Children who experience one mental health condition often face more than one — what is commonly referred to as having concurrent or co-occurring conditions. But just how common is this experience? A systematic review that combined data from 14 population-based surveys found that for children who met criteria for one mental disorder, 26.5% met criteria for two or more. Researchers have found even higher concurrent rates for children receiving mental health treatment services and for those in foster care.

Research on which disorders are more likely to co-occur is crucial for informing both prevention and treatment efforts. And the co-occurrence of substance use and other mental disorders has been particularly well studied. A systematic review of 21 population-based surveys compared young people with any substance use, including those whose use reached the level of a disorder, to individuals without any substance use. When young people had any substance use or a substance use disorder, their odds of having other disorders significantly increased. This included nearly eight times greater odds of also experiencing conduct, oppositional defiant or attention-deficit/hyperactivity disorders, slightly more than four times greater odds of co-occurring depressive disorders, and approximately two times greater odds of co-occurring anxiety disorders.

Data are more limited on the co-occurrence of disorders that do not involve substance use. A population-based survey of Puerto Rican children nevertheless provides insights on the overlap of conduct/oppositional defiant disorders, attention-deficit/hyperactivity disorder (ADHD), anxiety disorders and depression. Researchers found high levels of co-occurrence across all four conditions. But levels were particularly high for children whose primary diagnosis was conduct/oppositional defiant disorder — with anxiety disorders co-occurring for 55.3%, ADHD for 35.7%, and depression for 17.6%.

For more information, see Vol. 17, No. 3 of the Children’s Mental Health Research Quarterly.

A recent systematic review by the Children’s Health Policy Centre found that transdiagnostic interventions that addressed common risk factors underlying multiple disorders prevented or reduced symptoms of multiple childhood mental disorders. These results suggest six implications for practice and policy:

• Consider effective transdiagnostic prevention programs for better efficiency. Because multiple symptoms can be prevented using one intervention, greater efficiencies are possible. Efficiencies are also enhanced when programs address particularly common problems such as anxiety, depression, behaviour and substance use concerns. Such efficiencies, in turn, can help mitigate Canada’s limited public prevention investments.
• Build on the power of parents. Three of the four programs in the systematic review that produced beneficial outcomes for children included parents (or other caregivers). Consequently, including caregivers may be particularly helpful for prevention efforts.
• Deliver interventions according to need. To optimally support all children, a public mental health strategy should be employed. Such a strategy typically includes promoting healthy development for all children, preventing disorders for those at risk, providing treatment to those with disorders and monitoring outcomes. This approach aligns with efforts to reduce inequities by supporting all children, with an intensity tailored to levels of need.
• Offer programs that build on solid underlying approaches. Two of programs in the systematic review — Strengthening Families and Strong African American Families–Teen — used parenting training, which is backed by many studies showing reduced child behaviour and substance use problems. Similarly, the Super Skills for Life and EMOTION programs used cognitive-behavioural therapy techniques, which are supported by many studies showing reduced child anxiety and depressive symptoms. But there is only one high-quality randomized control trial evaluating each of these four programs for preventing symptoms of concurrent disorders. So replication evaluations are warranted. As well, adaptations may be needed for the Canadian context, including ensuring that content is culturally safe and relevant.
• Consider transdiagnostic interventions with children of varying ages. The four successful interventions in the systematic review were delivered to children spanning ages six to 16. This shows it is possible to use these efficient interventions with children at various of developmental stages.
• Know that effective program delivery can occur in a variety of settings. The four successful programs were delivered to children, and to parents as well in some cases, in community settings including schools. This demonstrates that these programs can be offered in venues that are convenient and accessible for children and families.

Children with one mental health problem often have more than one — resulting in added challenges for them and for their families, and for society when avoidable problems impede young people from flourishing. This systematic review indicates that transdiagnostic prevention programs can effectively and efficiently address multiple mental health needs, including symptoms associated with some of the most common childhood conditions. These programs should therefore be expanded so that more children can be helped. Expansion of transdiagnostic prevention programs may have the added benefit of reducing “downstream” treatment costs.

For more information, see Vol. 17, No. 2 of the Children’s Mental Health Research Quarterly.

Child and Youth Mental Health Day reminds us of the need to actively support children and youth who are experiencing mental health challenges. The theme for this year’s event is “I Care About You.”

Established by BC-based organization FamilySmart in 2007, the day aims to spark meaningful conversations about mental health between young people and adults. It is about building positive connections that help young people feel seen, heard and valued.

FamilySmart offers resources to help facilitate caring conversations, including a toolkit, videos and activities. You can find these resources and learn how to get involved at FamilySmart’s website.

Mental health disorders can be profoundly destabilizing for young people. Prevention programs can avert or reduce the impact of common disorders, but these efforts must be expanded in order to reach more children in need. To learn more about effective interventions that help prevent childhood mental disorders, see Volume 14, No. 1 of the Children’s Mental Health Research Quarterly.

A recent systematic review by the Children’s Health Policy Centre looked at Super Skills for Life, a targeted program which aimed to prevent depression and anxiety disorders for children who already had symptoms of them. The program produced multiple benefits for young children at one-year follow-up, including reducing symptoms of both disorders. Researchers then examined how children’s participation in and satisfaction with Super Skills for Life influenced their outcomes. First, they divided children into two groups based on their experiences with the program. The high-fidelity group included children who scored above 50% on three markers: attended seven or eight (of the eight) scheduled sessions, completed five to seven (of the seven) homework assignments, and rated their satisfaction with the program as nine or 10 (out of 10). This classification resulted in 61.2% of children being in the high-fidelity group and 38.8% in the low-fidelity group.

Children who participated in Super Skills for Life had significantly fewer anxiety and depressive symptoms compared to the control group, with no difference based on fidelity classification. However, for emotional symptoms and behavioural problems, only the high-fidelity group outperformed the control group at one-year follow-up. These findings suggest that while children can experience benefits from prevention programs even when their engagement is more limited, maximum gains occur when maximum fidelity is achieved. The take-away message for practitioners is to continue their efforts to engage children, including encouraging children’s attendance in sessions and their practice of skills outside of sessions, knowing the potential positive payoffs.

For more information, see Vol. 17, No. 2 of the Children’s Mental Health Research Quarterly.

As part of a recent systematic review, the Children’s Health Policy Centre examined the results of a study on the Strong African American Families–Teen (SAAF–T) program, which aimed to prevent substance use, behaviour problems and depressive symptoms for Black youth. The study not only examined whether that the Strong African American Families-Teen (SAAF-T) program was effective in preventing alcohol use, but it also looked at whether program was cost-effective.

After researchers determined that the program was indeed effective in preventing alcohol use, they calculated the cost of delivering the program while considering the benefits from reductions in alcohol use and binge drinking, to identify the estimated costs of preventing episodes of each of these events. They concluded that the program was cost-effective so long as policy-makers were willing to pay $100 to prevent an episode of alcohol use and $440 to prevent an episode of binge drinking.

Policy-makers, of course, need to weigh these expenditures against the costs of alcohol use by adolescents, including binge drinking, which can accrue health care costs from accidents and injuries, risky sexual behaviour and potential future substance use disorders. Given the high price of adolescent alcohol use, SAAF–T has the potential to not only improve lives but also to do so in a cost-effective manner. For more information, see Vol. 17, No. 2 of the Children’s Mental Health Research Quarterly.

World Autism Awareness Day this year will bring together global experts, policymakers and autistic voices to discuss policy issues that impact autistic individuals worldwide — including children and youth.

At a virtual event hosted by the United Nations (UN) on April 2, panelists and speakers will explore how neurodiversity shapes inclusive policymaking and contributes to the UN’s Sustainable Development Goals. Discussions will focus on inclusive healthcare, education and employment, and on designing autism-friendly cities and communities.

Designated by the UN in 2007, World Autism Awareness Day is an annual observance that celebrates neurodiversity and promotes the acceptance, appreciation and inclusion of autistic individuals. The theme for this year’s event, “Advancing Neurodiversity and the UN Sustainable Development Goals,” highlights how inclusive policies can support autistic individuals while also advancing global development priorities. These priorities — the Sustainable Development Goals — include eliminating poverty, providing quality education for kids and adolescents, creating job opportunities for youth and reducing inequality.

You can learn more and register to attend the event on the United Nations website.

A systematic review that focused on Arctic Indigenous Youth identified factors found to enhance their mental well-being. Many of the protective factors identified were not unique to Indigenous youth, such as positive parent-child relationships. However, some more specific factors emerged for Arctic Indigenous youth. These included living in communities that embraced Traditional Knowledge and cultural revitalization, and having kinship structures that emphasized family connections. These findings led the authors to stress the importance of community and culture for Arctic Indigenous youth. Applying these findings, practitioners can promote mental well-being by supporting Indigenous youth to connect with their cultures. Policy-makers can also play a role by supporting Indigenous communities to ensure that their cultures flourish.

For more information, see Vol. 17, No. 2 of the Children’s Mental Health Research Quarterly.