Objective: Traumatic stress can impact behaviours and neurological functioning of children and youth, with symptoms appearing similar to behaviours associated with psychiatric diagnoses (Siegfried et al., 2016). This study sought to examine the link between provisional diagnoses and trauma in a sample of children/youth receiving mental health services. Methods: A sample of 6649 children/youth (59% males) aged 4 -18 years (M age = 11.99, SD = 3.57) receiving services from 45 mental health agencies in Ontario were assessed using the interRAI Child and Youth Mental Health (ChYMH) instrument (Stewart et al., 2015a). We examined the interRAI Traumatic Life Events Collaborative Action Plan (CAP; Stewart et al., 2015b) and provisional diagnoses of attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, reactive attachment disorder (RAD), mood disorders, substance-related disorders, and sleep disorders. Results: Compared to boys, girls were more likely to trigger the interRAI Traumatic Life Events CAP and to have a provisional diagnosis of anxiety, mood, and sleep disorders. Boys were more likely to have a provisional diagnosis of ADHD than girls. Multiple logistic regression analyses indicated that boys diagnosed with substance-related disorders had 1.79 higher odds of triggering the interRAI Traumatic Life Events CAP. ADHD, anxiety disorders, RAD, and mood disorders were also each significant predictors of potential traumatic stress regardless of sex. Conclusions/Implications: Findings suggest that several provisional diagnoses were significantly related to potential traumatic stress. Clinicians may find value in assessing for trauma, asking the question "What happened?" when confirming a psychiatric diagnosis in order to determine the best plan of care.
This study investigated whether children/youth in Ontario triaged to residential services showed a higher intensity of need than those referred to outpatient services, and whether residential treatment gains were sufficient for transition to community services. Participants included 2053 children/youth assessed at 23 diverse mental health agencies across Ontario using the interRAI™ Child and Youth Mental Health (ChYMH) instrument. Various presenting problems were examined utilizing scales including: Disruptive/Aggressive Behavior, Hyperactive/Distraction, Social Disengagement, Anxiety, and Sleep Difficulties. Analyses were conducted separately for boys and girls. Notable differences were found in the initial assessment, with residential boys scoring higher on all scales than outpatient boys, and residential girls scoring higher on the externalizing scales (Disruptive/Aggressive Behavior, Hyperactive/Distraction) than outpatient girls. Treatment gains at residential discharge included improvements in Anxiety, Social Disengagement, Hyperactive/Distraction and Sleep Difficulties for boys and girls to levels at or below the initial scores of outpatient peers. Disruptive/Aggressive Behavior is still a high need following residential services. The results highlight differences in severity of mental health presentation between children/youth receiving residential and outpatient services, and how multiple agencies in Ontario are providing services that successfully reduce the severity of mental health needs.
Efficacy of psychotropic medication depends in large part on successful adherence to prescribed regimens. This study investigated child/youth nonadherence in relation to family dynamics and informal support. The participants were 10,225 children and youth prescribed psychotropic medication and receiving services from 50 Ontario mental health agencies, assessed with the interRAI™ Child and Youth Mental Health (ChYMH) and ChYMH-Developmental Disability (ChYMH-DD) tools. Findings suggest a cycle of parental stress and child/youth medication nonadherence possibly leading to or even perpetuated by worsening psychiatric symptoms. Informal supports do not appear to moderate this cycle. While the present data cannot speak to causes of medication nonadherence in children/youth or where the cycle begins, the results are consistent with the extant literature calling for attention to parental wellbeing to support children/youth for optimal therapeutic benefits. Understanding home dynamics related to nonadherence can assist care planning that engages the family to achieve best possible child/youth outcomes.
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