Understanding the Complex Mental Health Challenges of Children and Adolescents Seeking Community-based Care

Abstract

Studies have shown that children and adolescents with neurostructural and/or neurodevelopmental challenges experience worse mental health outcomes than their neurotypical peers, including more extensive service use, more severe symptomatology, and greater functional impairment. Despite the poor prognoses of these children and adolescents, few studies have investigated the neurocognitive contributions to mental health complexity among those seeking community-based mental health services. At present, environmental/social and behavioural factors remain the primary focus of treatment plans and much of the research examining this complex population has targeted psychosocial determinants. However, interventions based on these factors alone are not always effective, as they fail to account for neurocognitive challenges, which can significantly contribute to psychiatric presentations. This dissertation involves two studies that aimed to address these gaps in the literature and inform current practices in paediatric community mental health settings. Using Structural Equation Modeling (SEM), Study 1 tested the generalizability of a path model predicting service use among those with (n = 66) and without (n = 97) neurodevelopmental disorders (NDs). As expected, those with NDs had higher levels of symptomatology and greater service use than those without, and there were notable differences in the predictive pathways across ND groups. Similar paths were found between externalizing challenges and service use among all children/adolescents; however, the paths from internalizing challenges, early life adversity, and sex were only significant among the ND group, indicating that neurodevelopmental status is an important moderator of outcomes. In Study 2, a mixed methods approach was employed to examine how neuropsychological information could help inform current practice. Qualitative results confirmed that neuropsychological factors are often overlooked when utilizing current approaches and that observable symptoms, rather than underlying causes, are a primary focus of treatment. Further, neurocognitive deficits were found to be associated with self-reported interpersonal difficulties and caregivers’ reports of externalizing; however, only caregiver-reported externalizing challenges correlated with poorer treatment outcomes. Importantly, neurocognitive challenges were associated with long-term treatment responses, suggesting that these factors may be an important therapeutic target. Collectively, these findings indicate that using an exclusively psychosocial treatment approach, without considering neuropsychological factors, may not be effective among complex cases.