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From childhood to adulthood: The origins of mental health struggles

Aussie-based Professor Mark Dadds (yep, his real name!) is the mastermind behind Movember’s Family Man a new online tool aimed at helping parents (especially dads) master the art of parenting. He’s spent decades researching parenting techniques and after working with hundreds of parents through the years, Mark knows a thing or two about keeping the family out of the chaos zone. 

It’s won’t come as a surprise that mental health has been a popular topic of conversation over the last year. And with the immergence of COVID-19, mental health has been pushed into the spotlighta welcome change for many Canadians. Organizations like men’s health charity, Movember have been focused on encouraging mental health awareness during these challenging times, launching programs and online tools like Movember Conversations to better help Canadians reach out when they might be struggling. But with this renewed focus, how nations support those experiencing depression, anxiety and other mental health struggles during this hard time has quickly become a hot topic, making it a priority in many countries, including Canada 

Yet despite this focus, children’s mental health continues to be relatively neglected in the general mental health conversation. Why is this a problem? Research shows that children’s mental health plays a significant role in determining the risk of experiencing mental health challenges in adulthood. Addressing it early could be the best way to prevent mental health struggles later in life.  

But let’s take a step back… 

Longitudinal studies from all over the world show that in fact, conduct problems in early childhood are the single most reliable precursor for mental disorders in adulthood. What is a conduct problem? Conduct problems (let’s call them CPs moving forward) typically refer to a cluster of aggressive, antisocial behavioural problems, sometimes presenting as mental health disorder like Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Typically diagnosed during childhood or adolescence, children who are diagnosed with ODD or CD may appear angry, defiant or hostile. And while many parents may initially think their child is simply misbehaving, these are very real mental disorders. The Canadian Paediatric Society says that an estimated 9 to 15 percent of preschool aged children are living with disruptive behaviour problems, showing symptoms that may be indicative of conduct problems.

While it may seem understandable that CPs can lead to antisocial behaviour and potential substance abuse issues later in lifemany people don’t realize that CPs in children are the most common precursor for adult mental health struggles. Not only this, but CPs can also impact an adult’s physical healthincluding poorer dental health, decreased lung function and more visits to the GP or even the hospital.  

How can we treat CPs so they don’t become a larger issue later in life? 

A landmark study conducted in the late 1990s by a team of researchers found that behavioural training for parents is perhaps the most effective of all psychosocial interventions for mental health problems. In fact, early identification and evidence-based treatment of CP leads to a positive change in roughly 50 to 60 percent of cases.2 Early research from a study in 1982, also showed that programmed changes in parental responsesso changing how one might deal with a behavioural issueleads to reliable and clinically significant changes in child behaviour.3 To put it simply, parenting programs aimed at treating child conduct problems work (and, in fact, are considered to be one of the top achievements of the mental health sciences). Not only do they make a difference, but they also have a significant positive and lasting impact.   

Hmm… so, is bad parenting to blame for conduct problems?  

The short answer to this is no. There is no single cause of child conduct problems. It is nearly impossible to differentiate the impact biology and environment have in the development of CPs, and the same can be said for the role genetics and psychology playsWe all know, while painkillers can cure a headache, headaches themselves aren’t caused by a lack of painkillers. With this metaphor in mindwe know the effectiveness of parent training programs does not mean poor quality parenting is behind the development of CPs. While certain approaches to parenting may be correlated with child conduct problems, it is just as much a product of the problem as it is potential cause. However, it is also the main solution. The reality is, parents are often the best resource a child has when it comes to overcoming behavioural struggles.  

Are there ways to treat CPs? 

Absolutely! There are some amazing parent training programs developed to help parents better understand and respond to CPs, including Movember’s newly launched free online program Family Man – which was developed by Prof. Mark Dadds himself. However, there are some ways we can substantially improve the outcomes of these current programs available.

First things first: Not only do we need to ensure that evidence-based interventions are made available to those who need thembut just as importantly that those who need them are supported in using these tools and programs that are made available to them. Countries like Canada and Australia should be looking to improve general understanding around mental health, conduct problems, and look to provide more child mental health services aimed at providing these evidence-based treatments. The more available these programs are, the better chance parents have of actually using them and experiencing the positive impact they can have 

And there’s a huge role for caregivers as well. Many parents don’t end up implementing the recommended parenting strategies that are integral to the current available treatments. If parents don’t play their part, the program simply won’t be effective. Yet there is little research being invested into how to better set these services up in a way that maximizing parental engagement.  

As many clinicians know, another barrier to effective practice is the current one-size-fits-all approach that characterizes mainstream approaches to CPs in child psychology and psychiatry. Children with conduct problems are not all the same. Clinicians know that rather than a one-size-fits-all model, the way forward lies with developing algorithms for carefully matching interventions to specific child’s characteristics. And I’m hopeful science can catch up. We now know wonderful things, like how the quality of specific parenting practices at critical times determine which of the child’s genes are activated, and how these changes translate to specific neural receptor patterns, thus altering vulnerability to lifetime mental health problems. There’s a whole new generation of mental health treatments. We’ve just got to get science there.  

How worried should I be about a CP diagnosis?  

At the end of these day, children who are experiencing CPs are not just ‘naughty children, nor are they are not just a product of poor parenting. Rather these problems can be one of the earliest reliable signs of potential mental and physical health issues later in life. This isn’t to say children experiencing conduct problems will not emerge as healthy, happy adults. Absolutely not! Children who demonstrate CPs are not a lost causevery much the opposite. However, it’s on us as parents, it’s on our policy makers, and it’s on our society to ensure our mental health systems are best prepared to prioritize and treat children who might be struggling with CPs.  

*This article has been adapted from the journal article“Helping troubled children: Seven things you should know about the origins of mental health disorders” by Mark R. Dadds. To read the article in its entirety, visit: https://www.psychology.org.au/inpsych/2012/june/dadds

Sponsored by: Movember