The development of social competence during the early years is dependent on acquiring emotional, behavioral, and attentional self-regulation within the context of secure and nurturing relationships. However, determining what is developmentally normative behavior is not always easy.

The persistence, intensity, and pervasiveness of problematic behavior, as well as the degree to which it interferes with other developmental tasks, are critical considerations in discriminating children who will grow out of emotional and behavioral difficulties from those whose behavior warrants intervention.

In infants and toddlers, disruptions of healthy social and emotional development are most often manifested as difficulties in establishing wake and sleep rhythms and feeding routines, attachment difficulties, and excessive crying and resistance to soothing. These processes are embedded in relationships and interactions between the child and caregivers, and disruptions may be a function of child factors, such as temperament, or caregiver factors that affect the ability to provide responsive nurturing care.

In preschool age children, extremes of withdrawal and shyness, and of acting-out behaviors such as physical and verbal aggression, destruction, self-injury, and noncompliance, are indicators of problematic development (Smith & Fox, 2003).

Numerous studies have investigated the prevalence of social, emotional, and behavioral problems in young children. Though results vary depending on the methods, instruments, and populations used, studies of children aged 2–5 years within pediatric and preschool settings have found the rates of psychosocial problems to be between 9% and 23%.These

SERVICES FOR YOUNG CHILDREN 17 findings validate the anecdotal reports of preschool teachers and childcare providers that increasing numbers of the young children display behavior problems of increasing severity (Yoshikawa & Knitzer, 1997). For many young children, psychosocial problems are not transient, but rather persist over time. Approximately 50% of the children identified with problems as preschoolers continue to have problems into the school years (Campbell, 1995) and children whose disruptive behavior begins early are most likely to exhibit serious and intransigent antisocial problems in adolescence and adulthood (Campbell, Shaw, & Gilliom, 2000). However, despite such high prevalence and persistence rates, data for 1998 indicate that only 1–2% of preschoolers used any mental health specialty services during the year (Sturm et al., 2000).

Many circumstances in the lives of young children have been associated with psychosocial problems and poor outcomes, notably persistent poverty and chronic family adversity. These conditions act through direct effects on children and through contributions to family stress, and researchers have only recently begun to develop models that sort out relationships and interactions among these and other variables (Sameroff & Fiese, 2000). However, attention has increasingly turned to identifying those risk factors that are potent, causal, and amenable to change and thus should be the targets of intervention. These appear to be predominantly relationship-based factors, such as problematic parenting, parental mental health problems, poor bonding with parents, difficulties with teachers, and poor peer relationships (Huffman, Mehlinger, & Kerivan, 2000).