Having a child with a mental disorder can have considerable consequences for families. For example, one study found that parents of children with mental disorders were significantly more likely to reduce their work hours or to end their employment altogether, compared with parents of children with physical health conditions. Parents of children with mental disorders were also significantly more likely to spend more than four hours per week arranging for child care, compared with parents of children with physical health conditions. Financial costs can also add up. For example, parents may have to miss work to address their children’s mental health needs, or they may face out-of-pocket expenses for medications or for psychosocial interventions that are not publicly funded.

Beyond these high individual burdens, childhood mental conditions also have significant consequences for society. Because these disorders are the leading cause of childhood disability, they come with steep costs in lost human potential. These disorders also come with large expenditures across multiple public sectors, including health care, education, and social and justice services. Costs are particularly high when children do not receive needed treatments or receive them in a timely way, such that mental health problems worsen and become needlessly entrenched, even continuing into adulthood. Yet effective treatment approaches for the majority of these disorders already exist and many of these treatments have been shown to be cost-effective. For more information, see Vol. 16, No. 2 of the Children’s Mental Health Research Quarterly.

To estimate the percentage of children with mental disorders, the Children’s Health Policy Centre analyzed data from nearly 62,000 young people contained in 14 high-quality studies. We found that 12.7% of children, or approximately one in eight, met diagnostic criteria for a mental disorder at any given time. In BC, this means approximately 95,000 young people currently meet criteria for a mental disorder, making the burden high across the province. And many children carry an even higher burden as 26.5% of young people with disorders had two or more concurrently.

We also calculated prevalence for 12 of the most common disorders or disorder groups. Anxiety disorders topped the list at 5.2%. Other common problems included attention-deficit/hyperactivity disorder (ADHD, 3.7%), oppositional defiant disorder (3.3%), any substance use disorder (2.3%), major depressive disorder (1.3%) and conduct disorder (1.3%). For more information, see Vol. 16, No. 2 of the Children’s Mental Health Research Quarterly.

The UN will observe World Autism Awareness Day on April 2 with a virtual event designed to promote acceptance and appreciation of autistic people and their contributions to society. The theme for this year’s event is Moving from Surviving to Thriving: Autistic individuals share regional perspectives.

The event is organized in collaboration with autistic advocates and participants and will be delivered by the Institute of Neurodiversity, a non-profit organization established and run by neurodivergent people for neurodivergent people and their allies. Additional support comes from the Group for Autism, Insurance, Investment, and Neurodiversity.

Event organizers have gathered an all-autistic lineup of panelists representing the six inhabited areas of the globe — Africa, Asia and the Pacific, Europe, Latin American and the Caribbean, North America and Oceania. The panelists will share regional perspectives and together will provide a global overview of the state of affairs for autistic people.

The event will take place from 10 am to 1 pm EDT. You can register to attend the virtual event here.

Observed annually on March 21, the International Day for the Elimination of Racial Discrimination commemorates the Sharpeville Massacre of 1960, when police in Sharpeville, South Africa, killed 69 people at a peaceful demonstration against apartheid “pass laws.” The United Nations General Assembly designated the day in 1966. It calls on all of us — individuals, organizations and governments — to work to end racial discrimination in all areas of life.

As a determinant of health, racism has a profound impact on child well-being. To learn more about this and about our evaluation of childhood antiracism interventions, see Volume 15, No. 3 of the Children’s Mental Health Research Quarterly.

Findings from a recent systematic review by the Children’s Health Policy Centre offer hope for children with obsessive compulsive disorder (OCD). These results suggest five implications for practice and policy:

• Start with Cognitive Behavioural Therapy (CBT) for childhood OCD. A strong body of evidence supports CBT — showing that it produces clinically meaningful reductions in both symptoms and diagnoses. It is also effective for children ranging from ages three to 18. CBT should therefore be the starting point for treatment.
• Build CBT capacity. Despite the strong evidence for CBT’s effectiveness in treating OCD, many young people have difficulties finding a practitioner to provide this intervention. In fact, in most countries, young people with OCD have limited access to CBT. Canadian policy-makers therefore may need to invest in training so that more practitioners can provide this highly effective treatment in public settings — and so that all children with OCD can receive timely treatment, with no out-of-pocket costs.
• Support family involvement. CBT for OCD often incorporates families into the treatment. The roles for families can be extensive, ranging from helping to develop treatment goals to encouraging children to practise CBT techniques. For younger children, family involvement is critical, as Family CBT is the form of CBT that has shown efficacy with children younger than age eight. For older children, family involvement should also be encouraged where feasible. As well, when family issues impede CBT’s effectiveness, Positive Family Interaction Therapy may be a helpful addition.
• Reach more children in need by expanding delivery options. Many children can benefit from CBT without ever entering a practitioner’s office. Studies show the effectiveness of telephone- and internet-based CBT equals that of in-person delivery for many children. These delivery modalities also make it possible to reach more children, including those in more remote communities. Internet delivery may also help reduce costs because it requires less practitioner time.
• Consider medications when CBT does not succeed. Some children continue to experience impairing symptoms, even after an adequate course of CBT. For these children, medications should be considered — particularly fluoxetine and sertraline, given their efficacy and more favourable adverse event profile. Still, children taking either medication need to be carefully monitored to assess both its effectiveness and potential adverse events.

All children diagnosed with OCD need rapid access to CBT. By providing this treatment early in the disorder’s course, associated distress and impairment for children and their families can be greatly contained. For more information, see Vol. 16, No. 1 of the Children’s Mental Health Research Quarterly.

Watching a child struggle with OCD symptoms can be both agonizing and frustrating. As a result, many family members try to help by assisting with their child’s OCD rituals. This can range from a mother repeatedly answering her son’s questions about his well-being to reduce his distress to a father changing his work schedule to allow more time for his daughter to repeatedly check the locks when leaving home. The frequency of family members participating in children’s OCD symptoms is so common that the term “family accommodation” was coined to describe it.

In fact, one study found that 99% of parents reported participating in at least one type of accommodating behaviour and 77% reported doing so daily. Despite parents having the best of intentions, accommodating OCD symptoms comes with risks, including maintaining or worsening the severity of the child’s symptoms and impairment. But the good news is that parents can learn strategies that help them disengage from these behaviours. For more information, see Vol. 16, No. 1  of the Children’s Mental Health Research Quarterly.

Pink Shirt Day, also known as antibullying day, encourages people across Canada to stand against all forms of bullying. Since its inception in 2007, Pink Shirt Day has helped raise millions of dollars for antibullying initiatives. This year, on February 28, participants in schools and workplaces nationwide will come together to raise awareness, promote inclusion and celebrate acts of kindness.

Bullying remains a significant problem in schools — a 2019 report by Smith et al. and the McCreary Centre Society found that 53% of BC students aged 12 to 19 years reported experiencing at least one form of bullying in the past year. But the right interventions can make a difference. In fact, the Children’s Health Policy Centre’s recent systematic review of antibullying programs found five interventions that reduced at least one form of bullying. To learn more, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly.

A strong body of evidence supports cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD).  Beyond showing that CBT is effective, studies have also demonstrated that this treatment produces clinically meaningful reductions in both symptoms and diagnoses. When using CBT, practitioners typically begin by presenting children and parents with information about the disorder, including explaining what the treatment will involve. As part of this process, children are often encouraged to give the disorder a “nasty nickname” — to help them resist their symptoms and not blame themselves for having OCD. Children also identify their specific obsessions, compulsions, triggers and avoidance behaviours as part of developing the treatment plan.

To address physical OCD symptoms, children learn specific behavioural strategies such as relaxation and breathing techniques. Children also learn cognitive strategies such as challenging their beliefs about the likelihood of feared outcomes coming true. Children then practise exposure and response prevention, the core component of CBT. This involves children confronting their obsessions while resisting the urge to engage in compulsions. For more information, see Vol. 16, No. 1  of the Children’s Mental Health Research Quarterly.

Studies examining potential risk factors for obsessive-compulsive disorder (OCD) have identified both biological and environmental variables. Yet, the unique contribution of each identified variables was relatively small. This suggests that more research is needed to understand how OCD develops. In particular, studies identifying additional modifiable risk factors will be particularly helpful in informing and guiding the development of preventive interventions.

Still, research on protective factors for OCD is also beginning to emerge. For example, a prospective study in a representative sample of 515 adolescents identified one modifiable protective factor. Specifically, having higher emotional stability was associated with having fewer OCD symptoms in adolescence. (Emotional stability was defined as the ability to regulate emotions, or maintain a balanced affect over time.) For more information, see Vol. 16, No. 1 of the Children’s Mental Health Research Quarterly.

A recent meta-analysis estimated that 0.3% of children meet diagnostic criteria for obsessive-compulsive disorder (OCD) at any given time. This equates to about 18,500 children in Canada and 2,300 children in BC. OCD also starts early, with nearly 25% of boys who develop it doing so  before age 10 and with 25% of overall cases emerging by age 14. This early onset makes it crucial to identify these young people and provide effective treatments quickly, so children can thrive and so OCD does not persist into adulthood. For more information, see Vol. 16, No. 1  of the Children’s Mental Health Research Quarterly.