Resource Summary

The monthly research summary provides a selection of recently released papers, systematic reviews, and meta-analyses related to infant and child mental health.

Each summary includes an introductory overview of the content for the month, followed by a list of selected articles.  Each article is accompanied by a brief synopsis which presents the key messages and highlights.  Links to abstracts, full-text articles and related resources, where available, are provided.

What’s new this month in child mental health research?

This month’s highlights include:

Check out recently released reports and journal articles on the COVID-19 pandemic and how it might affect children and families.  While research articles are only just emerging into the effects of the pandemic on child mental health, a new narrative review on this topic has been included and summarised (i.e., Fegert, Vitiello, Plener, & Clemens, 2020).

Using data from two surveys conducted over a 16-year period, Schnyder and colleagues (2020) explored the changes that have occurred in barriers to mental health care for Australian children and adolescents across time.  The researchers concluded that despite considerable investment in mental health treatment and awareness-raising strategies, the main barriers to mental health care appear predominantly unchanged over time.

This study by Leckning and colleagues (2020) developed new practice guidelines for conducting psychosocial assessments with Aboriginal and Torres Strait Islander people who present to hospital with self-harm and thoughts of suicide.  The guidelines include a section dedicated to children and young people.

This study by Young and colleagues (2020) offers new guidelines and practice recommendations to support clinicians in the assessment, diagnosis, and treatment of individuals with co-existing attention-deficit/hyperactivity disorder and autism spectrum disorder.  The guidelines support a critical gap in the existing evidence-base.

Using survey data of over 44,000 children, this study found that family-level resilience and connectedness was a protective factor that buffered the negative impact of adverse childhood experiences (ACEs) on children’s mental health.  Parenting stress emerged as a potential risk factor through which ACEs may negatively impact on child mental health.

Coronavirus (COVID-19) and children: Resources, research, and reports

Recently released reports and journal articles on COVID-19 include:

This report presents the findings of a survey that explored the effects of the COVID-19 pandemic on children and young people with a disability in Australia.  The survey identifies areas of unmet need that require a response.

This report summarises survey data gathered from 3,155 Australians about the effects of the COVID-19 pandemic, including on levels of psychological distress.

This report outlines the findings of a survey of over 1,800 parents and caregivers in the United Kingdom about the impact of the COVID-19 pandemic on the mental health of their children.

This report discusses the increases in domestic violence and risk of violence in the home during the COVID-19 pandemic, with a focus on the impact on children and young people.  Recommendations are offered on how these challenges might be addressed.

This report discusses the needs of vulnerable children and young people in the context of the COVID-19 pandemic.  Recommendations are offered for safeguarding and supporting vulnerable children and youth during this challenging time.

 

While research articles are only just emerging into the effects of the pandemic on children’s mental health, a new narrative review is summarised below:

 

Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality

Authors: Fegert, J.M., Vitiello, B., Plener, P.L., & Clemens, V.

Journal: Child & Adolescent Psychiatry & Mental Health

Highlights:

  • This narrative review discusses the considerable impact of the COVID-19 pandemic (and its associated containment measures) on child and adolescent mental health.
  • While the COVID-19 pandemic may offer some potential benefits for children and families (e.g., increased cohesion between family members; increased time with caregivers; growing and developing as a person), the negative effects may overshadow these advantages.
  • The researchers consider the potential risks to child mental health with regards to the 3 main phases of the pandemic. The phases are (p. 2):
  1. “Preparation” – Governments implement containment and mitigation measures (e.g., social distancing, economic shutdowns, hygiene strategies).
  2. “Punctum maximum” – The curve (i.e. number of new cases) and mortality rate reach their maximum levels.
  3. “Return to normality” – Society recovers from the pandemic, which includes ensuring that services are re-organised and re-established.
  • During phases 1 and 2, the key factors that may increase the risk of children’s mental health problems include:
    • Restrictions to leisure and stress-reducing activities (e.g., playground closures, sporting club closures).
    • Limits to social interactions due to social distancing measures (e.g., minimal or no contact with peers or family members; school closures).
    • Stigma towards those children or families that have become infected.
    • Increased pressures on the family unit, including financial which is a well-documented risk factor for poorer child mental health.
    • Increased levels of parental mental health problems and substance misuse.
    • Heightened levels of domestic and family violence and child maltreatment.
    • Containment measures (e.g., isolation, quarantine), which can negatively-impact on mental health (e.g., post-traumatic stress symptoms).
    • Concerns about the impact of the virus itself on oneself or others.
    • Limited access to health and support services, including in relation to mental health.
  • During phase 3, potential risk factors for child mental health problems can include:
    • Economic problems and unemployment, which may create increased pressures for parents, children, and families.
    • Increased demand and pressure on mental health services as they work to address both the previous limitations to their service and the pandemic’s ongoing mental health effects. This can occur against a background of wider limitations in access to healthcare.
    • Ongoing increased risks of domestic and family violence and child maltreatment, which may be exacerbated by economic factors.
  • Those children who were already experiencing vulnerability pre-pandemic are considered to be at highest risk of mental health problems. These groups will require special attention by practitioners and service providers, and include:
    • children from low-income families
    • children with disabilities
    • children who have experienced adversity
    • children with pre-existing mental health problems
    • children who are refugees.
  • The pandemic may offer practitioners the opportunity to develop innovative strategies for delivering mental health services to children and families, as well as to up-skill. One example is the development of skills in telehealth delivery.
  • Future research will be critical for: 1) understanding the pandemic’s effects on child mental health, 2) identifying factors associated with risk and resilience, and 3) understanding how we might reduce the pandemic’s long-term effects. This could inform responses to similar future events.

 

Read the free full-text here

Barriers to accessing mental health care for Australian children

Barriers to mental health care for Australian children and adolescents in 1998 and 2013-2014 (Australia)

Authors: Schnyder, N., Sawyer, M.G., Lawrence, D., Panczak, R., Burgess, P., & Harris, M.G.

Journal:  The Australian and New Zealand Journal of Psychiatry

Highlights:

  • This study explored the changes that have occurred in the barriers to mental health care for Australian children and adolescents over time.
  • The study used data from two surveys of children and adolescents (aged 4 to 17 years old) performed in 1998 and 2013-2014. The nationally-representative surveys included over 4,000 participants in 1998 and over 6,000 participants in 2013-2014.
  • Barriers were assessed by adolescents (aged 11-14 years) and parents over the time period.
  • Parents endorsed the top barriers to child and adolescent mental health care at both time-points as:
    • Preferring to rely on themselves (i.e. self-reliance). This decreased over the 16-year-period from around 66% to around 35%.
    • Being uncertain of where they could get help.
    • Costs of mental health care.
  • Adolescents endorsed the top barriers to mental health care at both time-points as:
    • Preferring to rely on themselves. This remained unchanged over time.
    • Being concerned about what other people may think (i.e. stigma). This also remained unchanged over time.
  • The researchers concluded that despite considerable investment in mental health treatment and awareness-raising strategies, the main barriers to care for Australian children and adolescents appear to have remained largely the same over time.
  • Schnyder and colleagues (2020, p. 1) suggest that “the decrease in self-reliance [in parents] may reflect a positive shift in beliefs about the potential benefits of treatment” associated with strategies that have aimed to strengthen mental health literacy and decrease stigma.
  • The researchers highlight that their findings demonstrate an ongoing need for mental health supports and treatments that are free or minimal in cost.

 

Read the Abstract here

Self-harm and suicidal thoughts in Aboriginal and Torres Strait Islander people

Developing best practice guidelines for the psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts (Australia)

Authors: Leckning, B., Hirvonen, T., Armstrong, G., Carey, T.A., Westby, M., Ringbauer, A., & Robinson, G.

Journal:  The Australian and New Zealand Journal of Psychiatry

Highlights:

  • This study developed practice guidelines for conducting psychosocial assessments with Aboriginal and Torres Strait Islander people who present to hospital with self-harm and thoughts of suicide.
  • The guidelines aim to “address an important gap in the evidence-base for clinically effective and culturally responsive assessment of self-harm and suicidal thoughts by Aboriginal and Torres Strait Islander people in hospital settings” (Leckning et al., 2020, p. 1).
  • The researchers developed the guidelines using the Delphi method. This method involved 28 experts responding to three rounds of statements about best practice.  Statements that were rated by at least 90% of the expert panel as “essential or important” were used to develop the resulting principles and recommendations (Leckning et al., 2020, p. 1).
  • The 28 experts had clinical experience, community-based experience, and lived experience in the mental health and/or prevention of suicide of Aboriginal and Torres Strait Islander people. 11 experts identified as Aboriginal and 1 as Torres Strait Islander.
  • Especially relevant to child mental health practitioners is the section of the guidelines dedicated to children and young people (see p. 23 of the guidelines), which considers that this is a “high-risk group with specific developmental and socio-cultural needs” (Leckning et al., 2020, p. 7).
  • Researchers will now focus on developing a strategy for implementation and a framework for evaluation with an aim of strengthening the evidence and improving outcomes.

 

Read the free full-text here

Read the best practice guidelines here

Co-occurring attention-deficit/hyperactivity disorder and autism spectrum disorder

Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus (United Kingdom)

Authors:  Young, S.; Hollingdale, J., Absoud, M., Bolton, P., Branney, P., Colley, W., . . . Stover, N.

Journal:  BMC Medicine

Highlights:

  • This article provides new guidelines and practice recommendations to support practitioners in the assessment, diagnosis, and treatment of individuals with co-existing attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
  • The article will be of interest to healthcare professionals and allied health practitioners who work with children and their families.
  • Prior to the publication of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) in 2013, ADHD and ASD were not recognised as being able to co-occur.
  • While guidelines exist for ADHD and ASD as separate disorders, there has been a relative lack of understanding and guidance regarding the identification, assessment, and treatment of these conditions when these co-occur. Hence these guidelines were developed to address this gap in the evidence-base and to assist practitioners.
  • Co-existing ADHD and ASD can lead to an intensification of difficulties over and above that which might occur in either condition in isolation.
  • The recommendations were developed through consensus of a panel of expert professionals from the United Kingdom.
  • Guidance and practice recommendations are provided for (p. 2):
    • Identification and assessment, including the need for a multi-faceted approach that incorporates multiple sources of information.
    • The use of rating scales and clinical interviews.
    • The use of objective assessments.
    • Assessment outcomes, including assessment reports and their content.
    • Interventions for children with co-morbid ASD and ADHD, including psychoeducation, parent/caregiver interventions, behavioural interventions, CBT (Cognitive Behavioural Therapy), and school-based interventions.
    • Pharmacological treatments.

 

Read the free full-text here

Adverse childhood experiences: The role of family resilience and parenting stress

Parenting stress and family resilience affect the association of adverse childhood experiences with children’s mental health and attention-deficit/hyperactivity disorder (USA)

Authors:  Uddin, J., Alharbi, N., Uddin, H., Hossain, M.B., Hatipoğlu, S.S., Long, D.L., & Carson, A.P.

Journal:  Journal of Affective Disorders

Highlights

  • This study investigated how parenting stress and family resilience might influence the association between adverse childhood experiences (ACEs) and children’s mental health. It also explored the potential impact of these factors on the association between ACEs and outcomes related to attention-deficit/hyperactivity disorder (ADHD).
  • The study used data of over 44,000 children (aged 6 to 17 years) from the 2016-2017 National Survey of Children’s Health (NSCH) conducted in the United States.
  • Family connection and resilience was measured using responses of parents/carers to questions about the likelihood of the family responding to problems using positive strategies (e.g., discussing what to do as a family; working together to problem-solve).
  • Key findings included:
    • Around 7% of children exposed to ACEs had a mental health condition and around 10% had ADHD.
    • Consistent with past research, children with a higher ACEs score were more likely to have a mental health condition. They were also more likely to have ADHD. This finding persisted even after adjusting for the effect of social-demographic factors.
    • “Parenting stress mediated 57% of the total effect of ACEs on any mental health condition” (p. 104). That is, parenting stress appears to be a potential risk factor through which ACEs may have a negative impact on child mental health outcomes.
    • ACEs had a larger effect on mental health and ADHD outcomes in children with lower levels of family-level connection and resilience (compared to those with higher levels of family connection and resilience). That is, family resilience was a protective factor that buffered the negative impact of ACEs on children’s mental health.

The study highlights the importance of clinicians, service providers, and policy-makers targeting parental mental health (including parenting stress) and family functioning (including family relationships) when seeking to support the mental health of children who have experienced adversity.

 

Read the Abstract here

Up Next Coronavirus (COVID-19) and children: Resources, research, and reports

Discover more resources