Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.
This guide was last reviewed or updated on April 7, 2022.
What is this resource about? This paper provides information on the social, emotional and behavioural difficulties (SEBD) that emerge in the early childhood years (birth to age 3). It highlights the challenges of differentiating between normal concerns and SEBD, and offers practical tips that may assist practitioners to increase their knowledge, skills and confidence on this topic. Evidence from published research has been used to inform this resource, as well as practitioners’ experiences in working with children and families. This paper is not intended to be a comprehensive guide to the topic of childhood SEBD; nor is it meant to suggest that it is the role of early childhood practitioners to conduct comprehensive assessments of children’s emerging mental health problems. Knowledge of SEBD develops through experience working with children and families, professional training, reflective practice, discussion with colleagues, and supervision. A range of additional resources are listed at the end of this paper; these provide more information across a range of related topics. Who is this resource for? This paper may benefit any practitioners working in the health, community services and early childhood, education and care sectors. These practitioners are all well-placed to identify SEBD early in a child’s life, as they come into regular contact with children and families in the early years. While the focus of this paper is on identifying SEBD, the importance of using a strengths-based approach when working with children and families is emphasised throughout. Focusing on strengths does not mean ignoring challenges, and identifying SEBD in the early years supports the provision of effective and timely support to children and families. Definitions For ease of reference the term ‘practitioners’ will be used throughout this paper to refer to professionals working with families in the early childhood years. The term ‘parent’ will be used to describe a person undertaking the role of parenting and includes a range of caregivers (e.g. grandparents, foster carers, kinship carers). Social, emotional and behavioural difficulties (SEBD) are responses that are very different from generally accepted age-appropriate norms of children with the same ethnic or cultural background, and which significantly impair the child’s and/or family’s functioning (Poulou, 2015). The term ‘SEBD’ will be used throughout this article to describe clinically significant and persistent difficulties, whereas ‘problems’ or ‘concerns’ will be used to describe developmentally normal and transient issues.
The early childhood years (birth to age 3 or ‘the first 1,000 days’) are a time of rapid physical, emotional and cognitive development. Many children experience developmentally normal social, emotional and behavioural problems during this time which they simply ‘grow out of’, without the need for service or support. However, research shows that for some children, early childhood may also be the start of a pattern of more severe and persistent SEBD that continue throughout childhood, leading to a range of mental health problems (see Bagner et al., 2012). Most young children with social, emotional and behavioural difficulties do not receive professional help (Oh et al., 2015). Thus, the early childhood years represent a key period for identifying children at risk of ongoing difficulties, who are likely to benefit from early, appropriate and timely support.
Prevalence of early SEBD and help seeking A recent Australian study found that there is a substantial gap between the mental health needs in toddlers and preschoolers and the services accessed (Oh et al., 2015). This study found prevalence rates of SEBD were 13-19% (around 1 in 6); similar to findings from international studies of around 15% (e.g., Briggs-Gowen, 2001). While SEBDs were common, few families reported accessing services: around half sought no help at all, 34-45% received informal help (e.g. from friends, family, books, videos, etc.) and only a small proportion (7-8%) received help from health professionals (Oh et al., 2015).
Positive social, emotional and behavioural development is important for children’s overall wellbeing. In the early childhood years, there are rapid physical and cognitive changes that take place. These changes, along with children’s first experiences of complex emotions such as frustration, lead to a range of developmentally normal social, emotional and behavioural challenges, including:
Behavioural problems in particular are very common. For example, by 17 months of age, 70% of children are reported to take toys away from others, and almost half push others to obtain what they want (Tremblay et al., 1999). However, when these problems are more frequent, severe and impact on the child and/or family’s functioning, they may indicate SEBD. Other key points about early SEBD include:
What are externalising and internalising problems? SEBD can be categorised as externalising or internalising problems. Externalising problems include problems that are directed towards the external environment and include behaviours such as tantrums, defiance, aggression and destructiveness. These problems are common and can be developmentally normal; however, when symptoms are more frequent, severe or impair the child and/or family’s functioning, they can lead to a diagnosis of ‘disruptive behaviour disorders’ or ‘externalising disorders’. The most common externalising disorder in childhood is Oppositional Defiant Disorder (ODD) which is a pattern of angry/irritable mood, argumentative/defiant behaviour or vindictiveness lasting at least six months (American Psychiatric Association, 2013). While ODD can be diagnosed at any age, it would rarely be diagnosed before the age of 3 years. Internalising problems describe problems that are internal to the child, and most frequently include fears, worries and anxiety. The most common types of anxieties in early childhood are separation anxiety, which relates to fear of separation from their caregiver, or specific anxieties around particular events or situations (e.g. fear of the dark, animals, strangers). When fears or worries are excessive and/or developmentally inappropriate and impact on the child’s and/or family’s functioning they may lead to an anxiety disorder diagnosis. However, it would be rare for a child to be diagnosed with an anxiety disorder before the age of 3 years. It is important to note that young children may show both externalising and internalising problems, which may be due to underlying difficulties with poor self-regulation. Self-regulation involves the ability to control impulses and expressions of emotions. Children with difficulties in self-regulation might show a range of problems, including higher rates of tantrums, irritable mood and oppositionality, and disturbances in sleep, eating, activity or attention (Gardner & Shaw, 2008).
There are three main reasons why it is challenging for practitioners to differentiate SEBD from normal problems in the early childhood years:
In summary, key tips for practitioners to assist them to have helpful conversations with parents about children’s mental health include:
Conversations about early childhood social, emotional and behavioural problems may be initiated by parents or practitioners. Parents may mention specific symptoms, or they may express more general concerns about their child’s wellbeing or development. On the other hand, the conversation may be initiated by the practitioner either through general discussions about child wellbeing and parenting, following the use of screening tools, or during specific discussions that arise after they have observed the child. Regardless of whom initiated the conversation, it can be helpful to gather more information about the child’s social, emotional and behavioural development, as well as the family context. Such discussions do not require a practitioner to have mental health qualifications and the aim is not to ‘diagnose’ a disorder. Gathering more information about specific problems may help the practitioner to understand the nature of the problems and their likely impact on the child and family. The following tips may help practitioners ensure positive and collaborative conversations:
During discussions with parents, it may be useful for practitioners to gather information on the following aspects of each problem discussed (Perle et al., 2018):
Problems that occur more frequently or intensely, across contexts and that impact on the child and/or parents are more likely to indicate an SEBD than those that occur infrequently, in a single context and have no impact on the child and/or parents. Young children are highly dependent on their caregiving environment, so it is important for practitioners to assess risk and protective factors in the family environment which may influence SEBDs (Gardner & Shaw, 2008). Stable patterns of SEBD throughout childhood are associated with risk factors in the family environment, such as parents’ use of ineffective or harsh parenting strategies, parental mental health problems, parental conflict or violence, and childhood exposure to stressful or traumatic events (see Bagner et al., 2012). Problems in the parent-child relationship during the first 18 months have also been shown to be a risk factor for early SEBD (Skovgaard et al., 2007), which emphasises the importance of discussing the parent-child relationship and parenting more generally. Practitioners may also have a chance to observe the child if the child attends the session with the parent. This can provide a valuable opportunity to observe the child’s social, emotional and behavioural responses, as well as parent-child interaction. However, a single visit may not be representative of a child’s usual responses across contexts. It may be helpful for practitioners to ask the parent how typical the child’s current emotions and behaviours are in comparison with their usual functioning.
The use of routine screening measures may help with identification of SEBD, given that some parents may not report concerns about their child or may be reluctant to discuss difficulties (Alakortes et al., 2017b). The use of screening measures in practice will vary widely, and some practitioners may not have access to the specific screening tools for SEBD discussed in this section. Practitioners may already be using more general developmental screening measures (e.g. PEDS), which are still useful for gathering information to help assess SEBD. Measures that are quick and easy to administer are known as ‘screening measures’. Those which are longer and more detailed, often involving a multi-method approach (e.g. parent report, questionnaires, observation procedures) are also known as ‘evaluation measures’ (Bagner et al., 2012). If a child scores positive for a potential problem on a screening measure, the next step is often to conduct a more comprehensive evaluation or refer on for further evaluation. Early childhood practitioners are more likely to use screening measures than evaluation measures due to time limitations when working with families. There are a range of measures that practitioners may use to screen for developmental problems in the early childhood years, such as the Parents’ Evaluation of Developmental Status (PEDS: Glascoe, 1997). However, there are also certain measures used specifically to assess SEBD in the infant and toddler years (see Bagner et al., 2012). Two of the most commonly used parent-report screening measures that are brief and easy to administer, score and interpret are:
Regardless of the type of measure used, practitioners can follow these tips when using screening measures with parents:
Once practitioners have shared the findings of the screening measure with parents, practitioners and parents can discuss the options for next steps and decide together on a plan of action. More information about screening tools for early SEBD can be found in a systematic review by Bagner et al. (2012), available here.
Referral to other services may be warranted in cases where the child’s problems appear to be developmentally excessive or above screening cut-offs on assessment measures, or the parents are requesting further support. The child may be referred for further specialist assessment or for early intervention services. The extent to which childhood practitioners refer families to other services or provide services themselves will vary. For example, a survey of child health nurses in Melbourne found that the majority of those surveyed viewed it as part of their role to deal with, rather than refer, children with behavioural problems (Sarkardi et al., 2014). When providing families with a referral, the following tips may be helpful (Perle et al., 2018):
As noted throughout this paper, it is challenging to differentiate developmentally normal problems from SEBD in young children. Talking with parents and the use of assessment tools may be helpful for distinguishing between the two and determining next steps to take. Most practitioners are not expected to have expertise in child mental health problems or in conducting comprehensive assessments of childhood SEBD. Key barriers may include the lack of time to conduct assessments, and the limited availability of screening measures. Given the difficulty of differentiating developmentally normal problems from SEBD in young children, it is important for practitioners to have access to supervision and training on this topic. A recent survey of child health nurses found a key barrier to dealing with child behaviour problems was parents’ denial of problems and resistance (Sarkardi et al., 2017). This research suggests that practitioners may need training in specific strategies for addressing more challenging conversations with parents about SEBD, such as skills in motivational interviewing.
|
What are some of the problems with children describing their emotions and behaviors?
Pos Terkait
Copyright © 2024 menakung Inc.
