Highlights in child mental health research: December 2024 to January 2025

This month’s highlights include:

Sleep health characteristics and positive mental health in Canadian youth

This study used data nationally-representative, cross-sectional data from the Canadian 2017/2018 Health Behaviour in School-Aged Children study to understand how different sleep health characteristics can result in positive mental health outcomes. Sleep health was measured by nighttime insomnia symptoms, sleep duration, daytime wakefulness, and weekend catch-up sleep. Positive mental health was measured by life satisfaction, positive affect, self-efficacy, and self-confidence. The authors found that when good sleep health characteristics were present (e.g. less nighttime insomnia, meeting sleep duration recommendations, little to no daytime wakefulness and weekend catch-up sleep), children and young people were more likely to experience positive mental health.

Yoga as a complementary intervention for children and adolescents

This integrative literature review included a systematic review combined with a non-systematic search of research on yoga as a complementary intervention in the treatment of psychiatric illnesses in children and young people. The authors analysed 16 relevant studies and found that yoga provided significant benefits when used as a complementary treatment for children and young people with a psychiatric illness. Yoga was found to decrease symptoms of a psychiatric condition, strengthen self-control and behavioural changes, improve cognitive functioning, refine relaxation, and overall increase physical and mental wellbeing.

Effects of storytelling on anxiety and fear in hospitalised children

This systematic review explored the effects of storytelling on reducing anxiety and fear in hospitalised children (up to 18 years old). Storytelling therapy involves short sessions in which parents and practitioners tell stories to children that encourage them to talk about their worries and fears related to illnesses, medical procedures or the hospital experience. Compared to standard care, the authors found that storytelling consistently reduced both anxiety and fear in children across various age groups.

Mindfulness programs for children and adolescents with ADHD

This systematic review explored how mindfulness training affects Attention Deficit Hyperactivity Disorder (ADHD) or related symptoms in children aged 0-18 years old. ADHD symptoms can include hyperactivity, inattentiveness and impulsivity, and related symptoms such as anxiety and executive functioning. The reviewed articles used four different mindfulness interventions and ran weekly intervention sessions (30-90 minutes) for eight to 20 weeks. The authors found that mindfulness programs can effectively reduce ADHD symptoms and improve coping abilities in children and young people.

Why is this important?

• Sleep is vital for good physical and mental health outcomes.
• There is a large amount of research evidence highlighting how lack of sleep and poor-quality sleep can result in negative mental health outcomes for children and young people.
• More research is needed to understand how different sleep characteristics can result in positive mental health outcomes for children and young people.

What did they do?

• The authors used nationally-representative, cross-sectional data from the Canadian 2017/2018 Health Behaviour in School-aged Children (HBSC) study, which collects data from children in grades 6 to 10. The self-reported questionnaires focus on well-being, health behaviours and social contexts.
• Out of the original 21,745 children and young people who participated in the HBSC study, the authors used data from 14,868 children and young people for this sleep health study.
• Sleep health was assessed by measuring nighttime insomnia symptoms, sleep duration, daytime wakefulness, and weekend catch-up sleep.
• Positive mental health was assessed by measuring life satisfaction, positive affect, self-efficacy, and self-confidence.

What did they find?

• Overall, when positive sleep health characteristics were present, children and young people were more likely to experience positive mental health.
• There were gendered differences, with boys more likely to report better sleep health characteristics than girls. The only exception was for meeting the sleep duration recommendations.
• Age was also a factor, with children and young people in grades six to eight reporting better daytime wakefulness, lower weekend catch-up sleep, higher life satisfaction, higher positive affect, and higher self-confidence, than young people in grades nine to 10.
• Children and young people in the study who experienced little or no nighttime insomnia, met the recommended amount of sleep, did not experience daytime wakefulness problems, and did not need to catch-up on sleep on weekends, had significantly higher odds of having high life satisfaction, high positive affect, high self-efficacy, and high self-confidence.

What does this mean for practice?

• Practitioners, educators and parents need to be aware of how sleep health is strongly linked to positive mental health in children and young people.
• Further research is needed into understanding if there are strategies that can be encouraged to promote sleep health.

Why is this important?

• There is growing concern over the rise of mental health problems experienced by children and young people.
• Research has shown that complementary interventions such as meditation, yoga, tai chi, and qigong can have positive impacts on physical and mental health. Most research, however, has tended to focus on adults and the general population.
• Yoga, in particular, has been shown to be a valuable self-care tool. In addition, practising yoga may reduce anxiety, depression, and post-traumatic stress disorder.
• Psychiatric interventions for children and young people are primarily pharmacological. However, more research is being conducted into whether yoga, as a complementary invention, has the ability to help improve stress levels, resilience, mood and self-regulation skills for children and young people, particularly when implemented in school environments.

What did they do?

• The authors used an integrative literature review method. They conducted a systematic review which was combined with a non-systematic search of research that focused on the impact of yoga on mental health, for children and adolescents aged six to 18 years old.
• The authors found a total of 16 relevant articles (nine quantitative, two qualitative, and five mixed methods studies).
• Studies were organised into two subgroups: yoga interventions in school settings, and yoga interventions in psychiatric settings.
• The studies analysed researched children and young people aged from five to 19 years year old. Seven of the studies were conducted in general school populations, four in clinical settings, three in special school populations, and two in school populations of high-risk children.

What did they find?

• Yoga was shown to strongly benefit physical and mental wellbeing.
• Five themes emerged from the authors’ analysis: decreased symptoms of psychiatric condition, strengthened self-control and behavioural changes, improved cognitive functioning, refined relaxation, and increased well-being.
• The authors identified that children and adolescents who participated in yoga showed:
  • A significant reduction in symptoms of anxiety and depression.
  • Improvements in self-control, behavioural problems, and an increase in prosocial behaviours.
  • Improvements in cognitive functioning were measured by academic skills and executive functioning. Children and adolescents who participated in school-based yoga demonstrated improvements in school engagement.
  • Improvements in sleep and a reduction in stress.
  • Increased self-esteem, body awareness, resilience and quality of life.

What does this mean for practice?

• Practitioners may want to consider including yoga as a complementary intervention in the treatment of psychiatric illnesses in children and young people.
• Given the physical and mental health benefits of yoga, practitioners and educators may want to consider incorporating yoga into a child or young person’s life.

Why is this important?

• Hospitalisation can be a stressful experience for children that can negatively affect their emotional wellbeing and recovery. The experience has been linked to feelings of homesickness, fear of pain and diagnostic procedures, loneliness and anxiety.
• Evidence shows that children who have negative experiences during hospitalisation can avoid seeking medical assistance in the future.
• Storytelling programs are relatively common in hospitals but research on them is limited.

What did they do?

• Storytelling therapy involves short sessions (10–30 minutes) in which parents or healthcare workers tell stories to children that encourage them to talk about their worries and fears related to illnesses, medical procedures or the hospital experience.
• The authors conducted a systematic review of eight studies to determine the effects of storytelling on reducing anxiety and fear in hospitalised children (up to 18 years). They compared these effects to standard care.
• They statistically analysed experimental studies (randomised controlled trials and quasi-experimental studies) where storytelling was delivered individually or in groups, through videos, books or electronic devices.

What did they find?

• The studies were mostly from Asia and the Middle East (Iran, India, Egypt, Turkey and Indonesia).
• Storytelling research mostly focused on children below eight years old (mostly between three to 12 years old), hospitalised for surgery. Books were the most common delivery method.
• The authors found that storytelling consistently reduced both anxiety (measured in seven studies) and fear in children (measured in four studies) compared to standard care. However, none of the studies collected long term data.
• The effectiveness of storytelling was consistent across age groups, suggesting this may be useful in supporting the mental health of children of various ages.

What does this mean for practice?

• Storytelling can be used as a therapeutic tool in paediatric healthcare settings to support the emotional wellbeing of children. There is some evidence that it can reduce anxiety and fear in children of different ages.
• Practitioners can encourage and support parents to engage in storytelling to ensure the ongoing benefits from storytelling practices after hospitalisation.

Why is this important?

• Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that affects over 5% of children worldwide. ADHD presents significant behavioural, functional and performance challenges for children, and is a cause of parental stress.
• There is increasing evidence for the effectiveness of mindfulness interventions (MBT) in the management of ADHD. This may sometimes be more appropriate than medicinal drugs because ADHD is a complex illness with varied onset, severity and response to treatment.

What did they do?

• The authors undertook a systematic review that included 11 articles (published between 2000–2022) that included mindfulness interventions targeting children and adolescents (0–18 years of age), delivered individually or in groups.
• The authors explored how mindfulness training affects ADHD symptoms (e.g. hyperactivity, inattentiveness and impulsivity) or related symptoms (e.g. sleep quality, anxiety, executive functioning).
• They also considered various contributing factors that may influence these effects, such as, the ADHD subtype, co-morbidities, duration of the mindfulness intervention, parental training, and presence of other treatment interventions.
• The authors used descriptive statistics to analyse the results and identify changes in ADHD symptoms post mindfulness interventions.

What did they find?

• The interventions were based on the Mindfulness Based Stress Reduction protocol (MBSR), the Mindfulness-Based Cognitive Therapy (MBCT), the Mindful Movement Treatment (Tai Chi), and Mindfulness Martial Arts (MMA).
• The interventions were mostly weekly sessions (30–90 min), between eight to 20 weeks long.
• The authors found that mindfulness programs improved hyperactivity/inattentiveness and restlessness/impulsivity symptoms in children and adolescents with ADHD.
• Related symptoms (e.g. executive functioning, cognitive flexibility, focused control and self-control) also improved. Studies showed decreases in oppositional defiant and conduct problems, externalising problems, aggression and anxiety, among others.
• These results were not consistent across all studies, outcomes or confounding factors. The authors suggested this was because comparisons between studies were difficult because they explored different things (e.g. MBT program content and outcomes) rather than because mindfulness programs were ineffective.

What does this mean for practice?

• Mindfulness programs (eight to 20 weeks long) may effectively reduce ADHD symptoms and improve coping abilities in children and adolescents. However, more research is needed across the various symptoms and programs to grow the evidence base.