Highlights in child mental health research: October 2021

Highlights

• There is an increased risk of mental health problems for both adults and children in the aftermath of a mass trauma event such as a natural disaster.
• This scoping review found promising indications of program benefits for groups with repeated exposure to natural disasters.

Key findings

• The interventions included in this review showed positive impacts across a range of programs, delivery modes and settings, including a reduction in PTSD symptoms, depression, anxiety, sleep problems and the promotion of resilience, perceived social support and self-efficacy.
• Of the treatment-focused interventions, cognitive behavioural therapy (CBT) was the most beneficial intervention for children, followed by eye movement desensitisation therapy (EMDR).
• The most common focus across all interventions was promotion of a sense of calm and safety.
• The strength of evidence is limited due to heterogeneity in interventions and evaluations. Findings were often mixed in terms of which aspects of the interventions were most effective and which sub-groups benefitted the most.
• Gaps identified in the evidence included groups likely to be at most risk: preschool children, people with ethnically diverse, people with disability, and people experiencing social disadvantage.

Implications

• The review highlights that standardised programs may be more easily replicated across large geographic areas with multiple locations, but they can have the disadvantage of not adapting to local and individual resources and needs.
• Involvement in disaster recovery planning and activities can be beneficial for young people and this could have a positive influence on self-efficacy.
• It is important to include at risk groups in the development and evaluation of psychosocial support programs following natural disasters.

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Highlights

• COVID-19 led many mental health services across Australia to rapidly adapt to accommodate social restrictions, including using e-mental health services to support individuals aged 0–18 years and families.
• The authors conducted a lexical analysis of clinician reflections on how rapid responses to COVID-19 impacted psychiatry, patients and families, and the lessons learnt.

Key findings

• The reflections of child and adolescent psychiatry trainees and their supervisor on e-mental health during COVID-19 indicate there are advantages and disadvantages.
• E-mental health can help to extend the reach of, and access to psychiatry services, particularly for individuals who find travel difficult.
• However, some clinicians, children and families do not prefer e-mental health. This finding aligns with the results of a national survey of parents of children with neurodevelopmental disabilities that found just 30% reported telehealth worked well for their child.
• E-mental health services can also be inaccessible as they require equipment; (stable) internet access; space; (some degree of) digital literacy; skills and self-efficacy to conduct physical examinations, monitor child development and assess safety; risk management protocols; and privacy assurances.

Implications

• The findings suggests that e-mental health, in isolation, might not always meet the needs or preferences of clinicians, patients and families during pandemics. A model that allows for face-to-face and virtual psychiatry services might address this.
• This model would require practical, yet flexible policies and protocols that protect the privacy of children and families, safeguard them from harm, and respect the needs and preferences of children, families and clinicians.

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Highlights

• This systematic review synthesises the evidence for video-modelling interventions for individuals with attention-deficit hyperactivity disorder (ADHD).
• Video-modelling is where individuals watch footage of themselves (video self-modelling) or others (pre-taped video-modelling) demonstrating desired target behaviours successfully and discuss the behaviours.
• There is preliminary evidence to suggest video-modelling may be a promising intervention approach for targeting the social skills and behaviours of individuals with ADHD when used in conjunction with other intervention components.

Key findings

• Eleven original studies met the inclusion criteria. Studies included a total of 106 participants aged 5–16 years with ADHD. This contrasts with the large number of studies investigating the benefits of video-modelling for children with other diagnoses, including autism spectrum disorder (ASD).
• Nine studies reported positive outcomes immediately after intervention, including one RCT study with a control group which reported a significant improvement and large effect size in children’s social play skills following a play-based intervention.
• Two studies reported mixed findings including increased appropriate behaviours but no decrease in inappropriate behaviours, and an increased willingness to seek help with friendships but no effect was found on friendship quality.
• Video-feedback may be most effective for children with ADHD when an opportunity to practice skills follows immediately, or alongside spontaneous peer interaction and adult assistance.

Implications  

• Video-modelling studies for children with ADHD contain preliminary evidence for effectiveness with small samples. Emerging evidence suggests this approach has the potential to be an effective technique to capture the attention of children with ADHD.
• Video-modelling used in conjunction with other intervention components (i.e., parent training and involvement), and using video-modelling in multiple settings, may increase children’s ability to generalise the skills and behaviours and maintain treatment effects.

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Highlights

• Childhood anxiety and depression lead to great distress and impairment. Preventing them simultaneously in early life is critically important.
• This study evaluated the long-term efficacy of two programs aimed to build resilience to prevent worry, a transdiagnostic feature across anxiety and depression: an emotion regulation-based program and a behavioural activation-based program.

Key findings

• Participants in the emotion regulation-based and behavioural activation-based programs reported similar levels of worry, anxiety, or depression at post-program and at 6- and 12-month follow-ups compared to controls.
• The percentage of children who met the clinical cut-offs for generalised anxiety disorder and major depressive disorder decreased significantly in the behavioural activation-based program at 12-month follow-up, with no change in the control group.
• The percentage of children who met the clinical cut-off for obsessive compulsive disorder decreased in the emotion regulation-based program immediately after the program, but this was not maintained over time at 6- or 12-month follow ups.

Implications

• The emotional-regulation and behavioural activation-based prevention programs for childhood anxiety and depression showed promising results for certain anxiety disorders not otherwise observed in universal school-based studies.
• The results suggest that preventive strategies for children with symptoms of generalised anxiety disorder and depressive disorder may require a behavioural component to adequately target their symptoms and produce clinical benefits.
• Universal prevention programs often show null findings as participants are not required to experience symptoms to participate, which reduces their capacity for improvement over time. Observing effect sizes may be more appropriate to assess clinical and practical significance.

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