By Sarah Ford, Freelance journalist
A GOOD start in life does not guarantee a good life, but research shows it certainly helps. It's the early years of a child's life when the brain absorbs experiences and parents are critically important in influencing long-term social and emotional wellbeing.
In Australia this knowledge has produced various early assessment and intervention initiatives for children with, or at risk of, developing problems. The general wisdom is that the earlier the intervention, the better the outcome. But programs have generally been uncoordinated, with overlaps in some areas, and gaps in others.
Now the Federal Government plans to tackle this issue by coordinating services for children and families and developing a map to guide future investment in the area. The plan is part of a National Agenda for Early Childhood (NAEC) that was announced last February. The focus is on early intervention and prevention for children from birth to five years in the key areas of early child and maternal health, early learning and care, and supporting child-friendly communities.
According to the Government's NAEC consultation paper, research has shown that early interventions can yield lasting benefits for children, their families and society. There is also evidence that getting it right in the early years can save money by reducing future crime, substance abuse and reliance on welfare.
Federal Minister for Children and Youth Affairs and head of the NAEC initiative, Larry Anthony, has been asking stakeholders including the APS to contribute to the planning process. The APS submitted its recommendations last month (see below for a summary of key recommendations).
An opportunity for psychologists
APS Executive Director, Dr Lyn Littlefield, has years of teaching, research and clinical experience in child and family psychology and was the Inaugural Director of the Victorian Parenting Centre. She is heartened by the Government's focus on early intervention, and sees it as an opportunity for psychologists.
"Psychologists are really the best-trained professionals to assess learning, social and emotional problems," she says. "They are also taught to intervene to teach parent-child interaction skills, learning strategies, treat behavioural problems and tackle family issues that may arise all the way up the developmental ladder."
A barrier to providing this expertise is that people in need of psychological services, such as parents of children at risk, rarely seek help. "The people most in need will often not go to places that are seen as clinics or have anything to do with treating problems," Dr Littlefield says.
The solution is to resource the places they do access - primary health care services, childcare services and preschool - by training workers in these areas in basic screening and intervention. "If we get people skilled up in those settings to detect problems, you have your best chance of getting to the most needy people," Dr Littlefield says, adding that psychologists are well-placed to provide this training.
"The fact is we can't do it all ourselves because these people don't just walk into our offices, so we have to train others to pick up the markers and then refer for a full assessment. For example, these days maternal and child health nurses are much more astute at picking up postnatal depression and suggesting psychological assistance."
Addressing the potential risk factors from all possible angles is likely to have the most effective outcome. This involves making prevention resources, such as parenting tip sheets, available anywhere parents go for every developmental age. In addition, primary health and childcare workers need to be trained to look beyond developmental issues to the child's family and social environment, particularly the parent-child relationship, Dr Littlefield says.
Poor parenting practices and parent-child relationships are serious risk factors for young children. "A key thing to pick up on is where a parent is having difficulties bonding with a child," Dr Littlefield says. However, it is quite complex to understand where the difficulties arise, she says.
Comprehending the "grey areas"
Dr Sabine Wingenfeld is a senior lecturer in psychology in a joint position between La Trobe University and the Austin and Repatriation Medical Centre, Child and Adolescent Mental Health Service in Melbourne. She has been working in assessment research in cognitive abilities, and emotional and behavioural adjustment in children, since the early 1980s.
Dr Wingenfeld highlights comprehending the "grey areas" as an important contribution of psychologists to early assessment and intervention: "Psychologists can bring expertise in understanding the complexity of child development - it is difficult to draw a dividing line between when development is typical, regular and appropriate and when we start getting worried about development going wrong."
She says one challenge of detecting young children at risk is that they often show "subtle difficulties" that are hard to notice. For example, a child who has cognitive difficulties might not be recognised right away and so she/he might be seen as having a behavioural or emotional problem, rather than an underlying cognitive problem.
Alternatively, if a child has many emotional and behavioural problems and is acting up, he/she may not receive enough attention to develop cognitively and will fall behind as a result. "The tricky thing with young children is that we don't have a nice, clean line of causality," Dr Wingenfeld says.
While children at risk can be helped before they develop a full-blown problem, accurately assessing young children can be difficult.
Preschoolers for example, show much more variability in their cognitive, emotional and behavioural functioning than older children, Dr Wingenfeld says. Many preschool intelligence tests, for instance, are poor predictors of later intelligence test results.
"The challenge is to have measures that are both developmentally sensitive and capture the rapid pace of change in preschool age children, and that also tell us about ongoing or stable capacities," Dr Wingenfeld says. She has co-authored a rating scale for teachers to screen children aged five to 18 for emotional, behavioural and learning problems and is working on a pre-school version for three- to five-year-olds.
Attention Deficit Hyperactivity Disorder (ADHD) also illustrates the difficulties in assessing young children. The disorder is not officially supposed to be diagnosed in preschoolers because being inattentive, impulsive and hyperactive (all ADHD symptoms) is typical preschool behaviour. So at what point is such behaviour judged as a significant problem? "I believe there are some preschoolers we definitely can identify and help, but the line is much more blurred than it is with adults," Dr Wingenfeld says.
However, certain problems are easy to assess at a young age, such as anxiety problems, and research shows early assessment can predict long-term outcomes in particular areas.
Australian psychologists have developed numerous evidence-based early intervention programs, such as the Positive Parenting Program (Triple P), Friends, the Resourceful Adolescent program, Exploring Together and Parents and Adolescents Communicating Together.
Triple P is one of the best known, and has been widely adopted overseas. Professor Matt Sanders and his colleagues from the Parenting and Family Support Centre in the School of Psychology at The University of Queensland developed the program to prevent severe behavioural, emotional and developmental problems. The effectiveness of Triple P is supported by 20 years of clinical trials.
Dr Littlefield at the APS says that proven, effective intervention programs should be offered as early as possible to the children most at risk, such as families in conflict and living in stressful situations. Special programs for different cultural groups need to be developed and trialled, she says.
One example is the Exploring Together program, which is being adapted and trialled with Tiwi Islander communities/families. The first pilot has established the viability and appropriateness of the basic program structure, and that parent and child support for the program can be sustained. The second pilot is underway.
Social and emotional well-being the key
Dr Littlefield is concerned that the universal aims of the Government's agenda to give all children the best start in life is ideal, but financially difficult to achieve. The consultation paper also lacked due recognition of the importance of the parent-child relationship and focused more on learning than on social and emotional wellbeing.
"Learning is important," she says. "But if a child is shy and timid and anxious about going to school, it really interferes with their ability to learn".
However Dr Littlefield is positive about the initiative and its chances of succeeding. The project involves eight Commonwealth Government departments, including Treasury, as well as state, territory and local governments. It also has bipartisan support.
"It is very unusual to have this cross-department and bipartisan support," Dr Littlefield says. "The good part of this initiative is that it really is geared towards early intervention, which is just fantastic. But all this depends on it being resourced properly, having a properly trained workforce and a public awareness campaign. If all that is done, it should work."
For more information about the National Agenda for Early Childhood go to
* Statistic quoted in 'problem trends', a background paper available on the above website.
Key APS recommendations