Development of an Ultra-Brief Screening Tool for Disruptive Behavior Problems in Preschoolers

This research addresses the early identification and treatment of disruptive behavior problems (DBPs) in pediatric primary care. Early identification and treatment will prevent subsequent substance use disorders, school failure, criminality, dependence on social services, and morbidity/mortality. This project will achieve the crucial first step in that research agenda: to improve early identification of DBPs in preschool-aged children. Very young children with DBPs are at high risk for devastating long-term outcomes. In addition, children with DBPs and their families use more pediatric health care services at higher frequencies and overall costs than other children and families. Over 20% of young children in the U.S. exhibit clinically significant behavioral problems, but they are drastically under-identified, and only a small fraction receive treatment. Pediatric primary care is an ideal setting for screening preschoolers for DBPs. Accurate early identification facilitates optimal, early, and effective treatment for DBPs, preventing bleak consequences for very young children. Unfortunately, the informal screening methods used by primary care providers are abysmally inaccurate. An ultra-brief screening tool would (1) greatly enhance early identification efforts in the primary care setting, and (2) facilitate development of a screening/brief intervention/referral to treatment (SBIRT) primary care intervention for DBPs. No existing tools to screen preschoolers for DBPs are appropriate for primary care. Most are too lengthy for this setting, in which any additional requirements of clinic staff (i.e., for scoring and interpretation) are prohibitive; even 5 minutes spent on behavioral screening is excessive. Further, most existing instruments have not been adequately evaluated with preschoolers. Biased measurement has been reported with diverse and vulnerable populations of young children seen in primary care settings-especially female, minority, and low socioeconomic status (SES) children. To maximize the potential preventive impact of early identification efforts in primary care, an accurate ultra-brief screening tool for DBPs is needed. This tool should (a) be unbiased across diverse groups of young children, and (b) accurately measure clinically significant DBPs.