Mental Health in Early Childhood: A Q&A With Dr. Sarah Gray
Tell us a little about yourself and what you do in the field.
I am a licensed clinical psychologist and an Associate Professor in the Department of Psychological Sciences at UConn, with a joint appointment in Psychiatry at UConn’s School of Medicine. My primary roles are in research and teaching at both the undergraduate and graduate level, including clinical and research training of our doctoral students in clinical psychology at UConn. My areas of specialty in both my clinical practice and my research are early childhood mental health, parenting, and trauma, with a specific focus on how parents and other important caregivers support young children’s thriving under conditions of adversity. I am also a parent to two daughters, ages 4 and 7.
We’ve heard a lot about a youth mental health crisis in America. Is this something that we’re also seeing among children 0-5? Do we know if the crisis we’re seeing is related to Covid or screen time or other factors?
Recent research that has come out during and after the height of the COVID-19 pandemic did show critical disruptions to some of the most important contributors to children’s mental health during the earliest years. These disruptions include increases in family violence, decreases in parental mental health specifically among parents of young children, and broad disruptions to support networks for families. Importantly, some of this research — including work coming out of our lab — has highlighted some of the processes that buffered young children and their parents from these risks to mental health, including healthy family communication patterns, and caregivers’ material and psychological access to positive pandemic-related experiences, such as more quality time spent with family members or more time spent donating or volunteering to help those in need.
What is the relationship between social emotional development and mental health in young children?
This is a great question. Social-emotional development and mental health are deeply tied to one another across childhood, but perhaps especially during the earliest years. In many ways, children’s mental health in many ways is defined by their ability to move through developmental milestones in social-emotional development – for example, when we see disruptions in young children’s ability to share their joy or sadness with caregiving adults, or their ability to control their bodies in developmentally appropriate ways, these are signs we may be seeing emerging mental health concerns. When we support young children’s social-emotional development – their ability to use their words to tell an adult they are distressed, for example, or their prosocial connections with important adults and their peers – we are supporting their mental health, too.
What can parents and educators do to support children’s mental health?
For parents and educators alike, your relationship with a young child is the strongest tool in your arsenal for supporting their well-being. Young children learn about themselves and about the world – how safe it is, what to expect from it – through their relationships with important adults. Caring, responsive, and predictable relationships with loving adults during the earliest years are the greatest foundation for mental health across the lifespan. One of the sayings in our field is “behavior is communication.” When you are confronted with a challenging behavior, instead of immediately reacting, try taking a minute to ask yourself, “what need is their challenging behavior trying to communicate to me? How can I respond to that need?”
Common mental health challenges look different than the same mental health challenges in adults. How do young children present with these challenges in ways that are different than adults?
Young children struggle with many of the common mental health challenges that adults do – depression, anxiety, post traumatic stress, aggression – but of course, the way that they manifest looks different. In the area of posttraumatic stress, for example, we sometimes see developmental regression – this means losing skills that have already been developed, such as a return to bedwetting in a child who has already been potty-trained. Instead of re-experiencing the event through flashbacks like we may see in adults, young children experiencing posttraumatic stress might repeatedly play out scenes that they’ve experienced or witnessed in their pretend play. Sometimes this play might be healthy and constructive – helping them to make sense of what has happened – and sometimes it might be more “stuck,” repetitive, or disrupted, illustrating an unresolved narrative that might need clinical attention.
How can the mental health of the parent impact the mental health of the child?
There is a saying from pediatrician and psychoanalyst D.W. Winnicott that I and many others in the field like that speaks to this question: “There is no such thing as a baby.” That is to say, there is always someone else caring for that baby, or else the baby could not survive. Young children’s emotional worlds necessarily involve caregiving adults, and the well-being of that adult is a lens through which the child learns about and experiences the world. One of the things I am most drawn to in therapeutic work with young children is that no one pretends we can just see an infant or toddler alone in our office and fix the issue – of course we need to address their broader social environments, bring the parents and other important adults in on the work of the therapy. I think this is true of adults, too, but it can be harder to bring those broader social worlds into the treatment room with adults.
What steps should a family take if they have concerns?
Talk to the other adults on your team! Pediatricians are always a great place to start – part of their training is focused on normative developmental milestones, and if families are concerned about children’s development or their mental health, pediatricians can be a great resource about “when to worry.” Teachers and early education professionals can also be a resource.
Are there any books or articles that are family friendly that you’d recommend if people want to learn more about the mental health of young children?
Yes. Alicia F. Lieberman is a giant in the field of early childhood mental health, and she has written a very accessible book called The Emotional Life of the Toddler that I have recommended to friends and families I’ve worked with alike. The organization Zero to Three is also an amazing national resource, and they have many fact sheets and informational resources online about just about any issue facing young children and families.
