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Identification of preschool children with mental health problems by parent-report screening measures, primary or community health care practitioners, and psychiatric diagnoses
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Objective:
Primary care practitioners determine access to care for many preschool children with mental health (MH) problems. This study examined rates of mental health (MH) problem identification in preschoolers within primary healthcare settings, related service use, and MH status at follow-up. The findings may inform evidence-based policy and pr...
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Background:
China committed to establishing a family doctor (FD)-based referral system following the medical reform in 2009. This paper explored the effect of FD on establishing the anticipated system.
Methods:
Two waves of survey were conducted in Shanghai, China. 2754 and 1995 individuals were sampled in 2013 and 2016 respectively. We compared...
Citations
... Surveillance, screening, and intervention (hereafter referred to as monitoring) for social-emotional concerns in toddlers (age 2-3 years) have demonstrated longterm benefits across a wide range of socialemotional, behavioral, mental, and physical health outcomes (Ammerman et al., 2022;Harrison et al., 2022;Sandler et al., 2014;Smith et al., 2020;Stephenson, 2021). However, system, family, and clinician-level barriers may make it difficult for pediatric primary care clinicians to identify toddlers with social-emotional risk and engage caregivers (e.g., biological, step, adoptive parents, and others who have caretaking and medical decision-making responsibilities for toddlers in the primary care context) in referrals to behavioral health services (Charach et al., 2020;Godoy et al., 2014;Leslie et al., 2016). ...
Introduction: Screening to promote social-emotional well-being in toddlers has positive effects on long-term health and functioning. Communication about social-emotional well-being can be challenging for primary care clinicians for various reasons including lack of time, training and expertise, resource constraints, and cognitive burden. Therefore, we explored clinicians’ perspectives on identifying and communicating with caregivers about social-emotional risk in toddlers. Method: In 2021, semistructured interviews were conducted with pediatric clinicians (N = 20) practicing in Federally Qualified Health Centers in a single metropolitan area. Most participants identified as female (n = 15; 75%), white non-Hispanic/Latino (n = 14; 70%), and were Doctors of Medicine or Osteopathic Medicine (n = 14; 70%). Thematic analysis was conducted on audio-recorded interview transcripts. Results: Clinicians used various approaches to identify social-emotional concerns which were sometimes difficult to distinguish from other developmental concerns. The clinician–caregiver relationship guided identification and communication practices and cut-across themes. Themes include: starting with caregivers’ concerns, communicating concerns with data and sensitivity, navigating labels, culture, and stigma, and limiting communication based on family capacity and interest. Discussion: Prioritizing the clinician–caregiver relationship is consistent with best practice and family-centered care. Yet, the dearth of standardized decision support may undermine clinician confidence and impede timely conversations about social-emotional concerns. An evidence-based approach with developmentally based culturally informed quantitative tools and standardized decision supports could help ensure equitable management and decision making about young children’s social and emotional well-being and development.
... Infancy is a critical time with rapid, formative brain development and a dependence on attentive caregivers for healthy growth. Mental health problems in early childhood are as prevalent as in older age groups, but many infants at risk of poor development are neither identified nor treated (Egger and Angold, 2006;Skovgaard et al., 2007;Bagner et al., 2012;Wichstrøm et al., 2012;Charach et al., 2020). Infants express mental health problems in terms of sustained regulatory disturbance, for example, uneasiness or social withdrawal, which can negatively affect the child's development and parent-child interaction (Møller-Pedersen, 2010). ...
... Some recommend greater use of screening programmes (Bagner et al., 2012;Glascoe, 2015;Lipkin and Macias, 2020;Sheldrick et al., 2020); however, research shows divergent results. One systematic review on identifying preschool children with mental health problems in primary health care points to sparse literature and variation in methods' quality (Charach et al., 2020), while another reveals that evidence regarding psychometric properties of psychological tests is often lacking (Breivik et al., 2021). Others point to drift from screening guidelines (Wissow et al., 2013;Gellasch, 2016;Wallis et al., 2020) and low screening rates (Hirai et al., 2018). ...
Background
Infants’ symptoms of mental struggle are often diffuse and undifferentiated, and health services do not identify many infants at risk of poor development. However, primary health care is advantageous for early identification, given there are frequent consultations during the infant’s first two years. Health policy encourages using evidence-based screening but use varies in primary health care. The Alarm Distress Baby Scale (ADBB) is an assessment tool targeting social withdrawal in infants 2-24 months of age.
Aim
To explore contextual factors related to public health nurses’ (PHNs) acceptability of clinical assessment tools in a Norwegian child health centre.
Methods
Prior to an upcoming ADBB training, we used focus group discussions with PHNs to explore their views on their professional role and practice and how this concurs with using assessment tools.
Findings
Thematic analysis resulted in the following themes: (1) A Role requiring Supporting the Parents and Safeguarding the Infant; (2) The Challenge of Interpreting Infant Expressions; and (3) Organisational Preconditions for Accepting New Methods.
Conclusion
Our findings show that PHNs regard assessment tools as an aid to detect infants at risk, but that systematic use of such tools can hinder their ability to be flexible, egalitarian, and resource-focused. We also find that acceptability of assessment tools requires a system for continuous training and a well-established referral routine.
... According to statistics, 10-20% of children and adolescents worldwide suffer from mental health problems (MHP) to different degrees [2,3]. A systematic review demonstrated that MHP was identified in 17.6% of preschoolers, with psychiatric diagnoses reported in 18.4% of this age group [4]. In China, a population-based survey revealed that 17.5% of individuals exhibited MHP [5]. ...
... These may encompass an increased risk of developing chronic physical conditions such as cardiovascular disease, obesity, and compromised immune function [6]. Additionally, children grappling with MHP may face hurdles in their social and emotional development, significantly influencing their relationships, self-esteem, and overall quality of life [4]. Moreover, untreated MHP in early childhood can have long-term consequences on academic achievement, social adaptation, and psychological well-being [7]. ...
Background
Screen time and physical activity behaviors undergo development during early childhood and impact mental health. However, there is limited knowledge regarding the associations between physical activity, screen time, and mental health problems (MHP) in preschoolers. This study examines these associations using a large sample size and brief measures.
Methods
A multistage cluster stratified sampling method was used to conduct an observational cross-sectional study of 19,015 Chinese preschoolers in 2020. Information on physical activity, and screen time was collected by a self-administered questionnaire; MHP was assessed by the parent-reported Strengths and Difficulties Questionnaire (SDQ). Logistic regression models were used to obtain the odds ratios (ORs) and 95% confidence intervals (95% CIs) of preschoolers’ MHP associated with screen time, total physical activities, moderate to vigorous physical activity (MVPA), and outdoor physical activities.
Results
A total of 19,015 participants from the 19,548 recruited population were included in the analyses (missing rate: 2.73%), 52.60% were boys. 64.01%, 57.96%, 35.98%, and 82.64% of preschoolers were reported to meet total physical activities, MVPA, and outdoor activities with screen time recommendations level. The results of multivariable-adjusted ORs (95% CIs) of preschoolers’ MHP for comparisons of different levels of screen time (< 2 h/day, 2–4 h/day,≥4 h/day) show that screen time positively associated with MHP after adjusting for confounders (P < 0.05), but the association was not significant among girls with screen time ≥ 4 h/day. In addition, increased engagement in physical activity was reversely linked to MHP (P < 0.05). A stronger association between MHP and MVPA was observed in boys, however, this association was weakened when the total time spent engaging in MVPA exceeded two hours per day (P < 0.05).
Conclusion
Less physical activity and more screen time positively relate to MHP, but the relationship differs by type of physical activity, total time, and gender. These findings provide novel insights and evidence supporting for guidelines on physical activity, screen time, and improvement of mental health for preschoolers.
... The preschool years play a critical role in life, as many skills and behaviours are formed during this period. Conditions that emerge during the preschool years not only affect the child directly but also affect future development and health [1]. Findings suggest that up to 30% of preschool children have mental-health problems [1,2]. ...
... Conditions that emerge during the preschool years not only affect the child directly but also affect future development and health [1]. Findings suggest that up to 30% of preschool children have mental-health problems [1,2]. Emotional and behavioural problems (e.g. ...
Aims
The aim of this study was to explore the association between preschool-level socio-economic deprivation and emotional and behavioural problems among preschool children in Sweden using a multilevel approach.
Methods
In this cross-sectional study, we used data on 2267 children whose parents and preschool teachers had responded to items measuring individual-level socio-economic deprivation and the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems. Further, the Socioeconomic Structure Compensation Index (SSCI), collected from Uppsala municipality, was used to assess preschool-level socio-economic deprivation. Unadjusted and adjusted multilevel logistic regression models were used to explore the relations between preschool-level socio-economic deprivation and emotional and behavioural problems.
Results
In unadjusted models, children who attended preschools classified as highly deprived had elevated odds for emotional symptoms (odds ratio (OR) 1.71) as rated by parents. However, this association did not remain significant after adjusting for individual-level socio-economic deprivation factors. In both unadjusted and adjusted models, children who attended preschools classified as moderately deprived had elevated odds for peer-relationship problems as rated by parents (OR 1.63; adjusted OR 1.48). There were no significant associations between preschool deprivation and emotional and behavioural problems as rated by preschool teachers.
Conclusions
Swedish preschools may have a compensatory capacity in addressing children’s emotional and behavioural problems, whereas preschool-level deprivation remained significantly associated with peer-relationship problems after controlling for individual-level socio-economic deprivation factors. This implies that peer-relationship problems in deprived preschools need to be addressed in a broader community context.
... There is a lack of systematic exploration of the relationship between family upbringing environment and children's physical, emotional, and social development. The literature on the influencing factors of children's emotional and social development is mostly cross-sectional surveys (14). Hence, to understand the influence of early family rearing environment on children's development and emotional and social development, this paper will further clarify the specific influence of early family rearing environment on children's development and emotional and social development through longitudinal observation by summarizing the existing literature to provide theoretical reference for promoting the healthy development of children's bodies and minds. ...
Background
A good family environment and rearing mode play important roles in children’s physical and psychological growth. This study aims to clarify the specific influence of early family nurturing environment on children’s emotional and social development through longitudinal observation to provide theoretical reference for promoting the healthy development of children’s bodies and minds.
Methods
Overall, 1320 parents of children aged 2 to 6 yr old in Xinyang City, Henan Province in 2021, were selected by stratified sampling. The children’s physical and mental development, family rearing environment and emotional and social development were investigated by questionnaire.
Results
58.03% family rearing environment is good, 27.95% normal, and 14.02% bad. There were significant differences in positive rates of adaptive ability, social behavior, language, developmental quotient score and emotional sociality among children in different families (all P<0.05). Language/cognition was significantly positively correlated with adaptive ability, social behavior, language and developmental quotient (all P<0.05), and social adjustment/self-care was significantly positively correlated with adaptive ability, social behavior, language and developmental quotient (all P<0.05). Emotional warmth/environmental atmosphere was negatively correlated with implicit behavior and disorder and positively correlated with ability (all P<0.05). Language/cognition was positively correlated with explicit behavior and ability (all P<0.05). Social adjustment/self-care was negatively correlated with explicit behavior and positively correlated with ability (all P<0.05); Neglect/punishment was significantly negatively correlated with explicit behavior, implicit behavior and disorder and significantly positively correlated with ability (all P<0.05).
Conclusion
The early family environment affects children’s physical, mental, emotional and social development.
... The basis of the spiritual and moral health of preschool children is the system of values, motivations and behavioural attitudes in the social environment. A. Charach et al. (2020) note that children aged 3 to 7 learn about health through a variety of activities and use them to control their behaviour. The preschool and family should create an environment that promotes healthy development, transmits cultural knowledge and life lessons, protects independence, promotes socialisation, provides comfort and safety, and instils a love of life and resilience. ...
Children are increasingly at risk of various diseases, which has a rather negative impact on their intellectual development and can slow down social development in general, and therefore there is a need to address this issue. The main purpose of this study was to examine and analyse the state of physical, psychological, and social health of children in Ukraine based on preschool educational institutions in Mukachevo. The study used the Sensorimotor technique and the computer programme Efecton Studio 2009 to investigate preschool children’s visual-motor reactions. The Rufier-Dixon and Henchy tests were used to assess the cardiovascular and respiratory systems. It was found that every third child has problems in physical or intellectual development. It was substantiated that the tense sanitary and epidemiological situation in the country, environmental pollution, lower living standards of most families and access to medical care, insufficient physical activity, as well as environmental problems contribute to the deterioration of the psychophysical state of preschool children. It was emphasised that maintaining a healthy physical condition is an important element for the normal functioning and growth of a young organism. It was emphasised that the period of adaptation to school, which current preschoolers will go through in the future, depends considerably on the child’s health, as healthy children can better cope with mental and physical stress. It was found that most preschoolers have limited knowledge about healthy lifestyles. Only 28% of children understand what food is healthy, and 18% know the importance of eating fresh food. This indicates the need for more active work with children on healthy eating and lifestyles in general. It was found that many adults also do not have a holistic understanding of the principles of proper nutrition and do not discuss these issues with children, and therefore it is important to pay attention to adult education in the field of health and nutrition. The practical significance of the study is that all the theoretical provisions, conclusions and recommendations can be used by teachers and students of educational institutions to improve knowledge about the trends in the health status of preschoolers and schoolchildren in Ukraine, as well as by other scientists for in-depth study of the problem.
... In this article, we documented guidance from multiple participant groups on how to motivate parents effectively in primary care settings to utilize parenting programs. This guidance is critical because less than half of preschool children with SEB symptoms currently receive referrals, 36 and enrollment rates among those who receive referrals vary widely. 24 Through focus groups and interviews with researchers, PCCs at a FQHC, parents, and parent educators, we were able to synthesize recommended practices and strategies for referring parents and motivating them to initiate participation in support for parenting. ...
Objective:
To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents.
Methods:
We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5-year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups.
Results:
Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: (1) learning about a parent's questions and concerns, (2) sharing resources, and (3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check-in with parents. We provide examples for each strategy.
Conclusions:
Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.
... 3Y = 16.0%) of all children met the BITSEA criteria of psychosocial problems. The rates were closed to 13.8% found in 3-4-year-old children using Strengths and Difficulties Questionnaire (SDQ) and 18.4% found in preschool children using Diagnostic and Statistical Manual, third edition (DSM III-R) [31]. Next, four groups of pattern of presence/ absence of psychosocial problems were created based on the two assessments at age 2 and 3. ...
Socioeconomic status (SES) at different points in a child’s lifetime may have different effects on health outcomes. This study aimed to examine longitudinal associations between SES and psychosocial problems in preschool children (n = 2509, Mage = 24.2 ± 1.3 months). The psychosocial problems of children were assessed using the Brief Infant–Toddler Social and Emotional Assessment at age 2 years and age 3 years and categorized as having yes/no psychosocial problems. Four groups of pattern of presence/absence of psychosocial problems between age 2 and 3 years were classified: (1) ‘no problems’, (2) ‘problems at age two’, (3) ‘problems at age three’, and (4) ‘continuing problems’. Five indicators of SES (i.e., maternal education level, single-parent family, unemployment, financial problems, and neighborhood SES) were evaluated. Results showed around one-fifth (2Y = 20.0%, 3Y = 16.0%) of children had psychosocial problems. Multinomial logistic regression models revealed low and middle maternal education levels were associated with ‘problems at age two’; low maternal education level and financial problems were associated with ‘problems at age three’; low and middle maternal education level, single-parent family, and unemployment were associated with ‘continuing problems’. No associations were observed between neighborhood SES and any pattern. Results suggest children in a lower SES, indicated by maternal education, single-parent family, and financial stress, had higher odds of developing and continuously having psychosocial problems in early childhood. These findings call for optimally timing interventions to reduce the impact of disadvantaged SES in early childhood on psychosocial health.
... Emotional and behavioral problems (EBPs) are common mental health problems, referring to unexplained interpersonal disorders or feelings of unhappiness or depression, as well as a variety of physiologically undesirable symptoms or fear reactions, showing inappropriate emotions and behaviors [1], which often originate in early childhood and tend to be stable in the preschool stage [2]. A meta-analysis concluded that approximately 17.6% of preschool children aged 24-72 months are already identified with mental health problems by primary/community healthcare practitioners, and 25%-67% of these children developing mental disorders 1-3 years later [3]. Longitudinal evidence has shown that preschool children with externalizing and internalizing behavioral problems are at increased risk of mental health problems throughout childhood and adolescence [4]. ...
This study aimed to examine the association between nighttime sleep duration and emotional and behavioral problems (EBPs) among rural preschool children. This longitudinal study including 1595 preschool children aged 3–6 years from 26 kindergartens in four counties was conducted in Anhui Province rural areas. Cross-lagged panel models and multivariable logistic regressions were performed to examine the bidirectional association between nighttime sleep duration and EBPs and further explore the predictive effect of nighttime sleep duration on EBPs. Compared to baseline, preschool children at follow-up had significantly more nighttime sleep duration (10.01 ± 0.68 vs. 10.15 ± 0.69) and lower EBPs (total difficulties: 15.8% vs. 11.2%; prosocial behavior problems: 12.4% vs. 7.0%). Results of cross-lagged panel models indicated that nighttime sleep duration was a predictor for EBPs, but not vice versa. Results of logistic regression analysis showed that each 1-h increase in nighttime sleep duration at T1 was associated with a 0.77-fold reduction in the risk of total difficulties at T2 (the most adjusted OR = 0.774, 95% CI 0.607–0.988, P = 0.040), but not with the prosocial behavior. Interestingly, the predictive effect of nighttime sleep duration at T1 on EBPs at T2 was only found in girls, children aged 3 years and children with lower maternal education. The decreased nighttime sleep duration may predict future EBPs, especially in girls, younger preschool children and children with lower maternal education. Extending sleep duration may improve EBPs in preschool children.
... Mental health screenings by community practitioners show a comparable but not identical detection rate of mental health problems in young children as diagnostic tools used by experts (Charach et al., 2020). There is a wide array of mental health assessment approaches for young children (Szaniecki & Barnes, 2016), but not all of them are available in German. ...
Fast and accurate screening for mental health problems in early childhood is a prerequisite for effective early intervention. The Early Childhood Screening Assessment (ECSA) is a valid and standardized screening tool for young children. The aims of the current study were to examine the psychometric properties, the factorial structure, and validity evidence for test score interpretation of the German version of the ECSA. Results of a confirmatory factor analysis support a two-factor solution differentiating externalizing and internalizing problems in early childhood. Concurrent validity was demonstrated by positive associations with the Child Behavior Checklist (CBCL). Accuracy of identifying children at risk in comparison to CBCL was good with appropriate sensitivity and specificity. Moreover, ECSA problem scores showed specific associations with low ego-resiliency and field-independence scores and high ego-undercontrol, aggression, and anxiety scores. ECSA caregiver depression scores were associated with children’s ECSA problem scores. The German version of the ECSA is a short and accurate screening tool for mental health problems in early childhood.
