Clinical practice guidelines for mental health conditions in children and adolescents: A systematic review

Abstract

Objectives:

Clinicians rely on clinical practice guidelines to inform evidence-based management of conditions. However, the quality and availability of clinical practice guidelines for mental health conditions in children and adolescents vary. This systematic review aimed to assess the quality of existing clinical practice guidelines and identify gaps to inform future guideline development in child and adolescent mental health.

Methods:

A systematic literature search was conducted to identify clinical practice guidelines for mental health conditions in children and adolescents published between April 2019 and April 2025. Using the Appraisal of Guidelines for Research and Evaluation II tool, identified clinical practice guidelines were assessed for rigour of development (n = 85) using a 70% cut-off. Gaps in the literature were identified by categorising guidelines based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.), ensuring comprehensive coverage while considering feasibility in guideline development.

Results:

Nine of the 22 Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) categories were represented among the 20 clinical practice guidelines extracted. Literature gaps were identified for bipolar and related disorders, trauma and stressor-related disorders, sleep-wake disorders and neurocognitive disorders. In addition, gaps persisted in 13 categories where high-quality guidance was not identified. While methodological quality varied (M = 5.6/7 ± 0.7), guidelines that met threshold were identified for depressive disorders, attention deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, feeding and eating disorders, and suicidal behaviours and non-suicidal self-injury.

Conclusion:

There is a high degree of variability in the quality of available clinical practice guidelines for child and adolescent mental health conditions, emphasising the need for more rigorous development and implementation standards. While some disorders have sufficient guidance, there are major gaps, necessitating the development of high-quality resources to enhance clinical impact.