title: Disruptive behavior in young children: what does it mean?
abstract: OBJECTIVE
  To examine how the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3) primary diagnoses, Parent-Infant Relationship Global Assessment Scale, and Child Behavior Checklist/2-3 (CBCL/2-3) externalizing and internalizing symptoms augment the DSM-III-R/IV and guide treatment.
  
  
  METHODS
  82 children aged 18 to 47 months, who presented with disruptive behavior to an early childhood psychiatry clinic, were diagnosed using DSM-III-R/IV, DC 0-3, and the CBCL/2-3.
  
  
  RESULTS
  Children with DSM-III-R/IV disruptive disorders or attention-deficit/hyperactivity disorder were diagnosed with DC 0-3 regulatory disorders, disorders of affect, and traumatic stress disorder. Clinically significant externalizing and internalizing symptoms co-presented in 45.1% of the children. Of children with disorders of affect, 41.2% had relationships categorized as disordered, contrasting with 21.1% of those with traumatic stress disorder and 10.3% of those with regulatory disorders. Increasingly disordered relationships were significantly correlated with externalizing and internalizing symptoms, and children with disordered relationships were 3.6 times more likely to have clinically significant levels of internalizing symptoms.
  
  
  CONCLUSIONS
  In these children with disruptive behaviors, co-presentation of externalizing and internalizing symptoms is most common. Those with increased relational risk had more externalizing and internalizing symptoms and more disorders of affect.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Children's National Medical Center, 111 Michigan Avenue N.W., Washington, DC 20010-2970, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Thomas
authors.forename: K A
authors.initials: KA
authors.lastname: Guskin
mesh_terms: D000342:Affective Symptoms / Q000523:psychology*; D002653:Child Behavior Disorders / Q000523:psychology*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010287:Parent-Child Relations; D011379:Prognosis; D011594:Psychometrics; D012307:Risk Factors