Early Intervention Can Reduce Later Psychiatric Problems for At-Risk Children

FROM PSYCHIATRIC NEWS ALERT: Early and sustained intervention of children with conduct problems can lower the chances that those problems will extend into adulthood, reports a new study published in AJP in Advance titled “Impact of Early Intervention on Psychopathology, Crime, and Well-Being at Age 25.”

Known as Fast Track, this project enrolled kindergarteners who displayed aggressive or disruptive behaviors into a multi-component, 10-year, manualized program aimed at instilling social competencies that would extend throughout their lifetimes

“through social skills training, parent behavior-management training with home visiting, peer coaching, reading tutoring, and classroom social-emotional curricula,”

the researchers noted. The program took place in four communities: Durham, N.C., Nashville, Seattle, and rural Pennsylvania. A similar set of at-risk children receiving only the standard interventions in their community were followed as a control group.

There has not been much evidence showing that behavioral improvements in children translate into adulthood, but so far, the Fast Track study seems to suggests that such an intervention can have an impact, finding that while 69% of the adults in the control group displaying at least one psychiatric problem at age 25, only 59% of Fast Track participants displayed a psychiatric problem at the same age. Fast Track participants also displayed decreased rates of substance abuse crimes, violent crimes, and risky sexual behavior compared with controls, as well as higher levels of happiness and well-being.

“This shows that we can go a full eight years after last seeing these children and still see reductions in the rates of problem outcomes for this group as young adults,”

said study author Kenneth Dodge, Ph.D., director of the Center for Child and Family Policy at Duke University.

The improvements in behavior were consistent among each of the 13 subgroups assessed (including those defined by gender, ethnicity, study site, etc.), demonstrating that this approach has potential for a wide range of children and risk levels.

To read about a promising early-intervention effort with children in Australia, known as Headspace, see the Psychiatric News article “Australian Youth Get a ‘Soft Entry’ Into Mental Health System.”

The Importance of Developing Tools to Make Early Psychosis Intervention a Reality

Raquel Gur, M.D.

From Psychiatric News Alert: Early identification of schizophrenia and other psychoses should not just be a priority for clinicians—it should be a national priority, says psychiatrist Raquel Gur, M.D., a leading schizophrenia researcher. Speaking at the APA Institute on Psychiatric Services, Gur pointed out that despite the illness’s complexity, early psychosis identification is becoming more likely thanks to a growing research base linking genetic, neurodevelopmental, and behavioral findings about how psychosis progresses over time. Such early identification must follow the pattern that made it routine for diabetes, cardiovascular disease, and other disorders.

“It is no different for psychosis. When someone presents with a risk, we cannot send them away until they meet DSM criteria for schizophrenia.”

Pursuing the path of other illnesses, however, will not be simple, she added, in large part because of the stubborn stigma that attaches to mental illness and the complexity of the brain. But:

“the train toward psychosis leaves the station early, and we are trying to capture it before it derails.”

She cited several examples of research that is advancing the knowledge needed for early psychosis identification, including the Philadelphia Neurodevelopmental Cohort, which is seeking to describe how genetics impact trajectories of brain development and cognitive functioning in adolescence and understand how abnormal trajectories of development are associated with psychiatric symptoms. In this study, nearly 10,000 youth presenting at Children’s Hospital of Philadelphia for nonpsychiatric reasons have received a comprehensive genetic, psychiatric, and cognitive assessment, with a subsample of these participants receiving multimodal neuroimaging.

Read more about this and other studies laying the groundwork for early psychosis intervention in the Psychiatric News article “Expert Says Early Identification of Psychosis Should Be Priority.”

Project ABC

“It’s not only children who grow. Parents do too. As much as we watch to see what our children do with their lives, they are watching us to see what we do with ours. I can’t tell my children to reach for the sun. All I can do is reach for it, myself.” —Joyce Maynard

Project ABC is a collaborative partnership between professionals in Mental Health-LA County Department of Mental Health; Child Welfare-LA County Department of Children and Family Services; and Community Service Providers-Children’s Institute, Inc, For the Child, Pacific Asian Counseling Center and TIES for Families; designed to create a system of care for young children in the Los Angeles County area who would benefit from mental health services. With funding support from the SAMHSA, LADMH has taken the lead and has brought together the key partners from these varied disciplines to ensure that children birth through five have access to services that are family-centered, strength-based, and culturally competent.

“Family voice and choice is essential to everything we do and we are guided by the strengths of each family to plan and deliver services that will result in the best possible care for the children in our community.”

Community-based, infant/early childhood mental-health-treatment programs provide families with needed services and support when families identify challenges working through atypical behaviors in very young children or managing the after-effects of difficult family experiences or traumatic exposure.

What is Infant/Early Childhood Mental Health?

Infant/Early Childhood Mental Health is a comprehensive approach that refers to the social and emotional well being of very young children under the age of six. Positive relationships between young children and adults lay the foundation for healthy social and emotional development. This foundation allows children the freedom to:

  • Experience and manage a full range of emotions, cope with frustrations and regulate their behaviors
  • Develop supportive relationships with caregivers as well as other children
  • Safely and actively explore and learn from their environments, feel protected in the context of their families, neighborhoods, and cultures.

Project ABC’s History

In 2005 the Federal Substance Abuse and Mental Health Services Administration funded the Los Angeles County Department of Mental Health to develop Project ABC. In partnership with The Department of Children and Family Services,

Children’s Hospital Los Angeles and Children’s Institute, Inc., a system of care was developed in the Los Angeles County Metro region. This network of organizations provided professional training and consultation, leadership in relevant advocacy and policy changes and a wide array of educational and support materials for use by professionals as well as families with children birth to 5. The families also gained the benefit of a range of specialized and evidence-based services proven to strengthen infant-adult relationships and reduce the impact of traumatic exposure for children and their families. With the success of that partnership as our foundation, Project ABC has now redirected its efforts to focus on the South Bay, Long Beach and Inglewood communities and its partnership now includes For the Child, Pacific Asian Counseling Services and Ties for Families in addition to its on-going collaboration with DMH, DCFS, CII, and USC.

10 Simple Things to Help a Child’s Mental Health

1. Interaction – Spend time watching me and responding to my cues. It tells me I’m important and special to you.

2. Loving Touch – Cradle me, hold me. Give me lots of hugs. It keeps me calm and comforts me, and gives me courage to move on.

3. Stable Relationship – I need someone special to be there when I call. When I look around and see you, I know I can go far.

4. Safe, Healthy Environment – Plug the outlets, block the stairs. Keep lead away for sure! Make a safe, special place so I’m free to explore.

5. Self-Esteem – I can do it, yes I can, if you tell me. So pay attention, give me praise and watch me go, go, go!

6. Quality Child Care – When you’re gone I need to be with people you can trust to help me grow and teach me new, exciting stuff.

7. Communication – I may not talk, but don’t be fooled, I understand a lot. Our little conversations mean so very much!

8. Play – Play is fun, play is work, it’s how I learn the ropes. When we play together you help me more than you know.

9. Music – 1,2,3 sing to me and make up silly tunes. Music is special time that’s fun to share with you.

10. Reading – Read to me, show me books with lots of pretty pictures. Write my stories out in words. I’ll love to read forever.

Courtesy of Safe From The Start, California Attorney General’s Office.www.safefromthestart.org


CDC Finds Up to 20% of U.S. Children Have Mental Health Disorders

As many as one in five individuals in the U.S. under the age of 18 experience a mental health disorder each year, and that rate is climbing, according to a CDC report. The CDC report, which is the first comprehensive examination of the mental health of children, found that such illnesses cost about $247 billion annually in decreased productivity, juvenile justice, special education and treatment.

The CDC cites a pair of studies that found mental health disorders among adolescents are on the rise. For instance, one recent study found that hospital stays among children for mood disorders increased from 10 to 17 admissions per 100,000 individuals between 1997 and 2010. Another recent study found admissions from mental-health-substance-use disorders among children increased by 24% from 2007 to 2010.

The report also found that suicide among children was more prevalent in boys than in girls. According to the CDC, 35.5% of children who commit suicide were diagnosed with a mental health disorder when they died, while more than one in four children who died by suicide were being treated for a mental disorder at the time of their death, and 21% had made a previous suicide attempt (Washington Post, 5/19/13). Suicide was the second-leading cause of death among U.S. Children ages 12 to 17 in 2010 (Science Now, Los Angeles Times, 5/17/13).

The problem seems exacerbated by the fact that just 21% of children with mental disorders receive treatment because of a shortage of pediatric sub-specialists and psychiatrists. According to the Washington Post, the shortage has been caused by more children’s mental health providers retiring from the workforce and fewer medical students taking their place.

Early Detection of Schizophrenia–The Time Is Now

A message from APA President Jeffrey Lieberman, M.D., also appearing in  Psychiatric News Alert to all interested persons. Please send your comments to pnupdate@psych.org

“I believe that we are at another game-changing moment in psychiatry with the rise of the early detection and intervention strategy (EDIS). This new therapeutic strategy and model of care could have a significant effect on our ability to treat and limit the morbidity of mental illness beginning with schizophrenia and related psychotic disorders.

“While schizophrenia has been historically associated with a therapeutic nihilism due to its devastating and often irreversible consequences, research over the last two decades has changed attitudes and inspired optimism. Studies show that the earlier patients are diagnosed and treated, the better their responses to treatment. This leads to improved outcomes and higher chances of full recovery. The corollary to this is continued engagement of patients in treatment following their recovery and relapse prevention.

“Among the reasons for this are findings from neuroimaging studies showing that the hallmark clinical deterioration of schizophrenia is associated with cortical gray matter atrophy, reflecting the loss of cell processes and synaptic connections. Unlike Alzheimer’s disease though, for which there currently is no “disease-modifying” treatment, early intervention and relapse prevention methods for schizophrenia coupled with antipsychotic medication may prevent illness progression.

“Moreover, additional research and first-person reports indicate that resilience, coping skills, and peer and family support can substantially contribute to favorable outcomes and recovery. Collectively, these findings have suggested the value of early detection, intervention, and sustained engagement with treatment to enhance recovery and prevent disability.

“Unfortunately, these encouraging research findings have been slow to translate into clinical practice in the United States. It will not come as a surprise that an important reason for the slow implementation of the EDIS model of care is a lack of adequate financing. Many individuals in the earliest stages of psychosis do not have health insurance, and even if they do, their plans do not cover comprehensive psychosocial and rehabilitative services. And while the public mental health system is designed to serve individuals without health insurance and to provide services not covered by insurance, the system favors individuals who have already become disabled by mental illness, limiting the availability of services for patients in the early stages of psychotic disorders.”

For Dr. Lieberman’s full message and call to action, CLICK HERE.