Washington University. US: It’s normal for a young child to have tantrums and be otherwise
disruptive, but researchers have found that if such behavior is
prolonged or especially intense, the child may have conduct disorder, a
childhood psychiatric problem that could be a harbinger of antisocial
behavior.
Researchers at Washington University School of Medicine in St. Louis
found that certain symptoms of conduct disorder indicate problems are
likely to continue as kids reach school age. They recommend that
children who exhibit these symptoms — among them, high-intensity
defiant behavior, aggression and destruction of property — be referred
to mental health professionals for evaluation and possible intervention.
Their findings are published Jan. 15 in The Journal of Pediatrics.
“Previously, we did not understand the empirical differences between
normal disruptive behaviors in preschoolers – like temper tantrums, for
example — and behaviors that signal problems,” said senior investigator
Joan L. Luby, MD, professor of child psychiatry. “If you went to your
pediatrician and said, ‘My 3-year-old is having tantrums,’ the
pediatrician wouldn’t tell you to see a psychiatrist.”
Although there was overlap between healthy young children and
their peers who had conduct disorder, the researchers found that those
who
exhibited high-intensity defiant behavior, aggression toward people or
animals, high-intensity destruction of property, peer problems and
deceitfulness, including stealing, were likely to have conduct
disorder. Having those symptoms also made it more likely
they would carry the disorder into elementary school.
“We characterize a symptom as high-intensity when it’s
really ‘high-pitched’ — so just how severe the anger is,” Luby said.
“Other factors that would qualify a symptom as high-intensity would
hinge on how frequently the behavior occurs and the context in which it
occurs. A high-intensity symptom is one that is very acute or severe,
occurs over a long duration of time and happens in a number of different
contexts.”
“Children who had high-intensity symptoms as
preschoolers were likely to have conduct disorder,” said first author Ji Su Hong, MD, who now works as a mental health provider for children treated at Grace Hill Health Centers in St. Louis. “And
those symptoms also tended to predict conduct disorder when they reached
school age.”
Grace Hill operates neighborhood-based health centers and a community health program in the St. Louis region.
Although
healthy preschoolers also engage in disruptive behaviors — including
losing their tempers, throwing toys and being untruthful — about one in
20 preschoolers has conduct disorder.
“That’s about one child per preschool class,” Hong said. “And conduct
disorder is a serious problem when it affects a child under 10 because
early-onset problems are more likely to persist as the child grows up.”
Kids with conduct disorder often have other disadvantages, too. Many
children with school-age conduct disorder in the study were from homes
with low incomes, with almost half from families with incomes of $20,000
a year or less. Further, about half had a history of abuse or neglect;
43 percent came from intact families, meaning more than half were either
from single-parent homes or didn’t live with either parent; and more
than half had been diagnosed with preschool depression.
Hong and Luby believe that the best chance young children have to avoid recurring problems is early diagnosis and treatment.
“In young children, violent and destructive behavior that’s deliberate really seems to be a key warning sign,” Luby said.
Funded by the National Institute of Mental Health (NIMH) of the
National Institutes of Health (NIH). NIH grant number R01 021187.
Hong JS, Tillman R, Luby JL. Disruptive behavior in preschool
children: distinguishing normal misbehavior from markers of current and
later childhood conduct disorder. Pediatrics, Jan. 15, 2015.