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Medical Advances

When Should You Worry About Misbehavior?

A New Approach to Gauging Childhood Behavior

Temper tantrums and meltdowns aren’t unusual for preschool-age children, but frequent and intense irritable behaviors can leave parents questioning what’s normal and what’s not. A new method developed by Northwestern Medicine scientists and outlined in a recent study may be able to distinguish between misbehavior that is expected in early childhood and that which is cause for clinical concern.

“We are generating a science of when to worry in early childhood, a kind of behavioral precision medicine for preschoolers,” said Lauren Wakschlag, PhD, professor and vice chair of Medical Social Sciences at Northwestern University Feinberg School of Medicine.

To get an accurate view of irritable behavior over time, Wakschlag and her team developed a survey called the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB), which asked mothers to report their preschoolers’ irritability at multiple time points. They then used these patterns of irritability to predict which preschoolers would exhibit problems that interfere with their ability to regulate behavior and learning or participate in daily life activities.

“By combining this dimensional approach with 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,” said Wakschlag, who is also a fellow of the Institute for Policy Research.

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

A New Approach to Behavior

“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,” said Ryne Estabrook, PhD, assistant professor in Medical Social Sciences.

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 irritable moods and tantrums. A long-term goal of the scientists is to incorporate such measures 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 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 three- to five-year-old children, in collaboration with scientists at the University of Connecticut, the University of Illinois-Chicago and the National Institute of Mental Health.