Testing models of psychopathology in preschool-aged children using a structured interview-based assessment

An examination of the relationship between conduct problems and depressive symptoms comorbidity and temperament among elementary school children

Although the comorbidity between conduct problems (CP) and depressive symptoms (DS) is associated with a host of negative outcomes, the factors, such as temperament, that might explain this comorbidity in school-aged boys and girls are poorly understood. This study compared elementary school children presenting co-occurring CP and DS to children with DS only, CP only, and those with low-level symptoms on temperament dimensions, and explored the moderating role of child sex in the associations. Participants are 487 children (M = 8.38 years, SD = 0.92, 52.2% girls) divided into four groups (CP + DS, DS only, CP only, control). Findings suggest that boys with CP and DS presented a lower level of fear than boys with DS and boys from the control group. They also presented higher levels of activity than boys with DS. Girls with CP and DS presented lower levels of fear than girls with DS, lower levels of approach and activity than girls with CP, and higher levels of shyness than girls from the control group. These findings suggest that temperament may discriminate children with comorbid CP and DS from those presenting only CP or DS.

Reactive and control processes in the development of internalizing and externalizing problems across early childhood to adolescence

Reactive and control processes - e.g., negative emotionality and immediacy preference - may predict distinct psychopathology trajectories. However, externalizing and internalizing problems change in behavioral manifestation across development and across contexts, thus necessitating the use of different measures and informants across ages. This is the first study that created developmental scales for both internalizing and externalizing problems by putting scores from different informants and measures onto the same scale to examine temperament facets as risk factors. Multidimensional linking allowed us to examine trajectories of internalizing and externalizing problems from ages 2 to 15 years (N = 1,364) using near-annual ratings by mothers, fathers, teachers, other caregivers, and self report. We examined reactive and control processes in early childhood as predictors of the trajectories and as predictors of general versus specific psychopathology in adolescence. Negative emotionality at age 4 predicted general psychopathology and unique externalizing problems at age 15. Wait times on an immediacy preference task at age 4 were negatively associated with age 15 general psychopathology, and positively associated with unique internalizing problems. Findings demonstrate the value of developmental scaling for examining development of psychopathology across a lengthy developmental span and the importance of considering reactive and control processes in development of psychopathology.

Using Dispositions to Understand Otherwise Intractable Causal Pathways to Psychological Problems During Childhood and Adolescence

Studies of the genetic and environmental factors that make children more or less likely to develop distressing and impairing psychological problems, and studies of the psychobiological pathways through which these causal factors operate, have the goal of improving our understanding of the basic nature of psychological problems to develop better methods of prevention and treatment. For this reason, we have long had our eye on the prize of discovering the causes and psychobiological mechanisms underlying each dimension of psychological problems. There are compelling reasons, however, to seek a different and more achievable prize to understand psychological problems. Dimensions of psychological problems are both far too heterogeneous and too highly correlated to line up with distinct causal pathways. In contrast, a small number of orthogonal cognitive and socioemotional dispositional dimensions are correlated with psychological problems in revealing cross-cutting patterns. Each of these dispositions shares its independent causal pathways with psychological problems and help us understand the complex shared and heterogeneous nature of their causal processes. I outline a strategy for understanding the causes and mechanisms of psychological problems using studies of independently measured dispositions.

A Developmentally Informed Systematic Review and Meta-Analysis of the Strength of General Psychopathology in Childhood and Adolescence

Considerable support exists for higher-order dimensional conceptualizations of psychopathology in adults. A growing body of work has focused on understanding the structure of general and specific psychopathology in children and adolescents. No prior meta-analysis has examined whether the strength of the general psychopathology factor (p factor)-measured by explained common variance (ECV)-changes from childhood to adolescence. The primary objective of this multilevel meta-analysis was to determine whether general psychopathology strength changes across development (i.e. across ages) in childhood and adolescence. Several databases were searched in November 2021; 65 studies, with 110 effect sizes (ECV), nested within shared data sources, were identified. Included empirical studies used a factor analytic modeling approach that estimated latent factors for child/adolescent internalizing, externalizing, and optionally thought-disordered psychopathology, and a general factor. Studies spanned ages 2-17 years. Across ages, general psychopathology explained over half (~ 56%) of the reliable variance in symptoms of psychopathology. Age-moderation analyses revealed that general factor strength remained stable across ages, suggesting that general psychopathology strength does not significantly change across childhood to adolescence. Even if the structure of psychopathology changes with development, the prominence of general psychopathology across development has important implications for future research and intervention.

Between- and within-child level associations between externalizing and internalizing behavior problems in a nationally representative sample of US elementary school children

BACKGROUND

Both transactional and common etiological models have been proposed as explanations of why externalizing behavior problems (EBP) and internalizing behavior problems (IBP) co-occur in children. Yet little research has empirically evaluated these competing theoretical explanations. We examined whether EBP and IBP are transactionally related at the within-child level while also identifying antecedents commonly associated with between-child differences in underlying stability of both EBP and IBP across elementary school.

METHODS

We analyzed a nationally representative and longitudinal sample of US schoolchildren (N = 7,326; 51% male) using random-intercept cross-lagged panel modeling (RI-CLPM). We used teacher ratings of EBP and IBP as annually assessed from the spring of kindergarten (Mage  = 6.12 years) through the spring of 5th grade (Mage  = 11.09 years). Early childhood antecedents included child internal (i.e. inhibitory control, cognitive flexibility, working memory, and language/literacy) and external factors (i.e. parental warmth, harsh parenting, parenting stress, and maternal depressive symptoms).

RESULTS

We found little evidence for within-child, transactional relations between EBP and IBP. Both types of behavior problems instead were substantially associated at the between-child level. Inhibitory control was the strongest common antecedent that explained this longitudinal overlap. Cognitive flexibility, working memory, language/literacy skills, and maternal depression contributed specifically to the stability of IBP. Measures of parenting were specific to the stability of EBP.

CONCLUSIONS

Common etiological factors rather than transactional relations better explain the co-occurrence of EBP and IBP during elementary school. Inhibitory control is a promising target of early intervention efforts for schoolchildren at risk of displaying both EBP and IBP.

Structure of Psychopathology in Romanian Preschool-Aged Children in an Epidemiological and a High-Risk Sample

Objective

Research on bifactor models of psychopathology in early childhood is limited to community samples with little longitudinal follow-up. We examined general and specific forms of psychopathology within 2 independent samples of preschool-aged Romanian children. Within a sample with children exposed to psychosocial deprivation, we also examined antecedents and longitudinal outcomes of the general factor.

Method

One sample consisted of 350 Romanian children (mean age = 39.7 months, SD = 10.9) from an epidemiological study; the second sample consisted of 170 Romanian children (mean age = 55.6 months, SD = 1.9) exposed to severe early-life deprivation, as well as community comparison children, with longitudinal follow-up at 8 and 12 years. Psychopathology symptoms were assessed through caregiver-reported structured clinical interviews.

Results

An SI-1 bifactor model of psychopathology was supported in both samples and included specific factors for externalizing, internalizing, and disturbed relatedness symptoms. In the second sample, longer duration of psychosocial deprivation and lower-quality caregiving were associated with higher scores on the general and all specific factors. Higher scores on the general factor were associated with later cognitive function, competence, and psychopathology symptoms. Considering all factors together, only the general factor explained variance in later childhood outcomes and was slightly stronger compared to a total symptom count for some, but not all, outcomes.

Conclusion

General psychopathology in early childhood explains meaningful variance in child outcomes across multiple domains of functioning in later childhood. However, important questions remain regarding its clinical utility and usefulness, given complex measurement and limited explanatory power beyond the more accessible approach of a total symptom count.

Clinical trial registration information

The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.

The P3 ERP in Relation to General Versus Specific Psychopathology in Early Childhood

There is considerable covariation between externalizing and internalizing problems across the lifespan. Partitioning general and specific psychopathology is crucial to identify (a) processes that confer specific risk for externalizing versus internalizing problems and (b) transdiagnostic processes that confer risk for the covariation between externalizing and internalizing problems. The oddball P3 event-related potential (ERP) component, thought to reflect attentional orienting, has been widely examined in relation to psychopathology. However, prior studies have not examined the P3-or other aspects of neural functioning-in relation to general versus specific psychopathology in children. The present study examined whether children's (N = 124, ages 3-7 years) P3 amplitudes were associated with general versus specific psychopathology. Children's electroencephalography data were recorded during an oddball task. Parents rated their children's externalizing and internalizing problems. Using bifactor models to partition variance in parents' ratings of children's psychopathology symptoms, we examined children's P3 amplitudes in relation to three latent factors: (1) the general factor of psychopathology-the covariation of externalizing and internalizing psychopathology, (2) unique externalizing problems-the variance in externalizing problems after controlling for the general factor, and (3) unique internalizing problems. Results indicated that smaller P3 amplitudes were associated with unique externalizing problems at ages 3-5, and with general psychopathology at ages 6-7. Findings suggest that smaller P3 amplitudes may be associated with externalizing problems from a very young age. Moreover, there may be a developmental shift in the functional significance of the P3 in relation to general and specific psychopathology in childhood.

Psychopathology in children: The transdiagnostic contribution of affiliative capacity and inhibitory control

Recent initiatives have focused on integrating transdiagnostic biobehavioral processes or dispositions with dimensional models of psychopathology. Toward this goal, biobehavioral traits of affiliative capacity (AFF) and inhibitory control (INH) hold particular promise as they demonstrate transdiagnostic stability and predictive validity across developmental stages and differing measurement modalities. The current study employed data from different modes of measurement in a sample of 1830 children aged 5-10 years to test for associations of AFF and INH, individually and interactively, with broad dimensions of psychopathology. Low AFF, assessed via parent-report, evidenced predictive relations with distress- and externalizing-related problems. INH as assessed by cognitive-task performance did not relate itself to either psychopathology dimension, but it moderated the effects observed for low AFF, such that high INH protected against distress symptoms in low-AFF participants, whereas low INH amplified distress and externalizing symptoms in low-AFF participants. Results are discussed in the context of the interface of general trait transdiagnostic risk factors with quantitatively derived dimensional models of psychopathology.

Do general and specific factors of preschool psychopathology predict preadolescent outcomes? A transdiagnostic hierarchical approach

BACKGROUND

Preschool psychiatric symptoms significantly increase the risk for long-term negative outcomes. Transdiagnostic hierarchical approaches that capture general ('p') and specific psychopathology dimensions are promising for understanding risk and predicting outcomes, but their predictive utility in young children is not well established. We delineated a hierarchical structure of preschool psychopathology dimensions and tested their ability to predict psychiatric disorders and functional impairment in preadolescence.

METHODS

Data for 1253 preschool children (mean age = 4.17, s.d. = 0.81) were drawn from three longitudinal studies using a similar methodology (one community sample, two psychopathology-enriched samples) and followed up into preadolescence, yielding a large and diverse sample. Exploratory factor models derived a hierarchical structure of general and specific factors using symptoms from the Preschool Age Psychiatric Assessment interview. Longitudinal analyses examined the prospective associations of preschool p and specific factors with preadolescent psychiatric disorders and functional impairment.

RESULTS

A hierarchical dimensional structure with a p factor at the top and up to six specific factors (distress, fear, separation anxiety, social anxiety, inattention-hyperactivity, oppositionality) emerged at preschool age. The p factor predicted all preadolescent disorders (ΔR2 = 0.04-0.15) and functional impairment (ΔR2 = 0.01-0.07) to a significantly greater extent than preschool psychiatric diagnoses and functioning. Specific dimensions provided additional predictive power for the majority of preadolescent outcomes (disorders: ΔR2 = 0.06-0.15; functional impairment: ΔR2 = 0.05-0.12).

CONCLUSIONS

Both general and specific dimensions of preschool psychopathology are useful for predicting clinical and functional outcomes almost a decade later. These findings highlight the value of transdiagnostic dimensions for predicting prognosis and as potential targets for early intervention and prevention.

On the Meaning of the "P Factor" in Symmetrical Bifactor Models of Psychopathology: Recommendations for Future Research From the Bifactor-(S-1) Perspective

Symmetrical bifactor models are frequently applied to diverse symptoms of psychopathology to identify a general P factor. This factor is assumed to mark shared liability across all psychopathology dimensions and mental disorders. Despite their popularity, however, symmetrical bifactor models of P often yield anomalous results, including but not limited to nonsignificant or negative specific factor variances and nonsignificant or negative factor loadings. To date, these anomalies have often been treated as nuisances to be explained away. In this article, we demonstrate why these anomalies alter the substantive meaning of P such that it (a) does not reflect general liability to psychopathology and (b) differs in meaning across studies. We then describe an alternative modeling framework, the bifactor-(S-1) approach. This method avoids anomalous results, provides a framework for explaining unexpected findings in published symmetrical bifactor studies, and yields a well-defined general factor that can be compared across studies when researchers hypothesize what construct they consider "transdiagnostically meaningful" and measure it directly. We present an empirical example to illustrate these points and provide concrete recommendations to help researchers decide for or against specific variants of bifactor structure.

The harmonium model and its unified system view of psychopathology: a validation study by means of a convolutional neural network

The harmonium model (HM) is a recent conceptualization of the unifying view of psychopathology, namely the idea of a general mechanism underpinning all mental disorders (the p factor). According to HM, psychopathology consists of a low dimensional Phase Space of Meaning (PSM), where each dimension of meaning maps a component of the environmental variability. Accordingly, the lower thenumber of independent dimensions in the PSM, and hence its intrinsic complexity, the more limited the way of interpreting the environment. The current simulation study, based on a Convolutional Neural Network (CNN) framework, aims at validating the HM low-dimensionality hypothesis. CNN-based classifiers were employed to simulate normotypical and pathological cognitive processes. Results revealed that normotypical and pathological CNNs were different in terms of both classification performance and layer activation patterns. Using Principal Component Analysis to characterize the PSM associated with the two algorithms, we found that the performance of the normotypical CNN relies on a larger and more evenly distributed number of components, compared with the pathological one. This finding might be indicative of the fact that psychopathology can be modelled as a low-dimensional, poorly modulable PSM, which means the environment is detected through few components of meaning, preventing complex information patterns from being taken into account.

Genetic variance in conscientiousness relates to youth psychopathology beyond executive functions

Because deficits in self-regulation (SR) are core features of many diverse psychological disorders, SR may constitute one of many dimensions that underlie shared variance across diagnostic boundaries (e.g., the p factor, a dimension reflecting shared variance across multiple psychological disorders). SR definitions encompass constructs mapping onto different theoretical traditions and different measurement approaches, however. Two SR operationalizations, executive functioning and conscientiousness, are often used interchangeably despite their low empirical associations-a "jingle" fallacy that pervades much of the research on SR-psychopathology relationships. In a population-based sample of 1,219 twins and multiples from the Texas Twin Project (Mage = 10.60, SDage = 1.76), with a comprehensive battery of measures, we aimed to clarify how these often-muddled aspects of SR relate to individual differences in psychopathology, and whether links between them are accounted for by overlapping genetic and environmental factors. The p factor and an Attention Problems-specific factor were associated with lower executive functioning and conscientiousness. Executive functioning shared a small amount of genetic variance with p above and beyond conscientiousness, whereas conscientiousness shared substantial genetic variance with p independently of genetic variance accounted for by executive functioning. Conversely, the Attention Problems-specific factor was strongly genetically associated with executive functioning independently of genetic variance accounted for by conscientiousness. Results support the notion that SR and psychopathology, broadly conceived, may exist on overlapping spectra, but this overlap varies across conceptualizations of SR and the level of specificity at which psychopathology is assessed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A genome-wide association study of total child psychiatric problems scores

Substantial genetic correlations have been reported across psychiatric disorders and numerous cross-disorder genetic variants have been detected. To identify the genetic variants underlying general psychopathology in childhood, we performed a genome-wide association study using a total psychiatric problem score. We analyzed 6,844,199 common SNPs in 38,418 school-aged children from 20 population-based cohorts participating in the EAGLE consortium. The SNP heritability of total psychiatric problems was 5.4% (SE = 0.01) and two loci reached genome-wide significance: rs10767094 and rs202005905. We also observed an association of SBF2, a gene associated with neuroticism in previous GWAS, with total psychiatric problems. The genetic effects underlying the total score were shared with common psychiatric disorders only (attention-deficit/hyperactivity disorder, anxiety, depression, insomnia) (rG > 0.49), but not with autism or the less common adult disorders (schizophrenia, bipolar disorder, or eating disorders) (rG < 0.01). Importantly, the total psychiatric problem score also showed at least a moderate genetic correlation with intelligence, educational attainment, wellbeing, smoking, and body fat (rG > 0.29). The results suggest that many common genetic variants are associated with childhood psychiatric symptoms and related phenotypes in general instead of with specific symptoms. Further research is needed to establish causality and pleiotropic mechanisms between related traits.

Do the Temperamental Characteristics of Both Mother and Child Influence the Well-Being of Adopted and Non-Adopted Children?

(1) Background: For decades, the temperaments of infants and small children have been a focus of studies in human development and been seen as a potential contributor to children’s developmental patterns. However, less is known about the interplay between the temperamental characteristics of mothers and their children in the context of explaining variations in developmental outcomes. The aim of our study was to explore the associations—with or without genetic links—of the temperaments and psychological distress of mothers and the temperaments of children with behavioral problems in a group of internationally adopted children and their adoptive mothers and in a group of non-adopted children and their mothers. (2) Methods: Data (n = 170) were derived from the ongoing Finnish Adoption (FinAdo) follow-up study. The children included were under the age of 7 years; 74 were adopted internationally through legal agencies between October 2010 and December 2016, and the remaining 96 were non-adopted children living with their birth parents (biological group) recruited from day-care centers. We used Mary Rothbart’s temperament questionnaires to assess temperament, the Child Behavior Checklist (CBCL) to obtain data on the children’s behavioral/emotional problems and competencies, and the General Health Questionnaire (GHQ) to assess parental psychological distress. The study was approved by the Ethics Committee of the Hospital District of Southwest Finland, and written informed consent was obtained from the parents and the children themselves. (3) Results: The negative affectivities of both mothers and children were associated with the total CBCL and with both internalizing and externalizing problem behaviors after adjusting for age, gender, and adoption status. Both relationships remained significant when tested simultaneously, suggesting additive effects. Maternal negative affect was associated with problem behavior irrespective of child extraversion/surgency. Child extraversion/surgency was associated with lower levels of all internalizing behavioral problems when adjusted for maternal sociability. Child negative affect was associated with all behavioral problem measures irrespective of maternal sociability or maternal psychological distress. Maternal distress was associated with child problem behaviors only in children with low extraversion/surgency. (4) Limitations: The sample size was relatively small, and the information was gathered solely with questionnaires. (5) Conclusions: The results of the study may be clinically significant. Child negative affect, maternal negative affect, and maternal experienced distress, combined with low child extraversion/surgency, may increase the risk of child problem behaviors in both adoptees and non-adoptees.

Infant temperament prospectively predicts general psychopathology in childhood

Recent models of psychopathology suggest the presence of a general factor capturing the shared variance among all symptoms along with specific psychopathology factors (e.g., internalizing and externalizing). However, few studies have examined predictors that may serve as transdiagnostic risk factors for general psychopathology from early development. In the current study we examine, for the first time, whether observed and parent-reported infant temperament dimensions prospectively predict general psychopathology as well as specific psychopathology dimensions (e.g., internalizing and externalizing) across childhood. In a longitudinal cohort (N = 291), temperament dimensions were assessed at 4 months of age. Psychopathology symptoms were assessed at 7, 9, and 12 years of age. A bifactor model was used to estimate general, internalizing, and externalizing psychopathology factors. Across behavioral observations and parent-reports, higher motor activity in infancy significantly predicted greater general psychopathology in mid to late childhood. Moreover, low positive affect was predictive of the internalizing-specific factor. Other temperament dimensions were not related with any of the psychopathology factors after accounting for the general psychopathology factor. The results of this study suggest that infant motor activity may act as an early indicator of transdiagnostic risk. Our findings inform the etiology of general psychopathology and have implications for the early identification for children at risk for psychopathology.

Externalizing behavior in preschool children in a South African birth cohort: Predictive pathways in a high-risk context

Mental health problems often begin in early childhood. However, the associations of various individual and contextual risk factors with mental health in the preschool period are incompletely understood, particularly in low- to middle-income countries (LMICs) where multiple risk factors co-exist. To address this gap, we prospectively followed 981 children in a South African birth cohort, the Drakenstein Child Health Study, assessing pre-and postnatal exposures and risk factors. The predictive value of these factors for child mental health (assessed by the Child Behavior Checklist) was modeled using structural equation modeling. We identified two key pathways to greater externalizing behavior: (1) prenatal exposure to substances (alcohol and smoking) directly predicted increased externalizing behavior (β = 0.24, p < 0.001); this relationship was partially mediated by an aspect of infant temperament (negative emotionality; β = 0.05, p = 0.016); (2) lower socioeconomic status and associated maternal prenatal depression predicted more coercive parenting, which in turn predicted increased externalizing behavior (β = 0.18, p = 0.001). Findings in this high-risk LMIC cohort cohere with research from higher income contexts, and indicate the need to introduce integrated screening and intervention strategies for maternal prenatal substance use and depression, and promoting positive parenting across the preschool period.

Preschool Temperament as a Factor of Risk and Protection for Later Childhood Psychopathology

BACKGROUND

Temperament might be considered as a risk factor as well as a resilience factor for later externalizing and internalizing disorders. Therefore, this study examines different dimensions of temperament in preschool age with regard to their predictive value for psychopathology later in childhood.

METHODS

A total of 76 patients (63.2% male) were assessed in a special psychiatric consultation for preschool age at measuring point time t1 (x = 4.2) and measuring point time t2 (x = 9.2). At t1, the Integrative Child Temperament Inventory (ICTI) was used for assessment. At t2, parents completed the Strengths and Difficulties Questionnaire SDQ. Multiple regression analyses were used to test if the temperament factors of the ICTI predicted clinical abnormalities in the SDQ subscales or total difficulties score.

RESULTS

SDQ total difficulties score as an indicator of total psychiatric disturbance in childhood appears to be good predicted by the temperament factor frustration/anger. Sensory sensitivity in preschoolers serves as a risk factor for later emotional symptoms, whereas high activity levels appear to prevent later emotional symptoms. Behavioral inhibition appears to protect against hyperactivity/inattention.

CONCLUSION

Our data suggests that preschool temperament contributes differently to the development of externalizing and internalizing problems in childhood. The temperament factor frustration/anger in preschool children might be a strong predictor of the general mental condition in childhood at nine years of age and can therefore be used as a target for prevention of psychopathology in children. On one hand, high sensory sensitivity can be a predictor to identify preschool children at risk for later emotional symptoms, on the other hand, activity level acts as a protective factor against later emotional symptoms. An increased level of behavioral inhibition might be protective against the development of hyperactivity/inattention symptoms. Overall, this study illustrates the complexity and ambiguity of temperament in child development.

Maternal Depressive Symptoms Predict General Liability in Child Psychopathology

Objective: The current study examines how maternal depressive symptoms relate to child psychopathology when structured via the latent bifactor model of psychopathology, a new organizational structure of psychopathological symptoms consisting of a general common psychopathology factor (p-factor) and internalizing- and externalizing-specific risk.Method: Maternal report of depressive symptoms (Beck Depression Inventory - II) and child psychopathological symptoms (Child Behavior Checklist and Children's Behavior Questionnaire) were provided by 554 mother-child pairs. Children in the sample were 7.7 years old on average (SD = 1.35, range = 5-11 years), and were 49.8% female, 46% Latinx, and 67% White, 6% Black, 5% Asian/Pacific Islander, and 21% multiracial.Results: Maternal depressive symptoms were positively associated with the child p-factor but not with the internalizing- or externalizing-specific factors. We did not find evidence of sex/gender or race/ethnicity moderation when using latent factors of psychopathology. Consistent with past research, maternal depressive symptoms were positively associated with internalizing and externalizing composite scores on the Child Behavior Checklist.Conclusions: Findings suggest that maternal depressive symptoms are associated with transdiagnostic risk for broad child psychopathology (p-factor). Whereas the traditional Achenbach-style approach of psychopathological assessment suggests that maternal depressive symptoms are associated with both child internalizing and externalizing problems, the latent bifactor model suggests that these associations may be accounted for by risk pathways related to the p-factor rather than internalizing or externalizing specific risk. We discuss clinical and research implications of using a latent bifactor structure of psychopathology to understand how maternal depression may impact children's mental health.

Genome-wide DNA methylation patterns associated with general psychopathology in children

Psychiatric symptoms are interrelated and found to be largely captured by a general psychopathology factor (GPF). Although epigenetic mechanisms, such as DNA methylation (DNAm), have been linked to individual psychiatric outcomes, associations with GPF remain unclear. Using data from 440 children aged 10 years participating in the Generation R Study, we examined the associations of DNAm with both general and specific (internalizing, externalizing) factors of psychopathology. Genome-wide DNAm levels, measured in peripheral blood using the Illumina 450K array, were clustered into wider co-methylation networks ('modules') using a weighted gene co-expression network analysis. One co-methylated module associated with GPF after multiple testing correction, while none associated with the specific factors. This module comprised of 218 CpG probes, of which 198 mapped onto different genes. The CpG most strongly driving the association with GPF was annotated to FZD1, a gene that has been implicated in schizophrenia and wider neurological processes. Associations between the probes contained in the co-methylated module and GPF were supported in an independent sample of children from the Avon Longitudinal Study of Parents and Children (ALSPAC), as evidenced by significant correlations in effect sizes. These findings might contribute to improving our understanding of dynamic molecular processes underlying complex psychiatric phenotypes.

Developmental pathways from preschool irritability to multifinality in early adolescence: the role of diurnal cortisol

BACKGROUND

Early irritability predicts a broad spectrum of psychopathology spanning both internalizing and externalizing disorders, rather than any particular disorder or group of disorders (i.e. multifinality). Very few studies, however, have examined the developmental mechanisms by which it leads to such phenotypically diverse outcomes. We examined whether variation in the diurnal pattern of cortisol moderates developmental pathways between preschool irritability and the subsequent emergence of internalizing and externalizing symptoms 9 years later.

METHOD

When children were 3 years old, mothers were interviewed about children's irritability and completed questionnaires about their children's psychopathology. Six years later, children collected saliva samples at wake-up and bedtime on three consecutive days. Diurnal cortisol patterns were modeled as latent difference scores between evening and morning samples. When children were approximately 12 years old, mothers again completed questionnaires about their children's psychopathology.

RESULTS

Among children with higher levels of irritability at age 3, a steeper diurnal cortisol slope at age 9 predicted greater internalizing symptoms and irritability at age 12, whereas a blunted slope at age 9 predicted greater externalizing symptoms at age 12, adjusting for baseline and concurrent symptoms.

CONCLUSION

Our results suggest that variation in stress system functioning can predict and differentiate developmental trajectories of early irritability that are relatively more internalizing v. those in which externalizing symptoms dominate in pre-adolescence.

A Family Socialization Model of Transdiagnostic Risk for Psychopathology in Preschool Children

This longitudinal study examined the presence of general (P) and specific internalizing (INT) and externalizing (EXT) psychopathology factors in a community sample of preschool children. We assessed child and contextual correlates of P, INT, and EXT, and tested a model connecting socioeconomic risk to these factors through family socialization processes and child cognitive abilities. Participants were 501 children recruited at birth and followed up at 18 months and 3 years. Child and family functioning were measured using parental reports, observation, and standardized assessments. Both mothers and their partners reported on children's mental health, permitting the estimation of a trifactor model of psychopathology that captured caregivers' shared and unique perspectives with respect to P, INT, and EXT. Results revealed several transdiagnostic correlates of the common-perspective P factor, including family income, maternal education, maternal depression, and maternal responsiveness, as well as marginal associations with sibling negativity and children's language and theory of mind abilities. Several shared and unique correlates of INT and EXT were also observed. Structural equation modelling revealed that the effects of family income and maternal education on P operated indirectly through maternal responsiveness, while the effects of maternal education on INT and EXT operated through maternal reflective capacity, albeit in opposite directions. Together, these results suggest that the effects of socioeconomic disadvantage on general psychopathology are organized in a temporal cascade from distal to proximal risk.

The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence

Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.

Structural validity of the Child Behavior Checklist (CBCL) for preschoolers with neurogenetic syndromes

BACKGROUND

Psychologists routinely use the Child Behavior Checklist for Ages 1½-5 (CBCL) to assess challenging behaviors of preschoolers with developmental disabilities. However, the CBCL has not been thoroughly validated in neurogenetic syndromes (NGS).

AIM

We investigated the structural validity of the CBCL in NGS.

METHODS

Based on 152 preschoolers with Angelman, fragile X, Prader-Willi, and Williams syndromes, we employed confirmatory factor analysis (CFA) to evaluate the goodness-of-fit of CBCL narrowband, broadband, and DSM-oriented scales.

RESULTS

CFA models largely supported the unidimensionality of most narrowband scales and the two-factor structure of internalizing and externalizing broadband scales. However, there was limited evidence for the unidimensionality of most DSM-oriented scales.

CONCLUSIONS

Psychologists may consider using the CBCL as a psychometrically sound narrowband and broadband measure of challenging behaviors but should exercise caution when interpreting DSM-oriented scales for preschoolers with NGS. Our findings underscore a continued need to enhance assessment measures for identifying early precursors of child psychopathology in pediatric populations with atypical developmental trajectories.

Hierarchical models of psychopathology: empirical support, implications, and remaining issues

There is an ongoing revolution in psychology and psychiatry that will likely change how we conceptualize, study and treat psychological problems.- Many theorists now support viewing psychopathology as consisting of continuous dimensions rather than discrete diagnostic categories. Indeed, recent papers have proposed comprehensive taxonomies of psychopathology dimensions to replace the DSM and ICD taxonomies of categories. The proposed dimensional taxonomies, which portray psychopathology as hierarchically organized correlated dimensions, are now well supported at phenotypic levels. Multiple studies show that both a general factor of psychopathology at the top of the hierarchy and specific factors at lower levels predict different functional outcomes. Our analyses of data on a large representative sample of child and adolescent twins suggested the causal hypothesis that phenotypic correlations among dimensions of psychopathology are the result of many familial influences being pleiotropic. That is, most genetic variants and shared environmental factors are hypothesized to non-specifically influence risk for multiple rather than individual dimensions of psychopathology. In contrast, person-specific experiences tend to be related to individual dimensions. This hierarchical causal hypothesis has been supported by both large-scale family and molecular genetic studies. Current research focuses on three issues. First, the field has not settled on a preferred statistical model for studying the hierarchy of causes and phenotypes. Second, in spite of encouraging progress, the neurobiological correlates of the hierarchy of dimensions of psychopathology are only partially described. Third, although there are potentially important clinical implications of the hierarchical model, insufficient research has been conducted to date to rec-ommend evidence-based clinical practices.

Exposure to Bullying and General Psychopathology: A Prospective, Longitudinal Study

Although there is mounting evidence that the experience of being bullied associates with both internalizing and externalizing symptoms, it is not known yet whether the identified associations are specific to these symptoms, or shared between them. The primary focus of this study is to assess the prospective associations of bullying exposure with both general and specific (i.e., internalizing, externalizing) factors of psychopathology. This study included data from 6,210 children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Child bullying was measured by self-report at ages 8 and 10 years. Child psychopathology symptoms were assessed by parent-interview, using the Development and Well-being Assessment (DAWBA) at ages 7 and 13 years. Bullying exposure significantly associated with the general psychopathology factor in early adolescence. In particular, chronically victimized youth exposed to multiple forms of bullying (i.e., both overt and relational) showed higher levels of general psychopathology. Bullying exposure also associated with both internalizing and externalizing factors from the correlated-factors model. However, the effect estimates for these factors decreased considerably in size and dropped to insignificant for the internalizing factor after extracting the shared variance that belongs to the general factor of psychopathology. Using an integrative longitudinal model, we found that higher levels of general psychopathology at age 7 also associated with bullying exposure at age 8 which, in turn, associated with general psychopathology at age 13 through its two-year continuity. Findings suggest that exposure to bullying is a risk factor for a more general vulnerability to psychopathology.

Developmental pathways to social anxiety and irritability: The role of the ERN

Early behaviors that differentiate later biomarkers for psychopathology can guide preventive efforts while also facilitating pathophysiological research. We tested whether error-related negativity (ERN) moderates the link between early behavior and later psychopathology in two early childhood phenotypes: behavioral inhibition and irritability. From ages 2 to 7 years, children (n = 291) were assessed longitudinally for behavioral inhibition (BI) and irritability. Behavioral inhibition was assessed via maternal report and behavioral responses to novelty. Childhood irritability was assessed using the Child Behavior Checklist. At age 12, an electroencephalogram (EEG) was recorded while children performed a flanker task to measure ERN, a neural indicator of error monitoring. Clinical assessments of anxiety and irritability were conducted using questionnaires (i.e., Screen for Child Anxiety Related Disorders and Affective Reactivity Index) and clinical interviews. Error monitoring interacted with early BI and early irritability to predict later psychopathology. Among children with high BI, an enhanced ERN predicted greater social anxiety at age 12. In contrast, children with high childhood irritability and blunted ERN predicted greater irritability at age 12. This converges with previous work and provides novel insight into the specificity of pathways associated with psychopathology.

White Matter Microstructure and the General Psychopathology Factor in Children

OBJECTIVE

Co-occurrence of behavioral and emotional problems in childhood is widespread, and previous studies have suggested that this reflects vulnerability to experience a range of psychiatric problems, often termed a general psychopathology factor. However, the neurobiological substrate of this general factor is not well understood. We tested the hypothesis that lower overall white matter microstructure is associated with higher levels of the general psychopathology factor in children and less with specific factors.

METHOD

Global white matter microstructure at age 10 years was related to general and specific psychopathology factors. These factors were estimated using a latent bifactor model with multiple informants and instruments between ages 6 and 10 years in 3,030 children from the population-based birth cohort Generation R. The association of global white matter microstructure and the psychopathology factors was examined with a structural equation model adjusted for sex, age at scan, age at psychopathology assessment, parental education/income, and genetic ancestry.

RESULTS

A 1-SD increase of the global white matter factor was associated with a β = -0.07SD (standard error [SE] = 0.02, p < .01) decrease in general psychopathology. In contrast, a 1-SD increase of white matter microstructure predicted an increase of β = +0.07 SD (SE = 0.03, p < .01) specific externalizing factor levels. No association was found with the specific internalizing and specific attention factor.

CONCLUSION

The results suggest that general psychopathology in childhood is related to white matter structure across the brain and not only to specific tracts. Taking into account general psychopathology may also help reveal neurobiological mechanisms behind specific symptoms that are otherwise obscured by comorbidity.

Big five personality traits and common mental disorders within a hierarchical taxonomy of psychopathology: A longitudinal study of Mexican-origin youth

The present study (a) tested whether a structure of common mental disorders within the hierarchical taxonomy of psychopathology was invariant from late childhood to adolescence in a sample of Mexican-origin youth, (b) examined the developmental course of psychopathology at different levels of the hierarchy, and (c) tested the degree to which changes in psychopathology were associated with changes in the Big Five personality domains. Results were consistent with the longitudinal hierarchical invariance of common mental disorders from age 12 to 17 (n = 674). Further, initial levels of conscientiousness, agreeableness, and emotional stability were positively associated with lower initial levels of a higher order factor of psychopathology, and increases in extraversion and decreases in neuroticism were associated with decreases in a higher order factor of psychopathology, which captured the general tendency for externalizing, internalizing, and attention-hyperactivity-related dimensions of psychopathology to correlate. Results of the present study indicate that a hierarchical model of common mental disorders extends to Mexican-origin youth and that developmental change in Big Five personality are related to developmental change in psychopathology. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations Between Resting-State Functional Connectivity and a Hierarchical Dimensional Structure of Psychopathology in Middle Childhood

BACKGROUND

Previous research from the Adolescent Brain Cognitive Development (ABCD) Study delineated and validated a hierarchical 5-factor structure with a general psychopathology (p) factor at the apex and 5 specific factors (internalizing, somatoform, detachment, neurodevelopmental, externalizing) using parent-reported child symptoms. The present study is the first to examine associations between dimensions from a hierarchical structure and resting-state functional connectivity (RSFC) networks.

METHODS

Using 9- to 11-year-old children from the ABCD Study baseline sample, we examined the variance explained by each hierarchical structure level (p-factor, 2-factor, 3-factor, 4-factor, and 5-factor models) in associations with RSFC. Analyses were first conducted in a discovery dataset (n = 3790), and significant associations were examined in a replication dataset (n = 3791).

RESULTS

There were robust associations between the p-factor and lower connectivity within the default mode network, although stronger effects emerged for the neurodevelopmental factor. Neurodevelopmental impairments were also related to variation in RSFC networks associated with attention to internal states and external stimuli. Analyses revealed robust associations between the neurodevelopmental dimension and several RSFC metrics, including within the default mode network, between the default mode network with cingulo-opercular and "Other" (unassigned) networks, and between the dorsal attention network with the Other network.

CONCLUSIONS

The hierarchical structure of psychopathology showed replicable links to RSFC associations in middle childhood. The specific neurodevelopmental dimension showed robust associations with multiple RSFC metrics. These results show the utility of examining associations between intrinsic brain architecture and specific dimensions of psychopathology, revealing associations especially with neurodevelopmental impairments.

The breadth and potency of transdiagnostic cognitive risks for psychopathology in youth

OBJECTIVE

Multiple cognitive risks from different theoretical paradigms (dysfunctional attitudes, negative inferential style, self-criticism, dependency, brooding) predict depression, but may be transdiagnostic vulnerabilities for multiple psychopathologies. Risk factors can be identified as broadly transdiagnostic and relatively specific to psychopathological outcomes by organizing the common and specific aspects of each respective construct using latent bifactor models, and by examining links between dimensions of risk and psychopathology. This study evaluated (a) whether a bifactor model of cognitive vulnerabilities, including a general cognitive risk dimension (c factor) and several specific dimensions replicated in early adolescents (M_age = 13.50 years) and extended to younger and older youth, and (b) how the general and specific cognitive risk dimensions related to the general psychopathology (p factor) and internalizing- and externalizing-specific dimensions.

METHOD

Community youth (N = 571; 55% female) reported on cognitive risks; youth and a caregiver reported on psychopathologies (depression, anxiety, aggression, conduct, attention problems).

RESULTS

The cognitive risk bifactor model showed good fit and slight advantages over a correlated factors model. The bifactor model exhibited invariance across development and captured key associations that were identified when each individual cognitive risk was related to the bifactor model of psychopathology. The c factor strongly related to internalizing-specific, and moderately to the p factor and externalizing-specific dimensions. Specific cognitive risk dimensions (brooding, negative inferential style, dependency) related to all psychopathology dimensions.

CONCLUSION

A general cognitive vulnerability (c factor) transdiagnostically associates with a breadth of psychopathologies and most potently to internalizing-specific among youth. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Evidence for two genetically distinct pathways to co-occurring internalizing and externalizing problems in adolescence characterized by negative affectivity or behavioral inhibition

Unique pathways to adolescents' co-occurring internalizing/externalizing problems, a severe and common form of psychopathology, remain poorly delineated; this paucity of knowledge impedes the development of personalized interventions. We examined established measures of genetic risk and early childhood temperamental dimensions to clarify potentially distinct pathways to adolescents' co-occurring internalizing/externalizing problems. Participants were drawn from a longitudinal randomized controlled trial of a family-based intervention. The study employed multiple informants and methods, including observer ratings of toddlers' negative affectivity and behavioral inhibition, and primary caregiver ratings of toddlers' inhibitory control; internalizing and aggression polygenic risk scores (PRS) based on prior meta-genome-wide association studies (GWAS); and parents' and teachers' reports of adolescents' internalizing and externalizing problems. Higher levels of the aggression PRS indirectly predicted primary caregiver- and teacher-reported co-occurring problems relative to all other groups through greater early childhood negative affectivity. Lower levels of the aggression PRS and higher levels of the internalizing PRS indirectly predicted co-occurring problems relative to the externalizing "only" and low problem groups (primary caregivers only) through greater early childhood behavioral inhibition. Findings suggest two different genetic pathways to co-occurring problems that could lead to distinct prevention and intervention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The p factor and dimensional structural models of youth personality pathology and psychopathology

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a developing dimensional nosology which provides a joint framework for study of psychopathology and personality pathology. Dimensional structural models of psychopathology often include an overarching dimension of psychopathology (p factor) representing covariation among all forms of psychopathology. The p factor can be recovered in youth and adult samples, and has been found to relate to personality traits in similar ways in youth and adults. However, placement of personality pathology in an overarching psychopathology structure has almost exclusively been investigated in adults. We review evidence for the relationships between normal-range and pathological personality traits and psychopathology in adults and youth, ultimately making the case for study of a joint personality - psychopathology framework in youth.

Research Review: Do parent ratings of infant negative emotionality and self-regulation predict psychopathology in childhood and adolescence? A systematic review and meta-analysis of prospective longitudinal studies

BACKGROUND

Identifying low-cost and easy to implement measures of infant markers of later psychopathology may improve targeting of early intervention for prevention. Because of their early manifestation, relative stability and overlap with constructs central to affect-based dimensions of child and adolescent psychopathology, negative emotionality and self-regulation have been the focus of this research. We conducted a meta-analysis of longitudinal studies examining the prospective association between infant temperament measured with parent ratings and child/adolescent psychopathology.

METHODS

A systematic literature search for prospective longitudinal studies, which included measures of questionnaire-assessed infant temperament (negative emotionality, self-regulation, behavioural inhibition, surgency/extraversion, activity level) and symptoms of child or adolescent mental health (externalising, internalising) and neurodevelopmental problems (attention deficit/hyperactivity disorder [ADHD], autism spectrum disorder [ASD]), was conducted. Standardised estimates of association were calculated and pooled in meta-analyses.

RESULTS

Twenty-five studies (n = 28,425) met inclusion criteria. Small associations were seen between psychopathology aggregated across all domains and infant negative emotionality (r = .15; p < .001) and self-regulation (r = -.19; p = .007). Effects were also significant but weaker for behavioural inhibition (r = .10; p = .027) and activity level (r = .08; p = .016). Surgency/extraversion was not significantly associated with psychopathology in general (r = -.04; p = .094); however, it was negatively associated with ASD (r = -.10, p = .015). Significant correlations were observed with some outcomes isomorphic with predictors, internalising problems and behavioural inhibition (r = .10; p = .013), ADHD symptoms and activity level (r = .19; p = .009).

CONCLUSION

Questionnaire-based assessments of infant negative emotionality may have transdiagnostic potential to contribute to a risk index of later childhood psychopathology. Behavioural inhibition, surgency/extraversion and activity ratings may provide more specific predictive power. More data from prospective studies are required before the potential of self-regulation and surgency/extraversion can be properly gauged.

General Psychopathology and Dysregulation Profile in a Longitudinal Community Sample: Stability, Antecedents and Outcomes

The general factor of psychopathology (GP, or p factor) and the Dysregulation Profile (DP) are two conceptually similar, but independently developed approaches to understand psychopathology. GP and DP models and their stability, antecedents and outcomes are studied in a longitudinal sample of 1073 children (49.8% female). GP and DP models were estimated at ages 8 and 14 years using the parent-reported Child Behavior Checklist (CBCL) and Youth Self Report (YSR). Early childhood antecedents and adolescent outcomes were derived using a multi-method multi-informant approach. Results showed that the general GP and DP had similar key symptoms and were similarly related to early-childhood antecedents (e.g., lower effortful control, higher maternal depression) and adolescent outcomes (e.g., reduced academic functioning, poorer mental health). This study demonstrates that GP and DP are highly similar constructs in middle childhood and adolescence, both describing a general vulnerability for psychopathology with (emotional) dysregulation at its core. Scientific integration of these approaches could lead to a better understanding of the structure, antecedents and outcomes of psychopathology.

Telomere Length and Psychopathology: Specificity and Direction of Effects Within the Bucharest Early Intervention Project

OBJECTIVE

Telomere length (TL) has been linked to several psychiatric conditions in children and adults. Telomere shortening is accelerated by early adversity, including maltreatment and psychosocial deprivation. These experiences also increase the risk of psychopathology in many domains. Two fundamental issues remain unresolved. The first concerns the specificity of the relations between TL and different dimensions of psychopathology; and the second relates to the direction of association between TL and psychopathology.

METHOD

This study addressed these shortcomings in a 2-fold manner. First, the association between TL and statistically independent general, internalizing, and externalizing psychopathology factors was examined to determine the specificity of this relation. Second, a 2-wave longitudinal cross-lagged model was used to explicitly examine the direction of the relation between TL and each psychopathology factor. Data were drawn from the Bucharest Early Intervention Project, a longitudinal study exploring the impact of severe psychosocial deprivation on child health and development (N = 195). At 8 to 10 and 12 to 14 years of age, buccal DNA was collected and teachers and/or caregivers reported on different domains of psychopathology.

RESULTS

Longitudinal path analyses showed that shorter TL was specifically associated with higher internalizing psychopathology at 8 to 10 years of age. In contrast, at 12 to 14 years, shorter TL was associated with higher general psychopathology. Most telling, internalizing psychopathology at 8 to 10 years predicted shorter TL at 12 to 14 years, with no reciprocal effects.

CONCLUSION

Results suggest that telomere erosion could be a consequence of distress-related psychopathology rather than a selection mechanism for later psychiatric problems.

CLINICAL TRIAL REGISTRATION INFORMATION

The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.

Difficulties with emotion regulation as a transdiagnostic mechanism linking child maltreatment with the emergence of psychopathology

Childhood maltreatment is associated with increased risk for most forms of psychopathology. We examine emotion dysregulation as a transdiagnostic mechanism linking maltreatment with general psychopathology. A sample of 262 children and adolescents participated; 162 (61.8%) experienced abuse or exposure to domestic violence. We assessed four emotion regulation processes (cognitive reappraisal, attention bias to threat, expressive suppression, and rumination) and emotional reactivity. Psychopathology symptoms were assessed concurrently and at a 2-year longitudinal follow-up. A general psychopathology factor (p factor), representing co-occurrence of psychopathology symptoms across multiple internalizing and externalizing domains, was estimated using confirmatory factor analysis. Maltreatment was associated with heightened emotional reactivity and greater use of expressive suppression and rumination. The association of maltreatment with attention bias varied across development, with maltreated children exhibiting a bias toward threat and adolescents a bias away from threat. Greater emotional reactivity and engagement in rumination mediated the longitudinal association between maltreatment and increased general psychopathology over time. Emotion dysregulation following childhood maltreatment occurs at multiple stages of the emotion generation process, in some cases varies across development, and serves as a transdiagnostic mechanism linking child maltreatment with general psychopathology.

A choose your own adventure story: Conceptualizing depression in children and adolescents from traditional DSM and alternative latent dimensional approaches

For the past several decades, the phenomenon of depression largely has been defined, classified, and thus assessed and analyzed, according to criteria based on the Diagnostic and Statistical Manual (now DSM5). A substantial body of knowledge on epidemiology, course, risk factors, correlates, consequences, assessment, and intervention for youth depression is based on this classical nosological approach to conceptualizing depression. Yet, recent structural and classification approaches, such as latent dimensional bifactor models (e.g., P factor model; Caspi et al., 2014) and hierarchical organizations (e.g., HiTOP; Kotov, Waszczuk, Krueger, Forbes, & Watson, 2017), have been proposed and supported as alternative options to characterize features of depression. This paper considers conceptualizations of depression among youth with a particular focus on validity: how important clinical outcomes and risks (genetic, neural, temperament, early pubertal timing, stress, and cognitive) relate to depression when ascertained via traditional DSM-defined depression versus more recent latent dimensional model approaches. The construct validity of depression, in terms of associations within respective nomological networks, varies by depression conceptualization. Clinical scientists and applied practitioners need to clearly think through the nature of what depression is and how the latent construct is conceptualized and measured. Conclusions reached for research, teaching, and evidence-based clinical work are affected and may not be the same across different conceptual and nosological organizational schemes.

Homo- and Heterotypic Trajectories in a Preschool to Primary-School Clinical Sample: A Prospective Study Related to Maternal Psychopathology

Background: Most longitudinal or follow-up mental health studies describe developmental pathways using dimensional measures of psychopathology, but seldom using pathways described by clinical disorders. Objective: We aim to describe diagnostic pathways by homotypic (within the disorder continuity) and heterotypic development (between the disorder continuity), with maternal psychopathology as moderator for both trajectories. Methods: Clinically referred children (0-7 years; N = 83) were assessed at preschool age and at primary-school age through a clinical interview. We built a disorder cluster of emotional disorders (ED; F32, F40, F42, F43, F93.0, F93.1, F93.2, F93.8, F95), behavioral disorders (BD; F68.8, F90, F91, F91.3, F93.3, F93.9, F94), and specific early onset disorders (SEO; F50, F51, F70, F98.0, F98.1, F98.2, F98.8, F98.9). We describe the prevalence, comorbidity, and clinical trajectories of various types of homotypic and heterotypic development. Results: We observed a high rate of comorbidity throughout the study (62.6% at admission and 67.5% at follow-up) and in general, a high continuity of mental health problems from preschool to primary-school age children (69.9% of the sample showed continuity), with 50.6% of the sample showing homotypic and 44.6% showing heterotypic development. Hierarchical multiple regression analyses suggest that heterotypic development may be influenced by maternal psychopathology. Conclusion: Currently, evidence-based mental health guidelines for preschool populations are designed and evaluated assuming a homotypic development. However, our findings indicate that treatment interventions and outcome measures should also be designed and evaluated for heterotypic development especially in case of increased maternal psychopathology.

Effect of Foster Care Intervention on Trajectories of General and Specific Psychopathology Among Children With Histories of Institutional Rearing: A Randomized Clinical Trial

IMPORTANCE

It is unclear whether early institutional rearing is associated with more problematic trajectories of psychopathology from childhood to adolescence and whether assignment to foster care mitigates this risk.

OBJECTIVES

To examine trajectories of latent psychopathology factors-general (P), internalizing (INT), and externalizing (EXT)-among children reared in institutions and to evaluate whether randomization to foster care is associated with reductions in psychopathology from middle childhood through adolescence.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal, intent-to-treat randomized clinical trial was conducted in Bucharest, Romania, where children residing in 6 institutions underwent baseline testing and were then randomly assigned to a care as usual group (CAUG) or a foster care group (FCG). A matched sample of a never-institutionalized group (NIG) was recruited to serve as a comparison group. The study commenced in April 2001, and the most recent (age 16 years) follow-up started in January 2015 and is ongoing.

INTERVENTION

Institutionally reared children randomized to high-quality foster homes.

MAIN OUTCOMES AND MEASURES

Psychopathology was measured using the MacArthur Health and Behavior Questionnaire. Teachers and/or caregivers reported on symptoms of psychopathology in several domains.

RESULTS

A total of 220 children (50.0% female; 119 ever institutionalized) were included in the analysis at the mean ages of 8, 12, and 16 years. A latent bifactor model with general (P) and specific internalizing (INT) and externalizing (EXT) factors offered a good fit to the data. At age 8 years, CAUG (mean, 0.41; 95% CI, 0.17-0.67) and FCG (mean, 0.30; 95% CI, 0.04-0.53) had higher P than NIG (mean, -0.40; 95% CI, -0.56 to -0.18). By age 16 years, FCG (mean, 0.07; 95% CI, -0.18 to 0.29) had lower P than CAUG (mean, 0.37; 95% CI, 0.13-0.60). This effect was likely driven by modest declines in P from age 8 years to age 16 years among FCG (slope, -0.12; 95% CI, -0.26 to 0.04) compared with CAUG, who remained stably high over this period (slope, -0.02; 95% CI, -0.19 to 0.14). Moreover, CAUG and FCG showed increasing divergence in EXT over time, such that FCG (mean, -0.30; 95% CI, -0.58 to -0.02) had fewer problems than CAUG (mean, 0.05; 95% CI, -0.25 to 0.36) by age 16 years. No INT differences were observed.

CONCLUSIONS AND RELEVANCE

Institutionalization increases transdiagnostic vulnerability to psychopathology from childhood to adolescence, a period of significant social and biological change. Early assignment to foster care partially mitigates this risk, thus highlighting the importance of social enrichment in buffering the effects of severe early neglect on trajectories of psychopathology.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT00747396.

An experimental test of the fetal programming hypothesis: Can we reduce child ontogenetic vulnerability to psychopathology by decreasing maternal depression?

Maternal depression is one of the most common prenatal complications, and prenatal maternal depression predicts many child psychopathologies. Here, we apply the fetal programming hypothesis as an organizational framework to address the possibility that fetal exposure to maternal depressive symptoms during pregnancy affects fetal development of vulnerabilities and risk mechanisms, which enhance risk for subsequent psychopathology. We consider four candidate pathways through which maternal prenatal depression may affect the propensity of offspring to develop later psychopathology across the life span: brain development, physiological stress regulation (hypothalamic-pituitary-adrenocortical axis), negative emotionality, and cognitive (effortful) control. The majority of past research has been correlational, so potential causal conclusions have been limited. We describe an ongoing experimental test of the fetal programming influence of prenatal maternal depressive symptoms using a randomized controlled trial design. In this randomized controlled trial, interpersonal psychotherapy is compared to enhanced usual care among distressed pregnant women to evaluate whether reducing prenatal maternal depressive symptoms has a salutary impact on child ontogenetic vulnerabilities and thereby reduces offspring's risk for emergence of later psychopathology.

The Development of Latent Dimensions of Psychopathology across Early Childhood: Stability of Dimensions and Moderators of Change

Recent research has described the structure of psychopathology as including one general and multiple specific factors, and this structure has been found in samples across development. However, little work has examined whether this structure is consistent across time, particularly in young children, within the same sample. Further, few studies have examined factors that influence the magnitude of the stability of latent dimensions of psychopathology. In the present study, we examine these issues in a community sample of 545 children assessed at ages 3 and 6. In addition, we explored child temperament, parental history of psychopathology, and parenting behaviors as potential moderators of the longitudinal stability of latent dimensions of psychopathology. We found that the same bifactor model structure identified at age 3 provided an adequate fit to the data at age 6. Further, our model revealed significant homotypic stability of the general, internalizing, and externalizing specific factors. We also found evidence of differentiation of psychopathology over time with the general factor at age 3 predicting the externalizing factor at age 6. However, we failed to identify moderators of the longitudinal associations between psychopathology latent factors. Overall, our results bolster support for the bifactor structure of psychopathology, particularly in early childhood.

Continuity and stability of preschool depression from childhood through adolescence and following the onset of puberty

BACKGROUND

A growing body of research now supports the validity, clinical significance, and long-term negative impact of depression occurring during the preschool period. However, the prospective continuity of depressive symptoms and risk for major depressive disorder (MDD) from childhood through adolescence for preschoolers experiencing this highly impairing disorder remains unexplored. Such information is likely to be critical for understanding the developmental continuity of preschool depression and whether it continues to be a salient risk factor for an MDD diagnosis following the transition into adolescence and the onset of biological changes associated with it (i.e., puberty).

METHODS

Subjects were participants in the Preschool Depression Study conducted at the Early Emotional Development Program at Washington University School of Medicine in St. Louis. Subjects and their parents completed baseline assessments that included comprehensive measures of psychopathology and development at baseline and up to 9 follow-up assessments between 2003 and 2017. N = 279 subjects had diagnostic and clinical data available for the preschool period and the early pubertal and/or later pubertal periods and were included in the analyses. There were N = 275 subjects assessed during the early pubertal period and N = 184 subjects assessed during the later pubertal period.

RESULTS

Preschool depression was a highly salient predictor of prepubertal and mid-to-post pubertal MDD. Across all modeled time points children with a history of preschool depression continued to demonstrate elevated levels of depressive symptoms from childhood through adolescence, suggesting a heightened trajectory of depressive symptoms relative to their same age peers.

CONCLUSION

Findings from the current study suggest that children with a history of preschool depression follow a trajectory of depression severity elevated relative to their same age peers from childhood through adolescence but with a similar shape over time. They also support the homotypic continuity of preschool depression into adolescence and the onset of puberty.

Attention-deficit hyperactivity disorder and anxiety disorders as precursors of bipolar disorder onset in adulthood

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) and anxiety disorders have been proposed as precursors of bipolar disorder, but their joint and relative roles in the development of bipolar disorder are unknown.AimsTo test the prospective relationship of ADHD and anxiety with onset of bipolar disorder.

METHOD

We examined the relationship between ADHD, anxiety disorders and bipolar disorder in a birth cohort of 2 409 236 individuals born in Denmark between 1955 and 1991. Individuals were followed from their sixteenth birthday or from January 1995 to their first clinical contact for bipolar disorder or until December 2012. We calculated incidence rates per 10 000 person-years and tested the effects of prior diagnoses on the risk of bipolar disorder in survival models.

RESULTS

Over 37 394 865 person-years follow-up, 9250 onsets of bipolar disorder occurred. The incidence rate of bipolar disorder was 2.17 (95% CI 2.12-2.19) in individuals with no prior diagnosis of ADHD or anxiety, 23.86 (95% CI 19.98-27.75) in individuals with a prior diagnosis of ADHD only, 26.05 (95% CI 24.47-27.62) in individuals with a prior diagnosis of anxiety only and 66.16 (95% CI 44.83-87.47) in those with prior diagnoses of both ADHD and anxiety. The combination of ADHD and anxiety increased the risk of bipolar disorder 30-fold (95% CI 21.66-41.40) compared with those with no prior ADHD or anxiety.

CONCLUSIONS

Early manifestations of both internalising and externalising psychopathology indicate liability to bipolar disorder. The combination of ADHD and anxiety is associated with a very high risk of bipolar disorder.Declaration of interestNone.

Disruptive Behaviors across Different Disorders: Evaluation of a Clinical Sample Using the Eyberg Child Behavior Inventory

OBJECTIVE

The study reports the prevalence of disruptive behaviors in a help-seeking sample of young children across a diverse range of clinical diagnoses (based on ICD-10).

METHOD

The Eyberg Child Behavior Inventory (ECBI), a parent rating scale of disruptive behaviors, was completed on 310 children (2-11 years) at three child and adolescent psychiatry clinics in three German states (Bavaria, Hesse, Lower Saxony); the majority of children were outpatients.

RESULTS

Mean intensity scores of disruptive behaviors differed significantly by diagnostic group, with the lowest ratings within a community sample, and increasingly higher scores in children with a diagnosis from the internalizing spectrum, those with pervasive developmental disorders, and finally, those with externalizing disorders (e. g. hyperkinetic disorder, conduct disorders). Seventy percent of the clinical sample, compared to only 17 % of the community sample, exceeded the normative cut-off score of 111, indicating that disruptive behaviors are common in young German children seeking help for different mental health problems.

CONCLUSIONS

These findings support the Research Domain Criteria approach by showing that disruptive behaviors cross our current diagnostic labels and may need to be assessed and conceptualized in treatment planning, even in children without a primary diagnosis from the externalizing spectrum.

Evaluation of the Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP)

The Dysregulation Profile (DP) has emerged as a measure of concurrent affective, behavioral and cognitive dysregulation, associated with severe psychopathology, and poor adjustment. While originally developed with the Child Behavior Checklist, more recently the DP has also been defined on the Strengths and Difficulties Questionnaire (SDQ), mostly with a 5-item, but also a 15-item, SDQ-DP measure. This study evaluated the SDQ-DP by examining its factor structure, measurement invariance, and construct validity. Different SDQ-DP operationalizations were compared. In a United States longitudinal community sample (N = 768), a bifactor model consisting of a general Dysregulation factor and three specific factors of Emotional Symptoms, Conduct Problems, and Hyperactivity-Inattention fitted best, across three different developmental periods (early childhood, middle childhood, and adolescence) and across three different reporters (parents, teachers, and youth). Measurement invariance across reporter, gender, and developmental period was demonstrated. These findings indicate that the SDQ-DP, like the CBCL-DP, reflects a broad syndrome of dysregulation that exists in addition to specific syndromes of emotional symptoms, conduct problems, and hyperactivity-inattention. SDQ-DP bifactor scores were strongly related with scores on the 5- and 15-item SDQ-DP measures and similarly concurrently associated with two markers of self-regulation, ego-resiliency and effortful control, and longitudinally with antisocial behavior and disciplinary measures. As reliability, validity, and stability was weaker for the SDQ-DP 5-item measure, use of all 15 items is recommended. Advantages of using a bifactor approach are discussed as well as the potential of the SDQ-DP as an easy screening measure of children at risk for developing serious psychopathology. (PsycINFO Database Record

Developmental stability of general and specific factors of psychopathology from early childhood to adolescence: dynamic mutualism or p-differentiation?

BACKGROUND

Recent research indicates that the best-fitting structural model of psychopathology includes a general factor capturing comorbidity (p) and several more specific, orthogonal factors. Little is known about the stability of these factors, although two opposing developmental processes have been proposed: dynamic mutualism suggests that symptom-level interaction and reinforcement may lead to a strengthening of comorbidity (p) over time, whereas p-differentiation suggests a general vulnerability to psychopathology that gives way to increasingly distinct patterns of symptoms over time. In order to test both processes, we examine two forms of developmental stability from ages 2 to 14 years: strength (i.e., consistency in the amount of variance explained by general and specific factors) and phenotypic stability (i.e., homotypic and heterotypic continuity).

METHODS

Data are from the NICHD Study of Early Child Care and Youth Development. Psychopathology symptoms were assessed nine times between ages 2 and 14 years (n = 1,253) using the Child Behavior Checklist completed by mothers. Confirmatory bifactor modeling was used to test structural models of psychopathology at each age. Consistency in strength was examined by calculating the Explained Common Variance (ECV) and phenotypic stability was investigated with cross-lagged modeling of the general and specific factors.

RESULTS

Bifactor models fit the data well across this developmental period. ECV values were reasonably consistent across development, with the general factor accounting for the majority of shared variance (61%-71%). Evidence of both homotypic and heterotypic continuity emerged, with most heterotypic continuity involving the general factor, as it both predicted and was predicted by specific factors.

CONCLUSIONS

A bifactor model effectively captures psychopathological comorbidity from early childhood through adolescence. The longitudinal associations between the general and specific factors provide evidence for both the hypothesized processes (dynamic mutualism and p-differentiation) occurring through development.

Structural alterations within cerebellar circuitry are associated with general liability for common mental disorders

Accumulating mental-health research encourages a shift in focus toward transdiagnostic dimensional features that are shared across categorical disorders. In support of this shift, recent studies have identified a general liability factor for psychopathology-sometimes called the 'p factor'- that underlies shared risk for a wide range of mental disorders. Identifying neural correlates of this general liability would substantiate its importance in characterizing the shared origins of mental disorders and help us begin to understand the mechanisms through which the 'p factor' contributes to risk. Here we believe we first replicate the 'p factor' using cross-sectional data from a volunteer sample of 1246 university students, and then using high-resolution multimodal structural neuroimaging, we demonstrate that individuals with higher 'p factor' scores show reduced structural integrity of white matter pathways, as indexed by lower fractional anisotropy values, uniquely within the pons. Whole-brain analyses further revealed that higher 'p factor' scores are associated with reduced gray matter volume in the occipital lobe and left cerebellar lobule VIIb, which is functionally connected with prefrontal regions supporting cognitive control. Consistent with the preponderance of cerebellar afferents within the pons, we observed a significant positive correlation between the white matter integrity of the pons and cerebellar gray matter volume associated with higher 'p factor' scores. The results of our analyses provide initial evidence that structural alterations in corticocerebellar circuitry supporting core functions related to the basic integration, coordination and monitoring of information may contribute to a general liability for common mental disorders.

Comorbidity and continuity of depression and conduct problems from elementary school to adolescence

Despite nonoverlapping criterion sets, conduct disorder and depression co-occur at much higher rates than expected by chance. Contemporary model-based approaches to explaining heterotypic comorbidity use factor analysis and its variants to evaluate interrelations among symptoms in large population-based and twin samples. These analyses invariably yield broadband internalizing and externalizing factors, which load on a higher-order general liability factor-findings that are robust across age and informant. Although model-based approaches elucidate structural aspects of comorbidity, they are variable-centered, and usually cross-sectional. Most therefore do not assess developmental continuity of comorbidity, or whether noncomorbid individuals are prospectively vulnerable to heterotypic comorbidity. We use an accelerated longitudinal design to evaluate growth in parent-reported conduct problems (CPs) and depression among children, ages 8-15 years, who were recruited at study entry into depressed only (n = 27), CPs only (n = 28), comorbid (n = 81), and control (n = 70) groups based on levels of symptoms. Consistent with normative developmental trends across this age range, steep growth in depression was exhibited by all groups, including those who reported only CPs at study entry. In contrast, growth in CPs was restricted to those who reported high symptoms at intake (with or without comorbid depression), compared with low and stable among depressed only and control participants. To our knowledge, this is the first study to demonstrate, using carefully ascertained "pure" versus comorbid groups who were followed naturalistically, that comorbid depression is likely to develop among those with pure CPs, but comorbid CPs are not likely to develop among those with pure depression. (PsycINFO Database Record