Early detection and prevention of psychiatric disorders among preschoolers in the community

Young children have psychiatric disorders to a comparable extent with that of any other age group, and they endure. If undetected, problems may escalate and become more resistant to change. However, far fewer young children with psychiatric disorders rece ive treatment than do school age children, adolescents, and adults - most likely because they go undetected. These facts provide a strong rationale for community-wide screening programs in combination with effective early intervention. Existing screens produce high rates of false positives when used at the community level, which is unfortunate if prevention is to be based on screen results. Our aim is therefore to develop a screen with higher predictive power. Existing evidence based prevention programs for young children commonly target a specific set of disorders, most often behavior problems. Most communities do not have the resources to keep a series of programs targeting a variety of problems. Generic prevention programs strengthening the parent-ch ild relationship would therefore be the treatment of choice, if proven effective. All children meeting at the health check-up for 4-year olds will be screened by the parent version of the CBCL 1,5 - 5 and SDQ, and re-screened at age 6. A random sample of low-scorers (n=125), intermediate scorers (n=125) and high scorers (n=450) will be invited to a more detailed study consisting of a structured diagnostic interview with the parents (PAPA), samples of parent-child interaction, measures of child attachment and self-concept, and parental reports about temperament. CBCL and SDQ information will also be collected from day-care personnel, as will reports about social development. A second wave is scheduled after 2 years. A random half of parents of high-scorer s will be invited to take part in the intervention (ICDP - "Foreldreveiledningsprogrammet"). Participators and control will be re-examined after competition