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In young children, impairment in basic social interactions and the slowed development of self-care behaviors are thought to predict psychopathology and consequent mental health service use. Specifically, a parent may be more likely to identify externalizing disorder symptoms, while a child may report the same behavior as an internalizing depression symptom. To facilitate reports of behavior among very young children, pictures, or cartoons, have been used. The pictorial format has been found to focus the attention of children and to stimulate their interest. Puppets have been used since the 1950s in studies of young children to equalize the expressive abilities of verbal and nonverbal children, as well as inhibited and noninhibited children. Studies have shown that two puppets using a standardized script can enable even the youngest cohort of children to express their feelings and behaviors.
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