Public Release: 

New survey to distinguishing between expectable vs. worrisome early childhood misbehavior

Study published in Journal of the American Academy of Child and Adolescent Psychiatry


Researchers at Northwestern University are using a novel dimensional method for distinguishing misbehavior that is expectable in early childhood versus that which is cause for clinical concern. Their study is published in the August 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Using a survey developed by the researchers to enhance precision of clinical identification in early childhood the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB), scientists obtained mothers' reports of their preschoolers' irritability at multiple time points. They used these irritability patterns to predict which preschoolers would exhibit problems that interfered with their ability to regulate their behavior and learning and participate in daily life activities.

New approaches to mental health problems now recognize that behaviors fall along a continuum or dimension rather than as something you have or you don't have. However, this dimensional approach makes it difficult for clinicians to determine when irritable behavior is a result of normal variation of development and when it is problematic. This contributes to a high level of imprecision in early identification of young children's mental health problems, which may result in both over-and- under treatment of young children.

"Basically, we are generating a science of when to worry in early childhood, a kind of behavioral precision medicine for preschoolers" Lauren Wakschlag, PhD, professor and vice chair of the Department of Medical Social Sciences and fellow of the Institute for Policy Research at Northwestern University Feinberg School of Medicine and lead author of the study said. "By combining this dimensional approach with consideration of other key factors that influence the likelihood that high early irritability will result in mental health problems, our goal is to provide a clinical-decision making roadmap for pediatricians, teachers and mental health professionals caring for young kids."

Using the MAP-DB assessment, the researchers found that children whose irritability scores were at a level typically considered within the normal range had as high as a 67 percent risk of clinical problems. By assessing a broad spectrum of young children's behavior from typical tantrums to destructive tantrums and intense angry mood, researchers were able to calibrate how children's risk increased across the dimensional spectrum.

"The wait and see approach says we should wait until children are in first grade to identify problems, but by this time problems may have spiraled and symptoms may interfere with academic and social growth. With more accurate identification, we can identify kids much earlier and prevent more serious mental health problems later in life. Early, repeated assessment can help us accomplish that," Ryne Estabrook, PhD, assistant professor in Medical Social Sciences at Northwestern University Feinberg School of Medicine and co-lead author of the study said.

While clinical assessments traditionally rely on symptoms defined by extreme behaviors of older youth, the MAP-DB survey captures day-to-day behaviors of preschoolers, to measure how well they manage the irritable moods and tantrums. A long-term goal of the researchers is for such measures to be incorporated into routine pediatric care.

"We aim to move the dial of early identification of young children's behavior problems from the standard wait and see approach to a developmentally-informed watch and wait - with clear, scientifically-based mileposts to guide decision-making," Wakschlag said. "Our goal is to ensure that every child gets the help they need as early as possible, and that professionals have the tools they need to feel confident in making this determination, which is so crucial to ensuring that young children get the support they need to develop healthily."


This study was conducted over an average of 16 months in a diverse community sample of 497, 3-5 year old children, in collaboration with researchers from the University of Connecticut, the University of Illinois-Chicago and the National Institute of Mental Health. The National Institute of Mental Health funded this study.

The article "Clinical Implications of a Dimensional Approach: The Normal: Abnormal Spectrum of Early Irritability" by Lauren S. Wakschlag, Ryne Estabrook, Amelie Petitclerc, David Henry, James L. Burns, Susan B. Perlman, Joel L. Voss, Daniel S. Pine, Ellen Leibenluft, and Margaret Briggs-Gowan, ( appears in the Journal of the American Academy of Child and Adolescent Psychiatry, Volume 54, Issue 8 (August 2015), published by Elsevier.

Notes for editors

Full text of the article is available to credentialed journalists upon request; contact Mary Billingsley at +1 202 587 9672 or Journalists wishing to interview the authors may contact Dr. Lauren S. Wakschlag at

All articles published in JAACAP are embargoed until the day they are published as in press corrected proofs online at Articles cannot be publicized as in press accepted manuscripts. Contents of the publication should not be released to or by the media or government agencies prior to the embargo date.


Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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