Disruptive behavior in young children: What does it mean?

Objective: To examine how the Diagnostic Classification of Mental Health an d Developmental Disorders of Infancy and Early Childhood (DC 0-3) primary d iagnoses, Parent-infant Relationship Global Assessment Scale, and Child Beh avior Checklist/2-3 (CBCL/2-3) externalizing and internalizing symptoms aug ment the DSM-III-R/IV and guide treatment. Method: 82 children aged 18 to 4 7 months, who presented with disruptive behavior to an early childhood psyc hiatry clinic, were diagnosed using DSM-III-R/IV DC 0-3, and the CBCL/2-3. Results: Children with DSM-III-R/IV disruptive disorders or attention-defic it/hyperactivity disorder were diagnosed with DC 0-3 regulatory disorders, disorders of affect, and traumatic stress disorder. Clinically significant externalizing and internalizing symptoms co-presented in 45.1% of the child ren. Of children with disorders of affect, 41.2% had relationships categori zed as disordered, contrasting with 21.1% of those with traumatic stress di sorder and 10.3% of those with regulatory disorders. Increasingly disordere d relationships were significantly correlated with externalizing and intern alizing symptoms, and children with disordered relationships were 3.6 times more likely to have clinically significant levels of internalizing symptom s. Conclusion: In these children with disruptive behaviors, co-presentation of externalizing and internalizing symptoms is most common. Those with inc reased relational risk had more externalizing and internalizing symptoms an d more disorders of affect.