Mental health%20 problems_early%20childhood
Upcoming SlideShare
Loading in...5
×
 

Mental health%20 problems_early%20childhood

on

  • 1,171 views

 

Statistics

Views

Total Views
1,171
Views on SlideShare
1,171
Embed Views
0

Actions

Likes
1
Downloads
7
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Mental health%20 problems_early%20childhood Mental health%20 problems_early%20childhood Document Transcript

  • 6mental health problems in earlychildhood can impair learning andBehavior for lifeworking paper 6
  • memBers charles a. nelson, ph.D. Richard David Scott Chair in Pediatric DevelopmentalJack p. shonkoff, m.D., chair Medicine Research, Children’s Hospital Boston; ProfessorJulius B. Richmond FAMRI Professor of Child Health and of Pediatrics, Harvard Medical SchoolDevelopment; Director, Center on the Developing Child,Harvard University Deborah phillips, ph.D. Professor of Psychology and Associated Faculty, Publicw. thomas Boyce, m.D. Policy Institute; Co-Director, Research Center on ChildrenSunny Hill Health Centre/BC Leadership Chair in Child in the U.S., Georgetown UniversityDevelopment; Professor, Graduate Studies and Medicine,University of British Columbia, Vancouver ross a. thompson, ph.D. Professor of Psychology, University of California, DavisJudy cameron, ph.D.Professor of Psychiatry, University of Pittsburgh; SeniorScientist, Oregon National Primate Research Center; contriButing memBersProfessor of Behavioral Neuroscience and Obstetrics &Gynecology, Oregon Health and Science University susan nall Bales President, FrameWorks Institutegreg J. Duncan, ph.D.Distinguished Professor, Department of Education, Bruce s. mcewen, ph.D.University of California, Irvine Alfred E. Mirsky Professor; Head, Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology,nathan a. fox, ph.D. The Rockefeller UniversityDistinguished Professor; Director, Child DevelopmentLaboratory, University of Maryland College Park arthur J. rolnick, ph.D. Senior Vice President and Director of Research, Federalwilliam t. greenough, ph.D. Reserve Bank of MinneapolisSwanlund Professor of Psychology, Psychiatry, and Celland Developmental Biology; Director, Center for Ad-vanced Study at University of Illinois, Urbana-Champaign partners the frameworks institutemegan r. gunnar, ph.D. the Johnson & Johnson pediatric instituteRegents Professor and Distinguished McKnight UniversityProfessor, Institute of Child Development, University of the national conference of state legislaturesMinnesota the national governors association center for Best practiceseric knudsen, ph.D.Edward C. and Amy H. Sewall Professor of Neurobiology,Stanford University School of Medicine sponsors Birth to five policy alliancepat levitt, ph.D. the Buffett early childhood fundProfessor of Pharmacology, Annette Schaffer EskindChair; Director, Kennedy Center for Research on Human the John D. and catherine t. macarthur foundationDevelopment, Vanderbilt University the pierre and pamela omidyar fundabout the authorsThe National Scientific Council on the Developing Child, housed at the Center on the Developing Child at Harvard University, is amulti-disciplinary collaboration designed to bring the science of early childhood and early brain development to bear on publicdecision-making. Established in 2003, the Council is committed to an evidence-based approach to building broad-based public will thattranscends political partisanship and recognizes the complementary responsibilities of family, community, workplace, and government topromote the well-being of all young children.For more information, go to www.developingchild.net.Please note: The content of this paper is the sole responsibility of the authors and does not necessarily represent the opinions ofthe funders or partners.Suggested citation: National Scientific Council on the Developing Child (2008). Mental Health Problems in Early Childhood Can ImpairLearning and Behavior for Life: Working Paper #6. http://www.developingchild.net© December 2008, National Scientific Council on the Developing Child, Center on the Developing Child at Harvard University first printing: december 2008
  • the issuesignificant mental health problems can and do occur in young children. in some cases,these problems can have serious consequences for early learning, social competence, and lifelonghealth. Furthermore, the foundations of many mental health problems that endure through adult-hood are established early in life through the interaction of genetic predispositions and sustained,stress-inducing experiences. This knowledge should motivate practitioners and policymakers aliketo address mental health problems at their origins, rather than only when they become more seri-ous later in life.Public awareness of significant emotional and problems disrupt the typical pattern of devel-behavioral problems in early childhood is oping brain architecture and impair emerginggrowing, as preschool teachers report increas- capacities for learning and relating to others.ingly major disruptions in their classrooms1 Most important, there are indications thatand kindergarten teachers identify social and early intervention can have a profound posi-emotional problems as a common impedi- tive effect on the trajectory of emotional orment to school readiness.2,3 The emergence behavioral problems as well as improve out-of mental health problems in young children comes for children with serious disorders, beoccurs within the context of an environment they psychological or genetic in origin.of relationships that can include parents, rela- While all children experiencing prolongedtives, caregivers, teachers, and peers. Science adversity are at risk for poor outcomes, studiesshows that this environment of relationships show that long-term physical and mental healthplays a critical role in shaping a child’s social, impacts are most likely to affect individuals whoemotional, and cognitive development in the are genetically more vulnerable to stress. Earlyearliest years of life. In turn, problems in these stresses can include child abuse or neglect, fam-domains affect not only the child, but those ily turmoil, neighborhood violence, extremewho care for, play with, or attempt to teachthat child. Thus, while problems in cognitivedevelopment are already the focus of much the foundations of many mental health problemsattention, emerging emotional and behavioralproblems in the early years are also an impor- that endure through adulthood are establishedtant societal issue that must be addressed. early in life. The science of early childhood developmentalso tells us that, for some children, mentalhealth problems may begin early and endure. poverty, and other conditions in a child’s envi-Although establishing diagnostic criteria for ronment that can prime neurobiological stresspsychological disorders in young children re- systems to become hyper-responsive to adver-mains a challenge, many children show clear sity.7 Exposure to adverse experiences such ascharacteristics of anxiety disorders, attention- these early in life, particularly for vulnerabledeficit/hyperactivity disorder, conduct disor- children, predicts the emergence of later physi-der, depression, post-traumatic stress disorder, cal and mental health problems, including psy-and other problems at a very early age.4 Recent chological disorders like depression.8,9reports suggest that some of the characteris- Although mental health challenges for youngtics of neuro-developmental disabilities such children share many biological and behavioralas autism can be detected during the first year5 characteristics with those of older children andand that older children often exhibit the emo- adults, there are at least three ways in which ear-tional legacy of early abuse or neglect.6 Beyond ly childhood is a period of special vulnerability.the challenges facing these children and their First, psychological health for young children iscaregivers, attention to early mental health strongly influenced by their environment of re-problems is warranted because these kinds of lationships and the support or risks these rela-www.developingchild.net Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life 1
  • national scientific council on the Developing chilD tionships confer.10 Therefore, to understand the developmental differences are important to reasons that young children may be at risk for understanding the behavioral and emotional mental health impairments, how best to provide disturbances that young children may experi- assistance, and strategies for preventing these ence, how they are manifested, and how to assist problems from arising, it is important to look them. at the quality of their early relationships. To a Third, there is a broad range of individual greater extent than is true of older children and differences among young children that can adults, viewing the child alone as the “patient” make it difficult to distinguish typical varia- or the source of the problem can lead to costly tions in behavior from persistent problems, or or ineffective policies and practices. normal differences in maturation from signif- Second, young children often respond to icant developmental delays.11 Although many emotional experiences and traumatic events in enduring mental health problems have their ways that are very different from adults. They origins in the early years, many behavioral or understand, manage, and talk about their ex- emotional difficulties in children and even periences differently from adults. Their self- adolescents are transient.12,13,14 Thus, caution awareness and capacity to think about is needed when evaluating an infant or young their emotions and the events that trig- child for potential indicators of emotional or ger them are not yet well-developed. These behavioral difficulty.what science tells us significant adversity early in life can damage such as maternal depression, also have well- the architecture of the developing brain and documented effects on developing brain func- increase the likelihood of significant mental tion in the early years.24, 25, 26, 27, 28 health problems that may emerge either early All of these situations are stressful for chil- or years later.7, 15,16,17,18,19,20,21 Life circumstances dren. Persistent activation of biological stress re- associated with family stress, such as persis- sponse systems leads to abnormal levels of stress tent poverty, threatening neighborhoods, hormones that have the capacity to damage and very poor child care conditions, elevate brain architecture if they do not normalize. In the risk of serious mental health problems the absence of the buffering protection of sup- and undermine healthy functioning in the portive relationships, these hormone levels can early years.22 Early childhood adversity of this remain out of balance. Known as toxic stress, kind also increases the risk of adult health this condition literally interferes with develop- and mental health problems because of its ing brain circuits, and poses a serious threat to young children, not only because it undermines persistent poverty, threatening neighborhoods, their emotional well-being, but also because it can impair a wider range of developmental and very poor child care conditions elevate the outcomes including early learning, exploration and curiosity, school readiness, and later school risk of serious mental health problems. achievement.15,21,29,30,31,32,33,34,35 much impairment in mental health arises as a enduring effects on the body and brain de- result of the interaction between a child’s ge- velopment.23 Young children who experience netic predisposition and his or her exposure to recurrent abuse or chronic neglect, regularly significant environmental adversity. Differences witness domestic violence, or live in homes in individual behavioral styles (which child de- permeated by parental mental health or velopment researchers call temperament) influ- substance abuse problems are particularly ence the mental health consequences of early vulnerable. Relationship-based conditions traumatic, abusive, or stressful experiences. A contributing to early emotional difficulties, young child with a genetic predisposition to2 Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life www.developingchild.net
  • what science tells usfearfulness, for example, is more likely to de- be related to the development of more seriousvelop anxiety or depression than a child with- problems later in life, as other studies show thatout that predisposition, but particularly in the children who are behaviorally inhibited showcontext of harsh, inconsistent caregiving (per- different activation of brain regions related tohaps owing to the stresses of deep poverty, poor emotional withdrawal and fear than childrenquality child care, or a depressed mother) rather whose behavior is more typical.39,40,41,42than nurturing, sensitive care. This nature-nurture interaction is illus- the behaviors and characteristics associatedtrated in studies of behavioral inhibition, an with mental health problems in the earliest yearsearly-emerging pattern of fearful, withdrawn of life are often different from those seen in olderbehavior that is a risk factor for later anxiety children and adults with psychological difficul-problems.10,36 In a recent report, behavioral in- ties.43,44,45 Young children’s brains are not fullyhibition at age 7 was related to the interaction of developed and they do not respond to stressfultwo influences: (a) a gene that is associated with events the way adults do. A toddler who is cop-anxiety and fear in adults, and (b) the mother’s ing with trauma or the loss of a loved one actsreport that she lacked social support from oth- differently from a traumatized adolescent be-ers, which is likely to be associated with stress cause of the different psychological capabilities,for her children. In other words, the interaction emotional needs, and social experiences at eachof a genetic tendency toward anxiety along with age. Young children manifest the symptoms ofthe experience of life stress best predicted which depression or post-traumatic stress disorderchildren would remain behaviorally inhibited (PTSD) differently from young adults. Someat age 7.37,38 Such behavioral inhibition may mental health problems, such as attachment- mental health problems can occur across childhood any Diagnosis serious emotional Disorder anxiety Disorder age 2-5 Disruptive Behavior Disorder age 8-17 aDhD Depression 0 5% 10% 15% 20% 25% 30% percent of children Source: Egger & Angold (2006)4www.developingchild.net Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life 3
  • national scientific council on the Developing chilD related disorders (i.e., profound disturbances Promising approaches for some early mental in close relationships with caregivers), are spe- health challenges are well-described,60,61,62 yet cific to early childhood. Thus, although adult they are not widely available. Other problems diagnostic approaches can provide some guid- have been less well-studied in very young chil- ance for understanding the kinds of problems dren. Nevertheless, many disorders can be pre- that younger children may experience, new ap- vented before they begin through developmen- proaches to assessment and diagnosis based on tally appropriate, high-quality early care and the unique developmental needs and character- education, systems of support that assist parents istics of young children are also necessary.45,46 and caregivers to provide warm and secure re- Over the past few years, researchers have lationships and detect emotional problems be- validated diagnostic criteria specific to young fore they become more resistant to change, and children that are useful in identifying early public policies that help to ameliorate the physi- cal, social, and economic conditions that cause some families to struggle. if young children are not provided appropriate some individuals demonstrate remarkable re- help, emotional difficulties that emerge early in silience in the face of early, persistent maltreat- ment, trauma, and emotional harm, but there arelife can become more serious disorders over time. limits to the capacity of young children to recover psychologically from such adversity.63,64,65,66 Even forms of depression, post-traumatic stress under circumstances in which children have been disorder, autism, disruptive behavior disor- rescued from traumatizing circumstances and ders, anxiety disorders, and attention deficit/ placed in exceptionally nurturing homes, devel- hyperactivity disorder.4,47,48,49,50,51,52,53 Despite opmental improvements are often accompanied these gains, however, the accurate identifica- by continuing problems in self-regulation, emo- tion of serious mental health disorders dur- tional adaptability, relating to others, and self- ing the first three to four years of life remains understanding. There also is evidence to suggest a challenging task. As with older children that long-term physical health can be affected by and adults, it is unwise to assume that early early life adversity in the form of increased risk of problems can be classified simply into one heart disease, diabetes, hypertension, and other category within a diagnostic system. In fact, physical ailments, as stressful experiences can young children, like older children and adults, literally be “built” into the body and the brain.9 frequently experience multple prob- Generally speaking, when children overcome these lems (known as“co-morbidity”), as il- burdens, they have been the beneficiaries of ex- lustrated by the co-occurrence of depres- ceptional efforts on the part of supportive adults. sion with oppositional-defiant disorders These findings underscore the importance of pre- in early childhood or the increased preva- vention and timely intervention in circumstances lence of depression or anxious emotional that put young children at serious psychological problems in children with autism.4,54,55,56 risk. if young children are not provided appropriate serious developmental disabilities can also be help, emotional difficulties that emerge early associated with significant mental health impair- in life can become more serious disorders over ments that are affected by experience and ame- time.57,58,59 Early prevention strategies and efforts nable to intervention. Neuro-developmental dis- to identify and treat emergent mental health orders, such as autism, fragile X syndrome, and problems are likely to be more psychologically Down syndrome, for example, are the result of beneficial and cost-effective than trying to treat strong genetic influences. Nevertheless, genet- emotional difficulties after they become more ics is only part of the story. Although disorders serious at a later age. This field urgently needs such as Down syndrome have a strong genetic treatment strategies that are age-appropriate, etiology, mental health outcomes for these chil- support the development of healthy relation- dren are also affected by the quality of care and ships, and are consistent with scientific knowl- support they receive. The possibility of signifi- edge about early psychological development. cant improvement in quality of life, as well as in4 Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life www.developingchild.net
  • what science tells usboth cognitive and social functioning, as a result for many providers of child health services andof prompt intervention provides a strong argu- early care and education who are faced withment for the early detection and treatment of children who present problematic behavior, thethese developmental disorders. This is becom- question of “when to worry” is paramount, yeting increasingly apparent with respect to early little evidence exists to answer that questionintervention for autism.67 definitively. Although early mental health prob- lems can foreshadow enduring disorders, manythe powerful influences of early relationships il- difficulties are transient and disappear withlustrate how much the emotional well-being of appropriate management and further matura-young children is directly tied to the emotional tion.12,13,14 Generally speaking, clinical expertsfunctioning of their caregivers and the familiesin which they live.68 When these relationshipsare abusive, threatening, chronically neglect- the emotional well-being of young children isful, or otherwise psychologically harmful, theyare a potent risk factor for the development directly tied to the emotional functioning of theirof early mental health problems. In contrast, caregivers and the families in which they live.when these relationships are reliably warm,responsive, and supportive, they can actuallybuffer young children from the adverse effects advise greater concern when children exhibitof other stressors.19,63.69,70,71 It is essential to constellations of problems (e.g., persistent irri-treat young children’s mental health problems tability, eating and sleeping problems, combinedwithin the context of their family, home, and with defiance) that lead to significant impair-community environments. Stated simply, ad- ments (especially in age-appropriate behavioraldressing the stressors affecting a child requires skills and relationships). Nevertheless, in the ab-addressing the stressors on his or her family in sence of more extensive evidence on the natu-order to ensure that the critical environment ral history of many mental health disorders, theof relationships can be maximally supportive. “when to worry” problem remains a challenge.popular misrepresentations of scienceas the public devotes more attention to experiences in early childhood are not “forgot-the relation between early brain development ten” — they are built into the architecture ofand the emotional well-being of young children, the developing brain and can have a sustainedthe risk of misinformation and misleading or impact that extends well into the adult years,irresponsible messages also grows. Within this especially when they are severe, persistent, andcontext, it is essential that we distinguish scien- uncontrollable. Aversive family and communitytific fact from erroneous fiction. The following environments can have a similarly enduringtwo misconceptions are particularly important emotional impact on young children when theyto set straight. are experienced as toxic stress and not buffered by supportive relationships.contrary to popular belief, young children canand do experience serious emotional problems contrary to popular belief, young children liv-that are comparable in severity to what we ob- ing in highly disadvantaged environments canserve in older children and adults, and can have be protected from serious emotional or behav-lasting effects. Although young children are not ioral consequences. Although such conditionsas psychologically sophisticated as adults, re- increase their risk for serious mental healthsearch on early childhood development shows problems, learning impairments, and long-termthat they are capable of experiencing peaks of physical illnesses, children who experience seri-joy and elation as well as depths of grief, sadness, ous threats to their psychological health, suchhopelessness, intense anger, and rage. Contrary as those who are physically abused, chronicallyto traditional views, highly negative emotional neglected, or emotionally traumatized, do notwww.developingchild.net Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life 5
  • national scientific council on the Developing chilD inevitably develop significant mental illnesses. the context of stable, nurturing relationships These children can be protected through the with supportive and skilled caregivers as well as early identification of their emotional needs through preventive mental health services.64,66,72 and the provision of appropriate assistance inthe science-policy gap the fact that young children can present professionals who are regularly involved in the challenging behaviors is hardly news to the lives of infants, toddlers, and preschoolers often adults who care for them. It is less well known lack the knowledge and skills that would help that some serious behavior problems in the them identify the early signs of mental health early years of life may be the first signs of po- problems as well as fully understand the conse- tentially lifelong disorders that are preventable quences of family difficulties and parent mental if treated at a young age. Very young children health problems for young children’s develop- can experience significant impairments in their ment. These professionals include child care mental health that are embedded in the archi- providers and preschool teachers (who are of- tecture of their brains and may have life-long ten the first people outside the family to iden- consequences, according to a rich and growing tify a child who has serious emotional difficul- science base. Yet little attention has been paid to ties), physicians and other health care providers the development and implementation of strate- (who often lack a sophisticated understanding gies to identify children who are at risk for such of psychological development and early mental problems and provide supports for them and health), paraprofessional home visitors, pro- their families that will increase the probability gram administrators and personnel in social of more favorable outcomes. This gap between service, child protection, early intervention, and what we know and what we do is illustrated by welfare agencies, and others who regularly serve the following three examples. families with young children. antipsychotic prescriptions for children have increased five-fold 45 40 perscriptions per 1000 children 35 30 25 20 15 10 5 0 1995-1996 2001-2002 antipsychotic prescriptions for children ages 2-12 Source: Cooper et al. (2006)816 Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life www.developingchild.net
  • the science-policy gapin most communities, mental health services for young as age three.74 In most cases, these medi-young children and their families are often limit- cations for young children are prescribed “offed, of uneven quality, and difficult to access, and label,” which means that they have only beenthere are few well-trained professionals with ex- approved for treating adults and that there arepertise in early childhood mental health. Central no scientific data on their immediate or long-to this problem is the need to close the gap be- term effects on child behavior or early braintween the numbers of young children exhibit- development.47 Until the relevant clinical stud-ing emotional difficulties and/or problematic ies have been completed with the appropriatebehavior that cannot be managed adequately bytheir parents and the number of personnel whoare skilled in effective intervention approaches sometimes the best intervention strategy forthat are uniquely suited to this group. young children with serious behavioral orthere has been a dramatic increase in the use ofpsychoactive drugs for young children with be- emotional problems is to focus directly on thehavioral or mental health problems, despite thefact that neither the efficacy nor safety of many primary needs of those who care for them.of these medications has been studied specifi-cally in children at these early ages.47 A recent populations of young children, the use of suchreport from the National Survey of Children’s medications must be viewed as experimental andHealth, for example, reported that children age their safety and effectiveness unknown.75,76,77,784-8 were more likely to be taking medicationfor attention deficit/hyperactivity disorder thanolder children and adolescents.73 Of even greaterconcern, some studies have reported increasingnumbers of prescriptions for stimulant medi-cations and antidepressants to treat children asimplications for policy and programsthe science of early childhood develop- al and behavioral needs of infants, toddlers, andment, including knowledge about the extent to preschoolers are best met through coordinatedwhich serious emotional problems are embed- services that focus on their full environment of re-ded in the architecture of the developing brain, lationships. Multigenerational, family-centeredis sufficiently mature to support a number of approaches offer the most promising modelsevidence-based implications for those who de- for preventing and treating mental health prob-velop and implement policies that affect the lems in young children. These strategies rangehealth and well-being of young children. Both from providing information and support to ad-public and private actions can prevent the kinds dress problematic child behavior to initiatingof adverse circumstances that are capable of de- therapeutic interventions to address significantrailing healthy development, as well as increase parent mental health or substance abuse prob-the likelihood that effective supports and appro- lems, end domestic violence, or help familiespriate therapeutic interventions (where needed) to cope with the burdens of persistent poverty.will reduce the long-term consequences of early Indeed, sometimes the best intervention strat-threats to a child’s mental health. The follow- egy for young children with serious behavioraling points are particularly worthy of thoughtful or emotional problems is to focus directly onconsideration. the primary needs of those who care for them. However, most funding approaches to mentalBecause young children’s emotional well-being health services are client-specific rather thanis tied so closely to the emotional status of their family-focused, and most programs aimed atparents and non-family caregivers, the emotion- such “adult” problems as poverty, domesticwww.developingchild.net Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life 7
  • national scientific council on the Developing chilD violence, or substance abuse do not take into sources that do not relate easily. These might consideration the emotional well-being of the include early care and education, social service children affected by them. More flexible ap- and welfare departments, health care, schools, proaches to funding family-based preventive child welfare agencies, and early intervention and therapeutic mental health services are programs, to name a few. Reducing barriers to needed. greater coordination often requires attention to a tangle of administrative obstacles. One exam- therapeutic help for a young child with emotional ple would be a change in reimbursement regula- or behavioral problems can be provided through tions to allow “mental health funds” to be used a combination of home- and center-based to pay for specialized child care for a youngster services involving parents, extended family with emotional and behavioral problems, rather members, home visitors, providers of early care than restricting the funds to only “mental health and education, and/or mental health profession- programs.” als. The settings, partnerships, and targets of therapeutic assistance for young children with mental health services for adults who are parents mental health needs are much more diverse of young children would have broader impact if than those for adults because their emotional they routinely included attention to the needs of well-being is linked tightly to the quality of the children as well. Because of the close associ- their relationships with the important people in ation between young children’s emotional well- their lives. Effective intervention often requires being and the emotional health and functioning the coordination of services from multiple of their caregivers,79 therapeutic assistance to preschool explusions Decrease with access to mental health professionals 30% percent of pre-k teachers reporting expulsions 25% access to psychologist/psychiatrist 20% access to social worker 15% 10% 5% 0 unavailable on-call on-site or regular visits access to mental health professionals in preschools Source: Gilliam (2005)18 Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life www.developingchild.net
  • implications for policy anD programsa parent ought to include an automatic assess- (S-CHIP), early intervention services under Partment of any young children in the family to see C of the Individuals With Disabilities Educationhow they are experiencing the emotional conse- Act (IDEA), child welfare programs, and mater-quences of their parent’s problems. For exam- nal and child health initiatives.ple, any physician treating a depressed motherought to understand the consequences of that cultural differences in attitudes and beliefs aboutdiagnosis for her young children and therefore behavior and mental health require sensitivityassure that they receive careful examinations and respect for diversity as well as specializedand appropriate intervention as needed. intervention skills. The mental health needs of young children in families from different cul-physicians and providers of early care and edu- tural and ethnic groups would benefit consid-cation would be better equipped to understand erably from enhanced practitioner training andand manage the behavioral problems of young flexible service models that incorporate greaterchildren if they had more appropriate profes-sional training in this area and easier access tochild mental health professionals when they are Broader attention to early childhood mental healthneeded. Caregivers, teachers, and physicians are requires attention to the quality of out-of-homeoften the first to recognize serious emotionaldifficulties in a child who is in their care, and care that children typically experience in theon-site assistance from early childhood mentalhealth specialists can be particularly helpful in early years.providing guidance about how best to respondto the needs of the children, their parents, andproviders of early care and education. Preschool content representing a broad variety of cultures.teachers with access to mental health con- Differences are widespread across a variety ofsultation, for example, are less likely to expel domains that affect approaches to the sensitivechildren with behavioral problems from their issues of emotional well-being and mental healthprograms.80 Some states have made progress in the early childhood years. These include howin providing funds for early childhood mental children are taught to interpret and expresshealth consultations in early child-care settings, their experiences of fear, anger, and shame;often through the coordination of diverse fund- parents’ attitudes toward discipline; the relativeing streams. Broader attention to early child- reinforcement given to individual achievementhood mental health requires attention to the versus interdependent behavior; attitudes aboutquality of out-of-home care that children typi- mental health and mental illness; and accep-cally experience in the early years. tance of therapeutic intervention for very young children by non-family members; among manya better coordinated infrastructure for funding other concerns. The shifting demographics ofmental health services for young children could the early childhood population in the Unitedprovide a more stable and efficient vehicle for States make this a particularly compelling pri-assuring access to effective prevention and ority for future planning. Finally, the effectstreatment programs. Consistent with both the of cultural assimilation for immigrant groupsscience—physiological interrelations among across generations underscore the importancethe physical health, safety, and emotional well- of understanding individual differences withinbeing of young children—and recent federal cultural groups as well as continuous changes inlegislation regarding parity for coverage of cultural beliefs and practices over time.health care for both physical and mental healthimpairments, funding for early childhood men-tal health services could be integrated moreeffectively into a wide range of existing healthprograms. Examples include Early and PeriodicScreening, Diagnosis and Treatment (EPSDT)services under the Medicaid program, theState Children’s Health Insurance Programswww.developingchild.net Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life 9
  • national scientific council on the Developing chilDreferences 1 Gilliam, W. (2005). Prekindergarteners left behind: 15 Carrion, V., Weems, C., Ray, R., Glaser, B., Hessl, D., & Expulsion rates in state prekindergarten systems. New Reiss, A. (2002). Duirnal salivary cortisol in pediatric Haven, CT: Yale University Child Study Center. posttraumatic stress disorder. Biological Psychiatry, 51, 2 Lewit, E., & Baker, L. (1995). School readiness. The 575-582. Future of Children, 5, 128-139. 16 De Bellis, M., Baum, A., Birmaher, B., Keshavan, M., 3 Rimm-Kaufman, S., Pianta, R., & Cox, M. (2000). Eccard, C., Boring, A., Jenkins, F., & Ryan, N. (1999). Teachers’ judgments of problems in the transition to Developmental traumatology, Part 1: Biological stress kindergarten. Early Childhood Research Quarterly, 15, systems. Biological Psychiatry, 9, 1259-1270. 147-166. 17 De Bellis, M., Keshavan, M., Clark, D., Casey, B., 4 Egger, H. L., & Angold, A. (2006). Common emotional Giedd, J., Boring, A., Jenkins, F., & Ryan, N. (1999). and behavioral disorders in preschool children: Developmental traumatology, Part 2: Brain development. Presentation, nosology, and epidemiology. Journal of Biological Psychiatry, 45, 1271-1284. Child Psychology and Psychiatry, 47, 313-337. 18 Glaser, D. (2000). Child abuse and neglect and the brain: 5 Yirmiya, N., & Ozonoff, S. (2007). The very early A review. Journal of Child Psychology and Psychiatry, 41, autism phenotype. Journal of Autism and Developmental 97-118. Disorders (Special Issue), 37, 1-11. 19 Gunnar, M.R., Morison, S.J., Chisholm, K., & Schuder, 6 Teisl, M., & Cicchetti, D. (2008). Physical abuse, cognitive M. (2001). Salivary cortisol levels in children adopted and emotional processes, and aggressive/disruptive from Romanian orphanages. Development and behavior problems. Social Development, 17, 1-23. Psychopathology, 13, 611-628. 7 Gunnar, M.R. (2007). Stress effects on the developing 20 Kaufman, J., & Charney, D. (2001). Effects of early brain. In D. Romer, E.F. Walker (Eds.) Adolescent stress on brain structure and function: Implications psychopathology and the developing brain: Integrating for understanding the relationship between child brain and prevention science. (pp. 127-147). New York: maltreatment and depression. Development and Oxford University Press. Psychopathology, 13, 451-471. 8 Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R.F. 21 National Scientific Council on the Developing Child. (2003). Relationship between multiple forms of child (2005). Excessive Stress Disrupts the Architecture of the maltreatment and adult mental health in community Developing Brain, Working Paper #3. Retrieved 12/19/07 respondents: Results from the Adverse Childhood from http://www.developingchild.net/reports.shtml. Experiences Study. American Journal of Psychiatry, 160, 22 Brooks-Gunn, J., & Duncan, G.J. (1997). The effects of 1453-1460. poverty on children. The Future of Children, 7, 55-71. 9 Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. 23 Danese, A., Pariante, C. M., Caspi, A., Taylor, A., & F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. Poulton, R. (2007). Childhood maltreatment predicts (1998). Relationship of childhood abuse and household adult inflammation in a life-course study. Proc. Natl. dysfunction to many of the leading causes of death in Acad. Sci. USA, 104:1319-1324. adults: The Adverse Childhood Experiences (ACE) study. 24 Danese, A., Moffitt, T. E., Pariante, C. M., Ambler, A., American Journal of Preventive Medicine, 14, 245-258. Poulton, R., & Caspi, A. (2008). Elevated inflammation 10 Rubin, K., Bukowski, W., & Parker, J. (2006). Peer levels in depressed adults with a history of childhood interactions, relationships, and groups. In W. Damon maltreatment. Arch. Gen. Psychiat. 2008; 65:409-416. & R. M. Lerner (Eds.), Handbook of child psychology 25 Dawson, G., Ashman, S., Panagiotides, H., Hessl, D., Self, (6th Ed.), Vol. 3. Social, emotional, and personality J., Yamada, E., & Embry, L. (2003). Preschool outcomes development (N. Eisenberg, Vol. Ed.) (pp. 571-645). New of children of depressed mothers: role of maternal York: Wiley. behavior, contextual risk, and children’s brain activity. 11 Shonkoff, J. P., & Phillips, D. A. (Eds.) (2000). From Child Development, 74, 1158-1175. neurons to neighborhoods: The science of early childhood 26 Evans, G. W., Gonnella, C., Marcynyszyn, L. A., Gentile, development. Washington, DC: National Academy Press. L., & Salpekar, N. The role of chaos in poverty and 12 Peterson, B. S., Pine, D. S., Cohen, P., & Brook, J. S. children’s socioemotional adjustment. Psycholigical (2001). Prospective, longitudinal study of tic, obsessive- Science. 2004; 16:560-565. compulsive, and attention-deficit/hyperactivity disorders 27 Evans, G. W., Kim, P., Ting, A. H., Tesher, H. B., & in an epidemiological sample. Journal of the American Shannis, D. Cumulative risk, maternal responsiveness, Academy of Child & Adolescent Psychiatry, 40, 685-695. and allostatic load among young adolescents. 13 Pine, D. S., Cohen, P., Johnson, J. G., & Brook, J. S. Developmental Psychology. 2007; 43:341-351 (2002). Adolescent life events as predictors of adult 28 Goodman, S., & Gotlib, I. (1999). Risk for depression. Journal of Affective Disorders, 68, 49-57. psychopathology in the children of depressed mothers: a 14 Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. developmental model for understanding mechanisms of (1998). The risk for early-adult anxiety and depressive transmission. Psychological Review, 3, 458-490. disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56-64.10 Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life www.developingchild.net
  • references29 Dawson, G,. & Ashman, D. (2000). On the origins 43 Doll, B., Brehm, K., Zucker, S., Deaver-Langevin, J., of a vulnerability to depression: The influence of Griffin, J., & Hickman, A. (2000). Contrasting procedures the early social environment on the development of for empirical support of traditional and population- psychobiological systems related to risk of affective based mental health services. Psychology in the Schools, disorder. In C.A. Nelson (Ed.), The effects of early 37, 431-442. adversity on neurobehavioral development. Minnesota 44 Lieberman, A.F., Barnard, K.E., Wieder, S. (2004) Symposia on Child Psychology, Vol. 31 (pp. 245-279). Diagnosing infants, toddlers, and preschoolers: The Zero Mahwah, NJ: Erlbaum. to Three diagnostic classification of early mental health30 Luby, J., Belden, A., & Spitznagel, E. (2006). Risk factors disorders. In R. DelCarmen-Wiggins, & A. Carter (Eds.), for preschool depression: the mediating role of early Handbook of infant, toddler, and preschool mental health stressful life events. Journal of Child Psychology and assessment (pp141-160). Psychiatry, 47,1292-1298. 45 Zero to Three. (2005). DC:0-3R: Diagnostic classification31 Osofsky, J. (2004). Community outreach for children of mental health and developmental disorders of infancy exposed to violence. Infant Mental Health Journal, 25, and early childhood (rev. edu). Washington, DC, US: 478-487. Zero to Three National Center for Infants, Toddlers and32 Rubin, K., Burgess, K., Dwyer, K., & Hastings, P. (2003). families. Predicting preschoolers’ externalizing behaviors from 46 American Academy of Child & Adolescent Psychiatry toddler temperament, conflict, and maternal negativity. (AACAP) (2003). Research diagnostic criteria for infants Developmental Psychology, 39,164-176. and preschool children: The process and empirical33 Scheeringa, M., & Zeanah, C. (1995). Symptom support. Journal of the American Academy of Child & expression and trauma variables in children under 48 Adolescent Psychiatry, 42, 1504-1512. months of age. Infant Mental Health Journal, 16, 259-270. 47 Gleason, M. M., Egger, H. L., Emslie, G. J., Greenhill, L.34 Shaw, D., Owens, E., Giovannelli, J.,& Winslow, E. L., Kowatch, R. A., Lieberman, A. F., Luby, J. L., Owens, J., (2001). Infant and toddler pathways leading to early Scahill, L. D., Scheeringa, M. S., Stafford, B., Wise, B., & externalizing disorders. Journal of the American Academy Zeanah, C. H. (2007). Psychopharmacological treatment of Child & Adolescent Psychiatry, 40, 36-43. for very young children: Contexts and guidelines.35 Vasey, M., & Dadds, M. (2001). The developmental Journal of the American Academy of Child & Adolescent psychopathology of anxiety. London: Oxford University Psychiatry, 46, 1532-1572. Press. 48 Keenan, K., & Wakschlag, L. S. (2002). Can a valid36 Tincas, I., Benga, O., & Fox, N. (2006). Temperamental diagnosis of disruptive behavior disorder be made in predictors of anxiety disorders. Cognition, Brain, preschool children? American Journal of Psychiatry, 159, Behavior, 10, 489-515. 351-358.37 Fox, N., Hane, A., & Pine, D. (2007). Plasticity for 49 Luby, J. L. (Ed.) (2006). Handbook of preschool mental affective neurocircuitry: How the environment affects health: Development, disorders, and treatment. New York: gene expression. Current Directions in Psychological Guilford. Science, 16, 1-5. 50 Luby, J. L., Mrakotsky, C., Heffelfinger, A., Brown, K.,38 Fox, N., Nichols, K., Henderson, H., Rubin, K., Schmidt, Hessler, M., Spitznagel, E. (2003). Modification of DSM- L., Hamer, D., Ernst, M., & Pine, D. (2005). Evidence for IV criteria for depressed preschool children. American a gene-environment interaction in predicting behavioral Journal of Psychiatry, 160, 1169-1172. inhibition in middle childhood. Psychological Science, 16, 51 Lord, C., Risi, S., DiLavore, P. S., Schulman, C., Thurm, 921-926. A., & Pickles, A. (2006). Autism from 2 to 9 years of age.39 Fox, N., Henderson, H., Marshall, P., Nichols, K., & Archives of General Psychiatry, 63, 694-701. Ghera, M. (2005). Behavioral inhibition: Linking biology 52 Scheeringa, M., Peebles, C. D., Cook, C. A., & Zeanah, and behavior within a developmental framework. Annual C. H. (2001). Toward establishing procedural, criterion, Review of Psychology, 56, 235-262. and discriminant validity for PTSD in early childhood.40 Fox, N., Henderson, H., Rubin, K., Calkins, S., & Journal of the American Academy of Child & Adolescent Schmidt, L. (2001). Continuity and discontinuity Psychiatry, 40, 522-60. of behavioral inhibition and exuberance: 53 Scheeringa, M., Zeanah, C. H., Myers, L., & Putnam, F. Psychophysiological and behavioral influences across the (2005). Predictive validity in a prospective follow-up first four years of life. Child Development, 72, 1-21. of PTSD in preschool children. Journal of the American41 Pine, D. S. (2007). Research review: A neuroscience Academy of Child & Adolescent Psychiatry, 44, 899-906. framework for pediatric anxiety disorders. Journal of 54 Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Child Psychology and Psychiatry, 48, 631-648. Depression in persons with autism: Implications42 Schwartz, C., Wright, C., Shin, L., Kagan, J., & Rauch, for research and clinical care. Journal of Autism and S. (2003). Inhibited and uninhibited infants “grown Developmental Disorders, 32, 299-306. up”: Adult amygdalar response to novelty. Science, 300, 1952-1953.www.developingchild.net Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life 11
  • national scientific council on the Developing chilD 55 Ghaziuddin, M., & Greden, J. (1998). Depression in 70 Francis, D., Diorio, J., Plotsky, P.M., & Meaney, M.J. children with autism/pervasive developmental disorders: (2002). Environmental enrichment reverses the effects A case-control family history study. Journal of Autism of maternal separation on stress reactivity. Journal of and Developmental Disorders, 28, 111-115. Neuroscience, 22, 7840-7843. 56 Kim, J.A., Szatmari, P., & Bryson, S.E. (2000). The 71 Sweeney, G.M. (2007). Why childhood attachment prevalence of anxiety and mood problems among matters: Implications for personal happiness, families children with autism and Asperger syndrome. Autism, 4, and public policy. In A.S. Loveless, & T.B. Holman (Eds.), 117-132. The family in the new millennium: World voices supporting 57 Keenan, K., Shaw, D., & Delliquadri, E. (1998). the “natural” clan, Vol 1 (332-346). Westport, CT: Praeger Evidence for the continuity of early problem behaviors: Publishers/Greenwood Publishing Group.. Application of a developmental model. Journal of 72 Melton, G.B., Thompson, R.A., & Small, M.A. (2002). Abnormal Child Psychology, 26, 441-452. Toward a child-centered, neighborhood-based child 58 Shaw, D.S., Gilliom, M., & Ingoldsby, E.M. (2003). protection system: A report of the consortium on children, Trajectories leading to school-age conduct problems. families, and the law. Westport, CT: Praeger Publishers/ Developmental Psychology, Special issue: Violent Greenwood Publishing Group. Children, 39, 189-200. 73 Visser, S. N., Lesesne, C. A., & Perou, R. (2007). National 59 Suveg, C., Southam-Gerow, M.A., & Goodman, K.L. estimates and factors associated with medication (2007). The role of emotion theory and research in child treatment for childhood attention-deficit/hyperactivity therapy development. Clinical Psychology: Science and disorder. Pediatrics, 119, 99-106. Practice, 14, 358-371. 74 Zito, J.M., Safer, D.J., dosReis, S., Gardner, J.F., Boles, M., & 60 Lieberman, A. F., Ippen, C. G., & Van Horn, P. (2006). Lynch, F. (2000). Trends in the prescribing of psychotropic Child-parent psychotherapy: 6-month follow-up of a medications to preschoolers. Journal of the American randomized controlled trial. Journal of the American Medical Association, 283(8), 1025-1030. Academy of Child & Adolescent Psychiatry, 45, 913-918, 75 Carlezon Jr., W.A., & Konradi, C. (2004). Understanding 61 Peterson, C.A., Luze, G.J., & Eshbaugh, E.M. (2007). the neurobiological consequences of early exposure to Enhancing parent-child interactions through home psychotropic drugs: Linking behavior with molecules. visiting: Promising practice or unfulfilled promise? Neuropharmacology, 47, 47–60. Journal of Early Intervention, 29, 119-140. 76 Carlezon, Jr., W.A., Mague, S.D., & Andersen, S.L. 62 Sameroff, A.J., McDonough, S.C., & Rosenblum, K.L. (2003). Enduring behavioral effects of early exposure to (2004). Treating parent-infant relationship problems: methylphenidate in rats. Belmont: Society of Biological Strategies for intervention. New York, NY: Guilford Press. Psychiatry. 63 Graham-Berman, S.A., & Hughes, H.M. (2003). 77 Bairy, K.L., Madhyastha, S., Ashok, K.P., Bairy, I., & Intervention for children exposed to interparental Malini, S. (2006). Developmental and behavioral violence (IPV): Assessments of needs and research consequences of prenatal fluoxetine. Pharmacology, 79, priorities. Clinical Child & Family Psychology Review, 6, 1–11. 189-204. 78 Ashman, S., & Dawson, G. (2002). Maternal depression, 64 Judge, S. (2004). The impact of early institutionalization infant psychobiological development, and risk for on child and family outcomes. Adoption Quarterly, 7, depression. In S.H. Goodman & I.H. Gotlib (Eds.), 31-48. Children of depressed parents (pp. 37-58). Washington, 65 Lowenthal, B. (2001). Abuse and neglect: The educator’s DC: American Psychological Association. guide to the identification and prevention of child 79 Lesesne, C. A., Visser, S. N., & White, C. P. (2003). maltreatment. Baltimore, MD: Paul H. Brookes Attention-deficit/hyperactivity disorder in school-aged Publishing. children: Association with maternal mental health and 66 Watts-English, T., Fortson, B.L., & Gibler, N. (2006). The use of health care resources. Pediatrics, 111, 1232-1237. psychobiology of maltreatment in childhood. Journal of 80 Gilliam, W., & Zigler, E.F. (2000). A critical meta-analysis Social Issues, 62, 717-736. of all evaluations of state-funded preschool from 1977 67 Faja, S., & Dawson, G. (2006). Early intervention for to 1998: Implications for policy, service delivery and autism. In J. Luby (Eds.) Handbook of preschool mental program evaluation. Early Childhood Research Quarterly, health (pp. 388-416). New York: Guilford. 15, 441-473. 68 National Scientific Council on the Developing Child. 81 Cooper, W.O., Arbogast, P.G., Ding, H., Hickson, G.B., (2004). Young children develop in an environment of Fuchs, D.C., & Ray, W.A. (2006). Trends in prescribing of relationships, Working Paper #1. Retrieved 12/19/07 from antipsychotic medications for US children. Ambulatory http://www.developingchild.net/reports.shtml. Pediatrics, 6, 79-83. 69 Bredy, T.W., Humpartzoomian, R.A., Cain, D.P., & Meaney, M.J.P. (2003). Partial reversal of the effect of maternal care on cognitive function through environmental enrichment. Neuroscience, 118, 571-576.12 Mental Health Problems in Early Childhood Can Impair Learning and Behavior for Life www.developingchild.net
  • council working paper seriesworking paper #1Young Children Develop in an Environment of Relationships (2004)http://developingchild.net/pubs/wp-abstracts/wp1.htmlworking paper #2Children’s Emotional Development is Built into the Architecture of their Brain (2004)http://developingchild.net/pubs/wp-abstracts/wp2.htmlworking paper #3Excessive Stress Disrupts the Architecture of the Developing Brain (2005)http://developingchild.net/pubs/wp-abstracts/wp3.htmlworking paper #4Early Exposure to Toxic Substances Damages Brain Architecture (2006)http://developingchild.net/pubs/wp-abstracts/wp4.htmlworking paper #5The Timing and Quality of Early Experiences Combine to Shape Brain Architecture (2007)http://developingchild.net/pubs/wp-abstracts/wp5.htmlalso from the councilA Science-Based Framework for Early Childhood Policy: Using Evidence to ImproveOutcomes in Learning, Behavior, and Health for Vulnerable Children (2007)http://developingchild.net/pubs/pubs.htmlThe Science of Early Childhood Development: Closing the Gap Between What We Knowand What We Do (2007)http://developingchild.net/pubs/pubs.html50 Church Street, 4th Floor, Cambridge, MA 02138617.496.0578www.developingchild.netwww.developingchild.harvard.edu