Defining the “Disruptive” in Preschool Behavior: What Diagnostic Observation Can Teach Us

Abstract

This paper presents the clinical/developmental framework underlying a new diagnostic observational tool, the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). The special importance of observation for clinical assessment during the preschool period is delineated. The developmental rationale for a multi-dimensional assessment of disruptive behavior in young children, including problems in modulation of negative affect and low competence is discussed. The ways in which the DB-DOS will elucidate distinctions between normative and atypical behavior during this developmental period via (a) the integration of qualitative and quantitative dimensions of behavior within a clinically-sensitive coding system, (b) the observation of child behavior both within, and outside of, the parent-child context and (c) the use of specially designed tasks to "press" for clinically salient behaviors are addressed. The promise of this new method for yielding a more precise, developmentally based description of the phenotype of early onset disruptive behavior problems and for providing a standardized clinical tool for observational assessment of disruptive behavior in young children is presented. Large-scale validation of the measure is currently underway.

Clinical Usefulness of Observational Assessment in the Diagnosis of DBD and ADHD in Preschoolers

“…The question has indeed been raised as to how one differentiates clinical from normative transient disruptive behaviors within the preschool age, as most preschoolers exhibit at least some of the behaviors that fall under the rubric of disruptive behavior. This makes clinical assessment of preschool behavioral problems particularly subtle and complex (Wakschlag et al, 2005). In connection with this, a point of concern is the possibility of overidentification of preschool children as having ODD, CD, or ADHD, as the manifestations of most of the symptoms of these disorders are not atypical per se when observed in a preschooler, for example, losing his temper and physical aggression (Keenan et al, 2007).…”

Child and informant influences on behavioral ratings of preschool children

“…The identification of problem behaviors in the preschool period is complicated by the fact that many of the behaviors later seen as symptomatic of an externalizing disorder are normative and, in some cases, developmentally appropriate in this age group (Campbell, Pierce, Moore, Marakovitz, & Newby, 1996; Wakschlag et al, 2005). Some children will display noncompliant behavior toward their parents as they test limits and learn to function autonomously.…”

Relations between executive function and emotionality in preschoolers: Exploring a transitive cognition–emotion linkage

“…Smith-Donald et al (2007) developed a two-part assessment of self-regulation, the Preschool Self-Regulation Assessment (PSRA), which is composed of a direct assessment battery and an assessor report (AR) capturing global behavior. The AR consists of several rating items from the Leiter-R social–emotional rating scale (Roid and Miller, 1997) and the Disruptive Behavior-Diagnostic Observation Schedule (Wakschlag et al, 2005). A second study conducted by Isquith et al (2004) sought to downwardly shift the Behavior Rating Inventory of Executive Function (BRIEF) for a preschool sample (BRIEF-P).…”