Researchers: Miriam Peskin¹, Noa Vardi¹, Avi Wiezman^1,2

Background: The early years of life are critical for emotional and psychological development. According to the literature, there is often underdiagnosis of internalizing problems contrasted with overdiagnosis of externalizing disorders in older children—a gap that may hinder early intervention.

Objectives: To characterize the demographic and clinical profiles of children aged 1–5 referred to an infant psychiatry clinic, with an emphasis on referral patterns (reason for referral) and clinical diagnosis (using DC:0-3 or DC:0-5), as classified into internalizing or externalizing disorders.

Method: This retrospective quantitative study collected data from 546 clinical records at the infant psychiatry outpatient clinic; files lacking sufficient data were excluded. The final sample included 203 families who completed the BITSEA questionnaire, received a DC diagnosis, and had a documented referral reason. The majority of the children (90%) were between ages 1–3. Tools included demographic questionnaires, the BITSEA, and DC diagnostic assessment. Distribution and statistical associations were analyzed primarily using χ² tests.

Findings: Contrary to expectations, 43% of referrals were due to internalizing problems—a proportion notably higher than is typically observed among referrals of children aged 6–18 for internalizing disorders. Psychiatric diagnostic review showed internalizing disorders in 33% of cases, compared to just 2% for externalizing disorders. There was only a weak association between parent reports and clinical diagnoses, in proportion of internalizing disorders. Most participants came from socioeconomically advantaged backgrounds.

Recommendations: A multifocal diagnostic model is recommended alongside the development of accessible detection and treatment tools for all social groups. Follow-up research is needed to further examine reporting and diagnosis gaps in early childhood.

Research end date: 07/2025