Screening for childhood mental health problems: outcomes and early identification.
BACKGROUND
Many childhood psychiatric problems are transient. Consequently, screening procedures to accurately identify children with problems unlikely to remit and thus, in need of intervention, are of major public health concern. This study aimed to develop a universal school-based screening procedure based on the answers to three questions: (1) What are the broad patterns of mental health problems from kindergarten to grade 5? (2) What are the grade 5 outcomes of these patterns? (3) How early in school can children likely to develop the most impairing patterns be identified accurately?


METHODS
Mothers and teachers reported on a community sample (N = 328) of children's internalizing and externalizing symptoms in kindergarten and grades 1, 3, and 5. In grade 5, teachers reported on children's school-based functional impairments, physical health problems, and service use; mothers reported on children's specialty mental health care.


RESULTS
Four patterns distinguished children who (1) never evidenced symptoms; (2) evidenced only isolated symptoms; or evidenced recurrent symptoms, either (3) without or (4) with comorbid internalizing and externalizing. By grade 5, children with recurrent comorbid symptoms had the greatest impairments, physical health problems, and service use. These children can be identified quite accurately by grade 1.


CONCLUSIONS
Universal screening at school entry can effectively identify children likely to develop recurrent comorbid symptoms, and would provide a basis for developing optimal targeted intervention programs.
Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI 53719, USA. mjessex@wisc.edu
Marilyn J
MJ
Essex
Helena C
HC
Kraemer
Marcia J
MJ
Slattery
Linnea R
LR
Burk
W Thomas
WT
Boyce
Hermi R
HR
Woodward
David J
DJ
Kupfer
D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000523:psychology; D002675:Child, Preschool; D042241:Early Diagnosis; D006801:Humans; D007389:Internal-External Control; D008603:Mental Health / Q000706:statistics & numerical data; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales; D012574:Schools; D011795:Surveys and Questionnaires / Q000592:standards