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When babies see shrinks
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Victoria Clayton
Traditionally, young children have rarely crossed paths with psychiatrists
or psychologists. Not anymore. With a growing amount of research
focusing on early brain development, more youngsters — even
infants — are being targeted to receive the services of mental-health
professionals.
There are no hard numbers available for just how many pre-kindergarten
children are being seen, but experts say infant/toddler mental health
is moving into the mainstream. Psychological research on this age
group is a hot topic at major universities, and last year the American
Academy of Pediatrics launched a task force with at least part of
its purpose to push more infant/toddler mental health intervention.
This may cause some readers to roll their eyes — especially
those who believe Americans have a tendency to pathologize and treat
the slightest blip of a bad mood.
Before you pass judgment, however, it’s important to understand
what infant/toddler mental health is all about, says Ngozi Onunaku,
a policy analyst with Zero to Three, a Washington, D.C.-based nonprofit
organization dedicated to furthering mental wellness for preschool-age
children.
“When you put the words ‘infant’ and ‘mental-health
treatment’ next to each other, that’s really scary to
some people,” says Onunaku. “People think of medication
and, from a more comical standpoint, they think of a baby on the
couch.”
Onunaku says that, in fact, a more accurate way to talk about this
issue is to call it infant/toddler mental wellness. “It’s
more helpful to see mental health as a continuum. There are kids
who need intense interventions, there are kids in the middle who
are at risk for a problem and then at the other end you have your
everyday, typical children who also need their caregivers to promote
mental health and wellness.”
While all humans can benefit from what researchers and doctors
are learning about infant mental development — namely, that
infants are sentient, perceptive beings whose brain development
can be strongly influenced in the first weeks, months and years
of life — there are certain issues that drive most parents
to get help for their children.
When there may be a problem
Specialists in early childhood mental wellness say parents tend
to be at least nominally aware of their children’s problems
well before they’re officially diagnosed. For this reason,
parents should be frank with their pediatricians. Don't rush to
judgment about your child, but the following behaviors and symptoms
— particularly when persistent — are worth mentioning
to the doctor:
— Refusing food and losing weight
— Sleep problems so severe that your child or you aren’t
functioning well during the day
— General listlessness
— Inconsolability — the child is always crying or screaming
— Failure to walk, talk or relate to other children
Eating and sleep issues are primarily why mental-health professionals
see infants, says Dr. Thomas Anders, an infant psychiatrist at the
University of California, Davis M.I.N.D. Institute and president
of the American Academy of Child and Adolescent Psychiatry.
Toddlers are more often seen because of developmental delays or
behavioral problems such as temper tantrums.
Other reasons infants and toddlers are evaluated include abuse,
adoption or other separation from a birth parent, maternal depression,
premature birth and trauma such as a natural disaster or illness.
With the right therapy and care, many of these conditions can be
helped significantly and often swiftly. “Sometimes one session
or two sessions and a couple of phone consultations are all you
need to take care of a problem,” Anders says.
Parent-infant therapy
Oftentimes, it’s just a matter of educating parents or teaching
them some very specific parenting skills. For example, Anders, who
studies infant sleep, says he may get a call because an infant appears
to have a sleep disorder but sometimes it’s a matter of working
with parents to establish a more productive bedtime ritual.
“Most of the treatment for children under 3 or 4 is what
we call parent-infant therapy,” says Anders. “Medications
are very rarely used in this age group.” In fact, when a young
child is having any sort of problem it’s always a matter of
determining how the family can solve the problem.
“What we’re really doing primarily with infant and
toddler mental health is saying, ‘What guidance can we provide
to help a parent cope better?’” says Penny Glass, a
developmental psychologist with Children’s National Medical
Center in Washington, D.C. “Sometimes it’s amazing when
you just counsel parents on how to establish structure.”
Are babies too young to have 'issues'?
Glass notes that having organized mealtimes and bedtimes often help
families feel as if they have more control and helps eliminate toddler
behavioral problems. “Even if you just help a child get a
decent amount of sleep many of the problems don’t seem so
big,” says Glass.
In some cases, parents may mistake one issue for another. Glass
recently saw a boy, age 3 and a half, who was referred to her for
behavior problems. But when Glass did the full evaluation she found
out that the child was actually developmentally delayed and operating
more at a 2-year-old level. He didn’t understand some of the
words or thoughts and ideas that people were trying to convey to
him because they were speaking to him at the level of a 3- or 4-year-old.
Once this was understood Glass could recommend therapy to help get
him up to speed but she could also counsel the parents, teachers
and caregivers in how to speak and treat him appropriately.
Just knowing the problem and what they were dealing with, Glass
says, helped the parents feel better, understand the child better
and treat him in a more health-promoting way.
Some conditions are being detected at much earlier ages than ever.
Dr. Joan Luby, a child psychiatrist at Washington University in
St. Louis, says thanks to the attention being focused on infant
mental health, professionals are now more likely to diagnose certain
problems such as autism spectrum disorders as early as 18 months.
Research in the past several years by Luby and colleagues, published
in the Journal of the American Academy of Child and Adolescent Psychiatry
and elsewhere, has helped scientifically validate that children
as young as preschool age can suffer from depression, anxiety and
other mood disorders. Even with these disorders, though, doctors
tend to be wary about medicating the pre-kindergarten set because
most of the drugs used to treat the disorders haven’t been
properly studied in children.
“Treatment for mood disorders really depends on the disorder
but, in general, behavioral and psychotherapeutic modalities are
still the first line,” says Luby. The more severe the impairment,
she adds, the more likely the child will eventually need psychotherapy
and medication.
“It sometimes helps to think about [mental illness] in terms
of diabetes,” says Anders. “If a child was diabetic
you wouldn’t like it but you’d get treatment. If it’s
true that your child has a problem, you need to treat it.”
Teen problems can have early roots
Experts say that while many of us haven’t realized it, our
children have often paid steep prices for not having their mental
health taken into consideration. Dropout rates, drug abuse, suicide
and eating disorders are all adolescent problems that could have
roots in treatable early childhood mental health issues.
Zero to Three’s Onunaku points out that we don’t even
have to wait until adolescence to see the impact of ignoring early
childhood mental wellness.
A Yale study last year looked at the problem of pre-kindergarten
children being expelled. Led by Yale Child Study Center researcher
Walter S. Gilliam, the study found that in classrooms where the
teacher had no access to a psychologist or psychiatrist, preschool
students were expelled about twice as frequently.
http://msnbc.msn.com/id/12037118/
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