The mental health needs of young children in humanitarian contexts often remain unaddressed
]. During the acute phase of a humanitarian emergency, and in humanitarian contexts in general, psychological care of children may come far down on the list of priorities. The limited number of both local and international medical professionals combined with the relative lack of mental health professionals in these settings also hinders the implementation of mental health activities
]. Further, even when mental health professionals are present, they are rarely specialists in young children. Psychological distress in young children is particularly difficult to evaluate by non-specialists, requiring knowledge of normal child development, as many behaviors are normal at certain ages but not at others. Young children, between 3 and 6 years old, are in a vulnerable psychological period, which can have consequences on the quality of their emotional, cognitive, and physical capacities
]. Although 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
]. The training and infrastructure needs in children’s mental health remain the ultimate goal, but in their absence, tools that help identify children who require further assessment would help to rationalize scare resources and orient children to care in humanitarian contexts.
The lack of cross-culturally valid instruments, and data about child psychological difficulties, is a public health concern in humanitarian contexts
]. Although scales exist for general psychological difficulties, none of them concern children aged 3 to 6 years in humanitarian contexts
]. Further, before use, screening tools should be cross-culturally validated for specific contexts
]. Difficulties with mental health assessment include lack of consistent assessment tools for measuring psychological distress, lack of cross-cultural validation research and variation in methods for validity testing and differences in methods of translation
]. Typically, examining mental health cross-culturally involves simply transposing Western assessment tools with no examination of their validity
]. As result, children remain unscreened or evaluated using a scale not designed for either the specificities of childhood psychological distress or the context. The lack of a validated, rapid and simple tool for screening, combined with few mental health professionals able to accurately diagnose and provide appropriate treatment, mean that young children may remain without appropriate care.
In addition, interest in humanitarian settings has focused primarily on trauma rather than other disorders or psychological difficulties
], adding also that most of such studies were implemented in conflict affected settings. This focus is based on the assumption that exposure to violence frequently entails post-traumatic symptoms
]. This premise has been criticized recently, as well as the use of only a post-traumatic scale for screening
]. Research addressing the cross-cultural validity of Western diagnostic classification of psychological difficulties in such contexts remains essential to ensure appropriate care is provided
]. Recent research has shown the importance of tools able to detect and orient children in need, but has focused on children older than 6 years with an emphasis on post-traumatic stress disorder
]. In addition to PTSD, recent studies have also shown the importance of addressing depression and anxiety disorders
Our aim was to begin to respond to one of the gaps in addressing the mental health needs of young children in humanitarian contexts. Although there are many valid models of screening, evaluation and care, the need for a simple, rapid screening scale administered by non-specialists would fill one of the many gaps in responding to the mental health needs of young children in humanitarian contexts. We report the results of a study to cross-culturally adapt and assess the reliability, validity and psychometric properties of the Psychological Screening for Young Children aged 3 to 6 (PSYCa 3–6) following cross-cultural validation. Although the PSYCa 3–6 had been validated in several populations
], it had never undergone but had never undergone a rigorous cross-cultural validation process.
The entire validation process for the PSYCa 3-6-22 includes three steps, one called principal, including a large sample, and two called secondary, implemented to strengthen the results. The principle validation will be presented here. The overall process including the three steps will be the purpose of another publication. Selection of study sites were based on the political context and the population of children expected to be exposed to conflict to facilitate the evaluation of the post-traumatic component of the screening scale.