Beyond Theory of Mind: mentalization as a relational and developmental framework for autism
Development and Formative Evaluation of a Narrative-Based Serious Game for Pregnancy Education: Mixed Methods Study
Background: Serious games are increasingly used in professional health education and maternal health promotion. However, most pregnancy-related digital interventions target specific behaviors and do not provide a comprehensive, longitudinal simulation of the pregnancy journey that incorporates psychosocial and administrative aspects. Objective: This study aimed to develop and evaluate a narrative-based serious game that simulates the chronological course of pregnancy and to assess its perceived educational usefulness, accessibility, and user acceptance across multiple platforms. Methods: We developed a 9-chapter interactive serious game covering pregnancy recognition, partner communication, public health consultation, mid-pregnancy and late-pregnancy checkups, and home preparation for childbirth. The game was collaboratively created by a pediatrician, 6 medical students, and a student illustrator using a low-cost visual novel engine (TyranoBuilder). It was released in April 2025 on iOS, Android, and Steam. A voluntary, anonymous postgame survey was conducted between April 2025 and January 2026. Descriptive statistics were used to summarize survey responses and platform analytics. This study was approved by the Ethics Committee of Shinshu University Hospital. Results: A total of 65 users completed the postgame questionnaire. Most respondents were aged 10 to 19 years (38/65, 58.5%) and female (55/65, 84.6%). Nearly half of the participants (30/65, 46.2%) completed the game within 1 hour. Gameplay evaluation scores (5-point Likert scale; 3=neutral or appropriate) were balanced: game length (mean 3.37, SD 0.96), difficulty (mean 2.84, SD 0.85), and interactivity (mean 3.31, SD 1.10). Educational outcomes were rated highly (5-point Likert scale; higher=more favorable): reduced anxiety (mean 3.84, SD 0.96), perceived educational usefulness (mean 3.98, SD 1.02), perceived knowledge acquisition (mean 4.06, SD 1.06), story empathy (mean 3.80, SD 1.11), and overall satisfaction (mean 4.05, SD 1.04). Across all platforms, the game achieved 925 cumulative downloads. iOS and Android downloads were predominantly from Japan, whereas Steam downloads were geographically diverse. Of the 21 Steam reviews, 20 (95.2%) were positive. Conclusions: A serious pregnancy education game developed through a low-cost clinician-student collaborative model demonstrated high perceived educational usefulness, balanced gameplay characteristics, and broad user acceptance, including substantial engagement among teenagers and international users. Narrative-based serious games represent an accessible and scalable approach to maternal health education. Further research using more rigorous evaluation designs is warranted to assess long-term educational and behavioral impacts.
<img src="https://jmir-production.s3.us-east-2.amazonaws.com/thumbs/e2f36ab34de77d0bdb26718b9c29b61f" />
Maintaining Emotional Boundaries as a Parent
Parents often emphasize to children the importance of respecting others’ boundaries — don’t tickle another kid if they say they don’t like it, for example. Don’t kiss someone unless they welcome it. But within the family, we can fail to notice our own difficulty setting and respecting boundaries with our children, especially emotional boundaries.
What are emotional boundaries
Emotional boundaries refer to an individual’s sense of autonomy and ability to control how they think, feel, and engage with others. Those boundaries are crossed either when you try to control someone else’s thoughts or feelings or they try to control yours.
Difficulty setting your own and respecting others’ emotional boundaries often comes from a place of care and concern. Parents are usually concerned that their child is not going to make safe choices or are trying to protect their child from distressing emotions. But the intrusion can have a negative impact on children’s emotional development as well as parents’ mental health, especially when it’s done repeatedly. Everyone has boundaries, even parents, and it’s important for kids to learn that.
How parents overstep their child’s emotional boundaries
Parents can inadvertently encroach on their child’s right to their own thoughts and feelings through:
- Over-involvement in children’s academic and social life: Your child has a whole life outside the home, and it can be anxiety-provoking to trust them to manage their homework, advocate for themselves with teachers, and navigate conflicts with peers. It can alleviate your anxiety to get involved, but that can feel highly intrusive to your child. For example, if your kid feels snubbed by a friend, you might feel the urge to contact that friend’s parent to try to smooth things over. However, over-involvement in these tasks can prevent your kid from developing the skills they need to manage challenging situations successfully and can impact their confidence in their ability to cope independently.
- Overconcern to protect your child’s safety: Fears that something negative will happen to your child are understandable, but aggressive monitoring can backfire. This can include strict control over the ingredients in your teen’s food, the information they consume online, or what activities they do. This may temporarily alleviate anxiety about the child’s health and safety but it can lead to resentment and rebellion.
- Ignoring or rejecting children’s requests for privacy: It is normal for children and adolescents to want more privacy as they mature, from showering alone to keeping a private diary.Unless your child engages in an activity that suggests they are being unsafe, it is important to trust your child and let them decide what to share with you.
- Sharing private information without the child’s permission: Parents telling anecdotes about their children, much to their kids’ embarrassment, is hardly new. However, that sharing now includes photographs and videos posted on social media that is broadcast far beyond close friends.It is important to include your child in decisions about what information is shared with others (excluding, of course, medical professionals). When in doubt, consider what information you would feel comfortable with them sharing about you.
- Telling children what is or isn’t acceptable to value, think, or feel: Many parents, in an effort to help their child feel better, say things like, “Don’t worry about that” or “You can’t think that way.” These seemingly innocuous phrases can come across as attempts to control how the child feels. We can forget that kids are real people just like adults. And if they’re mad or upset about something, they want to be able to feel those feelings, not be told that that their feelings are wrong.
How parents fail to set their own emotional boundaries
Letting kids change your own values, thoughts, and feelings can also be unhealthy. Here are some common ways in which parents fail to set their own boundaries:
- Allowing your child’s thoughts and feelings to influence your own too much: Your child may act like it will be the end of the world if they don’t get into the right college. If their anxiety becomes your anxiety, then it’s going to be very hard for you to encourage your kid to have fun on the weekend or to go to bed with work left undone. What they need you to do is validate their feelings but challenge those worry thoughts and help them to relax.
- Implying that your child is responsible for how you feel: As a parent, your child’s well-being is your priority, and your emotional state is affected by your child’s behavior. But phrases like, “You are making me crazy” or “I cannot cope with one more word from you” unintentionally suggest that the child has control over your feelings. It’s not healthy for children to feel that they are responsible for your well-being.
- Depending on your child for emotional support: If you’re a parent under stress and you’re not getting support elsewhere, it makes sense that you’re going to vent to a child. It’s not necessarily meant to burden a kid with financial stressors or relationship drama, and the child might be a sympathetic ear. But it blurs the boundaries between the parent role and the kid role, and that often causes difficulties for the kid in accepting parental authority in other domains. If they see themselves as equals in terms of emotional support, then they might think, why can you tell me what to do?
- Sharing age-inappropriate information: Many children want to be treated as older than they are (at least in certain ways). So they might requestinformation about finances, romantic relationships, or family stressors that are inappropriate for their age. Although it can be tempting to share, it is not helpful long-term. It may alleviate the child’s current anxiety (and stop the nagging), but it will impair their ability to respect boundaries as well as interfere with them just being a kid.
- Difficulty saying no: If you’re exhausted, the last thing you want is an argument. One way to avoid an argument is to say yes to your kid’s requests to buy a toy, stay up 15 more minutes, or have a different dinner. If you have boundaries around what you will spend, how much sleep you need, or what you will cook, you are still a good parent. Sticking to your limits teaches your child to accept other people’s boundaries without whining or threats.
- Allowing your child to treat you unkindly: Many parents allow their children to treat them in ways they would never tolerate from another person. This includes calling the parent mean or profane names, hitting them, or disregarding their needs (for money, sleep, leisure time, etc.). Allowing this kind of behavior prevents the child from learning how to respect boundaries and tolerate the emotions they experience when they face them.
Factors that contribute to boundary concerns
There are specific circumstances that can make it difficult for a parent to know where the appropriate boundaries are. They include a child’s late development, psychiatric challenges, and history of unsafe choices. For example, a child may have delays in language, executive functioning, or social or emotional skills. These things can make it challenging to determine how involved you need to be in your child’s daily life and how much independence they can handle.
- Poor risk assessment and impulsivity: Many disorders can impact children’s ability to think clearly, regulate emotionally, and act safely. For example, a teen experiencing a manic episode may overestimate their abilities, underestimate risk, and act impulsively. Or a child with ADHD might hard to control on crowded city streets or in restaurants, so you avoid taking them out or letting them do activities on their own with friends.
- Lack of confidence: Anxious children may underestimate their abilities and request continued support past when they are capable of independence. For example, a socially anxious child may ask their parent to order for them at a restaurant or keep track of their homework assignments. When a parent accommodates these requests, it confirms their belief that they still need help.
- Executive functioning deficits: Children who struggle with executive functioning may need more scaffolding to complete daily self-care tasks than other kids their age. This can look like parents providing frequent reminders of assignments, events, or even hygiene tasks — as well as cleaning their room for them long past when an child with ADHD should be doing it themselves. Consider how you can scaffold the skills (packing their bookbag!) without doing tasks for them, and gradually remove the supports over time.
- History of not successfully navigating tasks: A child’s history of poorly handling a responsibility (safe use of technology, completion of homework, brushing their teeth) often reduces parents’ confidence in the child’s abilities and increases their inclination to step in. Although extra supervision and support may be needed initially, it is important to reassess your child’s abilities over time as they can learn and grow if you let them!
How to get better at boundaries
Once you have recognized the challenges in respecting your child’s boundaries and protecting your own, the next step is to figure out what those boundaries are.
- Identify your boundaries: What things are most important to support your child’s growing independence and sense of autonomy? What boundaries do you need to set to protect your own mental health? Consider what level of involvement you want to have in their academics, friendships, emotion regulation, and appearance and what you want to disclose to them about your own relationship, emotions, or work.
- Practice setting these boundaries: It is much easier to set a boundary when you are not forced to make the choice with a child’s puppy dog eyes looking at you. Rehearsing how you will say no, decline to share certain information, or respond to an anxiety-provoking situation can prepare you to respond more effectively and in line with your values in a moment of conflict.
- Share your reasons for boundaries: Children can be quick to interpret lack of boundaries as “more caring,” but being consistent in language around why boundaries are being set can help prevent this. When setting a boundary, it is helpful to couch it in care. For example, “I care about you enjoying your childhood, so I do not feel comfortable sharing with you about our family’s finances.”
When kids want more independence than you are sure they are ready to handle, identifying steps toward their goal can be effective. Giving them opportunities to show maturity, with success at one step leading to more responsibility, can help you trust your child with greater independence. What can your kids show you that will help you feel confident in their ability to manage their emotions themselves or make well thought-out decisions?
Kids also need to recognize that they sometimes overestimate their own abilities, that there are times they have not assessed risk accurately and still need their parents. It is important to teach your child that you should be alerted if they are experiencing something that is unsafe or concerning (such as a friend talking about suicide or sharing an inappropriate photo). Discussions with your kid can sort out how to work toward new milestones and help everybody feel confident that they have the skills to do it.
Modeling a healthy respect for boundaries will set your child up to establish their own and respect others’ boundaries throughout their life.
Frequently Asked Questions
Emotional boundaries are the limits that protect each person’s right to their own thoughts, feelings, values, and decisions. In families, healthy boundaries allow children to develop independence while helping parents avoid taking responsibility for emotions or choices that belong to their child.
Healthy emotional boundaries support children’s confidence, autonomy, and ability to solve problems on their own. They also protect parents’ well-being by preventing them from becoming overly responsible for their child’s feelings, worries, or decisions.
Common signs include getting overly involved in a child’s friendships or school life, refusing age-appropriate privacy, sharing personal information without permission, or telling a child what they should think or feel. While these behaviors often come from a place of love and concern, they can undermine a child’s confidence and independence.
Parents can start by considering where their child is developmentally and what level of support versus independence is appropriate. A good guideline is to provide enough structure to keep children safe while gradually giving them more responsibility and privacy as they demonstrate readiness.
The post Maintaining Emotional Boundaries as a Parent appeared first on Child Mind Institute.
The ECHO study: compassion-focused therapy for young voice hearers and their caregivers. A pilot study
Autistic- and attention-deficit/hyperactivity disorder-like traits: differential associations with burnout, depression and anxiety, and empathy among Japanese junior residents
Social Cognition in Children and Adolescents With Autism Spectrum Disorder
Sponsors: Children’s Hospital of Fudan University
Active, not recruiting
Millions of People in Canada Are Finding AI-Enabled Support for Mental Health Effective Amid Ongoing Questions Around Trust.
(OTTAWA) July 8, 2026 — New polling shows approximately six million people in Canada used AI-enabled tools for mental health support in the past year and most find them effective. Today, the Mental Health Commission of Canada (the Commission), in partnership with Mental Health Research Canada (MHRC) and Pollara Strategic Insights, releases the first nationally representative data on how people in Canada engage with digitally supported mental health tools, including AI and virtual care, across every province and demographic.
Quick Facts:
- 1 in 7 people in Canada used AI mental health tools in the past year
- Three out of four who used AI and virtual mental health services found them effective for their well-being
- Only 14 % trust AI tools, just 2% trust them completely
- 40 % of AI users said they were more likely to seek professional care
- Nearly half (45%) who accessed mental health care did so virtually, in whole or in part
WHY IT MATTERS
People in Canada are turning to AI as a convenient way to access mental health support. AI-enabled tools may offer greater convenience and accessibility. Among those surveyed, AI is being used because it is:
- Free or low-cost; 46% of AI users cite this as the reason they use it during a time when financial stress is itself a cause for anxiety.
- Always available; 44% of AI users cite 24/7 access.
- Immediate and convenient; it can be used from anywhere without travelling or waiting for an appointment. For someone in rural Canada, it saves time and travel costs.
- Seemingly private; 39 % of AI service users cite private, anonymous support as a reason for use, while privacy and data protection remain key public concerns.
AI is most used for general well-being (42%), companionship (36%), and mild-to-moderate stress (36%), and 40% of AI users said they were more likely to seek professional care.
WHO IS USING IT AND HOW MUCH DO THEY TRUST IT?
Use is higher among people in Canada under 35 (27%; 29% among men aged 25–34), newcomers to Canada (28%), racialized people in Canada (23%), and 2SLGBTQI+ communities (20%), populations that may experience greater barriers to traditional care.
Overall, trust remains low, particularly for AI-enabled tools, where only 2% of people in Canada trust them completely. People in Canada over 55 show the lowest adoption and trust.
VIRTUAL CARE: EFFECTIVE AND MORE TRUSTED BUT FALLS SHORT OF IN-PERSON SERVICES
45% of people in Canada who used mental health services in the past year did so virtually, with 75% reporting positive outcomes. However, nearly 1 in 3 prefer a hybrid model that combines virtual and in-person services. The data signals what people in Canada need: well-designed tools for safer digital mental health care that they can trust.
THE COMMISSION OFFERS GUIDANCE FOR THE DIGITAL MENTAL HEALTH ERA
The Commission is Canada’s trusted resource for safe digital mental health — assessing apps and tools, setting evidence-based standards, and leading the national conversation on guidance for AI in mental health and substance use health care.
As virtual services and AI-enabled tools continue to expand rapidly across the mental health landscape, there is a growing need for evidence-based insight into how people in Canada engage with, understand, and perceive them. The Commission partnered with MHRC to leverage their ongoing national polling initiative and provide timely insights into usage, attitudes, and concerns related to e-mental health and AI.
The polling is clear: people in Canada want to close the gap between availability and trust. The Commission is working with the Canadian Centre on Substance Use and Addiction and collaborators, provincial governments, technology developers, and health system partners to establish guidance for AI.
“Six million people in Canada have already used AI for mental health support and most found it convenient and effective for their well-being. It is critical that AI is safe and equitable to increase public trust and reduce harms.” – Lili-Anna Pereša, President and Chief Executive Officer, Mental Health Commission of Canada
“The people turning to digitally-supported mental health tools are often those facing some of the greatest barriers to care. Making sure these tools are safe, effective, evidence-based and human-centred is a matter of equity. Ongoing research is essential to understanding where they help and where safeguards are needed.”– Akela Peoples, Chief Executive Officer, Mental Health Research Canada
About Mental Health Commission of Canada
As an independent, not-for-profit with charitable status, the Commission collaborates with leading experts and organizations nationally and internationally, including with people with lived and living experience, to develop national guidelines, standards and strategies, promote innovation and best practices, reduce stigma, increase mental health literacy, and support all levels of government to improve mental health outcomes for everyone living in Canada. The Commission is Canada’s trusted resource for digital mental health best practices with the e-Mental Health Strategy for Canada, app assessment, e-modules for e-mental health implementation, and AI guidance for mental health and substance use health.
About Mental Health Research Canada
As an independent national charity, MHRC works hard to enable a future where mental health in Canada is transformed using evidence, data and stakeholder engagement. We unite researchers, communities, and people with lived experience to bridge gaps in care through national population polling, rapid data reporting, and partnerships that inform policy to improve outcomes. Learn more at www.mhrc.ca
About the Polling
Conducted by Pollara Strategic Insights in partnership with Mental Health Research Canada and the Mental Health Commission of Canada, this national poll (n=3,519) is the first representative data on AI use for mental health in Canada. Full findings: https://mentalhealthcommission.ca/AI-polling-report
About the Funding
The views in this report solely represent the views of the Mental Health Commission of Canada. Production of this report is made possible through financial contribution from Health Canada.
Media Contact
Heather Bakken, Pendulum Group
email: heather@pendulumgroup.ca
cell: 613-406-5432
The post Millions of People in Canada Are Finding AI-Enabled Support for Mental Health Effective Amid Ongoing Questions Around Trust. appeared first on Mental Health Commission of Canada.

