Nursing Recent research shows that mental health problems can manifest in early childhood. As many as one in ten Australian children under five exhibit symptoms of social, emotional, and mental disorders including temper tantrums, difficulty adapting to new surroundings, problems relating to peers, and hyperactivity (Edwards & Martin, 2012). Although psychological diagnoses like clinical anxiety or depression are not typically made on populations under five, researchers do identify early childhood behaviors as risk factors for developing mental health disorders later in life. Thus, being withdrawn or inhibited has been identified as "one of the best identified risk factors for later anxiety disorders," (Rapee, Kennedy, Ingram, Edwards & Sweeney, 2005, p. 488). Early childhood behaviors can reveal to parents and counselors the warning signs of childhood and adolescent psychiatric problems such as Depressive Disorder, Conduct Disorder and Attention Deficit Hyperactivity Disorder (Sawyer, Arney, Baghurst, et al., 2008). It is important to identify the early childhood warnings and risk factors because research shows that early intervention programs can prevent psychiatric disorders from emerging.

Risk Factors

At-risk populations should be especially targeted for intervention programs, in order to improve psychological health outcomes. Some populations seem more susceptible to mental health disorders than others, with children in foster care and abused children at highest risk for exhibiting symptoms of mental health problems (Tarren-Sweeney & Hazell, 2006). Children who are bullied at a young age can exacerbate mental health issues; having a lack of social support can have similar results (Rigby, 2000). Other demographic risk factors include a child who is raised by a single parent; children in families of five or more children; and socio-economic class factors (Meltzer, Gatward, Goodman & Ford, 2000). Socio-economic class factors have been shown to have a major bearing on childhood mental health outcomes. Duncan, Brooks-Gunn & Kato Klebanov (2008) found " family income and poverty status are powerful correlates of the cognitive development and behavior of children, even after accounting for other differences -- in particular family structure and maternal schooling -- between low- and high-income families," (p. 296). Simply having rich vs. poor neighbors can have a bearing on factors like intelligence and the emergence of behavioral problems in early childhood (Duncan, Brooks-Gunn & Kato Klebanov, 2008). Divorce and broken or reconstituted homes (with step-families) have been consistently correlated with the emergence of behavioral and mental health issues in early childhood (Meltzer, Gatward, Goodman & Ford, 2000; Felner, Stolberg & Cowen, 1975).

Early Intervention

A substantial number of children is identified as being at-risk for developing mental health problems, or as exhibiting behavioral problems that could be precursors of more serious mental health issues in adolescence and adulthood. Whenever the child has been identified at-risk, it is important to use early intervention programs. The nature of the early intervention programs will vary considerably. Regardless of their differences, all early childhood mental health intervention programs are designed "to improve the social and emotional well-being of young children and families by strengthening relationships with caregivers and promoting age-appropriate social and emotional skills," (Knitzer, 2000, p. 416). Programs of intervention will help the child develop healthy coping mechanisms for responding to external stressors, and to mitigate any problems that may be biological/neurological in nature.

Public Health Issues

Early childhood mental health should be viewed as a matter of public health. As Knitzer (2000) points out, "the need for early childhood mental health services and systems development is critical," (p. 416). Early intervention can help prevent adolescent suicides (Sawyer, Arney, Baghurst, et al., 2001). With early intervention, it may also be possible to prevent the need for pharmacological/drug interventions that have unwanted side effects. Also among the reasons why early childhood mental health services and systems development is critical includes cost savings as well as ethical and humanitarian reasons. If psychological problems are identified and treated early, they are less likely to evolve into more serious problems, which can be costly from a social and financial perspective. Sawyer, Whaites, Rey, et al. (2002) note that young children with mental health problems often experience physical health problems too. Therefore, early intervention can lead to reduced overall healthcare costs. Rapee, et al. (2005) point out the importance of early childhood mental health intervention programs as part of an overall public health policy. Sawyer, Arney, Baghurst, et al., 2001) concur with the assessment that "child and adolescent mental health problems are an important public health problem in Australia," (p. 806).

Program Implementation

When identifying young children...

Young children can be expected to exhibit crankiness and moodiness occasionally, and there is no need to be overly concerned. However, caregivers and childcare workers can be educated about the differences between warning signs of mental health problems and "normal" behaviors. One of the main ways of detecting mental illness will be to observe a child interact with peers and adults over a long period of time before making any judgments. There are also many different symptoms that caregivers can become aware of as they observe children. For example, Felner, Stolberg & Cowen (1975) found that children who experienced the death of a parent in early childhood were more likely to exhibit depression and anxiety; whereas children who experienced parents divorcing were more likely to exhibit symptoms of anger and aggression. If the parents, caretakers, or childcare workers know what is going on in the child's family or social life, they might be able to detect changes in behavior. These changes can be warning signs that the preschool child requires intervention.
Intervention programs should ideally be relaxed, holistic, and social in nature. Emphasizing social issues such as relationship building is important. Group based interventions are common, and highly recommended for young children (Rapee, et al., 2005). The group programs can be easily integrated into existing daycare or preschool programs, and can therefore be inexpensive and easy to design. Rapee, et al. (2005) also found that early childhood mental health intervention programs were most effective when they were both group-based and educational in nature. As the child learns healthy coping mechanisms in a group setting, healthy peer relationships and healthy relationships with adults become possible and likely. Group-based approaches in school focus on common issues like infant attachment (Bakermans-Kranenburg, van IJzendoorn & Juffer, 2003). Furthermore, the group approach that is integrated with preschool helps the child apply the skills learned in the intervention program to immediate daily life. There is no need to segregate mental health treatment from the development of general social skills in school. Likewise, there is no need to segregate mental health from physical health. Research has shown that "an integrated approach to health care delivery rather than the current distinction between physical and mental health services" is important, too (Sawyer, Whaites, Rey, et al., 2002, p. 530).

Research has also shown that certain types of interventions are more effective than others. Bakermans-Kranenburg, van IJzendoorn & Juffer (2003) found that randomized, rather than systematic, treatment interventions were effective. Likewise, it was more effective to have a moderate number of sessions than frequent sessions (Bakermans-Kranenburg, van IJzendoorn & Juffer, 2003). This may be because the young children respond better to a relaxed, spontaneous, or unstructured intervention program. The types of programs that were most effective for young children include those that enhance parental sensitivity to the child (Bakermans-Kranenburg, van IJzendoorn & Juffer, 2003). Therefore, treatment interventions should be undertaken with a family systems approach. Family systems approaches do not treat the child in isolation of his or her social environment. Instead, the early childhood educator, caretaker, and counselor work together with the child, peers, and family. It is important to treat the parents and identify possible sources of trauma and abuse, too. When the child is treated in isolation of the family, it may be impossible to effectively prevent mental health issues from developing. A family systems approach is one that encourages parental attentiveness, observation, and behavioral improvements. "A clear-cut behavioral focus in families with, as well as without, multiple problems" can lead to a reduction in mental health problems among children (Bakermans-Kranenburg, van IJzendoorn & Juffer, 2003, p. 195). Cultural sensitivity must also be taken into account when treating young children with potential mental health disorders.

A group-focused approach to intervention that is integrated with preschool and early childhood education is not only effective; it is also practical and easy to implement from a public health perspective. As Sawyer, Arney, Baghurst, et al., (2001) point out, "the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help.," (p. 806). It turns out that it is unnecessary to provide individualized care at the early childhood developmental phase. Because of the ways young children do positively respond to social interventions that are unstructured and relaxed, programs can also be included as part of foster care treatment programs and training.

Conclusions and Recommendations

The prevalence of mental health issues in early childhood makes it essential that governments respond. Early intervention can save money,…