Health Difficulties In Young People Research Articles

Loneliness in Young People with ADHD: A Systematic Review and Meta-Analysis

Many studies focus on problematic peer functioning in attention deficit/hyperactivity disorder (ADHD) but loneliness has been studied less. This paper examined (1) The loneliness level differences between young people (below 25 years old) with ADHD and those without ADHD, and (2) The association between loneliness and mental health difficulties in young people with ADHD. Six electronic databases were searched and 20 studies were included. A random effects meta-analysis was carried out in RStudio using the metafor package for the first question, while a narrative synthesis summarized the findings for the second question. The meta-analysis (n = 15) found that young people with ADHD reported significantly higher loneliness than those without ADHD, with a small-to-medium weighted pool effect (Hedges’ g = 0.41) and high heterogeneity (I2 = 75.1%). For the second question (n = 8), associations between loneliness and mental health difficulties in ADHD was found (r = 0.05–0.68). Targeted research and interventions on loneliness in young people with ADHD is needed.

The development and preliminary evaluation of Cognitive Behavioural Therapy (CBT) for Chronic Loneliness in Young People.

Approximately 10% of young people 'often' feel lonely, with loneliness being predictive of multiple physical and mental health problems. Research has found CBT to be effective for reducing loneliness in adults, but interventions for young people who report loneliness as their primary difficulty are lacking. CBT for Chronic Loneliness in Young People was developed as a modular intervention. This was evaluated in a single-case experimental design (SCED) with seven participants aged 11-18 years. The primary outcome was self-reported loneliness on the Three-Item Loneliness Scale. Secondary outcomes were self-reported loneliness on the UCLA-LS-3, and self- and parent-reported RCADS and SDQ impact scores. Feasibility and participant satisfaction were also assessed. At post-intervention, there was a 66.41% reduction in loneliness, with all seven participants reporting a significant reduction on the primary outcome measure (p < .001). There was also a reduction on the UCLA-LS-3 of a large effect (d = 1.53). Reductions of a large effect size were also found for parent-reported total RCADS (d = 2.19) and SDQ impact scores (d = 2.15) and self-reported total RCADS scores (d = 1.81), with a small reduction in self-reported SDQ impact scores (d = 0.41). Participants reported high levels of satisfaction, with the protocol being feasible and acceptable. We conclude that CBT for Chronic Loneliness in Young People may be an effective intervention for reducing loneliness and co-occurring mental health difficulties in young people. The intervention should now be evaluated further through a randomised controlled trial (RCT).

The Development of Mental Health Difficulties in Young People With and Without Developmental Language Disorder: A Gene-Environment Interplay Study Using Polygenic Scores.

Young people with developmental language disorder (DLD) have poorer mental health than those without DLD. However, not all young people with DLD are equally affected; some have more mental health difficulties than others. What explains these differences remains unclear. Data from a community cohort study, the Avon Longitudinal Study of Parents and Children, were analyzed to investigate genetic and environmental influences on the development of mental health difficulties at five time points from childhood (7 years) to adolescence (16 years) in 6,387 young people (8.7% with DLD). Regression and latent class models were fitted to the data. Polygenic scores (PGSs), indices of genetic risk, for common psychiatric disorders (major depressive disorder, anxiety disorder, and attention deficit hyperactivity disorder) predicted mental health difficulties in both groups (with and without DLD). The presence of DLD, in some instances, amplified mental health difficulties for those with high genetic risk for common psychiatric disorders. Subgroups of children with similar developmental trajectories of mental health difficulties were identified. Young people with DLD were more likely than those without DLD to follow mental health subgroups characterized by consistently high levels of difficulties during development. PGSs, socioeconomic status, and the early home environment distinguished subgroups with low mental health difficulties from those characterized by high levels of difficulties, but these effects did not differ based on DLD status. These findings suggest that, for the most part, both genetic and environmental risk affect the development of mental health difficulties in a cumulative way for young people with DLD (and those without). Some analysis did, however, suggest that genetic risk for common psychiatric disorders might manifest more strongly in those with DLD compared with those without DLD. https://doi.org/10.23641/asha.22351012.

Mental Health Provision in UK Secondary Schools.

Research reports high levels of mental health problems faced by young people in the UK. Schools provide a range of mental health support services, although these are often not robustly evaluated. This paper aims to explore the mental health provision of secondary schools across two large regions in the North of England and provide comparisons to the mental health questionnaire scores of their pupils. Results are part of a wider study providing an overview of the mental health of secondary school pupils. Measures include the Strengths and Difficulties Questionnaire, distributed to year 8, 9, and 11 pupils attending secondary schools and a bespoke mental health service provision questionnaire for school staff at the same schools. A total of 6328 pupil questionnaires and 36 staff questionnaires were returned from 21 schools. Results showed a non-significant correlation between provision and young people’s mental health scores and highlight a range of factors to take into consideration. There is a need to improve the evaluation and recording of school-based mental health provision. Mental health difficulties in young people are prevalent in schools. Future research is needed to elucidate which types of services are most helpful in preventing, supporting, and signposting those with mental health problems.

Is attachment style in early childhood associated with mental health difficulties in late adolescence?

AimsIdentifying factors that contribute to mental health difficulties in young people as early in life as possible are needed to inform prevention strategies. One area of interest is attachment. Although existing research has suggested an association between insecure attachment styles and mental health difficulties, these studies often have small sample sizes, use cross-sectional designs, and measure attachment as a discrete variable at a single point or use romantic relationship attachment as a proxy for childhood attachment. It is also unclear whether these associations persist into late adolescence. In this large prospective study we aimed to determine whether an insecure attachment style measured at repeated points in early childhood, is associated with depression and self-harm at 18 years.MethodWe used data from the Avon Longitudinal Study of Parents and Children cohort. Mothers completed attachment related questionnaires when their child was 18, 30, and 42 months old. Offspring depression and lifetime self-harm was assessed at 18 years in clinic using the Clinical Interview Schedule-Revised. Attachment was derived as a continuous latent variable in a structural equation modelling framework. Logistic regression was performed on participants with complete attachment data (n = 7032) to examine the association between attachment style and depression and self-harm, with adjustment for potential confounders. Differential dropout was accounted for using multiple imputation.ResultWe found some evidence for an association between a more insecure attachment style in childhood, and a diagnosis of depression and life-time self-harm at age 18. In the fully adjusted imputed model, a one standard deviation increase in insecure attachment was associated with a 13% increase in the odds of depression (OR = 1.13; 95%CI = 1.00 to 1.27) and a 14% increase in the odds of self-harm at age 18 (OR = 1.14; 95%CI = 1.02 to 1.25), for children who had more insecure attachment in early childhood, compared with children who had more secure attachment.ConclusionThis is the largest longitudinal study to examine the prospective association between childhood attachment and depression and self-harm in late adolescence. Our findings strengthen the evidence suggesting that a childhood insecure attachment style is associated with mental health difficulties in late adolescence. Policies and interventions to support parenting behaviours that foster the development of secure attachment styles, or attachment-based therapies to improve attachment quality, could help reduce depression and self-harm in adolescence/young adulthood.Philippa Clery is supported by the Elizabeth Blackwell Institute for Health Research at the University of Bristol and the Wellcome Trust Institutional Strategic Support Fund.

New models of care in general practice for the youth mental health transition boundary.

Mental illness represents the highest proportion of disease burden for children and young people in the UK.1 However, despite this, young people can struggle to access timely and appropriate mental health care. One particular barrier to continuity of care occurs when young people reach the upper age limit (usually 18 years) of child and adolescent mental health services (CAMHS). If they require ongoing specialist support, their care should be transferred to an adult mental health service (AMHS), through a purposeful and planned transfer of care known as ‘transition’. However, only around a quarter of young people transition to AMHS,2 and in the absence of specialist adult mental health care, GPs often become involved in the young person’s care ‘by default’.3 Although GPs become responsible for the young person’s care after they leave CAMHS, they may not have the necessary skills and resources to manage complex mental health difficulties in young people. ### The role of the GP in transition The National Institute for Health and Care Excellence (NICE) transition guidance calls for a named GP to be part of the transition process, emphasising the role GPs can have in continuity of care.4 The guidance states that the person acting as the ‘named worker’ (who is responsible for coordinating transition for the young person) should proactively engage GPs in transition planning, allowing GPs to be involved in the young person’s mental health care at this crucial stage. At present, however, there is no known evidence to suggest that GPs are regularly involved in transition planning. This may be due to differing organisational cultures which prevent collaborative working; something which has been identified as a barrier …

An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial.

BackgroundMental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs.ObjectiveThe objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people.MethodsThe cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up.ResultsThere were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone.ConclusionsIt is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted.International Registered Report Identifier (IRRID)RR2-10.2196/resprot.7019

The social context of adolescent mental health and wellbeing: parents, friends and social media

ABSTRACT Concerns about mental health difficulties in young people, mid-adolescent girls in particular, are on the rise. Many explanations ranging from peer pressure and bullying, to social media and gender inequality, have been offered for the rise in mental health problems. This study utilised data from the Millennium Cohort Study (Wave 6) to examine 14-year-olds’ mental health and wellbeing in relation to familial and peer interactions, gender, socio-economic factors and social media use. Across measures of mental health and wellbeing, the findings showed that girls fared much worse than boys, particularly in experiencing negative feelings and low self-concept and life satisfaction and in self-harming. Teenage girls appeared to have become the new ‘high risk’ group. The findings from this study have implications for young people’s mental health and wellbeing especially as seen through the lens of income and gender inequality. Given the current political concerns about young people’s mental health, this study is hoped to contribute to an informed debate about individual wellbeing within a broader social milieu.

Understanding resilience in young people with complex mental health needs: A Delphi study.

Resilience is a term used to describe an individual's adaptive coping following an adverse experience; it is important for gaining insight into the development of mental health difficulties in young people and their ability to manage adversity, informing both preventive and reactive clinical practice. The Delphi method was used whereby a panel of 15 clinical psychologists rated 67 statements, generated from focus groups with young people and interviews with multi-disciplinary staff, in terms of their importance relating to resilience for young people with complex mental health needs. A consensus level of 85% across the panel was set to include/exclude statements in terms of their importance for resilience. Nineteen statements were included in the final list. These were grouped into the following four themes: (1) understanding the self, (2) agency in recovery, (3) interpersonal relationships and (4) therapeutic setting and relationships. The results highlight specific resilience factors for young people with complex mental health needs, based upon ratings by clinical psychologists. Recommendations are made which focus upon how to promote resilience within this specific population. These include offering secure therapeutic relationships and a safe environment for young people to make decisions, develop a greater understanding of themselves, and build relationships and a sense of connection with others, both within the specialist mental health service and upon discharge.

Review: Low self-esteem and internalizing disorders in young people - a systematic review.

Cognitive behavioural therapy for low self-esteem (LSE) has shown promise as a trans-diagnostic model for treating mental health difficulties in adults. To ascertain the potential value of this treatment approach in working with young people with internalizing disorders, we need to develop our understanding of LSE within these mental health conditions. The aim of this review is to explore (a) the co-occurrence of clinically significant anxiety/depression and LSE in young people (aged 18 years and younger), and (b) the association between LSE in childhood and adolescence and mental health difficulties in later adolescence and emerging adulthood. A systematic search of three electronic databases (PsychInfo/Pubmed/Google Scholar) was conducted to identify relevant studies. Ten studies examining the association between LSE and clinically significant anxiety/depression in young people met the inclusion criteria, as did eight studies investigating the association between LSE in young people with internalizing difficulties in later adolescence/emerging adulthood. Although relatively few studies were identified, studies consistently supported the co-occurrence of LSE and internalizing disorders in young people, particularly in young people with co-morbid anxiety and depression. LSE in childhood and adolescence appears to be a relatively weak predictor of the development of anxiety and depression in later adolescence and early adulthood. Further research investigating the relationship between low self-esteem and mental health difficulties in young people and its implications for treatment in this age group is indicated.

Screening for psychological and mental health difficulties in young people who offend: a systematic review and decision model.

There is policy interest in the screening and treatment of mental health problems in young people who offend, but the value of such screening is not yet known. To assess the diagnostic test accuracy of screening measures for mental health problems in young people who offend; to evaluate the clinical effectiveness and cost-effectiveness of screening and treatment; to model estimates of cost; to assess the evidence base for screening against UK National Screening Committee criteria; and to identify future research priorities. In total, 25 electronic databases including MEDLINE, PsycINFO, EMBASE and The Cochrane Library were searched from inception until April 2011. Reverse citation searches of included studies were undertaken and reference list of included studies were examined. Two reviewers independently examined titles and abstracts and extracted data from included studies using a standardised form. The inclusion criteria for the review were (1) population - young offenders (aged 10-21 years); (2) intervention/instrument - screening instruments for mental health problems, implementation of a screening programme or a psychological or pharmacological intervention as part of a clinical trial; (3) comparator - for diagnostic test accuracy studies, any standardised diagnostic interview; for trials, any comparator; (4) outcomes - details of diagnostic test accuracy, mental health outcomes over the short or longer term or measurement of cost data; and (5) study design - for diagnostic test accuracy studies, any design; for screening programmes, randomised controlled trials or controlled trials; for clinical effectiveness studies, randomised controlled trials; for economic studies, economic evaluations of screening strategies or interventions. Of 13,580 studies identified, nine, including eight independent samples, met the inclusion criteria for the diagnostic test accuracy and validity of screening measures review. Screening accuracy was typically modest. No studies examined the clinical effectiveness of screening, although 10 studies were identified that examined the clinical effectiveness of interventions for mental health problems. There were too few studies to make firm conclusions about the clinical effectiveness of treatments in this population. No studies met the inclusion criteria for the assessment of the cost-effectiveness of screening or treatment. An exemplar decision model was developed for depression, which identified a number of the likely key drivers of uncertainty, including the prevalence of unidentified mental health problems, the severity of mental health problems and their relationship to generic measures of outcome and the impact of treatment on recidivism. The information evaluated as part of the review was relevant to five of the UK National Screening Committee criteria. On the basis of the above results, none of the five criteria was met. The conclusions of the review are based on limited evidence. Conclusions are tentative and the decision model should be treated as an exemplar. Evidence on the clinical effectiveness and cost-effectiveness of screening for mental health problems in young people who offend is currently lacking. Future research should consider feasibility trials of clinical interventions to establish important parameters ahead of conducting definitive trials. Future diagnostic studies should compare the diagnostic test accuracy of a range of screening instruments, including those recommended for use in the UK in this population. These studies should be designed to reduce the decision uncertainty identified by the exemplar decision model. This study is registered as PROSPERO CRD42011001466. The National Institute for Health Research Health Technology Assessment programme.

Responding to the Mental Health Needs of Young People with Profound and Multiple Learning Disabilities and Autistic Spectrum Disorders: Issues &amp; Challenges

Teachers in residential special schools often work with young people who experience some of the greatest obstacles to learning. In particular, young people with profound and multiple learning difficulties (PMLD) and those with autistic spectrum disorders (ASD) require expert teaching and management by professionals who have a detailed understanding of the individuality of these young people. The identification of mental health difficulties in young people with PMLD or ASD is often confused by the challenge of interpreting behaviours which become associated with a ‘condition’ rather than a manifestation of a mental health problem. This paper describes research which investigated professional understanding of and responses to mental health needs in young people with PMLD or ASD in a group of residential special schools. It is suggested that there remains a lack of understanding of the complex relationship between individual learning needs and mental health difficulties and that this is an obstacle to effective management and remediation. The development of greater cohesion across professional services, and with families, is perceived as an essential factor in enabling improved provision in this area.

Developmental differences and their clinical impact in adolescents

Adolescent mental health is a concern for health professionals as the prevalence of mental health problems appears to peak in adolescence and early adulthood because of the biological and psychosocial transitions that are occurring in this age group. Adolescence is a major transitional period between childhood and adulthood and many changes--physical, emotional and social--occur during this time. These changes can precipitate and perpetuate mental health difficulties in young people. Due to the amount of changes that occur in adolescence, younger and older adolescents are at quite distinct life stages and are biologically, cognitively, socially and emotionally distinct. There are also differences between younger and older adolescents in the prevalence of different disorders and in how they express their difficulties. It is, therefore, important for healthcare professionals to be mindful of the development level of the adolescents with whom they are working and the impact that this can have on the young person's presentation, understanding of their problems and in their ability to use different therapeutic interventions.

Cognitive Therapy for Children, Young People and Families: Considering Service Provision.

This article presents a case for the development of cognitive therapy services for children, adolescents and their families. The theoretical basis of cognitive therapy is described, and illustrated with a case. The article continues by exploring the context for service development, with a specific emphasis on evaluating the evidence-base for using cognitive therapy with children and adolescents. Consideration is also given to adapting cognitive therapy to the child's developmental level, and the evidence for the efficacy of cognitive-behavioural family approaches. The article concludes by arguing that there is a need to address mental health difficulties in young people by providing effective treatment approaches. The development of cognitive therapy services would support the further evaluation of this therapeutic approach.