Preschool children with ODD, CD and ADHD. Psychiatric assessment and stability of diagnosis

Abstract

It has been questioned how to differentiate clinical from normative transient disruptive behaviors within the preschool age as most preschoolers exhibit at least some of the behaviors that fall under the rubric of disruptive behavior, for example losing temper and physical aggression. This point of concern is relevant for diagnosing preschool children with Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) (ODD and CD also called Disruptive Behavior Disorder; DBD) or Attention Deficit Hyperactivity Disorder (ADHD). In this dissertation, 193 preschool children with externalizing behavioral problems referred to an outpatient clinic for child and adolescent psychiatry were included as well as 58 typically developing children. It was shown that the Kiddie Disruptive Behavior Disorder Schedule (K-DBDS), a semi-structured parent interview, is clinically useful in diagnosing ODD, CD and ADHD. In addition, the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a standardized observational assessment of the preschool child, can be used to help support a presumption of a DBD and/or ADHD diagnosis; to diagnose the latter disorder, the newly developed ADHD part was added. These preschool children were re-assessed after 9 and 18 months. It appeared that diagnostic reassessments are needed in order to distinguish children who were keeping the diagnosis of ODD, CD and ADHD and those who did not. There were also preschool children who did not receive a diagnosis at the first assessment but developed a disorder over time. Thus, the present study is bringing to clinicians’ attention that in the clinical evaluation of children referred for externalizing behavior it is important to monitor these children. The dissertation also examined which individual and family factors predicted stability of diagnosis within an 18 months period. It was shown that poor inhibition performance plays a role in the stability of diagnosis. The occurrence of DBD or ADHD Hyperactive/Impulsive symptoms at daycare or school and parental stress also were predictors of DBD and ADHD Hyperactive Impulsive type stability. This study thus suggests that the clinical evaluation of preschool children referred with behavior problems should include a neuropsychological assessment of inhibition, an assessment of symptoms in other settings than at home, and an assessment of parental stress.