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Prevalence of DSM-IV Disorder in a Representative, Healthy Birth Cohort at School Entry: Sociodemographic Risks and Social Adaptation

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Objective

The aims of this paper are as follows: to present past-year prevalence data for DSM-IV disorders in the early elementary school years; to examine the impact of impairment criteria on prevalence estimates; to examine the relation of sociodemographic and psychosocial risk factors to disorders; and to explore associations between ”internalizing” and ”externalizing” disorders and social competence and family burden as further validation of the impairing nature of these disorders.

Method

As part of a longitudinal representative population study of children born healthy between July 1995 and September 1997 in the New Haven–Meriden Standard Metropolitan Statistical Area of the 1990 Census (n = 1,329), parents of a subsample enriched for child psychopathology (n = 442; 77.6% response rate, 69.5% of eligible sample) were interviewed in the child's kindergarten or first-grade year with the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Parents were surveyed about sociodemographic and psychosocial characteristics, and both parents and teachers were surveyed about social competence.

Results

Approximately one in five (21.6 %) children met criteria for psychiatric disorder(s) with impairment. Sociodemographic and psychosocial correlates included persistent poverty beginning in early childhood, limited parental education, low family expressiveness, stressful life events, and violence exposure. Finally, diagnostic status was significantly associated with poorer social competence and family burden.

Conclusions

That approximately one in five children evidenced a psychiatric disorder with impairment during the transition to formal schooling highlights the importance of integrating psychiatric epidemiological and developmental approaches to inform conversations about school readiness and intervention planning

Section snippets

Participants

Children were selected from birth records (N = 8,404) provided by the State of Connecticut Department of Public Health for births at Yale-New Haven Hospital from July 1995 to September 1997 (Figure 1). Eligible children were born healthy in the New Haven–Meriden Standard Metropolitan Statistical Area of the 1990 Census. Children who were likely to have developmental delays because of low birthweight (<2,200 g), prematurity (<36 weeks), low APGAR scores (defined as both 1- and 5-minute scores

Prevalence of DISC Disorders

Rates of DISC disorder varied depending on whether impairment criteria were employed (Table 3). When impairment was not required for diagnosis, 32.0% of children met criteria for “any” disorder, 14.3% had one or more externalizing disorders, and 22.5% had one or more internalizing disorders. Without requiring impairment, the most common disorder was Specific Phobia (20.0%), and the majority of children who met criteria for this disorder (69.7%) did not have any other disorder. When impairment

Discussion

Prevalence rates for psychopathology in these young, school-aged children ascertained from birth records in a Northeastern urban and suburban SMSA are consistent with previous estimates of preschool children,12, 14, 16, 19 older children, and adolescents11, 15, 17, 18 and suggest that as children transition to formal schooling, approximately one in five (21.6%) will have a psychiatric disorder with impairment and may benefit from services. The estimated prevalence of psychiatric disorder was

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  • Cited by (0)

    Support for this research came from a grant to the first author from the National Institute of Mental Health (R01MH55278), the MRSA/MCHB LEND project (HERSA/MCHB T73MC00020l; Dr. David Helm, PI), and the Mental Health/Developmental Disabilities at Children's Hospital Boston (National Institute of Mental Health/National Institutes of HealthR25 MH0171286; Dr. Kerim Munir, PI).

    This article is discussed in an editorial by Neil W. Boris, M.D., on page 635.

    Disclosure: Drs. Carter and Briggs-Gowan receive royalties from the sale of the Infant Toddler Social and Emotional Assessment from Pearson Assessment. Drs. Wagmiller and Horwitz and Ms. Gray and McCarthy report no biomedical financial interests or potential conflicts of interest.

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