Psychological distress in young children

Wednesday 8 September 2021 - Updated on Thursday 9 September 2021
In crises, children’s mental health needs are often neglected due to the lack of local and international mental health professionals.
To help address this issue, Epicentre, Médecins Sans Frontières (MSF), and other partners, developed a cross culturally validated screening and orientation assessment scale, designed to evaluate the mental status of young children.
There are two versions of the tool: PSYCa6-36 for children aged 6 to 36 months, and PSYCa3-6 for children aged 3 to 6 years. PSYCa6-36 and 3-6 are simple and quick tools that can be administered by non-specialists.

A simple and cross-cultural screening scale for psychological distress in young children

Although young children make up more than half of the population in low- and middle-income countries, their mental health needs often go unmet. Young children are in a vulnerable psychological period, which influences their emotional, cognitive, and physical development.  This is especially true in crises when children’s risks of exposure to violence, abject poverty and displacement is increased.

Along with direct effects on the child's mental health, other potential consequences can occur, such as anxiety, depression, and somatic disorders. These are often not addressed, even when screening and treatment programs exist. Furthermore, psychological distress in young children is particularly difficult to assess, as many behaviors are normal at certain ages but not at others.

The limited number of local and international mental health professionals combined with the absence of simple, rapid, and cross-culturally validated screening tools often leads to children going without care. While training and infrastructure development would be ideal to address children's mental health, tools that help identify children in need of further assessment can help streamline resources and refer children if needed.

As the psychological response of children depends on their individual, family, and social environments among many other factors, recognizing the diversity of potential psychological responses is essential to provide appropriate interventions. This means the tool needs to be both generalizable and cross-cultural, but also simple.

PSYCa6-36 & PSYCa3-6: a simple cross cultural screening tool

PSYCa6 3-6 is a scale developed and cross-culturally validated by MSF and Epicentre for assessing potential psychological difficulties (depression, phobia, anxiety, regression, psychosomatic complaints, and psycho-traumatic disorder) in young children aged 3 to 6 years old to determine whether they need to be referred for additional evaluation or care.

The questionnaire, filled in by the parent or caregiver through the intermediary of a non-specialist (not a psychologist or psychiatrist) interviewer, is designed to uncover empirical observable information through hetero-assessment (hetero-assessment tools are based on the principle of observation by a third person (caregiver, family) of behavioral manifestations that are indicators). It is a tool for screening and orientation, and not a diagnostic tool.

Building on the methods used for the PSYCa 3 -6; MSF and Epicentre developed and cross-culturally validated a generalist tool to screen for psychological difficulties in younger children aged 6 to 36 months, the PSYCa 6-36.

Both the scale and the user guide are available here for public use.

Read publications to learn more about the validation of both scales

A screening tool for psychological difficulties in children aged 6 to 36 months: cross-cultural validation in Kenya, Cambodia and Uganda.

Journal Reference: BMC pediatrics 2019 Apr 12; 19(1); 108. doi: 10.1186/s12887-019-1461-3. Epub 2019 04 12

Screening for psychological difficulties in young children in crisis: complementary cross-cultural validation.

Journal Reference: International health 2015 Nov ; 7(6); 438-46. doi: 10.1093/inthealth/ihv006. Epub 2015 03 04

A rapid screening tool for psychological distress in children 3-6years old: results of a validation study.

Journal Reference: BMC psychiatry 2012 Oct 16; 12(); 170. doi: 10.1186/1471-244X-12-170. Epub 2012 10 16
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