Autistic children’s ability to access mental health services can be challenging due to the limited availability of therapists with autism experience, service ineligibility, and financial strain. This systematic review evaluated and synthesized literature regarding the impact of government policy levers on the access to, and utilization of, mental health services by Autistic children and their families. Interdisciplinary databases together with gray literature and supplementary searches were used to identify relevant articles. Peer-reviewed, English language studies which reported on the impact of government policy levers on the utilization of, and access to, mental health services by Autistic children and their families were included. Searches resulted in the identification of 2305 articles (database searches = 744, additional searches = 1531), six of which were included in the final review. All six articles were from the United States of America, published between 2013 and 2020, with a focus on national and state regulatory policy levers targeting insurance companies. Results indicated that most policy levers did not improve service access to, or utilization of, mental health services. Gray literature searches identified that several countries had implemented autism specific policy levers, most however had not been evaluated regarding their impact on mental health service access and utilization by Autistic children or their families. The majority of identified policy levers have not resulted in greater utilization or access of mental health services for Autistic children or their families. More global research, focusing on datasets that have allowed policies time to impact change, is needed.

Children and adolescents (henceforth “children”) with both attention-deficit/hyperactivity disorder (ADHD) and anxiety experience greater difficulties than children with either alone, though qualitative methodologies are yet to be used to understand the challenges this population experience. We aimed to explore parent-reported daily impacts of co-occurring anxiety in children with ADHD (aged 8–13 years). Participants were enrolled in a trial evaluating an adapted anxiety intervention and were eligible if their child met diagnostic criteria for ADHD plus separation, social, and/or generalized anxiety disorder. A baseline measure of life impacts associated with child anxiety captured situations parents reported were difficult, due to their child’s anxiety. Reflexive thematic analysis of free-text responses ( N = 203) facilitated new insights via inductively generating key themes. Three overarching themes highlighted (1) child difficulties with everyday situations and processes due to their anxiety; (2) the nature of the child’s anxiety being pervasive and unrelenting; and (3) the strain placed on the child’s family system. This study enhances understanding of daily impacts associated with co-occurring anxiety and ADHD and may contribute to an improved understanding of support needs. Results reiterate the need to identify co-occurring difficulties in children with ADHD and support both children and their families.

ObjectivesTo determine the proportion of Australian adolescent girls who experience menstrual pain (dysmenorrhea); to assess associations of dysmenorrhea and period pain severity with adolescents missing regular activities because of their periods.Study designProspective, population-based cohort study; analysis of Longitudinal Study of Australian Children (LSAC) survey data.Setting, participantsFemale adolescents in the nationally representative cross-sequential sample of Australian children recruited in 2004 for the Kinder cohort (aged 4-5 years at enrolment). Survey data from waves 6 (mean age 14 years), wave 7 (16 years) and wave 8 (18 years) were analysed.Main outcome measuresSeverity of period pain during the preceding three months (very, quite, a little, or not at all painful); number of activity types missed because of periods; relationship between missing activities and period pain severity.ResultsOf the 1835 participating female members of the LSAC Kinder cohort at waves 6 to 8, 1600 (87%) responded to questions about menstruation during at least one of waves 6 to 8 of data collection. At wave 6 (14 years), 227 of 644 respondents (35%) reported dysmenorrhea, 675 of 1341 (50%) at wave 6 (16 years), and 518 of 1115 (46%) at wave 8 (18 years). Of the 366 participants who reported period pain severity at all three waves, 137 reported no dysmenorrhea at all three waves (37%), 66 reported dysmenorrhea at all three waves (18%), 89 reported increasing period pain over time (24%), and 38 reported declining pain (10%). At wave 6, 223 of 647 participants reported missing at least one activity because of their periods (34%), 454 of 1341 at wave 7 (34%), and 344 of 1111 at wave 8 (31%). Of the participants who experienced very painful periods, 72% (wave 6), 63% (wave 7), and 65% (wave 8) missed at least one activity type because of their periods, as did 45% (wave 6), 36% (wave 7), and 40% (wave 8) of those who experienced quite painful periods.ConclusionsA large proportion of adolescent girls in Australia experience period pain that affects their engagement in regular activities, including school attendance. Recognising adolescent period pain is important not only for enhancing their immediate quality of life with appropriate support and interventions, but also as part of early screening for chronic health conditions such as endometriosis.

Background Toddlerhood (2–3 years) is a crucial period for the development of physical activity, sleep, and emotional self-regulation skills. Although there is growing evidence of positive associations between physical activity, sleep, and emotional self-regulation in school-aged children, the associations in toddlers remain unclear. Thus, this study aimed to examine the association between physical activity, sleep, and emotional self-regulation in toddlers. Methods Baseline data from 1350 toddlers (2.2 ± 0.33 year) from the Let’s Grow randomised controlled trial were used. Toddlers’ total physical activity (TPA) and moderate- to vigorous-intensity physical activity (MVPA) were assessed via 4 + days of accelerometry and a 3-item parent-report scale. Parent-reported total sleep quantity was calculated using the sum of average night-time sleep and daytime nap durations. Sleep behaviour data including bedtime routine, bedtime resistance, sleep onset-delay, sleep duration, and night waking were collected using relevant subsections from the Child Sleep Habits Questionnaire (CSHQ) and Brief Infant Sleep Questionnaire revised (BISQ-R). A 4-item parent-report scale adapted from the Fast Track Project Child Behaviour Questionnaire was used to assess toddlers’ emotional self-regulation. Linear regression models were used, adjusting for child age, sex, and parental education. Results Accelerometer-derived TPA, MVPA and parent-reported TPA were not associated with emotional self-regulation. Higher parent-reported MVPA (B = -0.01 CI 95 -0.03, -0.003) was associated with poorer emotional self-regulation. Higher sleep duration was associated with better emotional self-regulation (B = 0.06 CI 95 0.04, 0.08). The five sleep behaviours assessed were also positively associated with emotional self-regulation (all p < 0.01), with fewer problem sleep behaviours being associated with better emotional self-regulation. Conclusions This cross-sectional study suggests that sleep may be important for emotional self-regulation in toddlers, but the role of physical activity remains unclear. These findings suggest that interventions targeting sleep duration and sleep behaviours during the early toddler years may benefit the positive development of emotional self-regulation skills in this population.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience greater sleep difficulties compared to those without. However, findings are mixed, and other mental health conditions are often overlooked. This study aimed to examine the relationship between sleep problems, ADHD, and other mental health conditions in a sample of adolescents. Data from 373 adolescents aged 10-19 years was used as part of the wider 'Healthy Brain Network' study, which targets children and adolescents experiencing mental health and neurodevelopmental difficulties. Mental health conditions were assessed via a comprehensive assessment. Sleep was measured by self- and parent-report, as well as via up to a month of actigraphy data. Actigraphy data were analysed using mixed-methods modelling, while subjective sleep data were analysed using multiple regression. Subjectively-reported sleep was generally worse in adolescents who had ADHD and other mental health conditions compared to those with ADHD but no other conditions. There were no associations between ADHD status and objective sleep measures or self-reported measures, but a significant association was found between ADHD status and parent-reported sleep difficulties, even when accounting for other conditions. Parent-reported sleep problems were associated not only with ADHD, but also with anxiety, depression, and externalising disorders. The strength of association between ADHD and sleep problems is potentially not as strong as previously thought when considering the role of other mental health conditions. Clinicians should consider the role of other mental health conditions when sleep problems are present, and vice versa. The study also highlights the importance of comprehensive, multi-informant assessment of mental health conditions, including sleep.

Resilience in children has received considerable interest from research bodies, policymakers, practitioners, and education bodies due to its potential impact on well-being, as well as physical and mental health. To support and cultivate resilience, appropriate measurement is important. However, numerous definitions and measures of resilience exist. To provide clarity, this paper offers a systematic review of measures used to assess resilience in children. Systematic search conducted in Medline, ERIC, ProQuest Central, Scopus, PsychINFO, and Web of Science. Keywords included 'resilien* and measure* and child*'. Eligible studies: assessed children aged 0-12 years, of all abilities; and, contained a measure to assess resilience, inclusive of parent, teacher, and/or child-report measures. From 24,902 studies retrieved, 86 studies were included, identifying 54 measures for assessing resilience. 28 measures identified as proposing to measure resilience construct as their primary goal, whilst 27 were identified as proxy measures assessing constructs relating to resilience. Overall, 34% of articles reported on both reliability and validity, with 20 % reporting neither of these. While there is a range of measures used to assess resilience in children, there is a lack of consensus regarding what constructs and domains represent resilience. A large proportion had minimal or no psychometrics reported, highlighting the limitations of this area. This is an important starting point for consolidating how resilience is defined and measured within research.

The interactions between sleep problems, autism symptoms and emotional and behavioural difficulties were explored using network analysis in 240 autistic children (mean age: 8.8 years, range 5–13 years) with moderate to severe sleep problems. Findings revealed a highly connected and interpretable network, with three separate clusters identified of the modelled variables. Depression, anxiety and behavioural difficulties were the most central variables of the network. Depression, anxiety and restricted repetitive and stereotyped patterns behaviours (RRBs) were the strongest bridging variables in the network model, transmitting activation both within and between other symptom clusters. The results highlight that depression and anxiety were highly connected symptoms within the network, suggesting support in these areas could be helpful, as well as future research.

Objectives: To determine ADHD research priorities from the perspective of ADHD professionals internationally. Method: A two-stage modified Delphi design was used. In Stage 1 (qualitative), participants listed research questions relating to ADHD that they perceived to be most important ( N = 132). In Stage 2 (quantitative), participants were then asked to rate each research question that was deemed appropriate (able to be researched and not already addressed by research) in terms of perceived importance ( N = 180). Results: Stage 1 generated 382 research questions with 10 broad areas identified for example, co-occurring conditions and treatment, etc. The top 20 most important questions related to ADHD in women/girls, long-term medication use, non-pharmacological interventions, ADHD measurement/rating scales, and efficacy of emotional regulation interventions. Conclusion: These results can inform an ADHD research agenda which represents the views of the individuals from major ADHD professional groups internationally. Parallel work is needed focusing on research priorities from the perspective of ADHD consumers.

Objective: To compare family functioning over time for elementary school children with Attention-Deficit/Hyperactivity Disorder (ADHD; N = 179) and subthreshold ADHD (ST-ADHD; N = 86), to children without ADHD (Control; N = 212). Method: ADHD was assessed using the Conners 3 ADHD Index and Diagnostic Interview Schedule for Children IV. At baseline, 18-month follow-up and 36-month follow-up, parents completed measures assessing a range of family functioning domains. Results: At baseline, the ADHD group reported higher psychological distress, less parenting self-efficacy, less parenting consistency, and more stressful life events; and both groups reported poorer family quality of life (QoL) and greater parenting anger. Trajectories were largely similar to controls (i.e., stable over time), but unlike controls, ADHD and ST-ADHD groups showed lessening parent-partner support and parenting warmth, respectively; and both groups showed worsening aspects of family QoL. Conclusion: Families of children with ADHD and ST-ADHD report persistently poor or worsening family functioning; highlighting a need for tailored psycho-social supports.

Objective: To investigate the association between children’s health-related quality of life (HRQoL) and childhood attention-deficit/hyperactivity disorder (ADHD). Method: Databases were systematically searched for peer-reviewed literature published between 2010 and 2022. Two reviewers independently screened and assessed the quality of included studies. Meta-analysis was conducted for studies that used the Pediatric Quality of Life Inventory (PedsQL). Results: Twenty-three studies were included, with most rated as “good” quality. Meta-analysis found “very large” effect in both parent- (Hedges’ g −1.67, 95% CI [−2.57, −0.78]) and child-reported (Hedges’ g −1.28, 95% CI [−2.01, −0.56]) HRQoL for children with ADHD compared to children without ADHD. No difference between parent- and child-reported HRQoL in children with and without ADHD was found. However, parent-reported HRQoL was lower than child-reported HRQoL among children with ADHD. Conclusion: ADHD was associated with substantially poorer children’s HRQoL. Among children with ADHD, parents rated their children’s HRQoL lower than the children themselves.

This mixed-methods single arm pilot study examined the feasibility, acceptability, and preliminary outcomes of a co-designed mindful parenting intervention for parents of children with ADHD, Parents that Mind (PTM). The 5-week parent-only intervention comprised two face-to-face group retreats and 5 weeks home practice. Eighteen parents of children with ADHD participated in PTM, completing self-report questionnaires and semi-structured interviews. Indicating high acceptability, 100% of parents interviewed reported PTM was helpful and they would recommend PTM. High feasibility of parents attending one face-to-face retreat was observed, with all parents attending the first retreat, however intervention adherence was challenging, with 55% of parents attending the second retreat. Barriers to intervention adherence included: lack of time, work commitments, illness and exhaustion. Quantitative data indicate promising preliminary effects for parents and children. Addressing the barriers raised by parents in this pilot appear necessary, before examining efficacy in a blinded RCT.

Introduction Children and adolescents are increasingly prescribed antipsychotic medications off-label in the treatment of behavioural disorders. While antipsychotic medications are effective in managing behavioural issues, they carry a significant risk of adverse events that compromise ongoing physical health. Of particular concern is the negative impact antipsychotic medications have on cardiometabolic health. Interventions that aim to modify lifestyle habits have the potential to alleviate the adverse effects of antipsychotic medication by enhancing weight management, increasing physical activity, promoting better nutritional practices, improving dietary habits and promoting healthier sleep patterns and sleep hygiene. However, a comprehensive review has not been performed to ascertain the effectiveness of lifestyle interventions for children and adolescents who are at increased risk of antipsychotic-induced compromises to their physical health.Methods and analysis This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases will be searched without any year constraints to identify randomised controlled trials that are published in the English language and report a lifestyle intervention compared with usual care with any physical health outcome measure. Trial registers and results repositories will be scoured to identify additional studies. Two reviewers will independently conduct screening, data extraction and quality assessment and compare the results. Quantitative data will be synthesised, where appropriate, through a random-effects meta-analysis model. Otherwise, data will be reported in a qualitative (narrative) synthesis. Heterogeneity will be quantified using the I2 statistic. The Cochrane Risk of Bias 2 tool will be used for risk of bias assessment. The Grading of Recommendations, Assessment, Development and Evaluation system will be used to evaluate the cumulative body of evidence.Ethics and dissemination Ethics approval is not required. The publication plan will target high-impact, peer-reviewed journals that fall under the scope of Psychiatry and Mental Health.PROSPERO registration number CRD42022380277.

Summary Physical activity and self‐regulation are important predictors of pediatric overweight and obesity. Young children (0–5 years) with lower physical activity levels and poorer self‐regulation skills are at greater risk for overweight. Despite growing evidence that the two constructs are interrelated, their association remains unclear in young children. This review systematically summarized associations between physical activity and self‐regulation in early childhood and explored the directionality of associations. Searches were run in six electronic databases. Forty‐seven papers met inclusion criteria. Only three studies investigated all three domains of self‐regulation (behavioral, cognitive, and emotional). Overall, findings were inconclusive; studies reported weak to moderate positive associations ( n = 17), inverse associations ( n = 5), mixed associations ( n = 15), null association ( n = 2), and negative ( n = 1) between physical activity and self‐regulation. Compared with the emotional and cognitive domains, physical activity was most consistently positively associated with behavioral self‐regulation. Only one study assessed bidirectional associations, reporting a positive association. The three studies that included global self‐regulation showed contradicting findings. There is some evidence that physical activity dose and sex potentially confound these associations; however, further research is needed given the paucity of studies. This review highlights the need for more in‐depth investigation of the complex association between physical activity and global self‐regulation.

BackgroundAttention deficit hyperactivity disorder (ADHD) and irritability commonly co‐occur, and follow similar developmental trajectories from childhood to adolescence. Understanding of the developmental relationship between these co‐occurrences is limited. This study provides a longitudinal assessment of how ADHD diagnostic status and symptom patterns predict change in irritability.MethodsA community sample of 337 participants (45.2% ADHD), recruited for the Childhood Attention Project, completed the Affective Reactivity Index (ARI) to measure irritability at baseline (mean age 10.5 years) and follow‐up after 18‐months. Latent change score models were used to assess how (a) baseline ADHD vs. control group status, (b) baseline symptom domain (inattention, hyperactivity–impulsivity) and (c) longitudinal change in ADHD symptom severity predicted change in irritability.ResultsIrritability was significantly higher among the ADHD group than controls; however, change in irritability over time did not differ between groups. When assessed across the entire cohort, change in irritability was predicted by higher symptom count in the hyperactive–impulsive domain, but not the inattentive domain. Greater declines in ADHD symptoms over time significantly predicted greater declines in irritability. Baseline ADHD symptom severity was found to significantly predict change in irritability; however, baseline irritability did not significantly predict change in ADHD symptoms.ConclusionsADHD symptoms—particularly hyperactive–impulsive symptoms—predict the degree and trajectory of irritability during childhood and adolescence, even when symptoms are below diagnostic thresholds. The use of longitudinal, dimensional and symptom domain‐specific measures provides additional insight into this relationship.

Objective: This study examined associations between objective and subjective sleep parameters, and mental health symptoms (internalizing symptoms, externalizing symptoms, and irritability) and whether these relationships differed for adolescents with and without ADHD. Method: Participants were 373 adolescents aged 10 to 19 years ( M = 13.21, SD = 2.37). Sleep was measured both via actigraphy and self- and parent-report scales. Mental health symptoms were measured via a range of validated measures. Results: Few relationships were detected when examining actigraphy variables. Subjective sleep parameters were associated with almost all mental health variables. Some relationships were moderated by ADHD status, generally consistent with stronger relationships between subjective sleep quality and mental health in the non-ADHD group. Conclusion: Sleep problems, particularly subjective difficulties, are associated with a range of mental health outcomes, regardless of the presence of ADHD. Sleep problems may be a beneficial intervention target for adolescents experiencing mental health issues.

BACKGROUND:Few longitudinal studies have investigated whether white matter development reflects differential outcomes for children with and without attention-deficit/hyperactivity disorder (ADHD). To examine whether deviations from typical trajectories of white matter development were associated with the persistence or remission of ADHD symptoms, this study examined microstructural and morphological properties of 71 white matter tracts from 390 high angular diffusion scans acquired prospectively for 62 children with persistent ADHD, 37 children remitted from ADHD, and 85 children without ADHD. METHODS:Participants (mean age at wave 1 = 10.39 years, scan interval = 18 months) underwent up to 3 magnetic resonance imaging assessments. White matter tracts were reconstructed using TractSeg, a semiautomated method. For each tract, we derived measures of fiber density (microstructure) and fiber bundle cross-section (morphology) using fixel-based analysis. Linear mixed models were used to compare trajectories of fiber development between the persistent ADHD, remitted ADHD, and non-ADHD groups. RESULTS:Compared with the non-ADHD group, the remitted and persistent ADHD groups showed accelerated fiber development in thalamic pathways, striatal pathways, and the superior longitudinal fasciculus. In the remitted ADHD group, accelerated fiber development in corticospinal, frontopontine, striatal-premotor, and thalamo-premotor pathways was associated with greater reductions in ADHD symptom severity. The persistent ADHD group showed ongoing white matter alterations along sensorimotor pathways. CONCLUSIONS:These results suggest that variations in white matter development are associated with different clinical trajectories in ADHD. The findings advance our understanding of the neurobiological mechanisms underpinning ADHD symptom progression and provide novel evidence in support of developmental models of ADHD.

AbstractAimsADHD (attention‐deficit/hyperactivity disorder) affects 5% of children on average. Despite the high need to access services for ADHD treatment, not all children with ADHD utilise healthcare services equally. This study aims to systematically synthesise evidence of equity and equality in health service use/costs and health‐related quality of life (HRQoL)/wellbeing of children with ADHD across socioeconomic (SES) classes.MethodsThe literature search was conducted across seven databases (Academic Search complete, MEDLINE Complete, PsycINFO, ERIC, Global Health, CINAHL and EconLit). The search was limited to peer‐reviewed articles published to 23rd January 2023 in English and focused on children. Study quality was assessed using the Critical Appraisal Skills Program (CASP), Joanna Briggs Institute (JBI) and Mixed Methods Appraisal Tool (MMAT) checklists.Results25 out of 1207 articles were eligible for inclusion. The results showed that SES was associated with different types of healthcare utilisation. Only three studies were found on HRQoL/well‐being. Children with ADHD from low SES families had lower HRQoL than children from high SES families.ConclusionThis study found that a social gradient exists in both healthcare service use and children's HRQoL among those with ADHD.