Dialogue Based Early Detection—Development of a Novel Approach for Detection of Mental Health Problems Among Children in Daycare Centers

Abstract

BackgroundAmong 1–7 years old children the worldwide prevalence of mental disorders is ~20%. Without treatment, the prognosis of such disorders in children is poor. Early intervention is estimated to result in a positive return. However, traditional screening to detect children at need is particularly challenging due to the concerns by false positives. The aim of the current study was to develop a more acceptable though effective method using the existing annual evaluation meetings between parents and teachers in a more systematic and goal directed way. The method should build on the teacher's and parents' complementary knowledge and perception of the child, and fit into the everyday routines in daycare centers.MethodDuring a period of 6 years, a developmental process aiming for a novel screening method was carried out in cooperation with eight Norwegian daycare centers. After conception of the idea, the framework of the Dialogue Based Early Detection including the first version of the Early Worry Questionnaire (EWQ) was constructed. An iterative process involving parents and teachers completing workshops and subsequent testing facilitated a re-modeling of the method.ResultsIn the resulting Dialogue Based Early Detection a 36-item version of EWQ was completed by both parents and teachers ahead of the annual parent-teacher meeting. During that meeting the participants should try to reach a consensus whether there was a concern, some uncertainty, or no worry for the child, and which appropriate actions should be taken for a possible follow up. Both parents and teachers reported that the EWQ supported them in verbalizing already existing worries for the child. Teachers reported that parents were better prepared and participated more actively in the evaluation meetings. However, some parents complained that there was too much focus on possible worries. During the testing, challenges of language development, conduct, emotional reactions, toileting, attention, and eating were detected among the children.ConclusionThe Dialogue Based Early Detection method was endorsed by both teachers and parents and holds promise as a tool for improving early awareness and identification of developmental and mental health problems of preschool children in daycare centers.

The ESSENCE‐Q: Can specialist supervision improve scoring agreement across specialist and public health nurses/nursery teachers?

“…Neurodevelopmental problems in young children can be identified effectively by involving nursery school/preschool teachers who have frequent contact with children 9 . According to a previous study, 10 nursery school/preschool teachers and PHNs do not accurately recognise/understand early childhood developmental concerns and advice parents using the ‘Wait and See’ approach. Therefore, the need for improving the mental health competence of nursery teachers and early detection and intervention for children has been emphasised 10 .…”

“…According to a previous study, 10 nursery school/preschool teachers and PHNs do not accurately recognise/understand early childhood developmental concerns and advice parents using the ‘Wait and See’ approach. Therefore, the need for improving the mental health competence of nursery teachers and early detection and intervention for children has been emphasised 10 . There were many nursery school/preschool children whose teachers thought that they might have neurodevelopmental disorders but their parents had not informed the teachers whether their children had been diagnosed.…”

“…The ESSENCE‐Q enquires about ‘concerns’ rather than inquiring about the presence or absence of a particular symptom or behaviour 3 . Many parents and nursery/preschool school teachers tend to hesitate to objectively assess the child's symptoms 10 . The question about ‘concerns’ may be easy for teachers to answer and reduce their psychological resistance.…”

“…who have frequent contact with children. 9 According to a previous study, 10 nursery school/preschool teachers and PHNs do not accurately recognise/understand early childhood developmental concerns and advice parents using the 'Wait and See' approach.…”

“…Therefore, the need for improving the mental health competence of nursery teachers and early detection and intervention for children has been emphasised. 10 There were many nursery school/ preschool children whose teachers thought that they might have neurodevelopmental disorders but their parents had not informed the teachers whether their children had been diagnosed. In 28.3% of the cases, the teachers lacked the confidence to discuss their concerns about the children with their parents.…”