Time trends in childhood mental health problems: a 40-year cross-cohort comparison

Lead Research Organisation: Cardiff University
Department Name: School of Medicine

Abstract

Many people and professionals are worried that child mental health problems have become more common in recent years. For example, more children today are diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) than in the past. However, this could be due to better understanding of the condition by teachers and doctors. It is important to understand whether or not rates of ADHD, and of other child mental health problems such as emotional symptoms and behavioural problems, have actually increased in the population as a whole. This requires data from unselected representative national samples assessed in the same way over time. In our previous research we have shown that emotional and behavioural problems in adolescence have in fact become increasingly common in recent years. At present we don't know whether the same holds true for mental health problems in pre-adolescent children. The study will answer this question by using data on the mental health of seven-year-olds from five large UK cohorts studied between 1965 and 2008. Each study has used identical or closely comparable child mental health screens.

Another important issue is what might explain any changes in children's mental health. Very few studies have looked at this, because comparable information about possible contributory factors and mental health is only rarely available for the same individuals when combining cohorts across time. Mental health trends in adolescence are partly explained by increasing rates of parental mental health problems, by changes in youth drinking and drug use, and by increasingly stressful educational experiences. This type of research now needs to be undertaken in younger children. We will do this by testing whether rates of early known risk factors have changed across the five cohorts, and how such changes have contributed to trends in child mental health. We will focus on changes in pre- and peri-natal risks (e.g. prenatal maternal smoking, prematurity and low birth weight), in early neurodevelopmental risk factors (e.g. head injury and epilepsy), and early family adversity (e.g. parental involvement, parental divorce and family poverty).
Our third main aim is to test whether the impact of child mental health problems on children's later health and wellbeing has changed. In particular, we want to see whether any increases in mental health problems at age seven foreshadow increases in mental health problems in later childhood and adolescence. We also want to examine the consequences for children's psychosocial adaptation, including their peer relationships and educational success. This is made possible because three of the cohorts are being followed as they grow older. Information from middle childhood and adolescence is now available for two of these cohorts, previously assessed at age seven in 1965 and the late 1990s. Longitudinal outcome data will also soon become available for the most recent cohort of children who are currently being assessed at age eleven.

Understanding whether rates of child mental health problems have changed, the reasons behind trends in child mental health, and the consequences for children's later development has important practical consequences. This information in crucial for better planning of services, for influencing national and local policy and priorities, and for identifying targets for intervention to improve the mental health of future generations of children.

Technical Summary

Accurate understanding of mental health trends requires the comparison of representative unselected population samples assessed in the same way at different points in time. Cross-cohort comparisons have shown that rates of adolescent emotional and behavioural problems have increased in recent decades and identified some possible contributory factors. Evidence on mental health trends in pre-adolescent children is lacking. The study objectives are i) to test trends in child emotional, conduct and ADHD problems over a forty year period (1965-2008), ii) to test trends in known risk factors (pre- and peri-natal, neurodevelopmental, and early family adversity) and their contribution to trends in child mental health, iii) to assess the impact of child mental health problems on later psychosocial functioning for earlier and later cohorts. The study combines data across five UK population cohorts of seven-year-olds - the National Child Development Study (NCDS, assessed in 1965, N = 13500), the Avon Longitudinal Study of Parents and Children (ALSPAC, assessed in 1998/9, N = 8500), the ONS British Child and Adolescent Mental Health Surveys (assessed in 1999, N = 1000 and in 2004, N = 650), and the Millenium Cohort Study (MCS, assessed in 2008, N = 13500). Comparable parent-rated symptom screens were used in all five studies - the Rutter A scale in 1965 and the Strength and Difficulties Questionnaire (SDQ) in the latter four cohorts. This study draws on a core set of comparable items across the two scales. Minor differences in response format and wording will be addressed using calibration data. The cohorts include comparable assessments of proposed risk factors. Impact of child mental health problems on functioning will be assessed using parent and teacher symptom scores at age 11 (NCDS, ALSPAC, MCS) and age 16 (NCDS, ALSPAC), and exam attainment at age 16 (NCDS, ALSPAC).

Planned Impact

One in ten children and adolescents suffer from clinically significant emotional and behavioural disorders. Mental health problems impair children's quality of life and place a burden on families and schools. They also show strong continuities with mental health problems in adolescence and adulthood, and have consequences for young people's future life chances, health and education. It is therefore a key social, economic and health priority to develop policies and practical interventions that reduce the incidence and burden of child psychopathology.

It is of major concern that evidence now highlights that mental health problems have become substantially more common in recent decades, at least in adolescence. We do not yet know whether similar mental health trends are also observed in younger children. Direct tests of possible explanatory factors are rare. Some research has begun to identify possible contributors to mental health trends, but have mainly focused on risks of particular relevance to adolescents (e.g. substance use or exam stress). We do not know the implications of changes in pre-/peri-natal, neurodevelopmental, or early family risk factors for trends in child mental health. Consequences of changes in child mental health for functioning and future psychosocial adjustment also need to be better understood.

Our research addresses each of these important knowledge gaps, and findings will be of direct benefit to national and local policy makers, as well as more generally to health and social care professionals working with young children. Research has the potential to make significant impact on policy and practice. Knowing if mental health problems have increased for pre-adolescent children will inform whether policy efforts should already be focused on families with younger children. More generally, establishing changes in population prevalence contributes to determination of national and local government policy priorities. In this way, our previous research contributed to efforts to make youth mental health a national policy priority. Third, identification of plausible contributory factors underlying child mental health trends is a pre-requisite for evidence-based policy and prevention efforts to improve the mental health of future generations of children.

The applicants have a strong track record of engagement with policy makers, health and social care professionals, and others to maximise the impact of findings from the time trends research programme. Findings have also been communicated to the wider public via national and international media. The achievement of impact of this study will again be facilitated through rapid dissemination of key findings via web-based briefing papers, presentations to policy and professional audiences, and via local and national media. As noted in the application, this strategy has achieved significant policy impact, with citations by numerous governmental (e.g. parliamentary select committees on education and health, NICE, Institute of Medicine, WHO) and non-governmental bodies (e.g. Children's Society, Mind, NSPCC).

Publications

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Botting N (2016) Emotional health, support, and self-efficacy in young adults with a history of language impairment. in The British journal of developmental psychology

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Collishaw S (2019) Brief report: a comparison of child mental health inequalities in three UK population cohorts. in European child & adolescent psychiatry

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Collishaw S (2015) Annual research review: Secular trends in child and adolescent mental health. in Journal of child psychology and psychiatry, and allied disciplines

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Durkin K (2016) Learning to drive in young adults with language impairment. in Transportation research. Part F, Traffic psychology and behaviour

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Langley K (2017) An investigation of changes in children's mental health in Wales between 2007/2008 and 2012/2013. in Social psychiatry and psychiatric epidemiology

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Mok PL (2014) Longitudinal trajectories of peer relations in children with specific language impairment. in Journal of child psychology and psychiatry, and allied disciplines

 
Description Invited briefing paper - Children's Commissioner for Wales
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description Time trends in child mental health
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description policy brief on mental health trends for children's commissioner
Geographic Reach National 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description Wolfson Centre for Young People's Mental Health
Amount £10,000,000 (GBP)
Organisation The Wolfson Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 11/2020 
End 09/2025
 
Title Calibration 
Description Calibration methods development 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact ESRC Research methods festival presentation on cross-cohort comparisons, including calibration. Invited Annual Research Review on time trends in press in Journal of Child Psychology and Psychiatry. 
URL http://www.ncrm.ac.uk/RMF2014/home.php
 
Title calibration dataset 
Description calibration data used for harmonising child mental health data across uk cohorts 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact used in papers in progress 
 
Description ADR Wales Mental Health Research Group 
Organisation Government of Wales
Country United Kingdom 
Sector Public 
PI Contribution Dissemination of information about youth mental health trends Research input with respect to population prevalence and risk factors for child mental health problems Expert advice
Collaborator Contribution Policy context Scoping of administrative data relevant to mental health research
Impact none as yet
Start Year 2020
 
Description Brazil/UK time trends project 
Organisation University of Sao Paulo
Country Brazil 
Sector Academic/University 
PI Contribution Development of new joint project to examine and compare trends in child mental health in middle income country (Brazil) and high income country (UK) settings.
Collaborator Contribution Development of new joint project to examine and compare trends in child mental health in middle income country (Brazil) and high income country (UK) settings.
Impact Research grant application submitted but unsuccessful
Start Year 2016
 
Description Early Intervention Foundation 
Organisation Early Intervention Foundation
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Joined scientific advisory project on EIF project on ACEs and child development.
Collaborator Contribution EIF agreed to sit on Implementation and Engagement Board for new Wolfson Centre for Young People's Mental Health
Impact EIF ACEs report to be published spring 2020. Wolfson Centre I&E board to sit annually 2021-2025
Start Year 2019
 
Description Increased diagnosis of developmental disorders: Are there really more children with Autism, Dyslexia, and ADHD? 
Organisation University of Bristol
Department School of Social and Community Medicine
Country United Kingdom 
Sector Academic/University 
PI Contribution provided scientific guidance ensure rigor around time trends analysis, and that the work meets the highest academic standards. Co-author on paper. Adviser on NIHR fellowship to use English NHS digital data to examine trends in child mental health
Collaborator Contribution Project Leaders
Impact Russell et al, 2015. Changes in diagnosis rates and behavioural traits of autism spectrum disorder over time. BJP Open, 1, 110-115. Multidisciplinary collaboration involving epidemiology, developmental psychopathology, child psychiatry, social science
Start Year 2013
 
Description Increased diagnosis of developmental disorders: Are there really more children with Autism, Dyslexia, and ADHD? 
Organisation University of Exeter
Department Department of Sociology, Philosophy and Anthropology
Country United Kingdom 
Sector Academic/University 
PI Contribution provided scientific guidance ensure rigor around time trends analysis, and that the work meets the highest academic standards. Co-author on paper. Adviser on NIHR fellowship to use English NHS digital data to examine trends in child mental health
Collaborator Contribution Project Leaders
Impact Russell et al, 2015. Changes in diagnosis rates and behavioural traits of autism spectrum disorder over time. BJP Open, 1, 110-115. Multidisciplinary collaboration involving epidemiology, developmental psychopathology, child psychiatry, social science
Start Year 2013
 
Description Increased diagnosis of developmental disorders: Are there really more children with Autism, Dyslexia, and ADHD? 
Organisation University of Exeter
Department Medical School
Country United Kingdom 
Sector Academic/University 
PI Contribution provided scientific guidance ensure rigor around time trends analysis, and that the work meets the highest academic standards. Co-author on paper. Adviser on NIHR fellowship to use English NHS digital data to examine trends in child mental health
Collaborator Contribution Project Leaders
Impact Russell et al, 2015. Changes in diagnosis rates and behavioural traits of autism spectrum disorder over time. BJP Open, 1, 110-115. Multidisciplinary collaboration involving epidemiology, developmental psychopathology, child psychiatry, social science
Start Year 2013
 
Description Schools Health Research Network 
Organisation School Health Research Network
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Integration of mental health measures in all-Wales biennial secondary school pupil assessments. Validation of existing mental health assessment using clinical interview Analysis of trends in youth depression in Wales Feasibility/acceptability pilot study of genetic sampling in classroom settings Integral part of new £10m Wolfson Centre for Young People's Mental Health and proposed 5 year research programmes
Collaborator Contribution Access to SHRN survey data Facilitation of PPI work with youth, parents and teacher groups Integral part of new £10m Wolfson Centre for Young People's Mental Health and proposed 5 year research programmes
Impact Melendez-Torres (2019) - paper on validation on wellbeing questionnaire Component of successful grant to Wolfson foundation for new £10m Centre for Young People's Mental Health
Start Year 2018
 
Description Welsh Assembly Government - joint post 
Organisation Government of Wales
Country United Kingdom 
Sector Public 
PI Contribution Joint funded post between Cardiff University and Welsh Government to start 2021. The post will bridge across the Wolfson Centre for Young People's Mental Health and Welsh Government. This role will focus on evaluation of youth mental health policy, on using scientific discoveries on youth mental health to inform further policy developments, and on ensuring that the research activities of the Wolfson Centre for Young People's Mental Health are informed by policy and practice stakeholders in Wales. It will involve data analysis of longitudinal population data, national administrative data sets, and repeated whole school population health and wellbeing surveys. The postholder will work in partnership with policy makers, practitioners and the public to facilitate and conduct policy evaluation studies. This will include time spent working within Welsh Government.
Collaborator Contribution joint funding and supervision of this research/policy post
Impact none as yet
Start Year 2020
 
Description ADR Mental Health User Group 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Member of the ADR Wales Mental Health User Group. Considered utility and scope for future of administrative data for mental health research with ONS and Welsh Government colleagues
Year(s) Of Engagement Activity 2020
 
Description B debate Barcelona 2014 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Two day debate to inform future international epidemiological studies involving brain sciences, and to discuss and inform public health policy.



Possible future collaborations discussed including possible links with WHO asthma worldwide monitoring to consider whether could be extended to cover child mental health trends.
Year(s) Of Engagement Activity 2014
URL http://www.bdebate.org/en/forum/environment-and-child-brain-development-challenges-global-context
 
Description Cym Taf Health Board R&D conference (clinicians) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Presentation of findings from time trends project to clinicians who helped in recruiting participants for calibration substudy

None as yet
Year(s) Of Engagement Activity 2014
 
Description ESRCResearchMethods 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Well attended talk on methods for undertaking cross-cohort comparisons in understanding trends in mental health, e.g. calibration. Talk filmed and publically available.

Requests for further information on calibration methods
Year(s) Of Engagement Activity 2014
URL http://www.ncrm.ac.uk/TandE/video/RMF2014/filmed.php?id=24ca418
 
Description Epidemiology of ADHD Workshop - Aarhus University, Denmark 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation Workshop Facilitator
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Invited to provide an international workshop funded by UK science and innovation network entitled "Epidemiology of ADHD"

Unknown
Year(s) Of Engagement Activity 2012
 
Description Mental health resilience (School Ysgol Plasmawr) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Invited talk for school Inset day to train teachers in relation to youth mental health resilience
Year(s) Of Engagement Activity 2018
 
Description National Safeguarding Week 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Invited presentation about promoting mental health resilience in at-risk young people today followed by debate. Around 40 social care and educational practitioners attended this session as part of National Safeguarding Week
Year(s) Of Engagement Activity 2017
URL https://www.cardiffandvalelscb.co.uk/wp-content/uploads/Final-Programme-of-Events.pdf
 
Description Organiser of ESRC Festival of Social Science. 'How can science improve mental health' 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact A level students from two secondary schools attended an event in which they were able to engage with researchers in psychology, mental health and neuroscience with interactive displays showcasing mental health research. Students were given guided tours of the genetics labs and the Cardiff University Brain Research Imaging Centre. The second part of the visit involved a debate about youth mental health with an expert panel comprising researchers and clinicians. Feedback from students and their teachers was very positive, and students reported better understanding about mental health, both schools agreed to strengthen links with our department, and one of the schools has already helped by participating in research since the event. Other plans are to have a youth advisory group to guide future research studies.
Year(s) Of Engagement Activity 2016
 
Description Parents advisory group 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Parent advisory group to inform design and implementation of Mental Health Genes and Environment Study (MAGES)
Year(s) Of Engagement Activity 2019
 
Description RCPannualtrends 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Symposium on trends in child mental heath, autism, and prenatal risk factors. Stimulated much discussion in this important annual meeting of UK Child and Adolescent Psychiatrists.

none as yet
Year(s) Of Engagement Activity 2014
 
Description Resilience - CAMHS 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Local
Primary Audience Health professionals
Results and Impact Delivered a talk on resilience to health professions from CAMHS

Unknown
Year(s) Of Engagement Activity 2013
 
Description Schools advisory events 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact School leaders from 5 schools attended workshop and University facilities tour to advise on planned Mental Health in Adolescence Genes and Environment Study (MAGES). Discussion resulted in significant amendments to study research protocol. Three schools now agreed to take part in study. One school requested formal links with Cardiff University as 'twinned' school.
Year(s) Of Engagement Activity 2018
 
Description Scout evening - genetics workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Third sector organisations
Results and Impact Educational workshop around genetics with scouts group comprising presentation and practical activities.
Year(s) Of Engagement Activity 2019
 
Description Tackling tomorrow (Cardiff, 2016) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Cymorth Cymru, Tackling tomorrow, 2016 aimed at understanding challenges affecting young people in Wales and to promote Welsh Assembly government and third sector organisation planning to meet future challenges. Workshops given to delegates at the conference on the theme of youth mental health trends. The workshops involved presenting the most up to date information on the prevalence and impact of mental health problems in young people and how these are and likely to continue changing this Century. The debate focused on possible areas of policy and practice intervention to promote youth mental health and to provide appropriate services to young people with mental health problems.
Year(s) Of Engagement Activity 2016
URL http://www.cymorthcymru.org.uk/en/events-and-training/events/tackling-tomorrow
 
Description Talk to SPRs, 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Seminar on life course links, risk and resilience in psychopathology for SPRs and consultant psychiatrists in South Wales
Year(s) Of Engagement Activity 2016
 
Description Time trends in child mental health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Regional
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Delivered a seminar entitled "time trends in child mental health" at Exeter University

Unknown
Year(s) Of Engagement Activity 2013
 
Description Time trends in child mental health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation Keynote/Invited Speaker
Geographic Reach Local
Primary Audience Health professionals
Results and Impact Delivered a talk entitled "time trends in child mental health" to specialist registrars in Child Psychiatry

Unknown
Year(s) Of Engagement Activity 2013
 
Description Together for Children and Young People, Cardiff 2015 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Participated in debate and workshops on CAMHS service development in Wales
Year(s) Of Engagement Activity 2015
URL https://www.eventsforce.net/nliah/frontend/reg/thome.csp?pageID=210965&eventID=662&eventID=662&CSPCH...
 
Description Youth advisory group 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Youth advisory group to inform design and implementation of MAGES schools study
Year(s) Of Engagement Activity 2019
 
Description formal meeting with Cardiff and Vale UHB to discuss joint research 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Meeting with health board directors to discuss plans for joint funded post and research collaboration in area of youth mental health.
Year(s) Of Engagement Activity 2020
 
Description formal meeting with Prince's Trust to discuss joint activity 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Third sector organisations
Results and Impact Agreement reached on future research collaboration and letter of support provided for funding application for new Youth Centre
Year(s) Of Engagement Activity 2019