More than the terrible twos: The nature and severity of behavior problems in clinic-referred preschool children

The primary goals of this study are to describe the nature and severity of disruptive behavior problems in clinic-referred preschoolers from low-incom e environments and to explore the validity of DSM-IV disruptive disorders f or young children. We examine the relation between DSM-IV symptoms, standar dized behavior checklists, and observational ratings as a means of explorin g measurement validity in this age group. Seventy-nine clinic-referred pres choolers (ages 21/2 through 51/2 years) from low-income environments were a ssessed. To examine whether clinic-referred preschool children have symptom s that are consistent with DSM-IV disruptive behavior disorders, parents we re administered a semistructured diagnostic interview, modified for develop mentally appropriate usage. In addition, parents completed the Child Behavi or Checklist (CBCL) and children's behavior problems were assessed with obs ervational ratings during parent-child interaction. Nearly half of the samp le met criteria for conduct disorder, and three quarters met criteria for o ppositional defiant disorder. Preliminary evidence for the validity of DSM- IV disruptive disorders in preschool children was demonstrated through asso ciation with CBCL scores, behavior ratings, and significant levels of impai rment. Future efforts aimed at validating these diagnoses in preschoolers a nd implications for prevention are discussed.