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Centers for Disease Control and Prevention (CDC)

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Children's Mental Health Disorders - A Journey for Parents and Children

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Center on the Developing Child at Harvard University

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Language: English | French

Abstract

A clear understanding of infant mental health will significantly assist a clinician's ability to provide high-quality paediatric care for children and their families, given the new understanding of its role in overall development. The present commentary describes the mental health needs of children <3 years of age and provides practical suggestions for the office setting.

Keywords: Attachment, Infant mental health, Infant/parent relationships

Résumé

En raison des nouvelles connaissances sur le rôle de la santé mentale dans le développement global, le clinicien sera mieux en mesure de fournir des soins pédiatriques de qualité aux enfants et à leur famille s'il comprend bien la santé mentale des nourrissons. Le présent commentaire décrit les besoins des enfants de moins de trois ans en matière de santé mentale et contient des suggestions pratiques à utiliser en cabinet.

Irrefutable evidence indicates that brain growth makes the first years of life qualitatively and quantitatively different than any other time of life ( 1). Early experience 'gets under the skin' and shapes the brain, affecting lifelong health, behaviour and learning. No other stage depends more on the external environment for growth and development. Very young children, whose brains are still extremely malleable to environmental stress, also respond differently to external stress than older children. While later interventions are also effective and essential, the return on investment is greatest in the earliest years.

The attachment relationship between infant and caregiver(s) is crucial to healthy development. A secure, warm, responsive and predictable relationship with at least one caregiver influences the formation of neural structures in the brain that lead to positive infant well-being. Secure attachment also positively affects the development of the hypothalamic pituitary axis, which regulates stress ( 2).

Even in situations of stress, secure attachment relationships can help buffer the developing brain from significant harm ( 3). A sound social and emotional base is the launching pad for all other development - the physical, motor and cognitive development that prepares children for school and for eventual success in life.

If those early relationships are highly stressful - through absence, poverty, unpredictability or violence - neuronal pathways more attuned to reactivity are forged. This puts children at greater risk for challenges in life, including school failure and social difficulties ( 4).

The Adverse Childhood Experiences study ( 5) shows that traumatic or abusive events in childhood are associated with depression, cardiovascular disease, cancer, alcoholism and drug abuse in adult life, as well as encounters with the justice/legal system, and risk-taking behaviours later in adolescence and adulthood.

The potential of each child is realized through the interaction of genes and the environment. It is not either nature or nurture, but nature × nurture ( 6). The genes wait and listen to the environment, whether in the home or in child care. Each child's environment and experiences define the world and, consequently, 'customize' their brain.

When infants are in poor-quality child care or parental care is compromised due to issues such as serious depression, the infant's responsiveness can be compromised. This can affect brain development and subsequent mental well-being. Parents and caregivers need to be attuned to their own mental health and seek help when needed.

In medical practice, the conceptual 'milestone' framework for motor and language development is well outlined but is less robust for social/emotional, behavioural and relational development. Neverthless, we are experiencing a recent increase in interest as to how domains such as language and cognitive capabilities may be inter-related.

For example, language research has demonstrated that children who are spoken to less frequently have poorer overall readiness for school and school success. In fact, researchers are now focusing not just on the number of words but on the quality of the interaction, based on the original work by Hart and Risley ( 7).

Various reports suggest that social-emotional regulation and behaviour problems in children have increased. In a recent survey, Ontario service providers reported a significant gap in mental health resources for children from birth to six years of age ( 8). In the United States, more children are expelled from preschool than from kindergarten to grade 12 combined ( 9).

WHAT IS INFANT MENTAL HEALTH?

Infant mental health, or 'infant brain health', is crucial to development ( 10) and can be defined as ( 11):

The developing capacity of the child from birth to five years of age to: form close and secure adult and peer relationships, experience, manage and express a full range of emotions, and explore the environment and learn - all in the context of family, community and culture.

Children <6 years of age have a similar rate of mental illness as older children and youth (14% to 20%). Youth and their families often report that their challenges began in the preschool years ( 8).

In the first few months of life, just as parents are busy learning to read their baby's cues, the baby also learns to read a parent's emotional cues - the reciprocal serve-and-return experience. Infants sense and respond to their parent's moods and emotions. Although an infant's language lacks words, it is rich with facial expressions, crying, cooing, gurgling or withdrawal. Young infants experience sadness, fear and a whole range of human emotions ( 12). We are just beginning to understand the depths of feelings, emotions and stress responses that infants can experience.

Health professionals - nurse practitioners, family physicians and paediatricians - see infants and their caregivers regularly over the first few years of life. While these health professionals may not be mental health specialists, by devoting attention to socioemotional factors, they can take meaningful action to ensure infant health and well-being. These include:

Building relationships with parents/caregivers and encouraging both parents (or caregivers) to attend office visits:

Sharing observations of the infant's growth and development with parents;

Offering anticipatory guidance to parents specific to their infant;

Providing an accessible, reliable parenting resource (eg, Caring for Kids < www.caringforkids.cps.ca>);

Alerting the parent(s) to the infant's individual accomplishments and needs that they may have overlooked;

Be a cheerleader for the infant;

Fostering interaction and exchange between parent(s) and infant or parent(s) and practitioner (eg, giving a book and talking about the baby's response);

Allowing the parent to take the lead in interacting with their infant or determining the 'agenda' or 'topic for discussion';

Identifying and enhancing the strengths that each parent brings to the care of the infant;

Be a cheerleader for the parent;

Remaining open, curious and reflective;

Routinely using a checklist in the office visit (eg, Rourke Baby Record); and

Identifying, treating and/or collaborating with others if needed, in the treatment of disorders, delays and disabilities, parental mental illness and family dysfunction.

Referring families to specialists if there are red flags or issues of special concern identified through office interactions. For example:

Overwhelming breastfeeding struggles;

Unhealthy beliefs about attachment, such as "they have to learn, so I'm letting her cry it out";

Expressions of anger directed toward the infant;

Beliefs about crying, such as "the baby is trying to make me mad";

How or whether parents respond to a baby's pain or crying during or after vaccinations

Parents who do not set firm, loving boundaries (eg, related to feeding, or sleep cycles).

(Adapted from reference 13)

Raising children in Canada is complex, with parents, grandparents and other caregivers playing significant roles. If other caregivers devote a significant amount of time with an infant, where possible, have them in for a visit to have similar discussions on infant well-being. Knowledge of high-quality care programs will make it easier for you to recommend supports to families. Resources and supports for caregivers are available throughout the country in various settings.

Observe for attachment behaviours:

Ask:

How are things at home?

What is it like looking after your baby?

Does your baby give you pleasure, or are you still in the 'hard work' stage?

Is your baby comforted when you try to soothe him?

Added to regular reading with the child, these further suggestions will help parents be more reflective of their children's needs and help develop their language skills.

Encourage parents on the four Ts

Tune in more to your child's cues and interests

Talk more - describe the world around them

Take turns - be a conversational partner

Turn off background TV

(Adapted from reference 14)

Ontario has Ontario Early Years Child and Family Centres, which offer a suite of services, connections and supports for families. British Columbia has Sure Start centres, Alberta has Parent Link centres, Saskatchewan and Manitoba offer 'Kids First' programs. Nova Scotia offers parenting resource centres, and in Newfoundland and Labrador, the Brighter Futures coalition operates in many communities providing similar services. All of these services provide parent support and links to other resources. In Ontario, a parent resources pathway for many communities is available at www.18monthvisit.ca. Other provinces are discussing introducing similar features. The website www.findingquality-childcare.ca provides region-specific information and general information about what to look for in quality child care.

CONCLUSION

Promoting infant mental health is both a serious task and an opportunity. Infants 'speak' about their social and emotional status in their own special language, which parents, families and caregivers are increasingly coming to understand. In this commentary, we shared a high-level overview of infant mental health and the primary care approach to its support and management. While infant mental health is a rapidly burgeoning field, there is a sufficient foundation in science and practice to wholly recommend this clinical approach. Assessment, observation, modelling, tracking and referral to community resources will make a difference in your youngest patients' lives and well-being.

REFERENCES

2. National Scientific Council on the Developing Child The Science of Neglect: The Persistent Absence of Responsive Care Disrupts the Developing Brain: Working Paper 12. 2012. < www.developingchild.harvard.edu> (Accessed April 20, 2016).

3. National Scientific Council on the Developing Child 2008/2012. Establishing a Level Foundation for Life: Mental Health Begins in Early Childhood: Working Paper 6. Updated Edition. < www.developingchild.harvard.edu> (Accessed April 20, 2016).

4. National Scientific Council on the Developing Child 2005/2014. Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper No. 3. Updated Edition. < www.developingchild.harvard.edu> (Accessed April 20, 2016).

5. Felitti VJ, Anda RF, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. Am J Prevent Med. 1998;14:245-58. [[ PubMed] Google Scholar]

6. Barr R, Boyce T, Fleming A, et al. In: Early Childhood Development: Adverse experiences and developmental health. In: Boivin M, Hertzman C, editors. Royal Society of Canada - Canadian Academy of Health Sciences Expert Panel. Ottawa: Royal Society of Canada; 2012. [ Google Scholar]

7. Hart B, Risley TR. The early catastrophe:The 30 million word gap by age 3. American Educ. 2003:4-9. [ Google Scholar]

9. Gilliam WS, Shahar G. Preschool and child care expulsion and suspension: Rates and predictors in one state. Infants Young Child. 2006;19:228-45. [ Google Scholar]

10. National Scientific Council on the Developing Child 2008/2012. Establishing a Level Foundation for Life: Mental Health Begins in Early Childhood: Working Paper 6. Updated Edition. < www.developingchild.harvard.edu> (Accessed April 20, 2016).

12. Gopnik A, Meltzoff AN, Kuhl PK. In: The Scientist in the Crib: What Early Learning Tells Us About the Mind. New York: William Morrow-Harper Collins; 2000. [ Google Scholar]

14. Suskind D. In: Thirty Million Words: Building a Child's Brain. Boston: Dutton; 2015. [ Google Scholar]

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Language: English | French A clear understanding of infant mental health will significantly assist a clinician's ability to provide high-quality paediatric care for children and their families, given the new understanding of its role in overall development. The present commentary describes the mental health needs of children <3 years of age and provides practical suggestions for the office setting.

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Mental illness is a common problem in the United States.

According to the Centers for Disease Control and Prevention (CDC), more than 43 million American adults suffer from mental illness. That accounts for 1 in 5 Americans 18 years and older. About 20 percent of children and teens also suffer from mental illness, according to the CDC.

Even if you don't have a diagnosed mental illness, it's likely you still will face mental health challenges in your life. Everyday situations can cause stress, anxiety, or other emotional impacts.

There are ways you can manage whatever mental health challenges come your way. Mental Health America's Tools 2 Thrive provide a guideline for how you can ease mental health burdens.

Why It's Important to Manage Mental Health

The COVID-19 pandemic has brought mental health to the forefront. The pandemic has caused a disruption in many people's lives. Challenges like lost jobs or decreased pay, the possibility of illness, and the loss of socializing all can cause emotional impacts.

"Mental health-related issues and concerns have affected everybody worldwide in the context of the crisis," says Jennifer Beckjord, PsyD, senior director of clinical services at UPMC Western Psychiatric Hospital. "I don't know if one person has gone through this without feeling some anxiety or loneliness or experiencing some mental health-related challenge."

Mental Health America created its toolkit to provide some simple steps for people to manage their mental health. People can follow some of these steps to try to relieve what they're feeling at any time.

"It doesn't necessarily need to take a crisis to benefit from resilience-related resources or coping skills," Dr. Beckjord says.

How Can I Improve My Mental Health?

The Mental Health America toolkit includes six ways you can manage mental health challenges that come your way.

Own your feelings: Are you angry, sad, stressed, anxious, irritable, or something else? Don't ignore the emotions that you're feeling. The first step to overcoming negative thoughts or feelings is to recognize and identify them, then take action. You can cope by writing out your thoughts, talking to someone you trust, or seeking professional help.

Find the positive: Experiencing a loss is common, whether it's a loved one, a job, or a relationship. In difficult times, it can help to focus on the positives to recover from the emotional impact of your loss.

Eliminate toxic influences: Many different sources can cause problems - drugs and alcohol, social media, and even people in our lives. Identifying the influences that are causing us pain and then working to eliminate or manage them can ease our mental burden.

Create a routine: A healthy body and a healthy mind can go hand in hand. Try to control what you can by creating a routine of diet, exercise, social interaction, and more.

Support others: Everyone faces mental challenges at some point, and other people may need help getting through theirs. Try to be there for the people in your life who may need some help. Listen to them and try to help.

Connect with others: Loneliness can be a heavy burden, but there are ways you can prevent it. Connecting with others, whether it's in person or through technology, can help provide a lift.

One or more of these steps can help you manage your own mental challenges. But if you still are having a difficult time, seeking professional help is another option.

For more information, call UPMC Western Psychiatric Hospital at 412-624-2100.

Sources

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UPMC HealthBeat: Everyday Ways to Manage Your Mental Health

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Mental illness is a common problem in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 43 million American adults suffer from mental illness. That accounts for 1 in 5 Americans 18 years and older. About 20 percent of children and teens also suffer from mental illness, according to the CDC.

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Examples of types of psychotherapy for treating mental illnes in children. Based on informations of the WHO (world health organization).

Globally, 50 percent of mental illnesses that occur in a lifetime begin by age 14 according to the World Health Organization. Some examples of mental disorders that are diagnosed during childhood include attention-deficit/hyperactivity disorder ( ADHD), oppositional defiant disorder ( ODD), and Autistic Disorder. Mental disorders with onsets that occur during either childhood or adulthood include anxiety disorders such as social phobia and obsessive compulsive disorder ( OCD); and mood disorders such as depression. Along with pharmacological treatment, mental illness in children is treated with a range of psychotherapy as reviewed.

Types of Psychotherapy

Play Therapy

Play therapy is used to treat mental disorders such ODD, ADHD, anxiety, and depression in children between the ages of 3 to 12. It involves a non-threatening form of communication in which toys represent words. Concepts such as displacement (redirecting feelings from an original target to someone else) and projection (attributing one's own thoughts and feelings toward someone else) are explored during games. Specifically, children engage in storytelling followed by identifying the feelings of characters in the story; role-playing with puppets as a form of feeling projection; and blowing bubbles to improve deep and controlled breathing. The therapist observes feelings and recurring themes, while challenging the child with more effective alternatives to replace disturbing behavior.

Art Therapy

Art therapy is also used to treat ADHD, anxiety, depression, and family/relationship struggles. Children draw a story of their life events, which is a non-threatening form of feeling expression. Therapists may link a color to certain emotions such as red symbolizing anger. Therapists then analyze the drawing for themes and feelings that they discuss with the child.

Animal-Assisted Therapy

Animal-Assisted Therapy is a new approach that is used to treat depression, anxiety, and Autistic Disorder. Specifically, during equine-assisted therapy or horseback riding, the rhythm of the horse soothes, focuses, and improves the moods of children with Autism. Feeding and grooming horses encourage social interaction and personal responsibility in children. Likewise, canine-assisted therapy is used to reduce stress and calm children with depression, anxiety, and ADHD. These animals are also used as a conversation topic between therapists and children.

Operant Conditioning/Applied Behavior Analysis

Children with more severe mental challenges, where they function significantly below average, are treated with operant conditioning. This approach involves reinforcing a desired behavior in increments through cognitive-behavioral techniques. An example is the self-instructive training of reciting instructions while performing a behavior.

A final, valuable form of treatment is the multi-system approach that involves intervention in multiple settings including family, schools, and peer environments. Family training teaches family members effective ways to respond to children with mental illnesses such as by using positive reinforcement for desirable behavior. Therapists also use multimodal therapy, which is a combination of psychosocial and pharmacological therapy. Specifically, antipsychotic medications treat Autism, antidepressants treat depression, and selective serotonin reuptake inhibitors ( SSRI s) treat obsessive compulsive disorder in children.
Source
Atlas: Child and adolescent mental health resources. (2005). World Health Organization.

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How Is Mental Illness in Children Treated

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­ Globally, 50 percent of mental illnesses that occur in a lifetime begin by age 14 according to the World Health Organization. Some examples of mental disorders that are diagnosed during childhood include attention-deficit/hyperactivity disorder ( ADHD), oppositional defiant disorder ( ODD), and Autistic Disorder.

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Centers for Disease Control and Prevention

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Being mentally healthy during childhood means reaching developmental and emotional milestones and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities.

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day. Many children occasionally experience fears and worries or display disruptive behaviors. If symptoms are serious and persistent and interfere with school, home, or play activities, the child may be diagnosed with a mental disorder.

Mental health is not simply the absence of a mental disorder. Children who don't have a mental disorder might differ in how well they are doing, and children who have the same diagnosed mental disorder might differ in their strengths and weaknesses in how they are developing and coping, and in their quality of life. Mental health as a continuum and the identification of specific mental disorders are both ways to understand how well children are doing.

What are common childhood mental disorders?

Among the more common mental disorders that can be diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), anxiety (fears or worries), and behavior disorders.

Learn more about childhood mental disorders, symptoms, and treatment.

Other childhood disorders and concerns that affect how children learn, behave, or handle their emotions can include learning and developmental disabilities, autism, and risk factors like substance use and self-harm.

Read more about related conditions.

What are the symptoms of childhood mental disorders?

Symptoms of mental disorders change over time as a child grows, and may include difficulties with how a child plays, learns, speaks, and acts, or how the child handles their emotions. Symptoms often start in early childhood, although some disorders may develop during the teenage years. The diagnosis is often made in the school years and sometimes earlier; however, some children with a mental disorder may not be recognized or diagnosed as having one.

Can childhood mental disorders be treated?

Childhood mental disorders can be treated and managed. There are many treatment options based on the best and most current medical evidence. Parents and doctors should work closely with everyone involved in the child's treatment-teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help parents, health professionals, and educators guide the child towards success. Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders.

Get help finding treatment

If you have concerns about a child, you can use these resources to help you find a healthcare provider familiar with treatment options.

Who is affected?

Childhood mental disorders affect many children and families. Boys and girls of all ages and ethnic/racial backgrounds and living in all regions of the United States experience mental disorders. Based on the National Research Council and Institute of Medicine report, which gathered findings from previous studies, it is estimated that in 2007, 13-20% of children living in the United States (up to 1 out of 5 children) experienced a mental disorder in a given year, costing individuals, families, and society an estimated $247 billion per year.

What is the impact of mental disorders in children?

Mental health is important to overall health. Mental disorders are chronic health conditions-conditions that last a long time and often don't go away completely-that can continue through the lifespan. Without early diagnosis and treatment, children with mental disorders can have problems at home, in school, and in forming friendships. Mental disorders can also interfere with a child's healthy development, causing problems that can continue into adulthood.

Public health includes mental health

Supporting children's mental health also includes making sure children meet developmental milestones, understanding what to do when there is a concern, supporting positive parenting strategies, and improving access to care.

CDC works with partner agencies to better understand mental health and mental disorders and the impact they have on children.
Read more about research on children's mental health.
What you can do

Parents: You know your child best. Talk to your child's healthcare professional if you have concerns about the way your child behaves at home, in school, or with friends.

Youth: It is just as important to take care of your mental health as it is to take care of your physical health. If you are angry, worried or sad, don't be afraid to talk about your feelings and reach out to a trusted friend or adult.

Healthcare professionals: Early diagnosis and appropriate treatment based on updated guidelines are very important. There are resources available to help diagnose and treat children's mental disorders.

Teachers/school administrators: Early identification is important so that children can get the help they need. Work with families and healthcare professionals if you have concerns about the mental health of a child in your school.

Resources

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Learn more about mental health, mental disorders, treatments, prevention, and public health research on children's mental health.

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Mental illness, also called mental health disorders, refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors

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a person’s condition with regard to their psychological and emotional well-being.