Highlights in child mental health research: September 2025

This month’s highlights include:

Art therapy with children and adolescents experiencing mental health conditions

This systematic review of 90 studies examined the effectiveness and acceptability (i.e. how well an intervention is received by the target group) of art therapy for children and adolescents experiencing an acute and/or severe mental health phase. The authors found art therapy to be effective in responding to a range of mental health conditions and particularly effective in reducing symptoms of post-traumatic stress disorder (PTSD). In addition, many studies reported high levels of acceptability with children and adolescents receiving art therapy reporting high satisfaction and/or enjoyment of the activities.

Food insecurity and rural child and family functioning

This study examined the relationship between daily food insecurity and child and family functioning with families living in rural north-eastern United States. The authors conducted baseline study visits with 61 caregivers, who then completed a daily diary for one month. The diaries captured daily food insecurity, caregiver perceptions of the direct effects of food insecurity on their children and themselves, and parent–child interactions. Caregivers also reported on their levels of hunger and how much time they spent with their child each day. The findings indicated that overall household food insecurity was linked to poor child mental health outcomes, including child internalising symptoms (e.g. symptoms of anxiety and/or depression). These daily changes in food insecurity affected child mental health more than the overall severity of household food insecurity. For caregivers, daily food insecurity and increased hunger were associated with negative affect (e.g. symptoms of anxiety, depression, feeling angry), reduced effective action (e.g. being able to start and complete tasks, ability to follow through with plans), and reduced attention and impulse control (ability to focus on tasks, decision-making, making mistakes, impulsiveness, forgetfulness). These in turn could increase parent–child conflict.

The changing role of family income in mental health from childhood to adolescence

This study measured the impact of family income on child mental health from early childhood through to adolescence. The authors used data from the longitudinal UK Millennium Cohort Study. The dataset included 18,818 children from 18,552 families born in the United Kingdom between 2000 and 2002, whose caregivers completed surveys at seven timepoints. It was found that lower family income was associated with poorer child mental health outcomes and increased externalising symptoms at ages 11 and 14 years. Higher family income was associated with fewer internalising symptoms in adolescence. Adolescents experiencing poverty had poorer mental health outcomes and were more likely to experience internalising symptoms than children and adolescents from higher income families.

Parents’ experiences of supporting their autistic child with mental health difficulties

This study explored parents’/caregivers’ experiences of the accessibility of child and adolescent mental health services for autistic children and adolescents living in the United Kingdom. The authors analysed qualitative responses from 300 parents/caregivers of autistic children with a mental health condition. Parents/caregivers indicated that caring for their child negatively affected their mental health and wellbeing. They also described the negative impact on their family overall, including relationships between their autistic child/adolescent and their siblings, and the parent’s/caregiver’s relationship with the other parent/caregiver. Parents/caregivers also reported that they found it challenging to access adequate support (e.g. feeling that they had to ‘fight’ and ‘battle’ to find appropriate services and services not being well-equipped to support autistic children and families). Parents/caregivers also reported feeling lonely, isolated, and being stigmatised by others in the local community (e.g. glances, looks or mutters when in public spaces with their child and/or their child being bullied at school).

Impacts of maternal depression on sleep duration and attentional and behavioural outcomes among preschool-aged children

This study used data from 2,974 mothers and their pre-school aged children who participated in a United States longitudinal study called the Future of Families and Child Wellbeing study. This study aimed to analyse the association between maternal depression, child sleep duration, and the internalising and externalising behaviours of the child. The study found that longer sleep in children was linked to fewer externalising, internalising and attention issues in kindergarten-aged children who had a mother experiencing depression. That is, adequate sleep appeared to play a protective role in managing some of the behavioural issues that are commonly associated with maternal depression.

Why is this important?

• Art therapy has been shown to be effective for children and adolescents experiencing mental health challenges.
• However, previous systematic reviews on art therapy have not explored acceptability (i.e. how well an intervention is received by the target group) and have excluded non-English studies. In addition, limitations have been placed on outcome measures and reviews have excluded qualitative studies and case studies.

What did they do?

• The authors conducted a systematic review of 90 studies (67 case studies and 23 original research studies) to explore the outcomes, effectiveness and acceptability of art therapy for children and young people (from birth to 24 years) who had experienced an acute and/or severe mental health phase. The authors also included studies that were in a language other than English.
• An acute and/or severe mental health phase was defined as being admitted to an inpatient mental health setting, experiencing active psychotic, manic or suicidal symptoms, and/or experiencing severe, extreme or sudden onset of symptoms of other psychiatric disorders.

What did they find?

• In most cases art therapy was delivered by art therapists, but there were instances of art therapy being delivered by other health professionals (e.g. psychologists, psychiatrists or psychotherapists).
• Art therapy was found to be effective in responding to a range of mental health conditions. It was found to be particularly effective in reducing symptoms of post-traumatic stress disorder (PTSD).
• Art therapy was found to be effective in addressing other mental health conditions. For example, improving emotion regulation, reducing trauma symptoms related to sexual abuse history, and improving self-efficacy, empowerment, assertiveness, accomplishment and self-esteem. It also helped children and young people with understanding their feelings, sense of identity and self-expression. It improved symptoms of depression, and increased hope and resilience.
• 34 studies reported on acceptability, with many indicating high levels of acceptability for art therapy (n=24). It was observed that those who participated in art therapy expressed high satisfaction and enjoyment in clinical observations and self-reports.

What does this mean for practice?

• There is strong evidence that art therapy can be an effective intervention for children and young people experiencing acute and/or severe mental health conditions.
• The evidence suggests that children and young people find art therapy enjoyable, and this can help keep them engaged in therapy.

Why is this important?

• Food insecurity has been shown to affect children’s mental health and developmental outcomes. It has been linked to hyperactivity, disruptive behaviours, language delays, anxiety, depression, suicidal ideation, substance abuse and absenteeism.
• Food insecurity can also affect caregivers’ mental health and family functioning.
• Research on food insecure households has traditionally measured food insecurity over longer periods of time (e.g. over a 12-month period). However, emerging research has started to use methods such as daily-diary designs, which allow for understanding how food insecurity effects families on a day-to-day basis.

What did they do?

• The authors explored how rural families experience daily food insecurity and its impact on family functioning. They did this by conducting a baseline study visit, followed by one month of daily surveys completed by 61 caregivers of school-aged children experiencing food insecurity and living in rural counties in north-eastern United States.
• The baseline data collection was conducted remotely with caregivers. Caregivers completed online questionnaires and a computerised cognitive assessment.
• The daily mobile survey was completed every day for one month. The survey consisted of 42 multiple choice questions assessing daily food insecurity, caregiver perceptions of the direct effects of food insecurity on their children and themselves, and parent–child interactions. Caregivers were also asked about their levels of hunger each day and how much time they spent with their child.

What did they find?

• There was an association between overall household food insecurity and child internalising symptoms (e.g. symptoms of anxiety and/or depression) and overall poor mental health.
• There was also an association between higher levels of daily fluctuations in food insecurity and higher levels of child internalising symptoms. Daily changes in food insecurity affected child mental health more than the overall severity of household food insecurity.
• For caregivers, daily food insecurity and hunger were associated with negative affect (e.g. symptoms of anxiety, depression, feeling angry), and reduced effective action (e.g. being able to start and complete planned activities, ability to follow through with plans), and reduced attention and impulse control (e.g. ability to focus on tasks, decision-making, making mistakes, impulsiveness, forgetfulness) in caregivers. These were in turn associated with increased parent–child conflict.
• Routine (e.g. regular mealtimes) and predictability (e.g. ability to access food on a regular basis) may be a protective factor for families experiencing disadvantage. However, caregivers’ ability to provide these may be limited because food insecurity often requires families to source foods in a variety of time-consuming and inconvenient ways (e.g. travelling to food banks, skipping meals, spending time sourcing the lowest priced food, travelling to the houses of family and friends for meals).

What does this mean for practice?

• Practitioners working with families experiencing economic vulnerability should consider screening them for (or asking about) food insecurity. This will enable practitioners to direct families to relevant support services.
• It is important that hunger-alleviation programs are convenient, accessible and are mindful of caregivers’ time and energy. This can help caregivers prioritise stability and routine for their children and family. Practitioners directing families to these services should be mindful of these family needs (e.g. by not referring them to a geographically distant location if that is avoidable).

Why is this important?

• Socio-economic status (SES) – which is often measured by family income, parents’/caregivers’ education levels and their occupational status – has been shown to affect children’s mental health.
• Children from families with lower family income are at risk of experiencing poorer mental health outcomes in comparison to children from families with higher family income.
• Measuring the impact of family income on child mental health from early childhood through to adolescence can help with understanding the importance of family income on child mental health outcomes and children’s evolving support needs.

What did they do?

• Data was used from a nationally representative study, the UK Millennium Cohort Study (MCS). The MCS collected data on child and parental health, parental SES, pregnancy-related factors, and other family circumstances and lifestyles.
• The authors used data from 18,818 children from 18,552 families born in the United Kingdom between 2000 and 2002. The surveys collected data from families at seven age-points (nine months, three, five, seven, 11, 14 and 17 years).
• The authors used the Strengths and Difficulties Questionnaire to assess child mental health problems and family income was adjusted using the Organisation for Economic Co-operation and Development equivalence scale.

What did they find?

• Lower family income was associated with poorer child mental health outcomes, but this varied at different ages, with poorer outcomes at ages 11 and 14 years. Lower family income was also associated with more externalising symptoms (i.e. behaviours such as hyperactivity and aggression).
• Adolescents who experienced poverty were more likely to have poor mental health outcomes and experience more internalising symptoms. Conversely, higher family income was associated with fewer internalising symptoms (i.e. symptoms of anxiety and/or depression) in adolescence.

What does this mean for practice?

• Adolescence is a particularly vulnerable developmental phase. Practitioners working with adolescents from families with low SES need to understand that these adolescents have a higher risk for poor mental health and may require additional specialist mental health supports.
• There is a need for affordable and accessible mental health services for low SES families and families experiencing poverty. Although individual practitioners cannot directly affect service availability, they should work to make their services accessible to low-income families.

Why is this important?

• Autistic children and adolescents are more likely to face mental health challenges than their non-autistic peers.
• While there is growing research on parenting autistic children, there is limited research about parenting autistic children who are also experiencing mental health challenges.

What did they do?

• The authors used qualitative data from a research project exploring parents’ perceptions of the accessibility of child and adolescent mental health services for autistic children and adolescents living in the United Kingdom using a mixed-methods survey.
• The study reported on the analysis of four open-text questions from a larger data set collected from 300 parents/caregivers of autistic children with a mental health condition. In these questions, caregivers were asked questions about the impact of their child’s mental health difficulties on all aspects of their life.

What did they find?

• Three common themes were identified by the authors: deteriorating parental wellbeing, the knock-on effects of poor child mental health on the whole family, and a lack of support.
• Parents/caregivers indicated that caring for their child affected their own mental health and wellbeing. They described feeling worried about their child, in distress and exhausted.
• Parents/caregivers also described the impact on the whole family, including strained relationships between siblings and between parents/caregivers.
• Many parents/caregivers reported feeling loneliness, isolation and a lack of support. They also reported their perceptions of being stigmatised by others in the local community (e.g. glances, looks or mutters when in public spaces with their child and/or their child being bullied at school).
• Parents/caregivers also described the challenges in accessing adequate mental health support for their child and their feeling that they had to ‘fight’ and ‘battle’ to find appropriate services. Many felt that services were not well-equipped to support autistic children and reported feeling responsible for educating service providers (e.g. schools, teachers, doctors) about autism.

What does this mean for practice?

• There is a need for greater understanding of autism in child and adolescent mental health services. Practitioners should consider neuro-affirmative training to increase their knowledge of autism and how mental health challenges may present in autistic children and adolescents.
• Mental health services and services working with autistic children also need to understand the challenges of parenting an autistic child with mental health difficulties and how they can support families to support children. Services should be family-centred, neurodivergence-informed and take into account the lived experiences of autistic children and their families.

Why is this important?

• Maternal depression has been identified as a risk factor associated with children’s development. It is associated with increasing internalising behaviours (such as anxiety and depression) and externalising behaviours (such as aggression and delinquency).
• Children’s sleep duration (i.e. getting enough sleep) is known to help regulate their behaviours and emotions and this may moderate the effects of other factors on child development and mental health. This study explores how adequate sleep among young children may mitigate the influence of maternal depression on children’s development.

What did they do?

• This study used data from the Future of Families and Child Wellbeing Study (FFCWS), a longitudinal survey following over 4,800 children born in 20 major cities in the USA between 1998 and 2000. The authors analysed data from 2,974 mothers (average age 30.2 years) and their preschool-aged children. A range of racial and ethnic identities were represented in the study, including 50% of participants identifying as Black.
• FFCWS data was collected through interviews with the primary caregiver shortly after the birth of the child followed by five interviews at different age-points (at ages one, three, five, nine and 15 years). This study used the data from the interviews of children aged five years, and compared data collected on maternal depression, child sleep duration, and internalising and externalising behaviours of the children.
• Maternal depression was measured using the Composite International Diagnostic Interview, and sleep data was provided by mothers who reported on the number of hours their child slept on a weeknight at age five years.
• During interviews with the primary caregiver, externalising, internalising and attention issues were assessed using the Child Behaviour Checklist.

What did they find?

• The study found that longer sleep (greater than eight hours) was linked to fewer attention, externalising and internalising issues in kindergarten-aged children whose mother was experiencing depression than in children who had less sleep (and whose mother was experiencing depression).
• The findings suggested that a longer sleep duration can mitigate or play a protective role against child behavioural issues, such as attention problems and internalising behaviours, that are typically associated with maternal depression.

What does this mean for practice?

• The findings of this study support measures to promote sleep routines or sleep support for at-risk families (e.g. those where parents are experiencing depression).
• Professionals working with children whose parents experience depression may support children with identified negative internalising and externalising behaviours by encouraging positive sleep habits and sleep hygiene.