for stronger efforts to prevent mental, emotional, and behavioral disorders in
children are beginning the new decade with momentum.
National Research Council and the Institute of Medicine are among the latest
voices to call for a shift in policy and practice toward addressing the roots
of mental, emotional, and behavioral problems rather than waiting until a
disorder is well established and has caused harm. A March 2009 report published
by the influential National Academies concluded that preventing such problems
and promoting the mental health of children should be a national priority.
shift presents a number of challenges for behavioral science, educators and
those who make and implement public policy. Chief among them is embracing the
early childhood years—when the quality of a child’s environment, relationships,
and other experiences have a profound impact on development and later
outcomes—as a window of opportunity to prevent mental, emotional, and
behavioral problems later in life.
"It is a
new way of thinking for everyone involved," said Ray Firth, director of the
Division of Policy Initiatives at the University of Pittsburgh Office of Child
Development (OCD). “In psychology, there had been the nature-versus-nurture
debate. Now, it’s the interaction of the two.”
County appears to be ahead of the curve when it comes to adopting approaches
focused on preventing a problem from occurring in the first place. Prevention has
gained traction in the county over the past decade as a prudent way of
addressing issues related to children and families such as school readiness,
social-emotional problems, and maternal depression.
A Widespread Problem
emotional, and behavioral disorders among children, adolescents, and young
adults can range from depression to conduct disorders and substance abuse.
These problems impose serious hardships on children and on their families and
society as well.
disorders are not uncommon among that population. Studies cited in the National
Academies report suggest that between 14 percent and 20 percent of children,
adolescents, and young adults experience a mental, emotional, or behavioral
disorder at a given point in time. For example, one study found that in 2006 an
estimated 21 percent of adolescents ages 12-17 years received treatment or
counseling for mental, emotional, and behavioral problems.
these problems can be seen at an early age, even before age 5. Evidence
suggests, for instance, that the rate of expulsion from preschool programs for
behavioral problems is higher than expulsion rates for behavioral problems in
grades kindergarten through 12.
address these disorders can be devastating to the child and costly to the
nation, the National Academies report suggests. Early onset of mental,
emotional, and behavioral problems predicts lower school achievement, a higher burden
on the child welfare system, and greater demands on the juvenile justice system. Early
aggressive behavior increases the risk of conduct disorder and later drug use. And
one estimate cited in the report suggests the costs associated with mental,
emotional, and behavioral problems in the United States totaled $247 billion in
provides strong support for addressing these problems during childhood. Studies
suggest, for example, that half of all mental, emotional, and behavioral
disorders among adults were first diagnosed before they were 14 years old.
Risks Can Be Reduced
have identified many factors within the family, schools, and community that can
increase or decrease the risk of children developing mental, emotional, and
behavioral problems. In addition, several interventions have shown promise in
reducing the risk of such problems becoming well-established disorders.
parent’s mental illness, child abuse and neglect, divorce and separation, and
poor parenting are among the family circumstances that put children at greater
risk of developing disorders. Academic failure, bullying, and violence are
among the risk factors children may encounter in their schools and communities.
perspectives on the development of the brain that researchers began reporting
more than a decade ago also have implications for preventing the onset of mental,
emotional, and behavioral problems. They found that not only does a great deal
of brain development occur very early in childhood, it also is greatly
influenced by experience and environment.
National Academies report recognizes this, stating that the body of evidence
shows that mental, emotional, and behavioral disorders are developmental; that
the earliest years of life are the most opportune times to affect change; and
that children develop in the context of their families, schools, and communities—environments
that cannot be ignored if their risks of developing disorders are to be
also argues that supporting the development of children requires coordination
and collaboration across systems—such as public health, health care, and
education—in order to more effectively support and finance preventive interventions
on multiple levels.
Paradigm Shift Needed
prevention of mental, emotional, and behavioral problems first and foremost
requires a way of thinking that goes beyond the traditional disease model of
waiting until a disorder occurs and then providing treatment.
challenges everyone from researchers and educators to practitioners and
policymakers to develop and adapt to approaches designed to prevent these
disorders from becoming stubborn, debilitating problems for children and young
to a prevention model that focuses on early childhood as an advantageous period
for addressing mental, emotional, and behavioral problems will likely not be
easy or quick. Such a change affects everything from government reimbursement
structures to the training of those who work with children but are not familiar
with the development of mental, emotional, and behavioral disorders. In fact,
many professionals in fields ranging from health care to childcare fall into
said Firth, “when you talk to speech therapists, they know that a lot of the
children they serve for a speech problem also have emotional problems. But they
haven’t been trained to address it as part of speech therapy. Their training is
limited, even though they know that it is an important dimension of the
children they are serving—that the child’s speech is not independent of the
child’s socio-emotional development. Many people in early childhood don’t even
have that level of training.”
news is that prevention-based approaches have steadily gained support in recent
years as effective ways to improve a range of child outcomes, particularly in Allegheny
for example, is home to one of the nation’s most successful networks of family
support centers, which take a collaborative, prevention-based approach to
improving the well-being of children by strengthening families and communities.
The Pittsburgh Public Schools is one of several districts that uses Promoting
Alternative Thinking Strategies, a curriculum for helping educators promote
development of self-control, emotional awareness, and problem-solving skills
among children. The Allegheny County Maternal and Child Depression Initiative
organized a partnership to build a more cohesive, seamless system for
diagnosing and treating women for depression that includes health insurance
companies, Pennsylvania Department of Public Welfare, Medicaid managed care organizations,
OCD and local general health and mental health providers, service agencies,
community organizations, and consumers. Left untreated, a mother’s depression
increases the risk of her child developing behavioral problems, experiencing
academic difficulties, and other poor outcomes.
Pennsylvania, early childhood education has gained considerable support in
recent years across Pennsylvania as a way to prevent school failure.
Initiatives such as Pre-K Counts and Keystone STARS, for example, have improved
the quality of early learning environments, making it more likely that children
will be prepared to succeed in school.
national perspective, much work remains to be done to more broadly and
effectively address mental, emotional, and behavioral disorders through
prevention, according to the National Academies report.
calls on the White House to create a federal entity to lead the implementation
of evidence-based prevention approaches and fund state and local efforts to put
those approaches into practice. It also urges continuing research across
disciplines to better understand what prevention approaches work and how to
best implement them, and suggests that the National Institutes of Health
develop a 10-year plan to study ways to promote mental health and prevent
mental, emotional, and behavioral disorders in children.
“There is a
substantial gap between what is known about preventing mental, emotional, and
behavioral disorders and what is actually being done,” said Kenneth E. Warner,
dean of the University of Michigan School of Public Health, who chaired the
committee that oversaw the National Academies report. “It is no longer accurate
to argue that these disorders can never be prevented. Many can. The nation is
well positioned to equip young people with the skills and habits needed to live
healthy, happy, and productive lives in caring relationships. But we need to
develop the systems to deliver effective prevention programs to a far wider
group of children and adolescents.”
Research Council and Institute of Medicine. (2009). Preventing Mental,
Emotional, and Behavioral Disorders Among Young People: Progress and
Possibilities. Committee on the Prevention of Mental Disorders and Substance
Abuse Among Children, Youth, and Young Adults: Research Advances and Promising
Interventions. O’Connell, M.E., Boat, T., & Warner, K.E. Ed. Board on
Children, Youth, and Families, Division of Behavioral and Social Sciences and
Education. Washington, DC: The National Academies Press.
A brief for
researchers of the above report is available online at: http://www.bocyf.org/prevention_policymakers_brief.pdf