Commentary: Timely recognition of mental health needs in young children - parental perception as a way for professionals to understand child, parent, and family needs? - a commentary on McGinnis et al. (2021).

There is a growing awareness that identification and intervention of mental health problems in early childhood are effective and have a preventive effect. Nevertheless, the use of mental health services in early childhood is still limited. Investigating parental perception of mental health needs in young children is highly relevant, as parents are the primary informants for young children. In this commentary, we discuss the findings reported by McGinnis et al. on child and parent factors associated with parent perception of mental health needs in young children. We agree with their plea for a shift from the individual child to the family in assessment and intervention, and elaborate on the relevance of endorsing a transdiagnostic, relationship-based approach to early detection, assessment, and intervention. We propose beginning with the acknowledgment and deeper understanding by professionals of parental perception of young children's mental health problems and needs, and the realization that the young child's symptoms and needs are connected with the family and broader (relational) context.

Course of disinhibited social engagement behavior in clinically referred home-reared preschool children.

BACKGROUND: Evidence supporting clinical relevance and persistence of disinhibited social engagement behavior (DSEB) pertains mostly to children reared in institutions and foster care. This study examined the course of DSEB in clinically referred home-reared children from early into middle childhood, and associations with neglect/emotional maltreatment, effortful control, Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Autism Spectrum Disorder. METHODS: Disinhibited social engagement behavior was examined in 124 children (82% boys, M = 4.06 years, SD = 0.89), referred for treatment of emotional and behavioral problems, by use of the Disturbances of Attachment Interview (DAI) with biological parents. Neglect and emotional maltreatment were assessed from case records and effortful control by use of the Child Behavior Questionnaire. At follow-up, on average 4 years later, DSEB was examined by use of DAI as well as two observational ratings: the Stranger at the Door procedure (SatD) and a structured home observation of stranger approach. Psychiatric disorders were assessed by means of the Kiddie-Schedule for Affective Disorders and Schizophrenia. RESULTS: Persistence of parent-reported DSEB was found in 57% (n = 27) of the children with DSEB at baseline (n = 47). Parent-reported DSEB at follow-up was significantly related to DSEB observed in the SatD (rpb  = .31, p = .001) and to observed stranger approach (rs  = .41, p < .001), but only stranger approach was associated with baseline DSEB. The course of DSEB was not related to neglect/emotional maltreatment, nor to the level of effortful control. There was no association between DSEB and Autism Spectrum Disorder, but course of DSEB was associated with Attention Deficit/Hyperactivity Disorder/Oppositional Defiant Disorder at follow-up (χ2  = 13.08, p = .004). CONCLUSIONS: Although explanations for the onset and course of DSEB in home-reared children remain elusive, findings suggest that DSEB is part of a complex of clinically significant problem behaviors in referred home-reared preschool children.

Temperament Traits and Psychopathology in Young Clinically Referred Children Compared to a General Population Sample.

Evidence from general population studies shows the contribution of various temperament traits to the development of child psychopathology. Little is known about which traits are associated with internalizing and externalizing problems in young clinically referred children. The current study assessed temperament and internalizing and externalizing problems in 216 referred children (M = 4.35 years, SD 0.89, 81% boys). A comparison was made with an age and gender matched general population sample. Referred children showed less effortful control than general population children. Less effortful control and more negative affectivity were associated with more internalizing and externalizing problems across groups. Surgency, and specifically temperamental impulsivity, was more strongly associated with externalizing problems in referred children compared to general population. Less soothability, less inhibitory control and more frustration predicted (sub)clinical levels of comborbid internalizing and externalizing problems in referred children. The results can be used in diagnostic and treatment procedures in early childhood.

Etiology of mental retardation in children referred to a tertiary care center: a prospective study.

A prospective assessment following a step-wise protocol in 281 patients with unexplained cognitive delay was used to assess diagnostic possibilities. Diagnostic procedures were complex and required a multidisciplinary approach. One third of diagnoses was established based on clinical history and physical exam only; for another third, clinical history and physical exam provided essential clues for additional investigations; and a third were established by additional investigations only. The likelihood to reach a diagnosis did not depend on the severity of mental retardation. We found that in a tertiary care center, a diagnosis can be established in 1 out of every 2 patients. Clinical history and physical examination are the most important instruments to reach a diagnosis.

Tourette syndrome, growth retardation, and platyspondyly: an entity?

A 14-year-old male is described with Tourette syndrome, platyspondyly, a marked delay in bone age, growth retardation that is more expressed in the limbs and talipes equinovarus. This appears to be a new entity.