Unrecognised and Untreated: Improving the Identification of Mental Health Problems in Preschool-age Children through Examining Screening Measures, Multi-informant Reports and Symptom Stability

Abstract

Despite evidence for the high prevalence of mental health (MH) problems in children aged 3–5 years, parents of preschool-age children are less likely to recognise and access support for MH problems compared to parents of older children. This thesis evaluates screening measures for young children, which could help parents and educators identify children at risk of MH problems. Chapter 2 presents a systematic review of existing multi-informant MH measures for young children and examines their predictive and incremental validity, effectiveness and acceptability. Chapters 3–4 present a series of studies evaluating the reliability, validity and acceptability of two versions of the Pediatric Symptom Checklist (PSC), the Preschool PSC and PSC-17, reported by parents and educators, in a national, cross-sectional study. Chapters

4–5 present a longitudinal study in which a paired, community sample of parents and educators were tested at three time points to examine incremental and diagnostic validity, and symptom stability.

The systematic review concluded that several existing measures had acceptable predictive validity, but there were many shortcomings concerning incremental validity (Chapter 2). Subsequent studies reported strong psychometric properties for both PSC measures, including internal consistency, concurrent validity, and high acceptability (Chapters 3–4). Parent reports improved the prediction of functioning scores over and above educator reports supporting incremental validity. PSC measures had moderate–strong associations with diagnostic severity and functioning scores (Chapter 5). Total scores for both PSC measures, PSC-17 externalising and attention subscales had significant measurement stability across time. Together these studies demonstrate the validity, acceptability and clinical utility of the PSC measures, and contribute new evidence supporting measures that can be used for multi-informant, universal screening of MH problems in preschool children.