Recognizing and Addressing Mental Health Issues in the EI Setting

Recognize common behavioral/ mental
issues in children
Identify and differentiate between
behavioral concerns and true developmental
Recognize and understand the impact of
familial mental health on children
Identify and understand how to respond to
common behavioral issues and when to refer.
• duration
• Intensity
• Time of day
• Setting
• triggers
• Impulsive
• Anger vs. Communication
• triggers
• Setting
• Physical reactions
• interaction
• Family vs. public
• Age of onset
• Child history
• triggers
• Setting – time of day
• Setting limits/boundaries
• Age
• Frequency/external factors
• Duration of sleep
Conversation/observation is key in determining
if behavior is typical or atypical. Here are a
few things to observe:
 Duration – is the behavior lasting for long
periods of time i.e. greater than 15-30 minutes
 Does behavior occur in a variety of settings?
 Is the child able to “self-calm”?
 Do triggers appear to be present?
 Is the behavior easily explained?
 Are there recent changes in the family?
You determine the behavior present is not typical,
what do you do now?
 Have a caring, supportive conversation with
the family.
 Discuss with the family their concerns and
ways you can help
 Assist the family in getting everyone “on
board” with interventions
 Depending on the concern, refer to outside
**Interventions need to be addressed on IFSP**
Matthew is a two year old boy who was initially
referred to EI for speech concerns. At your last
visit Mom tells the EI provider that Matthew’s
temper tantrums are worse. Through conversation
you learn that Matthew is having approximately 56 tantrums a day lasting 30 minutes or longer.
Tantrums occur at home, the store etc. Along with
his tantrums he is becoming aggressive. Mom has
difficulty cooking dinner, shopping ,etc due to his
increased tantrums.
Do we address this concern on the IFSP?
What does his IFSP look like? What are his
outcomes? Who will provide the service?
Outcomes need to be specific and functional for
the family
Procedures need to be specific for the family
Services may need to be addressed as a non-EI
 Anxiety
 Personality Disorders
 Substance Abuse
 Major Mental Health Disorder
Slow to respond to overtures for verbal or physical
interactions by their children
Make critical comments
Have difficulty in encouraging the child’s
speech/language facility.
Have difficulty asserting authority and setting
limits which would help the child learn to regulate
his or her own behavior.
Talk less to their infants
Do use lilt and exaggeration that are typical of
non-depressed mothers
Less aware and responsive to their infant’s cues
Have difficulty in providing appropriate
Nine month-old “Grace” is listless. Referral
information indicates she is not sitting up or
pulling to a stand.
What type of evaluations would you recommend based on
this information?
Typically this information would lend to PT
evaluation…here is more information before we refer.
Nine month-old “Grace” is listless. Referral
information indicates she is not sitting up or
pulling to a stand.
Grace’s mother has frequent crying spells and
spends little time with her infant. Left alone in
her crib for long periods of time. Grace is
unresponsive, difficult to arouse and looks
Does this information change or alter our referral in
any way?
PT evaluation would be beneficial and
necessary, however should not stand alone.
Conversation with Mom and possible referral
is vital.
Routine Based Assessment is key in
determining other causes to a child’s delay.
When we evaluate the child, we need to look at
the family as a whole
Maternal Depression has been shown to be
associated with the following:
 Increase in behavior problems
 Social-Emotional maladjustment
 Deficits in Cognitive functioning
 Difficulty with attachment
Research has shown that if attachment is secure, the
young child is more likely to successfully negotiate
developmental tasks.
Listen to the family – a good Routine Based
Assessment will lead to discussion and help
identify the parents concerns and possible
behavior problems
Focus on the issue – not the person. The child
or parent is not “bad” – the behavior or
behavior pattern is of concern.
Be open and honest - ignoring issues will only
lead to them becoming worse.
Traditional behavioral interventions are not
Behavioral disruptions are occur in a variety of
settings i.e. home, church, daycare etc.
A person is at risk of harming themselves or
someone else
Suicidal ideations
Behavior Problems in Children
 Licensed Counselor/Play Therapist who
specializes in children
 Psychologist/Psychiatrist
 Local Mental Health Center
Familial Mental Health Problems
 Licensed Counselor/Psychologist
 Substance Abuse Counselor/Group
 Local Mental Health Center
 Name/Number of local Crisis Line
Behavior problems are common in toddlers
Evaluate behavior to determine if it is typical or
Familial mental health is important, and left
untreated directly affects the child
Many behavior problems can be addressed on
the IFSP, however it is important to know
when to refer

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