Prevalence and Co-Occurrence of Developmental and Emotional-Behavioral Problems in Young Children

Published:November 19, 2022DOI:



      A limited number of studies have estimated the prevalence of emotional-behavioral disorders among young children. None have assessed their co-occurrence with developmental delays using standardized assessment tools. Our objective was to estimate the prevalence of emotional-behavioral disorders and their co-occurrence with developmental delays among young children (2-5.5 years).


      Parents of young children (N=987) enrolled from pediatric waiting rooms completed developmental-behavioral screening questionnaires. Based on results, 585 families were invited to and 439 completed evaluations that included structured diagnostic interviews with parents to assess child psychopathology (Preschool Age Psychiatric Assessment (PAPA)), developmental testing with children (including the Bayley Scales of Infant and Toddler Development, 3rd Edition for children ≤ 42 months; Differential Ability Scales, 2nd Edition for older children), and videotaped observation to establish whether autism risk was sufficient to warrant further evaluation.


      According to PAPA algorithms, 23.0% of children met criteria for a DSM-IV disorder, while 9% qualified for a developmental delay. Presence of delay doubled the odds of having a DSM-IV disorder (OR=2.1; CI: 1.02-4.3), and presence of disorder doubled the odds of having a moderate-to-severe developmental delay (OR=2.0;CI: 1.10-3.50). Prevalence of DSM-IV disorders (48.8% (95% CI: 33.5-64.5%)) and developmental delays (57.5% (95% CI: 41.7-71.9%)) were both higher among children at risk for autism. While developmental delay did not vary by race/ethnicity, prevalence of DSM-IV disorders was lower among African-American/Black (10.6%; CI: 2.9-18.3) and Hispanic/Latino children (11.1%; CI: 4.3-17.9).


      Developmental delays and emotional-behavioral disorders among young children seen in pediatric settings are characterized by high prevalence and substantial co-occurrence.

      What's New

      Few studies investigate the prevalence of emotional-behavioral disorders among young children in pediatrics, and none assess co-occurrence with developmental test results. Replicating prior studies, we confirm that emotional-behavioral-disorders are highly prevalent in pediatrics and document substantial co-occurrence with developmental delays.



      ASQ-3 (Ages and Stages Questionnaire, 3rd edition), ASQ-SE-2 (Ages and Stages: Social-Emotional, 2nd edition), BDI-II (Battelle Developmental Inventory, Second Edition), BSID-III (Bayley Scales of Infant and Toddler Development, Third Edition), CARS2-ST (Childhood Autism Rating Scale, Second Edition (Standard Version)), DAS (Differential Ability Scales, Second Edition (DAS-II)), DSM-IV-PC (DSM-IV-Primary Care), M-CHAT-R (Modified Checklist for Autism in Toddlers-Revised), PAPA (Preschool Age Psychiatric Assessment), PEDS (Parents’ Evaluation of Developmental Status), PLS-5 (Preschool Language Scale, Fifth Edition), STAT (Screening Tool for Autism in Toddlers and Young Children), SWYC (Survey of Wellbeing of Young Children)
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