Even with half-finished crayon drawings and an abandoned puzzle by the reading nook, a Tuesday morning in almost any preschool classroom still gives the impression that childhood is going according to plan. However, a different picture begins to emerge when you take the time to speak with the educators, the pediatricians, and the weary parents who are waiting for someone to explain why their four-year-old has had his third meltdown before nine in the morning. Young children’s coping mechanisms have changed, and the clinical community is just now starting to catch up.
By all standards, the United States’ preschool expulsion rates are concerning. Early learning programs are dismissing young children at a rate that is about three times higher than that of elementary school students. Three times. for actions. at four years old. Once you see that figure, it makes you uncomfortable because it implies that the issue is a systemic failure to support children during one of the most neurologically sensitive periods of their lives rather than a small number of exceptionally challenging children.
For years, the data supporting this has been quietly accumulating. One in six American children between the ages of two and eight had a behavioral, developmental, or mental health disorder by 2016. Approximately 7% of children between the ages of three and seventeen suffer from anxiety disorders. It is now common for children as young as two to be diagnosed with ADHD. The fact that only about 25% of kids who are diagnosed with a behavioral or mental health issue actually receive treatment is perhaps more telling than any official diagnosis statistic. There is no fissure between need and care. It’s a canyon.
The social media spiral, the high school anxiety epidemic, and the scarcity of college counselors are just a few examples of how much of the discussion surrounding youth mental health centers on teenagers. Everything is genuine. Everything is urgent. However, there’s an odd silence about what’s going on much earlier, in the years leading up to kindergarten, when intervention might be most beneficial. Preschool is not only crucial but also fundamental in a way that still doesn’t seem to be acknowledged in policy discussions, as research increasingly indicates that adult psychological difficulties frequently have roots in early childhood.
The fragmented nature of care is one of the reasons this crisis is so challenging to resolve. A referral, which is a document directing a struggling four-year-old to a behavioral health professional who may have a six-month waitlist, may not take insurance, and most likely has never visited the child’s classroom, has been the most typical response. Parents deal with this on their own, frequently juggling their own work schedules, stress, and the silent guilt of feeling like they’ve somehow failed at something as simple as raising a quiet child. The obstacles are not coincidental. They are structural.
Some pediatric practices have begun taking a different approach, such as integrating behavioral health professionals directly into primary care, reaching out to families prior to the peak of the crisis, and consulting with childcare teachers who would otherwise be left to handle severe behavioral episodes without any kind of clinical support. The statewide early childhood consultation program in Connecticut produced real results, including a decrease in expulsions and quantifiable reductions in disruptions in the classroom. Wider use of such models may have a significant impact on results. However, it’s still unclear whether there is political support for such an investment in young people who aren’t yet able to vote.
It’s becoming more and more obvious that waiting—hoping a child will “grow out of it,” postponing assessment until first grade—usually makes matters worse rather than better. The habit becomes more ingrained. Relationships within the family are further strained. The child is already labeled and behind when they start formal schooling. Children are always learning new things, such as the fact that adults around them are unsure of what to do and that their impulses are unbridled. Prior to the age of seven, early intervention is not only recommended. The evidence currently indicates that it is almost necessary.
America has been discussing a youth mental health crisis for years. Maybe it’s time to begin the discussion ten years earlier.
