Persistence of psychiatric disorders in pediatric settings

Objective: To examine the longitudinal course of subthreshold and full-criteria child psychiatric disorders. Method: Nine hundred ninety-six children, aged 4 to 9 years, from a representative sample of pediatric primary care practices participated in a 1-year follow-up in 1989-1990. Parent interviews included the Diagnostic Interview Schedule for Children, measures of psychosocial problems, stress, social support, possible child abuse, and sociodemographics. Results: The initial prevalence of full and subthreshold disorders was 18.8% and 14.0%, respectively. Full and subthreshold disorders were associated with impairment. Approximately 37% of children with full disorders had persistent disorders. Persistence was more common among boys than girls, particularly when comorbidity was present. Children with initial subthreshold disorders only were five times more likely than those without disorder to develop a full disorder. Persistence of full disorders was associated with high initial symptoms. Among boys, persistence was linked to possible child abuse, whereas among girls it was associated with full externalizing disorders that were accompanied by subthreshold internalizing disorders. Conclusions: Intervention may be particularly crucial when a high number of symptoms and/or both internalizing and externalizing problems are present. Underscoring the importance of family-centered rather than child-centered interventions, boys whose parents reported possible child abuse were more likely to have persistent disorders.