A newly released study of children has connected the extra stress of an “unpredictable” environment early on to depression, obesity and mental health issues, factors that previously weren’t always included in traditional childhood risk screenings, its authors said.

Researchers from UC Irvine and Chapman University and two doctors from Rady Children’s Health, formerly known as CHOC, examined 30,000 children who went through the children’s hospital’s pediatric clinic. After adding five new questions to a routine questionnaire, the researchers found that inconsistent routines, erratic household conditions and an unknown future provided insight into a child’s mental health risks beyond what has been “captured by traditional measures of childhood adversity.”

With the study’s information, Tallie Baram, a UC Irvine professor of pediatrics, neurology and anatomy, said parents, childcare providers and even lawmakers can use these new insights and tools to intervene early on in youth development.

“Early in life, children are really sensitive to the input from the environment of the family,” Baram said. “And the environment really is the family and the parents. So, we need to be aware of that (so) we do what we can to optimize it.

“The neat thing about unpredictability and adversity is that it’s actionable and trackable.”

Baram collaborated in the study — funded by a $2.9 million grant from the California Initiative to Advance Precision Medicine and now published in Nature Mental Health — with Laura Glynn, a professor at Chapman; Dr. Michael Weiss, a pediatrician, vice president of population health and Clavis Foundation Chair for Wellness at Rady Children’s Health; and Dr. Charles Golden, a pediatrician and vice president and assistant chief medical officer at Rady Children’s Health.

The work grew out of a collaboration launched in 2021, when researchers from the three institutions were asked to investigate how to better address the effects of many childhood stresses on neurodevelopment.

The study’s results are a call to action, Baram said, adding she’s hopeful people who create policy understand that measures of unpredictability are actually things they can do something about and help educate parents about.

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

Baram said the idea to look into the role that unpredictability plays actually draws from her own experiences as a child in Ethiopia, where she spent some of her early years.

“Kids were as poor as church mice, but they were doing fine,” she said. “As a child neurologist, I went to LA and went down to South Central, and it was the same socioeconomic level, and the kids were not fine. The question is what is the difference?”

In Ethiopia, she noted that the children had structured days and routines with predictable caregivers. In comparison, she noted that the children at the Los Angeles clinics she interacted with often came accompanied by different caregivers at each visit, and often didn’t know who was picking them up from school or when their dinner was.

“What we thought we knew about early life stress or adversity — people think about neglect, abuse and low socioeconomic levels — didn’t explain things,” Baram said.

Baram and Glynn began their study with mice and rats in Baram’s lab at UCI, simulating poverty and noting how the stress changed adult behavior, which affected the young pups. Baram said she realized that the rodents’ “optimal development of the brain” depended on consistent patterns. These, she said, enable the maturation of brain connections.

When they began looking at videos of mother-child interactions, Baram said, “We began to think about the idea that maybe people have a thought about consistency and predictability.

“You have to think about patterns,” she said, “because this is how the brain works.”

Baram said she and Glynn took their hypothesis to the real world and, with a group of psychiatrists and statisticians, teamed up with Rady Children’s, where children who went through its well-child clinics between 2021 and 2024 were asked the five additional questions. The collaboration allowed the two researchers to get input from children of diverse backgrounds.

“The idea was that they wanted to look at how predictable experiences help shape healthy brain development, while unpredictability can leave children more vulnerable to later mental health challenges,” Baram said.

What really helped, Baram said, is that the state surgeon general at that time mandated that all pediatricians in California screen regularly for adverse childhood events.

But the typical questions asked at pediatric visits were “frustrating” for the research efforts, Baram said. Traditionally, she said, children are given questionnaires that ask about things “that are supposed to be bad for early development,” but they don’t really explain the outcome.

“You can ask, ‘Do you have abuse problems?’ The only thing the kid or parent can say is ‘yes or no,’ so you end up with a number one through four, but you don’t have a clue what’s really going on,” she said. “Because of privacy, you cannot really tell.”

She came up with five questions that weren’t invasive, but could paint a picture of stability or lack thereof.

Among them were, she said, “Do you have a routine? Do people tuck you in to sleep? Do your parents have a good relationship? Can one of your parents go from pleasant to angry in a nano-second?”

“What we found was that asking about the family routine was just as important in identifying problems,” she said. “A significant portion of kids don’t seem to have any of the ‘usual adversities,’ but do have chaotic family life, and that’s important. Nobody would pick them up otherwise.”

Since the study began, Baram said, she and others have received about 80,000 questionnaires, but they chose to analyze the first 30,000. All the children analyzed are from 19 clinics across Orange County.

Baram said what surprised her in the results was that there were some differences between clinics in different areas of the county, but not as much as she may have thought there would be, indicating socioeconomic status made very little difference to the prevalence of unpredictability.

The researchers said among the most “notable results” of the study is that children who reported a lack of predictability in their home lives but not the traditional adverse childhood experiences previously focused on, “were substantially more likely to have depression than children who scored low on both measures.”

The traditional screening “helped our understanding of childhood adversity, but it fails to identify many children who are at risk for mental health problems,” Glynn said in a statement. “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.”

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