Hard-to-manage preschool boys and comparison boys were studied at age 4 years and followed at ages 6 and 9 years. Externalizing problems at ages 4 and 9 were associated with concurrent family stress, but this relationship was partially mediated by negative maternal control. Cross-lagged regressions indicated that despite the high stability in children's problem ratings, observed negative maternal control at age 4 and self-reported negative discipline at age 9 predicted externalizing problems at age 9 years, controlling for earlier levels of symptoms. Hierarchical regression analyses revealed that problems were more likely to persist in the context of chronic family stress, defined as negative life events, marital dissatisfaction, and maternal depressive symptoms. When problem boys who met diagnostic criteria for Oppositional Disorder and/or Attention Deficit Disorder were compared with boys who were improved by age 9 years, family stress and earlier symptom levels, as well as maternal control differentiated between them. Teacher ratings suggested that these boys were on a clear pathway to persistent problems by age 6 years. A small sample of comparison boys with emerging problems also were living in more dysfunctional families and their mothers reported using more negative discipline at age 9 years.

screening is widely recommended, yet studies of the accuracy of commonly used questionnaires reveal mixed results, and previous comparisons of these questionnaires are hampered by important methodological differences across studies.OBJECTIVE To compare the accuracy of 3 developmental screening instruments as standardized tests of developmental status. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional diagnostic accuracy study recruited consecutive parents in waiting rooms at 10 pediatric primary care offices in eastern Massachusetts between October 1, 2013, and January 31, 2017. Parents were included if they were sufficiently literate in the English or Spanish language to complete a packet of screening questionnaires and if their child was of eligible age. Parents completed all questionnaires in counterbalanced order. Participants who screened positive on any questionnaire plus 10% of those who screened negative on all questionnaires (chosen at random) were invited to complete developmental testing. Analyses were weighted for sampling and nonresponse and were conducted from October 1, 2013, to January 31, 2017. EXPOSURES The 3 screening instruments used were the Ages & Stages Questionnaire, Third Edition (ASQ-3); Parents' Evaluation of Developmental Status (PEDS); and Survey of Well-being of Young Children (SWYC): Milestones. MAIN OUTCOMES AND MEASURES Reference tests administered were Bayley Scales of Infant and Toddler Development, Third Edition, for children aged 0 to 42 months, and Differential Ability Scales, Second Edition, for older children. Age-standardized scores were used as indicators of mild (80-89), moderate (70-79), or severe (<70) delays.RESULTS A total of 1495 families of children aged 9 months to 5.5 years participated. The mean (SD) age of the children at enrollment was 2.6 (1.3) years, and 779 (52.1%) were male. Parent respondents were primarily female (1325 [88.7%]), with a mean (SD) age of 33.4 (6.3) years. Of the 20.5% to 29.0% of children with a positive score on each questionnaire, 35% to 60% also received a positive score on a second questionnaire, demonstrating moderate co-occurrence. Among younger children (<42 months), the specificity of the ASQ-3 (89.4%; 95% CI, 85.9%-92.1%) and SWYC Milestones (89.0%; 95% CI, 86.1%-91.4%) was higher than that of the PEDS (79.6%; 95% CI, 75.7%-83.1%; P < .001 and P = .002, respectively), but differences in sensitivity were not statistically significant. Among older children (43-66 months), specificity of the ASQ-3 (92.1%; 95% CI, 85.1%-95.9%) was higher than that of the SWYC Milestones (70.7%; 95% CI, 60.9%-78.8%) and the PEDS (73.7%; 95% CI, 64.3%-81.3%; P < .001), but sensitivity to mild delays of the SWYC Milestones (54.8%; 95% CI, 38.1%-70.4%) and of the PEDS (61.8%; 95% CI, 43.1%-77.5%) was higher than that of the ASQ-3 (23.5%; 95% CI, 9.0%-48.8%; P = .012 and P = .002, respectively). Sensitivity exceeded 70% only with respect to severe delays, with 73.7% (95% CI, 50.1%-88.6%) for the SWYC Milestones among younger children, 78.9% (95% CI, 55...

There is support for a differentiated model of early internalizing emotions and behaviors, yet researchers have not examined the course of multiple components of an internalizing domain across early childhood. In this paper we present growth models for the Internalizing domain of the Infant-Toddler Social and Emotional Assessment and its component scales (General Anxiety, Separation Distress, Depression/Withdrawal, and Inhibition to Novelty) in a sample of 510 one- to three-year-old children. For all children, Internalizing domain scores decreased over the study, although girls had significantly higher initial levels and boys had steeper declines. General Anxiety increased over the study period and, when modeled individually, girls evidenced higher initial levels and greater increases. For all children, Separation Distress and Inhibition to Novelty decreased significantly over time, while Depression/Withdrawal remained low without change. Findings from our parallel process model, in which all components were modeled simultaneously, revealed that initial levels of internalizing scales were closely associated while rates of change were less closely related. Sex differences in variability around initial levels and rates of change emerged on some scales. Findings suggest that, for one- to three-year-olds, examining scales of the internalizing domain separately rather than as a unitary construct reveals more meaningful developmental and gender variation.