Highlights in child mental health research: June 2024

Evaluating a parenting support program in remote Aboriginal and Torres Strait Islander communities

In partnership with an Aboriginal community, this study tailored and evaluated the Triple P – Positive Parenting Program for Aboriginal and Torres Strait Islander families living in remote Western Australia. This study found that the program improved child behaviours and parent mental health and reduced unhelpful parenting styles. The findings also suggest that adapting programs to the specific needs of the people and context may contribute to participant satisfaction with the program and possibly improve outcomes.

The health and social impacts associated with having ADHD

In this study, the authors reviewed the literature about the impact of ADHD on the physical and mental health, and social and lifestyle functioning of adults and children. ADHD was associated with multiple health and social impacts, such as addiction, self-harm and suicidality, relationship difficulties, and risky behaviours. Given the potential for multiple health, social and lifestyle impacts, practitioners should use a holistic, person-centred approach when working with people with ADHD.

Children and young people’s perspectives on living in the foster care system

This systematic review examined the qualitative research on the experiences of children and young people in foster care. It found that young people faced many difficulties being in foster care, such as sustaining relationships with their biological parents while also trying to build new relationships with their foster family and feeling that being removed from their family was often a traumatic and confusing event. This review highlights the importance of including children and young people in the design and delivery of services and systems that impact them.

Interventions to treat complex trauma using the Attachment, Regulation, and Competency (ARC) Framework

The study reviews the evidence on the effectiveness of interventions that use the Attachment, Regulation, and Competency (ARC) Framework to treat complex trauma. There is some evidence that interventions that use the ARC framework can reduce complex trauma symptoms in children. These findings suggest that interventions that use the ARC framework may be promising to address complex trauma in children.

Why is this important?

• Parenting programs, such as Triple P, have been shown to be effective at reducing emotional and behavioural problems in children in non-Indigenous families.
• However, parenting programs can be inaccessible to many families, including Aboriginal families.
• In partnership with Aboriginal communities, this study tailored and evaluated the Triple P – Positive Parenting Program for Aboriginal families living in remote areas that was named Jandu Yani U, meaning “for all families”.

What did they do?

• This study was co-designed by Aboriginal leaders in the Fitzroy Valley, Western Australia from October 2014 to June 2019. The authors and Aboriginal leaders consulted with local communities to guide the tailoring and implementation of the program.
• The Fitzroy Valley is very remote and predominantly made up of Aboriginal families.
• Triple P teaches parenting strategies to encourage positive child-parent relationships, promote child development and guide child behaviour. In this study, the Indigenous Group Triple P was delivered with additional strategies for neurodevelopmental impairment added from Stepping Stones Triple P. The authors didn’t report the usual length of the program. The program was delivered flexibly (e.g., language, pace, session length, location, examples used, active skills practice) and focused on the parents’ goals. Families had the option to participate in individual or group sessions. Local services were engaged with and trained in delivering Triple P.
• The authors assessed child behaviour, parenting styles, parent self-confidence, parent mental health, parent empowerment (i.e. whether they feel they have a voice in their family and community, and program satisfaction.
• Assessments were conducted before the program and 2 weeks and 8 months after the program. There was no comparison group.
• Any family in the Fitzroy Valley with children (up to 15 years old) was invited to participate. Thirty families completed the program, 27 families completed the assessment 2 weeks after program completion, and 20 families completed the assessment 8 months after program completion.

What did they find?

• At two-weeks after program completion, there was a small-medium reduction in unhelpful parenting styles (i.e. over-reactivity and hostility) and a large improvement in parent empowerment, compared to before the program. There were no significant changes to child behaviour or parent mental health at this time point.
• At 8-months after program completion, there was a medium reduction in child problem behaviours (including frequency and number) and a medium increase in child prosocial behaviours. For parents, there was a large reduction in unhelpful parenting styles (i.e. over-reactivity and hostility), a small reduction in anxiety and small improvement in self-efficacy. There were no significant changes to child emotional problems or parent depression and stress at this time point.
• The program was rated highly by parents. Most parents reported the quality of the program was good or higher (92%), thought it helped them manage their child’s challenging behaviour (92%), and were satisfied or very satisfied with the program (96%).

What does this mean for practice?

• This study suggests that a tailored and co-designed Triple P program may contribute to improving child and parent outcomes among Aboriginal families living in remote areas in Australia.
• This study also suggests that adapting programs to the specific needs of the people and context may contribute to participant satisfaction with the program and possibly improve outcomes.

Why is this important?

• Approximately 5% of children globally have diagnosed attention deficit hyperactivity disorder (ADHD).
• The symptoms of ADHD can impact people throughout their life and may place them at an increased risk of poor outcomes.
• This study reviewed the literature about the impact of ADHD on the physical and mental health, and social and lifestyle functioning of adults and children.

What did they do?

• The authors conducted a review of previous reviews (i.e. an umbrella review) that examined the impacts, long-term outcomes or risks associated with ADHD.
• They included all types of reviews that were published in academic journal articles, examined either adults or children who meet the criteria for or have been diagnosed with ADHD, and examined the impact of having ADHD.
• The authors analysed the included reviews using narrative synthesis, which involves collating the themes from the findings to develop a set of conclusions or recommendations.

What did they find?

• The authors found 125 reviews that met their inclusion criteria. These were published between 1991 and 2023. The authors didn’t explicitly state which countries were covered in the previous reviews but stated that there was ‘worldwide representation’.
• The authors rated the majority of the included studies as either moderate (48%) or good (42%) quality.
• The outcomes that were most commonly and consistently associated with ADHD in the reviews were addiction, self-harm and suicidality, psychiatric and personality disorders, and poor self-esteem, sleep disorders, overweight/obesity, accidents/injuries, offending and criminality, lower educational attainment/occupational functioning, reduced quality of life, relationship difficulties, and risky behaviours such as driving accidents/convictions and unplanned pregnancy.

What does this mean for practice?

• Given the multiple health and social impacts that this study found was associated with having ADHD, practitioners can consider taking a holistic, person-centred approach to working with people who have ADHD.
• Practitioners should be mindful of the mental and physical health conditions that often co-occur with ADHD and the impacts of ADHD on people’s lifestyle.

Why is this important?

• The number of children entering foster care is growing globally. In Australia, the number of children and young people in out-of-home care increased by 7% from 2017 to 2020.
• Although sometimes necessary, entering foster care can be a challenging time of transition for children and young people that often comes with the complete or partial removal from their families, communities and peer supports.
• Children and young peoples’ experiences and perspectives must be taken into consideration to ensure their rights are upheld and for foster care systems to provide the best possible care.

What did they do?

• The authors conducted a systematic review of qualitative research on the experiences of children and young people in foster care.
• They included peer-reviewed journal articles of qualitative research, published in English, about children and young people who were currently living in foster care.
• The authors analysed the included studies using a reflexive thematic analysis, which involves identify patterns and themes across the studies.

What did they find?

• The authors found 20 studies that met their inclusion criteria. These were most frequently conducted in the United Kingdom (n=9) followed by the United States (n=3). No included studies were conducted in Australia.
• The authors rated majority of the included studies as high quality (n=18).
• Four key themes in the perspectives of children and young people in foster care were identified across the studies:
  • Young people face complexities in trying to sustain relationships with their biological parents and siblings while also trying to navigate building new relationships with foster families and new communities.
  • Young people want to feel and be seen as ‘normal’ but felt that they were different because they were in foster care.
  • Young people have a fundamental desire to belong and are searching for belonging in school and their foster family.
  • Being removed from their family was often a traumatic and confusing event that often happened in a way that felt abrupt to them.

What does this mean for practice?

• This review highlights the importance of including children and young people in the design and delivery of services and systems that impact them.
• The authors state that these findings can help inform co-designed workshops and training for foster parents, education and health care professionals to help make foster care more child-centred.

Why is this important?

• Children who have traumatic experiences and seek treatment have often been exposed to multiple traumatic experiences resulting in complex trauma. Complex trauma is associated with multiple mental health challenges for children, such as depression, anxiety and poor emotion regulation.
• Addressing complex trauma can improve the mental health of the child and their caregiver. Healthy and positive relationships with caregivers can play a key role in addressing complex trauma in children.
• The study reviews the evidence on the effectiveness of interventions that use the Attachment, Regulation, and Competency (ARC) Framework to treat complex trauma. The ARC is a treatment for complex trauma in children that engages caregivers in the treatment and aims to address the impacts of trauma on children’s attachment patterns, self-regulation and developmental skills.

What did they do?

• The authors conducted a rapid scoping review. This is a type of literature review that uses systematic methods to map existing research and identify gaps in research.
• They included quantitative, qualitative, and mixed methods studies that were published in academic journals and written in English.
• The authors didn’t explicitly report how they analysed the studies, but they outlined the findings of the studies descriptively.

What did they find?

• The authors found ten studies that met their inclusion criteria. All of the included studies were conducted in the United States and were quasi-experimental studies (i.e. a type of study that can be used to evaluate programs or interventions that doesn’t include randomising participants). Only half of the studies had a comparison group.
• There was a lot of variation across the different interventions that use the ARC framework. The interventions varied in their duration (12- 180 sessions), setting (outpatient therapy, residential treatment, community outreach and school-based intervention) and age of participants (birth-22 years).
• The interventions described in the review reduced post-traumatic stress disorder (PTSD) and externalizing, and internalizing problems in children and young people. These interventions reduced caregiver stress and increased caregiver functioning, and improved trauma sensitive classroom environments.
• However, as studies used quasi-experimental designs that often didn’t have a comparison group to evaluate the interventions more research is needed to confirm these findings.

What does this mean for practice?

• This study suggests that interventions that use the ARC framework may be a promising approach to address complex trauma in children. It may also have benefits for the caregivers of these children.