6.3 SPECIFYING OPPORTUNITY TO RESOLVE RACE-BASED MENTAL HEALTH INEQUITY IN EARLY CHILDHOOD

Abstract

Identifying opportunities to resolve racial inequities in mental health outcomes is an urgent national priority. In this presentation, the impact of current racial inequities on early childhood development will be traced in: 1) a large national sample of African American children affected by autism spectrum disorder (ASD); 2) an epidemiologic cohort of Hispanic twins in the state of California; and 3) a court-referred sample of over 600 infants and toddlers consecutively enrolled with their parents into a 2-generation clinical psychiatric service (the SYNCHRONY Project) after having been placed in protective custody for child abuse in St. Louis, Missouri. In these analyses: 1) a grossly disproportionate burden of cognitive impairment—accounting for hundreds of thousands of excess cases of intellectual disability in the United States—was traced to systematic (structural) delays in both diagnosis and service access among African American children with ASD; 2) untreated mental health conditions of Hispanic parents were shown to exert more deleterious effects than poverty on early childhood mental health; and 3) a missed opportunity to support parents with documented mental health conditions resulted in catastrophic inequities in the integrity of minority households and the adaptive outcomes of young children. In a diverse sample of high-risk pregnant women—for whom prediction algorithms estimated future risk of child abuse to their newborns to be comparable to the recidivism risk in the court sample—prospective engagement into a program of resource navigation for evidence-based supports demonstrated the feasibility of migrating preventive intervention from the social service sector into the health system. Strategies to resolve race-based mental health inequity in the United States must seriously consider starting at the beginning of life, when excess adverse experience, and deficiency in mental health support, exact disproportionate and enduring consequences on minority children and their families. Judicious adherence to clinical standards of care in the field of psychiatry, broadly defined, represents a potent opportunity to level the playing field for all children, at a critical node in the historically inexorable transfer of racial injustice and its impact across generations.