Elsevier

The Journal of Pediatrics

Volume 166, Issue 3, March 2015, Pages 723-730.e1
The Journal of Pediatrics

Original Article
Disruptive Behavior in Preschool Children: Distinguishing Normal Misbehavior from Markers of Current and Later Childhood Conduct Disorder

https://doi.org/10.1016/j.jpeds.2014.11.041Get rights and content

Objectives

To investigate which disruptive behaviors in preschool were normative and transient vs markers of conduct disorder, as well as which disruptive behaviors predicted the persistence of conduct disorder into school age.

Study design

Data from a longitudinal study of preschool children were used to investigate disruptive behaviors. Caregivers of preschoolers ages 3.0-5.11 years (n = 273) were interviewed using the Preschool Age Psychiatric Assessment to derive the following diagnostic groups: conduct disorder, externalizing disorder without conduct disorder, internalizing disorder without externalizing disorder, and healthy. At school age, participants were again assessed via an age-appropriate diagnostic interview. Logistic and linear regression with pairwise group comparisons was used to investigate clinical markers of preschool conduct disorder and predictors of school age conduct disorder.

Results

Losing one's temper, low-intensity destruction of property, and low-intensity deceitfulness/stealing in the preschool period were found in both healthy and disordered groups. In contrast, high-intensity argument/defiant behavior, both low- and high-intensity aggression to people/animals, high-intensity destruction of property, high-intensity deceitfulness/stealing, and high-intensity peer problems were markers of preschool conduct disorder and predictors of school age conduct disorder. Inappropriate sexual behavior was not a marker for preschool conduct disorder but was a predictor of school age conduct disorder.

Conclusion

These findings provide a guide for primary care clinicians to help identify preschoolers with clinical conduct disorder and those who are at risk for persistent conduct disorder in childhood. Preschoolers displaying these symptoms should be targeted for mental health assessment.

Section snippets

Methods

Preschoolers between 3 and 5.11 years of age were recruited from multiple sites throughout the greater metropolitan St. Louis area for participation in the Preschool Depression Study. Recruitment was done through primary care practices and preschools/daycares in an effort to increase the diversity of the final sample. Participants were screened via a validated checklist to identify those with symptoms of major depressive disorder (MDD) or other psychiatric disorders, and healthy controls.17

Results

There were 273 participants who had at least one assessment during both the preschool (3-5.11 years) and school age periods (6-9.11 years) and were therefore included in the analyses. There were 86 children with 1 preschool assessment, 113 children with 2 preschool assessments, and 74 children with 3 preschool assessments. There were 38 children with 1 school-age assessment, 153 children with 2 school-age assessments, and 82 children with 3 school-age assessments. The mean age of the children

Discussion

The first aim in our study was to investigate which misbehaviors were normative and common among preschool children. Losing one's temper, low-intensity destruction of property, and low-intensity deceitfulness/stealing emerged as common misbehaviors that did not serve as markers of clinical disruptive disorders. Wakschlag et al14, 15 also found that temper loss was a common misbehavior in preschoolers but that it ranged from normative problems to clinically significant levels. In a previous

References (43)

  • A.C. Belden et al.

    Temper tantrums in healthy versus depressed and disruptive preschoolers: defining tantrum behaviors associated with clinical problems

    J Pediatr

    (2008)
  • A. Stringaris et al.

    Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions

    J Am Acad Child Adolesc Psychiatry

    (2009)
  • A. Gray et al.

    Developmental and etiological characteristics of children with sexual behavior problems: treatment implications

    Child Abuse Negl

    (1999)
  • J.D. Burke et al.

    Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II

    J Am Acad Child Adolesc Psychiatry

    (2002)
  • R. Loeber et al.

    Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study

    J Am Acad Child Adolesc Psychiatry

    (1995)
  • B.B. Lahey et al.

    Validity of DSM-IV subtypes of conduct disorder based on age of onset

    J Am Acad Child Adolesc Psychiatry

    (1998)
  • S.J. Bufferd et al.

    Psychiatric disorders in preschoolers: continuity from ages 3 to 6

    Am J Psychiatry

    (2012)
  • J. Kim-Cohen et al.

    Five-year predictive validity of DSM-IV conduct disorder research diagnosis in 4(1/2)-5-year-old children

    Eur Child Adolesc Psychiatry

    (2009)
  • K. Keenan et al.

    Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers

    J Child Psychol Psychiatry

    (2011)
  • K. Keenan et al.

    Can a valid diagnosis of disruptive behavior disorder be made in preschool children?

    Am J Psychiatry

    (2002)
  • K. Keenan et al.

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

    J Abnorm Child Psychol

    (2000)

    • Cited by (31)

    • Designing and Testing a Developmentally Appropriate Intervention for Children in a Psychiatric Residential Treatment Facility

      2021, Child and Adolescent Psychiatric Clinics of North America
      Citation Excerpt :

      In addition, it is important that some allowance is made for normal, nondisruptive misbehavior as not requiring intervention.17 Specifically, there is a need to distinguish between normative problem behavior (eg, not doing what they are asked to do, resisting bedtime, low-level defiance) and clinically problematic behavior.20–22 Although most children occasionally display aggressive behaviors, aggression may indicate psychopathology and be clinically problematic when it is severe, is frequent, or occurs across multiple settings.13

    • A Randomized Trial of Digitally Delivered, Self-Administered Parent Training in Primary Care: Effects on Parenting and Child Behavior

      2021, Journal of Pediatrics

    • Disruptive Behavior Disorders in Children 0 to 6 Years Old

      2017, Child and Adolescent Psychiatric Clinics of North America
      Citation Excerpt :

      Prevalence of ODD in preschoolers is estimated at 4% to 16.6%, with CD incidence at 3.9% to 6.6%. ODD specifically is associated with later mood disorders; childhood-onset CD predicts later educational and legal issues.1 Preschool-age ODD is a less robust predictor than preschool CD of poor school-age and adolescent outcomes, but still confers the risk of later impairment, likely through progression to CD.2

    • Hyperactivity precedes conduct problems in preschool children: A longitudinal study

      2018, BJPsych Open

    • Child and adolescent mental health and psychosocial support interventions: An evidence and gap map of low- and middle-income countries

      2023, Campbell Systematic Reviews

    • Parenting self-efficacy in relation to children’s executive function and externalizing behavior

      2023, Journal of Early Childhood Research
    View all citing articles on Scopus

    Supported by the National Institute of Mental Health (R01 021187 [to J.L.]). The authors declare no conflicts of interest.

    View full text
    Copyright © 2015 Elsevier Inc. All rights reserved.