Comparison of Global and Daily Ratings of Associations between Anxiety and Depressive Behaviors and Impairment in Preschool-Aged Children.

Anxiety and depressive difficulties can emerge during early childhood and cause impairment in functioning. Anxiety and depressive behaviors and impairment are typically assessed with global questionnaires that require recall of children's behavior over an extended period which could reduce the accuracy of parent report of children's behavior and functioning. The current study compared parents' report of children's anxiety and depressive behaviors and impairment when evaluated with global measures versus a daily diary measure. Participants (N = 901 parents of 3-5-year-old children) completed global and daily measures of children's behavior and impairment during enrollment to the study. Global measures were completed at baseline and the 14 daily diary measures were completed consecutively for two weeks. Across most measures, daily associations between parent-reported anxiety and depressive behaviors and impairment were stronger compared to associations with global measures. These results suggest that daily measures may better capture links between young children's typical behavior and functioning compared to global measures. In addition, daily assessment might be more effective for measuring mild to moderate yet still impairing behaviors that may be missed on global reports that require longer periods of recall.

Children's emotional reactivity and negative affect predict future ADHD symptom severity beyond initial ADHD symptom severity.

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience significant emotion dysregulation. However, there is limited longitudinal data on associations between multiple aspects of emotion dysregulation and ADHD symptoms. Additionally, given substantial evidence that increased levels and variability of negative affect (NA) are identified in children with ADHD, it is important to examine the role of NA in this relationship. The present study used momentary and longitudinal data to examine the relation between two aspects of emotion dysregulation (emotional lability and emotional reactivity), the two ADHD symptom clusters separately (inattentive and hyperactive/impulsive), total ADHD symptom severity, and NA variability over a period of six months. Participants (N = 68) were parents of children aged 7-12 years old (M = 9.80, SD = 1.34) who completed baseline and 6-month follow-up reports of children's ADHD symptoms and emotion dysregulation as well as ecological momentary assessments (EMA) of their children's NA for one week. Results were threefold: (1) children's emotional reactivity predicted inattentive, hyperactive/impulsive, and total ADHD symptom severity above and beyond initial ADHD symptom severity, but emotional lability did not significantly predict severity of any ADHD symptom cluster; (2) NA variability predicted hyperactive/impulsive and total ADHD symptom severity, but not inattentive severity; and (3) initial ADHD symptom severity did not predict emotion dysregulation at follow-up. The current study provides novel insight regarding the longitudinal influence of specific aspects of emotion dysregulation and NA on ADHD symptom severity in children and suggests that targeting emotional reactivity could minimize ADHD symptom severity.

Mapping the duration and severity of preschool-aged children's depressive moods and behaviors.

BACKGROUND: Depressive moods and behaviors are developmentally normative, yet potentially impairing, in preschool-aged children. In addition to frequency, duration of behavior is an important parameter to consider when characterizing risk for worsening mood dysregulation. The goal of this study was to identify the duration and severity of depressive moods and behaviors and associations with impairment in a large community sample of preschool-aged children using an online parent-report daily diary. METHODS: Primary caregivers (N = 900) of 3-5-year-old children reported the daily duration of each instance of seven depressive moods and behaviors for 14 days. We used item response theory analyses to examine duration item characteristics. RESULTS: Moods and behaviors occurred at specific durations to be considered psychometrically severe/rare; for example, instances of sadness had to last an average total of 32 min per day or more, irritability at least 38 min, tantrums at least 30 min, and tearfulness/sensitivity at least 35 min. Longer durations of mood and behavior were associated with daily impairment, as well as older child age and less parental education. CONCLUSIONS: To our knowledge, this is the first study to delineate specific duration ranges for depressive moods and behaviors in preschool-aged children. These data, coupled with information about the frequency of mood-related behaviors, can assist child practitioners in differentiating normative patterns from less normative mood problems to evaluate which children may be at risk. Future work should identify the duration of depressive moods and behaviors in early childhood that predict clinically significant psychopathology over time.

Early childhood anxiety disorders: continuity and predictors in adolescence.

Anxiety disorders are among the most common disorders in early childhood. Although many older children and adolescents with anxiety disorders recover and remain well, little is known about the continuity of early childhood anxiety and the factors that predict persistence/recurrence in later childhood and adolescence. We followed 129 children who met anxiety disorder criteria at age 3 and/or 6 and determined how many continued to experience an anxiety disorder between age 7 and 15, as well as the continuity of specific anxiety disorders. We explored whether biological sex, number of anxiety disorders, early childhood persistence (i.e., anxiety diagnosis at both age 3 and 6), childhood comorbidities, temperamental behavioral inhibition, a maternal history of anxiety, and authoritarian and overprotective parenting predicted persistence/recurrence of an anxiety disorder from age 7 to 15. Sixty-five (50.4%) of the adolescents with an early childhood anxiety disorder met anxiety disorder criteria during the age 7-15 interval. Homotypic continuity from early childhood to school-age/mid-adolescence was observed for social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). Early childhood agoraphobia predicted school-age/mid-adolescent GAD and early childhood GAD predicted school-age/mid-adolescent specific phobia. In bivariate analyses, number of anxiety disorders, persistence of anxiety from age 3 to 6, and having a mother with a history of anxiety predicted the persistence/recurrence of anxiety disorders from age 7 to 15. Only early childhood persistence of anxiety uniquely predicted the persistence/recurrence of an anxiety disorder over and above the other predictors. Early intervention efforts should focus on identifying and intervening with young children who demonstrate a protracted course of anxiety.

Preschool-aged children's hair cortisol and parents' behavior, psychopathology, and stress.

Parental factors, including parenting behavior, parent mental health, and parent stress, are associated with child stress. More recently, studies have shown that these parental factors may also be associated with children's hair cortisol concentration (HCC). HCC is a novel biomarker for chronic stress. HCC indexes cumulative cortisol exposure thereby reflecting longer-term stress reactivity. Although HCC is associated with a range of problems in adults such as depression, anxiety, appraisal of stressful events, and diabetes, studies investigating HCC in children have been inconsistent, with particularly little information about parental factors and HCC. As chronic stress may have long-term physiological and emotional effects on children, and parent-based interventions can reduce these effects, it is important to identify parental factors that relate to children's HCC. The aim of this study was to examine associations between preschool-aged children's physiological stress measured via HCC and mother- and father-reported parenting behavior, psychopathology, and stress. Participants included N = 140 children ages 3-5-years-old and their mothers (n = 140) and fathers (n = 98). Mothers and fathers completed questionnaire measures on their parenting behavior, depressive and anxiety symptoms, and perceived stress. Children's HCC was assessed by processing small hair samples. HCC levels were higher in boys compared to girls, and higher in children of color compared to white children. There was a significant association between children's HCC and fathers' authoritarian parenting. Children's HCC was positively associated with physical coercion, a specific facet of fathers' authoritarian parenting, even after accounting for sex of the child, race/ethnicity of the child, stressful life events, fathers' depression, fathers' anxiety, and fathers' perceived stress. In addition, there was a significant interaction between higher levels of both mothers' and fathers' authoritarian parenting and children's HCC. Children's HCC was not significantly related to mothers' and fathers' anxiety and depression or mothers' and fathers' perceived stress. These findings contribute to the large literature that links harsh and physical parenting practices with problematic outcomes in children.

Is the distinction between tonic and phasic irritability meaningful in 3-year-old children?

Irritability encompasses both normative misbehavior in early childhood and clinically significant problems across development. Recent studies have distinguished between tonic (i.e., persistently angry or grumpy mood) and phasic (i.e., temper tantrums or outbursts) forms of irritability and shown that they have different implications for psychopathology and functioning. However, data on this distinction in young (i.e., preschool aged) children are nonexistent. We utilized data from a longitudinal study of a community sample of 462 3-year-olds followed to age 15. We conducted confirmatory factor analysis (CFA) using items from a diagnostic interview and several parent-report inventories and examined concurrent and prospective associations with clinically relevant variables. The CFA identified dimensions consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent-reported temperamental negative affectivity and surgency, and depressive and oppositional defiant (ODD) disorders, and predicted higher rates of disruptive behavior disorders (DBD) and suicidal behavior in later childhood and adolescence. Phasic irritability was independently associated with concurrent laboratory observations of child impulsivity, parent-reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting, and generalized anxiety disorder (GAD), attention-deficit hyperactivity disorder (ADHD), and ODD, but it did not predict later psychopathology. Tonic and phasic irritability are separable in 3-year-old children, but their correlates and outcomes are not as distinct as in older youth. This may reflect the greater difficulty characterizing normative and pathological irritability in the preschool period.

Tonic and phasic irritability in 6-year-old children: differential correlates and outcomes.

OBJECTIVE: Irritability is a common and clinically important problem in children and adolescents and a risk factor for later psychopathology and impairment. Irritability can manifest in both tonic (e.g., irritable, touchy mood) and phasic (e.g., temper outburst) forms, and recent studies of adolescents suggest that they predict different outcomes. However, no studies have examined whether tonic and phasic irritability are empirically distinguishable in 6-year-old children and whether they have distinct correlates and outcomes. METHOD: We utilized data from a longitudinal study of an unselected community sample of four hundred fifty-two 6-year-olds followed at 3-year intervals to age 15. We conducted confirmatory factor analysis (CFA) using relevant items from a diagnostic interview and several parent-report inventories. RESULTS: The CFA identified dimensions that were consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent-reported temperamental negative affectivity and internalizing and externalizing disorders at age 6 and predicted higher rates of internalizing psychopathology, and suicidal ideation, in adolescence. Phasic irritability was independently associated with concurrent parent-reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting styles and practices, and externalizing disorders at age 6, and predicted higher rates of externalizing psychopathology in adolescence. CONCLUSIONS: Tonic and phasic irritability in 6-year-old children appear to be distinguishable constructs with different temperament and parenting correlates and psychopathological outcomes. Distinguishing these components has implications for research on the etiology and pathophysiology of irritability and developing effective treatments.

Quantifying Severity of Preschool-Aged Children's Internalizing Behaviors: A Daily Diary Analysis.

A subset of preschool-aged children meets criteria for impairing and persistent anxiety and depression. However, the overlap between normative emotional development and impairing symptoms complicates assessments of internalizing problems in early childhood. Given the benefits of early identification/prevention and avoiding overpathologizing typical development, empirical information is needed to norm expression of internalizing behaviors. In this 14-day online diary study, 609 primary caregivers of 3- to 5-year-old children reported the frequency of children's daily separation and social anxiety and depressive behaviors and impairment. Item response theory analyses quantified specific frequencies at which each behavior was psychometrically severe/rare. Patterns varied for each behavior; for example, distress when anticipating separation had to occur at least 10 times and sadness at least 35 times over 14 days to be considered severe. Most social anxiety behaviors had to occur approximately every other day to be considered severe. Parameters did not vary by child age or sex, and behaviors were significantly associated with impairment. These data provide empirical information for refining internalizing behavior assessment in preschool-aged children and can be used as benchmarks by child practitioners to assess the extent to which frequencies fall in the range of developmentally typical behavior versus those that may be more severe.

Temperament and psychopathology in early childhood predict body dissatisfaction and eating disorder symptoms in adolescence.

Eating disorders (ED) are highly impairing and dangerous conditions that typically onset in adolescence. However, very few prospective studies have examined early childhood risk factors for ED pathology. Given well-established links between temperament and psychopathology, examination of these factors could inform prevention efforts. The current multi-method, multi-informant prospective longitudinal study tested whether laboratory-observed and parent-reported temperament and psychiatric disorders at ages 3 and 6 (N = 609) predict body dissatisfaction at ages 12 and 15 and dimensional symptoms of EDs (anorexia nervosa [AN] and bulimia nervosa [BN]) at age 15 (n = 458) in a community sample. Results indicated that early childhood temperament (positive and negative emotionality, perceptual sensitivity, impulsivity, less shyness) and childhood psychopathology (anxiety, oppositional defiant, attention deficit/hyperactivity, and depressive disorders), predicted body dissatisfaction in adolescence. In addition, childhood perceptual sensitivity and oppositional defiant and depressive disorders predicted AN symptoms. Demographic characteristics (female sex, lower levels of fathers' education, and parental marital status) in childhood predicted body dissatisfaction and AN symptoms. No temperament or psychopathology variables predicted BN symptoms. This study is an important first step toward continuing to identify areas of focus for future research on early childhood risk factors for ED symptoms and body dissatisfaction.

Depression in 3/6-year-old children: clinical and psychosocial outcomes in later childhood and adolescence.

BACKGROUND: In recent years, epidemiological and clinical studies have revealed that depressive disorders can present in early childhood. To clarify the validity and prognostic significance of early childhood-onset depression, we investigated diagnostic and functional outcomes in later childhood and adolescence. METHODS: A community sample (N = 516) was assessed for psychopathology at ages 3 and 6 using the Preschool Age Psychiatric Assessment. When participants were 9, 12, and 15 years old, children and parents completed the Kiddie Schedule for Affective Disorders and Schizophrenia and measures of symptoms and functioning. RESULTS: In models adjusting for covariates, depressed 3/6-year-old children were more likely to experience subsequent episodes of depressive disorders and exhibited significantly higher rates of later anxiety disorder, attention deficit hyperactivity disorder, and suicidality compared to children without depressive disorders at age 3/6. Early childhood depression was also associated with higher levels of mother, but not child, reported depressive symptoms at age 15 compared to children without depressive disorders at age 3/6. Finally, depression at age 3/6 predicted lower levels of global and interpersonal functioning and higher rates of treatment at age 15 compared to children without depressive disorders at age 3/6. CONCLUSIONS: Results support the clinical significance of depression in 3/6-year-old children, although further studies with larger samples are needed.

Affective Dynamics and Mean Levels of Preschool Irritability and Sadness: Predictors of Children's Psychological Functioning Two Years Later.

Although irritability and sadness are cardinal symptoms of depression, they are also common in preschoolers. The daily experiences of these emotions are not well-understood during early childhood, yet may provide insight into identification of early depressive symptoms. The current longitudinal study examined daily mean levels and emotion dynamics of preschool-aged children's irritability and sadness and psychiatric outcomes in early school-age. Parents (n = 291) completed 14 consecutive daily diaries about their preschoolers' emotions. Two years later, parents (n = 164) completed a semi-structured clinical interview and questionnaires about their children's psychological functioning. Strong correlations between mean and dynamic measures (rs = 0.65-0.91) were identified. Preschoolers' mean daily levels and dynamics of irritability (variability, instability, inertia) and sadness (instability, inertia) predicted symptoms and impairment 2 years later. Sadness instability and inertia continued to predict difficulties after adjusting for mean daily sadness. Fine-grained daily measures of preschoolers' affect may be help identify children at-risk for psychological problems.

Using Item Response Theory to Compare Irritability Measures in Early Adolescent and Childhood Samples.

Limited psychometric information is available to guide best practices for measuring youth irritability. This report compares performance of irritability measures using item response theory (IRT). Study 1 used a sample of 482 early adolescents and compared the parent- and youth-report affective reactivity index (ARI) and irritability factors derived from the parent-report Child Behavior Checklist (CBCL) and clinician-administered Kiddie Schedule for Affective Disorders (K-SADS). Study 2 combined data from three childhood samples (N = 811) and compared performance of the parent-report ARI and CBCL and the clinician-administered Preschool Age Psychiatric Assessment (PAPA). The ARI emerged as the best measure of childhood irritability across the developmental periods, while the CBCL and K-SADS provided an adequate amount of information in early adolescents. No measure reliably assessed irritability at modest severity levels. Using IRT across large pools of developmental samples and measures is needed to guide the field in the measurement of youth irritability.

Early Childhood Psychopathology Prospectively Predicts Social Functioning in Early Adolescence.

Psychopathology in school-age children predicts impairment later in development. However, the long-term psychosocial consequences of early childhood psychopathology are less well known. The current study is the first to prospectively examine how a range of diagnoses and symptoms in early childhood predict psychosocial functioning across specific domains during early adolescence 6-9 years later. A community sample (N = 595; 44.9% female; 88.7% White, 12.6% Hispanic) was assessed for psychopathology at ages 3 and 6 using the Preschool Age Psychiatric Assessment. Diagnoses and dimensional scores for depressive, anxiety, attention-deficit/hyperactivity (ADHD), and oppositional defiant disorders (ODD) were examined. When children were 12 years old, children and parents completed the UCLA Life Stress Interview for Children, a semistructured interview assessing functioning in multiple domains (academic, behavior, close friends, broader peers, maternal relationship, paternal relationship). Having a diagnosis in early childhood predicted greater impairment in all domains in early adolescence, except paternal relationship. Externalizing disorders predicted impairment in more domains than internalizing disorders. Most of the associations between early childhood psychopathology and poorer functioning in adolescence persisted after taking into account adolescent psychopathology. Moreover, the majority of bivariate associations with depressive, ODD, and ADHD symptoms, but not anxiety symptoms, persisted in a subsample of children who did not meet criteria for a diagnosis in early childhood. Early childhood psychopathology has long-lasting deleterious effects on several domains of psychosocial functioning, often beyond the effects of continuing or recurring adolescent psychopathology. Findings thereby highlight the validity and clinical significance of early psychopathology.

A Daily Diary Analysis of Preschool Depressive Behaviors: Prospective Associations and Moderators Across 14 Days.

Depressive disorders can be observed in early childhood and are associated with significant concurrent and prospective impairment; however, little is known about day-to-day variations in common depressive behaviors in children. This study examined the day-to-day variability of two common depressive behaviors in preschool-aged children, sadness and irritability, and factors associated with the daily occurrence of these behaviors. Participants included 291 parents of preschool-aged children, and parents completed a 14-day daily diary. Results indicated that sleep quality did not prospectively predict next-day sadness or irritability the following day. We observed between-person stability, but within-person variability, in children's sadness and irritability across 14 days. We observed greater between-person stability and greater within-person variability in sadness and irritability for males and for children with fewer baseline psychiatric symptoms and lower baseline impairment. Findings provide a developmental perspective on normative patterns of sadness and irritability in young children and can inform prevention and individualized intervention efforts to reduce negative sequelae in at-risk preschoolers.

Mapping the frequency and severity of anxiety behaviors in preschool-aged children.

Although anxiety can be early-emerging, impairing, and persistent, behaviors relevant to anxiety mirror typical development in early childhood. To better understand the spectrum of typical to problematic behavior, this study characterizes the range of frequency and severity of separation and social anxiety behaviors and associated impairment in preschool-aged children using a novel daily diary method. Primary caregivers of 291 3-5-year-old children reported the frequency of children's daily separation and social anxiety behaviors and related impairment for 14 days. Frequencies of each separation and social anxiety behavior were computed and item response theory analyses revealed the specific frequencies at which the behavior was considered psychometrically severe/rare. Patterns varied across items; for example, worry that caregiver would not return and shyness with familiar adults had to occur at least 3-4 times over 14 days for the behavior to be considered severe/rare, whereas shyness around peers and new people were not severe at any frequency. In addition, behaviors were associated with impairment. To our knowledge, these data are the first to delineate empirical, dimensional information about the frequency and severity of anxiety behaviors and associated impairment in early childhood. Such data could be useful for clinical practice to enhance empirically-driven assessment of anxiety.

The BDNF gene val66met polymorphism and behavioral inhibition in early childhood.

Stably elevated behavioural inhibition (BI) is an established risk factor for internalizing disorders. This stability may be related to genetic factors, including a valine-to-methionine substitution on codon 66 (val66met) of the brain-derived neurotrophic factor (BDNF) gene. Past work on the BDNF met variant has inconsistently linked it to vulnerability to internalizing problems; some of this inconsistency may stem from the failure to consider gene-trait interactions in shaping the course of early BI. Toward elucidating early pathways to anxiety vulnerability, we examined gene-by-trait interactions in predicting the course of BI over time in 476 children, assessed for BI using standardized laboratory methods. We found that children with the met allele showed lower stability of BI between ages 3 and 6 than those without this allele. While the mechanisms that underlie this effect are unclear, our findings are consistent with the notion that the met variant, in the context of early BI, influences the stability of this trait in early development.

The Development of Latent Dimensions of Psychopathology across Early Childhood: Stability of Dimensions and Moderators of Change.

Recent research has described the structure of psychopathology as including one general and multiple specific factors, and this structure has been found in samples across development. However, little work has examined whether this structure is consistent across time, particularly in young children, within the same sample. Further, few studies have examined factors that influence the magnitude of the stability of latent dimensions of psychopathology. In the present study, we examine these issues in a community sample of 545 children assessed at ages 3 and 6. In addition, we explored child temperament, parental history of psychopathology, and parenting behaviors as potential moderators of the longitudinal stability of latent dimensions of psychopathology. We found that the same bifactor model structure identified at age 3 provided an adequate fit to the data at age 6. Further, our model revealed significant homotypic stability of the general, internalizing, and externalizing specific factors. We also found evidence of differentiation of psychopathology over time with the general factor at age 3 predicting the externalizing factor at age 6. However, we failed to identify moderators of the longitudinal associations between psychopathology latent factors. Overall, our results bolster support for the bifactor structure of psychopathology, particularly in early childhood.

Preschool psychiatric disorders: homotypic and heterotypic continuity through middle childhood and early adolescence.

BACKGROUND: Many preschool-age children meet criteria for psychiatric disorders, and rates approach those observed in later childhood and adolescence. However, there is a paucity of longitudinal research examining the outcomes of preschool diagnoses. METHODS: Families with a 3-year-old child (N = 559) were recruited from the community. Primary caregivers were interviewed using the Preschool Age Psychiatric Assessment when children were 3 years old (n = 541), and, along with children, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version when children were 9 and 12 years old. RESULTS: Rates of disruptive behavior disorders (DBD) decreased from preschool to middle childhood and early adolescence, whereas rates of attention-deficit/hyperactivity disorder (ADHD) increased. Rates of any psychiatric disorder and depression increased from preschool to early adolescence only. Preschoolers with a diagnosis were over twice as likely to have a diagnosis during later periods. Homotypic continuity was present for anxiety disorders from preschool to middle childhood, for ADHD from preschool to early adolescence, and for DBD through both later time points. There was heterotypic continuity between preschool anxiety and early adolescent depression, and between preschool ADHD and early adolescent DBD. Dimensional symptom scores showed homotypic continuity for all diagnostic categories and showed a number of heterotypic associations as well. CONCLUSIONS: Results provide moderate support for the predictive validity of psychiatric disorders in preschoolers. Psychopathology in preschool is a significant risk factor for future psychiatric disorders during middle childhood and early adolescence.

Temperament Distinguishes Persistent/Recurrent from Remitting Anxiety Disorders Across Early Childhood.

Up to 20% of preschool-age children meet criteria for anxiety disorders and, for a large subset, anxiety appears to persist throughout early childhood. However, little is known about which factors predict persistence/recurrence of anxiety in young children. Temperament, including behavioral inhibition (BI), negative emotionality (NE), and positive emotionality (PE), predict the onset of anxiety disorders, but to our knowledge no study has examined whether temperament predicts the course of anxiety in young children. From a community sample of 3-year-olds, we identified 89 children (79.8% White, non-Hispanic; 41.6% female) who met criteria for an anxiety disorder and examined whether observed and parent-reported BI, NE, and PE at age 3 distinguished children who continued to meet criteria for an anxiety disorder from those who remitted by age 6. Higher levels of BI and lower levels of PE assessed in the laboratory and higher parent-reported BI and shyness and lower surgency at age 3 significantly predicted persistence/recurrence of anxiety disorders from age 3 to 6. These data are the first to demonstrate the influence of temperament on the course of anxiety disorders in young children. These findings can enhance assessment and treatment of anxiety by focusing intervention efforts on children who are at risk for persistent or recurring anxiety rather than children who are displaying transient, and possibly developmentally normative, anxiety.

Mapping the Frequency and Severity of Depressive Behaviors in Preschool-Aged Children.

Depressive emotions and behaviors, such as sadness, irritability, and sleep difficulties, are often early-emerging, impairing, and persistent. However, these behaviors are normative in early development, so it is critical to identify the spectrum of behaviors that may be relevant to the development of depression. This study characterizes the frequency and severity of depressive behaviors and impairment in preschool-aged children using a novel daily diary method with 291 parents. A coherent depression dimension was identified, and the specific frequency at which individual behaviors were identified as severe is reported. Behaviors such as sadness, irritability, and tearfulness/sensitivity were found to be relatively normative, whereas other behaviors (e.g., low interest/pleasure, low self-worth) were less normative. These are the first known data to delineate empirical information about the frequency and severity of behaviors that may be relevant to the development of depression; such data provide quantitative information for child practitioners to make distinctions between developmentally typical and problematic behavior, which is essential for improving assessment and minimizing impairing developmental trajectories.