For the first time, the Department of Health and Social Care has published statistics on preschool children with mental health conditions.
Findings from the 2017 prevalence survey show that one in eighteen two- to four-year-olds has a condition that meets diagnostic thresholds – which, by definition, causes them significant distress or impairs their functioning.[1] These consist mainly of behavioural disorders, autism spectrum disorder and conditions specific to very early life, including sleeping or feeding problems.
This is low compared to older age groups. For boys, the prevalence of disorders peaks at 14 per cent in 11- to 16-year olds, and for girls, at a striking 24 per cent in ages 17 to 19. As the survey authors note, it can be difficult to identify issues in this very young, and rapidly developing, age group. In addition, prevalence in preschool children is based solely on parental report of symptoms – whereas input from teachers and children themselves at older ages helps to paint a clearer picture of problems.
Despite this, policy-makers should be wary of overlooking very young children – for several reasons.
The overall figure masks substantially higher prevalence in some groups of vulnerable children. Similar to older children, parental mental health is a key risk factor: conditions are more than three times more common in children with parents suffering from difficulties themselves. Lower income children are more than twice as likely to be affected compared to their more affluent peers, with boys from white ethnic backgrounds also at higher risk. One in ten children in the North were identified with a condition compared to only 3 per cent in the South East, and 5 per cent in London and the Midlands and East respectively.
Moreover, these findings follow anecdotal reports of rising incidence of self-harm among children as young as three. The vast majority of lifelong mental health conditions develop in childhood and adolescence, and adverse experiences in very early life have lasting negative consequences for health, attainment and income potential.
EPI’s recent report on the state of child and adolescent mental health services in 2018 found that approximately a quarter of all children referred to specialist services are turned away – with wide variation across the country – mainly because they do not meet eligibility criteria. Our previous research has highlighted that children with complex issues often do not fit into diagnostic boxes, which can result in those most in need of support missing out; the complexities around diagnosing problems in very young children may exacerbate this risk. Added to this, the significant reduction in child and family early intervention services over the last eight years means that children with lower-level needs may not be able to access help in some areas.
Effectively addressing mental ill health in children requires an up-to-date understanding of the scale of difficulties. These statistics provide a starting point.
Yet more research is required into how emotional ill health presents in very young children, as well as the impact of conditions in this period on later life outcomes. We need a better understanding of the number of children with mental health needs who do not meet diagnostic thresholds.
This should be coupled with concerted action to tackle the known risk factors for poor mental health in children of all ages. It is widely accepted that prevention and early intervention are best, both for the well-being of those with difficulties and because of the much higher cost of acute treatment; addressing mental ill health in this very young age group is likely to reduce the significantly higher prevalence we see in older children.
An effective strategy must include policies that create and support the conditions for healthy child development and positive early life experiences. The NHS has committed to rolling out mental health services to expectant and new mothers and fathers – a positive first step in addressing one of the key contributors to children’s mental health.
[1] These are experimental statistics, defined as official statistics published to involve users and stakeholders in their development, and to introduce quality at an early stage.
