Journal of Child Psychology and Psychiatry

Lauren S. Wakschlag et al

Background: Attaining a developmentally sensitive nosology for preschool disruptive behavior requires characterization of the features that distinguish it from the normative misbehavior of this developmental period. We hypothesize that quality of behavior and its pervasiveness across contexts are critical dimensions for clinical discrimination in young children and propose that structured diagnostic observation provides a systematic method for their identification. We use the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) to examine whether:
(a) observed quality and pervasiveness of behavior distinguishes preschoolers with clinically concerning disruptive behavior from typically developing preschoolers, and
(b) observed pattern of clinically salient behavior predicts impairment above and beyond maternal report of behavioral frequency.

Methods: Participants are a behaviorally heterogeneous sample of preschoolers (N = 327). Diagnostic methods developed for clinical assessment of preschoolers were used to classify children as (a) Non-Disruptive, (b) Sub-Clinical, or (c) Disruptive. Child behavior was coded based on interactions with parent and examiner during the DB-DOS.

Results: Quality and pervasiveness of observed behaviors during the DB-DOS significantly distinguished the three behavioral groups. Discriminative utility varied depending on the comparison. With few exceptions, clinically concerning patterns on the DB-DOS added significant incremental utility in predicting impairment.

Conclusions: Observed patterns of clinically salient behavior show promise for advancing developmentally-informed characterization of disruptive behavior within the preschool period.

David C. R. Kerr et al

Background: Children's early problem behavior that manifests in multiple contexts is often more serious and stable. The concurrent and predictive validity of ratings of externalizing and internalizing by four informants was examined at preschool and early school age in an at-risk sample.

Methods: Two hundred forty children were assessed by mothers and fathers (Child Behavior Checklist (CBCL)), and teachers and laboratory examiners (Teacher Report Form (TRF)) at ages 3 and 5 years.

Results: All informants' ratings of externalizing converged on a common factor at ages 3 and 5 that showed strong stability over time (â = .80). All informants' age 3 externalizing ratings significantly predicted the problem factor at age 5; mothers', fathers', and teachers' ratings were independently predictive. Ratings of internalizing (except by examiners at age 3) also converged at both ages; the problem factor showed medium stability (â = .39) over time. Only fathers' ratings of age 3 internalizing predicted the age 5 problem factor.

Conclusions: Findings support the value of multi-informant assessment, uphold calls to include fathers in childhood research, and suggest that examiners provide valid, though non-unique assessment data. Examiner
contributions may prove useful in many research contexts.

Stephanie Stadelmann et al

Background: The quality of the family relationships plays an important role in the development of children's psychopathology and in their socio-emotional development. This longitudinal study aims to investigate whether family relationships are related to children's symptoms/strengths at kindergarten, and whether family relationships are predictors of changes in children's symptoms/strengths between 5 and 6. Our main interest is to examine the role of children's parental representations.

Methods: One hundred and fifty-three kindergarten children (67 girls, 86 boys) participated in this study. Children's parental representations were assessed using a story stem task (age 5). The family environment was assessed using parents' ratings (age 5). A multi-informant approach (parent, teacher, child) was employed to assess children's symptoms/strengths at 5 and 6. Children were interviewed using a standardised puppet interview. Parents and teachers completed questionnaires.

Results: Children's parental representations as well as the family environment were associated with children's symptoms/strengths at 5 and 6. When controlled for gender, children's representations were the only predictor of changes in symptoms/strengths between 5 and 6. A large number of negative parental representations at 5 predicted an increase in conduct problems. A large number of positive parental representations at 5 predicted an increase in pro-social behaviour. In terms of emotional symptoms and hyperactivity/inattention, symptoms at 5 were the only predictor for symptoms one year later.

Conclusions: Our results suggest that kindergarten children's narrative representations may elaborate the processes underlying the expression of child disturbance and strengths, and underline the relevance of the play and narration of young children for diagnostics and therapy.

Sonya Sterba et al

Background: The appropriateness of the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) nosology for classifying preschool mental health disturbances continues to be debated. To inform this debate, we investigate whether preschool psychopathology shows differentiation along diagnostically specific lines when DSM-IV symptoms are aggregated statistically.

Methods: One thousand seventy-three parents of preschoolers aged 2-5 years attending a large pediatric clinic completed the Child Behavior Checklist 1.5-5. A stratified probability sample of 193 parents of high scorers and 114 parents of low scorers were interviewed with the Preschool Age Psychiatric Assessment (PAPA). Confirmatory factor analysis was performed on symptoms from seven DSM disorders.

Results: Comparison of competing models supported the differentiation of emotional syndromes into three factors: social phobia (SOC), separation anxiety (SAD), and depression/generalized anxiety (MDD/GAD), and the differentiation of disruptive syndromes into three factors: oppositional defiant/conduct syndrome (ODD/CD), hyperactivity/impulsivity, and inattention. Latent syndrome correlations were moderately high after accounting for symptom overlap and measurement error.

Conclusions: Psychopathology appears to be differentiated among preschoolers much as it is among older children, and adolescents. We conclude that it is as reasonable to apply the DSM-IV nosology to preschoolers as it is to apply it to older individuals.

Relations to Different Types of Inhibitory Control and Working Memory
Karin C. Brocki et al

Background: The aim of the present study was to investigate how three different types of inhibitory control - interference control within task, interference control outside task, and prepotent response inhibition - and two types of working memory - verbal and spatial - would relate to early symptoms of attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), both concurrently and longitudinally.

Methods: Seventy-two preschoolers, 1/3 who had been identified as being at risk for developing ADHD and/or ODD, completed neuropsychological tasks designed to measure inhibitory control and working memory. Behavioral symptoms were measured through parental and teacher ratings of the DSM-IV criteria for ADHD and ODD.

Results: Our results suggest distinct types of inhibitory control as being good predictors of concurrent and longitudinal symptoms of ADHD, rather than ODD. However, no associations were obtained between working memory and ADHD or ODD symptoms either concurrently or longitudinally.

Conclusions: This study emphasizes the need to isolate complex executive processes and break them down into components in order to properly understand the neuropsychological roots involved in ADHD and ODD.

Robert J. Coplan

Background: Much of the evidence suggesting that loneliness is a risk factor for socio-emotional adjustment difficulties comes from studies with older children and adolescents. Comparatively less is known about the mental health implications of loneliness in early childhood. The goals of the present study were to provide additional convergent validity of the Loneliness and Social Dissatisfaction Questionnaire for Young Children (Cassidy & Asher, 1992) and explore potential gender differences in relations between loneliness and behavior problems in early childhood.

Methods: A multiple source assessment of 139 kindergarten-aged children (Mage = 64.76 mos., SD = 4.48) was undertaken, including parental ratings, behavioral observations, child interviews, and teacher ratings.

Results: Overall, loneliness was positively associated with anxiety, aggression, and peer exclusion. However, several gender differences were also observed.

Conclusions: Loneliness may be a marker variable for both early internalizing and externalizing problems. However, gender differences in the behavioral associates of loneliness are also evident.

An Initial Twin Study of the Infant-toddler Social and Emotional Assessment.
C.A. Van Hulle et al

Background: Relatively little is known about the genetic architecture of childhood behavioral disorders in very young children.

Method: In this study, parents completed the Infant-Toddler Social and Emotional Assessment, a questionnaire that assesses symptoms of childhood disorders, as well as socio-emotional competencies, for 822 twin pairs (49.3% female; age 17-48 months) participating in the Wisconsin Twin Project. Psychometric, rater bias, and sex-limitation models explored the role of genetic and environmental influences on
(1) externalizing and internalizing behavior;
(2) less commonly assessed behaviors pertaining to physical and emotional dysregulation, general competencies, social relatedness; and
(3) infrequent behaviors such as those associated with pervasive developmental delays.

Results: Heritable influences accounted for the majority (56% or more) of variation in behavior that was commonly observed by both parents. The remaining variance was associated with non-shared environmental factors, with the exception of competency and atypical behavior, which were also influenced by shared environmental factors. In contrast, for most behaviors, the variation unique to mother and father ratings was split between variation due to shared environment or rater biases and to measurement error. Little evidence emerged for sex differences in the underlying causes of variation.

Claire Hughes and Rosie Ensor

Background: Exposure to harsh parenting and children's skills in 'Theory of Mind' (ToM) show independent and interacting associations with problem behaviors at age 2 (Hughes & Ensor, 2006). This study examined whether these age-2 measures also predict age-4 problem behaviors.

Method: In a socially diverse sample (N = 120), multi-informant, multi-measure, multi-setting ratings indexed problem behaviors at ages 2, 3 and 4; children completed both ToM and verbal-ability tasks at age 2, while video-based ratings of maternal negative affect and control within dyadic mother-child play indexed harsh parenting.

Results: Age-2 harsh parenting and ToM were independent and interacting predictors of age-4 problem behaviors, even with age-2 problem behaviors, verbal ability and social disadvantage all controlled. The interaction between harsh parenting and ToM distinguished persistent vs. diminishing problem behaviors.

Conclusions: Both child and family characteristics predict increases in problem behaviors from 2 to 4; adverse effects of harsh parenting are attenuated for children with good ToM skills.

Links to Toddler Behaviour Problems
Sheri Madigan

Background: Attachment theory's original formulation was substantially driven by Bowlby's (1969/1982) quest for a meaningful model of the development of psychopathology. Bowlby posited that aberrant experiences of parenting increase the child's risk of psychopathological outcomes, and that these risks are mediated by the quality of the attachment relationship. To empirically examine this hypothesis, the current study explores the associations between the development of toddler behavior problems and a) maternal unresolved attachment representations, b) maternal interactive behavior, and c) infant attachment relationships. Second, we test the mediating role of disorganized attachment in the association between disruptive behavior and toddler behavior problems, as well as unresolved attachment and behavior problems.

Method: Sixty-four adolescent mother-infant dyads participated in this longitudinal study. The Adult Attachment Interview was administered at 6 months, the Strange Situation procedure was conducted at 12 months, disrupted behavior was assessed during play interactions at 12 months using the AMBIANCE measure, and the Child Behavior Checklist (CBCL) was used to assess behavior problems at 24 months of age.

Results: Maternal reports of externalizing problems were significantly associated with unresolved representations of attachment, disrupted maternal behavior, and disorganized attachment. Inclusion of these variables in a path analytic model suggested that disorganized attachment mediated the associations between disrupted maternal behavior and externalizing problems. Although the association between unresolved attachment representations and externalizing problems was no longer significant when mediation by disrupted behavior and disorganized attachment was taken into account, this indirect pathway was not significant.

Conclusions: The results are consistent with Bowlby's (1969/1982) original conceptualization of the explanatory role of the attachment relationship in the development and manifestation of behavioral maladaptation. Effects of unresolved attachment on externalizing problems await further explanation.