Highlights in child mental health research: January 2023

This month’s highlights include:

• Childhood maladaptive coping mechanisms and risk for later depression

This review found that children who exhibit maladaptive coping mechanisms are at high risk of developing depressive disorders later in life. The findings suggest that identification of these coping mechanisms in children could indicate a need for early mental health interventions to prevent depression later in life.

• Effective psychotherapy for children with ASD and co-occurring mental disorders

This systematic review explored effective psychotherapy treatments for children with autism spectrum disorder (ASD) and other co-occurring mental disorders. There was strong evidence for the effectiveness of cognitive behavioural therapy (CBT) for anxiety, and some evidence for an impact of social skills training (SST) on depression in children with ASD. There was less robust evidence for the effectiveness of CBT (for depression and OCD) or SST for anxiety and OCD in children with ASD.

• Influence of physical illness on mental health symptoms across childhood

This study found that severe physical illness in early childhood is associated with increased depressive and anxiety symptoms in late childhood. However, there were diminishing correlations through adolescence and into adulthood, indicating positive adaptation over time.

• Improving services for children with speech and language challenges and co-occurring mental health difficulties

This study identified concerns and barriers for professionals working with children with speech, language, and communication needs (SLCN) and co-occurring mental health difficulties. More collaboration and communication between speech and language therapists and mental health professionals may address current gaps in best-practice care for children with SLCN and co-occurring mental health difficulties.

Why is this important?

• This study investigated if children that use maladaptive coping mechanisms were at higher risk of developing depressive disorders later in life.
• Maladaptive coping mechanisms are coping strategies that can have negative impacts, usually in the long-term. In children, this typically manifests in externalising behaviours.

What did they do?

• The review included studies of children with disorders that involve maladaptive coping including conduct disorder (CD), oppositional defiant disorder (ODD) and disruptive disorder (DD).
• The authors analysed data from 17 longitudinal studies on CD, ODD, and DD that included a later measure of depressive disorder. Initial assessments occurred between ages 3- 17 years and follow up measurement occurred at various times from 1-20 years later.

What did they find?

• All 17 studies found that CD, ODD and DD in children was associated with increased risk of later depression.
• The odds ratios for depression were 3.9 for children with CD, and 5.6 for children with ODD/DD.
• Risk for depression was greater for children with more severe symptoms of CD, ODD, and/or DD.

What does this mean for practice?

• Practitioners working with children who display maladaptive coping mechanisms or who have CD, ODD, and/or DD should identify any contributing factors (including bullying, and child abuse).
• Social skills training and/or resilience training may be helpful interventions in cases where the risk factor of maladaptive coping has been identified.
• Addressing maladaptive coping in childhood may reduce the risk of depression later in life.

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Why is this important?

• Multiple, co-occurring mental disorders are highly prevalent for people with autism spectrum disorder (ASD), but individuals may struggle to access psychotherapy services that address their unique needs.
• This study explored which psychotherapy treatments are effective for co-occurring mental health disorders in individuals with ASD.

What did they do?

• This review analysed 36 studies on various psychotherapy treatments for symptoms of anxiety, depression, or obsessive-compulsive disorder (OCD) in children and adults with ASD.
• The authors analysed patient and study characteristics, as well as baseline and post-treatment outcome measures of each study to understand the effectiveness of treatments.

What did they find?

• Cognitive behavioural therapy (CBT) was found to significantly reduce symptoms of anxiety in children with ASD (p<0.01). There was insufficient data to assess the impact of CBT on depression or OCD in children with ASD. However, the analysis of all ages (adults and children) indicated significant impacts on depression (p=0.02), but not OCD (p=0.06)
• Social skills training (SST) is a behavioural therapy that can help with learning social skills and improve understandings of social interactions. SST did not have a statistically significant impact on symptoms of anxiety (p=0.06) but did significantly reduce symptoms of depression in children with ASD (p=0.05). There was insufficient data to explore the impact of SST on OCD for children and/or adults with ASD.

What does this mean for practice?

• There is strong evidence in this paper and the broader literature for the effectiveness of CBT for anxiety in children with ASD.
• There was some evidence for the effectiveness of SST for depression in children with ASD.
• There was insufficient data to assess the impact of CBT on depression or OCD in children with ASD. There was also insufficient data to assess the impact of SST on OCD in children with ASD.
• The authors suggest children with ASD may benefit from psychotherapy delivered individually (rather than in group sessions with other children) and support which involves other family members. This is because group-settings may induce overstimulation and including parents can help manage parental stress and improved parental skills.

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Why is this important?

• Childhood illnesses are associated with increased risk for mental health problems in later life. However, it remains unclear when mental health challenges first emerge.
• This study examined the mental health of children with physical illnesses throughout childhood, adolescence, and into young adulthood.

What did they do?

• This study utilised data from a large Australian population-based cohort.
• Authors examined the presence of physical illness in children aged 5-8 years, against the child’s depression and anxiety symptoms until the age of 28.
• The authors did not outline what physical illnesses were included, nor whether they were acute or chronic in nature.

What did they find?

• At 5-8 years of age, 56% of children in the cohort had a physical illness, and 8% of parents believed their child was so sick they might die.
• Compared to children with no physical illnesses, children with a physical illness at ages 5-8 had increased levels of depression at ages 12-13, and anxiety at ages 7-10.
• However, the association diminished by 15-16 years and became equivalent to the general population from into young adulthood (17-29 years), suggesting a process of positive adaptation over time.
• A similar pattern of reduced depression and anxiety over time was found in children who were so sick it was thought they might die. However, childhood symptoms of depression and anxiety (in particular) were significantly more pronounced in this group.
• Overall, males were found to have more mental health difficulties, and for a longer period, than females.

What does this mean for practice?

• The findings suggest psychosocial support at the time of diagnosis and in the following 2–3 year period may be helpful, particularly for children with life threatening illnesses and for boys.
• The authors recommend individualised approaches from mental health and allied health professionals, such as proving routine check-ups. The authors also suggest peer-support may be helpful for children with physical illness and their families.

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Why is this important?

• Existing research has found that children and young people (CYP) with speech, language, and communication needs (SLCN) are likely to experience mental health difficulties.
• This study explored the views of practitioners working with children with both SLCN and mental health difficulties.

What did they do?

• Semi-structured interviews were undertaken with eight speech and language therapists (SLTs) and six mental health professionals (including clinical psychologists, play therapists and counsellors) in the United Kingdom.

What did they find?

• Participants said that children with SLCN and co-occurring mental health difficulties are often misunderstood or undiagnosed. They may be misidentified as ‘naughty’ for behaviours such as emotional outbursts, disengagement, and problems building adult and peer relationships.
• The findings suggest that there are barriers to effective collaboration between SLTs and mental health professionals that affect the efficacy of assessment and treatment. Barriers included a lack of communication, differences in approaches to working with children, and lack of knowledge of each other’s disciplines and protocols.
• SLTs and some mental health clinicians perceived traditional talking therapies (without suitable modifications) as inaccessible and ineffective for children who may find understanding and expressing emotions challenging.
• Blended SLCN and mental health interventions and individualised approaches were considered beneficial by participants.

What does this mean for practice?

• More collaboration and communication between SLTs and mental health professionals, including multidisciplinary care teams, may address current gaps in best-practice care for children with SLCN and mental health difficulties.
• Programs that are child-led, include parents/caregivers, and do not emphasise verbal language may benefit children with SLCN and mental health challenges.
• The authors argue traditional talking therapies can be beneficial for children with SLCN when modified to account for communication difficulties, such as using visual supports. They also suggest similar SLCN and mental health programs could be blended (e.g., parent-child interaction therapy typically used by SLTs) and include play therapy (typically used by psychotherapists) for a more interconnected approach.

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