Related Experiment Videos
Can a valid diagnosis of disruptive behavior disorder be made in preschool children?
Kate Keenan1, Lauren S Wakschlag
1Department of Psychiatry, University of Chicago, IL 60637, USA. kkeenan@yoda.bsd.uchicago.edu
Insights
Disruptive behavior in preschoolers can be identified using the Diagnostic and Statistical Manual of Mental Disorders (DSM) framework with developmental modifications. Further research is needed to refine assessment tools for this age group.
Area of Science:
- Child Psychology
- Developmental Psychiatry
- Clinical Child Psychology
Background:
- Disruptive behavior problems are a leading cause for preschool mental health referrals.
- Lack of consensus exists on conceptualizing and measuring these behaviors in young children.
- The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is widely used, but its validation primarily involved older children.
Purpose of the Study:
- To compare approaches to conceptualizing disruptive behavior in preschoolers.
- To review the construct validity of DSM-based oppositional defiant disorder and conduct disorder in this age group.
- To propose future research directions for assessment.
Main Methods:
- Comparative analysis of conceptualization approaches.
- Evidence review for DSM-based disorder validity in preschoolers.
- Outline of a future research agenda.
Main Results:
- Typical and atypical behavior problems are distinguishable in preschoolers.
- The DSM framework, adapted for developmental level, shows validity for identifying impairing disruptive behaviors.
- Empirical work is required for tool standardization and improved observational data use.
Conclusions:
- The DSM framework, with developmental adjustments, is a viable method for identifying disruptive behavior disorders in preschoolers.
- Standardizing assessment tools and enhancing observational methods are crucial next steps.
- Further research is essential for valid and sensitive assessment of preschool disruptive behaviors.
Objective:
Disruptive behavior problems are the most common reason preschool children come to mental health clinics. Yet consensus on the conceptualization and measurement of such problems in young children is lacking. DSM-IV is the most widely used nosologic system for children, but the majority of the validation sample consisted of school-age children and adolescents. It is debatable whether behavioral problems in young children should be considered within a diagnostic framework at all, since normative behavioral disruption occurs during the preschool period. Developing valid methods for assessing child behavior problems across development is critical for etiologic and prevention research.
Method:
The authors compare different approaches to conceptualizing disruptive behavior in young children, review evidence for the construct validity of DSM-based oppositional defiant disorder and conduct disorder in preschool children, and outline an agenda for future research.
Results And Conclusions:
Typical and atypical behavior problems can be differentiated in preschool children, and the DSM framework, with some modification to address the child's developmental level, appears to be a valid method for identifying preschool children with disruptive behavior that is impairing. Empirical investigation is needed to standardize modification of existing assessment tools so that they can be used with preschool children and to develop more clinically sensitive methods for using observational data in assessment and for establishing the child's level of development.