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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Children's Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25941.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Megan Snair, Rapporteur Forum for Children’s Well-Being: Promoting Cognitive, Affective, and Behavioral Health for Children and Youth Board on Children, Youth, and Families Division of Behavioral and Social Sciences and Education

THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the American Board of Pediatrics (Unnumbered Award); Centers for Disease Control and Prevention (200-2011-38807, TO #69); Conrad N. Hilton Founda- tion (17605); Doris Duke Charitable Foundation (2018120); Health Resources and Services Administration of the U.S. Department of Health and Human Services (HHSH250201500001I/75R60219F34017); and Robert Wood Johnson Foundation (74234). Additional support came from the American Academy of Pediatrics, the American Psychological Association, Autism Speaks, Children’s Hospital Associa- tion, the Global Alliance for Behavioral Health and Social Justice, the National Federation of Families for Children’s Mental Health, the Nemours Children’s Health System, the Society for Child and Family Policy and Practice, the Society of Clinical Child and Adolescent Psychology, Well Being Trust, and ZERO TO THREE. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-68337-1 International Standard Book Number-10: 0-309-68337-8 Digital Object Identifier: https://doi.org/10.17226/25941 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2020 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Children’s Mental Health and the Life Course Model: A Virtual Workshop Series: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25941.

The National Academy of Sciences was established in 1863 by an Act of Con- gress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, En- gineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medi- cine at www.nationalacademies.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

PLANNING COMMITTEE ON CHILDREN’S MENTAL HEALTH AND THE LIFE COURSE MODEL: A VIRTUAL WORKSHOP SERIES WILLIAM R. BEARDSLEE, Department of Psychiatry, Boston Children’s Hospital and Department of Child Psychiatry, Harvard Medical School THOMAS F. BOAT, Cincinnati Children’s Hospital Medical Center and Division of Pulmonary Medicine, University of Cincinnati LAUREL K. LESLIE, American Board of Pediatrics and Tufts University School of Medicine NEAL HALFON (Liaison), Center for Healthier Children, Families, and Communities, University of California, Los Angeles v

FORUM FOR CHILDREN’S WELL-BEING: PROMOTING COGNITIVE, AFFECTIVE, AND BEHAVIORAL HEALTH OF CHILDREN AND YOUTH WILLIAM R. BEARDSLEE (Co-Chair),1 Baer Prevention Initiatives and Department of Psychiatry, Boston Children’s Hospital; Department of Psychiatry, Harvard Medical School C. HENDRICKS BROWN (Co-Chair),1 Departments of Psychiatry, Behavioral Sciences, and Preventive Medicine, Feinberg School of Medicine, Northwestern University CHERYL POLK (Co-Chair),2 Safe & Sound DAVID W. WILLIS (Co-Chair),1 Center for the Study of Social Policy SANDRA BARRUECO,2 Catholic University of America HAROLYN M.E. BELCHER, Johns Hopkins University School of Medicine and Center for Diversity in Public Health Leadership Training, Kennedy Krieger Institute THOMAS F. BOAT,1 University of Cincinnati, College of Medicine; Cincinnati Children’s Hospital Medical Center FELESIA R. BOWEN,1 College of Nursing, Medical University of South Carolina RAHIL D. BRIGGS, ZERO TO THREE; Department of Pediatrics, Montefiore Medical Group TINA CHENG,2 Department of Pediatrics, Johns Hopkins University School of Medicine NATHANIEL Z. COUNTS, Montefiore Medical Group MARTHA B. DAVIS, Robert Wood Johnson Foundation ROBERT H. DUGGER,1 Hanover Provident Capital, LLC; ReadyNation ALEXA EGGLESTON, Domestic Programs, Conrad N. Hilton Foundation MARY FRISTAD, Society for Clinical Child and Adolescent Psychology; Nationwide Children’s Hospital LYNDA GARGAN, National Federation of Families for Children’s Mental Health J. DAVID HAWKINS,1 School of Social Work, University of Washington KIMBERLY EATON HOAGWOOD, Department of Child and Adolescent Psychiatry, School of Medicine, New York University STEPHANIE M. JONES,2 Harvard Graduate School of Education JENNIFER W. KAMINSKI, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention 1Until October 2019. 2Beginning October 2019. vi

KELLY J. KELLEHER, Center for Innovation in Pediatric Practice, Health Services Research, Community Health, and Services Research; Research Institute, Nationwide Children’s Hospital AMY WIMPEY KNIGHT, Children’s Hospital Association UMA KOTAGAL,1 Cincinnati Children’s Hospital Medical Center LAUREL K. LESLIE, American Board of Pediatrics; Department of Medicine and Pediatrics, Tufts University School of Medicine MARY ANN McCABE, Society for Child and Family Policy and Practice; Society of Pediatric Psychology; Department of Pediatrics, George Washington University School of Medicine; Department of Applied Psychology, George Mason University TYLER NORRIS, Well-Being Trust MARY JANE ROTHERAM-BORUS,1 Child Psychiatry and Biobehavioral Sciences, Global Center for Children and Families; Center for HIV Identification, Prevention, and Treatment Services; Department of Psychiatry, University of California, Los Angeles CARLOS E. SANTOS,2 Luskin School of Public Affairs, University of California, Los Angeles ANDY SHIH, Autism Speaks JOSÉ SZAPOCZNIK,1 Department of Public Health Sciences, Miami Clinical Translational Science Institute; Center for Family Studies, University of Miami VERA FRANCES “FAN” TAIT, American Academy of Pediatrics DEBORAH KLEIN WALKER, Global Alliance for Behavioral Health and Social Justice; Boston University School of Public Health LESLIE R. WALKER-HARDING,2 Department of Pediatrics, Seattle Children’s Hospital Forum Staff SUZANNE LE MENESTREL, Director ERIN KELLOGG, Associate Program Officer STACEY SMIT, Senior Program Assistant DIANNA TRAN, Christine Mirzayan Science and Technology Fellow ( January–April 2020) vii

Acknowledgments This workshop proceedings record was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published record of proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review com- ments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceed- ings: David W. Willis, Senior Fellow, Center for the Study of Social Policy, Washington, DC. We also thank staff member Ann Styka for reading and providing helpful comments on this manuscript. Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings, nor did they see the final draft before its release. The review of this record of proceedings was overseen by Patrick H. Deleon, F. Edward Hebert School of Medicine and the Graduate School of Nursing, Uniformed Services University of the Health Sciences. He was responsible for making certain that an independent examination of this record of proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. ix

Preface A better understanding of the developmental origins of and influence on children’s behavioral and mental health is especially important now, given a number of rapidly changing patterns observed in society and an increasing level of morbidity. This includes the growing prevalence of men- tal health disorders and a growing appreciation of the role and impact of neurodevelopmental health problems. This webinar series aimed to both raise awareness about these alarming trends and activate stakeholders, advocates, researchers, practitioners, and partners to implement change strategies that can effectively address these trends. The Forum for Children’s Well-Being expresses its appreciation to Neal Halfon, University of California, Los Angeles, and the teams at the Life Course Research Network and the Life Course Intervention Research Network for their extensive support in the planning and hosting of this webinar series. The Forum also thanks Stephen Buka, Brown University, and Matthew Biel, Georgetown University, for the time and expertise they have offered in developing this webinar series. xi

Contents 1 Introduction 1 Organization of Webinars, 2 Organization of Proceedings, 2 2 Overview and Trends in Children’s Mental Health 5 Shifting Epidemiology and Drivers of Change, 5 Increasing Mental Health Disorders in Children and Adolescents, 6 Developmental Implications, 9 3 Developmental Origins of Children’s Mental Health Disorders 13 Adverse Childhood Experiences and Mental Disorders, 13 Stress Pathways in the Brain and Impacts on Development, 16 Impact of Stress During Periods of Development, 20 Opportunities for Intervention, 24 4 New Ways of Thinking about Children’s Mental Health 27 Analytical Frameworks, 27 Future Opportunities and Challenges, 34 5 Policy Responses to Support Children’s Mental Health 39 National-Level Policies, 39 State-Level Policy, 45 Going Beyond Technical Solutions, 48 xiii

xiv CONTENTS 6 Transforming Children’s Health Care to Improve Lifelong Behavioral Health 53 Transforming Children’s Health Care, 54 Challenging the Field to Embrace Transformational Change, 61 References 65 Appendixes A Schedule of Webinars 71 B Biographical Sketches of Workshop Presenters and Planning Committee Members 73

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With rapidly rising rates of mental health disorders, changing patterns of occurrence, and increasing levels of morbidity, the need for a better understanding of the developmental origins and influence of mental health on children’s behavioral health outcomes has become critical. This need for better understanding extends to both the growing prevalence of mental health disorders as well as the role and impact of neurodevelopmental pathways in their onset and expression. Addressing these changes in disease patterns and effects on children and families will require a multifaceted approach that goes beyond simply making changes to clinical care or adding personnel to the health services system. New policies, financing, and implementation can put established best practices and numerous research findings from around the country into action.

The Maternal and Child Health Life Course Intervention Research Network and the Forum for Children's Well-Being at the National Academies of Sciences, Engineering, and Medicine jointly organized a webinar series to explore how mental health disorders develop over the life course, with a special emphasis on prenatal, early, middle, and later childhood development. This series centered on identifying gaps in our knowledge, exploring possible new strategies for using existing data to enhance understanding of the developmental origins of mental disorders, reviewing potential approaches to prevention and optimization, and proposing new ways of framing how to understand, address, and prevent these disorders from a life course development perspective. This publication summarizes the presentations and discussions from the series.

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