Father engagement in child and adolescent mental health care: From neurobiology to clinical practice.

Fathers influence child development through biological, relational, and family-system pathways, yet they remain comparatively underrepresented in research and child mental health care. Emerging neurobiological evidence suggests that paternal caregiving is associated with experience-dependent adaptations in neural and neuroendocrine systems involved in caregiving and social responsiveness. Developmental research further identifies both direct pathways, including father-child interaction, play, caregiving, and emotional responsiveness, and indirect pathways involving coparenting, family functioning, resources, and support of other caregivers. These processes may also influence children's emotional and behavioral health, although much of the evidence is observational and should not be interpreted as establishing causality. Despite the importance of fathers within children's developmental environments, fathers remain underrepresented in parenting intervention research and may be insufficiently engaged in psychiatric assessment and treatment. Father-inclusive care requires moving beyond physical presence or appointment attendance toward meaningful participation in assessment, treatment planning, behavioral interventions, medication monitoring, and safety planning when clinically appropriate. National, state, and health-system initiatives provide models for improving father engagement. This review proposes a practical framework: Identify, Invite, Listen, Engage, Collaborate, and Sustain, for incorporating fathers and father figures into child and adolescent mental health care while recognizing diverse family structures, safety considerations, and individual circumstances.