The truth about Early Childhood Mental Health

Today I had a child in my office, the 4th time this week, for repeated unsafe behavior in the classroom. In talking with him after I was able to calm him, he told me how he hadn’t really slept the night before and he was having bad dreams about people trying to kill him. We talked about his dreams and why he might be having them. We talked about home and his family. When he had decompressed a bit I finally asked why he was participating in such risky behavior in his classroom. He told me that he didn’t care if he got hurt. I informed him that his teachers didn’t want anything bad to happen to him and that I loved him. He responded with “nobody loves me” followed by “I’m stupid” and “I want to kill myself”.

He just turned 5.

Unfortunately, this is not a rare occurrence. We hear these comments from our school-age children as well as our preschoolers on a fairly regular basis. So often, in fact, that we have an on-site mental health professional who immediately screens children who make these comments to determine their level of risk. Unlike some who say these things, this child was able to tell us how he would do it.

Society has come a long way in working to reduce the stigma around mental health issues. More adults are speaking openly about their own struggles. Facebook is ripe with support groups and forums for people who are struggling. After a rash of suicides and school violence it seems that maybe, just maybe, we are starting to acknowledge the need for accessible mental health services for children as young as middle school.  Unfortunately, the need begins much earlier than that.

Children as young as 3-5 are exhibiting behavior that ECE professionals are ill-prepared to handle. My center rarely gets through a day without a child throwing furniture, assaulting staff or peers, trying to run away or self-harming. These are behaviors that used to be more typical of treatment center settings than preschools and childcare. Trauma-Informed Care has become the key phrase for working with children. Centers with families of all socioeconomic classes are seeing these behaviors.

Such behavior and secondary trauma can be extremely taxing on staff members and can traumatize or re-traumatize classmates, leading to isolation for the child in crisis. This isolation only serves to further upset the child. Furthermore, for a child who enjoys attention, even bad attention will do. Sending a child with such behaviors home only reinforces the behavior if being home is what they want. Most early childhood professionals are employed at agencies that prohibit physical discipline in any form; by this, I mean holding a child to stop a behavior or physically moving them during an outburst. This leaves educators with very few options.

This all speaks to a greater need for more access to mental health professionals and resources. Many schools do not have an on-site mental health worker. This is especially true of early childhood programs. Unfortunately, funding does not allow for such resources. Furthermore, the availability of mental health professionals who are qualified to work with children is lacking.

In addition, there needs to be a recognition that these issues can arise in children this young. A quick internet search will yield few results that speak specifically to preschoolers and mental health struggles. The CDC acknowledges that children as young as 2 can suffer from ADHD and children as young as 3 can be diagnosed with anxiety and depression. In fact, as of 2018 a total of 6.3 million children between ages 3 and 17 had diagnosed depression or anxiety and 73.8% of children with depression also have anxiety.  These statistics should be an alarming call to action, especially considering the high rate of suicide among children. It is the leading cause of death among those aged 10-24 and suicidal children often have a comorbid diagnosis of depression or anxiety.

Pushback from parents who are unfamiliar with signs of mental illness or frightened by the thought of their child being diagnosed is another factor that limits intervention in these situations. Below is a list of signs that parents should watch for according to Dr. Susan Newman in Psychology Today. If parents notice these signs they should contact their child’s pediatrician right away.

  1. Having new or additional difficulty at school
  2. Physically harming or bullying others
  3. Participating in self-injurious behavior (this includes extreme risk-taking behavior)
  4. Avoiding loved ones
  5. Frequent mood swings
  6. Intense emotions including outbursts of anger or extreme fear
  7. Lacking energy or motivation
  8. Difficulty concentrating
  9. Sleep disturbances or frequent nightmares
  10. Somatic complaints
  11. Neglecting appearance
  12. Obsession with body image
  13. Drastic changes in appetite

It is imperative that we as a society make greater efforts to recognize these issues with young children and work to get them the earliest intervention possible. We, as parents, must also be brave enough to admit when our child is struggling and strong enough to be their best advocates.

For information on what to do if your child is showing symptoms:

For more statistics and research:


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