Early Learning Project
What is mental health?
When we think of children’s health, we usually think of their physical well-being. “Are they active and fit? Do they get sick often?” Mental health is just as important as physical health. Mental health in young children is closely related to their social and emotional development.
Mental health includes how people feel about themselves and other people, how they approach problems and challenges, and how they cope with life. Good mental health helps people handle stress, make wise decisions, and get along with others, in childhood and throughout adulthood.
Caregivers, teachers, and family members all have roles to play in fostering young children’s mental health. Caregivers and teachers may be the first people to notice that a young child is experiencing mental health problems. Support from caring adults can help most children recover even when very bad things have happened in their lives. But some mental health problems last a long time and get in the way of learning and enjoying life.
What are some signs that a child may need professional help?
A child who is having mental health difficulties may benefit from an evaluation and receiving some form of professional help--family counseling, play therapy, or other individual therapy. Listed below are a number of indicators identified by mental health professionals that an adult can look for in a child:
- He almost always appears to feel sad and hopeless. He may cry a lot for no apparent reason.
- She often seems very angry, or is constantly irritable or tense, getting extremely upset about things that seem minor to others. Any child can have an irritable day, but a pattern of tension, irritability, and anger are cause for concern.
- He is frequently aggressive toward peers, adults, or pets, perhaps when he thinks no one else can see his behavior. Other children may be afraid of him. A child who often goes out of his way to hurt or scare others is not a happy child, even if he smiles or laughs during the aggression.
- She is often difficult to comfort or calm when she is angry, frustrated, frightened, or otherwise upset. Any child may have times when she can’t seem to comfort herself or be comforted. But if she is often “lost” in negative feelings, she may need help to recover her resilience.
- She startles very easily or seems to “freeze” in fear, or is overly vigilant. For example, she may seem afraid to close her eyes at naptime.
- He regresses in his toilet training or other developmental milestones.
- She often expresses feelings of worthlessness; or seems to feel excessively guilty, anxious, or worried.
- She seems very afraid in situations that do not frighten other children.
- He often has sleep problems, such as terrifying nightmares, or great difficulty falling asleep or waking up. Any child can have an occasional bad dream or be hard to awaken, even at naptime. But any severe sleep disturbance can signal a mental health problem.
- She avoids activities she once enjoyed, such as playing with friends. Any child may go through periods of preferring to be alone, and any child’s friendships and interests may shift over time. But there is cause for concern when an active, sociable child begins to pull away from everyone, especially if she also shows any other behaviors that cause concern.
- He seems unable to relax or is in constant motion (much more than his peers are). Many young children fidget, especially when they are required to sit for long periods or to do things that have little meaning for them. A child who cannot be still or focused long enough to enjoy many activities is probably not able to have good experiences in school or with friends.
- She tries to hurt herself, hurts herself deliberately, or says she wants to hurt herself. Although rare in preschool-age children, this behavior can be a reason for deep concern.
- He is often “oppositional” or often defies adults’ requests for constructive behavior. Many toddlers or preschool-age children sometimes refuse to do what is needed or expected. In fact, we want young children to say no to some requests— for example, when a stranger tells them to do something that might cause them harm. But when a child seems almost driven to reject rules or guidance, she is likely to have trouble getting along with adults or peers. Her safety may even be jeopardized if she refuses to do as she is told during an emergency.
- She seldom “stands up” to others who are bossy or bullying. Many young children will give in sometimes to another’s demands in order to avoid conflict or simply because they feel friendly toward the other person. If a child never asserts herself, she may fall victim to other people who wish to exploit her—to take her toys or food, or get her to do things that are not good for her.
- He becomes very upset if his usual routine is changed. Many young children prefer a familiar schedule, but when even small changes cause a child serious distress, that may be a sign that the child already feels overwhelmed by some life situation.
What can I do when I’m concerned about the mental health of a child in my care?
Educators and caregivers may be among the first people to notice changes in a child’s mental health. Here are important steps to take when a child’s behavior raises concerns:
- Observe and take notes on the child throughout the day. Do this over several days or weeks to help you see patterns. Does the behavior that concerns you occur at certain times of day? In certain parts of the building? Be sure to note the child’s strengths as well as areas of concern.
- Share your concerns with your program’s director, principal, or social worker. Be as specific as possible in explaining why you are concerned. Give details: “Emily pried the arms off of all the dolls twice this week. Every day after lunch, she slammed into children who were playing alone, knocked them down, and ran away laughing. She seemed to single out children who are smaller than she is.”
- Learn and follow your program’s procedures for working with children with challenging behaviors. Whose responsibility is it to talk to the family? If a child’s actions are dangerous, can an extra adult stay in the room to help out? Does the school have a referral process in place?
- Be ready to talk with the child’s family about your concerns.
When a child you know seems to be having mental health difficulties, you can take action to help the child. It is important to be sensitive to a child’s individual needs. For example, a child who is overly watchful as a result of trauma may not want to take part in any activity that involves closing his eyes. A child who is grieving may need some time to cry in private or on a teacher’s lap. Relationships with adults who are warm, nurturing, and respectful of the child can be extremely helpful.
Validate the child’s feelings, but set some limits. For example, let the child know you can accept his being angry, but he is not allowed to hurt people or pets. It may be necessary to have an extra person in the classroom to help out if a child’s aggressive or reckless behavior poses a safety threat to herself or others.
Maintain a consistent routine to reassure children who have been through chaotic times such as disasters or family trauma. If there will be a change in routine, try to let children know ahead of time what to expect.
Keep in mind that a child who believes he is bad and unlovable may act in ways that make others dislike him. This is sometimes called a “recursive cycle.” He may believe that the teacher cares less about him than about the other children. Reassuring the child may be very difficult, especially if he seems to reject what you say. It may take awhile for children to understand that there is a difference between themselves and the things they do. Specifically separating the behavior from the child can be helpful. For example, you might say, “I really don’t like for you to hit people, but I still like you.”
Some children will respond positively to suggestions for ways to express feelings effectively, or ways to act on their own behalf: “When you feel so angry you want to hit, you could punch this pillow or stomp your feet.” “When you feel lonesome and sad, would you like to ask a friend or a teacher for a hug?” “If you don’t like what Jake says, you can tell him to stop.”
A traumatized child may need opportunities to draw or play about what has happened. Provide toys and materials that children may use to help express feelings or relieve stress. A child may start to cope with fear, anxiety, anger, or grief by playing with play dough, clay, water, puppets, dollhouses, art supplies, and other “open-ended” items. A child involved in such therapeutic play may need to be able to play alone. Asking him or her to share or take turns at such times may not be helpful. Keep extra materials around in order to avoid conflict.
Be aware of how other children in the class may be feeling about the child who is having difficulties. Are they afraid of her? Worried about her? Angry? Rejecting? Your modeling can be very important. You can model acceptance of the child’s needs, while at the same time assuring the class that each of them deserves the care and concern of everyone in the group. Help children find ways to express care and support for a child who is recovering from a difficult experience. Show them how to stand up to someone who is aggressive and hostile, and show them how to defuse aggression.
How should I approach the family when I am concerned about a child’s mental health?
When a teacher or caregiver notices that a child’s mental health may be in jeopardy, it is important to talk with the child’s family. Such conversations call for tact and thoughtful preparation.
Being well prepared for the conversation is extremely important. If your program has social workers, nurses, or counselors, talk with them about the child’s behaviors. Ask them for suggestions about the best ways to approach the family. Before talking with the family, ask your local school district and mental health agencies about available support services. Who can evaluate a preschooler’s mental health? Is affordable counseling or play therapy available? Collect materials about these resources to give to the family.
With others in your program, decide what you or other staff members can do to help the child. For example, what will you do if the child puts herself in danger? Can an aide be provided for a child with serious problems? Be ready to present these options to the family.
Consider which staff members know the child or the family best. Be sure to include them in meetings with the family.
Also, be aware that if the family’s cultural background is different from your own, you may want to find out first what some of their perspectives might be on mental health and social-emotional development. A librarian may be able to help you find information about cultural variations in ideas about mental health. But it will be very important as you talk with the family to listen closely to what they seem to believe about the child’s behavior and about children’s mental health in general. You may need to spend extra time establishing some common ground in order to work most effectively with the family. If possible, you might want to find someone who works regularly with immigrant and refugee families who can give you firsthand information about what to expect and how to approach mental health issues in this situation.
Similarly, if you have concerns about the mental health of a child whose home language is not English, it would be helpful to use an interpreter who can translate ideas and terminology so that everyone can understand each other during potentially sensitive discussions about a child’s behavior and well-being.
No parent wants to hear bad news about his or her child, and some parents may be defensive. They may accuse others, even program staff, of causing the child’s difficulties or of exaggerating the problems. Other parents may not be ready to accept that a problem exists; this is sometimes known as denial. Still others may be deeply relieved that someone else shares their concerns about the child. In any case, when you express your concerns to the family, it is important to be tactful but candid. Here are some points to remember:
- Explain that you need to hear the family’s point of view. You might say something like, “We need your help. We’ve seen a change in Olivia. She cries very hard for more than an hour every day. Will you meet with us to talk about ways to help her feel better at school?”
- Avoid labels. If you say, “Olivia seems depressed,” the parents will not be able to picture her behavior. Instead, describe clearly what the child does. For example, “Olivia hides under her coat and cries herself to sleep. Nothing we do seems to comfort her.”
- Ask the parents if they see similar behaviors at home. What have they tried that helps the child feel better?
- Invite parents to watch the child in the classroom, so they can see what you have described.
- If necessary, explain how the child’s behavior gets in the way of friendships and learning activities. Again, it is important to describe exactly what you have seen the child do. Instead of saying, “She doesn’t like her friends any more,” you might say, “She stopped playing with friends about two weeks ago. When someone invites her to play, she just turns away. She doesn’t watch the others play. She just curls up inside her coat.”
- Do not use diagnostic terms--even if parents press you to do so. A mental health specialist should be the one who diagnoses and explains such conditions as depression, autism, etc.
- Word your comments with care so that parents do not feel blamed for the child’s troubles. Ask them what they think might be going on.
- Be sure to spend time talking about the child’s strengths as well as her difficulties. Her strengths are what you and the family can build on to help her.
It also helps to show the family that you do not expect them to “fix” the child by themselves. Give the parents or guardians materials you have collected. They might appreciate free pamphlets about children’s social and emotional well-being or materials about mental health services in the area. If it seems appropriate, you might also make referrals to community resources such as mental health clinics or play therapists who have been recommended by other parents.
Engage the family in planning some ways to help the child. For example, the parents might agree first to take the child to a pediatrician, and you might agree to write a letter to the doctor carefully describing what you have noticed about the child’s behavior. Or the parents might decide to find counseling, while the center director agrees to have an aide stay near the child during the day. The plan should include setting a time to touch base in three or four weeks to discuss how things are going for the child.
Keep in mind that it may take time for parents to think about what to do when a child seems to be having problems that affect his or her mental health.
The following Web resources may help you provide information to families.
Web Resources
IEL Resources
- IEL Tip Sheets on Emotional and Social Development
http://illinoisearlylearning.org/cgi-bin/iel/searchiel.asp?st=a&sl=s - Young Children’s Mental Health: Live Interactive Chat
http://www.illinoisearlylearning.org/chat/wulfsohn/trans.htm - What Is the Best Way to Assess Young Children's Social Competence?
http://illinoisearlylearning.org/faqs/socialcomp.htm#5 - What Do I Need to Know about Social and Emotional Development in Young Children? http://www.illinoisearlylearning.org/faqs/socemotdev.htm
Illinois Resources
- Illinois Mental Health Services (a directory)
http://store.samhsa.gov/mhlocator - National Mental Health Association Affiliates in Illinois
http://www.mentalhealthamerica.net/index.cfm?objectid=E422360D-1372-4D20-C8A0285839C8503C&search=yes&srch_state_id=16
Additional Resources
- Child Mental Health
http://eric.ed.gov/PDFS/ED465154.pdf - Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised http://zttcfn.convio.net/site/PageServer?pagename=ter_key_dc03_overviewRegistration required.
- Off to a Good Start: Research on the Risk Factors for Early School Problems and Selected Federal Policies Affecting Children's Social and Emotional Development and Their Readiness for School
http://www.eric.ed.gov/PDFS/ED476378.pdf - Ten Tips for Building Resilience in Children and Teens
http://www.apa.org/helpcenter/resilience.aspx - Resilience and Pre-school Children (Click on link in box on right.)
http://www.apa.org/helpcenter/resilience.aspx - Family Guide to Systems of Care for Children with Mental Health Needs
http://store.samhsa.gov/shin/content/SMA05-4054/SMA05-4054.pdf - What Are Children Trying to Tell Us? Assessing the Function of Their Behavior
http://csefel.vanderbilt.edu/briefs/wwb9.html - ¿Qué están intentando decirnos los niños?: La evaluación de la función de su comportamiento
http://csefel.vanderbilt.edu/briefs/wwb9-sp.html - The Myth of the Bad Kid
http://library.adoption.com/articles/the-myth-of-the-bad-kid.html - Ready to Enter: What Research Tells Policymakers about Strategies to Promote Social and Emotional School Readiness among Three- and Four-Year-Old Children
http://www.nccp.org/publications/pub_485.html - Making Dollars Follow Sense: Financing Early Childhood Mental Health Services to Promote Healthy Social and Emotional Development in Young Children
http://www.nccp.org/publications/pub_483.html - Set for Success: Building a Strong Foundation for School Readiness Based on the Social-Emotional Development of Young Children
http://nieer.org/publications/related-publications/set-success-building-strong-foundation-school-readiness-based - Early Head Start Program Strategies: Responding to the Mental Health Needs of Infants, Toddlers, and Families
http://www.ehsnrc.org/PDFfiles/mpsmentalhealth.pdf
ERIC Database: Selected Records
To search the ERIC database for resources on this topic, use this search strategy: search on descriptors young children or preschool children or preschool education or early childhood education or early experience or infants or toddlers or kindergarten children. Combine with descriptor mental health.
How to Obtain ERIC Documents and Journal Articles:
References identified with an ED (ERIC document)or EJ (ERIC journal) are cited in the ERIC database. ERIC Documents (citations identified by an ED number) may be available in full text from ERIC at no cost at the ERIC Web site: http://www.eric.ed.gov. Journal articles are available from the original journal, interlibrary loan services, or article reproduction clearinghouses.
If you would like to conduct your own free ERIC database searches via the Internet, go directly to http://www.eric.ed.gov/ERICWebPortal/search/basic.jsp
ERIC Search
- 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. - 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. - 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
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 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. - ERIC Document No.: ED458985
When Things Go Wrong: Managing Critical Incidents in Children's Services
Author(s): Legg, Chris
Source: AECA Research in Practice Series, v8 n3 2001
Publication Date: 2001
Availability: Publications Section, Australian Early Childhood Association, P.O. Box 105, Watson, ACT 2602, Australia
This booklet is designed to inform staff, parents, management committees, and owners of services about some of the issues involved when managing critical incidents in children's services. - ERIC Journal No.: EJ637795
Alerting the Early Childhood Educator to Depression in Young Children: Characteristics and Interventions. Nutrition, Health and Safety.
Author(s): Welton, Evonn; Vakil, Shernavaz
Source: Journal of Early Education and Family Review, v9 n1 p27-35 Sep-Oct 2001
Publication Date: 2001
This article presents information to assist early childhood educators in recognizing possible depression in young children, including intervention strategies.
Spanish: ¿Cuál es el papel del maestro en fomentar la salud mental de niños pequeños?
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.