Universal Child Mental Health Screening for Parents: a Systematic Review of the Evidence.

Childhood represents a critical window for the emergence and treatment of mental health disorders, yet many are not being identified, or are identified too late to receive adequate intervention. This systematic review (Prospero registration: CRD42022299560) aimed to determine the effectiveness and acceptability of parent reported universal mental health screening (UMHS) to improve the early identification of children at-risk of mental health difficulties, and to identify barriers and enablers that may influence parental engagement. Six databases were searched in February 2022 for peer-reviewed, primary research. Studies conducted in targeted populations, evaluating psychometric properties, or focused on screening non-psychological problems were excluded. Ten studies examined parent reported (n = 3,464 parents) UMHS for children from birth to 18 years, suggesting an overall scarcity of research. Findings are presented in a table of study characteristics and a narrative summary of acceptability, effectiveness, barriers, and enablers. Quantitative findings indicated that parents generally support and accept UMHS. Research assessing effectiveness was limited, although two studies indicated increased referrals and referral adherence following positive screens. Confidentiality and stigma were commonly identified barriers. Quality assessment using the Mixed Methods Appraisal Tool indicated that studies varied in quality, meeting four to seven of the seven quality criteria. Understanding and addressing parent attitudes to UMHS across settings is necessary for the successful implementation of screening and improvement of child mental health outcomes. More high-quality research studies, including randomized controlled trials are therefore needed to examine the acceptability and effectiveness of UMHS for parents and their children.

Sympathetic nervous system functioning during the face-to-face still-face paradigm in the first year of life.

Contemporary theories of early development and emerging child psychopathology all posit a major, if not central role for physiological responsiveness. To understand infants' potential risk for emergent psychopathology, consideration is needed to both autonomic reactivity and environmental contexts (e.g., parent-child interactions). The current study maps infants' arousal during the face-to-face still-face paradigm using skin conductance (n = 255 ethnically-diverse mother-infant dyads; 52.5% girls, mean infant age = 7.4 months; SD = 0.9 months). A novel statistical approach was designed to model the potential build-up of nonlinear counter electromotive force over the course of the task. Results showed a significant increase in infants' skin conductance between the Baseline Free-play and the Still-Face phase, and a significant decrease in skin conductance during the Reunion Play when compared to the Still-Face phase. Skin conductance during the Reunion Play phase remained significantly higher than during the Baseline Play phase; indicating that infants had not fully recovered from the mild social stressor. These results further our understanding of infant arousal during dyadic interactions, and the role of caregivers in the development of emotion regulation during infancy.

Building a National Clinical Trials Network in child and youth mental health: Growing Minds Australia.

Many fields of medicine have benefitted from the formation of clinical trials networks, whereby researchers come together on a large scale to identify high-priority questions and implement coordinated clinical trials. Clinical trials networks in the field of mental health, however, have been rare and largely absent from the Australian context. Here, we present an overview of the newly formed Growing Minds Australia Clinical Trials Network, which represents the first comprehensive clinical trials network in child and youth mental health in Australia. The 60 principal members of the Growing Minds Australia Clinical Trials Network represent teams across 19 diverse areas related to specific forms of psychopathology (e.g. internalising, externalising, neurodevelopmental disorders, early psychosis, substance use), specific research methods and processes (e.g. health economics, eHealth, implementation science) and specialised areas of practice (e.g. school-based systems, parenting interventions, Indigenous mental health, refugee families). Core functions of the Growing Minds Australia Clinical Trials Network include collaborative trial protocol development; peer review, prioritisation and endorsement of proposed trials; training; development of clinical guidelines; and consumer representation. The research by the clinical trials network will encompass the populations typically accessing youth mental health services, while placing a key emphasis on the early periods of life, and the role of parents and caregivers as critical partners in the co-design of research and the delivery of intervention and prevention strategies. The structures and processes built into the network are designed to coordinate collaboration between diverse stakeholders and ensure that provisions for translation are integrated into research from the outset. In this paper, we examine the potential for a dedicated clinical trials network to initiate fundamental improvement in child and youth mental health systems, and discuss the unique and complex challenges associated with establishing such an initiative.

More than a feeling? An expanded investigation of emotional responsiveness in young children with conduct problems and callous-unemotional traits.

Children with conduct problems and high callous-unemotional (CP+CU) traits are characterized by dampened emotional responding, limiting their ability for affective empathy and impacting the development of prosocial behaviors. However, research documenting this dampening in young children is sparse and findings vary, with attachment-related stimuli hypothesized to ameliorate deficits in emotional responding. Here we test emotional responsiveness across various emotion-eliciting stimuli using multiple measures of emotional responsiveness (behavioral, physiological, self-reported) and attention, in young children aged 2-8 years (M age = 5.37), with CP+CU traits (CP+CU; n = 36), CPs and low CU traits (CP-CU; n = 82) and a community control sample (CC; n = 27). We found no evidence that attachment-related stimulus ameliorated deficits in emotional responding. Rather, at a group level we found a consistent pattern of reduced responding across all independent measures of responsiveness for children with CP+CU compared to the CC group. Few differences were found between CP+CU and CP-CU groups. When independent measures were standardized and included in a regression model predicting to CU trait score, higher CU traits were associated with reduced emotional responding, demonstrating the importance of multimodal measurement of emotional responsiveness when investigating the impact of CU traits in young children.

Still connecting the dots: An investigation into infants' attentional bias to threat using an eye-tracking task.

An attentional bias toward threat has been theorized to be a normative aspect of infants' threat and safety learning, and an indicator of risk for internalizing psychopathology in older populations. To date, only four studies have examined this bias using the dot-probe task in infancy and the findings are mixed. We extended the literature by examining patterns of attention to threat in a culturally and linguistically diverse sample of infants aged 5-11 months old (N = 151) using all measures previously employed in the infant dot-probe literature. Given that an attentional bias toward threat is associated with higher risk of developing anxiety disorders later in life, we also examined how negative affect-an early correlate of later anxiety disorders-is related to attentional bias toward threat in infancy. This study was the first to use a consistent measure of negative affect across the whole sample. An eye-tracking dot-probe task was used to examine attentional bias toward threat (i.e., angry faces) relative to positive (i.e., happy faces) stimuli. Results showed that an attention bias to threat was not characteristic of infants at this age, and negative affect did not moderate the putative relationship between attention and emotional faces (angry, happy). These findings therefore suggest that attention biases to socio-emotional threat may not have emerged by 11 months old.

No hard feelings: maternal emotion socialization and callous-unemotional traits in children.

Parents' identification and discussion of their own and their children's emotions are important emotion socialization behaviors (ESBs) that may mitigate child conduct problems (CPs). However, if parents perceive their child to be relatively unemotional, which may be the case for children with conduct problems and high callous-unemotional traits (CP + CU), these parents may be limited in their capacity to use ESBs effectively. This study tested these questions by looking at ESBs in mothers (N = 145) of children aged 2-8 years with CP + CU (n = 24), CPs and low CU traits (CP-CU; n = 94) and a non-clinical community sample (n = 27). After watching an emotional movie excerpt, mothers were asked to (1) provide ratings of their child's emotional experience and then (2) engage in a debriefing task with their child about the content. Children's expressed emotion during the excerpt and transcriptions of the debriefing task were coded by masked raters. Unexpectedly, mothers' perceptions of their children's emotion did not vary by group. Emotional ratings provided by mothers of children in the CP + CU group most closely aligned with ratings from independent observers. ESBs did not differ by group in the debriefing task. Mothers of children with CP + CU traits were shown in this study to be reliable reporters of their children's expressed emotion and showed similar rates of parental ESBs as mothers of children in the other groups. Results are discussed in reference to various models of parenting and CU traits that might account for these unexpected findings.

Moral reasoning, emotion understanding, and callous-unemotional traits in early-to-middle childhood.

Relatively little is known about features of moral reasoning among young children with callous-unemotional (CU) traits (e.g., lack of guilt and empathy). This study tested associations between CU traits and emotion attributions (i.e., identification of others' emotional states) and justifications (i.e., explanations for those emotional states), across social scenarios involving discreet versus salient distress cues. The participants were boys aged 6-to-10 years (N = 50; Mage  = 7 years 7 months), who were interviewed about 12 hypothetical scenarios (eight with discreet and four with salient distress cues). Regression models indicated that CU traits, in interaction with high levels of antisocial behaviour, were associated with reduced emotion attributions of fear in discreet but not salient immoral scenarios. Higher CU traits were also associated with reduced justifications referencing others' welfare in discreet scenarios, and increased references to action-orientated justifications in salient scenarios. These findings suggest that CU traits are associated with early moral reasoning impairments and that salience of distress may be important to these processes.

Is Callous Always Cold? A Critical Review of the Literature on Emotion and the Development of Callous-Unemotional Traits in Children.

Low emotional responsiveness is considered a core feature of callous-unemotional (CU) traits in childhood and, in the context of antisocial behavior, a precursor of psychopathic traits in adulthood. However, recent findings suggest that CU traits are not always characterized by low emotional responsiveness and the evidence base requires review. This review asks a fundamental question- 'Is callous always cold?'-with a specific focus on emotional responsiveness and CU traits in children with conduct problems (CPs). PRISMA review protocols were followed to identify literature reporting on emotional responsiveness for children 3-18 years with CPs and varying (high and low) CU traits. Results from eligible studies were contrasted by age (children 3-11 years, adolescents 12-18 years), emotional responsive measurement type (physiological, behavioral, self-report), emotion-eliciting stimuli type (interactive activities, static imagery, film) and socio-emotional context of the stimuli (other-orientated, self-orientated, neutral). This review highlights considerable variation in results across studies: reduced emotional responsiveness was not synonymous with participants demonstrating high CU traits. A more consistent picture of reduced emotional responsiveness in participants with high CU traits was found when studies used physiological measures, when stimuli were other-orientated in socio-emotional context, and in older, adolescent samples. In conclusion, this paper advocates for a more nuanced understanding of the relationship between high CU traits and the specific factors involved in emotional responsiveness, ultimately suggesting that callous is not always cold. Given that emotional responsiveness is central to theories of moral development, these findings may suggest innovative approaches to early intervention.