Screening mental health in kindergarten is way too late, experts say

Half of all children with mental illness show symptoms before they turn 14, says child psychologist Rahil Briggs.
LA Johnson

This story is part of our NPR Ed series on mental health and schools.

When it comes to children's brains, Rahil Briggs describes them as ... sticky.

"Whatever we throw, [it] sticks. That's why they can learn Spanish in six months when it takes us six years," says the New York City based child psychologist, "but also why if they're exposed to community violence, or domestic violence, it really sticks."

Briggs works at the Healthy Steps program at the Montefiore Comprehensive Health Care Center in the South Bronx, screening children as young as 6 months for mental health issues.

That may sound young, too young maybe, but that's when some experts believe it's important to catch the first signs that something may be wrong. Many say waiting until kindergarten is too late.

Rahil Briggs, a child psychologist, works at a health care center in the South Bronx. It's one of the poorest urban areas in the country.
Rahil Briggs, a child psychologist, works at a health care center in the South Bronx. It's one of the poorest urban areas in the country.
Kavitha Cardoza

So Briggs sees a lot of babies at the Healthy Steps program, but the crying doesn't seem to faze her at all. Visiting with baby and parent, she watches the way they interact.

Does the baby look to the parent for comfort? And does the parent respond?

"If a baby feels safe, a baby will explore, and if a baby explores, a baby will learn," she says, and that's the basis for mental health.

What can interfere with that learning? Things like divorce, neighborhood violence and poverty. And sometimes the signs are right in front of us. Briggs says half of all children with mental illness show symptoms before they turn 14.

"I don't want to wait until a child has missed five days of school because his anxiety is so bad that he can't get on the school bus. That to me is a red flag," she says.

Instead: "I want to see the pink flags."

What she means by that is when a child "starts to chew on his shirt a little bit when you say, 'tomorrow is school.' Just very early, early warning signs of something going wrong."

The best place to spot these pink flags, she believes, is in a pediatrician's office. It's a place all new parents bring their babies regularly and a place they trust.

Katherine is one of those parents. We're not using her last name to protect her privacy.

She and her daughters, Emma Rose, who's 2, and her twins, Kimberley Rose and Emily Rose, both 1, have come to see Dr. Nina Castelnuovo for a checkup at Montefiore.

In a pediatrician's office, doctors typically spend just a few minutes with each patient. There's no way Castelnuovo has time for much more than a physical exam. But today, Katherine says she's worried that her daughter Emma Rose hasn't gained any weight in the past year. She's 23 pounds, but should be closer to 25.

"I think she can also pick up that you're anxious about this," Castelnuovo says to Katherine.

Here's where the Healthy Steps program kicks in full-force. Castelnuovo brings Rahil Briggs, the child psychologist, into the office with the family.

Instead of the pediatrician giving the family a referral to a child psychologist — which they may never follow up on — Briggs is right here, close at hand. The program calls this a warm handoff.

Battles over feeding, toilet training or sleep might indicate an underlying struggle, Briggs tells Katherine. If excessive, it might have psychological roots.

"It's mostly in the social relationships, the parent-child relationships, and not something medical," she says.

(Again, those little pink flags.)

Briggs is reassuring, and they work out a plan for Emma Rose, explaining, "We never want to try and force her to eat. We don't want to get into that struggle with her, that back-and-forth."

In the following months, Briggs will follow up with the family. She says it's all about empowering parents so they feel more confident.

"I know a lot of people feel like a normal childhood gets a diagnosis now. And that is not at all what we're trying to do," she says. "Everything starts somewhere. Diabetes starts somewhere, obesity starts somewhere and mental health illness starts somewhere."

Focusing on that starting point is what is important for Briggs, because if we can predict it, she says, we can prevent it. Copyright 2019 WAMU 88.5. To see more, visit WAMU 88.5.