Early identification of children with initial signs of mental health difficulties can help ensure they receive help before problems get worse (Durlak & Wells, 1997).
Recognising mental health problems and seeking support
Ella loves playing with dolls and spends lots of time feeding them, brushing their hair and putting them to bed. She likes her own space and can get upset if other children at preschool try to join in or play with ‘her’ dolls. Ella is very quiet and will actively avoid group sessions unless coaxed by an adult. She often puts her head down when spoken to and prefers to use gestures to indicate her needs, although adults have overheard Ella talking to her dolls. She is very independent and likes to do things for herself.
Lots of children display behaviours similar to Ella’s at some point within their early childhood period. The question is: How do we know which children are simply going through a temporary developmental phase and which are showing early signs of mental health problems?
Defining Mental Health
Mental health in early childhood has been described as ‘an ability to form satisfying relationships with others, play, communicate, learn and experience the range of human emotions’ (Parlakian & Seibel, 2002). Research shows that the development of social and emotional skills influence and enhance children’s quality of life and lifelong learning (Denham & Weissberg, 2004).
In contrast, children who have difficulty regulating, expressing emotions and building positive relationships are more likely to experience greater challenges throughout their lives, with poorer long-term outcomes (Boyd et al., 2005). Therefore, mental health must be viewed as equally important as other areas of child development.
Identifying mental health difficulties
Adults working with and caring for children can make a difference by being aware of early signs of potential difficulties. Some of the behaviours which might give cause for concern can be summarised in the following way:
- Externalising problems or ‘acting out’: Refers to a wide range of disruptive, impulsive, angry or hyperactive behaviours, which are generally observed and therefore relatively easy to detect.
- Internalising problems or ‘holding in’: Refers to inhibited or over-controlled behaviours, including withdrawal, worry, and emotional responses that primarily affect the individual child and not others around the child.
Additional concerns might centre around relationships (e.g. the child’s ability to understand and interpret social cues, or develop secure attachments to key people in their lives) and regulatory issues (e.g. excessive crying, sleeping and eating problems). Remember, some of these behaviours are very typical within the early childhood period, as children try to make sense of their world, find out about what they can expect from others and what is expected of them. Most children will, at different times, act out physically or verbally, or feel the need for additional comfort or some time and space on their own.
When to seek help?
Making decisions about whether a child and family need professional help can be guided by thinking about the following:
- Frequency – How often does the behaviour happen?
- Severity – How does the child’s behaviour compare to other children’s behaviours within the same age group? Does it interfere with everyday functioning?
- Persistence – When did the behaviour start and how long has it been going on? Does the behaviour only occur in certain situations, or across multiple situations?
When behaviours happen on a regular basis, are distressing to the child and those around him or her, persist over a period of time (e.g. a month or longer) or across situations (e.g. at home and at child care) then it is time to get support or advice.
What can adults do to help?
To support children showing early signs of mental health difficulties, adults can:
- Observe the child and record key features:
- Time of day, what was happening before the behaviour began, who was involved, what were the behaviours, what happened afterwards?
- When does the behaviour not occur? What is happening at these times?
- Think about:
- Are there any patterns to the behaviour? Does it happen at particular times of day or during particular activities?
- Children communicate through their behaviour. What does the child's behaviour tell you? How might the child be feeling? What can you do to help?
- What are the child's strengths? Noticing strengths can be useful; e.g. Ella loves playing with dolls – this is where she feels most comfortable and it could be an opportunity for adults around her to build stronger relationships
- Share information:
- Finding out how the child responds in different situations and places can be useful. When early childhood practitioners and families share information, it can help to identify the sort of support the child needs.
- Talk to someone:
- Adults working with young children should seek appropriate advice when they have a concern about a child's wellbeing, and individuals should not feel a responsibility to manage the problem on their own.
Professional advice and support
Resources and professional services available to support children showing signs of mental health difficulties vary from state to state. It is therefore important to find out what is available in your area.
Some options are:
A General Practitioner (GP) or paediatrician can be an excellent first port of call for families. They can investigate any physical/medical reasons for the behaviour and also provide referrals to other health professionals who can help.
Psychologists are health professionals who, through a range of strategies and therapies, aim to reduce distress and enhance emotional wellbeing.
- assist families to support children who are having difficulty controlling their emotions, thinking or behaviour
- advise on parenting strategies
- advise on strategies for the early childhood service.
The Medicare rebate is now available for psychological services (a referral from a GP, paediatrician or psychiatrist is required). Maternal and child health nurses and other allied health providers can provide information, guidance and support on issues around parenting, child health and development.
Boyd, J., Barnett, W. S., Bodrova, E., Leong, D. J., & Gomby, D. (2005). Promoting children's social and emotional development through preschool education. New Brunswick, NJ: RUTGERS.
Denham, S. A. & Weissberg, R. P. (2004). Social-emotional learning in early childhood: What we know and where to go from here. In E. Cheesebrough, P. King, T. P. Gullotta & M. Bloom (Eds.), A blueprint for the promotion of prosocial behavior in early childhood, pp. 13-50. New York: Kluwer Academic/ Plenum Publishers.
Parlakian, R. & Siebel, N. (2002). Building strong foundations: Practical guidance for promoting the social-emotional development of infants and toddlers. Washington, DC: Zero to Three.
Durlak, J. A. & Wells, A. M. (1997). Primary prevention mental health programs for children and adolescents: A meta-analytic review. American Journal of Community Psychology, 25(2), 115-153.
Stress in early childhood: Helping children and their carers offers practical and effective strategies for stress management for both early childhood staff and the children in their care. ECA Code: PUB39
Published in Every Child, 2010, Ed 16, p8-9