Child Mental Health Symptoms Research Articles

Mental health problems in children with neuromotor disabilities.

Mental health in children with neuromotor disorders is part of a dynamic system, including medical and developmental domains, family, school and community. Presentations are often complex and multifactorial, requiring a broad, individualized approach. A narrative overview of mental health symptoms in children with neuromotor disabilities is provided, along with recommendations for their assessment and management using the WHO's International Classification of Functioning framework.

Identifying mental health symptoms in children and youth in residential and in-patient care settings.

This study demonstrates the use of the interRAI assessment instruments to examine mental health symptoms in children and adults within residential and in-patient care settings. Regardless of service setting, children exhibited more harm to self and others than adults. Children in adult in-patient beds were more likely to exhibit suicide and self-harm and less likely to exhibit harm to others compared to children in child-specific service settings. Implications related to service system improvements are discussed.

Media Violence Exposure and Physical Aggression in Fifth-Grade Children

ObjectiveTo examine the association of media violence exposure and physical aggression in fifth graders across 3 media types. MethodsWe analyzed data from a population-based, cross-sectional survey of 5,147 fifth graders and their parents in 3 US metropolitan areas. We used multivariable linear regression and report partial correlation coefficients to examine associations between children's exposure to violence in television/film, video games, and music (reported time spent consuming media and reported frequency of violent content: physical fighting, hurting, shooting, or killing) and the Problem Behavior Frequency Scale. ResultsChild-reported media violence exposure was associated with physical aggression after multivariable adjustment for sociodemographics, family and community violence, and child mental health symptoms (partial correlation coefficients: TV, 0.17; video games, 0.15; music, 0.14). This association was significant and independent for television, video games, and music violence exposure in a model including all 3 media types (partial correlation coefficients: TV, 0.11; video games, 0.09; music, 0.09). There was a significant positive interaction between media time and media violence for video games and music but not for television. Effect sizes for the association of media violence exposure and physical aggression were greater in magnitude than for most of the other examined variables. ConclusionsThe association between physical aggression and media violence exposure is robust and persistent; the strength of this association of media violence may be at least as important as that of other factors with physical aggression in children, such as neighborhood violence, home violence, child mental health, and male gender.

Differential roles of childhood adversities and stressful war experiences in the development of mental health symptoms in post-war adolescents in northern Uganda.

BackgroundPrevious studies have shown a relationship between stressful war experiences and mental health symptoms in children and adolescents. To date, no comprehensive studies on the role of childhood adversities have been conducted with war-exposed adolescents living in post-war, low-resource settings in Sub-Saharan Africa.MethodsA cross-sectional study of 551 school-going adolescents aged 13-21 years old was undertaken four years post-war in northern Uganda. Participants completed self-administered questionnaires assessing demographics, stressful war experiences, childhood adversities, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms.ResultsOur analyses revealed a main effect of gender on all mental health outcomes except avoidance symptoms, with girls reporting higher scores than boys. Stressful war experiences were associated with all mental health symptoms, after adjusting for potential confounders. Childhood adversity was independently associated with depression symptoms but not PTSD, anxiety, and PTSD cluster symptoms. However, in situations of high childhood adversity, our analyses showed that stressful war experiences were less associated with vulnerability to avoidance symptoms than in situations of low childhood adversity.ConclusionsBoth stressful war experiences and childhood adversities are risk factors for mental health symptoms among war-affected adolescents. Adolescents with histories of high childhood adversities may be less likely to develop avoidance symptoms in situations of high stressful war experiences. Further exploration of the differential roles of childhood adversities and stressful war experiences is needed.

Relative influence of genetics and shared environment on child mental health symptoms depends on comorbidity.

BackgroundComorbidity among childhood mental health symptoms is common in clinical and community samples and should be accounted for when investigating etiology. We therefore aimed to uncover latent classes of mental health symptoms in middle childhood in a community sample, and to determine the latent genetic and environmental influences on those classes.MethodsThe sample comprised representative cohorts of twins. A questionnaire-based assessment of mental health symptoms was used in latent class analyses. Data on 3223 twins (1578 boys and 1645 girls) with a mean age of 7.5 years were analyzed. The sample was predominantly non-Hispanic Caucasian (92.1%).ResultsLatent class models delineated groups of children according to symptom profiles–not necessarily clinical groups but groups representing the general population, most with scores in the normative range. The best-fitting models suggested 9 classes for both girls and boys. Eight of the classes were very similar across sexes; these classes ranged from a “Low Symptom” class to a “Moderately Internalizing & Severely Externalizing” class. In addition, a “Moderately Anxious” class was identified for girls but not boys, and a “Severely Impulsive & Inattentive” class was identified for boys but not girls. Sex-combined analyses implicated moderate genetic influences for all classes. Shared environmental influences were moderate for the “Low Symptom” and “Moderately Internalizing & Severely Externalizing” classes, and small to zero for other classes.ConclusionsWe conclude that symptom classes are largely similar across sexes in middle childhood. Heritability was moderate for all classes, but shared environment played a greater role for classes in which no one type of symptom predominated.

Adolescent behavior and PTSD 6-7years after the World Trade Center terrorist attacks of September 11, 2001.

Behavioral problems and psychopathologies were reported in children exposed to the World Trade Center (WTC) attacks in New York City within 2–3 y post-disaster. Little is known of subsequent 9/11 related behavioral and emotional problems. We assessed risk factors for behavioral difficulties and probable posttraumatic stress disorder (PTSD) in 489 adolescent enrollees ages 11–18 y of age in the World Trade Center Health Registry cohort using the Strengths and Difficulties Questionnaire (SDQ) and DISC Predictive Scales (DPS), respectively, as reported by the adolescents. Associations between parental PTSD and adolescent PTSD and behavioral problems were studied in a subset of 166 adolescent-parent pairs in which the parent was also a Registry enrollee. Nearly one-fifth (17.4%) of the adolescents, all of whom were 5–12 y old at the time of the attacks, scored in the abnormal (5.7%) or borderline (11.7%) range of total SDQ. Problems were more frequent in minority, low-income, and single-parent adolescents. Abnormal and borderline SDQ scores were significantly associated with direct WTC exposures and with WTC-related injury or death of a family member. Adolescent PTSD was significantly associated with WTC exposure and with fear of one's own injury or death, and with PTSD in the parent (OR = 5.6; 95% CI 1.1–28.4). This adolescent population should be monitored for persistence or worsening of these problems. Co-occurrence of parent and child mental health symptoms following a disaster may have implications for healthcare practitioners and for disaster response planners.

Perceptions of parental pressure to eat and eating behaviours in preadolescents: The mediating role of anxiety

Previous research suggests that parental controlling feeding practices are associated with children's overeating and undereating behaviours. However, there is limited research addressing the link between children's mental health symptoms (specifically anxiety and depression) and their reports of eating behaviours, despite knowledge that these psychopathologies often co-exist. The current study aimed to identify the relationships between preadolescents’ perceptions of their parents’ feeding practices with reports of their own anxiety, depression and eating behaviours. Three hundred and fifty-six children (mean age 8.75 years) completed questionnaires measuring their dietary restraint, emotional eating and external eating, as well as their perceptions of their parents’ use of pressure to eat and restriction of food. Children also completed measures of general anxiety, social anxiety and depression symptomology. Results indicated that preadolescents’ eating behaviours were associated with their perceptions of the controlling feeding practices their parents used with them. Preadolescents’ dietary restraint, emotional eating and external eating behaviours were positively associated with their reports of general and social anxiety, and depression symptomology. In addition, perceptions of parental pressure to eat were positively related to preadolescents’ anxiety and depression levels. Child anxiety (general and social) was found to mediate the relationship between perceptions of parental pressure to eat and preadolescents’ eating behaviours (dietary restraint, emotional eating and external eating). The results suggest that greater anxiety in preadolescents may explain why children who perceive greater pressure to eat by their parents are more likely to exhibit maladaptive eating behaviours.

Associations of Child Insomnia, Sleep Movement, and Their Persistence With Mental Health Symptoms in Childhood and Adolescence

To examine the patterns of insomnia and sleep-related movement from ages 4.5 to 9 years, their concurrent associations with mental health symptoms in childhood, and the longitudinal associations of sleep-problem persistence with mental health symptoms at ages 9 and 18 years. A 14-year prospective follow-up study. Assessments included maternal report on the Children's Sleep Habits Questionnaire at ages 4.5 and 9, and child mental health symptoms via maternal report at age 4.5, multi-informant (child, teacher, mother) report at age 9, and adolescent report at age 18. Community. A total of 396 children (51% female). N/A. Sleep problems were more common at age 4.5 than 9; symptoms of insomnia and abnormal sleep movement both had persistence rates of 9-10%. At age 4.5, insomnia was associated with hostile-aggressive and hyperactive-distractible behavior, but there were no significant associations for sleep movement. At age 9, both insomnia and sleep movement were associated with symptoms of depression, externalizing, and attention deficit hyperactivity disorder (ADHD). Insomnia persistence was associated with symptoms of depression, externalizing, and ADHD at age 9 and anxiety and externalizing at age 18; sleep- movement persistence was associated with externalizing and ADHD at age 9, and ADHD at age 18. The age 18 persistence effects for insomnia and anxiety and for sleep movement and ADHD were significant when controlling for earlier mental health. Childhood insomnia and sleep movement are common and associated with mental health symptoms. Their persistence from middle to late childhood predicts associations with specific types of mental health symptoms at age 18.

EPA-0669 – Food insecurity and children's symptoms of hyperactivity and inattention

Food insecurity (that is inadequate access to sufficient, safe, and nutritious food that meets individuals’ dietary needs) is concurrently associated with children's psychological difficulties. However, the predictive role of food insecurity with regard to specific types of children's mental health symptoms has not previously been studied. We used data from the Longitudinal Study of Child Development in Québec, LSCDQ, a representative birth cohort study of children born in the Québec region in Canada in 1997-1998 (n=2120) . Family food insecurity was ascertained when children were 1½ and 4½ years old. Children's mental health symptoms were assessed longitudinally using validated measures of behaviour at ages 4½, 5, 6 and 8 years. Symptom trajectory groups were estimated to identify children with persistently high levels of depression/anxiety (21.0%), aggression (26.2%), and hyperactivity/inattention (6.0%). The prevalence of food insecurity in the study was 5.9%. In sex-adjusted analyses, children from food-insecure families were disproportionately likely to experience persistent symptoms of depression/anxiety (OR: 1.79, 95% CI 1.15–2.79) and hyperactivity/inattention (OR: 3.06, 95% CI 1.68–5.55). After controlling for immigrant status, family structure, maternal age at child's birth, family income, maternal and paternal education, prenatal tobacco exposure, maternal and paternal depression and negative parenting, only persistent hyperactivity/inattention remained associated with food insecurity (fully adjusted OR: 2.65, 95% CI 1.16–6.06). Family food insecurity predicts high levels of children's mental health symptoms, particularly hyperactivity/inattention. Addressing food insecurity and associated problems in families could help reduce the burden of mental health problems in children and reduce social inequalities in development.

Sluggish Cognitive Tempo in Psychiatrically Hospitalized Children: Factor Structure and Relations to Internalizing Symptoms, Social Problems, and Observed Behavioral Dysregulation

As research examining sluggish cognitive tempo (SCT) advances, it is important to examine the structure and validity of SCT in a variety of samples, including samples of children who are clinically-distressed but not referred specifically for attention-deficit/hyperactivity disorder (ADHD). The present study used a large sample of psychiatrically hospitalized children (N = 680; 73 % male; 66 % African American) between the ages of 6 and 12 to examine the latent structure of SCT, ADHD, oppositional defiant disorder (ODD), depression, and anxiety using confirmatory factor analysis (CFA). Results of the CFA analyses demonstrated that SCT is distinct from these other dimensions of child psychopathology, including ADHD inattention, depression, and anxiety. Regression analyses indicated that SCT symptoms were positively associated with depression and, to a lesser degree, anxiety. SCT symptoms were also positively associated with children's general social problems, whereas SCT symptoms were negatively associated with an observational measure of behavioral dysregulation (i.e., frequency of time-outs received as a part of a manualized behavior modification program). These associations were significant above and beyond relevant child demographic variables (i.e., age, sex, race), children's other mental health symptoms (i.e., ADHD, ODD, depression, anxiety symptoms), and, for all relations except child anxiety, parents' own anxiety and depression symptoms.

Internalized symptoms in adolescence as predictors of mental health in adulthood in the Northern Swedish cohort

Although mental health symptoms in children and adolescents are shown to predict young adult mental health outcomes, long-term prospective studies of childhood cohorts are few. The aim of the present study was to analyze the prospective importance of internalized mental health symptoms in adolescence for internalized symptoms in adulthood. Methods: A community-based prospective longitudinal cohort provided information by questionnaire about psychological status at age 16 and 43 (n=1010, representing 94.3% of those still alive). Socio-demographic variables which were indicative of possible childhood adversity (parental class, absence, illness, unemployment, relationship, crowding, number of moves) were treated as confounders and controlled for in ordinal regression. Results: For both women and men, internalizing mental health symptoms reported at 16 significantly predicted the same outcome at 43 years, after controlling for previous adverse environmental conditions (OR =1.2 for women, 1.3 for men). Conclusion: In this representative cohort studied over 27 years with excellent retention rates, the occurrence of self-reported worry, panic and sadness in mid-adolescence significantly increased the likelihood of similar states in middle adulthood.

Item-Level Discordance in Parent and Adolescent Reports of Parenting Behavior and Its Implications for Adolescents’ Mental Health and Relationships with Their Parents

The phenomenon of discordance between parents' and children's ratings of the child's mental health symptoms or of parenting behavior until recently has been treated as a problem of reliability. More recent work has sought to identify factors that may influence discordance, yet much remains to be learned about why informants' ratings of developmental phenomena are discordant and the meaning of such discordance. This study examined the extent to which discordance can be treated as a measure of the difference between two equally valid perceptions, and as such an indicator of the quality of the parent-adolescent relationship. One category of concordance and three patterns of discordance were derived from item-level differences in ratings of affection, control, and punitiveness provided by a diverse sample (53% female; 46% Hispanic-American, 35% African-American, 15% European-American, 4% another race/ethnicity) of 484 adolescents aged 12-20 years (M = 15.67, SD = 1.72) and their parents. Over and above adolescents' and parents' independent ratings of parenting, the discordance between these ratings was found to predict adolescent reports of anxiety and conduct disorder symptoms, as well as the quality of the parent-adolescent relationship. This was particularly true when adolescents and parents were discordant in their ratings of affection and when adolescents rated their parents higher on affection than did parents themselves. Implications of these findings and future research directions are discussed.

Risk Factors for Childhood Mental Health Symptoms: National Longitudinal Study of Australian Children

To determine predictors of child externalizing (behavioral) and internalizing (emotional) symptoms in a national population sample. Data were collected in 3 biennial waves (2004, 2006, and 2008) from 2 cohorts in the Longitudinal Study of Australian Children, initially including 5107 children 0 to 1 year of age and 4983 children 4 to 5 years of age. The primary outcomes were child externalizing and internalizing symptoms. Relationships between potential risk factors and child mental health outcomes were described by using linear regression. In unadjusted analyses, children's mental health symptoms were predicted by a large number of risk factors. In multivariate models, early childhood factors (birth through 5 years) explained 30% and 18% of variations in externalizing and internalizing symptoms, respectively, at 4 to 5 years of age. Middle childhood (5-9 years of age) factors explained 20% and 23% of variations in externalizing and internalizing symptoms, respectively, at 8 to 9 years of age. Harsh discipline was a strong consistent predictor of externalizing symptoms in both age groups, whereas poorer child physical health, maternal emotional distress, harsh discipline, and overinvolved/protective parenting (younger cohort only) predicted internalizing symptoms consistently. National data on predictors of child mental health symptoms highlighted a small number of significant risk factors, situated in the family context and present from a very young age. This knowledge is informing population-level, randomized, prevention trials of family support programs.

The Effect of Severe Child Sexual Abuse and Disclosure on Mental Health during Adulthood

This study examined the relationship among severe child sexual abuse, disclosure, and mental health symptoms during adulthood. The sample consisted of 172 adults who were sexually abused in childhood. The multivariate model showed that respondents in their 30s and 40s who were abused by more than one abuser, who were injured by their abusers, who were abused by a biological relative, who told someone about the abuse when it occurred, and who did not discuss their abuse in depth within one year of the abuse had a greater number of mental health symptoms. Abuse severity and disclosure history should be assessed by professionals to identify clients who are at higher risk of mental health symptoms and to focus therapy.

Screening to Identify Mental Health Problems in Pediatric Primary Care: Considerations for Practice

Few pediatric primary care providers routinely use mental health screening tools, in part because they may have concerns about whether screening is useful and how it will affect their practice. This study examined the extent to which screening in primary care would increase the identification of mental health problems among a diverse population of children and youth. Prior to the visit, the parents of 767 patients age 5 to 16 completed the Strengths and Difficulties Questionnaire to report their child's mental health symptoms and impairment. Without viewing the screening results, each child's provider (N = 53) completed a questionnaire to report whether the child or youth demonstrated a mental health problem. Compared with providers, the screen identified twice as many patients with moderate symptoms and nearly 28% more patients with high symptoms. Among patients with high symptoms, providers failed to identify a problem among 78% of those who were Latino/Other and 55% of those who were African American compared with 27% of Caucasian patients (p < 0.001). Providers were not more likely to identify patients with externalizing versus internalizing symptoms but were more likely to identify patients who demonstrated symptoms across multiple domains of functioning. Screening substantially increased the number of children and youth who would be identified as possibly having a mental health problem. Screening may have the most potential to increase the identification of problems among patients who have moderate mental health symptoms and those who are African American or Latino.

Disparities in Utilization of Mental Health Services: Explanations and Possible Solutions

I t is increasingly understood that at the root of hope for recovery from a mental health disorder is the therapeutic alliance created by the partnership of the clinician, the patient, and the family and their engagement in the process of care. Elements of a therapeutic alliance and utilization of mental health services include access and availability of the clinician; a shared belief in what has caused the disability; a common understanding of the possible therapies and their effectiveness; trust in the relationship between healer and the one to be healed; and an understanding of what needs to be done, how it is to be done, and the time course. However, there are serious concerns about the current child mental health system’s ability to provide the opportunity for this therapeutic alliance and to meet the mental health care needs of youth. The article by Coker and colleagues in this issue of Academic Pediatrics underscores this concern and raises some important questions regarding our understanding of access to mental health services for children of different sociodemographic groups. The study reports on mental health care utilization of a cross-sectional sample of 5th graders in 3 metropolitan areas. The authors noted disparities in utilization, with lower use of mental health services among black and Hispanic children, and persistence of these disparities for black children independent of identified sociodemographic characteristics and child mental health symptoms. The paper concludes that efforts to reduce disparities may benefit from addressing not only access to mental health care and diagnosis issues, but also parents’ help-seeking preferences. To our minds, the conclusions proposed by the authors raise the question as to whether these findings reflect patient/family preferences, and hence are not disparities as defined by the Institute of Medicine, or are indeed disparities as per the World Health Organization (WHO) definition, in which differ-

Disagreement in Parent and Primary Care Provider Reports of Mental Health Counseling

The goals were to examine disagreement in primary care provider and parent reports of mental health counseling and to determine whether disagreement was associated with provider, parent, youth, and visit characteristics. Directly after 749 visits to 54 pediatric primary care providers in 16 practices, the parents of youths 5 to 16 years of age and the providers independently reported whether mental health counseling was provided. The parent also reported child mental health symptoms, the reason for the visit, and his or her attitudes about receiving treatment for child mental health problems in primary care. The provider reported confidence in his or her mental health treatment skills, burden and beliefs associated with treating mental health problems, and the accessibility of mental health specialists. Providers reported delivering counseling during 31.9% of visits (n=239), whereas parents reported receiving counseling during only 11.4% of visits (n=86). Parents did not report receiving counseling during 74.8% of the visits in which the provider reported delivering counseling; this was more common when the parent was seeking help for a mental health problem, when the provider reported greater burden associated with treating mental health problems, and when the youth had more mental health symptoms or was of other race/Hispanic. Provider report of counseling in the absence of parent report of counseling was less common when the provider had greater access to mental health specialists. Parents often did not report that the counseling delivered in primary care was mental health treatment. Counseling that is not perceived as mental health treatment may fail to meet parent expectations for care or fail to help parents identify mental health problems.

Assessment and management of psychosocial challenges in pediatric liver transplantation

Assessment and management of psychosocial challenges in pediatric liver transplantation

Post-September 11 Mental Health Service Help Seeking among a Group of Highly Exposed New York City Parents

The current study examines factors related to mental health help seeking among highly exposed New York City parents of young children (&lt; 5 years) after the September 11 terrorist attacks. Data were gathered from 180 parents through in-depth interviews 9 to 12 months postdisaster. Parents described family disaster-related experiences, mental health, changes in parenting and couple function, and mental health service use. In a multivariate model, child direct exposure to the World Trade Center disaster, as well as parent and child mental health symptoms 1 to 3 months post-September 11, were significant predictors of parent help seeking. Findings suggest the need to design disaster relief services that consider family disaster exposure and postdisaster family mental health symptoms, including the functioning of young children and related parental stress in the postdisaster context.

Exploring Risk Factors for the Emergence of Children's Mental Health Problems

Exploratory studies that generate testable models of how risk factors for childhood mental health problems work together over time are critical for developing effective prevention and treatment strategies. To build models addressing the following 2 questions: (1) How early can we identify children at risk for mental health problems in third grade? (2) How do the risk factors work together over time? We assessed a Wisconsin community sample 8 times, beginning during pregnancy. Three hundred seventy-nine families completed multi-informant reports (mothers, teachers, and children) of children's mental health symptoms in third grade. Symptom severity and directionality (externalizing vs internalizing). The hypothesis was generated that family socioeconomic status (SES) defined different pathways to symptom severity. In low/middle SES families, children were at risk if their mothers were distressed during the infancy period, which was then associated with more generalized maternal and child distress and dysregulation during the preschool period. In high SES families, the picture was more complex, beginning with parental histories of depression and family psychopathology, which then led to greater family stress in the infancy period and maternal and child distress and dysregulation during the preschool period. For all children, social and academic impairment during the school transition was an important mediator. Two pathways to later symptom directionality consisted of one beginning with child sex and the other with child temperament. Most risk factors predicted symptom severity and not directionality. The risk factors for internalizing and externalizing problems may be much the same, and the same preventive interventions might be effective for both classes of problems. Furthermore, at-risk children from high SES families might be identifiable as early as infancy, whereas those from lower SES families may be identifiable only as preschoolers.