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IEL Interactive Chat: Young Children's Mental Health
Samantha Wulfsohn, April 2005

Even young children can experience mental health problems. Trauma or loss can be devastating to children's emotional well-being even in infancy, and a disorder such as ADHD needs to be addressed as early as possible. Questions answered in this Chat include, “Isn't a preschool child too young to have a serious mental health problem? Won't he or she just grow out of it?” “Do more young children have serious emotional problems today than 5 or 10 years ago?” “What approaches can parents and teachers of young children take to develop children's mental health in positive ways?”

Biography

Samantha Wulfsohn, Ph.D. is a licensed psychologist with a degree in Human Development and School Psychology from the University of Wisconsin-Madison. She has been working with children for over 15 years and has specialized in infant mental health and Autism spectrum disorders. Dr. Wulfsohn has experience providing mental health consultation to staff and families participating in Head Start and Early Head Start programs. Additionally, she has been a supervising psychologist for an intensive in-home program for children with Autism Spectrum Disorders. Currently, Dr. Wulfsohn directs an inclusion and mental health consultation project at Erikson Institute and provides Relationship Development Intervention and other services to children with Autism.

Questions & Answers (Transcript)

Introduction to the Topic

Within the last decade, the early childhood field has started to develop an interest in the mental health of young children. Researchers and advocates agree on the importance of young children's mental health to their overall development. In fact, children whose mental health needs are not met are at increased risk for significant impairment at home, with their peers, in school and in the community. This is especially relevant in light of the recent research on the importance of early brain development for later functioning. Moreover, evidence about how stress can negatively impact young children's development further demonstrates the importance of considering mental health in the early years.

Infant and early childhood mental health refers to children's healthy emotional development and social competence. This includes the way that children relate to others, how they feel about themselves, and how they manage emotions and impulses. The earliest experiences in life can set the stage for age-appropriate social-emotional development. Nurturing and positive relationship with parents or caregivers, safe and stable environments, and overall supportive emotional experiences are all important aspects of these early experiences. However, for some children these early experiences are problematic, resulting in social and emotional delays. Early warning signs of mental health concerns vary dramatically for children according to the child's temperament, environment, and age. For younger children, relationships with their caregivers and peers may be problematic. Additionally, some children may exhibit extreme aggression and emotional dysregulation, while others may be sad, withdrawn, or unengaged with others.

For these young and vulnerable children it is imperative that we address concerns as early as possible to prevent problems from becoming extreme. Services for young children with mental health concerns should adopt a prevention and family-centered focus with the goal of strengthening parent-child relationships and promoting children's social and emotional skills.


IEL moderator Greetings, IEL Chat participants. Welcome to the first online Chat of 2005, another in the online chat series sponsored by the Illinois Early Learning Project (IEL). Our Chat tonight is titled "Young Children's Mental Health." To begin, let me introduce our guest speaker for the evening, Samantha Wulfsohn, of the Erikson Institute in Chicago.

Guest Samantha Wulfsohn
I am so pleased to be here tonight and appreciate your interest in mental health issues. This is an exciting topic and I am looking forward to a lively conversation.

IEL moderator The procedure for the live Chat session is as follows. Participants can send questions to the chat guest at any time. When you send your question, please note that it will not be visible to all chat participants. The IEL Moderator receives the question first and will post it to the whole chat group. If there's a long queue of questions, the Moderator will notify the questioner that the question was received. Then, at the next break in the discussion, the question will be posted for all to see and for our guest to answer.

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If your question is not answered by the time the Chat session ends at 8 pm, the question and its answer will be included in the Chat transcript that will be made available online approximately 3 weeks from today.

If, at any time during the chat, you want to review the procedure for participating in the chat session, you can do that in English or in Spanish.

IEL moderator Now let's begin our chat. Dr. Wulfsohn, we have a question that we received in advance of the session.

Isn't a preschool child too young to have a serious mental health problem? Won't he or she just grow out of it? Sometimes I think that we are manufacturing conditions that don't exist.

Guest Samantha Wulfsohn
First, I want to recognize that the word "mental health" is a scary word which carries a lot of stigma, especially for our youngest children. Additionally, on rare occasions, young children are incorrectly diagnosed with a variety of mental health problems such as Attention Deficit Hyperactivity Disorder (ADHD) or Juvenile Bipolar Disorder.

However, it is extremely important not to dismiss the importance of children's healthy emotional development early in life especially in light of the research on brain development in the first three years. For these reasons much of the work around mental health concerns emphasizes prevention and early intervention with the goal of avoiding serious mental health problems later in life.

In spite of prevention and early intervention efforts, young children do experience extreme mental health problems. For instance, the effects of trauma or loss can be devastating to children's emotional well-being even in infancy. Moreover, a disorder such as ADHD can occur in young children and needs to be addressed as early as possible.

ParticipantNancy
In my experience as a teacher, my impression has been that young boys exhibit mental and emotional health problems more often than girls do. Is there a gender difference?

Guest Samantha Wulfsohn
Nancy, boys often will demonstrate what we call externalizing behavior. This refers to things like aggression, hyperactivity, etc. For these reasons, boys often come to our attention. Girls are more likely to demonstrate what we call internalizing behavior, things like withdrawal, and so they get lost in the system sometimes. Also, keep in mind that girls will sometimes demonstrate "relational aggression." This can involve hurting other’s relationships by manipulating or eliciting peer rejection of others and can be quite problematic.

IEL moderator Dr. Wulfsohn, here's another question we received prior to the chat session.

I hear from many preschool teachers that more children are coming to their classrooms with serious emotional problems today than 5 years ago. Do more young children have serious emotional problems today than 5 or 10 years ago?

Guest Samantha Wulfsohn
There is certainly a greater awareness and value placed on children's emotional well-being. This suggests that increases in the number of children with emotional problems may be in part a result of us noticing something that already existed. However, over the past decade children have been experiencing a greater number of stresses that can contribute to emotional problems.

Children who experience multiple stresses are at a greater risk for experiencing emotional problems. These include the stress associated with poverty (1 in every 4 or 5 children is living in poverty today), violence in the home and community, parent mental health problems, single parents, parent incarceration, homelessness, etc.

IEL moderator And here's our next question:

Low-quality child care, watching too much TV, poor parenting, and neighborhood violence have all been cited as root causes for emotional problems in children today. What do you see as the primary root causes for emotional problems in young children?

Guest Samantha Wulfsohn
The cause of emotional problems is complicated, because children are complicated. As we know from developmental research many factors contribute to a child's emotional problems including their own biological risk, problems in their relationships with others, and the stresses in their environment.

Poverty is one example of an extremely harmful risk factor to children's emotional development. Moreover, the more stresses a child experiences, the more likely the child's emotional well-being may be compromised. However, a child's predisposition and temperament can put them at risk for having mental health problems even when there are no environmental risk factors present. Moreover, a positive relationship with a caring adult or an easygoing temperament may provide a buffer to the negative effects of multiple environmental stresses.

IEL moderator You can find additional resources on "Young Children's Mental Health" in the supplement to this Chat session.

Participantmaryjo
Could you please distinguish between a young child's healthy sexual behavior and indicators of possible sexual abuse to the young child?

Guest Samantha Wulfsohn
It is normal for young children to engage in sexual exploration. Parents and teachers are sometimes concerned when they see young children looking at each other's private parts or masturbating. However, this behavior is normal.

When children engage in activity that seems adult-like, something that they had to learn from watching others for instance, then we should be concerned. Also children who engage in excessive masturbation and demonstrate sudden changes in their behavior or regression are concerning. Finally, when this behavior is accompanied by other aggression or withdrawal, teachers and parents should be concerned.

IEL moderator Dr. Wulfsohn, here's our next question.

What kinds of mental health problems are difficult to diagnose in young children?

Guest Samantha Wulfsohn
Generally, it is difficult to diagnose young children using the current system, the Diagnostic Classification System for Mental Health Disorders (DSM IV). For instance, Attention Deficit Hyperactivity Disorder (ADHD) can be difficult to diagnose in young children. Some of the features of ADHD are part of normal development, whereas some of the symptoms may be caused by stress or trauma.

However, there is a system that has been developed specifically for young children, the Diagnostic Classification System for 0 to Three. This taxonomy was developed for children from birth to six and considers concerns with the child, their relationship with primary caregivers, and other environmental stresses.

IEL moderator The transcripts of the IEL Chat sessions from 2002 through 2004 are archived on the IEL Web site. Go to the IEL Chat page, then scroll down the page to the particular chat that you're interested in. For each chat, you'll see a link for "chat transcript." Click on that link to view the transcript for that particular Chat.

The most recent Chat (from last November) was on the topic of "TV, Computers, and Video Games—How Much Is Too Much?" with Carol Weisheit of STARnet. The transcript for this chat can be read at:

  • IEL Interactive Chat: TV, Computers, and Video Games—How Much Is Too Much?
    Carol Weisheit, November 2004

The Spanish version of this transcript, "La televisión, las computadoras y los videojuegos: ¿Cuánto tiempo es demasiado?" is also available.

The previous chat was "From Chewing to Choosing: Bonding Books and Children," with Elizabeth Hearne of the University of Illinois. The transcript of this Chat session is available at:

  • IEL Interactive Chat: From Chewing to Choosing: Bonding Books and Children
    Elizabeth Hearne, October 2004

Similar to the other transcripts, this one is available in Spanish as "Algunos los mascan y otros los buscan: La relación entre niños y libros"

IEL moderator Dr. Wulfsohn, here's our next question.

What approaches can parents and teachers of young children take to develop children's mental health in positive ways?

Guest Samantha Wulfsohn
Early positive relationships provide the foundation for children's positive mental health. Children who experience consistent, nurturing, and responsive caregiving early in life will be more likely to have success later in life.

After this foundation is set, parents and teachers can foster positive mental health by encouraging children to understand their own emotions and the emotions of others. Moreover, children who learn how to regulate their behavior and feelings will develop positive mental health. This includes learning how to express negative feelings appropriately and how to calm down. Additionally, children who are able to get along with their peers and solve conflicts are more likely to be socially and emotionally well adjusted.

Two excellent books that provide more information on how to address preschooler's mental health needs and facilitate emotional development are Unsmiling Faces: How Preschools Can Heal, by Lesley Koplow (published by Teachers College Press in 1996) and The Emotional Development of Young Children: Building an Emotion-Centered Curriculum, by Marilou Hyson (published by Teachers College Press in 2003).

ParticipantKNS
Can you please explain further about the classification system?

Guest Samantha Wulfsohn
KNS, do you mean the DC 0-3?

ParticipantKNS
Yes.

Guest Samantha Wulfsohn
The DC 0-3 was developed specifically because of concerns about diagnosing young children. It considers the importance of relationships for young children, problems with the child, stresses in the environment, and developmental issues. It is used formally in several states and Illinois is looking to adopt it. You can learn more about this system at the Zero to Three Web site.

Participantmaryjo
Could you please tell us how to obtain the Diagnostic Classification system for 0-3 that you just mentioned?

Guest Samantha Wulfsohn
maryjo, the DC 0-3 is published by Zero to Three.

Participantmaryjo
Thank you.

IEL moderator Here's a URL suggested by Nancy.

ParticipantNancy
Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood™

IEL moderator Thanks, Nancy.

IEL moderator As noted earlier, Samantha Wulfsohn is on staff at the Erikson Institute in Chicago, IL. She is a licensed psychologist with a degree in Human Development and School Psychology from the University of Wisconsin-Madison. She has been working with children for over 15 years and has specialized in infant mental health and Autism spectrum disorders.

Dr. Wulfsohn has experience providing mental health consultation to staff and families participating in Head Start and Early Head Start programs. Additionally, she has been a supervising psychologist for an intensive in-home program for children with Autism Spectrum Disorders. Currently, Dr. Wulfsohn directs an inclusion and mental health consultation project at Erikson Institute and provides Relationship Development Intervention and other services to children with Autism.

Concerning the Erikson Institute, information on the work of the institute can be found on its Web site at: http://www.erikson.edu.

IEL moderator Dr. Wulfsohn, here's our next question.

What are some promising practices or initiatives you are seeing around the state to address concerns about young children's mental health?

Guest Samantha Wulfsohn
There are many mental health initiatives in the state of Illinois. To access information on these initiatives, you can go to the Illinois Association for Infant Mental Health, the Ounce of Prevention Fund, and the Illinois Children's Mental Health Partnership (ICMHP).

With regard to the latter organization, see the ICMHP's "Draft PLAN Recommendations and Strategies for Building a Comprehensive Children's Mental Health System in Illinois."

IEL Editor
The Web sites of the organizations that Dr. Wulfsohn just mentioned are available at:

ParticipantNancy
In my question related to gender, you mentioned girls with a mental health problem demonstrating internalizing behavior. Does that include shyness or should this be considered a normal personality trait?

Guest Samantha Wulfsohn
Nancy, shyness is a personality trait and is normal. Children who are extremely inhibited might be at risk for developing anxiety disorders later in life. Of course, the role of a child's environment, experiences, and relationships can all have an impact on this. Jerome Kagan is a researcher who has done a lot of work on temperament and inhibition, if you are interested in the science. He also has a readable book called Galen’s Prophecy: Temperament in Human Nature (published by Westview Press, reprint edition, 1995).

Participantmaryjo
In my work as an early childhood mental health specialist, I often have to refer children for further evaluation. The difficulty comes with many parents not accepting that their child may need further mental evaluation. Do you have any suggestions on how to talk with the parents to get them to realize that early intervention is so important.

Guest Samantha Wulfsohn
maryjo, this can be very difficult as it is hard for families to accept problems of any kind in their child. Sometimes it is helpful to provide some developmental expectations that are realistic. Perhaps they can be invited to observe their child in the classroom. Also, with time as you build relationships with parents, they may come to trust your perspective. Finally, emphasizing the prevention piece, "We don't want this to grow into something extremely problematic," may help.

IEL moderator Remember that the IEL Web site is available not only in English but also in Spanish. The Spanish home page is at http://illinoisearlylearning.org/index-sp.html.

Participantmaryjo
What would you suggest to a parent whose child age 6 with Asperger's Syndrome is in a public school that wants the child to attend for only 3 hours a day? The parent is frustrated with the current recommendation.

Guest Samantha Wulfsohn
maryjo, are there any reasons for why the school is limiting the child's time? Is it because of behavior and safety issues? I can imagine that this is frustrating for the family. It is always best to work collaboratively with the school if at all possible. It is hard for families not to become angry with schools, but they can get more if they are on the same side.

Participantmaryjo
The parent seems to think that it's because the school does not want to take the extra effort needed for the child. The parent has had difficulty getting the school to follow the therapy schedules this year and is considering home schooling the child. However, the parent also very much sees that the child loves and needs the social learning with other children. That is why it is such a difficult decision.

IEL moderator There's a little less than 30 minutes remaining in tonight's chat.

Guest Samantha Wulfsohn
maryjo, one way to ensure the child is getting a fuller day is through the IEP process. If this is written into the IEP the school will need to make its best effort to meet this need. Also, ask for an autism consultant with the district. If they decide to home school, it may be important to try to access social groups or find some after school activities.

IEL moderator Remember that you may send a question at any time to the IEL staff. Just email your question to: iel@illinois.edu.

You can also phone in a question. Please note that IEL's toll-free telephone number has recently changed. The new number is 877-275-3227. IEL staff are usually available between 8-12 and 1-5 on business days.

IEL moderator Dr. Wulfsohn, here's our next question.

What resources exist for parents and teachers of young children who have specific concerns about their children's mental health?

Guest Samantha Wulfsohn
There are some excellent resources on line focusing specifically on young children's mental health. Some examples of these are as follows.

ParticipantKNS
How are children affected that have siblings with emotional or behavior disorders?

Guest Samantha Wulfsohn
KNS, siblings can be affected in several ways. This of course can depend on what the disorder is. First, they may demand a lot of time from their parents, so the siblings' needs may become secondary. Because some disorders have a genetic risk, siblings may demonstrate some problems also.

Stress at home can contribute to children's problems with adjusting. So if a child has a sibling with extremely aggressive behavior, for instance, this can create stress for the child. Siblings, however, may be fine in spite of having a brother or sister with mental health issues and may learn from this.

IEL moderator Chat participants may be interested in an earlier chat in the IEL online chat series. This chat was about "Communicating with Parents during Sensitive or Difficult Situations" by Karen Stephens. The transcript for this chat is available at:

  • IEL Interactive Chat: Communicating with Parents during Sensitive or Difficult Situations
    Karen Stephens, November 2003

Note that this particular chat was actually called a "Web Talk," but the idea is basically the same.

Participantmaryjo
Do you have any suggestions about what to provide to help children with sensory integration disorder, specifically mouthing objects and clothing excessively?

Guest Samantha Wulfsohn
maryjo, this is an area for the expertise of an OT (occupational therapist). However, I have seen that giving them something appropriate to chew on is a good option. For children who are old enough, chewing gum or having something chewy in their mouths can be helpful. Sometimes using a toothbrush with peanut butter or lemonade powder can be helpful.

Some great resources in this area are The Out of Sync Child and The Out of Sync Child Has Fun.

IEL Editor
Here's some more bibliographic information for these books:

  • The Out-Of-Sync Child: Recognizing and Coping With Sensory Integration Dysfunction, by Carol Stock Kranowitz, published by Perigee Books in 1998.
  • The Out-of-Sync Child, Revised Edition, by Carol Stock Kranowitz, published by Perigee Books in 2005. (This edition is scheduled for release later in the summer of 2005.)
  • The Out-Of-Sync Child Has Fun: Activities for Kids With Sensory Integration Dysfunction, by Carol Stock Kranowitz, published by Perigee Books in 2003.

IEL moderator Dr. Wulfsohn, here's our next question.

A young child in my child care program displays emotional extremes: he is very angry one day, very withdrawn the next, and very happy and bubbly another day. I would like to talk to this child's parents about my concerns, but I don't know how to start a conversation without alarming them. What suggestions do you have?

Guest Samantha Wulfsohn
It is always easier to talk to parents about a concern if you already have a positive relationship with them, one that is built on your shared goal of trying to help their child grow and develop. If you have talked to this child's parents about things that have been going well, it may be easier for them to hear about your concerns.

Also, I always consider parents as the "experts" on their child, so it will be helpful to ask them what they see at home. They may be worried but have not had a way to bring it up with anyone. Or they may provide you with information about changes that have been going on at home. You could start the conversation by describing what you see, asking them if they see the same things at home, and asking them if this is something that concerns them.

IEL moderator Tonight's online chat is the first IEL chat of calendar year 2005 (though it's the fourth chat in academic year 2004-2005). The next IEL Chat is scheduled for 7:00 pm Central Time on Wednesday, May 4. In this chat, Dr. Lilian Katz, Director of the Illinois Early Learning Project, will address the topic of "Saying 'No' to Your Child."

Subsequently, on June 1 (also on a Wednesday at 7:00 pm Central Time), Sallee Beneke will discuss "The Project Approach and the Early Learning Standards." Additional information related to both of these chats will be posted to the IEL Web site as it becomes available. Visit the Chat page.

IEL moderator Dr. Wulfsohn, here's our next question.

I have heard that if children ingest lead or mercury, it can affect their mental health. Is there any way to tell if a child is being affected by environmental poisons? And what can be done to help such children?

Guest Samantha Wulfsohn
I am aware that lead poisoning can have a negative impact on children's development in many areas. With regard to the social emotional arena, children who have had high levels of lead in their system may demonstrate behavior problems including impulsivity, attention problems, and problems with peers. The only way to determine if a child has ingested lead is to test their blood levels.

Mercury has been implicated by some for the increased rise of Autism. Thimerosal, which is a mercury-based preservative used in the Mumps, Measles, Rubella vaccine, was blamed for causing Autism by many parents and some researchers. However, the Institute of Medicine of the National Academies conducted a thorough review of clinical and epidemiological studies. They showed that the measles-mumps-rubella (MMR) vaccine and Thimerosal, the mercury-based preservative used in vaccines, are NOT associated with autism.

IEL moderator Participants in IEL chats may also be interested in the series of online chats offered by the Center for Evidence-Based Practice: Young Children with Challenging Behavior (CEBP) and the Center on the Social and Emotional Foundations for Early Learning (CSEFEL). For general information on the work of these two centers, visit their Web sites, respectively, at: http://challengingbehavior.fmhi.usf.edu and http://www.vanderbilt.edu/csefel.

So far, four online chats have been held in the CEBP/CSEFEL Chat series. The first of these was "What to Do When Children Say 'NO!'" with Lise Fox from the University of South Florida. This was followed by "Classroom Environments That Work: Preventing Problem Behavior" with University of Illinois professors Micki Ostrosky and Tweety Yates.

The third chat presented information on "Creating Home/Program Partnerships That Work: Supporting Children with Problem Behavior" by Matt Timm of Tennessee Voices for Children. Finally, in the fourth chat, Barbara Smith of the University of Colorado at Denver discussed the topic of "Leadership Strategies for Supporting Children's Social and Emotional Development and Addressing Challenging Behavior."

Further information, including transcripts, for each of these chat sessions is available on the CSEFEL Chat Resources page. at: http://csefel.vanderbilt.edu/chat.html.

Participantmaryjo
How much do researchers know about the heredity possibility of children diagnosed with autism spectrum disorders?

Guest Samantha Wulfsohn
maryjo, researchers have started working on this question. Different projects have attempted to identify specific combinations of genes. However, there is no consistent finding yet. There is general agreement, however, that Autism is a brain-based disorder and has a genetic component.

Go to the National Institute for Health for updates on research in this area. I will get the Web site to you shortly. . .

. . . Here is the Web site on Autism research at NIH: Autism Spectrum Disorder

Participanteileen
Recently there have been articles and news items marking the striking increase in Autism/Asperger's Syndrome, especially it seems, in California. Do you have any thoughts on why this is? Better diagnosis or is it some environmental factor?

Guest Samantha Wulfsohn
Eileen, the increase in diagnosis has been related to an increased awareness in part. Also, the diagnosis catches more children because it has become more open. As a "spectrum" disorder it is capturing children with less extreme problems.

I have heard a statistic from California suggesting that the increase in diagnosis of Autism has been accompanied by a decrease in the diagnosis of "non-specified mental retardation."

IEL moderator Participants in tonight's Chat session may be interested in a few Tip Sheets prepared by the IEL staff that are related to this evening's topic. Although they don't deal with serious mental health issues, some of the Tip Sheets in the Social and Emotional development section of the Tip Sheets page may be helpful.

These possibly relevant Tip Sheets include:

Participantmaryjo
Any specific resources that you are aware of to help teachers with children diagnosed or exhibiting characteristics of Asperger's Syndrome?

Guest Samantha Wulfsohn
There are many resources and I would start with the Web. Try the Autism Society of America, http://asa.org.

Also, the Family Village is a great resource: http://familyvillage.wisc.edu.

Some books are:

  • Children with Autism: A Parent's Guide, by Michael D. Powers (published by Woodbine House, 2nd edition, 2000)
  • Everyday Practical Solutions, by Mindy Small and Lisa Kontente (published by Autism Asperger Publishing Company, 2003)
  • Autism/Aspergers: Solving the Relationship Puzzle, by Steven E. Gutstein (published by Future Horizons, 2001)
  • Autism Spectrum Disorders: A Research Review for Practitioners, by Sally Ozonoff, Editor (published by the American Psychiatric Association, 2003)

Participantmaryjo
Your suggestions and resources have been very helpful to me this evening.

IEL moderator Another place to look for resources on the IEL Web site (besides the Tip Sheets just mentioned) that are related to young children's mental health is in the IEL "Early Learning Web Links" database. This is a database of Web resources on early learning that the IEL staff has compiled, using careful criteria, so that you don't have to hack and claw your way through the spiky brambles of the Google forest of search results! This easily searchable IEL collection of Web links is available at: http://illinoisearlylearning.org/cgi-bin/iel/searchiel.asp.

Once on the search page, you can search in one of two ways. First, you can search for a word in the title. For example, type "autism" (without the quotes) in the title box and click on the "Go Search" button.

Second, you can search on pre-assigned keywords. Scroll down to the "Choose the keywords" box and select a term, for example, "Mental Health," and then click on the "Go Search" button. With this sample search, you'll find a dozen or so resources.

IEL moderator Dr. Wulfsohn, here's our next question.

When people talk about "professional help" for young children with mental health problems, what exactly do they mean? I have a hard time picturing a young child on a psychiatrist's couch!

Guest Samantha Wulfsohn
Working with the family is the most common and effective way to address mental health concerns in young children. This may include supporting positive relationships between children and their parents, helping parents to respond to and address behavioral concerns at home, helping them to learn to play with their child and providing them with support around parenting their child.

Additionally, addressing parents' own stresses and mental health needs is an important aspect of supporting young children's mental health. In some cases a therapist will use play to address mental health concerns with children in individual therapy.

IEL moderator Dr. Wulfsohn, here's our next question.

Are children born with a predisposition to develop mental health problems, or are these problems caused by children's environment and care?

Guest Samantha Wulfsohn
As I mentioned earlier, some children come into the world with biological risk factors. For instance, children whose parents have mental health problems may be at greater risk for developing mental health problems. Moreover, disorders like Autism and ADHD are likely to be brain-based disorders.

However, environmental risk factors can also contribute to mental health problems. The interaction of environment factors and biology can be extremely complicated. For example, different children may react to the same stresses in different ways. On the one hand, a child who is temperamentally inhibited or who is hypersensitive to change may demonstrate behavior problems in response to a violent event. On the other hand, a child who is extremely social and has an easy temperament may be well adjusted in spite of witnessing a violent event.

Additionally, the same child may react to different situations in different ways. For example, a child may start acting aggressively after he witnesses his mother being beaten up by her boyfriend. In contrast, he may continue to be socially competent even after being homeless for several months.

IEL moderator There are just a few minutes remaining in tonight's chat. Maryjo, your questions are in the queue.

IEL moderator Chat participants may also be able to find some useful resources on young children's mental health from the following organizations.

Participantmaryjo
What are your thoughts on medicating children under age 5 with ADHD?

Guest Samantha Wulfsohn
There is no research on medication for preschool children. However, a recent study demonstrated that medication was the most effective first step to treat ADHD in older children. Research is on its way for younger children. From my own experience, I have seen many children medicated inappropriately and it is often turned to as a "fix it" approach.

Children who are misdiagnosed are often medicated. Additionally, children with ADHD need more than medication. They need to learn how to self-monitor and be more aware of their behavior as well as learn social skills. However, medication can be extremely helpful for children who have a true diagnosis of ADHD even when they are as young as 4 years.

You should be able to find information on the ongoing research at NIMH.

IEL moderator Dr. Wulfsohn, here's our last question of the evening.

Participantmaryjo
What are some signs of depression in young children?

Guest Samantha Wulfsohn
Maryjo, this can be a tough one because signs of depression in young children are not always the same as what you would expect in adults. Children who are extremely irritable and sad may be depressed. However, they may also demonstrate acting out behavior.

Here is a list of signs of depression in children and adolescents as presented by the American Academy of Child and Adolescent Psychiatry. However, it is important to consider these signs within the context of what you would expect for younger children.

  • Frequent sadness, tearfulness, crying
  • Hopelessness
  • Decreased interest in activities; or inability to enjoy previously favorite activities
  • Persistent boredom; low energy
  • Social isolation, poor communication
  • Low self esteem and guilt
  • Extreme sensitivity to rejection or failure
  • Increased irritability, anger, or hostility
  • Difficulty with relationships
  • Frequent complaints of physical illnesses such as headaches and stomachaches
  • Frequent absences from school or poor performance in school
  • Poor concentration
  • A major change in eating and/or sleeping patterns
  • Talk of or efforts to run away from home
  • Thoughts or expressions of suicide or self-destructive behavior

Also, take a look at the DC 0 to 3, mentioned earlier for additional information on mood disorders in young children.

IEL Editor
See the earlier discussion about DC 0 to 3.

IEL moderator Those of you who participated in tonight's chat, we'd like to thank you for your questions and for your patience in waiting for the responses. Please join us for the remaining chats that are to be held during Spring 2005. Once again, the next chat will be "Saying 'No' to Your Child" with Lilian Katz on Wednesday, May 4 at 7:00 pm Central Time. This will be followed on June 1, also Wednesday at 7:00 pm Central Time, by "The Project Approach and the Early Learning Standards" with Sallee Beneke.

IEL moderator And of course, many thanks to you, Samantha Wulfsohn, for sharing your expertise with us this evening.

ParticipantKNS
Thank you for all of the valuable information that you have provided.

Participantmaryjo
Thank you very much, Dr. Wulfsohn.

ParticipantNancy
Dr. Wulfsohn, thank you for an interesting and informative hour.

Guest Samantha Wulfsohn
Thank you, everyone, for participating tonight. Your questions were great and I have enjoyed talking with you all.

IEL moderator Thanks again, Chat Participants. Enjoy the beautiful weather as the buds and blossoms burst forth all about our subtly beautiful Illinois earth (that is, once the rain stops tonight!)—and have a good Earth Day on Friday.

Additional Questions

ParticipantQuestion
What are the signs that a child may need to be evaluated by a professional for mental health problems?

Guest Samantha Wulfsohn
Any time a parent or caregiver notices behavioral extremes it is worth looking further into the problem. If a child is doing things that are not typical for their age, and their behavior is getting in the way of the child’s ability to function normally (play, go to child care, explore, etc.) it is worth examining further.

Examples of concerning behavior in preschoolers can include extreme aggression, behavioral hyperactivity, and difficulty calming down. Children who can’t get along with their peers and don’t know how to play may also be demonstrating a need for help.

Additionally, it is important not to forget those “easy” and “quiet” children who can get lost in the system, those who are withdrawn, have flat affect, or cry easily. Finally, anytime you are aware of extreme stresses, loss, or trauma in a child’s life and see a sudden change in their behavior, it may be important to get further help for them.

ParticipantQuestion
Whom should a parent contact if concerned about possible mental health problems? Can pediatricians diagnose and treat mental health problems?

Guest Samantha Wulfsohn
The pediatrician is a good place to start when a parent has concerns about mental health problems. Typically, pediatricians are not trained to diagnose and treat mental health problems, although sometimes they will prescribe medication to young children.

It is best if parents obtain the name of a mental health professional (such as a psychiatrist, psychologist, or social worker) from the pediatrician to address concerns about mental health problems. Also, in seeking out the help of a professional, I would encourage parents to find a provider who has experience with young children.

Resources

Online Resources

  • Your Child's Mental Health: What's Up Doc?
    Mental health is how we think, feel, and act. It's common for children to feel sad or to behave badly from time to time; however, if you see troubling behaviors that seem persistent and severe, it's time to take action.
  • Does My Child Have an Emotional or Behavioral Disorder?
    Among all the dilemmas facing a parent of a child with emotional or behavioral problems, the first question-whether the child's behavior is sufficiently different to require a comprehensive evaluation by professionals-may be the most troublesome of all. Often the first indications that an infant may be experiencing significant problems will be delays in normal development.
  • Treatment of Children with Mental Illness
    This fact sheet addresses common questions about diagnosis and treatment options for children with mental illnesses.
  • Early Child Development in Social Context: A Chartbook
    This 115-page report reviews 33 indicators of intellectual, social, and emotional development for children up to age 6. The report also discusses indicators of children's health and family and neighborhood characteristics that affect children's readiness for school.
  • Depression in Children and Adolescents
    Depression is a disorder characterized by a persistent depressed (sad) mood that may last months or even years. It can occur at any age through the lifespan.
  • Bipolar Disorder and Children
    Bipolar disorder, also known as manic-depression, is a type of mood disorder marked by extreme changes in mood, energy levels, and behavior. Symptoms can begin in early childhood but more typically emerge in adolescence or adulthood.
  • Attention Deficit Hyperactivity Disorder
    Attention Deficit Hyperactivity Disorder (ADHD) is a condition that becomes apparent in some children in the preschool and early school years. This detailed booklet describes the symptoms, causes, and treatments of ADHD, with information on getting help and coping.
  • IEL Resource List: Handling Challenging Behaviors in Child Care and at Home: Autism This site also contains the transcript from an IEL Chat with Alyson Beytien, assistant project director of the Illinois Autism/Pervasive Developmental Disorder (PDD) Training & Technical Assistance Project in La Grange, Illinois.

Organizations

ERIC Database: Selected Records

To search the ERIC database for resources on this topic, use this search strategy: young children or preschool children or toddlers or infants or early experience or preschool education. Combine with mental health.

  • ERIC Document No.: ED480380
    Healing Magazine, Volume 8, 2003 Publication Date: 2003
    Availability: KidsPeace Creative Services, 1650 Broadway, Bethlehem, PA 18015-3998
    This volume of "Healing Magazine" features practical, clinical information aimed at sharing current work in children's mental health. Each issue contains supplementary resources and book reviews.
  • ERIC Journal No.: EJ676605
    Children's Mental Health. Beginnings Workshop Author(s): Plattner, Ilse Elisabeth; Haugen, Kirsten; Cohen, Alan; Levin, Diane E.
    Publication Date: 2003
    Source: Child Care Information Exchange, n152 p33-47 Jul-Aug 2003
    This issue presents four articles discussing mental health topics that pertain to early childhood education: "Granting Children Their Emotions" (Ilse Elisabeth Plattner); "Double Vision: Parent and Professional Perspectives on Our Family's Year in Crisis" (Kirsten Haugen); "Coping with Stress and Surviving Challenging Times" (Alan Cohen); and "When the World Is a Dangerous Place: Helping Children Deal with Violence in the News" (Diane E. Levin).
  • ERIC Journal No.: EJ673109
    Primary Prevention in Mental Health for Head Start Classrooms: Partial Replication with Teachers as Interveners Author(s): Serna, Loretta A.; Nielsen, Elizabeth; Mattern, Nancy; Forness, Steven
    Publication Date: 2003
    Source: Behavioral Disorders, v28 n2 p124-29 Feb 2003
    A previous study demonstrated that a 12-week universal intervention in three Head Start classrooms significantly improved outcomes on 5 of 10 measures of mental health. In this replication, regular Head Start teachers conducted the universal intervention. Outcomes for 98 children were significant on only 2 of 8 outcome measures.
  • ERIC Journal No.: EJ672034
    Remember the Person--Infant Mental Health Publication Date: 2003
    Source: Texas Child Care, v26 n4 p28-35 Spr 2003
    This article highlights the concept of infant mental health and discusses what early care and education professionals can do to boost babies' emotional well-being. The article offers steps for the following specific strategies: (1) developing trust, (2) being alert to risk conditions, (3) nurturing children's mental health, (4) creating supportive environments, and (5) offering nurturing activities.
  • ERIC Document No.: ED468044
    Family Strengths: Often Overlooked, but Real Author(s): Moore, Kristin Anderson; Chalk, Rosemary; Scarpa, Juliet; Vandivere, Sharon
    Publication Date: August 2002
    Availability: Child Trends, 4301 Connecticut Avenue, NW, Suite 100, Washington, DC 20008
    This research brief defines the concept of family strengths, identifies the characteristics of strong families from research, and examines several measures of family strengths in two recent national surveys, one dealing with family life of younger children and the other with adolescents. The brief also suggests some next steps to expand understanding of family strengths and what they mean for the well-being and development of family members.
  • ERIC Document No.: ED470020
    The ABCs of Children's Mental Health Author(s): Whelley, Pete; Cash, Gene; Bryson, Dixie
    Publication Date: 2002
    Source: Here's How, v21 n1 Fall 2002
    Availability: National Association of Elementary School Principals, 1615 Duke Street, Alexandria, VA 22314
    The U.S. Surgeon General's 2000 Report on Children's Mental Health estimates that one in five children and adolescents will experience a significant mental-health problem during their school years. It is recommended that educators educate themselves on types and symptoms of mental-health problems, develop procedures for addressing potential problems, and utilize community mental-health resources and provide their names and numbers to parents.
  • ERIC Journal No.: EJ657953
    Children's Emotional Growth: Adults' Role as Emotional Archaeologists Author(s): Dettore, Ernie
    Publication Date: 2002
    Source: Childhood Education, v78 n5 p278-81 2002
    This article discusses adults' roles in children's emotional development, focusing on ways that adults can help young children identify and communicate their feelings, become attuned to and accepting of the ways young children approach and deal with emotional issues, and provide environments that enable young children to express their feelings.
  • ERIC Document No.: ED468559
    Building Strong Foundations: Practical Guidance for Promoting the Social-Emotional Development of Infants and Toddlers Author(s): Parlakian, Rebecca; Seibel, Nancy L.
    Publication Date: 2002
    Availability: Zero to Three, 2000 M Street, NW, Suite 200, Washington, DC 20036-3307
    Supportive relationships, especially those with primary caregivers, are crucial for both the physical survival and the healthy social-emotional development of infants and toddlers. This guide, the first in a series on infant mental health from the Center for Program Excellence, describes how supportive relationships promote the social-emotional development of very young children.
  • ERIC Document No.: ED456596
    A Guidebook for Parents of Children with Emotional or Behavioral Disorders. Third Edition Author(s): Jordon, Dixie
    Publication Date: 2001
    Availability: PACER Center, 4826 Chicago Ave. South, Minneapolis, MN 55417-1098
    This handbook discusses different types of disorders, mental health services, and school services. A list of relevant organizations is provided, along with a list of parent training and information centers, state Medicaid offices, and the core values and principles of the CASSP system of care.

Disclaimer

The opinions, resources, and referrals provided on the IEL Web site are intended for informational purposes only and are not intended to take the place of medical or legal advice, or of other appropriate services. We encourage you to seek direct local assistance from a qualified professional if necessary before taking action.

The content of the IEL Web site does not necessarily reflect the views or policies of the Illinois Early Learning Project, the University of Illinois at Urbana-Champaign, or the Illinois State Board of Education; nor does the mention of trade names, commercial products, or organizations imply endorsement by the Illinois Early Learning Project, the University of Illinois at Urbana-Champaign, or the Illinois State Board of Education.

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