1. Onnembo, Jessica BSN
  2. Beal, Judy A. DNSc, RN, FNAP, FAAN

Article Content

Diagnosing psychopathology in very young children is an emerging debate in newborn and pediatric clinical practice. Advantages to implementing formal diagnostic criteria early in infancy include: (1) identifying symptoms to target in order to initiate timely and appropriate treatment; (2) enhancing research with defined criteria of psychological risks and comorbidities through cross-sectional and longitudinal studies during childhood and adolescence; and (3) providing a universal understanding of mental illness presentation (Schmid, Petermann, & Fegert, 2013). By diagnosing early, comorbidities can be explained. For example, in adolescents with posttraumatic stress disorder (PTSD), 48% met criteria for PTSD 3 to 4 years prior to diagnosis (Schmid et al.). Had early intervention been implemented, therapies to enhance coping mechanisms and manage anxiety could have been applied to initiate treatment.


At a November 2014 conference, Beyond the NICU; Addressing the Emotional and Developmental Health of NICU Graduates and Their Families, held by the Massachusetts School of Professional Psychology, current evidence on developmental effects in infants cared for in the NICU setting was discussed. According to research presented, low birthweight infants have a two-fold risk for developing attention-deficit hyperactivity disorder and autism spectrum disorder (Kerzner, 2014). Approximately 10% of low birthweight infants will exhibit soft neurological signs in speech, balance, and gait in the young adult years (Kerzner, 2014). In extremely low birthweight infants, 14% develop some type of neurosensory impairment, are at increased risk for avoidance attachment, show a decrease in physical activity and self-esteem, and will develop a learning disability (Kerzner, 2014). Based on these data, would implementing early diagnosis during infancy allow clinicians to implement treatment most effectively before long-term sequelae occur?


The cons of implementing formal diagnostic criteria too early in development are: (1) overlap of symptom criteria resulting in difficulty with distinction of different disorders; (2) lack of focus on the biopsychosocial model; (3) lack of age-specific distinctions in illness presentation; and (4) a negative influence on the therapeutic relationship between providers and the patient (Schmid et al., 2013). For example, according to the criteria for diagnosing a developmental trauma disorder (DTD), attachment disorder conduct disorder, and borderline personality disorder all contain similar diagnostic criteria, making distinction between these diagnostics challenging (Schmid et al.). When implementing a labeled diagnosis early, a greater emphasis on the biopsychosocial model and understanding development in context is often neglected. This frequently causes questions about accuracy of a later diagnosis as early development between the ages of 0 to 3 years of age is characterized by rapid shifts and constant change. Due to the paucity of research in childhood psychopathology versus adult psychopathology, failure to specify symptom differentiation between age groups can follow (Schmid et al.).


Early diagnosis is inappropriate due to need for time to allow for differentiation of normal versus abnormal development. Because there is so little available evidence regarding diagnostic criteria for infants versus adults, our role as nurses caring for young children and families should focus on contextual and individualized situations rather than fitting patients into stringent diagnostic criteria too early. A crucial consideration is in order to diagnose most childhood psychopathologies, the clinician must allow for development to occur normally over a period of time to see what happens with the child and the child's relationship to their environment, caregiver(s), and self. This additional time allows for nursing assessment of the family unit and environmental context as playing a central role in developmental outcomes.




Kerzner L. (2014). What happens afterwards? NICU follow-up; medical and developmental issues. Beyond the NICU: Addressing the emotional and developmental health of NICU graduates and their families. Boston, MA: Boston Institute for the Development of Infants and Parents. [Context Link]


Schmid M., Petermann F., Fegert J. (2013). Developmental trauma disorder: Pros and cons of including formal criteria in the psychiatric diagnostic systems. BMC Psychiatry, 13, 3. doi:10.1186/1471-244X-13-3 [Context Link]