The aim of this study was to determine the diagnostic accuracy of statutory health assessments in identifying existing mental health disorders in pre-school foster children. It was examined whether a foster carer completed screening instrument could enhance accuracy. A representative sample of 43 pre-schoolers under the care of one inner-city local authority underwent comprehensive multidimensional mental health assessments as the reference standard. Statutory health assessments gave false negative results for 65% (95% confidence interval (CI) 44–82%) of children diagnosed with at least one mental health disorder according to the reference standard and 18% (95% CI 3–52%) of children with developmental delay. The Ages & Stages Questionnaire completed by the foster carers failed to identify 65% (95% CI 44–82%) of the children with diagnosed mental health disorders. There was no evidence of selective underreporting by foster carers in relation to specific diagnostic categories. In conclusion, statutory health assessments in their current form may fail to identify the majority of pre-school foster children with mental health disorders. Adding a screening instrument to the assessment process may not be adequate to improve diagnostic accuracy.
Centile Psychological Assessments is an innovative pyschological testing and distribution company run and managed by licensed and experienced psychologist with years of experience in the field of psychological testing, assessment, diagnosis, therapy, research and human organization management. Psychological test scores can be very useful under the proper circumstances—and when the limitations of psychological testing are properly understood, respected, and made plain. Note, however, that the score you get on any psychological test is nothing more than “the score you have gotten on that test.”.
Anderson, L. M., Shinn, C., Fullilove, M. T., Scrimshaw, S. C., Fielding, J. E., Normand, J., Carande-Kulis, V. G. (2003). The effectiveness of early childhood development programs. American Journal of Preventive Medicine, 24, 32–46. Google Scholar | Crossref | Medline | ISI |
Blower, A., Addo, A., Hodgson, J., Lamington, L., Towlson, K. (2004). Mental health of ‘looked after’ children: A needs assessment. Clinical Child Psychology and Psychiatry, 9, 117–129. Google Scholar | SAGE Journals |
Briggs-Gowan, M. J., Carter, A. S. (2007). Applying the Infant-Toddler Social & Emotional Assessment (ITSEA) and Brief-ITSEA in early intervention. Infant Mental Health Journal, 28, 564–583. Google Scholar | Crossref | Medline | ISI |
British Association for Adoption and Fostering . (2004). Initial health assessment –child. Medical report & developmental assessment of child birth to nine years looked after or referred for adoption. London, UK: British Association for Adoption and Fostering. Google Scholar |
Carter, A. S., Briggs-Gowan, M. J., Davis, N. O. (2004). Assessment of young children’s social-emotional development and psychopathology: Recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry, 45, 109–134. Google Scholar | Crossref | Medline | ISI |
Chernoff, R., Combs-Orme, T., Risley-Curtiss, C., Heisler, A. (1994). Assessing the health status of children entering foster care. Pediatrics, 93, 594–601. Google Scholar | Medline | ISI |
Clyman, R. B., Jones Harden, B., Little, C. (2002). Assessment, intervention, and research with infants in out-of-home placement. Infant Mental Health Journal, 23, 435–453. Google Scholar | Crossref | ISI |
Department of Children, Schools and Families . (2009). Statutory guidance on promoting the health and well-being of looked after children. Nottingham, UK: DCSF publications. Google Scholar |
Durlak, J. A., Wells, A. M. (1997). Primary prevention mental health programs for children and adolescents: A meta-analytic review. American Journal of Community Psychology, 25, 115–152. Google Scholar | Crossref | Medline | ISI |
Egger, H. L., Angold, A. (2006). Test-retest reliability of the Pre-School Age Psychiatric Assessment (PAPA). Journal of the American Academy of Child and Adolescent Psychiatry, 45, 538–549. Google Scholar | Crossref | Medline | ISI |
Hillen, T., Gafson, L., Drage, L., Conlan, L. M. (2012). Assessing the prevalence of mental health disorders and mental health needs among pre-school children in care in England. Infant Mental Health Journal, 33, 411–420. Google Scholar | Crossref | Medline | ISI |
Horwitz, S., Gary, L., Briggs-Gowan, M., Carter, A. (2003). Do needs drive services use in young children? Pediatrics, 112, 1373–1378. Google Scholar | Crossref | Medline | ISI |
Horwitz, S. M., Owens, P., Simms, M. D. (2000). Specialized assessments for children in foster care. Pediatrics, 106, 59–66. Google Scholar | Crossref | Medline | ISI |
Kerker, B. D, Dore, M. M. (2006). Mental health needs and treatment of foster youth: Barriers and opportunities. American Journal of Orthopsychiatry, 76, 138–147. Google Scholar | Crossref | Medline | ISI |
Klee, L., Kronstadt, D., Zlotnick, C. (1997). Foster care’s youngest: A preliminary report. American Journal of Orthopsychiatry, 67, 290–299. Google Scholar | Crossref | Medline | ISI |
McMillen, J. C., Zima, B. T., Scott, L. D., Auslander, W. F., Munson, M. R., Ollie, M. T., Spitznagel, E. L. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 88–95. Google Scholar | Crossref | Medline | ISI |
Meltzer, H., Corbin, T., Gatward, R., Goodman, R., Ford, T. (2003). The mental health of young people looked after by local authorities in England. London, UK: The Stationery Office. Google Scholar | Crossref |
Milburn, N. L., Lynch, M., Jackson, J. (2008). Early identification of mental health needs for children in care: A therapeutic assessment progamme for statutory clients of child protection. Clinical Child Psychology and Psychiatry, 13, 31–47. Google Scholar | SAGE Journals |
Mount, J., Lister, A., Bennun, I. (2004). Identifying the mental health needs of looked after young people. Clinical Child Psychology and Psychiatry, 9, 363–382. Google Scholar | SAGE Journals |
Mullen, E. M. (1995). Mullen scales of early learning. (AGS ed.). Circle Pines, MN: American Guidance Service Inc. Google Scholar |
National Institute for Health and Clinical Excellence . (2010). Promoting the quality of life of looked after children and young people. London, UK: National Institute for Health and Clinical Excellence & Social Care Institute for Excellence, Public Health Guidance28. Google Scholar |
Newcombe, R. G. (1998). Two-sided confidence intervals for the single proportion: Comparison of seven methods. Statistics in Medicine, 17, 857–872. Google Scholar | Crossref | Medline | ISI |
Reams, R. (1999). Children birth to three entering the state’s custody. Infant Mental Health Journal, 20, 166–174. Google Scholar | Crossref | ISI |
Sayal, K., Taylor, E. (2004). Detection of child mental health disorders by general practitioners. British Journal of General Practice, 54, 348–352. Google Scholar | Medline | ISI |
Sempik, J., Ward, H., Darker, I. (2008). Emotional and behavioural difficulties of children and young people at entry into care. Clinical Child Psychology and Psychiatry, 13, 221–233. Google Scholar | SAGE Journals |
Sheldrick, R. C., Merchant, S., Perrin, E. C. (2011). Identification of developmental-behavioral problems in primary care: A systematic review. Pediatrics, 128, 356–363. Google Scholar | Crossref | Medline | ISI |
Squires, J., Bricker, D., Twombly, E. (2003). The Ages and Stages Questionnaires: Social Emotional (ASQ: SE) user’s guide. Baltimore, MD: Paul Brookes Publishing. Google Scholar |
Stahmer, A. C., Leslie, L. K., Hurlburt, M., Barth, R. P., Webb, M. B., Landsverk, J., Zhang, J. (2004). Developmental and behavioral needs and service use for young children in child welfare. Pediatrics, 116, 891–900. Google Scholar | Crossref | ISI |
Stancin, T., Palermo, T. M. (1997). A review of behavioral screening practices in pediatric settings: Do they pass the test? Journal of Developmental and Behavioural Pediatrics, 18, 183–194. Google Scholar | Crossref | Medline | ISI |
Thomas, J. M., Benham, A. L., Gean, M., Luby, J., Minde, K., Turner, S., Wright, H. H. (1997). Practice parameters for the psychiatric assessment of infants and toddlers (0–36 months). American Academy of Child and Adolescent Psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 21–36. Google Scholar | Crossref | Medline | ISI |
Urquiza, A. J., Wirtz, S. J., Peterson, M. S., Singer, V. A. (1994). Screening and evaluating abused and neglected children entering protective custody. Child Welfare, 73, 155–171. Google Scholar | Medline | ISI |
Weitzman, C. C., Leventhal, J. M. (2006). Screening for behavioral health problems in primary care. Current Opinion in Pediatrics, 18, 641–648. Google Scholar | Crossref | Medline | ISI |
World Health Organization . (1992). ICD-10: The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health Organisation. Retrieved from http://www.who.int/classifications/icd/en/bluebook.pdf Google Scholar |
Wotherspoon, E., O’Neill-Laberge, M., Pirie, J. (2008). Meeting the emotional needs of infants and toddlers in foster care: The collaborative mental health care experience. Infant Mental Health Journal, 29, 377–394. Google Scholar | Crossref | Medline | ISI |
Zeanah, C. H., Larrieu, J. A., Heller, S. S., Valliere, J., Hinshwa-Fuselier, S., Aoki, Y., Drilling, M. (2001). Evaluation of a preventive intervention for maltreated infants and toddlers in foster care. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 214–221. Google Scholar | Crossref | Medline | ISI |
Zero to Three . (2005). Diagnostic classification of mental health and developmental disorders of infancy revised edition (DC 0–3R). Washington, DC: Zero to Three Press. Google Scholar |
Test norms
Test norms consist of data that make it possible to determine the relative standing of an individual who has taken a test. By itself, a subject’s raw score (e.g., the number of answers that agree with the scoring key) has little meaning. Almost always, a test score must be interpreted as indicating the subject’s position relative to others in some group. Norms provide a basis for comparing the individual with a group.
Numerical values called centiles (or percentiles) serve as the basis for one widely applicable system of norms. From a distribution of a group’s raw scores the percentage of subjects falling below any given raw score can be found. Any raw score can then be interpreted relative to the performance of the reference (or normative) group—eighth-graders, five-year-olds, institutional inmates, job applicants. The centile rank corresponding to each raw score, therefore, shows the percentage of subjects who scored below that point. Thus, 25 percent of the normative group earn scores lower than the 25th centile; and an average called the median corresponds to the 50th centile.
Another class of norm system (standard scores) is based on how far each raw score falls above or below an average score, the arithmetic mean. One resulting type of standard score, symbolized as z, is positive (e.g., +1.69 or +2.43) for a raw score above the mean and negative for a raw score below the mean. Negative and fractional values can, however, be avoided in practice by using other types of standard scores obtained by multiplying z scores by an arbitrarily selected constant (say, 10) and by adding another constant (say, 50, which changes the z score mean of zero to a new mean of 50). Such changes of constants do not alter the essential characteristics of the underlying set of z scores.
The French psychologist Alfred Binet, in pioneering the development of tests of intelligence, listed test items along a normative scale on the basis of the chronological age (actual age in years and months) of groups of children that passed them. A mental-age score (e.g., seven) was assigned to each subject, indicating the chronological age (e.g., seven years old) in the reference sample for which his raw score was the mean. But mental age is not a direct index of brightness; a mental age of seven in a 10-year-old is different from the same mental age in a four-year-old.
To correct for this, a later development was a form of IQ (intelligence quotient), computed as the ratio of the subject’s mental age to his chronological age, multiplied by 100. (Thus, the IQ made it easy to tell if a child was bright or dull for his age.)
Ratio IQs for younger age groups exhibit means close to 100 and spreads of roughly 45 points above and below 100. The classical ratio IQ has been largely supplanted by the deviation IQ, mainly because the spread around the average has not been uniform due to different ranges of item difficulty at different age levels. The deviation IQ, a type of standard score, has a mean of 100 and a standard deviation of 16 for each age level. Practice with the Stanford-Binet test reflects the finding that average performance on the test does not increase beyond age 18. Therefore, the chronological age of any individual older than 18 is taken as 18 for the purpose of determining IQ.
The Stanford-Binet has been largely supplanted by several tests developed by the American psychologist David Wechsler between the late 1930s and the early 1960s. These tests have subtests for several capacities, some verbal and some operational, each subtest having its own norms. After constructing tests for adults, Wechsler developed tests for older and for younger children.