School Disengagement Among Children With Mental Health Conditions Pre- and Intra-COVID-19 Pandemic.

National Variation of ADHD Diagnostic Prevalence and Medication Use: Health Care Providers and Education Policies

Although mental health challenges are widespread, impacting 1 in 5 children and youth, only 25% of these young people receive the required mental health supports. Unmet mental health needs are strongly associated with functional impairments including poor self-care, interpersonal challenges, and school difficulties among young people. School disengagement, or a student's lack of involvement in education through interest, curiosity, motivation, and active participation, is associated with a wide array of detrimental outcomes including chronic mental health difficulties, conduct and delinquent behaviors, criminal justice involvement, and unemployment in adolescence and adulthood. Disengagement observed within the school setting may be indicative of underlying mental health challenges and reflective of service intensity need. The current study extends the literature by examining the relationship between school disengagement and mental health service intensity need among 14,750 clinically referred students across elementary and secondary school utilizing the interRAI Child and Youth Mental Health instrument. Findings indicated that more than 25% of clinically referred students were at heighted risk for school disengagement and required high-intensity services. Further, mental health service intensity need was positively associated with risk of school disengagement among students, along with the specific reason for referral (i.e., psychiatric symptoms, harm to self, harm to others, or addiction or dependency), after controlling for sex and age. Implications of the findings are explored within the context of the school setting and future directions are suggested.

We pooled data from four years (2016-2019) of the National Survey of Children's Health (NSCH) and included a nationally representative sample of 6 to 17years old US children (N = 94,369; Mean age = 11.53years, Standard Deviation [SD] = 3.53). Among 6-17-year-old US children, about 48% had a lifelong exposure to at least one of nine Adverse Childhood Experiences (ACEs), and 18.7% had a current diagnosis of at least one of four mental disorders. We examined the association between ACEs, neighborhood support, and mental disorders using several logistic regression models. More types of lifelong ACEs and lower neighborhood support were associated with a higher diagnosis of internalizing (anxiety/depression) and externalizing (ADHD/behavior problems) mental disorders (odds ratio [OR] > 1, and p < .001 for all relationships). After controlling for neighborhood support in the models, the odds ratios for ACEs attenuated but remained significant in all models regardless of mental disorder type or age group. However, the odds ratios for neighborhood support were larger for the association with ADHD/behavior problems than anxiety/depression. Moreover, odds ratios for neighborhood support levels were higher for older children (12-17years old) compared to younger (6-11years old) children. Higher neighborhood support appears to mitigate the adverse effects of ACEs on mental disorders, especially externalizing mental disorders (anxiety/depression) among adolescents (12-17years old).

Adverse childhood experiences (ACEs) are associated with a range of health outcomes and risk behaviors. In 2011-2012, the National Survey of Children's Health (NSCH) included questions about adverse family experiences (AFEs). AFE survey questions are similar to ACE questions, except there are no questions about emotional/physical/sexual trauma, and questions are asked of parents rather than children. Although the relationship between ACEs and work/school absenteeism has been studied, the relationships between AFEs of school-aged children, school performance, and buffering behaviors have not been explored in depth. We examined AFEs and measures of resilience and school engagement among 1330 Vermont children (6-17years) included in the NSCH, using descriptive, bivariate, and multivariable analyses. The most prevalent AFEs were divorce/separation of parents; family income hardship; substance use problems; and mental illness, suicidality, or severe depression. Adjusting for sex, age, special health care needs, poverty level, and maternal physical/mental-emotional health status, children who had three or more AFEs had lower odds of completing all required homework [adjusted odds ratio (AOR) 3.3, 95% confidence interval (CI) 1.7-6.3] and higher odds of failing to exhibit resilience (AOR 2.1, 95% CI 1.2-3.8), compared to children having no AFEs. Children with three or more AFEs had difficulty engaging in school and completing homework, though poor outcomes were buffered when children showed resilience. Parents, school-based mental health professionals, and teachers could help identify children who may be less resilient and have difficulties completing homework assignments. Preventive approaches to children's emotional problems (e.g., promoting family health, using family-based approaches to treat emotional/behavioral problems) could be applied in schools and communities to foster resilience and improve school engagement of children.

Lack of access to food is a significant concern for child well-being, and it creates many health disparities and adverse social outcomes. Food insecurity and its many associated risk factors increase parental stress, which are strongly correlated with an increased risk of child abuse and maltreatment. Research now identifies being witness to domestic abuse as a form of child maltreatment, and exposure to violence in the community has been shown to result in similar long-term impacts. Given the potential for lifelong adverse effects from experiencing adverse childhood events involving violence and food insecurity, our primary objective was to assess the relationship between the two and disparities among demographic factors. We conducted an observational study utilizing data from the National Survey of Children's Health (NSCH) 2016-2021. The NSCH is a United States nationally representative survey completed by primary caregivers of one child per home aged 0-17 years. We determined population estimates (n=216,799; n=83,424,126) and rates of children experiencing food insecurity and parent-reported exposure to violence. We then constructed logistic regression models to assess associations, through odds ratios (ORs), between food security and exposure to violence including demographic factors. Among the sample, 5.42 % of children experienced low food security and 7.4 % were exposed to violence. The odds of exposure to violence are 5.19 times greater for children with low food security compared to food-secure children (95 % confidence interval [CI]: 4.48-6.02). Indigenous and Black children were 7.8 and 6.81 times more likely to experience or witness violence when food insecure compared to food secure White children, respectively (95 % CI: 3.18-19.13, 5.24-8.86 respectively). Food insecurity was associated with increased odds of children experiencing and/or witnessing violence compared to those who were food secure. The interaction between exposure to violence and food insecurity also disproportionately impacts children with specific demographic factors, notably race/ethnicity including multiracial, Indigenous, and Black children. By developing and adapting strategies to improve food security, it is possible to indirectly reduce the rates of childhood exposure to violence and the long-term impacts that result.

PurposeThe purpose of this study is threefold: Determine recent trends in several mental health problems in the USA, identify risk factors that may be responsible for the trends and evaluate intervention policies to reduce the consequences of these problems.Design/methodology/approachThis study used data from the National Survey of Children's Health (NSCH), a nationally representative survey of children under the age of 17 that was conducted between 2016 and 2022. Prevalence rates in the data take into account the probability of selection and nonresponse. Because of the possible correlation in the longitudinal responses in the data, an appropriate extension of the generalized linear models (the marginal models) was used. Marginal models, also known as population-average models, do not require distributional assumptions for the observations, only a regression model for the mean response. The avoidance of distributional assumptions leads to the use of the generalized estimating equations (GEE) method.FindingsThe author found that the odds of children and adolescents experiencing mental health problems in the USA changed over a seven-year period, from 2016 to 2022. Anxiety and depression, in particular, have both increased, with anxiety increasing faster than depression; however, behavioral issues and attention deficit disorder/attention deficit hyperactivity disoder (ADD/ADHD) remained stable until 2020 (the start of COVID-19), when they began to rise. This paper also found a link between increased social media use and increased mental health problems, and bullying has a negative impact on the mental health of children and adolescents.Originality/valueThe NSCH, an annual representative survey, was used in this study to assess mental health problems among children and adolescents in the USA. Marginal models, which enable the capture of potential correlations among observations of the same subject, were used in conjunction with the GEE method. This study differs from previous research, which used other surveys, pre-COVID-19 data points and logistic regressions that assumed independence in repeated observations.

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

The purpose of the present study is to examine the association between household food insecurity and oral health problems among US children, and the role that socioeconomic, insurance, and oral health care utilization variables play in this association. A large, nationally representative sample of children from the 2016-2018 National Survey of Children's Health (NSCH) was employed in the present study (N=99,962). Logistic regression and negative binomial regression were used to assess the influence of household food insecurity on diverse oral health problems and unmet oral health care needs. The Karlson-Holm-Breen (KHB) method was used to examine the attenuating roles of socioeconomic, insurance, and oral health care utilization variables. Children in food-insecure households exhibited significantly greater odds of all examined oral health problems as well as unmet oral health care needs. These associations were a) most pronounced in the case of moderate-to-severe food insecurity and b) partly explained by a subset of socioeconomic and insurance-related variables. Household food insecurity is a potent risk factor for oral health problems and unmet oral health care needs among US children. Programmatic efforts to address household food insecurity may yield collateral benefits for the oral health of children. Furthermore, because socioeconomic status and insurance-related variables explain part of the association, targeted interventions to improve these factors may improve oral health among at-risk children.

Parenting stress and family resilience affect the association of adverse childhood experiences with children's mental health and attention-deficit/hyperactivity disorder

A conceptual framework for the revision of the ICD‐10 classification of mental and behavioural disorders

The Development, Implementation, and Evaluation of Innovative Strategies to Reduce Food Insecurity among Children in the United States

Behavioral and mental health problems in adolescents with ADHD: Exploring the role of family resilience

There is a current crisis in children's mental health. Defining social determinants of mental health (SDMH) facilitates investigations of social impact on mental health. To examine associations between nine SDMH and adolescent depression and anxiety in a U.S. nationally representative sample. Poor access to health care, caregiver underemployment, food insecurity, poorly built environment, housing insecurity, household dysfunction adverse childhood experiences (ACEs), racism, caregiver poor education, and poverty/income inequality were assessed from the 2018 to 2019 National Survey of Children's Health (NSCH) (N = 24,817). The likelihood of reporting adolescent depression and/or anxiety was assessed for each SDMH using multinomial logistic regressions. All SDMH, besides caregiver underemployment, were associated with increased odds of reporting adolescent anxiety, depression, or anxiety and depression. Only household dysfunction ACEs and racism had statistically significant associations for all three mental health outcomes. Interventions targeting ACEs and racism may be more impactful in mitigating mental health challenges associated with SDMH during adolescence. The NSCH may provide an important public health tool to investigate SDMH in children.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

The relationships between adverse childhood experiences (ACEs) and mental health conditions have received much attention in the literature. A particularly well-documented type of ACE is household dysfunction. However, compared to monoracial youth, little is known about the relationship between this type of ACE and mental health outcomes among multiracial adolescents. Objective The objective of this study was to verify the factor structure of the household dysfunction type of ACE using data from the National Survey of Children’s Health (NSCH), and then examine whether household dysfunction (measured as a latent construct) was associated with mental health conditions among multiracial adolescents. Design We used cross-sectional data collected in 2016 from caregivers who completed the NSCH and analyzed data from a subpopulation of adolescents (12–17) who reported more than one race (n = 1,231). Mplus 8.4 was used to conduct confirmatory factor analysis and probit models from a structural equation modeling framework. Results Results from this study indicated that the household dysfunction type of ACE, as a latent construct, had good model fit and was significantly associated with depression [standardized coefficient [B] = .50, 95% confidence interval [CI] .36, .65], anxiety [B = .61, 95% CI .48, .73], behavior problems [B = .58, 95% CI .44, .72], and ADHD [B = .54, 95% CI .38, .69] for multiracial adolescents. Conclusions Household dysfunction may result in adolescents being separated (physically or emotionally) from their caregivers, which may hinder adolescents’ ability to establish or maintain one of the most important relationships needed to promote racial/ethnic identity development and mental health. Implications for advancements in theory and NSCH are presented.