Skip to main content
SpringerLink
Log in

Five Systems of Psychiatric Classification for Preschool Children: Do Differences in Validity, Usefulness and Reliability Make for Competitive or Complimentary Constellations?

  • Original Article
  • Published:
Child Psychiatry and Human Development Aims and scope Submit manuscript

Abstract

DSM-IV and ICD-10 have limitations in the diagnostic classification of psychiatric disorders at preschool age (0–5 years). The publication of the Diagnostic Classification 0-3 (DC:0-3) in 1994, its basically revised second edition (DC:0-3R) in 2005 and the Research Diagnostic Criteria––Preschool Age (RDC-PA) in 2004 have provided several modifications of these manuals. Taking into account the growing empirical evidence highlighting the need for a diagnostic classification system for psychiatric disorders in preschool children, the main categorical classification systems in preschool psychiatry will be presented and discussed. The paper will focus on issues of validity, usefulness and reliability in DSM-IV, ICD-10, RDC-PA, DC:0-3, and DC:0-3R. The reasons for including or excluding postulated psychiatric disorder categories for preschool children with variable degrees of empirical evidence into the different diagnostic systems will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Osofsky J, Fitzgerald H (eds) (2000) WAIMH handbook of infant mental health. Wiley, New York

    Google Scholar 

  2. Zeanah CH (2000) Handbook of infant mental health, 2nd edn. Guilford, New York

    Google Scholar 

  3. Egger HL, Angold A (2006) Common emotional and behavioural disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiatry 47:313–337. doi:10.1111/j.1469-7610.2006.01618.x

    Article  PubMed  Google Scholar 

  4. Skovgaard AM, Houmann T, Christiansen E, Landorph S, Jorgensen T, Olsen EM et al (2007) The prevalence of mental health problems in children 1 ½ years of age––the Copenhagen Child Cohort 2000. J Child Psychol Psychiatry 48:62–70. doi:10.1111/j.1469-7610.2006.01659.x

    Article  PubMed  Google Scholar 

  5. Campbell SB, Ewing LJ (1990) Follow-up of hard-to-manage preschoolers: adjustment at age 9 and predictors of continuing symptoms. J Child Psychol Psychiatry 31:871–889. doi:10.1111/j.1469-7610.1990.tb00831.x

    Article  PubMed  Google Scholar 

  6. Caspi A, Moffitt TE, Newman DL, Silva PA (1996) Behavioral observations at age 3 predict adult psychiatric disorders: longitudinal evidence from a birth cohort. Arch Gen Psychiatry 53:1033–1039

    PubMed  Google Scholar 

  7. Fischer M, Rolf JE, Hasazi JE, Cummings L (1984) Follow-up of a preschool epidemiological sample: cross-age continuities and predictions of later adjustment with internalizing and externalizing dimensions of behaviour. Child Dev 55:137–150. doi:10.2307/1129840

    Article  PubMed  Google Scholar 

  8. Ialongo N, Edelsohn G, Werthamer-Larsson L, Crockett L, Kellam S (1995) The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade. J Child Psychol Psychiatry 36:427–437. doi:10.1111/j.1469-7610.1995.tb01300.x

    Article  PubMed  Google Scholar 

  9. Keenan K, Wakschlag LS (2000) More than the terrible twos: the nature and severity of behavior problems in clinic-referred preschool children. J Abnorm Child Psychol 28:33–46. doi:10.1023/A:1005118000977

    Article  PubMed  Google Scholar 

  10. Kellam S, Ling X, Merisca R, Brown C, Lalongo N (1998) The effect of the level of aggression in the first grade classroom on the course and malleability of aggressive behavior into middle school. Dev Psychopathol 10:165–185. doi:10.1017/S0954579498001564

    Article  PubMed  Google Scholar 

  11. Lavigne JV, Arend R, Rosenbaum D, Binns HJ, Christoffel KK, Gibbons RD (1998) Psychiatric disorders with onset in the preschool years. I: stability of diagnoses. J Am Acad Child Adolesc Psychiatry 37:1246–1254

    Article  PubMed  Google Scholar 

  12. McGee R, Partridge F, Williams S, Silva PA (1991) A twelve-year follow-up of preschool hyperactive children. J Am Acad Child Adolesc Psychiatry 30:224–232. doi:10.1097/00004583-199103000-00010

    Article  PubMed  Google Scholar 

  13. Olson SL, Bates JE, Sandy JM, Lanthier R (2000) Early development precursors of externalizing behavior in middle childhood and adolescence. J Abnorm Child Psychol 28:119–133. doi:10.1023/A:1005166629744

    Article  PubMed  Google Scholar 

  14. Briggs-Gowan MJ, Carter AS, Bosson-Heenan J, Guyer AE, Horwitz SM (2006) Are infant-toddler social-emotional and behavioral problems transient? J Am Acad Child Adolesc Psychiatry 45:849–858. doi:10.1097/01.chi.0000220849.48650.59

    Article  PubMed  Google Scholar 

  15. Carter AS, Briggs-Gowan MJ, Davis NO (2004) Assessment of young children’s social-emotional development and psychopathology: recent advances and recommendations for practice. J Child Psychol Psychiatry 45:109–134. doi:10.1046/j.0021-9630.2003.00316.x

    Article  PubMed  Google Scholar 

  16. Research Diagnostic Criteria––Preschool Age (RDC-PA) (2002) www.infantinstitute.org/RDC-PA.htm

  17. Zero to Three (1994) Diagnostic classification of mental health and developmental disorders of infancy and early childhood. Zero to Three Press, Washington

    Google Scholar 

  18. Zero to Three (2005) DC:0-3R. Diagnostic classification of mental health and developmental disorders of infancy and early childhood: revised edition. Zero to Three Press, Washington

    Google Scholar 

  19. Wiefel A, Titze K, Kuntze L, Winter M, Seither C, Witte B et al (2007) [German] Diagnostic classification of mental disorders in infants and toddlers age 0 to 5. Prax Kinderpsychol Kinderpsychiatr 56:59–81

    PubMed  Google Scholar 

  20. Luby JL, Belden A, Sullivan J, Spitznagel E (2007) Preschoolers contribution to their diagnosis of depression and anxiety: uses and limitations of young child self-report of symptoms. Child Psychiatry Hum Dev 38:321–338. doi:10.1007/s10578-007-0063-8

    Article  PubMed  Google Scholar 

  21. Emde RN, Wise BK (2003) The cup is half full: initial clinical trials of DC:0-3 and a recommendation for revision. Infant Ment Health J 24:437–446. doi:10.1002/imhj.10067

    Article  Google Scholar 

  22. Emde RN, Egger H, Fenichel E, Guedeney A, Wise BK, Wright HH (2005) Introducing DC:0-3R. Zero to Three Sept 2005:35–41

    Google Scholar 

  23. Papoušek M, von Hofacker N (1998) Persistent crying in early infancy: a non-trivial condition of risk fort he developing mother-infant relationship. Child Care Health Dev 24:395–424. doi:10.1046/j.1365-2214.2002.00091.x

    Article  PubMed  Google Scholar 

  24. Wakschlag LS, Keenan K (2001) Clinical significance and correlates of disruptive behavior in environmentally at-risk preschoolers. J Clin Child Psychol 30:262–275. doi:10.1207/S15374424JCCP3002_13

    Article  PubMed  Google Scholar 

  25. Shaw DS, Owens EB, Giovannelli J, Winslow EB (2001) Infant and toddler pathways leading to early externalizing disorders. J Am Acad Child Adolesc Psychiatry 40:44–51. doi:10.1097/00004583-200101000-00014

    Article  Google Scholar 

  26. Rutter M (2006) Genes and behaviour: nature-nurture interplay explained. Blackwell, London

  27. Schore AN (2003) Affect dysregulation and disorders of the self. Norton, New York

    Google Scholar 

  28. Schore AN (2003) Affect regulation and the repair of the self. Norton, New York

    Google Scholar 

  29. van der Valk JC, van den Oord EJ, Verhulst FC, Boomsma DI (2003) Genetic and environmental contributions to stability and change in children’s internalizing and externalizing problems. J Am Acad Child Adolesc Psychiatry 42:1212–1220. doi:10.1097/00004583-200310000-00012

    Article  PubMed  Google Scholar 

  30. DelCarmen-Wiggins R, Carter A (eds) (2004) Handbook of infant, toddler, and preschool mental health assessment. Oxford University Press, Oxford

  31. Sadler JZ (2005) Values and psychiatric diagnosis. Oxford University Press, Oxford

    Google Scholar 

  32. Fulford KWM, Thornton T, Graham G (2006) Oxford textbook of philosophy and psychiatry. Oxford University Press, Oxford

    Google Scholar 

  33. Lahey BB, Pelham WE, Stein MA, Loney J, Trapani C, Nugent K et al (1998) Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children. J Am Acad Child Adolesc Psychiatry 37:695–702

    PubMed  Google Scholar 

  34. Lahey BB, Pelham WE, Chronis A, Massetti G, Kipp H, Ehrhardt A et al (2006) Predictive validity of ICD-10 hyperkinetic disorder relative to DSM-IV attention-deficit/hyperactivity disorder among younger children. J Child Psychol Psychiatry 47:472–479. doi:10.1111/j.1469-7610.2005.01590.x

    Article  PubMed  Google Scholar 

  35. Luby JL, Heffelfinger AK, Mrakotsky C, Hessler MJ, Brown KM, Hildebrand T (2002) Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria. J Am Acad Child Adolesc Psychiatry 41:928–937. doi:10.1097/00004583-200208000-00011

    Article  PubMed  Google Scholar 

  36. Luby JL, Mrakotsky C, Heffelfinger A, Brown K, Hessler M, Spitznagel E (2003) Modification of DSM-IV criteria for depressed preschool children. Am J Psychiatry 160:1169–1172. doi:10.1176/appi.ajp.160.6.1169

    Article  PubMed  Google Scholar 

  37. Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87. doi:10.1017/S0021963098003448

    Article  PubMed  Google Scholar 

  38. Beyer T, Furniss T (2007) Child psychiatric symptoms in primary school: the second wave 4 years after preschool assessment. Soc Psychiatry Psychiatr Epidemiol 42:753–758. doi:10.1007/s00127-007-0224-x

    Article  PubMed  Google Scholar 

  39. Dunitz M, Scheer PJ, Kvas E, Macart S (1996) Psychiatric diagnoses in infancy: a comparison. Infant Ment Health J 17:12–23. doi:10.1002/(SICI)1097-0355(199621)17:1<12::AID-IMHJ2>3.0.CO;2-3

    Article  Google Scholar 

  40. DeGangi GA, Breinbauer C, Roosevelt JD, Porges S, Greenspan S (2000) Prediction of childhood problems at three years in children experiencing disorders of regulation during infancy. Infant Ment Health J 21:156–175. doi:10.1002/1097-0355(200007)21:3<156::AID-IMHJ2>3.0.CO;2-D

    Article  Google Scholar 

  41. DeGangi GA, Breinbauer C (1997) The symptomatology of infants and toddlers with regulatory disorders. J Dev Learn Disord 1:183–215

    Google Scholar 

  42. Frankel KA, Boyum LA, Harmon RJ (2004) Diagnoses and presenting symptoms in an infant psychiatric clinic: comparison of two diagnostic systems. J Am Acad Child Adolesc Psychiatry 43:578–587. doi:10.1097/00004583-200405000-00011

    Article  PubMed  Google Scholar 

  43. Thomas JM, Clark R (1998) Disruptive behavior in the in the very young child: diagnostic Classification 0-3 guides identification of risk factors and relational interventions. Infant Ment Health J 19:229–244. doi:10.1002/(SICI)1097-0355(199822)19:2<229::AID-IMHJ10>3.0.CO;2-#

    Article  Google Scholar 

  44. Thomas JM, Guskin KA (2001) Disruptive behavior in young children: What does it mean? J Am Acad Child Adolesc Psychiatry 40:44–51. doi:10.1097/00004583-200101000-00015

    Article  PubMed  Google Scholar 

  45. Cicchetti D, Toth SL (1998) The development of depression in children and adolescents. Am Psychol 53:221–241. doi:10.1037/0003-066X.53.2.221

    Article  PubMed  Google Scholar 

  46. Jensen PS, Hoagwood K (1997) The book of names: DSM-IV in context. Dev Psychopathol 9:231–249. doi:10.1017/S0954579497002034

    Article  PubMed  Google Scholar 

  47. Costello EJ, Egger H, Angold A (2005) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry 44:972–986. doi:10.1097/01.chi.0000172552.41596.6f

    Article  PubMed  Google Scholar 

  48. Klein A, Lang J, Cicchetti DV, Volkmar FR (2000) Brief report: interrater reliability of clinical diagnosis and DSM-IV criteria for autistic disorder: results of the DSM-IV autism field trial. J Autism Dev Disord 30:163–167. doi:10.1023/A:1005415823867

    Article  Google Scholar 

  49. Stone WL, Lee EB, Ashford L, Brissie J, Hepburn SL, Coonrod EE et al (1999) Can autism be diagnosed accurately in children under 3 years? J Child Psychol Psychiatry 40:219–226. doi:10.1017/S0021963098003370

    Article  PubMed  Google Scholar 

  50. Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2005) Predictive validity in a prospective follow-up of PTSD in preschool children. J Am Acad Child Adolesc Psychiatry 44:899–906. doi:10.1097/01.chi.0000169013.81536.71

    Article  PubMed  Google Scholar 

  51. Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2003) New findings on alternative criteria for PTSD in preschool children. J Am Acad Child Adolesc Psychiatry 42:561–570. doi:10.1097/01.CHI.0000046822.95464.14

    Article  PubMed  Google Scholar 

  52. Scheeringa MS, Peebles CD, Cook CA, Zeanah CH (2001) Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood. J Am Acad Child Adolesc Psychiatry 40:52–60. doi:10.1097/00004583-200101000-00016

    Article  PubMed  Google Scholar 

  53. Scheeringa MS, Zeanah CH, Drell MJ, Larrieu JA (1995) Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. J Am Acad Child Adolesc Psychiatry 34:191–200. doi:10.1097/00004583-199502000-00014

    Article  PubMed  Google Scholar 

  54. Scheeringa MS, Zeanah CH (1995) Symptom expression and trauma variables in children under 48 months of age. Infant Ment Health J 16:259–270. doi:10.1002/1097-0355(199524)16:4<259::AID-IMHJ2280160403>3.0.CO;2-T

    Article  Google Scholar 

  55. Luby JL, Sullivan J, Belden A, Stalets M, Blankenship S, Spitznagel E (2006) An observational analysis of behavior in depressed preschoolers: further validation of early-onset depression. J Am Acad Child Adolesc Psychiatry 45:203–212. doi:10.1097/01.chi.0000188894.54713.ee

    Article  PubMed  Google Scholar 

  56. Spitzer RL, Endicott J, Robins E (1978) Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 35:773–782

    PubMed  Google Scholar 

  57. Chatoor I (2002) Feeding disorders in infants and toddlers: diagnosis and treatment. Child Adolesc Psychiatr Clin N Am 11:163–183. doi:10.1016/S1056-4993(01)00002-5

    Article  PubMed  Google Scholar 

  58. Boris NW, Zeanah CH, Larrieu JA, Scheeringa MS, Heller SS (1998) Attachment disorders in infancy and early childhood: a preliminary investigation of diagnostic criteria. Am J Psychiatry 155:295–297

    PubMed  Google Scholar 

  59. Fonagy P, Gergely G, Jurist EL, Target M (2002) Affect regulation, mentalization, and the development of the self. Other Press, New York

    Google Scholar 

  60. Briggs-Gowan MJ, Carter AS, Schwab-Stone M (1996) Discrepancies among mother, child and teacher reports: examining the contributions of maternal depression and anxiety. J Abnorm Child Psychol 24:749–765. doi:10.1007/BF01664738

    Article  PubMed  Google Scholar 

  61. Richters JE (1992) Depressed mothers as informants about their children: a critical review of the evidence for distortion. Psychol Bull 112:485–499. doi:10.1037/0033-2909.112.3.485

    Article  PubMed  Google Scholar 

  62. Drake RE, Latimer EA, Leff HS, McHugo GJ, Burns B (2004) What is evidence? Child Adolesc Psychiatr Clin N Am 13:717–728. doi:10.1016/j.chc.2004.05.005

    Article  PubMed  Google Scholar 

  63. Kagan J, Reznick JS, Clarke C, Snidman N, Garcia-Coll C (1984) Behavioral inhibition to the unfamiliar. Child Dev 55:2212–2225. doi:10.2307/1129793

    Article  Google Scholar 

  64. Hirshfeld DR, Rosenbaum JF, Biederman J, Bolduc EA, Faraone SV, Snidman N et al (1992) Stable behavioral inhibition and its association with anxiety disorder. J Am Acad Child Adolesc Psychiatry 31:103–111. doi:10.1097/00004583-199201000-00016

    Article  PubMed  Google Scholar 

  65. Robinson JL, Kagan J, Reznick JS, Corley R (1992) The heritability of inhibited and uninhibited behavior: a twin study. Dev Psychol 28:1030–1037. doi:10.1037/0012-1649.28.6.1030

    Article  Google Scholar 

  66. Rosenbaum JF, Biederman J, Hirshfeld-Becker DR, Kagan J, Snidman N, Friedman D et al (2000) A controlled study of behavioral inhibition in children of parents with panic disorder and depression. Am J Psychiatry 157:2002–2010. doi:10.1176/appi.ajp. 157.12.2002

    Article  PubMed  Google Scholar 

  67. Hirshfeld-Becker DR, Biederman J, Calltharp S, Rosenbaum ED, Faraone SV, Rosenbaum JF (2003) Behavioral inhibition and disinhibition as hypothesized precursors to psychopathology: implications for pediatric bipolar disorder. Soc Biol Psychiatry 53:985–999. doi:10.1016/S0006-3223(03)00316-0

    Article  Google Scholar 

  68. Frick P (2004) Integrating research on temperament and and childhood psychopathology: its pitfalls and promise. J Clin Child Adolesc Psychol 33:2–7. doi:10.1207/S15374424JCCP3301_1

    Article  PubMed  Google Scholar 

  69. Minde K, Tidmarsh L (1997) The changing practices of an infant psychiatry program: the McGill experience. Infant Ment Health J 18:135–144. doi:10.1002/(SICI)1097-0355(199722)18:2<135::AID-IMHJ3>3.0.CO;2-O

    Article  Google Scholar 

  70. Maldonado-Duran M, Saudera-Garcia JM (1996) Excessive crying in infants with regulatory disorders. Bull Menninger Clin 60:62–78

    PubMed  Google Scholar 

  71. Wolke D, Rizzo P, Woods S (2002) Persistent infant crying and hyperactivity problems in middle childhood. Pediatr 109:1054–1060. doi:10.1542/peds.109.6.1054

    Article  Google Scholar 

  72. Keren M, Feldman R, Tyano S (2001) Diagnoses and interactive patterns of infants referred to a community-based infant mental health clinic. J Am Acad Child Adolesc Psychiatry 40:27–35. doi:10.1097/00004583-200101000-00013

    Article  PubMed  Google Scholar 

  73. Christensen M, Emde R, Fleming C (2004) Cultural perspectives for assessing infants and young children. In: DelCarmen-Wiggins R, Carter A (eds) Handbook of infant, toddler and preschool mental health assessment. Oxford University Press, Oxford, pp 7–23

    Google Scholar 

  74. Stafford B, Zeanah C, Scheeringa M (2003) Exploring Psychopathology in Early Childhood: PTSD and Attachment Disorders in DC:0-3 and DSM-IV. Infant Ment Health J 24:398–409. doi:10.1002/imhj.10064

    Article  Google Scholar 

  75. Angold A, Fisher PW (1999) Interviewer-based interviews. In: Shaffer D, Lucas C, Richters J (eds) Diagnostic assessment in child and adolescent psychopathology. Guilford Press, New York, pp 34–64

    Google Scholar 

  76. Angold A, Egger HL (2004) Psychiatric diagnosis in preschool children. In: DelCarmen-Wiggins R, Carter A (eds) Handbook of infant, toddler and preschool mental health assessment. Oxford University Press, Oxford, pp 123–139

    Google Scholar 

  77. Furniss T, Beyer T, Guggenmos J (2006) Prevalence of behavioural and emotional problems among six-years-old preschool children: baseline results of a prospective longitudinal study. Soc Psychiatry Psychiatr Epidemiol 41:394–399. doi:10.1007/s00127-006-0045-3

    Article  PubMed  Google Scholar 

  78. Skovgaard AM, Houmann T, Landorph SL, Christiansen E (2004) Assessment and classification of psychopathology in epidemiological research of children 0–3 years of age: a review of the literature. Eur Child Adolesc Psychiatry 13:337–346. doi:10.1007/s00787-004-0393-z

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Muenster University Hospital, Schmeddingstr. 50, 48149, Muenster, Germany

    Christian Postert, Marlies Averbeck-Holocher, Thomas Beyer, Jörg Müller & Tilman Furniss

Authors
  1. Christian Postert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marlies Averbeck-Holocher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Beyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jörg Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tilman Furniss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tilman Furniss.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Postert, C., Averbeck-Holocher, M., Beyer, T. et al. Five Systems of Psychiatric Classification for Preschool Children: Do Differences in Validity, Usefulness and Reliability Make for Competitive or Complimentary Constellations?. Child Psychiatry Hum Dev 40, 25–41 (2009). https://doi.org/10.1007/s10578-008-0113-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-008-0113-x

Keywords

Search

Navigation