Why Starting Early Matters in Mental Health

As I sat with a middle school student recently, who is struggling to succeed in school and manage her severe anxiety and depression, I could not help feeling genuinely sad. As a psychologist, I have learned how to manage my own emotions so that I can be most effective as a clinician. But this particular case really touched my heart, because it was one in which the parents had the education and resources to seek support. They chose not to, because they were very concerned about how their daughter would be perceived if she received mental health diagnoses or treatment. Fortunately, they now fully support her need for therapy and school interventions.

This is a common issue I have encountered since I entered private practice in 2007. I believe that I am in good company, along with many other professionals. I believe it is just as important that we speak out on this issue, as it is for celebrities and high-profile individuals to do so. While their endorsements may convince the masses that it is acceptable to seek help, we can educate the public about how early intervention is useful and effective. It is our job to be specific about how intervention works with young children, because if we cannot discuss specific strategies and resources, we cannot expect to be taken seriously for those who do choose to seek support.

I have frequently heard this question from parents, teachers, and other professionals: "How does therapy work with a young child? Do you talk to them and ask them questions?"

We have to be able to answer this question in a specific manner. Here are my thoughts:

  1. Intervention with young children integrally involves the parents. For children younger than five years, the parents must be counseled on how to modify behavior, and how to relate to and interact well with the child. 
  2. Modifying behavior is only scratching the surface. I cringe when I review the self-help literature for parents. It focuses almost exclusively on changing behaviors, such as decreasing tantrums and increasing compliance. Behavior modification does play an important role in early intervention. However, looking at the attachment relationship between the child and the primary caregiver is also key. Children are often much more willing to comply with the parent or caregiver they trust. Loving communication and compassion on the part of the parents is just as important as implementing proper discipline strategies.
  3. Assessment and evaluation often play an important initial role in treatment. There are lots of reasons why children misbehave, and behavior problems generally are a primary reason why a child is referred for treatment. Before intervention begins, having a clear understanding of why the problems are present is crucial. I believe that assessment is highly underutilized, or is minimally conducted in most treatment settings. The child in question often needs to be evaluated to ensure that there are no developmental delays or other cognitive issues that play a role in their ability to understand what is being expected of them. Furthermore, and just as important, is assessing their social and emotional functioning. We cannot act on the assumption that a child is misbehaving because they are merely strong-willed, or because the parents are not disciplining them properly.
  4. Assessing the mental health of the parent is helpful. If the primary caregiver or someone else living in the house is struggling with psychological problems, such as anxiety or depression, this definitely affects the child. While professionals who treat children are not responsible for doing an in-depth evaluation of the parent, it is important for them to educate the child's parents regarding their own mental health. The clinician can then refer the parents so they can obtain their own support. Numerous studies show that maternal depression can seriously impact the mental health of the young child. It can also affect the quality of the mother-child attachment. In households where the child isn't being raised by the mother, the mental health of the caregiver is still important.
  5. Clinicians who work with young children should feel very comfortable getting on the floor, having toys and other age-appropriate stimuli available, and spending some time observing the child in play. Play is such an important part of child development that it should be an important part of the assessment and treatment in a mental health setting. Children express their emotions through play, artwork, and other creative formats. Even if behavioral interventions are going to be recommended, play therapy is an important component of treating young children and understanding what is happening in the child internal life. 

Educating people about how therapy works with young children and their parents will likely be an effective tool to put parents at ease, and reduce their hesitations about pursuing help.