Robert Hitchcock
A child doesn’t have to experience abuse or neglect to face a greater risk of depression, anxiety, or other mental health conditions. New research co-led by Chapman psychologist Laura Glynn, Ph.D., found that everyday unpredictability at home — from inconsistent routines to changing caregivers — can also increase a child’s risk for mental health challenges.
The findings suggest that adding a brief screening for everyday unpredictability during pediatric visits could help identify children who may not be flagged by traditional childhood trauma screenings, giving families and health care providers an opportunity to intervene earlier.
Published in Nature Mental Health, the study analyzed data from nearly 30,000 children receiving care through Rady Children’s Hospital Orange County, formerly Children’s Hospital of Orange County (CHOC). Researchers found that screening for unpredictability alongside traditional childhood trauma screenings more accurately identified children at risk for depression, anxiety, sleep disorders, behavioral problems, and physical symptoms than screening for trauma alone.
“For decades, we’ve focused on what bad things happened to children,” said Laura Glynn, interim dean of Chapman’s Crean College of Health and Behavioral Sciences and professor of psychology. “Our research shows we also need to ask whether children know what to expect in their daily lives. That sense of predictability plays an important role in healthy development.”
The research was conducted in collaboration with Tallie Baram, M.D., Ph.D., of the University of California, Irvine, and Charles Golden, D.O., and Michael Weiss, D.O., of Rady Children’s Health.
What unpredictability looks like
Unlike traditional childhood trauma, unpredictability isn’t defined by a single traumatic event. Instead, it reflects the uncertainty children experience when daily life lacks consistency, such as changing caregivers, shifting schedules, or routines that are difficult to anticipate.
To measure unpredictability, researchers used a five-question screening in addition to Adverse Childhood Experiences (ACEs) screenings. They found that the two measures captured different aspects of a child’s experiences and, when used together, more accurately identified children at risk for depression, anxiety, sleep disorders, behavioral problems, and physical symptoms than ACE screenings alone.
Researchers say simple routines — such as consistent bedtimes, regular family meals, predictable daily schedules, and reliable caregiving — may help protect children’s mental health, even during stressful times.
The findings could help pediatricians identify children who may benefit from additional support before mental health challenges become more severe. They also offer reassurance that strengthening predictability doesn’t require perfection.
The study builds on years of National Institute of Mental Health-funded research showing that predictable experiences shape healthy brain development. Supported by a $2.9 million grant from the California Initiative to Advance Precision Medicine, it is one of the largest real-world studies of childhood adversity conducted in pediatric primary care.
“For parents, this isn’t about creating a perfect home,” the researchers noted. “It’s about recognizing that consistency matters. Small routines and predictable patterns in daily life can support healthy development.”
