Psychische Störungen bei Vorschulkindern : Unterschiede zwischen den DC: 0 – 5 und ICD-10 Klassifikationssystemen

Abstract

Zusammenfassung. Um psychische Störungen bei jungen Kindern zu erfassen, wurde das Klassifikationssystem DC: 0 – 5 entwickelt. Das Ziel dieser Studie war es, Diagnosen nach DC: 0 – 5 und ICD-10 zu vergleichen. Bei 176 konsekutiv vorgestellten Kindern (70,5 % Jungen) mit einem mittleren Alter von 3,96 Jahren wurden Diagnosen nach ICD-10 und DC: 0 – 5 vergeben. 78,4 % der Kinder hatten eine Diagnose nach ICD-10, 88,1 % der Kinder nach DC: 0 – 5. Die häufigste ICD-10 Diagnose war Störung des Sozialverhaltens mit oppositionellem Verhalten (ODD; 28,4 %), gefolgt von Schlafstörungen (21,0 %), ADHS (14,8 %) und Angststörungen (6,8 %). Die häufigsten DC: 0 – 5 Diagnosen waren ADHS (30,7 %) und die Dysregulierte Ärger- und Aggressionsstörung (31,3 %), gefolgt von Schlaf-‍, Angst-‍, Ess- und Traumafolgestörungen. Zusammengefasst ist die DC: 0 – 5 das spezifischste Klassifikationssystem zur Diagnose psychischer Störungen bei jungen Kindern. Es hat sich in Kombination mit der ICD-10 in der klinischen Praxis bewährt. Wünschenswert wäre die weitere Verwendung und Überprüfung der DC: 0 – 5 in klinischen Studien.

Mental Disorders in Young Children: Differences Between the DC: 0 – 5 and ICD-10 Classification Systems

Abstract. The DC: 0 – 5 ^TM: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Zero to Three (DC: 0 – 5) classification system was developed to assess mental disorders in young children, using age-specific and developmentally appropriate criteria. It is used in addition to the ICD-10 and DSM-5 classification systems. As the DC: 0 – 5 and the ICD-10 have not been compared systematically yet, the aim was to analyze both systems in a group of preschool children. A group of consecutive children ( N = 176) who presented to a specialized tertiary outpatient department were examined. The sample included 70.5 % boys, with a mean age of 3.96 years. The diagnoses were given according to clinical criteria of ICD-10 and DC: 0 – 5 after an assessment including history, questionnaires, mental state exam, developmental tests, and physical exam. Of the children, 78.4 % had an ICD-10, and 88.1 % a DC: 0 – 5 diagnosis. The most common ICD-10 diagnoses were oppositional defiant disorder (ODD; 28.4 %), sleep disorders (21.0 %), attention-deficit/hyperactivity disorder (ADHD; 14.8 %), and anxiety disorders (6.8 %). Infants (0 – 1 years) were mainly affected by sleep, adjustment, and eating disorders. Neurodevelopmental disorders were the most common DC: 0 – 5 diagnoses (60.2 %), including ADHD, autism spectrum disorders (ASDs) and their precursors, the overactivity disorder of toddlerhood, and early atypical ASD. ADHD (30.7 %) was almost as common as the disorder of dysregulated anger and aggression of early childhood (DDAA) with 31.3 %, followed by sleep, anxiety, eating, and trauma-associated disorders. Children with DDAA were significant older and had comorbid ODD and ADHD more often. Correlations between ICD-10 and DC: 0 – 5 diagnoses were highly significant. This is the first study comparing the DC: 0 – 5 and the ICD-10, which are both clinically useful and valid classification systems for children in the age group of 0 – 5 years. Neurodevelopmental disorders and their precursors could be diagnosed with the DC: 0 – 5, thus enabling early treatment. The most common externalizing disorder was DDAA, defined by an inadequate regulation of negative emotions. In summary, the DC: 0 – 5 is the best and most specific classification system for the diagnosis of mental disorders in young children in combination with the ICD-10 and the DSM-5. It can be applied in clinical practice and in research. In addition to the specific criteria for this age, the introduction of new constructs such as the DDAA and the precursors of ADHD and ASD are especially useful. The application of the DC: 0 – 5 in clinical practice and in research is recommended.