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Can a Valid Diagnosis of Disruptive Behavior Disorder Be Made in Preschool Children?

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.

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				J. L. Friedman-Weieneth, G. L. Doctoroff, E. A. Harvey, and L. H. Goldstein The Disruptive Behavior Rating Scale--Parent Version (DBRS-PV): Factor Analytic Structure and Validity Among Young Preschool Children J Atten Disord, July 1, 2009; 13(1): 42 - 55. [Abstract] [PDF]

				J. Pelletier, B. Collett, G. Gimpel, and S. Crowley Assessment of Disruptive Behaviors in Preschoolers: Psychometric Properties of the Disruptive Behavior Disorders Rating Scale and School Situations Questionnaire Journal of Psychoeducational Assessment, March 1, 2006; 24(1): 3 - 18. [Abstract] [PDF]

				J. Kim-Cohen, L. Arseneault, A. Caspi, M. P. Tomas, A. Taylor, and T. E. Moffitt Validity of DSM-IV Conduct Disorder in 41/2-5-Year-Old Children: A Longitudinal Epidemiological Study Am J Psychiatry, June 1, 2005; 162(6): 1108 - 1117. [Abstract] [Full Text] [PDF]

				K. Keenan and L. S. Wakschlag Are Oppositional Defiant and Conduct Disorder Symptoms Normative Behaviors in Preschoolers? A Comparison of Referred and Nonreferred Children Am J Psychiatry, February 1, 2004; 161(2): 356 - 358. [Abstract] [Full Text] [PDF]

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