IMPORTANCE OF EARLY INTERVENTION
A younger age of onset is associated with greater
severity of disruptive behavior throughout its
course,19 and disruptive behavior can be reliably
identified in children as young as age 3.32,41 Evidence
also suggests that intervention is more
effective at the preschool age than when children
are older.42–44 Effective treatment of disruptive behavior
prior to school entry may prevent the
associated problems with academic performance
and peer relationships that require multiple interventions
only a few years later.45–47
Primary care physicians are often the only professionals
to see young children before school
entry48 and are thus critical to early identification.
Studies49–51 have found that at least 20% of the 2- to
5-year-olds seen in primary care settings have
Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV)52 disorders, yet
young children with significant psychopathology
are frequently not referred for treatment.53 Identification
of child psychopathology is difficult.
Costello et al49 found that pediatricians were able to
correctly identify only 17% of children with mental
health problems. With increasing use of the Diagnostic
and Statistical Manual for Primary Care
(DSM-PC),54 recognition of the problems that require
referral to mental health providers is likely to
improve. Further, due to their effectiveness in
screening, behavior rating scales have been recommended
for use in primary care settings.2 The use
of rating scales has been shown to improve pediatrician
recognition and referral of children who
need mental health treatment.55 In the authors’
experience, pediatricians are the primary referral
source for children referred from the health center
to the clinic for parent-child interaction therapy.