Understanding Common Psychological Disorders in Young Children
An interview with Jenna Bilmes, author of Common Psychological Disorders in Young Children: A Handbook for Child Care Professionals

Redleaf Press (RLP): Why did you write Common Psychological Disorders in Young Children: A handbook for Child Care Professionals?

Jenna Bilmes (JB): I started writing this book because, selfishly, I needed this book. Often in my work with children, I have heard that a child was on a certain medication, was identified as needing special services based on the result of a screening test, or was diagnosed with a specific disorder. Other times, I would notice that a new child reminded me of another child who had been diagnosed with a psychological disorder and wondered if the new child should be screened? Although I have worked with typical and troubled children for two decades, I was finding more and more often that I didn't have the facts I needed to understand what was going on with some of these children and, even more importantly, I wasn't always sure that the way I was responding to these children was helping.

When I turned to our special needs folks and psychologists for teacher-friendly, general child mental health resources for our center, they didn't have anything available that was specific to the classroom teacher. They handed me the DSM-4 and the DC 0-3 (resources used by mental health professionals) but these books didn't tell me what to do to support these kids in group care. And to be honest, I really didn't understand all of the academic jargon in those resources.

In the funny way things happen, I had just complained once again to Tara Welker, our consulting psychologist, about the lack of a comprehensive early childhood mental health resource, when Sid Farrar, the editor-in-chief at Redleaf Press, contacted me about putting such a resource together. Tara and I jumped at the opportunity and the book was born. We made sure to include resources to address all those teacher questions that we were continually asking such as, what is that medication for? what was that screening test for? how should we talk to parents when we think a child needs screening? and most importantly, what can we do as caregivers to work with a child whose needs may be different because of a psychological disorder?

RLP: How common are psychological disorders in young children?

JB: People used to think that children could not be clinically depressed or have bipolar or other psychological disorders. However, recent research tells us that even babies can be depressed or have symptoms of posttraumatic stress disorder.

According to the 1999 Surgeon General report, one out of ten children from birth through 18 years old have a diagnosable psychological disorder. And of these children, only one in ten gets the diagnosis and treatment they need.

RLP: Are psychological disorders being diagnosed in young children more frequently? If so, what is the impact on child care professionals?

JB: With the increase in research on brain development and social/emotional development of young children, we are finding a corresponding increase in the numbers of children with diagnosed psychological disorders. Many of these children attend early childhood programs. Unfortunately, few early childhood caregivers receive training on how to distinguish between typical and atypical social/emotional development, how to respond effectively to children with psychological disorders in a group care setting, or what the possible side effects are of medications the children may be taking.

RLP: Why is it important for child care professionals to understand the differences in the different disorders?

JB: Most child care professionals will have one or more children with a psychological disorder in their care at one time or another. Without a clear understanding of the nature of those disorders, it's easy to misinterpret the symptoms or not know the best way to respond. For example, let me tell you about the child who first opened my eyes to the challenges of helping a child with a psychological disorder in group care. We had an older toddler who would sometimes "freak out" during clean up transitions. Being an older two, we assumed these were typical two-year-old tantrums. We tried our usual response of soothing the child and helping her to regain control, but for this little girl, it only drove her further into herself. She would arch her back and scream as if she were being hurt. We tried ignoring her, singing to her, holding her, etc., but nothing was working and teachers were beginning to dread having her in the classroom. Eventually, we discovered that the child was experiencing episodes of Post Traumatic Stress Disorder. With the support and guidance of a specialist, caregivers were able to understand and empathize with the child rather than feel angry with her. We couldn't "fix" her problems, but we learned strategies to make her days and ours more pleasant.

RLP: How should a child care provider approach the topic of psychological disorders with family members and when should he or she suggest getting outside help?

JB: The first piece of advice I give to caregivers is no matter how much experience we have or how much we learn, as early childhood educators, we are not therapists or psychologists. It may be tempting to diagnose kids, but we need to be very careful not to overstep our professional bounds. Not every overactive child has ADHD; not every child who plays alone and avoids eye contact has Autism; and not every child who refuses to cooperate has Oppositional Defiant Disorder.

However, we are experts in observing and reporting on children's behaviors, and noticing when something is out of the ordinary. I emphasize this because it is the underlying rule when talking to family members about concerns with their child's behavior. Early childhood professionals do our best work for children when we work with family members as partners. Ongoing two-way communications about a child's strengths and challenges is essential. When communicating concerns to family members, it is important to focus on observed behaviors rather than psychological labels. For example, "We have been noticing that Martin often plays alone, doing the same things over and over again. Do you see that at home too?" It is scary for a family to think that their child may have a problem. The way we usually approach the need for screening is to say something such as, "We wonder if you might allow us to ask Tara (a consulting psychologist) to come in and watch your child to help us rule out any problems we might not be aware of. If she does find something, we can start to work on any issues now, before he gets to school, so he can be ready to do his best work."

RLP: What are some of the treatments for psychological disorders?

JB: A child with a diagnosed psychological disorder will most likely be under the care of a specialist who may be prescribing medications, may be working with the family or the child individually in counseling sessions, and may be working with family on strategies to use at home to best support the child. Again, I want to emphasize that caregivers are not mental health specialists, and it is unethical for us as caregivers to push or otherwise get involved in a family's decision about the use of medications for their child.

The fact that a child has a diagnosable disorder does not mean that they will be put in a special program. Many of these children will continue in their regular group care programs. Unfortunately, the communication between therapists and caregivers is often inadequate, and the caregiver may feel left in the dark about the direction the therapist is taking with the child or family. The best scenario is to get written consent from the family to permit communication between a caregiver and the therapist. This allows the caregiver to report observations to the therapist and for the therapist to insure that everyone is on the same page when responding to a child's behavior.

Without direction from a therapist, caregivers can still get a general understanding of disorders, their treatment, and ideas on caregiver interventions from this book. Even without a diagnosis, there is a whole chapter devoted to more general kinds of behaviors a caregiver may notice and some specific strategies for dealing with those behaviors.

RLP: Your book Beyond Behavior Management: The Six Life Skills Children Need to Survive in Today's World looks at ways to help children develop life skills such as attachment, self-regulation, and respect. How does your new book examine the behavioral issues that can occur with psychological disorders?

JB: When we look at the field of early childhood mental health, we repeatedly see the emphasis on the triad of "Prevention-Promotion-Treatment." Research strongly suggests that the ways we interact with infants, toddlers, and young children have a significant impact on mental health outcomes. The literature emphasizes that best practices can both prevent mental health disorders and promote the development of mental health in young children.

Beyond Behavior Management was designed to provide caregivers with strategies to both prevent and promote mental health in young kids. When we look at the last piece of the triad, treatment, we find that children with diagnosable disorders need an extra dose of caregiver interventions in order to thrive in group care. For example, while all young kids benefit from learning about emotions as a prevention/promotion strategy, some children with anxiety disorders may need extra doses of emotional learning. And while most young children are best able to attend to group time when they aren't fiddling with other toys, we find that many children diagnosed with ADHD actually concentrate better when they have a small object to fiddle with.

One of the purposes of this new book is to give teachers some tips on these additional tweaks and strategies to help kids with the most common disorders we see in early childhood group care.

Jenna Bilmes is a mental health specialist with FACES of Crisis Nursery in Phoenix, Arizona, and is a consultant for the U.S. Department of Defense Dependent Schools and Sonoma State University. She is also the author of Beyond Behavior Management.