Abstract
This study determined the impact of impairment criteria on the prevalence and patterns of comorbidity of child DSM-IV disorders. The validity of these impairment criteria was tested against different measures of mental health care referral and utilization. We interviewed parents of 1,154 children aged 5–8 years in-depth using the Diagnostic Interview Schedule for Children in Rotterdam, the Netherlands, to establish DSM-IV diagnosis. These children were randomly selected or oversampled based on Child Behavior Checklist ratings from a large population-based study (N = 6,172). Referral data were extracted from the psychiatric interview as well as from a follow-up questionnaire. The results showed an overall prevalence of DSM-IV disorders of 31.1 % when impairment was not considered. This rate declined to 22.9 % when mild impairment was required and declined even further, to 10.3 %, for more severe levels of impairment. Similarly, the overall comorbidity rate declined from 8.5 to 6.7 and 2.7 % when mild and severe impairment were required, respectively. Virtually all children who attained symptom thresholds for a specific disorder, and had been referred to a mental health care professional because of the associated symptoms, also had mild impairment. The requirement of severe impairment criteria significantly increased diagnostic thresholds, but for most disorders, this definition captured only half of the clinically referred cases. In conclusion, prevalence was highly dependent upon the criteria used to define impairment. If severe impairment is made a diagnostic requirement, many children with psychiatric symptoms and mild impairment seeking mental health care will be undiagnosed and possibly untreated.
Highlights
Childhood psychiatric disorders often interfere with social and academic functioning and show considerable continuity over time [1,2,3]
Anxiety disorders were associated with conduct/oppositional disorder (OR = 7.12, 95 % CI = 1.95–26.0) and mood disorder (OR = 10.28, 95 % CI = 1.41–74.68). In this population-based cohort, an estimated 31.1 and 22.9 % of 5- to 8-year-old children had at least one psychiatric disorder without and with the additional requirement of impairment, respectively. This rate declined to 10.3 % when more severe levels of impairment were required for diagnosis
The prevalence of general comorbidity was 8.5 % when impairment was not considered, and declined to 6.7 and 2.7 % when mild and severe impairment were required for diagnosis, respectively
Summary
Childhood psychiatric disorders often interfere with social and academic functioning and show considerable continuity over time [1,2,3]. Well-planned interventions targeting children with psychiatric disorders may serve to ameliorate current problems and associated impairment in functioning and to prevent the persistence of problems into adolescence and adulthood. Epidemiological research investigating the prevalence of psychiatric disorders and patterns of comorbidity may inform nosology and intervention planning. Worries about losing major attachment figures or fear of dogs are common in young children and may be inappropriately diagnosed as psychiatric symptoms or disorders (e.g., separation anxiety or specific phobia). Perhaps most strikingly, structured lay interviews in epidemiological surveys have revealed unexpectedly high rates of psychiatric disorders in young children, phobias [7, 8, 10]. A prime alteration in DSM-IV from DSM-III was the requirement of clinically significant distress or impairment in social, occupational, or other important areas of functioning for psychiatric diagnosis [4]. In the recently published DSM-5 [12], the criterion of clinically significant impairment or distress in functioning is retained
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
