Peer Problems and Hyperactivity-Impulsivity Among Norwegian and American Children: The Role of 5-HTTLPR

Peer problems are linked to attention deficit hyperactivity disorder (ADHD) symptoms and the serotonin system is thought to be involved in ADHD-related behavior. Hence, from a Gene × Environment perspective, the serotonin transporter 5-HTTLPR may play a moderating role. In two large community samples, the moderating role of 5-HTTLPR was examined related to more hyperactivity-impulsivity symptoms (HI symptoms) predicted by more peer problems. In Study 1, involving 642 Norwegian children, results indicated that for s-allele carriers only, caregiver-reported peer problems at age 4 predicted more parent-reported HI symptoms at age 6. In Study 2, similar results emerged involving 482 American children. Discussion focuses on differential sensitivity to the adverse effects of poor peer relations.

Physical Activity, Sedentary Behavior, and Symptoms of Major Depression in Middle Childhood

OBJECTIVE

The prospective relation between physical activity and Diagnostic and Statistical Manual of Mental Disorders-defined major depression in middle childhood is unknown, as is the stability of depression. We therefore aimed to (1) determine whether there are reciprocal relations between moderate-to-vigorous physical activity (MVPA) and sedentary behavior, on one hand, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition defined symptoms of major depressive disorder, on the other and (2) assess the extent of stability in depressive symptoms from age 6 to 10 years.

METHODS

A community sample of children living in Trondheim, Norway, comprising a total of 795 6-year-old children was followed up at 8 (n = 699) and 10 (n = 702) years of age. Physical activity was recorded by accelerometry and symptoms of major depression were measured through semistructured clinical interviews of parents and children. Bidirectional relationships between MVPA, sedentary activity, and symptoms of depression were analyzed through autoregressive cross-lagged models, and adjusted for symptoms of comorbid psychiatric disorders and BMI.

RESULTS

At both age 6 and 8 years, higher MVPA predicted fewer symptoms of major depressive disorders 2 years later. Sedentary behavior did not predict depression, and depression predicted neither MVPA nor sedentary activity. The number of symptoms of major depression declined from ages 6 to 8 years and evidenced modest continuity.

CONCLUSIONS

MVPA predicts fewer symptoms of major depression in middle childhood, and increasing MVPA may serve as a complementary method to prevent and treat childhood depression.

Screening for pickiness - a validation study

Picky eating is prevalent in childhood and is associated with negative health outcomes. Therefore early detection of pickiness is pertinent. Because no psychometric measure of picky/fussy eating has been validated, we aimed to examine the screening efficiency of the 6-item ‘Food Fussiness’ (FF) scale from the Children’s Eating Behavior Questionnaire using structured psychiatric interviews (the Preschool Age Psychiatric Interview), providing meaningful cut-off values based on a large, representative sample of Norwegian 6 year olds (n = 752). Screening efficiency was evaluated using receiver operating characteristic curve analysis, revealing excellent discrimination. The cut-point maximizing the sum of sensitivity and specificity for the scale was found at a score of 3.33 for severe cases and 3.00 when both moderate and severe pickiness were included. The results suggest that the FF scale may provide a tool for identification of clinically significant picky eating, although further assessment may be needed to separate moderate from severe cases.

Interrelationships and Continuities in Symptoms of Oppositional Defiant and Conduct Disorders from Age 4 to 10 in the Community

Childhood oppositional defiant disorder (ODD) has commonly been thought to increase the risk of conduct disorder (CD) in late childhood and adolescence. However, symptoms of CD may also emerge during preschool and middle childhood. The few studies that have examined whether ODD increases the risk of such early onset CD have produced equivocal results, potentially due to methodological issues. In this study, a community sample of Norwegian 4-year-olds (n = 1042, 49.9 % males) was examined bi-annually over four waves of data collection. Symptoms of ODD, CD, attention-deficit/hyperactivity disorder (ADHD), anxiety and depressive disorders were measured through interviews with parents and children using the Preschool Age Psychiatric Assessment and the Child and Adolescent Psychiatric Assessment. The results showed that at all ages, more symptoms of ODD predicted more symptoms of CD at the next age of examination even after adjusting for previous CD and comorbid conditions. The effect of previous ODD on CD two years later did not differ according to gender, SES, or parental cohabitating status at any point in time. There was modest homotypical continuity in symptoms of CD and moderate homotypical continuity in symptoms of ODD. Symptoms of ODD increased from age 4 to 8 and declined to age 10. In conclusion, symptoms of ODD increase the risk of early onset symptoms of CD. The continuity in symptoms of ODD, and to some extent CD, combined with an increased risk of early symptoms of CD forecasted by symptoms of ODD, underscore the importance of detection, prevention and treatment of behavioral disorders already in early childhood.

Screening for Persistent Psychopathology in 4-Year-Old Children

OBJECTIVE

To inform primary care screening and preventive intervention efforts, the authors examined the screening efficiency of the parent version of the Strengths and Difficulties Questionnaire (SDQP4-16) for persistent disorders relative to transient disorders and its capacity to distinguish between the two.

METHODS

Persistence and transience in preschool-onset psychiatric disorders were identified by using data from a large population-based cohort study in Norwegian children initially assessed at age 4 and followed up at age 6 (n = 1038). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses at both time points were assigned by using the Preschool Age Psychiatric Assessment Interview, against which the SDQP4-16 was compared through receiver operating characteristics analysis.

RESULTS

The screening efficiency for persistent disorders exceeded that for transient disorders with a specificity of 86.1%, a sensitivity of 79.3%, and an area under the curve value of 0.85. The SDQP4-16 was able to discriminate persistent disorders from transient disorders at an area under the curve value of 0.71. At the selected cutoff of 10, the negative predictive value was 99.6%, whereas the positive predictive value was 9.5%, partly due to the low prevalence (1.8%) of persistent disorders.

CONCLUSIONS

The SDQP4-16 is a sensitive tool for detecting persistent psychiatric disorders in young children. However, a large proportion of positive screens are nonpersistent cases, as indicated by the high false-positive rate. Thus, the clinical utility of the SDQP4-16 in primary care screening for persistent disorders is uncertain, particularly in samples in which the rate of psychiatric disorders is low.

Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children's Behavior Problems. A Randomized Controlled Study

OBJECTIVE

The aim of the present investigation was to compare the effectiveness of Parent-Child Interaction Therapy (PCIT) with treatment as usual (TAU) in young children who were referred to regular child and adolescent mental health clinics for behavior problems.

METHOD

Eighty-one Norwegian families with two- to seven-year-old children (52 boys) who had scored ≥ 120 on the Eyberg Child Behavior Inventory (ECBI) were randomly assigned to receive either PCIT or TAU. The families were assessed 6 and 18 months after beginning treatment. Parenting skills were measured using the Dyadic Parent-Child Interaction Coding System (DPICS), and child behavior problems were measured using the ECBI and the Child Behavior Checklist (CBCL).

RESULTS

Linear growth curve analyses revealed that the behavior problems of children receiving PCIT improved more compared with children receiving TAU according to mother reports (ECBI d = .64, CBCL d = .61, both p < .05) but not according to father report. Parents also improved with regard to Do and Don't skills (d = 2.58, d = 1.46, respectively, both p ≤ .001). At the 6-month assessment, which often occurred before treatment was finished, children who had received PCIT had lower father-rated ECBI and mother-rated CBCL-scores (p = .06) compared with those who had received TAU. At the 18-month follow-up, the children who had received PCIT showed fewer behavior problems compared with TAU according to mother (d = .37) and father (d = .56) reports on the ECBI and mother reports on the CBCL regarding externalizing problems (d = .39). Parents receiving PCIT developed more favorable Do Skills (6-month d = 1.81; 18-month d = 1.91) and Don't Skills (6-month d = 1.46; 18-month d = 1.42) according to observer ratings on the DPICS compared with those receiving TAU.

CONCLUSION

Children receiving PCIT in regular clinical practice exhibited a greater reduction in behavior problems compared with children receiving TAU, and their parents' parenting skills improved to a greater degree compared with those receiving TAU.

TRIAL REGISTRATION

ClinicalTrials.gov NTC01085305.

Disorganization, COMT, and Children's Social Behavior: The Norwegian Hypothesis of Legacy of Disorganized Attachment

Why is disorganized attachment associated with punitive-controlling behavior in some, but caregiving-controlling in others? Hygen et al. (2014) proposed that variation in the Catechol-O-methyl transferase(COMT) Val158Met genotype explains this variation, providing preliminary data to this effect. We offer a conceptual replication, analyzing data on 560 children (males: 275) drawn from the NICHD Study of Early Child Care and Youth Development. As predicted, competitive model-fitting indicated that disorganized infants carrying Met alleles engage in more positive behavior and less negative behavior than other children at age 5 and 11, with the reverse true of Val/Val homozygotes, seemingly consistent with caregiving-controlling and punitive-controlling styles, respectively, but only in the case of maternal and not teacher reports, thereby confirmating a relationship-specific hypothesis.

Predictors of Psychosocial Outcomes in Hard-of-Hearing Preschool Children

Children with hearing loss are at risk for developing psychosocial problems. Children with mild to severe hearing loss are less frequently subject to research, in particular in preschool, and we therefore know less about the risk in this particular group. To address this, we compared psychosocial functioning in thirty-five 4-5-year olds with hearing aids to that of 180 typically hearing children. Parent ratings of psychosocial functioning and social skills, as well as scores of receptive vocabulary, were obtained. Children with hearing loss evidenced more psychosocial problems than hearing agemates. Female gender and early detection of hearing loss predicted better psychosocial functioning among children with hearing loss, whereas vocabulary and degree of hearing loss did not. Early intervention addressing psychosocial functioning is warranted for children with all degrees of hearing loss, including mild and moderate. Gender differences should be investigated in future research.

Polygenic Risk, Appetite Traits, and Weight Gain in Middle Childhood: A Longitudinal Study

IMPORTANCE

Genome-wide association studies have identified genetic risks for obesity. These genetic risks influence development of obesity partly by accelerating weight gain in childhood. Research is needed to identify mechanisms to inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Longitudinal studies are needed to test whether appetite traits mediate genetic influences on children's weight gain.

OBJECTIVE

To test whether genetic risk for obesity predicts accelerated weight gain in middle childhood (ages 4-8 years) and whether genetic association with accelerated weight gain is mediated by appetite traits.

DESIGN, SETTING, AND PARTICIPANTS

Longitudinal study of a representative birth cohort at the Trondheim Early Secure Study, Trondheim, Norway, enrolled at age 4 years during 2007 to 2008, with follow-ups at ages 6 and 8 years. Participants were sampled from all children born in 2003 or 2004 who attended regular community health checkups for 4-year-olds (97.2% attendance; 82.0% consent rate, n = 2475). Nine hundred ninety-five children participated at age 4 years, 795 at age 6 years, and 699 at age 8 years. Analyses included 652 children with genotype, adiposity, and appetite data.

MAIN OUTCOMES AND MEASURES

Outcomes were body mass index and body-fat phenotypes measured from anthropometry (ages 4, 6, and 8 years) and bioelectrical impedance (ages 6 and 8 years). Genetic risk for obesity was measured using a genetic risk score composed of 32 single-nucleotide polymorphisms previously discovered in genome-wide association studies of adult body mass index. Appetite traits were measured at age 6 years with the Children's Eating Behavior Questionnaire.

RESULTS

Of the 652 genotyped child participants, 323 (49.5%) were female, 58 (8.9%) were overweight, and 1 (0.2%) was obese. Children at higher genetic risk for obesity had higher baseline body mass index and fat mass compared with lower genetic risk peers, and they gained weight and fat mass more rapidly during follow-up. Each SD increase in genetic risk score was associated with a 0.22-point increase in BMI at age-4 baseline (for the intercept, unstandardized path coefficient B = 0.22 [95% CI, 0.06-0.38]; P = .008. Children with higher genetic risk scores also gained BMI points more rapidly from ages 4 to 6 years (B = 0.11 [95% CI, 0.03-0.20]; P = .01 ; β = 0.12) and from 6 to 8 years (B = 0.09 [95% CI, 0.00-0.19]; P = .05; β = 0.10), compared with their lower genetic risk peers. Children at higher genetic risk had higher levels of alleged obesogenic appetite traits than peers with lower genetic risk at age 6 years, but appetite traits did not mediate genetic associations with weight gain. The sum of the 5 indirect effects was B = -0.001 (95% CI, -0.02 -0.01); P = .86; β = 0.00.

CONCLUSIONS AND RELEVANCE

Genetic risk for obesity is associated with accelerated childhood weight gain. Interventions targeting childhood weight gain may provide one path to mitigating genetic risk. However, middle childhood appetite traits may not be a promising target for such interventions. Studies of early-childhood samples are needed to test whether appetite traits explain how genetic risks accelerate growth earlier in development.

Prevalence and comorbidity of mental disorders among adolescents living in residential youth care

Most adolescents are placed in residential youth care (RYC) because of severe psychosocial strains and child maltreatment, which represent risk factors for developing mental disorders. To plan RYC units and ensure that residents receive evidence-based psychiatric interventions, it is necessary to obtain reliable and valid prevalence estimates of mental disorders in this population. However, there is a lacuna of research on diagnoses derived from standardized clinical interviews. The aim of this study was to assess the prevalence and comorbidity of mental disorders applying diagnostic interviews in an entire population of adolescents living in RYC in Norway. All young people in RYC were invited to participate in the study. Eighty-six RYC institutions with 601 eligible adolescents were included and 400 adolescents, 12-20 years old, participated in the study, yielding a response rate of 67 %. Anonymous Child Behaviour Checklist scores for 141 (70 %) of the declining residents were also available, allowing diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) for 541 youths to be estimated. Diagnoses were assessed by trained interviewers with the Child and Adolescent Psychiatric Assessment interview (CAPA). Seventy-six point two per cent (71.5-80.8 CI 95 %) of adolescents received at least one 3-month DSM-IV diagnosis. Prevalence rates for internalizing psychiatric disorders were higher than for behavioural disorders. Comorbidity was high between these two groups. Mental disorders were prevalent among children and youth in RYC. Our results create major concerns and challenge the existing organization of the RYC system.

The development of global and domain-specific self-esteem from age 13 to 31

This study examines the development of global self-esteem and self-esteem in 6 specific domains across adolescence and young adulthood. Using a cohort-sequential design, we analyzed longitudinal data on 3,116 Norwegian men and women from 13 to 31 years of age by means of growth curve modeling. Questionnaire data provided information on global self-esteem and self-esteem in social, academic, athletic, and appearance domains. Data on important life outcomes was provided by register linkages. Results showed increasing levels of global self-esteem and self-esteem in most domains with increasing age. Being male, higher parental education, and reported higher levels of parental care were related to higher levels of global self-esteem and self-esteem in several domains. Self-esteem in the appearance domain showed high and stable correlations with global self-esteem, whereas in social domains, correlations with global self-esteem increased over age, with a particularly steep increase for romantic appeal self-esteem. As to the prospective relationship between self-esteem and important life outcomes, results showed that participants high in academic self-esteem attained higher education levels and higher income, but most of the relationship was explained by covariates such as parents' socioeconomic status and school grades. Low global self-esteem predicted later prescription of antidepressants, even after controlling for covariates. This study is the first to provide a comprehensive picture of the development of global and domain-specific self-esteem throughout adolescence and young adulthood using long-term longitudinal data. The results underscore the importance of examining development of self-esteem in specific domains in addition to global self-esteem.

Reciprocal relations between student–teacher conflict, children’s social skills and externalizing behavior

Research suggests that the relation between student–teacher conflict and children’s externalizing behavior might be reciprocal, and possibly also between student–teacher conflict and children’s social skills. Because children with externalizing behavior also tend to display low levels of social skills, we do not know if one or both of these student characteristics are involved in shaping and being shaped by the relationship to the teacher. In this study, we addressed this by means of a three-wave cross-lagged longitudinal study from preschool to third grade, including measures of social skills, externalizing behavior and student–teacher conflict. Bidirectional relations were observed between student–teacher conflict and social skills from first grade to third grade, and between student–teacher conflict and externalizing behavior between preschool and first grade. However, results from a model including both social skills and externalizing behavior suggested that externalizing behavior is a stronger predictor of conflicted student–teacher relationship than children’s social skills. Student–teacher conflict was predictive of externalizing behavior as well as of later social skills. Effect of children’s first-grade externalizing behavior on third-grade student–teacher conflict was gender moderated, with stronger effects of externalizing behavior observed in girls, combined with higher stability in first-grade student–teacher conflict in boys.

Child exposure to serious life events, COMT, and aggression: Testing differential susceptibility theory

Both genetic and environmental factors contribute to individual differences in aggression. Catechol-O-methyltransferase Val158Met (COMT), a common, functional polymorphism, has been implicated in aggression and aggression traits, as have childhood experiences of adversity. It is unknown whether these effects are additive or interactional and, in the case of interaction, whether they conform to a diathesis-stress or differential susceptibility model. We examined Gene × Environment interactions between COMT and serious life events on measures of childhood aggression and contrasted these 2 models. The sample was composed of community children (N = 704); 355 were boys, and the mean age was 54.8 months (SD = 3.0). The children were genotyped for COMT rs4680 and assessed for serious life events and by teacher-rated aggression. Regression analysis showed no main effects of COMT and serious life events on aggression. However, a significant interactive effect of childhood serious life events and COMT genotype was observed: Children who had faced many serious life events and were Val homozygotes exhibited more aggression (p = .02) than did their Met-carrying counterparts. Notably, in the absence of serious life events, Val homozygotes displayed significantly lower aggression scores than did Met carriers (p = .03). When tested, this constellation of findings conformed to the differential susceptibility hypothesis: In this case, Val homozygotes are more malleable to the effect of serious life events on aggression and not simply more vulnerable to the negative effect of having experienced many serious life events.

What enhances the development of emotion understanding in young children? A longitudinal study of interpersonal predictors

We studied potential determinants of the development of children's emotion understanding (EU) from age 4 to 6 in a Norwegian community sample (N = 974) using the Test of Emotion Comprehension. Interpersonal predictors included the accuracy of parental mentalization, parental emotional availability, and teacher-reported child social skills. Intrapersonal child factors were child gender and verbal skills. Overall, children's EU increased significantly over time. After adjusting for child gender, age-4 EU, and parental socio-economic status, greater child verbal and social skills and greater parental mentalization each uniquely predicted growth in EU. Results are discussed in terms of theory and research on children's EU and parents' emotion socialization.

Reciprocal associations between depressive symptoms and disordered eating among adolescent girls and boys: a multiwave, prospective study

Symptoms of depression and eating disorders increase during adolescence, particularly among girls, and they tend to co-occur. Despite this evidence, there is meager research on whether depression increases the risk of future eating pathology, or vice versa, and we do not know whether these processes are different for adolescent girls and boys. Accordingly, this study explored the prospective reciprocal associations between depressive symptoms and disordered eating at different time points from preadolescence to mid-adolescence and tested the moderator effect of gender on these associations. A community-based sample of Spanish youth (N = 942, 49 % female) was assessed at ages of approximately 10-11 (T1), 12-13 (T2), 14-15 (T3), and 16-17 (T4) years. The bidirectional relationships between depressive symptoms and disordered eating were estimated in an autoregressive cross-lagged model with latent variables. A unidirectional, age-specific association between depressive symptoms at T1 and disordered eating at T2 was found. No other significant cross-lagged effect emerged, but the stability of the constructs was considerable. Gender did not moderate any of the links examined. Regardless of gender, the transition from childhood to adolescence appears to be a key period when depressive symptoms foster the development of disordered eating. These findings suggest that early prevention and treatment of depression targeting both girls and boys may result in lower levels of depressive symptoms and disordered eating in adolescence.

Secure attachment promotes the development of effortful control in boys

Although effortful control (EC), a regulatory aspect of temperament, is associated with a wide range of developmental outcomes, knowledge about EC promoters is scarce. This study explored whether secure attachment promoted the development of EC from preschool to school age in a community sample of 903 Norwegian children. EC was measured using the parent-reported Children's Behavior Questionnaire at four (T1) and six (T2) years of age, and attachment was measured using the Manchester Child Attachment Story Task at T1. Previous research has indicated that a child's gender and socioeconomic status are possible covariates of EC; hence, these factors were included in the analyses. Despite considerable rank-order stability in EC, secure attachment contributed to an increase in EC. Furthermore, gender moderated the effect of attachment: secure attachment promoted EC in boys only. These findings emphasize preschool boys' need for emotional security to facilitate effortful capacities in their transition to school.

Secular trends in depressive symptoms among Norwegian adolescents from 1992 to 2010

Several survey studies among adolescents have shown increasing rates of depressive symptoms over the last two to three decades. We know however little about mechanisms that might explain this increase. The present study uses data from three nationwide representative surveys of 16-17 year-old Norwegian adolescents that were conducted according to identical procedures in 1992, 2002, and 2010 (response rates 97.0, 91.0, 84.3 %, respectively). At each time point, approximately 3,000 adolescents participated (48.8 % girls and 51.2 % boys). Questionnaire data on depressive symptoms and a variety of potential risk and protective factors that might explain time trends in such symptoms were assessed at all time points. The results showed that the prevalence of high scores on depressive symptoms increased significantly between 1992 and 2002 among both boys and girls. No significant changes were observed between 2002 and 2010. The increase from 1992 to 2002 among girls and boys could be partially attributed to increases in eating problems and cannabis use, while reduced satisfaction with own appearance among girls contributed as well. Although the study does not provide information about the causal direction between putative risk factors and depressive symptoms, the results provide some indication that eating problems, cannabis use, and appearance related factors may contribute in explaining secular trends in depressive symptoms.

Preschool Social Exclusion, Aggression, and Cooperation

The need-to-belong theory stipulates that social exclusion fosters aggression, whereas the social-reconnection hypothesis suggests that social exclusion promotes motivation to behave cooperatively. To date, empirical investigations of these contrasting views have focused on the immediate effects of social exclusion, yielding mixed results. Here we examine longer term effects of preschool social exclusion on children’s functioning 2 years later. Social exclusion was reported by teachers, aggression and cooperation by parents. Cross-lagged analyses showed that greater social exclusion at age 4 predicted more aggression and less cooperation at age 6, providing support for the need-to-belong rather than social-reconnection hypothesis. Secondary analyses showed that social exclusion predicted more aggression only among children scoring above mean on aggression at age 4, indicating that aggressive behavior is amplified by social exclusion among children already behaving aggressively. No gender differences were found. Implications and limitations are discussed in a developmental context.

Secular trends in eating problems among Norwegian adolescents from 1992 to 2010

OBJECTIVE

This study examines secular trends in eating problems among adolescents between 1992 and 2010. The study aims further to investigate whether such trends can be accounted for by secular changes in putative risk factors.

METHOD

Three nationwide surveys of Norwegian senior high-school students were conducted in 1992, 2002, and 2010 (response rates 97.0, 91.0, and 83.2%). At each time point, approximately 3,000 adolescents participated. Eating problems were assessed by means of the Dieting and the Bulimia and Food Preoccupation subscales of the Eating Attitude Test-12. Moreover, a variety of potential risk factors that might account for time trends in such problems were measured.

RESULTS

Dieting scores increased almost linearly for both genders during the research period. No differences over time in Bulimia and Food Preoccupation scores were seen among boys, whereas these symptoms peaked in 2002 for girls with considerably lower levels in both 1992 and 2010. The increase in Dieting from 1992 to 2010 for both genders could be attributed in part to increasing body mass index levels and, to a lesser degree, to depressive symptoms among females. The girls' time trend in Bulimia and Food Preoccupation was to some extent related to changes in appearance satisfaction, alcohol intoxication, and global self-worth.

DISCUSSION

This study is one of few to statistically examine how secular trends in eating problems are related to changes in putative risk factors. The study does not however provide conclusive information on the causal direction between putative risk factors and eating problems.

Psychiatric disorders in preschoolers: the structure of DSM-IV symptoms and profiles of comorbidity

Psychiatric disorders have been increasingly recognized in preschool children; at present, however, we know comparatively less about how well current diagnostic manuals capture the symptoms described in this age group and how comorbidity is patterned. Therefore, this study aimed to investigate whether the symptoms defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) load on their respective disorders, examine whether individual symptoms exist that load particularly high or low on the disorder they allegedly define, and analyze how comorbidity clusters in individual children. Parents of a community sample of Norwegian 4-year-olds (N = 995) were interviewed using the Preschool Age Psychiatric Assessment. A confirmatory factor analysis (CFA) and a latent profile analysis (LPA) were performed on the symptoms of seven DSM disorders: attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, major depressive disorder (MDD), generalized anxiety disorder (GAD), social phobia, and separation anxiety disorder. The results showed that the CFA solution that closely resembled the disorders delineated in the DSM-IV fitted the data best. However, vegetative symptoms did not define preschool depression. The LPA identified nine symptom profiles among preschoolers, of which four showed evidence of psychopathology: comorbid MDD/GAD ? ADHD combined type, comorbid MDD/GAD ? ADHD hyperactive/impulsive type, separation anxiety only, and social phobia only. In conclusion, the symptoms observed in preschoolers fit the DSM-IV well, and comorbidity followed specific patterns.