Social-emotional problems in preschool-aged children: opportunities for prevention and early intervention

Abstract

Objectives: To estimate the prevalence of positive screens for social-emotional problems among preschool-aged children in a low-income clinical population and to explore the family context and receptivity to referrals to help guide development of interventions.

Design: Observational, cross-sectional study.

Setting: Two urban primary care clinics.

Participants: A total of 254 parents of 3- and 4-year-old children at 2 urban primary care clinics.

Main outcome measures: Score on a standardized screen for social-emotional problems (Ages and Stages Questionnaire: Social-Emotional) and answers to additional survey questions about child care arrangements, parental depressive symptoms, and attitudes toward preschool and behavioral health referrals.

Results: Twenty-four percent (95% CI, 16.5%-31.5%) of children screened positive for social-emotional problems. Among those screening positive, 45% had a parent with depressive symptoms, and 27% had no nonparental child care. Among parents of children who screened positive for social-emotional problems, 79% reported they would welcome or would not mind a referral to a counselor or psychologist; only 16% reported a prior referral.

Conclusions: In a clinical sample, 1 in 4 low-income preschool-aged children screened positive for social-emotional problems, and most parents were amenable to referrals to preschool or early childhood mental health. This represents an opportunity for improvement in primary prevention and early intervention for social-emotional problems.

Figure

Distribution of Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) scores. The cutoff score was established by developers of the ASQ:SE by using receiver operating characteristic curves. Scores above the cutoff represent positive screens for social-emotional problems. The national median represents the median value in a nationally representative sample used to normalize the ASQ:SE.