Predictors of Partial Hospital Readmission for Young Children with Oppositional Defiant Disorder.

This study aimed to: (1) examine rates of readmission among young children with oppositional defiant disorder (ODD) following discharge from a psychiatric partial hospital treatment program, and (2) examine child factors (i.e., age, sex, co-occurring diagnoses, suicidality) and family factors (i.e., parental depression, stress) as prospective predictors of readmission. Participants were 261 children (ages 3-7 years) who entered the study at the time of their initial program admission and who met DSM-IV criteria for ODD. Of these 261 children, 61 (23%) were subsequently readmitted, with most readmissions occurring within 1 year. Cox regression survival analyses demonstrated that younger child age, child suicidal thoughts and behavior, and child PTSD diagnosis were associated with decreased time to readmission. Findings suggest that young children with ODD who present with co-occurring suicidality or PTSD are at risk for readmission following partial hospitalization, with implications for treatment and aftercare planning.

Temper Loss and Persistent Irritability in Preschoolers: Implications for Diagnosing Disruptive Mood Dysregulation Disorder in Early Childhood.

Disruptive Mood Dysregulation Disorder (DMDD) is a new and controversial child psychiatric disorder characterized by persistent irritability and frequent temper loss. Among the controversies surrounding DMDD is whether the age of onset criterion-that DMDD may not be diagnosed before age 6 years-is justified. This study examined DMDD symptoms and associated patterns of psychiatric comorbidity, behavioral, and family functioning in a sample of 139 preschoolers (ages 4-0 to 5-11 years) admitted to an early childhood psychiatric day treatment program. DMDD symptoms were common in this acute clinical sample, with 63 children (45.3 %) presenting with frequent temper outbursts and chronic irritability. As compared to children who did not present with DMDD symptoms, these children demonstrated more aggression and emotional reactivity and lower receptive language skills, with high rates of comorbidity with the disruptive behavior disorders. Findings contribute to an emerging literature on preschool DMDD, with implications for early childhood psychiatric assessment and clinical interventions.

Suicidal thoughts and behaviors in psychiatrically referred young children.

Despite increased awareness of the prevalence and seriousness of mental health problems in early childhood, there have been few empirical studies of suicidal thoughts and behaviors in this age group. This study examined suicidal thoughts and behaviors in 360 preschool-aged children (ages 3 to 7 years) presenting to a psychiatric day treatment program. A semi-structured diagnostic interview (conducted with primary caregivers) was used to assess for child suicidal thoughts and behaviors and psychiatric disorders. Participating mothers also reported on their own psychological distress and family psychiatric history. Forty-eight children (13%) were reported to have suicidal thoughts and behaviors, with suicidal plans or attempts endorsed for 2-3% of the sample. Suicidal thinking and behavior was associated with older child age and with higher rates of concurrent depression, oppositional defiant disorder, and posttraumatic stress disorder in univariate analyses, with age and depression remaining as significant predictors in a multivariate logistic regression model. Findings suggest that suicidal thoughts and behaviors are a significant clinical concern for young children presenting with early psychopathology, particularly depression, with implications for early childhood psychiatric assessment and treatment.