Highlights in child mental health research: September 2022

Highlights

• There is a need for a validated measure of resilience for children which is also culturally and socially appropriate.
• This paper describes the development and pilot testing of the child-report Child Resilience Questionnaire (CRQ-C), a culturally and socially inclusive multidimensional measure of child resilience factors.

Key findings

• Parents and children aged 5-12 in Victoria, Australia were recruited with representative sampling from Aboriginal and refugee-backgrounds.
• The CRQ-C measured is based on a socioecological model of resilience and was developed and revised using community-based participatory research methods with Aboriginal and refugee background communities. 
• Consultation driven revisions included including an item to capture a sense of belonging based on a refugee working group, and an item to capture acknowledgement of culture in the school setting based on an Aboriginal working group.
• Exploratory factor analyses and confirmatory factor analyses supported 10 subscales reflecting personal resilience factors (positive self/future, managing emotions) and connectedness to family, school and culture. Excellent scale reliability was found (α=0.7-0.9) for all but one scale (Friends, α=0.6).
• The CRQ-C demonstrated content, construct and scale reliability using culturally and socially inclusive self-report measures of resilience factors in childhood.

Implications

• The CRQ-C is a new self-report measure of factors supporting resilience in children across diverse contexts. It comprises 10 scales across the socioecological domains most relevant to children—the domains of personal, family, school and culture.
• The CRQ-C tool can be used in practice to measure resilience, start conversations with the family about the child’s wellbeing, highlighting strengths and where support may be helpful. It can also be used in research and policy to guide intervention efforts.

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Highlights

• No evidence synthesis of the Australian research exists on targeted prevention and early intervention for mental health concerns among young children.
• This review describes the types of targeted community-based mental health programmes evaluated in Australia, and the impact of these programs on internalising/externalising symptoms.

Key findings

• A systematic review and meta-analysis were conducted looking at Australian studies published in the past 10 years that quantitatively evaluated the impact of a targeted programme on children’s mental health.
• Forty-two studies were included (67% were medium quality), which investigated 16 different types of programs.
• Programs included: 1-2-3 Magic, Tuning into Kids, Triple P, Cool little Kids, Fear-less Triple P, Fun FRIENDS, No Worries!, Circle of Security.
• Aboriginal and Torres Strait Islander children were under-represented in the studies.
• Most of the interventions were group programmes delivered to the child’s primary caregiver.
• Externalising symptoms were targeted in 20 studies, internalising symptoms in 14 and 8 studies looked at both.
• Externalising programmes achieved a significant moderate mean reduction in externalising behaviours (standardised mean differences = -0.56), internalising programmes yielded a small mean improvement in anxiety symptoms (standardised mean differences = -0.25) and 57% reduced odds of anxiety disorder diagnosis.

Implications

• Parenting-focused programs targeting young children’s internalising or externalising behaviours have the largest local evidence base supporting their effectiveness. This aligns with international research. Limitations include a lack of engagement with fathers, triangulation of outcomes, homogeneity and implementation reporting.
• Caution must be taken when implementing an ‘effective’ program, it must be adapted based on the cultural, ethical and psychosocial aspects of the child and family.
• To build to the evidence base, organisations could consider implementation and evaluation of community-driven systemic, coordinated and integrated wrap-around approaches that intervenes at the child, parent, family and community level.

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Highlights

• Globally, ADHD diagnoses have increased substantially and there is concern that this trend does not necessarily reflect improved detection of cases but that overdiagnosis may be occurring.
• This study highlights the difference between ADHD diagnosis and hyperactive/inattentive behaviour based on longitudinal data of Australian children.

Key findings

• Secondary analysis of two cohorts of the Longitudinal Study of Australian Children data, following children from 4-13 years of age, was undertaken.
• The study compared pre-diagnosis parent-reported hyperactive/inattentive (H/I) behaviour scores between newly diagnosed (incident cases) and undiagnosed children and the relationship with the risk of incident ADHD diagnosis.
• H/I behaviour scores were measured using the parent-reported hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire (SDQ).
• The incident of ADHD diagnosis increased from 5.6% (children born 1999/2000) to 6% (children born 2003/2004), while H/I behaviour scores remained steady.
• Children born in the 2003/2004 cohort were more likely to be diagnosed with ADHD compared to children born in 1999/2000.
• Diagnostic increases were not driven by rises in H/I behaviours. A quarter of all children with an ADHD diagnosis recorded pre-diagnosis behaviours within the normal range.
• However, the study is limited by the fact that the scale that measures H/I behaviour (H/I SDQ scale), is known to have a relatively low sensitivity. This was accounted for by focusing results on the group of children scoring 4 points or lower.
  

Implications

• Over-diagnosis of ADHD could be occurring in practice, and this is a global phenomenon. It could be due to misdiagnosis of other conditions like autism obsessive compulsive disorder or transient behavioural problems. It could also be because no single diagnostic marker exists for definite diagnosis of ADHD and therefor is highly clinician dependant.
• This study highlights the need for a cautious clinical approach to ADHD diagnosis in children with subclinical-range H/I behaviours while it remains unclear how diagnosis may affect long-term outcomes in these children.

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Highlights

• There is a general belief that children rarely think about suicide because they do not understand or fathom their own death. However, children who experience distress may not be seeking help.
• This is the first systematic review and meta-analysis estimating the prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger in the general population.

Key findings

• A systematic review and meta-analysis was conducted to investigate studies that estimate prevalence of suicidal ideation (including suicide planning) and self-harm behaviours (self-harm, suicide attempts, and non-suicidal self-injury) in children aged 12 and younger.
• 28 articles were included, and none were from Australia. None were from low-income countries, half were from the USA.
• The pooled prevalence was:
  • 5% for suicidal ideation (28 studies)
  • 2% for suicide planning (3 studies)
  • 4% for self harm (4 studies)
  • 3% for suicide attempt (6 studies)
  • 9% for non-suicidal self injury (2 studies)
• Studies asking children about suicidal ideation yielded a higher prevalence than those asking parents.
• The prevalence of suicidal ideation and self-harm behaviours was similar between boys and girls.
• The prevalence estimates for suicidal ideation and self-harm behaviours showed high heterogeneity (different studies showed similar estimates).

Implications

• Although this is not specific to Australia, this study highlights that suicidal ideation and, to a lesser extent, self-harm behaviours are common among children aged 12 years and younger.
• Existing strategies have shown some benefits in preventing suicidal ideation and self-harm behaviours in adolescents (e.g. awareness and skills training) and for at-risk youths (e.g. dialectical behavioural therapy, cognitive behavioural therapy, and youth-nominated support teams). It is unclear, however, whether such interventions are developmentally appropriate for younger children and therefore this should be investigated.

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