Dozens of organizations are interested in child welfare and child development, some from the research point of view, some from a public policy perspective, and some with an emphasis on advocacy. Like other organizations, these often fail to work together. However, in 2009, a number of groups, including the Society for Research on Child Development and the American Psychological Association had a "summit meeting" in Denver and discussed some important issues about public understanding of children's mental health. This discussion is available in a report called "Healthy Development: A Summit on Young Children's Mental Health", at www.apa.org/pi/families/summit-report.pdf.
"Healthy Development" contains a number of essential points about family life and child mental health-- including an important emphasis on the fact that good mental health in childhood is essentially the same thing as good social and emotional development. Factors that support excellent development--- like opportunities for secure relationships with consistent, sensitive, responsive adults--- are the factors that help ensure child mental health, and that help to contribute to mental health as the child grows to adulthood.
There were two issues in "Healthy Development" that struck me particularly and made me think of a post I wrote some weeks ago about poverty and child mental health issues. That post explored some of the reasons why children eligible for Medicaid seemed more likely to be treated with serious psychiatric drugs than children from families who were privately insured. At that time, I commented on some of the facts of poor children's lives and access to medical and psychological care, and how those facts might make it less likely that play therapy or "talking therapy" would be used with them, and more likely that drug treatments would be pursued.
"Healthy Development" notes two important and related points. The first is that demographic variables such as race and socioeconomic status are important factors that help determine children's mental health outcomes. The second point, which I had never seen stated so clearly, is that predictable routines are a factor that helps children develop well socially and emotionally and escape mental health problems.
Why should predictable routines make any difference to young children? And what does poverty have to do with predictable routines? Let's consider the first question. We have a lot of evidence suggesting that young children are most comfortable and perform at their best when they can stay near familiar people who provide support and comfort. A critical aspect of attachment is the ability to use a familiar person as a secure base from which the child can venture out and explore unfamiliar territory, returning periodically for "emotional refueling". This fact helps us see that young children tend to regard the unfamiliar with great wariness, especially those who are temperamentally inclined to withdraw from unknown people and places. Although we don't usually speak of "place anxiety", young children have their fears about unfamiliar places and things, as well as their "stranger anxiety".
Especially between perhaps 8 months of age and 2 years, children accept the unfamiliar with difficulty, and do best with the careful support of some familiar person or thing. Many are helped along by carrying around an "attachment object" like a teddy bear or blanket (often hideous to adults because it becomes so bedraggled with hard wear). That familiar thing helps the child cope with the unfamiliar. Similarly, an unfamiliar person or event is more acceptable to the young child when it's seen in his familiar home rather than in a strange place. Even unfamiliar problems or information may cause difficulty for older children, as the Russian psychologist Lev Vygotsky pointed out years ago in his discussion of children who can solve a problem when a supportive adult is near, but not otherwise.
Just as young children have trouble with unfamiliar people or places, they often show difficulty in coping with transitions from one situation to another, as if even well-known experiences can have an element of unpredictability and anxiety. In high-quality nursery schools and day care centers, the handling of transitions (getting ready for nap time, going outdoors, getting ready to go home) is given a great deal of consideration. Children who can predict what will happen next and make a gradual transition can use their energy for their own developmental tasks rather than in trying to feel safe.
Predictability, security, and familiarity all seem to go together to help young children handle a world they do not understand very well. Daily routines of eating, sleeping, dressing, playing are a major part of a predictable world, and changes in them make it hard for young children to be at their best-- as all parents know from experiences with travel and holidays. While no one would suggest that a family or a day care center be in lockstep with the clock, providing a predictable life helps young children follow a desirable developmental trajectory.
Can't poor families have predictable lives too? Why should there be any connection among poverty, predictable routines, and childhood mental health problems? Of course, it's possible that a poor family living on an isolated farm could have predictable lives, but the urban poor, on the whole, do not. Poverty in 21st century America means a life of unpredictability and unwanted change. For example, poor families may find themselves frequently moving from one residence to another. They may be evicted for failing to pay rent, or their substandard housing may be shut down by the authorities. Those who have lost jobs may try to make ends meet by "couch-surfing" at the houses of friends or kin. Families may leave the cities where they have been living to seek shelter with family members in other parts of the country-- or they may simply send their children there. Spending time in one or more homeless shelters is another possibility (as the current issue of Zero to Three discusses in detail). All of these changes mean alterations in routines that are centered around the structure and quality of a home place.
Poor women with children are subject to unpredictable changes, whether they are employed or not. Unemployed women receiving job training report to training programs that are scheduled for them, and bring their children to child care programs that may or may not manage to create a predictable structure for them. Schedules are different from day to day, and are likely to be quite different from the family's previous routine. Poor women with jobs are likely to do the kind of work where schedules are changed frequently and where a worker may be "called in" abruptly to take the place of an absentee. She has to go, or risk losing the job, and the consistent routines her young children need are not a consideration.
Whether it's on the job or at job training, at home or at a health care facility, the lives of poor families involve unpredictable periods of waiting and unpredictable periods of hurrying to meet others' requirements. Children's needs for consistency and well-handled transitions are not met in these situations. We should not be surprised that poor outcomes of learning and social development accompany family poverty.
[I regret that a series of personal attacks on colleagues and contributors, as well as on me, make it impossible to allow comments on this post.]