Transcript Introduction to Infant and Early Childhood Mental

Introduction to
Infant and Early Childhood
Mental Health
Division of Child and Family Services
Early Childhood Mental Health Services
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Training Goals
At the end of this training, you will be able to:
1. Define infant mental health
2. Recognize mental health issues of young
children
3. Know how infant mental health issues are
assessed and treated
4. Understand how to access services in your
community to address mental health and
developmental needs of young children
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Goal #1:
Define infant mental health
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Definition of Infant Mental Health
Infancy is technically the period “without
language”, which is the first year of life
Infant mental health covers a broader age
range, and there is no universal definition
In Nevada, Early Childhood Mental Health
Services serves children birth – seven
years and their families
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Definition of Infant/
Early Childhood Mental Health
The developing capacity to:
experience, regulate and
express emotions,
form close and secure
interpersonal
relationships and
explore the environment
and learn.
www.zerotothree.org
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#1: Experience, Regulate and
Express Emotions
Initially infants depend on
adults to regulate their
interaction, attention, and
behavior
Gradually the young child
begins to regulate their
emotions through selfmonitoring, which increases
over time
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The Developing Capacity to
Regulate and Self-regulate
Sameroff & Fiese, 2000
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Basics of State Regulation
in Infancy
Infant Behavioral
States
Cry
Fuss
Alert
Waking Activity
Drowsy
Active Sleep
Quiet Sleep
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Developing Capacity
to Give Clear Cues
Over the first two
years of life, the child
learns to give cues,
both potent and
subtle, about his/her
interest in any given
moment in relating to
others
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Engagement Cues
Potent Cues
--Babbling, giggling
--Face gazing+
--Smiling+
--Reaching toward
caregiver
--Smooth movements
Subtle Cues
--Brow raising
--Eyes wide & bright
--Facial brightening
--Hands open, fingers
slightly flexed
--Head raising
--Stilling of body
NCAST, Kathy Barnard
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Disengagement Cues
Potent Cues
--Back arching
--Choking, coughing,
spitting up
--Crying, fussing, “No!”
--Halt hand
--Head shake
--Major gaze aversion
--Moving away
Subtle Cues
--Defensive posture
--Dull expression
--Grimaces, eye blinks
--Frown
--Hand behind head, to eye, ear,
back of neck
--Sobering
--Yawns
--Head lowering, minor gaze
aversion
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#2: Form Close and Secure
Interpersonal Relationships
Infants learn what people expect of them
and what they can expect of other people
Nurturing, protective, stable, and
consistent relationships are essential
The state of the adults’ emotional well
being and life circumstances profoundly
impact the quality of infant/caregiver
relationships
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Attachment
Secure attachment is a loving emotional
connection with caregiving adults who are
part of the child’s daily life.
Attachment begins at birth and continues
throughout life.
It is difficult to be separated from an
important attachment figure.
www,zerotothree.org
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Through this attachment,
the child:
Learns to depend on people to meet
his/her needs
Seeks comfort when distressed
Learns to express love/affection
Relies on the caregiver as a safe base
from which to explore the environment
Develops in the areas of emotionality,
social behavior, language and cognition
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Time Course of Normal
Attachment
0
6
12
18
24
30
36
42
48
54
Age in Months
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Goodness of Fit
Each of us is born with temperamental
characteristics that tends to persist lifelong
Caregivers and children who are
temperamentally similar will have an easier
time developing a good relationship than those
who are temperamentally dissimilar
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#3: Explore the Environment
and Learn
Young children learn
primarily through interactions
with caregivers
It is important for children to
have time playing with their
caregivers to maintain a
good relationship and to help
them with language and
cognitive development
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Development in Young Children
Is Vulnerable to Stress
Hierarchy of vulnerability:
emotional development
social development
language development
cognitive development
motor development
physical growth
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Infant Mental Health
Infant mental health is
synonymous with healthy
social and emotional
development.
It occurs in the context
of family, community
and cultural expectations
for the child.
www.zerotothree.org
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Goal #2:
Recognize mental health issues
of young children
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Facts about Mental Health
of Young Children
Young children are about as likely to have
mental health issues as are older children
and adults
In very young children, mental health
issues are most often expressed as
difficulties with eating, sleeping, and
regulation of behavioral states
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As children become older, they
increasingly express mental health issues
as more recognizable difficulties with
moods and behaviors
If mental health issues are left untreated,
children often begin to show more general
delays in the areas of social/emotional
functioning, language, cognition and even
motor and physical development
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How Do I Recognize
the Need for Mental Health
Treatment?
Issue is pervasive, meaning it occurs
across settings
Issue is persistent, meaning it occurs more
days than not for 2-4 weeks
Issue has a negative impact on a child’s
daily functioning
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Overview of Common
Mental Health Issues
Sleeping Disorders
Eating Disorders
Attention Deficit Hyperactivity Disorder (ADHD)
Post Traumatic Stress Disorder (PTSD)
Deprivation/Maltreatment Disorder (DMD),
Reactive Attachment Disorder (RAD) and
Disinhibited Social Engagement Disorder
(DSED).
Depression
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Sleeping Disorders
– Sleep onset
– Night waking
– Night Terrors
– Nightmares
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Typical Sleep Needs
of Young Children
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Eating Disorders
Eating– to be diagnosed,
must result in weight loss
or inadequate weight gain
– Difficulties of state regulation
– Difficulties with caregiver
relationship
– Sensory issues with food
textures
– Problems associated with
medical issues
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Symptoms of ADHD
Craving high-intensity sensory stimulation
High need for motor discharge: impulsive
High activity level
Seeking constant contact with people &
objects
Recklessness
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True ADHD is believed to be present from
birth, and to occur even in the absence of
major environmental stressors. However,
some of the symptoms of ADHD (high
level of motor activity, lack of focused
attention) can occur as part of an anxiety
response to environmental stressors.
Therefore it is important to see the child in
a stable environment over a period of
several months before making this
diagnosis.
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PTSD: Definition of Trauma
An event involving actual or
threatened death or serious injury or
threat to the physical or
psychological integrity of the child or
another person.
It may be a sudden & unexpected
event (e.g. car wreck), a series of
connected events (e.g. repeated
domestic violence) or an enduring
situation (e.g. chronic sexual abuse).
from DC: 0-3R
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Symptoms of PTSD
reliving the trauma, in children often
through post-traumatic play
avoiding reminders of the trauma
intense emotional responses to reminders
of the trauma
maintaining hypervigilance, startling easily
numbing of affect
difficulties falling and staying asleep,
nightmares
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Many stressful events in
children’s lives do not
rise to the level of
trauma, but may lead to a
variety of other mental
health issues, with
symptoms that may
appear similar in some
respects to those of
PTSD.
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DMD/RAD/DSED: Environment
Normal attachment during early
childhood can be disrupted
by specific conditions:
1. Several changes of primary
caregiver, such that the child
can not develop a focused
attachment
2. Extreme caregiving by a
consistent caregiver which
does not result in the child
learning to trust people
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DMD/RAD/DSED: Relatedness
Patterns
Sustained suspicion
(DMD/RAD)
Indiscriminant
approaches/closeness
(DMD/DSED)
Mixture of previous two
patterns (DMD)
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Attachment Issues Can Be
Associated with Poor Outcomes
Increased risk of juvenile (and adult)
justice involvement
Difficulties coping with stress
Increased risk of dangerous behaviors
Problematic peer relationships
Reduced likelihood of maintaining a
stable, loving relationship with an adult
partner
Poor parenting skills
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Symptoms of Depression
Change in mood– can be either
depressed or irritable
Loss of interest in many activities
Persistent, at least some of the time
uncoupled from sad/upsetting experiences
Pervasive across activities, settings or
relationships
Symptoms cause child distress, impair
functioning or impede development
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Goal #3:
Know how infant mental health
issues are assessed and treated
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Specific Issues to Refer
to Infant Mental Health
Difficulties with soothing and
comforting
Persistent issues in the
regulation of eating or sleep
Poor mood regulation
Difficulties with relatedness,
including attachment issues
Trauma, especially loss of a
primary caregiver
Behaviors that pose a
danger to self or others
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Why Refer Young Children to
Developmental and Mental Health
Services
Very young children can and do
suffer from trauma, abuse, neglect,
loss, stress and lack of opportunity
When these issues are identified
and treated early, outcomes are
better than when services are
delayed.
Most young children who receive
mental health services do not have
the stigma of lifelong labels.
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How to Refer a Child for Services
In Nevada, Child and
Family Teams (CFT’s)
make decisions about what
services a child needs. If
you think a child in your
care needs services, you
must begin with your DFS
caseworker, and ask for a
CFT to discuss the need
for services.
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Evaluation typically involves
several sessions
Parent interviews for family history
Direct observation & reports of family
interaction/functioning
Direct observation & reports of child’s
characteristics & development, including areas
of concern
General assessment of child: ability to regulate
mood and self-soothe, relatedness, sensory
function, motor tone and motor planning
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Diagnosis of Young Children
DSM-V was not
developed with
particular attention to
young children
DC: 0-3R has been
developed by Zero to
Three as a
developmentally
sensitive alternative
for young children
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Infant Mental Health
Specialists Provide:
Family therapy involving
child and parent/caregiver
Developmental guidance
Advocacy for child & family
Early relationship assessment & support
Emotional support for caregivers
Connection to other resources
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Therapeutic Interventions
Help caregivers establish/maintain
good schedules & routines
Improve attachment between
child and caregiver
Promote caregiver’s realistic
developmental expectations for
child
Address family systems issues
Address caregiver mental health,
substance abuse & domestic
violence issues
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The Importance of a Family Approach
to Treatment
Children learn in relationships
Relationships with caregivers are the
most important relationships children have
until their teenage years
Changes in the structure of the
environment and the behavior of important
caregivers toward the child contribute
most to changes in the child’s behavior
and/or mood
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Additional Therapeutic Services
Basic Skills Training (BST)
Psychosocial Rehabilitation (PSR)
Day Treatment and After School Services
Psychiatric Medications
Partial Hospitalization
Psychiatric Hospitalization
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Goal #4:
Understand How to Access
Services in the Community
to Address Mental Health and
Developmental Needs
of Young Children
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Resources for Young Children
in Clark County
Mental Health Services
-- Early Childhood Mental Health, DCFS
if fee-for-service Medicaid or uninsured
486-7764
-- Medicaid HMO’s and private insurance
providers
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Services for children with
developmental delays:
--Nevada Early Intervention Services
children birth to 36 months 486-7670
--CCSD Child Find children 33 months +
799-7463
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