research in child and adolescent development ppt

Child Growth and Development

(13 reviews)

Jennifer Paris

Antoinette Ricardo

Dawn Rymond

Alexa Johnson

Last Update: 2019

Publisher: College of the Canyons

Language: English

Formats Available

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Reviewed by Joanne Leary, adjunct faculty, North Shore Community College on 6/9/24

Comprehensiveness rating: 5 see less

Content Accuracy rating: 4

This text has an emphasis on object and sound development and best practices to support development.

Relevance/Longevity rating: 5

Content includes the latest research and best practices in the field. It gives the reader a sense of what is current in the field and notices current trends.

Clarity rating: 5

The Chapters begin with objectives and an introduction and end with a conclusion of key concepts addressed. Within the Chapters are found material bringing the theory and best practice to life.

Consistency rating: 5

The Chapters begin with objectives and an introduction and end with a conclusion of key concepts addressed. Physical Development, Cognitive Development and Social Emotional Development are covered in-depth for each age group. The format becomes predictable and familiar as the Chapters are read.

Modularity rating: 5

Each Chapter follows a familiar pattern. Each developmental domain within each age category has easy to follow information. The book also includes mini-lectures and powerpoint presentations to support the reading material.

Organization/Structure/Flow rating: 5

The early Chapters are outlined to give background information about the history of Child Development and factors effecting the family before birth. From Chapter 3 through the remainder of the text attention is given chronologically to each age group and developmental domain within each age category through Adolescence.

Interface rating: 5

The organization of the text is both linear and spiraling. Material covered in one Chapter is often seen again in later Chapters with more in-depth information.

Grammatical Errors rating: 5

Throughout the text an effort is clearly made to limit educational jargon and keep the language accessible to all readers.

Cultural Relevance rating: 5

The Chapters include relevant information about current topics, resources and pictures representing the diverse backgrounds of children and families that are in our classrooms and communities.

Child Growth and Development is a text that can be seamlessly used to accompany any Child Development Course Pre-birth through Adolescence. The material lays the foundation for understanding development along with the many theorists that paved the way to notice how genetics, environment, culture, family and experience impact growth and development. The organization of the text is both linear and spiraling. The early Chapters are outlined to give background information about the history of Child Development and factors effecting the family before birth. From Chapter 3 through the remainder of the text attention is given chronologically to each age group and developmental domain within each age category through Adolescence. Physical Development, Cognitive Development and Social Emotional Development are covered in-depth for each age group. The Chapters begin with objectives and an introduction and end with a conclusion of key concepts addressed. Each Chapters also include relevant information about current topics, resources and pictures representing the diverse backgrounds of children and families that are in our classrooms and communities.

Reviewed by Mistie Potts, Assistant Professor, Manchester University on 11/22/22

Comprehensiveness rating: 4 see less

This text covers some topics with more detail than necessary (e.g., detailing infant urination) yet it lacks comprehensiveness in a few areas that may need revision. For example, the text discusses issues with vaccines and offers a 2018 vaccine schedule for infants. The text brushes over “commonly circulated concerns” regarding vaccines and dispels these with statements about the small number of antigens a body receives through vaccines versus the numerous antigens the body normally encounters. With changes in vaccines currently offered, shifting CDC viewpoints on recommendations, and changing requirements for vaccine regulations among vaccine producers, the authors will need to revisit this information to comprehensively address all recommended vaccines, potential risks, and side effects among other topics in the current zeitgeist of our world.

Content Accuracy rating: 3

At face level, the content shared within this book appears accurate. It would be a great task to individually check each in-text citation and determine relevance, credibility and accuracy. It is notable that many of the citations, although this text was updated in 2019, remain outdated. Authors could update many of the in-text citations for current references. For example, multiple in-text citations refer to the March of Dimes and many are dated from 2012 or 2015. To increase content accuracy, authors should consider revisiting their content and current citations to determine if these continue to be the most relevant sources or if revisions are necessary. Finally, readers could benefit from a reference list in this textbook. With multiple in-text citations throughout the book, it is surprising no reference list is provided.

Relevance/Longevity rating: 4

This text would be ideal for an introduction to child development course and could possibly be used in a high school dual credit or beginning undergraduate course or certificate program such as a CDA. The outdated citations and formatting in APA 6th edition cry out for updating. Putting those aside, the content provides a solid base for learners interested in pursuing educational domains/careers relevant to child development. Certain issues (i.e., romantic relationships in adolescence, sexual orientation, and vaccination) may need to be revisited and updated, or instructors using this text will need to include supplemental information to provide students with current research findings and changes in these areas.

Clarity rating: 4

The text reads like an encyclopedia entry. It provides bold print headers and brief definitions with a few examples. Sprinkled throughout the text are helpful photographs with captions describing the images. The words chosen in the text are relatable to most high school or undergraduate level readers and do not burden the reader with expert level academic vocabulary. The layout of the text and images is simple and repetitive with photographs complementing the text entries. This allows the reader to focus their concentration on comprehension rather than deciphering a more confusing format. An index where readers could go back and search for certain terms within the textbook would be helpful. Additionally, a glossary of key terms would add clarity to this textbook.

Chapters appear in a similar layout throughout the textbook. The reader can anticipate the flow of the text and easily identify important terms. Authors utilized familiar headings in each chapter providing consistency to the reader.

Modularity rating: 4

Given the repetitive structure and the layout of the topics by developmental issues (physical, social emotional) the book could be divided into sections or modules. It would be easier if infancy and fetal development were more clearly distinct and stages of infant development more clearly defined, however the book could still be approached in sections or modules.

Organization/Structure/Flow rating: 4

The text is organized in a logical way when we consider our own developmental trajectories. For this reason, readers learning about these topics can easily relate to the flow of topics as they are presented throughout the book. However, when attempting to find certain topics, the reader must consider what part of development that topic may inhabit and then turn to the portion of the book aligned with that developmental issue. To ease the organization and improve readability as a reference book, authors could implement an index in the back of the book. With an index by topic, readers could quickly turn to pages covering specific topics of interest. Additionally, the text structure could be improved by providing some guiding questions or reflection prompts for readers. This would provide signals for readers to stop and think about their comprehension of the material and would also benefit instructors using this textbook in classroom settings.

Interface rating: 4

The online interface for this textbook did not hinder readability or comprehension of the text. All information including photographs, charts, and diagrams appeared to be clearly depicted within this interface. To ease reading this text online authors should create a live table of contents with bookmarks to the beginning of chapters. This book does not offer such links and therefore the reader must scroll through the pdf to find each chapter or topic.

No grammatical errors were found in reviewing this textbook.

Cultural Relevance rating: 3

Cultural diversity is represented throughout this text by way of the topics described and the images selected. The authors provide various perspectives that individuals or groups from multiple cultures may resonate with including parenting styles, developmental trajectories, sexuality, approaches to feeding infants, and the social emotional development of children. This text could expand in the realm of cultural diversity by addressing current issues regarding many of the hot topics in our society. Additionally, this textbook could include other types of cultural diversity aside from geographical location (e.g., religion-based or ability-based differences).

While this text lacks some of the features I would appreciate as an instructor (e.g., study guides, review questions, prompts for critical thinking/reflection) and it does not contain an index or glossary, it would be appropriate as an accessible resource for an introduction to child development. Students could easily access this text and find reliable and easily readable information to build basic content knowledge in this domain.

Reviewed by Caroline Taylor, Instructor, Virginia Tech on 12/30/21

Each chapter is comprehensively described and organized by the period of development. Although infancy and toddlerhood are grouped together, they are logically organized and discussed within each chapter. One helpful addition that would largely... read more

From my reading, the content is accurate and unbiased. However, it is difficult to confidently respond due to a lack of references. It is sometimes clear where the information came from, but when I followed one link to a citation the link was to another textbook. There are many citations embedded within the text, but it would be beneficial (and helpful for further reading) to have a list of references at the end of each chapter. The references used within the text are also older, so implementing updated references would also enhance accuracy. If used for a course, instructors will need to supplement the textbook readings with other materials.

This text can be implemented for many semesters to come, though as previously discussed, further readings and updated materials can be used to supplement this text. It provides a good foundation for students to read prior to lectures.

This text is unique in its writing style for a textbook. It is written in a way that is easily accessible to students and is also engaging. The text doesn't overly use jargon or provide complex, long-winded examples. The examples used are clear and concise. Many key terms are in bold which is helpful to the reader.

For the terms that are in bold, it would be helpful to have a definition of the term listed separately on the page within the side margins, as well as include the definition in a glossary at the end.

Each period of development is consistently described by first addressing physical development, cognitive development, and then social-emotional development.

This text is easily divisible to assign to students. There were few (if any) large blocks of texts without subheadings, graphs, or images. This feature not only improves modularity but also promotes engagement with the reading.

The organization of the text flows logically. I appreciate the order of the topics, which are clearly described in the first chapter by each period of development. Although infancy and toddlerhood are grouped into one period of development, development is appropriately described for both infants and toddlers. Key theories are discussed for infants and toddlers and clearly presented for the appropriate age.

There were no significant interface issues. No images or charts were distorted.

It would be helpful to the reader if the table of contents included a navigation option, but this doesn't detract from the overall interface.

I did not see any grammatical errors.

This text includes some cultural examples across each area of development, such as differences in first words, parenting styles, personalities, and attachments styles (to list a few). The photos included throughout the text are inclusive of various family styles, races, and ethnicities. This text could implement more cultural components, but does include some cultural examples. Again, instructors can supplement more cultural examples to bolster the reading.

This text is a great introductory text for students. The text is written in a fun, approachable way for students. Though the text is not as interactive (e.g., further reading suggestions, list of references, discussion points at the end of each chapter, etc.), this is a great resource to cover development that is open access.

Reviewed by Charlotte Wilinsky, Assistant Professor of Psychology, Holyoke Community College on 6/29/21

This text is very thorough in its coverage of child and adolescent development. Important theories and frameworks in developmental psychology are discussed in appropriate depth. There is no glossary of terms at the end of the text, but I do not... read more

Content Accuracy rating: 5

The citations throughout the textbook help to ensure its accuracy. However, the text could benefit from additional references to recent empirical studies in the developmental field.

It seems as if updates to this textbook will be relatively easy and straightforward to implement given how well organized the text is and its numerous sections and subsections. For example, a recent narrative review was published on the effects of corporal punishment (Heilmann et al., 2021). The addition of a reference to this review, and other more recent work on spanking and other forms of corporal punishment, could serve to update the text's section on spanking (pp. 223-224; p. 418).

The text is very clear and easily understandable.

Consistency rating: 4

There do not appear to be any inconsistencies in the text. The lack of a glossary at the end of the text may be a limitation in this area, however, since glossaries can help with consistent use of language or clarify when different terms are used.

This textbook does an excellent job of dividing up and organizing its chapters. For example, chapters start with bulleted objectives and end with a bulleted conclusion section. Within each chapter, there are many headings and subheadings, making it easy for the reader to methodically read through the chapter or quickly identify a section of interest. This would also assist in assigning reading on specific topics. Additionally, the text is broken up by relevant photos, charts, graphs, and diagrams, depending on the topic being discussed.

This textbook takes a chronological approach. The broad developmental stages covered include, in order, birth and the newborn, infancy and toddlerhood, early childhood, middle childhood, and adolescence. Starting with the infancy and toddlerhood stage, physical, cognitive, and social emotional development are covered.

There are no interface issues with this textbook. It is easily accessible as a PDF file. Images are clear and there is no distortion apparent.

I did not notice any grammatical errors.

Cultural Relevance rating: 4

This text does a good job of including content relevant to different cultures and backgrounds. One example of this is in the "Cultural Influences on Parenting Styles" subsection (p. 222). Here the authors discuss how socioeconomic status and cultural background can affect parenting styles. Including references to specific studies could further strengthen this section, and, more broadly, additional specific examples grounded in research could help to fortify similar sections focused on cultural differences.

Overall, I think this is a terrific resource for a child and adolescent development course. It is user-friendly and comprehensive.

Reviewed by Lois Pribble, Lecturer, University of Oregon on 6/14/21

This book provides a really thorough overview of the different stages of development, key theories of child development and in-depth information about developmental domains. read more

This book provides a really thorough overview of the different stages of development, key theories of child development and in-depth information about developmental domains.

The book provides accurate information, emphasizes using data based on scientific research, and is stated in a non-biased fashion.

The book is relevant and provides up-to-date information. There are areas where updates will need to be made as research and practices change (e.g., autism information), but it is written in a way where updates should be easy to make as needed.

The book is clear and easy to read. It is well organized.

Good consistency in format and language.

It would be very easy to assign students certain chapters to read based on content such as theory, developmental stages, or developmental domains.

Very well organized.

Clear and easy to follow.

I did not find any grammatical errors.

General content related to culture was infused throughout the book. The pictures used were of children and families from a variety of cultures.

This book provides a very thorough introduction to child development, emphasizing child development theories, stages of development, and developmental domains.

Reviewed by Nancy Pynchon, Adjunct Faculty, Middlesex Community College on 4/14/21

Overall this textbook is comprehensive of all aspects of children's development. It provided a brief introduction to the different relevant theorists of childhood development . read more

Overall this textbook is comprehensive of all aspects of children's development. It provided a brief introduction to the different relevant theorists of childhood development .

Most of the information is accurately written, there is some outdated references, for example: Many adults can remember being spanked as a child. This method of discipline continues to be endorsed by the majority of parents (Smith, 2012). It seems as though there may be more current research on parent's methods of discipline as this information is 10 years old. (page 223).

The content was current with the terminology used.

Easy to follow the references made in the chapters.

Each chapter covers the different stages of development and includes the theories of each stage with guided information for each age group.

The formatting of the book makes it reader friendly and easy to follow the content.

Very consistent from chapter to chapter.

Provided a lot of charts and references within each chapter.

Formatted and written concisely.

Included several different references to diversity in the chapters.

There was no glossary at the end of the book and there were no vignettes or reflective thinking scenarios in the chapters. Overall it was a well written book on child development which covered infancy through adolescents.

Reviewed by Deborah Murphy, Full Time Instructor, Rogue Community College on 1/11/21

The text is excellent for its content and presentation. The only criticism is that neither an index nor a glossary are provided. read more

Comprehensiveness rating: 3 see less

The text is excellent for its content and presentation. The only criticism is that neither an index nor a glossary are provided.

The material seems very accurate and current. It is well written. It is very professionally done and is accessible to students.

This text addresses topics that will serve this field in positive ways that should be able to address the needs of students and instructors for the next several years.

Complex concepts are delivered accurately and are still accessible for students . Figures and tables complement the text . Terms are explained and are embedded in the text, not in a glossary. I do think indices and glossaries are helpful tools. Terminology is highlighted with bold fonts to accentuate definitions.

Yes the text is consistent in its format. As this is a text on Child Development it consistently addresses each developmental domain and then repeats the sequence for each age group in childhood. It is very logically presented.

Yes this text is definitely divisible. This text addresses development from conception to adolescents. For the community college course that my department wants to use it is very adaptable. Our course ends at middle school age development; our courses are offered on a quarter system. This text is adaptable for the content and our term time schedule.

This text book flows very clearly from Basic principles to Conception. It then divides each stage of development into Physical, Cognitive and Social Emotional development. Those concepts and information are then repeated for each stage of development. e.g. Infants and Toddler-hood, Early Childhood, and Middle Childhood. It is very clearly presented.

It is very professionally presented. It is quite attractive in its presentation .

I saw no errors

The text appears to be aware of being diverse and inclusive both in its content and its graphics. It discusses culture and represents a variety of family structures representing contemporary society.

It is wonderfully researched. It will serve our students well. It is comprehensive and constructed very well. I have enjoyed getting familiar with this text and am looking forward to using it with my students in this upcoming term. The authors have presented a valuable, well written book that will be an addition to our field. Their scholarly efforts are very apparent. All of this text earns high grades in my evaluation. My only criticism is, as mentioned above, is that there is not a glossary or index provided. All citations are embedded in the text.

Reviewed by Ida Weldon, Adjunct Professor, Bunker Hill Community College on 6/30/20

The overall comprehensiveness was strong. However, I do think some sections should have been discussed with more depth read more

The overall comprehensiveness was strong. However, I do think some sections should have been discussed with more depth

Most of the information was accurate. However, I think more references should have been provided to support some claims made in the text.

The material appeared to be relevant. However, it did not provide guidance for teachers in addressing topics of social justice, equality that most children will ask as they try to make sense of their environment.

The information was presented (use of language) that added to its understand-ability. However, I think more discussions and examples would be helpful.

The text appeared to be consistent. The purpose and intent of the text was understandable throughout.

The text can easily be divided into smaller reading sections or restructured to meet the needs of the professor.

The organization of the text adds to its consistency. However, some sections can be included in others decreasing the length of the text.

Interface issues were not visible.

The text appears to be free of grammatical errors.

While cultural differences are mentioned, more time can be given to helping teachers understand and create a culturally and ethnically focused curriculum.

The textbook provides a comprehensive summary of curriculum planing for preschool age children. However, very few chapters address infant/toddlers.

Reviewed by Veronica Harris, Adjunct Faculty, Northern Essex Community College on 6/28/20

This text explores child development from genetics, prenatal development and birth through adolescence. The text does not contain a glossary. However, the Index is clear. The topics are sequential. The text addresses the domains of physical, cognitive and social emotional development. It is thorough and easy to read. The theories of development are inclusive to give the reader a broader understanding on how the domains of development are intertwined. The content is comprehensive, well - researched and sequential. Each chapter begins with the learning outcomes for the upcoming material and closes with an outline of the topics covered. Furthermore, a look into the next chapter is discussed.

The content is accurate, well - researched and unbiased. An historical context is provided putting content into perspective for the student. It appears to be unbiased.

Updated and accurate research is evidenced in the text. The text is written and organized in such a way that updates can be easily implemented. The author provides theoretical approaches in the psychological domains with examples along with real - life scenarios providing meaningful references invoking understanding by the student.

The text is written with clarity and is easily understood. The topics are sequential, comprehensive and and inclusive to all students. This content is presented in a cohesive, engaging, scholarly manner. The terminology used is appropriate to students studying Developmental Psychology spanning from birth through adolescents.

The book's approach to the content is consistent and well organized. . Theoretical contexts are presented throughout the text.

The text contains subheadings chunking the reading sections which can be assigned at various points throughout the course. The content flows seamlessly from one idea to the next. Written chronologically and subdividing each age span into the domains of psychology provides clarity without overwhelming the reader.

The book begins with an overview of child development. Next, the text is divided logically into chapters which focus on each developmental age span. The domains of each age span are addressed separately in subsequent chapters. Each chapter outlines the chapter objectives and ends with an outline of the topics covered and share an idea of what is to follow.

Pages load clearly and consistently without distortion of text, charts and tables. Navigating through the pages is met with ease.

The text is written with no grammatical or spelling errors.

The text did not present with biases or insensitivity to cultural differences. Photos are inclusive of various cultures.

The thoroughness, clarity and comprehensiveness promote an approach to Developmental Psychology that stands alongside the best of texts in this area. I am confident that this text encompasses all the required elements in this area.

Reviewed by Kathryn Frazier, Assistant Professor, Worcester State University on 6/23/20

This is a highly comprehensive, chronological text that covers genetics and conception through adolescence. All major topics and developmental milestones in each age range are given adequate space and consideration. The authors take care to summarize debates and controversies, when relevant and include a large amount of applied / practical material. For example, beyond infant growth patterns and motor milestone, the infancy/toddler chapters spend several pages on the mechanics of car seat safety, best practices for introducing solid foods (and the rationale), and common concerns like diaper rash. In addition to being generally useful information for students who are parents, or who may go on to be parents, this text takes care to contextualize the psychological research in the lived experiences of children and their parents. This is an approach that I find highly valuable. While the text does not contain an index, the search & find capacity of OER to make an index a deal-breaker for me.

The text includes accurate information that is well-sourced. Relevant debates, controversies and historical context is also provided throughout which results in a rich, balanced text.

This text provides an excellent summary of classic and updated developmental work. While the majority of the text is skewed toward dated, classic work, some updated research is included. Instructors may wish to supplement this text with more recent work, particularly that which includes diverse samples and specifically addresses topics of class, race, gender and sexual orientation (see comment below regarding cultural aspects).

The text is written in highly accessible language, free of jargon. Of particular value are the many author-generated tables which clearly organize and display critical information. The authors have also included many excellent figures, which reinforce and visually organize the information presented.

This text is consistent in its use of terminology. Balanced discussion of multiple theoretical frameworks are included throughout, with adequate space provided to address controversies and debates.

The text is clearly organized and structured. Each chapter is self-contained. In places where the authors do refer to prior or future chapters (something that I find helps students contextualize their reading), a complete discussion of the topic is included. While this may result in repetition for students reading the text from cover to cover, the repetition of some content is not so egregious that it outweighs the benefit of a flexible, modular textbook.

Excellent, clear organization. This text closely follows the organization of published textbooks that I have used in the past for both lifespan and child development. As this text follows a chronological format, a discussion of theory and methods, and genetics and prenatal growth is followed by sections devoted to a specific age range: infancy and toddlerhood, early childhood (preschool), middle childhood and adolescence. Each age range is further split into three chapters that address each developmental domain: physical, cognitive and social emotional development.

All text appears clearly and all images, tables and figures are positioned correctly and free of distortion.

The text contains no spelling or grammatical errors.

While this text provides adequate discussion of gender and cross-cultural influences on development, it is not sufficient. This is not a problem unique to this text, and is indeed a critique I have of all developmental textbooks. In particular, in my view this text does not adequately address the role of race, class or sexual orientation on development.

All in all, this is a comprehensive and well-written textbook that very closely follows the format of standard chronologically-organized child development textbooks. This is a fantastic alternative for those standard texts, with the added benefit of language that is more accessible, and content that is skewed toward practical applications.

Reviewed by Tony Philcox, Professor, Valencia College on 6/4/20

The subject of this book is Child Growth and Development and as such covers all areas and ideas appropriate for this subject. This book has an appropriate index. The author starts out with a comprehensive overview of Child Development in the Introduction. The principles of development were delineated and were thoroughly presented in a very understandable way. Nine theories were presented which gave the reader an understanding of the many authors who have contributed to Child Development. A good backdrop to start a conversation. This book discusses the early beginnings starting with Conception, Hereditary and Prenatal stages which provides a foundation for the future developmental stages such as infancy, toddler, early childhood, middle childhood and adolescence. The three domains of developmental psychology – physical, cognitive and social emotional are entertained with each stage of development. This book is thoroughly researched and is written in a way to not overwhelm. Language is concise and easily understood.

This book is a very comprehensive and detailed account of Child Growth and Development. The author leaves no stone unturned. It has the essential elements addressed in each of the developmental stages. Thoroughly researched and well thought out. The content covered was accurate, error-free and unbiased.

The content is very relevant to the subject of Child Growth and Development. It is comprehensive and thoroughly researched. The author has included a number of relevant subjects that highlight the three domains of developmental psychology, physical, cognitive and social emotional. Topics are included that help the student see the relevancy of the theories being discussed. Any necessary updates along the way will be very easy and straightforward to insert.

The text is easily understood. From the very beginning of this book, the author has given the reader a very clear message that does not overwhelm but pulls the reader in for more information. The very first chapter sets a tone for what is to come and entices the reader to learn more. Well organized and jargon appropriate for students in a Developmental Psychology class.

This book has all the ingredients necessary to address Child Growth and Development. Even at the very beginning of the book the backdrop is set for future discussions on the stages of development. Theorists are mentioned and embellished throughout the book. A very consistent and organized approach.

This book has all the features you would want. There are textbooks that try to cover too much in one chapter. In this book the sections are clearly identified and divided into smaller and digestible parts so the reader can easily comprehend the topic under discussion. This book easily flows from one subject to the next. Blocks of information are being built, one brick on top of another as you move through the domains of development and the stages of development.

This book starts out with a comprehensive overview in the introduction to child development. From that point forward it is organized into the various stages of development and flows well. As mentioned previously the information is organized into building blocks as you move from one stage to the next.

The text does not contain any significant interface issued. There are no navigation problems. There is nothing that was detected that would distract or confuse the reader.

There are no grammatical errors that were identified.

This book was not culturally insensitive or offensive in any way.

This book is clearly a very comprehensive approach to Child Growth and Development. It contains all the essential ingredients that you would expect in a discussion on this subject. At the very outset this book went into detail on the principles of development and included all relevant theories. I was never left with wondering why certain topics were left out. This is undoubtedly a well written, organized and systematic approach to the subject.

Reviewed by Eleni Makris, Associate Professor, Northeastern Illinois University on 5/6/20

This book is organized by developmental stages (infancy, toddler, early childhood, middle childhood and adolescence). The book begins with an overview of conception and prenatal human development. An entire chapter is devoted to birth and expectations of newborns. In addition, there is a consistency to each developmental stage. For infancy, early childhood, middle childhood, and adolescence, the textbook covers physical development, cognitive development, and social emotional development for each stage. While some textbooks devote entire chapters to themes such as physical development, cognitive development, and social emotional development and write about how children change developmentally in each stage this book focuses on human stages of development. The book is written in clear language and is easy to understand.

There is so much information in this book that it is a very good overview of child development. The content is error-free and unbiased. In some spots it briefly introduces multicultural traditions, beliefs, and attitudes. It is accurate for the citations that have been provided. However, it could benefit from updating to research that has been done recently. I believe that if the instructor supplements this text with current peer-reviewed research and organizations that are implementing what the book explains, this book will serve as a strong source of information.

While the book covers a very broad range of topics, many times the citations have not been updated and are often times dated. The content and information that is provided is correct and accurate, but this text can certainly benefit from having the latest research added. It does, however, include a great many topics that serve to inform students well.

The text is very easy to understand. It is written in a way that first and second year college students will find easy to understand. It also introduces students to current child and adolescent behavior that is important to be understood on an academic level. It does this in a comprehensive and clear manner.

This book is very consistent. The chapters are arranged by developmental stage. Even within each chapter there is a consistency of theorists. For example, each chapter begins with Piaget, then moves to Vygotsky, etc. This allows for great consistency among chapters. If I as the instructor decide to have students write about Piaget and his development theories throughout the life span, students will easily know that they can find this information in the first few pages of each chapter.

Certainly instructors will find the modularity of this book easy. Within each chapter the topics are self-contained and extensive. As I read the textbook, I envisioned myself perhaps not assigning entire chapters but assigning specific topics/modules and pages that students can read. I believe the modules can be used as a strong foundational reading to introduce students to concepts and then have students read supplemental information from primary sources or journals to reinforce what they have read in the chapter.

The organization of the book is clear and flows nicely. From the table of context students understand how the book is organized. The textbook would be even stronger if there was a more detailed table of context which highlights what topics are covered within each of the chapter. There is so much information contained within each chapter that it would be very beneficial to both students and instructor to quickly see what content and topics are covered in each chapter.

The interface is fine and works well.

The text is free from grammatical errors.

While the textbook does introduce some multicultural differences and similarities, it does not delve deeply into multiracial and multiethnic issues within America. It also offers very little comment on differences that occur among urban, rural, and suburban experiences. In addition, while it does talk about maturation and sexuality, LGBTQ issues could be more prominent.

Overall I enjoyed this text and will strongly consider using it in my course. The focus is clearly on human development and has very little emphasis on education. However, I intend to supplement this text with additional readings and videos that will show concrete examples of the concepts which are introduced in the text. It is a strong and worthy alternative to high-priced textbooks.

Reviewed by Mohsin Ahmed Shaikh, Assistant Professor, Bloomsburg University of Pennsylvania on 9/5/19

The content extensively discusses various aspects of emotional, cognitive, physical and social development. Examples and case studies are really informative. Some of the areas that can be elaborated more are speech-language and hearing development. Because these components contribute significantly in development of communication abilities and self-image.

Content covered is pretty accurate. I think the details impressive.

The content is relevant and is based on the established knowledge of the field.

Easy to read and follow.

The terminology used is consistent and appropriate.

I think of using various sections of this book in some of undergraduate and graduate classes.

The flow of the book is logical and easy to follow.

There are no interface issues. Images, charts and diagram are clear and easy to understand.

Well written

The text appropriate and do not use any culturally insensitive language.

I really like that this is a book with really good information which is available in open text book library.

Chapter 1: Introduction to Child Development
Chapter 2: Conception, Heredity, & Prenatal Development
Chapter 3: Birth and the Newborn
Chapter 4: Physical Development in Infancy & Toddlerhood
Chapter 5: Cognitive Development in Infancy and Toddlerhood
Chapter 6: Social and Emotional Development in Infancy and Toddlerhood
Chapter 7: Physical Development in Early Childhood
Chapter 8: Cognitive Development in Early Childhood
Chapter 9: Social Emotional Development in Early Childhood
Chapter 10: Middle Childhood - Physical Development
Chapter 11: Middle Childhood – Cognitive Development
Chapter 12: Middle Childhood - Social Emotional Development
Chapter 13: Adolescence – Physical Development
Chapter 14: Adolescence – Cognitive Development
Chapter 15: Adolescence – Social Emotional Development

Ancillary Material

About the book.

Welcome to Child Growth and Development. This text is a presentation of how and why children grow, develop, and learn. We will look at how we change physically over time from conception through adolescence. We examine cognitive change, or how our ability to think and remember changes over the first 20 years or so of life. And we will look at how our emotions, psychological state, and social relationships change throughout childhood and adolescence.

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Child and Adolescent Development

Nov 16, 2019

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Child and Adolescent Development. Our personal past. Oldest memory. Teenager. Young child. Foundations of C & YP development. Challenges for C & YP development. Physiological changes Sexual Changes Emotional changes. Biological challenges. Cognitive challenges. Abstract thinking

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Our personal past • Oldest memory • Teenager • Young child

Foundations of C & YP development

Challenges for C & YP development

Physiological changes • Sexual Changes • Emotional changes Biological challenges

Cognitive challenges • Abstract thinking • Egocentric thinking • Ability to think about other people • New ways of processing information • Ability to think critically • Ability to think creatively

Psychological challenges • Forming a new identity • New/emerging functions of personal identity • Individuation • Emotional responses • Ethnic /cultural identity

Social challenges • Society expectations • Parental expectations • Adolescent expectations

Moral and spiritual challenges • Moral development • Spiritual beliefs

Human Development Theories Erikson Psychosocial development Klein Object Relations Theory Winnicott Transitional object Bowlby Attachment Theory

Erikson (1902 – 1994) • Born to a Jewish mum and a Danish dad (not her husband), he grew up as a tall, blond, blue eyed boy with a Jewish mum (the details of his birth were a secret from him) – His mum having fled to Germany during her pregnancy. • In Temple he was labelled ‘Nordic’, in school he was labelled as a ‘Jew’. • He was not that academic, in late adolescence, he struggled with identity (ethnic/religious/national) • When he was 25, he came into contact with Freud in Vienna. Encouraged by daughter, Anna Freud (who noticed his sensitivity toward children) he began to study Psychoanalysis. • He studied Child Analysis alongside the Montessori method of Education (looking at child development and sexual stages) • He left Germany in 1938 because of the Nazi rise to power, ending up in the US with his wife and 2 sons. • 1stPsychoanalysist in Boston. Worked at Mass General, Harvard Med School & Yale University. • 1938 invited to observe education of native Sioux children in South Dakota. This was to prove significant in the development of his thinking.

Erikson: Psychosocial development

Donald Winnicott(1896-1971) • To the outside world, Winnicott appeared to have a happy childhood, but the reality was that he was oppressed by his mother’s depression. His father encouraged his creativity. • During adolescence, he showed considerable self awareness, and described himself as a ‘disturbed adolescent’ • That insight formed the basis of his interest in troubled children & young people. • He trained in Medicine and became a paediatrician/psychoanalysist • He was a contemporary of Anna Freud & Melanie Klein • Became a member of the ‘middle’ group rather than a ‘Kleinian’ or a ‘Freudian’ of the BPS • He worked extensively with evacuees in WW2 as a consultant Psychaitrist • Key concepts ‘holding environment’ ‘transitional object’ • Defined ‘Play’ as crucial for emotional/psychological wellbeing not just for children but for adults too – Art/Hobbies/Sport etc

Winnicott’s Transitional Object • Winnicott’s concept of the ‘transitional object’ is important and the transitional object, or security blanket, “acts as a bridge which connects the inner world of phantasy to the outer world of reality” • The transitional object thus represents the mother ‘out there’ and the ‘inner world’ of self • Winnicott’s theory (1965) of the ‘good enough’ mother concluded that ‘the mother is the place that all other relationships develop from’. Winnicott observed that therapists recreate a ‘holding’ environment which resembles the mother and infant/child. • Pre or delinquent behaviour may be related to a sense of loss/ or a cry for help. A search for holding not previously found within the family itself.

What does Transitional Object mean to a child? • Mother substitute: When a mother (or primary carer) leaves an infant, they can easily become upset by the disappearance of their primary care-giver. To compensate and comfort for this sense of loss, they imbue some object with the attributes of the mother. • Not-me: The transition object also supports the development of the self, as it is used to represent 'not me'. By looking at the object, the child knows that it is not the object and hence something individual and separate. In this way, it helps the child develop its sense of 'other' things (and self).

Transitional Object: Key attributes Key attributes of the transition object include: • The infant has total rights over it. • The object may be cuddled, loved and mutilated (by the infant). • It must never be changed, except by the infant. • It has warmth or some vitality that indicates it has a reality of its own. • It exists independently of 'inside' or 'outside' and is not a hallucination. • Over time, it loses meaning and becomes relegated to a kind of limbo where it is neither forgotten nor mourned.

Melanie Klein (1882 – 1960) Object Relations Theory • Born in Vienna, of Jewish parentage – invited to London in 1926 by British psychoanalyst Ernest Jones • 1st person to use psychoanalysis with children, she observed troubled children play with objects – dolls, animals etc and attempted to interpret specific meaning of play. Like FREUD, she emphasised the significant role parents play in children’s fantasy life, but unlike Freud, she felt the SUPEREGO was present from birth. • Klein felt that babies has no sense of ‘self’, that they are utterly dependant on their mother for sense of ‘self’ – that the mother is the baby’s ego. • Klein had a difference of opinion with Anna Freud in London in 1938 which led to many controversies – referred to as CONTROVERSIAL DISCUSSIONS which split the British Psycho – Analytic society into 3.

Freud’s stages of development

John Bowlby(1907 – 1990) • Born to an upper class British family, Bowlby rarely saw his mother and was cared for by a nanny who left him when he was 4, at 7 he went way to ‘board’ at school, which Bowlby observed was ‘emotionally impoverished’ • During WW2, after qualifying as psychoanalysist, he worked extensively with children who had been separated from their parents. This gained him significant evidence on which to base his theory. • While working for the WHO in 1951, he wrote widely on maternal deprivation, in 1956, he began his defining work on ‘Attachment’. This 3 volume body of work was published between 1969 and 1974. • Bowlby felt that the theory of Attachment is essentially an evolutionary mechanism designed to protect the vulnerable infant from predators. • Along with Mary Ainsworth, he created the theory of the ‘secure base’ – a position of safety from which the infant can explore their world and return to their secure base ( generally their mother) for reassurance. • Much of Bowlby’s work looked at the effects of poor Attachment, which is particularly noticeable when in crisis.

Bowlby’s cycle of arousal • In order to promote good attachment, the significant carer needs to be: • Accessible • Responsive • Consistent

Cycle of despair

Types of Attachment • Type A – Insecure Avoidant (casually avoids, nonchalantly ignores caregiver on return) • Type B – Secure (displays secure behaviour on return of parent) • Type C – Insecure Ambivalent (distressed & inconsolable upon return of parent) • Type D – Disorganised – Disorientated (conflicting, approach/flee, dazed, freezing on parent’s return – ‘frozen watchfulness’) (Fahlberg 1980)

Positive working model • About him/herself: • I am worthwhile/wanted • I am safe • I am capable • About his/her caregiver: • They are available • They are responsive • They meet my needs

Negative working model • About him/herself: • I am worthless • I am unsafe • I am impotent • About his/her caregiver: • He/she is unresponsive • He/she is unreliable • He/she is threatening/dangerous/rejecting

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Study Reveals that Memories of the COVID-19 Pandemic Lockdowns Predict Declines in Psychological Well-Being of Children and Adolescents

PRESS RELEASE / CHILD DEVELOPMENT: Embargoed for Release on August 14, 2024.

Q&A with Child Development Authors

The COVID-19 pandemic and the lockdown measures to prevent contagion resulted in extensive disruptions in children’s and adolescents’ everyday lives. A new study in Child Development from the Aarhus University Hospital in Denmark, University of California, Riverside and University of California, Davis in the United States, investigated personal memories (i.e., memories for episodes experienced in one’s own life) about the first lockdown in Denmark in Spring 2020 among children and adolescents and how this may have impacted their psychological well-being over the following year.

For context, in Denmark, the first school closure was mandated on March 11, 2020. School closure lasted until April 17, 2020, for younger students (preschool to 5th grade), and persisted until May 18, 2020, for older students (6th to 9th graders). As in other countries, the numbers of COVID-19 infections increased drastically during Fall 2020, resulting in a second school closure from December 17, 2020, until May 6, 2021. In addition to school closures, Danish policies also included more extensive government-enforced lockdown measures, such as closure of movie theaters, restaurants, social distancing, ban of gatherings, work from home orders and mask mandates.

The study, which may be the first and only longitudinal study to assess whether personal memories predict declines in the psychological well-being of children and adolescents during the COVID-19 pandemic, showed that the psychological well-being of adolescent females fared the worst. Moreover, memories that included more factual information about COVID-19 and included more negative affect predicted more robust declines in psychological well-being. The findings underscore how aspects of personal memories might help exacerbate or attenuate the negative consequences of the experience of the COVID-19 period from March 2020 to July 2021.

Researchers suggest that future work might benefit from investigating how children’s relative tendency to include semantic details (e.g., facts about COVID-19) versus episodic details (e.g., where they were when they first heard about lockdowns, what specific interaction happened with family or friends) in their narratives about past and future events of local and global significance might be linked to children's and adolescents' psychological adjustment and coping in difficult times. The Society for Research in Child Development had the opportunity to discuss this research with Dr. Tirill Fiellhaugen Hjuler from the Department of Child and Adolescent Psychiatry at the Aarhus University Hospital and Dr. Simona Ghetti from the Department of Psychology at the University of California, Davis.

SRCD: What led you to study how the COVID-19 pandemic affected children and adolescents in Denmark?

Dr. Hjuler : As lockdown policies began to be implemented across the world, scholars and lay people alike started asking how they would impact children and teens. Different positions were debated ranging from sobering concerns for their mental health to expectations of increased resilience, which were all based on little direct knowledge of how the effects of an event of the magnitude of this pandemic would manifest. We deemed it necessary to conduct a longitudinal study to seek empirical answers to the many questions our society was grappling with.

Dr. Ghetti: I want to add a word of praise about Dr. Hjuler’s ingenuity. At the time, she was a graduate student planning to spend a year visiting my laboratory. As the COVID-19 pandemic shut the world down, she immediately appreciated the importance of turning to her community and pivoting to address different research questions than originally planned. Examining autobiographical memory about lockdown periods provided an unprecedented vantage point on how children and adolescents experienced and were affected by this global event. Success in graduate school is often about understanding how to ask the right question at the right time.

SRCD: Can you please provide a brief overview o f the study?

Dr. Hjuler: We examined the longitudinal associations between the content of personal memories for the COVID-19 pandemic lockdowns and children's and adolescents’ (8- to 16-year-olds) mental health. Participants were assessed three times (June 2020, January 2021 and June 2021). At each time point, they were asked to write about their personal memory from the first lockdown and to assess their psychological well-being and depressive symptoms. All the memories were then coded for content such as the emotional tone, episodic details and semantic (i.e., factual) information about COVID-19 in general.

First, we found that children’s and adolescents’ mental health decreased over time, and that adolescent females fared the worst at all time points. Second, we found that the content of memories lost detail over time, in terms of episodic specificity, semantic content, and emotional valence. Critically, we found that children and adolescents whose narratives contained more negative emotional content and included more factual information about COVID-19 and the resulting restrictions, fared the worst over time.

SRCD: How can these findings be useful for parents and caregivers, policymakers, and educators interested in the well-being of children and adolescents?

Dr. Hjuler and Dr. Ghetti: Our findings suggest that the way children and adolescents remember and reflect upon difficult times, such as the COVID-19 lockdowns, might affect their mental health over time. We have known from previous research that there are associations between the emotional content of personal memories and indicators of psychological adjustment. Here, we are demonstrating a longitudinal association linking directly negative emotionality in narratives concerning events of global significance to measures of future well-being. One interesting finding is that integrating higher levels of factual information about difficult times also seems to have a negative impact on children’s and adolescents’ mental health. Imbuing factual information in a personal narrative may be a sign that children and teenagers attempted to distance themselves from the personally unique meaning of the lockdown experience. Thus, adults ought to be aware of how information about potential difficult times is discussed and communicated: observing certain content during child reminiscing may provide insight on risks for well-being.

SRCD: Were you surprised by any of the findings?

Dr. Hjuler and Dr. Ghetti : Yes, we were particularly surprised to find a decrease in the memories’ negative emotional content over time as actually we expected an increase in negativity, reflecting the burden of facing the continued consequences of the pandemic over time. It is possible that this is because our analysis focused on memories for the first lockdown and by the time we assessed them later, other memories for the pandemic became more dominant or emotionally relevant. Moreover, as children and adolescents during lockdowns were restricted from in-person socialization and were unable to leave their residence over extended periods of time, their experiences became less unique and more schematized. Despite this normative change, the participants whose narratives were rated as conveying greater negative emotionality did worse over time, underscoring the importance of that early emotional content for participants’ well-being.

SRCD: What’s next in this field of research?

Dr. Hjuler: We believe that future work might benefit from investigating how both factual and episodic information in personal memories might be linked to children's and adolescents' psychological adjustment and coping in difficult times. In addition, future research should examine how memory narratives concerning challenging times, such as the lockdowns, might be different from other types of children’s narratives, including children’s and adolescents' personal memories about other relevant events and thoughts about the future. Only by examining the content of all these different memories will we know if these results reported here are specific to the first period of the pandemic, when radical changes in children’s and adolescents’ lives occurred, or if instead our patterns of results extend to other forms of remembering and imagining pandemic-related experiences.

Summarized from an article in Child Development, “Remembering History: Autobiographical Memory for the COVID-19 Pandemic Lockdowns, Psychological Adjustment, and their Relation over Time,” by Hjuler, F.T. (Aarhus University Hospital), Lee, D. (University of California, Riverside), Ghetti, S. (University of California, Davis). Copyright 2024 The Society for Research in Child Development. All rights reserved.

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Introduction
Conclusions
Article Information

Data were compiled from the final master file of the Québec Longitudinal Study of Child Development (1998–2019), Gouvernement du Québec, Institut de la Statistique du Québec (Quebec Institute of Statistics). Details on the scales used and scoring are found in the Methods section and Table 1. NEET indicates not being in education, employment, or training; OR, odds ratio; and SES, socioeconomic status.

a NA (not applicable) represents variables that were not kept in the final model because they did not reach statistical significance.

b Factors remaining significant ( P < .05) after applying Bonferroni adjustment.

eTable 1. MIA and SBQ Depression Symptoms Items

eFigure. Correlation Plot of All Depression Symptoms Scores

eTable 2. Comparison of Included and Excluded Participants for Each Outcome

eTable 3. Estimated Coefficients (β or OR) Associated With an Increased Risk of Reporting Impaired Adult Outcomes

eTable 4. Estimated Coefficients (β or OR) of Unadjusted and Adjusted Depression Symptoms at Every Time Point Associated With an Increased Risk of Reporting Impaired Adult Outcomes

Data Sharing Statement

Depressive Symptoms in Childhood and Adolescence and Adult Psychosocial Outcomes JAMA Network Open Invited Commentary August 8, 2024 Natan J. Vega Potler, MD

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Psychogiou L , Navarro MC , Orri M , Côté SM , Ahun MN. Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes. JAMA Netw Open. 2024;7(8):e2425987. doi:10.1001/jamanetworkopen.2024.25987

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Childhood and Adolescent Depression Symptoms and Young Adult Mental Health and Psychosocial Outcomes

1 Mood Disorders Centre, University of Exeter, Exeter, United Kingdom
2 Department of Public Health, Bordeaux Population Health Research Centre, Institut National de la Santé et de la Recherche Médicale U1219, Bordeaux, France
3 McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada
4 Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Quebec, Canada
5 Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, Quebec, Canada
6 Axe Cerveau et Développement de l’Enfant, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Quebec, Canada
7 Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
8 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Invited Commentary Depressive Symptoms in Childhood and Adolescence and Adult Psychosocial Outcomes Natan J. Vega Potler, MD JAMA Network Open

Question Are depression symptoms during childhood and adolescence associated with poor mental health and psychosocial outcomes in young adulthood?

Findings In this cohort study using a representative population-based Canadian birth cohort of 2120 infants, depression symptoms during adolescence (ages 13 to 17 years) were associated with higher levels of depression symptoms and perceived stress in early adulthood (at ages 20 and 21 years), while both middle-childhood (ages 7 to 12 years) and adolescent depression symptoms were associated with decreased social support for participants at age 21 years, independent of early risk factors. There were no associations of depression symptoms with binge drinking; not being in education, employment, or training; or experiencing online harrasment.

Meaning The findings of this study underscore the importance of screening children and adolescents for depression, which may reduce depression symptoms and compromised psychosocial functioning in young adulthood.

Importance Depression is a leading cause of disability. The timing and persistence of depression may be differentially associated with long-term mental health and psychosocial outcomes.

Objective To examine if depression symptoms during early and middle childhood and adolescence and persistent depression symptoms are associated with impaired young adult outcomes independent of early risk factors.

Design, Setting, and Participants Data for this prospective, longitudinal cohort study were from the Québec Longitudinal Study of Child Development, a representative population-based Canadian birth cohort. The cohort consists of infants born from October 1, 1997, to July 31, 1998. This is an ongoing study; data are collected annually or every 2 years and include those ages 5 months to 21 years. The end date for the data in this study was June 30, 2019, and data analyses were performed from October 4, 2022, to January 3, 2024.

Exposures Depression symptoms were assessed using maternal reports in early childhood (ages 1.5 to 6 years) from 1999 to 2004, teacher reports in middle childhood (ages 7 to 12 years) from 2005 to 2010, and self-reports in adolescence (ages 13 to 17 years) from 2011 to 2015.

Main Outcomes and Measures The primary outcome was depression symptoms at age 20 years, and secondary outcomes were indicators of psychosocial functioning (binge drinking; perceived stress; not being in education, employment, or training; social support; and experiencing online harrasment) at age 21 years. All outcomes were self-reported. Adult outcomes were reported by participants at ages 20 and 21 years from 2017 to 2019. Risk factors assessed when children were aged 5 months old were considered as covariates to assess the independent associations of childhood and adolescent depression symptoms with adult outcomes.

Results The cohort consisted of 2120 infants. The analytic sample size varied from 1118 to 1254 participants across outcomes (56.85% to 57.96% female). Concerning the primary outcome, adjusting for early risk factors and multiple testing, depression symptoms during adolescence were associated with higher levels of depression symptoms (β, 1.08 [95% CI, 0.84-1.32]; P < .001 unadjusted and Bonferroni adjusted) in young adulthood. Concerning the secondary outcomes, depression symptoms in adolescence were only associated with perceived stress (β, 3.63 [95% CI, 2.66-4.60]; P < .001 unadjusted and Bonferroni adjusted), while both middle-childhood (β, −1.58 [95% CI, −2.65 to −0.51]; P = .003 unadjusted and P < .001 Bonferroni adjusted) and adolescent (β, −1.97 [95% CI, −2.53 to −1.41]; P < .001 unadjusted and Bonferroni adjusted) depression symptoms were associated with lower levels of social support. There were no associations for binge drinking; not being in education, employment, or training; or experiencing online harrasment.

Conclusions and Relevance In this cohort study of Canadian children and adolescents, childhood and adolescent depression symptoms were associated with impaired adult psychosocial functioning. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes.

Depression is a leading contributor to global disease burden. 1 A nationally representative US study of 2016 data found that 3.2% of children and adolescents (ages 3 to 17 years) were depressed and that prevalence rates tended to increase with age. 2 The timing of depression onset and symptom persistence may differentially impact an individual’s functioning. Longitudinal and meta-analytic evidence suggest that depression symptoms during adolescence are associated with mental health problems and impaired functioning in adulthood. 3 - 7

Because available studies do not often examine depression symptoms during childhood, it is not yet clear whether symptoms occurring during early (ages 1.5 to 6 years) and middle (ages 7 to 12 years) childhood and adolescence (ages 13 to 17 years) are independently associated with adult mental health and psychosocial outcomes. Additionally, focusing on 1 developmental period precludes the examination of whether individuals with persistent symptoms are at higher risk for worse outcomes later in life. This omission has implications for prioritizing the allocation of support to individuals who are most at risk. 8 Moreover, most studies focus on mental health as the primary outcome, thus overlooking the association of depression symptoms with pertinent psychosocial outcomes. 9 Therefore, it is important to examine a broad range of outcomes to understand the associations of depression symptoms with overall functioning in adulthood to inform policymaking. 9

Previous studies have investigated the associations of the timing of depression symptoms with adult outcomes. 8 , 10 A study examining trajectories of depression symptoms from ages 10.5 to 25 years found that individuals with persistent early-onset depression symptoms during adolescence were associated with poorer mental health and work and educational outcomes in early adulthood. 8 Another study found that depression during childhood and adolescence was associated with physical and mental health problems, risky behaviors, and problems in psychosocial functioning in adulthood. 10 Importantly, individuals who had adolescent-onset vs childhood-onset depression and individuals with depressive symptomatology across childhood and adolescence had worse outcomes in adulthood. 10

A limitation of the existing literature is that studies have often not considered a broad range of confounding factors. 10 Several factors, including being female, having a limited-income background, being exposed to parental psychopathology, and experiencing problematic family relationships, are known risk factors for depression symptoms and impaired adult functioning. 11 - 15 Therefore, it is important to consider these and other confounding factors to obtain an accurate estimate of the associations of childhood and adolescent depression symptoms with adult outcomes. 10

The objective of this study was to examine the associations of depression symptoms in early and middle childhood with depression symptoms (primary outcome) and psychosocial outcomes (secondary outcome) in young adulthood. Our hypothesis for the current study was that childhood and adolescent depression symptoms would be associated with primary and secondary outcomes in early adulthood, but no a priori hypotheses were made about the associations of childhood and adolescent depression symptoms on any specific adult outcome.

Data for this cohort study were drawn from the ongoing Québec Longitudinal Study of Child Development (QLSCD), a large, representative population-based birth cohort conducted by the Institut de la Statistique du Québec in Canada. The cohort in the QLSCD consisted of 2120 infants born from October 1, 1997, to July 31, 1998 (see the cohort profile for more information on the overall cohort 16 ). The end date for the data in this study was June 30, 2019. Baseline characteristics were assessed when children were aged 5 months old by trained research assistants during interviews held at participants’ homes or using mailed questionnaires. Depression symptoms during early childhood (ages 1.5 to 6 years) were reported by children’s mothers, from 1999 to 2004 and during middle childhood (ages 7 to 12 years) by teachers, from 2005 to 2010, whereas adolescent depression symptoms were self-reported by participants at ages 13, 15, and 17 years from 2011 to 2015. Adult outcomes were reported by participants at ages 20 and 21 years from 2017 to 2019 using online questionnaires. Informed written consent was obtained by all participating families (and teachers) at each assessment point. Participants consented to data collection from age 18 years onward. Ethics were approved by the health research ethics committees of the Institut de la Statistique du Québec and the Sainte-Justine Hospital Research Centre. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline for standard reporting in cohort studies. 17

The primary outcome of the present study was depression symptoms assessed at age 20 years. The secondary outcomes were indicators of psychosocial functioning (binge drinking; perceived levels of stress; not being in education, employment, or training [NEET] status; social support; and experiencing online harrasment at age 21 years.

We examined the independent and joint associations of depression symptoms in early and middle childhood and adolescence with young adult outcomes. Based on prior evidence, a broad range of covariates were adjusted for in the analyses. The early-childhood depression symptoms were reported when children were 1.5, 2.5, 3.5, 4.5, and 5, and 6 years of age, and middle-childhood symptoms when children were aged 7, 8, 10, and 12 years using items from the Social Behavior Questionnaire (SBQ 18 ). The SBQ integrates items from the Rutter Children’s Behaviour Questionnaire, 19 the Child Behavior Checklist, 20 the Ontario Child Health Study scales, 21 and the Preschool Behavior Questionnaire. 22 Mothers and teachers ranked the frequency with which children experienced different dimensions of depression (eg, unhappy, sad, or depressed or lacked energy) on a scale from 0 (never) to 2 (often), with higher scores indicating more depression. Given our focus on depression symptoms, we used 5 SBQ items that were similar to the items used to assess depression in adolescence (ages 13-17 years) and young adulthood (ages 18-24 years) (eTable 1 in Supplement 1 ). The internal consistency of these items ranged from 0.19 (95% CI, 0.14-0.25) to 0.63 (95% CI, 0.60-0.65).

To create childhood depression variables, we first calculated the mean scores, separately, of mother-reported and teacher-reported depression symptoms. To account for variation in the measures used to assess depression symptoms across developmental periods, we identified children in the top quintile of mother-reported and teacher-reported depression symptom scores. These variables were used as binary indicators of early-childhood (mother-reported) and middle-childhood (teacher-reported) depression symptoms, in which 1 indicated children rated in the top quintile of depression symptoms by mothers and teachers, respectively, and 0 indicated all other children.

Adolescents self-reported their depression symptoms using the SBQ at age 13 years and at ages 15 and 17 years (α = 0.90), using the Mental Health and Social Inadaptation Assessment for Adolescents. 23 We first calculated the mean of depression symptoms at ages 15 and 17 years using the Mental Health and Social Inadaptation Assessment for Adolescents and then identified participants in the top quintile of this mean score. We then identified participants in the top quintile of depression symptoms at age 13 years. The final variable was binary, with 1 indicating adolescents rated in the top quintile of depression symptoms at ages 13 or 15 and 17 years and 0 indicating all other children. To examine correlations between depression scores reported by different informants across different ages, we used the Spearman correlation coefficient. This test was used due to the nonnormal distribution of depression scores.

Outcomes in young adulthood were self-reported only at ages 20 and 21 years. At age 20 years, participants reported their depression symptoms using the Center for Epidemiologic Studies Depression (CES-D) scale, 24 a validated and widely used measure of depression symptoms in adults. Psychosocial outcomes were reported at age 21 years. Perceived levels of stress in the past month were assessed using the Perceived Stress Scale. 25 Social support was assessed using the validated short version of the Social Provisions Scale. 26 Experiencing online harrasment was assessed using a single item asking about the frequency (never, once, sometimes, often, or very often) with which the participant had been harrased (eg, insults, threats) over the internet or by telephone in the past year. We created a binary variable with 1 for participants who indicated being harrased at least once and 0 otherwise. Binge drinking was also assessed with a single item asking how often participants had consumed 4 (for females) or 5 (for males) or more drinks on a single occasion in the past year. Participants’ NEET status was determined using 2 items asking about their current studies and employment. Participants who indicated that they were not in school, in training, or employed were classified as NEET.

We searched previous literature for variables that could confound associations between depression symptoms and each of the adult outcomes. Different covariates were used in different models, as each outcome was included in a separate model. All of the following covariates were assessed at baseline when children were aged 5 months old: family socioeconomic status (derived from parental educational and occupational status and household income), maternal and paternal depression symptoms (based on the CES-D scale 24 ) and antisocial behavior in their adolescence and adulthood (assessed with 5 binary questions on conduct problems based on Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] 27 criteria), maternal employment status, maternal substance use during pregnancy (ie, tobacco, alcohol, or an illegal drug), in-home observations of mother and child interactions (stimulation and verbalization) using the Home Observation Measurement of the Environment, 28 self-reported maternal and paternal parenting practices (self-efficacy, reactive hostility, overprotection, affection, warmth, and parental impact) using the Parental Cognitions and Conduct Toward the Infant Scale, 29 and the child’s sex. Family functioning was assessed using the Family Dysfunction Scale, in which scores range from 0 to 10.00, with higher scores indicating higher levels of family dysfunction. 30

Data analysis was performed from October 4, 2022, to January 3, 2024. We estimated the association of early and middle childhood and adolescent depression symptoms with each adult outcome in separate regression models that were adjusted for the relevant covariates. Linear regression models were used for continuous outcomes (depression, perceived stress, and social support) and logistic regressions for binary outcomes (experiencing online harrasment, binge drinking, and NEET status). We also tested the interactions of depression symptoms in early childhood, middle childhood, and adolescence in each model. The interactions between depression symptoms in early childhood and at other time points were not significant and were therefore dropped from the models. Given the use of multiple testing, we present both the unadjusted and adjusted (Bonferroni-corrected) P values for all models; the Bonferroni correction was used for the final model of each outcome. A 2-sided P < .05 was considered significant.

Participants were included in analyses if they had available data for at least 1 time point for depression symptoms in early or middle childhood and adolescence and 1 adult outcome. The excluded and analytic samples significantly differed in baseline characteristics; we therefore used inverse probability weighting, in which weights represent the probability of being included in an analytic sample, in all analyses. 31 The comparison of each analytic sample with the excluded sample on the variables used for weighting is presented in eTable 2 in Supplement 1 . Missing data for covariates, ranging from 4.89% to 5.19% depending on the sample, were handled using multiple imputation by a chained equation (n = 50 imputed datasets). Statistical analyses were performed using R, version 4.2.3 (R Project for Statistical Computing). 32

Among the 2120 infants in the cohort, the analysis sample size varied from 1118 to 1254 across outcomes and included 648 to 713 females (56.85% to 57.96%) and 470 to 541 males (42.04% to 43.14%) ( Table 1 ). Participants who experienced high depression symptoms in adolescence were more likely to experience depression symptoms in young adulthood (β, 1.08 [95% CI, 0.84-1.32]; P < .001 unadjusted and Bonferroni adjusted) and to report higher levels of perceived stress (β, 3.63 [95% CI, 2.66-4.60]; P < .001 unadjusted and Bonferroni adjusted) after adjusting for covariates ( Figure and eTable 3 in Supplement 1 ). Depression symptom scores were created in the cohort of 2120 infants, including the mean, SD, range, and cutoff scores for children and adolescents in the top quintile in each developmental period (early childhood: mean [SD] score, 1.18 [0.87; range, 0-7.14]; middle childhood: mean [SD] score, 1.88 [1.54; range, 0-10.00]; adolescence: mean [SD] score, 3.62 [2.08; range, 0-10.00]) ( Table 2 ). The correlations between depression scores across different ages are presented in the eFigure in Supplement 1 . Depression symptoms’ correlation coefficients were greater when reported by the same informant compared with coefficients between informants.

High depression symptoms in middle childhood were not associated with higher levels of depression symptoms (β, 0.43 [95% CI, −0.03 to 0.90]; P = .07) and perceived stress (β, 1.90 [95% CI, 0.03-3.77]; P = .05) in young adulthood; these results remained nonsignificant after adjusting for multiple testing (depression symptoms: β, 0.43 [95% CI, −0.03 to 0.90]; P = .11 and perceived stress: β, 1.90 [95% CI, 0.03-3.77]; P = .10) (eTable 3 in Supplement 1 ). A similar pattern was observed between high depression symptoms in adolescence and NEET status in young adulthood, in which the statistical significance (β, 2.46 [95% CI, 1.09-5.56]; P = .03) did not survive the Bonferroni correction ( P = .06) (eTable 3 in Supplement 1 ).

The only outcome with which high depression symptoms in middle childhood and adolescence were associated was social support ( Figure and eTable 3 in Supplement 1 ). Participants in middle childhood (β, −1.58 [95% CI, −2.65 to −0.51]; P = .003 unadjusted and P < .001 Bonferroni adjusted) and adolescents (β, −1.97 [95% CI, −2.53 to −1.41]; P < .001 unadjusted and Bonferroni adjusted) who experienced more depression symptoms reported lower levels of social support in young adulthood. The interaction between high depression symptoms in middle childhood and adolescence was not significant, suggesting that the independent associations of depression symptoms in each period were more relevant than the cumulative experience of high depression symptoms ( Figure and eTable 3 in Supplement 1 ). We found no association between high depression symptoms across developmental periods with any outcome. The experience of high depression symptoms across (early and middle) childhood and adolescence was not associated with binge drinking, NEET status, or experiencing online harrasment ( Figure and eTable 3 in Supplement 1 ). To test whether the associations of depression symptoms with adult outcomes were mediated by depression symptoms at a later point, we conducted simple regression analyses between depression symptoms in each developmental period and adult outcomes to ensure that the impact of childhood depression symptoms was not overshadowed by later depression symptoms (eTable 4 in Supplement 1 ). As almost all of the results were not significant, it appeared that the association of childhood depression symptoms with adult outcomes was not masked by later depression symptoms, and therefore, we did not test mediation models.

In this cohort study using prospective longitudinal data from children, adolescents, and adults aged 1.5 to 21 years, we found that depression symptoms during adolescence were associated with increased depression symptoms at age 20 years and perceived stress at age 21 years, adjusting for covariates and multiple testing. Additionally, depression symptoms during adolescence were associated with compromised psychosocial outcomes at age 21 years, but the result was nonsignificant after correcting for multiple testing. Social support was the only outcome for which depression symptoms during middle childhood and adolescence had an association that persisted after adjusting for covariates and multiple testing. Depression symptoms were not associated with experiencing online harrasment, NEET status, or binge drinking.

Being in the top quintile of depression symptoms in adolescence was associated with a 1-point increase on the CES-D scale, an association that corresponds with a medium effect size (Cohen d = 0.5) and is thus relevant from a population and clinical perspective. These findings provide some support for the stability of depression symptoms and are consistent with previous research suggesting that depression symptoms during adolescence increase the risk of mental health problems in emerging adulthood. 7 Additionally, in our study, young adults who experienced depression symptoms during adolescence self-reported increased perceived stress at age 21 years, independent of early risk factors. One explanation for this finding is that the experience of depression symptoms may have contributed to cognitive vulnerabilities and the perception of events as more stressful. Alternatively, it could be that young adults may have experienced stressful life circumstances at the time of the assessment or that structural or social determinants not captured at birth may have contributed to depression symptoms. 33 - 35 Notably, these results were not significant for childhood depression symptoms, suggesting that the associations were confined to adolescent depression symptoms. However, it is worth mentioning that adolescence and adult depression symptoms were measured with self-reports, which may have reflected common rater bias, while early- and middle-childhood depression symptoms were measured with mothers’ (early childhood) and teachers’ (middle childhood) reports, which may have reflected measurement and rater difference. 36

The experience of depression symptoms in middle childhood and adolescence was associated with decreased social support at age 21 years. There were no significant interactions, suggesting that the independent associations of depression symptoms in each developmental period were more relevant than the cumulative experience of high depression symptoms. This finding is consistent with a previous study’s finding that adolescent depression symptoms were associated with lower social support in early adulthood 37 and adds to the existing literature by showing that the experience of depression symptoms during middle childhood (ages 7 to 12 years) may be independently associated with diminished social support. This is a concerning finding, as it implies that young adults may go through life transitions (eg, family and career) without adequate social support. 38 Similarly, they may be reluctant to access support provided by health services. 37 , 38 Future research should examine why this occurs and if the associations of childhood vs adolescent depression with social support have distinct environmental and genetic causes.

While no firm conclusions can be made about the timing (childhood vs adolescence) of depression symptoms and its prospective associations with adult outcomes, it appears that depression symptoms during adolescence were associated with a broader range of adult outcomes (depression symptoms, perceived stress, and social support) compared with depression symptoms during childhood (social support only). There was no evidence that individuals with persistently elevated depression symptoms relative to peers had worse adult outcomes. Except for social support, young adults whose depression symptoms did not persist beyond childhood showed no other impairments, suggesting that it was depression symptoms in adolescence that were associated with adult outcomes. However, this finding should be interpreted with caution because the association may be an artifact of the fact that depression symptoms were reported by different informants at different ages with different measures. 36

The onset and course of depression symptoms were not captured in this study. Future studies should examine trajectories of depression symptoms and their prospective associations with adult outcomes. Moreover, the overall low internal consistency of depression items in early childhood, reported by mothers and teachers, has to be considered, as it indicates a potential lack of validity of depression measures. There were no data on whether participants were treated with antidepressant medication or psychological therapy, which may have impacted depression symptoms and adult outcomes. Exposure variables during adolescence and outcomes in early adulthood were assessed using self-reports, which may have inflated associations between variables (eg, individuals experiencing depression being more vulnerable to negative self-perceptions). 39 , 40 However, different reporters (mothers, teachers) were used to measure depression symptoms across childhood, and self-reports are reliable for internalizing problems. 41 , 42

The findings have implications for mental health interventions. It is of clinical importance to identify children and adolescents experiencing depression early to decrease depression symptoms and prevent compromised functioning. Our findings suggest that mental health interventions including interpersonal/social components may improve psychosocial functioning in adulthood. Furthermore, some of the early risk factors we considered showed associations with adverse adult outcomes. Thus, mental health interventions that address exposure to early adversity or trauma could be beneficial to children and adolescents experiencing depression symptoms. 43 Last, mental health interventions should identify and monitor children and adolescents experiencing subclinical symptoms as our findings suggest that individuals who had increased depression symptoms during childhood or adolescence experienced adverse outcomes in young adulthood.

The findings of this cohort study suggest that both childhood and adolescent depression symptoms may be associated with adverse psychosocial outcomes, while adolescent depression symptoms were associated with depression symptoms and perceived stress in young adulthood independent of early risk factors. Interventions should aim to screen and monitor children and adolescents for depression to inform policymaking regarding young adult mental health and psychosocial outcomes.

Accepted for Publication: May 21, 2024.

Published: August 8, 2024. doi:10.1001/jamanetworkopen.2024.25987

Corresponding Author: Marilyn N. Ahun, PhD, Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, 5252 Boulevard de Maisonneuve, Montréal, H4A 3S5, Quebec, Canada ( [email protected] ).

Author Contributions: Drs Navarro and Ahun had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Psychogiou and Navarro were co–first authors.

Concept and design: Psychogiou, Navarro, Côté, Ahun.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Psychogiou, Ahun.

Critical review of the manuscript for important intellectual content: Navarro, Orri, Côté, Ahun.

Statistical analysis: Navarro, Orri, Ahun.

Obtained funding: Côté.

Administrative, technical, or material support: Côté.

Conflict of Interest Disclosures: None reported.

Funding/Support: The Québec Longitudinal Study of Child Development (QLSCD) was supported by funding from the Ministère de la Santé et des Services Sociaux, the Ministère de la Famille, Ministère de l’Éducation et de l’Enseignement Supérieur, the Lucie and André Chagnon Foundation, the Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, the Research Centre of the Sainte-Justine University Hospital, the Ministère du Travail, de l’Emploi et de la Solidarité Sociale, and the Institut de la Statistique du Québec. Additional funding was received by the Fonds de Recherche du Québec-Santé, the Fonds de Recherche du Québec-Société et Culture, the Social Science and Humanities Research Council of Canada, and the Canadian Institutes of Health Research.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

Additional Contributions: We are grateful to the children and parents of the QLSCD and the participating teachers and schools.

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This paper is in the following e-collection/theme issue:

Published on 16.8.2024 in Vol 8 (2024)

Using a Digital Mental Health Intervention for Crisis Support and Mental Health Care Among Children and Adolescents With Self-Injurious Thoughts and Behaviors: Retrospective Study

Authors of this article:

Original Paper

Darian Lawrence-Sidebottom 1 * , PhD ;
Landry Goodgame Huffman 2 * , PhD ;
Aislinn Brenna Beam 3 , PhD ;
Kelsey McAlister 4 , MS ;
Rachael Guerra 1 , PhD ;
Amit Parikh 5 , MD ;
Monika Roots 1 , MD ;
Jennifer Huberty 1, 4 , PhD

1 Bend Health, Inc, Madison, WI, United States

2 Advocates for Human Potential, Inc, Sudbury, MA, United States

3 SleepScore Labs, Sleep Solutions, LLC, Carlsbad, CA, United States

4 FitMinded Inc, LLC, Phoenix, AZ, United States

5 Mental Fitness Clinic, Los Angeles, CA, United States

*these authors contributed equally

Corresponding Author:

Darian Lawrence-Sidebottom, PhD

Bend Health, Inc

821 E Washington Ave

Madison, WI, 53703

United States

Phone: 1 8005160975

Email: [email protected]

Background: Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs.

Objective: To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs.

Methods: This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs).

Results: Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ 2 1 =1.2; P =.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ 2 1 =0; P =.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety ( t 80.20 =1.37; P =.28) and depressive ( t 83.75 =–0.08; P =.99) symptoms.

Conclusions: This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents.

Introduction

Over the past 3 decades, mental health disorders in children and adolescents have increased dramatically in prevalence around the globe, with an estimated 8.8% of children and adolescents having any mental health diagnosis [ 1 ]. In the United States, depressive disorders in children have increased from 4% to 6% in 2000 to 13% in 2016 [ 2 ]. Anxiety and depression are among the most common mental disorders in children and adolescents [ 3 , 4 ], and there is evidence that these mental health challenges have been exacerbated by the COVID-19 pandemic [ 5 ]. Furthermore, rates of self-injurious thoughts and behaviors (SITBs) as well as suicide attempts and completed suicide have been on the rise. Recent estimates report SITBs in 7.5% of children (aged 6-12 y) [ 6 ] and 16.9% of adolescents [ 7 ]. Indeed, since 2010, there have been alarming increases in pediatric hospital admissions for nonsuicidal self-injury [ 8 - 12 ], with 1 study reporting that hospitalization for suicidal ideation or attempts in children and adolescents more than doubled from 0.66% in 2008 to 1.82% in 2015 [ 10 ].

The co-occurrence of recent increases in mental health problems and SITBs in children and adolescents is unsurprising, given that mental health problems, particularly anxiety and depression, may underlie increased risk of SITBs [ 13 ]. Indeed, anxiety and depression have been viewed as risk factors for suicidal ideation and attempts [ 14 - 16 ], and those with depression are at particularly high risk for suicide [ 17 ]. Therefore, it is of great importance to address mental health issues—particularly anxiety and depression—to prevent SITBs in children and adolescents.

In the United States, the burden of mental health problems and the accompanying risk of suicide and self-harm is exacerbated by an overwhelmed health care system that is increasingly unable to provide adequate mental health care, especially for treatment of acute crises related to SITBs [ 18 ]. Most cases of individuals presenting with SITBs are addressed by emergency departments (EDs) that are not specialized in the treatment of SITBs [ 10 , 11 ], and many providers within these EDs report a limited capacity and expertise for treating mental health conditions [ 19 ]. ED visit costs have increased by 58% from 2012 to 2019 in the United States [ 19 ], reflecting a significant financial burden on both families and the health care system itself. Ultimately, there is a clear and pressing need for accessible, inexpensive, and high-quality mental health care for children and adolescents, especially among those experiencing SITBs [ 20 ].

In response to the overburdened mental health care system, digital mental health interventions (DMHIs) facilitated by common digital technologies (ie, internet websites, smartphone apps, or SMS text messages) have emerged as accessible and scalable alternatives to in-person mental health care [ 21 - 23 ]. Evidence suggests that DMHIs that include live interactions, such as video-based coaching and therapy, are similarly efficacious to in-person treatments for common mental and behavioral problems such as anxiety and depression [ 24 - 28 ]. Moreover, DMHIs that use the collaborative care model, in which behavioral care is integrated with primary medical care, are particularly effective for the treatment of mental health problems in children and adolescents [ 19 , 29 - 32 ].

Despite the demonstrated potential of collaborative care DMHIs and the increasing need for mental health care among children and adolescents presenting with SITBs [ 33 ], most commercially available DMHIs exclude those who exhibit such symptoms and may refer them to EDs [ 34 - 37 ]. DMHIs—and particularly those using nonclinical interventions such as behavioral health coaching—often lack the trained personnel necessary for appropriate management of, and follow-up with, those experiencing acute crises related to SITBs. Lack of accommodation for SITBs in pediatric DMHIs produces a cycle of exclusion, referral, and delayed treatment, preventing children and adolescents from receiving the care they need when experiencing acute symptoms.

For mental health treatment to become more accessible to children and adolescents with SITBs, it is crucial that DMHIs offer evidence-based crisis support and ongoing mental health care for children and adolescents at risk of suicide and self-harm [ 36 ]. Therefore, this study aims to provide preliminary evidence to inform the further development of digital crisis response services and continuing care for children and adolescents with SITBs and underlying mental health symptoms (ie, anxiety and depressive symptoms). By leveraging 12 months of retrospective data from a pediatric collaborative care DMHI that provides both crisis support and ongoing mental health services to children and adolescents (aged 1-17 y) presenting with SITBs, the purpose of this study is to (1) explore use, mental health symptoms, and demographic qualities of children and adolescents with SITBs who participate in a digital crisis response service; (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout the duration of care; and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs.

Design and Participants

Children aged 1 to 12 years and adolescents aged 13 to 17 years were eligible for inclusion in this study if they were in care (ie, had a coaching or therapy session) with Bend Health, Inc, between October 1, 2022, and October 1, 2023 (12 months; N=2161). In October 2022, a crisis support protocol was implemented to identify and de-escalate risk in children and adolescents presenting elevated risk of suicide, self-harm without intent to die, harming others, and experiencing violence when not in session with clinical providers (eg, in written communication or in a live coaching session). When a child or adolescent exhibits SITBs in these contexts, a rapid crisis support team (RCST), composed of qualified mental health practitioners experienced and trained in mental health crisis intervention, provide immediate support and work with the child or adolescent and their caregiver or caregivers to develop a safety plan. In this study, those who exhibited risk of suicide or self-harm were included in the group with SITBs, and all other children and adolescents were included in the group without SITBs; all study participants were in care with Bend Health, Inc.

Bend Health is a collaborative care DMHI for children and adolescents aged 1 to 17 years. All mental health care with Bend Health is delivered using a web-based platform, that is, via live video-based sessions with behavioral health coaches (hereinafter referred to as coaches ) and licensed therapists (practitioner qualifications are discussed later in this subsection), in a web-based learning resource center, using SMS with mental health practitioners and medication consultation with psychiatric providers (when referred). Most children and adolescents are referred to Bend Health, Inc, by their primary care provider, but they may also enroll through insurance, employer benefits, or direct-to-consumer pathways.

Care protocols have been described in detail elsewhere [ 31 , 32 ] and are diagrammed in Figure 1 . In brief, caregivers of children and adolescents enroll in care using the web-based Bend Health platform, where they provide demographic information, complete mental health symptom assessments (described in the Measures subsection), and schedule their first session with a behavioral care manager (BCM). BCMs are responsible for coordinating and overseeing a member’s care with Bend Health (ie, they do not deliver mental health care). After a caregiver completes enrollment, the BCM completes member intake and meets with the member and their caregiver in a live video-based session. During this session, the BCM discusses all current mental health concerns; obtains a full history (ie, a history of >2 weeks), including anxiety, depression, and screen for suicidality; and begins planning mental health care. This planning includes the assignment of other Bend Health practitioners to the child’s or adolescent’s care team based on the information gathered. If it is necessary to meet the member’s individual care needs, the BCM will refer the member to 1 of the specialty care tracks at Bend Health, Inc, to provide targeted care.

research in child and adolescent development ppt

Coaches are assigned to every child’s or adolescent’s care team. The coach is responsible for leading the delivery of mental health care, and they are required to have one of the following qualifications to work at Bend Health, Inc: (1) be certified by the International Coaching Federation, (2) be certified by the National Board for Health & Wellness Coaching, and (3) hold a master’s degree in a psychology-related field. Other practitioners are assigned to the care team based on the child’s or adolescent’s symptom severity, individual needs, type of referral, insurance coverage, and desired services. Children and adolescents with elevated symptom severity or complex symptom presentation may have a licensed therapist added to the care team. The licensed therapist is responsible for providing a clinical framework to the child’s or adolescent’s mental health treatment, and to work at Bend Health, Inc, they are required to hold a license in one of the following fields: (1) marriage and family therapy, (2) professional counseling, (3) clinical social work, or (4) mental health counseling. If the child’s or adolescent’s referral includes consultation for psychotropic medication, a psychiatric provider (psychiatrist or nurse practitioner) is added to the member’s care team.

Children and adolescents participate in one-on-one live video-based sessions each month with the practitioners on their care team. Coaching and therapy sessions deliver evidence-based behavior change tools to children and adolescents and their families. These sessions aim to facilitate self-reflection and improve self-efficacy and autonomy. Coaches and therapists lead children and adolescents through structured care programs, which were designed by Bend Health, Inc, to target specific symptom domains in a manner that is age appropriate for each member; for example, care programs for children include more simple language compared to care programs for adolescents, and example scenarios are different for these age groups. Caregivers attend live coaching and therapy sessions with their child (aged <13 y). Care for adolescents (aged 13-17 y) is more independent (ie, less focus is placed on the caregiver), and adolescents may attend live coaching and therapy sessions alone. However, their caregiver is required to be nearby (eg, in the same home) during all live interactions with practitioners for safety reasons.

Care program content is also available in a web-based learning resource center, which includes web-based interactive learning tools that reinforce skills learned in sessions to manage and improve symptoms between sessions. The Bend Health care program content is based on the most up-to-date clinical guidelines and practices for pediatric behavioral health, rooted in evidence-based theoretical frameworks such as cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy, positive parenting, and mindfulness [ 38 ]. Unlimited SMS is also available for caregivers to communicate directly with their child’s care team on a secure portal. Within the same secure portal, caregivers and adolescents are asked to complete mental health symptom assessments (web-based screeners and full validated assessments) at enrollment and approximately once a month thereafter. Mental health symptom assessments are completed between live sessions with practitioners. Children and adolescents may participate in Bend Health care as long as their symptoms persist or until they are discharged from care (eg, by caregiver choice or due to nonengagement).

Risk Assessment and Intervention Protocol

To provide response and safety planning services for children and adolescents presenting with SITBs and other acute risk behaviors exhibited during nonclinical sessions (ie, sessions with BCMs or coaches) or in asynchronous contact (eg, messages to the care team), Bend Health, Inc, developed a procedure informed by evidence-based practices to identify, intervene with, and manage children and adolescents with SITBs or other mental health crises (eg, intent to harm others) [ 39 , 40 ]. All members of the care team conduct screening for risk at intake and during each live session. To identify suicide risk, practitioners administer the Columbia–Suicide Severity Rating Scale (C-SSRS) [ 41 ]. The C-SSRS has been widely used in pediatric populations [ 42 , 43 ] and is validated for use in adolescents aged 13 to 17 years [ 44 , 45 ]. In addition, several studies have used the C-SSRS in children aged 6 to 12 years [ 46 ]. The C-SSRS includes items related to wishing to be dead, nonspecific active suicidal thoughts, and plans of suicide (discussed in detail later in this subsection). In addition, practitioners ask children and adolescents about current and past self-injurious behaviors without intent to die, thoughts of hurting another person, and experiencing violence (self or other) in the last 24 hours or being worried about violence in the next 24 hours. Self-harm behaviors are assessed using a 3-item questionnaire. The questionnaire queries whether the child or adolescent has ever harmed or hurt themself (without wanting to die), whether this self-harm happened in the past 2 weeks, and whether the harm was at >1 location or required surgical intervention. Children and adolescents are flagged for SITBs when they answer positively to any of the C-SSRS items and indicate engagement in self-injurious behaviors without intent to die in the last 2 weeks.

If a member is identified with SITBs or another risk during intake or any live video-based session with a BCM or coach or if risk is identified in other web-based communication, the BCM, coach, or other Bend Health, Inc, employee (eg, customer service) contacts the RCST. The RCST is a group of mental health professionals qualified to assess and address risk in clinical settings, including those with a master’s degree in a mental health field and previous experience managing acute crises in a clinical setting. Upon receiving the notification, an RCST practitioner immediately meets with the member and their caregiver to assess the type and severity of risk, provide crisis support, and develop a safety plan. If a member is flagged for SITBs or other high-risk behaviors during a session with a clinician (therapist or psychiatric provider), the clinician conducts the assessment, provides crisis support, and develops a safety plan with the member and their caregiver.

The risk event assessment involves the evaluation of additional risk factors and protective factors, as well as attempts to identify precipitating circumstances and any plans for suicide or homicide. Specific queried risk factors included previous suicide attempt, depression, access to lethal means, experiencing bullying, social isolation, adverse childhood experience, family history of suicide, and stigma associated with mental health problems or help seeking [ 47 ]. Protective factors included limited access to lethal means, connections with friends, family, or community, and positive coping and problem-solving skills [ 47 ]. On the basis of the information collected during the risk event assessment, as well as responses to the C-SSRS, the RCST practitioner determines the risk level of the member during the risk event (described in further detail in the Measures section). Then, on the basis of this risk level and the nature of the risk, the RCST practitioner develops a safety plan with the member and their caregiver. The safety plan includes the development of a series of strategies aimed to mitigate the member’s risk (eg, safeguarding the home), as well as the identification of social supports and resources, recognizing warning signs and triggers, self-management skills, and the initiation of immediate actions that the member or caregiver can take to ensure their safety and the safety of others. Safety planning may also involve the alerting (eg, notifying via telephone call) any individuals at risk (eg, intended victims) and the completion of mandatory abuse reporting. In more serious cases, the member’s caregiver may be asked to take the member to the nearest ED, or the RCST practitioner may contact emergency services to go directly to the member’s location.

After the identification of SITBs and other risks, all practitioners in a member’s care team are notified to ensure continuous monitoring and relevant care during sessions. In some cases, BCMs may suggest escalating the child’s or adolescent’s level of care (eg, adding additional therapy sessions). If signs of SITBs or other risks are identified outside of live sessions, an RCST practitioner may offer immediate risk consultation to the care team, or they may contact the caregiver directly to provide immediate crisis support.

Risk Event Measures

If the responses to C-SSRS item 1, 2, or 6 are yes , the member is considered positive for suicide risk. On the C-SSRS, a yes response to item 1 or 2 is classified as mild risk , a yes response to item 3 or 6 (lifetime) is classified as moderate risk , and a yes response to item 4, 5, or 6 (in the last 3 months) is classified as high risk . Data collected before March 1, 2023, were stored in a secure external document. Data collected beginning March 1, 2023 (including the highest suicide risk identified using the C-SSRS), were stored in the electronic health records of Bend Health, Inc.

For the entirety of the study, the following risk event data were collected: random member ID number, date of risk event, type of risk (suicide, self-harm without intent to die, harm to others or homicidal ideation, and abuse or violence), practitioner type (ie, the practitioner who initiated the risk event), and location in care (initial evaluation, follow-up session, or other). From March 1, 2023, onward, these additional metrics were collected: risk factors and protective factors, risk level (mild, moderate, or high), recommended ED evaluation ( yes or no ), and calling emergency services on site ( yes or no ). The type of risk was identified from responses to the C-SSRS and other practitioner questions. SITB risk was classified using the criteria outlined in Textbox 1 for events flagged with suicide risk, and events flagged with self-harm risk only were always classified as mild risk . Identification of risk behaviors could occur at several points throughout participation, including in the first session with a practitioner (labeled “initial evaluation”); after the first session with a practitioner (labeled “follow-up session”); and outside of live sessions, such as via the member chat (labeled “other”).

SITB risk and criteria

Mild: low risk on the C-SSRS; or moderate risk on the C-SSRS, and there is a caregiver or other responsible adult present
Moderate: moderate risk on the C-SSRS, and there is not a caregiver or other responsible adult present; or high risk on the C-SSRS, and there is a caregiver or other responsible adult present
High: high risk on the C-SSRS, and there is not a caregiver or other responsible adult present

Demographic Information

Upon enrollment with Bend Health, Inc, caregivers answer questions about their child’s or adolescent’s demographic information, including date of birth (used to determine age), sex at birth (male, female, or other), gender (boy, girl, transgender, nonbinary, or other), and race or ethnicity (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latinx, Native Hawaiian or other Pacific Islander, White, or other). As described in further detail in Multimedia Appendix 1 , the race or ethnicity response options were expanded starting May 26, 2023, to more clearly align with US census standards. After completing the demographic section, caregivers of children and adolescents complete screening questions for anxiety and depressive symptoms as well as other mental and behavioral health symptoms. These screening questions are repeated approximately every month thereafter throughout the duration of care with Bend Health, Inc.

Mental Health Symptoms

Anxiety and depressive symptom severity are assessed for children and adolescents using screeners followed by assessments, which are prompted to be completed on the Bend Health portal monthly. The assessments have been validated for the following age groups [ 48 - 52 ]: children aged 6 to 12 years (caregiver report) and adolescents aged 13 to 17 years (self-report). Different validated assessments were given to caregivers of children versus adolescents (self-report), given best practices for these age groups. Caregivers of children aged 1 to 5 years completed the same assessments as caregivers of children aged 6 to 12 years, but mental health outcome data from children aged 1 to 5 years (161/2161, 7.45%) at baseline were excluded from analysis, given that the measures were not valid for this age group.

For children, caregivers first respond to the anxiety and depressive symptom screening questions derived from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , cross-cutting symptom measure for children and adolescents aged 1 to 17 years. These screening questions ask caregivers to report on their child’s symptoms in the past 2 weeks, with responses on a 5-item Likert-type scale ranging from 0= not at all to 4= nearly every day . There are 2 depressive symptom screener questions and 3 anxiety symptom screener questions. If the response to either depressive symptom screener question or any of the anxiety symptom screener questions is ≥2 ( several days or more frequently), the caregiver is prompted to complete the full Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire to assess depression or anxiety, respectively [ 48 , 49 ]. The PROMIS questionnaire has been validated among caregivers of children aged 5 to 17 years [ 48 , 49 ]. The PROMIS depression measure has 11 questions, and the PROMIS anxiety measure has 10 questions. After being prompted with “During the past two (2) weeks, how much (or how often) has your child,” caregivers select the best-fit response to each item using the same 5-item Likert-type scale used in the child screening questions.

For adolescents, the adolescent first responds to the anxiety and depressive symptom screening questions, which consist of the first 2 questions from the Generalized Anxiety Disorder-7 (GAD-7 [ 50 ]) and questions derived from the first 2 questions of the Patient Health Questionnaire-9, adolescent version (PHQ-9A [ 51 ]). On the basis of their responses to these screening measures, which are referred to as the Generalized Anxiety Disorder-2 (GAD-2) and the Patient Health Questionnaire-2 (PHQ-2), adolescents are prompted to complete the entire GAD-7 and PHQ-9A; both the GAD-2 and the PHQ-2 have been validated as screening tools for identifying probable anxiety and depressive disorders [ 52 , 53 ]. All items in the GAD-2 and PHQ-2, as well as items in the GAD-7 and PHQ-9A, ask adolescents to report on how often they have been bothered by a particular problem (eg, feeling anxious) over the last 2 weeks. Responses are made on a 4-item Likert-type scale ranging from 0= not at all to 3= nearly every day . If the sum of the scores on the GAD-2 or PHQ-2 is ≥2, the adolescent is prompted to respond to the entire GAD-7 or PHQ-9A, respectively. While the original PHQ-9A includes 9 questions, the version used in this study included 8 questions because the question about suicide and self-harm was omitted.

After the completion of all child or adolescent assessments, assessment scores are saved on a web-based portal for care team review (ie, to guide the care plan), and they are also reported to the caregiver. All demographic information and results from mental health symptom assessments were stored in the electronic health records of Bend Health, Inc, for the duration of the study. For the purposes of this study, mental health symptoms were assessed from January 2023 to October 2023.

Statistical Analysis

Data were analyzed in the following groups to address study goals: member characteristics and risk event characteristics (aim 1a) and mental health symptom severity (baseline severity: aim 1b; change in severity across participation in the DMHI compared to baseline: aim 2). Throughout, standard descriptive statistics are used to describe group characteristics, namely percentage, mean and SD, and median and IQR. The α level was set to .05 for all analyses. All P values were adjusted using the Bonferroni correction to account for multiple comparisons. Data sources were integrated before analysis using deidentified member ID numbers. All analyses were performed retrospectively using R (version 4.2.2; R Foundation for Statistical Computing) [ 54 ].

Member Characteristics

As 1 aim of this study was to explore the demographic qualities of members using a crisis intervention, all eligible children and adolescents (aged 1-17 y; N=2161) were included in the descriptive analyses of member demographics, with various exclusion criteria applied for subsequent analyses (the participant flowchart is available in Figure 2 ). For children and adolescents in the group with SITBs (those who had an SITB event) and the group without SITBs (those with no SITB event), the following characteristics were described: age group (at baseline), sex, gender and sex conformity, race or ethnicity, and mental health conditions reported in the electronic health record (anxiety disorder, depressive disorder, and attention-deficit/hyperactivity disorder). For gender and sex conformity, a reported gender identical to sex at birth was considered conforming , and a reported gender different from sex at birth was considered nonconforming . Given the many race or ethnicity response options, as well as the changes made to the options partway through the study, the responses were categorized into more general categories ( Multimedia Appendix 1 ).

For participation in behavioral care, the rates of children and adolescents who did not begin coaching or therapy (ie, BCM only) were reported for both groups. The rates of children and adolescents in coaching (coaching only or coaching and therapy) and therapy (therapy only or coaching and therapy) were reported only for children and adolescents who began coaching or therapy. The number of months in care (months from the first session to the last session) were also reported for both groups.

Risk Event Characteristics

Member use of crisis support services was quantified for the 12-month period, including the rates of children and adolescents who used the services, the number of total risk events, the types of risk identified, and the number of risk events per member. The timing of the first risk event was identified for all children and adolescents and reported as a percentage of events occurring at intake (first BCM session with Bend Health, Inc) and months in care at the time the first event occurred. Reporting practitioner type and location of event in the member journey was reported for all events. For events recorded after March 1, 2023, the following additional characteristics were reported: SITB risk level, whether ED evaluation was recommended, whether emergency services were called, and whether mandatory reporting was needed. The risk factors and protective factors identified during these sessions were also reported. We did not classify SITBs identified during therapy or psychiatry sessions as a risk event here because the services of the RCST were not required.

Mental Health Symptom Severity

Only children and adolescents who had mental health symptom assessments at baseline (ie, the last assessment before the first live session) from January 1, 2023, were included in the analyses of mental health symptom severity (317/2161, 14.67% were excluded). Additionally, only children and adolescents aged 6 to 17 at baseline were included (additional 161/1844, 8.73% were excluded). The rates of elevated (moderate or greater severity) and negative (screened out of completing the full assessments) anxiety and depressive symptoms at baseline were reported for each group and compared between the groups using chi-square tests to identify differences in mental health symptom severity.

All subsequent mental health symptom analyses included only children and adolescents with elevated symptoms at baseline (moderate or greater severity; additional 956/1683, 56.8% were excluded from anxiety symptom analyses; additional 1113/1683, 66.13% were excluded from depressive symptom analyses) and at least 1 postcare mental health assessment (after the first BCM, coaching, or therapy session; additional 217/727, 29.9% excluded from anxiety symptom analyses; additional 185/570, 32.5% excluded from depressive symptom analysis) to assess changes in mental health symptoms from before to after care with the DMHI. The rates of symptom improvement from baseline to the last assessment (after the start of care) were calculated as follows: for children and adolescents who did not switch from the child to adolescent assessments during care, a decrease in assessment score or screening out of the last assessment was considered symptom improvement; and for children and adolescents who changed from the child to adolescent assessments during care, a decrease in symptom severity (eg, from moderate to mild) was considered symptom improvement. The rates of symptom improvement from the first to the last assessment were reported by group for anxiety and depressive symptoms and then compared between the groups using chi-square tests.

The change in mental health symptom severity was quantified for children and adolescents with elevated symptoms at baseline and at least 1 full postcare assessment and the same full assessment at baseline and after care (ie, no change in assessment type; additional 314/727, 43.2% excluded from anxiety symptom analyses; additional 257/570, 45.1% excluded from depressive symptom analyses). This analysis was performed to ensure that the findings of percentage improvement were not driven by screened-out scores (ie, no full assessment). Assessment scores were z scored using data from full assessments completed at baseline by all children and adolescents enrolled in Bend Health in 2023 (n=1972) to calculate the reference mean and SD (by validated assessment). The z scores at baseline were compared between the groups for anxiety and depressive symptoms using Wilcoxon signed rank tests to identify differences at baseline. Next, the change in z score from baseline to the last full assessment (negative value indicates a reduction in symptom severity) was compared between the groups using 2-tailed t tests to determine whether the 2 groups differed in their rates of symptom improvement.

It should be noted that, given individual differences in care duration, the last assessment may have been completed at different times in care for each participant. Thus, the number of months in care from the start of care to the last assessment (ie, screener-only or full assessment) and to the last full assessment (ie, excluding screener-only assessments) were reported for anxiety and depressive symptoms by group. Wilcoxon signed rank tests were used to assess between-group differences in the timing of assessments. Given the study time frame, it was possible for children and adolescents to have been in care for a minimum of 1 month to up to 12 months.

Ethical Considerations

Study participants provided informed consent upon enrollment in care with Bend Health, Inc, for primary data collection—a component of regular participation in care—and the use of their data in further analyses. Study participants were not compensated for their participation in the study because data analysis was retrospective. Procedures for this study were approved by the Biomedical Research Alliance of New York (23-12-034-1374; June 5, 2023). All participant data (eg, data from electronic health records) were deidentified before analysis.

Of the 2161 children and adolescents in the study, 184 (8.51%) had an SITBs risk event (group with SITBs), and 1977 (91.49%) did not have an SITBs risk event (group without SITBs). Comprehensive child or adolescent characteristics for both groups are reported in Table 1 . In the group with SITBs, most of the participants (107/184, 58.2%) were adolescents, while 41.9% (77/184) were children. In the group without SITBs, most of the participants (1266/1977, 64.04%) were children, while 35.96% (711/1977) were adolescents. Children and adolescents with SITBs were predominantly female compared to those with no SITBs (118/184, 64.1% vs 986/1977, 49.87%). While the rates of anxiety disorders (group with SITBs: 54/184, 29.4%; group without SITBs: 554/1977, 28.02%) and attention-deficit/hyperactivity disorder (group with SITBs: 21/184, 11.4%; group without SITBs: 305/1977, 15.43%) were similar between the 2 groups, depressive disorders were nearly 5 times more common in the group with SITBs compared to the group without SITBs (33/184, 17.9% vs 74/1977, 3.74%).

Demographics			Group with SITBs (n=184), n (%)		Group without SITBs (n=1977), n (%)

	Child (1-12)	77 (41.85)		1266 (64.04)
	Adolescent (13-17)	107 (58.15)		711 (35.96)

	Female	118 (64.13)		986 (49.87)
	Male	63 (34.24)		980 (49.57)
	Nonbinary	3 (1.63)		11 (0.56)

	Conforming	167 (90.76)		1860 (94.08)
	Nonconforming	17 (9.24)		117 (5.92)

	Asian	6 (3.26)		97 (4.91)
	Black or African American	11 (5.98)		107 (5.41)
	Hispanic or Latinx	11 (5.98)		94 (4.75)
	White	97 (52.72)		915 (46.28)
	Other or multiracial	59 (32.07)		764 (38.64)

	Anxiety disorder	54 (29.35)		554 (28.02)
	Depressive disorder	33 (17.93)		74 (3.74)
	ADHD	21 (11.41)		305 (15.43)

a A reported gender identical to sex at birth was considered conforming, and a reported gender different from sex at birth was considered nonconforming.

b ADHD: attention-deficit/hyperactivity disorder.

Of the 184 children and adolescents in the group with SITBs, 30 (16.3%) did not have coaching or therapy sessions (ie, BCM only), indicating that they had not yet started care. Similarly, 312 (15.78%) of the 1977 children and adolescents without SITBs did not have coaching or therapy sessions. Of the 154 children and adolescents in the group with SITBs with coaching or therapy, 146 (94.81%) were in coaching, and 71 (46.1%) were in therapy. Of the 1665 children and adolescents in the group without SITBs with coaching or therapy, 1608 (96.58%) were in coaching and 389 (23.36%) were in therapy. The group with SITBs had approximately twice the rate of children and adolescents in therapy compared to the group without SITBs (71/154, 46.1% vs 389/1665, 23.36%). For children and adolescents in coaching or therapy, the group with SITBs was in care for a median of 3.63 (IQR 2.20-5.54) months, and the group without SITBs was in care for a median of 3.27 (IQR 1.87-5.17) months.

Of the children and adolescents in the group with SITBs, 84.8% (156/184) had suicidal ideation, and 44% (81/184) had self-harm behaviors, with 28.8% (53/184) flagged as having both suicidal ideation and self-harm. There were 207 SITBs risk events in total, with 89.7% (165/184) of children and adolescents in the group with SITBs having a single event, 8.2% (15/184) having 2 events, and 2.2% (4/184) having 3 events. The first SITB risk events requiring an RCST practitioner took place during the intake process for 44.6% (82/184) of the children and adolescents with SITBs, and the first event occurred a median of 0.03 (IQR 0-0.47; range 0-10.07) months after intake. BCMs initiated 70.5% (146/207) of the SITB risk events, and coaches initiated 18.4% (38/207). Of the 207 SITB risk events, 145 (70.0%) were initiated during an initial evaluation with a BCM or a care provider, and 51 (24.63%) were initiated during a follow-up appointment.

For the 163 events recorded after March 1, 2023, the SITB risk levels were as follows: mild severity=68 (41.7%), moderate severity=75 (46%), high severity=11 (6.8%), and no severity classification=9 (5.52%). ED evaluation was recommended for 7.9% (13/163) of the SITB risk events. No events warranted calling emergency services to the child’s or adolescent’s location, and no events necessitated mandatory reporting. The primary risk factors identified in the SITB risk events were as follows: depression=57.7% (94/163), previous suicide attempt=20.3% (33/163), social isolation=14.1% (23/163), and bullying=12.3% (20/163). The primary protective factors identified were as follows: connections to friends, family, and community=81.6% (133/163), limited access to lethal means=58.3% (95/163), and coping and problem-solving skills=49.7% (81/163). All risk and protective factors identified during SITB risk events are reported in Table S1 in Multimedia Appendix 2 .

The group with SITBs had a higher rate of elevated anxiety symptoms (94/144, 65.3%) than the group without SITBs (633/1539, 41.13%; Χ 2 1 =30.3, P <.001), and they also had a lower rate of negative (ie, screened out) anxiety symptoms (26/144, 18.1% vs 553/1539, 35.93%; Χ 2 1 =17.9, P <.001). For depressive symptoms, the group with SITBs had a higher rate of elevated symptoms (101/144, 70.1%) than the group without SITBs (469/1593, 29.44%; Χ 2 1 =90.7, P <.001), and they also had a lower rate of negative (ie, screened out) symptoms (31/144, 21.5% vs 876/1539, 56.92%; Χ 2 1 =64.9, P <.001). Notably, 51.4% (74/144) of the children and adolescents in the group with SITBs had both elevated anxiety and depressive symptoms, and 21.18% (326/1539) in the group without SITBs had both elevated anxiety and depressive symptoms.

Details regarding the duration between baseline and the last assessment, as well as baseline and the last full symptom assessment, are reported in Table S2 in Multimedia Appendix 2 . The group with SITBs and the group without SITBs did not differ significantly in their rates of anxiety symptom improvement from baseline to the last assessment (54/70, 77% vs 368/440, 83.6%; Χ 2 1 =1.2, P =.32). Similarly, the group with SITBs and the group without SITBs did not differ significantly in their rates of depressive symptom improvement from baseline to the last assessment (58/72, 81% vs 255/313, 81.5%; χ 2 1 =0, P =.99). The change in assessment score from baseline to the last full symptom assessment did not differ between the groups; baseline symptom severity and the change in symptom severity for both groups, as well as between-group comparisons of these values, are reported in Table 2 .

	Group with SITBs , n	Group without SITBs, n	Baseline symptom severity					Change in symptom severity
			Group with SITBs, score, median (IQR)	Group without SITBs, score, median (IQR)	Comparison		Group with SITBs, Δ score, mean (SD)		Group without SITBs, Δ score, mean (SD)	Comparison
					score	value				test ( )	value
Anxiety symptoms	61	353	0.47 (1.56)	–0.15 (1.53)	–1.94	.09	–1.32 (1.37)		–1.06 (1.31)	1.37 (80.20)	.28
Depressive symptoms	55	211	0.08 (1.62)	–0.22 (1.57)	–2.43	.03	–0.74 (1.36)		–0.76 (1.35)	–0.08 (83.75)	.99

a SITBs: self-injurious thoughts and behaviors.

b Change from before participating in care with the digital mental health intervention to after participating in care with the digital mental health intervention.

c Between-group comparisons of baseline symptom severity (Wilcoxon signed rank tests).

d Between-group comparisons of the change in symptom severity ( t tests).

e Statistical (nonsignificant) trend ( P <.10).

f Statistically significant P value.

Principal Findings

We assessed the characteristics and mental health outcomes of children and adolescents presenting with SITBs who participated in a novel digital crisis response service delivered by a pediatric DMHI. Across the 12-month study period, 8.51% (184/2161) of the children and adolescents presented with SITBs and participated in SITB assessment and response services. Children and adolescents presenting with SITBs were older, predominantly female, and had higher rates of elevated anxiety and depressive symptoms than children and adolescents who did not present with SITBs during care. Symptom progression throughout participation did not differ significantly based on SITB presentation, that is, children and adolescents with SITBs exhibited similar rates of symptom improvement over time compared to children and adolescents without SITBs. These findings highlight the critical opportunity to deliver evidence-based crisis response to SITBs in the context of a pediatric DMHI involving nonclinical and clinical care.

The group with SITBs comprised more adolescents than children (107/184, 58.2% vs 77/184, 41.9%). This trend is supported by current national data reporting increased suicidal ideation, self-harm, and death by suicide among adolescents compared to children [ 55 ]. Mental health difficulties often increase during adolescence due to the convergence of physiological changes [ 56 ], higher levels of stress [ 57 ], and relational changes with caregivers and peers [ 58 , 59 ]. Our results highlight the importance of considering age-related developmental differences in the assessment and treatment of SITBs in pediatric DMHIs. However, children engaged in mental health care should still be included in SITB assessments because even mild SITB events in childhood can be a precursor to more serious risk in adolescence or adulthood [ 60 ]; for example, 17% of children with suicidal ideation will eventually escalate to attempting suicide [ 59 ]. Given our limited ability to investigate within-person development of SITBs over time, longitudinal research is necessary to better understand the long-term impact of DMHIs in mitigating SITBs and associated mental health symptoms in the transition from childhood to adolescence.

Female children and adolescents made up 64.1% (118/184) of the group with SITBs, while female children and adolescents made up 49.87% (986/1977) of the group without SITBs. This apparent sex disparity among those with SITBs is supported by substantial evidence that female adolescents exhibit higher rates of self-harm, suicide attempt, and suicidal ideation across countries [ 60 - 63 ]. In children receiving mental health care, female children were more likely to experience posttraumatic stress disorder [ 64 ]. These disparities may have been exacerbated by the stress and social isolation of the COVID-19 pandemic, during which female adolescents reported larger increases in depression and suicidal thoughts than male adolescents [ 65 ]. This sex disparity is irrespective of the country of residence: a study that spanned 25 countries highlighted increasing self-harm behaviors in female adolescents since the start of the pandemic [ 66 ]. Nonetheless, female children and adolescents are less likely to receive mental health treatment than their male peers [ 67 ].

In this study, children and adolescents with SITBs had higher rates of elevated anxiety and depressive symptoms at baseline than those without SITBs (anxiety: 94/144, 65.3% vs 633/1539, 41.13%; depressive symptoms: 101/144, 70.1% vs 469/1539, 30.47%). While other mental health conditions, such as obsessive-compulsive disorder, have been associated with SITBs as well, these conditions are often also comorbid with anxiety and depressive symptoms [ 68 , 69 ]. Indeed, extensive research suggests consistent associations between anxiety and depression and risk of suicide, suicidal ideation, and self-harm in children and adolescents [ 59 , 60 , 62 , 70 ]. However, not all children and adolescents with SITBs experience anxiety and depression, and as such, screening for anxiety and depressive symptoms alone does not identify all those with SITBs [ 71 ]. In this study, 18.1% (26/144) of the children and adolescents with SITBs tested negative for anxiety symptoms at baseline, and 21.5% (31/144) tested negative for depressive symptoms at baseline. These findings highlight the need for pediatric DMHIs to provide screening and treatment of both SITBs and associated mental health problems.

In this study, the collaborative care DMHI effectively addressed anxiety and depression in individuals with SITBs as well as those without SITBs. This is consistent with prior literature, which has found that therapeutic digital health interventions are effective for treating SITBs. A meta-analysis of SITBs in adolescents across multiple countries found that specific therapies were effective for treating SITBs and self-harm [ 72 ], while another meta-analysis found that specific digital health therapies were effective for treating anxiety and depression in children and adolescents from across the globe [ 73 ]. However, it is important to note that these meta-analyses revealed that some types of therapeutic interventions had no significant effect on anxiety and depression. The intervention in this study tailors treatment to the child’s or adolescent’s needs and circumstance, which may be 1 reason that participation in the DMHI in this study has been shown to be largely effective for various symptom types and for those with different risk types (eg, SITBs and posttraumatic stress disorder) [ 31 , 32 , 64 , 74 ].

Notably, we found that anxiety and depressive symptom severity decreased at similar rates for the group with SITBs and the group without SITBs, with 77% (54/70) of the children and adolescents with SITBs exhibiting improvement in anxiety symptoms after a median of 3.32 (IQR 1.95-4.58) months in care and 81% (58/72) of the children and adolescents with SITBs exhibiting improvement in depressive symptoms after a median of 3.02 (IQR 1.88-3.88) months in care. Although these findings are preliminary, they suggest that SITB presence does not preclude children and adolescents with anxiety and depressive symptoms from benefiting from DMHIs. Several studies have demonstrated that pediatric DMHIs may effectively reduce anxiety and depressive symptoms [ 31 , 75 , 76 ], with 1 study reporting that reductions in symptoms become clinically significant and persistent for most children and adolescents after 6 coaching sessions [ 77 ]. To our knowledge, this study is the first to suggest that children and adolescents with SITBs exhibit similar decreases in anxiety and depressive symptoms to children and adolescents without SITBs while participating in a collaborative care DMHI. These are timely findings, given the increases in suicide and suicidal ideation spurred by the recent COVID-19 pandemic [ 65 , 66 , 75 , 78 ] and the consequent need for accessible, scalable, and evidence-based SITBs intervention for children and adolescents. Indeed, few commercially available pediatric DMHIs provide crisis support and mental health services for those exhibiting acute mental health crises or SITBs, citing a lack of adequate risk management strategies, increased liability, and the likelihood of adverse outcomes during care [ 65 ]. The findings and methods from this study will ideally inform the further implementation of these services in pediatric DMHIs.

Strengths and Limitations

The findings presented here should be taken in the context of the strengths of this study. First, this study is novel in that it implements a risk intervention protocol within the framework of a family-centered DMHI. This work is timely, considering the critical need for high-quality and accessible digital crisis support interventions to address the critical public health need of providing quality care to children and adolescents. Second, this study reports on the demographics and mental health symptom outcomes of a group of children and adolescents classified as high risk seeking mental health treatment, thereby adding to the field’s ability to identify and target children and adolescents with SITBs. Third, this study adds to the growing evidence that family-centered, collaborative care DMHIs are well positioned to provide high-quality care to children and adolescents with mental health challenges. Previous studies have demonstrated improvements in a variety of child, adolescent, and caregiver symptoms associated with pediatric mental health care delivered digitally [ 25 , 31 , 32 , 64 , 74 , 76 , 79 ]. This is the first study, to our knowledge, to demonstrate improvements in SITBs and comorbid anxiety and depressive symptoms in children and adolescents classified as at risk within the framework of a novel crisis intervention protocol.

Although this study suggests the need for, and the effectiveness of, DMHIs as providers of SITB-related care, it is limited in several aspects. Risk events were only tracked when the RCST was activated, which occurred primarily in the context of sessions with BCMs and coaches. Therefore, our data collection did not adequately gather information from SITBs presented during sessions with a licensed provider (eg, a therapist). Given that many children and adolescents with higher mental health symptom acuity participated in therapy and psychiatry, we expect that there were risk events not captured by this study protocol. However, it should be noted that many of the children and adolescents with SITBs in this study (71/154, 46.1%) participated in therapy during care with the DMHI, but the SITB event was recorded during a coaching or BCM session. Furthermore, 44.6% (82/184) of the risk events occurred during intake, which suggests that SITB risk levels were identified in the early stages of care for many children and adolescents.

The study used a retrospective, pre-post test design. Given the observational nature of retrospective studies, we are unable to make causal inferences; for example, this study did not assess whether mental health problems would have abated in the absence of care with the DMHI. Similarly, it was outside of the scope of this study to investigate associations between variances in care participation (eg, frequency of coaching sessions) and mental health outcomes of children and adolescents presenting with SITBs. Future studies would be strengthened by comparing outcomes among those participating in a DMHI and those in a waitlist-control group or alternative forms of care (eg, in-person care or self-guided DMHIs). In addition, because many children and adolescents had a relatively short duration of participation, we were unable to investigate outcomes associated with long-term participation, particularly in tandem with other demographic factors such as sex and age. However, it should be noted that the study period lasted for 12 months, and thus we were able to summarize outcomes in a relatively large cohort of children and adolescents. Future studies within the Bend Health cohort are planned to assess the effects of longer participation and include follow-up with participants after discharge from the DMHI.

In this study, mental health outcomes were first assessed by screener questions that were followed by full validated assessments only if elevated symptoms were flagged by the screener. With this method, the granularity of our symptom measurement may have been limited, particularly for those with lower symptom severities who may have screened out of completing the full assessments. Of those that completed the full validated assessments (ie, did not screen out) at baseline, 65.85% (727/1104) had elevated symptoms of anxiety and 76.4% (570/746) had elevated symptoms of depression, suggesting that the screener questions alone effectively identified children and adolescents with elevated symptoms. While it is possible that respondents (caregivers or adolescents) may have screened out of completing full assessments due to noncompliance, our primary findings remain consistent across analyses including or excluding screened-out assessments. Some of the assessments included in this study were not validated for all age ranges (eg, C-SSRS was not validated for children and adolescents aged 6-12 y). However, we removed those aged 1 to 5 years where this was applicable. Nonetheless, future studies would be improved by using an assessment protocol that has all study participants complete full symptom assessments and uses validated tools across all age ranges.

In addition, this study is somewhat limited in its assessment of demographic factors. Children aged <6 years were excluded from the analyses of symptom outcomes because the mental health assessments used in this study were not validated for this age range. While less common in this age group, children aged <6 years may experience SITBs [ 80 ], and there are mental health symptom assessments designed for use in young children [ 81 , 82 ]. Thus, future studies would be strengthened by the inclusion of measures suitable for children of all ages. The measure of race or ethnicity used for part of this study was limited by a lack of representation racial and ethnic minority people and people of mixed race. Although more than half the cohort (1149/2161, 53.17%) identified as a race other than White, we were unable to assess race or ethnicity as a potential predictor of symptom severity due to the lack of specificity of our measure. In recent years, increases in suicide rates of young people have been particularly pronounced among racial and ethnic minority people [ 83 ], and there is evidence that web-based mental health resources may be particularly critical for identifying and mitigating SITBs in populations historically underserved by traditional mental health care [ 84 ]. An assessment of the relationship between demographics and SITB-related outcomes was outside of the scope of this study. However, we found that children and adolescents with SITBs were more likely to be female than male, and children and adolescents with SITBs tended to be older than children and adolescents without SITBs. Indeed, it is likely that these demographic factors may predict or otherwise relate to mental health outcomes and responsiveness to behavioral care. Therefore, future research should seek to assess the role of demographic factors in SITB-related outcomes more directly, including the use of a more precise measure of race and ethnicity.

Future Directions

Considering both current research and the findings presented here, we recommend the following for future research: (1) Conduct qualitative follow-up studies of children and adolescents and their families who have used digitally administered crisis support to increase understanding of the user experience and facilitate consequent improvements to these services. Indeed, qualitative studies have been crucial to expanding and improving digital mental health services in the past [ 85 ]. (2) Implement and investigate the effectiveness of web-based intensive outpatient programs for children and adolescents with SITBs and related mental health symptoms. Early evidence suggests that both virtual and in-person intensive outpatient programs for SITBs and related symptoms are acceptable modes of treatment for those who are either transitioning out of, or looking for alternatives to, inpatient programs [ 86 , 87 ]; however, more research is necessary among commercially available pediatric DMHIs. (3) Incorporate peer support and investigate its impact in digital care for SITBs and other acute conditions because a growing body of research suggests that peers, particularly those who have experienced SITBs, may play an important role in SITB prevention and treatment programs [ 88 ].

Conclusions

This study provides preliminary evidence for the utility and effectiveness of SITB assessment, mitigation, and ongoing mental health care in the context of a collaborative care DMHI. Children and adolescents with SITBs exhibited unique demographic characteristics and baseline mental health symptom severity compared to those without SITBs; however, children and adolescents’ symptoms improved throughout care regardless of SITB presentation. Further research is necessary to replicate these results in an experimental setting and determine whether child and adolescent DMHI participation also reduces SITBs and the use of emergency medical services.

Acknowledgments

Funding for this study was provided by Bend Health, Inc.

Data Availability

The data sets analyzed during this study are not publicly available because this would violate the privacy policy of Bend Health, Inc. However, aggregated and anonymized data that are not associated with individual users and do not include personal information are available from the corresponding author on reasonable request.

Authors' Contributions

DL-S was responsible for conceptualization, methodology, formal analysis, writing the original draft, reviewing and editing the manuscript, and visualization. LGH was responsible for conceptualization, methodology, formal analysis, writing the original draft, reviewing and editing the manuscript, and visualization. ABB was responsible for writing the original draft and reviewing and editing the manuscript. JH was responsible for conceptualization, writing the original draft, reviewing and editing the manuscript, and supervision. RG was responsible for conceptualization, writing the original draft, and reviewing and editing the manuscript. MR was responsible for reviewing and editing the manuscript and funding acquisition. KM was responsible for reviewing and editing the manuscript. AP was responsible for reviewing and editing the manuscript.

Conflicts of Interest

At the time of initial submission for publication, all authors were employed or contracted with Bend Health, Inc, which delivered the treatment used in this retrospective study. However, the authors’ employment status and salary were not, and are not, dependent upon the results of their research.

Supplemental methods information, detailing the measure of race and ethnicity used in the study.

Supplemental results, including detailed rates of identified risk factors for self-injurious thoughts and behaviors, as well as descriptive statistics and between-group comparisons for the timing of assessments taken after the start of care.

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Abbreviations

behavioral care manager

Columbia–Suicide Severity Rating Scale

digital mental health intervention

emergency department

Generalized Anxiety Disorder-2

Generalized Anxiety Disorder-7

Patient Health Questionnaire-2

Patient Health Questionnaire-9, adolescent version

Patient-Reported Outcomes Measurement Information System

rapid crisis support team

self-injurious thoughts and behaviors

Edited by A Mavragani; submitted 22.11.23; peer-reviewed by N Kaur, H Kautz; comments to author 20.01.24; revised version received 16.02.24; accepted 17.06.24; published 16.08.24.

©Darian Lawrence-Sidebottom, Landry Goodgame Huffman, Aislinn Brenna Beam, Kelsey McAlister, Rachael Guerra, Amit Parikh, Monika Roots, Jennifer Huberty. Originally published in JMIR Formative Research (https://formative.jmir.org), 16.08.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

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Are We Thinking About the Youth Mental Health Crisis All Wrong?

Global trends in economics, climate and technology are weighing on young adults, a report finds. It recommends overhauling how we approach mental health care.

Boy sits behind his backpack leaning against lockers with his hand on his head while two other people walk down the hall.

By Christina Caron

Chloé Johnson, 22, has been feeling hopeless lately.

She’s struggling to focus on classes at her local community college in Dallas while also working full-time, making $18 an hour as a receptionist.

Her car broke down, so the $500 that she had managed to save will now go toward a down payment for a used vehicle.

And she was recently passed over for a promotion.

“Right now it just feels, like, very suffocating to be in this position,” said Ms. Johnson, who was diagnosed last year with bipolar II disorder, depression and A.D.H.D. “I’m not getting anywhere or making any progress.”

It’s an endless loop: Ms. Johnson’s mental health has worsened because of her financial difficulties and her financial problems have grown, partly because of the cost of mental health treatment but also because her disorders have made it more difficult to earn a college degree that could lead to a more lucrative job.

“I’ve failed several classes,” she said. “I burn out really easily, so I just give up.”

The mental health of adolescents and young adults has been on the decline and it’s partly because of “harmful megatrends” like financial inequality, according to a new report published on Tuesday in the scientific journal The Lancet Psychiatry. The global trends affecting younger generations also include wage theft , unregulated social media , job insecurity and climate change , all of which are creating “a bleak present and future for young people in many countries,” according to the authors.

Why focus on global trends?

The report was produced over the course of five years by a commission of more than 50 people, including mental health and economic policy experts from several continents and young people who have experienced mental illness.

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KOICA, United Nations call for an Adolescent Pregnancy Prevention Law in PH

Following the commemoration of International Youth Day, the Korea International Cooperation Agency (KOICA) and the United Nations in the Philippines, including the United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), jointly call for the urgent passage of the adolescent pregnancy bill in the Philippines. This legislation is crucial in addressing the rising rates of adolescent pregnancy and ensuring the well-being of young people in the country.

The proposed legislation aims to provide a comprehensive national framework for preventing adolescent pregnancies and ensuring the well-being of young children in the Philippines. While the bill has been approved by the House of Representatives, its progress in the Senate has stalled, highlighting the urgent need for action.

Recognizing the pressing need, the UN agencies are collaborating on the KOICA-funded Joint Programme on Accelerating the Reduction of Adolescent Pregnancy (JPARAP) in Southern Leyte and Samar. This program focuses on strengthening comprehensive sexuality education and improving access to adolescent-friendly sexual and reproductive health services.

"Having legislation that ensures access to essential reproductive health services is a crucial step towards a more equitable and sustainable future, where every young person can thrive and reach their full potential,” said Gustavo González, UN Resident Coordinator in the Philippines. "Adolescent pregnancy is also not just a health issue, but a social and economic one as well. This bill will help us address the root causes of adolescent pregnancy, including lack of access to education and health services."

The urgency of the situation is underscored by data from the Philippines’ Commission on Population and Development, which reveals a 10.2% increase in live births by girls aged 10-19 between 2021 and 2022.

KOICA also expressed its strong support for the bill. "We believe that investing in young people is essential for sustainable development. In addition to celebrating 75 years of Korea-Philippines diplomatic relations and 30 years of KOICA’s presence in the Philippines, this bill will make us more inspired to strengthen our assistance to the country’s health projects. We assure you of KOICA’s continuing support and commitment not only for better health and well-being, but also a brighter future for young Filipinos," said KOICA Country Director Kim Eunsub.

UNFPA stresses the necessity of the bill to remove barriers to healthcare access for adolescents. Currently, young people under 18 require written parental consent for family planning services, which can significantly hinder their access to essential care.

“Adolescent pregnancy can result in significant health risks, including increased rates of preventable maternal and infant deaths, as well as the dangerous practice of unsafe abortions. Having a comprehensive framework to address this urgent issue and to protect the sexual and reproductive health and rights of young Filipinos, will help empower adolescents to make informed choices about their bodies and pave the way for better futures," said UNFPA Philippines Country Representative Dr. Leila Saiji Joudane.

Meanwhile, UNICEF underscored the importance of protecting the rights and aspirations of young girls.

“Adolescent girls’ dreams to learn and get decent jobs should not be cut short. UNICEF is committed to supporting girls through laws, policies and programmes that prioritize their rights, their agency, and opportunities to pursue their dreams and to prevent early and unintended pregnancies. This bill needs to retain the clauses that better define roles and accountability of duty bearers, which can help everyone in the community to work together to tackle the social factors that lead to more teen pregnancies,” said Behzad Noubary, UNICEF Philippines Representative a.i.

“These girls have the right to be informed about decisions that affect their lives. They need support, not stigma and blame,” he said.

The World Health Organization also recognizes that addressing adolescent pregnancy is a global health and development priority.

“Addressing adolescent pregnancy is part of the global health and development agenda. Together with partners, WHO Philippines continues to address adolescent pregnancy by supporting national programmes and policies. Rights-based policies alongside community-based care and evidence-informed interventions are crucial to strengthening frameworks and strategies to scale up interventions and collective action from various sectors, agencies, and communities,” said Dr Graham Harrison, Officer-in-Charge of WHO Philippines.

The UN agencies and KOICA call on all stakeholders, including government agencies, civil society organizations, and young people themselves, to unite in advocating for the passage of the adolescent pregnancy bill to create a brighter future for young people in the Philippines.

About the Joint Programme on Accelerating the Reduction of Adolescent Pregnancy (JPARAP):

This is a joint initiative of UNFPA, UNICEF, WHO, and KOICA that aims to reduce adolescent pregnancy in Southern Leyte and Samar. The partners are working closely with the Department of Health, the Department of Education, and the governments of Samar and Southern Leyte, as well as other government agencies in rolling out adolescent-friendly services, building the capacity of community adolescent health service providers, accelerating the integration of comprehensive sexuality education in schools, implementing youth leadership and governance initiatives, and conducting research on adolescent pregnancy and child, early, and forced marriage.

The 2021 Young Adult Fertility and Sexuality Study showed that Eastern Visayas, where Samar and Southern Leyte are located, has one of the highest rates of 15 to 19-year-old female youths that had begun childbearing.

For more information contact:

Kristine Guerrero | Media and Communications Analyst | United Nations Population Fund | [email protected]

Lely Djuhari | Advocacy & Communication Chief| UNICEF Philippines |

Cling Malaco | Communications Officer | World Health Organization Philippines | [email protected]

Media Contacts

Cling Malaco

Communications Officer

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