New Monash research highlights mental health complexity among Australian preschoolers

New Monash University research has raised important questions about how Australia identifies and supports the mental health and wellbeing needs of children in the earliest years.

The study, led by researchers from Monash University and drawing on the Mercy Pregnancy Emotional Wellbeing Study, assessed 545 Australian children aged three to four using the internationally recognised Preschool Age Psychiatric Assessment. Researchers found that almost half of the children assessed met criteria for at least one mental health disorder, with many experiencing more than one condition at the same time. 

According to Monash University, 48 per cent of children met criteria for at least one mental disorder, while 44 per cent of those children had at least one additional disorder. The findings included anxiety, depression, attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and panic attacks. 

The research also found that depressive disorders did not appear in isolation, and were always identified alongside anxiety or externalising disorders. More than half of children with externalising disorders, such as ADHD or oppositional defiant disorder, also had at least one anxiety disorder. 

Why the findings matter

For early childhood education and care (ECEC) services, the findings are likely to resonate with a growing awareness of the complexity many educators and leaders are seeing in practice.

While some anxiety, fear and emotional intensity can be developmentally normal in preschool-aged children, the Monash findings point to a more significant concern: for some children, mental health challenges are presenting early, overlapping with other developmental or behavioural concerns, and potentially affecting learning, relationships and participation.

Lead researchers have warned that early mental health disorders can continue into middle childhood, adolescence and adulthood if children and families do not receive timely support. 

This raises important questions for policymakers, health professionals and the ECEC sector about whether current systems are equipped to respond early enough.

A complex picture for educators and families

Comorbidity, where more than one disorder occurs at the same time, can make children’s needs harder to identify and support.

For educators, behaviours such as distress at separation, withdrawal, aggression, difficulty with transitions, impulsivity, persistent fearfulness or emotional dysregulation may not point to one single issue. They may reflect a more complex pattern of anxiety, developmental vulnerability, trauma, family stress, or emerging mental health concerns.

For families, the pathway to support can also be difficult to navigate, particularly where concerns are subtle, waiting lists are long, or services are fragmented.

Emerging Minds notes that understanding children’s mental health, including what is developmentally typical and when extra support may be needed, is important in building strong foundations for children’s wellbeing. 

Implications for ECEC

The findings reinforce the importance of ensuring early childhood services are not left to respond to complex mental health needs without adequate support.

Key implications for the sector include the need for:

• stronger referral pathways between ECEC, child health, allied health and family support services
• greater access to behaviour and mental health specialists
• trauma-informed and developmentally appropriate practice support
• stronger educator training in child mental health literacy
• timely support for families before concerns escalate
• workforce wellbeing strategies for educators supporting children with complex needs

The research also supports growing calls for more integrated child and family wellbeing models, where early learning, health, mental health and family support services are better connected.

Balancing early identification with care

While the findings are significant, some experts have also urged caution about over-pathologising normal early childhood behaviour. Reporting on the study has noted debate about how best to balance early screening and support with the need to avoid labelling developmentally typical fears, emotions or behaviours as disorders. 

For the ECEC sector, this balance is critical.

The goal is not to turn educators into clinicians, but to ensure they are supported to notice concerns, work in partnership with families, and connect children with appropriate help when needed.

Early childhood mental health as a national priority

The Monash findings add weight to a broader national conversation about the role of the early years in shaping children’s lifelong learning, wellbeing and development.

They also highlight the need for systems that recognise mental health and development do not begin at school age. For many children, the signs of vulnerability are already visible in the preschool years.

As ECEC services continue to support children with increasingly diverse and complex needs, the research provides a clear message for policymakers: early childhood mental health must be part of the national reform agenda, supported by funding, workforce development and integrated service pathways.

Without this, services may continue to carry growing expectations without the specialist support required to meet children and families where they are.

Read the full Monash University research report here.