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

For more
Name of instrument Age range
information
Ages and States Questionnaire: Social-Emotional
2-60 months Link
(ASQ:SE)™
Baby Pediatric Symptom Checklist (BPSC) 1-18 months Link
Brief Infant Toddler Social Emotional Assessment 12-36
Link
(BITSEA)™ months
18-60
Early Childhood Screening Assessment (ECSA) Link
months
18-65
Preschool Pediatric Symptom Checklist (PPSC) Link
months
Young Child PTSD Screen 3-6 years Link

Early childhood mental health assessment instruments

General child symptoms/strengths

For more
Name of instrument Age range
information
Behavior Assessment System for Children,
Third Edition (BASC™-3) - Preschool 2-5 years Link
Forms
 1 month - 5 years
Devereux Early Childhood Assessment
(versions available for Link
(DECA)©
infant, toddler, and
preschool)
Diagnostic Infant and Preschool
Link
Assessment (DIPA)
Infant Toddler Social Emotional
12-36 months Link
Assessment (ITSEA)™
Preschool Age Psychiatric Assessment
2-5 years Link
(PAPA)
Preschool Child Behavior Checklist
1.5-5 years Link
(CBCL)©
2-4 years and 4-10
Strengths and Difficulties Questionnaire
years(also versions for older Link
(SDQ)©
children)
Early Childhood Mental Health Assessment tools

Specific diagnostic categories

Name of instrument Age For more
range information
EybergChild Behavior Inventory (ECBI)™ 2-16 Link
years
Spence Preschool AnxietyScale 3-6 years Link
Stutter-EybergStudent Behavior Inventory - Revised 2-16 Link
(SESBI-R)™ years
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
3-10 years
Child Rearing Inventory (based on
Link
(CRI) initial
study)
Dyadic Parent-Child
Interaction Coding System 2-7 years Link
(DPICS)©
Modified Crowell 12-60 Crowell JA (2003). Assessment of attachment
Procedure months security in a clinical setting: Observations of
 parents and children. Developmental
andBehaviouralPediatrics, 24:199-204
Parenting Interactions with
Children: Checklist of 10-47
Link
Observations Linked to months
Outcomes (PICCOLO)™
Parenting Stress Index
0-12 years Link
(PSI)™
Parenting Stress Index -
0-12 years Link
Short Form (PSI-SF)™
VreeswijkC, Maas J, VanBakelH (2012). Parental
Working Model of the No specific Representations: A Systematic Review of the
Child Interview age range Working Model of the Child Interview. Infant
Mental Health Journal, 33:314-328

Tools focused on assessment of developmental milestones or delays

For more
Name of instrument Age range
information
1 months - 5.5
Ages and Stages Questionnaire 3rdEdition (ASQ:3)™ Link
years
Bayley Scales of Infant and Toddler Development ®,
1-42 months Link
Third Edition (Bayley-III®)
Developmental Milestones (from the Survey of Well-
1-65 months Link
Being in Young Children) (SWYC)

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.

 University of Colorado, Denver: Website

 Cornell: Sackler Fellowship: Website
 Arizona
 Yale: Website