Commentary: Comment and reflection about Mental health outcomes of the Daily Mile in elementary school children: a single-arm pilot study. The implementation of the Daily Mile in the school context

In ‘Mental health outcomes of the Daily Mile in elementary school children: a single-arm pilot study’, Arkesteyn et al. (Child and Adolescent Mental Health, 2022) discussed and investigated the effect of a classroom activity break, named The Daily Mile, on pupils' self-esteem, self-perception competence, and mental health. Starting from the interesting and novel results of Arkesteyn et al. (Child and Adolescent Mental Health, 2022), this comment focuses on the concurrent evidence about the effect of The Daily Mile on pupils' physical and mental health. Overall, this comment would reflect and critically review considerations for future research on the topic and to adopt it in the school context.     

Pubertal growth spurt: the rapid progress and future directions for Child and Adolescent Mental Health

Child and Adolescent Mental Health aims to publish high‐quality, clinically relevant research to assist practitioners working in and/or interested in young people's mental health in their clinical practice and continuing professional development. This is last editorial that I will write for Child and Adolescent Mental Health before leaving the journal in the capable hands of Crispin Day, so it seems important to reflect on the rapid and important changes I have seen over the last 7 years.     

Editorial: Child and Adolescent Mental Health: a global challenge

Welcome to the first issue of Child and Adolescent Mental Health of 2015. A pleasure of being an editor of this journal is the sheer breadth and diversity of papers that we receive. The best papers not only share the achievements and successes of new research and innovation but also shed light on the complex struggles and challenges involved in helping children and young people overcome the emotional, behavioural and other mental health difficulties they endure. Child and Adolescent Mental Health aims to publish high quality health services research that informs, influences and transforms the quality and effectiveness of the mental health care available to children, young people, their parents and families. When placed in the global context outlined by Patel and Rahman (2015) in this issue, the scale of this task is daunting. Nearly half of the world's population are under the age of 18 and only a small fraction of the global mental health resources currently available are invested in child and adolescent mental health care across low, medium and high income countries. Patel and Rahman (2015) argue that the step change needed to transform global child mental health requires a bold agenda that mobilises community assets, such as lay health workers, harnesses the use of mobile and electronic health technologies alongside more conventional improvement in access and effectiveness of both universal and specialist services from early life onwards. This agenda resonates for children and young people in high income countries as much as it does for those living in low and middle income countries. Child and Adolescent Mental Health needs to reflect the global challenge of children and young people's mental health. This issue contains papers from authors based in Australia, Brazil, India, Italy, Ireland, Turkey, the UK and the USA, each of which uses scientific methods to make an informed contribution to clinical practice.     

Editorial: Evidence,policy and practice – gold standard,good enough or doing it differently?

Welcome to the first issue of Child and Adolescent Mental Health (CAMH) in 2021 and also to my first issue as editor-in-chief. Needless to say, 2020 has been one of the most difficult years in living memory for many children and young people around the globe, and, as we discussed in our recent issues, the potential impact of COVID-19 on children’s mental health is profound. The case for increased funding for child and adolescent mental health and investing in research has never been greater. Nevertheless, as we step into 2021, there are seeds of optimism as science drives forward treatment and vaccine developments.     

Editorial: Adolescent mental health: the role of identity,methods for measuring change,and promising intervention developments

Adolescence marks a period in development when self‐image and negative thoughts becomes particularly salient in relation to the development mental health problems. This issue of Child and Adolescent Mental Health includes a set of articles that focus on questions related to the association between negative thoughts and adolescent mental health across a range of cultures and using diverse methodologies. Given the escalating salience of technology and social media in the lives of children and adolescents, we encourage future contributions that incorporate such technologies as methods of assessment and treatment delivery in relation to mental health services.     

The Future of Gaming Disorder Research and Player Protection: What Role Should the Video Gaming Industry and Researchers Play?

In May 2019, the World Health Organization (WHO) officially included gaming disorder (GD) in the eleventh revised edition of the International Classification of Diseases. Although the video game industry does not accept the WHO’s decision to class GD as a genuine mental disorder, there is now arguably an onus on the video game industry to develop and undertake responsible gaming initiatives aimed at player protection and harm minimization. The present paper argues that the gaming industry does not have to “reinvent the wheel” as there are many responsible gaming tools and initiatives used by the gambling industry that they could implement (e.g., limit-setting, self-exclusions, personalized messaging, pop-up reminders). The paper also argues that like the gambling industry, the video game industry has an abundance of high-quality data in the form of player account data (i.e., behavioral tracking data) and that researchers should work collaboratively with the gaming industry to use such data to learn more about the acquisition, development, and maintenance of gaming and GD among its clientele. It is also noted that while there is the need for such cooperation, the integrity of independent research should not be jeopardized nor undermined in this process. In addition to the clear need of establishing a scientific partnership between gaming operators and researchers, the paper also outlines several steps and recommendations to improve the overall quality of research in GD.

     

Book review

The Classification of Child and Adolescent Mental Diagnoses in Primary Care. Edited by Mark Wolraich, Marianne Felice and Dennis Drotar. (Elk Grove Village, IL: American Academy of Pediatrics, 1996). [Pp. 368]. ISBN: 60009-0927. $39·95.     

The NIMH blueprint for change report: research priorities in child and adolescent mental health

The National Institute of Mental Health established a special subgroup of its National Advisory Mental Health Council to review major research findings on child and adolescent psychiatric disorders over the past decade and to recommend research priorities for the next decade. This Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment published its report, titled Blueprint for Change: Research on Child and Adolescent Mental Health, in August 2001, and several new research announcements reflecting these new directions have been issued since that time. This article summarizes the rationale for and background to the report, its major conclusions, and the reasons why interdisciplinary and translational approaches to research questions in child and adolescent mental health will help to maximize scientific advances.     

Psychometric evaluation of the Dutch language version of the Child and Family Follow-up Survey

Abstract

Aim: The Child and Family Follow-up Survey (CFFS) is developed to monitor long-term outcomes of children and youth with acquired brain injury (ABI). The aim of this study was to translate and adapt it into the Dutch language and to evaluate its reliability and validity.

Methods: The CFFS includes the Child and Adolescent Scale of Participation (CASP), the Child and Adolescent Factors Inventory (CAFI) and the Child and Adolescent Scale of Environment (CASE). The CFFS was translated into Dutch following international guidelines and adapted. The internal consistency, validity and test–retest reliability were examined among two groups of patients (n?=?140 and n?=?27) in the age of 5–22 years with ABI and their parents.

Results: The translation and adaptation resulted in the CFFS-DLV, Dutch language version. The CASP-DLV, CAFI-DLV and CASE-DLV had a good internal consistency, with Cronbach’s alpha being 0.95, 0.89 and 0.83, respectively. There were statistically significant correlations among the three CFFS subscale scores. These scores were also significantly correlated with the total scores of the Pediatric Quality of Life Inventory (PedsQL, parent) and the Pediatric Stroke Outcome Measure, but not with the domain scores of the Children’s Assessment of Participation and Enjoyment (CAPE). The test–retest reliability was good to moderate, with the intra-class correlation coefficients being 0.90 for the CASP-DLV, 0.95 for the CAFI-DLV and 0.81 for the CASE-DLV.

Conclusions: The CFFS-DLV, as translation and adaptation of the CFFS into Dutch, proved to be a promising instrument to measure long-term outcomes of children and youth with ABI. Further research is needed to examine its responsiveness to change and potential in other patient groups.     

Overview of CAPICE—Childhood and Adolescence Psychopathology: unravelling the complex etiology by a large Interdisciplinary Collaboration in Europe—an EU Marie Skłodowska-Curie International Training Network

European Child & Adolescent Psychiatry - The Roadmap for Mental Health and Wellbeing Research in Europe (ROAMER) identified child and adolescent mental illness as a priority area for research....     

Diskussion: Kritiska synpunkter på psykiatrisk variabelforskning: Replik till Karl Erik Törnqvist (Nordisk psykiat. Medlems-blad1958/hefte 1, s. 48)

Abstract

Background: Consumer satisfaction studies with the Child and Adolescent Mental Health Service (CAMHS) have mainly assessed evaluations in a short-term follow-up perspective. Adolescent reports with CAMHS have not been included nationally. Aims: The purposes of this study were to explore adolescent and parental satisfaction with the CAMHS in a 3–4-year follow-up perspective, and to examine the relationships between reported consumer satisfaction and clinical parameters such as reason for adolescent referral, emotional/behavioral symptoms and treatment outcome. Methods: Of 190 adolescent–parent pairs in a sample of CAMHS outpatients, 120 completed a Consumer Satisfaction Questionnaire. Parents assessed adolescent emotional/behavior problems both at baseline and at follow-up by completing the Child Behavior Checklist (CBCL). Correlations were examined between adolescent and parental evaluations. The relationships between service satisfaction and symptom load at baseline and follow-up and treatment outcome at follow-up were explored. Results: Overall, adolescents and parents were satisfied with the services received from the CAMHS. The correlations between adolescent and parent consumer satisfaction ratings were low to moderate. Consumer satisfaction was significantly and negatively correlated with symptom load on the CBCL Total Problems scores at baseline, but not at follow-up. There was no difference in satisfaction levels between those who improved after treatment and those who did not. Conclusions: Given the differences in informant ratings of consumer satisfaction, it is important to include both adolescent and parental perceptions in evaluations of CAMHS services and treatment outcomes. Consumer satisfaction should serve as a supplement to established standardized outcome measures.     

Rationale and content of psychenet: the Hamburg Network for Mental Health

With the public-funded research and development project psychenet: the Hamburg Network for Mental Health (2011–2014), the Federal Ministry of Education and Research contributes to strengthening healthcare regions in Germany by establishing new trans-sectoral cooperations and implement and evaluate selected innovations. More than 60 partners from research, health care, health industry and government in the Free and Hanseatic City of Hamburg are promoting innovative measures to improve the treatment for mental disorders. The main objective is to implement integrated healthcare networks based on evidence for effective treatment methods, deriving from high-quality research throughout five indications such as psychosis, depression, somatoform and functional syndromes, anorexia and bulimia and addiction illnesses in adolescence. Those networks are accompanied by additional measures, for example, for improving information and education, addressing occupational health or strengthening the participation of patients and their families suffering from mental illness.

     

TIGA-CUB-manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5–11 with treatment-resistant conduct disorders and their primary carers: results from a randomised controlled feasibility trial

Background: Parenting programmes are recommended for conduct disorders in 5–11 year olds, but ineffective for 25–33%. A feasibility trial was needed to determine whether a confirmatory trial of second-line, manualised short-term psychoanalytic child psychotherapy (mPCP) versus treatment as usual (TaU) is practicable.

Method: This was a two-arm, pragmatic, parallel-group, multi-centre, individually-randomised controlled feasibility trial with blinded outcome assessment. Child–primary carer dyads were recruited from National Health Service Child and Adolescent Mental Health Services and mPCP delivered by routine child psychotherapists.

Results: Thirty-two dyads (50% of eligible, 95% CI 37 to 63%) were recruited, with 16 randomised to each arm. Eleven (69%) completed ≥50% of 12 week mPCP and 13 (81%) ≥1 session. Follow-up was obtained for 24 (75%) at 4 months and 14/16 (88%) at 8 months. Teacher follow-up was 16 (50%). Manual adherence was good. Baseline candidate primary outcomes were 37.4 (SD 11.4) and 18.1 (SD 15.7) on the Child Behaviour Checklist/Teacher Report Form externalising scale and 102.8 (SD 28.4) and 58.8 (SD 38.9) on the total score. Health economics data collection was feasible and the trial acceptable to participants. Conclusion: Recruitment, teacher follow-up and the manual need some refinement. A confirmatory trial is feasible, subject to funding of research child psychotherapists.     

Uses and Abuses of Patient Reported Outcome Measures (PROMs): Potential Iatrogenic Impact of PROMs Implementation and How It Can Be Mitigated

Having been a national advocate for the use of patient reported outcome measures (PROMs) in Child and Adolescent Mental Health Services (CAMHS) in the UK for the last decade, I have become increasingly concerned that unless the potential iatrogenic impact of widespread policy requirement for use of PROMs (Department of Health, Children and Young People’s Health Outcomes Strategy, 2012) is recognised and addressed their real potential benefits (Sapyta et al., J Clin Psychol 61(2):145–153, 2005) may never be realized. Drawing on examples from PROMs implementation in CAMHS in the UK (Wolpert et al., J Ment Health 21(2):165–173, 2012a; Child Adolesc Mental Health 17(3):129–130, 2012b). I suggest key ways forward if PROMs are to support best clinical practice rather than undermine it.     

The 2-Repeat Allele of the MAOA Gene Confers an Increased Risk for Shooting and Stabbing Behaviors

There has been a great deal of research examining the link between a polymorphism in the promoter region of the MAOA gene and antisocial phenotypes. The results of these studies have consistently revealed that low activity MAOA alleles are related to antisocial behaviors for males who were maltreated as children. Recently, though, some evidence has emerged indicating that a rare allele of the MAOA gene—that is, the 2-repeat allele—may have effects on violence that are independent of the environment. The current study builds on this research and examines the association between the 2-repeat allele and shooting and stabbing behaviors in a sample of males drawn from the National Longitudinal Study of Adolescent Health. Analyses revealed that African-American males who carry the 2-repeat allele are significantly more likely than all other genotypes to engage in shooting and stabbing behaviors and to report having multiple shooting and stabbing victims. The limitations of the study are discussed and suggestions for future research are offered.     

A first-level evaluation of a family intervention for adolescent social,emotional and behavioural difficulties in Child and Adolescent Mental Health Services

This study is a first-level evaluation of a family intervention targeted at adolescents with social, emotional and behavioural difficulties (SEBD) attending Child and Adolescent Mental Health Services (CAMHS) in Ireland. It is a combined implementation of the Working Things Out adolescent programme and the Parents Plus Adolescent Programme (WTOPPAP).

Method: A total of 93 adolescents aged 11–17 years (M = 14.64, SD = 1.31; 39% male) and their parents took part in the study. The study used a quasi-experimental One-Group Pretest-Posttest design to assess change from pre- to post-intervention using the Strengths and Difficulties Questionnaire, the McMaster General Functioning Scale, Goal Attainment, Parent Stress Scale and the Kansas Parenting Satisfaction Scale. Both parent- and adolescent-rated goal attainment and general family functioning improved from pre- to post-intervention. Parents also rated their satisfaction with parenting as having significantly improved. Adolescent-rated emotional difficulties significantly improved for the overall sample and parent-rated child total difficulties for female adolescents significantly improved from pre-test to post-test. Parents of female adolescents also reported a significant drop in parental stress. These findings indicate that the WTOPPAP may be an effective intervention for adolescents with SEBD, particularly females, and their parents. Further implications are discussed.     

Computer Use and Attitudes Towards Computerised Therapy Amongst Young People and Parents Attending Child and Adolescent Mental Health Services

Background: There has been little research examining attitudes towards computerised therapy in young people. Method: A self‐report survey of 37 young people and 31 parents using Child and Adolescent Mental Health Services (CAMHS). Results: Young people reported high levels of computer usage and online help‐seeking behaviour. Young people were cautious about computerised therapy whereas parents were more positive, identifying more benefits than concerns. Conclusions: Mental health professionals need to be aware of young people’s online help‐seeking behaviour in order to correct inaccuracies and maximise uptake of computerised therapy.     

Attitudes and knowledge of child and adolescent mental health clinicians in relation to the psychosis risk syndrome

Aim: To evaluate the knowledge and attitudes of clinicians in a Child and Adolescent Mental Health Service in relation to the ‘At‐Risk Mental State’ concept in psychosis. Methods: A questionnaire was constructed and administered to child and adolescent mental health clinicians working in North East England. Results: Sixty‐seven per cent (n = 121) of eligible clinicians responded. Almost all the participants believed that young people ‘At‐Risk’ needed support. However, only around half felt confident in identifying this patient group. Approximately a third felt that antipsychotic medication may be useful. Some interprofessional differences were noted in relation to both knowledge and attitudes. Conclusions: Further training would be required for most health workers in this sample to feel confident in identifying the syndrome. These findings require replication in other service settings and may have implications for the implementation of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic category relating to the At‐Risk Mental State.     

Assessing the feasibility of a web-based outcome measurement system in child and adolescent mental health services – myHealthE a randomised controlled feasibility pilot study

Background

Interest in internet-based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web-based monitoring system was developed to address the limitations of paper-based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinical information and track their child's progress. This study aimed to assess whether MHE improves the completion of the Strengths and Difficulties Questionnaire (SDQ) compared with paper collection. Secondary objectives were to explore caregiver satisfaction and application acceptability.

Methods

A 12-week single-blinded randomised controlled feasibility pilot trial of MHE was conducted with 196 families accessing neurodevelopmental services in south London to examine whether electronic questionnaires are completed more readily than paper-based questionnaires over a 3-month period. Follow up process evaluation phone calls with a subset (n = 8) of caregivers explored system satisfaction and usability.

Results

MHE group assignment was significantly associated with an increased probability of completing an SDQ-P in the study period (adjusted hazard ratio (HR) 12.1, 95% CI 4.7–31.0; p = <.001). Of those caregivers' who received the MHE invitation (n = 68) 69.1% completed an SDQ using the platform compared to 8.8% in the control group (n = 68). The system was well received by caregivers, who cited numerous benefits of using MHE, for example, real-time feedback and ease of completion.

Conclusions

MHE holds promise for improving PROM completion rates. Research is needed to refine MHE, evaluate large-scale MHE implementation, cost effectiveness and explore factors associated with differences in electronic questionnaire uptake.     

Depressive and Disruptive Disorders and Mental Health Service Utilization in Children and Adolescents

ObjectiveTo examine the relationship of depressive and disruptive disorders with patterns of mental health services utilization in a community sample of children and adolescents.MethodData were from the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The sample consisted of 1,285 child (ages 9–17 years) and parent/guardian pairs. Data included child psychopathology (assessed by the Diagnostic Interview Schedule for Children), Impairment, child need and use of mental health services, and family socioeconomic status.ResultsAfter adjusting for potential confounding factors, disruptive disorder was significantly associated with children's use of mental health services, but depressive disorder was not. For school-based services, no difference was found between the 2 types of disorders. Parents perceived greater need for mental health services for children with disruptive disorders than for those with depression. Conversely, depression was more related to children's perception of mental health service need than was disruptive disorder.ConclusionsThe findings highlight the need for more effective ways to identify and refer depressed children to mental health professionals, the importance of improving school-based services to meet children's needs, and the necessity to better educate parents and teachers regarding the identification of psychiatric disorders, especially depression. J. Am. Acad. Chlid Adolesc. Psychiatry, 1999, 38(9):1081–1090.