Mental Illnesses Start Earlier Than Thought, Expert Says

BALTIMORE — There's a growing appreciation among pediatric psychiatrists that mental illnesses occur among preschoolers and that identification and treatment are critical to getting these kids back on track for healthy development, according to Dr. Joyce N. Harrison, director of Preschool Clinical Programs at Johns Hopkins Bayview Medical Center in Baltimore.

“When I was in training 15 years ago, I thought all psychiatric disorders started at age 6 because that's when we started seeing kids, but we've begun to see kids younger and younger,” she said at a meeting on developmental disabilities sponsored by Johns Hopkins University.

Around 10% of preschoolers are believed to have a severe impairing psychiatric disorder; rates of attention-deficit/hyperactivity disorder, disruptive behavior disorders, depression, and anxiety in preschool children are estimated at 3%, 8%, 2%, and 9%, respectively.

Symptoms of these disorders can interfere with parent-child relationships, family functioning, social development, the ability to participate in child care, and with learning and school readiness.

“We have a very narrow window to get them back on the developmental trajectory,” she said. During early childhood, brain development is rapid and attachment to caregivers is critical. All learning occurs within the context of relationships and life experiences have a profound effect on later development.

Nationally, early care and education providers report that challenging behavior and problems with social skills are their greatest challenge; preschoolers are expelled at a rate three times higher than that for school-aged children, according to Dr. Harrison.

In 2006–2007, 67% of the referrals to the Michigan Child Care Expulsion Prevention Initiative were for children aged 0–3 years. That state-funded project is aimed at supporting the mental health needs of children ages 0–5 years. Children are referred to the program for frequent aggressive behavior such as biting, or for developmental concerns.

An estimated 10%–15% of children aged 1–2 years have significant social-emotional problems, according to Dr. Harrison. “The prevalence of social/emotional behavior problems in preschoolers is almost at epidemic proportions,” Dr. Harrison said.

“A stereotypical presentation in my clinic is a kid who is aggressive and they don't sleep and they're out of control or they're hyperactive,” Dr. Harrison said. “My approach is that it's a disruptive behavior disorder until proven otherwise, until we can get at what's underneath the behavior,” she said.

The evaluation process usually requires three to five sessions, and family interviews are the preferred method for obtaining information. Such interviews elicit details about the reason for the referral, current difficulties, traumatic events; temperament; family, medical and developmental history; and physical, cognitive, emotional, and social development. Child/caregiver interactions warrant observation, as does the child when playing alone and with other children. Standardized instruments are used for these evaluations.

Dr. Harrison reported that she has no relevant financial relationships.

BALTIMORE — There's a growing appreciation among pediatric psychiatrists that mental illnesses occur among preschoolers and that identification and treatment are critical to getting these kids back on track for healthy development, according to Dr. Joyce N. Harrison, director of Preschool Clinical Programs at Johns Hopkins Bayview Medical Center in Baltimore.

“When I was in training 15 years ago, I thought all psychiatric disorders started at age 6 because that's when we started seeing kids, but we've begun to see kids younger and younger,” she said at a meeting on developmental disabilities sponsored by Johns Hopkins University.

Around 10% of preschoolers are believed to have a severe impairing psychiatric disorder; rates of attention-deficit/hyperactivity disorder, disruptive behavior disorders, depression, and anxiety in preschool children are estimated at 3%, 8%, 2%, and 9%, respectively.

Symptoms of these disorders can interfere with parent-child relationships, family functioning, social development, the ability to participate in child care, and with learning and school readiness.

“We have a very narrow window to get them back on the developmental trajectory,” she said. During early childhood, brain development is rapid and attachment to caregivers is critical. All learning occurs within the context of relationships and life experiences have a profound effect on later development.

Nationally, early care and education providers report that challenging behavior and problems with social skills are their greatest challenge; preschoolers are expelled at a rate three times higher than that for school-aged children, according to Dr. Harrison.

In 2006–2007, 67% of the referrals to the Michigan Child Care Expulsion Prevention Initiative were for children aged 0–3 years. That state-funded project is aimed at supporting the mental health needs of children ages 0–5 years. Children are referred to the program for frequent aggressive behavior such as biting, or for developmental concerns.

An estimated 10%–15% of children aged 1–2 years have significant social-emotional problems, according to Dr. Harrison. “The prevalence of social/emotional behavior problems in preschoolers is almost at epidemic proportions,” Dr. Harrison said.

“A stereotypical presentation in my clinic is a kid who is aggressive and they don't sleep and they're out of control or they're hyperactive,” Dr. Harrison said. “My approach is that it's a disruptive behavior disorder until proven otherwise, until we can get at what's underneath the behavior,” she said.

The evaluation process usually requires three to five sessions, and family interviews are the preferred method for obtaining information. Such interviews elicit details about the reason for the referral, current difficulties, traumatic events; temperament; family, medical and developmental history; and physical, cognitive, emotional, and social development. Child/caregiver interactions warrant observation, as does the child when playing alone and with other children. Standardized instruments are used for these evaluations.

Dr. Harrison reported that she has no relevant financial relationships.

BALTIMORE — There's a growing appreciation among pediatric psychiatrists that mental illnesses occur among preschoolers and that identification and treatment are critical to getting these kids back on track for healthy development, according to Dr. Joyce N. Harrison, director of Preschool Clinical Programs at Johns Hopkins Bayview Medical Center in Baltimore.

“When I was in training 15 years ago, I thought all psychiatric disorders started at age 6 because that's when we started seeing kids, but we've begun to see kids younger and younger,” she said at a meeting on developmental disabilities sponsored by Johns Hopkins University.

Around 10% of preschoolers are believed to have a severe impairing psychiatric disorder; rates of attention-deficit/hyperactivity disorder, disruptive behavior disorders, depression, and anxiety in preschool children are estimated at 3%, 8%, 2%, and 9%, respectively.

Symptoms of these disorders can interfere with parent-child relationships, family functioning, social development, the ability to participate in child care, and with learning and school readiness.

“We have a very narrow window to get them back on the developmental trajectory,” she said. During early childhood, brain development is rapid and attachment to caregivers is critical. All learning occurs within the context of relationships and life experiences have a profound effect on later development.

Nationally, early care and education providers report that challenging behavior and problems with social skills are their greatest challenge; preschoolers are expelled at a rate three times higher than that for school-aged children, according to Dr. Harrison.

In 2006–2007, 67% of the referrals to the Michigan Child Care Expulsion Prevention Initiative were for children aged 0–3 years. That state-funded project is aimed at supporting the mental health needs of children ages 0–5 years. Children are referred to the program for frequent aggressive behavior such as biting, or for developmental concerns.

An estimated 10%–15% of children aged 1–2 years have significant social-emotional problems, according to Dr. Harrison. “The prevalence of social/emotional behavior problems in preschoolers is almost at epidemic proportions,” Dr. Harrison said.

“A stereotypical presentation in my clinic is a kid who is aggressive and they don't sleep and they're out of control or they're hyperactive,” Dr. Harrison said. “My approach is that it's a disruptive behavior disorder until proven otherwise, until we can get at what's underneath the behavior,” she said.

The evaluation process usually requires three to five sessions, and family interviews are the preferred method for obtaining information. Such interviews elicit details about the reason for the referral, current difficulties, traumatic events; temperament; family, medical and developmental history; and physical, cognitive, emotional, and social development. Child/caregiver interactions warrant observation, as does the child when playing alone and with other children. Standardized instruments are used for these evaluations.

Dr. Harrison reported that she has no relevant financial relationships.