CHAPTER 22
Preschool Problems
Many children under the age of 5 years have attentional, emotional or
behavioural problems, including the well-recognised disorders described
elsewhere in this book, for example, autism or a disinhibited attachment
disorder. In other instances, however, the preschool child has just one
area of problems (for example, faddy eating) or a few problems that do
not add up to any recognised diagnosis. In these instances, the assessment
generates a list of problem areas rather than a specific diagnosis.
Common problems
The classic community study of preschool problems and their conse-
quences is the Preschool to School study (see Box 22.1). Preschool
children can present with the same sorts of symptoms that commonly
bring older children to psychiatric attention: worries, fears, misery, ag-
gression, tantrums, over-activity, inattention, and so on. As shown in Box
22.1, age trends differ by symptom. Thus, as children mature, over-activity
and fears become less common while worries become more common – and
the number of ‘hard to manage’ children stays fairly constant.
Developmental or habit problems are particularly common among
preschool children. Delays in toilet training are very frequent, as are com-
fort habits such as rocking, thumb sucking, head banging, masturbation
or hair sucking. Other common difficulties include poor appetite, faddy
eating, difficulty settling to sleep at night and frequent night wakening. As
shown in Box 21.1, maturation leads to the resolution of many develop-
mental and habit problems. Once parents know this, they are often willing
to wait for their child to grow out of these behaviours. If the family do
want help, then advice on behavioural management is often the answer.
This advice may come from a health visitor, a family doctor, a paediatrician
or a mental health professional.
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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