1.  Early Childhood Mental Health Issues of Diagnosis and Treatment Jeffrey Rowe, MD Supervising Psychiatrist, County of San Diego Associate Clinical Professor, UCSD

2. What is ECMH????  To better understand, we have to work backwards  Start with the hard-to-treat kids  Juvenile Hall  Polinsky Center  Residential Treatment Centers  Hospitals  Special education placements  Outpatient settings

3. Easiest Cases to See ECMH Origin  CWS and Probation cases  Lots of data to show the teens in RTC and JH had troubles early on (before 6)  Many of these kids had troubles related to neglect, abuse, exposure to trauma*

4. Why does early trauma/neglect cause later mental health problems?  This is relatively well studied  2 principles  Development before birth is dependent on DNA and mother’s health  Development after birth is dependent on DNA and experiences (the Holding Environment the child is raised in)

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6. Foundation for Future Development  Neurological  Psychological  Sociological

7. Potential Problems  Sleeping  Eating  Crying, irritable or depressed mood  Social interaction  Aggression  Attachment  Easily over stimulated  Parent-Child Relationship (defiance, temperamental mismatch) 7

8. “Holding Environment” factors  Lack of knowledge about children  Troubles nursing, lack of understanding about feeding kids  Violence in the home  Low IQ of caretaker  Financial stress  Substance abuse by caretakers  Mental illness or physical illness of caretaker  Multiple children close in age 8

9. Early Potential Problems can become diagnosable conditions, but many factors determine whether that happens and how it evolves Potential Problems at T 1 Holding environment Factors Developmental Changes - of the child -of the family -of the environ Subsequent Interventions Early Interventions + Worsening, of problem at T 2 then … + Worsening of problems(s) at T 3 9

10. What is ECMH?  DNA- watching for early signs and symptoms of biological mental health problems  Supporting Mom’s health prenatally  Helping the Holding Environment meet the needs of the child  Educating, supporting, and treating the different parts when things go wrong  Not waiting for the problems to become incorporated in the kid’s neurodevelopment