Diagnoses and presenting symptoms in an infant psychiatry clinic: comparison of two diagnostic systems

To present data from a general infant psychiatry clinic, including range and frequency of presenting symptoms, relationship between symptoms and diagnoses, and comparison of two diagnostic systems, DSM-IV and Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3).

A retrospective chart review was conducted for 177 children, ages birth to 58 months, who were seen between 1982 and 1997. Presenting symptoms were identified. Subjects were given diagnoses using both DSM-IV and DC: 0-3. Presenting symptom variables were reduced using subjective and empirical determinants. Stepwise regression analyses were used to determine whether presenting symptoms and demographic variables predicted diagnoses.

Descriptive statistics on the distribution of current presenting symptoms and assigned diagnosis were compared with previous studies. The study demonstrated interrater reliability for diagnoses using both diagnostic systems, evidence of diagnostic validity via the regression analyses, and good concordance where DSM-IV and DC: 0-3 overlap. DSM-IV disruptive behavior disorders may be better conceptualized in DC: 0-3 as regulatory disorders, leading to alternative conceptualization of the disorder and a different course of treatment.

This study clarifies a developmental progression of presenting symptoms and diagnoses and suggests the need for continued diagnostic re-evaluation in early childhood. Greater attention to relationship factors and consideration of trauma factors is encouraged.