October 1st, 2010

Pre-schoolers display mental health issues

It’s well-known that social competence and behavior problems that are apparent when children are five or six are predictors of their later academic and social functioning. Yet a team of psychologists has shown that these problems can be identified earlier on, suggesting intervention need not begin only when formal schooling does.

In a longitudinal study of more than 1,300 children from the New Haven-Meriden area of Connecticut, Alice S. Carter, Ph.D., a professor of psychology at the University of Massachusetts-Boston and colleagues found that problems noted by parents and teachers in kindergarten and first grade were evident at earlier ages. They also found that factors including early poverty, level of parental education and amount of family expressiveness – which were assessed by surveys starting when the children were a year to two years old – correlated with children meeting psychiatric disorder criteria when they entered formal schooling.

“We don’t have to wait until children are older to start treating and screening,” Carter says. She and her colleagues argue for interventions that take into account the home and community context, not only school.

The researchers chose a representative sample culled from birth records provided by Connecticut’s Department of Public Health. The children were diverse in terms of socioeconomic status, ethnicity, parental educational level and other factors. Carter and her colleagues surveyed parents periodically starting when the children were between 12 and 36 months old, asking about levels of social support, parental depression and anxiety, family conflict, children’s exposure to violence and behavior and social competence. Later, the researchers surveyed kindergarten and first-grade teachers as well.

They then narrowed down their sample to 442 children who showed social or behavioral problems or language or learning difficulties. They had parents complete the Diagnostic Interview Schedule for Children-Version IV about their children to determine a diagnosis. The team reported that roughly one in five children (21.6 percent) had a psychiatric disorder with impairment as they entered kindergarten or first grade, the most common being attention deficit hyperactivity disorder and oppositional defiant disorder.

Because parents’ early responses seemed to bear out in what teachers said how the children were diagnosed later on, the researchers said that assessment should not begin when a child is showing signs of trouble, but should be integrated into settings like the pediatrician’s office, perhaps by having a mental health services provider onsite.

Parents and even pediatricians “often think a problem is transient, but that’s not the case,” Carter says. “Problems toddlers are having often continue when they’re older.”

Poverty, as much research has shown, can contribute to mental health difficulties in a number of ways. Housing and childcare worries, constant preoccupation with making ends meet, inadequate nutrition and parental depression can all take a toll on children’s mental health.

“We need to think about how to help families living in poverty,” Carter says. “There could be a continuum of services that starts out at pretty light and goes all the way up to more intensive supports. We need to be serious about making family life safe.”

The research suggests that parents and teachers also need to watch out for children who may be suffering in silence. Carter and her colleagues separated internalizing and externalizing disorders, finding stressful life events and low family expressiveness tended to be related to externalizing disorders, while low level of parental education and recent exposure to violence were more closely related to internalizing disorders. Parents and teachers were less apt to pick up on the latter category, perhaps because these children weren’t acting out – suggesting that these children may be less likely to be referred for services.

Child psychologists found the take-away lesson easy to embrace.

“If the message is screen early and screen often, I’m all for that,” says Walter Gilliam, Ph.D., associate professor in Yale University’s Child Study Center.

By Ami Albernaz

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