Characteristics of an infant/preschool psychiatric clinic sample: Implications for clinical assessment and nosology

The purpose of this study was to describe the methods of clinical assessment in an academic infant/preschool subspecialty clinic and to investigate the psychosocial demographic and diagnostic characteristics of this outpatient population. The clinic charts of 120 patients seen by the clinic director (first author) and second-year child psychiatry fellows were reviewed for data entry and analysis. Patients and their primary caretakers had undergone a comprehensive, multiple-session interactive play assessment to formulate clinical diagnoses using the DSM-III-R. Mean age of patients was 42 months ±13 with a range of 9 to 70 months. Similar to previous reports, a preponderance of externalizing disorders were seen (66%). A variety of Axis I DSM-III- R diagnoses were found and 37% of children had a developmental disorder on Axis II. Not-otherwise-specified categories were used in 8% of cases due to the lack of any other appropriately descriptive classification. Eighty-eight percent of these occurred in children younger than 4 years of age. A high rate of prematurity (20%), maternal psychiatric history (44%), as well as the use of corporal punishment (28% frequent; 37% occasional) was found in the sample. The implications of these findings for the clinical assessment and classification of early onset psychiatric disorders are discussed. The utilization of mental health services by the youngest children for whom the DSM taxonomy was disproportionately inadequate is noted.