Mental health treatment: Reaching more kids

Background: Nearly 70% of children who are in need of specialized mental health services do not access them. We set out to identify effective self-delivered interventions as a way to help bridge the gap between those in need and those being serviced. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating self-delivered treatments. After applying our rigorous inclusion criteria, we accepted five RCTs evaluating five treatment interventions. Results: Three self-directed family interventions reduced anxiety diagnoses and symptoms for school age children. One self-directed parenting intervention reduced ADHD diagnoses for school age children. Additionally, one self-directed youth invention reduced depression symptoms for adolescents. Conclusions: Strong research evidence supports the use of self-directed treatments to address three common childhood mental disorders. Greater use of these interventions can expand the number of children who are reached with effective treatments

Preventing and Treating Childhood Mental Disorders: Effective Interventions

Background: Social and emotional wellbeing is a crucial resource for all children. Yet high-quality epidemiological studies suggest that 12.7% of children will experience a mental disorder.  Methods: We used systematic review methods to identify 113 randomized controlled trials and six systematic reviews on effective interventions for preventing and treating the most common childhood mental disorders.  Results: We found effective prevention interventions for anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant and conduct disorders, depression, eating disorder and posttraumatic stress disorder. In addition to identifying useful treatments for all of these disorders, we also found effective treatments for autism spectrum, obsessive-compulsive and bipolar disorders as well as schizophrenia.  Conclusions: Mental disorders, which typically start in childhood, cause significant distress and impairment for children. Beyond the hardships they cause for children and families, there are also significant avoidable costs for society as a whole. By implementing effective prevention interventions and treatments for these concerns, it is possible to avert unnecessary hardships for young people, their families and their communities

Six decades of preventing and treating childhood anxiety disorders: A systematic review and meta-analysis to inform policy and practice

Question Anxiety disorders are the most prevalent childhood mental disorders. They also start early and persist, causing high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders? Methods We sought randomised controlled trials (RCTs) evaluating interventions addressing anxiety problems in young people. We identified RCTs by searching CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science. Thirty-three RCTs met inclusion criteria—evaluating 8 prevention programmes, 12 psychosocial treatments and 7 pharmacological treatments. We then conducted meta-analyses by intervention type. Findings For prevention, the cognitive-behavioural therapy (CBT) programme Coping and Promoting Strength stood out for reducing anxiety diagnoses. For psychosocial treatment, 9 CBT interventions also reduced diagnoses: Cool Kids; Cool Little Kids Plus Social Skills; Coping Cat; Coping Koala; One-Session Treatment; Parent Education Program; Skills for Academic and Social Success; Strongest Families and Timid to Tiger. Successful CBT interventions were used with children ranging from pre-schoolers to teens in homes, communities/schools and clinics. For pharmacological treatment, selective-serotonergic-reuptake-inhibitors (SSRIs) significantly improved symptoms. Fluoxetine stood out for also reducing post-test diagnoses, but caused adverse events. Meta-analyses indicated strongest effects for CBT (Log OR=0.95; 95% CI, 0.69 to 1.21) and SSRI treatments (1.57; 1.09 to 2.06). Conclusions CBT is effective for preventing and treating childhood anxiety—across a range of ages and formats. Fluoxetine is also an effective treatment but side effects must be managed. CBT prevention and treatment interventions should be made widely available, adding fluoxetine in severe cases

Treating substance misuse in young people

Background: At any given time, an estimated 2.4% of Canadian youth use alcohol or drugs at a level that qualifies for a substance use disorder diagnosis, with alcohol and cannabis problems being the most common. Given that substance use disorders take a tremendous toll on young people and can become entrenched, effective interventions need to be provided early in life. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to treat adolescent substance use disorders.  Applying our inclusion criteria to the 104 studies identified from our searches, we accepted eight RCTs. Results: The following seven community-based treatments showed evidence of success: Adolescent Cannabis Check-Up, Case Management, Cognitive Behavioural Therapy (CBT), Community Reinforcement, Ecologically Based Family Therapy, Motivational Interviewing and Multidimensional Family Therapy. Of these, CBT, Multidimensional Family Therapy and Motivational Interviewing had particularly strong evidence of effectiveness, with positive outcomes from multiple RCTs. Conclusions: There are many effective interventions for treating youth substance misuse. By intervening at this early point in the lifespan, it is possible to avert far more serious problems later in life

Helping youth with bipolar disorder

Background: Although bipolar disorder is rare in young people, effective treatments are critical for those experiencing it. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for youth with bipolar disorder. Applying our inclusion criteria to the 50 studies identified from our searches, we accepted 12 RCTs. Results: Among the five medications assessed, aripiprazole and lithium stood out. Aripiprazole significantly reduced disorder severity and manic symptoms while improving overall functioning. Lithium also reduced manic symptoms while improving overall functioning. Still, both had significant side effects. Among the three psychosocial interventions assessed — Multifamily Psychoeducational Psychotherapy, Child and Family-Focused Cognitive-Behavioural Therapy, and Family-Focused Therapy — all showed benefit. In contrast, the dietary supplement flax oil was not effective. Conclusions: Most young people with bipolar disorder will need medication to manage this condition. Aripiprazole and lithium should be considered first, given their effectiveness and their regulatory approval. The three effective psychosocial treatments should also be considered as an adjunct to medication.&nbsp

Preventing child maltreatment

Background: All children need safety, stability and nurturing in order to flourish. Yet many children experience maltreatment, including neglect, emotional abuse, exposure to intimate partner violence, physical abuse or sexual abuse. Consequently, effective interventions to prevent maltreatment are crucial. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions designed to prevent child maltreatment.  Applying our inclusion criteria to the 43 studies identified from our searches, we accepted three RCTs. Results: We found strong evidence showing two programs — Child FIRST and Nurse-Family Partnership (NFP) — were successful in preventing child maltreatment. NFP, which targets key risk factors for maltreatment, including socio-economic disadvantage resulted particularly strong benefits, including reducing families’ involvement with child protective services as well as reducing child behaviour problems and improving mothers’ life circumstances.  Conclusions: The success of NFP and Child FIRST provides evidence that child maltreatment can be prevented

Helping children who have been maltreated

Background: Child maltreatment is an avoidable form of adversity that puts children at risk for negative mental health and life course outcomes making prevention imperative. Nevertheless, when maltreatment has occurred, interventions can help reduce harm for children while also supporting parents. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for children who have been maltreated. Applying our inclusion criteria to the 68 studies identified from our searches, we accepted seven RCTs. Results: Six interventions showed benefits. Promoting First Relationships reduced child apprehensions due to maltreatment and improved children’s behaviour and emotional responses. Child-Parent Psychotherapy increased children’s “secure attachment” to their mothers and improved their behaviour. Project Support reduced physical abuse among children exposed to intimate partner violence and improved children’s behaviour and emotional well-being. Multisystemic Therapy reduced re-abuse and out-of-home placements; it also reduced child posttraumatic stress, dissociation, and other emotional and behavioural problems. Fostering Healthy Futures reduced placement changes as well as child dissociation and emotional distress. Finally, It’s My Turn Now reduced children’s posttraumatic stress symptoms. Conclusions: The best way to help children flourish is to support families to meet children’s basic needs, including preventing maltreatment. When children have been mistreated, practitioners should intervene before mental health symptoms develop given that emotional or behavioural problems can be prevented. Finally, children who have been maltreated and then develop emotional or behavioural symptoms need to receive effective interventions as quickly as possible

Fifty years of preventing and treating childhood behaviour disorders: A systematic review to inform policy and practice

Question Oppositional defiant and conduct disorders (ODD and CD) start early and persist, incurring high individual and collective costs. To inform policy and practice, we therefore asked: What is the best available research evidence on preventing and treating these disorders? Study selection and analysis We sought randomised controlled trials (RCTs) evaluating interventions addressing the prevention or treatment of behaviour problems in individuals aged 18 years or younger. Our criteria were tailored to identify higher-quality RCTs that were also relevant to policy and practice. We searched the CINAHL, ERIC, MEDLINE, PsycINFO and Web of Science databases, updating our initial searches in May 2017. Thirty- seven RCTs met inclusion criteria—evaluating 15 prevention programmes, 8 psychosocial treatments and 5 medications. We then conducted narrative synthesis. Findings For prevention, 3 notable programmes reduced behavioural diagnoses: Classroom-Centered Intervention; Good Behavior Game; and Fast Track. Five other programmes reduced serious behaviour symptoms such as criminal activity. Prevention benefits were long term, up to 35 years. For psychosocial treatment, Incredible Years reduced behavioural diagnoses. Three other interventions reduced criminal activity. Psychosocial treatment benefits lasted from 1 to 8 years. While 4 medications reduced post-test symptoms, all caused important adverse events. Conclusions Considerable RCT evidence favours prevention. Clinical implications Effective prevention programmes should therefore be made widely available. Effective psychosocial treatments should also be provided for all children with ODD/CD. But medications should be a last resort given associated adverse events and given only short-term evidence of benefits. Policymakers and practitioners can help children and populations by acting on these findings

Parenting without physical punishment

Background: Most parents use effective disciplinary strategies, such as modelling positive behaviours and setting age-appropriate expectations. Still, some parents resort to using physical punishment despite it being linked to problematic outcomes, such as injuries and emotional problems for children. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating parenting interventions with outcomes that included parents’ use of physical punishment and children’s wellbeing. Applying our inclusion criteria to the 48 studies identified from our searches, we accepted five RCTs evaluating three parenting programs. Results: Our review found Chicago Parent Program and Incredible Years  reduced physical punishment and other problematic forms of discipline and also enhanced positive parenting. As well, both programs resulted in improved mental health outcomes for children, including reductions in behaviour problems. Conclusions: This review finds that parents can be taught effective alternatives to physically punishing children. Investments in effective parenting programs can have produce long term benefits including advancing children’s wellbeing and safety

Promoting positive behaviour in children

Background: For some children challenging behaviours, including defiance and aggression, start to impede their development and well-being. We set out to determine whether early interventions could assist these young people. Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for preventing child behaviour disorders, including oppositional defiant disorder and conduct disorder. Applying our inclusion criteria to the 166 studies identified from our searches, we accepted 13 RCTs. Results: We found five programs — Chicago Parent Program, Fast Track, Incredible Years, Nurse-Family Partnership, and Parent Management Training — that had positive behavioural outcomes. All either focused primarily on parenting or included parents to a substantial degree. Additionally, Fast Track and Nurse-Family Partnership were also shown to be cost-effective. Conclusions: It is possible to avert behavioural problems early in a child’s development before they become entrenched. Doing so comes with substantial long-term benefits to children, families and society