Highlights in child mental health research: March 2025

This month’s highlights include:

Strength-based programs for youth at risk of toxic stress

This international scoping review describes strengths-based programs for youth at risk of toxic stress. Included programs that targeted mental health or substance use outcomes by focusing on improving family functioning and/or parenting skills. The review found that family-focused interventions improved communication and reduced family conflict. It also found that using culturally responsive interventions is essential when working with Indigenous populations.

The protective role of community cohesion across rural and urban contexts for youth mental health

This study used data from a longitudinal study on youth development in the United States. It investigated the role of community cohesion in rural and urban areas as a protective factor for youth mental wellbeing. Community cohesion was found to reduce rule-breaking and aggressive behaviour. Results suggest that community cohesion is a significant protective factor for youth experiencing neighbourhood socio-economic disadvantage in urban areas.

Risk factors for suicidality in children with Fetal Alcohol Spectrum Disorder (FASD) in Western Australia

This paper reported on a retrospective study of participants in Western Australia who met the diagnostic criteria for FASD and were aged between 5 and 21 years. Data on experiences of suicidality were collected, along with medical diagnoses. It found that the risk of suicidality is four times higher in young people who are diagnosed with both FASD and depression, compared to those with only FASD. A comorbid diagnosis of attention-deficit hyperactivity disorder (ADHD) was also common in young people with FASD.

A cohort profile of children with neurodevelopmental problems and their families

This paper reported on a longitudinal Australian study of children with neurodevelopmental issues. The study examined the frequency of co-occurring conditions such as depression and anxiety, as well as dual diagnoses of autism and ADHD. They found that autism and ADHD dual diagnoses are common, with 51% of participants having two or more neurodevelopmental conditions. 77% of children were also experiencing mental health symptoms. Over a third of parents in the study had also received a diagnosis for a mental health condition.

Why is this important?

• Extended exposure to trauma or adverse childhood experiences (also known as toxic stress) during childhood (ages 0–17 years) can negatively impact young peoples’ short- and long-term health and social outcomes.
• Positive relationships with caregivers can protect against or limit the negative impact of these events on youth development. Positive relationships can also contribute to young people’s resilience and positive emotional wellbeing.
• This scoping review describes strengths-based programs for youth at risk of toxic stress. Included programs targeted mental health or substance use outcomes by aiming to improve family functioning and/or parenting skills.

What did they do?

• The scoping review identified and included 33 articles and programs, made up of 25 research studies and eight descriptive papers. Programs predominantly employed behavioural frameworks with varying duration and caregiver involvement. Most studies targeted mental health outcomes.
• The studies included programs for youth between the ages of 12 and 24 years.
• The programs were delivered primarily in the United States, though included studies were also conducted in Sweden, Australia and the UK.

What did they find?

• Behavioural frameworks were commonly used across the reviewed programs (52%). Evidence supports using multiple frameworks (such as behavioural, resilience, developmental-based, social and systemic frameworks) for youth at risk of toxic stress.
• Programs included in the review consistently reported mental health improvements. However, limited outcomes could be reported on substance-use outcomes given the low representation of programs focusing on this issue.
• Family-focused interventions demonstrated improved family communication and significant reduction in family conflict. Programs focusing on family functioning and parenting skills also reported increased resilience and positive developmental outcomes.
• Culturally responsive interventions for Aboriginal and Torres Strait Islander populations are needed to improve healing and cultural reconnection because of the context of intergenerational trauma and cultural disconnection.

What does this mean for practice?

• Addressing family functioning and parenting skills through evidence-based practices can create more effective interventions for young people at risk of, or experiencing, toxic stress.
• Considering the cultural responsiveness in programs can ensure interventions meet the needs and preferences of diverse families. This may include providing services that are language appropriate and address barriers to access.
• Program providers should aim to include caregivers in interventions and provide them with the skills they need to effectively support youth at risk of toxic stress. Fostering trust and respect with families is central to successful outcomes.

Why is this important?

• Exposure to adversity and poverty can increase the risk of mental health problems for young people. Community cohesion can help promote resilience in young people.
• Community cohesion is defined as a sense of mutual trust, support and unity within a community in a particular geographic area.
• Risk and protective factors may change for young people depending on what area they live in. This may be influenced by community cohesion, cultural norms, expectations, and resources available to families and young people.

What did they do?

• This study used data from the Adolescent Brain Cognitive Development (ABCD) Study, a longitudinal study on youth development in the United States. The authors analysed data from 11,868 participants.
• The study included analysis of data on neighbourhood disadvantage, experiences of adversity, community cohesion, rurality and urbanicity, mental health symptoms and demographic information. The analysis included the baseline data collection and data from three subsequent time points (across ages 9–13 years).

What did they find?

• Findings suggest that young people living in rural areas are more likely to experience neighbourhood disadvantage. However, they are also more likely to experience higher levels of community cohesion compared to youth in urban areas.
• Higher levels of community cohesion may reduce youth externalising behaviours such as aggression and rule-breaking. There was no clear impact on internalising behaviours such as anxiety or depressive symptoms.
• Results suggest that community cohesion is a significant protective factor for youth experiencing neighbourhood socio-economic disadvantage in urban areas.

What does this mean for practice?

• Programs and policies that strengthen community cohesion, such as interventions that facilitate community service or community social events, may help to minimise externalising behaviours among young people.
• Fostering a sense of belonging and collective responsibility may help to reduce the prevalence of youth mental health problems. Young people in disadvantaged neighbourhoods may benefit from programs that focus on collective wellbeing and community involvement.

Why is this important?

• Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at a greater risk of suicide compared to the general population.
• Young people with FASD are highly likely to experience adverse childhood experiences (ACEs) and 94% of individuals living with FASD experience at least one mental health condition in their lifetime.
• Suicidality rates are up to 19% in children (aged 0–12 years) and 39% in adolescents living with FASD. Suicidality includes both suicidal ideation and suicide attempts. This greater risk, compared to the general population, highlights the need for better understanding of the associated characteristics and risk factors for suicidality among young people with FASD.

What did they do?

• This study was a retrospective cohort design of 195 participants who attended a clinic in Perth, Western Australia, between 2016 and 2019. Participants met the diagnostic criteria for FASD and were aged between 5 and 21 years.
• 73% of participants were male and 77% identified as Aboriginal. More than half of the sample (56%) had a recorded history of abuse or neglect, and 64% of individuals over the age of 10 were involved in the justice system at the time of assessment.
• FASD diagnostic reports and other medical documents were retrospectively reviewed. Other medical information on psychiatric and neurodevelopmental diagnoses was collected. Participants were interviewed to establish recent experiences of suicidality.

What did they find?

• 21% of participants reported suicidality; the mean age of this subgroup was 14.4 years old. The youngest participant reporting suicidality was five years old.
• A comorbid diagnosis of attention-deficit hyperactivity disorder (ADHD) was present in almost half of participants (45%). Other diagnoses in the population included sleep disorders (32% of participants), attachment disorders (29%), anxiety disorders (25%) and depression (10%).
• The risk of suicidality was four times higher in young people diagnosed with both FASD and depression compared to those with only a FASD diagnosis.
• Members of an Aboriginal community advisory group for this study noted that knowing or witnessing someone close who lost their life to suicide is a significant risk for suicide in Aboriginal people. However, connection to Country, culture and spirituality can act as a protective factor and source of resilience within the FASD cohort.

What does this mean for practice?

• Young people living with FASD are likely to have comorbidities including psychological and neurodevelopmental conditions. It is important that practitioners and service providers understand the prevalence of comorbidities in this population when considering the needs of young people.
• Awareness of the increased risk for suicidality among young people with FASD, as well as improvements in access to evidence-based therapies for this population, may improve mental health outcomes.
• Cultural sensitivity and cultural continuity can act as a protective factor for Aboriginal young people with FASD and reduce the risk of suicidality. Therefore, it is important that practitioners and services working with Aboriginal young people with FASD use a ‘cultural continuity’ model to ensure protective factors are strengthened. This model increases connectedness with past and future cultural lineage.

Why is this important?

• Neurodevelopmental disorders include a range of mental conditions such as intellectual developmental disorders, communication disorders, autism spectrum disorder (autism), attention-deficit hyperactivity disorder (ADHD), learning disorders and motor disorders. ADHD and autism are the most common and affect approximately 3.4% of children and adolescents.
• Co-occurring neurodevelopmental disorders are common, with 30% of people experiencing more than one disorder. In addition, children with co-occurring autism and ADHD are at a higher risk of other psychiatric conditions including depression and anxiety.
• Neurodevelopmental disorders have been shown to be highly genetically heritable. In addition, an association has been found between gut microbiota and anxiety, depression, autism and ADHD.

What did they do?

• 1,084 families were recruited for a longitudinal study from a Child Development Service at the Children’s Health Queensland Hospital. Data was collected through a survey and from medical records. A follow-up survey was conducted six months after a formal diagnosis was received from the clinic. If they had not received a formal diagnosis within nine months of their initial visit, they also completed the follow-up. Participants were contacted a total of four times.
• A randomised control trial was embedded in the study to investigate parental mental health symptoms and benefits to the child’s mental health following participation in a parenting program. It included parents who scored in the sub-clinical or clinical range for self-reported mental health symptoms. Biological samples were also collected.

What did they find?

• 49% of participants had one diagnosed neurodevelopmental disorder, while the remaining 51% had two or more diagnoses. The average age of the children in the study was 5.6 years.
• 77% of children were currently experiencing mental health symptoms and over a third of parents reported having a diagnosis for a mental health condition.
• Data collected from parents regarding children’s clinical mental health symptoms showed that 17.1% of children aged 15 years were exhibiting anxiety symptoms. Follow-up data collected when the children were aged 6–18 years showed parents reporting clinical anxiety symptoms in 33.2% of children.

What does this mean for practice?

• When working with children with neurodevelopmental conditions, it is important to recognise that co-morbidities, particularly co-occurring diagnoses of ADHD and autism, are common in this cohort.
• Future research will investigate whether increasing the intensity of parenting programmes improves mental health symptoms in children. Data from the longitudinal study will also allow for future investigation into the link between genetic and microbiome factors in neurodevelopmental conditions.