Extended childhood disorder (ECD): Proposal and preliminary empirical support for a new ecologically-based diagnostic category of teen dysfunction

Abstract

Background/objective: Existing diagnostic categories of teen dysfunction often refer to hypothetical biological or developmental factors, even though teen dysfunction is often absent in many non-Western cultures. Diagnostic categories of this sort do not do justice to the social causes of many teen problems in the United States (U.S.) and other Western countries. To put more emphasis on known cultural causes of teen dysfunction, we propose adopting an ecologically-based diagnostic category we call "extended childhood disorder" (ECD), characterized by (1) excessive and sometimes harmful involvement with peers, (2) conflict centering around control issues with authority figures, and (3) mood problems centering around control issues with authority figures.

Method: 5198 individuals were evaluated, either by themselves or by therapists, counselors, teachers, or parents: a diverse group of 3147 females, 1750 males, and 301 others, mean age 23.4. 54.3 % of the participants were from the U.S., and the remaining 46.7 % were English speakers in 74 other countries.

Results: Total scores on a diagnostic test of ECD were negatively correlated with level of happiness and positively correlated with levels of anger, depression, and anxiety, whether reported by self or others (note that higher scores on the ECDI indicate greater dysfunction). Total scores were also predictive of 13 clinically significant criterion variables. Notably, prevalence of ECD in our sample roughly matched the 2010 National Comorbidity Survey estimates of the prevalence of teen disorders in the U.S.

Conclusion: The ECD diagnostic category should be considered as a viable alternative to current diagnoses of teen problems that emphasize hypothetical endemic or neural deficits.

Keywords: Adolescent diagnoses; Adolescent dysfunction; DSM diagnoses; ECD; Extended childhood disorder; Teen diagnoses; Teen dysfunction.

Fig. 1

Prevalence of extended childhood disorder by age. Variability increased for older people because of small n’s. Only two individuals were between the ages of 85 and 90.

Fig. 2

Proportion of items selected by age, separated by diagnostic criteria. Variability increased for older people because of small n’s. Only two individuals were between the ages of 85 and 90.