Multi-informant universal mental health screening for preschool-aged children by parents and educators: a PRISMA systematic review

Children develop rapidly in the preschool period, making accurate appraisals of mental health (MH) difficult. The preschool years are a key period for early identification of MH concerns and could benefit from multi-informant, universal MH screening (UMHS). This systematic review aimed to identify multi-informant UMHS measures for preschool-aged children, and to examine their clinical utility, effectiveness, and acceptability. Studies reporting the predictive and incremental validity, effectiveness or acceptability of parent and educator-report UMHS measures for children aged 3–5 years were identified through CINAHL, Embase, ERIC, Medline, PsycINFO, Scopus and Web of Science. Studies were excluded if screening was not the primary focus, not universal, single informant, or primarily focussed on Autism Spectrum Disorder. A total of 11 studies using 10 measures was identified. Ten studies screened for broad MH difficulties. Three educator-report and one parent- and educator-report measures had acceptable predictive validity. One study reporting incremental validity found that adding educator-report to parent ratings significantly improved the identification of MH concerns. No studies reported on effectiveness. Three studies that explored acceptability reported strong support for either UMHS in general or specific measures. There are promising results that UMHS can accurately identify child MH concerns in the preschool period using parent and educator reports. However, with few of the examined measures reaching the benchmark standards for predictive validity and only one study examining incremental validity, further research is needed to establish clinical utility. UMHS with preschool populations appears to be acceptable; future studies should further examine multi-informant screening in preschool populations. This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; https://www.crd.york.ac.uk/prospero; registration number: CRD 42022383426).