Preschools grapple with mental health

Janene Johnson takes on some of the city’s hardest cases – the violent, the depressed, the angry.

But Johnson isn’t a cop or a judge. She’s a preschool director.

“A 5-year-old is not the same 5-year-old they were 20 years ago,” said Johnson, director of Megadoodle’s Learning Center, where the majority of the children are supported by state programs for low-income families. “There’s been a huge change in family structure and, with that, different child behaviors.”

Many children in Johnson’s care end up there for a simple reason: They have been expelled from other preschools.

Children in preschool programs are three times more likely to be expelled than school-age children, according to a study released last year by Yale University. At facilities where teachers did not have access to mental health professionals, children were twice as likely to be expelled, the study found.

This month, the state Legislature is set to approve $250,000 for a pilot program that would allow preschools and day cares to consult with mental health experts about the behavior of children in their care.

The legislative push sparked a debate: Can toddlers have mental illness? Are extreme incidents of hitting, biting and isolation – once viewed as natural “stages” for the pre-kindergarten set – in fact signs of deeper psychological issues?

“A lot of these children do carry a psychiatric diagnosis,” said Michael Manz, chief child psychiatrist at Sacred Heart Medical Center’s Psychiatric Center for Children and Adolescents. “Does that make them mentally ill? We could talk about that for the next couple hours.”

A House bill that would have provided more funding for the pilot program died after legislators were flooded with angry e-mails and phone calls.

“People just came unglued that we were addressing mental health problems of preschoolers,” said Rep. Maureen Walsh, R-Walla Walla. “There’s a huge stigma when you use the term mental health.”

Parenting woes and intervention

Online parenting message boards are replete with tales of out-of-control toddlers, or children who exhibit signs of depression and anxiety.

One woman, whose husband’s military career often took him away from home, wrote that her 3-year-old daughter had stopped eating and had shown signs of depression for months.

“It hurts me so badly to see a beautiful, intelligent little girl be so sad all of the time,” the woman wrote. “Help me if you can.”

For some, the solution may simply be finding the right day care.

Kenny and Robin Stinebaugh were shocked when their son was expelled from several Spokane facilities. At day care, their normally well-behaved son continually separated himself from other children and lashed out both physically and verbally.

“It blew me away,” Kenny Stinebaugh said. “He was a great kid at home. But he was overwhelmed in a room full of screaming kids.”

At Janene Johnson’s center, the Stinebaughs’ son quickly adjusted. Johnson – who has an associate degree in early childhood education – said her center provides a quiet, structured environment for children, some of whom may come from chaotic lives.

But while the Stinebaughs’ son improved his behavior, other children prove far more challenging.

A decade ago, Johnson videotaped a day with one of the most troubled toddlers in her care. When the child’s mother saw her son’s violent behavior, she broke down in tears, Johnson said.

“It’s very hard to explain this kind of behavior until you see it for yourself,” Johnson said. “There are so many children who don’t get the attention they need. Some of them haven’t been regularly held or told they are loved. They may not even be used to eye contact.”

Mental health professionals and advocates are careful to point out that some of these children are going through more than just a prolonged bout of the “terrible twos.” Some are suffering from severe emotional and behavioral issues that require professional counseling and, sometimes, medication.

“This isn’t just a typical 2-year-old misbehaving,” said Rep. Mary Helen Roberts, D-Edmonds, who sponsored a bill to fund the pilot program. “It makes it very disruptive to the whole class and the other children.”

A national study last year estimated that more than 5,000 children are expelled from state-funded pre-kindergarten programs alone; for-profit and faith-affiliated centers were nearly twice as likely to expel children. Many others aren’t expelled but disrupt classrooms, experts say.

As many as 20,000 children under the age of 5 in Washington state may have “significant emotional behavioral problems,” according to an estimate from Sheri L. Hill, faculty lead on policy at the University of Washington’s Center on Infant Mental Health and Development.

“It pains us to think that young children can suffer,” Hill said. “We don’t want to believe that. But we have tons of research that shows they really suffer distress.”

‘The kids who end up costing us so much’

In a House committee hearing last month, a member of the Citizens Commission on Human Rights, which was co-founded by the Church of Scientology to advocate against the practice of psychiatry, protested the bill as a “program that turns into a drugging of our kids.”

Walsh, a member of the House Children and Family Services Committee, expressed concern about the use of medication to curb children’s behavior.

“I do think that we tend to be drugging our society as a whole these days,” Walsh said. “When you’re talking about kids who are not yet in the school system, those are not mental health issues. They’re behavioral.”

Hill said early intervention focuses on educating the day care and counseling the family and child – not on prescribing medications.

“People think this is about giving drugs to little kids,” Hill said. “The hope is that if you begin this work in early childhood, you can prevent them from needing medication later in life.”

Whatever the terminology, bad toddler behavior has a real impact at day cares and preschools, which have begun to expel some children.

A recent study in Illinois found that 42 percent of day cares expelled infants or toddlers because they could not handle the child’s social or emotional problems.

“Children are presenting with problems that child care providers don’t know how to resolve, and they’re saying, ‘Let’s get rid of this child,’” said Mary Leighton, a children’s mental-health counselor in Olympia. “You have to have someone trained well enough to know what is appropriate and what is cause for concern.”

Leighton, who has worked in child care for more than 40 years, said she assesses both the child and the learning center. In chaotic environments, some children may not be able to control their emotions.

“If children are not mastering those skills early on, then those behaviors and distress can get in the way of learning in the years that follow,” Leighton said.

Those behaviors may also be signs of more serious problems: One study found that young children with serious behavioral problems were 52 times more likely to be diagnosed with a conduct disorder as adolescents than those children whose behaviors were resolved.

Conduct disorder, which typically presents itself as aggressive or destructive behavior, was cited in more than one-third of all cases in which Washington schoolchildren were hospitalized for mental illness in 1999, the most recent available data.

“Those are the kids who end up costing us so much in the juvenile justice system,” Hill said. “We know we can prevent it if we start early enough.”