Early identification of psychopathology

This chapter deals with identification of psychopathology in the first 3 years of life. Early identification implies, by definition, the use of assessment tools. We will show how assessment must be tailored to the specific culture to which the infant and his/her parents belong: tools that fit Western cultures will probably not fit nonWestern cultures. As an instance of the Western culture, we describe the Infant Mental Health Assessment Form that was developed in Finland to help primary health care professionals identify infants and families in need of psychosocial support. The tool has two cutoffs: Exceeding the lower cut-off score indicates that the infant or the family needs further examination at the primary level of care, while the higher cut-off indicates that the infant and his/her parents needs a referral to a child psychiatric clinic. In contrast, the typical clinical situation in a nonWestern country such as South Africa is characterized by numerouschallenges that do not allow for the usually known methods of assessment, such as a quiet, contained space, toys, and time. A simple, creative assessment tool, named the “biscuit game” has been developed in Capetown, as a cultural appropriate assessment tool that provided a useful adjunct to observing the infant with an eating disorder, as illustrated with a clinical vignette. Finally, early identification of psychopathology requires knowing about risk and protective factors in the infant, the parents, and their environment, as also illustrated by a clinical vignette. After reading this chapter, the reader will realize that early signs of psychopathology are already evident in infants and most of the major mental disorders like anxiety, depression, and behavioral disorders often have their origin already in this early age; the reader will also become more aware of the need to use culture appropriate assessment tools.