Post on 23-May-2020
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.