Abstract about what to look out for...

A prospective study of childhood psychopathology: independent predictors of change over three years

Tamsin Ford, Stephan Collishaw, Howard Meltzer, Robert Goodman

Background: Whilst the correlates of child mental health problems are well understood, less is known about factors that operate to maintain healthy or unhealthy functioning, or that contribute to change in functioning. A range of factors may be of interest here, including relatively stable characteristics of children or their environment, that may have long lasting and enduring consequences for their mental health, along with events that prompt changes in a child’s mental state.

Methods: Children were followed up 3 years after the original survey for a sub-sample of the 1999 British Child and Adolescent Mental Health Survey (N = 2,587 children). Latent mental health ratings drew on data provided by parent, teacher, and youth versions of the Strengths and Difficulties Questionnaire at baseline, and at follow-up. A residual scores method was used to assess change in functioning over time.

Results and Conclusions: Latent mental health scores showed strong stability over time (r = 0.71) indicating the need for effective intervention with children who have impairing psychopathology, since they are unlikely to get better spontaneously. A poorer outcome was associated with:

• externalizing as opposed to emotional symptoms
• reading difficulties
• living in a single-parent or reconstituted family at baseline
• and after exposure between Time 1 and Time 2 to parental separation, parental mental illness, child illness, and loss of a close friendship.

All these factors could be targeted in public health or clinical interventions, particularly as predictors of change in child mental health were closely comparable across the range of initial SDQ scores, suggesting that they operated in a similar manner regardless of the initial level of (mal)adjustment.

Key words child mental health – prognosis – stability – change – epidemiology

So these are the kids that need help the most (those acting out behaviorally, those with reading problems, those in single-parent or blended families, and those recently faced with parental separation, parental mental illness, child illness and loss of a close friendship).

This article calls for universal - school-wide or community-wide approaches - to build resilience in all children and attend to these children. Without mental health intervention, they are unlikely to get better on their own.

One question is, how can we systematically screen for these kid populations in our schools rather than wait for someone to notice them and refer? I think waiting around in pain to be noticed, referred and treated is one of the saddest states for our kids. It is what is meant as "falling through the cracks."

How can we do better? That is, what can we do differently? Because redoubling our efforts when we are now doing more with less is what is meant as "dying on the vine." Kids matter and their grown-ups matter, too. This includes their parents, teachers, and all the mental health providers who care about them. There are better and more efficient ways. Interested?