Early Childhood Mental HealthIssues of Diagnosis and Treatment

Jeffrey Rowe, MDSupervising Psychiatrist, County of San DiegoAssociate Clinical Professor, UCSD

What is ECMH????

To better understand, we have to work backwards

Start with the hard-to-treat kids Juvenile Hall Polinsky Center Residential Treatment Centers Hospitals Special education placements Outpatient settings

Easiest Cases to See ECMH Origin

CWS and Probation cases

Lots of data to show the teens in RTC and JH had troubles early on (before 6)

Many of these kids had troubles related to neglect, abuse, exposure to trauma*

Why does early trauma/neglect cause later mental health problems?

This is relatively well studied

2 principles

Development before birth is dependent on DNA and mother’s health

Development after birth is dependent on DNA and experiences (the Holding Environment the child is raised in)

5

Foundation for Future Development

Neurological

Psychological

Sociological

Potential Problems Sleeping Eating Crying, irritable or depressed mood Social interaction Aggression Attachment Easily over stimulated Parent-Child Relationship (defiance,

temperamental mismatch)

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“Holding Environment” factors

Lack of knowledge about children Troubles nursing, lack of understanding

about feeding kids Violence in the home Low IQ of caretaker Financial stress Substance abuse by caretakers Mental illness or physical illness of

caretaker Multiple children close in age

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Early Potential Problems can become diagnosable conditions, but many factors determine whether that

happens and how it evolves

Potential Problems

at T1

Holding environment

Factors

Developmental Changes

- of the child-of the family

-of the environ

SubsequentInterventions

Early Interventions+

Worsening, of problem at T2

then…

+Worsening of problems(s)

at T3

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What is ECMH?

DNA- watching for early signs and symptoms of biological mental health problems

Supporting Mom’s health prenatally

Helping the Holding Environment meet the needs of the child

Educating, supporting, and treating the different parts when things go wrong

Not waiting for the problems to become incorporated in the kid’s neurodevelopment