DSM-PC Internalizing and Externalizing Diagnoses Predict Psychiatric Morbidity One Year Later
BACKGROUND
The AAP published the Diagnostic and Statistical Manual for Primary Care (DSM-PC) to help pediatricians identify mental health disorders and newly defined conditions of lesser severity called developmental variation and problem. We developed a computerized parent questionnaire to facilitate making DSM-PC diagnoses as part of the Child Health and Development Interactive System (CHADIS). CHADIS/DSM is now validated for disorder (Sturner, Morrel, and Howard, 2003a) and the new problem and variation categories (Sturner, Morrel, and Howard, 2003b) compared to independent concurrent assessments. Intervention is recommended for the new problem category yet it is not clear if this level is only transient, especially for internalizing difficulties which have been found to persist less than externalizing at this age (e.g.,Lavigne, et al 1998). In addition, unlike externalizing conditions, internalizing symptoms are generally felt to be under reported by parents until symptoms become more severe.
PURPOSE
To describe the DSM-PC mental health status over one year in a group of inner city children, contrasting outcome for internalizing conditions with externalizing.
METHODS
This was a prospective cohort study in which caregivers of a convenience sample of inner city children aged 3 - 12 were administered CHADIS/DSM after child health supervision visits initially and again approximately one year later (mean = 12 months, range 9-19)
RESULTS
Categorical scores were used to represent mental health status: 3 if at least 1 disorder, 2 if no disorder but at least 1 problem, 1 if no disorder or problem but at least 1 variation, 0 if no diagnoses. Total scores show similar stability for internalizing (r = .46, p<.001) and externalizing (r = .51, p<.001) problems. The DSM-PC problem category does not represent transient concerns; significant numbers of children reach the disorder category one year later (17% for internalizing, 35% for externalizing) and half or more have a problem or disorder level diagnosis one year later (50% for internalizing, 65% for externalizing). Children with no diagnosis initially are no more likely to develop serious internalizing problems (4%) than externalizing ones (3%).
CONCLUSIONS
This preliminary study provides evidence for the predictive utility of the DSM-PC risk categories for both internalizing and externalizing diagnoses and provides further justification for implementation of the Academy's recommendation for its use in pediatric practice.
Sturner, R., Morrel, T and Howard, B.J. DSM-PC Internalizing and Externalizing Diagnoses Predict Psychiatric Morbidity One Year Later. Society of Developmental-Behavioral Pediatrics, presented September, 2005.
