EI Talk: A Blog for Early
Childhood Professionals


Accessibility to Mental Health Services for Children: How Can We Improve?

Jonathan Polakoff January 31, 2022

Mental health disorders can be detrimental to many aspects of life, including relationships, employment, long-term health effects, etc. According to the American Disability Act, mental impairment that substantially limits at least one significant life activity is considered a disability. More often than not, a mental health disability can lead to a financial burden to patients, families, and society (Drake et al., 2012). A report on mental health disability from an international perspective found that the rate of mental health disability is growing dramatically in free-market countries like the US. Furthermore, the prevalence of mental health disorders in children is as high as 13.4% (Polanczyk et al., 2015), which will be the focus of this blog.

Unless treated, mental health problems in children can persist from childhood through adulthood (Anderson et al., 2017). While mental health disorders are common among children, there are barriers to mental health services, which prevent them from receiving the help they need. As we know, COVID-19 was declared a pandemic over a year ago. Reports in late 2020 show evidence of declined mental health in children due to social isolation and loneliness from lockdown (Loades et al., 2020). Moreover, the pandemic increases children’s vulnerability to depression, stress, anxiety, avoidance behavior, and PTSD (Thakur et al., 2020). With the pandemic passing over us, we need to address the barriers to mental health services now more than ever.

Mental health services should be accessible to everyone as it has proven to be an essential component of overall health. Service-level barriers for access and engagement have been highlighted by different groups of users (Anderson et al., 2017). These barriers include lack of knowledge about available services, difficulty access and stress associated with the help-seeking process, extensive wait time, and financial restrictions. In addition, vulnerable populations like children and families living in poverty experience the barriers to a greater extent (Hodgkinson et al., 2017). Removing these barriers will help address rising rates of mental health disability (Drake et al., 2012).

In current literature, several methods had been proposed to tackle the barriers to mental health services, with policy change as the primary target. A on international trends suggests shifting to the prepayment system from out-of-pocket payment systems widely used in many countries (Drake et al., 2012). One benefit highlighted by the article is that the prepayment system allows individuals with low socioeconomic status to receive the equivalent healthcare as the wealthier people. Additionally, a different study recommends that we address a set of complementary policies, rather than focusing on just one lever, such as insurance-based policy lever, to manage multiple outcomes at the same time to see a population-level impact (So et al., 2019). Outside of the policy realm, one study suggests increased training of pediatric primary care physicians (PCP) as vulnerable children and families are more likely to use a pediatric PCP as a resource of mental health services (Hodgkinson et al., 2017). Overall, there are many ways to address the barriers to mental health services, but past studies suggest that policy changes will create the most impactful results.

References

Anderson, J. K., Howarth, E., Vainre, M., Jones, P. B., & Humphrey, A. (2017). A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people. Children and Youth Services Review, 77, 164–176. https://doi.org/10.1016/j.chil...

Drake, R. E., Bond, G. R., Thornicroft, G., Knapp, M., & Goldman, H. H. (2012). Mental health disability: An international perspective. Journal of Disability Policy Studies, 23(2), 110–120. https://doi.org/10.1177/104420...

Hodgkinson, S., Godoy, L., Beers, L. S., & Lewin, A. (2017). Improving mental health access for low-income children and families in the primary care setting. Pediatrics, 139(1), e20151175. https://doi.org/10.1542/peds.2...

Loades, M., Chatburn, E., Higson-Sweeney , N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M., Borwick, C., & Crawley, E. (2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59(11), 1218–1239. https://doi.org/10.1016/j.jaac...

Polanczyk, G.V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. , Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. . Journal of Child Psychology and Psychiatry, 2015. 56(3): p. 345-365

So, M., McCord, R. F., & Kaminski, J. W. (2019). Policy levers to promote access to and utilization of children’s mental health services: A systematic review. Administration and Policy in Mental Health and Mental Health Services Research, 46(3), 334–351. https://doi.org/10.1007/s10488...

Thakur, K., Kumar, N., & Sharma, N. (2020). Effect of the pandemic and lockdown on mental health of children. The Indian Journal of Pediatrics, 87(7), 552–552. https://doi.org/10.1007/s12098...

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Covid-19 and Child Development

Jennifer Guo December 21, 2021

For the past year and a half, Covid-19 has greatly affected the way we live. The virus’ high risk of transmission has caused shut-downs all over the world, confining people to their homes. The economic recession has also cost many people their jobs, leading to financial insecurity. While we are all feeling the negative effects of the pandemic, young children are in a particularly vulnerable position right now. The combination of decreased socialization and the added financial stress on parents can have a profound effect on a child’s early development. (Rafanelli, 2021).

Children greatly benefit from interaction with others. During playtime with their peers, they learn methods of navigating different social situations, emotional regulation, and speech and language skills. When isolated at home, children are largely deprived of these learning opportunities. Even though kids are slowly returning to in-person classes, teachers have noticed differences in behavior. For example, in order to social distance, the children know that they have to stand far apart and sharing is discouraged; however, sharing is very important in life, and they are missing the chance to develop this and other interpersonal skills (https://www.sharp.com/health-news/how-does-limited-socialization-affect-young-kids.cfm). Specifically, in terms of communication, restrictions on large in-person gatherings have also prevented children from participating in “peer talk.” During conversations with classmates, they typically would learn new words, how to take turns speaking, and how to pick up on nuances and tones in speech. Less “peer talk” leads to delayed development of these skills. Also, since a mask covers the bottom half of the face, children may also miss out on comprehending facial expressions. (Charney, Camarata, & Chern, 2020).

In addition to social skill concerns, economic consequences of Covid-19 can also negatively affect child development. Many families are currently experiencing financial, food, and housing insecurities. In order to deal with these immediate issues, parents have less time to devote to their kids. Parent-child interactions are very important for growing neural connections and language and emotional skills under normal circumstances; given that the pandemic has cut children off from interactions with non-family individuals, their relationships with their parents are even more crucial. Financial, food, and housing insecurity can also be considered adverse childhood experiences (ACEs). Continued exposure to ACEs can cause toxic stress, which can lead to educational delays and predisposition to adult-onset health problems. Parents may also experience toxic stress due to added burdens. If they react poorly or cannot manage the stress, their actions may also negatively affect their kids (https://developingchild.harvard.edu/resources/what-is-covid-19-and-how-does-it-relate-to-child-development).

In an unprecedented and stressful event like the pandemic, it is especially important that programs be implemented to aid the families of young children. Family-centered care will not only benefit the children and promote proper development, but also to give parents the resources to be better caregivers. With support systems in place, we can provide the children of this pandemic the opportunity to thrive.

References

Charney, S. A., Camarata, S. M., & Chern, A. (2020). Potential impact of the covid-19 pandemic on communication and language skills in children. Otolaryngology–Head and Neck Surgery, 019459982097824. https://doi.org/10.1177/019459...

How does limited socialization affect young kids? (n.d.). Retrieved April 9, 2021, from https://www.sharp.com/health-n...

Rafanelli, A. (2021, January 19). Growing up in a pandemic: How covid is affecting children’s development. Direct Relief. https://www.directrelief.org/2...

What is covid-19? And how does it relate to child development? (n.d.). Center on the Developing Child at Harvard University. Retrieved April 9, 2021, from https://developingchild.harvar...

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Hiding in Plain Sight: Females with ASD

Anna Missner (GU ’22) October 25, 2021

One aspect of disability that warrants attention is the sex disparity in Autism Spectrum Disorder (ASD) diagnoses. One in 54 children in the United States are diagnosed with ASD, and for every four males diagnosed, only one female is (CDC, n.d.). While part of this discrepancy can be attributed to biological differences between males and females that protect females from ASD, the disparity is exacerbated by biases in diagnostic measures and the perception of ASD as a male disorder. As a result, many females with ASD, particularly those without co-occurring intellectual disabilities (ID), and thus more mild manifestations of ASD, remain undiagnosed.

Females are likely biologically protected from ASD, though the reason for this is not entirely known. Some postulate that the hormone testosterone underlies many characteristics of ASD, and females have less testosterone than males, resulting in less ASD among females (Hull et al., 2020). Another explanation is that the X chromosome is protective against ASD, and because females have one more X chromosome than males, females are more protected from ASD (Hull et al., 2020). However, a specific protective gene on the X chromosome has yet to be found (Hull et al., 2020). Thus, while female biology likely plays some role in protecting them from ASD, the reasons for this effect are not entirely known.

While biology plays a role in the ASD diagnostic sex disparity, biases and the perception of ASD as a male disorder greatly perpetuate the discrepancy. Ratto et al. (2019) and Lundstrom et al. (2019) found that females must have more ASD symptoms than males to meet the criteria on the ASD diagnostic measures most commonly used today, such as the Autism Diagnostic Interview (ADI). Thus, research by Ratto et al. (2019) and Lundstrom et al. (2019) reveal that females must have a stronger manifestation of ASD than males to obtain a diagnosis, suggesting that females with more mild symptoms of ASD, such as those without co-occurring ID, remain undiagnosed. Researchers attribute these findings to the fact that the ASD diagnostic measures most commonly used today were developed based on predominantly male samples. Therefore, these measures are skewed towards detecting a male type of ASD. While females with strong symptomology or a prototypical male manifestation of ASD meet the criteria on these diagnostic measures, females with different patterns of ASD or less severe symptoms are missed by these diagnostic measures.

The ASD diagnostic sex disparity can result in poor mental health among females that remain undiagnosed in addition to missed opportunities for early intervention. Females with ASD who remain undiagnosed may feel alienated and confused, resulting in mental health issues such as depression and anxiety (Hull et al., 2020). These females also miss the opportunity for early intervention, which is the most crucial and effective time to intervene. By spreading awareness of the ASD diagnostic sex disparity, I hope to shift the current perception of ASD to include both males and females.

References

Centers for Disease Control and Prevention (CDC). (n.d.) “Data and statistics on autism spectrum disorder.” www.cdc.gov/ncbddd/autism/data.html.

Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 1-12. doi:/10.1007/s40489-020-00197-9.

Lundstrom, S., Marland, C., Kuja-Halkola, R., Anckarsater, H., Lichtenstein, P., Gillberg, C., & Nilsson, T. (2019). Assessing autism in females: The importance of a sex-specific comparison. Psychiatry Research, 282, 1-4. doi:/10.1016/j.psychres.2019.112566.

Ratto, A. B., Kensworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., Wallace, G. L., Pugliese, C., Schultz, R. T., Ollendick, T. H., Scarpa, A., Seese, S., Register-Brown, K., Martin, A., & Anthony, L. G. (2018). What about the girls? Sex-based differences in autistic traits and adaptive skills. Journal of Autism and Developmental Disorders, 48(5), 1698-1711. doi:10.1007/s10803-017-3413-9.


Anna Missner (GU ’22)

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COVID-19’s Impact on Special Education

Anny Angel (GU ’21), Bella Carlucci (GU ’23), Sela Dragich (GU ’21), Jonathan Kay (GU ’21), Hannan Moallin (GU ’22), & Taylor Villante (GU ‘21) October 04, 2021

The outbreak of the COVID-19 pandemic in the spring of 2020 has resulted in a complete shift to remote learning, which has posed an incredible set of challenges for educators, students, families, and caregivers. This post focuses on the unique challenges and impact the COVID-19 pandemic has had on children and families who receive Special Education Services in schools. An international CARING through COVID Online Survey assessed the impact the COVID-19 stay at home orders has had on the access to educational and medical services for those with intellectual and developmental disabilities (IDDs) and their respective caregivers. These stay-at-home orders caused a substantial loss in access to educational supports and services, with 74% of the parents reporting that their child lost access to at least one therapy or educational service (Jeste et al., 2020). The results from this survey reveal the particular impact of the reduction in access to in-person educational services for all students on people with intellectual and developmental disabilities (IDD). Many individuals with IDDs receive special education services and interventions including speech therapy, occupational therapy, and behavioral support within their academic setting. The loss of these supports impacts not only the child, but also caregivers who relied on schools’ provision of services for their students (Jeste et al., 2020). The isolation caused by the pandemic have also caused challenges for families of children who receive special education services (Toseeb et al., 2020). Many families who usually rely on established relationships and professional support through schools had to figure out other ways to meet their child’s unique educational needs when certain in-person therapies via schools were halted entirely in the pandemic. A study in the UK entitled Supporting Families with Children with Special Educational Needs and Disabilities During COVID-19 focused on finding the most important support needs during lockdown, and during the transition back to in-person learning. Families expressed many needs but creating an established routine and providing mental health resources were identified as families’ most-needed supports (Toseeb et at., 2020).

Though the COVID-19 pandemic has brought about great difficulties for all families and students receiving special education services, some school districts planned and communicated effectively to provide SPED services relatively smoothly in a virtual environment. The rural Commerce Independent School District (CISD) in northeast Texas implemented effective communication, collaboration, professional development and resource distribution, compliance, and effective translation of state and federal guidelines to continue providing special education services via online instruction, take-home packets, Zoom meetings, and telehealth services (Tremmel et al., 2020). CISD sets a positive example that other rural, under-resourced districts may follow to effectively provide special education services to maximize caregiver and student engagement and ultimately reduce the gap of learning outcomes between students with and without disabilities. It is vital for school districts to receive feedback from families, special education professionals, and students themselves in order to provide adequate support to meet the needs of students with disabilities and their families during this difficult time. As schools transition back to in-person learning, it is extremely important for schools to prioritize the social, emotional, and academic support for students receiving special education resources.

Anny Angel (GU ’21), Bella Carlucci (GU ’23), Sela Dragich (GU ’21), Jonathan Kay (GU ’21), Hannan Moallin (GU ’22), and Taylor Villante (GU ‘21

References:

Jeste, S., Hyde, C., Distefano, C., Halladay, A., Ray, S., Porath, M., ... & Thurm, A. (2020). Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID‐19 restrictions. Journal of Intellectual Disability Research, 64(11), 825-833.

Toseeb, U., Asbury, K., Code, A., Fox, L., & Deniz, E. (2020, April 21). Supporting Families with Children with Special Educational Needs and Disabilities During COVID-19. https://doi.org/10.31234/osf.io/tm69k

Tremmel, P., Myers, R., Brunow, D. A., & Hott, B.L. (2020). Educating Students With Disabilities During the COVID-19 Pandemic: Lessons Learned From Commerce Independent School District. Rural Special Education Quarterly, 39(4), 201-210. https://doi.org/10.1177/8756870520958114.


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Recent Posts


Accessibility to Mental Health Services for Children: How Can We Improve?

Jonathan Polakoff January 31, 2022

Covid-19 and Child Development

Jennifer Guo December 21, 2021

Hiding in Plain Sight: Females with ASD

Anna Missner (GU ’22) October 25, 2021

COVID-19’s Impact on Special Education

Anny Angel (GU ’21), Bella Carlucci (GU ’23), Sela Dragich (GU ’21), Jonathan Kay (GU ’21), Hannan Moallin (GU ’22), & Taylor Villante (GU ‘21) October 04, 2021

Disability: A Reflection

Jonathan Kay (GU ’21) July 15, 2021

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Jillian Archer (GU ’24), Rebecca Bullied (GU ’21), Caroline Fisher (GU ’21), Daniela Mateo (GU ’23), Megan McCrady (GU ’21), Quynh Pham (GU ’22) June 15, 2021

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Physician as Advocate

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