Preventing substance-induced psychotic disorders is possible

Controversy persists about whether it is possible to prevent all forms of psychosis. But one form — namely substance-induced psychotic disorders — is clearly preventable. Youth can develop these disorders due to substance intoxication or withdrawal, including from alcohol and cannabis. And many young Canadians require medical care for this problem.

In fact, among 10- to 24-year-olds, 15% of hospital stays for harms caused by substance use involved this form of psychosis, leading to 3,537 hospitalizations between 2017 and 2018.

Reducing the number of youth who experience substance-induced psychosis is a viable goal. Mainly, this can be achieved by providing effective substance use prevention programs and by offering effective treatments to youth who are struggling with problematic substance use. For more information on psychosis, see Vol. 14, No. 3  of the Children’s Mental Health Research Quarterly.

Inuit youth benefit from program designed as computer game

A team from New Zealand created SPARX, an online cognitive-behavioural therapy (CBT) program designed for Maori youth with depression. The program takes the form of a fantasy computer game, with players progressing through a series of problem-solving stages. Given the success of SPARX in New Zealand, researchers set out to adapt the program for Inuit youth in Canada.

The first step involved adapting the program to ensure cultural sensitivity. To this end, youth leaders and Elders educated the development team about cultural healing concepts, including Pijitsirniqatigiingniq (consensus decision-making), Pilimmaksarniq (skills and knowledge acquisition), Piliriqatigiingniq (collaborative relationships) and Qanuqtuurunnarniq (being resourceful to solve problems). Adaptations also included making images and audio components appropriate to Nunavut (for example, replacing palm trees with arctic tundra and featuring local community members speaking in English and Inuktitut). The program is available for Inuit youth at shttps://www.isparxnunavut.com.

For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

The importance of knowing what needs fixing

Could better monitoring of children’s mental health conditions lead to better outcomes for BC’s children?

That was the subject of a 60-minute virtual talk to graduate students in UBC’s school of population and public health on March 17, 2022, by Charlotte Waddell, director of the Children’s Health Policy Centre.

Speaking on the serious mental health service shortfalls for BC youth and children before Covid-19, Waddell said there is an urgent need to for better measurement now.

“If we measure it, we can start to shift the public conversation,” she said. “This is crucial because until it is their child, people just do not know and so, do not ask policymakers to pay attention.”

The 60-minute talk included enthusiastic discussion of case studies.

Self-delivered treatments can allow more children to be helped

While there are effective self-delivered treatment options for some of the most common childhood mental disorders, they are used by a relatively small number of children. These findings suggest four implications for practice and policy.

  1. Expand the number of children being reached by self-delivered treatments. Some children can greatly benefit from self-delivered interventions, even becoming disorder free. Greater use of these interventions can expand the number of children who are reached with effective treatments.
  2. Provide more support to those with greater needs. Some children and families have needs that cannot be met by self-delivered interventions, such as youth who are suicidal. As well, the ability of children and families to implement interventions without the support of a practitioner will vary. Families who are more disadvantaged may require extra supports, such as telephone coaching, to fully benefit from self-delivered interventions.
  3. Increase the availability of other effective self-delivered treatments. Beyond the successful self- delivered interventions described above, there are others that are not yet available in Canada. Consequently, additional investments in getting effective self-delivered interventions into the hands of Canadian children may increase treatment options.
  4. Build on the research to create new self-delivered treatments. We did not find any effective self- delivered treatments for two of the five most common childhood mental disorders — substance use and conduct disorders. Creating new and effective treatments for these disorders too could benefit many young people and their families.

Research evidence supports using self-delivered treatments as part of the continuum of care for childhood mental disorders. Including these interventions in service planning can make it possible to reach more young people in need. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

World Autism Awareness day is marked this weekend

April 2 marks the twelfth annual World Autism Awareness Day. Hundreds of thousands of landmarks, buildings, homes and communities around the world will shine with blue light in recognition of people living with autism.

Autism spectrum disorder refers to a group of complex neurodevelopment disorders. They are characterized by repetitive patterns of behaviour and difficulties with social communication and interaction. The symptoms are present from early childhood. Children’s Health Policy Centre director Charlotte Waddell, has been co-author of a study on Autism Spectrum Disorder.  See full text of the article and a link to the study here.

Innovative approaches can help some youth with depression

Leap, now called BreathingRoom, focused on teens aged 13 to 18 with depression. The program used mindfulness techniques, including increasing forgiveness, gratitude and compassion while also reducing negative thinking, loneliness and boredom. Teens completed the eight internet-based modules within two months.

The Leap study assessed depression severity at the end of treatment. For intervention youth, severity of depression was significantly reduced compared to controls. Even so, the average depression severity score for Leap youth was still within the range of scores typically experienced by depressed young people. So some young people may still need the support of a practitioner even after trying a self-directed intervention. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

ADHD can be treated with innovative approaches

Parenting the Active Child, now called Parents Empowering Kids, focused on children aged eight to 12 with ADHD. This program aimed to help parents notice and reward good behaviour; ignore challenging behaviours (such as whining and complaining); use time outs effectively; prepare children for transitions; and collaborate with schools. Parents were given a handbook, a video and a behaviour chart, which were supplemented with weekly telephone sessions with a coach. Parents completed the program in slightly less than seven months.

The Parenting the Active Child led to benefits for children. Approximately 65% of intervention children were diagnosis free at 5 1⁄4-month follow-up, compared to 40% of controls. The high remission rate for controls may have been due, in part, to these children receiving mental health treatments outside of the study — such as behavioural interventions — at significantly higher rates than intervention children. Despite this, intervention children still had more than 2.7 times the odds of not having an ADHD diagnosis by final follow-up. For more information, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

Pink shirt day signifies a stand against bullying

The last Wednesday in February — this year, Feb. 23 — signifies a national stand against bullying. The theme of this year’s celebration is Lift Each Other Up — showing acceptance, respect, and inclusion for everyone. Helping children learn to self-regulate — by paying attention and inhibiting impulsivity — is an important step in reducing bullying. Parents can promote this skill by being responsive to their children, providing positive feedback during challenging tasks, and supporting older children and teens to be more autonomous. For more information, see Vol. 10, No. 4 of the Children’s Mental Health Research Quarterly.

Evaluating the impact of COVID-19 on child health in Canada

A McMaster University team is leading Canada’s first comprehensive investigation of the impact of the COVID-19 pandemic on child health, with a team from the Children’s Health Policy Centre as Co-Principal Investigators.

Together, we are building on Statistics Canada’s uniquely-positioned 2019 Canadian Health Survey of Children and Youth — conducted just prior to the start of the pandemic. In re-interviewing this representative, population-based sample of 45,000 young people and their families, we will be able to measure the impact not only of COVID-19 but also of pandemic responses on mental health, physical health, learning and social inequities.

This project is funded by the Canadian Institutes of Health Research (CIHR) and Statistics Canada, with additional supports from Children’s Healthcare Canada, the Public Health Agency of Canada, McMaster University, BC MCFD and donors. Initial results are anticipated in 2023–2024.

Centre members are also providing supports for an associated study of the impact of the pandemic on Ontario children, funded by the province of Ontario. Results are anticipated in 2022. Beyond this, we contributed to a Royal Society of Canada volume outlining safe ways for children to return to school during the COVID-19 pandemic.

Working to end child maltreatment

How can child maltreatment be prevented?

That was the subject of a 60-minute virtual talk, on February 22, 2022, by Nicole Catherine, scientific director for the BC Healthy Connections Project and Christine Schwartz, adjunct professor with the Children’s Health Policy Centre.

They were speaking with just over 200 practitioners attending a virtual conference titled “A multidisciplinary approach to child maltreatment — a path to healing,” sponsored by the Vancouver-based Sophie’s Place Child & Youth Advocacy Centre.

Speaking on the prevalence, risks and outcomes of child maltreatment, Schwartz told the group that one in three Canadians has experienced some form of maltreatment in childhood and that the COVID pandemic has only increased the risk. “Families being isolated in their homes, especially during periods in which schools have been closed, have come at a great cost to children,” she said.

Schwartz also discussed a systematic review of maltreatment prevention programs, citing strong evidence that child maltreatment can be prevented. She also noted that, home-visiting programs, like Nurse-Family Partnership, “provide needed supports to address family socioeconomic disadvantage, promote parenting skills and help children flourish.”

Nicole Catherine then summarized the early results of a recent BC-based scientific evaluation of the Nurse-Family Partnership. Findings of the BC Healthy Connections Project have shown that Health Authorities successfully reached the population that the program is designed to benefit and that it helped reduce prenatal substance use. Findings on child maltreatment and developmental outcomes, as well as maternal life course are anticipated later in 2022.

“To prevent child maltreatment, we must invest in programs that start early, in pregnancy and ensure that we reach underserved children and families who can benefit the most,” Catherine said.