Three-and-a-half year old Danisha had been expelled from her preschool program. Her older brother, Damon, had also endured a number of suspensions. Concerned about her children's behavior and well-being, their mother, Nicole, brought them in for clinical evaluations. Danisha, who had witnessed domestic violence, showed extreme impulsivity and had some signs of post-traumatic stress disorder, including hypervigilance (on alert at all times) and extreme distress when she heard shouting or arguments. Damon was often uncooperative, defiant, and hostile, but his mood was generally happy. However, Danisha's emotions fluctuated greatly. She was more emotionally reactive to even slight frustrations or provocations and found it difficult to calm or be comforted. In particular, she was highly anxious when having to separate from her mother.
Through Parent-Child Interaction Therapy (PCIT) -- an evidence-based mental health intervention for young children together with their parents -- clinicians worked with Nicole, coaching her on how to reinforce her children's positive behaviors and proactively engage with them. As Nicole learned and practiced the specific techniques in PCIT, her children's emotional reactions and behavior improved so that they could function in their new classrooms and the interactions at home were no longer overwhelming and exhausting.
As the experiences of Danisha and Damon illustrate, young children can and do face mental health challenges. Many factors contribute to mental health difficulties of infants and young children -- from medical and developmental disorders to exposure to adversity, such as trauma or the stress that can come from situations such as witnessing domestic/community violence or living in poverty. Unfortunately, Danisha and Damon aren't isolated cases. It is estimated that between 9.5 percent and 14.2 percent of children age birth-5 experience an emotional or behavioral disturbance.
It might be hard to imagine what mental health problems look like for such young children. But like any person, young children experience a range of emotions and react and recall situations in unique and dynamic ways. For instance:
- Infants and toddlers have the capacity to experience peaks of joy and elation as well as depths of grief, sadness, hopelessness, and intense anger and rage.
Years of research and the clinical expertise of practitioners who work with infants, young children, and their families, however, have resulted in effective treatments for infant and early childhood mental health disorders, which focus on rebuilding healthy and secure relationships between the child and parent or primary caregiver. Such interventions work to build positive and attuned caregiving skills, teach problem solving and coping strategies, and enhance support systems. For babies, they promote social, emotional, and cognitive development by nurturing healthy relationships and creating opportunities for play, exploration, communication, and learning.
Interventions geared toward young children rarely involve the child alone and more typically engage the parent(s) or caregivers together with the infant or young children. Some of the evidence-based treatments that are available to treat a variety of disorders that occur in early childhood include:
- Child-Parent Psychotherapy (CPP), which addresses symptoms of post-traumatic stress;
Additionally, Early Head Start (EHS) supports the social, emotional, cognitive, and physical development in economically disadvantaged young children. EHS seeks to promote positive social-emotional development and prevent problems from developing (discussed in my earlier blog posts on promotion and prevention), but also incorporates mental health consultation to support teachers in working with children and connect families to early childhood mental health practitioners, if needed. Early childhood mental health consultation has been found effective in decreasing preschool expulsion rates.
Untreated mental health problems can take root early and get worse over time, with potentially serious consequences for early learning, social competence, and lifelong health. By investing in early mental health treatment, it is possible to change the course for children, reduce the need for treatment later in life, and save time and money in the long-run. Furthermore, supporting clinicians with tools and techniques to best diagnose and treat mental health challenges in the earliest years will ensure a smoother road to success.
Unfortunately, most children are not as lucky as Danisha and Damon, who were connected to expert clinicians and received high-quality, well-coordinated treatment. Despite all we know about the effectiveness of early childhood mental health services, most children still do not receive necessary treatment and services. Clinicians who specialize in early childhood mental health, and particularly the needs of infants and toddlers, are scarce, limiting access to services.
To turn the tide on this trend and make effective treatments available to more families, we must ensure they are accessible and affordable. One such way is to make sure mental health treatment for very young children is covered by health insurance, including the Medicaid program. Ensuring that state Medicaid programs and other health insurers will pay mental health clinicians for the types of services proven to work -- not the case in many states -- will allow thousands of children like Danisha and Damon to progress on a sound developmental trajectory. This in turn will avoid costly health, special education, and even juvenile justice costs later in life. It is crucial that parents, professionals, policymakers and politicians come together and invest in young children's mental health now -- and reap the positive benefits for generations.
This blog post is the final installment in a three-part series exploring the mental health needs of very young children. Click here to read the first post on promotion of infant and early childhood mental health and here to read the second part on prevention and early intervention strategies.