Early childhood is a critical time for children’s development that lays a foundation for the way children learn, grow, and interact with other people. While young children commonly show more negative emotions than in later years, it is still a time where diagnosable concerns related to social-emotional development are fairly common. Based on data from the CDC, 1 in 6 US young children between 2 and 8 years of age are likely to have a mental health or developmental disorder. Early childhood social-emotional and behavioral concerns reduce over toddlerhood for many children; however, a surprising number of young children (up to 50% of those with elevated concerns) continue to show mental health concerns.
Children with multiple socio-emotional concerns, such as internalizing and externalizing problems, or live in families with high life disruption and heightened parenting stress tend to have mental health concerns that persist in early childhood. Early intervention that includes caregivers is crucial for helping children veer off this trajectory and prevent the development of later, worse problems, such as depression, academic challenges, social difficulties, and conduct issues.
Screening for early childhood mental health concerns
There are several validated measures for broadly screening mental health concerns in early childhood.
Specific screening domains
Early childhood mental health concerns can cover a broad range of presenting domains, including behavioral concerns, internalizing concerns (e.g., anxiety, depression), and neurodevelopmental concerns (e.g., Autism Spectrum Disorder, Attention/Deficit/Hyperactivity Disorder).
Behavioral concerns, such as noncompliance, tantrums and aggression, are the most common concerns mentioned to pediatricians.
Neurodevelopmental concerns, including Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD), affect between 10-20% of young children and can be effectively screened in pediatric primary care.
Internalizing concerns, such as anxiety and depression, are increasingly recognized as clinically significant and impairing during early childhood. Epidemiological studies find that up to 10.5% of young children between 2 and 5 years old can be affected by diagnosable internalizing disorders.
Young children are especially vulnerable to environmental influences. Below are a few environmental areas to consider while caring for families with young children.
Social determinants of health
Social determinants of health are recognized as environmental conditions across 5 domains that have a significant impact on young’s children physical health, mental health, wellbeing and development. These domains include:
- Economic stability (e.g., poverty, food insecurity)
- Education access and quality (e.g., early childhood education)
- Healthcare access and quality (e.g., health insurance status)
- Neighborhood and built environment (e.g., neighborhood violence)
- Social and community context (e.g., concerns about immigration status)
- Trauma can be caused by a variety of events ranging from intentional violence (e.g., physical or sexual abuse, domestic violence, witnessing caregiver being harmed), disasters/accidents (e.g., car accident, forest fire) and medical procedures.
- Early childhood trauma can have a lasting impact on child development and their families.
- The National Childhood Traumatic Stress Network provides a wealth of information and resources on early childhood trauma, including its effects on young children, methods to screen and assess trauma and appropriate interventions to recommend for early childhood trauma.
- The National Institute of Health provides a fact sheet on helping children cope with trauma.
Prevention and early intervention
Clinical practice guidelines suggest starting with environmental, psychosocial interventions as a first line of intervention for children with early childhood mental health concerns. Behavioral parent training and behavioral classroom interventions are the first-line interventions for behavioral concerns (e.g., disruptive behavior, ADHD). The American Academy of Pediatrics (AAP) provides a list of evidence-based interventions for children younger than 5 years old with behavioral concerns, trauma history and/or parent-child relational concerns.
The AAP provides video resources on using motivational techniques to talk to stressed caregivers about interventions, such as:
Pediatric mental health services at Children’s Hospital Colorado
If screening reveals elevated mental health concerns, high quality mental health services for the early childhood age range can be provided in the Pediatric Mental Health Institute Outpatient Clinic. Families and providers can call for more information at 720-777-6200.
We also offer a brief, group-based version of behavioral parent training that connects caregivers of children with challenging behavior to feel less isolated while providing evidence-based behavior management strategies. This Brief Behavioral Parenting Group is typically accessible within 3 to 6 weeks of a referral or families calling our clinic at 720-777-4020. Families will be provided referrals for ongoing services, if needed, following the group.