Early Childhood Education Journal, Vol. 32, No.

4, February 2005 ( 2005)

DOI: 10.1007/s10643-004-0754-8

Working with Families

Using an Ecological Framework for Understanding and Treating

Externalizing Behavior in Early Childhood
Ann M. Stacks1,2

This paper will review the literature on the rate, stability, and outcomes associated with
externalizing behavior problems prior to kindergarten entry. Bronfenbrenners (The ecology
of human development. Cambridge, MA: Harvard University Press) ecological framework
will be used to present the factors related to the onset and persistence of externalizing behavior
problems in young children. Behavior problems prior to school entry are somewhat developmentally appropriate and most can be resolved within the classroom or child care setting.
Intervention for children with moderate to severe behavior problems in early childhood is
crucial because behavior problems are likely to persist into elementary school leading to a
variety of social and academic concerns. Steps will be presented to help teachers determine
whether or not a referral to a specialist is needed and locate an appropriate specialist.
KEY WORDS: behavior problems; early childhood intervention; preschool children; therapeutic referrals.

Child behavior problems represent one important risk factor (Tremblay, Pihl, Vitaro, & Dobkin,
1994). Behavior problems are conceptualized across
two broad categories: (1) externalizing behaviors,
which consist of delinquent and aggressive behavior;
and (2) internalizing behaviors, which are reective of
internal states like anxiety, depression, and withdrawal. Research has documented a variety of child,
family, and community factors that are associated
with behavior problems in children. While internalizing diculties are a risk factor for later maladjustment in later childhood and adolescence (Rubin,
Bukowski, & Parker, 1998), they tend not to be as
stable over time (Mesman, Bongers, & Koot, 2001)
and teachers do not perceive shyness and child anxiety to be as disturbing as externalizing behaviors
(Lovejoy, 1996). As a result, this paper is limited to a
review of the literature on the rate, stability, and
outcomes associated with externalizing behavior
problems prior to kindergarten entry. Bronfrenbrenners (1979) ecological framework will be used to
present the factors found to account for the most
variance in the onset and persistence of externalizing
behavior problems in young children. An ecological
framework conveys the complexity of interactions

A successful transition to kindergarten is

increasingly recognized as a foundation for later
school success (Alexander & Entwisle, 1988;
Alexander, Entwisle, & Dauber, 1993). Children who
are socially competent are the most likely to make a
successful transition, to be successful in school, and
to be more accomplished adults (Peth-Pierce, 2001).
Clearly, a successful transition to formal schooling
represents an important developmental milestone,
however not all children are ready to enter kindergarten. One study indicated that kindergarten teachers perceived that 16% of children did not make a
smooth transition into kindergarten. Furthermore,
1346% of kindergarten teachers reported that half
of their class or more entered with problems related
to a successful transition (Rimm-Kaufman, Pianta, &
Cox, 2000). There are a variety of risk factors that
contribute to an unsuccessful transition to early
school.

1
2

Bowling Green State University, Bowling Green, OH, USA.

Correspondence should be directed to Ann M. Stacks, Bowling
Green State University, 16G Family and Consumer Sciences,
Bowling Green, OH 43403, USA; e-mail: astacks@bgnet.bgsu.
edu.

269
1082-3301/05/0200-0269/0 2005 Springer ScienceBusiness Media, Inc.

270
between the individual and his or her environment.
While factors such as prenatal exposure to drugs and
alcohol, complications with child birth, and genetic
makeup clearly interact with the preschool childs
environment and can contribute to the onset and
persistence of externalizing behaviors, they will not
be covered in this review. This review focuses on
factors that can be changed with classroom or therapeutic interventions.
Clearly classrooms and child care centers can be
a haven of safety for children and many of the
behavioral issues that occur can be resolved through
interventions at home and at school. However,
teachers and child care providers cannot possibly
impact all areas of a childs life that may be aecting
his or her behavior and the child and family may need
specialized assistance outside of the classroom; in
these situations, a referral to family therapy is warranted. Steps will be presented to help teachers
determine whether or not a referral to a therapist is
needed and to locate an appropriate therapist.
RATE, STABILITY, AND OUTCOMES
ASSOCIATED WITH EXTERNALIZING
BEHAVIOR
Specic behaviors, like temper tantrums,
clowning, hitting, and trouble paying attention are
associated with externalizing problems and are normal for typically developing preschool children.
However, when these behaviors are severe and persistent across situations they can be predictive of
more serious or clinical levels of behavior problems,
which are more likely to be stable over time (Campbell, 1995). A great deal of research in early childhood has focused on externalizing behavior problems
because children exhibiting these behaviors are disruptive to parents and teachers and are much more
likely to cause harm to another person. Most studies
indicate that 1015% of preschool children have mild
to moderate behavior problems as dened by cut-o
scores on published psychiatric checklists of childrens behaviors (Campbell, 1995). Some studies with
high-risk samples have documented that the rates of
behavior problems in young children may be as high
as 2037% (Pianta & Caldwell, 1990). Research has
consistently demonstrated that teachers tend to rate
African American males and females as having higher
rates of externalizing behavior than white children
(Epstein, March, Connors, & Jackson, 1998). It is
unclear, however whether this is a reection of actual
behavioral dierences or teacher perceptions based

Stacks
on their own cultural standards. There is evidence to
suggest that teachers own minority status may alter
his or her expectations and perceptions of child
behavior (Rimm-Kaufman, et. al., 2000)
It is important to understand the factors that are
associated with the development of externalizing
behavior problems because behavior problems tend to
be stable over time and predictive of future negative
social and academic problems. Across studies 4780%
of preschool children identied as having behavior
problems continue to exhibit these problems into
school age (Campbell & Ewing, 1994; Egeland, Kalkoske, Gottesman, & Erickson, 1990). Furthermore,
preschool children with behavior problems are likely to
experience social and academic diculties (Campbell,
1994, 1995; Huesmann, Eron, & Yarmel, 1987; Nagin
& Tremblay, 1999). Preventing behavior problems requires that one understands the factors related to the
onset and persistence of such issues. Child, caregiver,
and environmental factors contribute to the development and continuation of problematic behavior. Human ecological theory provides a framework for
understanding how these factors impact child behavior. Ecological theory is the study of the relationship
between living organisms and their natural, human
constructed and social environments (Bubolz & Sontag, 1993; Griore & Phenice, 2001). Bronfenbrenners
psychological approach to human ecology recognizes
that development is always embedded in and expressed
through behavior in ones environment (Bronfenbrenner, 1979). Bronfenbrenner conceptualizes the
environment in four levels of interdependent structures
that he called the microsystem, the mesosystem, the
exosystem, and the macrosystem. Factors related to
the onset and persistence of externalizing problems will
be presented in sections according to the levels used by
Bronfenbrenner (1979).

FACTORS RELATED TO THE ONSET

AND PERSISTENCE OF EXTERNALIZING
PROBLEMS
Microsystemic Factors
The microsystem is the pattern of activities,
roles, and interpersonal relations experienced by the
developing person....with particular physical, social,
and symbolic features that invite, permit, or inhibit,
engagement in sustained, progressively more complex
interaction with, and activity in, the immediate
environment (Bronfenbrenner, 1993, p. 15). Most of
the research on behavior problems has focused on the

Ecological Factors Associated with Externalizing Behavior

microsystem. Research has consistently examined
and found support for a number of factors in the
childs environment that contribute to the development of externalizing behavior. These factors include
initial problem severity, quality of the home environment, quality of the childcare or preschool environment, parenting behavior, attachment, divorce
and parental psychopathology.
Initial Problem Severity
The severity of behavioral problems at an early
age, most often conceptualized as temperament, has
been shown to contribute to the maintenance and later
severity of behavior problems in elementary school
children. (Campbell & Ewing, 1990; Campbell, 1995).
Some studies have supported the notion that early reports of infant diculty predict later problem behavior
(Campbell & Ewing, 1990), while others report that
infant diculty interacts with the quality of parenting,
developmental problems, and sex of the child to
determine whether or not a child will exhibit behavior
problems (Campbell, 1995). In a prospective study,
Aguilar, Sroufe, Egeland, and Carleson (2000) found
that temperament did not distinguish between groups
of children who had persistent behavior problems
beginning in preschool, who had problems that began
in adolescence, or children who had never exhibited
clinical levels of behavior problems. One factor that
may account for the dierence in the ndings is that
Campbell and Ewing (1990) used mothers retrospective accounts of their infants temperament, while
Aguilar and colleagues (2000) began measuring temperament at birth and used multiple measures and
informants until 12 months of age.
Quality of the Home and School Environment
Many children spend time in non-parental care.
The quality of the child care, relationships with teachers
or child care providers, and the classroom environment
inuence childrens behavior. Studies have consistently
shown that non-maternal care in the rst year of life
predicted behavior problems in preschool (Baydar &
Brooks-Gunn, 1991) and in kindergarten (Egeland &
Heisters, 1995). Upon closer examination of the data, it
appears that it is not simply entry into non-maternal
care that inuences child behavior; several factors could
mediate the relationship between non-maternal care
and behavior problems. For example, the NICHD
Early Child Care Research Network (2003) suggested
that the amount of time in care, the quality of the care,

271
and maternal sensitivity signicantly impact child outcome. In addition, factors in the preschool classroom
appear to be related to the onset and persistence of child
behavior problems.
Quality of the Childcare Environment
Research supports the view that prior to kindergarten, childrens relationships with important adults
may have a stronger inuence on outcomes related to
school performance than relationships in later childhood (Pianta, Nimetz, & Bennett, 1997). Teacher
child relationships that are characterized as conictual,
dependent, and non-close, are associated with child
externalizing behaviors. However, this relationship is
not simple; externalizing behaviors can evoke negative
responses from teachers, which in turn furthers childrens problematic behavior (Howes, 2000). When
children experience predominantly negative interaction patterns with teachers they tend to construct
mental representations of negative teacherchild relationships that they carry forward to new relationships
(Howes & Smith, 1995). Peer relationships within the
classroom environment also impact childrens aggressive behavior. Children who are in classroom environments characterized by high levels of aggression,
poor peer relations, and poor academic focus are more
likely to exhibit aggressive behaviors (Barth, Dunlap,
Dane, Lochman, & Wells, 2004; Kelleam, Xiange,
Mersica, Brown, & Ialongo, 1998).
While the childcare environment inuences childrens behavior, it appears that this inuence is
dependent on factors related to the home environment. In general, preschoolers who had clinically
signicant behavior problems that persisted into
adolescence tended to live in disorganized homes that
were not responsive to the childrens needs. For
example, adolescents who exhibited behavior problems as preschoolers, but were found to be competent
as adolescents, came from homes that were more
developmentally stimulating, predictable and organized (Egeland et al., 1990).
Parent Behaviors
Research representing a variety of theoretical
perspectives has found that parenting and the family
environment play a role in the development of disruptive behaviors (Campbell, 1995). The level of
parental warmth, degree of responsiveness, eective
and consistent limit setting, and presence of family
violence, impact the parentchild relationship,

272
thereby impacting child behavior. Campbell and
Ewing (1990) found that compared to boys whose
behavior problems did not persist from preschool to
school age, boys whose preschool behavior problems
remained stable had mothers who used more negative
control to gain compliance from their children.
Negative family interaction may provide reinforcement for aggression that is generalized from home to
other settings (Patterson, Capaldi, & Bank, 1992).
Negative family interactions can be described on
a continuum, with the most severe interactions being
violent. Witnessing and directly experiencing violence
impacts childrens behavior. Children who witness
domestic violence are at increased risk of developing
clinical levels of behavior problems (Fantuzzo et al.,
1991; Jae, Suderman, & Reitzel, 1992). Some studies
indicate that the frequency and intensity of interparental violence is directly related to the severity of the
childs symptoms (Jouriles, Farris, & McDonald,
1991), while others suggest that domestic violence
indirectly eects child aggressive behavior because it
impacts family functioning and the quality of
parentchild interaction (English, Marshall, & Stewart, 2003).
Externalizing behavior has also been associated
with experiencing violence directly; corporal punishment, physical abuse, and sexual abuse have been
correlated with clinical levels of behavior problems in
young children. Corporal punishment is the use of
physical force to control the childs behavior by
inicting pain, but not injury (Straus & Donnely,
1994). Brenner and fox (1998) found that mothers use
of physical and verbal punishment accounted for
13% of the unique variance and almost 20% of the
total variance in their young childrens behavior
problems. Mother and father reports of child externalizing behaviors are signicantly related to selfreported use of corporal punishment; however it is
unclear from these studies if the childrens behaviors
were the result of corporal punishment or a cause of
increases in parental use of corporal punishment
(Mahoney, Donnely, Lewis, & Maynard, 2000).
Physical abuse, which is distinguished from corporal
punishment in that it consists of inicting physical
injury on a child (National Clearinghouse on Child
Abuse and Neglect Information, 2000), is also associated with child externalizing behaviors (Aguilar
et al., 2000; George & Main, 1979; Herrenkohl &
Herrenkohl, 1981; Herrenkohl & Russo, 2001). There
are several explanations for the relationship between
child physical abuse and child externalizing behavior.
First, physical abuse provides a model of behavior;

Stacks
children learn that violence is a way to respond to
others (Patterson, DeBaryshe, & Ramsey, 1989).
Second, the preschool period is a sensitive period in
which physical abuse is more likely to lead to
aggressive behaviors (Herrenkohl & Russo, 2001).
Finally, the relationship between physical abuse and
aggression may be mediated by the quality of
parent-child attachment.
Attachment
Negative parentchild interaction and lack of
consistent sensitive care is related to the development
of insecure attachment in infancy; parenting that is
considered abusive or frightening is associated with
disorganized attachment in infancy. Research has
consistently shown that aggression in preschool and
elementary school is related to a history of insecure
and disorganized attachment patterns in infancy
(Lyons-Ruth, Easterbrooks, & Cibelli, 1997; Shaw,
Owens, Vondra, Keenan, & Winslow, 1996). Infants
classied as disorganized are at the most risk for later
behavior problems (Solomon, George, & DeJong,
1995). Shaw and his colleagues (1996) examined the
relationship between parent-infant attachment and
clinical levels of aggression at ages 3 and 5. Disorganized attachment at 12 months was a signicant
predictor of clinical levels of aggressive behavior at
age 5. Disorganized infants were twice as likely as
those classied as insecure, to show clinical levels of
aggression at age 5.
Divorce
Negative parentchild interactions and an
unpredictable environment may be the result of
changes occurring at the family level; one such
change is divorce. Research with school-age children
has consistently found that children from divorced
families have more behavior problems, more social
diculties, and more academic diculties than children in non-divorced families (McLanahan & Teitler,
1999). Children who experience divorce before the
age of 6 are at higher risk of developing behavioral
diculties (Howell, Portes, & Brown, 1997; Pagani,
Boulerice, Tremblay, & Vitaro, 1997), including
regressive behavior, separation anxiety, aggression,
nightmares and bed-wetting (Wallerstein & Blakslee,
1989); these eects tend to dissipate over time (Harland, Reijneveld, Brugman, Verloove-Vanhorick, &
Verhulst, 2002) and younger children appear to
recover better from a divorce than their older siblings

Ecological Factors Associated with Externalizing Behavior

(Wallerstein & Blakslee, 1989). There is some evidence that it is not the divorce itself that is responsible for the increase in behavioral problems. Rather
factors such as diminished parenting, economic
hardship, and psychological distress that are associated with the eects of divorce may actually mediate
the relationship between divorce and childrens
behavior (Clark-Stewart, Vandell, McCartney, Owen,
& Booth, 2000).
Parental Psychopathology
Parental psychological well-being appears to
impact child behavior in a number of ways, including:
genetic transmission, fetal exposure to neuroendocrine correlates of psychopathology, indirect eects
through parent behavior and aect, and environmental stressors that are associated with having a
depressed parent (Connell & Goodman, 2002).
Although psychopathology is a broad category that
encompasses personality disorders, anxiety, depression, and alcoholism, most of the research on parental
psychopathology and child externalizing behavior has
focused on mothers, typically depressed mothers.
Findings from studies of mothers with depression,
anxiety, or schizophrenia indicate that maternal psychopathology is related to child externalizing behavior (Connell & Goodman, 2002). High levels of
maternal depression are associated with the onset and
persistence of behavior problems in children (Campbell, 1995; Campbell & Ewing, 1990; Egeland et al.,
1990). When maternal depression decreases over time,
child externalizing behavior also decreases (Egeland
et al., 1990). The relationship between maternal
depression and child behavior problems is somewhat
unclear. The decreased levels of maternal tolerance
for developmentally appropriate, but dicult behavior may explain the relationship between depression
and behavior problems (Campbell, March, Pierce, &
Ewing, 1991). Another explanation for this relationship includes the notion that behavior problems in
children contribute to feelings of depression in caregivers and that childrens externalizing behavior may
co-occur with family problems.
Despite the fact that most of the research on
parental psychopathology has focused on mothers, it
is clear that paternal psychopathology (alcoholism
and depression) is more closely related to behavioral
and emotional problems in older children than in
younger children (Connell & Goodman, 2002).
Research with fathers indicates that paternal alcoholism and antisocial personality disorder are asso-

273
ciated with sons disruptive behavior (Loukas,
Zucker, Fitzgerald, & Krull, 2003). Family conict
and parental depression mediate the relationship between paternal substance abuse and child outcome;
these factors may be stronger predictors of child
behavior than substance use alone. It appears that
paternal alcoholism is predictive of baseline levels of
externalizing problems, but the stability of externalizing problems is however dependent upon factors
such as family conict and parental depression
(Loukas, Fitzgerald, Zucker, & von Eye, 2001).
Mesosystemic Factors
The mesosystem is comprised of the relationships that exist between two or more settings
(Bronfenbrenner, 1993). An example of a mesosystemic variable that impacts child behavior might include the strength of the homeschool relationship.
This research can be found in the transition to kindergarten literature, but is lacking in the research on
early childhood behavior problems. Research of this
type is desperately needed if we are to better understand how to prevent behavior problems in young
children.
Exosystemic Factors
The exosystem is made of linkages between at
least two settings, one of which the developing person
is not a part. The events in the setting that does not
contain the developing person, however indirectly
inuence the process in that persons immediate
environment (Bronfenbrenner, 1993). Research has
not focused specically on how factors in a caregivers environment may impact child behavior. For
example, stress at a parents place of employment
may indirectly aect their childs behavior through
parenting behavior. Exosystemic factors that have
been studied include low levels marital satisfaction
(Campbell, 1994) and low levels of satisfaction with
ones
support
network
(Renken,
Egeland,
Marvinney, Mangelsdorf, & Sroufe, 1989). With the
number of children in out of home child care and the
question of whether this type of care negatively
impacts childrens behavior, child care provider
exosystemic factors need to be investigated.
Macrosystemic Factors
Bronfenbrenners macrosystem is made up of
belief systems, resources, and patterns of social

274
interchange that are part of the culture of systems
(Bronfenbrenner, 1993). Macrosystemic factors,
which may contribute to the development and
maintenance of problem behavior, include poverty
and a family history of stressful life events. Research
has consistently shown that poverty is correlated with
childhood externalizing problems (Deater-Deckard,
Dodge, Bates, & Pettit, 1998; McLyod, 1998;). It is
likely that families living in poverty are also more
likely than families who are not living in poverty to
experience a greater number of stressful life events.
The onset and persistence of behavior problems in
children is related to stressful life events (Aguilar,
et al., 2000; Campbell, 1995; Campbell & Ewing,
1990;). When families stress levels remain high or
increase over time, their preschool children who had
severe behavior problems may be more likely to
continue these problems into school age (Campbell &
Ewing, 1990) and adolescence (Aguilar et al., 2000).
When family levels of stress decrease, children who
exhibited behavior problems in preschool are less
likely to have behavior problems in elementary
school (Egeland et al., 1990). Some suggest that
stressful life events, such as marital discord, single
parenting, multiple changes in location, money or
employment indirectly aect children through their
impact on parenting (Belsky, 1984) specically on the
use of physical discipline (Herrenkohl & Russo,
2001).
IMPLICATIONS FOR PRACTICE
If research on the rate of externalizing behavior
problems is accurate, teachers should expect that at
least one child in their class will be struggling with
behavioral issues, which are beyond the scope of
classroom intervention. While many of the symptoms
of externalizing problems are considered developmentally appropriate, early identication is necessary
because many of the children with behavior diculties
prior to school entry will have serious behavior problems in elementary school. It may be useful to child care
providers and teachers to become familiar with the
community agencies that serve young children and
their families experiencing problems related to basic
needs, violence, aggressive behavior, or development.
Building relationships with therapists, developmental
specialists, and nurses allows teachers to seek advice
and supervision about a childs behavior. Suggestions
for nding these professionals are presented in the
section Where to Refer Young Children When
Behavior Requires More Serious Intervention.

Stacks
Before eective intervention can take place, one
must understand the contexts in which the problem
behavior is occurring. Between the ages of 2 and 5
children are likely to encounter a variety of transitions that will negatively impact their behavior, for
example, changing schools or child care providers,
moving, losing a parent to death or divorce, a signicant change in family nances, or the birth of a
sibling. With supportive parents and child care providers, most children will move through these changes successfully. However, many children will
experience an accumulation of co-occurring risk
factors, which have the potential to impact their
behavior long-term (Samero, Seifer, & Bartko,
1997). For example, a toddler who experiences the
loss of his father through divorce, may also encounter
the loss of family income, which could result in
moving to a smaller, less safe location, and the
beginning or changing of childcare. The stress of the
fathers absence has the potential to impact the mothers mental health, which could negatively impact
her parenting, which has the potential to exacerbate
the childs behavior at home and at child care or
preschool.
As with the above example, clinical levels of early
childhood behavior problems can be the result of an
accumulation of risk factors, many of which are at the
microsystemic level. Unfortunately, early childhood
educators may be limited in their interventions because of time constraints and the scope of their profession. However, there are a number of ways that a
teacher or child care provider can intervene.
Is Outside Intervention Required?
Some diculties may be addressed in the classroom, while others may require outside intervention.
To determine if an outside intervention is warranted,
it is helpful to start with a social emotional screen
such as Ages and Stages Social-Emotional (ASQ-SE,
Squires, Bricker, & Twombly, 2002). Because socialemotional concerns may be the result of developmental delay in other domains, teachers may want to
administer the Ages and Stages to rule-out the possibility of concerns in other domains of development.
When a developmental screen indicates concern, a
more thorough assessment by a developmental specialist is necessary.
Whether or not a developmental screen indicates
concern, detailed observations of the child over a
period of time help document when problem behaviors are occurring and when the child is acting

Ecological Factors Associated with Externalizing Behavior

appropriately. These detailed observations can help
to identify appropriate classroom or home-based
interventions and can provide important information
to parents and early intervention specialists. Some
questions that a teacher or child care provider may
want to ask themselves during an observation include: Are problems frequent around the timing of a
meal or transition? Are children having trouble
joining the group? Are they able to begin to understand how their actions impact others? Teachers and/
or an outside person should document specic
behaviors, the intensity of the response, how long it
takes the child to recover, and what type of help the
child needs to recover.
Detailed, objective observations also allow
teachers or child care providers a framework for
discussing these issues with parents in a
non-threatening way. Sometimes an objective observation requires a third person who focuses on the
childs strengths and limitations in the classroom
and/or at home. By focusing on the times when
children are in control of their behavior and when
their behavior is out of control, teachers send a
message to parents that they are looking at the whole
child and recognize the childs strengths. Recognition
of the childs strengths and limitations, backed up by
evidence, help create a good relationship with parents
(Lawrence-Lightfoot, 2003) and a foundation for a
discussing childrens behavioral concerns. Before
making a referral, teachers should ask parents if they
are having the same issues at home and how they are
being handled. If parents are not experiencing problems at home, it may be an indication that changes
need to be made within the classroom environment.
Some changes in the classroom environment might
include: more notice given to children before a transition, allowing the child to make appropriate choices
(i.e. allowing them to choose if they would like to use
a purple crayon or a red crayon during an activity,
rather than a choice of whether or not to participate
in the class), reecting feelings and suggesting alternatives for aggressive behavior, and helping children
develop skills for working together. Teachers should
also examine their own feelings toward a child who is
aggressive in the class; are these feelings contributing
to negative, conictual, or distant relationships that
perpetuate child aggressive behavior?
Parents and teachers should work together to
understand some of the environmental factors that
could be associated with the behavioral concerns,
for example the birth of a new sibling. Teachers and
parents may also want to examine health related

275
issues, for example sleep and diet. For young children, especially, consistency across contexts is
important; building consistency requires communication between the parent and teacher or child care
provider.
Outside intervention may be warranted when:
(1) child behavior problems are a function of family
dynamics that teachers cannot be expected to impact;
(2) a developmental screen indicates risk for socialemotional or other developmental disabilities;
(3) behavioral diculties are consistent across contexts, persist over a period of time, and do not respond to traditional classroom intervention.
Behaviors including violence toward others, self inicted harm, inappropriate sexual behaviors, violence
toward animals, and compulsive stealing always
warrant a referral to a mental health specialist.
Where to Refer Young Children When Behavior
Requires More Serious Intervention
Parents who are concerned about their childs
behavior often feel comfortable conding in teachers,
especially those who see the parent as their partner in
helping the child to overcome his or her behavioral
issues. Teachers may be aware that the child has a
dicult temperament or that the parent is overwhelmed and has a dicult time responding to his or
her child in a consistent and sensitive manner.
Teachers or child care providers who know that a
parent has recently experienced stressful events that
are impacting the parent and the parent child relationship are in a position to refer parents and children
for more specialized services. Research has demonstrated that many of the factors associated with
childrens behavioral problems are related to events
in the family environment, consequently family
therapy is usually the treatment of choice.
After deciding that intervention beyond the
classroom is necessary, teachers can refer children to a
variety of private or social service agencies. A childs
physician can be the rst step when sleep issues or
nutrition problems may be impacting childrens
behavior. Pediatricians may also have a list of providers or agencies to which they refer parents. Often
times, there are partnerships established in the community and a resource network. Teachers and child
care providers who are not associated with comprehensive early intervention programs may nd referral
information by contacting local community agencies
such as: Head Start, Department of Social Services,
Intermediate School District, Community Mental

276
Health, or Health Department. Although low-income
families typically utilize these services, they are often
available for middle and high-income families. Families who prefer to be involved with private pay or
have health insurance to cover the cost of services may
benet from a private-pay therapist with a background in Infant Mental Health or Early Intervention. Regardless of the type of service providers that
families choose, services for families with young
children should be family-centered and the provider
should be experienced with children under the age of
5. For young children it is very important that the
therapist is experienced working with families and is
able to conduct play therapy or lial play therapy.
Finding a private pay therapist who specializes in
families with children under 5 can seem like a daunting task, however there are several places to start.
While most states do not oer licensure in infant
mental health or play therapy, many therapists have
extra training or certication in infant mental health
or play therapy. These therapists are often listed on
websites such as The Association for Play Therapy
(http://www.a4pt.org) or the World Association for
Infant Mental Health (http://www.waimh.org/aliates.htm). Early childhood therapists or infant mental
health specialists at the local Community Mental
Health or Head Start can be a good source of information about how to locate an appropriate privatepay therapist in the area.
Most children who exhibit behavioral concerns
in the classroom will not need a referral to a mental
health specialist, however when developmental
screens indicate concern, the behavioral problem is a
function of family dynamics, behavioral diculties
are consistent and do not respond to traditional
classroom interventions, or when children exhibit
high-risk behaviors, a referral to an early childhood
mental health therapist is warranted. Teachers and
child care providers are in a position to recognize the
signs of early behavioral problems and refer to the
appropriate agency. Intervention for children with
moderate to severe behavior problems in early
childhood is crucial because behavior problems are
likely to persist into elementary school leading to a
variety of social and academic concerns.
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