Developmental perspective

Children are not small adults; they have particular emotional, social and physical capacities and needs. To be effective, service delivery must be designed around infant and child developmental stages.

Children’s mental health needs to be understood within the context of the child’s development, and more so than for adult mental health, is closely related to the concepts of healthy social and emotional development¹.

Infant and child mental health is often described with a focus on the development of capacities such as forming close and secure relationships, exploring environments and learning, and regulating and expressing emotions¹. These capacities are established in different ways for children of different ages¹. As such, intervention strategies used with infants and children experiencing mental health conditions need to be appropriate to the developmental level of the individual infant or child and reflective of approaches that are relevant and applicable to each age group².

The signs and symptoms of mental health conditions, and the types of interventions that are appropriate, will differ depending on infant’s and children’s developmental stage:

• 0–2 years: Symptoms may include taking no pleasure in interacting with their parents, crying easily or continuously, having disturbed sleeping and eating cycles, or appearing passive, unreceptive or unhappy. Identifying mental health difficulties in infants and young children can be a difficult task as it is normal for children to demonstrate some of these symptoms at certain times in their lives. As there are many potential causes, diagnosis and treatment would usually be carried out by specialists and interdisciplinary teams³.
• 2–4 years: Symptoms may include disinterestedness in play, pronounced separation anxiety, and problems with eating, sleeping and toileting. When behavioural or emotional problems such as these start to significantly interfere with children’s capacity to function, there may be cause for concern. Interventions may include cognitive behavioural therapy or parent–child interaction therapy³.
• 5–8 years: Early primary school aged children may begin exhibiting the signs and symptoms typically associated with depression and anxiety, such as persistent sadness, moodiness, lack of motivation, loss of hope, fear of social situations, and sleeping difficulties. School-based Interventions may be appropriate at this age⁴.
• 8–12 years: Children in the later primary years may exhibit similar signs and symptoms as those in early primary school. However, their experience may be affected by issues such as increasing independence, developing social capacities, and physical development (including early puberty).

^1. Miles, J., Espiritu, RC., Horen, N., Sebian, J., & Waetzig, E., A public health approach to children’s mental health: a conceptual framework. 2010, Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health.
^2. AICAFMHA. Improving the mental health of infants, children and adolescents in Australia: Position paper of the Australian, Infant, Child, Adolescent and Family Mental Health Association Ltd (AICAFMHA). 2011; Available here.
^3. von Klitzing, K., Döhnert, M., Kroll, M., Grube, M, Mental Disorders in Early Childhood. Dtsch Arztebl Int, 2015. 112(21-22): p. 375-386.
^4. Herzig-Anderson, K., Colognori, D., Fox, J.K., Stewart, C.E., Warner, C.M., School-based anxiety treatments for children and adolescents. Child Adolesc Psychiatric Clin N Am, 2012. 21: p. 655-668.