Assessment of Young Children

The assessment of young children (age 0-5) should incorporate a developmental, relational, and biological perspective on the presenting symptoms and include data collected on interview, observation of dyadic or triadic interactions, as well scores on validated screening tools. This portion of the website provides more information on these considerations when assessing a young child.

Typical Development

Typical development is defined by the attainment of specific physical, cognitive, linguistic, social-emotional, and behavioral milestones that are influenced by historical, cultural, genetic and environmental factors. Developmental theory has historically embraced both the theories of continuous (slow, gradual) developmental changes and discontinuous (step-wise, and with periods of rapid growth) progression over time, while highlighting the presence of both critical and sensitive periods. A critical period is a discrete time period during which a specific function develops making it difficult or even impossible to develop these functions later in life. For example, the first five years of life are considered a particularly critical period for language acquisition. On the other hand, a sensitive period describes a time when it is easiest for children to acquire certain skills, but the onset/offset of the period is more gradual, and acquisition is not impossible following this timeframe. An example of this is that very young children readily acquire second languages when exposed. However, these same languages can certainly be learned later in life.

The assessment of a young child should be approached with these developmental lenses, where the assessor is attuned to where that child may align or stray from a typical developmental trajectory, whether the child is in a time of continuous or discontinuous change, or a critical versus sensitive period.

References:

  1. Guerra NG, Williamson AA, Lucas-Molina B. Normal development: Infancy, childhood, and adolescence. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2012.

Social Emotional Screening Tools for Young Children

Screening and assessing young children for social and emotional health can be quite challenging due to several factors. First of all, the child usually does not have the language skills to explain coherently what they are experiencing - rather they will communicate their problems through behavioral red flags, which, by their very nature, are non-specific. Similarly, parents may also struggle to understand and explain the difficulties they are experiencing with their children and with parenting skills. Additionally, medical, social work, or educational professionals looking to screen for emergent social-emotional challenges in early childhood may not be certain how to ask the questions. Moreover, although clinicians are generally trained extensively in assessing symptoms in an individual, fewer are familiar with the systematic evaluation of relationships between parents and children - but this is an integral part of the early childhood assessment.

Despite these challenges, accurate and efficacious screening and assessment maximizes the potential to direct young children and families to the help they need before problems have become entrenched. Standardized tools validated for the young child can assist with screening and assessing young children and the relationships with their caregivers in a reliable way. Following is a list of tools that are available and are commonly used - although not comprehensive, hopefully this can be a good starting point to help you find what you need in your work with young children!

It is useful also to assess progress across domains of development since young children are not developing social-emotional skills independent of language, cognitive, and motor development. Some useful broad range developmental questionnaires are in the final table below.

Social/emotional development screening instruments

Name of instrument

Age range

For more information

Ages and States Questionnaire: Social-Emotional (ASQ:SE)

2-60 months

Link

Baby Pediatric Symptom Checklist (BPSC)

1-18 months

Link

Brief Infant Toddler Social Emotional Assessment (BITSEA)

12-36 months

Link

Early Childhood Screening Assessment (ECSA)

18-60 months

Link

Preschool Pediatric Symptom Checklist (PPSC)

18-65 months

Link

Young Child PTSD Screen

3-6 years

Link

Early childhood mental health assessment instruments

General child symptoms/strengths

Name of instrument

Age range

For more information

Behavior Assessment System for Children, Third Edition (BASC-3) - Preschool Forms

2-5 years

Link

Devereux Early Childhood Assessment (DECA)©

1 month - 5 years

(versions available for infant, toddler, and preschool)

Link

Diagnostic Infant and Preschool Assessment (DIPA)

Link

Infant Toddler Social Emotional Assessment (ITSEA)

12-36 months

Link

Preschool Age Psychiatric Assessment(PAPA)

2-5 years

Link

Preschool Child Behavior Checklist (CBCL)©

1.5-5 years

Link

Strengths and Difficulties Questionnaire (SDQ)©

2-4 years and 4-10 years(also versions for older children)

Link

Early Childhood Mental Health Assessment tools-

Specific diagnostic categories

Name of instrument

Age range

For more information

EybergChild Behavior Inventory (ECBI)

2-16 years

Link

Spence Preschool AnxietyScale

3-6 years

Link

Stutter-EybergStudent Behavior Inventory - Revised (SESBI-R)

2-16 years

Link

Young Child PTSD Checklist(YCPC)

1-6 years

Link

Assessment tools focused on the parent-child relationship

Name of instrument

Age range

For more information

Child Rearing Inventory (CRI)

3-10 years (based on initial study)

Link

Dyadic Parent-Child Interaction Coding System (DPICS)©

2-7 years

Link

Modified Crowell Procedure

12-60 months

Crowell JA (2003). Assessment of attachment security in a clinical setting: Observations of parents and children. Developmental andBehaviouralPediatrics, 24:199-204

Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO)

10-47 months

Link

Parenting Stress Index (PSI)

0-12 years

Link

Parenting Stress Index - Short Form (PSI-SF)

0-12 years

Link

Working Model of the Child Interview

No specific age range

VreeswijkC, Maas J, VanBakelH (2012). Parental Representations: A Systematic Review of the Working Model of the Child Interview. Infant Mental Health Journal, 33:314-328

Tools focused on assessment of developmental milestones or delays

Name of instrument

Age range

For more information

Ages and Stages Questionnaire 3rdEdition (ASQ:3)

1 months - 5.5 years

Link

Bayley Scales of Infant and Toddler Development ®, Third Edition (Bayley-III®)

1-42 months

Link

Developmental Milestones (from the Survey of Well-Being in Young Childrenor SWYC)

1-65 months

Link

Psychological Testing and Developmental Assessments

Obtaining formal developmental and neuropsychological testing can be very helpful in working with very young children. Reasons for obtaining testing include: 1. To help clarify diagnostically complex and ambiguous cases, 2. To further evaluate a specific cognitive domain, 3. For educational placements and to tailor educational plans, 4. Pre-post comparisons after intervention (e.g. medication) or injury (e.g. head trauma). Developmental assessments usually are broad evaluations of various neuropsychiatric domains and can help provide a lens through which we might be better able to perceive the world from the child's perspective. Neuropsychological testing can be more specific and includes assessments of general abilities and intelligence, achievement, behavioral, social and emotional functioning, adaptive functioning, and diagnostic profiles. Particularly for young children, the conditions of the testing (environmental, psychological and physical) can have a profound impact on test scores. Furthermore, young children are rapidly developing and learning, which means that evaluation results only provide a snapshot picture of the child's current level of functioning, which may change over time. These assessments usually rely on direct assessment, incidental observation, and caregiver report.

Subspecialized clinicians usually conduct developmental and neuropsychiatric assessments. However, knowing the purpose, limitations, and strengths of developmental and neuropsychiatric assessments can be very helpful for clinicians using these evaluative findings to make diagnostic and treatment determinations.

The following are some commonly used developmental and neuropsychiatric assessments. For more information, each test developer usually has webpages with the target age, limitations, strengths, scoring, and norming samples.

Select Developmental Assessment Tools

Brazelton Neonatal Behavioral Assessment Scale, 4th Edition (NBAS-4): assesses neonate's current level of neurobehavioral organization, capacity to respond to the stress of labor and delivery, and adjustment to the ex-utero environment.

Bayley Scales of Infant and Toddler Development-III (BSID-3)- is the most widely used measure of the development of infants and toddlers, and the most psychometrically sophisticated infant test on the market. Administration time is about 25 to 90 minutes depending on the child's age. It assesses cognition, language, motor, social-emotional, and adaptive behaviors.

Mullen Scales of Early Learning (MSEL)- assesses child development in five separate domains: gross motor, visual reception, fine motor, receptive language, and expressive language. Overall, reliability is acceptable to high, but normative data are two decades old, which may overestimate scores.

Resources

* Mares, S., & Graeff-Martins, A.S. (2012). The clinical assessment of infants, preschoolers and their families. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Available: http://iacapap.org/wp-content/uploads/A.4.-INFANT-ASSESSMENT-072012.pdf

* Gilliam, W.S., & Mayes, L.C. (2007). Clinical assessment of infants and toddlers. In A. Martin & F.R. Volkmar (Eds.), Lewis's child and adolescent psychiatry: A comprehensive textbook (4th ed.; pp. 309-322). Philadelphia: Lippincott, Williams & Wilkins.

Training in Early Childhood Mental Health for Psychiatrists

The ACGME requires that child and adolescent psychiatry fellows care for patients from each developmental age group, including preschool, school-age and adolescent populations. However, with school age and adolescent children constituting the majority of presentations to child and adolescent inpatient and outpatient services, accessing robust clinical experiences with the infant and early childhood (age 0-5) population in particular, can present a challenge during training. To enhance and contextualize the clinical experiences, it is also important to acquire the appropriate depth and breadth of knowledge in early childhood mental health issues in the context of a formalized curriculum.

Several academic medical centers across the United States have created more formalized training experiences in preschool mental health. This ranges from early childhood clinics within the typical 2-year CAP fellowship, to post-fellowship training extensions that provide an immersion into perinatal, infant, and early childhood patient care and literature. Rich educational experiences can also be accessed outside the department of psychiatry through interaction with community and ancillary resources (Preschools, Speech & Language Therapists, Occupational therapists), interdisciplinary medical resources (Pediatric Neurology, Developmental Pediatrics, Genetics) as well as psychological resources (Child-Parent Psychotherapists, Parent-Child Interaction Therapists) which taken together can comprise a robust, nuanced, and balanced training for the assessment and treatment of very young children.

Below are a list of academic training programs that currently have formalized experiences for training in early childhood mental health. With new curricula constantly being developed, it is likely that this list is not comprehensive, but can serve as a starting point in exploring available opportunities.