KidsMatter Early Childhood

Early childhood mental health: An introduction

Acknowledgement:

KidsMatter Australian Early Childhood Mental Health Initiative has been developed in collaboration with beyondblue, the Australian Psychological Society and Early Childhood Australia, with funding from the Australian Government Department of Health and beyondblue.

Disclaimer:

While every care has been taken in preparing this publication, Beyond Blue Ltd, The Australian Psychological Society Limited, Early Childhood Australia Inc. and the Commonwealth of Australia do not, to the extent permitted by law, accept any liability for any injury, loss or damage suffered by any person arising from the use of, or reliance upon, the content of this publication.

Important Notice:

KidsMatter Australian Early Childhood Mental Health Initiative and any other KidsMatter mental health initiatives are not to be confused with other businesses, programs or services which may also use the name ‘Kidsmatter’.

Copyright

© Commonwealth of Australia 2014

This work is copyright. Provided acknowledgment is made to the sources, early childhood education and care services are permitted to copy material freely for communication with teachers, staff, parents, carers or community members. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Communications Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to copyright@health.gov.au.

While the resources are available freely for these purposes, to realise the full potential of KidsMatter Early Childhood, it is recommended that the resources be used with the appropriate training and support under the KidsMatter Initiative.

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ContentsIntroduction3 Welcome to KidsMatter Early Childhood Early childhood mental health: An introduction eBook

Recommended reading 4 Other resources that may be of interest

KidsMatter Early Childhood Early childhood mental health: An introduction eBook map

Mental health in early childhood11 Mental health difficulties12 How common are mental health problems in early childhood?13 Looking after yourself

Risk and protective factors for children’s mental health16 Warm, responsive and trusting relationships are a significant

protective factor for mental health

Relationships are the foundation of children’s mental health17 Children learn when they feel safe

How mental health difficulties affect children18 Children develop at different rates and stages19 Internalising and externalising behaviours20 What causes mental health difficulties in children?

Knowing when to get help21 Gathering good observations22 Working with families23 Look for B-E-T-L-S25 When more support might be needed

Mental health supports26 Professional mental health services27 Do you know?28 Diagnosis in the early years28 Is a diagnosis necessary?

Common presenting mental health difficulties

Anxiety30 How anxiety affects children31 How might you notice anxiety in children?31 Common anxiety disorders in early childhood 32 How do anxiety disorders develop?33 How to assist children with anxiety disorders

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Trauma and stressor-related disorders34 Trauma in early childhood35 How trauma affects children35 Relational trauma36 How might you notice a trauma response in children?37 Trauma and stressor-related disorders in early childhood38 What are the effects of trauma on children?38 How to assist children with trauma-related disorders

Depression41 How depression affects children41 How does depression in childhood develop?42 How to assist children with depressive disorders

Neurodevelopmental disorders43 Autism spectrum disorder43 ASD and early development44 What signs might suggest a child has ASD?45 How Autism Spectrum Disorders (ASDs) are diagnosed45 How does ASD develop?46 How to assist children with ASD47 Attention Deficit Hyperactivity Disorder47 What would you notice in a child with ADHD?48 Attention problems and ADHD48 How does ADHD affect attention?49 Children with ADHD at ECEC services49 How is ADHD diagnosed?49 ADHD and other mental health problems50 Supporting children with ADHD51 Other neurodevelopmental disorders in early childhood

Serious behaviour problems

Regulatory difficulties

Summary

References and resources

Glossary

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Contents

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Introduction

Welcome to the KidsMatter Early Childhood Early childhood mental health: An introduction eBook This eBook is about the development of mental health in

early childhood and how mental health difficulties in early

childhood influence children’s emotions, behaviour and

social skills. The eBook aims to provide an understanding

of early childhood mental health and when a significant

concern may be present.

The eBook content provides a general understanding of

mental health in the early years. It has been specifically written

for early childhood educators, but is useful for a range of

audiences interested in early childhood mental health. Each

section includes a summary of content about specific aspects

of early childhood mental health. Links to other written and

multimedia resources related to content in each section have

also been included for those who want to learn more or go

deeper. The content of this book is also reinforced by the

messages of the Belonging, Being and Becoming: The Early

Years Learning Framework for Australia.

We encourage you to use this eBook to support your ongoing

learning and professional development. We hope you enjoy the

resource.

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Recommended reading

KidsMatter Early Childhood: A framework for improving

mental health and wellbeing.

www.kidsmatter.edu.au/early-childhood/kidsmatter-early-

childhood-practice/framework-improving-childrens-mental-

health-and.

Other resources that may be of interest include: Everyday Learning Series by Early Childhood Australia

The Everyday Learning Series focuses attention on the

everyday ways in which young children—babies, toddlers,

preschoolers—can be supported in their growth and

development. www.earlychildhoodaustralia.org.au/everyday_

learning_series.html.

These resources can be purchased for a small cost from Early

Childhood Australia.

Books in the series that are relevant to early childhood mental

health include:

� Everyday learning about babies as amazing learners

� Everyday learning about responding to the emotional needs

of children

� Everyday learning about play and learning

� Everyday learning about making the most of your

environment

� Everyday learning about confidence and coping skills.

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Raising Children Network

The Raising Children Network is a national

website which provides articles on a range of

issues relevant to children’s development.

www.raisingchildren.net.au.

KidsMatter Early Childhood resources

Information for families and early

childhood staff: Component 2 Developing

children’s social and emotional skills,

KidsMatter Early Childhood:

� Helping children manage their emotions

� Helping children learn to make decisions

� Curiosity and confidence: developing

motivation

� Children and play

� Managing life’s ups and downs.

Information for families and early

childhood staff: Component 4 Helping

children who are experiencing mental

health difficulties, KidsMatter Early

Childhood:

� Getting help

� Should I be concerned?

� Keeping a balance: Managing feelings and

behaviours

� When times get tough: Managing trauma

and ways to recover.

www.kidsmatter.edu.au/early-childhood/

resources-support-childrens-mental-health/

information-sheet-index-0.

ZERO TO THREE

ZERO TO THREE is a national non-

profit organisation that provides parents,

professionals and policy-makers with

information on how to nurture early

development.

www.zerotothree.org/child-development/early-

childhood-mental-health/.

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KidsMatter Early Childhood Early childhood mental health: An introduction eBook map

SECTION MAIN MESSAGES

Mental health in

early childhood

� Everyone has mental health and like physical health, it can range

from ‘good’ to ‘poor’ and can change over time.

� Early childhood mental health lays the foundations for mental

health and wellbeing now and into the future and is about the

ability to manage emotions, experience and express emotions in

different ways, and maintain effective relationships.

� Children with lifelong mental health diagnoses can move towards

and experience good mental health when supported in an

environment that meets their individual needs.

� Most children experience good mental health and variations in

behaviour are a normal part of a child’s development.

Risk and protective

factors for children’s

mental health

� Risk factors for children’s mental health increase the likelihood of

mental health difficulties developing and include elements such

as experiencing trauma or abuse, family conflict or separation, or

lacking supportive relationships.

� Protective factors for children’s mental health decrease the

likelihood of mental health difficulties developing and include

elements such as a stable and warm home environment, support

from a wide range of people and being able to manage and

adapt to stress.

� In the early childhood period, having warm, responsive and

predictable relationships with families and educators is a

particularly important protective factor for a child’s mental health.

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Relationships are

the foundation of

children’s mental

health

� Relationships provide children with opportunities for engagement

and develop children’s learning about how to respond to others

and manage their emotions.

� Warm, responsive and trusting relationships help children to feel

safe and explore their environment.

How mental health

difficulties affect

children

� Early childhood is a period of rapid development and

change, meaning children’s behaviour is best viewed within a

developmental framework.

� It can be common for all young children to show disruptive

behaviours, strong emotions and worried thoughts now and

again.

� Children’s mental health difficulties are generally classified as

being ‘internalising’ or ‘externalising’ and it is not uncommon for

children to show behaviours associated with both these patterns.

� Mental health difficulties are caused by multiple factors that

interact in different ways depending on the individual child, their

family and the environment around them.

Knowing when

to get help

� The earlier in life mental health difficulties are addressed, the

better chance a child has of improving their long-term mental

health and wellbeing.

� Making some careful observations of a child can help families

and educators to work together on deciding the best way to

support them.

� Working with families is an important part of supporting a child’s

mental health.

� When concerned about a child, it helps to think about

their Behaviour, Emotions, Thoughts, Learning and Social

relationships (B-E-T-L-S).

� The more pervasive, frequent, persistent and severe a group of

behaviours, thoughts and emotions are, the higher the level of

concern.

� Mental health professionals can help by working with families

and educators to support the individual needs of a child.

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Mental health

supports

� There are a range of mental health professionals and supports

that can assist young children and their families.

� The Better Access and Access to Allied Psychological Services

(ATAPS) mental health care programs provide young children

experiencing mental health problems with the ability to access a

Medicare rebate for services provided by an eligible allied health

care professional.

� If a child is diagnosed with a mental health disorder, recognising

their strengths and drawing on these to meet their individual

needs supports their learning and development.

Common presenting

mental health

difficulties

� Infants and young children can and do experience the same

mental health conditions as adults, but the way these disorders

are expressed is different.

� Young children display some behaviours that may be a sign of

mental health difficulties

Anxiety � Anxiety in young children is often shown by their fear, avoidance

or anxious feelings about situations or interactions.

� Common anxiety disorders in early childhood include separation

anxiety and selective mutism.

� As children with anxiety difficulties are quiet and compliant, their

problems may be overlooked.

Trauma and

stressor-related

disorders

� Trauma occurs when an event creates a feeling of being

overwhelmed and impacts on a person’s ability to cope.

� Young children are especially vulnerable to the effects of trauma,

as they are highly dependent on adults for protection.

� Trauma can affect a child’s learning, memory, relationships and

behaviour.

� A safe, secure and predictable environment can help children

recover from the effects of trauma and begin to feel safe and

confident to explore their world.

Depression � When feeling depressed, young children are often unable to

explain how they are feeling.

� Children are likely to exhibit irritability, sleep changes,

restlessness and appetite changes.

� Paying attention to children’s underlying emotional states and

encouraging them to explore their feelings can help adults notice

signs of depression in childhood.

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Neurodevelopmental

disorders

� Autism Spectrum

Disorder

� Autism Spectrum Disorder (ASD) is a developmental

disorder which affects a child’s communication and language

development, social skills development and emotional awareness

and management.

� A diagnosis of ASD is best undertaken by a team of mental

health professionals.

� ASD is a lifelong disorder and problems with communication and

social interaction may continue into adulthood.

� Keeping the environment predictable and focusing on children’s

strengths can help children engage more effectively in everyday

interactions.

� Attention-Deficit

Hyperactivity

Disorder

� Attention-Deficit Hyperactivity Disorder (ADHD) is a

developmental disorder which often presents through symptoms

such as difficulties with paying attention, impulsive behaviour and

overactivity.

� Children with ADHD have been shown to have minor differences

in brain function compared with other children, especially with the

thought processes controlling attention and memory.

� Other developmental disorders in early childhood include

intellectual disability, communication disorders and motor

disorders.

Serious behaviour

problems

� Children with serious behaviour problems show patterns of

acting impulsively, reacting with aggression, refusing to follow

reasonable directions and defying adult authority.

� These patterns interfere with children’s social and learning

development and children may often feel disconnected from their

environment.

Regulatory

difficulties

� Most young children encounter difficulties with their ability

to self-regulate (including problems with self-soothing, sleep

disturbances, eating difficulties).

� Infants with significant regulatory problems are more likely to be

diagnosed with developmental difficulties at around three years

of age.

� Feeding and sleeping difficulties are two common presenting

regulatory disorders in early childhood.

Summary

References and resources

Glossary

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Everyone has mental health and like physical health, it

can range from ‘good’ to ‘poor’ and can change over time.

Having good mental health is not about feeling happy

all the time, but is about being able to experience and

express feelings in different ways, to manage stressful or

challenging situations without becoming overwhelmed and

to develop and maintain relationships with others.

Everyone, including children, will experience ups and downs in

their mental health throughout their life and this is a regular part

of development. When adults help children to feel good about

themselves and work through life’s challenges, their mental

health is supported. This increases the likelihood of children

feeling confident to explore their world, being able to bounce

back from and manage difficulties or stress and strengthens

their social and emotional learning.

Mental health in early childhood

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Mental health difficultiesIt is important to remember that most young

children do experience good mental health.

Variations and fluctuations in emotions and

behaviour are a normal part of development

for children and can often arise in response to

change or other common life stressors.

While everyone experiences difficulties from

time to time, for a small number of children

difficulties happen more often or affect

them greatly.

Mental health difficulties have been defined

as ‘a very broad range of social, emotional

or behavioural difficulties that may cause

concern or distress. They are relatively

common, may or may not be transient, but

encompass mental health disorders, which are

more severe and/or persistent’ (Adapted from

Child and Adolescent Mental Health Services,

2001).

Often, the term ‘emotional and/or behavioural

difficulties’ is the description most used to

talk about mental health difficulties in early

childhood. It is also helpful to think about

children’s mental health as ranging on a

continuum from ‘good mental health’ to

‘mental health difficulties’.

Many people move from ‘good mental health’

to ‘mental health difficulties’ and back again

over the course of a lifetime. Children with

a mental health diagnosis can also move

towards and experience good mental health

when supported in an environment that meets

their individual needs.

‘Early childhood mental health and

wellbeing is seen in the capacity of a

young child—within the context of their

development, family, environment and

culture—to:

� participate in the physical and social

environment

� form healthy and secure relationships

� experience, regulate, understand and

express emotions

� understand and regulate their behaviour

� interact appropriately with others,

including peers

� develop a secure sense of self.

Early childhood mental health and

wellbeing is related to healthy physical,

cognitive, social and emotional

development. Early childhood development

and life experiences contribute strongly

to a person’s mental health and wellbeing

during childhood and later in life.’ (HIMH &

CSHISC, 2012, p. 13)

Mental health is about having a healthy

mind and body, and influences how

children feel about themselves, what they

do, how they think, and how they relate to

others. Having good mental health in early

childhood lays the foundations for mental

health and wellbeing now and into the

future.

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How common are mental health problems in early childhood? The Australian National Survey of Mental Health and Wellbeing

(Sawyer et al., 2001) estimated that among children aged 4–16

years, rates of mental health disorders were approximately

14 per cent. ADHD was the most common condition reported

by this age group (11 per cent), followed by depression (4 per

cent) and conduct disorder (3 per cent) (Sawyer et al., 2001).

One in 10 preschool children (aged 3–5) in a survey conducted

in South Australia in 2005 reported significant mental health

problems, including emotional, behavioural and social problems

(DECS, 2006). More recently, research has shown that up to 20

per cent of children from birth to school age experience mental

health difficulties, with elevated internalising and externalising

behaviour symptoms (Bayer et al., 2012).

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Looking after yourself Adults play a great role in children’s health and development, and may at times need additional

support for their own mental health to do the best job they can. Here are some useful contacts

for adults:

ORGANISATION PHONE WEBSITE � SERVICES

PROVIDED

Lifeline 13 11 14 www.lifeline.org.au � 24-hour phone

counselling

beyondblue 1300 22 4636 www.beyondblue.

org.au

� 24-hour telephone

and online

information

and support

SANE 1800 18 7263 www.sane.org.au � Information

line 9am–5pm

weekdays

� Online helpline,

factsheets and

resources

Australian

Psychological

Society

www.psychology.

org.au/

FindaPsychologist/

Default.aspx

� Find a

psychologist

service

KidsMatter Understanding mental health—Resources for families and staff www.kidsmatter.edu.au/early-childhood/about-mental-health/mental-health-basics/

understanding-mental-health-resources.

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One way to understand mental health in early childhood

is through risk and protective factors. Risk factors are

experiences or situations that increase the likelihood for

developing mental health difficulties. Protective factors

buffer the effects of risk factors and improve children’s

mental health. The relationship between risk and protective

factors is complex, however it is known that reducing

risk factors and building protective factors has a positive

effect on children’s mental health and wellbeing. Risk and

protective factors change over time and according to the

situation.

Risk and protective factors for children’s mental health

Risk and protective

factors can occur in

different areas of a child’s

life, for example an

early childhood setting

can provide stability if

a child and family are

experiencing stress. Risk

and protective factors

change over time and

can be identified in the

following areas:

� The individual child:

their abilities and needs.

� The family: their

circumstances and

relationships.

� Life events and

situations: the

opportunities and

stressors.

� The community: its

capacity for access

to support and social

inclusion.

� Connection with culture:

histories, tradition and

sense of belonging.

� The early childhood

setting: relationships,

practices and

environment.

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The relationships

between risk and

protective factors for

mental health are

complex and change

over time. The presence

of risk factors increases

the likelihood of

developing mental health

difficulties. Risk factors

don’t necessarily lead to

mental health difficulties,

especially if a child

has protective factors

to support their mental

health.

Protective factors for children’s mental health decrease the

likelihood of experiencing mental health difficulties. They help

to balance out the risk of developing mental health difficulties

and build resilience—the ability to cope with life’s difficulties.

Examples of children’s mental health protective factors include:

� a stable and warm home environment

� having supportive families and early childhood education and

care (ECEC) services

� achieving developmental milestones

� having an ambition to overcome challenges

� routines and consistency in life

� having support from a wide circle of family, friends and

community members.

Risk factors for children’s mental health increase the chance

of mental health difficulties developing. These may be events

that challenge children’s social and emotional wellbeing, such

as:

� family conflict or separation

� parents or carers experiencing mental health difficulties

� being affected by natural disasters

� experiencing stressful events

� experiencing trauma or abuse

� lacking friends or supportive relationships with adults.

KidsMatter—Risk and protective factors www.kidsmatter.edu.au/early-childhood/about-mental-

health/risk-and-protective-factors/risk-and-protective-

factors-early.

Responsibility—Risk and protective factors www.responseability.org/__data/assets/pdf_

file/0017/4922/Risk-and-Protective-Factors.pdf.

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Warm, responsive and trusting relationships are a significant protective factor for mental healthWarm, responsive and trusting relationships between

children and their families and educators are essential for

the development of positive mental health. They also provide

children with the template to form and maintain positive

relationships in later life. Warm, responsive and trusting

relationships between children and the adults around them

establish a sense of security and safety. Children can use this

base to go and explore the world, knowing that there is a safe

person or place to come back to. Children learn through their

positive relationships that:

� they will be responded to when they are distressed

� they will be supported in making sense of their own and

others’ emotions

� they have a safe base to explore the world around them.

Children who have had little experiences of warm, responsive

and trusting relationships are at greater risk of having

difficulties in self-regulation and the development of

serious difficulties in many areas of their life.

This includes their overall development,

capacity to form relationships, and

how they manage their feelings and

behaviour.

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The relationships between young children, their families

and educators provide the foundations of positive mental

health. Children are born with the need to connect to

others. Children’s first relationships with their families

provide the basis for their social and emotional learning.

Social and emotional learning is the foundation for good

early childhood mental health. From birth, children learn

how to be in relationships with other people—how to

interact, respond and manage their feelings and to get

their needs met. The repeated interactions of being ‘in

tune’ with another support children’s development and can

only be experienced through relationships.

Early Childhood Australia, Research in Practice Series—The Circle of Security by Robyn Dolby

www.earlychildhoodaustralia.org.au/pdf/rips/rip0704.pdf.

NQS-PLP—Supporting babies’ social and emotional wellbeing

www.earlychildhoodaustralia.org.au/nqsplp/wp-content/uploads/2013/08/NQS_PLP

_E-Newsletter_No61.pdf.

Relationships are the foundation of children’s mental health

Children learn when they feel safeWarm, responsive and

trusting relationships

provide children with

a sense of safety.

Their sense of safety

comes from nurturing,

predictable and stable

environments, where the

adults around them attend

to their physical, social

and emotional needs.

When children feel safe

they can try new things

and feel supported in their

attempts to develop new

skills. It provides them

with the confidence to

explore their environment

and drive their own

learning. Children learn

how to trust and that

someone is there for them

when they need help.

The still-face experiment www.zerotothree.org/child-development/early-childhood-mental-health/.

NQS-PLP—Development of children’s social and emotional learning www.facebook.com/photo.php?v=553580974683886.

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Early childhood is a period of rapid development and

change which means that children show a great range of

behaviours. A major challenge is that children in this age

group grow and develop at different rates and stages,

making it difficult to recognise when a concern may be

present. For example, being distressed when a primary

caregiver is out of sight is expected for a 10-month-old

baby, but becomes more problematic for a four-year-old.

Children develop at different rates and stagesChildren like to explore

their surroundings in

different ways as they

learn new skills. It is very

common for children in

the early years to show

strong emotions that

can often be expressed

through behaviour. For

example, frustration or

worry can be expressed

as a strong temper.

Difficulties can occur

when children are

learning how to respond

to new situations, social

relationships and their

own feelings.

Warm, responsive and

trusting adults can help

children to understand

their feelings. For some

children, this can be more

difficult than others and

may affect their ability

to learn new things and

to interact with others.

These children can often

require extra support

as they go about their

day and may benefit

from professional

support services.

How mental health difficulties affect children

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Features associated with

children’s ‘externalising’

difficulties might include:

� attention difficulties

� hyperactivity

� aggressive behaviour

� reduced problem-solving

skills

� oppositional behaviour (e.g.

don’t like to follow rules,

don’t like to be told what

to do).

This might look like a child

who comes to an ECEC

service and can’t sit still, is

fidgety, gets angry easily,

interrupts and finds it difficult

to finish what they’ve started.

Children with internalising

difficulties in early childhood

may be at increased risk

of developing an anxiety

disorder or depression

in later childhood or

adolescence. Children

with ADHD often show

severe externalising

behaviours. Children with

other serious behaviour

problems also show

externalising patterns of

behaviour such as persistent

aggression. Depression

and anxiety commonly

underlie internalising

as well as externalising

behaviour problems.

Internalising and externalising behavioursA common way of understanding children’s mental

health difficulties is along a continuum of ‘internalising’ to

‘externalising’, referring to whether the feeling is expressed

inwardly or outwardly. Children with internalising difficulties

show behaviours that are inhibited or over-controlled. They

may have a nervous or anxious temperament, be worried, sad,

fearful or withdrawn.

Children with externalising difficulties show behaviours that

are less controlled. Rather than being able to sit with or talk

about their feelings, they may manage them through impulsive

or reactive behaviour. Sometimes this pattern can lead to

difficulties with attention, aggression or oppositional behaviour.

These behaviours are relatively easy to recognise as they are

quite disruptive and are likely to require attention from families

and educators.

It is not uncommon for children to show behaviours associated

with both internalising and externalising patterns of behaviour.

The typical features associated with each pattern are

summarised below.

Features associated with children’s ‘internalising’ difficulties

might include:

� nervous/anxious temperament

� excessive worrying

� withdrawn behaviour

� peer relationship difficulties (e.g. isolating themselves from

other children).

This might look like a child who comes to an ECEC service and

finds it difficult to separate from their family member, prefers to

keep on their own and doesn’t talk much to others.

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What causes mental health difficulties in children? Mental health difficulties affect children’s behaviour, feelings, ability to learn, social relationships,

as well as their physical health and wellbeing. Unlike some medical conditions that have a direct

cause (e.g. a virus causes the flu), mental health difficulties are caused by multiple factors

that interact in different ways depending on the individual child, their family and their social

circumstances. Reducing risk factors and building protective factors in children has a positive

effect on their mental health and wellbeing.

Biological, psychological and social factors all influence children’s mental health. Any one of these

factors can have either a positive or negative influence on a child’s mental health. For example,

low self-esteem might impact on confidence and positive family relationships could help a child

adjust to change.

Some of the biological, psychological and social factors which can influence children’s mental

health include:

BIOLOGICAL PSYCHOLOGICAL SOCIAL

Physical health Social and emotional skills Exposure to trauma

Temperament Thinking style Community connectedness

Genetic vulnerability Self-esteem Socioeconomic status

Disability Family relationships Access to support services

Physical development Attachment style Cultural connection

KidsMatter—How mental health difficulties affect children www.kidsmatter.edu.au/families/about-mental-health/should-i-be-concerned/how-

mental-health-difficulties-affect-children.

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Getting help early for children’s mental health difficulties

is important. Children with mental health difficulties may

have trouble getting along with others or struggle with

their learning. The earlier in life mental health difficulties

are addressed, the better chance a child has at improving

their long-term mental health and wellbeing.

The adults in children’s lives such as families or early childhood

educators are often the first to recognise if a child is having

social, emotional or behavioural problems. Children’s behaviour

can change in different environments, sometimes families might

approach educators with concerns they are seeing at home to

find out if the behaviour is happening at the service. Sometimes

a child’s difficulties might be more obvious in the service

where educators have the opportunity to observe a range of

children and their behaviour. It is also possible that children

have difficulties at home that they don’t have at the service

because children commonly wait for the safety of their family

relationships to express their distress.

Knowing when to get help

Gathering good observationsThere are many reasons for children’s behaviour, and most of the time it’s not because they

have a mental health difficulty. However, if children are showing signs of emotional and/or

behavioural difficulties, making some careful observations of a child can help families and

educators to work together on deciding the best way to support them.

NQS-PLP—noticing and recording learning www.earlychildhoodaustralia.org.au/nqsplp/e-newsletters/newsletters-51-55/

newsletter-55/.

Early childhood educators

are well placed to support

children’s mental health, as

they are important adults in

the lives of children and are

observing groups of children

every day. Early childhood

educators can help parents

understand where their child

is placed within the group.

This means they can work

together to understand if

something is a problem or

within the expected range.

ECEC services can also be

ideal places for families to

access information about

supporting the mental

health and wellbeing of

their children.

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� seeking consultation from a mental health

service directly about a child or a number of

children in the service

� reflective practice, such as using journals or

professional conversations with colleagues

� arranging guest speakers to conduct

information sessions about children’s mental

health at the service

� making referrals to appropriate professionals

in the community

� knowing their community and supporting

families to access mental health services.

Working with familiesThere are many ways that families and

educators can support children who are

experiencing mental health difficulties. These

are underpinned by a strong partnership

and may include attending information

sessions on particular childhood mental

health difficulties or getting a referral to a

mental health professional. While there are

effective supports for children experiencing

mental health difficulties, many children do not

receive the help they need. This can happen

because families are unsure of whether their

child has a difficulty, or they do not know

where to go or what to do to get mental health

support. There may also be long waiting lists

or limited services available in certain areas.

ECEC services may be working with and

supporting children and families experiencing

mental health difficulties in a number of

ways, by:

� implementing practices that promote

and support the mental health of all

children, including those who have mental

health difficulties

� learning about mental health in early

childhood and sharing understandings with

families and other members of the early

childhood service community

� making mental health part of the culture of

an early childhood community. This creates

a shared language about mental health

and reduces stigma, supporting families to

access services when needed

� having information related to children’s

mental health available at the service

(e.g. information sheets, pamphlets, books)

Parenting and child health: www.cyh.com/Default.aspx?p=1.

Kidscount (see ‘Understanding children’s experiences’ and ‘Responding to children’): www.kidscount.com.au/website/

default.asp.

Hunter Institute of Mental Health (see ‘Current projects—Foundations’): www.himh.org.au/.

KidsMatter has developed an e-learning

course ‘Connecting with families:

conversations that make a difference’.

This course is to support early childhood

educators and school staff in their work

with families. The course provides a

practical framework and model to help

structure conversations and is available

at: www.kidsmatter.edu.au/health-and-

community/resources-professionals/

elearning.

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Look for B-E-T-L-SWhen you are concerned

about a child, think about

their:

� Behaviour

� Emotions

� Thoughts

� Learning

� Social relationships.

All children experience

difficulties in these areas

from time to time; however,

there are some children

who may experience

them more often and will

need additional support.

Recognising when there is a

concern for a child’s mental

health is not easy. Having an

understanding of children’s

behaviour as they develop

can offer some clues, but

knowing a child and their

family well is invaluable.

Strong relationships between

educators, children and

families means that the

information needed to make

decisions around children’s

mental health is available.

Children may have difficulties in more than one of these

areas as they all link and influence one another.

Behaviours: Are often the first and easiest sign of a mental

health concern to observe. Behaviours can be broken down

into two broad categories: externalising and internalising.

Emotions: Refer to how a child is feeling. Children with

emotional difficulties may have trouble expressing or

managing their feelings. For example, some children may

find it hard to calm down after being upset.

Thoughts: Refer to how and what a child is thinking. A child

may experience negative thoughts about themselves or

what is happening around them (e.g. they may think that

nobody likes them, or that their parent will not come back

to pick them up), which stop them from interacting with

others or getting involved in experiences. It can be harder

to notice these thoughts in younger children who have not

yet developed their language skills. Sometimes we can

guess what a younger child may be thinking based on the

behaviours and feelings they show.

Learning: Refers to how well a child is able to take in,

understand and remember information. It also relates to

how well they can communicate and interact with others,

and use their physical skills (e.g. crawling, walking or

drawing). Children with difficulties in learning may also have

problems with attention and concentration and therefore not

be able to understand what they have to do, or find it hard

to complete a particular task, movement or action. They

may not be able to make friends because they are unsure

of, or have forgotten, what to do or say.

Social relationships: Refer to a child’s ability to form

relationships with others. A child with difficulties in this

area may find it hard to play with other children, make

friends or interact with their family members. They may

also have difficulty understanding social cues and behaving

appropriately in social situations (e.g. a child may not

respond when an educator is making playful sounds

and smiling at them or may struggle with taking turns in

group play).

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One of the major challenges of recognising

the signs of emotional and behavioural

difficulties in early childhood is deciding when

a concern is significant enough to take further

action. Concerning behaviours and emotions

can sometimes be related to what’s going on

in a child’s surroundings or specific events in

their life (e.g. moving house, birth of a new

sibling, parents returning to work). Other

behaviours or emotions can be associated

with a particular situation (e.g. acting out due

to disrupted sleep routines). Examining the

pervasiveness, frequency, persistence and

severity of children’s behaviours, thoughts and

emotions can help educators recognise the

level of concern present.

BETLS is a way of organising observations

about a child. Completing a BETLS

observation can be useful when:

� There are concerns about a child’s

development and wellbeing.

� There are questions about a child’s

behaviour.

� An educator wants to get to know a

child better.

� Information is needed to help support

and nurture a child.

� Having discussions with families,

educators and services when there is

a concern for a child’s development

and wellbeing.

KidsMatter—Knowing when to get help

www.kidsmatter.edu.au/health-and-

community/mental-health-basics/

supporting-mental-health/knowing-

when-get-help-children.

Pervasiveness: The number of settings

in which a child is displaying particular

behaviours, emotions and thoughts (e.g.

ECEC service, home, when visiting friends

and family).

Frequency: How often these behaviours,

emotions and thoughts are observed (e.g.

rarely, all the time, only at certain times of the

year, i.e. after holiday periods).

Persistence: How long the behaviours,

emotions and thoughts have been present for

(e.g. days, weeks, months etc.).

Severity: How severe a child’s behaviours are

(i.e. mild, moderate or severe). Severity also

relates to how much these behaviours are

influencing a child’s day-to-day experiences

and how a child’s behaviour compares to

other children’s behaviour within the same age

group.

The more pervasive, frequent, persistent

and severe a particular group of behaviours,

thoughts and emotions are, the higher the

level of concern and the greater the impact

on their learning and social relationships.

Taking time to observe a child who has been

showing signs of difficulty, having professional

conversations and reflecting with colleagues

can help educators understand the meaning

behind a child’s behaviour. It can also help

to reflect on the level of concern present and

whether it is causing difficulties for a child

in their everyday life. This means educators

are well placed to meet a child’s needs and

support their mental health.

BETLS observations can be used

to understand how pervasive,

frequent, persistent and severe a

child’s concerns are.

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The KidsMatter directory for children’s

mental health and wellbeing has a range of

mental health supports listed for children,

families and professionals:

www.kidsmatter.edu.au/node/3154.

When more support might be neededMental health professionals work with families

and educators to support the individual needs

of a child. After educators and families have

worked together to gather information about

a child’s social and emotional wellbeing and

development, mental health professionals can

assess whether there is a significant concern

present for a child.

Local community services can also be helpful;

sometimes they can provide parenting groups

or parenting programs that are designed to

support parenting, which can also have an

influence on children’s behaviour.

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Professional mental health services � General practitioners (GPs) can provide referrals to mental health professionals under the

Medicare system, who can provide a number of sessions for free or at a subsidised rate.

� GPs can also provide specialist referrals for speech pathologists, physiotherapists,

occupational therapists and paediatricians.

� Community-based programs may provide sessions run by professionals on strategies for

dealing with particular concerns (e.g. challenging behaviour, sleep difficulties etc.).

� Psychologists, social workers, occupational therapists, speech pathologists, early

intervention services and other allied health professionals can support families and

children. Some of these professionals can also conduct assessments for diagnosis where

appropriate. They are specialised in working with children, and also work with their families

and other services which might be involved.

� Maternal child health nurses can provide families with information on child development, and

may provide guidance on useful community programs and professional services.

� Early parenting centres offer direct support as well as education sessions and internet

resources. Professional development and training can provide training around strategies for

working with children who have specific mental health difficulties.

Mental health supports

Children who may be showing signs of mental health difficulties can benefit from a range

of supports available in the community. These can range from community-based programs

to professional mental health services.

Mental health professionals work in partnership with families and ECEC services to provide

support and consultation.

Partnering with health and community professionals www.kidsmatter.edu.au/health-and-community/partnerships/partnership-tools.

KidsMatter Early Childhood Tools and Guidelines resource www.kidsmatter.edu.au/early-childhood/kidsmatter-early-childhood-practice/tools-and-

guidelines-implementation.

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Do you know? There are two schemes available to support children and

families accessing mental health services.

The Medicare Benefits Scheme includes mental health

care treatments for adults and children experiencing mental

health difficulties and problems (the Better Access to Mental

Health Care Program). This allows access to a Medicare

rebate provided by an eligible health care professional

(including psychiatrists, psychologists, occupational

therapists and social workers).

How do I know if a child is eligible?

1. Families need to make a double appointment with a GP,

requesting a Mental Health Care Plan Consultation.

2. The GP will assess whether the child has a mental health

problem covered by the extended Medicare rebates to be

eligible for assistance.

3. If deemed eligible, the GP will make a referral to an

appropriate allied health professional and the child can

start receiving assistance. Children and families can

receive subsidised assistance for mental health services

via the Better Access or Access to Allied Psychological

Services (ATAPS) program. For more information on

the Better Access program and eligibility, please visit:

www.health.gov.au/internet/main/publishing.nsf/Content/

mental-ba-fact-pat.

For more information on the ATAPS program and eligibility,

please visit: www.health.gov.au/internet/main/publishing.nsf/

Content/mental-boimhc-ataps.

KidsMatter has developed an information sheet for primary

schools and ECEC services about Medicare Locals, Better

Access and ATAPS: www.kidsmatter.edu.au/sites/default/

files/public/Medicare%20locals%20and%20ATAPS%20

3%20FINAL%20301013.pdf.

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Diagnosis in the early childhood yearsWith well-informed observation, assessment

and understanding of a child and family,

a mental health professional may make a

diagnosis. Some children in ECEC services

may have already been diagnosed with

a mental health disorder. Understanding

how a particular disorder affects a child’s

experiences, responding to their individual

needs and working together with families can

help support a child’s development.

Is a diagnosis necessary? A diagnosis is a medical name or label that

helps mental health professionals to make

sense of a child’s difficulties. A diagnosis

simply describes a pattern of common signs of

a disorder.

A diagnosis can guide the types of supports

needed to promote a child’s development or

recovery from a specific concern. Making an

accurate diagnosis can sometimes be difficult,

and the diagnosis may change over time. With

appropriate support and consultation between

families, professionals and educators, most

children will no longer meet the criteria for a

mental health diagnosis. This is because the

opportunities for development are greatest

in early childhood, meaning that targeted

supports can make significant improvements

in children’s health and wellbeing.

For families it can be a relief to have a name

for their child’s difficulties. A diagnosis helps

them to explain why their child is behaving the

way they do and helps families to know the

best way to help.

Mental health difficulties can be recognised

when families, educators and others who

know and care for a child work together,

taking time to observe, reflect and share

concerns. Seeking the support of a mental

health professional may be useful to provide

reassurance and/or further help to families

if they have concerns about their child’s

mental health.

Having high expectations

for children whether they have

a diagnosis or not is essential

for optimal development

and wellbeing.

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Some of the behaviours that young children display that

can be a sign they may be experiencing mental health

difficulties include:

� persistent sleep and feeding problems

� irritability and fussiness

� uncontrollable crying that is not responsive to soothing

� difficulty adjusting to new situations

� inability to form relationships with peers and adults

� excessive aggression towards other children

� significant and age-inappropriate separation anxiety

� very withdrawn behaviour.

Below are some of the common presenting mental health

difficulties in early childhood. Remember, while it is helpful

for educators and families to know more about potential

mental health difficulties in children, diagnoses of particular

disorders should be made by mental health professionals.

Common presentingmental health difficulties

Research has shown that infants and young children can

and do experience the same mental health conditions

as adults, but the way these disorders are expressed is

different during the early childhood years and can be more

difficult to identify.

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Fearful and anxious behaviour is common in children.

Most children learn to cope with a range of normal fears

and anxieties. However, extra help may be needed in the

following situations:

� when children feel more anxious more often than other

children of their age and level

� when anxiety stops children participating in social activities

or peer play

� when anxiety interferes with a child’s ability to do things that

other children their age do easily

� when anxiety disrupts a child’s day-to-day routines

and experiences.

How anxiety affects childrenChildren with anxiety may develop their own strategies to try to

manage situations that cause them distress. Often this involves

trying to avoid the situation or having a parent or other adult

manage it for them. Avoiding a situation makes it more likely

that the child will feel anxious and be unable to manage it the

next time. This behaviour makes it more difficult for the child to

cope with everyday challenges at home, the ECEC service and

in social settings.

Anxiety can also result in physical difficulties such as

sleeplessness, stomach-aches, headaches, or diarrhoea. It can

also involve irritability, difficulty concentrating and tiredness.

Anxiety

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Common anxiety disorders in early childhoodIt has been found that the most prevalent anxiety symptoms

in three- to five-year-old children relate to fears about physical

injury (e.g. the dark, spiders, swimming), social fears (e.g.

playing with other children, meeting unfamiliar people) and

separation (e.g. sleeping by themselves or being away from

home). Three-year-old children may be particularly distressed

by being left at preschool or with a babysitter, whereas older

preschoolers may be more likely to be anxious about talking in

front of their group.

Separation Anxiety Disorder

Separation Anxiety Disorder refers to a developmentally

inappropriate and excessive fear or anxiety when separated

from significant caregivers. Some of the symptoms can include:

� a persistent fear or anxiety about harm coming to their

significant caregivers and events that could lead to loss of or

separation from significant caregivers

� a reluctance to go away from significant caregivers

� nightmares and physical symptoms of distress, such as

headaches, vomiting or nausea

� an inability to go into or stay in a room by themselves

� ‘clinging’ behaviour, staying close to or ‘shadowing’ a

significant caregiver around the house

� difficulty at bed time and insisting someone stay with them

until they fall asleep.

Children may become extremely upset at the prospect of

separation, and some may become angry or show aggression

towards someone who is trying to take them away from their

significant caregiver.

How might you notice anxiety in children? Common signs may include:

� fear and avoidance

of a range of issues

and situations

� headaches and stomach-

aches that seem to occur

when the child has to

do something that is

unfamiliar or that they feel

uneasy about

� sleep problems, including

problems falling asleep,

nightmares, trouble

sleeping alone

� lots of worries and a strong

need for reassurance.

Raising Children Network—Anxiety and fears http://raisingchildren.net.au/articles/anxiety_and_fears.html.

Early Childhood Australia—Separation anxiety www.earlychildhoodaustralia.org.au/feelings_and_behaviours/everyday_feelings/separation_anxiety.

html.

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Selective mutism

Selective mutism occurs when children refuse

to speak in specific social situations in which

there is an expectation for speaking (e.g.

ECEC service and school settings), despite

speaking in other situations. This is separate

from children who prefer not to speak because

they have a limited understanding of English.

In social situations, children with selective

mutism do not prompt an interaction or

respond when spoken to by others.

Children with selective mutism will speak

in their home in the presence of their

immediate family. They often refuse to speak

in front of close friends or relatives, such

as grandparents or cousins. Children with

selective mutism sometimes use non-spoken

or non-verbal means (e.g. grunting, pointing or

drawing) to communicate. They may be willing

to perform or engage in social situations

where speech is not required (e.g. non-verbal

play).

How do anxiety disorders develop? Some children react more quickly or more

intensely to situations where there is

danger or threat. The physical symptoms

of anxiety (e.g. increased heart rate and

faster breathing) are more easily triggered in

children with anxious temperaments.

Having an anxious temperament often means

that children have a heightened awareness of

any potential threats in the environment and

may react more to these threats. This appears

to be partly an inherited characteristic.

Children with anxious temperaments are often

cautious in their outlook and shy in relating to

other people.

Sometimes stressful events trigger problems

with anxiety. Children who experience

more stressful events over their lifetime

than others or who have gone through

particularly traumatic events may experience

increased anxiety; however, this depends

on biopsychosocial influences such as an

individual child’s temperament and the

presence of supportive and responsive

relationships.

Learning may also play a part in the

development of an anxiety disorder. Some

anxious children learn that the world is a

dangerous place. They may think that it is

easy to get hurt either physically, socially or

emotionally. They may fail to learn positive

ways to cope and depend more and more on

unhelpful ways of dealing with situations that

cause them anxiety. Sometimes families may

unintentionally contribute to children’s natural

cautiousness by being over-protective. This

can encourage children to avoid situations

they feel anxious about.

Selective mutism www.asha.org/public/speech/

disorders/selectivemutism/.

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How to assist children with anxiety disorders Children with anxiety problems are often

quiet and compliant. This can lead to their

difficulties being overlooked. Taking note

of children’s worries means their problems

can be addressed sooner rather than later.

Some ways of helping children include:

� giving positive feedback to children when

they try new things

� helping children to develop their coping

skills and learn about managing their

feelings

� setting realistic expectations for children

� introducing challenges gradually

� helping to recognise and understand

anxiety in a child

� providing a warm and supportive

environment where children feel calm

and safe

� providing a very predictable environment

and frequently reminding the child of

what is happening during the day

� getting help from other professionals.

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Trauma in early childhoodA traumatic experience is when a person’s life or wellbeing

has been, or is perceived to be, threatened. It can occur due

to a car accident, refugee experiences, a natural disaster such

as a bushfire or cyclone, or being the victim of, or witness to,

violence such as physical and sexual abuse.

Trauma occurs when an event creates a feeling of being

overwhelmed and impacts on a person’s ability to cope.

A trauma might happen once, or it might be experienced

over a period of time. A person doesn’t need to be injured

to experience trauma—feeling threatened or witnessing

distressing events is enough for a person to experience

trauma. Sometimes the effects of trauma are immediate and

more obvious and at other times they take a while to appear.

It is important to keep in mind that the mental health effects of

trauma are about how the event is experienced rather than the

event itself.

Australian Child Adolescent Trauma, Loss and Grief Network—Trauma resources http://earlytraumagrief.anu.edu.au/resource-centre/trauma.

KidsMatter Early Childhood Trauma Information for families and early childhood staff www.kidsmatter.edu.au/families/resources/mental-health-difficulties/trauma.

Australian Childhood Foundation—Learning resources www.childhood.org.au/training/learning-resources.

Australian Childhood Foundation Strategies for Managing Abuse Related Trauma (SMART) discussion papers www.childhood.org.au/training/smart-online-training.

Trauma and stressor-related disorders

Trauma affects every child

differently depending on their

age, personality and past

experiences. Trauma can

disrupt the relationships a

child has with their families

and educators, as well as

affect the development of

a child’s language skills,

physical and social skills and

the ability to manage their

emotions and behaviour.

The support and care

children receive from the

adults in their lives can have

a strong positive impact

on how they cope with a

traumatic event.

For more information on

trauma in childhood see the

resources below:

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How trauma affects childrenYoung children are especially vulnerable to the

effects of trauma as they are highly dependent

on adults for protection and have limited ability

to control events occurring in their immediate

environment. Visualisations or re-experiencing

memories of the trauma, repetitive behaviours,

such as acting out the trauma over and over

in play, dissociative symptoms (i.e. acting

stunned or numb), specific fears associated

with the traumatic event, such as being

frightened someone will break into the

house, startling easily (e.g. hiding under the

table when hearing loud noises) and altered

views about certain people and the future

are considered to be some of the typical

behaviours presented by traumatised children.

Children under six are likely to report

very detailed accounts of their traumatic

experiences with their drawings and play

commonly reflecting what occurred at the

time of the trauma. Hyperactivity, aggression

and antisocial behaviour are also common

reactions seen in traumatised children and

are often misdiagnosed as symptoms of

ADHD. Traumatised children may regress,

function at a level lower than expected for

their age group, develop new fears and

become hypervigilant, show signs of reckless

behaviour, become anxious around separation

from caregivers and, similar to depressive

disorders, frequently report somatic aches and

pains.

Child Trauma Academy—Trauma and PTSD http://childtrauma.org/cta-library/

trauma-ptsd/.

Relational traumaRelational trauma can occur if a child

experiences maltreatment (e.g. physical,

sexual, emotional abuse or neglect)

from significant caregivers. Children

who have experienced threat or harm

through maltreatment are at great risk for

experiencing difficulties in forming and

engaging in relationships. If these types

of traumatic experiences are prolonged,

children’s reactions to them can become

embedded into their development.

Warm, responsive and trusting

relationships between children and

caregivers can promote feelings of safety

when a traumatic event has occurred.

Remember, even if a child experiences

trauma or other challenging situations,

having a caregiver or other adult who

responds with nurturing care is a

protective factor for their mental health

and wellbeing.

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How might you notice a trauma response in children? Experiencing trauma can impact on a child’s

behaviour. They might become quiet and

withdrawn; or their behaviour might become

more explosive, aggressive and unpredictable.

They might damage furniture, or do things that

could hurt others. Sometimes children may

also engage in repetitive routines in order to

self-soothe and make themselves feel better.

Some of the behaviours seen in children who

have experienced trauma include:

� Sudden mood swings: Children might

appear happy and relaxed one minute and

then become frightened the next.

� Outbursts of temper: Sudden aggression or

rage, including yelling and throwing things.

� Nightmares: Calling out in sleep, waking

suddenly in the night appearing confused

or frightened.

� Problems sleeping: Early waking, problems

falling asleep, waking up frequently.

� Flashbacks: Appearing disengaged, a child

acts or feels as if they are back experiencing

(reliving) the trauma.

� Hypervigilance: Being startled easily,

appearing ‘jumpy’ and always paying

attention to what’s going on around them.

� Anxiety or panic: Appearing scared,

experiencing physical anxiety such as

sweating, shaking, nausea, shortness

of breath.

� Depression: Crying, sadness, no interest in

playing with others or engaging in previously

enjoyed activities.

� Dissociative experiences: A child’s face and

expression appears ‘frozen’ and they behave

as if they are thinking intently or listening to

something only they can hear, they appear

not ‘present’ or ‘zoned out’.

� Problems communicating: Might be selective

about who they speak with.

Experiencing trauma can have a great impact

on how children relate to the people in their

lives. They may have difficulty in trusting other

people, making and sustaining friendships

with their peers and developing relationships

with the adults in their life (including their

educators). Children who have experienced

trauma can find the ECEC service

environment challenging and difficult to

navigate. Trauma can affect a child’s learning,

memory, relationships and behaviour, making

it difficult for them to attend the service and be

around other children.

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Trauma and stressor-related disorders in early childhood

Acute stress disorder When a child has experienced, witnessed or has been exposed

to details of a traumatic event. Children may become distressed

by memories of the traumatic event or they may express themes

associated with the trauma in their play. They may experience

sleep difficulties, nightmares, sadness, forgetfulness and day

dreaming. Children may also try to avoid memories or reminders

of traumatic events.

Adjustment disorder When a child has difficulty adjusting to or coping with a particular

life transition or stressor. Often children with this disorder display

symptoms such as sadness, lack of enjoyment, hopelessness and

sleeping troubles.

Reactive attachment

disorder (RAD)

Arises from children’s limited experiences of trusting relationships

with significant caregivers in early childhood. Children with RAD

have difficulty initiating and receiving comfort and affection from

caregivers. They have difficulty in social interactions and rarely

experience positive emotions. Children with RAD often show

unexplained irritability, sadness and fearfulness. Children with

RAD are likely to have had limited experiences of warm, trusting

and responsive relationships.

Post-traumatic

stress disorder

Results from direct exposure to or witnessing actual or

threatened death, physical, emotional or sexual abuse, violence

and assault. This leads to prolonged distress and symptoms

such as disengagement, trauma re-enactment in play, and

sleeping difficulties.

Post-traumatic stress disorder is distinguished from Acute

stress disorder because of the timing of when symptoms are

experienced. When the effects of trauma take longer to appear

and longer to resolve, this is described as Post-traumatic

stress disorder.

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How to assist children with trauma-related disordersIn consultation with families and mental health

professionals, educators can support children

who have experienced trauma by:

� encouraging them to connect and develop

relationships with educators and other

children at the service

� listening to them if they tell a traumatic story

and reminding them of their safety, as well

as doing something to make them safe

� ensuring the ECEC service is a safe place

where children feel secure and confident

to develop relationships with others and

explore their world safely.

� staying connected with the child’s family in

order to support children

� taking care of yourself—hearing about

trauma in young children can be distressing

for educators—and making sure you have a

place for support if you need to access it.

What are the effects of trauma on children?

Experiencing trauma can have both short-

term and long-term effects for children. In

the short term, experiencing trauma causes

children to have a stress response. Usually

children’s brain and nervous systems

work together, to help them make sense

of incoming information from their senses,

like sight and sound. When they experience

trauma, chemicals like adrenaline rush around

a child’s body, affecting how well their brain

and nervous systems work together. Having

a stress response after trauma might make

it harder for children to process information;

to remember things; to concentrate; and

to manage their feelings. It might also take

children who have experienced trauma a

long time to calm down after having a stress

response.

In the long term, trauma can affect children

in lots of different ways that are not always

obvious to others. Sometimes things like

sights, sounds, smells and movements that

remind children of trauma can trigger stress

responses again, even though the actual

event happened a long time ago. Repeated

trauma reactions can be embedded in brain

architecture meaning that traumatised children

are more likely to experience frequent stress

responses, even when there is no threat or

danger present. It can be difficult for others

such as educators to understand what is

upsetting to a child when the trigger is not

known to them. Sometimes a child doesn’t

understand what made them react in such a

way; this is where adults can help children to

understand and manage their feelings.

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Children who have experienced trauma

are likely to have disrupted relationships

with their families. Sometimes the trauma

is a consequence of the relationship

itself (as seen in children who have

experienced abuse or neglect). In other

cases, it may be difficult for a child to

engage in a relationship with a family

member or educator as they are distracted

by internal feelings about a trauma they

have experienced. Some children may

have experienced frequent changes in

significant caregivers (e.g. foster care),

meaning they haven’t had repeated

and continuous experience of warm,

responsive and trusting relationships.

This makes it hard for children to develop

the social and emotional skills needed

to interact in relationships. Children who

have experienced trauma and stress

can benefit greatly from responsive

caregivers in predictable, warm and stable

environments.

Early Childhood Australia, Research in Practice Series—The Circle of Security by Robyn Dolby www.earlychildhoodaustralia.org.au/

pdf/rips/rip0704.pdf.

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Feeling depressed is more than just feeling sad. It’s normal

to feel sad for a while as a result of being hurt or of losing

something or someone special. Depression affects a child’s

thinking. They see themselves and the future negatively.

Along with feeling sad or irritable it may seem that nothing is

worthwhile.

Children who are depressed may show:

� sadness

� irritability

� somatic complaints

� feelings of guilt that are resistant to change

� excessive tiredness

� sleep problems

� appetite and weight changes

� lack of enjoyment doing pleasurable activities

� fidgeting and restlessness

� preferences for being alone and away from other children

� difficulties in attention and concentration

� withdrawal from relationships and lack of interaction

with others.

Depression and anxiety often occur together. Symptoms

of anxiety in children include having fears and worries and

complaining often of aches and pains.

Depression Depression can be seen in very young infants as well as

toddlers and preschoolers.

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How does depression in childhood develop? Children who get depressed often live with families where other

members have also experienced depression. This may be due

to genetic factors. Alternatively it may be that living with adults

who are depressed may change how parents and children

relate. A depressed parent may be struggling so much with

their own illness that they have less time to spend with children

and they are less able to be there for them. This means that

children miss out on the ‘in tune’ interactions they need to

develop an understanding of how to interact with others. A

third possibility is that the stress affecting the child affects the

whole family.

Stressful events such as death of a parent, parental divorce,

being rejected or being bullied may trigger an episode of

depression in children. This is more likely in children with

anxious temperaments and when multiple risk factors and few

protective factors are present.

Young children who have an early episode of clinical

depression have a heightened risk of having another episode

later in their life.

How depression affects childrenChildren are often unable to

explain how they are feeling,

especially when depressed.

In diagnosing depression,

mental health professionals

look for key signs and

symptoms in children’s

behaviour. When several

signs or symptoms occur

together for a prolonged

period and are out of

character for the child, they

indicate that a significant

concern may be present

which needs attention.

When adults are depressed,

feelings of sadness are

often very obvious. In

children, irritability may

be more noticeable than

sadness. Sleep changes

in children are more likely

to be a change to sleeping

less rather than sleeping

more. Loss of appetite and

weight loss sometimes

occur in children but are

less common than in adults

with depression.

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How to assist children with depressive disordersDepression may often be overlooked

in children. Because the symptoms of

depression are often disruptive behaviours

(e.g. irritability, whingeing) it is easy for

adults to feel annoyed by them and to

blame or punish the child for his or her

behaviour. This can lead to missing other

signs of depression. Paying attention to

children’s underlying feelings will help

adults notice signs of depression earlier so

that help can be accessed.

KidsMatter—About depression www.kidsmatter.edu.au/primary/

mental-health-information/

depression/about-depression.

The trauma of depression in infants www.aipsych.org.au/articles/trauma_

of_depression_in_infants.pdf.

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ASD and early developmentChildren all develop at different rates. Development is

monitored by checking whether children are achieving

various important milestones, which can be physical,

emotional, social, linguistic or behavioural.

During the first year, monitoring a child’s social

communication development is especially important for

spotting early signs of ASD. Watching for behaviour such

as smiling, reciprocity in social relationships, eye contact

and the use of gestures can help you gauge a child’s

social development.

Neurodevelopmental disorders occur as a consequence of

altered brain development. How the brain grows and works

is affected, having a range of impacts on a child’s learning

and development.

Neurodevelopmental disorders

Autism awareness—Early signs www.autismawareness.com.au/information/early_signs.

Autism Spectrum DisorderAutism Spectrum Disorder (ASD) is a disorder that influences

the way the brain develops and works. Many aspects of

children’s development are affected, causing problems with

communication, social relatedness and unusual behaviours.

ASD also commonly presents with other diagnoses such as

anxiety, depression and ADHD.

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What signs might suggest a child has ASD? Typically, ASD is identified before a child starts school and

many children are now diagnosed from a very young age.

Usually parents, a health professional or an educator will

have noticed something unusual in the child’s development.

Examples include:

� failure to respond with appropriate social behaviours such as

smiles or other facial expressions

� failure to respond to his/her name

� a lack of interest in other children

� slow or limited language development

� limited imagination and initiation in play

� difficulty understanding one-step instructions, e.g. ‘give that

book to Dad’

� an intense interest in certain objects and only playing with

particular toys, often in a prescribed or repetitive manner such

as lining things up

� being easily upset by change and displaying a preference

for routines

� a significant sensitivity to sensory experiences, e.g. only

eating food of a certain texture or being distressed by

particular noises

� a lack of other forms of communication such as pointing

and waving.

Some children are not diagnosed until they are at school, with

concerns often raised by teachers. Less commonly, a diagnosis

may occur in late adolescence or adulthood. Those diagnosed

at an older age are generally higher functioning and have

less severe symptoms. However, they still experience social,

communication and behavioural difficulties.

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How Autism Spectrum Disorders (ASDs) are diagnosedTo make a diagnosis a thorough assessment

is best undertaken by a multi-disciplinary

team of mental health professionals.

The team may include a paediatrician

or psychiatrist, a speech pathologist, a

psychologist and an occupational therapist.

They will comprehensively review the child’s

progress through early development, any

prior experience of trauma or ill health,

family circumstances, learning behaviours

and current functioning. The team will also

undertake direct observations and conduct

an individual assessment. Sometimes

educators and families are asked to fill

out questionnaires related to the child’s

behaviour. The diagnosis is based on all of the

information collected. Children with relatively

severe ASD are usually diagnosed by the age

of three years.

How does ASD develop?As of now, research has not identified any

particular cause for ASD. Experts agree that

brain development does not occur normally in

people with these disorders, but research has

not been able to isolate what makes up the

differences. There is some evidence of genetic

factors influencing the development of ASDs.

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Raising Children Network—Children with Autism Spectrum Disorder http://raisingchildren.net.au/children_with_autism/children_with_autism_landing.html.

How to assist children with ASDWhile the patterns of symptoms for children diagnosed with

ASD are similar, no one child will have the same pattern of

strengths and needs as another. Autism especially varies

in severity and children may have very different levels

of difficulty.

Early intervention so that children and families can get

appropriate specialised help is important. Because

children with these disorders have different strengths

and difficulties, careful assessment is required in order

to develop a treatment plan. It is also important to build

language skills and social skills so that children can engage

more effectively in everyday situations. Speech therapists

have an important role to play in providing individualised

programs and/or consultation to the ECEC service

and family.

ASDs are lifelong disorders. Though children grow and

learn new skills, problems with social interaction and

communication may continue into adulthood. It is important

to focus on developing strengths and to put in place

strategies to build these strengths in children.

Other things which may assist children:

� Keep the environment predictable—children may not cope

well with change and become distressed when routines

are disrupted.

� Encourage social and emotional learning, particularly

showing children how to notice others’ feelings and

thoughts and how to respond appropriately.

� Focus on children’s strengths—this will enhance a child’s

sense of confidence and security.

� Provide visual cues such as pictures or a story outline

to support communication, understanding and learning

new skills.

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Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder

(ADHD) is a neurodevelopmental disorder

that first appears in childhood and is most

commonly identified in the preschool and

early school years, however a diagnosis is not

typically made until later in childhood.

Since the symptoms of ADHD are seen in all

children from time to time, it can be difficult to

diagnose. Typically a diagnosis is made by the

age of seven, when the symptoms are most

obvious. Although the symptoms of ADHD

may improve as children mature, as many as

60 per cent of those diagnosed with ADHD in

childhood continue to have some symptoms

in adulthood.

What would you notice in a child with ADHD? The most striking features of ADHD in children

are difficulties with paying attention, impulsive

behaviour and overactivity. They find it hard

to control their immediate reactions and

frequently act impulsively without thinking first.

Children with impaired attention change their

activities often without finishing what they are

doing. They have difficulty concentrating and

remembering what they are told to do.

Children with hyperactivity often talk too

much and behave noisily. They seem to

be always on the go and are frequently

restless in situations where they need to be

calm. As well, children with ADHD may be

careless in dangerous situations as they are

impulsive or misjudge environmental cues.

They may constantly interrupt or intrude

on others and have difficulty taking turns in

games or conversation. Older children with

ADHD are often not able to plan ahead or get

themselves organised.

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They are also important for learning new

things. Because children with ADHD have

poor executive functioning, they often have

difficulty in social situations. The most

common difficulties are with sustaining

attention and controlling impulsive reactions.

This pattern is referred to as hyperactive-

impulsive ADHD. Other children may show

inattentive ADHD, where their main problems

are to do with the rate at which they can

take in and process information. Inattention

can be more difficult to notice and requires

careful observation.

Though problems with concentration and

attention are central features of ADHD, they

may still vary under different circumstances.

For example, concentration may be good

when the child is highly motivated by a video

game but may be much poorer when reading

a book.

Attention problems and ADHDPoor attention regulation, being overactive

and acting on impulse rather than thoughtfully

are seen in all children from time to time, and

may be quite common at different ages. There

is no clear cut-off between those with ADHD

and those without. For a diagnosis to be

made, the difficult behaviours are:

� far more common than are expected in

children of the same age

� evident in more than one situation

� likely to cause problems for a child to get on

well at home, at school or with friends.

When behaviours are significantly out of

step with the performance of other children

and are causing problems for a child, at

home, at school and with friends, then further

investigation should be undertaken.

How does ADHD affect attention? Children with ADHD have been shown to have

minor differences in brain function compared

to other children, especially with those thought

processes that control attention and organise

memory. These processes are known as

‘executive functions’.

Executive functions allow us to set goals and

maintain focus, screen out distractions, check

our progress and regulate feelings. They are

necessary for directing our own actions and

controlling our emotions.

In brief: Executive function: Skills for life and learning http://developingchild.harvard.edu/

resources/multimedia/videos/inbrief_

series/inbrief_executive_function/.

Center on the Developing Child, Harvard University: Building the brain’s ‘air traffic control’ system: How early experiences shape the development of executive function http://developingchild.harvard.edu/

resources/reports_and_working_

papers/working_papers/wp11/.

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Children with ADHD at ECEC servicesChildren with ADHD have a difficult time in

environments where specific behaviours are

required of them, such as an ECEC service.

Sitting still, listening to instructions, needing

to wait before speaking and engaging in

play experiences are activities that involve

executive functioning, and so are more

difficult for children with ADHD. Their inability

to maintain attention and control impulsive

behaviour can interfere with the routines of

an ECEC service. Their behaviour can also

disrupt the learning experiences of other

children. Educators may find it difficult to meet

their special needs.

Although children with ADHD continue to

learn, they often fall behind the progress of

other children. As they get older, they may

develop secondary problems, such as poor

self-esteem and anxiety, because they find

it difficult to meet the expectations of certain

experiences such as social relationships

with peers. They may receive negative

feedback about themselves as students. Early

difficulties with attention have been shown to

negatively affect achievement at school.

How is ADHD diagnosed? A diagnosis of ADHD is not straightforward.

It cannot be diagnosed by any one clinical or

laboratory test. To make a diagnosis, a mental

health professional needs to undertake a

thorough assessment of many factors. These

include the child’s progress through early

development, any prior experience of trauma

or ill health, family circumstances, learning

and behaviour at their ECEC service. Families

and educators will be asked about behaviours

they have observed at home and at school.

Sometimes families and educators are asked

to complete questionnaires that rate children’s

behaviour to assess the severity of the ADHD

symptoms. They will ask how much symptoms

affect a child’s capacity to cope at home, at

school and with friends. All of the evidence

will be combined to help the mental health

professional come to a conclusion about

whether the child has ADHD or not.

ADHD and other mental health problemsChildren with ADHD are at greater risk of

developing other mental health disorders.

These particularly include behaviour and

learning disorders, such as Oppositional

Defiant Disorder (ODD), Conduct Disorder

(CD), learning and/or language disorders,

which may occur alongside ADHD. Children

with ADHD may also experience feeling

depressed or anxious, have low self-esteem

and difficulties with making or keeping friends.

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Australian Psychological Society—Attention Deficit Hyperactivity Disorder www.psychology.org.au/community/topics/adhd/.

Raising Children Network—Attention Deficit Hyperactivity Disorder http://raisingchildren.net.au/articles/adhd.html/

context/732.

Supporting children with ADHD The best way to support and assist children with ADHD is to

have a coordinated approach involving families, mental health

professionals and educators. ADHD is a disorder that can look

different in different children, so it is important to be aware of

each child’s specific strengths and areas of difficulties.

Some suggestions include:

� provide structure and routine, give clear instructions to

children

� maintain good relationships with the child, including having

fun and tuning in to their interests

� tune into what might trigger certain behaviours for a child and

what helps them to feel calm

� give positive feedback when children are doing well.

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Other neurodevelopmental disorders in early childhoodOther neurodevelopmental disorders which may present during the early childhood years include:

Intellectual disability Characterised by deficits in general intellectual functioning, such

as reasoning, planning, judgement, thinking and learning. These

may lead to impairments in practical functioning.

Communication

disorders

Difficulties in understanding spoken language (receptive

language), being understood by others (expressive language),

and social communication. Communication difficulties impact on

children’s social relationships, mental health, behaviour, learning

and development.

Sensory processing

disorders

Children with sensory processing disorders misinterpret sensory

information, such as touch, sound and movement. They may also

have difficulty integrating sensory information. Children may feel

overwhelmed by sensory information (e.g. lights, noise), may seek

out sensory experiences (e.g. requiring lots of sensory input) or

avoid them (e.g. being reluctant to engage in different activities).

Motor disorders Gross and fine motor skills refer to the way that children use

their bodies. Difficulties in these areas impact on children’s play,

development of self-care skills, learning, behaviour and social and

emotional wellbeing

Child Youth Health—Intellectual Disability www.cyh.com/healthtopics/healthtopicdetails.aspx?p=114&np=306&id=1876.

Psychology Today—Communication disorders www.psychologytoday.com/conditions/communication-disorders.

Speech Pathology Australia—Communication disorders www.speechpathologyaustralia.org.au/publications/fact-sheets.

Minnesota Association for Children’s Mental Health—Regulation disorder of sensory processing www.macmh.org/publications/ecgfactsheets/regulation.pdf.

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Children’s behaviour can be disruptive and difficult at

times. As part of learning how to behave appropriately

children may test adult rules at home, an ECEC service or

in the community. Often such behaviour is a reaction to

stress or frustration.

For some children, testing behaviour can be taken to the

extreme and develop into a problematic pattern that can include

acting impulsively, reacting with aggression, refusing to follow

reasonable directions and defying adult authority. Children

who behave like this usually have trouble in their social

relationships, including making and keeping friends. They may

be excluded from play, as they often have trouble with following

the rules or behave aggressively to get their own way

These patterns of behaviour interfere with children’s learning

and development. They often lead to consequences, such

as needing supervision at their ECEC service. Children with

serious behaviour problems might not feel connected at

the ECEC service and can experience low self-esteem and

depression.

When children show persistent and extreme patterns of

disruptive behaviours they may be diagnosed by mental health

professionals as having a Disruptive Behaviour Disorder (DBD).

There is debate amongst professionals as to the usefulness of

diagnosing DBD. Some specialists are concerned that mental

health labels can cause children to be stigmatised. They argue

that the strategies for assisting children with serious behaviour

problems are the same for those whose problems may be less

severe. They feel that the diagnosis can lead others to see the

child rather than the behaviour as the problem. Such negative

evaluations can be a significant obstacle to effective treatment

of children with behaviour problems.

Serious behaviour problems

Other mental health

professionals say that the

diagnosis helps to identify

those children who are

most in need of additional

help. They argue that early

identification and specialist

intervention for DBD is

necessary, particularly

because these disorders

can have very serious long-

term consequences if not

addressed early.

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ODD is described as a pattern of thinking

and behaving that is resistant, impulsive

and reactive. Children given this label may:

� argue constantly with adults

� refuse to carry out requests or conform

to rules

� blame others for their mistakes

or misbehaviour

� have frequent temper tantrums and

show resentment

� behave in a negative, hostile way

towards authority figures

� deliberately annoy others

� be quick to react when others

annoy them.

The two main diagnostic categories for severe

behaviour problems are Oppositional Defiant

Disorder (ODD) and Conduct Disorder (CD).

ADHD is also sometimes included as a

third category.

Conduct disorder (CD) is not usually

diagnosed in the early childhood

years. CD is more commonly seen in

adolescence when behaviours that were of

concern at a younger age have grown to a

more serious level.

Children with serious behaviour problems

can be helped by the adults in their lives

building strong relationships with them as well

as helping them to develop their social and

emotional skills.

For more information, see:

Response ability—Identifying emotional and behavioural problems www.responseability.org/__data/

assets/pdf_file/0009/4869/

Identifying-Emotional-and-

Behavioural-Problems.pdf.

Kidspot—Oppositional Defiant Disorder www.kidspot.com.au/

familyhealth/Learning-and-

Behaviour-Understanding-

Oppositional-Defiance-

Disorder+4807+188+article.htm.

Minnesota Association for Children’s Mental Health—Conduct Disorder www.macmh.org/publications/fact_

sheets/Conduct.pdf.

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When babies are born they are faced with a very new and

foreign environment. They have to adjust to new types of

lighting, noises, colours, temperatures and people in the

world outside the womb. This means that newborns often

have irregular cycles of sleeping, waking and feeding as

they adjust to their new environment.

Over time, with the support of warm, responsive and nurturing

caregivers, babies begin to develop more of a routine in their

sleep, waking and feeding patterns. However, even the most

reliable routines can come undone as children become ill,

experience change or have developmental spurts. In these

circumstances, routines often settle back again after a period

of adjustment.

Regulatory difficulties

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There are some children who show persistent regulatory difficulties. They often have irregular

sleep/wake cycles and sleep disturbances, difficulties in self-soothing, distress associated with

routine and can become distressed by sensory experiences. Children who show such issues are

at greater risk for developing mental health difficulties as they get older.

Feeding

and eating

disorders

A persistent disturbance in eating-related behaviour results in the altered

consumption of food and impairs a child’s physical health and their

psychological functioning. Disorders in early childhood can include:

Pica: Eating non-food substances over a period of at least one month.

Rumination disorder: Repeated regurgitation of food over a period of at

least one month.

Avoidant/restrictive food intake disorder: Lack of interest in food,

avoiding food which may result in interference in psychological functioning

and physical effects such as weight loss or nutritional deficiency.

Sleep/wake

disorders

When a child experiences difficulties with sleep patterns, getting to sleep,

insomnia, breathing-related disorders or nightmare disorders.

Minnesota Association for Children’s Mental Health—Regulation disorder of sensory processing www.macmh.org/publications/ecgfactsheets/regulation.pdf.

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� Children with mental health diagnoses can move towards and experience good mental health when supported in an environment that meets their individual needs.

� There are a range of risk and protective factors that can influence children’s mental health and wellbeing. Reducing risk factors and building on protective factors promotes children’s mental health.

� Warm, responsive and trusting relationships with families and educators support children’s development and mental health.

� Children experience mental health difficulties for a range of reasons and the way they present is dependent on the individual child, their family and the environment.

� Making observations, considering BETLS and consulting with families and mental health professionals can provide a better understanding of a child and their difficulties.

� There are a range of mental health professionals and supports that can assist children and their families.

� Children experiencing anxiety may be fearful, avoidant or nervous about situations or interactions.

� Children who have experienced trauma may become easily overwhelmed and benefit from safe, predictable and stable environments to support their wellbeing.

� Children with depression may be disengaged, irritable, have sleep problems and appetite changes. They may also have difficulty describing how they are feeling and need adults to help them explore underlying feelings.

� Neurodevelopmental disorders occur when the course of brain development is altered. Autism and ADHD are neurodevelopmental disorders which are associated with a range of learning, behavioural and social difficulties.

� Children with serious behaviour problems may act impulsively, aggressively and defy adults. These behaviours can isolate children, affecting their learning, development and social experiences.

� Most children have difficulty self-regulating in the early years, though with time, they develop predictable patterns of behaviour and the capacity to self-soothe. Children who continue to have trouble with self-regulation are at risk of developing mental health difficulties as they get older.

� Early support and consultation between families, mental health professionals and educators can greatly benefit children’s

mental health development.

SummaryEveryone has mental health and like physical health, it can range from ‘good’ to ‘poor’ and

can change over time. Some children will experience mental health difficulties and require

further support. Early childhood is a period of great developmental potential; supporting

children with difficulties during this time is likely to be associated with improvements in

learning, development and mental health.

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Anderson, P. (2002). Assessment and

development of executive function during

childhood. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 8(2), 71–82.

Angold, A., & Egger, H. L. (2007). Preschool

psychopathology: Lessons for the lifespan.

Journal of Child Psychology and Psychiatry,

48(10), 961–966.

Bayer, J. K., Hiscock, H., Ukoumunne, O. C.,

Price, A., & Wake, M. (2008). Early childhood

aetiology of mental health problems: A

longitudinal population-based study. Journal of Child Psychology and Psychiatry, 49(11),

1166–1174.

Bayer, J. K., Ukoumunne, O. C., Mathers,

M., Wake, M., Abdi, N., & Hiscock, H. (2012).

Development of children’s internalising and

externalising problems from infancy to five

years of age. Australian and New Zealand Journal of Psychiatry, 46(7), 659–668. doi:

10.1177/0004867412450076

Carter, A. S., Wagmiller, R. J., Gray, S. A.

O., McCarthy, K. J., Horwitz, S. M., & Briggs-

Gowan, M. J. (2010). Prevalence of DSM-IV

disorder in a representative, healthy birth

cohort at school entry: Sociodemographic risks

and social adaptation. Journal of the American Academy of Child and Adolescent Psychiatry,

49(7), 686–698.

Cavanagh, S., Lawrence, J., & Hirst, M. (2010).

Recognising mental health problems and

seeking support. Every Child, 16, 8–9.

Child & Adolescent Mental Health Services.

(2001). Everybody’s business. Cardiff: National

Assembly for Wales. Retrieved from http://www.

wales.nhs.uk/publications/men-health-e.pdf.

Degani, G. A., Breinbauer, C., Roosevelt, J. D.,

Porges, S., & Greenspan, S. (2000). Prediction

of childhood problems at three years in children

experience disorders of regulation during

infancy. Infant Mental Health Journal, 21(3),

156–175.

Department of Education and Children’s

Services (DECS). (2006). Healthy minds/Healthy futures: Child mental health and wellbeing study. Summary of findings.

Retrieved from http://www.decs.sa.gov.au/

speced2/files/pages/chess/hsp/Research/

final_2005_parent_results.pdf.

Donohue, P. J., Falk, B., & Provet, A. G. (2007).

Promoting social-emotional development in

young children: Mental health supports in early

childhood. In D. F. Perry, R. K. Kaufmann &

J. Knitzer (Eds.), Social and emotional health in early childhood: Building bridges between services and systems (pp. 281–312). Maryland:

Paul H. Brooks Publishing Company.

Hunter Institute of Mental Health and

Community Services and Health Industry

Skills Council (HIMH & CSHISC). (2012).

Children’s mental health and wellbeing: Exploring competencies for the Early Childhood Education and Care Workforce. Final Report.

Department of Education, Employment and

Workplace Relations (DEEWR). Canberra,

ACT: Commonwealth of Australia.

References and resources

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National Scientific Council on the Developing

Child. (2008). Mental health problems in early childhood can impair learning and behaviour for life. Retrieved from http://developingchild.

harvard.edu/index.php/resources/reports_

and_working_papers/.

Sawyer, M. G, Arney, F. M., Baghurst, P. A.,

Clark, J. J., Graetz, B. W., Kosky, R. J., &

Zubrick, S. R. (2001). The mental health of

young people in Australia: Key findings from

the child and adolescent component of the

national survey of mental health and well-

being. Australian and New Zealand Journal of Psychiatry, 35, 806–814.

Spence, S. H., Rapee, R., McDonald, C., &

Ingram, M. (2001). The structure of anxiety

symptoms among preschoolers. Behaviour Research and Therapy, 39, 129–1316.

U.S Congress Office of Technology

Assessment. (1986). Children’s mental health: problems and services—A background paper. Washington D.C: U.S Government

Printing Office.

Zeanah Jnr, C. H. (2009). Handbook of Infant Mental Health (3rd edn). New York:

The Guilford Press.

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GlossaryBiopsychosocial

model

The biological, social and psychological factors that influence an

individual’s mental health and wellbeing.

Community

connectedness

The coming together of individuals in a community. Involves

relationships that benefit individuals and society.

Conduct disorder A serious behaviour disorder categorised by a repetitive and

persistent pattern of behaviour in which the basic rights of others

or societal rules and norms are violated. Conduct disorder is

not usually diagnosed in the early childhood years and is more

commonly seen in adolescence when behaviours that were of

concern at a younger age have grown to a more serious level.

Dissociative

symptoms

Detachment from immediate surroundings and reality.

Fine motor

movements

Movements that involve small muscle groups such as in the fingers

and toes.

Genetic vulnerability Being at greater risk for developing disorders as a consequence of

inherited genes.

Gross motor

movements

Movements that involve large muscle groups such as the legs

and arms.

Hypervigilant Being on the constant lookout for danger, and perceiving levels of

threat to be higher.

Impulsive

behaviours

The tendency to act with little forethought, reflection or

consideration of consequences of behaviour.

Intellectual disability Characterised by intellectual functioning well below what is

expected for a child of the same age and difficulties in adaptive

behaviour. This may include communication, self-care, social skills

and learning.

Mental health

professional

A professional with qualifications in mental health who can provide

assessments, diagnosis and therapy for mental health difficulties.

Neurodevelopmental

disorders

Diagnoses that occur in response to altered brain development.

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Oppositional

behaviour

Disobedient, aggressive and defiant behaviour.

Re-experiencing Having recurrent thoughts, memories and nightmares about a

traumatic event. Feeling as if the traumatic event were happening

again in a ‘flashback’. Having strong emotional and physical

reactions when reminded of a traumatic event.

Self-esteem Confidence in own worth and abilities.

Self-regulate The ability to self-soothe, manage emotions and follow a routine.

Social and emotional

learning

Learning how to interact in relationships, and managing one’s own

feelings and reactions towards others and experiences.

Socioeconomic

status

An individual’s or family’s economic and social position in relation to

others, based on income, education and occupation.

Somatic Physical complaints that are the consequence of psychological

distress (e.g. stomach-ache from nervousness).

Stressor An event or experience that leads to stress.

Temperament Innate characteristics that a child is born with that affect their

personality and behaviour.

Thinking style The way individuals think, perceive and remember information.

For example, some individuals respond better to visual information

as opposed to verbal information.