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Díaz-Vázquez B, López-Romero L, Romero E. Emotion Recognition Deficits in Children and Adolescents with Psychopathic Traits: A Systematic Review. Clin Child Fam Psychol Rev 2024; 27:165-219. [PMID: 38240937 PMCID: PMC10920463 DOI: 10.1007/s10567-023-00466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 03/08/2024]
Abstract
Children and adolescents with psychopathic traits show deficits in emotion recognition, but there is no consensus as to the extent of their generalizability or about the variables that may be moderating the process. The present Systematic Review brings together the existing scientific corpus on the subject and attempts to answer these questions through an exhaustive review of the existing literature according to PRISMA 2020 statement. Results confirmed the existence of pervasive deficits in emotion recognition and, more specifically, on distress emotions (e.g., fear), a deficit that transcends all modalities of emotion presentation and all emotional stimuli used. Moreover, they supported the key role of attention to relevant areas that provide emotional cues (e.g., eye-region) and point out differences according to the presence of disruptive behavior and based on the psychopathy dimension examined. This evidence could advance the current knowledge on developmental models of psychopathic traits. Yet, homogenization of the conditions of research in this area should be prioritized to be able to draw more robust and generalizable conclusions.
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Affiliation(s)
- Beatriz Díaz-Vázquez
- Department of Clinical Psychology and Psychobiology, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, Spain
| | - Laura López-Romero
- Department of Clinical Psychology and Psychobiology, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, Spain.
| | - Estrella Romero
- Department of Clinical Psychology and Psychobiology, Facultade de Psicoloxía, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, Spain
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2
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Li Y, Grabell AS, Perlman SB. Irritability Moderates the Association between Cognitive Flexibility Task Performance and Related Prefrontal Cortex Activation in Young Children. Brain Sci 2023; 13:882. [PMID: 37371362 PMCID: PMC10296206 DOI: 10.3390/brainsci13060882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
The association between cognitive flexibility and related neural functioning has been inconsistent. This is particularly true in young children, where previous studies have found heterogenous results linking behavior and neural function, raising the possibility of unexplored moderators. The current study explored the moderating role of dimensional irritability in the association between cognitive flexibility task performance and prefrontal activation in young children. A total of 106 3- to 7-year-old children were recruited to complete a custom-designed, child-adapted, cognitive flexibility task, and 98 of them were included in the data analysis. The children's dorsolateral prefrontal cortex activation was monitored using functional near-infrared spectroscopy, and their levels of irritability were reported by parents using the MAP-DB Temper Loss subscale. Results indicated that the mean reaction time of the cognitive flexibility task was negatively correlated with concurrent prefrontal activation. No evidence was found for the association between task accuracy and prefrontal activation. Moreover, irritability moderated the association between the mean reaction time and prefrontal activation. Children high in irritability exhibited a stronger negative association between the mean reaction time and related prefrontal activation than children low in irritability. The moderating model suggested a novel affective-cognitive interaction to investigate the associations between cognitive task performance and their neural underpinnings.
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Affiliation(s)
- Yanwei Li
- College of Early Childhood Education, Nanjing Xiaozhuang University, Nanjing 210017, China
| | - Adam S. Grabell
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA 01003, USA
| | - Susan B. Perlman
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63130, USA
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3
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Damme KSF, Norton ES, Briggs-Gowan MJ, Wakschlag LS, Mittal VA. Developmental patterning of irritability enhances prediction of psychopathology in preadolescence: Improving RDoC with developmental science. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:556-566. [PMID: 35901387 PMCID: PMC9439570 DOI: 10.1037/abn0000655] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The transdiagnostic importance of irritability in psychopathology has been demonstrated. However, the contribution of developmentally unfolding irritability patterns to specific clinical and neural outcomes remains an important and unanswered question. To address this gap in the literature, irritability patterns of 110 youth from a large, diverse cohort were assessed at preschool age and again at early school age (∼2.5 years later) with a dimensional irritability scale designed to capture the normal:abnormal spectrum. At preadolescence (∼6 years later), clinical outcomes (internalizing/externalizing symptoms) derived from a semistructured clinical interview and neural outcomes (characterized as gray-matter-volume abnormalities) were assessed. For clinical outcomes, preschool-age irritability alone was a transdiagnostic predictor of internalizing and externalizing symptoms at preadolescence. However, in a model including both preschool and early school age, irritability provided greater specificity, suggesting that higher irritability at early school age related to elevated preadolescent externalizing but not internalizing symptoms. In terms of neural outcomes, elevated preschool irritability did not predict preadolescent gray-matter-volume abnormality; however, irritability at early school age demonstrated an interactive effect among regions, with reduced volume in preadolescence emotional regions (e.g., amygdala, medial orbitofrontal cortex) and increased volume in other regions (e.g., cerebellum). These complex patterns highlight the contribution of a developmentally informed approach, the National Institute of Mental Health's Research Domain Criteria (RDoC) approach, to yield transdiagnostic phenotypes and multiple units of analysis. Capturing these individual differences and developmental heterogeneity can provide critical insight into the unfolding of mechanisms underlying emerging psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Elizabeth S Norton
- Department of Communication Sciences and Disorders, Northwestern University
| | | | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University
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Krogh-Jespersen S, Kaat AJ, Petitclerc A, Perlman SB, Briggs-Gowan MJ, Burns JL, Adam H, Nili A, Gray L, Wakschlag LS. Calibrating temper loss severity in the transition to toddlerhood: Implications for developmental science. APPLIED DEVELOPMENTAL SCIENCE 2021; 26:785-798. [PMID: 36387581 PMCID: PMC9648691 DOI: 10.1080/10888691.2021.1995386] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The integration of neurodevelopmental perspectives into clinical science has identified irritability as an early dimensional marker of lifespan mental health risk. Elucidating the developmental patterning of irritable behavior is key to differentiating normative variation from risk markers. Accounting for dysregulation and contextual features of irritability is useful for differentiation at preschool age, laying the groundwork for even earlier characterization. We provide initial evidence for the validity of the Multidimensional Assessment Profile of Disruptive Behavior Temper Loss Scale, Infant-Toddler version in two independent samples of 12-18-month-olds from the US. We calibrated the measure using item response theory in a large representative sample, then validated within an independent sample. We characterized the developmental patterning of irritable behaviors and their dimensional spectrum, and demonstrated test-retest reliability, and convergent validity. The MAP-DB-IT is a standardized, dimensional survey assessing irritability that serves as a tool for characterizing the developmental expression of early mental health risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Larry Gray
- Northwestern University
- Ann and Robert H. Lurie Children’s Hospital of Chicago
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5
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Wiggins JL, Briggs-Gowan MJ, Brotman MA, Leibenluft E, Wakschlag LS. Toward a Developmental Nosology for Disruptive Mood Dysregulation Disorder in Early Childhood. J Am Acad Child Adolesc Psychiatry 2021; 60:388-397. [PMID: 32599006 PMCID: PMC7769590 DOI: 10.1016/j.jaac.2020.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/30/2020] [Accepted: 06/17/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Disruptive mood dysregulation disorder (DMDD) in DSM, characterized by severe, chronic irritability, currently excludes children <6 years of age. However, capitalizing on a burgeoning developmental science base to differentiate clinically salient irritability in young children may enable earlier identification. The objective of this study was to advance an empirically derived framework for early childhood DMDD (EC-DMDD) by modeling and validating DMDD patterns in early childhood and generating clinically informative, optimized behaviors with thresholds. METHOD Data (N = 425) were from 3 longitudinal assessments of the MAPS Study, spanning preschool (means = 4.7 and 5.5 years) to early school age (mean = 6.8 years). The Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) Temper Loss scale captured irritability, the Family Life Impairment Scale (FLIS) assessed cross-domain impairment at the preschool time points and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was used to assess clinical status at early school age. Latent transition analyses differentiated children with EC-DMDD from children with low, transient, or nonimpairing irritability. RESULTS Developmental patterning of irritability proved important for normal:abnormal differentiation. Of children, 27% had initially high irritability, but only two-thirds of these were persistently highly irritable. Thus, "false positives" based on a single screen would be substantial. Yet, "false negatives" are low, as <1% of children with baseline low irritability demonstrated later high irritability. Based on the sequential preschool-age time points, 6.7% of children were identified with EC-DMDD, characterized by persistent irritability with pervasive impairment, similar to prevalence at older ages. Specific behaviors included low frustration tolerance; dysregulated, developmentally unexpectable tantrums; and sustained irritable mood, all of which sensitively (0.85-0.96) and specifically (0.80-0.91) identified EC-DMDD. EC-DMDD predicted irritability-related syndromes (DMDD, oppositional defiant disorder) at early school age better than downward extension of DSM DMDD criteria to preschool age. CONCLUSION These findings provide empirical thresholds for preschool-age clinical identification of DMDD patterns. The results lay the foundation for validation of DMDD in early childhood and inform revision of DSM criteria.
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Affiliation(s)
- Jillian Lee Wiggins
- San Diego State University and the San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, California.
| | | | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Lauren S Wakschlag
- Feinberg School of Medicine and Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, Illinois
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6
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Kryza-Lacombe M, Hernandez B, Owen C, Reynolds RC, Wakschlag LS, Dougherty LR, Wiggins JL. Neural mechanisms of reward processing in adolescent irritability. Dev Psychobiol 2021; 63:1241-1254. [PMID: 33462834 PMCID: PMC10171261 DOI: 10.1002/dev.22090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/28/2022]
Abstract
Irritability is impairing and prevalent across pediatric psychiatric disorders and typical development, yet its neural mechanisms are largely unknown. This study evaluated the relation between adolescent irritability and reward-related brain function as a candidate neural mechanism. Adolescents from intervention-seeking families in the community (N = 52; mean age = 13.80, SD = 1.94) completed a monetary incentive delay task to assess reward anticipation and feedback (reward receipt and omission) during fMRI acquisition. Whole-brain analyses, controlling for age, examined brain activation and striatal and amygdala connectivity in relation to irritability. Irritability was measured using the parent- and youth-reported Affective Reactivity Index. Irritability was associated with altered reward processing-related activation and connectivity in multiple networks during reward anticipation and feedback, including increased striatal activation and altered ventral striatum connectivity with prefrontal areas. Our findings suggest that irritability is associated with altered neural patterns during reward processing and that aberrant prefrontal cortex-mediated top-down control may be related to irritability. These findings inform our understanding of the etiology of youth irritability and the development of mechanism-based interventions.
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Affiliation(s)
- Maria Kryza-Lacombe
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Brianna Hernandez
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Cassidy Owen
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Richard C Reynolds
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine & Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Lea R Dougherty
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Jillian L Wiggins
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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7
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Quiñones-Camacho LE, Fishburn FA, Camacho MC, Hlutkowsky CO, Huppert TJ, Wakschlag LS, Perlman SB. Parent-child neural synchrony: a novel approach to elucidating dyadic correlates of preschool irritability. J Child Psychol Psychiatry 2020; 61:1213-1223. [PMID: 31769511 PMCID: PMC7247953 DOI: 10.1111/jcpp.13165] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Research to date has largely conceptualized irritability in terms of intraindividual differences. However, the role of interpersonal dyadic processes has received little consideration. Nevertheless, difficulties in how parent-child dyads synchronize during interactions may be an important correlate of irritably in early childhood. Innovations in developmentally sensitive neuroimaging methods now enable the use of measures of neural synchrony to quantify synchronous responses in parent-child dyads and can help clarify the neural underpinnings of these difficulties. We introduce the Disruptive Behavior Diagnostic Observation Schedule: Biological Synchrony (DB-DOS:BioSync) as a paradigm for exploring parent-child neural synchrony as a potential biological mechanism for interpersonal difficulties in preschool psychopathology. METHODS Using functional near-infrared spectroscopy (fNIRS) 4- to 5-year-olds (N = 116) and their mothers completed the DB-DOS:BioSync while assessing neural synchrony during mild frustration and recovery. Child irritability was measured using a latent irritability factor that was calculated from four developmentally sensitive indicators. RESULTS Both the mild frustration and the recovery contexts resulted in neural synchrony. However, less neural synchrony during the recovery context only was associated with more child irritability. CONCLUSIONS Our results suggest that recovering after a frustrating period might be particularly challenging for children high in irritability and offer support for the use of the DB-DOS:BioSync task to elucidate interpersonal neural mechanisms of developmental psychopathology.
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Affiliation(s)
| | - Frank A. Fishburn
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - M. Catalina Camacho
- Department of Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Lauren S. Wakschlag
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Susan B. Perlman
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
- Department of Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
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Ljungström BM, Kenne Sarenmalm E, Axberg U. Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study. Child Adolesc Psychiatry Ment Health 2020; 14:34. [PMID: 32944068 PMCID: PMC7491084 DOI: 10.1186/s13034-020-00339-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 08/26/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Children with clinical levels of conduct problems are at high risk of developing mental health problems such as persistent antisocial behavior or emotional problems in adolescence. Serious conduct problems in childhood also predict poor functioning across other areas of life in early adulthood such as overweight, heavy drinking, social isolation and not in employment or education. It is important to capture those children who are most at risk, early in their development. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is commonly used in clinical settings, to identify children with conduct problems such as oppositional defiant disorder (ODD).This paper presents a cross-sectional study in a clinical setting, and describes behaviors in 3- to 8-year-olds with ODD. Our aim was to investigate whether there were problematic behaviors that were not captured by the diagnosis of ODD, using two different methods: a clinical approach (bottom-up) and the nosology for the diagnosis of ODD (top-down). METHOD Fifty-seven children with clinical levels of ODD participated in the study. The mothers were interviewed with both open questions and with a semi-structured diagnostic interview K-SADS. The data was analyzed using a mixed method, convergent, parallel qualitative/quantitative (QUAL + QUAN) design. For QUAL analysis qualitative content analysis was used, and for QUAN analysis associations between the two data sets, and ages-groups and gender were compared using Chi-square test. RESULTS In the top-down approach, the ODD criteria helped to identify and separate commonly occurring oppositional behavior from conduct problems, but in the bottom-up approach, the accepted diagnostic criteria did not capture the entire range of problematic behaviors-especially those behaviors that constitute a risk for antisocial behavior. CONCLUSIONS The present study shows a gap between the diagnoses of ODD and conduct disorder (CD) in younger children. Antisocial behaviors manifest in preschool and early school years are not always sufficiently alarming to meet the diagnosis of CD, nor are they caught in their entirety by the ODD diagnostic tool. One way to verify suspicion of early antisocial behavior in preschool children would be to specify in the ODD diagnosis if there also is subclinical CD.
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Affiliation(s)
- Britt-Marie Ljungström
- grid.8761.80000 0000 9919 9582Department of Psychology, University of Gothenburg, Box 500, 405 30 Göteborg, Sweden
| | - Elisabeth Kenne Sarenmalm
- grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Box 400, 405 30 Göteborg, Sweden ,grid.416029.80000 0004 0624 0275Research and Development, Skaraborg Hospital, 541 85 Skövde, Sweden
| | - Ulf Axberg
- grid.463529.fFakultet for Sosialfag/Faculty of Social Studies, Familieterapi Og Systemisk Praksis/Family Therapy and Systemic Pratice, VID Vitenskapelige høgskole/VID Specialized University, Oslo, Norway ,grid.8761.80000 0000 9919 9582Department of Psychology, University of Gothenburg, Box 500, 405 30 Göteborg, Sweden
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Mauri M, Crippa A, Bacchetta A, Grazioli S, Rosi E, Gazzola E, Gallace A, Nobile M. The utility of NIRS technology for exploring emotional processing in children. J Affect Disord 2020; 274:819-824. [PMID: 32664020 DOI: 10.1016/j.jad.2020.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Deficits in emotional processing and, in particular, in emotional self-regulation represent non-specific risk factors for transdiagnostic poor outcomes. Researches have been focusing on the investigation of possible emotional processing and regulation biomarkers. The present brief review of the literature aims to evaluate whether NIRS signal might be one of them. METHODS We reviewed 8 original articles investigating children's hemodynamic response to emotional tasks using NIRS, or exploring the association between NIRS response to cognitive tasks and behavioral emotional regulation. RESULTS All the works revised found significant associations between NIRS data and emotional indexes. Furthermore, significant hemodynamic response is found in different age-groups (3-12 years of age), suggesting that cortical response to emotional processing as measured by NIRS is a marker consistently recognizable throughout the development. LIMITATIONS Given that the studies in this field were still limited and used heterogeneous protocols, addressed different functions or aspects of emotional processing, these results are preliminary. CONCLUSIONS NIRS seems a reliable tool to describe brain activation during emotional processing and regulation. Moreover, it seems to be particularly useful in studies including either developmental-aged participants or clinical samples, due to its clear advantages and non-intrusiveness, offering a potential marker for deficits in emotional processing and regulation.
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Affiliation(s)
- Maddalena Mauri
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy; PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Crippa
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.
| | - Andrea Bacchetta
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Silvia Grazioli
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Eleonora Rosi
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Erica Gazzola
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy; Department of Psychology, University of Milano Bicocca
| | - Alberto Gallace
- Department of Psychology, University of Milano Bicocca; Milan Center for Neuroscience - NeuroMi -, University of Milano Bicocca, Italy; Mind and Behavior Technological Center - MibTec-, University of Milano Bicocca, Italy
| | - Maria Nobile
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
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10
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Hukkelberg S, Keles S, Ogden T, Hammerstrøm K. The relation between behavioral problems and social competence: A correlational Meta-analysis. BMC Psychiatry 2019; 19:354. [PMID: 31706279 PMCID: PMC6842530 DOI: 10.1186/s12888-019-2343-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/24/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies have shown that children who display behavioral problems also tend to display low social competence. The relation does however vary according to type of behavior being measured, as well as demographic characteristics of the respondent. The present meta-analysis examined the correlation between different types of behavioral problems and social competence among children aged 3-13, and investigated possible moderators in this relation. METHODS A systematic literature search was conducted for English language studies from January 2008 to January 2018 that reported correlations between three types of behavioral problems (i.e., externalizing behaviors, conduct problems, or aggression) and two types of social competence (i.e., social competence or social skills). The studies included reports from parents and teachers, or both as a dyad. The review included data from 54 independent studies and a total of 46,828 participants. Effect sizes were estimated using a random effects approach and moderator analyses between subsets of categorical variables were tested by the significant Q test. RESULTS Results showed an overall correlation between behavioral problems and social competence of medium effect size (r = -.42, p < .01). Moderation analyses indicated no significant differences for different types of behavioral problems or social competence. However, a significant difference was found with regard to type of respondent; the correlation was significantly higher when both measures were reported by the same respondent (teacher or parent) compared to when measures were reported by parent-teacher as a dyad. CONCLUSIONS Findings summarized and quantified a robust negative correlation between behavioral problems and social competence. The results indicate that intervention programs targeting problem behaviors in children would benefit from reducing behavioral problems and in concert, increase social competence to help children with emerging or present problem behaviors.
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Affiliation(s)
- Silje Hukkelberg
- The Norwegian Center for Child Behavioral Development (NUBU), Norwegian Research Centre (NORCE), Oslo, Norway.
| | - Serap Keles
- 0000 0004 1936 8921grid.5510.1The Norwegian Center for Child Behavioral Development (NUBU), Norwegian Research Centre (NORCE), Oslo, Norway
| | - Terje Ogden
- 0000 0004 1936 8921grid.5510.1The Norwegian Center for Child Behavioral Development (NUBU), Norwegian Research Centre (NORCE), Oslo, Norway
| | - Karianne Hammerstrøm
- grid.458806.7Center for Child and Adolescent Mental Health, Oslo, Eastern and Southern Norway
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11
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Lopez U, Martin J, van Assche M, Fleury Schubert A, Fournet M, Quartier V, Habre W, Van der Linden M. Classification of postoperative behavior disturbances in preschool children: A qualitative study. Paediatr Anaesth 2019; 29:712-720. [PMID: 30873694 DOI: 10.1111/pan.13627] [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] [Received: 04/18/2018] [Revised: 02/27/2019] [Accepted: 03/09/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Negative postoperative changes in children are frequent and have been described for decades. However, there is currently no theoretical framework, nor any consensual operational criteria for identifying them. This study aims at characterizing the many dimensions involved in postoperative behavioral disturbances in early childhood, using a qualitative analysis applied for the first time to these symptoms. METHOD Fifty-seven parents of preschool children (1-5 years old; 38 boys), who underwent general anesthesia, were interviewed 10 days after surgery. Semi-structured interviews investigated behavioral disturbances classically described in preschool children. Qualitative analysis of the transcripts allied both deductive and inductive reasoning, and inductive coding was carried out using constant comparison method with dedicated qualitative software. RESULTS Parents reported both positive and negative postoperative changes. Negative changes were classified in four main categories: (a) Externalizing and (b) Internalizing problems behaviors, (c) Feeding sleeping disruption and (d) Somatic problems, each comprising different sub-categories. Importantly within these categories, the symptoms distribution changed in 5 years old children, compared to younger children. Finally, our method allowed defining whether these (negative or positive) changes were significant or not, that is, the importance of postoperative behavioral changes. CONCLUSION The results of this study highlight the heterogeneity of postoperative disturbances in preschool children. These results are of primary importance for the definition and measurement of postoperative behavioral disturbances.
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Affiliation(s)
- Ursula Lopez
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland.,Hôpital fribourgois, HFR Fribourg, Unity of neuropsychology and logopedy, Fribourg, Switzerland
| | - Jennifer Martin
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland
| | - Mitsouko van Assche
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Maryll Fournet
- Department of Neurology, University Hospitals of Geneva, Geneva, Switzerland.,Faculty of Psychology and Education Sciences, University of Geneva, Geneva, Switzerland
| | - Vincent Quartier
- Department of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Walid Habre
- Department of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Martial Van der Linden
- Psychopathology and Cognitive Neuropsychology Unit, Department of Psychology, University of Geneva, Geneva, Switzerland
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12
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Kircanski K, Craske MG, Averbeck BB, Pine DS, Leibenluft E, Brotman MA. Exposure therapy for pediatric irritability: Theory and potential mechanisms. Behav Res Ther 2019; 118:141-149. [PMID: 31085355 PMCID: PMC6590706 DOI: 10.1016/j.brat.2019.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/20/2019] [Accepted: 04/17/2019] [Indexed: 01/05/2023]
Abstract
Pediatric irritability is prevalent and impairing, yet little is known about its pathophysiology and treatment. In this article, we build on our and others' previous work to posit core mechanisms of irritability operating across the brain, behavior, and environment. Specifically, we propose proximal processes that surround the symptomatology of irritability and are potential targets for an exposure-based cognitive-behavioral therapy (CBT) for irritability that our group has developed. The heart of this model focuses on neurocognitive processes: youth's encoding of nonreward and threat stimuli, which involves prediction error signaling in the brain, and cognitive control in the context of frustration. Alterations in these processes are theorized to be central to chronic, severe irritability. Environmental responses to youth's symptom expression are also examined. Exposure-based CBT for irritability utilizes controlled, in vivo exposure to nonreward and threat stimuli with the aim to engage cognitive control and target top-down regulation of frustration. This intervention integrates selected parent management training techniques to target symptom reinforcement processes. Continued pathophysiological and treatment studies of irritability will not only refine our emerging understanding of the phenotype, but also inform broader questions on the brain and behavioral mechanisms of CBT efficacy.
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Affiliation(s)
- Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892-2670, USA.
| | - Michelle G Craske
- Department of Psychology, University of California-Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90025, USA
| | - Bruno B Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, 9000 Rockville Pike, Building 49, Bethesda, MD, 20892-4415, USA
| | - Daniel S Pine
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892-2670, USA
| | - Ellen Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892-2670, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892-2670, USA
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13
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Bufferd SJ, Dougherty LR, Olino TM. Mapping the frequency and severity of anxiety behaviors in preschool-aged children. J Anxiety Disord 2019; 63:9-17. [PMID: 30731395 PMCID: PMC6414242 DOI: 10.1016/j.janxdis.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
Although anxiety can be early-emerging, impairing, and persistent, behaviors relevant to anxiety mirror typical development in early childhood. To better understand the spectrum of typical to problematic behavior, this study characterizes the range of frequency and severity of separation and social anxiety behaviors and associated impairment in preschool-aged children using a novel daily diary method. Primary caregivers of 291 3-5-year-old children reported the frequency of children's daily separation and social anxiety behaviors and related impairment for 14 days. Frequencies of each separation and social anxiety behavior were computed and item response theory analyses revealed the specific frequencies at which the behavior was considered psychometrically severe/rare. Patterns varied across items; for example, worry that caregiver would not return and shyness with familiar adults had to occur at least 3-4 times over 14 days for the behavior to be considered severe/rare, whereas shyness around peers and new people were not severe at any frequency. In addition, behaviors were associated with impairment. To our knowledge, these data are the first to delineate empirical, dimensional information about the frequency and severity of anxiety behaviors and associated impairment in early childhood. Such data could be useful for clinical practice to enhance empirically-driven assessment of anxiety.
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Affiliation(s)
- Sara J Bufferd
- California State University San Marcos, Department of Psychology, 333 S. Twin Oaks Valley Road, San Marcos, CA, 92096-0001, United States.
| | - Lea R Dougherty
- Department of Psychology, University of Maryland, 4094 Campus Dr., College Park, MD, 20742, United States.
| | - Thomas M Olino
- Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, United States.
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14
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Kaat AJ, Blackwell CK, Estabrook R, Burns JL, Petitclerc A, Briggs-Gowan MJ, Gershon RC, Cella D, Perlman SB, Wakschlag LS. Linking the Child Behavior Checklist (CBCL) with the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB): Advancing a dimensional spectrum approach to disruptive behavior. JOURNAL OF CHILD AND FAMILY STUDIES 2019; 28:343-353. [PMID: 31452592 PMCID: PMC6709983 DOI: 10.1007/s10826-018-1272-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Disruptive behavior in childhood is common. It spans from normative child misbehaviors to clinically-significant and impairing problems. While there are many rating scales evaluating such behaviors, historically, measurement has emphasized counting the number of symptoms present rather than assessing the normal-abnormal spectrum of behavioral expression. This study uses data from 644 early school age children aggregated from two data sources to statistically link a commonly used symptom count measure, the Child Behavior Checklist (CBCL), to a more developmentally-sensitive measure, the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB). Two links between conceptually similar scales on each measure were developed: CBCL Conduct Problems and MAP-DB Aggression; and CBCL Oppositional Defiant Problems and MAP-DB Temper Loss. We compared two innovative methods-Item Response Theory (IRT) and Deming regression-to determine the optimal linking relationship. Results suggest IRT methods were superior in reducing linking error compared to Deming regression. While Deming regression accurately modeled the mean scores (thus minimizing linking bias), this method could not adequately address the floor effect for scores on the CBCL. For practical purposes, this study provides a crosswalk of score conversions between the CBCL and MAP-DB, such that data aggregation and group comparisons can be made across the two measures; this enables longitudinal analyses with historically-collected CBCL data to transition to the more innovative dimensional scales of the MAP-DB without undo loss of extant data. This study furthers efforts to shift from historical symptom counts to more developmentally-sensitive measurement across the disruptive behaviors spectrum.
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Affiliation(s)
- Aaron J Kaat
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Courtney K Blackwell
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Ryne Estabrook
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - James L Burns
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Amelie Petitclerc
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | | | - Richard C Gershon
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - David Cella
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
| | - Susan B Perlman
- University of Pittsburgh Department of Psychiatry, Pittsburgh, PA
| | - Lauren S Wakschlag
- Northwestern University Department of Medical Social Sciences, Feinberg School of Medicine and the Institute for Innovations in Developmental Sciences, Chicago, IL
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Charach A, Bélanger SA, McLennan JD, Nixon MK. Screening for disruptive behaviour problems in preschool children in primary health care settings. Paediatr Child Health 2018; 22:478-493. [PMID: 29601056 DOI: 10.1093/pch/pxx128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Disruptive behaviour problems in preschool children are significant risk factors for, and potential components of, neurodevelopmental and mental health disorders. Some noncompliance, temper tantrums and aggression between 2 and 5 years of age are normal and transient. However, problematic levels of disruptive behaviour, specifically when accompanied by functional impairment and/or significant distress, should be identified because early intervention can improve outcome trajectories. This position statement provides an approach to early identification using clinical screening at periodic health examinations, followed by a systematic mental health examination that includes standardized measures. The practitioner should consider a range of environmental, developmental, family and parent-child relationship factors to evaluate the clinical significance of disruptive behaviours. Options within a management plan include regular monitoring, accompanied by health guidance and parenting advice, referral to parent behaviour training as a core evidence-based intervention, and referral to specialty care for preschool children with significant disruptive behaviours, developmental or mental health comorbidities, or who are not responding to first-line interventions.
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Affiliation(s)
- Alice Charach
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee, Ottawa, Ontario.,Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario
| | | | - John D McLennan
- Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario
| | - Mary Kay Nixon
- Canadian Academy of Child and Adolescent Psychiatry, Ottawa, Ontario
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16
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Wakschlag LS, Perlman SB, Blair RJ, Leibenluft E, Briggs-Gowan MJ, Pine DS. The Neurodevelopmental Basis of Early Childhood Disruptive Behavior: Irritable and Callous Phenotypes as Exemplars. Am J Psychiatry 2018; 175:114-130. [PMID: 29145753 PMCID: PMC6075952 DOI: 10.1176/appi.ajp.2017.17010045] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The arrival of the Journal's 175th anniversary occurs at a time of recent advances in research, providing an ideal opportunity to present a neurodevelopmental roadmap for understanding, preventing, and treating psychiatric disorders. Such a roadmap is particularly relevant for early-childhood-onset neurodevelopmental conditions, which emerge when experience-dependent neuroplasticity is at its peak. Employing a novel developmental specification approach, this review places recent neurodevelopmental research on early childhood disruptive behavior within the historical context of the Journal. The authors highlight irritability and callous behavior as two core exemplars of early disruptive behavior. Both phenotypes can be reliably differentiated from normative variation as early as the first years of life. Both link to discrete pathophysiology: irritability with disruptions in prefrontal regulation of emotion, and callous behavior with abnormal fear processing. Each phenotype also possesses clinical and predictive utility. Based on a nomologic net of evidence, the authors conclude that early disruptive behavior is neurodevelopmental in nature and should be reclassified as an early-childhood-onset neurodevelopmental condition in DSM-5. Rapid translation from neurodevelopmental discovery to clinical application has transformative potential for psychiatric approaches of the millennium. [AJP at 175: Remembering Our Past As We Envision Our Future November 1938: Electroencephalographic Analyses of Behavior Problem Children Herbert Jasper and colleagues found that brain abnormalities revealed by EEG are a potential causal factor in childhood behavioral disorders. (Am J Psychiatry 1938; 95:641-658 )].
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Affiliation(s)
- Lauren S Wakschlag
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Susan B Perlman
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - R James Blair
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Ellen Leibenluft
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Margaret J Briggs-Gowan
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
| | - Daniel S Pine
- From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md
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17
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Grabell AS, Li Y, Barker JW, Wakschlag LS, Huppert TJ, Perlman SB. Evidence of Non-Linear Associations between Frustration-Related Prefrontal Cortex Activation and the Normal:Abnormal Spectrum of Irritability in Young Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 46:137-147. [PMID: 28315125 PMCID: PMC5603348 DOI: 10.1007/s10802-017-0286-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Burgeoning interest in early childhood irritability has recently turned toward neuroimaging techniques to better understand normal versus abnormal irritability using dimensional methods. Current accounts largely assume a linear relationship between poor frustration management, an expression of irritability, and its underlying neural circuitry. However, the relationship between these constructs may not be linear (i.e., operate differently at varying points across the irritability spectrum), with implications for how early atypical irritability is identified and treated. Our goal was to examine how the association between frustration-related lateral prefrontal cortex (LPFC) activation and irritability differs across the dimensional spectrum of irritability by testing for non-linear associations. Children (N = 92; ages 3-7) ranging from virtually no irritability to the upper end of the clinical range completed a frustration induction task while we recorded LPFC hemoglobin levels using fNIRS. Children self-rated their emotions during the task and parents rated their child's level of irritability. Whereas a linear model showed no relationship between frustration-related LPFC activation and irritability, a quadratic model revealed frustration-related LPFC activation increased as parent-reported irritability scores increased within the normative range of irritability but decreased with increasing irritability in the severe range, with an apex at the 91st percentile. Complementarily, we found children's self-ratings of emotion during frustration related to concurrent LPFC activation as an inverted U function, such that children who reported mild distress had greater activation than peers reporting no or high distress. Results suggest children with relatively higher irritability who are unimpaired may possess well-developed LPFC support, a mechanism that drops out in the severe end of the irritability dimension. Findings suggest novel avenues for understanding the heterogeneity of early irritability and its clinical sequelae.
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Affiliation(s)
- Adam S Grabell
- Department of Psychiatry, Laboratory for Child Brain Development, University of Pittsburgh School of Medicine, Loeffler Building, 121 Meyran Avenue, Pittsburgh, PA, 15213, USA.
| | - Yanwei Li
- Department of Psychiatry, Laboratory for Child Brain Development, University of Pittsburgh School of Medicine, Loeffler Building, 121 Meyran Avenue, Pittsburgh, PA, 15213, USA
- Research Center for Learning Science, Key Laboratory of Child Development and Learning Science of Ministry of Education, Southeast University, Nanjing, Jiangsu, China
| | - Jeff W Barker
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, and the Institute for Policy Research, Northwestern University, Chicago, IL, USA
| | - Theodore J Huppert
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan B Perlman
- Department of Psychiatry, Laboratory for Child Brain Development, University of Pittsburgh School of Medicine, Loeffler Building, 121 Meyran Avenue, Pittsburgh, PA, 15213, USA
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18
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Dimensional Latent Structure of Early Disruptive Behavior Disorders: A Taxometric Analysis in Preschoolers. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 46:1385-1394. [DOI: 10.1007/s10802-017-0383-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Charach A, Bélanger SA, McLennan JD, Nixon MK. Le dépistage des comportements perturbateurs en première ligne chez les
enfants d’âge préscolaire. Paediatr Child Health 2017; 22:485-493. [PMCID: PMC5804786 DOI: 10.1093/pch/pxx129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Chez les enfants d’âge préscolaire, les comportements perturbateurs sont d’importants facteurs de risque et des éléments potentiels de troubles du neurodéveloppement et de la santé mentale. Entre l’âge de deux et cinq ans, il est normal d’observer des comportements transitoires comme un certain défaut de se conformer, des crises de colère et de l’agressivité. Cependant, il est important de dépister les comportements perturbateurs problématiques, particulièrement lorsqu’ils s’accompagnent d’une atteinte fonctionnelle ou d’une détresse marquée, car une intervention précoce peut améliorer le pronostic. Le présent document de principes décrit une démarche pour diagnostiquer rapidement ce type de comportements grâce au dépistage clinique lors des examens de santé réguliers, suivis d’un examen de la santé mentale qui inclut des mesures standardisées. Le praticien devrait envisager une série de facteurs liés à l’environnement, au développement, à la famille et à la relation parent-enfant pour évaluer la signification clinique des comportements perturbateurs. Parmi les plans de prise en charge possibles, soulignons un suivi régulier conjugué à des conseils sur la santé et sur les habiletés parentales, l’orientation vers une formation sur les comportements destinée aux parents (une intervention fondamentale fondée sur des données probantes) et l’orientation des enfants d’âge préscolaire vers des soins spécialisés lorsqu’ils présentent des comportements perturbateurs importants, qu’ils ont des comorbidités touchant le déve loppement ou la santé mentale ou qu’ils ne répondent pas aux interventions de première ligne.
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Affiliation(s)
- Alice Charach
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles
du développement, Ottawa (Ontario)
- Académie canadienne de psychiatrie de l’enfant et de l’adolescent, Ottawa
(Ontario)
| | - Stacey Ageranioti Bélanger
- Société canadienne de pédiatrie, comité de la santé mentale et des troubles
du développement, Ottawa (Ontario)
| | - John D McLennan
- Académie canadienne de psychiatrie de l’enfant et de l’adolescent, Ottawa
(Ontario)
| | - Mary Kay Nixon
- Académie canadienne de psychiatrie de l’enfant et de l’adolescent, Ottawa
(Ontario)
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20
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Charach A, McLennan JD, Bélanger SA, Nixon MK. Screening for Disruptive Behaviour Problems in Preschool Children in Primary Health Care Settings. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2017; 26:172-178. [PMID: 29056978 PMCID: PMC5642455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Disruptive behaviour problems in preschool children are significant risk factors for, and potential components of, neurodevelopmental and mental health disorders. Some non-compliance, temper tantrums and aggression between two and five years of age are normal and transient. However, problematic levels of disruptive behaviour, specifically when accompanied by functional impairment and/or significant distress, should be identified because early intervention can improve outcome trajectories. This position statement provides an approach to early identification using clinical screening at periodic health examinations, followed by a systematic mental health examination that includes standardized measures. The practitioner should consider a range of environmental, developmental, family and parent-child relationship factors to evaluate the clinical significance of disruptive behaviours. Options within a management plan include regular monitoring accompanied by health guidance and parenting advice, referral to parent behaviour training as a core evidence-based intervention, and referral to specialty care for preschool children with significant disruptive behaviours, developmental or mental health comorbidities, or who are not responding to first-line interventions.
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Affiliation(s)
- Alice Charach
- Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee
- Canadian Academy of Child and Adolescent Psychiatry
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21
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White SF, Briggs-Gowan MJ, Voss JL, Petitclerc A, McCarthy K, R Blair RJ, Wakschlag LS. Can the fear recognition deficits associated with callous-unemotional traits be identified in early childhood? J Clin Exp Neuropsychol 2016; 38:672-84. [PMID: 27167866 PMCID: PMC5155588 DOI: 10.1080/13803395.2016.1149154] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Callous-unemotional (CU) traits in the presence of conduct problems are associated with increased risk of severe antisocial behavior. Developmentally sensitive methods of assessing CU traits have recently been generated, but their construct validity in relation to neurocognitive underpinnings of CU has not been demonstrated. The current study sought to investigate whether the fear-specific emotion recognition deficits associated with CU traits in older individuals are developmentally expressed in young children as low concern for others and punishment insensitivity. METHOD A subsample of 337 preschoolers (mean age 4.8 years, SD = 0.8) who completed neurocognitive tasks was taken from a larger project of preschool psychopathology. Children completed an emotional recognition task in which they were asked to identify the emotional face from the neutral faces in an array. CU traits were assessed using the Low Concern (LC) and Punishment Insensitivity (PI) subscales of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB), which were specifically designed to differentiate the normative misbehavior of early childhood from atypical patterns. RESULTS High LC, but not PI, scores were associated with a fear-specific deficit in emotion recognition. Girls were more accurate than boys in identifying emotional expressions but no significant interaction between LC or PI and sex was observed. CONCLUSIONS Fear recognition deficits associated with CU traits in older individuals were observed in preschoolers with developmentally defined patterns of low concern for others. Confirming that the link between CU-related impairments in empathy and distinct neurocognitive deficits is present in very young children suggests that developmentally specified measurement can detect the substrates of these severe behavioral patterns beginning much earlier than prior work. Exploring the development of CU traits and disruptive behavior disorders at very early ages may provide insights critical to early intervention and prevention of severe antisocial behavior.
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Affiliation(s)
- Stuart F White
- a Section on Affective Cognitive Neuroscience , National Institute of Mental Health , Bethesda , MD , USA
| | | | - Joel L Voss
- c Department of Medical Social Sciences , Feinberg School of Medicine Northwestern University , Chicago , IL , USA
| | - Amelie Petitclerc
- c Department of Medical Social Sciences , Feinberg School of Medicine Northwestern University , Chicago , IL , USA
| | | | - R James R Blair
- a Section on Affective Cognitive Neuroscience , National Institute of Mental Health , Bethesda , MD , USA
| | - Lauren S Wakschlag
- c Department of Medical Social Sciences , Feinberg School of Medicine Northwestern University , Chicago , IL , USA
- d Institute for Policy Research, Northwestern University , Chicago , IL , USA
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Increasing the Sensitivity of Measures to Change. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:978-86. [PMID: 25703381 DOI: 10.1007/s11121-015-0545-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Little attention is paid in prevention research to the ability of measures to accurately assess change, termed "responsiveness" or "sensitivity to change." This paper reviews definitions and measures of responsiveness, and suggests five strategies for increasing sensitivity to change, with central focus on prevention research with small samples: (a) improving understandability and cultural validity, (b) assuring that the measure covers the full range of the latent construct being measured, (c) eliminating redundant items, (d) maximizing sensitivity of the device used to collect responses; and (e) asking directly about change. Examples of the application of each strategy are provided. The discussion focuses on using the issues as a checklist for improving measures and the implications of sensitivity to change for prevention research with small samples.
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23
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Dimensions of oppositional defiant disorder in young children: model comparisons, gender and longitudinal invariance. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:423-39. [PMID: 25117577 DOI: 10.1007/s10802-014-9919-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Identifying the latent structure of Oppositional Defiant Disorder (ODD) may have important clinical and research implications. The present study compared existing dimensional models of ODD for model fit and examined the metric and scalar invariance of the best-fitting model. Study participants were a diverse (38.8% minority, 49.1% boys) community sample of 796 children. Parents completed the Child Symptom Inventory and the DISC-YC ODD scales at child ages of 4, 5 and 6-7 years. When comparing single-factor (DSM-IV model), two-factor (oppositional behavior, negative affect), and three-factor models (one with dimensions of oppositional behavior, negative affect, antagonistic behavior; a second with dimensions of irritable, hurtful, and headstrong), the two-factor model showed the best fit. The two-factor model showed configural, metric and scalar invariance across gender and age. Results suggest that, among existing models, ODD is best characterized as two separate dimensions, one behavioral and one affective, which are comparable for both boys and girls in these age groups.
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24
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Wakschlag LS, Estabrook R, Petitclerc A, Henry D, Burns JL, Perlman SB, Voss JL, Pine DS, Leibenluft E, Briggs-Gowan ML. Clinical Implications of a Dimensional Approach: The Normal:Abnormal Spectrum of Early Irritability. J Am Acad Child Adolesc Psychiatry 2015; 54:626-34. [PMID: 26210331 PMCID: PMC4515952 DOI: 10.1016/j.jaac.2015.05.016] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/23/2015] [Accepted: 06/08/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The importance of dimensional approaches is widely recognized, but an empirical base for clinical application is lacking. This is particularly true for irritability, a dimensional phenotype that cuts across many areas of psychopathology and manifests early in life. We examine longitudinal, dimensional patterns of irritability and their clinical import in early childhood. METHOD Irritability was assessed longitudinally over an average of 16 months in a clinically enriched, diverse community sample of preschoolers (N = 497; mean = 4.2 years; SD = 0.8). Using the Temper Loss scale of the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) as a developmentally sensitive indicator of early childhood irritability, we examined its convergent/divergent, clinical, and incremental predictive validity, and modeled its linear and nonlinear associations with clinical risk. RESULTS The Temper Loss scale demonstrated convergent and divergent validity to child and maternal factors. In multivariate analyses, Temper Loss predicted mood (separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and depression/dysthymia), disruptive (oppositional defiant disorder [ODD], attention-deficit/hyperactivity disorder [ADHD], and conduct disorder [CD]) symptoms. Preschoolers with even mildly elevated Temper Loss scale scores showed substantially increased risk of symptoms and disorders. For ODD, GAD, SAD, and depression, increases in Temper Loss scale scores at the higher end of the dimension had a greater impact on symptoms relative to increases at the lower end. Temper Loss scale scores also showed incremental validity over DSM-IV disorders in predicting subsequent impairment. Finally, accounting for the substantial heterogeneity in longitudinal patterns of Temper Loss significantly improved prediction of mood and disruptive symptoms. CONCLUSION Dimensional, longitudinal characterization of irritability informs clinical prediction. A vital next step will be empirically generating parameters for the incorporation of dimensional information into clinical decision-making with reasonable certainty.
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Affiliation(s)
- Lauren S Wakschlag
- Department of Medical Social Sciences and the Institute for Policy Research, Northwestern University, IL.
| | | | | | - David Henry
- Institute for Health Research and Policy, University of Illinois at Chicago
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Nichols SR, Briggs-Gowan M, Estabrook R, Burns J, Kestler J, Berman G, Henry D, Wakschlag L. Punishment Insensitivity in Early Childhood: A Developmental, Dimensional Approach. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 43:1011-23. [PMID: 25425187 PMCID: PMC4446258 DOI: 10.1007/s10802-014-9950-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Impairment in learning from punishment ("punishment insensitivity") is an established feature of severe antisocial behavior in adults and youth but it has not been well studied as a developmental phenomenon. In early childhood, differentiating a normal: abnormal spectrum of punishment insensitivity is key for distinguishing normative misbehavior from atypical manifestations. This study employed a novel measure, the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB), to examine the distribution, dimensionality, and external validity of punishment insensitivity in a large, demographically diverse community sample of preschoolers (3-5 years) recruited from pediatric clinics (N = 1,855). Caregivers completed surveys from which a seven-item Punishment Insensitivity scale was derived. Findings indicated that Punishment Insensitivity behaviors are relatively common in young children, with at least 50 % of preschoolers exhibiting them sometimes. Item response theory analyses revealed a Punishment Insensitivity spectrum. Items varied along a severity continuum: most items needed to occur "Often" in order to be severe and behaviors that were qualitatively atypical or intense were more severe. Although there were item-level differences across sociodemographic groups, these were small. Construct, convergent, and divergent validity were demonstrated via association to low concern for others and noncompliance, motivational regulation, and a disruptive family context. Incremental clinical utility was demonstrated in relation to impairment. Early childhood punishment insensitivity varies along a severity continuum and is atypical when it predominates. Implications for understanding the phenomenology of emergent disruptive behavior are discussed.
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Affiliation(s)
- Sara R. Nichols
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | | | - Ryne Estabrook
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - James Burns
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Jacqueline Kestler
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Grace Berman
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - David Henry
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Lauren Wakschlag
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
- Institute for Policy Research, Northwestern University, Evanston, IL
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Hong JS, Tillman R, Luby JL. Disruptive behavior in preschool children: distinguishing normal misbehavior from markers of current and later childhood conduct disorder. J Pediatr 2015; 166:723-30.e1. [PMID: 25598304 DOI: 10.1016/j.jpeds.2014.11.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/31/2014] [Accepted: 11/18/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To investigate which disruptive behaviors in preschool were normative and transient vs markers of conduct disorder, as well as which disruptive behaviors predicted the persistence of conduct disorder into school age. STUDY DESIGN Data from a longitudinal study of preschool children were used to investigate disruptive behaviors. Caregivers of preschoolers ages 3.0-5.11 years (n = 273) were interviewed using the Preschool Age Psychiatric Assessment to derive the following diagnostic groups: conduct disorder, externalizing disorder without conduct disorder, internalizing disorder without externalizing disorder, and healthy. At school age, participants were again assessed via an age-appropriate diagnostic interview. Logistic and linear regression with pairwise group comparisons was used to investigate clinical markers of preschool conduct disorder and predictors of school age conduct disorder. RESULTS Losing one's temper, low-intensity destruction of property, and low-intensity deceitfulness/stealing in the preschool period were found in both healthy and disordered groups. In contrast, high-intensity argument/defiant behavior, both low- and high-intensity aggression to people/animals, high-intensity destruction of property, high-intensity deceitfulness/stealing, and high-intensity peer problems were markers of preschool conduct disorder and predictors of school age conduct disorder. Inappropriate sexual behavior was not a marker for preschool conduct disorder but was a predictor of school age conduct disorder. CONCLUSION These findings provide a guide for primary care clinicians to help identify preschoolers with clinical conduct disorder and those who are at risk for persistent conduct disorder in childhood. Preschoolers displaying these symptoms should be targeted for mental health assessment.
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Affiliation(s)
- Ji S Hong
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO.
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Dougherty LR, Leppert KA, Merwin SM, Smith VC, Bufferd SJ, Kushner MR. Advances and Directions in Preschool Mental Health Research. CHILD DEVELOPMENT PERSPECTIVES 2015. [DOI: 10.1111/cdep.12099] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
From the existing self-report measures for youth Obsessive-Compulsive (OC) symptoms, several challenges can be delineated to further improve the assessment of youth OC-related pathology. The current manuscript incorporates these challenges and reports on the development and validation of a new self-report OC scale for younger age groups, that was labeled the Youth Obsessive-Compulsive Symptoms Scale (YOCSS), assessing OC symptoms and impairment in adolescents (three independent samples: N = 336; N = 289; and N = 209). Study 1 reports on the construction of the items and facets, and their higher-order structure, whereas Study 2 focuses on the confirmation of this structure, measurement invariance across age, and on the convergent and incremental predictive validity. These psychometric analyses resulted in ten symptom facets (structured in three domains) and one impairment facet, and further suggest that the YOCSS is a promising tool for describing early OC symptoms along a dimensional perspective.
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Althoff RR, Kuny-Slock AV, Verhulst FC, Hudziak JJ, van der Ende J. Classes of oppositional-defiant behavior: concurrent and predictive validity. J Child Psychol Psychiatry 2014; 55:1162-71. [PMID: 24673629 PMCID: PMC4159429 DOI: 10.1111/jcpp.12233] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oppositional defiant disorder (ODD) has components of both irritability and defiance. It remains unclear whether children with variation in these domains have different adult outcomes. This study examined the concurrent and predictive validity of classes of oppositional defiant behavior. METHODS Latent class analysis was performed on the oppositional defiant problems scale of the Child Behavior Checklist in two samples, one in the US (the Achenbach Normative Sample, N = 2029) and one in the Netherlands (the Zuid-Holland Study, N = 2076). A third sample of American children (The Vermont Family Study, N = 399) was examined to determine concurrent validity with DSM diagnoses. Predictive validity over 14 years was assessed using the Zuid-Holland Study. RESULTS Four classes of oppositional defiant problems were consistent in the two latent class analyses: No Symptoms, All Symptoms, Irritable, and Defiant. Individuals in the No Symptoms Class were rarely diagnosed concurrently with ODD or any future disorder. Individuals in the All Symptoms Class had an increased frequency of concurrent childhood diagnosis of ODD and of violence in adulthood. Subjects in the Irritable Class had low concurrent diagnosis of ODD, but increased odds of adult mood disorders. Individuals in the Defiant Class had low concurrent diagnosis of ODD, but had increased odds of violence as adults. CONCLUSIONS Only children in the All Symptoms class were likely to have a concurrent diagnosis of ODD. Although not diagnosed with ODD, children in the Irritable Class were more likely to have adult mood disorders and children in the Defiant Class were more likely to engage in violent behavior.
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Affiliation(s)
- Robert R. Althoff
- Department of Psychiatry and Pediatrics at the University of Vermont College of Medicine, Rotterdam, The Netherlands,Department of Psychology at the University of Vermont, Rotterdam, The Netherlands,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - James J. Hudziak
- Department of Psychiatry and Pediatrics at the University of Vermont College of Medicine, Rotterdam, The Netherlands,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands,Department of Medicine, University of Vermont College of Medicine, Albuquerque
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
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Krieger FV, Leibenluft E, Stringaris A, Polanczyk GV. Irritability in children and adolescents: past concepts, current debates, and future opportunities. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35 Suppl 1:S32-9. [PMID: 24142126 DOI: 10.1590/1516-4446-2013-s107] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.
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Wakschlag LS, Briggs-Gowan MJ, Choi SW, Nichols SR, Kestler J, Burns JL, Carter AS, Henry D. Advancing a multidimensional, developmental spectrum approach to preschool disruptive behavior. J Am Acad Child Adolesc Psychiatry 2014; 53:82-96.e3. [PMID: 24342388 PMCID: PMC4244819 DOI: 10.1016/j.jaac.2013.10.011] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 10/03/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Dimensional approaches are gaining scientific traction. However, their potential for elucidating developmental aspects of psychopathology has not been fully realized. The goal of this article is to apply a multidimensional, developmental framework to model the normal-abnormal spectrum of preschool disruptive behavior. The Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), a novel measure, was used to model dimensional severity across developmental parameters theorized to distinguish the normative misbehavior of early childhood from clinically salient disruptive behavior. The 4 MAP-DB dimensions are Temper Loss, Noncompliance, Aggression, and Low Concern for Others. METHOD Parents of a diverse sample of 1,488 preschoolers completed the MAP-DB. Multidimensional item response theory (IRT) was used for dimensional modeling. RESULTS The 4-dimensional, developmentally informed model demonstrated excellent fit. Its factor loadings did not differ across demographic subgroups. All dimensions provided good coverage of the abnormal end of the severity continuum, but only Temper Loss and Noncompliance provided good coverage of milder, normatively occurring behaviors. The developmental expectability and quality of behaviors distinguished normative from atypical behaviors. The point at which frequency of behaviors was atypical varied based on dimensional location for Temper Loss, Noncompliance, and Aggression. CONCLUSION The MAP-DB provides an innovative method for operationalizing developmentally specified, dimensional phenotypes in early childhood. Establishing the validity of these dimensional phenotypes in relation to clinical outcomes, neurocognitive substrates, and etiologic pathways will be a crucial test of their clinical utility.
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Affiliation(s)
- Lauren S Wakschlag
- Feinberg School of Medicine and Institute for Policy Research, Northwestern University.
| | | | | | | | | | - James L Burns
- Feinberg School of Medicine, Northwestern University
| | | | - David Henry
- Institute for Health Research and Policy, University of Illinois at Chicago
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Aebi M, Plattner B, Metzke CW, Bessler C, Steinhausen HC. Parent- and self-reported dimensions of oppositionality in youth: construct validity, concurrent validity, and the prediction of criminal outcomes in adulthood. J Child Psychol Psychiatry 2013; 54:941-9. [PMID: 23356718 DOI: 10.1111/jcpp.12039] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different dimensions of oppositional defiant disorder (ODD) have been found as valid predictors of further mental health problems and antisocial behaviors in youth. The present study aimed at testing the construct, concurrent, and predictive validity of ODD dimensions derived from parent- and self-report measures. METHOD Confirmatory factor analyses were performed to test a three-dimensional model (ODD-irritability, ODD-headstrong, and ODD-hurtful) and a two-dimensional model (ODD-irritability, ODD-headstrong/hurtful) based on items of the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) collected in a Swiss community study of 1,031 adolescents (519 boys, 512 girls) aged between 10.7 and 17.9 (M = 13.85, SD = 1.63) years. Logistic regression analyses were applied to predict scores in the clinical range of concurrent CBCL/YSR-anxiety/depression, CBCL/YSR-attention problems, and CBCL/YSR-delinquent behavior and depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D) as well as to predict the presence of adult criminal convictions. RESULTS CFA findings were in favor of a three-dimensional model rather than a two-dimensional model of ODD. The CBCL/YSR-ODD-irritability scale was related to concurrent self-reported depression, but also to attention problems and delinquent behavior. CBCL/YSR-ODD-hurtful and less strongly also the combined YSR-headstrong/hurtful scale predicted adult criminal outcomes. CONCLUSIONS As proposed by the DSM-5 workgroup, different ODD-dimensions were confirmed by the present study. ODD-irritability predicts psychiatric comorbidity and ODD-hurtful symptoms should be specifically considered in youth at risk for criminal outcomes.
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Affiliation(s)
- Marcel Aebi
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland.
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Krieger FV, Polanczyk GV, Goodman R, Rohde LA, Graeff-Martins AS, Salum G, Gadelha A, Pan P, Stahl D, Stringaris A. Dimensions of oppositionality in a Brazilian community sample: testing the DSM-5 proposal and etiological links. J Am Acad Child Adolesc Psychiatry 2013; 52:389-400.e1. [PMID: 23582870 PMCID: PMC3834546 DOI: 10.1016/j.jaac.2013.01.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 12/19/2012] [Accepted: 01/11/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Investigating dimensions of oppositional symptoms may help to explain heterogeneity of etiology and outcomes for mental disorders across development and provide further empirical justification for the DSM-5-proposed modifications of oppositional defiant disorder (ODD). However, dimensions of oppositionality have not previously been tested in samples outside Europe or the United States. In this study, we used a large Brazilian community sample to compare the fit of different models for dimensions of oppositional symptoms; to examine the association of psychiatric diagnoses and symptoms with dimensions of oppositionality; and to examine the associations between dimensions of oppositionality and parental history of mental disorders. METHOD A Brazilian community sample of 2,512 children 6 through 12 years old were investigated in this study. Confirmatory factorial analyses were performed to compare the fit of alternative models, followed by linear and logistic regression analyses of associations with psychiatric diagnosis and parental history of psychopathology. RESULTS A three-factor model with irritable, headstrong, and hurtful dimensions fitted best. The irritable dimension showed a strong association with emotional disorders in the child (p<.001) and history of depression (p<.01) and suicidality (p<.05) in the mother. The headstrong dimension was uniquely associated with attention-deficit/hyperactivity disorder (ADHD) in the child (p<.001) and with maternal history of ADHD symptoms (p<.05). The hurtful dimension was specifically associated with conduct disorder (p< .05). CONCLUSIONS Our findings from a large community sample of Brazilian children support a distinction between dimensions of oppositionality consistent with current DSM-5 recommendations and provide further evidence for etiological distinctions between these dimensions.
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Affiliation(s)
| | - Guilherme Vanoni Polanczyk
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil,Research Support Center on Neurodevelopment and Mental Health at the University of São Paulo
| | | | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil,Federal University of Rio Grande do Sul, Brazil
| | - Ana Soledade Graeff-Martins
- University of São Paulo,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
| | - Giovanni Salum
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil,Federal University of Rio Grande do Sul, Brazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil
| | - Pedro Pan
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), Brazil,Federal University of São Paulo
| | - Daniel Stahl
- Institute of Psychiatry at King’s College London
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Bunte TL, Laschen S, Schoemaker K, Hessen DJ, van der Heijden PGM, Matthys W. Clinical Usefulness of Observational Assessment in the Diagnosis of DBD and ADHD in Preschoolers. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 42:749-61. [DOI: 10.1080/15374416.2013.773516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tessa L. Bunte
- a Department of Psychiatry and Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht
| | - Sarah Laschen
- a Department of Psychiatry and Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht
| | - Kim Schoemaker
- a Department of Psychiatry and Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht
- b Department of Child and Adolescent Studies , Utrecht University
| | - David J. Hessen
- c Department of Methodology and Statistics , Utrecht University
| | | | - Walter Matthys
- a Department of Psychiatry and Rudolf Magnus Institute of Neuroscience , University Medical Center Utrecht
- b Department of Child and Adolescent Studies , Utrecht University
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Kuny AV, Althoff RR, Copeland W, Bartels M, Van Beijsterveldt CEM, Baer J, Hudziak JJ. Separating the domains of oppositional behavior: comparing latent models of the conners' oppositional subscale. J Am Acad Child Adolesc Psychiatry 2013; 52:172-183.e8. [PMID: 23357444 PMCID: PMC3558689 DOI: 10.1016/j.jaac.2012.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 08/21/2012] [Accepted: 10/09/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although oppositional defiant disorder (ODD) is usually considered the mildest of the disruptive behavior disorders, it is a key factor in predicting young adult anxiety and depression and is distinguishable from normal childhood behavior. In an effort to understand possible subsets of oppositional defiant behavior (ODB) that may differentially predict outcome, we used latent class analysis of mother report on the Conners' Parent Rating Scales Revised Short Forms (CPRS-R:S). METHOD Data were obtained from mother report for Dutch twins (7 years old, n = 7,597; 10 years old, n = 6,548; and 12 years old, n = 5,717) from the Netherlands Twin Registry. Samples partially overlapped at ages 7 and 10 years (19% overlapping) and at ages 10 and 12 years (30% overlapping), but not at ages 7 and 12 years. Oppositional defiant behavior was measured using the six-item Oppositional subscale of the CPRS-R:S. Multilevel LCA with robust standard error estimates was performed using the Latent Gold program to control for twin-twin dependence in the data. Class assignment across ages was determined and an estimate of heritability for each class was calculated. Comparisons with maternal report Child Behavior Checklist (CBCL) scores were examined using linear mixed models at each age, corrected for multiple comparisons. RESULTS The LCA identified an optimal solution of four classes across age groups. Class 1 was associated with no or low symptom endorsement (69-75% of the children); class 2 was characterized by defiance (11-12%); class 3 was characterized by irritability (9-11%); and class 4 was associated with elevated scores on all symptoms (5-8%). Odds ratios for twins being in the same class at each successive age point were higher within classes across ages than between classes. Heritability within the two "intermediate" classes was nearly as high as for the class with all symptoms, except for boys at age 12. Children in the Irritable class were more likely to have mood symptoms on the CBCL scales than children in the Defiant class but demonstrated similar scores on aggression and externalizing scales. Children in the All Symptoms class were higher in both internalizing and externalizing scales and subscales. CONCLUSIONS The LCA indicates four distinct latent classes of oppositional defiant behavior, in which the distinguishing feature between the two intermediate classes (classes 2 and 3) is the level of irritability and defiance. Implications for the longitudinal course of these symptoms, association with other disorders, and genetics are discussed.
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Affiliation(s)
- Ana V Kuny
- Vermont Center for Children, Youth, and Families at the University of Vermont, Burlington, VT 05401, USA
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