Speaking of Science - From discovery to impact: improving access to mental health care for children

Australian health and medical researchers funded by NHMRC have played key roles in demonstrating the importance of early anxiety intervention for children. This work has led to the development of new treatment methods that are now in use globally.

An integral researcher within this team from Macquarie University and the University of Queensland is Professor Jennie Hudson now of the Black Dog Institute and the University of New South Wales. Professor Hudson was our April Speaking of Science guest speakers to discuss her research into improving access to mental health care for children.

Watch and listen as Professor Hudson discusses the decades of NHMRC supported research that has impacted early anxiety intervention for children.

Recorded on Thursday 23 April 2026 at 2:00PM–3:00PM.

Video transcript

00:35 Professor Steve Wesselingh  
All right, sorry for the delay. There was a minor hiccup. But I think we'll start. I think everyone who's waiting in the lobby has come in, and obviously more will join us but I might as well go through the housekeeping while that's happening, and then we can get on to what I think is a very exciting talk.

00:59 Professor Steve Wesselingh  
Thank you for joining us today for the another instalment of Speaking of Science. Before we start, I'd like to acknowledge the traditional custodians of the lands that everyone is meeting on across Australia. I'd like to acknowledge their continuing culture and contributions, and pay my respects to elders past, present and emerging, and to all the Aboriginal and Torres Strait Islanders who are joining us today,

01:26 Professor Steve Wesselingh 
I'd like to remind you that at the end, there will be an opportunity to ask questions, so you can put those into the chat and this is being recorded, and so we will be able to watch it later should you want to watch it, or ask invite others or encourage others to watch it later on.

01:45 Professor Steve Wesselingh  
We've really been focusing this these webinars on NHMRC funded work that has had a real impact on healthcare across the country. Obviously today's talk fits very much into that, with the impact on childhood mental health research and and today we're going to be talking about anxiety disorders, which are really very common in children and adolescents. I know they worry, children and adolescents, and this can have a big impact on their early life and therefore impact on later life as well. I also know that there are a lot of parents out there who worry about this a lot as well.

02:34 Professor Steve Wesselingh  
There's been quite a lot of work funded in Australia by NHMRC, and that has led to early intervention in these problems, in these issues and and certainly new treatments. One of the really important researchers in the area is from Macquarie University and the University of Queensland, and that's our special guest today, Professor Jennie Hudson.

02:59 Professor Steve Wesselingh  
Professor Hudson currently leads the Child Mental Health Research Program at the Black Dog Institute, and she has made a lot of distinguished and major contributions to scientific understanding and the clinical treatment of anxiety disorders in children and adolescents. She's recognised as a world leader for her work on parent child interactions and the development and treatment of anxiety. She's a Fellow of the Australian Academy of Social Sciences, as well as one of our Investigator Grant holders, which is terrific.

03:36 Professor Steve Wesselingh  
She also works on a number of government advisory panels, such as the MRFF Childhood Mental Health Research Expert Advisory Panel, of which she was appointed Chair by the Health Minister. I'm really looking forward to this talk, and I'm going to hand over to Jennie to give us the talk. Thanks very much for joining us.

03:58 Professor Jennie Hudson  
Great. Thank you so much. It is great to be here and thank you very much for the opportunity to speak as as part of this Speaking of Science series, and also for the opportunity to mark World Infant Child and Adolescent Mental Health Day as well. You'll hopefully hear from the presentation why I think that's important that we do acknowledge child and adolescent and infant mental health. Today, I really wanted to share a story with you, about how science has changed the way we understand anxiety disorders in children, and also how that knowledgement has been translated into real world impact.

04:43 Professor Jennie Hudson  
But before I can do that, I want to acknowledge, as it's already been done, but acknowledge the traditional custodians of the lands that we're all connecting on today. We're from around Australia, and we come together to share knowledge. Particularly around science, and this is a long held custom that's been nurtured by Australian First Nations peoples and communities across time for 1000s and 1000s of years. I want to take this time to acknowledge this knowledge and pay my respect to elders past, present and across time from all nations across this country.

05:22 Professor Jennie Hudson  
The story, for me, starts with this impact case study that NHMRC released last year. If you haven't seen it, you can get access to it on the NHMRC website. But really it kind of started with this case study as a story of discovery, and I want to share with you how the science has changed the way we understand anxiety disorders in children, and importantly, the impact.

05:54 Professor Jennie Hudson
I want to talk about how that knowledge has been translated, kind of moving from discovery into impact and real world impact, and then also beyond the case study where the field is heading next. That's going to be the three sections of the talk today.

06:12 Professor Jennie Hudson  
Let's get started on discovery. I want to focus on why anxiety disorders in children matter, and so far, what the science has revealed, and importantly, part of this story is the contribution that Australian researchers have made to this space. I think it's quite substantial. When you look globally in terms of what has been discovered about anxiety disorders in children, a lot of it has stemmed from Australian researchers, which is really great to see.

06:42 Professor Jennie Hudson
Alright, so I'm talking about anxiety, but anxiety itself is a really natural normal emotion. Might be thinking, why is there health and medical research about this normal emotion that everyone experiences? Everyone has anxiety. It's a natural experience that we all have. I had a little bit of it before, when I was trying to get online today for the presentation and my link wasn't working. That was the drama that delayed everybody joining the presentation today. It's normal.

07:16 Professor Jennie Hudson  
There has been a lot of confusion around it, though, because it's a natural emotion. I think this has really helped to play into the lack of recognition about anxiety, in that it is a natural experience, but for some children and adults, they experience it more severely, more frequently, and it impacts on their day to day lives. They can't go to school, they can't separate from their parents, kind of normal developmental experiences and this is when when it starts to impact and happen that kind of severely, and for a long period of time. It's not just transient that we would call it an anxiety disorder.

07:57 Professor Jennie Hudson  
Anxiety disorders are actually the one of the most common mental health conditions in children and in young people as well. In adolescence it affects around, we think, estimated between 7 and 15% possibly even more globally. We know that when it onsets early, it has long term consequences. We know anxiety impacts on learning, impacts on a child's friendships and their capacity to develop social networks, impacts on the family life. You can talk to any parent who has a child who struggles with anxiety, and they will tell you the big load that they carry and the impact that it has across the family.

08:44 Professor Jennie Hudson  
It also has an impact on educational development as well. If a child is really anxious at school or not able to go to school, they miss out on learning because of their mental health. They are not able to go to school, not able to engage in friendships, and it also increases risk for mental health problems into adulthood as well. It's not just the distress in childhood, but across the life if it's untreated. It's not just about distress that a child might experience or fear that a child might experience at one particular time. We're talking about something much more substantial than that, something that shapes a child's development.

09:31 Professor Jennie Hudson  
I want to just step back for a bit, because there's a myth that has really been shaping policy in the mental health space in Australia that I wanted to kind of bring your attention to, and it's really been guided by the idea that anxiety disorders start in adolescence. That belief came from a misunderstanding of the global data, the epidemiological data in median age of onset.

10:01 Professor Jennie Hudson  
Let me take you through that. Here's a graph of median age of onset, which for all mental disorders, is a median of 14 years. This epidemiological data across mental disorders, revealing that if you ask adults who experience a mental disorder, at what age did you first start to experience these symptoms at a level that impacted on your life? We know that by 14, 50% of people who will have a mental disorder in their life will have already developed it by 14.

10:36 Professor Jennie Hudson  
In Australia, this has kind of been used to argue for adolescent services like Headspace, and we've got services for children, for adolescents with mental health disorders. It's also been an indicator for parents, as well as a parent. For me, if I was to interpret this without my science hat on, it would be okay. Well, this is when I need to pay attention to when my teenager is experiencing emotional symptoms or anxiety or depression. This is when I need to pay attention because this is when it's likely to start. But I think this is really misleading, and I'll tell you why. When we dive deeper into the data, because that first slide I showed you just pulled all the disorders together, if we just separate anxiety and mood disorders, we see a different picture. The left hand side, we've got the blue graph, which shows the pool data for anxiety disorders, and that shows much earlier median age of onset again, median of 11 years with mood disorders much higher.

11:49 Professor Jennie Hudson  
If we were looking at this to say, okay, well, when do we need to intervene? It wouldn't be in late adolescence. If we do an even deeper dive when you look at specific disorders, and this is kind of peak age of onset, slightly different data from the meta analysis in 2022, but what you see here is when you break it down even further to separation anxiety and specific fears, the peak age of onset is much earlier before school starts, even in preschool, around the age of five. Important thing to note, if we wait until adolescence to deliver mental health care or for these families to reach out for care or have services available when they need it, we've already missed a critical window, and we know that anxiety disorders will lead to more substantial problems across the lifespan if they go untreated.

12:54 Professor Jennie Hudson
So

12:55 Professor Jennie Hudson  
I want to talk now about the discovery: why we've been trying to take childhood anxiety seriously. The work that has been funded early by NHMRC, funded research really challenged the assumption that children would simply grow out of anxiety, or that it's not an important issue to pay attention to. This work really reframed anxiety as something that we could treat, and that should be treated early.

13:25 Professor Jennie Hudson  
Before the 1990s I was still in high school, but in children, anxiety was really largely ignored, and it was these early NHMRC and also some ARC funded research at that time that really challenged those assumptions of anxiety being a treatable disorder and some of the work that I did for my PhD as well really looked at the role of the child's environment in maintaining anxiety.

13:53 Professor Jennie Hudson  
What we discovered was that anxiety is maintained by the child's environment. There are specific things that might contribute to making anxiety hang around longer than what it needs to and encouraging the development of disorders rather than preventing it or stopping the development of the disorder. What I want wanted to point out too, was that Australia has really been leading the field globally in this space, not just the research that I'm talking about today from my team or the team at Macquarie University or Queensland University, that Australia really punches way above its weight when it comes to this field. We have a lot of research, as I've listed there. Please don't get offended about just as a random selection of sizes for those people who are looking at this beautiful graph, but there is a lot of Australian researchers who have really shaped what we know about anxiety disorders in children, and really helped us to think differently about this condition in children and young people. What it has led to really is building treatments that work from all of the work that this team has done. All of those researchers that I had on the previous slide, we have been building treatments that work and led to this idea that cognitive behaviour therapy is the foundation and the most effective treatment for childhood anxiety. These teams have built these treatments and number of different components that might make up that treatment. We've got psycho education, cognitive restructuring, gradual exposure, parent training that really came from the work that we were looking at during my PhD around the importance of parents and the importance of the parent environment and relaxation is also another component that's often included in a cognitive behavioural treatment. We've built these treatments that work, and we know that they're effective in reducing anxiety symptoms, but what we've also learned over time is that while CBT has a number of these components that you can see here, that one of the most effective components is exposure, helping children to gradually face what they fear. This is one of the active ingredients that really drives change.

16:38 Professor Jennie Hudson  
Let me move on to talk about the impact. We have this treatment that works and what what we've been doing, and particularly the work that was focused in the NHMRC case study, was the work, particularly at Macquarie University, led by Professor Ron Rapee, translated this work into the Cool Kids Program, and if you're in the field, you're very much aware of this program. It's manualised cognitive behavioural treatment for childhood anxiety. It includes parents and has an early intervention focus, and that we're trying to deliver evidence based care to children who, and families who, are experiencing a lot of distress and interference impairment because of their anxiety.

17:29 Professor Jennie Hudson  
I had the privilege of being part of this process of both the original edition of Cool Kids and then the second edition with the beautiful covers that you can see here. It's taken decades of research, and it's turned it into something that clinicians could deliver consistently and families can access.

17:51 Professor Jennie Hudson  
We've also developed training and accreditation processes for Cool Kids as well, so that it can be accessed by people across Australia and across the world. In terms of its impact, it has had global reach today. Cool Kids is one of the most widely used and researched anxiety programs for children globally. It's used in over 25 countries, 1000s of clinicians have been trained. It's been translated into multiple languages, and we also know that there is a strong return on investment, that if we do intervene early, it is likely to return a very long term benefit for the child if they receive effective treatment early in life. This is a really, really great story of research going from discovery to impact, and this is what led to this NHMRC impact case study.

18:54 Professor Jennie Hudson  
I want want to pause here and explicitly acknowledge NHMRC's role in the story. The impact case study really captures decades of sustained NHMRC investment from recognising a childhood anxiety disorders as a serious mental disorder, through to development and global dissemination of Cool Kids.

19:16 Professor Jennie Hudson  
My journey started in 1996 on the graph, early on in this this space on this timeline, if you can see it on your screens. I joined Ron Rapee's team in 1996 as a PhD student, and have been involved in the multiple clinical trials supported by NHMRC across this timeline. I led my first NHMRC trial in 2006 that was funded by NHMRC, and now I've moved to the Black Dog Institute, where I'm currently luckily funded by an NHMRC Investigator Grant, and I can support my own team now of stellar early career researchers, then the Child Mental Health Team at the Black Dog. It's a really powerful example of what happens when discovery is supported long enough and to be able to reach real world impact beyond just the discoveries of what's important and understanding anxiety disorders in children and being able to then translate that into effective treatments and then also disseminate that so people can have access to those treatments.

20:33 Professor Jennie Hudson  
But what this case study shows is it's mostly because impact really never stops, right? We never stop as researchers, what it doesn't show is what comes next, and what is coming next. I want to talk now, kind of beyond the case study, where we're headed, and what we're wanting to do next and kind of the steps beyond that beautiful case study that NHMRC put together and the QR code, I don't know if you could see that, but anyway, you could search on online to get access to that case study. There's a lot more information available there as well, and kind of in more detail, but the success from this work really revealed the next set of problems. That's how we work as researchers, right? We're always looking for what to do next.

21:36 Professor Jennie Hudson  
There are a number of other treatments as well, like Cool Kids, other programlike Friends and the Bave Program, and now A Momentum which is available, but that work revealed the next set of problems. So for me, that's really where my work has been focusing on, particularly with the Investigator Grant. Even with effective treatments, many, many children still can't access care. We have long wait lists that were particularly exacerbated by COVID, and it's still difficult to get access to care if you are a child. If you're a parent of a child or a child yourself, it is hard to access care. When you try to, you're put on long wait lists, particularly in community mental health. You will most likely age out of child community mental health services if you have anxiety and depression that doesn't have suicidal ideation or suicide risk attached to it. If it's anxiety and depression, you most likely age out of services and before you ever received care at Child Mental Health Service, because of the overload and that clinicians have to focus on the most severe cases, and those where that it's life threatening. Even though we know how important anxiety disorders are and the impact that's going to have long term children are not getting access to care.

23:17 Professor Jennie Hudson  
We also know there's significant workforce shortages. Not enough psychologists, not enough child psychiatrists, not enough paediatricians. But it's also the limited training in child mental health. It's not something that we really, even you know as a psychologist being trained, there's not a lot of focus on delivering care for children specifically and what the unique features and treatment might be, and so quite limited in people's expertise. There are very few psychologists and psychiatrists that have expertise specifically in child mental health, so this kind of adds to those shortages. There's also geographic inequity. If you're a family living in rural Australia, the chances of being able to access a really good clinical psychologist that could deliver you care and evidence based care is unlikely. It's really hard to get access to services quickly when you need it in different areas of Australia.

24:32 Professor Jennie Hudson  
We know that many families are really still missing out on care. We've still got a problem with access, and this is really clear from our waitlists and absence of training and the number of families that are still missing out. But let's just say a family does get access to care when they access treatment, what we know from the work that we've done also is that they're more likely to receive treatment that's not evidence based care. If they do get access to care, it is not necessarily the best treatment that science has to offer. We're looking at a number of barriers as to why that might be, why that's partly to do with training and also partly to do with, I think, science not catching up to what clinicians need. I'll talk more about that that later.

25:37 Professor Jennie Hudson  
Even if a family does access treatment, and let's just say they get access to the best the best treatment science has to offer, they go to a specialised clinic and they get the best treatment we have to offer. We know that 40 to 50% after treatment will still experience anxiety disorders so that's good, but it's not great. I think we can do a lot better. These have been the challenges, and I think the next major challenges for the field.

26:16 Professor Jennie Hudson  
What I've been working on in my Investigator Grant, can we do better in terms of access and in terms of outcomes? Can we improve the number of children who go into high school with an anxiety disorder? Can we reduce that number so that when puberty hits, when high school hits, that they're already at a really good place? They have the skills they need to be able to manage their anxiety and then live a full and fulfilling life, get as much education that they can and not let their mental disorders impact on their access to education and what life has to offer.

27:05 Professor Jennie Hudson  
This is where I've been focusing my work with the Investigator Grant over the past decade, really extending the science and asking, how do we deliver and optimise the most powerful elements of treatment to more families? How can we get it to families in rural Australia? How can we get it earlier, and how can we deliver it at scale? What we've been working on, a number of teams around Australia also have been working on, is working towards sort of digital care. I'm particularly interested in digital and blended care interventions, which is where you can combine person to person care, so there's still connection with a human being and digital care. Can we get the best of both worlds? Also, with digital rather than having to have somebody in person, creates that opportunity that we can deliver at scale, and can make sure that children in rural Australia do have access to this evidence based care? I've been working on developing a parent led intervention, which also helps with access, in that it can be delivered at home and this is the work we've been doing at the Black Dog Institute with the Child Mental Health Team. It's a program that can be delivered at home that gets actually straight to the critical ingredient in the first session.

28:37 Professor Jennie Hudson  
As I mentioned before, we think exposure is a really critical component to treatment, but when we know there's a lot of dropout for care, and even if somebody gets access to care, they might drop out if this critical ingredient is introduced later in treatment. We wanted to bring it even earlier than other programs, introduce it in the first session and really just pair it down to the most effective treatment.

29:08 Professor Jennie Hudson  
What we're looking at is an exposure based programme that's parent led. Can we actually do exposure really well and train parents to deliver exposure really well without actually having to come in to see a therapist or have minimal support with a clinician. We've been optimising that critical ingredient of exposure, and I'll talk a little bit more about that.

29:40 Professor Jennie Hudson  
Families can get access to this critical ingredient earlier. I've also been working on trying to improve access through training and training other people in the child's life as well. Training parents, training teachers as well. We're currently doing a trial led by Dr Chloe Lim through the premise Centre for Research Excellence delivering a training for teachers who come across kids in their classroom every day who experience anxiety and how can teachers can create the right environment for kids, rather than maintain the anxiety, but encourage them to face situations that they struggle with and to apply best practice in the classroom, rather than just keeping treatment for clinical psychologists or psychiatrists, psychologists. Just making sure that other people are trained up in these strategies as well.

30:50 Professor Jennie Hudson  
There's some of the things we've been working on. I wanted to show you a bit more about this digital intervention. This is called the Courage Quest. I love the name. It's a great way of kind of phrasing it, particularly for 8 to 12 year olds. We're focusing specifically on encouraging parents to encourage their kids to face their fears and worries through an idea of a quest. This is a digital program. We don't actually sit down with the kids at any point, we sit down with the parents, we give them everything online that they can go through themselves, and then they work through that. Work through this web based programme with their child at home and we provide support.

31:37 Professor Jennie Hudson  
A lot of the information that they would get from a clinical psychologist or psychiatrist would be available online. Then we also add in some parent support sessions as well by a therapist. We'll call them up just checking in. It's not really delivering new content, but just helping support those parents. We're trying to empower parents to be able to better support their young person, to be able to face their fears and worries. This is a trial that's funded by the National Health and Medical Research Council, as well as Australian Rotary Health, and it's about expanding reach, reducing wait times, and supporting families earlier, and trying to preserve what works, what we know is effective in getting kids to face situations that are difficult rather than avoiding them, and we know that's what helps in reducing anxiety.

32:36 Professor Jennie Hudson  
My work has also been focusing on trying to understand who doesn't respond to treatment? Understanding poor response, if 50 to 60% of kids are responding, what happens to those other 40%, other 50% who are they? Can we understand who doesn't respond, and can we improve outcomes for those young people? Some of the work that we've been doing, particularly led by Dr Lazelle Berties in my Child Mental Health Team at the Black Dog Institute, looking at predictors and moderators of treatment, trying to understand what works for whom, and understanding who doesn't respond, who are the non responders, and we've actually been able to make some headway in that space in being able to understand that children who have parents who are also anxious, and children with social anxiety disorders or specific type of anxiety disorder, and also who have comorbid depression, that those children are more likely to be the ones who don't respond. They still respond, but they have a higher chance of being in that group that don't respond.

34:00 Professor Jennie Hudson  
We have some now clear indicators of poor response. We've been trying to answer this second question of, can we improve outcomes? We've conducted years and years of clinical trials, numerous clinical trials, and we haven't yet been able to get better outcomes. Everything we test, we've tried different things, for social anxiety disorders, for depression, for parents who have anxiety, we still can't get better than the 50 to 60% so we're still at this point despite decades of clinical trials that CBT works for 50 to 60% of children no longer meeting criteria.

34:51 Professor Jennie Hudson  
We're kind of at this point, and it's been frustrating after investing in clinical trials and not getting anything back. Then this kind of been sitting back looking at it from bigger picture, and thinking, you know where to from here. If these aren't working, where do we want to go from here? Can we actually improve outcomes? But was reflecting on these findings, and I think one really important factor in when we were doing the early work trying to understand what works, importantly, we were looking at what works on average. We lump everything together. We look at remission rates for everybody. We always power our clinical trials to look at whether or not one treatment is better than another or better than wait list. We never power it enough to be able to look at those effects for specific kids and really be able to answer the question, what works for whom?

36:02 Professor Jennie Hudson  
I've been asking this question whether precision medicine might be possible for common mental health disorders like anxiety disorders in children. It's been really effective in cancer treatment, but is it really possible in in mental health? We've had personalised care for a really long time where a clinician might modify the treatment when they see a particular child for care, they might modify based on their clinical intuition or their clinical formulation, and they might modify the treatment, but that's not precision care. We actually don't know whether those kind of modifications work better. The data would indicate not. But precision care is about using data to make better decisions and actually improve outcomes for children, and we're not fully there yet. This, to me, is the next frontier. We can't do it because the science is missing so far. We don't know the answer to the question of what works for him and under what conditions, what dosage.

37:15 Professor Jennie Hudson  
We've had 279 trials for child and adolescent anxiety disorders since 1994 - 279 the that's a lot. Each study is only ever powered to look at these average effects. But we know all kids aren't the same, and the clinicians in the audience will know that as well, that in parents, what might work for one child might not work for another. Our team have been doing a deeper dive to see if we can understand the answer to the question as to what works for whom and what circumstances with bigger data.

37:59 Professor Jennie Hudson  
This is a project that we're working on at the moment. Again, this is being led by an early career researcher, Dr lazelle Bertie at the Black Dog Institute. Alongside our partners in the Netherlands at the University of Groningen, this work is hosted at the Black Dog Institute at University of New South Wales and supported by NHMRC, but we've developed a platform for harmonising this data. The 279 trials we're working towards that we have been requesting all of the data from around the world to build the clinical trials into one data set, rather than them being siloed, so that we can answer that question of what works for whom.

38:50 Professor Jennie Hudson  
This is a picture of globally where we've been able to extract data. We're still working on it. I think now, over 80 trials that we've been able to collect, that we have access to, and that we have harmonised with a total of 44,000 variables, which is quite mind numbing that we're trying to bring together. Often people will include additional variables that maybe are not included in the bigger trial, but when there's enough participants and enough data that we might be able to look more closely or be able to answer that question, particularly for children with social anxiety disorder or depression or parents with anxiety. What is it that might work better? Using this data set to be able to answer those questions.

39:50 Professor Jennie Hudson  
This is what we've been working on, being able to use PADDY and where we're going to be working over the next five years IS expanding PADDY as well. We want to be able to be at that point where we can deliver precision mental health care, matcH the right intervention, and using that data set so that we can say when a child presents for a mental health condition like anxiety, that we know what treatment is available, and being able to optimise that care and make it more equitable.

40:28 Professor Jennie Hudson  
Alright, so to summarise, what we're working on is moving from this late, fragmented, one size fits all care that a child might get at the moment it can be best practice. Moving towards, making sure that treatment is available earlier, that it's scalable, available using digital platforms, that it's friendlier as well. We're working on that using lived experience, and we have a fabulous peer researcher working with our team to make our tools, both from assessment perspective and treatment, friendlier and more usable, and working towards precision care so that we can have the science to be able to do that.

41:15 Professor Jennie Hudson  
This is kind of a nice summary and a story of pathway to impact. We've had the discovery of the early science around anxiety disorders, moving to translation of developing new interventions, scaling that with digital and global delivery, and then through that cycle again. We need more discovery and going through that pathway again, of more discovery so that we can move towards precision care.

41:46 Professor Jennie Hudson  
I also just wanted to highlight two other things that are kind of happening in the child mental health space. Something that happened a couple of years ago now that we're starting to see the benefits of the Childhood Mental Health Research Plan that came about as a result of the Child Mental Health Strategy that the Mental Health Commission released, and then a research plan that attached to that so that we can increase the pipeline of early career researchers and mid career researchers in the childhood mental health space. If we were to go back to that graph of Australian researchers, many of those names on that graph are retiring. We need to be able to support the next generation of researchers so the Childhood Mental Health Research Plan outlines, through the MRFF some really great investment in child mental health.

42:44 Professor Jennie Hudson  
Also another thing that I think will be a game changer for childhood mental health is the next Child's Mental Health and Wellbeing Survey that has been conducted by the Young Minds Initiative through Curtin University. Led by David Lawrence, and this will actually give us accurate data on children and young people, at the moment, with anxiety disorders. We've had kind of a limited understanding of that, and we haven't had an assessment of Australians mental health at a kind of national level for more than a decade now. This will be really exciting. This is currently data that's being collected at the moment. It's exciting new developments in the child mental health space.

43:36 Professor Jennie Hudson  
Thank you very much. I might open it up now for questions, and there's just some cute pictures of the Child Mental Health team, and to thank them for the incredible work that they do, and support me and make it a pleasure to come to work and do this science. It's a stellar group of early career researchers. If you want to have a look at some of the work that we're doing at the Black Dog Institute, there's a QR code for our research page, and we are currently recruiting for a number of different clinical trials at the moment, testing out these treatments. So thank you very much.

44:14 Professor Steve Wesselingh  
Thank you very much. That was fabulous and such an important problem to be looking at and great progress being made.

44:22 Professor Steve Wesselingh  
Might get you to take your slides down and and encourage everyone to put some questions in the chat so that we can start a bit of a discussion here. Maybe I'll start with a couple of questions while people are thinking.

44:42 Professor Steve Wesselingh  
One is that particularly with social anxiety disorders and depression, the really difficult issues that, as you acknowledge, a little difficult to work on, is and you talked mainly about CBT and other talking therapies. Is there a role for drugs at all?

45:06 Professor Jennie Hudson  
Yeah, definitely. The work that we've been doing is focused on CBT, but we also have good evidence that medication such as serotonin transporter uptake inhibitors, that SSRIs, work effectively for child anxiety as well. A lot of parents are reluctant to use medication earlier. There has been a shift, I think, in that over the last five to 10 years as well with children getting access to medications that help, particularly if they don't have access to psychological treatment. This is another option. It doesn't work better than CBT. There's some indication that combining medication worked more effectively, but we completed a clinical trial showing that may not necessarily be the case, but there is something about the combination or kind of enhancing expectations for treatment that might deliver better expectations of change.

46:15 Professor Jennie Hudson  
But at the moment, the recommendations, the guidelines that David Coghill and his team at Melbourne have developed for treatment of child and adolescent anxiety disorders suggest that CBT is a first line of treatment. If that's not effective, then try medication.

46:39 Professor Jennie Hudson  
Alright, thanks for that. Did you want to just take just take your slides down?

46:44 Professor Jennie Hudson  
I thought I had. I hadn't sorry. I've stopped sharing. I thought I'd taken it down.

46:50 Professor Steve Wesselingh  
There you go. That's better. Now we can see you.

46:53 Professor Steve Wesselingh  
We do have a couple of questions there, but I just wanted to follow up that comment you just made. In terms of looking at sort of precision medicine, have you thought about things like platform trial designs, so that you actually start with CBT and then cascade along, which has been very effective in the cancer area, because you're not always just comparing one treatment with another treatment, you're actually cascading along using Bayesian theory and to find the best treatment. Would that work? Or are the numbers too small?

47:31 Professor Jennie Hudson  
No, it would work. I'll take you through a different approach that we're using at the moment, but we don't have at the moment good enough indications around mid treatment. Those adaptive trials, I haven't started exploring that, but purely because I'm not sure about the early indicators, whether you need early indicators of response, and at the moment, most of our trials are focused on pre, post and follow up, and not on that in between, and can we actually get good early indicators of response?

48:04 Professor Jennie Hudson  
For a lot of kids, it's just that they need to use the strategies, and that if we pull them out of CBT early, maybe they haven't actually been delivered the active ingredients yet, soI haven't. The way I've been focusing is more on a factorial design of optimising treatment, so just testing different aspects of treatment, turning different treatments on and off, or different features of treatment in a large scale factorial design. We've got a trial that we're working on at the moment, with over 500 children allocated to kind of five different features of exposure, kind of working out how we can optimise exposure, treatment.

48:49 Professor Steve Wesselingh  
I think your commentary there goes on a little bit to Alex's question, and he's asked, what are your picks for key variables that would allow personalised or precision approaches?

49:00 Professor Jennie Hudson  
Great question. I like that.

49:03 Professor Jennie Hudson  
I think the fact that we know that some children don't respond to me, that's the first step in precision care. It's assessment of those variables. Can we assess anxiety disorders? If a child has social anxiety disorder, we need to be able to assess that effectively in order for precision care to be able to be delivered and be able to assess depression. Having the platforms to do that assessment well, which is something we're also working on, but then it's being able to see if we can get better outcomes for those kids. We've tried different things that haven't worked so well, but it may be that there are specific components and other things that we can add to treatment that might expand, might be the combination of medication, or it might be the inclusion of other lifestyle factors, changing diet, changing exercise, sleep is something else. One of the postdocs in the team, Melissa Argy, is working on looking at sleep pathways as well. I would think the fact that we know what the predictors are, can we actually get better outcomes? I think by doing exposure better and making sure that kids get access to that, then we might be able to see better outcomes for those kids.

50:35 Professor Steve Wesselingh  
Terrific.

50:36 Professor Steve Wesselingh  
Richelle has asked, is there a genetic basis for children developing anxiety and could this be used to identify potential non responders to CBT?

50:47 Professor Jennie Hudson  
Yes, we went down this road for a good decade looking at biological markers, genetic markers, and we had a really exciting effect, initially showing that because there is a genetic basis to anxiety disorders, it explains moderate amount of variance, but doesn't explain everything. We know, environment and family factors do have a big impact, so we were looking at genetic factors might predict treatment response. We found something initially, but we haven't been able to replicate it, so we've kind of moved away from that waiting for the field to catch up, for other biological markers that might indicate response to psychological therapy. We did trial, kind of thinking about precision care. We did trial a risk indicator that included clinical information as well as genetic information, and it looked like there was some benefit in terms of predicting who's not going to respond to treatment. That is also something that we are looking at.

51:58 Professor Steve Wesselingh  
Thanks for that. Wee-Ming asked or firstly, made the comment. The concept of training the parents is a good one, as they can deliver interventions all the time in everyday life, as opposed to limited time with a healthcare professional. Has that part of your work delivered success?

52:16 Professor Jennie Hudson  
It's been great. We've had a lot of a lot of positive feedback. Sorry, I've been talking too long. A lot of positive feedback from parents who they didn't really want to take their child to see a psychologist, or they couldn't access it, but they were able to introduce it, particularly with kids who might struggle talking about their fears. It gave the parents a language to be able to talk to their kids about their anxiety and be able to practice at home and be able to practice in their real environment as well. Not just in a therapy setting, but at home where they're getting anxious or at school, or on their way to school, so being able to kind of be in that real environment, and parents giving us really positive feedback. We haven't analysed the results for that study yet, we're still in the middle of recruitment, a quiet plug for anybody who needs a referral aross Australia, for a child with anxiety and anxiety disorder, we have a treatment program available that they can just sign up through our website and get access to this programme. We've still got space for another 100 or so families, so bring them on. It's been a really great response from parents and from kids.

53:42 Professor Steve Wesselingh  
That's the Black Dog website.

53:43 Professor Jennie Hudson  
They go Black Dog Institute. It's the Courage Quest Program.

53:49 Professor Steve Wesselingh  
This was the perfect place to pitch that. I'm sure you'll get some referrals.

53:57 Professor Steve Wesselingh  
Ruth has asked two questions which are sort of linked, and so I'll ask them together. Do kids need a diagnosis of anxiety before they try the Cool Kids Program? Is the Cool Kids book available to kids remotely?

54:13 Professor Jennie Hudson  
Great questions. I mean, you don't necessarily need a diagnosis to get access to care, unless it's through health insurance potentially. But most families would go to their GPs as a first point of call and get a mental health care plan. Then you could get access through a psychologist. There's a lot of psychologists across Australia that are trained in Cool Kids. On the Macquarie University Cool Kids website, you can see access to all the practitioners who've been trained in Cool Kids in Australia. Families could get access to it that way. But you don't necessarily need a diagnosis, although for me, it's really if the symptoms are impacting on the child's life and causing interference. It warrants when treatment is low cost, particularly when it's delivered digitally, that your families can access it, and it has the potential to prevent mental health disorders and distress across the child's life.

55:29 Professor Steve Wesselingh  
And the book is available remotely?

55:31 Professor Jennie Hudson  
Yes, on the on the Macquarie University website, you can get access to not the child workbook. As a parent, the clinician would need to get access to it and deliver it.

55:45 Professor Steve Wesselingh  
Okay, alright, we're getting close to the end, but you did mention the environment. Are there particular aspects to the environment that you've identified, particularly reversible aspects?

56:02 Professor Jennie Hudson  
Yeah, the reversible aspects, what we we find is, when you're anxious about something, and everyone will be able to relate to this that, our natural response is to want to stay away from things that scare us, right? If you're scared about catching a plane, you're not going to be getting on a plane every day. You want to kind of stay away from things that scare you. But what happens is, if you never catch a plane, you never realise well, actually, most planes take off and land. Thousands of them do every day, and nothing bad is going to happen. That avoidance really helps to maintain the learning that you have that planes equal danger and threat.

56:44 Professor Jennie Hudson  
Any environment that helps to encourage that avoidance, we've been looking at it from parents who encourage avoidance, or, a child who might be distressed and fearful, and a parent might just kind of rush in and want to reduce their distress, which is a natural response. I want to do this as a parent when my kids get nervous about something. You want to reduce their distress, but parents might do that and pull them away from the situation or tell them they don't need to go to school, or they don't have to go to the party that they're worried about. But what happens then is that that maintains the child's anxiety. They never learn actually, they can do it, and the situation isn't as scary as what they thought. That can happen in the classroom, with teachers creating that environment, parents doing that. To me, it's those environments that create and encourage approach that will lead to better outcomes, right?

57:50 Professor Steve Wesselingh  
Ruth as a follow up question, if someone did the Cool Kids Program but didn't have anxiety, per se, would there be any issues?

58:00 Professor Jennie Hudson  
That's interesting question. Kind of curious about, you know, what would be the benefits if they wanted to do it? Was it about learning the strategies? To me, a lot of the strategies that are taught, which is about how to realistically interpret situations, and then also how to face fears. they're kind of life skills. I don't see any particular harm, except that's just a big investment of time. But they're all skills we could learn in being able to face difficult situations.

58:38 Professor Steve Wesselingh  
Perhaps one last question, sometimes anger in kids is a manifestation of anxiety. Is there anything particular in that area that you guys have looked at?

58:49 Professor Jennie Hudson  
That kind of irritability that happens. We see it a lot. It hasn't been investigated as much as probably what it needs to be, because it often presents as irritability in kids who might be struggling at school all day. They come home and they're kind of irritable with everybody in their house. Kind of understanding that as a symptom, because it has led to a bit of misdiagnosis and thinking it's a behaviour problem, when really it's just anxiety. I think it's something that we do need to understand more about.

59:26 Professor Steve Wesselingh  
Alright, we've run out of time. We could go on forever, I'm sure, but that's been fantastic. Such a great presentation on such a really important issue. Also for us, what a great example of NHMRC funding leading to examination of a critical question for Australian children and Australian parents, and lots of really practical solutions. I know there's a way to go, but you've gone a long way, and your plans for the future? Look, you know, really excited. Particularly exciting, we'll have to get you back, I think, in a year or so, to see where that has all gone.

1:00:07 Professor Steve Wesselingh  
Thank you very much. I just wanted to remind everyone this will be online so people can watch it again or suggest that other people watch it. I'd like to thank everyone who's joined us online, everyone who put up the questions, because they were terrific questions, and particularly, thank you for coming on board and giving such a great presentation. Thank you very, very much.

1:00:31 Professor Jennie Hudson  
Thanks so much, Steve, for having me.

1:00:37 Professor Steve Wesselingh  
Everyone will slowly disappear now so but thanks. That was great.

1:00:41 Professor Jennie Hudson  
Thank you. Steve, bye.

End of transcript.