Assessing Disordered Thoughts in Preschoolers with Dysregulated Mood

Abstract

Objectives There is rising interest in identifying precursors to bipolar disorder symptoms, including thought disorder. Thought disorder is identified in adults through self-report and in school-aged children through parent report and child story-telling. This study is an exploration to determine if preschoolers with mood dysregulation have evidence of disordered thoughts using a story-stem completion method. Methods Participants included two groups of 3.5–6 year-old children: 20 with mood dysregulation including manic symptoms and 11 typically-developing comparison children. Children were administered story completion narratives including one story where the child character accidentally cuts him/herself while pretending to cook. The children were asked to complete the stories and their responses were analyzed for atypical themes consistent with disordered thoughts such as violence or bizarreness outside of the story or props coming to life. Results 35% of symptomatic preschoolers versus 0% of typically-developing preschoolers ascribed independent actions to inanimate props (p=0.03). 80% of symptomatic preschoolers versus 9% of typically-developing preschoolers utilized props in a violent or bizarre manner outside the central story (p<0.001). Conclusions Preschool children with symptoms of dysregulated mood express themes related to the unusual use of story props which may indicate disordered thoughts. This preschool expression of dysregulated mood appears similar to and possibly continuous with school-age and adult versions of bipolar disorder.

Thought Disorder in Preschool Children with Attention Deficit/Hyperactivity Disorder (ADHD)

“…This is consistent with the previous reports (26), providing additional support to the hypothesis that thought disorder can be reliably detected in preschool children using story stems.…”

“…The scoring method used to rate thought disorder was developed to address prevalent themes in stories found in prior work (26). These themes included bizarreness or violence outside of the original story stem and props coming to life and acting on their own accord.…”

“…Recently, we have developed a process for identifying thought disorder in preschool children which involves the use of story stems (26). In preschoolers, thought disorder can manifest as bizarreness or violence outside of the initial content of a story stem or having props in a story come to life and act on their own accord.…”

“…Story Stem paradigms can elicit violent themes in preschoolers with a history of violence or violence exposure; however, that violence tends to be expressed within the context of the story-line; the expression of violent themes unrelated to the story are thought to be more reflective of thought disorder. Similarly, while the purpose of Story Stem paradigms including props is for children to use (“play”) with the props, the embodiment of the prop with an independent identity whose actions are only tangentially or even unrelated to the initial story theme is unusual in other populations and felt to be evidence of thought disorder (26). Preschool children exhibiting symptoms of severe mood and behavioral dysregulation, which may now fall under the Diagnostic and Statistical Manuals, Fifth Edition (DSM 5)(27) category of Disruptive Mood Dysregulation Disorder (DMDD) commonly exhibit thought disorder, with 80% being identified as having thought disorder as compared to 9% of healthy comparison children (26).…”

“…Similarly, while the purpose of Story Stem paradigms including props is for children to use (“play”) with the props, the embodiment of the prop with an independent identity whose actions are only tangentially or even unrelated to the initial story theme is unusual in other populations and felt to be evidence of thought disorder (26). Preschool children exhibiting symptoms of severe mood and behavioral dysregulation, which may now fall under the Diagnostic and Statistical Manuals, Fifth Edition (DSM 5)(27) category of Disruptive Mood Dysregulation Disorder (DMDD) commonly exhibit thought disorder, with 80% being identified as having thought disorder as compared to 9% of healthy comparison children (26). In children ages 7 and older, thought disorder is present not only in children with severe psychiatric illnesses, but also is present in a broader range of psychopathology including ADHD (28).…”