DSM-IV Can Identify Preschoolers Whose Disruptive Behavior Is Atypical

Two- to 5-year-old children aren’t exactly known to be paragons of virtue. Temper tantrums, sassing, balking, kicking, and other socially unacceptable behaviors are sometimes the rule. Thus, psychiatrists have been debating whether, when it comes to very young children, DSM-IV criteria for oppositional defiant disorder and conduct disorder can be used to pick out children who are truly disturbed from children who are misbehaving.

The debate appears to be over, a preliminary study reported in the February American Journal of Psychiatry suggests. The study was conducted by Kate Keenan, Ph.D., and Lauren Wakschlag, Ph.D., assistant professors of psychiatry at the University of Chicago.

Their subjects were 79 preschoolers referred to a psychiatry clinic for behavior problems and 50 preschoolers who had not been so referred. The subjects in both groups were similar in age, gender, race, and socioeconomic status.

The researchers assessed the number of symptoms of DSM-IV oppositional defiant disorder and of DSM-IV conduct disorder in each subject and compared the rates of symptoms for subjects in the referred group with the rates of symptoms for subjects in the nonreferred group.

Only one (2 percent) of the nonreferred subjects met criteria for oppositional defiant disorder, compared with 47 (60 percent) of the referred subjects, the researchers found. Only one (2 percent) of the nonreferred children met criteria for conduct disorder, compared with 33 (42 percent) of referred children.

“Our results [thus] provide preliminary evidence for the discriminative validity of DSM-IV oppositional defiant and conduct disorder symptoms in preschool children,” Keenan and Wakschlag concluded. In other words: “The DSM-IV nosology appears to be a valid diagnostic system for discriminating between typical and atypical disruptive behaviors in preschool children.”

The study report, “Are Oppositional Defiant and Conduct Disorder Symptoms Normative Behaviors in Preschoolers? A Comparison of Referred and Nonreferred Children,” is posted online at http://ajp.psychiatryonline.org/cgi/content/full/161/2/356?. ▪

Am J Psychiatry 2004 161 356