Prevention and Early Intervention in Mental Health- Early Childhood to Puberty

Early Childhood to Puberty

Early childhood through puberty is an important time in childhood development, as it comes with more time spent outside of the home and increasingly complex thought processes for kids.[i] Children become more socially aware, starting to compare themselves to their peers and becoming more interested in their place in the world.[ii] Self-esteem, individuality, and relationships all grow in importance, and children begin to reason as they are exposed to different people and ideas. These changes increase the importance of not only having a healthy and stable support system at home but also trying lots of new things in a safe way.[iii] This is a sensitive period in brain development as children are more receptive to receiving new information and internalizing experiences.[iv] During this stage, children begin to understand themselves and the rules of the world, leaving them particularly vulnerable to intense experiences.[v]

Health:

  • Nutrition: Nutrition during early childhood through puberty is important for both daily functioning and brain development. Nutrition is not only calories but the quality of the food as well. Generally, a healthy diet should consist of fewer processed foods and more nutrient-dense foods like vegetables, fruits, fish, and good fats.[vi], [vii] In a review of 12 studies examining the impact of diet and on children’s mental health, healthy diet was associated with better mental health in children in multiple studies and children with high levels of unhealthy food intake consistently reported higher levels of internalizing behavior, like social withdrawal or anxiety, and externalizing behavior, such as aggression or fighting.[viii],[ix] This information is particularly concerning in the United States, where empty calories from added sugars and solid fats make up almost half of what children consume on a daily basis, and 6.5 million children live in food deserts—areas more than a mile away from a super market—making it more difficult to access quality food.[x]

Safety & Security:

  • Adverse Childhood Experiences: A large amount of research has been done on Adverse Childhood Experiences (ACES) and their impact on later health problems. The ten experiences included in studies of ACES are:

1) Physical Abuse

2) Verbal Abuse

3) Sexual Abuse

4) Physical Neglect

5) Emotional Neglect

6) Living with a family member who is incarcerated

7) Living with a family member who is diagnosed with a mental illness

8) Living with a family who abuses substances

9) Exposure to violence against one’s mother

10) The absence of one parent through divorce, separation, or other factors
  • Studies consistently find that the more Adverse Childhood Experiences an individual has the more likely he or she is to develop health problems later in life, including heart and lung disease. ACES have also been strongly linked to long-term mental health and substance use disorders. Higher ACES are associated with earlier first time tobacco and alcohol use,[xi]  and increase one’s likelihood of heavy drinking and self-reported alcoholism by two to fourfold.[xii] Compared to those with no ACES, individuals with exposure to five or more Adverse Childhood Experiences are seven to ten times more likely to report illicit drug use or addiction.[xiii] There is also a relationship between the amount of ACES experienced and the likelihood of suicide attempts into adolescence and adulthood.[xiv] In terms of specific mental health disorders, each experience increases the likelihood of both lifetime and recent major depressive episodes, and experiencing seven or more ACES is linked to a fivefold increase in reporting hallucinations.[xv],[xvi] These early experiences, which occur at surprisingly high rates across all socioeconomic groups, have a clear impact on long-term development and health outcomes.
  • Community Violence: A child’s sense of safety in their community also affects their mental health. Studies estimate that 50% to 96% of children living in urban areas have been exposed to some form of community violence, with rates of exposure staying stable over time.[xvii] Exposure to community violence is split into three areas: victimization, witnessing violence, and hearing about violence. A child’s reaction is related to both the level of exposure and age. While victimization has the largest association with externalizing and internalizing behaviors, all three types have significant effects on experiencing symptoms of posttraumatic stress disorder (PTSD), including being constantly on guard and repeatedly thinking about the trauma.[xviii] These effects are likely related to the ‘collective traumatization’ that results from consistently being exposed to the idea that no one is safe and the world is a dangerous place.[xix] Young children are more likely to show internalizing behaviors, while adolescents are more likely to respond with externalizing behaviors like ‘acting out.’ Even though children may not be able to express feelings in a way that adults can understand, children still need help and support after exposure to violence.[xx]

Resources:

  • Homelessness: Children experiencing homelessness are exposed to many factors that impact both their short- and long-term mental health, including increased exposure to trauma and fewer school supports. By age 12, 83% of children experiencing homelessness will have experienced at least one serious violent event.[xxi] Around 80% of children experiencing homelessness report symptoms of posttraumatic stress disorder (PTSD), and over 60% report symptoms of depression.[xxii] This results in three times the rate of emotional and behavioral problems as non-homeless youth in schools.[xxiii]  Children experiencing homelessness are four times as likely to show delayed development and twice as likely to experience learning disabilities compared to other children.[xxiv] Long-term, about 75% of these students drop out of school.[xxv]

Relationships:

  • Family: As children are being exposed to different types of people and events outside of the home, stable, engaged family supports are important for mental health. For example, studies show that children living in single parent homes, where the parent may not be as available due economic and other pressures, have twice the rate of emotional, behavioral, and attentional disorders compared to children in two-parent homes.[xxvi]

Interventions:

During this stage, sometimes referred to as middle childhood, schools provide an important opportunity for addressing the mental health and well-being of children. In terms of prevention and early intervention, schools allow us to provide all students with the tools they need to be mentally well and to watch for early signs that a child might need extra support. Programs that target an entire class, in addition to providing a spectrum of mental health services as needed, can change each child’s long-term development, even for those who are at-risk for developing mental health disorders. A well-researched example of a school-based prevention program is PAX Good Behavior Game (GBG). PAX GBG, which is on SAMHSA’s National Registry of Evidence-based Programs and Practices, is a game that targets early elementary school students using a classroom game of ‘kernels’ to promote positive behavior and decrease unwanted behavior called ‘spleems.’[xxvii] PAX GBG has been found to improve a number of outcomes. For example, schools that use PAX GBG had a 50 to 90% decrease in disruptive or disorderly behavior in school settings, a 10 to 30% decrease in the need for special education services, and a 30 to 60% reduction in referrals, suspensions, or expulsions.[xxviii] The Washington State Institute for Public Policy found that the benefits of the program far outweighed the costs, with the state seeing $58.56 of benefits for each $1 they spent on the program.[xxix] Long-term, PAX GBG improves mental health and related outcomes, particularly for those with the highest levels of aggression. After participating in PAX GBG in first grade, those with the highest levels of aggression were half as likely to use special education services by the age of 21, more than twice as likely to graduate from high school, and 20% less likely to have a personality disorder by age 21.[xxx] It has also been linked to reductions in suicidal thoughts and actions.[xxxi]

Prevention and Early Intervention in Mental Health- Home

[i] Eccles, J. S. (1999). The development of children ages 6 to 14. The future of children, 30-44.

[ii] Middle Childhood (6-8 years of age). (2015, August 24). Retrieved from http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.html

[iii] Eccles, J. S. (1999). The development of children ages 6 to 14. The future of children, 30-44.

[iv] Mah, V. K., & Ford-Jones, E. L. (2012). Spotlight on middle childhood: Rejuvenating the “forgotten years.” Paediatrics & Child Health, 17(2), 81–83.

[v] Mah, V. K., & Ford-Jones, E. L. (2012). Spotlight on middle childhood: Rejuvenating the “forgotten years.” Paediatrics & Child Health, 17(2), 81–83.

[vi] O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., … Jacka, F. N. (2014). Relationship Between Diet and Mental Health in Children and Adolescents: A Systematic Review. American Journal of Public Health, 104(10), e31–e42. http://doi.org/10.2105/AJPH.2014.302110

[vii] Jacka, F. N., Ystrom, E., Brantsaeter, A. L., Karevold, E., Roth, C., Haugen, M., ... & Berk, M. (2013). Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1038-1047. http://www.sciencedirect.com.proxyau.wrlc.org/science/article/pii/S0890856713004498

[viii] O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., … Jacka, F. N. (2014). Relationship Between Diet and Mental Health in Children and Adolescents: A Systematic Review. American Journal of Public Health, 104(10), e31–e42. http://doi.org/10.2105/AJPH.2014.302110

[ix] Jacka, F. N., Ystrom, E., Brantsaeter, A. L., Karevold, E., Roth, C., Haugen, M., ... & Berk, M. (2013). Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(10), 1038-1047. http://www.sciencedirect.com.proxyau.wrlc.org/science/article/pii/S0890856713004498

[xi] Dube SR, Miller JW, Brown DW, Giles WH, Felitti VJ, Dong M, Anda RF. Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. Journal of Adolescent Health2006;38(4):444.e1-444.e10.)

[xii] Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. Adverse Childhood Experiences and personal alcohol abuse as an adult. Addictive Behaviors 2002;27(5):713–725.

[xiii] Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF. Childhood abuse, neglect and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experience Study. Pediatrics 2003;111(3):564–572.)

[xiv] Dube SR, Anda RF, Felitti VJ, Chapman D, Williamson DF, Giles WH. Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: Findings from Adverse Childhood Experiences Study. JAMA 2001;286:3089–3096.

[xv] Chapman DP, Anda RF, Felitti VJ, Dube SR, Edwards VJ, Whitfield CL. Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders 2004;82:217–225.

[xvi] Whitfield CL, Dube SR, Felitti VJ, Anda RF. Adverse childhood experiences and hallucinations. Child Abuse and Neglect 2005;29(7):797–810.

[xvii] Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A., & Baltes, B. B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology,21(1), 227-59. doi:http://dx.doi.org/10.1017/S0954579409000145

[xviii] Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A., & Baltes, B. B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology,21(1), 227-59. doi:http://dx.doi.org/10.1017/S0954579409000145

[xix] Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A., & Baltes, B. B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology,21(1), 227-59. doi:http://dx.doi.org/10.1017/S0954579409000145

[xx] Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A., & Baltes, B. B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology,21(1), 227-59. doi:http://dx.doi.org/10.1017/S0954579409000145

[xxi] The Characteristics and Needs of Families Experiencing Homelessness. (2011, December 1). Retrieved from http://www.familyhomelessness.org/media/306.pdf

[xxii] Youth Homelessness. (2014).

[xxiii] The Characteristics and Needs of Families Experiencing Homelessness. (2011, December 1). Retrieved from http://www.familyhomelessness.org/media/306.pdf

[xxiv] The Characteristics and Needs of Families Experiencing Homelessness. (2011, December 1). Retrieved from http://www.familyhomelessness.org/media/306.pdf

[xxv] Youth Homelessness. (2014).

[xxvi] Bramlett, M. D., & Blumberg, S. J. (2007). Family structure and children’s physical and mental health. Health affairs, 26(2), 549-558.

[xxvii] Intervention Summary - PAX Good Behavior Game (PAX GBG). (2014, January 28). Retrieved from https://www.samhsa.gov/

[xxviii] The PAX Good Behavior Game: A Teacher's Toolkit for Creating a Productive, Peaceful Classroom. (n.d.). Retrieved from https://www.hazelden.org/HAZ_MEDIA/gbg_insert.pdf

[xxx] Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., Toyinbo, P., Wilcox, H. C. (2008). Effects of a universal classroom behavior management program in first and second grades on young adult behavioral, psychiatric, and social outcomes, Drug & Alcohol Dependence(Special Issue), 24.

[xxxi] ibid