Introduction

This chapter introduces the revised volume and notes that the book highlights the most recent empirical data and conceptual developments in the field. Each chapter is introduced within four major sections of the volume including (1) Contextual Factors in Early Assessment; (2) Temperament and Regulation in Assessment of Young Children; (3) Early Problems and Disorders; and (4) Translation and Varied Applied Settings for Assessment. It notes that developmental, social, and cultural contexts in relation to the assessment of early problems and disorders are included in the volume in hopes that the field will continue to generate and empirically test multilevel, systemic models that can be applied to the assessment and understanding of mental disorders in infants, toddlers, preschoolers, and their families.

Epilogue and Future Directions

The second edition of the Oxford Handbook of Infant, Toddler, and Preschool Mental Health Assessment offers historical understandings and highlights recent enhancements in the assessment of infant, toddler, and preschool mental health. Authors present empirical findings across a variety of assessment methods and measures developed to capture variability in normative and psychopathological social-emotional development, including assessments of multiple dimensions of temperament, emotion regulation and dysregulation, behavior problems, social-emotional competencies, diagnostic symptoms, and diagnostic conditions. Notable in this edition is the consensus regarding the importance of identifying and assessing the relevant relational contexts in which early development is fostered. Also emphasized is the need for professionals to enhance their cultural awareness and responsiveness. Finally, greater dissemination of evidence-based young child mental health assessment methods is encouraged, which will require training interdisciplinary professionals in the cultural and domain expertise to identify and evaluate children with and at risk for clinically significant psychopathology.

Addressing Barriers and Limitations of Developmental Screening in Community Contexts

This chapter describes the triage assessment, a structured way for mental health consultants to conceptualize concerns identified via developmental screening processes and frame feedback to support family engagement with next steps. This chapter (a) describes the rationale, goals, and critical elements of triage assessments; (b) suggests pragmatic guidelines for implementation; and (c) discusses lessons learned from experience conducting triage assessments in community settings, including the importance of promoting family engagement and considerations for increasing sustainability. This chapter describes work conducted in pediatric primary care clinics serving young children at high risk for adverse developmental, behavioral, and social-emotional outcomes. However, the purpose, essential components, and structure of triage assessments are relevant as second-stage screening practices for all settings. As screening becomes broadly implemented, the triage assessment helps providers respond to red flag concerns highlighted by first-stage screening practices and support families to get help to address these concerns.

Affective Disorders

There is substantial evidence for symptoms of affective distrubances in high-risk infants and toddlers. Significant progress has been made in characterizing and validating clinical depression in the preschool period. Identification of affective disorders in the infancy and preschool periods may be critical to early and potentially more effective intervention. However, the accurate identification of affective disorders in this very young age group is complicated by several factors. A central issue was the basic developmental question of whether the emotional repertoire was itself sufficiently differentiated to encompass true “depressive” and/or “elated” affect during early life. However, empirical studies have shown that many of these emotional capacities are present in early childhood. Further, a significant limitation was the fact that many standard assessment tools failed to describe the developmentally specific manifestations of symptoms, an issue that measures described in this chapter now address. The fact that the symptoms of depressive disorders are internalizing, and therefore less apparent to caregivers, is an obstacle to appropriate referral. For these reasons, an assessment for the symptoms of affective disorders in infants and toddlers should include direct observational play assessment, parental interview that probes for developmental manifestation of affective symptoms and consideration of normative variations in affect that must be distinguished from clinical symptoms.This chapter will discuss strategies useful for the assessment of affective symptoms and disorders in infants and toddlers. Data supporting major depressive disorder criteria for preschoolers will be reviewed. Case examples of preschool children with depression and a presumptive bipolar subsyndrome will be presented.

Assessment of Sensory Processing Disorder

This chapter explores the influence of sensory processing disorder on mental health in infants and young children. A bidirectional and interconnected framework is proposed for understanding the interplay between sensory processing and affect expression, across a wide range of emotions, within a caring relationship. Sensory processing disorder is defined and described. Current research on sensory processing disorder is summarized and evaluation tools are reviewed. A clinical method is proposed for screening for sensory processing and affect difficulties during mental health evaluations of young children. Finally, future directions for research and treatment are suggested.

Assessment in Early Care and Education Environments

Early care and education (ECE) settings are major developmental contexts for the majority of young children. This chapter presents research on the importance of these settings for child development, covering measures of setting quality and child outcomes in ECE research and empirical studies relating setting quality to child outcomes in depth. One important issue is the consistently significant but small developmental effects of ECE quality. Current research on possible factors contributing to these small associations is outlined, highlighting the potential for child characteristics to interact with setting quality in supporting or undermining child outcomes and the importance of acknowledging the nonrandom ways in which different families come to use different ECE settings (including barriers to obtaining ECE arrangements that are a good fit for the child and family). The chapter ends with a discussion of current practice and policy, featuring mental health consultation models.

The Interpersonal Context of Early Childhood Development

With the 2016 release of Zero to Three’s Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, the eyes of the field are newly trained on assessment of the full family caregiving contexts in which children are raised. This chapter presents a conceptual model for assessing coparenting alliances in families of infants and toddlers intended to provide information to both researchers and practitioners. The chapter defines coparenting in a manner that is relevant for various family systems, identifies important elements of effective coparenting alliances, and presents a schematic for assessing quality of coparenting in the young child’s family. Guidance based on lessons learned from extensive field experience with coparenting in diverse families is provided, and both reported and observed coparenting assessment methods are discussed. Growing points for this relatively new field of infant–family mental health assessment are enumerated.

Assessment of Language in Young Children

Language delay is one of the major reasons that young children are referred for developmental or psychological evaluation. When no more primary condition is present, a child with a language delay is diagnosed with specific language impairment, with children ages 2 to 3 usually called late talkers. A vocabulary checklist such as the Language Development Survey (Rescorla, 1989) is an efficient screening tool for identifying language delay in toddlers. Research findings in five major domains of language and communication (gestures/play, phonology/vocalizations, vocabulary, grammar, and pragmatics) are reviewed, as well as standardized and naturalistic methods for assessing development in each domain. It is good clinical practice to screen for psychopathology when conducting a language assessment of young children, even though many preschoolers with language delay do not have significant psychopathology. Findings on associations between language delay and behavioral/emotional problems are reviewed, as well as commonly used rating forms for identifying maladjustment.

Dimensional and Multicultural Assessment of Preschoolers’ Behavioral, Emotional, and Social Problems

This chapter presents nosological models for early childhood psychopathology embodied in the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition, and the International Classification of Diseases, 10th revision. It also presents the revised Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood as another nosological approach that provides more differentiated diagnostic categories and criteria for early childhood disorders. As an alternative to the top-down nosological approaches based on experts’ concepts of disorders, the chapter presents bottom-up approaches that statistically derive dimensional syndromes from ratings of problems in large samples of children. Statistically derived syndromes have been supported by data from multiple informants in dozens of societies around the world. The data from these societies have been used to construct multicultural norms for the syndromes, for DSM-oriented scales, and for broad-spectrum Internalizing, Externalizing, and Total Problems scales. Case illustrations are provided for translational applications in medical, mental health, educational, and child or family service settings.

Assessment of Early Parent–Child Relationships

Using a relational approach to assessment integrates the theoretical application of developmental, psychological and psychiatric disciplines (Clark, Tluczek, & Gallagher, 2004; Sameroff & Emde, 1989; Sameroff, McDonough, & Rosenblum, 2004). Clark, Tluczek, Moore, and Evenson (2019, Chapter 2) presents a review of these perspectives. This chapter introduces best practices in the assessment of parent–child relationships and provides an in-depth description and illustration of the Parent–Child Early Relational Assessment, composed of both objective ratings and a subjective video replay interview used to engage the parent in assessing his or her relationship with his or her child. In addition, reliability, validity, research findings, and the clinical utility of a wide range of parent–child relationship assessment tools and procedures are provided. The importance of considering the individual contributions of the parent, the infant or young child, the family, and the cultural context in the assessment process is highlighted. Guidelines are also included on the use of relational assessments in research and to inform clinical practice.