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DiSalvo M, Vater CH, Green A, Woodworth KY, Farrell A, Biederman J, Faraone S. Further Evidence of an Association Between a Positive Child Behavior Checklist-Bipolar Profile and a Diagnosis of Pediatric Bipolar Disorder: A Meta-Analysis. Scand J Child Adolesc Psychiatr Psychol 2023; 11:44-59. [PMID: 37273800 PMCID: PMC10236377 DOI: 10.2478/sjcapp-2023-0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Background Previous research has found that a unique profile of the Child Behavior Checklist comprising of aggregate elevations of the Attention, Anxiety/Depression and Aggression scales (A-A-A profile, CBCL-Bipolar (BP) profile, CBCL-Dysregulation profile (DP); henceforth CBCL-BP/DP profile) is associated with a clinical diagnosis of pediatric bipolar (BP) disorder. Objective The main aim of the study is to evaluate the strength of the association between the CBCL-BP/DP profile and the clinical diagnosis of pediatric BP disorder through a meta-analysis. Methods A literature search was performed to identify studies that examined the association between a positive CBCL-BP/DP profile and a clinical diagnosis of pediatric BP disorder. The meta-analyses first examined studies assessing the rates of a positive CBCL-BP/DP profile in youth with BP disorder versus those with 1) ADHD, anxiety/depression, or disruptive behavior disorders (DBDs), and 2) non-bipolar controls. The second analysis evaluated studies examining the rates of pediatric BP disorder in youth with and without a positive CBCL-BP/DP profile. Results Eighteen articles met our inclusion and exclusion criteria, and fifteen articles had adequate data for meta-analysis. Results showed that BP youth were at significantly increased odds of having a positive CBCL-BP/DP profile compared to those with other psychiatric disorders (i.e., ADHD, anxiety/depression, or DBDs) (pooled OR=4.34, 95% CI=2.82, 8.27; p<0.001) and healthy control groups (pooled OR=34.77, 95% CI=2.87, 420.95; p=0.005). Further, meta-analysis results showed that youth with a positive CBCL-BP/DP profile were at significantly increased odds of having a BP disorder diagnosis compared to those without (pooled OR=4.25, 95% CI=2.12, 8.52; p<0.001). Conclusion Our systematic review and meta-analysis of the extant literature provides strong support for the association between the CBCL-BP/DP profile and pediatric BP disorder.
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Affiliation(s)
- Maura DiSalvo
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, United States
| | - Chloe Hutt Vater
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, United States
| | - Allison Green
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, United States
- Department of Psychological and Brain Sciences, Indiana University, Indiana, United States
| | - K. Yvonne Woodworth
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, United States
| | - Abigail Farrell
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, United States
- Department of Psychology, University of Houston, Houston, United States
| | - Joseph Biederman
- Pediatric Psychopharmacology Program, Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, United States
- Boston Department of Psychiatry, Massachusetts General Hospital, Boston, United States
| | - Stephen Faraone
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, United States
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Wang B, Becker A, Kaelble C, Rothenberger A, Uebel-von Sandersleben H. Dysregulation profile (DP) as a transdiagnostic psychopathological factor in clinically referred children - comparisons between disorders and latent structure. Nord J Psychiatry 2022; 76:71-79. [PMID: 34126841 DOI: 10.1080/08039488.2021.1936167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dysregulation Profile (DP) describes the psychopathological construct of concurrent impairments in the ability to regulate emotion, behaviour, and cognition measured by the Child Behaviour Checklist (CBCL). Such transdiagnostic dimensions of psychopathology play an important role in addition to core symptoms of psychiatric diagnosis in clinical practice. Evaluation of DP in children with different mental disorders may improve our understanding and treatment of both contents. METHODS 911 clinically referred children between 6 and 18 years were investigated. The sample consisted of five 'pure' disorders groups, that is, tic disorder (TIC), anxiety disorder, obsessive compulsive disorder, depression, Attention Deficit Hyperactivity Disorder (ADHD), and two comorbid disorder group, that is, ADHD + TIC and ADHD + oppositional defiant disorder (ODD). DP level and latent structure were compared across groups. RESULTS The rate of severe/abnormal dysregulation rates varied from 15% to 44% when the 210 cut-off was used, and 5% to 18% when stringent cut-off was used (i.e. ≥70 on all DP-subscales). The most affected population were children with comorbid ADHD with ODD/TIC, while least were those with TIC only. Five different latent phenotypes of DP were found. CONCLUSION DP above clinical cut-off level widely exists in clinically referred children in parallel to core symptoms of their diagnosis, especially among children with comorbidities. During clinical assessment it would be worth to clarify the role of DP-related problems within the general psychosocial impairment of the patient to improve a personalized approach.
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Affiliation(s)
- Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Christina Kaelble
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Henrik Uebel-von Sandersleben
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
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Makarow-Gronert A, Margulska A, Strzelecki D, Krajewska K, Gmitrowicz A, Gawlik-Kotelnicka O. Comparison of thyroid-stimulating hormone levels in adolescents with schizophrenia, bipolar disorder, unipolar depression, conduct disorders, and hyperkinetic disorders. Medicine (Baltimore) 2021; 100:e28160. [PMID: 34889284 PMCID: PMC8663859 DOI: 10.1097/md.0000000000028160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to retrospectively compare values of thyroid-stimulating hormone (TSH) in adolescent patients diagnosed with schizophrenia, bipolar disorder, unipolar depression (UNI-DEP), conduct disorders (CD), and hyperkinetic disorders.The research involved 1122 patients (718 women, 64%); aged 12 to 18 hospitalized in the Department of Adolescent Psychiatry, Medical University of Lodz. We analyzed TSH levels in the whole study population and compared it between the above-mentioned subgroups of diagnoses.Mean serum TSH concentration in the studied population (n = 1122) was 2.06 μIU/mL. The values of percentiles were as follows: 2.5th - 0.53 μIU/mL, 10th - 0.89 μIU/mL, 25th - 1.31 μIU/mL, 50th - 1.9 μIU/mL, 75th - 2.6 μIU/mL, 90th - 3.43 μIU/mL, 97.5th - 4.72 μIU/mL. TSH values were negatively correlated with patients' age (P = .00001). Patients with bipolar depression had higher TSH levels than patients with CD (P = .002). Also, when male and female groups were examined separately we found that female patients with UNI-DEP and bipolar disorder had higher TSH levels than female patients with CD (P = .001; P = .001).Our results confirm that there may be a higher prevalence of thyroid dysfunctions in bipolar and UNI-DEP subgroups among adolescents and that it is worthy to consider some kind of interventions regarding thyroid function in depressed individuals.
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Affiliation(s)
- Agnieszka Makarow-Gronert
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Aleksandra Margulska
- Department of Adolescent Psychiatry, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Katarzyna Krajewska
- Department of Child Psychiatry, Babinski Psychiatry Hospital in Lodz, Aleksandrowska 159, Łódź, Poland
| | - Agnieszka Gmitrowicz
- Department of Adolescent Psychiatry, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Oliwia Gawlik-Kotelnicka
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
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Masi G, Sesso G, Pfanner C, Valente E, Molesti A, Placini F, Boldrini S, Loriaux N, Drago F, Montesanto AR, Pisano S, Milone A. An Exploratory Study of Emotional Dysregulation Dimensions in Youth With Attention Deficit Hyperactivity Disorder and/or Bipolar Spectrum Disorders. Front Psychiatry 2021; 12:619037. [PMID: 33935827 PMCID: PMC8086702 DOI: 10.3389/fpsyt.2021.619037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Emotional dysregulation (ED) is currently the most frequently used term to describe children with an impaired regulation of emotional states. Recent research studies speculate whether ED may be a neurodevelopmental disorder itself, a shared risk factor, or a common key feature of several psychiatric disorders, including, among others, attention deficit hyperactivity disorder (ADHD), and bipolar spectrum disorders (BSD). The association between ADHD and ED is one of the main reasons of misconceptions in the definition of boundaries between ADHD and BSD, leading to the frequent misdiagnosis of ADHD as BSD. Since ED is a multidimensional concept, a novel instrument-the Reactivity, Intensity, Polarity and Stability (RIPoSt) scale-was recently developed to assess the different dimensions of ED, which could help in detecting specific ED profiles in clinical youths. Our study included 154 patients, aged 13.8 ± 2.3 years, diagnosed with either ADHD, BSD, or comorbid condition, and a school-based sample of 40 healthy control (HC) adolescents, aged 12.5 ± 1.2 years. The RIPoSt scale and the Child Behavior Checklist were administered to both groups. Our results indicate that affective instability and negative emotionality subscales, as well as negative emotional dysregulation, are higher in BSD, both pure and comorbid with ADHD, while emotional impulsivity is higher in the comorbid condition and similar in the ADHD and BSD alone group; all clinical groups scored higher than HC. Conversely, positive emotionality is similar among clinical groups and within them and HC. Our findings also support the validity of the RIPoSt questionnaire, since the instrument proved to have good-to-excellent internal consistency, and strongly significant positive correlations were found with the CBCL-Dysregulation Profile, which is a commonly used, indirect measure of ED. Hence, the five subscales of the RIPoSt can be reliably used as an effective tool to study the emotional dysregulation in different clinical conditions, to help disentangle the complex relationship between ADHD and juvenile BSD and to provide clinicians with crucial evidence for better diagnostic characterization and therapeutic indications.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Gianluca Sesso
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Pfanner
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Elena Valente
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Agnese Molesti
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Francesca Placini
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Silvia Boldrini
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nina Loriaux
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Flavia Drago
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Anna Rita Montesanto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Simone Pisano
- Department of Neuroscience, Santobono-Pausilipon Children Hospital, Naples, Italy
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
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Scaini S, Centorame G, Lissandrello F, Sardella S, Stazi MA, Fagnani C, Brombin C, Battaglia M. The role of genetic and environmental factors in covariation between anxiety and anger in childhood. Eur Child Adolesc Psychiatry 2021; 30:607-617. [PMID: 32382880 DOI: 10.1007/s00787-020-01543-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/24/2020] [Indexed: 11/27/2022]
Abstract
Higher levels of anger expression, as well as lower levels of anger control, have been reported for adults with anxiety disorders compared to individuals without anxiety disorders. Different to the research on adults, very few studies examined the relationship between anxiety and anger in childhood. In our study, we investigated 398 Italian twin pairs (74 MZ male, 70 MZ female, 134 same-sex dizygotic-53 male, 81 female-, and 120 unlike-sex dizygotic twin pairs), aged 8-17 (mean 13.06 ± 2.59): (i) the heritability of a childhood anger phenotype; (ii) the association between five anxiety domains and anger; (iii) the role of possible common etiological factors in explaining the observed comorbidity and overlap in the risk between anxiety phenotypes and anger. The study demonstrated that anger, assessed by CBCL items, is heritable in children at a similar rate to prior studies (40%). Our research found low to moderate rate of correlation between anger and anxiety (from 0.10 to 0.19). Finally, the present study found that the majority of etiological influences on anxiety and anger are independent of each other. Data showed that shared environmental influences have some small effects on the phenotypic covariation between the anxiety phenotypes and anger (12%); whereas unique environmental influences have an almost negligible effect (1%). Our analyses did not reveal the effect of genetic effects in explaining the covariation between these phenotypes.
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Affiliation(s)
- Simona Scaini
- Child and Youth Lab, Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20143, Milan, Italy.
| | - Giulio Centorame
- Child and Youth Lab, Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20143, Milan, Italy
| | - Francesca Lissandrello
- Child and Youth Lab, Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20143, Milan, Italy
| | - Stella Sardella
- Child and Youth Lab, Department of Psychology, Sigmund Freud University, Ripa di Porta Ticinese 77, 20143, Milan, Italy
| | - Maria Antonietta Stazi
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Corrado Fagnani
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore Di Sanità, Rome, Italy
| | - Chiara Brombin
- CUSSB-University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, ON, M6J 1H4, Canada.,Division of Child and Youth Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, ON, M6J 1H4, Canada
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6
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Benton TD, Muhrer E, Jones JD, Lewis J. Dysregulation and Suicide in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:389-399. [PMID: 33743946 DOI: 10.1016/j.chc.2020.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Suicide rates continue to rise among children and adolescents; suicide is the second leading cause of death in the United States. Although research studies have identified factors associated with suicide risks for youths, none distinguishes those who have suicidal ideation from those who most likely will make an attempt or die by suicide. Most studies focus on psychiatric diagnoses associated with suicide risks. Recent studies suggest that cross-cutting symptom profiles may be a stronger predictor of risks for suicide than diagnosis. This article provides an overview of emotional dysregulation as it relates to suicidal ideation, intent, and behaviors for youth.
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Affiliation(s)
- Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Eli Muhrer
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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7
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Alfieri P, Cumbo F, Serra G, Trasolini M, Frattini C, Scibelli F, Licchelli S, Cirillo F, Caciolo C, Casini MP, D’Amico A, Tartaglia M, Digilio MC, Capolino R, Vicari S. Manic and Depressive Symptoms in Children Diagnosed with Noonan Syndrome. Brain Sci 2021; 11:brainsci11020233. [PMID: 33668418 PMCID: PMC7918671 DOI: 10.3390/brainsci11020233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Noonan syndrome (NS) is a dominant clinically variable and genetically heterogeneous developmental disorder caused by germ-line mutations encoding components of the Ras–MAPK signaling pathway. A few studies have investigated psychopathological features occurring in individuals with NS, although they were poorly analyzed. The aim of the present work is to investigate the psychopathological features in children and adolescents with NS focusing on depressive and hypo-manic symptoms. Thirty-seven subjects with molecularly confirmed diagnosis were systematically evaluated through a psychopathological assessment. In addition, an evaluation of the cognitive level was performed. Our analyses showed a high recurrence of attention deficit and hyperactivity disorder symptoms, emotional dysregulation, irritability, and anxiety symptomatology. The mean cognitive level was on the average. The present study provides new relevant information on psychopathological features in individuals with NS. The implications for clinicians are discussed including the monitoring of mood disorders in a clinical evolution.
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Affiliation(s)
- Paolo Alfieri
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
- Correspondence: ; Tel.: +39-0668594721
| | - Francesca Cumbo
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
| | - Giulia Serra
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
| | - Monia Trasolini
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
| | - Camilla Frattini
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
| | - Francesco Scibelli
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
| | - Serena Licchelli
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
- Fondazione UILDM Lazio Onlus, 00167, Rome, Italy
| | - Flavia Cirillo
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
| | - Cristina Caciolo
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
| | - Maria Pia Casini
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
- Section of Child and Adolescent Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, 00161 Rome, Italy
| | - Adele D’Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (M.T.); (M.C.D.); (R.C.)
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (M.T.); (M.C.D.); (R.C.)
| | - Rossella Capolino
- Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy; (M.T.); (M.C.D.); (R.C.)
| | - Stefano Vicari
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.C.); (G.S.); (M.T.); (C.F.); (F.S.); (S.L.); (F.C.); (C.C.); (M.P.C.); (S.V.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Masi G, Fantozzi P, Muratori P, Bertolucci G, Tacchi A, Villafranca A, Pfanner C, Cortese S. Emotional dysregulation and callous unemotional traits as possible predictors of short-term response to methylphenidate monotherapy in drug-naïve youth with ADHD. Compr Psychiatry 2020; 100:152178. [PMID: 32386957 DOI: 10.1016/j.comppsych.2020.152178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/20/2020] [Accepted: 04/25/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) and callous unemotional (CU) traits can be associated with ADHD in youth, influencing its natural history and outcome, but their effect on medication efficacy is unexplored. We examined whether two measures of baseline ED and CU traits, the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) and the Antisocial Process Screening Device (APSD), respectively, were predictors of change of ADHD-Rating Scale (ADHD-RS) after a 4-week methylphenidate (MPH) monotherapy. METHODS 43 patients (37 males, 8-16 years, mean 9.9 ± 2.7 years) were included. Hierarchical linear regression models were used to explore whether CBCL-DP and APSD might predict ADHD-RS score, controlling for baseline severity. RESULTS Baseline CBCL-DP predicted higher post-treatment ADHD-RS scores in total and hyperactivity-impulsivity, but not in inattention subscale. Baseline APSD was not significantly related to ADHD-RS scores at the follow-up. LIMITATIONS Small sample size, lack of gender diversity, non-blind design and short period of observation. CONCLUSION ED, assessed with that CBCL-DP, might be a negative predictor of change of hyperactive-impulsive symptoms after MPH treatment and should be systematically assessed at baseline.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
| | - Pamela Fantozzi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Giulia Bertolucci
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Annalisa Tacchi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Arianna Villafranca
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Chiara Pfanner
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Samuele Cortese
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Environmental and Life Sciences and Faculty of Medicine, University of Southampton, Southampton, UK
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9
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Correlates of the Dysregulation Profile Among Emerging Adults. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Leaving A Mark, An Animal-Assisted Intervention Programme for Children Who Have Been Exposed to Gender-Based Violence: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214084. [PMID: 31652894 PMCID: PMC6862676 DOI: 10.3390/ijerph16214084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 12/04/2022]
Abstract
Gender-based violence is one of the most serious social and health problems faced by women around the world. Importantly, it has a negative impact not only on the woman’s physical and mental health, but also on all members of the family system in which it takes place. The aims of this study were to implement Leaving a Mark, an animal-assisted intervention (AAI) programme for children who have been exposed to gender-based violence, and to examine its effect on their associated clinical symptoms. The participants were 19 children (13 boys and 6 girls; Mage = 8.89, SD = 2.23) who had been exposed to domestic violence perpetrated either by their father or their mother’s intimate partner. Clinical symptoms were assessed using the Child Behaviour Checklist (CBCL). After taking part in the AAI programme, the children showed a reduction in internalizing symptoms and in symptoms associated with post-traumatic stress disorder. However, no significant changes were observed in externalizing symptoms or in affective and behavioural dysregulation (CBCL-Dysregulation Profile). These results provide preliminary support for the use of the Leaving a Mark programme with children who have been exposed to domestic violence. However, further studies with a larger sample and more rigorous design are required.
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11
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Momany AM, Troutman B. Neonatal Negative Emotionality and the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) in middle childhood. J Reprod Infant Psychol 2019; 39:100-110. [PMID: 31397592 DOI: 10.1080/02646838.2019.1652257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Determine whether an association exists between neonatal negative emotionality and childhood emotional dysregulation. Background: The Child Behaviour Checklist-Dysregulation Profile (CBCL-DP) has been used as a measure of emotional dysregulation in childhood. Although there is now good evidence that the CBCL-DP predicts later psychopathology, little is known about what factors predict elevations on the CBCL-DP. Methods: 30 mother-child dyads who previously participated in a study of neonatal temperament were recruited to a follow-up study of emotional dysregulation during middle childhood. The Neonatal Behaviour Assessment Scale (NBAS) and the Infant Characteristics Questionnaire (ICQ) were utilised as observer and maternal measures of neonatal negative emotionality, respectively. Maternal post-partum depression was also measured during the neonatal period using the Edinburgh Post-Partum Depression Scale (EPDS). The Child Behaviour Checklist-Dysregulation Profile (CBCL-DP) was used as a measure of childhood emotional dysregulation. Results: The ICQ fussy-difficult scale was significantly correlated with the CBCL-DP score (r = .46, p = .010), and this correlation remained significant after controlling for maternal EPDS score (CBCL-DP r = .51, p = .01). The NBAS irritability score was not associated with the CBCL-DP score. Conclusions: This association provides preliminary results that neonates rated as having high negative emotionality may indeed experience chronic difficulties with emotional dysregulation.
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Affiliation(s)
- Allison M Momany
- Department of Psychological and Brain Sciences, University of Iowa , Iowa City, IA, USA
| | - Beth Troutman
- Department of Psychiatry, University of Iowa , Iowa City, IA, USA
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12
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Aitken M, Battaglia M, Marino C, Mahendran N, Andrade BF. Clinical utility of the CBCL Dysregulation Profile in children with disruptive behavior. J Affect Disord 2019; 253:87-95. [PMID: 31029857 DOI: 10.1016/j.jad.2019.04.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 03/08/2019] [Accepted: 04/07/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Children who are severely dysregulated experience a range of concurrent and long-term impairments and psychopathology and are particularly at-risk for mood and anxiety disorders. The Child Behavior Checklist Dysregulation Profile (CBCL-DP) may be useful in identifying children who are highly dysregulated, which could facilitate early intervention. METHODS We examined the prevalence, gender differences, parent-teacher agreement, and concurrent validity of two categorical definitions of the CBCL-DP in 348 children ages 6-12 who were clinic-referred for assessment and treatment because of disruptive behavior. RESULTS Rates of the CBCL-DP were 3 times higher when a less stringent versus a more stringent definition of the CBCL-DP was used (46.8% vs. 15.2%). Girls were more likely than boys to meet criteria for the CBCL-DP when the more stringent definition was used. Parent-teacher agreement was low, particularly when the more stringent definition of the CBCL-DP was used. Children with the CBCL-DP were rated by their parents, but not their teachers, as more impaired than other children, regardless of the definition of the CBCL-DP used, and even when compared to children with clinically elevated scores on other CBCL subscales. LIMITATIONS Our cross-sectional data did not allow us to examine the predictive validity of the CBCL-DP, informant effects may have inflated associations between CBCL-DP and parent-rated impairment, and teacher ratings were missing for many children. CONCLUSIONS Our findings support other reports that provide evidence that the CBCL-DP may identify a particularly symptomatic and impaired group of children with disruptive behavior, as rated by their parents.
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Affiliation(s)
- Madison Aitken
- Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto, Department of Psychiatry, Toronto, Canada.
| | - Marco Battaglia
- Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto, Department of Psychiatry, Toronto, Canada
| | - Cecilia Marino
- Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto, Department of Psychiatry, Toronto, Canada
| | | | - Brendan F Andrade
- Centre for Addiction and Mental Health, Toronto, Canada; University of Toronto, Department of Psychiatry, Toronto, Canada
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13
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Melegari MG, Sacco R, Manzi B, Vittori E, Persico AM. Deficient Emotional Self-Regulation in Preschoolers With ADHD: Identification, Comorbidity, and Interpersonal Functioning. J Atten Disord 2019; 23:887-899. [PMID: 26744314 DOI: 10.1177/1087054715622015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to develop an age-adjusted Child Behavior Checklist- (CBCL) and Teacher Report Form (TRF)-based method for the detection of deficient emotional self-regulation (DESR) in preschoolers with ADHD and to assess its incidence, comorbidities, and consequences on interpersonal functioning. METHOD Eighty-six ADHD preschoolers and 104 controls were assessed using CBCL, TRF/1½ to 5, Psychiatric Interview With Preschool Age Psychiatric Assessment, Leiter-R, and ADHD rating scales. RESULTS Greatest sensitivity and specificity were obtained applying slightly lower threshold scores compared with school-age children (CBCL: Anxiety/Depression [A/D] ≥ 59, Attention Problems [AP] ≥ 60, Aggression Behaviors [AB] ≥ 58; TRF: A/D ≥ 59, AP ≥ 60, AB ≥ 60). DESR was detected in 33/86 (38.4%) and in 16/54 (29.6%) ADHD preschoolers versus 2/104 (1.9%) controls using CBCL and TRF, respectively. DESR is associated with significantly greater comorbidity and impairment in interpersonal functioning. CONCLUSION Among ADHD preschoolers, DESR (a) requires lower CBCL and TRF threshold scores for detection, compared with school-age children, (b) displays similar incidence rates, and (c) is associated with enhanced psychiatric comorbidity and interpersonal difficulties.
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Affiliation(s)
| | | | | | | | - Antonio M Persico
- 4 University of Messina, Messina, Italy.,5 Mafalda Luce Center for Pervasive Developmental Disorders, Milan, Italy
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14
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Benarous X, Consoli A, Cohen D, Renaud J, Lahaye H, Guilé JM. Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association. Eur Child Adolesc Psychiatry 2019; 28:667-683. [PMID: 30293122 DOI: 10.1007/s00787-018-1234-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
While many psychiatric disorders are associated with an increased risk for suicidal behaviors (SB) in children and adolescents, a few studies have explored the role of clinical symptoms based on a dimensional approach. Irritability is seen as a marker, a general psychopathology, and a symptom of both externalizing and internalizing disorders. In this review, we are interested in determining whether and how irritability can predict SB in youth. First, we reviewed consistencies and variation in the literature linking irritability to suicidal ideation (SI) and suicide attempt (SA). Second, based on the available models, we proposed specific mechanistic pathways, whereby irritability may modulate the risk for SB. Irritability has been found associated with SB both in cross-sectional and in longitudinal studies. The relation is consistent in different settings (i.e., general population and clinical settings) and across psychiatric disorders. The association is reduced but persists after adjusting for psychiatric disorder, including depression. On one hand, irritability constitutes a risk factor for SI via the onset of internalized disorder. On the other hand, irritable youth may be more prone to attempt suicide when experiencing SI. The measures for irritability were heterogeneous. A limited number of studies were designed to explore the role of mediators and/or moderators. Recognizing irritability in children and adolescents is a key issue with regards to suicide prevention.
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Affiliation(s)
- Xavier Benarous
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 83, boulevard de l'Hôpital, 75013, Paris, France. .,INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 83, boulevard de l'Hôpital, 75013, Paris, France.,GRC-15, Dimensional approach of Child and Adolescent Psychotic Episodes, Pierre and Marie Curie University (UPMC), Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, 83, boulevard de l'Hôpital, 75013, Paris, France.,CNRS, UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne Université, UPMC, Paris, France
| | - Johanne Renaud
- Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Hélène Lahaye
- Child and Adolescent Psychopathology Department, Amiens University Hospital, Amiens, France
| | - Jean-Marc Guilé
- INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardy Jules Verne (UPJV), Amiens, France.,Department of Psychiatry, McGill University, Montreal, Canada.,Child and Adolescent Psychopathology Department, Amiens University Hospital, Amiens, France
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15
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Kang NR, Kwack YS. Temperament and Character Profiles Associated with Internalizing and Externalizing Problems in Children with Attention Deficit Hyperactivity Disorder. Psychiatry Investig 2019; 16:206-212. [PMID: 30934188 PMCID: PMC6444095 DOI: 10.30773/pi.2019.01.10.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 01/10/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE This study aimed to identify temperament and character profiles associated with internalizing and externalizing problems in children with attention deficit hyperactivity disorder (ADHD). METHODS Children with ADHD (n=114, 8.51±1.87 years) were selected from the Department of Child and Adolescent Psychiatry at Jeju National University Hospital. They were diagnosed by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version and evaluated using the Advanced Test of Attention and Korean Wechsler Intelligence Scale for Children-Fourth Edition. Their parents completed the ADHD Rating Scale, Korean-Child Behavioral Checklist, and Junior Temperament and Character Inventory. RESULTS The participants with both internalizing and externalizing problem had more severe ADHD symptoms and significantly higher novelty seeking, harm avoidance, and self-transcendence, as well as lower self-directedness and cooperativeness than those who had not comorbid problems. Harm avoidance was correlated with their level of internalizing problems regardless of severity of ADHD symptoms. In addition, novelty seeking and sex (male) were being associated with the level of externalizing problems. CONCLUSION Differences were observed in the temperament and character profiles of children with ADHD according to their comorbid psychopathology. Results suggested that temperament and character profiles may affect the comorbid psychopathology in children with ADHD regardless of ADHD symptom severity.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Young Sook Kwack
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
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16
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Yule A, Fitzgerald M, Wilens T, Wozniak J, Woodworth KY, Pulli A, Uchida M, Faraone SV, Biederman J. Further Evidence of the Diagnostic Utility of the Child Behavior Checklist for Identifying Pediatric Bipolar I Disorder. Scand J Child Adolesc Psychiatr Psychol 2019; 7:29-36. [PMID: 32995342 PMCID: PMC7521745 DOI: 10.21307/sjcapp-2019-006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Pediatric bipolar (BP) disorder is a prevalent and highly morbid disorder. While structured diagnostic interviews have been developed to aid in the diagnosis of pediatric BP disorder, these tools are lengthy, costly and not widely available. One possible diagnostic aid is the Child Behavior Checklist (CBCL). Objective: To assess the diagnostic utility of the CBCL-BP profile to identify children with a diagnosis of BP-I disorder. Method: Subjects were derived from four independent data sets of children and adolescents with and without attention deficit hyperactivity disorder and BP-I. Subjects were recruited from pediatric and psychiatric clinics and the community. All subjects had structured clinical interviews with raters blinded to subject ascertainment status. We used an empirically derived profile from the CBCL consisting of an aggregate t-score from the Attention, Anxiety/Depression and Aggression subscales (CBCL-BP profile) to operationalize the presence or absence of BP symptoms. Receiver operating characteristic (ROC) curves were used to examine the ability of the CBCL-BP profile to identify children with and without a structured interview diagnosis of BP-I disorder. Results: The sample consisted of 661 subjects (mean age: 11.7 ± 3.3 years, 57% male and 94% Caucasian). In total, 20 percent of participants (n = 130) met structured interview criteria for a full diagnosis of BP-I disorder. The ROC analysis of the CBCL-BP profile yielded an area under the curve (AUC) of 0.91. A t-score of ≥ 195 on the CBCL-BP profile correctly classified 86% of subjects with BP-I disorder with 80% sensitivity, 87% specificity, 61% positive predictive value (PPV) and 95% negative predictive value (NPV). Conclusion: The CBCL-BP profile efficiently discriminated pediatric subjects with and without a structured interview diagnosis of BP-I disorder. Findings suggest that the CBCL-BP profile may be an efficient tool to help identify children who are very likely to suffer from BP-I disorder.
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Affiliation(s)
- Amy Yule
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Maura Fitzgerald
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
| | - Timothy Wilens
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Janet Wozniak
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - K Yvonne Woodworth
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
| | - Alexa Pulli
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA
| | - Mai Uchida
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY.,K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Joseph Biederman
- Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
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17
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Haltigan JD, Aitken M, Skilling T, Henderson J, Hawke L, Battaglia M, Strauss J, Szatmari P, Andrade BF. "P" and "DP:" Examining Symptom-Level Bifactor Models of Psychopathology and Dysregulation in Clinically Referred Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2018; 57:384-396. [PMID: 29859554 DOI: 10.1016/j.jaac.2018.03.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study examined cross-informant evidence for a general factor of psychopathology ("P") and a narrower, clinically oriented dysregulation general factor based on the Dysregulation Profile ("DP") in a large clinical sample of children and adolescents. We also compared the magnitude of P and DP general factor associations with self-harm and suicidal ideation as an indicator of criterion validity. METHOD Itemwise data from the Child Behavior Checklist (N = 2,934; 4-18 years of age) were analyzed using confirmatory bifactor modeling and replicated in a supplementary analysis using Youth Self Report data (N = 2,395). RESULTS General P and DP bifactor models fit the data better than single-factor and correlated factor models. Cross-informant criterion analyses on a subset of youth (n = 1,552) suggested that whether modeled as latent P or DP, associations with a brief composite index of self-harm and suicidal ideation are essentially of the same magnitude. CONCLUSION Our findings provide novel, large-sample support for the existence of general factors of psychopathology and dysregulation in clinically referred children and adolescents using a standardized rating system of psychopathology symptoms. Moreover, our results provide preliminary evidence that general psychopathology and dysregulation factors are clinically meaningful constructs. In addition, our findings raise the possibility that the DP general factor may serve as an efficient proxy for the general psychopathology factor in future clinical applications. Further efforts are necessary to understand the core empirical meaning of the P factor and to determine how it can be applied to clinical assessment and intervention.
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Affiliation(s)
- John D Haltigan
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Madison Aitken
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tracey Skilling
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada
| | - Lisa Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marco Battaglia
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada
| | - John Strauss
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brendan F Andrade
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada
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18
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McQuillan ME, Kultur EC, Bates JE, O'Reilly LM, Dodge KA, Lansford JE, Pettit GS. Dysregulation in children: Origins and implications from age 5 to age 28. Dev Psychopathol 2018; 30:695-713. [PMID: 29151386 PMCID: PMC6460462 DOI: 10.1017/s0954579417001572] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Research shows that childhood dysregulation is associated with later psychiatric disorders. It does not yet resolve discrepancies in the operationalization of dysregulation. It is also far from settled on the origins and implications of individual differences in dysregulation. This study tested several operational definitions of dysregulation using Achenbach attention, anxious/depressed, and aggression subscales. Individual growth curves of dysregulation were computed, and predictors of growth differences were considered. The study also compared the predictive utility of the dysregulation indexes to standard externalizing and internalizing indexes. Dysregulation was indexed annually for 24 years in a community sample (n = 585). Hierarchical linear models considered changes in dysregulation in relation to possible influences from parenting, family stress, child temperament, language, and peer relations. In a test of the meaning of dysregulation, it was related to functional and psychiatric outcomes in adulthood. Dysregulation predictions were further compared to those of the more standard internalizing and externalizing indexes. Growth curve analyses showed strong stability of dysregulation. Initial levels of dysregulation were predicted by temperamental resistance to control, and change in dysregulation was predicted by poor language ability and peer relations. Dysregulation and externalizing problems were associated with negative adult outcomes to a similar extent.
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19
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Uljarević M, Hedley D, Nevill R, Evans DW, Cai RY, Butter E, Mulick JA. Brief report: Poor self-regulation as a predictor of individual differences in adaptive functioning in young children with autism spectrum disorder. Autism Res 2018; 11:1157-1165. [DOI: 10.1002/aur.1953] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Mirko Uljarević
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of Medicine; Stanford University; Stanford California
- Olga Tennison Autism Research Centre; La Trobe University; Melbourne Victoria Australia
| | - Darren Hedley
- Olga Tennison Autism Research Centre; La Trobe University; Melbourne Victoria Australia
- Nationwide Children's Hospital; Columbus Ohio
| | - Rose Nevill
- The Ohio State University; Columbus Ohio
- Kennedy Krieger Institute and John Hopkins School of Medicine; Baltimore Maryland
| | | | - Ru Ying Cai
- Olga Tennison Autism Research Centre; La Trobe University; Melbourne Victoria Australia
| | - Eric Butter
- Nationwide Children's Hospital; Columbus Ohio
- The Ohio State University; Columbus Ohio
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20
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Masi G, Milone A, Montesanto AR, Valente E, Pisano S. Non suicidal self-injury in referred adolescents with mood disorders and its association with cyclothymic-hypersensitive temperament. J Affect Disord 2018; 227:477-482. [PMID: 29156361 DOI: 10.1016/j.jad.2017.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/24/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non suicidal self-injuries (NSSIs) are deliberate self-harm behaviors without suicidal intent, usually starting in adolescence, with increasing rates of occurrence both in epidemiological and clinical samples. Several studies associated cyclothymic-hypersensitive temperament (CHT) with self-harm behaviors and suicidal risk. Aim of this study is to explore the association between NSSIs and CHT in a clinical sample of adolescents. We hypothesized that CHT may differentiate NSSI from non-NSSI adolescents with mood disorders, when other psychopathological features are controlled for. METHODS A consecutive sample of 89 adolescents with mood disorders were assessed for presence and phenomenology of NSSIs, CHT, demographics, comorbid categorical psychiatric diagnoses, dimensional psychopathology, impairment and previous suicide attempts. RESULTS NSSIs were reported in 52% of the sample, with higher rates in females and in bipolar disorder. Regression analyses showed that CHT, but not age, gender, bipolar vs depression diagnosis, functional impairment, was associated with NSSIs. DISCUSSION CHT may be in close association with NSSIs in adolescents with mood disorders. An assessment of CHT in adolescents referred for mood disorder may help to detect specific psychological features of NSSIs, which may improve diagnostic and treatment strategies. LIMITATIONS Given the cross-sectional design, a developmental relation between CHT and NSSIs cannot be determined. The small sample size and the selection bias of severely impaired patients limit the generalization of the results. More sophisticated measures of CHT may consent to explore other dimensions of the cyclothymic construct (i.e., emotional intensity, emotional reactivity, emotional stability, positive vs. negative emotions, interpersonal sensitivity, impulsivity).
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Anna Rita Montesanto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Elena Valente
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Simone Pisano
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Baronissi, Salerno, Italy.
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21
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Kunze B, Wang B, Isensee C, Schlack R, Ravens-Sieberer U, Klasen F, Rothenberger A, Becker A. Gender associated developmental trajectories of SDQ-dysregulation profile and its predictors in children. Psychol Med 2018; 48:404-415. [PMID: 28637519 DOI: 10.1017/s0033291717001714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Severe mood dysregulation is common in childhood and can be highly impairing. The Dysregulation Profile (DP) can be considered as a broader phenotype of emotional dysregulation, including affect, cognition and behaviour. Since mood dysregulation may persist, but differently in boys and girls, the gender associated course needs to be considered longitudinally to gain a better insight in order to support the children more adequately. This study is focusing on gender associated subgroup trajectories of the Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP) in middle childhood (9-13 years of age) and includes the potential impact of clinical and psychosocial characteristics. METHOD The data set was available from the BELLA study on mental health and well-being in children and adolescents, which is the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A representative epidemiological sample of 564 children living in Germany was examined at three assessment points over 2 years (data collection 2003-2006). The SDQ-DP of children aged 9-13 years was evaluated using Latent Class Growth Analysis (LCGA). RESULTS For both genders three trajectories with low (girls 67.0% and boys 59.5%), moderate (girls 28.0% and boys 31.7%) and high SDQ-DP (girls 5.0% and boys 8.8%) scores were detected. The courses of low and moderate subgroups were stable, while in the high SDQ-DP subgroup boys showed a decreasing and girls an increasing trend in symptom severity on a descriptive level. The results of the multinomial logistic regression analyses revealed a significant influence of mainly externalising but also internalising problems both increasing the risk of moderate and high SDQ-DP in both genders. Good quality of life was a protective factor for the SDQ-DP course in all subgroups. CONCLUSION In addition to the known clinical and scientific value of the SDQ-DP, three distinguishable trajectories of SDQ-DP in boys and girls could be found. High externalising problems at the beginning of the trajectory were associated with an undesirable course of SDQ-DP. These findings might be helpful for better psychoeducation, counselling and monitoring in clinical cases and public health.
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Affiliation(s)
- B Kunze
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - B Wang
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - C Isensee
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - R Schlack
- Robert Koch Institute,Department of Epidemiology and Health Monitoring,Berlin,Germany
| | - U Ravens-Sieberer
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Hamburg- Eppendorf,Germany
| | - F Klasen
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Hamburg- Eppendorf,Germany
| | - A Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
| | - A Becker
- Clinic for Child and Adolescent Psychiatry and Psychotherapy,University Medical Center Göttingen,Germany
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Taskiran C, Karaismailoglu S, Cak Esen HT, Tuzun Z, Erdem A, Balkanci ZD, Dolgun AB, Cengel Kultur SE. Clinical features and subjective/physiological responses to emotional stimuli in the presence of emotion dysregulation in attention-deficit hyperactivity disorder. J Clin Exp Neuropsychol 2017; 40:389-404. [PMID: 28721740 DOI: 10.1080/13803395.2017.1353952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Emotion dysregulation (ED) has long been recognized in clinical descriptions of attention-deficit hyperactivity disorder (ADHD), but a renewed interest in ED has advanced research on the overlap between the two entities. Autonomic reactivity (AR) is a neurobiological correlate of emotion regulation; however, the association between ADHD and AR remains unclear. Our aim was to explore the clinical differences, AR, and subjective emotional responses to visual emotional stimuli in ADHD children with and without ED. METHOD School-aged ADHD children with (n = 28) and without (n = 20) ED, according to the definition of deficiency in emotional self-regulation (DESR), and healthy controls (n = 22) were interviewed by using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime version (K-SADS-PL) to screen frequent psychopathologies for these ages. All subjects were evaluated with Child Behavior Checklist 6-18 (CBCL), the Strengths and Difficulties Questionnaire (SDQ), the McMaster Family Assessment Device (FAD), the School-Age Temperament Inventory (SATI), and Conners' Parent Rating Scale (CPRS-48), which were completed by parents. To evaluate emotional responses, the International Affective Picture System (IAPS) and the subjective and physiological responses (electrodermal activity and heart rate reactivity) to selected pictures were examined. RESULTS Regarding clinically distinctive features, the ADHD+ED group differed from the ADHD-ED and the control groups in terms of having higher temperamental negative reactivity, more oppositional/conduct problems, and lower prosocial behaviors. In the AR measures, children in the ADHD+ED group rated unpleasant stimuli as more negative, but they still had lower heart rate reactivity (HRR) than the ADHD-ED and control groups; moreover, unlike the two other groups, the ADHD+ED group showed no differences in HRR between different emotional stimuli. CONCLUSION The presented findings are unique in terms of their ability to clinically and physiologically differentiate between ADHD children with and without ED.
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Affiliation(s)
- Candan Taskiran
- a Department of Child and Adolescent Psychiatry , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
| | - Serkan Karaismailoglu
- b Department of Physiology , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
| | - Halime Tuna Cak Esen
- a Department of Child and Adolescent Psychiatry , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
| | - Zeynep Tuzun
- c Division of Adolescent Medicine, Department of Pediatrics , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
| | - Aysen Erdem
- b Department of Physiology , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
| | - Zeynep Dicle Balkanci
- b Department of Physiology , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
| | - Anil Barak Dolgun
- d Department of Biostatistics , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
| | - Sadriye Ebru Cengel Kultur
- a Department of Child and Adolescent Psychiatry , Hacettepe University Faculty of Medicine , Sıhhiye , Ankara , Turkey
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Effect of Methylphenidate on Emotional Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder + Oppositional Defiant Disorder/Conduct Disorder. J Clin Psychopharmacol 2017; 37:220-225. [PMID: 28225747 DOI: 10.1097/jcp.0000000000000668] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Emotional dysregulation (ED) is a frequent feature of attention-deficit/hyperactivity disorder (ADHD). It can be observed as a dysregulation profile or a deficient emotional self-regulation (DESR) profile. Oppositional defiant disorder/conduct disorder (ODD/CD) comorbidity is prevalent in ADHD and known to be related with ED. The first-line treatment of ADHD includes psychostimulants, but their effects on ED are not well studied. This study aimed to evaluate the outcomes of methylphenidate (MPH) treatment on ED in ADHD + ODD/CD cases. METHODS A total of 118 ADHD + ODD/CD patients with a mean age of 9.0 ± 1.9 years were treated with MPH for 1 year. Also, parents of cases were recruited for a parent-training program, which initiated after first month of MPH treatment. Symptom severity was assessed at baseline and 12th month by Turgay Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parent Form, Children Depression Inventory, Child Behavior Checklist 4-18 years, and Parental Acceptance and Rejection Questionnaire-Mother Form. RESULTS Emotional dysregulation (DESR + DP) was present in 85.6% of cases. Conduct disorder was significantly higher in patients with DP, whereas ODD was significantly higher in the DESR and non-ED groups (P < 0.0001). Symptoms of ADHD and ED were significantly improved with 1-year of MPH treatment (P < 0.05). The improvement in ED was independent of improvement in ADHD symptoms and parent training (P < 0.05). CONCLUSIONS Emotional dysregulation is highly prevalent in disruptive behavioral disorders as ODD and CD, which are comorbid with ADHD. The MPH treatment is effective on ED independently from other clinical determinants.
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Muratori P, Pisano S, Milone A, Masi G. Is emotional dysregulation a risk indicator for auto-aggression behaviors in adolescents with oppositional defiant disorder? J Affect Disord 2017; 208:110-112. [PMID: 27764737 DOI: 10.1016/j.jad.2016.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/22/2016] [Accepted: 08/29/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Child Behavior Checklist Dysregulation Profile (CBCL-DP), (high scores in Anxious/Depressed, Attention Problems, and Aggressive Behavior subscales), has been related to poor emotional and behavioral self-regulation in children and adolescents. Our aim is to evaluate if it may be associated with auto-aggression in youth with oppositional defiant disorder (ODD). Method In 72 consecutively referred youths with ODD, emotional dysregulation was assessed with the CBCL-DP, auto-aggression and physical aggression against other persons with the Modified Overt Aggression Scale. RESULTS Regression analysis showed that greater higher CBCL-DP scores were associated to higher levels of auto-aggression, even when controlling for the levels of physical aggression against others and CBCL Total score. LIMITATIONS The small sample size, the cross-sectional design, and the lack of a control group limit the generalization of our findings. CONCLUSIONS Referred ODD youths with higher scores of CBCL-DP are more likely to present auto-aggression, besides aggression against others. The CBCL could improve the screening and detection of these high-risk patients.
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Affiliation(s)
- Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
| | - Simone Pisano
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division, Second University of Naples, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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Jordan P, Rescorla LA, Althoff RR, Achenbach TM. International Comparisons of the Youth Self-Report Dysregulation Profile: Latent Class Analyses in 34 Societies. J Am Acad Child Adolesc Psychiatry 2016; 55:1046-1053. [PMID: 27871639 DOI: 10.1016/j.jaac.2016.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/14/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We used latent class analysis (LCA) to examine the prevalence and characteristics of the Dysregulation Profile (DP) based on data from the Youth Self-Report (YSR). The DP comprises elevated scores on the Anxious/Depressed, Attention Problems, and Aggressive Behavior syndromes and thus reflects significant problems in self-regulation of affect, attention, and behavior. METHOD We examined YSR data for 38,070 adolescents (48.1% male) in 34 societies. Participants ranged in age from 11 to 16 years. Researchers in 31 societies used translations of the YSR (not in Jamaica, Australia, or the United States). RESULTS The various statistical indices for good LCA model fit (entropy, bootstrapped parametric likelihood ratio test, adjusted Bayesian Information Criterion, and probability of correct assignment) were not always consistent but generally supported a DP class in every society. However, prevalence of the DP ranged from 1% to 26% and the T score syndrome profile for the DP class in many societies featured elevations on all scales. In every society, the DP class had significantly higher scores than the pooled non-DP classes on all 3 DP syndromes, with large d values. CONCLUSION Because model fit, the number of classes, and the prevalence of the DP class varied across societies, and because the DP "3-peak" profile was relatively uncommon, results for the DP based on adolescents' ratings in 34 societies must be considered as mixed.
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Dölitzsch C, Kölch M, Fegert JM, Schmeck K, Schmid M. Ability of the Child Behavior Checklist-Dysregulation Profile and the Youth Self Report-Dysregulation Profile to identify serious psychopathology and association with correlated problems in high-risk children and adolescents. J Affect Disord 2016; 205:327-334. [PMID: 27566452 DOI: 10.1016/j.jad.2016.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/20/2016] [Accepted: 08/14/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The current analyses examined whether the dysregulation profile (DP) 1) could be used to identify children and adolescents at high risk for complex and serious psychopathology and 2) was correlated to other emotional and behavioral problems (such as delinquent behavior or suicide ideation). DP was assessed using both the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) in a residential care sample. METHODS Children and adolescents (N=374) aged 10-18 years living in residential care in Switzerland completed the YSR, and their professional caregivers completed the CBCL. Participants meeting criteria for DP (T-score ≥67 on the anxious/depressed, attention problems, and aggressive behavior scales of the YSR/CBCL) were compared against those who did not for the presence of complex psychopathology (defined as the presence of both emotional and behavioral disorders), and also for the prevalence of several psychiatric diagnoses, suicidal ideation, traumatic experiences, delinquent behaviors, and problems related to quality of life. RESULTS The diagnostic criteria for CBCL-DP and YSR-DP were met by just 44 (11.8%) and 25 (6.7%) of participants. Only eight participants (2.1%) met the criteria on both instruments. Further analyses were conducted separately for the CBCL-DP and YSR-DP groups. DP was associated with complex psychopathology in only 34.4% of cases according to CBCL and in 60% of cases according to YSR. YSR-DP was somewhat more likely to be associated with psychiatric disorders and associated problems than was the CBCL-DP. LIMITATIONS Because of the relatively small overlap between the CBCL-DP and YSR-DP, analyses were conducted largely with different samples, likely contributing to the different results. CONCLUSIONS Despite a high rate of psychopathology in the population studied, both the YSR-DP and the CBCL-DP were able to detect only a small proportion of those with complex psychiatric disorders. This result questions the validity of YSR-DP and the CBCL-DP in detecting subjects with complex and serious psychopathology. It is possible that different screening instruments may be more effective.
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Affiliation(s)
- Claudia Dölitzsch
- University Hospital of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Germany.
| | - Michael Kölch
- Medical School Brandenburg, Department of Child and Adolescent Psychiatry, Germany
| | - Jörg M Fegert
- University Hospital of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Germany
| | - Klaus Schmeck
- University Hospital of Basel, Department of Child and Adolescent Psychiatry, Switzerland
| | - Marc Schmid
- University Hospital of Basel, Department of Child and Adolescent Psychiatry, Switzerland
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Child behavior checklist profiles in adolescents with bipolar and depressive disorders. Compr Psychiatry 2016; 70:152-8. [PMID: 27624435 DOI: 10.1016/j.comppsych.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 07/03/2016] [Accepted: 07/22/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the Child Behavior Checklist (CBCL) profiles in youths with bipolar and depressive disorders. METHODS Seventy-four subjects with a mean age of 14.9±1.6years (36 boys) with mood disorders and their parents were recruited from September 2011 to June 2013 in the Department of Psychiatry, Asan Medical Center, Seoul, Korea. Diagnosis of mood disorder and comorbid psychiatric disorder was confirmed by child psychiatrists using the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime version (K-SADS-PL). The parents of the subjects completed the Parent General Behavior Inventory-10-item Mania Scale (P-GBI-10M), Parent-version of Mood Disorder Questionnaire (P-MDQ), ADHD rating scale (ARS) and CBCL. The adolescents completed the 76-item Adolescent General Behavior Inventory (A-GBI), Beck Depression Inventory (BDI), and Adolescent-version of Mood Disorder Questionnaire (A-MDQ). RESULTS When adjusted for gender and the comorbidity with ADHD, the Withdrawn and Anxious/Depressed subscale scores of the CBCL were higher in subjects with bipolar disorder than in those with depressive disorder. Higher scores of A-GBI Depressive subscale, A-MDQ and BDI were shown in subjects with bipolar disorder than in those with depressive disorder. There was no significant difference on CBCL-DP, P-GBI-10M, P-MDQ, A-GBI Hypomanic/Biphasic subscale and ARS between two groups. All eight subscales of the CBCL positively correlated with the P-GBI-10M and P-MDQ scores, and seven of all eight subscales of the CBCL positively correlated with A-GBI Depressive and Hypomanic/Biphasic subscales. The BDI score was positively associated with the Withdrawn, Somatic Complaints, Anxious/Depressed, and Social Problems subscale scores. CBCL-DP score was strongly correlated with manic/hypomanic symptoms measured by P-GBI-10M and P-MDQ (r=0.771 and 0.826). CONCLUSIONS This study suggests that the CBCL could be used for measuring mood symptoms and combined psychopathology, especially internalizing symptoms, in youth with mood disorder. However, CBCL-DP had limited ability to differentiate bipolar from depressive disorder, at least in adolescents.
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Caporino NE, Herres J, Kendall PC, Wolk CB. Dysregulation in Youth with Anxiety Disorders: Relationship to Acute and 7- to 19- Year Follow-Up Outcomes of Cognitive-Behavioral Therapy. Child Psychiatry Hum Dev 2016; 47:539-47. [PMID: 26384978 PMCID: PMC4798924 DOI: 10.1007/s10578-015-0587-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study evaluated the impact of dysregulation across cognitive, affective, and behavioral domains on acute and 7- to 19-year follow-up outcomes of cognitive-behavioral therapy (CBT) for anxiety, and explored dysregulation as a predictor of psychopathology and impairment in young adulthood among individuals who received anxiety treatment as youth. Participants (N = 64; 50 % female, 83 % non-Hispanic White) from two randomized clinical trials completed a follow-up assessment 7-19 years later. Latent profile analysis identified dysregulation based on Anxious/Depressed, Attention Problems, and Aggressive Behavior scores on the Child Behavior Checklist. Although pretreatment dysregulation was not related to acute or follow-up outcomes for anxiety diagnoses that were the focus of treatment, dysregulation predicted an array of non-targeted psychopathology at follow-up. Among youth with a principal anxiety disorder, the effects of CBT (Coping Cat) appear to be robust against broad impairments in self-regulation. However, youth with a pretreatment dysregulation profile likely need follow-up to monitor for the emergence of other disorders.
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Affiliation(s)
- Nicole E Caporino
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA.
| | - Joanna Herres
- Department of Couple and Family Therapy, Drexel University, Philadelphia, Pennsylvania
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
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Fernandez E, Johnson SL. Anger in psychological disorders: Prevalence, presentation, etiology and prognostic implications. Clin Psychol Rev 2016; 46:124-35. [DOI: 10.1016/j.cpr.2016.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/14/2015] [Accepted: 04/25/2016] [Indexed: 01/21/2023]
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Masi G, Milone A, Manfredi A, Brovedani P, Pisano S, Muratori P. Combined pharmacotherapy-multimodal psychotherapy in children with Disruptive Behavior Disorders. Psychiatry Res 2016; 238:8-13. [PMID: 27086204 DOI: 10.1016/j.psychres.2016.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/15/2015] [Accepted: 02/08/2016] [Indexed: 11/16/2022]
Abstract
Although multi-component psychotherapeutic interventions are first-line treatments for Disruptive Behavior Disorders (DBD), pharmacotherapy is often associated for more severe patients. Our aim was to explore effectiveness of an associated pharmacotherapy in referred children with DBD receiving a one-year psychotherapeutic intervention. Aggression, callous unemotional (CU) traits and emotional dysregulation were outcome measures. The sample included 144 children, aged 8-12 years, 41 (29%) with an ADHD comorbidity. Fifty-five (38%) patients received an additional pharmacotherapy with one medication, methylphenidate, a second generation antipsychotic, or a mood stabilizer. Data were collected before and after the one-year treatment. According to the Child Behavior Checklist (CBCL), aggressive behaviors, rule-breaking behaviors and emotional dysregulation improved in the whole group, as well as parent- and child-reported CU traits. The hierarchical regression model showed that additional pharmacotherapy significantly predicted lower scores at the CBCL aggressive behaviors and emotional dysregulation, but not CU traits at the end of the treatment. The interaction between methylphenidate and ADHD comorbidity predicted lower aggressive behaviors after the treatment. In summary, this naturalistic investigation suggest that an additional pharmacotherapy significantly improved aggression and emotional dysregulation, but not CU traits. When ADHD was comorbid, methylphenidate was more effective than antipsychotics or mood stabilizers in reducing aggression.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Azzurra Manfredi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Paola Brovedani
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Simone Pisano
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division, Second University of Naples, Italy
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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Carlson GA, Danzig AP, Dougherty LR, Bufferd SJ, Klein DN. Loss of Temper and Irritability: The Relationship to Tantrums in a Community and Clinical Sample. J Child Adolesc Psychopharmacol 2016; 26:114-22. [PMID: 26783943 PMCID: PMC4800384 DOI: 10.1089/cap.2015.0072] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study explores the relationship of irritability to tantrums and loss of temper in a community and clinical sample. METHODS The community sample, recruited via commercial mailing lists, consisted of 462 6-year-olds whose parents completed the Child Behavior Checklist (CBCL), and Preschool Age Psychiatric Assessment (PAPA). Tantrums were assessed in the oppositional defiant disorder (ODD) section of the PAPA. Irritability was assessed in the depression section to identify persistently irritable and/or angry mood. The clinic sample, drawn from a child psychiatry clinic, included 229 consecutively referred 6-year-olds from 2005 through 2014 whose parents completed the CBCL and Child and Adolescent Symptom Inventory (CASI). Temper loss and irritability items came from the ODD and depression sections of the CASI, and tantrum description was taken from an irritability inventory. Children's Global Assessment Scale (CGAS) and the CBCL Dysregulation Profile were examined in both samples. Logistic and multiple regression were used to compare rates of diagnosis, CBCL subscales, CGAS, and tantrum quality between children with tantrums only and tantrums with irritability. RESULTS Almost half (45.9%) of clinic children had severe tantrums; only 23.8% of those were said to be irritable. In the community, 11% of children had tantrums, but 78.4% of those were called irritable. However, irritability in the clinic, although less common, was associated with aggressive tantrums and substantial impairment. In contrast, irritability was associated with only a relatively small increase in impairment in the community sample. CONCLUSIONS Irritability may have different implications in community versus clinic samples, and tantrums assessed in the community may be qualitatively different from those seen in clinics.
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Affiliation(s)
- Gabrielle A. Carlson
- Division of Child and Adolescent Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Allison P. Danzig
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Lea R. Dougherty
- Department of Psychology, University of Maryland, College Park, Maryland
| | - Sara J. Bufferd
- Department of Psychology, California State University, San Marcos, California
| | - Daniel N. Klein
- Department of Psychology, Stony Brook University, Stony Brook, New York
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Nobile M, Bianchi V, Monzani D, Beri S, Bellina M, Greco A, Colombo P, Tesei A, Caldirola D, Giorda R, Perna G, Molteni M. Effect of family structure and TPH2 G-703T on the stability of dysregulation profile throughout adolescence. J Affect Disord 2016; 190:576-584. [PMID: 26583347 DOI: 10.1016/j.jad.2015.10.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/09/2015] [Accepted: 10/31/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Two different polymorphisms (TPH2 G-703T and 5-HTTLPR) involved in the serotonergic pathway have been reported to play a role, both alone and in interaction with the environment, in early and adult emotion regulation. As most of these studies are cross-sectional, we know little about the impact of these polymorphisms over time, particularly during adolescence. METHODS Because we were interested in the effects of these polymorphisms and environment (i.e., family structure) at different time-points on the emotional dysregulation profile, we performed a path analysis model in a general adolescent population sample of a five-year follow-up study. RESULTS We found a high stability of Dysregulation Profile problems independently from the examined allelic variants. We also found that early family structure directly influences the levels of dysregulation problems in early adolescence, both alone and in interaction with TPH2, suggesting the presence of a gene-environment interaction effect. Furthermore, we found that in adolescents homozygous for the TPH2 G allele, the effect of the early family structure remains active during late adolescence, albeit mediated by earlier emotional problems. LIMITATIONS The high attrition rate, the use of only one source on behavioral problems of adolescents, and the focus on a single polymorphism in the investigated genes could limit the generalizability of the present results. CONCLUSIONS These results suggest that early family structure could play a significant role in the development and maintenance of emotional and behavioral problems not only in early adolescence but also in late-adolescence, although this effect was mediated and moderated by behavioral and genetic variables.
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Affiliation(s)
- Maria Nobile
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy; Department of Clinical Neurosciences, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Italy.
| | - Valentina Bianchi
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy; Institute of Molecular Imaging and Physiology, National Research Council, Segrate, Milan, Italy
| | - Dario Monzani
- Department of Psychology, Università degli Studi di Milano Bicocca, Milan, Italy
| | - Silvana Beri
- Molecular Biology Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Monica Bellina
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Andrea Greco
- Department of Psychology, Università degli Studi di Milano Bicocca, Milan, Italy
| | - Paola Colombo
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Alessandra Tesei
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Daniela Caldirola
- Department of Clinical Neurosciences, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Italy
| | - Roberto Giorda
- Molecular Biology Lab, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Italy
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
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Papachristou E, Schulz K, Newcorn J, Bédard ACV, Halperin JM, Frangou S. Comparative Evaluation of Child Behavior Checklist-Derived Scales in Children Clinically Referred for Emotional and Behavioral Dysregulation. Front Psychiatry 2016; 7:146. [PMID: 27605916 PMCID: PMC4995201 DOI: 10.3389/fpsyt.2016.00146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/08/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We recently developed the Child Behavior Checklist-Mania Scale (CBCL-MS), a novel and short instrument for the assessment of mania-like symptoms in children and adolescents derived from the CBCL item pool and have demonstrated its construct validity and temporal stability in a longitudinal general population sample. OBJECTIVE The aim of this study was to evaluate the construct validity of the 19-item CBCL-MS in a clinical sample and to compare its discriminatory ability to that of the 40-item CBCL-dysregulation profile (CBCL-DP) and the 34-item CBCL-Externalizing Scale. METHODS The study sample comprised 202 children, aged 7-12 years, diagnosed with DSM-defined attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), and mood and anxiety disorders based on the Diagnostic Interview Schedule for Children. The construct validity of the CBCL-MS was tested by means of a confirmatory factor analysis. Receiver operating characteristics (ROC) curves and logistic regression analyses adjusted for sex and age were used to assess the discriminatory ability relative to that of the CBCL-DP and the CBCL-Externalizing Scale. RESULTS The CBCL-MS had excellent construct validity (comparative fit index = 0.97; Tucker-Lewis index = 0.96; root mean square error of approximation = 0.04). Despite similar overall performance across scales, the clinical range scores of the CBCL-DP and the CBCL-Externalizing Scale were associated with higher odds for ODD and CD, while the clinical range scores of the CBCL-MS were associated with higher odds for mood disorders. The concordance rate among the children who scored within the clinical range of each scale was over 90%. CONCLUSION CBCL-MS has good construct validity in general population and clinical samples and is therefore suitable for both clinical practice and research.
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Affiliation(s)
- Efstathios Papachristou
- Department of Primary Care and Population Health, University College London (UCL) , London , UK
| | - Kurt Schulz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Jeffrey Newcorn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, NY , USA
| | - Anne-Claude V Bédard
- Ontario Institute for Studies in Education, University of Toronto , Toronto, ON , Canada
| | - Jeffrey M Halperin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychology, Queens College, New York, NY, USA
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, NY , USA
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Deutz MHF, Geeraerts SB, van Baar AL, Deković M, Prinzie P. The Dysregulation Profile in middle childhood and adolescence across reporters: factor structure, measurement invariance, and links with self-harm and suicidal ideation. Eur Child Adolesc Psychiatry 2016; 25:431-42. [PMID: 26226917 PMCID: PMC4820491 DOI: 10.1007/s00787-015-0745-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 07/10/2015] [Indexed: 11/30/2022]
Abstract
Recently, a phenotype of severe dysregulation, the Dysregulation Profile (DP), has been identified. DP consists of elevated scores on the Anxious/Depressed (AD), Aggressive Behavior (AGG) and Attention Problems (AP) scales of the Child Behavior Checklist (CBCL), Teacher Report Form (TRF), or Youth Self Report (YSR). A drawback in current research is that DP has been conceptualized and operationalized in different manners and research on the factor structure of DP is lacking. Therefore, we examined the factor structure of DP across multiple reporters, measurement invariance across gender, parents, and time, as well as links between DP and self-harm and suicidal ideation. Data from a large community sample were used (N = 697), covering middle childhood (Mage = 7.90, (SD = 1.16) and adolescence (Mage = 13.93, SD = 1.14). Mothers, fathers, teachers, and youth themselves reported on children's emotional and behavioral problems using the CBCL, TRF, and YSR. Results indicated that in middle childhood and in adolescence, a bifactor model with a general factor of Dysregulation alongside three specific factors of AD, AGG, and AP fitted best, compared to a second-order or one-factor model. The model showed good fit for mother, father, teacher, and youth reports and showed invariance across gender, parents and time. Youth, mother, and father reported Dysregulation was uniquely and positively related to adolescent-reported self-harm and suicidal ideation. The DP is best conceptualized as a broad dysregulation syndrome, which exists over and above anxiety/depression, aggression, and attention problems as specific problems. The bifactor model of DP explains the uniqueness and interrelatedness of these behavioral problems and can help explaining shared and non-shared etiology factors. The exclusive link between the general dysregulation factor and adolescents' self-harm and suicidal ideation further established the clinical relevance of the bifactor model.
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Affiliation(s)
- Marike H. F. Deutz
- />Department of Child and Adolescent Studies, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands
| | - Sanne B. Geeraerts
- />Department of Child and Adolescent Studies, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands
| | - Anneloes L. van Baar
- />Department of Child and Adolescent Studies, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands
| | - Maja Deković
- />Department of Child and Adolescent Studies, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, The Netherlands
| | - Peter Prinzie
- />Department of Pedagogical and Educational Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Masi G, Pisano S, Milone A, Muratori P. Child behavior checklist dysregulation profile in children with disruptive behavior disorders: A longitudinal study. J Affect Disord 2015; 186:249-53. [PMID: 26254616 DOI: 10.1016/j.jad.2015.05.069] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/16/2015] [Accepted: 05/26/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND A Child Behavior Checklist (CBCL) profile defined as Dysregulation Profile (DP) (scores 2 standard deviations or more in anxiety/depression, aggression, attention subscales) has been correlated to poor emotional and behavioral self-regulation. The clinical meaning and the prognostic implications of CBCL-DP are still debated, although it seems associated with severe psychopathology and poor adjustment. METHOD In the present study, we used the CBCL-DP score to examine the adolescent outcomes (psychiatric diagnosis, substance use, psychiatric hospitalization) in 80 referred children with disruptive behavior disorders -DBD- (Oppositional Defiant Disorder or conduct disorder), aged 8-9 years, 72 males (90%) and 8 females (10%), followed-up until the age of 14-15 years. RESULTS Children with higher score on the CBCL-DP profile were at increased risk for presenting ADHD and mood disorders in adolescence. While ADHD in adolescence was predicted also by an ADHD diagnosis during childhood, CBCL-DP score was the only significant predictor of a mood disorder at 14-15 years. On the contrary, CBCL-DP score was not associated with a higher risk of conduct disorder, substance use and hospitalizations in adolescence. A cost-effective and reliable diagnostic measure such as the CBCL may be a part of the diagnostic procedure aimed to capture these at-risk children, to monitor their natural history up to adolescence, and to prevent the risk of a full-blown mood disorder. LIMITATIONS The small sample size and a selection bias of severe patients with DBD limit the generalization of the findings.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
| | - Simone Pisano
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division, Second University of Naples, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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Frazier JA, Wood ME, Ware J, Joseph RM, Kuban KC, O'Shea M, Allred EN, Leviton A. Antecedents of the child behavior checklist-dysregulation profile in children born extremely preterm. J Am Acad Child Adolesc Psychiatry 2015; 54:816-23. [PMID: 26407491 PMCID: PMC4615708 DOI: 10.1016/j.jaac.2015.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 07/25/2015] [Accepted: 07/29/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Extremely preterm newborns are at heightened risk for emotional and behavioral dysregulation later in childhood. Our goal was to systematically evaluate the antenatal and early postnatal antecedents that might mediate the association between extreme preterm birth and emotional and behavioral dysregulation at age 2 years (corrected age). METHOD In a multi-site prospective study, the parents of 826 infants born before 28 weeks gestation completed a Child Behavior Checklist (CBCL) when the child was 2 years corrected age. We compared the maternal, pregnancy, placenta, delivery, and newborn characteristics, as well as early postnatal characteristics and exposures of those who satisfied criteria for the CBCL-Dysregulation Profile (CBCL-DP) to those of their peers. We then used time-oriented logistic regression models, starting first with antenatal variables that distinguished children with the CBCL-DP profile from their peers, and then added the distinguishing postnatal variables. RESULTS Approximately 9% of the children had a CBCL-DP. In the time-oriented logistic regression model with antenatal variables only, low maternal education achievement, passive smoking, and recovery of Mycoplasma from the placenta were associated with increased risk, whereas histologic chorioamnionitis was associated with reduced risk. None of the postnatal variables added statistically significant discriminating information. CONCLUSION Very preterm newborns who later manifest the CBCL-DP at age 2 years differ in multiple ways from their preterm peers who do not develop the CBCL-DP, raising the possibility that potentially modifiable antenatal and early postnatal phenomena contribute to the risk of developing emotional and behavioral dysregulation.
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Affiliation(s)
- Jean A Frazier
- University of Massachusetts Memorial Health Care/University of Massachusetts Medical School, Worcester, MA.
| | - Mollie E Wood
- University of Massachusetts Memorial Health Care/University of Massachusetts Medical School, Worcester, MA
| | - Janice Ware
- Boston Children's Hospital/Harvard Medical School, Boston, MA
| | - Robert M Joseph
- Boston Medical Center/Boston University School of Medicine, Boston, MA
| | - Karl C Kuban
- Boston Medical Center/Boston University School of Medicine, Boston, MA
| | | | | | - Alan Leviton
- Boston Children's Hospital/Harvard Medical School, Boston, MA
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Ratheesh A, Berk M, Davey CG, McGorry PD, Cotton SM. Instruments that prospectively predict bipolar disorder - A systematic review. J Affect Disord 2015; 179:65-73. [PMID: 25845751 DOI: 10.1016/j.jad.2015.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification of earlier stages of Bipolar Disorder (BD), even prior to the first manic episode, may help develop interventions to prevent or delay the onset of BD. However, reliable and valid instruments are necessary to ascertain such earlier stages of BD. The aim of the current review was to identify instruments that had predictive validity and utility for BD for use in early intervention (EI) settings for the prevention of BD. METHODS We undertook a systematic examination of studies that examined participants without BD I or II at baseline and prospectively explored the predictive abilities of instruments for BD onset over a period of 6 months or more. The instruments and the studies were rated with respect to their relative validity and utility predicting onset of BD for prevention or early intervention. Odds ratios and area under the curve (AUC) values were derived when not reported. RESULTS Six studies were included, identifying five instruments that examined sub-threshold symptoms, family history, temperament and behavioral regulation. Though none of the identified instruments had been examined in high-quality replicated studies for predicting BD, two instruments, namely the Child Behavioral Checklist - Pediatric BD phenotype (CBCL-PBD) and the General Behavioral Inventory - Revised (GBI-R), had greater levels of validity and utility. LIMITATION Non-inclusion of studies and instruments that incidentally identified BD on follow-up limited the breadth of the review. CONCLUSION Instruments that test domains such as subthreshold symptoms, behavioral regulation, family history, and temperament hold promise in predicting BD onset.
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Affiliation(s)
- Aswin Ratheesh
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia.
| | - Michael Berk
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia; Impact Strategic Research Centre, Deakin University, Australia
| | - Christopher G Davey
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia
| | - Patrick D McGorry
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia
| | - Susan M Cotton
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre For Youth Mental Health, University of Melbourne, Australia
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Child behaviour checklist emotional dysregulation profiles in youth with disruptive behaviour disorders: clinical correlates and treatment implications. Psychiatry Res 2015; 225:191-196. [PMID: 25480545 DOI: 10.1016/j.psychres.2014.11.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/05/2014] [Accepted: 11/09/2014] [Indexed: 11/23/2022]
Abstract
Two Child Behaviour Checklist (CBCL) profiles were correlated to poor self-regulation, Deficient Emotional Self-Regulation (DESR) (elevation between 1 and 2 Standard Deviations (SD) in Anxiety/Depression, Aggression, Attention subscales), and Dysregulation Profile (DP) (elevation of 2 Standard Deviations or more). We explored youths with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) whether these profiles are associated with specific clinical features. The sample included 57 patients with DESR profile and 41 with DP profile, ages 9 to 15 years, all assigned to a non-pharmacological Multimodal Treatment Program. No differences resulted between groups in demographic features, diagnosis ratio, and comorbidities with Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder (BD), and Anxiety Disorder. The DP group was associated with higher scores in Withdrawn, Social Problem, Thought, Rule Breaking, and Somatic CBCL subscales, and higher scores in Narcissism and Impulsivity (but not Callous-Unemotional (CU)), according to the Antisocial Process Screening Device (APSD). After treatment, patients with DESR improved their personality traits (Narcissistic and Callous-Unemotional, but not Impulsivity), while changes in CBCL scales were modest. Patients with DP improved scales of Attention, Aggression, Anxiety-Depression, Rule Breaking, Withdrawal, Social Problem and Thought, while personality features did not change. These results suggest diagnostic implications of CBCL profiles, and indications for targeted treatment strategies.
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Rizzutti S, Schuch V, Augusto BM, Coimbra CC, Pereira JPC, Bueno OFA. Neuropsychological Profiles Correlated with Clinical and Behavioral Impairments in a Sample of Brazilian Children with Attention-Deficit Hyperactivity Disorder. Front Psychiatry 2015; 6:163. [PMID: 26635638 PMCID: PMC4661035 DOI: 10.3389/fpsyt.2015.00163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/29/2015] [Indexed: 01/10/2023] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD.
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Affiliation(s)
- Sueli Rizzutti
- Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil
| | - Viviane Schuch
- Psychobiology Department, Universidade Federal de São Paulo , São Paulo , Brazil
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Peyre H, Speranza M, Cortese S, Wohl M, Purper-Ouakil D. Do ADHD children with and without child behavior checklist-dysregulation profile have different clinical characteristics, cognitive features, and treatment outcomes? J Atten Disord 2015; 19:63-71. [PMID: 22837549 DOI: 10.1177/1087054712452135] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Child Behavior Checklist-Dysregulation Profile (CBCL-DP), characterized by elevated scores on the "Attention Problems," "Aggressive Behavior," and "Anxious/Depressed" scales in the CBCL, has been associated with later severe psychopathology. In a sample of children with ADHD, this study sought to further explore the clinical characteristics, the response to methylphenidate medication, and the cognitive features of ADHD children with CBCL-DP. METHOD The sample consisted of 173 ADHD outpatients (age = 10.9 ± 2.81) assessed using symptom severity scales, personality questionnaires (Emotionality Activity Sociability [EAS] and Junior Temperament and Character Inventory [JTCI]), and neuropsychological tests. A subsample of 136 participants was reassessed after optimal adjustment of methylphenidate dosage. RESULTS AND CONCLUSION Variables that were independently associated with CBCL-DP were clinical severity (ADHD Rating Scale [ADHD-RS]), internalized disorders, high emotionality (EAS), and low self-directedness (JTCI). CBCL-DP was associated neither with poorer response to methylphenidate nor with more side effects. There were no differences in cognitive performances between participants with and without CBCL-DP.
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Affiliation(s)
- Hugo Peyre
- INSERM U669, University Paris-Sud and University Paris Descartes, Paris, France Robert Debré Hospital, Paris, France
| | - Mario Speranza
- INSERM U669, University Paris-Sud and University Paris Descartes, Paris, France Versailles General Hospital. Le Chesnay, France University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Samuele Cortese
- University Hospital, Tours, France New York University Child Study Center, New York, USA INSERM U894, University Paris Descartes, Paris, France
| | - Mathias Wohl
- INSERM U894, University Paris Descartes, Paris, France Louis Mourier Hospital, Colombes, France
| | - Diane Purper-Ouakil
- Robert Debré Hospital, Paris, France INSERM U894, University Paris Descartes, Paris, France
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Basten M, van der Ende J, Tiemeier H, Althoff RR, Rijlaarsdam J, Jaddoe VWV, Hofman A, Hudziak JJ, Verhulst FC, White T. Nonverbal intelligence in young children with dysregulation: the Generation R Study. Eur Child Adolesc Psychiatry 2014; 23:1061-70. [PMID: 24802760 DOI: 10.1007/s00787-014-0551-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
Children meeting the Child Behavior Checklist Dysregulation Profile (CBCL-DP) suffer from high levels of co-occurring internalizing and externalizing problems. Little is known about the cognitive abilities of these children with CBCL-DP. We examined the relationship between CBCL-DP and nonverbal intelligence. Parents of 6,131 children from a population-based birth cohort, aged 5 through 7 years, reported problem behavior on the CBCL/1.5-5. The CBCL-DP was derived using latent profile analysis on the CBCL/1.5-5 syndrome scales. Nonverbal intelligence was assessed using the Snijders Oomen Nonverbal Intelligence Test 2.5-7-Revised. We examined the relationship between CBCL-DP and nonverbal intelligence using linear regression. Analyses were adjusted for parental intelligence, parental psychiatric symptoms, socio-economic status, and perinatal factors. In a subsample with diagnostic interview data, we tested if the results were independent of the presence of attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders (ASD). The results showed that children meeting the CBCL-DP (n = 110, 1.8%) had a 11.0 point lower nonverbal intelligence level than children without problems and 7.2-7.3 points lower nonverbal intelligence level than children meeting other profiles of problem behavior (all p values <0.001). After adjustment for covariates, children with CBCL-DP scored 8.3 points lower than children without problems (p < 0.001). The presence of ADHD or ASD did not account for the lower nonverbal intelligence in children with CBCL-DP. In conclusion, we found that children with CBCL-DP have a considerable lower nonverbal intelligence score. The CBCL-DP and nonverbal intelligence may share a common neurodevelopmental etiology.
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Affiliation(s)
- Maartje Basten
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
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Correll CU, Olvet DM, Auther AM, Hauser M, Kishimoto T, Carrión RE, Snyder S, Cornblatt BA. The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls. Bipolar Disord 2014; 16:505-22. [PMID: 24807784 PMCID: PMC4160534 DOI: 10.1111/bdi.12209] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/22/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the psychometric properties of the Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P), the first specific interview for emerging bipolar disorder (BD) symptoms. METHODS A total of 205 youth aged 12-23 years and/or their caregivers underwent BPSS-P interviews: 129 patients with mood spectrum disorders [depression spectrum disorder (n = 77), mood disorder not otherwise specified (NOS) (n = 27), BD-NOS (n = 14), bipolar I disorder (BD-I)/bipolar II disorder (BD-II)/cyclothymia (n = 11), 34 with non-mood spectrum disorders, and 42 healthy controls (HCs)]. We used Cronbach's α to assess internal consistency; intra-class correlation (ICC) for inter-rater reliability; Spearman's rho for convergent validity with the Young Mania Rating Scale (YMRS), General Behavior Inventory-10-item Mania Form (GBI-M-10), and Cyclothymic-Hypersensitive Temperament (CHT) scale; and analysis of variance for discriminatory power between diagnostic groups. RESULTS Internal consistency was good to very good for the BPSS-P Mania (Cronbach's α = 0.87), Depression (Cronbach's α = 0.89), and General Symptom indices (Cronbach's α = 0.74). Inter-rater reliability was high for the BPSS-P Total score (ICC = 0.939), and BPSS-P Mania (ICC = 0.934), Depression (ICC = 0.985), and General (ICC = 0.981) indices. Convergent validity was large (ρ ≥ 0.50) between the BPSS-P Mania Index and YMRS, GBI-M-10, and CHT; BPSS-P Depression Index and Montgomery-Åsberg Depression Rating Scale (MADRS) and CHT; and BPSS-P General Index and GBI-M-10 and CHT. Expectedly, convergent validity was small (ρ = 0.10 to < 0.30) between the BPSS-P Mania Index and MADRS, and BPSS-P Depression Index and YMRS. Furthermore, the BPSS-P and its subscales discriminated each patient group from HCs and from non-mood spectrum patients (except for the BPSS-P General Index). Moreover, the BPSS-P Total score discriminated BD-I/BD-II/cyclothymia from depression spectrum patients, and the BPSS-Mania Index differentiated all three bipolar spectrum groups from depression spectrum patients. CONCLUSIONS The BPSS-P has good to excellent psychometric properties. Its use across multiple settings and predictive validity requires further investigation.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Albert Einstein College of Medicine, Bronx, NY
| | - Doreen M Olvet
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY
| | - Andrea M Auther
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
| | - Marta Hauser
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
| | - Taishiro Kishimoto
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Ricardo E Carrión
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
| | - Stephanie Snyder
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
| | - Barbara A Cornblatt
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY,Hofstra North Shore–LIJ School of Medicine, Hempstead, NY,The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
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Uchida M, Faraone SV, Martelon M, Kenworthy T, Woodworth KY, Spencer T, Wozniak J, Biederman J. Further evidence that severe scores in the aggression/anxiety-depression/attention subscales of child behavior checklist (severe dysregulation profile) can screen for bipolar disorder symptomatology: a conditional probability analysis. J Affect Disord 2014; 165:81-6. [PMID: 24882182 PMCID: PMC4066999 DOI: 10.1016/j.jad.2014.04.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/11/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous work shows that children with high scores (2SD, combined score≥210) on the Attention Problems, Aggressive Behavior, and Anxious-Depressed (A-A-A) subscales of the Child Behavior Checklist (CBCL) are more likely than other children to meet criteria for bipolar (BP)-I disorder. However, the utility of this profile as a screening tool has remained unclear. METHODS We compared 140 patients with pediatric BP-I disorder, 83 with attention deficit hyperactivity disorder (ADHD), and 114 control subjects. We defined the CBCL-Severe Dysregulation profile as an aggregate cutoff score of ≥210 on the A-A-A scales. Patients were assessed with structured diagnostic interviews and functional measures. RESULTS Patients with BP-I disorder were significantly more likely than both control subjects (Odds Ratio [OR]: 173.2; 95% Confidence Interval [CI], 21.2 to 1413.8; P<0.001) and those with ADHD (OR: 14.6; 95% CI, 6.2 to 34.3; P<0.001) to have a positive CBCL-Severe Dysregulation profile. Receiver Operating Characteristics analyses showed that the area under the curve for this profile comparing children with BP-I disorder against control subjects and those with ADHD was 99% and 85%, respectively. The corresponding positive predictive values for this profile were 99% and 92% with false positive rates of <0.2% and 8% for the comparisons with control subjects and patients with ADHD, respectively. LIMITATIONS Non-clinician raters administered structured diagnostic interviews, and the sample was referred and largely Caucasian. CONCLUSIONS The CBCL-Severe Dysregulation profile can be useful as a screen for BP-I disorder in children in clinical practice.
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Affiliation(s)
- Mai Uchida
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - MaryKate Martelon
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Tara Kenworthy
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Spencer
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Mbekou V, Gignac M, MacNeil S, Mackay P, Renaud J. The CBCL dysregulated profile: an indicator of pediatric bipolar disorder or of psychopathology severity? J Affect Disord 2014; 155:299-302. [PMID: 24230916 DOI: 10.1016/j.jad.2013.10.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To evaluate whether the Child Behavior Checklist Dysregulated Profile (CBCL-DP) can be used as an effective predictor of psychopathological severity as indicated by suicidality and comorbidities, as well as a predictor of pediatric bipolar disorder (PBD). METHOD CBCL-DP scores for 397 youths seeking treatment for mood disorders were calculated by summing the t-scores of the Anxious/Depressed, Aggressive Behaviors, and Attention Problems subscales such that a clinical cut-off of 210 was used to indicate the presence of a dysregulated profile. Suicidality and an increased number of diagnoses were used as markers of illness severity. RESULTS Those with a dysregulated profile presented more severe suicidal ideation when compared to those without the profile. They also had a significantly larger number of Axis I diagnoses. Groups did not differ in the amount of individuals diagnosed with PBD. LIMITATIONS Suicidal ideation was assessed by a third-party informant and not from the youths themselves. No other forms of suicidal behavior such as self-harm or suicide attempt were measured. Also there may not be complete convergence between parental reports on behavior and youth reports, which might have affected the results. CONCLUSIONS These findings suggest that the CBCL-DP is an effective indicator of psychopathological severity through its association with more comorbidities and more severe suicidality. Earlier detection of psychopathological severity through an initial screening tool could aid clinicians in planning treatment and providing quicker and more structured care based on the client's needs.
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Affiliation(s)
- Valentin Mbekou
- Standard Life Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Montréal, Canada.
| | - Martin Gignac
- Philippe Pinel Institute, Université de Montréal, Montréal, Canada
| | - Sasha MacNeil
- Psychology Department, Concordia University, Montréal, Canada
| | - Pamela Mackay
- Psychology Department, McGill University, Montréal, Canada
| | - Johanne Renaud
- Standard Life Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Montréal, Canada
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Mick E, McGough J, Deutsch CK, Frazier JA, Kennedy D, Goldberg RJ. Genome-wide association study of proneness to anger. PLoS One 2014; 9:e87257. [PMID: 24489884 PMCID: PMC3905014 DOI: 10.1371/journal.pone.0087257] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 12/27/2013] [Indexed: 11/19/2022] Open
Abstract
Background Community samples suggest that approximately 1 in 20 children and adults exhibit clinically significant anger, hostility, and aggression. Individuals with dysregulated emotional control have a greater lifetime burden of psychiatric morbidity, severe impairment in role functioning, and premature mortality due to cardiovascular disease. Methods With publically available data secured from dbGaP, we conducted a genome-wide association study of proneness to anger using the Spielberger State-Trait Anger Scale in the Atherosclerosis Risk in Communities (ARIC) study (n = 8,747). Results Subjects were, on average, 54 (range 45–64) years old at baseline enrollment, 47% (n = 4,117) were male, and all were of European descent by self-report. The mean Angry Temperament and Angry Reaction scores were 5.8±1.8 and 7.6±2.2. We observed a nominally significant finding (p = 2.9E-08, λ = 1.027 - corrected pgc = 2.2E-07, λ = 1.0015) on chromosome 6q21 in the gene coding for the non-receptor protein-tyrosine kinase, Fyn. Conclusions Fyn interacts with NDMA receptors and inositol-1,4,5-trisphosphate (IP3)-gated channels to regulate calcium influx and intracellular release in the post-synaptic density. These results suggest that signaling pathways regulating intracellular calcium homeostasis, which are relevant to memory, learning, and neuronal survival, may in part underlie the expression of Angry Temperament.
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Affiliation(s)
- Eric Mick
- Department of Quantitative Health Sciences and the Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
- * E-mail:
| | - James McGough
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles California, United States of America
| | - Curtis K. Deutsch
- Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Jean A. Frazier
- Psychiatry Department, Division of Child and Adolescent Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - David Kennedy
- Psychiatry Department, Division of Neuroinformatics and the Child and Adolescent NeuroDevelopment Initiative, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Robert J. Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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Carballo JJ, Serrano-Drozdowskyj E, García Nieto R, Díaz de Neira-Hernando M, Pérez-Fominaya M, Molina-Pizarro CA, De León-Martínez V, Baca-García E. Prevalence and correlates of psychopathology in children and adolescents evaluated with the strengths and difficulties questionnaire dysregulation profile in a clinical setting. Psychopathology 2014; 47:303-11. [PMID: 24819241 DOI: 10.1159/000360822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 02/23/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. SAMPLING AND METHODS In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. RESULTS Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. CONCLUSIONS A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates.
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Affiliation(s)
- Juan José Carballo
- Child and Adolescent Psychiatric Unit, Department of Psychiatry, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, CIBERSAM, Madrid, Spain
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Holtmann M, Poustka L, Zepf FD, Banaschewski T, Priller J, Bölte S, Legenbauer T. Severe Affective and Behavioral Dysregulation in Youths Is Associated with a Proinflammatory State 1MH and LP contributed equally to the paper. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 41:393-9. [DOI: 10.1024/1422-4917/a000255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective: A heritable behavioral phenotype, the so-called Dysregulation Profile (DP), characterized by extreme scores on the syndrome scales Anxious/Depressed (A/D), Attention Problems (AP), and Aggressive Behavior (AGG), has been identified on the Child Behavior Checklist (CBCL). It characterizes children with severe affective and behavioral dysregulation. The present study examined possible alterations of the inflammatory system in CBCL-DP using a clinical sample of n = 133 children and adolescents. Method: Participants with the CBCL-DP scoring ≥ 2.5 SDs above average constituted the CBCL-DP subgroup (n = 51). Those with CBCL-DP scores of 1 SD or less above average were regarded as controls (n = 82). Groups were compared in terms of serum levels of C-reactive protein (CRP) and albumin. Results: Participants showing the CBCL-DP exhibited increased CRP and decreased albumin levels compared to controls. CRP was correlated with AGG, AP, and the CBCL-DP total score. A negative correlation was observed between albumin and AGG, AP, the CBCL-DP score, and A/D. These associations could not be attributed to differences in age, sex, weight, socioeconomic status, global functioning, or duration of illness. Conclusions: This is the first study to demonstrate associations between the CBCL-DP and a proinflammatory state. Limitations include the lack of a healthy control group, the use of a single measurement of inflammatory markers, and the lack of follow-up data. Future research should address whether inflammatory diathesis in these children confers increased susceptibility to later development of cardiovascular disease and other medical morbidities.
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Affiliation(s)
- Martin Holtmann
- Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Florian D. Zepf
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
- Department of Child & Adolescent Psychiatry & Psychotherapy, RWTH Aachen University, Germany
- JARA Translational Brain Medicine, Aachen, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Josef Priller
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy; Charité University Medicine, Berlin
| | - Sven Bölte
- Department of Child and Adolescent Psychiatry and Psychotherapy, Goethe-University, Frankfurt/Main, Germany
- Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
| | - Tanja Legenbauer
- Ruhr-University Bochum, LWL-University Hospital for Child and Adolescent Psychiatry, Hamm, Germany
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McGuire JF, Small BJ, Lewin AB, Murphy TK, De Nadai AS, Phares V, Geffken G, Storch EA. Dysregulation in pediatric obsessive compulsive disorder. Psychiatry Res 2013; 209:589-95. [PMID: 23623154 DOI: 10.1016/j.psychres.2013.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/31/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Abstract
Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Pediatrics, University of South Florida, Tampa, FL, USA.
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Kotte A, Joshi G, Fried R, Uchida M, Spencer A, Woodworth KY, Kenworthy T, Faraone SV, Biederman J. Autistic traits in children with and without ADHD. Pediatrics 2013; 132:e612-22. [PMID: 23979086 PMCID: PMC3876754 DOI: 10.1542/peds.2012-3947] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To assess the implications of autistic traits (ATs) in youth with attention-deficit/hyperactivity disorder (ADHD) without a diagnosis of autism. METHODS Participants were youth with (n = 242) and without (n = 227) ADHD and controls without ADHD in whom a diagnosis of autism was exclusionary. Assessment included measures of psychiatric, psychosocial, educational, and cognitive functioning. ATs were operationalized by using the withdrawn + social + thought problems T scores from the Child Behavior Checklist. RESULTS A positive AT profile was significantly overrepresented among ADHD children versus controls (18% vs 0.87%; P < .001). ADHD children with the AT profile were significantly more impaired than control subjects in psychopathology, interpersonal, school, family, and cognitive domains. CONCLUSIONS A substantial minority of ADHD children manifests ATs, and those exhibiting ATs have greater severity of illness and dysfunction.
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Affiliation(s)
- Amelia Kotte
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts
| | - Gagan Joshi
- Department of Psychiatry, Harvard Medical School and,Alan & Lorraine Bressler Center, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts;,Department of Psychiatry, Harvard Medical School and
| | - Mai Uchida
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrea Spencer
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts
| | - K. Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts
| | - Tara Kenworthy
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephen V. Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, New York
| | - Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts;,Department of Psychiatry, Harvard Medical School and
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Papachristou E, Ormel J, Oldehinkel AJ, Kyriakopoulos M, Reinares M, Reichenberg A, Frangou S. Child Behavior Checklist-Mania Scale (CBCL-MS): development and evaluation of a population-based screening scale for bipolar disorder. PLoS One 2013; 8:e69459. [PMID: 23967059 PMCID: PMC3743889 DOI: 10.1371/journal.pone.0069459] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 06/10/2013] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Early identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder. OBJECTIVE We developed and evaluated a new DSM orientated scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used scales. METHODS The new scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample. RESULTS The CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other scales. CONCLUSIONS Our data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.
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Affiliation(s)
- Efstathios Papachristou
- Child Psychiatry Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Johan Ormel
- Interdisciplinary Center of Psychpathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albertine J. Oldehinkel
- Interdisciplinary Center of Psychpathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marinos Kyriakopoulos
- Child Psychiatry Department, Institute of Psychiatry, King's College London, London, United Kingdom
- Child and Adolescent Mental Health Services, Maudsley Hospital, London, United Kingdom
| | - María Reinares
- Child Psychiatry Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Abraham Reichenberg
- Ichan School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Sophia Frangou
- Ichan School of Medicine at Mount Sinai, New York City, New York, United States of America
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