- INTRODUCTION
- EARLY PROBLEMS MATTER
- Progress in Psychiatric Diagnosis in Young Children
- IMPORTANT CONSIDERATIONS IN YOUNG CHILD ASSESSMENT
- Reliance on Caregivers for Information
- Sensitivity to Contextual Influences, Including Caregiving Contexts
- DOMAINS OF DEVELOPMENT
- SELECTING AN ASSESSMENT APPROACH AND TOOL
- Types of Tools
- Understanding Psychometric Properties
- Reliability
- Validity
- Validity of Classification
- Normatization
- Cultural Validity and Cultural Norms
- Knowing What Problems Are Really Being Assessed
- Response Formats
- Summary
- ASSESSMENT TOOLS
- Screening Methods
- Screening Methods Characteristics of Screening Tools
- Selected Screening Tools
- Comprehensive Dimensional Tools for Assessing Social-Emotional/Behavioral Problems
- Selected Dimensional Checklists
- Variation in Emphasis of the Domains That Are Assessed
- Diagnostic Approaches
- Selected Diagnostic Interviews
- Psychometric Properties of Diagnostic Interviews
- Observational Assessment
- Assessing Impairment
- CONCLUSIONS AND DIRECTIONS FOR FUTURE RESEARCH
- REFERENCES
Introduction
The past 20 years have witnessed a sea change for young children's mental health. It is now recognized that early childhood (0–5 years) is a crucial period for the development of self-regulation, a critical set of competencies that have implications for adaptive functioning in school and through the life span. Early childhood is also recognized as a time when psychopathology may begin to emerge and disrupt young children's developmental progress. In addition, enormous progress has been made in demonstrating that, when psychiatric disorders are defined in a manner that is developmentally meaningful, even very young children suffer from psychiatric disorders that are valid, impairing, and clinically very similar to those experienced by older children (Egger & Angold, 2006; Egger et al., 2006). Indeed, recent research has indicated that psychiatric disorders are just as prevalent in early childhood as they are in school-age children (Egger & Angold, 2006). Moreover, when young children manifest psychopathology that is impairing, it is often persistent and predicts later difficulties once they become of school age. Equally important, there is increasing awareness that these problems can interfere with learning within early childhood and may set in motion a developmental cascade that likely predicts challenges to lifespan functioning in multiple domains. Research focused on specific disorders has driven discovery of neurobiologic substrates, which has further validated the relevance and reality of early life psychopathology (Luby, Belden, Pautsch, Si, & Spitznagel, 2009; Luby, Si, Belden, Tandon, & Spitznagel, 2009; Stalets & Luby, 2006). These advances in our understanding of young child psychopathology are paralleled by, and one might argue largely driven by, an explosion in reliable, valid, developmentally sensitive measures for assessing a full range of self-regulation, social-emotional development in young children. Specifically, over the past 15-plus years, a number of instruments have been developed to assess parent and other caregiver appraisals of social-emotional functioning utilizing both questionnaire and interview methods. There have also been advances in observational tools to assess clinically significant emotional and behavior problems. With greater acceptance and building on advances in measurement, we are poised to evaluate the benefits of a broad range of prevention and intervention efforts and see increasing discovery of biological and environmental influences on young children's mental health.
As the field presses forward to address the mental health needs of young children both efficiently and effectively, success will be optimized by a well-informed approach to assessment that (1) acknowledges contextual factors, including the caregiving environments at home and in other settings, such as child care and early education environments, caregiver influences on social-emotional functioning and assessment, recent changes in family structure or contextual stressors, and sociocultural factors; (2) is framed within the context of a child's functioning in other developmental domains, such as language, cognition, adaptive functioning, health, and sensory; (3) is tailored to the goals and purposes of the assessment and evaluation setting (e.g., pediatric clinic, day care center, mental health clinic, or private practice); (4) utilizes reliable, valid, developmentally sensitive tools; and (5) employs an approach to interpretation that views the whole child in relation to contextual and developmental factors and evaluates his or her capacities and participation in developmentally appropriate activities and settings (i.e., impairment).
A primary goal of this chapter is to help clinicians and researchers determine the most suitable measures to use from a wide array of parent and other caregiver report, observational, and direct assessment measures that are now available. Rather than trying to offer an exhaustive list of all existing measures of social-emotional functioning and psychopathology appropriate for young children, we highlight some of the most widely employed and promising tools and approaches, including those that reflect advances in screening, comprehensive dimensional parent- and other caregiver-report instruments, and diagnostic approaches to young child evaluation. These assessment tools can be categorized as follows: (1) parent and other caregiver report instruments that focus on general problem behaviors; (2) parent and other caregiver report instruments that focus on specific problem areas or disorders (e.g., anxiety, disruptive behavior); (3) parent and other caregiver report instruments designed to assess both problem behaviors and competencies; (4) comprehensive diagnostic interviews for parents of young children; and (5) observational tools and methods. Within the first three categories, measures can be further divided according to whether they are brief tools appropriate for screening or longer checklist tools or diagnostic interviews that provide more detailed information. Finally, we will close the chapter with a discussion of ongoing challenges, future directions, and opportunities in research on and clinical applications with assessment of young child psychopathology. Although many researchers and clinicians continue to express discomfort about pathologizing, or labeling, young children, our focus is on assessment tools that enhance the recognition and detection of early emerging psychopathology to address mental health needs in an effort to minimize adverse developmental cascades. Moreover, we argue optimistically that by labeling systematic behavioral patterns observed within young children (rather than labeling individual children) we create the potential to develop and disseminate guidance regarding appropriate contextual supports and specific behavioral interventions that are tailored to the needs of children with different behavioral profiles; these early prevention and targeted interventions can be designed to support family beliefs, values, and goals and children's developmental progress while minimizing child and family distress.
Early Problems Matter
There is now a consensus among child clinicians that children as young as 2 years of age can suffer from significant social-emotional and behavior problems, or psychopathology. Prevalence estimates of clinically significant problems in nonreferred samples have ranged considerably, from as low as 7% to as high as 26%, depending on whether problems are defined in terms of meeting criteria for psychiatric diagnosis or by exceeding a clinical cutoff on a checklist measure (Briggs-Gowan, Carter, Skuban, & Horwitz, 2001; Egger & Angold, 2006; Gleason et al., 2011; Karabekiroglu et al., 2013; Keenan et al., 1997; Lavigne, Lebailly, Hopkins, Gouze, & Binns, 2009; ...
