Early Childhood Mental Health Research Articles

Early childhood risk factors for later onset of pediatric chronic pain: a multi-method longitudinal study

BackgroundPediatric chronic pain (i.e., pain lasting ≥ 3 months) is prevalent, disabling, and costly. It spikes in adolescence, interrupts psychosocial development and functioning, and often co-occurs with mental health problems. Chronic pain often begins spontaneously without prior injuries and/or other disorders. Prospective longitudinal cohort studies following children from early childhood, prior to chronic pain onset, are needed to examine contributing factors, such as early pain experiences and mental health. Using data from a longitudinal community pregnancy cohort (All Our Families; AOF), the present study examined the associations between early developmental risk factors, including early childhood pain experiences and mental health symptoms, and the onset of pediatric chronic pain at ages 8 and 11 years.MethodsAvailable longitudinal AOF data from child age 4 months, as well as 1, 2, 3, 5, 8, and 11 years, were used. Mothers reported their child’s pain experiences (e.g., hospitalizations, vaccinations, gut problems) at each timepoint from 4 months to 8 years, child chronic pain at age 8, and child mental health symptoms at ages 5 and 8 years. Children reported their chronic pain frequency and interference at age 11. Adaptive least absolute shrinkage and selection operator (LASSO) regressions were used to select predictor variables. Complete case analyses were complemented by multiple imputation using chained equation (MICE) models.ResultsGut problems, emergency room visits, frequent pain complaints, and headaches at age 5 or earlier, as well as female sex, were associated with increased risk of maternal reported child chronic pain at age 8. Maternal reported chronic pain at age 8 was associated with higher levels of child-reported pain frequency and pain interferences at age 11. Boys self-reported lower levels of pain interference at age 11.ConclusionsSome, but not all, painful experiences (e.g., gut problems, ER visits, pain complaints) in early life contribute to pediatric chronic pain onset and should be considered for screening and early intervention.

Infant and Early Childhood Mental Health (IECMH) and Early Childhood Intervention: Intentional Integration.

Infant and Early Childhood Mental Health (IECMH) is a multidisciplinary field of inquiry, practice, and policy concerned with enhancing the social-emotional competence of infants and young children. Early Childhood Intervention (ECI) is a system of services that supports infants and toddlers with disabilities and their families. ECI providers promote a child's development in all domains, including social-emotional. The purpose of this paper is to describe how two systems, Early Childhood Intervention and Infant Early Childhood Mental Health, collaborate when serving children who have developmental delays or disabilities and their families and other caregivers. We will discuss two models used to promote social-emotional development, the Pyramid Model and IECMH Consultation, and provide three examples that demonstrate how ECI and IECMH intersect at both the family, classroom, and system levels.

Maintaining Children's Mental Health: Revealing Teacher Strategies During Offline Learning for Early Childhood

Purpose – School preparation in response to the new government policy for face-to-face learning requires the active roles of teachers and students, particularly concerning children's mental health. The importance of addressing children's mental health during the transition from online to face-to-face learning needs more attention. The purpose of this research is to identify and describe the strategies employed by teachers in maintaining children's mental health during face-to-face learning at Playgroup Jaya Lestari in Kalinyamat Wetan Village, Tegal City. Design/methods/approach – This research adopts a qualitative method with a descriptive approach. Data collection techniques used include observation, interviews, and documentation. The subjects of this research are educators, including principals and teachers. The data analysis techniques applied are data reduction, data display, and verification. To test the validity of the data, source triangulation was used, involving teachers and students at Playgroup Jaya Lestari. Findings – The results indicate that strategies employed by teachers to maintain children's mental health during face-to-face learning include using both individual and group approaches. These strategies emphasize the roles and functions of teachers as inspirers, mentors, and more. Teachers can maintain children's mental health by organizing learning activities that involve play, ensuring children remain happy, cheerful, and free from stress or laziness. These strategies are reinforced through their direct application in teaching and learning activities. Research implications/limitations – The findings highlight the importance of increased awareness of children's mental health, which impacts developmental psychology and the learning process. This research underscores the necessity for educators to focus on mental health early in the educational environment. Practical implications – The research demonstrates the need for effective strategies for teachers to maintain children's mental health during the learning process. It also emphasizes the importance of institutional readiness to address future challenges and the necessity for collaboration with professionals in psychology to tackle early childhood mental health issues. Originality/value – This study provides a new perspective by examining the mental health of children in relation to Early Childhood Development psychology and the role of teachers in this developmental process. Paper type Research Paper

The ChAMP App: A Scalable mHealth Technology for Detecting Digital Phenotypes of Early Childhood Mental Health.

Childhood mental health problems are common, impairing, and can become chronic if left untreated. Children are not reliable reporters of their emotional and behavioral health, and caregivers often unintentionally under- or over-report child symptoms, making assessment challenging. Objective physiological and behavioral measures of emotional and behavioral health are emerging. However, these methods typically require specialized equipment and expertise in data and sensor engineering to administer and analyze. To address this challenge, we have developed the ChAMP (Childhood Assessment and Management of digital Phenotypes) System, which includes a mobile application for collecting movement and audio data during a battery of mood induction tasks and an open-source platform for extracting digital biomarkers. As proof of principle, we present ChAMP System data from 101 children 4-8 years old, with and without diagnosed mental health disorders. Machine learning models trained on these data detect the presence of specific disorders with 70-73% balanced accuracy, with similar results to clinical thresholds on established parent-report measures (63-82% balanced accuracy). Features favored in model architectures are described using Shapley Additive Explanations (SHAP). Canonical Correlation Analysis reveals moderate to strong associations between predictors of each disorder and associated symptom severity (r = .51-.83). The open-source ChAMP System provides clinically-relevant digital biomarkers that may later complement parent-report measures of emotional and behavioral health for detecting kids with underlying mental health conditions and lowers the barrier to entry for researchers interested in exploring digital phenotyping of childhood mental health.

Early Childhood Income Instability and Mental Health in Adolescence: Parenting Stress and Child Maltreatment as Mediators.

Ample research has examined how point-in-time or static measures of economic deprivation are associated with children's mental health outcomes. Less is known about the relationship between early childhood unstable income and mental health outcomes. Using the Future of Families and Child Wellbeing Study, this study examined (1) the latent patterns of early childhood economic well-being, predicted by income level and instability (i.e., direction and frequency of income change); (2) the association of income deprivation patterns with subsequent anxiety and depression symptoms, paying particular attention to the mediating roles of parenting stress and child maltreatment risk. The latent class analysis results suggested four distinct groups representing different combinations of income level and instability. Structural equation modeling results indicated indirect links between income deprivation patterns and mental health outcomes, through parenting stress and physical and psychological abuse. Findings indicated the importance of policies and programs promoting economic stability over the long run.

Counselors’ Knowledge of Serving the Birth to Six Population

Infant and Early Childhood Mental Health (IECMH) is a culturally informed, relationally focused area of clinical expertise which addresses the social–emotional needs of very young children and their families. IECMH addresses a critical need and, because of the nuances of the population, requires specific knowledge and skills. Although counselors are often providers of this type of clinical work, very little training exists in counselor education programs, leaving counselors to possibly work outside of scope of competence. This article explores the knowledge and experiences of counselors’ with IECMH. The results of a quantitative survey will be addressed, along with implications and recommendations for counselor education programs and professional counselors to further their knowledge on IECMH.

Perceived Stress of Mothers, Harsh Discipline, and Early Childhood Mental Health: Insights from a Cross-Sectional Study in Marginalized Roma Communities.

Objectives: This study aims to compare the early childhood mental health of children from marginalized Roma communities (MRCs) in Slovakia with that of the majority and explore possible mediating pathways of mothers' perceived stress and harsh discipline practices. Methods: We used data from the first wave of the longitudinal RomaREACH study collected in 2021-2022. Two populations were included in the sample: 94 mother-child dyads from MRCs and 79 from the majority population (children aged 14-18months). Data were analysed using linear regression, and mediation was tested using PROCESS Macro in SPSS. Results: Belonging to MRCs vs. the majority, perceived stress of mothers and harsh discipline were found to be associated with early mental health problems in children. Perceived stress of mothers partially mediates the relationship between belonging to MRCs vs. majority and harsh discipline and harsh discipline partially mediates the relationship between perceived stress of mothers and the mental health of children. Conclusion: Mothers from MRCs perceive more stress, which is associated with more frequent use of harsh discipline practices having a negative impact on the mental health of young children.

Improved classroom and child outcomes through mental health consultation in New York City subsidized early care and education programs.

This paper describes the evaluation of one year of infant/early childhood mental health consultation (IECMHC) in subsidized early care and education settings provided by the New York City Early Childhood Mental Health Network. The evaluation examined direct and indirect outcomes of IECMHC including (1) improved classroom practices by ECE teachers, and (2) improved social, emotional, and behavioral outcomes among children in the classroom. The study also reviewed child attributes that might have moderated outcomes. An analysis using paired t-tests of pre-and post-assessment data found significant improvements over time in the classroom environment and management practices, as well as in teachers' perceptions of the degree of difficulty presented by children's classroom behaviors. There were significant improvements in protective factors and problem behaviors among the subset of 138 children who received assessments. Improvements were greater for Black/African American children and for all children with pre-assessment scores in the concern range. Males showed greater improvement in protective factors whereas females showed greater improvement in behavioral concerns. IECMHC is a powerful intervention to improve teachers' classroom management and their perceptions of children's behavior and is important in the context of biases that place marginalized groups at risk of punitive actions by teachers and administrators.

Child-focused infant and early childhood mental health consultation: Shifting adult attributions to reduce the risk for preschool expulsion.

Infant and early childhood mental health consultation (IECMHC) in early care and education (ECE) settings is a promising approach to support young children. Although research on the effects of IECMHC is encouraging, it is limited by the complexities of the systems in which IECMHC is implemented and the variability in IECMHC models. The current study aims to clearly articulate a statewide, child-focused, short-term IECMHC model, assess consultee satisfaction, examine the effects of consultation on children's functioning in the school and home settings, and evaluate changes in teacher perceptions associated with expulsion risk following consultation. In total, 268 children ages 1-5 (69% White, 75% male) and their family and school caregivers participated in consultation in a New England state, and 95 children and caregivers were included in an evaluation subsample. Of this subsample, teachers and ECE administrators, but not families, indicated significant improvement in children's functioning from referral to end of consultation. There was also a significant decrease in children's risk of expulsion, as measured by teachers' perceptions associated with expulsion decisions. This study contributes to the IECMHC literature by providing results specific to a child-focused model of consultation and highlighting the possible role of adult attributions for children in ECE.

Association between screen time and physical activity on mental health among preschoolers: a cross-sectional study from Southwest China.

Screen time and physical activity behaviors undergo development during early childhood and impact mental health. However, there is limited knowledge regarding the associations between physical activity, screen time, and mental health problems (MHP) in preschoolers. This study examines these associations using a large sample size and brief measures. A multistage cluster stratified sampling method was used to conduct an observational cross-sectional study of 19,015 Chinese preschoolers in 2020. Information on physical activity, and screen time was collected by a self-administered questionnaire; MHP was assessed by the parent-reported Strengths and Difficulties Questionnaire (SDQ). Logistic regression models were used to obtain the odds ratios (ORs) and 95% confidence intervals (95% CIs) of preschoolers' MHP associated with screen time, total physical activities, moderate to vigorous physical activity (MVPA), and outdoor physical activities. A total of 19,015 participants from the 19,548 recruited population were included in the analyses (missing rate: 2.73%), 52.60% were boys. 64.01%, 57.96%, 35.98%, and 82.64% of preschoolers were reported to meet total physical activities, MVPA, and outdoor activities with screen time recommendations level. The results of multivariable-adjusted ORs (95% CIs) of preschoolers' MHP for comparisons of different levels of screen time (< 2h/day, 2-4h/day,≥4h/day) show that screen time positively associated with MHP after adjusting for confounders (P < 0.05), but the association was not significant among girls with screen time ≥ 4h/day. In addition, increased engagement in physical activity was reversely linked to MHP (P < 0.05). A stronger association between MHP and MVPA was observed in boys, however, this association was weakened when the total time spent engaging in MVPA exceeded two hours per day (P < 0.05). Less physical activity and more screen time positively relate to MHP, but the relationship differs by type of physical activity, total time, and gender. These findings provide novel insights and evidence supporting for guidelines on physical activity, screen time, and improvement of mental health for preschoolers.

Infant and early childhood teleconsultation and training: Program description and feasibility outcomes from a statewide implementation.

To address high rates of mental health and developmental concerns facing young children ages 0-6 in the United States and internationally, providers across professional sectors need Infant and early childhood mental health (IECMH) training and support. The training and teleconsultation program (TTP) is a state-funded program developed in one Mountain West state in the United States to provide free IECMH training and teleconsultation to any provider working with young children. The TTP included access to webinars and individual or group consultation with licensed mental health providers. Webinars focused on increasing awareness and knowledge related to attachment and child development, supporting parents and caregivers, trauma-informed practice, supporting emotional health of staff and providers, and culturally responsive practices with infants, young children, and caregivers. Teleconsultation included case consultation, reflective individual and group supervision, and collaboration supports/referrals. During the 18-month evaluation period, 1568 unique providers engaged in either training or teleconsultation services, an average of 9% growth in new providers each month, with representation from all professional sectors and all state counties. This program demonstrates the feasibility and need for statewide training and teleconsultation programs to help meet the needs of providers who interact with and support young children and caregivers.

African American Parents’ experience with early childhood mental health and child welfare services: Racism and seeking understanding

BackgroundImpacts of child maltreatment and child welfare involvement on young children are significant and early childhood mental health services are important to reduce risk factors for them. However, racial disparities limit access to mental health services. ObjectiveThe purpose of this study is to understand the experience and perspective of birth parents accessing mental health services for their child welfare-involved toddlers and preschoolers aged 1.5 to 5 years. Specifically, this study seeks to examine racism and service disparities among African American parents. To our knowledge, there is no study examining birth parents’ perspectives on mental health services for young children.Participants & Setting: This study collected original qualitative data using semi-structured interviews. Nine African American participants shared their experiences from February 2018 to November 2019. MethodsQualitative data analysis used a pragmatic realist approach to understand the complex phenomenon of parents’ experience accessing services. NVivo 12 was used for qualitative analysis to help condense themes for the study. Quantitative descriptive analysis using Stata 14.2 provided the sample description. ResultsEquity and understanding was a main theme with three sub-themes; racism, child welfare understanding the family, and mental health provider understanding the family. Participants experienced racism, creating a mistrust of mental health providers and child welfare workers. ConclusionImplications for policy and practice to improve equity and understanding of families in child welfare are discussed. Future research can build on this study by examining how racism impacts service use and how interventions can increase understanding of families using child welfare and mental health services.

Parent-Child Interaction Therapy for Muslim-American Parents and Young Children

There are limited data available regarding early childhood mental health in the Muslim American population. Nevertheless, the literature has shown that American Muslims are more likely to experience mental health disorders, including being twice as likely to report a history of suicide attempt1 compared to other religious communities.2 Despite these challenges, Muslims in America are often underserved and tend to underutilize mental health services, compared to other minority groups.2-5 The combination of Muslim children with significant mental health challenges and caregivers who underutilize mental health services reduces the likelihood that effective treatments will be used and increases risk of long-term harm for Muslim American children. Research has shown that Muslim American populations may be hesitant in seeking mental health treatment for a variety of reasons, including associated stigma behind mental illness within the community, fears related to past experiences of racism and discrimination in a post-9/11 world, differing way of conceptualizing mental illness and psychological distress that may lead to seeking alternative supports within family and community instead of mental health providers, and lack of knowledge about how to access formal mental health services.6,7 Another plausible reason for the underutilization of mental health services in this population is the concern that mental health treatment may not align with religious or cultural values.3

Early Childhood Play and Mental Health

Early Childhood Play and Mental Health

Assessment and Diagnostic Classification Using DC:0-5 in Early Childhood Mental Health Clinics: The Protocol for the Developmental Psychiatry Diagnostic Challenges Study (DePsy).

Mental health problems in early childhood are common, but there is a lack of psychiatric research on this age group. DC:0-5 is a multiaxial classification system for mental disorders in early childhood, providing a framework for standardizing clinical practice and research. However, research on the validity of DC:0-5 is scarce. The Developmental Psychiatry Diagnostic Challenges Study (DePsy) is a multi-site, prospective clinical study including six German early childhood mental health (ECMH) clinics. The main objective of the study is to contribute to the validation of Axis I and Axis II of DC:0-5. A second aim of the study is to describe the population of the participating clinics regarding diagnoses, family context, and treatment outcomes. Additionally, the impact of environmental risk factors, including parental Adverse Childhood Experiences (ACEs) and media use, on child psychopathology and caregiver-child relationships will be examined. Over two years, patients aged 0.0-5.9 years old will be enrolled in the study. Assessments include ICD-10 and DC:0-5 diagnoses, developmental tests, video-based observations of caregiver-child interactions, and questionnaires on child psychopathology, media use, parental stress, and treatment satisfaction. Study results will promote the standardization of assessment and treatment in ECMH clinics aiming to improve the development of patients and their families.

Addressing Early Education and Child Care Expulsion.

An important goal of early childhood education is teaching emotional self-regulation within the context of a safe, stable, nurturing environment. Expulsion of young children ignores underlying emotional and behavioral concerns, disproportionately affects children of color (Black or Hispanic), males, children with disabilities, and socioeconomically disadvantaged populations, and has long-term consequences on educational and life success. Addressing implicit bias and providing child mental health consultation (psychologists, social workers, developmental behavioral pediatricians, child psychiatrists, and child neurologists) to child care providers can prevent expulsion. Pediatricians and other providers within the medical home play an important part in preventing expulsion. However, pediatricians need more training in early childhood mental health and in understanding how systemic racism and implicit bias lead to preschool expulsion in children of color. By identifying children at risk for expulsion because of poverty, racial discrimination, toxic stress, insecure attachment, or history of trauma, the pediatrician can connect families with community resources that may ameliorate these effects. Pediatricians can provide information on social-emotional development in early childhood, promote positive parent-child relationships, and model and discuss age-appropriate and developmentally appropriate behavior management. Pediatricians can also guide parents toward high-quality child care programs that use mental health consultation and developmentally appropriate activities, both of which lessen the chance of child expulsion. Furthermore, behavioral health providers integrated into the medical home can provide consultation to child care providers on managing patients. These recommendations are consistent with our knowledge of early child brain development and support the current tenets of the American Academy of Pediatrics regarding the pediatrician's role in building resilience and buffering toxic stress to promote optimal child development.

Looking back to light the path forward: Ghosts in the Nursery revisited.

The infant health movement was launched nearly 50 years ago with the publication of the now classic paper, Ghosts in the Nursery: A psychoanalytic approach to the problems of impaired infant-mother relationships, written by Selma Fraiberg, Edna Adelson, and Vivian Shapiro (1975). This paper offers us lessons for infant mental health practice that have been proven true time and again over the last 50 years. These lessons both underscore the factors essential to clinical progress across a range of interventions, and remind us of the significant challenges we face in these times of massive, global trauma and oppression, extreme economic hardship, and systemic racism. This commentary reviews the key lessons of Fraiberg and her colleagues' classic paper, addresses some of the challenges inherent in retaining the breadth and substance of Fraiberg's model in contemporary practice, and proposes a model for conceptualizing infant and early childhood mental health practice that is geared toward building the relational foundations of reflection (Slade, 2023).

1.48 Follow-up Success After Early Childhood Mental Health Consultation

1.48 Follow-up Success After Early Childhood Mental Health Consultation

1.49 Accessing Timely Infant and Early Childhood Mental Health Care Through a Regional Mental Health Navigation Service

1.49 Accessing Timely Infant and Early Childhood Mental Health Care Through a Regional Mental Health Navigation Service

Virtual Delivery of Parent Coaching Interventions in Early Childhood Mental Health: A Scoping Review.

Parent-coaching interventions positively impact child development. Virtual delivery of such interventions is supported by literature reviews and a practice guideline, however, none of these focused on children under age six. A scoping review of virtually-delivered parent-coaching interventions for disruptive behaviour, anxiety, and parent-child relationship concerns in children under age six was conducted between Dec. 15, 2020 and April 22, 2021. Iterative searches of the databases PubMed, CINAHL, and PsycINFO were complemented by reference list searches and clinician expert review (N = 1146). After relevance screening and duplicate removal, collaboratively-developed inclusion criteria were applied to records, followed by data extraction from eligible articles (n = 30). Most literature documented behavioural-based interventions targeting disruptive behaviour which were delivered individually, by therapists, to White, non-Hispanic parents. Evidence supports feasibility and efficacy of virtually-delivered parent-coaching interventions to improve child disruptive behaviour (strong), anxiety (moderate), and parent-child relationship (weak). There is a significant gap in the literature regarding the virtual delivery of attachment-based parent-coaching interventions. In sum, virtual parent coaching can be an efficacious approach for children under age six, particularly for behavioural challenges.