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Purpose: Evidence from systematic reviews suggests that adult immigrants living in areas of higher immigrant density (areas with a higher proportion of foreign-born residents) tend to experience fewer mental health problems-likely through less discrimination, greater access to culturally/linguistically appropriate services, and greater social support. Less is known about how such contexts are associated with mental health during childhood-a key period in the onset and development of many mental health challenges. This study examined associations between neighbourhood immigrant density and youth mental health conditions in British Columbia (BC; Canada)., Methods: Census-derived neighbourhood characteristics were linked to medical records for youth present in ten of BC's largest school districts from age 5 through 19 over the study period (1995-2016; n = 138,090). Occurrence of physician assessed diagnoses of mood and/or anxiety disorders, attention deficit hyperactivity disorder (ADHD), and conduct disorder was inferred through International Classification of Diseases (ICD) diagnostic codes in universal public health insurance records. Multi-level logistic regression was used to model associations between neighbourhood characteristics and odds of diagnoses for each condition; models were stratified by generation status (first-generation: foreign-born; second-generation: Canadian-born to a foreign-born parent; non-immigrant)., Results: Higher neighbourhood immigrant density was associated with lower odds of disorders among first-generation immigrant youth (e.g., adjusted odds of mood-anxiety disorders for those in neighbourhoods with the highest immigrant density were 0.67 times lower (95% CI: 0.49, 0.92) than those in neighbourhoods with the lowest immigrant density). Such protective associations generally extended to second-generation and non-immigrant youth, but were-for some disorders-stronger for first-generation than second-generation or non-immigrant youth., Conclusions: Findings suggest there may be protective mechanisms associated with higher neighbourhood immigrant density for mental health conditions in immigrant and non-immigrant youth. It is important that future work examines potential pathways by which contextual factors impact immigrant and non-immigrant youth mental health., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Parents play a vital role in supporting children with learning disabilities, but little is known about their understanding of this diagnosis. The experiences of parents with the diagnostic process and the services their children receive post-diagnosis vary widely. Parents who participated in this study reported that they understand learning disabilities broadly but not their underlying neurobiology. Those who noted understanding the neurobiology indicated that it helped them better support their child, and those who did not understand it wanted to learn more. Parents generally noted that their children received less support during COVID-19 and that they had to seek more private services in order to support their child's academic progress, which caused additional strain on families. Finally, parents reported that having a child with a learning disability negatively affected their mental health, especially when parents feel like they have had to advocate strongly for their child to receive services.

Rates of mental health challenges among children and youth are on the rise. Physical activity has been identified as a promising intervention to improve mental health outcomes for youth. This study aimed to investigate how mental health clinicians perceive and utilize physical activity as a mental health intervention for children and adolescents. Seventy-four Ontario mental health clinicians (psychologists, psychotherapists, and social workers) were surveyed about their perspectives and practices related to physical activity as part of mental health care for children and adolescents using a mixed-methods approach. Survey respondents were also asked about barriers to including physical activity in care. Although 100% of clinicians agreed that physical activity was beneficial to their own and to their clients' mental health, only 61% reported prescribing physical activity to their clients. Barriers to prescribing physical activity as a treatment option included lack of training, time, and resources. Clinicians who were more physically active themselves were more likely to view physical activity as beneficial for mental health and were less likely to view time as a barrier to discussing and prescribing physical activity in their practice. Many clinicians expressed a need for more training, knowledge, and resources. The results of this study suggest that with improved access to training and resources, clinicians will be well-positioned to leverage the benefits of physical activity for mental health in their practice.

Physical activity (PA) and screen time (ST) are associated with mental health in adolescents, though little is known about their inter-relationships. This study examined the associations of PA and ST with psychosomatic complaints in adolescents. Data from four cycles of the Canadian Health Behaviour in School-aged Children (HBSC) surveys, collected between 2002 and 2014, were analysed. Eight psychosomatic health complaints were assessed and dichotomised as frequent (≥2 complaints/week) vs. infrequent. PA was assessed by number of days/week participants were physically active for ≥60 min. Discretionary ST was assessed by adding three screen uses: television, electronic games, and computer. Of the 37,829 adolescents (age 13.74 (SD 1.51) years; 52% girls), 25% boys and 39% girls reported frequent psychosomatic complaints. Multilevel logistic analyses showed that ST levels were positively associated while PA levels were negatively associated with reporting frequent psychosomatic complaints in a dose-dependent manner. Compared with ST ≤ 2 hrs/d, ST ≥ 4 hrs/d in girls and ST ≥ 6 hrs/d in boys showed higher odds of reporting psychosomatic complaints. Participating in PA ≥ 60 min every day compared to no PA showed lower odds of reporting psychosomatic complaints by 44% in girls and 57% in boys. Prospective research is needed to understand the causal pathway of these dose-dependent relationships.

Objectives: Children's mental health and wellbeing declined during the first COVID-19 lockdown (Spring 2020), particularly among those from disadvantaged settings. We compared mental health and wellbeing of school-aged children observed pre-pandemic in 2018 and after the first lockdown was lifted and schools reopened in Fall 2020. Methods: In 2018, we surveyed 476 grade 4-6 students (9-12 years old) from 11 schools in socioeconomically disadvantaged communities in Northern Canada that participate in a school-based health promotion program targeting healthy lifestyle behaviours and mental wellbeing. In November-December 2020, we surveyed 467 grade 4-6 students in the same schools. The 12 questions in the mental health and wellbeing domain were grouped based on correlation and examined using multivariable logistic regression. Results: There were no notable changes pre-pandemic vs. post-lockdown in responses to each of the 12 questions or any of the sub-groupings. Conclusion: Supporting schools to implement health promotion programs may help mitigate the impact of the pandemic on children's mental health and wellbeing. The findings align with recent calls for schools to remain open as long as possible during the pandemic response., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dabravolskaj, Khan, Veugelers and Maximova.)

Emerging research shows that Acceptance and Commitment Therapy (ACT) may improve mental health for caregivers. Parents of autistic children, adolescents, and adults (N = 54) were randomly assigned to either complete a brief group-based ACT intervention or remain on the waitlist. Participants completed surveys immediately prior to randomization, and 3-, 7-, and 17-weeks post-randomization. The primary outcome was depression symptoms and secondary outcomes included stress, goal attainment, positive affect, ACT psychological processes, child mental health, and family functioning. Mixed effects linear models testing Group × Time interaction indicated the Treatment group (n = 27) demonstrated greater post-intervention improvements than the Waitlist group (n = 27) in parent depression (p = 0.03, d = -0.64) and family distress (p = 0.04, d = -0.57). Treatment group parents also reported greater short-term gains in positive affect (p =< 0.001, d = 0.77) and personal goal attainment (p = 0.007, d = 0.80), compared to the Waitlist group. Although there was no significant Group × Time interaction for other outcomes, stress (b = -2.58, p = 0.01), defusion (b = -3.78, p = 0.001), and experiential avoidance (b = -4.22, p = 0.01) showed improvement for the Treatment group, but not the Waitlist group, at post-intervention. All Treatment group improvements were maintained at follow-up. Results suggest that a brief ACT group intervention is efficacious for improving some aspects of mental health for parents of autistic children.

This study investigated the relationship between traumatic life stress, trust, and prosocial behavior as a positive mental health outcome in Syrian refugee children in Canada. Trust is a resilience factor shown to promote adjustment after resettlement. The specific goals of the study were to test the influence of refugee children's traumatic life stress on their prosocial behavior and the mediating role of trust in this link. Five- to 12-year-old Syrian refugee children (N = 124) and their caregivers (N = 51) who recently resettled in Canada participated in this study. Children retrospectively reported their experiences of traumatic life stressors, and caregivers reported their children's current level of trust and prosocial behavior using questionnaires. Traumatic life stress (e.g., witnessing violence and conflict, separation from family, death of family members) was negatively related to refugee children's trust in others, while trust was related to more prosocial behaviors, confirming its mediating role. These results suggest that experiencing more traumatic life stressors is associated with less prosocial behaviors as a positive mental health outcome through lower levels of trust. The current findings suggest that fostering trust may be a promising avenue for intervention to promote prosocial behavior and resilience in refugee children who are resettling in a new society.

Background: Canada recently adopted the 24-Hour Movement Guidelines for Children and Youth (24-Hour Guidelines) for young people aged 5 to 17 years-an international first, providing integrated recommendations for physical activity, sedentary time and sleep. Since the release of the guidelines, very few studies have examined the associations of adherence to the 24-Hour Guidelines with health outcomes-and none focus on psychosocial health. Therefore, the objective of this study was to assess the associations of meeting the 24-Hour Guidelines and their behaviour-specific recommendations with psychosocial health among Canadian children and youth., Data and Methods: This cross-sectional study included 4,250 children and youth aged 5 to 17 years with valid accelerometer data. The study data were collected from 2009 to 2015 with the Canadian Health Measures Survey and pooled. Moderate-to-vigorous physical activity was measured using accelerometers; screen time, sleep duration and measures of psychosocial health were self- or proxy-reported. Multivariate logistic regression models were used to examine the associations of meeting individual or different combined recommendations from the 24-Hour Guidelines with psychosocial health., Results: There was low overall adherence to all three 24-Hour Guidelines recommendations, especially among youth (children: 13.9%, youth: 4.8%). Meeting two or more of the recommendations was associated with higher odds of positive psychosocial health among youth (odds ratio [OR] = 3.10; 95% confidence interval [CI]: 1.17-8.19). Sleep duration and screen time were strongly associated with social behaviour and psychosocial health among Canadian youth., Discussion: Adherence to the 24-Hour Guidelines was significantly associated with better psychosocial health among Canadian youth.

Using a linked population-based database established on healthcare, socio-economic, and survey datasets in British Columbia, Canada, we examined how biological, socio-demographic, and socio-economic status (SES) factors at birth related to children's emotional development and mental health. One analysis examined teacher-rated anxiety, hyperactivity, and aggression for kindergarten children (M age  = 5.7; n = 134,094). Another analysis examined administrative healthcare records comprising of physician-assigned diagnostic codes for mental health conditions (conduct disorder, attention deficit hyperactivity disorder, anxiety disorder and depression) from ages 5 through 15 (n = 89,404). Various factors at birth, including gestational age, birthweight, and maternal demographics, were related to emotional development and mental health in childhood. Across outcomes, low SES indicated detrimental associations with various aspects of children's emotional development and mental health (e.g., adjusted odds of mental health conditions were 25-39% higher for children of low income families versus others). Findings reinforce evidence that poverty (reduction) is a primary public health issue.

Indigenous young people in Canada are disproportionately overrepresented in suicide rates and alarmingly, young children are accounted for in these disparities. Since children spend much of their day at school, schools are a vital context for suicide prevention, identification, and intervention. However, research indicates that educators often report that they feel unprepared to address mental health challenges within the classroom. Indigenous communities are developing community driven responses to suicide that are culturally relevant and strengths based. It is critical that these models are considered when developing such suicide prevention within schools as they diverge from medicalized focused approaches and attend to broader social dimensions. It is imperative that educators and the education system are properly equipped with the training and resources to provide suicide prevention within schools and communities servicing Indigenous children. School psychologists can play an important role in providing this prevention leadership. Through interviews with educators, we learned about the types of supports that are needed within schools to address Indigenous child suicide, and in what ways school psychologists could enhance prevention efforts. Using a reflexive approach to thematic analysis, we identified four main themes related to support needed. Findings are discussed in conversation with the current state of child specific suicide and suicide prevention literature. Applied implications for suicide prevention within schools for Indigenous children, as well as future research and community-based recommendations are considered.

Introduction: Compared to their neurotypical peers, children and adolescents with neurodevelopmental disorders (NDs) experience worse mental health outcomes, including greater service use and functional impairment. Few studies, however, have examined the neurodevelopmental contributions to mental health complexity among those seeking community-based mental health services. Methods: Archival data from a publicly-funded mental health center was used to test the generalizability of a path model predicting service use among those with (n = 66) and without (n = 97) NDs. Results: Those with NDs were found to experience more symptoms and had greater service use than those without NDs, and there were notable differences in the predictive pathways across groups. Specifically, the paths from internalizing challenges, early life adversity, and biological sex were only significant among the ND group. Conclusions: These findings indicate that neurodevelopmental status is an important moderator of mental health outcomes that warrants consideration when treating complex cases.

Mental health literacy (MHL) encompasses understanding mental health and learning how to obtain and maintain good mental health. Increasing MHL may increase help-seeking behaviors and positive mental health. This study aimed to identify school-based MHL interventions for children/youth using a scoping review methodology following the Johanna Briggs Model. The interventions were assessed for quality of evidence using the National Institutes of Health Study Quality Assessment Tools. Six databases were searched: Scopus, APA PsycInfo, Cochrane Library, ERIC, PubMed, and ProQuest Psychology. Search terms included "mental health literacy," "intervention," and "children." The search yielded 27 studies after applying inclusion criteria. Eight of these studies were assessed as "poor" quality, twelve as "fair" quality, and seven as "good" quality. The results highlight the need for more research to implement and evaluate interventions to sustainably and feasibly incorporate school-based MHL interventions for children and youth into practice.

School social workers possess a unique perspective and skill set for school leadership. However, common conceptualizations of the role have unnecessarily limited this capacity, and as a result, school social workers have struggled to carve out an identity in education. By reframing the role of school social workers as school leaders, schools will have an opportunity to leverage their best qualities. Social workers who are willing to work closely with school administrators, build strong partnerships with schools, and advocate for themselves as school leaders stand to gain a great deal from added legitimacy to their role.

Research on adults indicates other-oriented perfectionism (requiring perfection from others) is associated with various consequential outcomes independent of self-oriented perfectionism (requiring perfection of the self) and socially prescribed perfectionism (believing others require perfection of the self). However, historically, the most widely used and researched measure of trait perfectionism in children, the Child-Adolescent Perfectionism Scale (CAPS), has omitted other-oriented perfectionism. In the present study, we address this by reporting on the multisource development and validation of the first self-report measure of other-oriented perfectionism specifically intended for youths: the Other-Oriented Perfectionism Subscale-Junior Form (OOPjr). Children (N = 107; M[subscript age] = 11.5, SD = 1.7) completed the OOPjr, CAPS, and measures of perfectionistic self-presentation, narcissism, social disconnection, depressive symptoms, and parental psychological control. Parents provided ratings of children's self-oriented, socially prescribed, and other-oriented perfectionism. Psychometric analyses indicated the OOPjr is a homogenous and internally reliable scale that, when factor analyzed alongside the CAPS, displays measurement invariance across gender and replicates the three-factor solution found in adults. Furthermore, parent ratings of other-oriented perfectionism showed unique positive relationships with OOPjr scores, but not CAPS scores. Likewise, other-oriented perfectionism had independent positive relationships with narcissistic superiority and achievement-oriented parental psychological control, after controlling for self-oriented and socially prescribed perfectionism. Overall, our findings provide preliminary support for the use of the OOPjr as a measure of other-oriented perfectionism in youths.

Given the rise and diversification of the immigrant student population within Canadian school systems, the establishment of policies that support immigrant pupils' transition and integration has become of pressing concern for policymakers. Following our multi-dimensional support model, this study examined the extent to which Ontario's provincial education policies, guidelines, and strategies respond to the needs of immigrant students within the K-12 public education system. For the most part, the current analysis indicated that the ministry has established the necessary educational support measures to integrate immigrant students. However, our findings also suggest that this group of students warrants a stand-alone policy document to comprehensively address all of their unique needs. Moreover, this study underscores the importance of greater policy coherence and direction within Ontario, as well as the ongoing role that evidenced-based research should serve in the development and refinement of existing policies.

Developmental research during COVID-19 suggests that pandemic-related disruptions in family relationships are associated with children's mental health. Most of this research has focused on 1 child per family, thereby obfuscating patterns that are differentially operative at the family-wide (i.e., between-family) versus child-specific (i.e., within-family) levels of analysis. Thus, the current study evaluates multilevel, longitudinal associations between COVID-19 disruption, family relationships, and caregiver/child mental health using a sibling comparison methodology. Caregivers (N = 549 families with 1098 children between 5 and 18 years old) were recruited from the Prolific research panel (73% White-European; 68% female; 76% United Kingdom, 19% U.S.A.; median 2019 income $50,000-$74,999). Caregiver reports of COVID-19 disruption, psychological distress, family functioning, parenting, and child mental health (for 2 children per family) were provided during May (time 1) and July (time 2) 2020. A Bayesian multilevel path analysis with random effects revealed: (a) families were experiencing difficulties across domains when COVID-19 disruption was high; (b) COVID-19 disruption corresponded to greater sibling differences in mental health; and (c) the sibling with poorer mental health received lower quality parenting over time, especially in families who reported higher levels of differential parenting. Findings suggest that understanding children's mental health difficulties during COVID-19 requires a family system lens due to the multiple ways these consequences permeate across the family unit. Comprehensive interventions for children's mental health during this time will likely require an examination of caregiver, sibling, and whole-family dynamics in the context of evidence-based telehealth practice.

Attachment difficulties are associated with a range of adverse outcomes in mental health, and people with intellectual disabilities (IDs) may be at greater risk of experiencing difficulties in their attachment relationships. This review critically evaluated recent research measuring the prevalence of attachment difficulties in people with ID. Eight studies met the inclusion criteria, and a higher prevalence of insecure and disorganized attachment classifications, and symptoms of attachment disorder, was found across a number of subgroups of people with diagnoses of ID. However, the validity and reliability of measures of attachment have not been empirically established in this population, and control groups were not always appropriate. These findings indicate the need to (1) develop reliable and standardized assessments of attachment for people with ID and (2) evaluate the efficacy of attachment-based interventions in relation to reducing psychological distress, mental health problems and expression of behaviours experienced by others as challenging.

The purpose of this pilot study was to evaluate the preliminary effects of a curriculum resource on elementary school children's social and emotional skills. In total, 98 Grade 3 children were randomly allocated to either a control or experimental group and evaluated before and after a 3-month implementation period. Experimental group showed improved prosocial behaviors (p < 0.01), concern for others (p = 0.02), and emotional skills (p < 0.01) over time, as well as improved relaxation levels (p < 0.01) after partaking in relaxation activities. Compared with the control group, experimental group's emotional skills were significantly higher at posttest (p < 0.01). No significant differences were observed for children's self-perceptions (p > 0.05). Results from this study indicate that the curriculum resource may facilitate the development of children's social and emotional skills. A future definitive randomized-controlled trial should strive for a longer implementation period in response to small effect sizes, taking into account target population, sample size, and persistence of effects over the life span and in different environmental contexts.

A number of cross-sectional studies report extensive use of psychiatric services and high healthcare costs in autistic youths. However, little is known about how the use of these services evolves from the time of diagnosis, as children grow up. Our objectives were to investigate the use, costs, and predictors of psychiatric services following autism spectrum diagnosis. We built a cohort of 1227 newly diagnosed autism spectrum individuals identified in the Quebec (Canada) "Régie de l'assurance maladie du Québec" administrative database (January 1998 to December 2010). Mean number and cost per individual of psychiatric healthcare use (hospitalizations, medical visits, psychoactive drug use) were calculated yearly for 5 years following autism spectrum diagnosis. Mean number of psychiatric visits decreased over time by more than threefold (7.5 vs 2.1 visits) from year 1 to year 5, whereas psychoactive drug use increased from 16.0 to 25.2 claims. Psychiatric hospitalizations decreased during follow-up, but still represented the greatest costs per individual (CAD9820 for year 1; CAD4628 for year 5). Antipsychotics represented over 50% of drug costs. Mixed-effect model with repeated measures showed that previous psychoactive drug use was the strongest predictor of greater psychiatric healthcare cost during follow-up (odds ratio: 9.96; 95% confidence interval: 7.58-13.10). These trends contrast with guidelines advocating cautious prescribing of antipsychotics with periodical re-assessment of their benefit.

How are mental health practitioners using Snoezelen rooms with children with fetal alcohol spectrum disorder (FASD) within a community mental health setting? Using purposive sampling, we collected information from seven practitioners on how they currently use Snoezelen rooms to support children with FASD and what evidence they believe is needed to assess Snoezelen's treatment efficacy. Using grounded theory methodology, results indicated that priority research areas include the efficacy of Snoezelen for increasing self-regulation skills, positive parent-child interactions, and parent education. To support evidence-driven use of Snoezelen rooms for mental health treatment, we recommend that future research be focused in these areas.

Mental health challenges are common among children, and can interfere with learning and adjustment to school. Although early intervention is crucial and the family-school partnership plays an integral role in the development and implementation of individual education plans (IEPs), there are few supports to assist families in navigating this partnership. This study describes the experiences of parents who participated in the Parents in Partnership with Educators (PIPE) program, an individualized intervention for families who are struggling to communicate and problem-solve with schools around the mental health needs of their children. File review and semi-structured interviews were conducted for ten families. Results indicated that the program gave parents unconditional support and guidance, as well as new skills to help them communicate their perspective in a meaningful way. Parents reported feeling empowered, informed, and prepared to advocate for their children.

There are a growing number of children who begin to develop mental concerns during the school-age years. As such, it is important that schools recognize and understand mental health issues and are actively engaged in supporting these students. This article provides a review of mental health in schools, highlighting the importance of school-health partnerships and supportive school environments. Additionally, the role of teacher training programs, prevention and intervention programs, professional development for teachers, and school leadership in the context of mental health support are discussed.

Several studies have linked specific learning disorders (SLDs) with suicidal ideation, but less is known about the disorders' association with suicide attempts. This gap in the literature is addressed via the 2012 nationally representative Canadian Community Health Survey (n = 21,744). The prevalence of lifetime suicide attempts among those with an SLD was much higher than those without (11.1% vs. 2.7%, p < 0.001). In comparison with their peers without SLDs, adults with SLDs had 46% higher odds of having ever attempted suicide, even after adjusting for most known risk factors (e.g., childhood adversities, history of mental illness and substance abuse, sociodemographics; odds ratio = 1.46, 95% CI [1.05, 2.04]). The largest attenuation in the association between SLD and suicidal attempts was accounted for by adverse childhood experiences. Among those with SLDs (n = 745), a history of witnessing chronic parental domestic violence and ever having had a major depressive disorder were associated with substantially higher odds of suicide attempts.

All around the world, partnerships among schools and other youth-serving systems are promoting more comprehensive school-based mental health services. This article describes the development of international networks for school mental health (SMH) including the International Alliance for Child and Adolescent Mental Health and Schools (INTERCAMHS) and the more recent School Mental Health International Leadership Exchange (SMHILE). In conjunction with World Conferences on Mental Health Promotion, SMHILE has held pre-conference and planning meetings and has identified five critical themes for the advancement of global SMH: 1) Cross-sector collaboration in building systems of care; 2) meaningful youth and family engagement; 3) workforce development and mental health literacy; 4) implementation of evidence-based practices; and 5) ongoing monitoring and quality assurance. In this article we provide general background on SMH in four nations, two showing strong progress (the United States and Canada), one showing moderate progress (Norway), and one beginning the work (Liberia). Following general background for each country, actions in relation to the SMHILE themes are reviewed. The article concludes with plans and ideas for future global collaboration towards advancement of the SMH field.

Worldwide, prevalence rates of students experiencing mental health difficulties are growing, with only one in five receiving treatment. The role of teachers in collaborative efforts both to identify and to provide effective services for these students is an essential one. However, scant research has explored the mental health literacy of pre-service teachers. In the present study, 186 pre-service teachers completed a vignette-based measure (Child or Adolescent version based on each teacher's experience) in order to assess their mental health literacy, comprised of beliefs and knowledge. Results indicate that participants expressed lower efficacy when teaching children or adolescents with externalizing as compared to internalizing behaviours but believed that a child or adolescent experiencing behaviours indicative of depression was of the greatest concern and in need of intervention. Pre-service teachers were able to correctly identify cases of anxiety and ADHD, but many attributed behaviours typical of depression to home life difficulties (Child version) or substance use/abuse (Adolescent version). Results are discussed in light of previous research in the field; recommendations for future research and practice are provided.

Previous research linking school disruption with mental health problems has largely relied on assessments of academic achievement to measure school disruption. Early disruptive classroom behaviour (e.g., conflict with school staff, negative attitudes toward school), however, may precipitate poor academic performance and may stem from emerging mental health concerns, particularly among young children. To address this gap in the literature, 912 clinically referred children and youth (ages 4-18 years old) were assessed using the interRAI Child and Youth Mental Health (ChYMH) assessment utilizing a cross-sectional study design. The ChYMH assessment evaluates school disruption independently of academic achievement, and includes a comprehensive assessment of the child's mental health functioning, needs, and preferences. A logistic regression analysis revealed that various provisional mental health diagnoses (i.e., attention-deficit/hyperactivity disorder, disruptive behaviour, mood disorders, and, to a lesser extent, anxiety) were associated with disruption in the classroom. Implications for school-based care planning are discussed.

Given the increasing identification of children with emotional/behavioral disorders (EBD), it is imperative that innovative ways of addressing these concerns are explored. Fewer than half of students identified with mental illness receive treatment, leaving a significant proportion of students to cope with mental illness without support. One option for increasing children's access to mental health service looks at incorporating treatment programs into educational systems, thereby allowing more children to access a greater variety of service. However, it is necessary to ensure that school-based personnel have the required training and understanding of mental health issues so that children may be appropriately supported. As such, providing university-level training programs for teachers and school staff to better understand and identify mental health issues may be a key factor in supporting children with EBD.

Most research on mental health in individuals with autism spectrum disorder (ASD) and intellectual disability (ID) has focused on deficits. We examined individual (i.e., sociocommunicative skills, adaptive behavior, functional cognitive skills) and contextual (i.e., home, school, and community participation) correlates of thriving in 330 youth with ID and ASD compared to youth with ID only, 11-22 years of age (M = 16.74, SD = 2.95). Youth with ASD and ID were reported to thrive less than peers with ID only. Group differences in sociocommunicative ability and school participation mediated the relationship between ASD and less thriving. Research is needed to further elucidate a developmental-contextual framework that can inform interventions to promote mental health and wellness in individuals with ASD and ID.

Mental health issues continue to present barriers for Canadian children, in terms of both psychological and academic outcomes. Growing numbers of students are placed "at risk" as a result. A mental health promotion approach suggests that students can develop a number of skills and competencies, namely those related to social-emotional learning (SEL), which can reduce their chance of developing mental health difficulties. In Canada, a wide range of curricula, frameworks, initiatives, and programs have been put in place that address elements of SEL. In this paper, a sampling of these drawn from across the country is described. The emphasis on SEL apparent in many provinces and territories is evidence of the shared understanding of its importance with respect to improving student outcomes. However, a lack of evidence to support these approaches, inconsistencies in terms of terminology and practices, the lack of alignment between SEL and academics, and the piecemeal approach adopted within some provinces leave SEL and mental health promotion approaches vulnerable to being labelled "add-ons" and becoming transient initiatives.

Background: Clinic and community-based epidemiological studies have shown an association between child psychopathology and language impairment. The demands on language for social and academic adjustment shift dramatically during adolescence and the ability to understand the nonliteral meaning in language represented by higher order language becomes essential. Objectives: This article reports on the association between difficulties in higher order language skills, reading, cognition, and social-emotional adjustment in adolescents. Method: 144 clinic-referred and 186 comparison youth aged 12-18 years were administered a battery of standardized tests of intelligence, working memory, structural and higher order language, and reading achievement. Parent ratings on the Child Behavior Checklist were used as a measure of severity of social-emotional problems. Results: Clinic-referred youth scored significantly lower than comparison youth on measures of structural and higher order language, working memory, and reading. Of the clinic-referred youth, 45% had some type of higher order language impairment, whereas this was the case for 15% of youth in the comparison group. Lower levels of nonverbal ability and working memory as well as lower level of mothers' education were associated with greater risk of having higher order language impairment. Conclusions: Findings have implications for practitioners' seeking to understand and treat adolescents since therapeutic techniques rely on skills where higher order language is at play including the ability to discuss opinions flexibly and to weigh interpretations. Therapists must be aware that there are areas that have potential for miscommunication with some adolescents and where inaccurate inferences may be made about their behavior. Furthermore, educators must consider resources for youth who may increasingly struggle in high school because of such difficulties. (Contains 6 tables and 1 note.)

Objective: We review all available controlled outcome studies of solution-focused brief therapy (SFBT) to evaluate evidence of its effectiveness. Method: Forty-three studies were located and key data abstracted on problem, setting, SFBT intervention, design characteristics, and outcomes. Results: Thirty-two (74%) of the studies reported significant positive benefit from SFBT; 10 (23%) reported positive trends. The strongest evidence of effectiveness came in the treatment of depression in adults where four separate studies found SFBT to be comparable to well-established alternative treatments. Three studies examined length of treatment and all found SFBT used fewer sessions than alternative therapies. Conclusion: The studies reviewed provide strong evidence that SFBT is an effective treatment for a wide variety of behavioral and psychological outcomes and, in addition, it may be briefer and therefore less costly than alternative approaches. (Contains 6 tables and 1 figure.) [A list of SFBT Outcome Studies is included.]

It is now recognized that there is a very high prevalence of psychological disorders among children and adolescents and relatively few receive psychological treatment. In the current article, we present the argument that levels of distress and dysfunction among young people are substantially underestimated and the prevalence of psychological problems is higher than realized because of a variety of factors. In particular, it is suggested that psychological problems are underestimated due, in part, to the presence of subthreshold conditions that do not meet diagnostic criteria yet involve substantial distress and impairment. In addition, we focus on a subset of children and adolescents who experience profound distress yet keep it hidden or disguised because of a personality style characterized by self-concealment and a tendency to engage in perfectionistic self-presentation. The characteristics of these students who are "flying under the radar" are described with a discussion of associated familial, cultural, and school factors that reduce the likelihood of these students ever seeking help. Given our premise that psychological problems are substantially underestimated, it is apparent that schools have a vitally important role in mental health promotion in terms of the need for proactive system-wide preventive interventions led by school mental health counsellors. Broad programs are needed to bolster levels of resilience and the willingness to seek help among all children and adolescents but especially among those students who would otherwise not be on anyone's radar screen.

The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youth's perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youth's mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental health disorders, depression in particular, though youth also reported a sense of well-being and a positive outlook for the future. Many youth were able to articulate the improvements in their mental health and functioning after accessing intensive mental health treatment. Youth also divulged perceptions of their treatment and care. Implications are discussed. (Contains 1 note.)

Parents with cognitive impairments (CI) are overrepresented in child custody cases and their children are at risk for adverse outcomes. Ecological-transactional researchers propose that child outcomes are a function of the interaction of multiple distal, intermediate, and proximal risk and resilience factors. This study tested the fit of, and hypotheses from, an interactional model proposed by Feldman (2002) in a child protection sample of parents with CI ("Canadian Incidence Study of Reported Child Abuse and Neglect" [Trocme et al., 2003]). We found a range of child outcomes, with many children without problems. Different child outcomes were associated with different types of alleged abuse. Low parental social support and mental health issues predicted child functioning, with parental mental health mediating the relationship between social support and child outcome. Findings support an interactional view of families with parents with CI and suggest the need for comprehensive, ecologically-based family interventions to promote parent and child well-being. (Contains 3 figures, 6 tables, and 1 footnote.)

We investigated the interaction effects between mother's lifetime depressive/anxiety disorders and psychosocial correlates of 6 to 11 year-old children's self-reported externalizing symptoms in the Quebec Child Mental Health Survey. A representative subsample of 1,490 Quebec children aged 6 to 11 years was selected from the original sample. We conducted multiple linear regression analyses using externalizing symptoms as reported by children through the Dominic questionnaire and multiple child, family and socioeconomic characteristics. Two variables interacted significantly with mother's lifetime depressive/anxiety disorders to predict 6 to 11 year-old children's self-reported externalizing symptoms: physical/sexual abuse and mother's caring behaviours. Results underline the main contribution of mother-child relationship and stressful events in the association between mother's lifetime depressive/anxiety disorders and children's externalizing symptoms. It is suggested to develop preventive intervention programs oriented towards children of lifetime depressed/anxious parents who also report parent-child relational difficulties.

The authors reexamine the study of generational differences in adjustment among the children of immigrants by arguing that the country of origin defines and shapes the adaptation process across generations. Using a sample of children in Toronto, the authors demonstrate that generational differences in the mental health of children occur only in families from countries of origin at the lowest levels of economic development. Among those at the lowest levels of economic development, a mental health advantage in the first generation evolves to a disadvantage in the 2.5 generation relative to third or later generational children. Children from backgrounds characterized by higher economic development show no initial or eventual differences from the native born. Using data from the Toronto Study of Intact Families, the authors are able to explain differences among children from low economic development backgrounds specifically in terms of increasing family conflict and decreasing school involvement across generations. (Contains 1 figure, 3 tables, and 4 notes.)

Given today's climate of economic uncertainty and fiscal restraint, organizations providing child and youth mental health services are required to do so with limited resources. Within this context, service providers face added pressure to deliver evidence-based programs and demonstrate program effectiveness. The Ontario Centre of Excellence for Child and Youth Mental Health works with organizations to meet these demands by building capacity in program evaluation. While personal instruction and mentoring are important ways of providing support, face-to-face consultations are not always cost-effective. In this article we describe the use of interactive technology and computer-based learning as an alternative and/or complementary (to face-to-face) means of delivering evaluation information and training. We discuss the process of developing these tools and share findings from our preliminary evaluation of their effectiveness in enhancing the evaluation-related supports we offer to providers of child and youth mental health services. (Contains 5 notes.)

Background: Previous research on psychiatric and health disparities according to level of cognitive functioning has focused on adults within an American healthcare context. The current study compares children with and without cognitive and developmental delays in Quebec, Canada, using physician billing data from a longitudinal study of low-income, francophone families. Canada is an ideal context for studying medical billing data as its equal access healthcare system removes many socioeconomic biases. Methods: A large sample (n = 1050) of children is used to describe psychiatric and health disparities, as well as differences in Ambulatory Care Sensitive (ACS) conditions and primary healthcare, between children with (n = 107) and without (n = 943) diagnoses in their billing history indicative of delays. Results: The findings demonstrated a relatively high level of psychiatric diagnoses for children with delays. However, no difference was found between children with and without delays in regard to emergency room visits and hospitalizations for ACS conditions and primary healthcare. Conclusions: The findings suggest that, within a universal healthcare system, disparities in primary healthcare may not emerge until adulthood in individuals with delay status.

Background: This study examines the use of the Brief Child and Family Phone Interview (BCFPI) to screen for childhood psychiatric disorder based on Diagnostic Interview Schedule for Children Version IV (DISC-IV) classifications of attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety (SAD), generalized anxiety (GAD) and major depression (MDD). Methods: Data for analysis come from a sample of 399 children and adolescents aged 5-17 years old referred to child mental health outpatient services in three Ontario cities. Mothers were administered the BCFPI on three occasions: baseline, 2 and 13 months; and the DISC-IV on two occasions: 1 and 12 months. Results: Based on kappa, test-retest reliability for disorders classified by the BCFPI exceeded 0.50 for all conditions except MDD (0.45). In receiver operating characteristic (ROC) analysis, area-under-the-curve (AUC) estimates for BCFPI scale score associations with DISC-IV classifications of disorder exceeded 0.80 for CD, ODD, ADHD and SAD; and were lower for GAD (0.76) and MDD (0.75). In stratified analyses, there were no statistically significant differences in AUC estimates for boys versus girls and 5 to 11 versus 12 to 17-year-olds. Conclusions: Classifications of childhood disorder derived from the BCFPI provided a reasonable approximation to disorders classified by the DISC-IV administered by lay interviewers.

Background: This study describes the development of the Brief Child and Family Phone Interview (BCFPI)--a computer-assisted telephone interview which adapts the revised Ontario Child Health Study's (OCHS-R) parent, teacher, and youth self-report scales for administration as intake screening and treatment outcome measures in children's mental health services. It focuses on the factor structure of the BCFPI's hypothesized parent-reported child mental health scales describing attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and major depression (MDD). Methods: Data for the analysis come from an OCHS-R measurement study that included two groups of children and adolescents selected from the same urban area: a general population sample (n = 1,712) and a clinic-referred sample (n = 1,512); and a third sample that was enlisted in a province-wide implementation study of clinic-referred 6- to 18-year-olds (n = 56,825). We used confirmatory factor analysis to assess the factor structure of the BCFPI scales in different populations and to test measurement equivalence across selected groups. Results: Despite the strong constraints imposed on the measurement models, estimates of model fit across the three samples were comparable in magnitude and approached the cut-offs suggested for the GFI and CFI (greater than 0.9) and RMSEA (less than 0.05). Measurement equivalence was demonstrated between the OCHS-R clinic and provincial implementation samples. Within the implementation sample, the factor structure of the BCFPI scales was equivalent for boys versus girls and for 6- to 12- versus 13- to 18-year-olds. A companion paper examines the test-retest reliability, sensitivity, specificity, and validity of these BCFPI scales when used for screening. Conclusion: This project supports the feasibility and acceptability of a computer-assisted telephone interview for assessing emotional-behavioral problems of children and adolescents referred to children's mental health services.

This article explores the core themes and issues of private residential service delivery for children and youth in Ontario, with a specific focus on staffed group care within this sector. Such exploration highlights the juxtaposition of the public rights of children with the private world of service provision. Based on twenty interviews with owners of private residential care facilities and an examination of government and professional writing and reports about residential care in Ontario, there is no obvious reason to dismiss or be critical of private residential care. However, both private and public residential care in Ontario are under-regulated, resulting in significant variations in terms of organizational structures, the quality of staffing and training, accountability and transparency, and ultimately, the efficacy of specific residential services.

Objective: Cognitive behavior therapy (CBT) for children has been shown efficacious, but community access to it is often limited by the lack of trained therapists. This study evaluated a child, CBT-focused, 20-session weekly group supervision seminar with a didactic component which was provided to community mental health practitioners by experienced CBT therapists from an academic center. Methods: Twenty-two practitioners from four community mental health agencies completed the training in four groups (one for each agency); one group was trained by videoconference. The authors assessed outcomes immediately after the training and at 6-month follow-up using a mixed-method design including quantitative and qualitative methods to ensure a comprehensive evaluation. Results: Participants' knowledge on a multiple-choice test of child CBT increased with training, as did their self-reported confidence using CBT and desire to do further child CBT. Therapist age and use of an intake diagnostic screen related to positive outcomes, and participants advocated for more structured training. Conclusion: Child CBT can be successfully taught to community practitioners using this training model, but refinement based on participant feedback and further studies that include direct observation of CBT skills are needed.

Continuous quality improvement (CQI) is increasingly being adopted by health care, including child and youth mental health services. As part of the commitment to ongoing quality improvement, child and youth mental health teams in the Fraser region in British Columbia undertook CQI projects over a one year period (2007-2008). The projects covered a range of domains and service features and staff gained experience in developing projects. Patience, management support and ongoing dialogue were key elements in the implementation of CQI. Three projects are highlighted to illustrate how teams developed their own unique projects and the outcomes. (Contains 1 table.)

Objective: To explore parent perspectives regarding the early experiences of their children with Developmental Coordination Disorder (DCD). Methods: A phenomenological approach was used to explore the meaning of developmental experiences for children with DCD and their families. Parents of 13 children with DCD, aged 6-14, were recruited through purposeful sampling. Parents completed two indepth interviews, and a set of questionnaires. Transcripts and questionnaires were systematically coded to identify emergent themes. Results: There was an evolution over time in the differences that parents noticed and the concerns that they had for their child. There seemed to be a progression from motor and play concerns in the early years, to self-care, academic and peer problems in middle childhood, to significant challenges with self-esteem and emotional health in later childhood. Conclusions: Defining the developmental trajectory of children with DCD highlights the importance of understanding the impact of this disorder as it relates to developmental age and environmental expectations. Implications for early screening and increased awareness of health care professionals are discussed. (Contains 1 figure and 2 tables.)

Context: There is insufficient literature documenting the mental health experiences and needs of rural communities, and a lack of focus on children in particular. This is of concern given that up to 20% of children and youth suffer from a diagnosable mental health problem. Purpose: This study examines issues of access to mental health care for children and youth in rural communities from the family perspective. Methods: In-depth interviews were conducted in rural Ontario, Canada, with 30 parents of children aged 3-17 who had been diagnosed with emotional and behavioral disorders. Findings: Interview data indicate 3 overall thematic areas that describe the main barriers and facilitators to care. These include personal, systemic, and environmental factors. Family members are constantly negotiating ongoing tension, struggle, and contradiction vis-a-vis their attempts to access and provide mental health care. Most factors identified as barriers are also, under different circumstances, facilitators. Analysis clustered around the contrasts, contradictions, and paradoxes present throughout the interviews. Conclusions: The route to mental health care for children in rural communities is complex, dynamic, and nonlinear, with multiple roadblocks. Although faced with multiple roadblocks, there are also several factors that help minimize these barriers.

A process-oriented approach to parental divorce locates the experience within the social and developmental context of children's lives, providing greater insight into how parental divorce produces vulnerability in some children and resiliency in others. The current study involves prospectively tracking a nationally representative sample of Canadian children of ages 4-7 and living with two biological parents at initial interview in 1994 (N = 2,819), and comparing the mental health trajectories of children whose parents remain married with those whose parents divorce by 1998. Results from growth curve models confirm that, even before marital breakup, children whose parents later divorce exhibit higher levels of anxiety/depression and antisocial behavior than children whose parents remain married. There is a further increase in child anxiety/depression but not antisocial behavior associated with the event of parental divorce itself. Controlling for predivorce parental socioeconomic and psychosocial resources fully accounts for poorer child mental health at initial interview among children whose parents later divorce, but does not explain the divorce-specific increase in anxiety/depression. Finally, a significant interaction between parental divorce and predivorce levels of family dysfunction suggests that child antisocial behavior decreases when marriages in highly dysfunctional families are dissolved.

In order to determine the prevalence and characteristics of childhood physical and sexual abuse in China, the authors conducted a survey in Shanghai. The Dissociative Disorders Interview Schedule was administered to 423 inpatients and 304 outpatients at Shanghai Mental Health Center, and to a non-clinical sample of 618 workers at a clothing factory. The results were compared to a previous sample of 502 respondents in the general population in Winnipeg, Canada. The identities of the perpetrators of physical and sexual abuse, and the types of sexual abuse reported were similar in the two countries; however, the rates of reported abuse were lower in China. Childhood sexual abuse appears to be far less common in the general population in Canada than in China. (Contains 4 tables.)

Free play is essential for children's development and for their physical, mental, and social health. Opportunities to engage in outdoor free play—and risky play in particular—have declined significantly in recent years, in part because safety measures have sought to prevent all play-related injuries rather than focusing on serious and fatal injuries. Risky play is defined by thrilling and exciting forms of free play that involve uncertainty of outcome and a possibility of physical injury. Proponents of risky play differentiate "risk" from "hazard" and seek to reframe perceived risk as an opportunity for situational evaluation and personal development. This statement weighs the burden of play-related injuries alongside the evidence in favour of risky play, including its benefits, risks, and nuances, which can vary depending on a child's developmental stage, ability, and social and medical context. Approaches are offered to promote open, constructive discussions with families and organizations. Paediatricians are encouraged to think of outdoor risky play as one way to help prevent and manage common health problems such as obesity, anxiety, and behavioural issues. [ABSTRACT FROM AUTHOR]

Newcomer women and children are less likely to access and utilize mental health support services as compared to the general Canadian population, despite reporting experiences of mental health issues. This review aimed to map out the social support interventions that are available for promoting the mental well-being of newcomer women and children living in Canada. A search using Medline, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, and the Cochrane library was conducted to identify published studies. Studies were screened, extracted, and synthesized by two independent reviewers in line with the methodological approach for scoping reviews. Fourteen articles published in English between 2012–2023 were reviewed. Results identified five types of interventions: art and sand play interventions, support groups and workshops, assessment of existing support services, social media interventions, and short-term cognitive behavioral therapy. Our results suggest that culturally appropriate social support interventions increase mental well-being outcomes, such as self-esteem and social support, and reduce peri-migratory traumas for newcomer women and children in Canada. However, findings from this review underscore the need for more quantitative and participatory research approaches so that newcomer women's and children's needs are adequately explored and addressed. [ABSTRACT FROM AUTHOR]

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