Editorial: Early Recognition and Assessment


  • Crispin Day

Welcome to this first Virtual Issue of Child and Adolescent Mental Health (CAMH). The last few years has seen an important and growing weight given to early recognition, assessment and intervention. This has been supported by a growing understanding of foetal, infant and early childhood development and the factors that influence developmental trajectories. Child and family policy in the UK and internationally has come to emphasise the clinical, social and economic benefits of early recognition and intervention. At the same time, child and adolescent mental health practitioners have become increasingly involved in infant mental health and the early years.

To reflect this, we have selected a range of previously published articles from the past three volumes of CAMH that examine these developments in relation to research and practice. The articles included investigate and review the use of diagnostic and assessment tools across a range of childhood disorders and difficulties as well as report on and review methods of effective early intervention.

The Virtual Issue begins with an important review of reviews conducted by Jane Barlow et al. (2010). Their article reflects the critical role that maternal mental health and early parenting play in optimising the later mental health of the child. Barlow and colleagues provide a valuable synthesis of current knowledge about effective health-led interventions to support parents, parenting, infant development and the parent-infant relationship during the perinatal period and early phase of infants’ lives. This is followed by an article authored by Thomas O’Connor & Gerard Byrne (2007), who review the strategies and specific measures for assessing attachment in infancy and childhood. Within their chosen area of interest, these authors highlight a key aspect of the research-practice gap. Although the evidence base for a number of measures of attachment is now robust, the incorporation of these instruments into clinical practice has been relatively slow. O’Connor and Byrne identify a number of the practical barriers to their inclusion in clinical practice and ideas for overcoming these are proposed.

In keeping with this focus, this Virtual Issue includes four articles that examine key aspects of assessing child development in practice. James Law & Penny Roy (2008) describe the development and wide spread application of the Communicative Development Inventories. These parent-report measures of vocabulary and other aspects of language development in very young children are the first measures of their kind to be widely translated and adapted for use in many different languages. The inventories measure early language acquisition, and assist in identifying and describing children whose early language is significantly delayed. In a reminder that there is nothing as valuable as the perceptions and voice of the child and parent, the article by Melanie Marysko et al. (2010) focuses on the value and reliability of mothers’ capacity to recognise the needs of their young infants. The results of their study suggest that behavioural inhibition, as a potential risk factor for childhood shyness and anxiety, can be predicted by maternal judgment of infant distress to novelty at age four months. Marysko and colleagues suggest that the Infant Behaviour Questionnaire used in their study could be used to identify infants potentially at risk of childhood anxiety disorders.

Early intervention is recommended for autism spectrum disorders but is often delayed because children have not received a formal diagnosis. Nonetheless parents are likely to identify features of autism spectrum disorders from an early age. In a qualitative study, Roy McConkey et al. (2009) examined mothers’ recollections of early signs that alerted them to their child’s developmental difficulties. Their findings offer valuable insights for clinicians into parents’ sensitive observations of the nascent indications of autism spectrum disorders. In their review article (‘Diet and Mental Health in Children’), Diane Tomlinson, Heather Wilkinson & Paul Wilkinson (2009) examine the literature concerning the role of diet in childhood cognitive development, school performance and behaviour, particularly the effects of inadequate dietary intake and of nutrient supplements.

Accurate understanding of the developmental trajectory of early difficulties underpins effective assessment and intervention. Valerie Muter & Margaret Snowling (2009) describe a longitudinal study that tracked a group of at risk poor readers over a 10-year period. The study offers a rich description of the incidence of the children’s reading problems, the course of developmental relationships among language and literacy skills and the factors that influence outcome, including risk and protective factors and co-morbid difficulties. These findings have implications for the early recognition of children at risk of dyslexia, assessing and teaching poor readers, addressing co-occurring difficulties, capitalising on compensatory or protective factors and providing emotional support.

Two articles then explore the effectiveness of early intervention. Robert Fox & Casey Holtz (2009) investigated the inherent challenges of working with at-risk families and delivering mental health services for very young children. They examined the effectiveness of a treatment programme (Parenting Young Child Program) for toddlers whose behaviour problems were further complicated by their families living in poverty. Fox and Holz found significant improvements in the young children’s behaviour problems and their compliance to parent requests. In a similar vein, Jon Pollock & Sue Horrocks (2010) describe the routine effectiveness of a primary mental health service for families with pre-school children. The results of this uncontrolled evaluation suggested significant improvement in the behavioural difficulties of the young children but no improvements in the general well being of the presenting parent. From a broader perspective on intervention, Amali Chandrasena, Raja Mukherjee & Jeremy Turk (2009) review the literature on recent advances and directions of the range of psychological, social, educational, and pharmacological interventions available to manage complex difficulties of children affected by foetal alcohol syndrome.

The final articles extend the examination of the Virtual Issue’s key themes. The meta-analysis conducted by Erin Warnick, Michael Bracken & Stanislav Kasl into the screening efficiency of two widely used instruments, the Child Behavior Checklist and the Strengths and Difficulties Questionnaire, confirms the value of both measures for use with clinical and community samples. The authors caution that further research is required to determine if there is a true difference in efficiency between the two scales. Kapil Sayal, Nicole Letch & Samaa El Abd investigated the implementation of a routine screening procedure involving parent and teacher completed questionnaires for children referred for an ADHD assessment. The introduction of this screening procedure contributed to an increase in the proportion of assessed children receiving a clinical diagnosis of ADHD. Although screening prior to assessment may improve the use of specialist clinical resources in the identification of children with ADHD, caution needs to be exercised as false positives remained common.

The review by Nadia Micali & Jennifer House (2011) describes the strengths and limitations of the range of diagnostic and screening instruments are available for assessing child and adolescent eating disorders. The authors make recommendations about assessment measures to improve the recognition and treatment child and adolescent eating disorders

In the final article of the Virtual Issue, Deena Chisolm et al. (2008) extended the functions and procedures of assessment in a novel way. This group evaluated an adolescent satisfaction with computer-assisted mental health and risk-behaviour screening tool in primary care. The majority of users were satisfied with their experience and satisfaction was not related to computer experience or risk behaviour status.

We hope this collection of articles will be useful both for researchers in child development, those involved in policy development for children and families, and for CAMH practitioners and other professionals in healthcare, early-years education and child development. We hope it will be widely used as a reference source to the growing evidence base for effective early intervention and the benefits of early recognition and assessment.


C.D. has no competing or potential conflicts of interest relating to this Editorial; he has declarations of interest in relation to his role as an Editor of the journal as follows: South London and Maudsley NHS Foundation Trust, employee, intervention programme developer; Research Grants: NIHR, SLaM Charity, Guy’s and St Thomas’ Charity, Best Beginnings. Consultancies: Department of Health, England: consultant advisor; Barnado’s Ireland: consultant; Family Partnership Australasia: consultancy, speaker fees; Murdoch Research Institute: consultancy, speaker fees; Kumara: speaker fees, consultancy.