1 in 5 preschoolers in the US demonstrates mental health issues when entering kindergarten

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Social competence and behavior problems that are evident at kindergarten and first grade are known to be strong predictors of a child's academic and social functioning. However, findings reported in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry suggest that psychosocial risk factors can be identified even earlier and can be observed during the transition from preschool to formal schooling.

The article titled "Prevalence of DSM-IV Disorder in a Representative, Healthy Birth Cohort at School Entry: Sociodemographic Risks and Social Adaptation" Dr. Alice S. Carter and colleagues report on 1,329 healthy children born between July 1995 and September 1997 in the New Haven–Meriden Standard Metropolitan Statistical Area of the 1990 Census. The researchers sought to determine the prevalence of psychiatric disorders in the early elementary school years and to examine the relationship between the sociodemographic and psychosocial risk factors and these disorders.

The study sample was ascertained through birth records, and represents one of the first longitudinal studies to evaluate psychopathology in children within the United States as they negotiate the transition to school. One parent from each family of a subsample of 442 enriched for child psychopathology was interviewed using the Diagnostic Interview Schedule for Children–Version IV (DISC IV) to determine the diagnosis. Parents were surveyed about sociodemographic factors, such as parental age and education, and poverty as well as psychosocial characteristics. Both parents and teachers of the children were surveyed about social competence.

Dr. Carter and colleagues report that as children transition to formal schooling, approximately one in five (21.6%) will have a psychiatric disorder with impairment. The findings confirm that the prevalence of psychopathology during the transition to school age is not dissimilar to that documented for preschool-aged children.

In addition, the risk of comorbidity (the risk of two or more disorders of any type) was 5.8%. Within the study cohort, the prevalence of externalizing disorders was 13.8% and 11.1% for internalizing disorders. Of those individuals who had more than one disorder, more than 60% had both an externalizing and an internalizing disorder.

In the article, the researchers report, "Sociodemographic and psychosocial correlates included persistent poverty beginning in early childhood, limited parental education, low family expressiveness, stressful life events, and violence exposure. Finally, diagnostic status was significantly associated with poorer social competence and family burden."

An accompanying editorial by Dr. Neil W. Boris of Tulane University can be found in the same issue of the Journal of the American Academy of Child and Adolescent Psychiatry. About the study, Dr. Boris states, "More than anything, Carter et al. remind us that young children are at significant risk for psychopathology just like older children. As children transition to school age, be on the lookout for problems."

Commenting on the potential impact of their findings, Carter and colleagues observe, "Epidemological data on prevalence and risk co-incidence with disorders during the transition to school can and should inform conversations about psychosocial school readiness, early intervention, and prevention programming."

Screening for psychopathology at the transition to school age is warranted and based on the impairment data of affected children early intervention seems appropriate. Cater and colleagues further state that, "intervention should also take into account the social context, not only within the school setting but also with respect to risk factors in the home and broader community."

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