Judy Kynaston, National Project Manager KidsMatter Early Childhood Australia

Mental health difficulties is a term used to describe a broad range of emotional and behavioural difficulties that may cause concern or distress. Mental health disorders are more severe and describe a recognisable set of symptoms and behaviours. In most cases they are associated with distress and difficulty in functioning which typically persist for a longer period of time such as anxiety or depression.


Some children in the community are at greater risk for developing mental health difficulties. Understanding the factors that put children at risk of mental health difficulties, the common signs and symptoms and the impact that they have on children and families, can assist with the early recognition of mental health difficulties in children.


Dr Nicole Milburn,

Clinical Psychologist and Infant Mental Health Consultant

There’s an important distinction between a mental health difficulty and a mental health disorder.  And in fact, mental health.  This is a continuum.  We have good mental health on one end, where people can pretty much roll with the punches and get over things.  And then we have difficulties where kids might be struggling for a little while, to manage a stress or some sort of problem.  A mental health disorder is where there is much more of an entrenched and enduring pattern of behaviour in a child.  And this is when we have problems that are present more days than not, and really interfering with the child’s development. 


Dr Sophie Havinghurst, Clinical Child Psychologist

As an early childhood educator you are constantly seeing kids on a continuum of difficulties, functioning normally, having difficulties, to in some cases having mental health problems.  And while they’re not a large number of kids who come into that last category, there are some who do.  And it’s quite tricky sometimes to work out when is it just a difficulty that we can resolve, and when is it actually something that we probably need to get some other help for in terms of a mental health problem.  Now what are the signs of this?  There are going to be a number of things.  They are going to be how intense or severe is the problem?  Is the problem just happening in childcare or is it happening in childcare and also at home as well? 



So it’s about looking across context and severity and how long the problem is going on for as well.  Are there some things that tend to help the child like certain educators who will be able to help the child and work through the problem and others who can’t?  So it may be that different people can help a child and some people can’t.  Or is it happening across all early childhood educators, that this child is having trouble with everybody.  And in that case you’ll be looking at something that’s probably more of a mental health difficulty, a more consistent problem.  So it will depend on the severity level, how intense a problem is, where it’s happening and who it’s happening with.


Dr Nicole Milburn,

Clinical Psychologist and Infant Mental Health Consultant

We see mental health difficulties in children in a number of different ways, primarily through their behaviour and how they are in relationships.  So for example, we can see a lot of externalising problems.  And what this means is that whatever yucky feeling inside, the child externalises in their behaviour.  And so they can be angry, they can be aggressive, they can have temper tantrums.  They can be oppositional.  These things can all be indicators of mental health problems.  We can also see the opposite, what we call internalising behaviours.  And what this means is more of a withdrawal and a holding on to a feeling.  And these are more of your sadness, isolation, anxiety types of behaviours, worries, sitting away, not making friends and not playing.  These are indicators of poor mental health or mental health difficulties.  Now every child will, at some point, want to sit in the corner and not talk to anyone, and at some other point will tell someone that they’re not going to do it, and stamp their foot, and get cross.  So we really need to see mental health difficulties as being at an extreme end of a continuum of behaviour.  Just because a child has a tantrum, it doesn’t mean that they’ve got an externalising mental health problem.


Dr Sophie Havinghurst, Clinical Child Psychologist

So mental health difficulties in young children look quite different than the way they do when children are older.  One of the first things is that kids are not really able to tell you if they’re having a hard time.  They don’t use language to say “I’m depressed”, “I’m having a hard time at school”, “I’m not getting on with my friends”.  They don’t communicate with words.  Instead they communicate with their behaviour.  So what we do when we’re observing a child who is having difficulties, is we identify what’s happening in terms of how they’re managing their emotional world, how they are managing their separation from their caregivers, their parents.  That’s one of the first critical things that you would look at and identify.  How are they managing the emotional part of that?  How are they managing the relational part of that in terms of separating?  What we are seeing in terms of their social relationships?


Dr Sarah Mares, Consultant and Infant, Child and Family Psychiatrist

Children have spurts of development and then they might have a period when really they’re very unsettled and they seem really cranky for a period of time, or they seem to lose an element of development that they’d gained.  I think what you’re looking for is that they don’t get stuck there.  And that the people around them can support them and stick with them during what might be a little bit of a worry for a period of time. 


Professor Helen Milroy,

Consultant Child and Adolescent Psychiatrist

If we think about how mental health problems might present in the early years, then there’s an array of difficulties that the infant or the young child may have.  Initially in the very young child you’re going to see either an arrest or regression in development.  So a child may be developing really well, and then suddenly they seem to be going backwards.  Or a development seems to stop.  For example, one of the big hallmarks that you’d be very, very concerned about is if the child is starting to develop language and then language somehow gets slowed up or stops.  That would be a very concerning part.  So if you’re looking at developmental milestones, they’re the things you’re going to be watching for.  Is the child on track for development in all of those sort of domains?


The child’s behaviour may well change.  The child might have gone from a somewhat happy, outgoing kind of child, and start to become withdrawn.  That would be a very concerning behaviour.  Or it might be the opposite.  That they become far more aggressive and these behaviours are new and developing in a very aggressive kind of way.  So hitting and biting and all those sort of things.  Maybe signalling that there’s distress. 


Dr Nick Kowalenko, Consultant Infant, Child and Adolescent Psychiatrist

So early childhood educators, as I was saying, have that advantage of seeing lots of normal kids.  They get a really good sense often about what’s at the edges of normal development, and they get a good sense of those kids who are more aggressive than others; those kids who are more inattentive than others; those kids who are struggling with social relationships and find social relationships really difficult.  They often get a good sense of those kids who are much more clingy, much more shy, than their similarly aged peers.  And they’re the kind of early signs sometimes that kids might be having emotional difficulties or social difficulties, or they might be at risk of developing problems further on.