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"There is no health without mental health." (WHO, 2007)
Mental health influences our overall wellbeing
Mental health affects our sense of wellbeing as well as our physical health. It influences the way we think and feel about ourselves and what is going on around us, and how we cope with the ups and downs of life. Children that are mentally healthy can cope better with the challenges of life. They tend to get along better with other children and are more open to learning. Good mental health helps children enjoy their experiences and respond to their families, friends and the community in positive ways.
Being mentally healthy in early childhood provides a foundation for positive mental health and wellbeing throughout life; however, good mental health does not mean children will never have a ‘bad day’. Feeling worried, sad, frustrated or angry are all normal emotions for children and adults to have sometimes. These feelings only become a concern when they make it difficult for people to cope with day-to-day life. Children who are mentally healthy can learn good coping skills which help them to manage their feelings and deal with difficulties.
Mental health can change over time
Most children experience good mental health. While everyone experiences difficulties from time to time, for a small number of children difficulties happen more often or affect them greatly. These mental health difficulties are known by lots of different names but the descriptions most frequently used with children are emotional and/or behavioural difficulties. Rather than thinking about children as having either good mental health or mental health difficulties, it is best to think about mental health as ranging on a continuum from good mental health to mental health difficulties. Many of us can move from good mental health to mental health difficulties and back again over the course of our lives. Children with mental health diagnoses that are lifelong (for example, Autism Spectrum Disorder), can also move towards and experience good mental health when supported in an environment that meets their individual needs. This can be compared with physical health, for example a person diagnosed with a chronic illness (such as diabetes) can experience positive wellbeing when their condition is managed effectively.
Mental health difficulties in the early years
Children who are aged birth to five years show a great range of behaviours. This is because they like to explore their surroundings and are learning many new skills. It is very common for children of this age group to show challenging behaviours, strong emotions and worried thoughts. These occur often as children are learning how to deal with new situations and how to manage their feelings. Warm, supportive and trusting adults can help young children to work through their feelings and respond to situations in more positive ways. However, some children find this more difficult than others and this may affect their ability to learn new things and to interact with others. These children can often require extra support from caring adults and may even benefit from professional support.
The diagram above shows some of the biological, psychological and social factors that influence children’s mental health.
Any one of these factors can have either a positive or negative influence on a child’s mental health. For example, self-esteem may be high or low, family circumstances may be positive or difficult and both may vary at different times.
Early recognition of children who may be experiencing emotional and/or behavioural difficulties means that they can be referred to a mental health professional who can assess whether there is a significant concern present. Mental health professionals work in partnership with parents, carers and early childhood staff to come up with strategies to meet the individual needs of the child. Community services can also be helpful; sometimes they can provide parenting groups or parenting programs that are designed to support parenting, which can also have an influence on children’s behaviour.
There are a range of reasons why young children behave the way they do, and many of them are not due to experiencing mental health difficulties. However, if children are showing signs of emotional and/or behavioural difficulties, making some careful observations of a child can help parents, carers and early childhood staff to work together on deciding the best way to support them.
Risk and protective factors for children’s mental health
There are a number of risk and protective factors that impact children’s mental health and wellbeing. Recognising children who have mental health risk factors in their lives and providing them with support to build on the protective factors may prevent them from showing signs of mental health difficulties later in life. The points below show some examples of risk and protective factors that influence children’s mental health. A child who is exposed to mental health risk factors will not necessarily experience mental health difficulties; however, when many risk factors are present, their likelihood of developing difficulties increases.
What kinds of emotional and behavioural difficulties do children experience in the early years?
Parents, carers and early childhood staff can support children’s mental health by being aware of the impact particular difficulties can have on children’s Behaviour, Emotions, Thoughts, Learning, and Social relationships. All children can experience difficulties in these areas from time to time; however, there are some children who may experience them more often and will need additional support. It is important to have knowledge of child development and the individual child before deciding there is a mental health concern. Children may have difficulties in more than one of these areas as they all link and influence one another.
Behaviours: Are often the first and easiest sign of a mental health concern to observe. Behaviours can be broken down into two broad categories: externalising and internalising.
- Externalising behaviours can include one or more of angry, impulsive, hyperactive (for example, restlessness, difficulty paying attention) and challenging (for example, not following an adult’s instructions) behaviours. These behaviours are relatively easy to recognise as they are quite disruptive and are likely to demand attention from parents, carers and staff.
- Internalising behaviours can include one or more of, inhibited and over-controlled behaviours such as withdrawal, worry, fearfulness and becoming easily upset. These behaviours are a lot more difficult to notice as they are mostly experienced internally by the child and don’t necessarily draw attention from others. Younger children may also experience difficulties in regulating their behaviour. This means that they find it hard to manage their feelings and responses to particular experiences. As an example, a younger child may have difficulties in settling into a predictable routine (for example, sleeping, feeding) and managing reactions to changes in the environment (for example, loud noise, bright lights). An older child may find it difficult to wait their turn or calm down after becoming upset. Many children in these age groups experience difficulties in regulating their behaviour from time to time, as they are still developing this skill. It is when this occurs more often and for an extended period of time that a concern may be present.
Emotions: Refer to how a child is feeling. Children with emotional difficulties may have trouble expressing or managing their feelings. For example, some children may find it hard to calm down after being upset.
Thoughts: Refer to how and what a child is thinking. A child may experience negative thoughts about themselves or what is happening around them (for example, they may think that nobody likes them, or that their parent or carer will not come back to pick them up), which stops them from interacting with others or getting involved in experiences. It can be hard to notice such thoughts in younger children who have not yet developed the ability to talk. Sometimes we can guess what a younger child may be thinking based on the behaviours and feelings they show.
Learning: Refers to how well a child is able to take in, understand and remember information. It also relates to how well they can communicate and interact with others, and use their physical skills (for example, crawling, walking or drawing). Children with difficulties in learning may also have problems with attention and concentration and therefore not be able to understand what they have to do, or find it hard to complete a particular task, movement or action. They may not be able to make friends because they are unsure of, or have forgotten what to do or say.
Social relationships: Refer to a child’s ability to form relationships with others. A child with difficulties in this area may find it hard to play with other children, make friends or interact with their parents or carers. They may also have difficulty understanding social cues and behaving appropriately in social situations (for example, a child may not respond when a staff member is making playful sounds and smiling at them or may struggle with taking turns in group play).
Diagnosis in the early childhood years
There is some controversy about the diagnosis of mental health disorders in very young children. With well-informed observation, assessment and understanding of a child, a mental health professional may make a diagnosis. Some children in early childhood services may have been diagnosed with a mental health disorder. Understanding how a particular disorder affects a child’s experiences, responding to their individual needs and working together with parents and carers can help to support a child’s development.
Is a diagnosis necessary?
A diagnosis is a medical label that helps mental health professionals to make sense of a child’s difficulties. Diagnosing a child as having a particular mental health disorder can help to decide what kind of support is needed. Making an accurate diagnosis can sometimes be difficult. This is because children’s growth and development can vary from one child to another and an individual child may show some signs of a disorder but not others. This is particularly the case in young children, therefore some disorders are easier to diagnose when they are older and more developed.
For families it can be a relief to have a name for their child’s difficulties. A diagnosis helps them to explain why their child is behaving the way they do and helps families to know the best way to help. It is also important to recognise that a diagnosis simply describes a pattern of common signs of a disorder. If a child is diagnosed with a mental health disorder it is always important to recognise a child’s strengths and use these to meet their individual needs.
A range of behaviours can be observed in the early childhood years, as children are exploring their surroundings, learning how to manage their emotions and testing boundaries. Young children will at some time express themselves strongly physically or verbally, or feel worried or scared about particular situations. Taking time to observe, reflect and share concerns with others who know and care for the child, can help parents, carers and early childhood staff recognise whether a child may be experiencing an emotional or behavioural difficulty. Seeking the support of a mental health professional may be useful to provide reassurance and/or further help to families if they have concerns about their child’s mental health.
Mental health supports for children and families: a good place to start
Your family doctor can give you advice and help you decide whether further investigation and treatment is necessary. A doctor’s referral is needed to be able to claim the Medicare rebate for treatment from mental health professionals.
Many school based preschools and some early childhood services have access to a regional or on site psychologist or counsellor. Psychologists or counsellors with specialist knowledge and experience working with children with mental health difficulties can provide assessment and treatment. They work in partnership with parents, carers and early childhood staff to support children and may recommend specialist services for families who need extra help.
Other health professionals who can help:
Early childhood advisor
Some services have access to an early childhood specialist who can provide assistance to parents, carers and early childhood staff to find ways to support children. They can also assist family’s access specialist services if they need extra help.
Paediatricians are doctors who are specialists in treating children for a wide range of difficulties. When investigating a difficulty, they consider the child’s level of development compared to other children of the same age. A referral from your family doctor is needed to see a paediatrician.
Mental health professional
Mental health professionals provide assessment and treatment for a range of emotional, behavioural, social and developmental difficulties. They have specialised in working with children, and also work with their families/ carers, and other services who might be involved. Different professions specialise in childhood mental health – child psychiatrists, psychologists, occupational therapists, social workers, speech and language therapists, child psychotherapists, family therapists and nurses. These professionals offer a variety of therapies; in addition child psychiatrists also prescribe medication. Mental health professionals work in the public and the private sector.
A good place to start getting help is your family doctor or paediatrician.