Abstract
The primary goals of this study are to describe the nature and severity of disruptive behavior problems in clinic-referred preschoolers from low-income environments and to explore the validity of DSM-IV disruptive disorders for young children. We examine the relation between DSM-IV symptoms, standardized behavior checklists, and observational ratings as a means of exploring measurement validity in this age group. Seventy-nine clinic-referred preschoolers (ages 2\(\frac{1}{2}\) through 5\(\frac{1}{2}\) years) from low-income environments were assessed. To examine whether clinic-referred preschool children have symptoms that are consistent with DSM-IV disruptive behavior disorders, parents were administered a semistructured diagnostic interview, modified for developmentally appropriate usage. In addition, parents completed the Child Behavior Checklist (CBCL) and children's behavior problems were assessed with observational ratings during parent–child interaction. Nearly half of the sample met criteria for conduct disorder, and three quarters met criteria for oppositional defiant disorder. Preliminary evidence for the validity of DSM-IV disruptive disorders in preschool children was demonstrated through association with CBCL scores, behavior ratings, and significant levels of impairment. Future efforts aimed at validating these diagnoses in preschoolers and implications for prevention are discussed.
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REFERENCES
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont Department of Psychiatry.
Achenbach, T. M. (1992). Manual for the Child Behavior Checklist/2-3 and 1992 Profile. Burlington: University of Vermont Department of Psychiatry.
Achenbach, T. M. (1997). What is normal? What is abnormal? Developmental perspectives on emotional and behavioral problems. In S. Luthar, J. Burack, D. Cichetti., & J. Weisz (Eds.), Developmental psychopathology: Perspectives on adjustment, risk and disorder (pp. 93-114). New York: Cambridge University Press.
Adams, C. D., Hillman, N., & Gaydos, G. R. (1994). Behavioral difficulties in toddlers: Impact of sociocultural and biological risk factors. Journal of Clinical Child Psychology, 23, 373-381.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Arend, R., Lavigne, J. V., Rosenbaum, D., Binns, H. J., & Christoffel, K. K. (1996). Relations between taxonomic and quantitative diagnostic systems in preschool children: Emphasis on disruptive disorders. Journal of Clinical Child Psychology, 25, 388-397.
Boggs, S. R., Eyberg, S., & Reynolds, L. A. (1990). Concurrent validity of the Eyberg Child Behavior Inventory. Journal of Clinical Child Psychology, 19, 75-78.
Campbell, S. B. (1995). Behavior problems in preschool children: A review of recent research. Journal of Child Psychology and Psychiatry, 36, 113-149.
Campbell, S. B., & Ewing, L. J. (1990). Follow-up of hard-to-manage preschoolers: Adjustment at age 9 and predictors of continuing symptoms. Journal of Child Psychology and Psychiatry, 31, 871-889.
Crockenberg, S., & Litman, C. (1990). Autonomy as competence in 2-year-olds: Maternal correlates of child defiance, compliance and self-assertion. Developmental Psychology, 26, 961-971.
Crowell, J., & Fleischmann, M. (1993). Use of structured research assessments in clinical assessments of infants. In C. Zeanah (Ed.), Handbook of infant mental health (pp. 210-222). New York: Guilford Press.
Dumas, J. E., & Wahler, R. G. (1983). Predictors of treatment outcome in parent training: Mother insularity and socioeconomic disadvantage. Behavior Assessment, 5, 301-313.
Elliot, C. (1983). Differential Abilities Scales: Introductory and technical handbook. New York: Psychological Corporation.
Eyberg, S., & Boggs, S. R. (1989). Parent training for oppositional-defiant preschoolers. In C. E. Schaefer & J. M. Briesmeister (Eds.), Handbook of parent training: Parents as Co-therapists for children's behavior problems (pp. 105-132). New York: Wiley.
Eyberg, S. M., Schuhmann, E. M., & Rey, J. (1998). Child and adolescent psychotherapy research: Developmental issues. Journal of Abnormal Child Psychology, 26, 71-82.
Fagot, B. I., & Leve, L. D. (1998). Teacher ratings of externalizing behavior at school entry for boys and girls: Similar early predictors and different correlates. Journal of Child Psychology and Psychiatry, 39, 555-556.
Hinshaw, S. P., Han, S. S., Erhardt, D., & Huber, A. (1992). Internalizing and externalizing behavior problems in preschool children: Correspondence among parent and teacher ratings and behavior observations. Journal of Clinical Child Psychology, 21, 143-150.
Jensen, P., Salzberg, A., Richters, J., & Watanabe, H. (1993). Scales, diagnoses, and child psychopathology: I. CBCL and DISC relationships. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 397-406.
Kazdin, A. E., & Wassell, G. (1999). Barriers to treatment participation and therapeutic change among children referred for conduct disorder. Journal of Clinical Child Psychology, 28, 160-172.
Keenan, K., Shaw, D., Delliquadri, E., Giovannelli, J., & Walsh, B. (1999). Evidence for the continuity of early problem behaviors: Application of a developmental model. Journal of Abnormal Child Psychology, 26, 443-454.
Keenan, D., Shaw, D., Walsh, B., Delliquadri, E., & Giovannelli, J. (1997). DSM-III-R disorders in preschool children from lowincome families. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 620-627.
Kochanska, G. (1997). Multiple pathways to conscience for children with different temperaments: From toddlerhood to age 5. Developmental Psychology, 33, 228-240.
Lahey, B. B., Loeber, R., Quay, H. C., Frick, P. J., & Grimm, J. (1992). Oppositional defiant and conduct disorders: Issues to be resolved for DSM-IV. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 539-546.
Lavigne, J., Arend, R., Rosenbaum, D., Binns, H., Christoffel, K., & Gibbons, R. (1998). Psychiatric disorders with onset in the preschool years: I. Stability of diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1246-1254.
Lavigne, J. V., Gibbons, R. D., Christoffel, K. K., Arend, R., Rosenbaum, D., Binns, H., Dawson, N., Sobel, H., & Isaacs, C. (1996). Prevalence rates and correlates of psychiatric disorders among preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 204-214.
Luby, J., & Morgan, K. (1997). Characteristics of an infant/preschool psychiatric clinic sample: Implications for clinical assessment and nosology. Infant Mental Health Journal, 18, 209-220.
Matas, L., Arend, R., & Sroufe, L. A. (1978). Continuity of adaptation in the second year: The relationship between quality of attachment and later competence. Child Development, 49, 547-556.
McLoyd, V. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53, 185-204.
NICHD Early Child Care Research Network (1998). Early child care and self-control, compliance and problem behavior at twenty-four and thirty-six months. Child Development, 69, 1145-1170.
Orvaschel, H., & Puig-Antich, J. (1995). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic 5th Version. Ft. Lauderdale, FL: Nova University.
Pierce, E., Ewing, L., & Campbell, S. (1999). Diagnostic status and symptomatic behavior of hard-to-manage preschool children in middle childhood and early adolescence. Journal of Clinical Child Psychology, 28, 44-57.
Reznick, J. S., Corley, R., & Robinson, J. (1997). A longitudinal twin study of intelligence in the second year. Monographs for the Society for Research in Child Development, 62 (Serial No. 249).
Ross, C., Blanc, H., McNeil, C., Eyberg, S., & Hembree-Kigin, T. (1998). Parenting stress in mothers of young children with oppositional defiant disorder and other severe behavior problems. Child Study Journal, 28, 93-110.
Schuhmann, E., Foote, R., Eyberg, S., Boggs, S., & Algina, J. (1998). Efficacy of parent-child interaction therapy: Interim report of a randomized trial with short-term maintenance. Journal of Clinical Child Psychology, 27, 34-45.
Setterberg, S., Bird, H., Gould, M., Shaffer, D., & Fisher, P. (1992). Parent and interviewer versions of the Children's Global Assessment Scale. New York: Columbia University.
Speltz, M. L., DeKlyen, M., Greenberg, M. T., & Dryden, M. (1995). Clinic referral for oppositional defiant disorder: Relative significance of attachment and behavioral variables. Journal of Abnormal Child Psychology, 23, 487-507.
Speltz, M., Greenberg, M., & DeKlyen, M. (1990). Attachment in preschoolers with disruptive behavior: A comparison of clinic-referred and nonproblem children. Development and Psychopathology, 2, 31-46.
Wakschlag, L., Chase-Landsdale, P. L., & Brooks-Gunn, J. (1996). Not just “Ghosts in the Nursery”: Contemporaneous intergenerational relationships and parenting in young African-American families. Child Development, 67, 2132-2147.
Webster-Stratton, C. (1996). Early-onset conduct problems: Does gender make a difference? Journal of Consulting and Clinical Psychology, 64, 540-551.
Webster-Stratton, C. (1997). Early intervention for families of preschool children with conduct problems. In M. Guralnick (Ed.), The effectiveness of early intervention (pp. 429-454). Baltimore: Brookes.
Webster-Stratton, C., & Lindsay, D. (1999). Social competence and conduct problems in young children: Issues in assessment. Journal of Clinical Child Psychology, 28, 25-43.
Zeanah, C., Boris, N., & Scheeringa, M. (1997). Psychopathology in infancy. Journal of Child Psychology and Psychiatry, 138, 81-99.
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Keenan, K., Wakschlag, L.S. More than the Terrible Twos: The Nature and Severity of Behavior Problems in Clinic-Referred Preschool Children. J Abnorm Child Psychol 28, 33–46 (2000). https://doi.org/10.1023/A:1005118000977
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DOI: https://doi.org/10.1023/A:1005118000977