MADISON, Wis.—As the first day of school approaches, teachers know that some children will have a difficult time.
But which children will grow out of their problems, and which are likely to develop impairing mental health problems by the end of elementary school?
A research team at the University of Wisconsin School of Medicine and Public Health has come up with a screening tool that appears to predict, with startling accuracy, the small percentage of children most likely to benefit from early intervention.
“We wanted to find the longer-term patterns of mental health symptoms of kids who are most likely to develop problems that would impair them, so they could be identified very early in school before the problems become entrenched,’’ said Dr. Marilyn Essex, leader of the study, which was published in a recent edition of the Journal of Child Psychology and Psychiatry. “In our study, we did a phenomenal job of picking up those kids very early. Now those findings need to be replicated by others.”
Essex said the findings might be especially important for children with internalizing symptoms, such as anxiety, because they tend to be overlooked and untreated more often than those who show externalizing symptoms such as conduct problems.
“There are ways to improve how we identify children and how they are treated,’’ she said.
Her group looked at a sample of 328 children whose mothers and teachers reported on the children’s mental health symptoms in kindergarten, and grades one, three and five.
When they looked at the patterns of symptoms from kindergarten to grade five, they identified four groups:
• Those who never showed high levels of symptoms
• Those who showed high levels of symptoms but never in consecutive school years
• Those who showed high levels of symptoms in consecutive school years of internalizing (depression, anxiety) or externalizing (oppositional defiance, conduct problems, inattention, impulsivity, aggression)
• Or those who showed both internalizing and externalizing in consecutive years.
By the fifth grade, the children most in need of help were those who had showed both internalizing and externalizing symptoms in at least two, and usually more, consecutive school years.
“Looking back, we were able to tell in kindergarten and grade one which children were very likely to develop this pattern of mental health problems,’’ she said. “We were able to predict quite well long-term patterns from early behavior issues.”
While many children have some of these issues some of the time, those who showed recurring patterns of both internalizing and externalizing symptoms fared the worst. Of the small number of children who showed both types of mental health problems in kindergarten, all of them still had those issues in fifth grade. Fortunately, they represented only three percent of the total number of children.
“We can potentially identify these kids early and help them from ever developing longer-term problems,’’ Essex said.
The next step would be for other researchers to replicate these findings, and then for researchers and educators to take the screening tool developed in the study and formally apply it in different school settings, Essex said. Then, the question will be what types of intervention are most effective.
The children in the study come from a larger group of 570 children born in Milwaukee and Madison in 1990 and 1991. They are now 17 and 18 years old, and many continue to be studied into their late teens. This most recent study was funded by the John D. and Catherine T. MacArthur Foundation Research Network on Psychopathology and Development and the National Institute of Mental Health.
Essex says that ongoing studies are looking back from the teen years to see if the issues identified in kindergarten remain.
“That’s a major reason why this data set is so useful,’’ she said. “We hope to be able to identify very early the kids most likely to develop different types of child and adolescent mental health problems so that more effective preventive strategies can be designed and implemented.”
The Journal of Child Psychology and Psychiatry, published by Wiley-Blackwell for the Association for Child and Adolescent Mental Health, is the leading journal covering both child and adolescent psychology and psychiatry. An abstract of the study is available at http://www3.interscience.wiley.com/journal/122343659/abstract .
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