Continuity Between Behavioral/Emotional Problems at Ages 2-3 and Externalizing Disorders at Ages 5-6

Using a sample of 235 low SES children, Shaw, Owens, Giovannelli, & Winslow (2001) tested the relations between parent-rated problems on the CBCL/2-3 administered when the children were 24 and 42 months of age and DSM-IV disruptive behavior disorder (DBD) diagnoses based on K-SADS-E maternal interviews when the children were 5½. Children with no DBD at 5½ had obtained significantly lower CBCL Aggressive and Destructive syndrome scores at 24 and 42 months than children with ADHD+ODD or CD at 5½. Children with ODD or CD at 5½ scored higher than non-diagnosed children on the CBCL Destructive syndrome at 24 and 42 months, whereas children with CD at 5½ scored higher than non-diagnosed or ODD children on the Aggressive syndrome at 42 months.

A four-item “attention problems” scale the researchers derived from the CBCL at 24 months also discriminated the non-diagnosed 5½-year-olds from the ODD and ADHD+ODD or CD groups. Children with ADHD at 5½ were only different from the non-diagnosed group on the CBCL Aggressive syndrome at 42 months. The researchers also formed ADHD, ODD, CD, and ADHD+ODD or CD diagnostic groups from the TRF administered at age 6. They did this by constructing scales of TRF items that they considered to correspond to DSM-IV criteria for the DBD diagnoses.

These diagnostic groupings manifested fewer significant relationships with preschool measures. However, children identified as ODD by the TRF at age 6 had significantly higher scores on the CBCL Destructive syndrome at 24 months than non-diagnosed children. Additional results indicated that children in the ADHD+ODD or CD group were more temperamentally difficult as toddlers, had mothers with more depressive and aggressive symptoms and lower social support, experienced more rejecting parenting, and lived in more dangerous neighborhoods than non-diagnosed children. Children with ODD and CD also had many of these same risk factors, whereas the ADHD children were similar to the non-diagnosed children on these risk factors. Results of the study suggest strong continuity between behavior problems identified at ages 2-3 and the presence of DBD at ages 5-6, as well as significant associations between DBD in young children and maternal, familial, and environmental risk factors.

Reference: Shaw, D.S., Owens, E.B., Giovannelli, J., & Winslow, E.B. (2001). Infant and toddler pathways leading to early externalizing disorders. Journal of American Academy of Child and Adolescent Psychiatry, 40, 36-43.