Viewing Preschool Disruptive Behavior Disorders and ADHD Through A Developmental Lens: What We Know & What We Need to Know

Authors

Anil Chacko, Queens College, City University of New YorkFollow
Lauren Wakschlag, University of Illinois at ChicagoFollow
Carri Hill, University of Illinois at ChicagoFollow
Barbara Danis, University of Illinois at ChicagoFollow
Kimberly A. Espy, University of Nebraska–LincolnFollow

Document Type

Article

Date of this Version

2009

Citation

Published in final edited form as: Child Adolesc Psychiatr Clin N Am. 2009 July ; 18(3): 627–643. doi:10.1016/j.chc.2009.02.003.

Comments

Author manuscript; available in PMC 2023 May 10.

Abstract

There is now little doubt that DSM-IV behavior disorders are present and identifiable during the preschool years (1,2). With only minor modifications to DSM-IV Disruptive Behavior Disorders (DBDs) and attention-deficit/hyperactivity disorder (ADHD) nosology, multiple, independent studies have shown similar prevalence rates and correlates as in older children (1). In the preschool age range, these disorders also have modest stability (3-6). It is clear that the behaviors that comprise DBDs and ADHD (e.g., noncompliance, rule-breaking, aggression, destruction of property, hyperactivity, inattention, and impulsivity) impair children’s functioning and that caregivers of young children often experience considerable difficulty in managing those who exhibit high levels of these behaviors. Increasingly, preschoolers are being referred to mental health clinics for DBDS and ADHD (7), with escalating rates of pharmacological treatments (8). Thus, the “real world” consequences of behavior disorders are substantial for young children and their families and often mark the onset of long-term developmental maladaptation that marks psychopathology (9). Concerted effort to characterize the clinical manifestations of these disorders in early childhood more precisely will maximize our ability to intervene effectively in the lives of young children affected with DBDs and ADHD and, ultimately to reduce their long-term health burden. The increasing consensus that these syndromes exist in young children also comes with growing concern that these disorders may be developmentally misspecified, particularly for young children who are not at the extremes (10). In this paper, we review the extant empirical evidence through a “developmental lens,” with an eye to analyzing how the absence of a developmental approach may hinder accurate identification. Further, we show how integrating evidence from developmental science provides useful guideposts for generating and testing a developmentally-specified nosology. Together with the plethora of work on preschool psychopathology over the past decade, this provides a strong foundation for charting a course for the next generation of more refined efforts in early childhood.