Patterns of Mental Disorders in a Large Child Psychiatric Sample (N = 65,363): A DREAMS Study

Objective: To provide a comprehensive overview of the prevalence and comorbidity patterns of mental disorders in a large child and adolescent psychiatry sample. Method: Data on DSM diagnoses were retrieved from medical records of children (0.5-18 years old) who received care at a DREAMS center between 2015 and 2019. DREAMS is a consortium of 4 academic centers for child and adolescent psychiatry in the Netherlands that provide both outpatient and inpatient care. Diagnoses were assigned in regular clinical practice. Results: Between 2015 and 2019, 65,363 children received care at a DREAMS center (mean [SD] age at admission = 10.8 [4.1] years; 60.7% male). Of these children, 46,762 (71.5%) had a registered DSM disorder. The most prevalent primary diagnoses were autism (34.6%), attention-deficit/hyperactivity disorder (24.6%), and trauma and stressor-related disorders (8.4%). Approximately half of all children (47.2%) had at least 1 comorbid diagnosis, of which intellectual disabilities were the most prevalent (29.5%). Conclusion: Diagnostic patterns across sex and age as well as comorbidity patterns were generally consistent with previous research, but the prevalence of autism and attention-deficit/hyperactivity disorder was higher than in other studies. Real-world diagnostic information such as presented here is essential to understand the use of DSM-5 in clinical practice, put differences between contexts and countries into perspective, and ultimately improve our diagnostic protocols and treatments. Plain language summary: This study analyzed data from the medical records of 65,363 children who received psychiatric care in the Netherlands between 2015 and 2019. The authors found that 71.5% of these children had a registered mental disorder, with the most common being autism (34.6%), followed by attention-deficit/hyperactivity disorder (ADHD) (24.6%) and trauma-related disorders (8.4%). In addition, nearly half of the children had at least one other co-occurring diagnosis, with intellectual disability being the most prevalent (29.5%). These diagnostic findings are essential in clinical practice, placing differences between contexts and countries into perspective, and ultimately improving our diagnostic protocols and treatments.