Changes in diagnosis, particularly to schizophrenia, are mostly attributable to the evolution of the illness. Rigid adherence to DSM-IV requirements may have led to underdiagnosis of schizophrenia. The findings support the need for a longitudinally based diagnostic process in incidence samples.

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Objective Recent studies indicate that many preschoolers meet diagnostic criteria for psychiatric disorders. However, data on the continuity of these diagnoses are limited, particularly from studies examining a broad range of disorders in community samples. Such studies are necessary to elucidate the validity and clinical significance of psychiatric diagnoses in young children. The authors examined the continuity of specific psychiatric disorders in a large community sample of preschoolers from the preschool period (age 3) to the beginning of the school-age period (age 6). Method Eligible families with a 3-year child were recruited from the community through commercial mailing lists. For 462 children, the child’s primary caretaker was interviewed at baseline and again when the child was age 6, using the parent-report Preschool Age Psychiatric Assessment, a comprehensive diagnostic interview. The authors examined the continuity of DSM-IV diagnoses from ages 3 to 6. Results Three-month rates of disorders were relatively stable from age 3 to age 6. Children who met criteria for any diagnosis at age 3 were nearly five times as likely as the others to meet criteria for a diagnosis at age 6. There was significant homotypic continuity from age 3 to age 6 for anxiety, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder, and heterotypic continuity between depression and anxiety, between anxiety and oppositional defiant disorder, and between ADHD and oppositional defiant disorder. Conclusions These results indicate that preschool psychiatric disorders are moderately stable, with rates of disorders and patterns of homotypic and heterotypic continuity similar to those observed in samples of older children.

BACKGROUND-Volatile, aggressive behavior is the chief complaint that brings children to inpatient psychiatric care. These difficulties are increasingly conceptualized as bipolar disorder (BPD). The impact of doing so on clinical diagnoses in clinical care is uncertain.

This study evaluated factors associated with depression and suicidal behavior in 8-13-year-old child psychiatric inpatients. Major differences were found in the correlates of depression and suicidal behavior. Suicidal behavior was associated with a tendency for children to perceive their families as low in control and cohesiveness and high in conflict. Suicidal children also spontaneously generated significantly fewer cognitive mediationai strategies for coping with stressful life events than nonsuicidal children. Depression was associated primarily with variables reflecting negative cognitive biases. However, this negative bias was not generalized across all situational contexts.The understanding of factors that contribute to depression and suicide is crucial for the prevention and treatment of these major mental health problems. Current evidence indicates that between 27%-52% of child clinic samples meet the criteria for depressive disorders, that many of these children will suffer relapses and continued dysfunction, and that many will feel suicidal or make suicide attempts (