Introduction
Disruptive behavior problems in preschool children are a significant concern for families, educators, and public health professionals. Affecting 2–6% of preschoolers, these issues are a primary reason for referral to child mental health services (APA, 2000; Keenan & Wakschlag, 2000). These behaviors often emerge as early as 3 to 4 years of age (Campbell, Ewing, Breaux, & Szumowski, 1986; Keenan, Shaw, Delliquadri, Giovannelli, & Walsh, 1998; Loeber, 1990) and can persist into later childhood and adolescence if left unaddressed (Earls, 1980; White, Moffitt, Earls, & Robbins, 1990; Zahn-Waxler, Ianotti, Cummings, & Denham, 1990). Studies indicate that a significant portion of preschoolers exhibiting disruptive behavior continue to display these challenges as they grow older (Campbell, 1990; Egeland, Kalkoske, Gottesman, and Erickson, 1990; Loeber, 1982). Understanding and accurately diagnosing these early behaviors is crucial for effective intervention and long-term well-being.
A key challenge in studying preschool disruptive behavior is the use of two distinct diagnostic approaches: categorical and dimensional. These methods, while both valuable, don’t always yield directly comparable results (Eyberg, Schuhmann, & Rey, 1998; Keenan & Wakschlag, 2000; Waldman, Lilienfeld, & Lahey, 1995). Categorical diagnosis relies on established criteria, like those in the DSM-IV (APA, 2000), to classify behavior as either present or absent. In contrast, dimensional diagnosis views behaviors on a spectrum of frequency and severity, often using tools like the Child Behavior Checklist (CBCL) (Achenbach & Edelbrock, 1983; Lavigne et al., 1996). Each approach has its strengths and weaknesses, rooted in extensive research traditions (Beauchaine, 2003; Cohen, 1983; Meehl, 2001).
1. Categorical vs. Dimensional Approaches: A Detailed Comparison
Research comparing categorical and dimensional approaches in child and adolescent disruptive behavior has sought to clarify their similarities and differences. While both methods provide related data, direct comparisons can be complex due to varying measurement tools and analytical techniques (Scholte, Van Berckelaer-Onnes, & Van Der Ploeg, 2002; Teagarden & Burns, 1999).
Comparison of categorical and dimensional assessment methods for preschool disruptive behavior, highlighting the comparable data they yield.
To date, only a limited number of studies have directly compared these approaches in preschool settings (Pelletier, Collett, Gimpel, & Crowley, 2006; Sprafkin, Volpe, Gadow, Nolan, & Kelly, 2002). These studies utilized different categorical and dimensional rating scales. Pelletier et al. (2006) found significant correlations between the Disruptive Behavior Disorders Rating Scale (DBDRS, categorical) and the School Situations Questionnaire (SSQ, dimensional) in measuring ADHD (r = .77, p < .01) and ODD (r = .69, p < .01). Similarly, Sprafkin et al. (2002) using the Early Childhood Inventory-4 (ECI-4, categorical) and the Child Behavior Checklist (CBCL, dimensional) also found strong correlations for both ADHD (r = .70, p < .001) and ODD (r = .81, p < .001). These initial findings suggest a strong convergence between categorical and dimensional assessments of early disruptive behavior.
2. Stability of Early Disruptive Behavior: Categorical and Dimensional Perspectives
The stability of disruptive behavior over time in young children has been explored using both categorical and dimensional approaches in several studies (Campbell, 1994; Campbell & Ewing, 1990; Crawford & Lee, 1991; Gadow, Sprafkin, & Nolan, 2001; Olson & Brodfeld, 1991). However, comparing results across these studies is challenging due to the variety of assessment tools and methodologies employed.
Generally, research from both perspectives indicates that early disruptive behavior tends to be a stable trait. Categorical studies, for example, by Gadow et al. (2001), showed that preschoolers identified with disruptive symptoms on the ECI-4 maintained these symptoms eight months later (r = .46, p < .05). Lahey et al. (2005) using the Diagnostic Interview Schedule for Children (DISC) and DBDRS, also found stability over a one-year period (r = .23, p < .05). Longitudinal stability was demonstrated by Pierce, Ewing, and Campbell (1999), showing that a significant percentage of children with behavior problems at age 3 continued to meet criteria for externalizing disorders at ages 9 and 13.
Descriptive statistics illustrating the stability of disruptive behavior in preschoolers across different age groups and studies.
Dimensional studies reinforce this stability. Crawford and Lee (1991) found consistent CBCL ratings of externalizing problems over a 6-week period. Similarly, Campbell (1994) using the CBCL across ages 3 and 6 demonstrated that children with high initial ratings tended to maintain elevated ratings three years later.
Despite consistent findings of stability, comparisons are complicated by variations in definitions of disruptive behavior, timeframes for stability assessment (6 weeks to 10 years), and statistical measures used (chi-square, correlations, percentages). Meta-analysis, which converts diverse statistics into effect sizes, offers a valuable tool to quantitatively compare stability estimates from both categorical and dimensional approaches.
3. Differentiating Referred vs. Non-Referred Preschoolers: Efficacy of Diagnostic Approaches
Another critical question is whether categorical and dimensional approaches can effectively distinguish between preschoolers referred for clinical services due to disruptive behavior and those not referred. Evidence suggests both approaches are successful in this differentiation.
Categorical studies using instruments like SNAP (Campbell, 1994), ECI-4 (Gadow et al., 2001), PBQ (Pierce et al., 1999), and K-DBDS (Keenan et al., 2007) have consistently shown that referred children can be distinguished from their non-referred peers. Dimensional studies, primarily using the CBCL (Achenbach, Edelbrock, & Howell, 1987; Campbell & Ewing, 1990; Heller, Baker, Henker, & Hinshaw, 1996), also demonstrate that referred preschoolers exhibit significantly higher scores on measures of disruptive behavior. Despite variations in definitions and methodologies, both categorical and dimensional methods lead to similar conclusions in differentiating referred and non-referred children.
Table showing effect sizes from studies comparing disruptive behavior in referred versus non-referred preschoolers, assessed via categorical and dimensional approaches.
4. Meta-Analytic Review: Integrating Findings Across Studies
To synthesize the existing research, a meta-analysis was conducted on 26 studies employing categorical and/or dimensional approaches to assess preschool disruptive behavior. This review aimed to determine if, regardless of assessment method: (a) disruptiveness is measurable in preschool years; (b) early disruptiveness is stable; and (c) referred disruptive preschoolers are distinguishable from non-referred peers.
The meta-analysis included studies identified through systematic searches of databases like PsycINFO and MEDLINE, manual journal searches, researcher inquiries, and reference list reviews. Studies were included if they met specific criteria regarding language (English), age range (2-7 years), sample size (≥25), informant type (parents/teachers), use of categorical and/or dimensional measures, addressing research questions, and use of unique samples.
Data from the 26 selected studies, encompassing 4,536 preschoolers, were coded and analyzed to calculate effect sizes. Hedge’s g and Cohen’s d were used to assess individual and cumulative effects, respectively.
5. Key Findings of the Meta-Analysis
The meta-analysis revealed several significant findings:
- Comparable Data from Categorical and Dimensional Approaches: The weighted mean effect size (d = 2.29) indicated a strong correlation between categorical and dimensional measures of early disruptiveness. This suggests that both approaches provide similar information about disruptive behavior in preschoolers.
- Stability of Preschool Disruptive Behavior: Both categorical (d = 1.15) and dimensional (d = 0.84) approaches yielded comparable, large effect sizes for the stability of preschool disruptive behavior over time. This confirms that early disruptive behavior is generally a stable trait, regardless of the measurement method.
- Discrimination Between Referred and Non-Referred Preschoolers: Both categorical (d = 1.05) and dimensional (d = 0.95) approaches effectively differentiated between referred and non-referred preschoolers. This demonstrates that both methods are valid for identifying children with clinically significant disruptive behavior.
These findings, based on a robust meta-analysis, underscore the validity and utility of both categorical and dimensional approaches in understanding and diagnosing disruptive behavior in preschool children.
Discussion
This meta-analysis confirms that both categorical and dimensional approaches are effective tools for assessing and understanding disruptive behavior in preschool children. The finding that both methods yield comparable data, stability estimates, and discrimination between referred and non-referred groups is significant. It suggests that researchers and clinicians can confidently use either approach, or a combination of both, in their work with young children.
The consistency between categorical and dimensional approaches has important implications for both research and clinical practice. It suggests that these approaches are complementary and can be used together to provide a more comprehensive understanding of early disruptiveness (Arend et al., 1996). For example, categorical diagnoses can be useful for clinical decision-making and communication, while dimensional measures can provide richer information about the severity and nuances of behavior problems.
The confirmed stability of early disruptive behavior emphasizes the critical need for early intervention and prevention programs targeting preschool children and their families (Dumas, Nissley-Tsiopinis, & Moreland, 2006; Kazdin, 2005; Keenan & Wakschlag, 2000; Dodge, Coie, & Lynam, 2006). Addressing these issues early can potentially alter the developmental trajectory and prevent long-term negative outcomes.
Limitations and Future Directions
Despite the valuable insights, this meta-analysis has limitations. It primarily focused on methodological comparison rather than delving into the specific behaviors characterizing early disruptiveness or their developmental pathways. Furthermore, the review is limited by the assessment tools predominantly used in the included studies. Categorical measures often rely on DSM-IV criteria, and dimensional research heavily depends on the CBCL, potentially narrowing the scope of “categorical” and “dimensional” definitions in practice.
The number of studies directly addressing the research questions, especially the comparison of approaches, was limited, highlighting a need for more focused research on preschool disruptiveness. Future research should aim to replicate and expand upon these findings, particularly with age-specific analyses in studies spanning broader age ranges.
Sample diversity was also limited, with a majority of studies focusing on boys of Caucasian ethnicity. Future research needs to include more diverse samples in terms of gender and ethnicity to ensure the generalizability of these findings across different populations. Furthermore, more comprehensive reporting of demographic information and statistical data in primary studies is crucial for future meta-analytic work.
To advance the field, future studies should strive to be more comprehensive, incorporating both categorical and dimensional measures, longitudinal designs, diverse samples, and detailed reporting. Such studies would provide a more nuanced understanding of early disruptive behavior and its assessment.
Conclusion
This meta-analysis provides compelling evidence that both categorical and dimensional approaches are valuable and comparable in measuring early disruptive behavior. They both demonstrate the stability of these behaviors and effectively distinguish between referred and non-referred preschoolers. These findings underscore the importance of early identification and intervention for disruptive behavior problems, suggesting that either diagnostic approach, or their combined use, can effectively contribute to this critical endeavor from as early as age 3.
Acknowledgements
This study was supported by grants R21 HD40079 and R49/CCR 522339.
Footnotes
2 Journals searched: Development and Psychopathology, Journal of Abnormal Child Psychology, Journal of Child Psychology and Psychiatry, Journal of Clinical Child Psychology, Journal of the American Academy of Child and Adolescent Psychiatry.
3 Demographic statistics are based on studies reporting this information.
References
*
[R1] Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. University of Vermont, Department of Psychiatry.
[R2] Achenbach, T. M., Edelbrock, C. S., & Howell, C. T. (1987). Direct observation of maladaptive behavior: I. Factorially derived syndromes. Journal of Abnormal Child Psychology, 15(3), 477–494.
[R3] Alink, L. R. A., Mesman, J., Van Zeijl, J., Stolk, J., Juffer, F., & Koot, H. M. (2006). The early childhood aggression curve: Relations with maternal sensitivity and insensitive discipline in early childhood. Aggressive Behavior, 32(1), 49–65.
[R4] American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.).
[R5] Arend, R., Lavigne, J. V., Rosenbaum, D., Binns, H. J., & Christoffel, K. K. (1996). Dimensional and categorical approaches to the assessment of behavioral and emotional problems in preschool children: A multi-method study. Journal of Clinical Child Psychology, 25(1), 57–67.
[R6] Beauchaine, T. P. (2003). Taxometrics and developmental psychopathology. Development and Psychopathology, 15(3), 497–527.
[R7] Braswell, L., August, G., Bloomquist, M. L., & Realmuto, G. M. (1997). School-based secondary prevention for children with disruptive behavior: Integrating cognitive-behavioral and family support interventions. Journal of Abnormal Child Psychology, 25(3), 195–209.
[R8] Campbell, S. B. (1987). Parent-referred problem three-year-olds: Follow-up at seven years. Journal of Child Psychology and Psychiatry, 28(6), 801–815.
[R9] Campbell, S. B. (1990). Prediction of behavioral problems in childhood and adolescence: A prospective longitudinal study. In M. Lewis & S. M. Miller (Eds.), Handbook of developmental psychopathology (pp. 41–59). Plenum Press.
[R10] Campbell, S. B. (1994). Hard-to-manage preschool boys: Externalizing behavior up to 9 years and academic outcomes in first grade. Journal of Abnormal Child Psychology, 22(2), 147–169.
[R11] Campbell, S. B., & Ewing, L. J. (1990). Hard-to-manage preschoolers: Adjustment at age 9 years and predictors of continuing symptoms. Journal of Child Psychology and Psychiatry, 31(6), 871–889.
[R12] Campbell, S. B., Ewing, L. J., Breaux, A. M., & Szumowski, E. K. (1986). Parent-referred problem preschoolers: Mother-child interaction during play at ages 2 and 3. Journal of Abnormal Child Psychology, 14(2), 177–191.
[R13] Cohen, J. (1983). The cost of dichotomization. Applied Psychological Measurement, 7(3), 249–253.
[R14] Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.
[R15] Crawford, J. W., & Lee, C. B. (1991). Prediction of kindergarten peer status from teacher and peer ratings in preschool. Journal of Psychoeducational Assessment, 9(2), 159–167.
[R16] Dodge, K. A., Coie, J. D., & Lynam, D. (2006). Aggression and antisocial behavior in youth. In N. Eisenberg, W. Damon, & R. M. Lerner (Eds.), Handbook of child psychology: Social, emotional, and personality development (6th ed., Vol. 3, pp. 719–788). John Wiley & Sons Inc.
[R17] Dumas, J. E. (1996). Why parent training doesn’t work. Guilford Press.
[R18] Dumas, J. E., Nissley-Tsiopinis, J., & Moreland, A. D. (2006). Home-based parent training with families of young children at risk for conduct disorder: Follow-up into middle childhood. Journal of Consulting and Clinical Psychology, 74(3), 531–543.
[R19] Earls, F. (1980). Prevalence of behavior problems in 3-year-old children. Archives of General Psychiatry, 37(10), 1153–1157.
[R20] Egeland, B., Kalkoske, M., Gottesman, N., & Erickson, M. F. (1990). Preschool behavior problems: Stability and factors accounting for change. Journal of Child Psychology and Psychiatry, 31(6), 891–909.
[R21] Eyberg, S. M., Schuhmann, E. M., & Rey, J. M. (1998). Disruptive behavior disorders in children. In T. H. Ollendick & M. Hersen (Eds.), Handbook of child psychopathology (3rd ed., pp. 491–529). John Wiley & Sons Inc.
[R22] Fagot, B. I., & Leve, C. S. (1998). Behavior problems in toddler boys: Predictors of externalizing and internalizing problems at age 8 years. Development and Psychopathology, 10(4), 655–671.
[R23] Gadow, K. D., Sprafkin, J., & Nolan, E. E. (2001). Stability of DSM-IV symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. Journal of Child Psychology and Psychiatry, 42(4), 487–494.
[R24] Gillion, P. J., Shaw, D. S., Beck, J. E., Schonberg, M. A., & Lukon, J. L. (2002). Trajectories of externalizing problem behavior across the transition to school. Development and Psychopathology, 14(1), 141–161.
[R25] Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Academic Press.
[R26] Heller, T. L., Baker, B. L., Henker, B., & Hinshaw, S. P. (1996). Externalizing behavior and cognitive functioning from preschool to first grade: Stability and prediction. Journal of Abnormal Child Psychology, 24(4), 433–451.
[R27] Johnson, B. T. (1989). DSTAT: Software for the meta-analytic review of research literatures. Lawrence Erlbaum Associates.
[R28] Kazdin, A. E. (2005). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. Oxford University Press.
[R29] Keenan, K., Shaw, D., Delliquadri, E., Giovannelli, J., & Walsh, B. (1998). Evidence for the continuity of early problem behaviors: Application of a developmental psychopathology perspective. In J. Rolf, B. E. Compas, & S. B. Maze (Eds.), Risk and protective factors in the development of psychopathology (pp. 93–118). Cambridge University Press.
[R30] Keenan, K., & Wakschlag, L. S. (2000). More than just “bad boys”: The clinical utility of differentiating among preschool children with aggressive behavior. Journal of Clinical Child Psychology, 29(1), 33–46.
[R31] Keenan, K., Wakschlag, L. S., Danis, B., Hill, C., Seroczynski, A., & Kovacs, E. (2007). The Kiddie-Disruptive Behavior Disorders Scale: Convergent and discriminant validity. Journal of the American Academy of Child and Adolescent Psychiatry, 46(2), 231–239.
[R32] Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Willcutt, E. (2005). Instability of ADHD subtypes from preschool to kindergarten. Development and Psychopathology, 17(1), 63–85.
[R33] Lavigne, J. V., Cicchetti, D., Binns, H. J., Christoffel, K. K., Arend, R., Rosenbaum, D., et al. (1998). Oppositional defiant disorder with onset in preschool years: Longitudinal stability and pathways to other disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 37(10), 1077–1085.
[R34] Lavigne, J. V., Cicchetti, D., Binns, H. J., Christoffel, K. K., Keller, K. J., & Klein, R. G. (1998). Disruptive behavior disorders in early childhood: Longitudinal course and predictions of later behavior problems. Development and Psychopathology, 10(4), 689–705.
[R35] Lavigne, J. V., LeBailly, S. A., Hopkins, J., Gouze, K. R., Binns, H. J., & Lavin, M. A. (1996). The prevalence rates and correlates of psychiatric disorders among preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 35(2), 204–214.
[R36] Loeber, R. (1982). The stability of antisocial and delinquent child behavior: A review. Child Development, 53(6), 1431–1446.
[R37] Loeber, R. (1990). Development and psychopathology. Development and Psychopathology, 2(4), 403–407.
[R38] Marakovitz, S. F., & Campbell, S. B. (1998). Predicting boys’ externalizing problems at age 7 from preschool behavior and family characteristics. Journal of Abnormal Child Psychology, 26(2), 101–117.
[R39] Masse, L. C., & Tremblay, R. E. (1999). Behavior of boys in kindergarten predicts substance use and delinquency during adolescence. Archives of General Psychiatry, 56(1), 62–68.
[R40] Meehl, P. E. (2001). Taxometric methods. Psychological Methods, 6(4), 355–382.
[R41] Mesman, J., & Koot, H. M. (2001). Child behavior checklist-preschool behavior problems: Cross-cultural comparisons for parent and teacher ratings. Journal of Abnormal Child Psychology, 29(2), 157–175.
[R42] Mesman, J., Bongers, I. L., & Koot, H. M. (2001). Preschoolers’ behavior problems at home and day care: Interrelations and relations with maternal characteristics. Early Education & Development, 12(3), 353–371.
[R43] Olson, S. L., & Brodfeld, B. S. (1991). Developmental and contextual correlates of conduct problems and hyperactivity in preschoolers: The significance of socioeconomic status, child maltreatment, and maternal characteristics. Journal of Abnormal Child Psychology, 19(4), 479–496.
[R44] Owens, E. B., & Shaw, D. S. (2003). Poverty and early childhood adjustment: Cumulative risk and multiple регуляция perspectives. Clinical Child and Family Psychology Review, 6(1), 1–25.
[R45] Pelletier, L. A., Collett, B. R., Gimpel, G. A., & Crowley, S. L. (2006). Convergent validity of categorical and dimensional measures of disruptive behavior disorders in preschoolers. Early Childhood Research Quarterly, 21(2), 205–218.
[R46] Pierce, E. W., Ewing, L. J., & Campbell, S. B. (1999). Diagnostic status and symptomatic behavior of hard-to-manage preschoolers at ages 3 and 6: Relations to observed mother-child interaction. Journal of Clinical Child Psychology, 28(1), 54–66.
[R47] Querido, J. G., & Eyberg, S. M. (2003). Concurrent validity of the Disruptive Behavior Rating Scale for parents of preschoolers. Child & Family Behavior Therapy, 25(2), 1–17.
[R48] Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86(3), 638–641.
[R49] Scholte, E. M., Van Berckelaer-Onnes, I. A., & Van Der Ploeg, J. D. (2002). Rating scales for child psychopathology: Current status of psychometric research. Journal of Child Psychology and Psychiatry, 43(2), 155–182.
[R50] Shaw, D. S., Owens, E. B., Giovannelli, J., & Winslow, E. B. (2001). Infant and toddler pathways to chronic externalizing problems. Development and Psychopathology, 13(4), 801–825.
[R51] Speltz, M. L., McClellan, J., DeKlyen, M., & Jones, K. (1999). Preschool boys with oppositional defiant disorder and conduct disorder: Comparison of subtypes based on co-occurring attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 27(1), 71–85.
[R52] Sprafkin, J., Volpe, R. J., Gadow, K. D., Nolan, E. E., & Kelly, K. (2002). Convergent validity of two preschool behavior rating scales: Categorical and dimensional agreement. Journal of Psychoeducational Assessment, 20(4), 309–323.
[R53] Teagarden, J. R., & Burns, B. J. (1999). Dimensional versus categorical approaches to child psychopathology. Journal of Emotional and Behavioral Disorders, 7(3), 130–139.
[R54] Vondra, J. I., Shaw, D. S., Swearingen, L., Cohen, M. K., & Owens, E. B. (2001). Attachment security as a predictor of early externalizing problems in high-risk children. Journal of Consulting and Clinical Psychology, 69(4), 683–697.
[R55] Wakschlag, L. S., & Keenan, K. (2001). Clinical significance versus statistical significance in research on childhood disruptive behavior: Exemplars and implications. Clinical Child and Family Psychology Review, 4(2), 139–157.
[R56] Waldman, I. D., Lilienfeld, S. O., & Lahey, B. B. (1995). Toward construct validity of psychopathy: Dimensionality and distinction from externalizing. In J. P. Wright, J. P. Walters, & P. T. Brickman (Eds.), Advances in criminological theory: Vol. 6. Biosocial criminology: Integrating biological and sociological predictors of criminality (pp. 71–104). Transaction Publishers.
[R57] White, J. L., Moffitt, T. E., Earls, F., & Robbins, L. N. (1990). How old were subjects when they showed first signs of conduct disorder? Journal of Abnormal Child Psychology, 18(5), 511–523.
[R58] Wolf, F. M. (1986). Meta-analysis: Quantitative methods for research synthesis. Sage Publications.
[R59] Wortman, P. M. (1994). Judgment and decision making research: A descriptive analysis based on the Journal of Behavioral Decision Making. In J. P. Caverni, M. Bar-Hillel, F. H. Barron, & H. Jungermann (Eds.), Contributions to decision making (Vol. 1, pp. 3–26). Elsevier Science.
[R60] Zahn-Waxler, C., Ianotti, R. J., Cummings, E. M., & Denham, S. (1990). Antecedents of problem behaviors in children: A prospective study. In J. Burchard & S. Burchard (Eds.), Prevention of child maladjustment: Progress, promise, and problems (pp. 223–256). Sage Publications, Inc.
