Functional impairment among preschoolers using mental health services

Serious emotional disturbance that develops before the age of 6 can interfere with crucial developmental processes, presaging a lifetime of problems. We identify the social stress and illness characteristics of children under the age of 6 years in U.S. specialty mental health programs, and estimate the relative influence of these characteristics on functional impairment with data from the national Client/Patient Sample Survey in order to recommend strategic interventions. Between one-third and three-quarters of preschoolers were seriously impaired, based on Global Assessment of Functioning scores of ≤ 50 and ≤ 60, respectively. Nearly 40% were admitted to mental health services without a psychiatric diagnosis or were identified as having psychiatric problems that stemmed from family stress (e.g., assigned an adjustment disorder). Factors associated with functional impairment in multivariate analyses were (1) minority versus non-minority, (2) public-insurance versus private insurance coverage, and (3) a psychiatric diagnosis of pervasive developmental disorder versus no diagnosis. Programming that addresses the complexities of early childhood development and the social stresses that contribute to poor outcomes will be necessary for effective preventative services and psychiatric treatment for the youngest youths in mental health care. This will require collaboration between mental health clinicians and child welfare professionals.