Nearly 13% of children with a DSM-IV diagnosis?

I had tweeted about the paper by Sandra Petresco and colleagues [1] (open-access here) a while back as being the source of the sentence: "Nearly 13 % of the children presented a psychiatric diagnosis according to DSM-IV" based on their analysis of the Pelotas Birth Cohort [2] in Brazil.

Aleijadinho: Angel of the Passion @ Wikipedia 

The crux of the Petresco paper was that by looking at all the children, or at least the majority of children, born during 2004 in the city of Pelotas in Brazil and following them up when aged 6 years using the Developmental and Wellbeing Assessment (DAWBA) schedule [3], the rates of various developmental and/or psychiatric conditions according to ICD-10 and DSM-IV criteria were estimated.

The results (bearing in mind the paper is open-access)...

• Out of 4231 live births, 3,585 children were available for investigation at the age of 6. Trained interviewers delivered the DAWBA to parents, mostly in the clinical setting but about a fifth delivered in the family home. Data was analysed taking into account demographic information such as gender and socioeconomic status and various diagnoses assessed.
• Results: "It was found that 13.2% (N=475) and 12.8% (N=458) of the children fulfilled criteria for at least one diagnosis of psychiatric disorder according to DSM-IV and ICD-10, respectively". Boys were more likely to present with "any diagnosis". Top of the diagnostic pops was "any anxiety disorder" reported in nearly 9% of both boys and girls across both DSM and ICD definitions and then other diagnoses like ADHD (attention deficit hyperactivity disorder) and conduct disorder figured less frequently (both hovering around the 2-3% mark) which is interesting. Children from lower income families also seemed to have more risk of diagnosis.
• Another interesting figure here: autism was only picked up in 0.3% (n=10, 8 boys and 2 girls) of cases for both DSM-IV and ICD-10 criteria. Certainly spot on the mark for the 4:1 sex ratio but frequency-wise, quite a lot less than has been quoted in other parts of the world accepting some differences in the numbers included for study. That being said the authors do note that they only administered the screening questions from the "developmental section" of the DAWBA so might not have caught every case of autism. Other studies looking at DAWBA as a screening instrument for autism have also tended to suggest under-diagnosis as potentially being an issue [4].
• When it came to presenting with symptoms reflective of more than one condition, about 16-17% of children fitted this bill across the diagnostic schedules. An ADHD / conduct disorder came out as the most common combination (29%). More than two comorbid conditions was a rare event (n=3) but when present, all were boys.

I'm sure you'll agree that there is some rather interesting data to be had there. I can't help but wonder if similar cohorts using the same DAWBA tool and screening method sited at other areas of the globe would provide a rather interesting comparison to the Brazil data. Not least covering any relationship between different ethnicities in different environments and the frequency of reported DSM-IV and ICD-10 diagnoses?

That headline figure of 13% of children fitting some kind of diagnostic bill when it comes to DSM-IV and ICD-10 also merits a lot more examination. Again, with my head full of wonder, I'd be asking about whether further genetic / biochemical / other inspection might be revealing for this cohort, particularly when one takes into account the discussions about ESSENCE (see here) and the introduction of RDoC (see here) to research proceedings. How this figure might ebb and flow would also be a good idea for future study, bearing in mind the changing diagnostic times that we live in (see here).

Music to close. Grenade by Bruno Mars.

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[1] Petresco S. et al. Prevalence and comorbidity of psychiatric disorders among 6-year-old children: 2004 Pelotas Birth Cohort. Soc Psychiatry Psychiatr Epidemiol. 2014 Feb 1.

[2] Santos IS. et al. Cohort profile: the 2004 Pelotas (Brazil) birth cohort study. Int J Epidemiol. 2011 Dec;40(6):1461-8.

[3] Goodman R. et al. The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry. 2000 Jul;41(5):645-55.

[4] Posserud M. et al. The prevalence of autism spectrum disorders: impact of diagnostic instrument and non-response bias. Soc Psychiatry Psychiatr Epidemiol. 2010 Mar;45(3):319-27.

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Petresco S, Anselmi L, Santos IS, Barros AJ, Fleitlich-Bilyk B, Barros FC, & Matijasevich A (2014). Prevalence and comorbidity of psychiatric disorders among 6-year-old children: 2004 Pelotas Birth Cohort. Social psychiatry and psychiatric epidemiology PMID: 24488152