Transcript Mental Health

Mental Health
Impacts on Child Development
Jacqui Van Horn, MPH, IMH-E
[email protected]
Co-creating Mental Health
Early Childhood Mental Health
• Begins before birth;
• Inextricably connected to:
– The health (physical, mental, spiritual) of the parents;
– All other areas of health and development;
• Is formative and provides the basic
structure within which all development
unfolds throughout our lives.
Across the Lifespan . . .
Human relationships, and the effects of
relationships on relationships, are the
building blocks of healthy development.
From the moment of conception to the
finality of death, intimate and caring
relationships are the fundamental mediators
of successful human adaptation.
(From Neurons to Neighborhoods, p. 27)
Mentally healthy people . . .
• Experience, express, respond to and manage a
full range of emotions in ways that support their
ability to function across contexts and settings;
– Their own emotions; and
– The emotions of others.
• Successfully engage in a range of relationships
with others within a range of social contexts.
• Can recognize and repair disruptions in
relationships.
Irreducible Needs
• Ongoing, nurturing relationships
• Physical protection, safety and regulation
• Experiences that are developmentally
appropriate and tailored to individual
differences
• Limit setting, structure and expectations
• Stable, supportive communities and
cultural continuity
(Brazelton & Greenspan, 2000)
Needs
• Ongoing, nurturing
relationships
• Physical protection,
safety and regulation
• Experiences that are
developmentally
appropriate and tailored
to individual differences
• Limit setting, structure
and expectations
• Stable, supportive
communities and cultural
continuity
(Brazelton & Greenspan, 2000)
Vulnerabilities
• Chronic stress
• Emotionally
unavailable caregivers
• Maltreatment
• Foster Care
• Homelessness
• Domestic Violence
• Drug and alcohol
exposure
Development is Impacted
• Brain development is impacted by stress.
• Babies experience (and remember) stress
when:
– Their signals are not responded to
sensitively
– Their attachment figure does not help
them feel safe and cared for
– Their attachment figure is not physically
or emotionally available to them
National Clearinghouse on Child Abuse and Neglect Information
Healthy Child
Neglected Child
Both size and functioning of the brain are impacted.
Development is Impacted
• The brain organizes itself to support
survival in either a positive environment
OR a negative environment.
• The early organizational structures
continue to influence behavior and
development over time.
National Clearinghouse on Child Abuse and Neglect Information
Impacts of Trauma
• Structural changes occur to the brain:
– Less brain mass
– Less brain tissue connecting the hemispheres
• Neuronal pathways become over-sensitized
• Areas of the brain involved with
fear/anxiety responses can become overdeveloped – other areas are then underdeveloped
• When the brain’s resources are focused on
survival, other aspects of development
suffer – the child has fewer resources
available for learning.
• These physiological changes are associated
with changes in cognitive functioning
National Clearinghouse on Child Abuse and Neglect Information
Many “Wake Up!” Calls
• High rates of maltreated infants, toddlers
and young children present with
significant physical, cognitive, socialemotional, relational and psychological
problems.
• Most children placed in foster care have a
history of severe neglect or abuse and
have experienced significant stress during
critical periods of early brain
development.
Shaw, E. and Goode, S. (2008)
Many “Wake Up!” Calls
• Young children in foster care have higher rates
of chronic health conditions and special needs
than national estimates for children living at
home.
• Very young children exposed to domestic
violence may experience extreme stress that can
have a potentially serious impact on brain
development.
• Homeless children are twice as likely to
experience learning disabilities and three times
as likely to experience an emotional disturbance
as other children.
Shaw, E. and Goode, S. (2008)
Stay Awake!
Approximately 10-15%
of all typically
developing
preschool children
have chronic mild to
moderate levels of
behavior problems.
Children who are poor are much more likely to develop
behavior problems with prevalence rates that approach
30%.
Children who are identified as hard to manage at ages 3
and 4 have a high probability of continuing to have
difficulties into adolescence.
Center for Evidence Based Practice: Young Children with Challenging Behavior
www.challengingbehavior.org
Still Awake?
• Behavior problems in a child’s preschool career
are the single best predictor of delinquency in
adolescence, gang membership, and adult
incarceration.
• If challenging behaviors are not altered by the
end of the third grade, it appears that they
should be treated as a chronic condition;
hopefully kept somewhat in check by continuing
and ever more costly intervention.
Center for Evidence Based Practice: Young Children with Challenging Behavior
www.challengingbehavior.org
Looking Ahead
• Children who grow into adolescence with challenging
behaviors are likely to drop out of school, be
arrested, abuse drugs and alcohol, have marginalized
adult lives, and die young.
• There is evidence to show that young children with
challenging behavior are more likely to experience:
– early and persistent peer rejection
– mostly punitive contacts with teachers
– family interaction patterns that are unpleasant for all
participants
– school failure
– high risk of fatal accidents, substance abuse, divorce,
unemployment, psychiatric illness, and early death
Center for Evidence Based Practice: Young Children with Challenging Behavior
www.challengingbehavior.org
Looking Back
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP,
et al JS. The relationship of adult health status to childhood abuse and household
dysfunction. American Journal of Preventive Medicine. 1998;14:245-258.
Adverse Childhood Experiences
Emotional Abuse
Physical Abuse
Sexual Abuse
Emotional Neglect
Physical Neglect
Mother Treated Violently
Household Substance Abuse
Household Mental Illness
Parental Separation or Divorce
Incarcerated Household Member
http://www.cdc.gov/nccdphp/ace/findings.htm
ACE Study Basics
• The ACE Study is the largest study of its kind
ever conducted (more than 17,000 study
participants) and the range of adverse childhood
experiences and health related outcomes studied
was unprecedented.
• An unexpectedly high number of adults who
came to the Department of Preventive Medicine
for comprehensive medical screening had
experienced significant abuse or household
dysfunction during their childhoods (only 1/3
reported no ACEs).
http://www.cdc.gov/nccdphp/ace/findings.htm
ACE Study Findings
• ACEs were not only unexpectedly common, but
their effects were found to be cumulative.
• As the ACE score increased the chances of
being a user of street drugs, tobacco or having
problems with alcohol abuse increased in a
stepwise fashion.
• As the ACE score increased the number of risk
factors for the leading causes of death increased.
http://www.cdc.gov/nccdphp/ace/findings.htm
ACE Scores have demonstrated
As the number of ACE increase, the risk for the following health
problems increases in a strong and graded fashion:
– alcoholism and alcohol abuse
– chronic obstructive pulmonary disease (COPD)
– depression
– fetal death
– health-related quality of life
– illicit drug use
– ischemic heart disease (IHD)
– liver disease
– risk for intimate partner violence
– multiple sexual partners
– sexually transmitted diseases (STDs)
– smoking
– suicide attempts
– unintended pregnancies
http://www.cdc.gov/nccdphp/ace/findings.htm
• Those with an ACE score of 4 or more were:
–
–
–
–
Twice as likely to be smokers,
12 times more likely to have attempted suicide,
7 times more likely to be alcoholic, and
10 times more likely to have injected street
drugs.
(compared to score of “0”)
• The behaviors such as alcohol or drug abuse,
smoking, or sexual promiscuity are likely the
result of the effects of ACEs on childhood
development, which we now know to be
neurodevelopmental in nature.
http://www.cdc.gov/nccdphp/ace/findings.htm
Adverse childhood
experiences would
typically go undetected
because of shame,
secrecy and social taboo.
The fallout from various forms of
child abuse & household dysfunction
is monumental,
costing Americans untold sums of money
because of the health risks such as the use of
street drugs, tobacco, alcohol, overeating and
sexual promiscuity. Not the least of these highticket medical costs is due to: cardiovascular
disease, cancer, AIDS and other sexually
transmitted diseases, unwanted often-high-risk
pregnancies, chronic obstructive pulmonary
disease, and a legacy of self-perpetuating child
abuse.
Early Childhood Mental Health
Promotion
Preventive
Intervention
Treatment
ECMH Promotion
• A population-based strategy that highlights the
necessity for predictable, nurturing, sensitive
caregiver-child interactions:
– Public Awareness
– Universal screening systems that:
• Systematically address all developmental issues, including
social and emotional development; and
• Are conducted in collaboration with parents and other
primary caregivers and seen as informative and supportive;
and
• Result in appropriate supports, referrals and interventions.
Opportunities
to Promote Nurturing Interactions
• Well Child Visits
• WIC
• Early Care and Education Settings
– Child Care
– Early Head Start & Head Start
• Universal Home Visiting Services
• IDEA, Part C Programs
• Others?!
Pitfalls of
Developmental Screening
•
•
•
•
•
Waiting until a problem is observable
Ignoring screening results
Relying on informal methods
Using a measure that is not suitable
Assuming services are limited or
nonexistent
www.dbpeds.org/articles/detail.cfm?TextID=5
For More Information
•
Facts about Developmental Screening Tools
http://www.cdc.gov/ncbddd/child/tools.htm
•
Developmental screening and assessment instruments
with an emphasis on social and emotional development
for young children ages birth through five.
www.nectac.org/~pdfs/pubs/screening.pdf
•
Early Identification/Developmental Screening
http://www.aap.org/healthtopics/early.cfm
•
Pediatric Developmental Screening:
Understanding and Selecting Screening
Instruments
http://www.commonwealthfund.org/publications/
publications_show.htm?doc_id=614864
Screen . . . and then what?
• Identify community resources
• Identify service accessibility and
availability challenges
• Collaborate . . . start with what “is”; work
toward “good enough” . . . (for now); and
collaborate to achieve a high quality
system of caring for all children and
families.
Supporting
Mental Health to
Positively Impact
Child Development
[email protected]