Unpredictable childhood routines reveal mental health risks missed by standard screenings

by University of California, Irvine

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Children who grow up in unpredictable environments may face elevated risks for depression, anxiety, sleep disorders and other mental health challenges, according to a new study by researchers at the University of California, Irvine, Chapman University and Rady Children's Hospital Orange County, formerly called Children's Hospital of Orange County.

Published in Nature Mental Health, the study examined nearly 30,000 children receiving care through CHOC's pediatric clinic network and found that a child's experience of unpredictability—inconsistent routines, changing household conditions and uncertainty about what comes next—can provide important clues about mental health risk beyond those captured by traditional measures of childhood adversity.

In addition, the work highlights the power of cross-institutional collaboration to translate discoveries about brain development into clinical practice.

Unpredictability adds a missing signal

UC Irvine researchers partnered with Laura M. Glynn, Ph.D., professor of psychology at Chapman University; Dr. Michael Weiss, pediatrician, vice president of population health and Clavis Foundation Chair for Wellness at Rady Children's Health; and Dr. Charles Golden, pediatrician, vice president and assistant chief medical officer at Rady Children's Health, to evaluate how a neuroscience-informed measure of childhood unpredictability could help pediatricians better identify children at risk for mental health challenges.

The team learned that both established types of childhood adversity and childhood unpredictability were associated with increased risks for depression, anxiety, behavioral problems, sleep disorders and physical symptoms such as headaches and abdominal pain. But the unpredictability measure also detected youngsters whose mental health risks were not recognized through typical adversity screening alone.

When researchers combined both measures, they often found stronger links to mental health outcomes than with either screening tool. Importantly, unlike many other types of adversity that are difficult to eradicate, parents, families and others can strive to improve the consistency and predictability of children's environments.

From mouse studies to clinics

The findings build on years of neuroscience research led by Dr. Tallie Z. Baram, UC Irvine Donald Bren Professor and Distinguished Professor of pediatrics, neurology and anatomy and neurobiology, as well as Danette Shepard Chair in Neurological Studies, whose work helped establish that predictability plays an important role in brain health.

"What we discovered in the laboratory mice is that optimal development of the brain depends on consistent patterns, which enable the maturation of brain connections," said Baram, the study's senior author and co-corresponding author.

"Like mice, children's brain connections involved in happiness, threat and safety benefit from repeated, predictable experiences. This study shows that those principles matter not only in neuroscience research but also in the lives of children and families from a broad range of wealth and backgrounds."

A statewide screening opportunity

The work grew out of a collaboration launched in 2021, with researchers from UC Irvine, CHOC and Chapman University, to investigate how to better address the effects of childhood stress on neurodevelopment.

For Baram and her colleagues, the project provided a chance to test in real-world settings, with children from diverse backgrounds, a concept that had emerged from years of neuroscience research: Predictable experiences help shape healthy brain development, while unpredictability can leave children more vulnerable to later mental health challenges.

The collaboration brought together neuroscientists, psychologists, pediatricians and data scientists across the three institutions and leveraged California's statewide effort to screen children for adverse childhood experiences (ACEs). California became the first state in the nation to implement a publicly supported ACEs screening program, creating an opportunity to examine how different forms of childhood adversity can influence mental health.

Researchers added a five-question measure of childhood unpredictability to routine childhood adversity screenings at 19 Rady-affiliated well-child clinics between 2021 and 2024. The sites serve youngsters from a wide range of socioeconomic, ethnic and cultural backgrounds throughout Orange County, making the study one of the largest investigations of childhood risk factors in a real-world setting.

Children missed by ACEs alone

The findings suggest that discoveries originating in neuroscience laboratories can be translated into practical tools that help pediatricians identify children who may benefit from additional support.

Among the study's most notable results is that children who reported high levels of unpredictability despite having no traditional ACEs were substantially more likely to have depression than children who scored low on both measures. The unpredictability screening tool also showed value in recognizing children at risk for sleep disorders.

"Traditional ACEs screening has helped our understanding of childhood adversity, but it fails to identify many children who are at risk for mental health problems," said Glynn, co-corresponding author of the study.

"Our findings suggest that unpredictability is a distinct and meaningful form of adversity that contributes to risk in ways that existing screening tools do not detect, thus increasing our ability to target individual children."

Consistency as a practical intervention

The study also demonstrated that large-scale screening for childhood unpredictability can be integrated into routine pediatric care. Nearly 30,000 children younger than 18 were screened at Rady clinics in Orange County during the study period.

For researchers and clinicians, the findings may be especially significant because unpredictability is often something that families, communities and policymakers can address.

Unlike some forms of childhood adversity, unpredictability could be reduced by urging families to establish consistent routines and provide reliable caregiving. Previous research by members of the team found that predictable home environments helped buffer children from the effects of stress and adversity, specifically during the COVID-19 pandemic.

"For parents, this isn't about creating a perfect home," Baram said. "It's about recognizing that consistency matters. Small routines and predictable patterns in daily life can support healthy development."

Publication details

Laura M. Glynn et al, Unpredictability is a childhood adversity that contributes to mental health problems, Nature Mental Health (2026). DOI: 10.1038/s44220-026-00681-x

Journal information: Nature Mental Health

Clinical categories

PediatricsChildren's healthPsychology & Mental healthPsychiatry Provided by University of California, Irvine Who's behind this story?

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