for refugee children.

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Highlights

• Disruptive behaviour problems are a frequent reason for children’s referrals to psychological services and can have negative effects on social and academic
• This randomised control study, based in Iceland, looks at the effects of ‘Tuning Your Temper’, a brief cognitive behavioural program on children with disruptive behaviour problems. It finds that the program is a promising early intervention program for managing disruptive behaviour problems at school.

Key findings

• The intervention ‘Tuning Your Temper’ consists of six, weekly 60 minute sessions focussing on children recognising their emotional reactions, learning behavioural ways to control emotional reactions and overcoming hostile attribution bias and greater awareness of environmental cues. These sessions were delivered by a clinical psychologist.
• Students were included in the study if they had previously been referred to psychological services due to verbal/physical aggression, noncompliance, temper outbursts or frequent conflicts with peers.
• 125 six- to eleven-year-old school students with disruptive behaviour problems were either assigned to the intervention or put on the waitlist (which acted as a control group).
• Assessments included teacher and parent ratings on the Strengths and Difficulties Questionnaire (SDQ) and the Disruptive Behaviour Rating Scale (DBRS) pre- and post-treatment and at 6-month follow-up.
• Results showed a significant reduction in behaviour problems for the group that undertook the intervention on both the SDQ and DBRS scales and effects were maintained at 6-month follow-up.
  

Implications

• This study found that the ‘Tuning Your Temper’ program can be effective in reducing disruptive behaviours in children in classrooms. This aligned with previous research on using problem solving, arousal reduction and cognitive strategies to reduce aggression and externalising behaviours in children.
• Practitioners can consider working with schools to deliver the program to children.

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