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Persistence of Mental Health Problems in Very Young Children Investigated by US Child Welfare Agencies

      Abstract

      Objective

      To document the persistence and predictors of mental health problems in children aged 12 to 18 months investigated for alleged maltreatment.

      Methods

      Data came from the second National Survey of Child and Adolescent Well-being (NSCAW II), a longitudinal study of youth 0 to 17.5 years referred to US child welfare agencies. These analyses involved children 12 to 18 months. Baseline sociodemographic, social services, developmental data, and health data were collected on children and caregivers. Potential social-emotional problems at baseline were assessed with the Brief Infant–Toddler Social and Emotional (BITSEA) scales. Outcomes were scores over the clinical cutoff on the Child Behavior Checklist (CBCL) 1.5–5 assessed at 18 months after study entry.

      Results

      The multivariable analyses showed that an elevated BITSEA score at baseline (odds ratio 9.18, 95% confidence interval 1.49, 56.64; P = .018) and living with a depressed caregiver (odds ratio 13.54, 95% confidence interval 2.50, 73.46; P = .003) were associated with CBCL scores in the clinical range at the 18-month follow-up. For children who scored both positive on the BITSEA and lived with a depressed caregiver, 62.5% scored positive on the CBCL compared to 10.7% of the children with one risk factor and 3.8% of the children with neither risk factor. Only 23.9% of children and/or their caregivers received any service.

      Conclusions

      Data show considerable persistence of mental health problems in very young children that 2 factors could identify. Lack of services to these children is a tremendous missed opportunity for identification and treatment that could potentially prevent more serious mental health problems.

      Keywords

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      References

        • Egger H.L.
        • Angold A.
        Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology.
        J Child Psychol Psychiatr. 2006; 47: 313-337
        • Briggs-Gowan M.J.
        • Carter A.S.
        • Bosson-Heenan J.
        • et al.
        Are infant–toddler social-emotional and behavioral problems transient?.
        J Am Acad Child Adolesc Psychiatry. 2006; 45: 849-858
        • Briggs-Gowan M.J.
        • Carter A.S.
        • Skuban E.M.
        • et al.
        Prevalence of social-emotional and behavioral problems in a community sample of 1-and 2-year-old children.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 811-819
        • Carter A.S.
        • Briggs-Gowan M.J.
        • Davis N.O.
        Assessment of young children’s social-emotional development and psychopathology: recent advances and recommendations for practice.
        J Child Psychol Psychiatr. 2004; 45: 109-134
        • Del Carmen-Wiggins R.
        • Carter A.S.
        Introduction—assessment of infant and toddler mental health: advances and challenges.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 8
        • Lavigne J.V.
        • Cicchetti C.
        • Gibbons R.D.
        • et al.
        Oppositional defiant disorder with onset in preschool years: longitudinal stability and pathways to other disorders.
        J Am Acad Child Adolesc Psychiatry. 2001;
        • Mäntymaa M.
        • Puura K.
        • Luoma I.
        • et al.
        Predicting Internalizing and Externalizing Problems at Five Years by Child and Parental Factors in Infancy and Toddlerhood.
        Child Psychiatry Hum Dev. 2012; 43: 153-170
        • Luby J.L.
        • Si X.
        • Belden A.C.
        • et al.
        Preschool depression: homotypic continuity and course over 24 months.
        Arch General Psychiatry. 2009; 66: 897
        • Lahey B.B.
        • Van Hulle C.A.
        • Keenan K.
        • et al.
        Temperament and parenting during the first year of life predict future child conduct problems.
        J Abnorm Child Psychol. 2008; 36: 1139-1158
        • Briggs-Gowan M.J.
        • Carter A.S.
        Social-emotional screening status in early childhood predicts elementary school outcomes.
        Pediatrics. 2008; 121: 957-962
        • Horwitz S.M.
        • Hurlburt M.S.
        • Zhang J.
        Patterns and predictors of mental health services use by children in contact with the child welfare system.
        in: Webb M.B. Dowd K. Jones Harden B. Landsverk J. Testa M. Child Welfare and Child Well-Being—New Perspectives from the National Survey of Child and Adolescent Well-Being. Oxford University Press, New York, NY2010: 279-329
        • Minnis H.
        • Everett K.
        • Pelosi A.J.
        • et al.
        Children in foster care: mental health, service use and costs.
        Eur Child Adolesc Psychiatry. 2006; 15: 63-70
        • Jee S.H.
        • Conn A.M.
        • Szilagyi P.G.
        • et al.
        Identification of social-emotional problems among young children in foster care.
        J Child Psychol Psychiatr. 2010; 51: 1351-1358
        • Clausen J.M.
        • Landsverk J.
        • Ganger W.
        • et al.
        Mental health problems of children in foster care.
        J Child Family Stud. 1998; 7: 283-296
        • Burns B.J.
        • Phillips S.D.
        • Wagner H.R.
        • et al.
        Mental health need and access to mental health services by youths involved with child welfare: a national survey.
        J Am Acad Child Adolesc Psychiatry. 2004; 43: 960-970
        • Horwitz S.M.
        • Hurlburt M.S.
        • Heneghan A.
        • et al.
        Mental Health Problems in Young Children Investigated by US Child Welfare Agencies.
        J Am Acad Child Adolesc Psychiatry. 2012;
        • Dowd K.
        • Dolan M.
        • Wallin J.
        • et al.
        National Survey of Child and Adolescent Well-Being II: Combined Waves 1–2 Data File User’s Manual Restricted Release Version.
        Cornell University, National Data Archive on Child Abuse and Neglect, Ithaca, NY2011
        • Sparrow S.S.
        • Carter A.S.
        • Cicchetti D.V.
        Vineland Screener: Overview, Reliability, Validity, Administration, and Scoring.
        Yale University Child Study Center, New Haven, Conn1993
      1. Ringeisen H, Casanueva C, Smith K, et al. NSCAWII Baseline Report. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, US Department of Health and Human Services; 2011. OPRE Report 2011–27d.

        • Kessler R.C.
        • Andrews G.
        • Mroczek D.
        • et al.
        The World Health Organization Composite International Diagnostic Interview Short-Form (CIDI-SF).
        In J Methods Psychiatric Res. 1998; 7: 171-185
        • Ascher B.H.
        • Farmer E.M.Z.
        • Burns B.J.
        • et al.
        The Child and Adolescent Services Assessment (CASA) description and psychometrics.
        J Emot Behav Disord. 1996; 4: 12-20
        • Briggs-Gowan M.J.
        • Carter A.S.
        • Irwin J.R.
        • et al.
        The Brief Infant–Toddler Social and Emotional Assessment: screening for social-emotional problems and delays in competence.
        J Pediatr Psychol. 2004; 29: 143-155
        • Achenbach T.M.
        • Rescorla A.A.
        Manual for the ASEBA Preschool Forms and Profiles.
        University of Vermont, Research Center for Children, Youth, & Families, Burlington, Vt2013
        • Burns B.J.
        • Mustillo S.A.
        • Farmer E.M.Z.
        • et al.
        Caregiver depression, mental health service use, and child outcomes.
        in: Webb M.B. Dowd K. Harden B.J. Child Welfare and Child Well-being: New Perspectives from the National Survey of Child and Adolescent Well-being. Oxford University Press, New York, NY2009: 351-379
        • Walker J.
        Caregiver–child: mutual influences on mental health.
        Focal Point. 2008; 22: 2-3
        • Shonkoff J.P.
        • Boyce W.T.
        • McEwen B.S.
        Neuroscience, molecular biology, and the childhood roots of health disparities.
        JAMA. 2009; 301: 2252-2259
        • Shonkoff J.P.
        • Phillips D.
        From Neurons to Neighborhoods: The Science of Early Childhood Development.
        National Academies Press, Washington, DC2000
        • Fisher P.A.
        • Chamberlain P.
        • Leve L.D.
        Improving the lives of foster children through evidenced-based interventions.
        Vulnerable Child Youth Stud. 2009; 4: 122-127
        • Aarons G.A.
        • James S.
        • Monn A.R.
        • et al.
        Behavior problems and placement changes in a national child welfare sample: a prospective study.
        J Am Acad Child Adolesc Psychiatry. 2010; 49: 70-80
        • Henkel V.
        • Mergl R.
        • Kohnen R.
        • et al.
        Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups.
        Gen Hosp Psychiatry. 2004; 26: 190-198