Crying child
"If (parents) know what to look for, they can learn how to better understand their baby's cues," says Janna Hack, an infant mental health specialist with the Wisconsin Alliance for Infant Mental Health. iStock photo

Can a baby be depressed? Can a toddler have a mental illness? Are pre-schoolers being expelled from day care for aggressive, unmanageable behavior?

The answer to all these questions is "yes," and experts say a lack of understanding about the social and emotional development and psychological well-being of babies and young children is at the root of many vexing long-term problems, from school failure to serious mental health issues.

“When we talk about infant mental health, we’re not putting babies on the psychologist’s couch or diagnosing a two year old with schizophrenia,” Therese Ahlers, executive director of the Wisconsin Alliance for Infant Mental Health (WI-AIMH), says.

Instead, Ahlers explains, the burgeoning field of infant and early childhood mental health focuses on the importance of promoting social and emotional health from the earliest possible age. It also teaches how to identify the behavioral warning signs in babies or young children who can’t talk about their psychological distress or mental or emotional pain, and recommend the help they, and their caregivers, need.

Social and emotional problems in young children can be expressed as aggressive behavior, including fighting, hitting, biting and pulling hair. Studies done in Wisconsin and nationally show that there are high rates of expulsion from childcare for such behavior.

In fact, according to a frequently cited 2005 study by Yale-based researcher Walter Gilliam, more pre-school children are expelled from childcare situations than from kindergarten through grade 12 combined.

“It’s a shocking number,” says Janna Hack, an infant mental health specialist with the Wisconsin Alliance for Infant Mental Health. She notes that small children with psychological troubles can least afford the emotional turbulence surrounding an expulsion from childcare, and their fragile families often also suffer from the disruption.

But given what we know about the terrible two’s and other developmental stages, how does a parent or day care provider distinguish between deeper problems and typically rebellious behavior?

Hack acknowledges that there could be a variety of reasons a baby shows signs of stress by biting or pulling hair or being unable to be comforted. A child could be coming down with an illness, is teething, hungry or tired. But when a small child’s troubling behavior is consistent over time and in a variety of settings, Hack says it’s a symptom of more serious problems, either physical or psychological. At that point, there should be a formal assessment of the child’s mental and physical health that results in the child and his or her caregiver getting the help they need.

Both Ahlers and Hack say there’s a growing awareness that many individuals in contact with young children may not know how to recognize signs of psychological stress in pre-school age children, or even know that children as young as four months can show symptoms of depression. When parents and family members, childcare workers, teachers, social workers, nurses, pediatricians or other professionals, including judges and court-appointed guardians, don’t know the symptoms of emotional distress in little children, they aren’t able to help, and may, in fact, make bad situations worse.

A new postgraduate certification program that began earlier this summer at the University of Wisconsin aims to help. The UW Infant, Early Childhood and Family Mental Health Postgraduate Certificate Program is unique in Wisconsin and among only a handful of programs throughout the country that focus on the social and emotional health of very young children.

The program’s first cohort of 45 students includes childcare administrators, psychologists, social workers and health care professionals; they began their part-time studies in June and will finish up next summer. Participants come to Madison for 13 months of two to three days of intensive classes, small-group sessions and training with courses taught and facilitated by state and national experts. Next week, for example, Dr. T. Berry Brazelton, one of the pioneers of the study of infant mental health and a nationally renowned pediatrician, author and host of the Emmy-winning television series, “What Every Baby Knows,” will be a guest lecturer and instructor for the program.

The course is designed to fill in many of the blanks in recognizing and treating mental health issues in babies and pre-school age children and supporting the development of healthy parent-child relationships.

Program co-director Roseanne Clark, a psychologist and associate professor at the University of Wisconsin School of Medicine and Public Health, says children in the first year of life can show signs of social and emotional disturbances through their sleeping or eating patterns, or by extreme sensitivities to sounds or touch or difficulty in social communication or engagement with those around them. Between two and five, children who are consistently overly aggressive, hyperactive or withdrawn may be showing signs of anxiety or depression.

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If untreated, Clark says, these kinds of social and emotional problems may lead to further problems, especially when children enter school. Inability to focus, to concentrate and learn and to relate to others can set a person up for a lifetime of mental health struggles.

“The cornerstone of human relationships is formed between a baby and his or her caregivers,” says Clark. If something goes amiss in building that bond, either because of the caregiver’s own depression, a family illness or stress, it can be more difficult for children to develop the trust they need to regulate emotions, form healthy attachments or to explore the world.

The good news is that early clinical evaluation and therapeutic intervention is especially effective for infants, young children and their caregivers; it means that a lifetime of more serious mental health disorders may be avoided if someone recognizes the problem, and recommends appropriate treatments or strategies.

As a mental health specialist for very young children, Hack has worked with many parents and children and now consults with childcare providers, providing suggestions on how they can help their most fragile families.

“If they know what to look for, they can learn how to better read their baby’s cues,” Hack says. In addition, it’s a help for parents to understand what they can expect developmentally from a baby or toddler, from month to month.

“It’s also important for parents to address what we call ‘ghosts in the nursery,’ or the patterns and impact of how they were raised. All of us carry forward our own history and just recognizing that can often be a help in beginning to change the ways we relate to our children,” she adds.

The program, co-sponsored by the UW Department of Psychiatry, University of Wisconsin School of Medicine and Public Health; the UW-Madison’s Division of Continuing Studies; the Waisman Center and the Wisconsin Alliance for Infant Mental Health, has already exceeded initial expectations for enrollment, reports Ann Whitaker of the Division of Continuing Studies.