Early Childhood Mental Health

By: Clare Nimura

Can a toddler have anxiety, post-traumatic stress disorder, or depression? We don’t often think about mental health problems afflicting very young children, but about ten percent of preschool-aged children have some form of emotional, behavioral, or relationship conflict. Currently, most young children (<5 years old) with these issues receive no diagnosis or intervention. Left untreated, they suffer long-lasting effects to their social and emotional well-being, including impaired social interactions, parent-child relationships, physical safety, and school readiness. If emotional, behavioral, and relationship problems are so common in young children, and can have such significant negative implications, why are they so often neglected? Moreover, how can we increase access to effective diagnoses?

The symptoms of emotional, behavioral, and relationship problems look very different in young children than in adults, which can make them difficult to recognize. For example, a depressed child might exhibit more irritability than a depressed adult, who might instead show sadness. Additionally, almost all children display these behaviors, though in milder forms. For these reasons, it can be difficult for parents or caregivers to recognize when children are showing signs of poor mental health, such as changes in mood or behavior, intense feelings, or difficulty concentrating. Conversely, healthy children are able to express their emotions and then return to stability without extensive intervention. 

Additionally, emotional, behavioral, and relationship problems are difficult to identify in young children because they can be caused by innumerable factors. While some children may have a genetic predispositionto mental health problems, a child’s environment is critically important to the state of their social and emotional well-being. Environmental influences can work both ways: a supportive family can greatly improve a child’s mental health, whereas adverse life experiences can be powerful contributors to poor mental health. These experiences can include exposure to violence, parental depression, and housing or food insecurity, such that children in poverty are at a disproportionately higher risk for mental health issues. According to the CDC, 1 in 5 children living below the federal poverty line have a mental, behavioral, or developmental disorder. 

Despite the staggering statistics surrounding early childhood mental health issues, both the general public and the medical field lacks awareness, reflected in the shortage of trained mental health providers; one study found that 43 statesare considered to have a severe shortage of child psychiatrists. For pediatricians not explicitly trained in mental health care, systematic screening surveys can be invaluable tools to identify young children with emotional, behavioral, or relationship problems, as well as children at risk. The only problem is that most surveys are arduous and time consuming. For primary care physicians under pressure from the medical system, extensive surveys can be infeasible; optimally, they would have a simple yet informative survey for their diagnoses.

Mary Margaret Gleason, a pediatrician, child psychiatrist, and graduate of the Columbia University College of Physicians and Surgeons, helped develop one such survey: the Early Childhood Screening Assessment (ESCA). The survey takes just 5 to 7 minutes and is written at a fifth-grade reading level. Parents complete this form in the waiting room, rating 36 items relating to their child’s behaviors on a scale of 0 (never/rarely), 1 (sometimes/somewhat), and 2 (always/almost always). The last 4 items on the survey screen for parental depression or other mental illnesses that could interfere with childcare.

The score determined by the survey can identify emotional, behavioral, or relationship problems and also serves as a risk assessment based on environmental conditions. This quantitative information can flag concerns that might otherwise remain unnoticed in a hurried pediatric physical. And as we know, neglecting to diagnose mental health in very young children can have many negative implications for their future well-being.
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Mental health problems in very young children often go undiagnosed. Clearly, diagnosis is not the only factor—effective and sustainable treatment also requires great advancements—but awareness is a very important first step. Surveys like the ESCA can improve diagnosis and treatment for children in areas with limited access to trained mental health professionals. Increasing awareness of the prevalence and long-term implications of mental health problems in young children is essential to ensure that all children have the support they need to develop to their full potential.