Curr Psychiatry Rep (2011) 13:84–92
DOI 10.1007/s11920-011-0181-7
Assessment of Behavioral Disorders
in Preschool-Aged Children
Wanjiku F. M. Njoroge & Kristin P. Bernhart
Published online: 28 January 2011
# Springer Science+Business Media, LLC 2011
Abstract The preschool-aged clinical practice of child and
adolescent psychiatrists is increasing as the awareness of
very young children with social/emotional and/or behav-
ioral problems continues to grow. As the referrals grow, so
do the ways in which we assess these disturbances of
behavior and regulation. This review attempts to highlight
the most often used measures and to investigate developing
tools and their current status.
Keywords Early childhood . Preschoolers . Mental health .
Assessment . Measures . Observational methods
Introduction
This article highlights the most recent information regard-
ing the assessment of preschool-aged children. Although
many of the means of assessment are unchanged, some
exciting new developmental tools will help clinicians in
their evaluation and treatment of very young children. This
comprehensive review begins with the methodologies most
often used in the psychiatric assessment of young children
and then addresses the newest evidence-based tools. The
discussion of the assessment of preschoolers requires a
thorough understanding of child development and what is
normative for this age range. It is also critical to understand
W. F. M. Njoroge (*) : K. P. Bernhart
Department of Psychiatry and Behavioral Sciences,
Division of Child and Adolescent Psychiatry,
University of Washington, Seattle Children’s Hospital,
M/S W3636,
P.O. Box 5371, Seattle, WA 98105, USA
e-mail: njoroge@u.washington.edu
K. P. Bernhart
e-mail: kristin.bernhart@seattlechildrens.org
the tenets of the evaluation of young children, which
includes multiple informants, multiple appointments, and
varied assessments with consideration that young children
may look very different in diverse contexts and have
different relationships with the adults in their lives such that
they may appear extremely different over the course of the
evaluation [1, 2, 3••]. The American Academy of Child and
Adolescent Psychiatry’s introduction of practice parameters
for the purpose of the diagnostic assessment of young
children is multifold and complex, as we are assessing the
child and the family system and how it functions [1].
Wakschlag and Danis [4] highlight the importance of
integrating information gathered from various assessment
tools with clinical judgment in generating an appropriate
guideline for care.
The scope of child and adolescent psychiatry practice is
broadening such that psychiatric practices are assessing
younger patients. Data gathered by the US Department of
Health and Human Services indicate that one in five
children has a diagnosable mental disorder [5]. As
underscored by the growing literature, 10% of preschoolers
are diagnosed with mental health issues that impair their
functioning [6–8]. Developmental screening is often used in
pediatric practices more routinely; however, early identifi-
cation of pediatric psychiatric issues is still an ongoing
challenge, and many young children with disturbances are
still missed [9, 10]. In many cases, the referrals to a child
psychiatrist are for a more rigorous, developmentally
sensitive assessment [11]. The literature highlights that
preschoolers are most often referred for disruptive and
attentional behaviors [12].
The importance of early detection and identification
using developmentally appropriate and validated instruments/
measures has been highlighted in the literature with the
increasing knowledge that severe emotional and behavioral
Curr Psychiatry Rep (2011) 13:84–92
disturbances occurring in the first 5 years of life continue
unmitigated or worsen during the school-age years and
adolescence [13–15]. It should be noted that the risk of
worsening psychopathology in the preschool population can
cause significant family disruptions and place increased
stressors on family relations and quality of life, and can affect
the self-esteem and self-efficacy of the preschooler [16].
The assessment of the preschooler consists of multiple
parts and is fairly complicated secondary to the lack of
direct information gathered from the preschooler and the
reliance on the parent/caregiver or teachers as primary
informants. The domains of interest in the assessment
include social/emotional, behavioral, cultural, parent–child
interaction, and the ways in which the preschooler’s
behaviors are impacting those various domains.
Coding/Classification Systems
There are two ways to formulate or conceptualize pathol-
ogy in preschoolers found throughout the literature (ie,
dimensional or categorical). The measures included in this
review use both classification systems.
Due to the lack of developmentally validated instruments
to guide clinicians and researchers in the valid and reliable
diagnosis of preschoolers, two different paths were taken.
One used a modification of the DSM-IV-TR [17], recogniz-
ing the lack of developmental sensitivity in many diagnoses
[18]. The second system was an attempt to use the structure
of the DSM-IV-TR, layering on knowledge of infant/young
child development within a larger context including infant/
toddler state and relationship with family, in the effort to
simplify diagnosis in young children [10, 19, 20]. Both
systems, however, use a categorical approach to determine
diagnoses.
Rating scales often used in the assessment of young
children come in a variety of forms, including checklists
and questionnaires such as the Child Behavior Checklist
(CBCL) [21] and the Preschool Feelings Checklist (Luby et
al., unpublished checklist), which base the symptomatology
on DSM criteria using a dimensional approach. For a more
thorough discussion, see articles by Egger and Angold [16]
and McClellan and Werry [22]. The biopsychosocial
formulation allows clinicians and researchers to expand on
the wealth of information important to the child’s function-
ing; however, diagnostic classification is important in
developing treatment goals [23, 24].
Brief Primer on Psychometric Properties
The effectiveness of the tools and measures is based on the
current nosology used to describe pathology in preschoolers
85
and therefore is based on phenomenological criteria. Most
of these measures have sound psychometric properties,
specifically internal consistency, test–retest reliability, and
validity (relative to other measures, most often the CBCL
[21]). One difficulty inherent in developing psychometri-
cally sound measures in young children is related to the
heterogeneity of presentation in the preschool population,
particularly in light of the rapid changes that occur during
this period, thereby changing the behavioral disturbances
and ruling out transient perturbations and comorbidity
[16, 25, 26].
Reliability
This construct is often determined first as a foundational
tool for validity and essentially states that the measure
performs the same way irrespective of administrator and
across diverse settings. The most important aspects of this
construct are test–retest and interrater reliability, such that
diverse administrators are trained to administer and code
the measure reliably.
Test–Retest Reliability
This construct states that the administration of the measure
is stable over time and is often noted by how different
responders report the same diagnosis over time, with the
key being agreement in their assignation of diagnoses
[26, 27].
Interrater Reliability
This construct states that different interviewers agree and
rate the symptoms the same. Due to the difficulty of similar
assignation, this construct requires a fair amount of training
to ensure consistency, with correlation scores of greater
than 0.70 to 0.80 deemed acceptable. This measures
stability over several weeks to months.
Validity
Establishing validity is an essential step before a tool can be
used broadly. However, the scale must be reliable before
validity is determined. There are multiple types of validity,
including content (face), construct, and criterion (predic-
tive) validity, but the construct generally is determined if
the tool accurately measures what it was designed to
examine. This construct usually takes years to manifest, as
the criteria against which the tool must be measured are
stringent; therefore, this construct may not be seen in the
newer tools discussed in this article. As with all childhood
disorders, this construct is particularly fraught with prob-
lems secondary to the uncertainty surrounding the validity
86
of the diagnostic criteria themselves (against which validity
is measured) [22, 27].
Face Validity
The type of validity most often measured in child
psychiatric research is face validity, as it records items
taken from diagnostic criteria and determines if they
accurately describe the illness.
Construct Validity
This measures the scale’s ability to have meaning within a
particular construct. This domain is often examined by
comparing newer tools with well-established measures with
strong psychometric properties.
Predictive Validity
This domain measures the ability of the scale to predict
some future outcome.
The key element in determining the usefulness of a tool
depends on the psychometric properties of the diagnostic
classification system and the methodology used [22].
Measurements
In this section of the review, we discuss important factors in
choosing appropriate measures by providing enough infor-
mation regarding the constructs or domains examined, the
time constraints and cost of administration and scoring the
measure, the skill level needed for administration, and the
availability of the tool in the public domain. The assessment
of children with autism spectrum disorders is outside the
scope of this review, but several well-validated and reliable
measures are currently in use [28, 29]. Although we
recognize the complexity inherent in attempting to codify
the breadth of preschool psychopathology, the tools currently
in use—both the older, more well-established tools with
proven psychometric properties and some new, promising
tools in development with early testing showing strong
psychometric properties in small, limited studies—are
presented. We have highlighted the measures currently in
use or in development that assess or establish diagnoses in
preschool children 3 to 5 years of age, recognizing the
complexity in diagnosis, as developmental growth is rapid in
this phase. We included measures that can be used
throughout the entire preschool period and excluded meas-
ures that address only 1 or 2 years of the preschool period.
We did not include measures that assess functional impair-
ment, an important part of the assessment of psychopathol-
ogy in preschoolers.
Curr Psychiatry Rep (2011) 13:84–92
When systematically gathering data on preschoolers,
parent/teacher report measures, structured interviews, and
careful observations are required. The different methodol-
ogies are discussed, and examples are given for each and
included in Table 1.
Parent/Caregiver Report
The parent/caregiver report of symptoms has a longstanding
history as a well-validated tool. These measures are typically
rating scales that cover broad constructs of behaviors and are
symptom or problem focused, typically easy to complete and
score, and standardized [22, 27]. Other benefits of question-
naires or checklists are that they do not require administra-
tion or interpretation by skilled personnel; however, the
limitations are intrinsic in the nature of the tool in that the
reporter may overreport or underreport the level of pathology
[18, 27]. Other limitations include the inability to use the
tools for diagnostic purposes, as they lack information on
severity, frequency, and context [23]. Secondary to the
nature of the ease and rapidity of questionnaires, they have
been identified as the one of the most widely used types of
measure in assessments [30].
Specific measures are described below and include the
following:
Screening Tools
Early Childhood Screening Assessment (ECSA) The ESCA
is a screening tool based on parent or caregiver report
designed to identify children 1 to 5 years of age with
emotional or behavioral problems requiring further evalu-
ation [31]. It was developed for ease of use in primary care
clinics. It has the added function of screening for maternal
distress and depression and is a means to identify
symptoms of particular concern to the parent. This measure
derived the items from the DSM-IV, DC:0–3R, and
Research Diagnostic Criteria and included validated depres-
sion screening questions from the US Preventative Health
Task Force [31].
It is a 40-question checklist with 36 questions focused
on child behavior and emotion, while 4 questions screen for
parental distress and include the Patient Health
Questionnaire-2 for maternal depression. It is considered
fast to score and does not require software to score. It is
available in published form in the Infant Mental Health
Journal and by request to the author.
Preliminary psychometric testing evidenced good valid-
ity and reliability for identifying preschoolers in need of
further assessment for emotional and behavioral problems.
Ages & Stages Questionnaire–Social Emotional Version
(ASQ-SE) The ASQ-SE is a screening tool based on parent
Table 1 Summary of selected instruments to assess behavioral disorders in preschool-aged children

Measure Target population Parameters Administration Availability

Parent reports
ECSA 1.5–5 y (emotional and behavioral problems needing 40 questions (36 about child, 4 about Fast scoring Publicly available and by
further evaluation) parent) No technology needed request to author
No training needed
ASQ-SE 6 mo–5 y (social, emotional, and behavioral difficulties or 8 sets of questions (19–33 questions in 10–15 min to complete Commercially available
delays) each) at various age intervals Paper or CD-ROM format
Requires training to administer
Curr Psychiatry Rep (2011) 13:84–92

CBCL 1.5–5 y (internalizing or externalizing behaviors; social, 99 questions 15–20 min to complete Commercially available
emotional, and behavioral problems)
PFC 3–5.6 y (children with depression seen in primary care 16 questions 2–4 min to complete Available by request to
setting) Easy to score author
No training needed
DBRS-PV 3 to 4 y (disruptive behaviors and attention-deficit/ 26 questions Brief Commercially available
hyperactivity disorder)
No training needed
Structured interviews
PAPA 2 to 5 y (behavior and mood problems and normative 1,500 questions 60–100 min to administer Available by request to
behavior) Paper or database format author
Requires trained individual to
administer and score
DIPA 0–6 y (behavior and mood symptoms) 517 questions 45-90 minutes to administer New instrument
and score
No training needed
K-DBDS 3 to 5 y (disruptive behavior and conduct disorder) 370 questions (47 main stem questions) Requires clinical training to Available by request to
administer author
Observational measures
DB-DOS Age preschool (disruptive behavior) 3 components (2 with interviewer and 50 min to administer Available by request to
child, 1 with parent and child) Requires observation or taping and author
viewing to score
Requires clinically trained observer
Clinical problem- 12–60 mo (observe problem solving) 8 tasks between parent and child 45–60 min to administer Available
solving procedure Requires skilled examiner to
administer and training to score

ASQ-SE—Ages and Stages Questionnaire–Social Emotional Version; CBCL—Child Behavior Checklist; DB-DOS—Disruptive Behavior-Diagnostic Observation Schedule; DBRS-PV—Disruptive
Behavior Rating Scale-Parent Version; DIPA—Diagnostic Infant Preschool Assessment; ECSA—Early Childhood Screening Assessment; K-DBDS—Kiddie-Disruptive Behavior Disorder Schedule;
PAPA—Preschool Age Psychiatric Assessment; PFC—Preschool Feelings Checklist
87
88
or caregiver report designed to identify children 6 months
to 5 years of age who have social, emotional, or behavioral
difficulties or delays [32]. Specifically, it looks at self-
regulation, compliance, communication, adaptive function-
ing, autonomy, affect, and interaction with others.
It is made up of a set of eight developmentally appropriate
questionnaires that may be administered at 6, 12, 18, 24, 30,
36, 48, and 60 months. Each set has 19 to 33 questions and
takes about 10 to 15 min to complete. It is commercially
available, may be completed on paper or with a CD-ROM,
and requires training to score (http://www.brookespublishing.
com/store/books/squires-asqse/index.htm).
Psychometric testing evidenced good validity, test–retest
reliability and sensitivity in identifying young children with
emotional and behavioral problems as well as developmen-
tal delays; clinical validity is still pending.
Comprehensive Assessment Tools
CBCL The CBCL is one of the most widely used
comprehensive screening and assessment tools based on
parent or caregiver report [21]. It is designed to identify
children 1.5 to 5 years of age with internalizing and/or
externalizing social/emotional or behavioral problems.
Specifically, it looks at the following areas: emotional
reactivity, anxiety/depression, somatic complaints, being
withdrawn, attention problems, aggressive behavior, and
sleep problems. It sums the symptoms for an internalizing,
externalizing, or total problems score. It also includes DSM-
based scales for affective symptoms, anxiety, attention and
hyperactivity symptoms, pervasive developmental symp-
toms, and oppositional symptoms (http://www.aseba.org/
preschool.html) [33].
It includes 99 questions and is reported to take 15 to
20 min to complete. It provides scores and cutoffs to
indicate a normative, subclinical, and clinical range. It
includes open-ended questions to elicit additional concerns.
It has been evaluated in cross-cultural settings and requires
some training to score and interpret results. It is not
publicly available.
Psychometric testing has shown good test–retest reli-
ability and validity and is used against newer measures to
determine convergent validity.
Narrow Symptom-Based Tools
Preschool Feelings Checklist The Personal Feelings
Checklist is a screening tool based on parent/caregiver
report designed to identify symptoms of depression in
preschool children 3 to 5.6 years old [34]. It was developed
to identify symptoms of depression in young children in the
Curr Psychiatry Rep (2011) 13:84–92
primary care setting based on literature suggesting that
clinical depression is present and identifiable in young
children and that many children with depressive symptoms
go undetected.
It is a 16-question checklist that takes 2 to 4 min to
complete. It is easy to score and does not require additional
training. It is available upon request to the author or on the
Journal of the American Academy of Child and Adolescent
Psychiatry website.
Preliminary psychometric testing evidenced good sensi-
tivity and specificity for major depression.
Disruptive Behavior Rating Scale-Parent Version
(DBRS-PV) The DBRS-PV was included due to its strong
preliminary data for use in the downward extension of the
assessment of oppositional defiant disorder and attention-
deficit/hyperactivity disorder symptoms in 3- and 4-year-
olds [35]. This is a brief rating scale consisting of 26 items
that is used to assess inattention, hyperactive-impulsive,
and oppositional domains.
Structured Interviews
Diagnostic interviews have been identified as the second
most widely used measures in assessments despite varia-
tions in adherence to a script (highly structured [Preschool
Age Psychiatric Assessment (PAPA)] [36] vs semistruc-
tured). The incorporation of these tools has been shown to
increase the reliability of the assessment. They typically
take longer to administer and require more highly trained
interviewers who can adhere to the structure or adapt the
questions appropriately based on clinical judgment [7, 27].
Specific measures are described below:
Preschool Age Psychiatric Assessment
The PAPA is a structured interview administered by a PAPA-
trained individual and given to the parent or caregiver of a
child 2 to 5 years of age [37]. It was developed to evaluate
younger children based on literature showing that mental
health and behavioral difficulties can be identified in
preschool-aged children. It also draws from the DSM-IV,
ICD-10, and DC:0–3R systems [10, 17, 19, 38]. Of note, this
tool was intended as one component of a comprehensive
assessment and does not include direct evaluation or
observation of the child.
The tool investigates multiple symptom and behavior
domains in children, including attention-deficit/hyperactivity
disorder, oppositional defiant disorder, conduct disorder,
separation and other anxieties, post-traumatic stress disorder,
depression, mania, tics, and stereotypies. It also includes
assessment of family functioning, parental psychopathology,
Curr Psychiatry Rep (2011) 13:84–92
life events, normative behavior, and preschool-specific
domains such as functioning at daycare in play and with
siblings and peers, eating habits, sleep habits, toileting, and
attachment difficulties. It evaluates dysfunction and the
impact on a child’s activities, participation in daily life, and
relationships by including observation of frequency as well as
the context and with whom behaviors occur most often.
The PAPA was originally developed as a research tool to
better elucidate preschool behavior and as such contains
1,591 questions, takes about 60 to 100 min to administer,
and is administered by trained individuals. Currently, it is
offered in paper and electronic format (ePAPA administered
on tablet personal computer); however, there is an addi-
tional time requirement if using the paper form to input the
scores into the database. The electronic form includes
access to a database.
The empirically established psychometric properties
include test–retest reliability compared with the most
frequently used measures in child and adolescent psychiatry
[39••] and represent an important step in the development
of validity.
Diagnostic Infant Preschool Assessment
The Diagnostic Infant Preschool Assessment (DIPA) is a
structured diagnostic interview administered to caregivers
of children 9 months to 6 years of age [40]. The DIPA was
created to target even younger children and to provide a
shorter version to adapt to clinical settings. It frames
behavior as problem behavior or problematic level of a
behavior. It relies on a parent’s judgment of whether the
child’s behavior is more problematic than that of other
children of the same age. No interview or observation of the
child is involved.
It evaluates 13 disorders (similar to the PAPA) and multiple
symptom domains, including attention-deficit/hyperactivity
disorder, oppositional defiant disorder, conduct disorder,
anxiety disorders (separation anxiety, generalized anxiety
disorder, obsessive-compulsive disorder, agoraphobia, reac-
tive attachment, and post-traumatic stress disorder), as well as
major depression and sleep disorders. It should be noted that
this tool has taken into account the recommendations of the
Research Diagnostic Criteria: Preschool Age for diagnosing
preschoolers.
It is a diagnostic tool consisting of 517 questions that has
been reported to be easy to administer and score manually,
taking 45 to 90 min.
In a recent study [40], early psychometric properties
compared with the CBCL showed acceptable criterion
validity and adequate test–retest reliability for some
disorders. However, secondary to small numbers, the same
psychometrics were not found for anxiety (generalized
anxiety disorder and obsessive-compulsive disorder) and
89
depression disorders (major depressive disorder). However,
this is reflective of the literature regarding older children
and internalizing disorders.
Kiddie-Disruptive Behavior Disorder Schedule
The Kiddie-Disruptive Behavior Disorder Schedule is a
semistructured interview measurement administered to
parents/caregivers [41]. It assesses DSM-IV oppositional
defiant disorder, conduct disorder, and attention-deficit/
hyperactivity disorder symptoms. Its administration allows
the interviewer to use clinical judgment based on the
response of the caregiver to determine criteria consistency
and to probe a topic further.
Observational Measures
One of the key tenets of evaluation of a preschooler
includes direct observation of the child—alone as well as
interacting with parents in structured and nonstructured
settings—and understanding the importance of observation
of the child’s behaviors and how they change in different
contexts and with different relationships. The power of the
observation is a lessening of the subjectivity inherent in
parent/teacher report measures that allows for skilled
clinical judgment. Difficulty in assessing behaviors that
may vary across settings with different caregivers has
complicated the reliable diagnosis of the preschooler,
exemplifying the importance of observation in all young
child assessments. One new tool that attempts to help
inform clinical diagnosis of disruptive behaviors with a
developmentally rigorous observational tool is described
below. Although this structured tool only focuses on
disruptive behaviors, we highlight it as an exciting
development in the standardization of tools for observa-
tional use in preschoolers.
Disruptive Behavior-Diagnostic Observation Schedule
The Disruptive Behavior-Diagnostic Observation Schedule is
a structured, standardized, clinic-based observational tool
developed to assess preschool disruptive behavior [42, 43]. It
has three components, two involving the examiner and the
child and one observing the parent and child. It is designed
to elicit disruptive behavior by providing an “engaged
examiner” component, a “busy examiner” component, and
typical tasks (including direction and rules). It is based on
the DSM diagnostic categories and developmental theories
designed to elucidate problem from normative behavior in
areas of behavioral control, emotion modulation, and social
orientation. There is no explicit parental evaluation compo-
nent, but the developers used an additional parent scoring
tool, Parenting Clinical Observations Schedule, to evaluate
90
parental factors. It was originally designed as a research tool
with intent to transfer to clinical use.
It takes about 50 min to administer and requires an
examiner and parent to be observed or taped and scored.
The administrator or scorer needs to be clinically trained
with knowledge of normative development. It was designed
to add a structured observational assessment to a parent
interview evaluation.
Preliminary psychometric testing evidenced good reliabil-
ity (both test–retest and inter-rater).
Clinical Problem-Solving Procedure
The clinical problem-solving procedure is based on the
interaction between mother and child, based on a selection
of tasks that the toddler cannot complete alone [44]. The
assessment consists of eight different tasks that increase in
difficulty up to the last task, which is beyond the skills of
the child working independently. It assesses the parent–
child interaction with respect to a demanding task. The
observation also includes free play, cleanup, and separation/
reunion episodes.
The procedure takes 45 to 60 min to complete and must
be administered by a skilled examiner, as the examiner
must select the tasks based on his or her assessment of the
child’s skills and the ability to interpret the interactions. The
tool has been used in populations of 12 to 60 months in
clinical and research settings. Scales have been developed
to reliably code each of the segments for research purposes,
and training is required to score the scales (seven child
scales, five caregiver scales) on a seven-point system.
Conclusions
We hope that this article has emphasized the importance of
a systemic, comprehensive, reliable, validated, develop-
mentally sensitive assessment approach to diagnosis of
psychopathology in preschoolers. We have highlighted the
importance of the multimodal assessment, including clinical
judgment as well as varied measures in the hope of
capturing the heterogeneity of the clinical presentation of
preschool psychopathology [45]. The list of tools included
in this review is by no means exhaustive, and we have
included within the body of the text other sources that
specifically cover the breadth of problematic behaviors seen
in preschool populations. It also should be noted again that
a coherent nosology for the diagnosis of psychiatric
disorders in very young children is lacking. However, the
newer measures highlighted in this article have used
developmentally sensitive criteria in their creation and have
referenced the Research Diagnostic Criteria: Preschool Age
or DC:0–3R diagnostic systems.
Curr Psychiatry Rep (2011) 13:84–92
Although we have focused on standardized, structured
measurements in this article, we want to highlight the core
tenets of assessment of that should be included in any
comprehensive assessment on preschoolers. Main princi-
ples of infant mental health include understanding child
behavior using a developmental perspective, understanding
the variability of behaviors across settings and with
different caregivers, and understanding the intersection of
culture with beliefs and parenting practices, all while
recognizing the rapid growth and development occurring
in the preschooler from 36 to 60 months of age. This
includes language, cognitive abilities, and motoric abilities,
as well as social/emotional/cultural growth [46].
There is a clarion call regarding the importance of
further development of standardized measures examining
psychopathology in preschoolers due to the extant literature
citing the continuation and worsening of symptoms
throughout childhood [14]. Although the preschool period
is highlighted by rapid developmental changes, there is a
critical period for developmentally appropriate standardized
assessment in light of the evidence describing the contin-
uation and worsening of problematic behaviors. This article
underscores important measures to consider in the treatment
of preschoolers while echoing the call for further research
to aid clinical judgment and develop evidence-based
methodologies.
Disclosure Dr. Njoroge has served on a board for A Home Within.
Dr. Bernhart reported no potential conflicts of interest relevant to this
article.
References
Papers of particular interest, published recently, have been
highlighted as:
•• Of major importance
1. AACAP: Practice parameters for the psychiatric assessment of
infants and toddlers (0-36 months). J Am Acad Child Adolesc
Psychiatry 1997b, 36 (10): 21s–36s.
2. Gleason MM, Egger HL, Emslie GJ, et al.,: Psychopharmacolog-
ical treatment for very young children: contexts and guidelines. J
Am Acad Child Adolesc Psychiatry 2007, 46(12): 1532–1572.
3. •• Egger HL. Psychiatric assessment of young children. Child
Adolesc Psychiatric Clin N Am 2009, 18:559–80. This seminal
article thoroughly covers the topic of early-childhood assessments
by highlighting the important tenets of such an assessment and
discussing various methodologies. In addition to discussing the
essential components of a systematic evaluation, the author also
discusses treatment planning and challenges inherent in evaluating
young children.
4. Wakschlag LS, Danis B: Characterizing early childhood disruptive
behavior: enhancing developmental sensibility. In Handbook of
Curr Psychiatry Rep (2011) 13:84–92
Infant Mental Health, edn 3. Edited by Zeanah CH. New York:
Guilford Press; 2009.
5. Centers for Disease Control and Prevention, Child Development:
Using Developmental Screening to Improve Children’s Health.
Centers for Disease Control and Prevention, 2005. Available at
http://www.cdc.gov.
6. Campbell SB: Behavior problems in preschool children: a review
of recent research. J Am Acad Child Adolesc Psychiatry 1995,
36:113–149.
7. McClellan JM, Bresnahan MA, Echeverria D, et al.: Approaches
to psychiatric assessment in epidemiological studies of children. J
Epidemiol Community Health 2009, 63(1): i4–14.
8. Gleason MM, Zeanah CH, Dickstein S: Recognizing young
children in need of mental health assessment: development and
preliminary validity of the early childhood screening assessment.
Inf Mental Hlth J, 2010. 31(3): 335–357.
9. Lavigne JV, Gibbons Rd, Christoffel KK, et al.: Prevalence rates
and correlates of psychiatric disorders among preschool children.
J Am Acad Child Adolesc Psychiatry 1996, 35(2): 204–214.
10. Zero to Three. Diagnostic Classification: 0-3r: diagnostic classi-
fication of mental health and developmental disorders of infancy
and early childhood: revised edition. Washington, DC: Zero to
Three Press; 2005.
11. Bergman D: Screening for Behavioral Developmental Problems:
Issues, Obstacles, and Opportunities for Change. National Academy
for State Health Policy, 2004. Available at http://www.nahsp.org.
12. Keenan K, Wakcshlag LS, Danis B, et al.: Further Evidence of the
reliability and validity of DSM-IVodd and cd in preschool children. J
Am Acad Child Adolesc Psychiatry 2007, 46(4): 457–468.
13. Lavigne JV, Gibbons Rd, Christoffel KK, et al.: Prevalence rates
and correlates of psychiatric disorders among preschool children.
J Am Acad Child Adolesc Psychiatry 1996, 35(2): 204–214.
14. Lavigne JV, Arend R, Rosenbaun D, et al.: Psychiatric disorders
with onset in the preschool years: I. Stability of diagnoses. J Am
Acad Child Adolesc Psychiatry 1998a, 37: 1246–54.
15. Keenan K, Wakschlag LS: More than the terrible twos: the nature
and severity of disruptive behavior problems in clinic-referred
preschool children. J Abnorm Child Psychol 2000, 28:33–46.
16. Egger HL, Angold, A: Common emotional and behavioral
disorders in preschool children: presentation, nosology, and
epidemiology. J Child Psychol Psychiatry 2006, 47(3/4): 313–
337.
17. American Psychiatric Association: Diagnostic and Statistical
Manual of Mental Disorders. Text Revision. 4th edition. Wash-
ington, DC: American Psychiatric Press; 2000.
18. Task Force on Research Diagnostic Criteria: Infancy and
Preschool. Research diagnostic criteria for infants and preschool
children: the process and empirical support. J Am Acad Child
Adolesc Psychiatry 2003, 42:1504–12.
19. Zero to Three: Diagnostic Classification: 0-3: diagnostic classifi-
cation of mental health and developmental disorders of infancy
and early childhood. Arlington (VA): National Center for Clinical
Infant Programs; 1994.
20. Emde RN. RDC-PA: a major step forward and some issues. J Am
Acad Child Adolesc Psychiatry, 2003; 42:1513–6.
21. Achenbach T and Rescorla LA: Manual for the ASEBA preschool
form, 2000. Burlington: University of Vermont.
22. McClellan JM and Werry JS: Introduction-Research Psychiatric
Diagnositc Interviews for Children and Adolescents. J Am Acad
Child Adolesc Psychiatry 2000, 39(1): 19–27.
23. Egger HL: Psychiatric assessment of young children. Child
Adolesc Psychiatric Clin N Am 2009, 18:559–80.
24. Gleason MM, Egger HL, Emslie GJ, et al.,: Psychopharmacological
treatment for very young children: contexts and guidelines. J Am
Acad Child Adolesc Psychiatry 2007, 46(12): 1532–1572.
91
25. Zeanah, CH Jr. Editor. Handbook of infant mental health. Second
edition. New York: Guilford Press; 2000.
26. McClellan JM, Werry JS: Evidence-based treatment in child and
adolescent psychiatry: an inventory. J Am Acad Child Adolesc
Psychiatry 2003, 42 (12): 1388–1400.
27. Myers K and Winters NC: Ten-Year Review of Rating Scales. I:
Overview of Scale Functioning, Pscyhometric Properties, and
Selection. J Am Acad Child Adolesc Psychiatry 2002, 41(2):114–
122.
28. Lord C, Risi S, Lambrecht L, et al.: The Autism Diagnostic
Observation Schedule-Generic: A standard measure of social and
communication deficits associated with the spectrum of autism. J
Autism and Dev Disorders 2000, 30:205–223.
29. Gotham K, Risi S, Dawson G, et al.: A replication of the Autism
Diangnostic Observation Schedule (ADOS) revised algorithms. J
Am Acad Child Adolesc Psychiatry 2008; 47: 142–151.
30. McClellan JM, Bresnahan MA, Echeverria D, et al.: Approaches
to psychiatric assessment in epidemiological studies of children. J
Epidemiol Community Health 2009, 63(1): i4–14.
31. Gleason MM, Zeanah CH, Dickstein S: Recognizing young
children in need of mental health assessment: development and
preliminary validity of the early childhood screening assessment.
Inf Mental Hlth J, 2010. 31(3): 335–357.
32. ASQ-SE; Squires J, Bricker D, Twombly E. The ASQ: SE user’s
guide. 2002b. Baltimore, MD: Paul H. Brookes Publishing Co,
Inc.
33. Achenbach System of Empirically Based Assessment (ASEBA):
CBCL 1.5 to 5. Available at http://www.aseba.org/preschool.html.
34. Luby JL, Heffelfinger A, Koeing-McNaught Al, et al.,: The
preschool feeling checklist: a brief and sensitive screening
measure for depression in young children. J Am Acad Child
Adolesc Psychiatry 2004a, 43:708–716.
35. Barkley RA and Murphy KR: Attention-deficit hyperactivity
disorder: a clinical workbook. New York: Guilford; 1998.
36. Egger HL, Angold A: The Preschool Age Psychiatric Assessment
(PAPA): a structured parent interview for diagnosing psychiatric
disorders in preschool children. In Handbook of infant, toddler,
and preschool mental health assessment. Edited by DelCarmen-
Wiggins R, Carter AS. New York: Oxford University Press;
2004:223–44.
37. World Health Organization. ICD-10: the ICD-10 classification of
mental and behavioral disorders: clinical descriptions and diag-
nostic guidelines. Geneva, Switzerland: World Health Organiza-
tion; 1992.
38. Egger HL, Erkanli A, Keeler G, et al.: The test–retest reliability of
the Preschool Age Psychiatric Assessment (PAPA). J Am Acad
Child Adolesc Psychiatry 2006, 54(5): 538–49.
39. •• Scheeringa MS, Haslett N: The Reliability and Criterion
Validity of the Diagnostic Infant and Preschool Assessment: A
New Diagnostic Instrument for Young Children. Child Psychiatry
Hum Dev 2010, 41: 299–312. This article describes the strong
preliminary psychometric properties of a new tool that was
created to assess very young children. This measurement was
developed with awareness of differences in young child behavior
and used developmentally sensitive diagnoses for said behaviors.
It highlights a new diagnostic interview that may have great
potential for benefits in clinical and research settings, based on
further studies.
40. Keenan K, Wakschlag LS, Danis B: Kiddie-Disruptive Behavior
Disorder Schedule (version 1.1). 2001. Available at kkeenan@yoda.
bsd.uchicago.edu.
41. Wakschlag LS, Hill C, Carter A, et al.: Observational assessment of
preschool disruptive behavior Part I: reliability of the Disruptive
Behavior Diagnostic Observation Schedule (DB-DOS). J Am Acad
Child Adolesc Psychiatry 2008c, 47(6): 622–31.
92
42. Wakschlag LS, Hill C, Carter A, et al.: Observational assessment
of preschool disruptive behavior Part II: validity of the Disruptive
Behavior Diagnostic Observation Schedule (DB-DOS). J Am
Acad Child Adolesc Psychiatry 2008d, 47(6): 632–41.
43. Crowell J and Feldman S: The effects of mothers’ internal working
models of relationships and children’s behavioral and developmental
status on mother–child interaction. Child Dev 1988, 59: 1273–1285.
44. Wakschlag LS, Danis B: Characterizing early childhood disruptive
behavior disorder: enhancing developmental sensitivity. In Hand-
Curr Psychiatry Rep (2011) 13:84–92
book of infant mental health,3rd edition. Edited by Zeanah CH.
New York, Guilford Press, 2009.
45. Njoroge W, Benton TD, Lewis M, Njoroge NM: What are
infants learning about race? A look at a sample of infants from
multiple racial groups. Infant Mental Health J 2009, 30(5):
549–567.
46. Gadow KD, Sprafkin J, Nolan EE: DMM-IV Symptoms in
Community and Clinic Preschool Children. J Am Acad Child
Adolesc Psychiatry 2001, 40 (12): 1383–1392.