Absolutely, early interventions for behavioral health problems are critical for assuring persons’ well-being and long-term mental health. Early identification and intervention, according to research, can greatly improve results for those living with behavioral health difficulties, such as anxiety, depression, and other developmental disorders.
Data from over 15,000 low-income children aged 2 to 6 show higher-than-expected levels of serious behavioral disorders. The authors advocate for improved screening and prevention initiatives in primary care settings.
A six-year study that reviewed data from a 25-question screening questionnaire discovered worrying evidence of poor behavioral trajectories beginning as early as age 2 among low-income and other social stressor families. JAMA Pediatrics published the findings of a study performed by Robert Ammerman, PhD, and colleagues at Cincinnati Children’s.
Another study finding a link between family stress and kid behavioral problems may not surprise experts. The early start and severity of behavioral disorders, on the other hand, were unexpected. Importantly, the ability of a 10-minute screening test to uncover higher-risk groups of children shows that practical techniques to help professionals target limited intervention resources toward those most in need may already be available.
“The elevated results we saw reflect significant behavioral problems starting at very early ages,” Ammerman says. “The findings suggest that we cannot afford to wait until children enter school or reach their teen years to intervene. Our field needs to focus much more intently on prevention.”
Rx: population-level action PLUS earlier individual care
The elevated results we saw reflect significant behavioral problems starting at very early ages. The findings suggest that we cannot afford to wait until children enter school or reach their teen years to intervene. Our field needs to focus much more intently on prevention.
Robert Ammerman
The research team administered the Strengths and Difficulties Questionnaire (SDQ), a well-established screening tool, to 15,218 children during yearly well-child visits at three primary care offices and three school-based care clinics.
The caregivers, usually mothers, responded to the questions by reporting whether their children were more likely than others to display specific behaviors. Fighting, temper tantrums, fearfulness, excessive fidgeting, readiness to help others, avoiding other children, and other issues were addressed in the questions.
The research looked at the overall frequency of reported problems rather than the precise sort of conduct. The researchers looked at the relationship between reported issues and other family information, such as the mother’s mental health status and whether any of the numerous known social determinants of health were present.
34% of the children examined had major behavior difficulties, according to caregivers. The researchers also classified “trajectory groups” based on whether behavioral issues diminished or worsened with age. Those with rising trajectories were more likely to be male, publicly insured (Medicaid), have a depressed caregiver, or live in a family with additional social needs.
Recognizing the importance of these early trajectories, the pediatric practices have implemented the new Integrated Behavioral Health Program at Cincinnati Children’s. That program provides psychologists who meet directly with families during well-child visits to recommend steps parents can take at home and evaluate children who may need more intensive support.
“Screening for behavior problems in primary care has been recommended since 2015 by the American Academy of Pediatrics but only some practices are routinely doing this,” Ammerman said. “We also understand that many pediatric primary care practices do not have a mental or behavioral health professional working in the office.”
As a result, unless care resources are drastically increased across the country, the initial steps for treating behavioral health concerns must focus more on preventive treatments to promote healthy behavioral development.
“It’s critical to remove or reduce as many of the stresses that are negatively affecting early childhood development as possible,” says Robert Kahn, MD, MPH, director of Cincinnati Children’s Michael Fisher Child Health Equity Center and study co-author. “We know that when children have safe housing and enough nutritious food to eat, they are less likely to develop behavioral disorders.” We know that depression in new mothers can be efficiently treated, which can considerably enhance the child’s mental health. More safe children and families are less likely to require difficult-to-obtain professional services.”
According to Ammerman, it is critical for more pediatric practices to screen for child behavior problems, even if there aren’t as many resources for referrals as they would want to see.
“Pediatricians are frequently the first, sometimes the only trusted person to hear about behavioral health concerns before children reach school age,” he said. “They are very busy but taking this time can provide an opportunity to intervene before behavior problems elevate into more serious and harder-to-treat diagnoses later.”
Next steps: Longer-term analysis
Cincinnati youngsters’s Hospital plans to expand its SDQ data collection in youngsters up to the age of 12. Ammerman argues that different screening technologies would be utilized for teenagers and youngsters under the age of two. Over time, the data will aid in determining which types of inventions are most beneficial and when they should be used.
Meanwhile, this type of data will help to drive a large-scale mental health trajectories research study currently underway at Cincinnati Children’s. This initiative, led by researchers John Pestian, Ph.D., and Tracy Glauser, MD, entails employing one of the nation’s most powerful supercomputers to train an artificial intelligence software platform capable of rapidly analyzing several types of patient data and producing mental health “growth charts.” These reports would help clinicians identify at-risk children at significantly earlier stages than current practices.
Cincinnati Children’s has a long history of addressing child development issues outside of the hospital, including years of partnership with legal aid and child welfare organizations, home visiting programs for new moms, and other initiatives. According to local experts, integrated behavioral health is a particularly promising technique for increasing access to essential therapy and support. Cincinnati Children’s recently announced Mental and Behavioral Health Institute aims to expedite the growth of integrated behavioral health services into community-based pediatric practices.
