Jl. Luby et K. Morgan, CHARACTERISTICS OF AN INFANT PRESCHOOL PSYCHIATRIC CLINIC SAMPLE - IMPLICATIONS FOR CLINICAL-ASSESSMENT AND NOSOLOGY/, Infant mental health journal, 18(2), 1997, pp. 209-220
The purpose of this study was to describe the methods of clinical asse
ssment in an academic infant/preschool subspecialty clinic and to inve
stigate the psychosocial demographic and diagnostic characteristics of
this outpatient population. The clinic charts of 120 patients seen by
the clinic director (first author) and second-year child psychiatry f
ellows were reviewed for data entry and analysis. Patients and their p
rimary caretakers had undergone a comprehensive, multiple-session inte
ractive play assessment to formulate clinical diagnoses using the DSM-
III-R. Mean age of patients was 42 months +/- 13 with a range of 9 to
70 months. Similar to previous reports, a preponderance of externalizi
ng disorders were seen (66%). A variety of Axis I DSM-III-R diagnoses
were found and 37% of children had a developmental disorder on Axis II
. Not-otherwise-specified categories were used in 8% of cases due to t
he lack of any other appropriately descriptive classification. Eighty-
eight percent of these occurred in children younger than 4 years of ag
e. A high rate of prematurity (20%), maternal psychiatric history (44%
), as well as the use of corporal punishment (28% frequent; 37% occasi
onal) was found in the sample. The implications of these findings for
the clinical assessment and classification of early onset psychiatric
disorders are discussed. The utilization of mental health services by
the youngest children for whom the DSM taxonomy was disproportionately
inadequate is noted.