‘Keep the focus on kids’ — Waddell

A Canadian South Asian lifestyle magazine based in Vancouver, DARPAN, recently interviewed Children’s Health Policy Centre director Charlotte Waddell.

The feature, called the Darpan 10, is directed at community and thought leaders, addressing them with 10 questions relating to their role. Here, for example, is one of the questions:

“As part of your education and work that you have done with children, can you share some insights that would help better the public education system as a whole?”

Waddell’s answer:

“A huge lesson for me, in thinking of the research and the young people I have cared for as a child and youth psychiatrist, is to address social disparities in our society. Again, I am considering adversities such as socioeconomic disadvantage, colonialism, and racism. These problems do not cause all childhood mental disorders. But they affect kids unequally.

“So some kids have to carry higher burdens than others, through no fault of their own. In turn, the stresses associated with kids having to take these extra burdens can translate into higher rates of certain mental disorders over time. So it would help to address these disparities, treat all kids well, and ensure adequate prevention and treatment services for mental health difficulties. In turn, it will help the public education system if more kids are flourishing.”

The entire interview can be seen here.

How practitioners and policy-makers can support children with PTSD

The results of a systematic review by the Children’s Health Policy Centre suggest five implications for practice and policy relating to posttraumatic stress disorder (PTSD):

  • Use cognitive behavioural therapy when treating childhood PTSD. Our review showed that CBT was effective for children who had experienced a variety of traumas, including multiple and complex traumas. As well, many children in these studies were experiencing concurrent mental health concerns, and this treatment was still effective for their PTSD.
  • Consider Eye Movement Desensitization and Reprocessing (EMDR) as a reasonable second choice. Although there is more evidence supporting CBT to treat childhood PTSD, EMDR showed promise for children exposed to a single trauma, based on one trial. That said, EMDR needs further rigorous evaluation.
  • Do not rely on medications to treat childhood PTSD. Based on this review, there are no medications that are effective in treating childhood PTSD. Instead, effective psychosocial treatments should be the mainstay.
  • Treat concurrent conditions using effective interventions. Some children with PTSD will have concurrent mental disorders. These children should be provided with effective treatments addressing all of their mental health concerns. (Information about effective treatments for 12 of the most common disorders is available from one of our reports.) https://childhealthpolicy.ca/preventing-and-treating-childhood-mental-disorders/
  • Be prepared for more children to present with PTSD during COVID-19. Recent estimates suggest that PTSD may greatly increase due to the pandemic as many children may experience the trauma of losing loved ones or witnessing loved ones being seriously affected. CBT should still be used when trauma stems from COVID-19.

No child should be exposed to the kinds of serious adverse experiences that can give rise to PTSD. Prevention of such experiences therefore remains the top priority. But when prevention has not been possible, CBT can help. For more information, see Vol. 15, No. 2 of the Children’s Mental Health Research Quarterly.

Service shortages have created a crisis

There is a crisis in children’s mental health due to service shortages.

That was the key message of an April 4/23 talk by Children’s Health Policy Centre director Charlotte Waddell to roughly 200 public health leaders and practitioners from across BC.

Hosted by BC Centre for Disease Control Foundation for Public Health, the talk was the keynote event opening a two-day conference on strengthening mental health for children and youth — or the “Best Brains Exchange.”

“Public health can help greatly to improve children’s mental health by advocating for comprehensive population health approaches,” Waddell told the group. “You can also ensure that effective prevention and treatment interventions are made available to all children in need, and insist on good public data to track our progress.”

The talk was 20 minutes, followed by 40 minutes of conversation.

Moving eyes and thoughts may help kids move on from trauma

In a head-to-head trial, both Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioural Therapy (CBT) led to improvements on posttraumatic stress disorder (PTSD) diagnostic measures by three-month follow-up.

Specifically, 86–95.0% of children who had been treated with EMDR were diagnosis free after three months, compared with 87 to 89% of children who had been treated with CBT (figures varied by informant, whether self- or parent-report), with no significant differences between the two treatments.

At one-year follow-up, even more children were diagnosis free. By self-report, 100% of EMDR children and 92% of CBT children were diagnosis free after one year, with no significant difference between the two groups.

But by parent report, there was a statistically significant difference favouring EMDR, with 100% of children who received this treatment being diagnosis free, compared to 88% of those who received CBT.

Beyond diagnoses, both EMDR and CBT also reduced PTSD symptoms at three-month and one-year follow-ups, with no significant difference between the two treatments. In sum, both treatments were effective, with EMDR showing only one statistically significant benefit over CBT greater reductions in PTSD diagnostic rates by parent report at one-year follow-up. Table 4 summarizes these outcomes. For more information, see Vol. 15, No. 2 of the Children’s Mental Health Research Quarterly.

How to treat PTSD?

Once a child has been diagnosed with PTSD, and their safety has been assured, they need immediate access to effective treatments. The Children’s Health Policy Centre has conducted a systematic review on what such treatments entail.

Among the successful interventions was Prolonged Exposure, a program based on cognitive-behavioural therapy (CBT). It led to statistically significant improvements for all PTSD-related outcomes. In particular, 63% of Prolonged Exposure youth were diagnosis free at six-month follow-up, compared to 26.% of controls. Prolonged Exposure youth also reported significantly fewer PTSD symptoms, differences that were both statistically significant and clinically meaningful. However, group differences were no longer significant for the one PTSD symptom measure used at 17-month follow-up.

In a second Prolonged Exposure study, the intervention led to significant improvements on most PTSD- related outcome measures. In particular, 89 % of Prolonged Exposure youth were diagnosis free at one- year follow-up, compared to 54 % of controls. Prolonged Exposure youth also had significantly milder PTSD symptoms than controls by both self-report and examiner ratings, with a large effect size for the latter. But there was no significant difference on a measure that combined the number and severity of self-reported PTSD symptoms. Finally, overall functioning improved significantly more for Prolonged Exposure youth.

A treatment called KIDNET, which also based on CBT, similarly led to several benefits at four-month follow-up. Intervention children had significantly fewer intrusive thoughts and avoidance symptoms. KIDNET also significantly reduced the severity of PTSD symptoms — by 60%. As well, 84% of intervention children no longer met diagnostic criteria for PTSD, compared with 30% of controls. KIDNET also led to better overall functioning. Hyperarousal was the only PTSD symptom that this intervention did not significantly improve.

The sole medication trial found no difference in posttraumatic stress symptoms for children on D-cycloserine compared with controls at three-month follow-up. Importantly, both intervention and control children received CBT — and all had significantly lower posttraumatic stress symptom scores at follow-up. In fact, scores were reduced by approximately 50% between baseline and follow-up, suggesting benefits from CBT.

For more information, see Vol. 15, No. 2 of the Children’s Mental Health Research Quarterly.

You can celebrate Child & Youth mental health day

The key message or theme for Canada’s Child & Youth Mental Health Day, May 7, is “I care about you.”

Founded by FamilySmart in 2007, the special day aims to build caring connections between young people and the adults in their lives. It is intended to create awareness and acknowledgement of the thousands of children, youth, and families needing mental health support and care across Canada.

In honour of the day, in 2019, the Children’s Health Policy Centre released its 50th issue of the Quarterly publication about children’s mental health research. This celebratory edition — focusing on good news to safeguard children’s health — is titled Celebrating children’s mental health: 50 lessons learned.


Extraordinary children’s mental health needs arise from COVID-19

Many more children have needed treatment for mental health conditions — particularly anxiety and depression — during the pandemic, compared to before. This is according to a report authored by the Children’s Health Policy Centre and released April 27/23.

Concerningly, this situation arises against a backdrop of stark pre-existing service shortfalls. Recent international estimates have suggested that only 44.2% of children with mental disorders were receiving any services for these concerns before COVID-19.

The report concludes that BC should make additional investments in children’s mental health, to offset future health care and related social costs and to better meet children’s needs.

Funded by the BC Representative for Children and Youth, the report begins by identifying eight studies in high-income jurisdictions. Seven of eight studies found that children’s mental health suffered during the pandemic. And across three of them, these increases in clinically-important problems were substantial — ranging from 48.1% to 94.2%.

Children’s mental health symptoms also changed during the pandemic, albeit with different patterns for different conditions. Multiple studies found that anxiety and depressive symptoms increased. In contrast, behaviour problems improved according to one study but were unchanged according to another. Substance-related outcomes varied as well, with nicotine and cannabis use and alcohol intoxication showing significant declines in some studies but no change in others.

Beyond increased mental health concerns, some children experienced additional challenges during the pandemic. Those from families facing socio-economic disadvantage tended to have poorer mental health outcomes. As well, children had more mental health difficulties when they knew someone who had experienced COVID-19 and when they had fewer supports and less consistent daily routines. 

The report concludes: “Collectively, our current and future well-being depends on recognizing and addressing children’s rights to social and emotional well-being.”

The full report may be found here.

Identifying PTSD risk can encourage resilience

Many children show great resilience in the face of adversity. In particular, approximately 75–90% of children exposed to trauma do not develop PTSD. Factors that protect children from developing this disorder include strong family and peer supports. Besides recognizing protective factors, it is also important to consider risk factors for developing PTSD after trauma.

To determine risk factors, researchers systematically identified and analyzed 40 long-term studies on posttraumatic stress reactions in children. Predictors for developing posttraumatic stress reactions included injury severity and days in hospital, as well as the stress symptoms occurring soon after the trauma.

Having a parent with posttraumatic stress symptoms also increased risk, as did the child having symptoms of depression or anxiety. In contrast, child age, ethnicity and socio-economic status were unrelated to risk.

The research as to what increases risks for posttraumatic stress also suggests ways to help, for example, by strengthening family supports. But the foremost goal should be to prevent avoidable childhood adversities wherever possible.

When trauma cannot be prevented, ensuring the child’s basic safety is the first step. And if PTSD symptoms have developed, effective treatments are urgently required. For more information, see Vol. 15, No. 2 of the Children’s Mental Health Research Quarterly.

What are the symptoms of Complex PTSD?

A condition known as Complex Posttraumatic Stress Disorder has been recognized by the World Health Organization, in its International Classification of Diseases, 11th revision. Calls to recognize complex PTSD as a distinct disorder arose from concerns that the PTSD diagnosis may not adequately capture the experiences of those exposed to repeated traumas.

Complex PTSD is recognized as typically developing after prolonged exposure to extremely threatening or horrific events such as repeated sexual or physical abuse that the child cannot escape from. Complex PTSD includes all the PTSD criteria — coupled with severe and persistent difficulties in regulating emotions, along with experiencing guilt or shame related to the trauma and challenges in sustaining relationships. For more information, see Vol. 15, No. 2 of the Children’s Mental Health Research Quarterly.