Collaboration in the assessment and diagnosis of preschoolers: Challenges and opportunities

The preschool assessment and diagnostic process offers many opportunities for collaboration across disciplines that can enrich the professional’s understanding of the young child. This article addresses the advantages and complexities of such collaboration including opportunities for infusing collaboration across the multiple steps of assessment. Challenges commonly seen in a collaborative process, involving issues of time, decisions regarding diagnosis and recommended interventions, shared responsibilities, conflict across disciplines, and the need for administrative support, are explored. Special issues around creating meaningful partnerships with families are examined with attention to fully including families at whatever level they are comfortable. Finally, trends in consultation and collaboration that require the specialized expertise of preschool psychologists are described, along with promising models of training that incorporate collaboration, consultation, and policy work into the pre-service experience. C 2011 Wiley Periodicals, Inc. Three-year-old Anna was referred to the school psychologist shortly after the school year began. Her preschool teacher is concerned about Anna’s inability to attend group activities and her flat affect, limited eye contact, hypersensitivity to touch by others (and extreme response when a classmate accidentally brushes into her), long periods of staring into space, limited expressive language, and lack of interest in engagement with peers and most classroom activities. This is Anna’s first year at this school because her family moved to the community the month before school began. It is often unclear how comprehensive or far reaching an assessment process will need to be when a preschool child is first referred for assessment. Clearly, cognitive assessment, social– emotional assessment, assessment of motor and adaptive skills, evaluation of speech and language, and information related to medical history, family background, risk, and demographics are important components of any thorough assessment process. But where do we place a priority focus, and are there disciplines that should be involved in every assessment or should some professionals only be relied on to answer specific types of questions raised by the assessment and diagnostic process? In looking briefly at the referral information about Anna, individual professionals may begin to hypothesize about a variety of possible reasons for Anna’s behaviors: Is she exhibiting signs of autism? Does she have developmental delays that are restricting her responses and interactions? Could she have a seizure disorder that is undiagnosed? Does she have some type of regulatory disorder? Has she experienced trauma? Is she depressed? Is she displaying signs of grieving? The emphasis placed on any given area may change somewhat when we begin to gather more information. If we learn that Anna’s mother died suddenly in July, our assessment process may change direction, with the significance of gathering extensive information related to background and family factors becoming clear. If we learn that Anna was in an automobile accident in August and suffered a head injury, our process may take a different direction, and our hypotheses about what may be going on may involve questions about possible seizures due to brain injury that will require collaboration with the medical professionals involved in her care. If we learn that Anna is in foster care and has just been placed in her fourth foster home in 2 years, the type of information and professional collaborators required changes yet again. When working with preschool-aged children, collaboration across disciplines and appropriate communication among disciplines is of great value. Many children enter the assessment and