Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, 60608-1264, USA.
J Child Psychol Psychiatry. 2010 Jan;51(1):3-22. doi: 10.1111/j.1469-7610.2009.02184.x. Epub 2009 Oct 28.
There is increasing consensus that disruptive behavior disorders and syndromes (DBDs) are identifiable in preschool children. There is also concomitant recognition of the limitations of the current DBD nosology for distinguishing disruptive behavior symptoms from the normative misbehavior of early childhood. In particular, there appears to be substantial insensitivity to heterotypic manifestations of this developmental period and problems in identifying meaningful heterogeneity. As a result, the developmental basis for much of the current nosology may be called into question. To address these and other critical issues, this paper reviews the foundational elements of clinical and developmental science pertinent to developmental differentiation of disruptive behavior in the preschool period as paradigmatic for developmental specification across the lifespan and generates an agenda for future research. We begin by reviewing evidence of the validity of DBDs in preschool children. This is followed by an outline of key developmental concepts and a review of the corollary evidence from developmental science. These provide a basis for conceptualizing disruptive behavior in reference to developmental deviation in four core dimensions hypothesized to mark the core features of disruptive behavior syndromes. Finally, we propose a program of research to establish an empirical basis for determining the incremental utility of a developmentally specified nosology. Central to this approach is a contention that the benefits of developmental specification are extensive and outweigh any disadvantages. This is because a developmentally specified approach holds substantial promise for increasing sensitivity and specificity for differentiating disruptive behavior from normative misbehavior and from other related syndromes as well as for improving prediction. Further, more precisely defined, developmentally based phenotypes are likely to elucidate distinct mechanisms within translational studies and to serve as a catalyst for the generation of novel treatments.
越来越多的人认为，破坏性行为障碍和综合征（DBDs）在学龄前儿童中是可识别的。同时也认识到，目前的 DBD 分类法在区分破坏性行为症状与幼儿正常行为方面存在局限性。特别是，它似乎对这个发育阶段的异型表现缺乏敏感性，并且在识别有意义的异质性方面存在问题。因此，目前分类法的许多发展基础可能受到质疑。为了解决这些问题和其他关键问题，本文回顾了与学龄前儿童破坏性行为发展分化相关的临床和发展科学的基本要素，这些要素是整个生命周期发展特异性的典范，并为未来的研究制定了议程。我们首先回顾了 DBDs 在学龄前儿童中有效性的证据。其次，概述了关键的发展概念，并回顾了发展科学的相应证据。这些为在四个核心维度上参照发展偏差来概念化破坏性行为提供了基础，这四个核心维度假设可以标记破坏性行为综合征的核心特征。最后，我们提出了一项研究计划，以建立一个确定发展特异性分类法增量效用的实证基础。这个方法的核心是，发展特异性的好处是广泛的，超过任何缺点。这是因为，发展特异性方法在区分破坏性行为与正常行为以及其他相关综合征方面具有提高敏感性和特异性的巨大潜力，并且可以改善预测。此外，更精确定义的、基于发展的表型更有可能在转化研究中阐明不同的机制，并作为产生新治疗方法的催化剂。
