The goal is to examine the prevalence, comorbidity and impairment of DSM-IV disorders in 3-year-old children from the Spanish general population.
A sample of 1,341 3-year-old preschoolers were randomly selected and screened for a double-phase design. In total, 622 families were assessed with a diagnostic semi-structured interview and functional impairment measures.
Prevalence of any diagnosis was 29.9 %, the most prevalent disorders being primary insomnia (11.7 %) and oppositional defiant disorder (ODD) (6.9 %). There were no sex differences in the prevalence. One-third of the families had sought professional help for the child’s symptoms, and 9.4 % received treatment (4.4 % psychological and 2.1 % pharmacological). After controlling for other comorbidities, ADHD was significantly associated with ODD, CD, insomnia and social phobia; ODD was associated with CD, separation anxiety, specific phobia and major depression. Diagnostic categories were associated with impairment, family burden, seeking professional help and receiving treatment. A diagnosis was more frequent in children of low socioeconomic status, born outside Spain, from one-parent families, with younger parents and with parents of lower educational level.
Psychopathology, comorbidity and associated factors are very frequent from age three, suggesting a need for efforts of detection, prevention and treatment in the different societies.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Costello EJ, Egger HL, Angold A (2005) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatr 44:972–986
Costello EJ, Foley D, Angold A (2006) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: II. Developmental epidemiology. J Am Acad Child Adolesc Psychiatr 45:8–25
Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescent. Arch Gen Psychiatr 60:837–844
Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS (2010) Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics 125(1):75–81. doi:10.1542/peds.2008-2598
Fanti KA, Henrich CC (2010) Trajectories of pure and co-occurring internalizing and externalizing problems from age 2 to age 12: findings from the National Institute of Child Health and Human Development Study of Early Child Care. Dev Psychol 46:1159–1175. doi:10.1037/a0020659
Slemming K, Sorensen MJ, Thomsen PH, Obel C, Henriksen TB, Linnet KM (2010) The association between preschool behavioural problems and internalizing difficulties at age 10–12 years. Eur Child Adolesc Psychiatr 19:787–795. doi:10.1007/s00787-010-0128-2
Angold A, Egger HL (2007) Preschool psychopathology: lessons for the lifespan. J Child Psychol Psychiatr 48:961–966
Egger HL, Angold A (2006) Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiatr 47:313–337
Egger HL, Erkanli A, Keeler G, Potts E, Walter B, Angold A (2006) Test-retest reliability of the preschool age psychiatric assessment (PAPA). J Am Acad Child Adolesc Psychiatr 45:538–549
Lavigne JV, Lebailly SA, Hopkins J, Gouze KR, Binns HJ (2009) The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. J Clin Child Adolesc Psychol 38:315–328
Birmaher B, Ehmann M, Axelson DA, Goldstein BI, Monk K, Kalas C, Kupfer D, Gill MK, Leibenluft E, Bridge J, Guyer A, Egger HL, Brent DA (2009) Schedule for affective disorders and schizophrenia for school-age children (K-SADS-PL) for the assessment of preschool children–a preliminary psychometric study. J Psychiatr Res 43:680–686
Bufferd SJ, Dougherty LR, Carlson GA, Klein DN (2011) Parent-reported mental health in preschoolers: findings using a diagnostic interview. Compr Psychiatr 52:359–369. doi:10.1016/j.comppsych.2010.08.006
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders-IV. American Psychiatric Association, Washington, DC
World Health Organization (1992) The ICD-10. Classification of mental and behavioral disorders. Clinical descriptions and diagnostic guidelines. World Health Organization, Geneva
Skovgaard AM, Houmann T, Christiansen E, Landorph S, Jorgensen T, Olsen EM, Heering K, Kaas-Nielsen S, Samberg V (2000) Lichtenberg A (2007) The prevalence of mental health problems in children 1 1/2 years of age—the Copenhagen Child Cohort. J Child Psychol Psychiatry 48(1):62–70. doi:10.1111/j.1469-7610.2006.01659.x
Achenbach TM, Rescorla LA (2000) Manual for the ASEBA preschool-age forms & Profiles. University of Vermont, Research Center for Children, Youth & Families, Burlington, VT
Goodman R (1997) The Strenghts and difficulties questionnaire: a research note. J Child Psychol Psychiatr 38:581–586
Koot HM, Verhulst FC (1991) Prevalence of problem behavior in dutch children aged 2–3. Acta Psychiatr Scand 83:1–37
Sourander A (2001) Emotional and behavioural problems in a sample of Finnish three-year-olds. Eur Child Adolesc Psychiatr 10(2):98–104
Holling H, Kurth BM, Rothenberger A, Becker A, Schlack R (2008) Assessing psychopathological problems of children and adolescents from 3 to 17 years in a nationwide representative sample: results of the German health interview and examination survey for children and adolescents (KiGGS). Eur Child Adolesc Psychiatr 17:34–41. doi:10.1007/s00787-008-1004-1
Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatr 40:1337–1345
Ezpeleta L, Granero R, de la Osa N, Penelo E, Doménech JM (2013) Psychometric properties of the strengths and difficulties questionnaire3-4 in 3 year-old preschoolers. Compr Psychiatry 54:282–291. doi:10.1016/j.comppsych.2012.07.009
Ezpeleta L, de la Osa N, Granero R, Doménech JM, Reich W (2011) The diagnostic interview for children and adolescents for parents of preschool children. Psychiatr Res 190:137–144. doi:10.1016/j.psychres.2011.04.034
Reich W (2000) Diagnostic interview for children and adolescents (DICA). J Am Acad Child Adolesc Psychiatr 39:59–66
American Psychiatric Association (2000) DSM-IV Diagnostic and statistical manual of mental disorders. 4th text revised edn. American Psychiatric Association, Washington, DC
Ezpeleta L, Granero R, de la Osa N (1999) Evaluación del deterioro en niños y adolescentes a través de la Children’s global assessment scale (CGAS). Rev Psiquiatría Infanto-Juvenil 1:18–26
Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Arch Gen Psychiatr 40:1228–1231
Altman DG, Machin D, Bryant TN, Gardner MJ (eds) (2000) Statistics with Confidence 2nd Edition, 2nd edn. BMJ Books, London
Newcombe RG (1998) Two-sided confidence intervals for a single proportion: comparison of seven methods. Stat Med 17:857–872
Reef J, van Meurs I, Verhulst FC, van der Ende J (2010) Children’s problems predict adults’ DSM-IV disorders across 24 years. J Am Acad Child Adolesc Psychiatr 49(11):1117–1124. doi:10.1016/j.jaac.2010.08.002
Reef J, Diamantopoulou S, van Meurs I, Verhulst FC, van der Ende J (2011) Developmental trajectories of child to adolescent externalizing behavior and adult DSM-IV disorder: results of a 24-year longitudinal study. Soc Psychiatr Psychiatr Epidemiol 46(12):1233–1241. doi:10.1007/s00127-010-0297-9
Lavigne JV, Cicchetti C, Gibbons RD, Binns HJ, Larsen L, DeVito C (2001) Oppositional defiant disorder with onset in preschool years: longitudinal stability and pathways to other disorders. J Am Acad Child Adolesc Psychiatr 40(12):1393–1400
Maughan B, Rowe R, Messer J, Goodman R, Meltzer H (2004) Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. J Child Psychol Psychiatr 45:609–621
Rowe R, Costello EJ, Angold A, Copeland WE, Maughan B (2010) Developmental pathways in oppositional defiant disorder and conduct disorder. J Abnorm Psychol 119(4):726–738. doi:10.1037/a0020798
Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatr 40:57–87
Farmer E, Burns BJ, Phillips SD, Angold A, Costello EJ (2003) Pathways into and through mental health services for children and adolescents. Psychiatr Serv 54:60–66
Shankman SA, Lewinsohn PM, Klein DN, Small JW, Seeley JR, Altman SE (2009) Subthreshold conditions as precursors for full syndrome disorders: a 15-year longitudinal study of multiple diagnostic classes. J Child Psychol Psychiatr 50(12):1485–1494. doi:10.1111/j.1469-7610.2009.02117.x
Angold A, Messer SC, Stangl D, Farmer E, Costello EJ, Burns BJ (1998) Perceived parental burden and service use for child and adolescent psychiatric disorders. Am J Public Health 88:75–80
Knapp PK, Ammen S, Arstein-Kerslake C, Poulsen MK, Mastergeorge A (2007) Feasibility of expanding services for very young children in the public mental health setting. J Am Acad Child Adolesc Psychiatr 46(2):152–161. doi:10.1097/01.chi.0000246058.68544.35
Kataoka SH, Zhang L, Wells KB (2002) Unmet need for mental health care among US children: variation by ethnicity and insurance status. Am J Psychiatr 159:1548–1555
Lavigne JV, Arend R, Rosenbaum D, Binns HJ, Christoffel KK, Burns A, Smith A (1998) Mental health service use among young children receiving pediatric primary care. J Am Acad Child Adolesc Psychiatr 37(11):1175–1183
Zwaanswijk M, Verhaak PFM, Bensing J (2003) M, van der Ende J, Verhulst FC. Help seeking for emotional and behavioural problems in children and adolescents—A review of recent literature Eur Child Adolesc Psychiatr 12:153–161
Cabiya JA, Canino G, Chavez L (2006) Gender disparities in mental health service use of Puerto Rican children and adolescents. J Child Psychol Psychiatr 47:840–848
Carter AS, Wagmiller RJ, Gray SAO, McCarthy KJ, Horwitz SM, Briggs-Gowan MJ (2010) Prevalence of DSM-IV disorder in a representative, healthy birth cohort at school entry: sociodemographic risks and social adaptation. J Am Acad Child Adolesc Psychiatr 49:686–698. doi:10.1016/j.jaac.2010.03.018
Lavigne JV, Arend R, Rosenbaum D, Binns HJ, Christoffel KK, Gibbons RD (1998) Psychiatric disorders with onset in the preschool years: II. Correlates and predictors of stable case status. J Am Acad Child Adolesc Psychiatr 37:1255–1261
Funding was from Spanish Ministry of Science and Innovation Grant PSI2009-07542. We thank the participating schools and families.
Conflict of interest
Rights and permissions
About this article
Cite this article
Ezpeleta, L., de la Osa, N. & Doménech, J.M. Prevalence of DSM-IV disorders, comorbidity and impairment in 3-year-old Spanish preschoolers. Soc Psychiatry Psychiatr Epidemiol 49, 145–155 (2014). https://doi.org/10.1007/s00127-013-0683-1
- Functional impairment
- Mental disorders
- Service use