Highlights in child mental health research: April 2022

Highlights

• This study investigated the relationship between both the severity and chronicity of interparental conflict (IPC) across early and middle childhood and examined the emotional–behavioural functioning of children exposed to IPC at 10–11 years.
• There is growing evidence of the enduring long-term effects of IPC on children’s emotional-behavioural functioning.
• Children exposed to trajectories with high IPC at any point during the study period were reported by their mothers to be experiencing more emotional–behavioural difficulties than children exposed to low IPC over time.

Key findings

• Drawing from a nationally representative longitudinal study of Australian families (N = 4875) four distinct trajectories of IPC were identified: (1) consistently low exposure to IPC over time, (2) persistently elevated exposure to IPC, (3) increasing IPC exposure over time, and (4) decreasing IPC exposure over time.
• Approximately one in eight children were exposed to trajectories with elevated levels of IPC at some point in the first 10 years of life; 8% of children were exposed to chronic and frequent IPC from infancy; 3.5% were exposed to steadily increasing IPC over time; and 2% were exposed to decreasing IPC over time.
• Children exposed to the three trajectories with high IPC at any point during the study period had elevated Strengths and Difficulties Questionnaire – Total Difficulties, Internalising and Externalising Symptoms.
• Children experiencing persistently high IPC or increasing IPC had more emotional–behavioural difficulties than children experiencing consistently low IPC.
• In addition to direct exposure, it is also likely that IPC has indirect effects on children via negative impacts on parent mental health, parenting quality, and parent–child relationships.

Implications

• The higher levels of emotional-behavioural difficulties experienced by children who experienced high IPC in the early years of their lives that decreased over time compared to those experiencing consistently low IPC over time, highlight the importance of early identification and intervention.
• Health professionals may want to enquire about relationship conflict throughout the postnatal, early and middle childhood years of parenting, including asking whether conflict is perceived to be the same, getting better or worsening over time to assist in identifying parents who would benefit from intervention.

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Highlights

• This survey study aims to report on mental health symptoms in Australian children and adolescents during the initial stages of the pandemic (May to Nov 2020) and to examine their association with child/family characteristics and exposure to the broad COVID-19 environment.
• Findings indicate that parent reported mental health symptoms for children and adolescents were notably high during the initial stages of the pandemic in Australia.
• Mental health symptoms were greater in those with pre-existing vulnerabilities and whose parents had experienced greater psychological distress and financial hardship.

Key findings

• A total of 1327 of parents and carers of Australian children aged 4-17 years completed the online baseline survey, reporting on their child’s mental health using five measures, including emotional symptoms, conduct problems, hyperactivity/inattention, anxiety symptoms and depressive symptoms.
• Approximately 1 in 3 children and adolescents reported high to very high levels of emotional symptoms, 1 in 4 experienced high to very high levels of conduct problems, and 1 in 10 experienced high to very high levels of hyperactivity/inattention.
• One in five children and adolescents reported symptoms of anxiety and/or depression indicative of a mental health disorder.
• Children with a pre-existing mental health disorder, neurodevelopmental condition or chronic physical illness had higher levels of parent-reported mental health symptoms compared to those without these difficulties.
• Application for government financial assistance during COVID-19 was significantly associated with parent reported emotional symptoms and depressive symptoms.
• Days in lockdown was significantly associated with parent reported child conduct problems. Conduct problems were also reported to be higher in children living in Victoria compared to the rest of Australia.

Implications

• The authors recommend providing parenting interventions which target child behavioural difficulties in any future lockdowns, given the rise in conduct problems.
• A focus on the prevention of mental health difficulties and encouraging help-seeking behaviours in youth, particularly for those with pre-existing vulnerabilities and in times of crisis, may be necessary.
• Parent-report symptoms may not be a reliable source of child/youth mental health experience. This highlights the importance of a multi-informant approach to obtain a richer and more accurate perspective.

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Highlights

• This systematic review found that lower levels of social support are associated with more negative psychosocial adjustment among siblings of children with neurodevelopmental disorders.
• The findings suggest that social support is important to consider in relation to siblings’ adjustment and that social support may be an important protective factor for siblings at risk of various negative emotional and behavioural outcomes.

Key findings

• Fifteen articles were eligible for the review, 13 of which used cross-sectional designs. The 15 included studies involved 1312 siblings aged between 4 and 18 years. Siblings had a brother or sister with a range of different neurodevelopmental disorders.
• Multiple variables were negatively related to social support, including sibling depression, loneliness, stress, and contextual and family-related variables such as parental mental health concerns and problem behaviour of the child with neurodevelopmental disorder.
• Variables that were positively related to social support included problem-focused coping, prosocial behaviour, higher self-concept, family-related quality of life, competence, and academic functioning.
• Potential moderators of the relationship between social support and psychosocial adjustment included the type of disorder of the affected sibling and the type of social support provider.
• Siblings of children with autism reported lower social support compared to siblings of children with other disorders.
• The authors found significant heterogeneity and mixed findings across studies, and a lack of discussion on the possible negative effects of social support, such as unwanted attention, greater awareness of their negative circumstances, and concerns of the visibility of their distress.

Implications

• Results from this review highlight the potential importance of providing social support for siblings of children with neurodevelopmental disorders due to several associations with other psychosocial variables.
• Parent social support for siblings of children with an autism spectrum disorder in families with a higher level of stress, parent health concerns, and sibling depression symptoms, and psychosocial adjustment problems may be particularly important.
• There is a need for the use of a more homogenous definition of social support and better agreement regarding measurement methods, and to consider sibling’s self-reported social support as they are reliable sources of information about their own experiences.

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Highlights

• Refugee and asylum seeker children and young people are at increased risk of psychological symptomatology and disorders compared to children without experiences of forced migration. These children and young people often require specialised psychological support.
• This scoping review aimed to synthesise all literature regarding practitioner competencies that are considered important for working in the area of mental health with refugee and asylum seeker children and young people.

Key findings

• Nine articles met criteria and a deductive thematic analysis identified six key competencies:
• Knowledge of the complexity of needs of refugees: knowledge of cultural background, refugee journeys, trauma, and resettlement stressors, including how or when to approach discussions about traumatic experiences with children.
• Use of holistic approaches: using a range of practices, including ability to treat a range of clinical problems as well as provide support with non-clinical needs such as housing and education on health using a strengths-based approach.
• Ability to work in co-ordination with others in the child’s network: collaborating with other services and key support people, most notably broader family members and schools.
• Ability to build therapeutic relationships: building trust and rapport in a therapeutic relationship is particularly important for refugee children and young people given the added complexity of experiences associated with refugee status.
• Seeking feedback: adopting a client-led approach that includes children’s voices and advocates for children in healthcare and social service settings.
• Cultural competency: being culturally sensitive and working with interpreters, whilst understanding that it can be difficult for children to feel confident providing feedback about interpreters.

Implications

• Further empirical research that directly aims to identify practitioner competencies, from both the practitioner and client perspective, will support the challenging work done by practitioners working with refugee and asylum seeker children and young people.
• Holistic and social determinants of mental health approaches raise broader practice considerations, including the difficulties practitioners face in providing multifaceted support due to the inflexibility of the systems in which they work.

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