Correlates of clinic referral for early conduct problems: variable- and person-oriented approaches

Principles, policies, and practices: Thoughts on their integration over the rise of the developmental psychopathology perspective and into the future

Developmental psychopathology has, since the late 20th century, offered an influential integrative framework for conceptualizing psychological health, distress, and dysfunction across the lifespan. Leaders in the field have periodically generated predictions about its future and have proposed ways to increase the macroparadigm's impact. In this paper, we examine, using articles sampled from each decade of the journal Development and Psychopathology's existence as a rough guide, the degree to which the themes that earlier predictions have emphasized have come to fruition and the ways in which the field might further capitalize on the strengths of this approach to advance knowledge and practice in psychology. We focus in particular on two key themes first, we explore the degree to which researchers have capitalized on the framework's capacity for principled flexibility to generate novel work that integrates neurobiological and/or social-contextual factors measured at multiple levels and offer ideas for moving this kind of work forward. Second, we discuss how extensively articles have emphasized implications for intervention or prevention and how the field might amplify the voice of developmental psychopathology in applied settings.

Co-developmental trajectories of aggression and rule-breaking from middle childhood to early adolescence: individual and environmental predictors

This study examined the heterogeneous co-developmental trajectories of aggression and rule-breaking from middle childhood to early adolescence, as well as how these identified, distinct trajectories related to individual and environmental predictors. A total of 1944 Chinese elementary school students in grade 4 (45.5% girls, Mage = 10.06, SD = 0.57) completed measures on five occasions across two and a half years, using six-month intervals. Findings included: (a) Parallel process latent class growth modeling revealed four distinct co-developmental trajectory groups of aggression and rule-breaking: congruent-low (84.0%); moderate-decreasing aggression and high-decreasing rule-breaking (3.8%); moderate-increasing aggression (5.9%); and moderate-increasing rule-breaking (6.3%); (b) Multivariate logistic regression analyses revealed that children belonging to the high risk groups were more likely to experience multiple individual and environmental difficulties. Implications for prevention of aggression and rule-breaking were discussed.

Gender-specific co-developmental trajectories of internalizing and externalizing problems from middle childhood to early adolescence: Environmental and individual predictors

This study aimed to identify gender-specific co-developmental trajectories of internalizing and externalizing problems from middle childhood to early adolescence, along with key environmental and individual predictors among Chinese youth. A total of 1653 Chinese elementary school students (M age = 9.40; SD = 0.51; 54.57% boys) participated in assessments at six time points, using 6-month assessment intervals. Parallel process latent class growth modeling identified four trajectories for boys: Congruent-low (65.74%), moderate-decreasing internalizing and moderate-stable externalizing problems (18.40%), high increasing-internalizing and low-stable externalizing problems (8.20%), and high decreasing-internalizing and low-stable externalizing problems (7.65%). Three trajectories were identified for girls: Congruent-low (81.09%), moderate co-occurring (7.19%), and high increasing-internalizing and low-stable externalizing problems (11.72%). Multivariate logistic regression analyses revealed that peer victimization served as an environmental risk predictor for the adverse co-developmental trajectories of internalizing and externalizing problems for boys and girls. High sensation-seeking and low self-control served as individual risk variables predicting the trajectories of high increasing-internalizing and low-stable externalizing problems, and low self-control also predicted the trajectories of high decreasing-internalizing and low-stable externalizing problems for boys. The findings highlight the importance of gender differences in understanding the progression of internalizing and externalizing problems and inform effective strategies for prevention and intervention.

Short version of the Inventory of Parental Representations, a self-report for attachment assessment among adolescents

BACKGROUND

 The Inventory of Parental Representations (IPR), a self-administered questionnaire, was developed primarily to identify styles of attachment in adolescence. However, it did not present stable psychometric properties in the various American studies carried out. The aim of this study was to adapt the IPR in French and to provide a shorter version with improved psychometric properties and sound content.

METHODS

The cross-cultural adaptation and content validity were carried out based on qualitative analysis by an Expert Committee and 10 non-clinical adolescents. For the quantitative analyses a cohort of 535 adolescent volunteers was enrolled, corresponding to 1070 responses, and divided into two groups: development and validation. The study of the metric properties of the adapted version of the IPR was realized in the development group, a sample of 275 responses. In case of mediocre results in the Confirmatory Factor Analysis, the development of a new and reduced IPR structure was planned using a mixed method including Classical Test Theory and Rasch Modelling in the development group. Subsequently, the study of the psychometric properties of the short, adapted version was confirmed in an independent sample of 795 responses (validation group).

RESULTS

Out of 62 items translated, 13 needed adaptations. The analysis of their metric properties produced mediocre results. Content and psychometric property analyses generated two Short version of the IPR in the development group: a paternal scale for Fathers (Short IPRF) with 15 items and a maternal scale for Mothers (Short IPRM) with 16 items. The sound content and good psychometric properties were confirmed in the validation group (Short IPRF: Comparative Fit Index = 0.987, Tucker-Lewis Index = 0.982, Root Mean Square Error of Approximation = 0.027; Short IPRM: Comparative Fit Index = 0.953, Trucker-Lewis Index = 0.927, Root Mean Square Error of Approximation = 0.068). Using Rasch modelling, the attachment was correctly measured overall especially for insecure attachment.

CONCLUSIONS

A step-by-step process involving led to the generation of two questionnaires: a paternal scale, the Short IPRF, and a maternal scale with the Short IPRM providing opportunities to use this self-questionnaire to assess attachment among adolescents. Further work will provide a solid rating for this new tool.

A Controlled Trial Evaluating the Impact of a Home-Visiting Program on Maternal Disruptive Communication in a Vulnerable Population

Attachment disorganization is a significant high-risk factor for infant mental health. Its association with high-risk psychosocial contexts has been clearly identified, but the link between these difficult social contexts and maternal disruptive communication has been poorly explored. The CAPEDP (Compétences Parentales et Attachement dans la Petite Enfance; Parental competences and attachment in early childhood) study assessed the effects of a manualized home-intervention on the mental health of children and its major determinants. In this controlled trial, 440 young, first-time mothers belonging to socially vulnerable populations were recruited. Mothers in the intervention group received psychological support from the 27th week of pregnancy through to their child’s second birthday, while both groups received assessment visits at the 3rd, 6th, 9th, 18th, and 24th months of age of the child and benefited from assistance by the research team. When the children reached 12 months of age, an ancillary study, the CAPEDP-Attachment (n = 119) evaluated the effects of this intervention on attachment. The current paper describes the program’s impact on this subsample concerning maternal disruptive behavior, while exploring the role of socioeconomic risk factors. Our results showed that: (a) mothers in the intervention (IG) group presented significantly less disruptive communication than those in the control group (CG), even though the CG received a significant level of care over and above that which is available to the public in the French health system as ‘care as usual’; (b) having a “low income” and “having given birth prematurely” was associated with maternal disruptive communication; and (c) the intervention impact increased when the model was adjusted for these two variables. Results suggest that attachment focused intervention programs should invest both maternal interactional skills and social and economic vulnerability.

Association between early risk factors and level of functioning at age seven in children at familial risk for schizophrenia or bipolar disorder - The Danish High Risk and Resilience Study VIA 7

Background

Facing multiple risk factors, relative to single risk factor exposure early in life can have great implications for negative child development.

Objective

We aim to examine whether the prevalence of early risk factors is higher among children with familial high risk for schizophrenia or bipolar disorder compared to controls. Further, to investigate the association between number of early risk factors and level of functioning at age seven, and whether this possible association is different in children with familial high risk compared to controls.

Method

The Danish High Risk and Resilience Study VIA 7 is a population-based cohort study of children of parents diagnosed with schizophrenia (N = 202), bipolar disorder (N = 120) and controls (N = 200). We conducted a semi-structured anamnestic interview with the child’s primary caregiver to assess early risk factors from pregnancy to age four. We used the Children’s Global Assessment Scale to measure level of functioning at age seven.

Results

13 out of 17 risk factors were more prevalent in children at familial high risk for schizophrenia and 7 out of 17 risk factors were more prevalent in children at familial high risk for bipolar disorder compared to controls. Level of functioning decreased 2.7 (95% CI, 2.2; 3.3)-points per risk factor, but the association was not significantly different across the three groups (p = 0.09).

Conclusions

Our results showed that children at age seven with familial high risk for schizophrenia or bipolar disorder experience a greater number of early risk factors. A higher number of early risk factors were associated with lower level of functioning at age seven. However, the association is not different for children with familial high risk or controls.

Configural frequency trees

Although variable-oriented analyses are dominant in developmental psychopathology, researchers have championed a person-oriented approach that focuses on the individual as a totality. This view has methodological implications and various person-oriented methods have been developed to test person-oriented hypotheses. Configural frequency analysis (CFA) has been identified as a prime method for a person-oriented analysis of categorical data. CFA searches for configurations in cross-classifications and asks whether the number of observed cases is larger (CFA type) or smaller (CFA antitype) than expected under a probability model. The present study introduces a combination of CFA and model-based recursive partitioning (MOB) to test for type/antitype heterogeneity in the population. MOB CFA is well suited to detect complex moderation processes and can distinguish between subpopulation and population types/antitypes. Model specifications are discussed for first-order CFA and prediction CFA. Results from two simulation studies suggest that MOB CFA is able to detect moderation processes with high accuracy. Two empirical examples are given from school mental health research for illustrative purposes. The first example evaluates heterogeneity in student behavior types/antitypes, the second example focuses on the effect of a teacher classroom management intervention on student behavior. An implementation of the approach is provided in R.

Executive Functions and Attachment Relationships in Children With ADHD: Links to Externalizing/Internalizing Problems, Social Skills, and Negative Mood Regulation

Objective: Theoretical models suggest multiple underlying pathways for ADHD and multiple risk factors' co-occurrence as impairing this population's affective, interpersonal, and behavioral adjustment. After comparing groups' executive functioning (EF) difficulties and attachment security with each parent, this study primarily aimed to examine four risk factors (ADHD, child-father attachment, child-mother attachment, EF) as possibly explaining children's socioemotional/behavioral measures (externalizing/internalizing behavior, social skills, negative mood regulation). Method: Participants were 100 children in Grades 5-6 (ages 11-12 years; M=11.45 years, SD=.50): 50 with formally diagnosed ADHD, and 50 with typical development (TD). Instruments were children's self-report measures and teachers' evaluation. Results: Significant group differences emerged on all EF measures and attachment relationships, and most socioemotional/behavioral measures. Findings demonstrated the significant contribution of children's ADHD, parental attachments, and, partially, EF difficulties in explaining children's socioemotional/behavioral adjustment. Conclusion: Children with ADHD, compared to children with TD, reported significantly larger EF deficits and a significantly higher incidence of insecure attachment to the father as well as a lower sense of trust and closeness to the mother. Outcomes highlighted the role of children's four risk factors (ADHD, child-father attachment, child-mother attachment, EF) in explaining their socioemotional/behavioral adjustment. The EF deficits contributed only to intrapersonal maladjustment.

Self-Regulatory Profiles and Conduct Problems in Youth Referred to Juvenile Diversion

The current study utilized a person-centered approach to explore how self-regulatory profiles relate to conduct problems in an ethnically diverse sample of 197 adolescents referred to juvenile diversion programming. Utilizing a multidomain, multimethod battery of self-regulation indicators, three common profiles emerged in a latent profile analysis. The profiles represented an Adaptive group, a Cognitively Inflexible group, and an Emotionally Dysregulated group. Group membership was associated with severity and type of conduct problems as well as callous and unemotional traits. The Adaptive group demonstrated lower severity conduct problems when compared to the other groups. The Emotionally Dysregulated group was more likely to commit violent offenses and demonstrated higher levels of some callous and unemotional traits than youth characterized by cognitive inflexibility.

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

Background: Substance use disorders (SUDs) represent a worldwide epidemic with extensive costs to the individual and to society. Occasionally described as an attachment disorder, they have been linked to various impairments in self-regulation and social functioning. However, while there have been significant advances in the development and validation of treatment strategies for SUD in recent years, the components of these treatment approaches have yet to be fully explored. The characteristics of polydrug use disorder (PUD) especially need to be addressed in more detail, as this diagnosis is highly common in individuals seeking treatment, while simultaneously being associated with poor treatment success. Aim and Scope: This review aims at further exploring the relevance of attachment in PUD and its treatment. To this end, this review provides a concise summary of relevant theories on the development and treatment of SUD in general, including related parameters of attachment, emotion regulation, and neuroscience. Furthermore, several studies focused specifically on PUD are described in more detail. These studies explored the connections between attachment, personality structure, primary and higher emotions (including spirituality), as well as structural and functional neural parameters in inpatients with PUD as well as in healthy controls. Most notably, the described studies highlight that insecure attachment and impairments in personality structure are present in inpatients with PUD. In addition, these characteristics are paralleled by extensive impairments in white matter integrity, especially in tracts connected to facets of emotion regulation. Conclusions: Based on our findings, we emphasize conceptualization of PUD as an Attachment Disorder, on a behavioral as well as on a neural level. Furthermore, we point out the importance of an integrated bio-psycho-social approach in this research area. Consequently, future studies might more closely focus on the influence of attachment-based interventions on emotion regulation abilities as well as a potentially related neuroplasticity. Neuroplastic changes, which are still rather unexplored, might represent important parameters for the assessment of treatment outcomes especially in long-term SUD treatment.

Social centrality and aggressive behavior in the elementary school: Gender segregation, social structure, and psychological factors

In this paper, we build on key findings in the sociological literature regarding different patterns of association between social centrality and overt aggressive behavior in the context of same-and-cross gender social interactions. We explore these associations in a population of urban elementary school students ( Age ^   = 8.62 , SD = 0.69, N = 848), while addressing claims that the role of psychological factors is overstated in this literature. Our results indicate that, on average, social centrality is positively associated with aggressive behavior for boys, but negatively for girls. We also find a moderating effect indicating that the proportion of male peers with whom participants are reported to hang around, as well as their own gender play a role in the association between social centrality and aggression. These findings are discussed in the context of an ecological perspective on human development in which interactions among individuals, their social groups, and key environments are viewed as central to shaping developmental pathways.

Mother-child interactions in young children with excessive physical aggression and in typically developing young children

BACKGROUND

Among the multiple risk factors, the emergence of conduct problems in young children may be linked to harsh parenting and child's temperamental difficulties, leading to a reciprocal early discordant relationship. Little is known about the characteristics of early parent-child interactions in young children with physical aggression.

OBJECTIVE

The purpose of the current study was to evaluate the characteristics of mother-child interactions in dyads referred for excessive physical aggression in young children under 5 years of age compared to mother-child interactions in typically developing young children.

METHOD

Mother-child interactions were assessed during a free-play session in both a clinical sample ( N = 70, child mean age  = 3.5 years) and a nonclinical sample ( N = 80, child mean age  = 3.5 years) by using the Rating Scale of Interaction Style (Clark and Seifer, adapted by Molitor and Mayes).

RESULTS

Significant differences were found between several interactive features in clinical and nonclinical dyads. In clinical dyads, mothers' behaviors were often characterized by intrusiveness and criticism toward children, and poor facilitative positioning. Children with excessive aggressive behavior often displayed poor communication, initiation of bids, and poor responsiveness toward the mother. They displayed fewer sustained bouts of play than typically developing children did. In clinical dyads, strong positive correlations were found between child responsiveness and maternal interest in engagement ( r = .41, p < .001), while the child displaying sustained bouts of play was negatively correlated with the mother's attempts to intrude on the child's activity ( r = .64, p < .05).

CONCLUSIONS

These data show that children with excessive aggressive behavior develop disrupted mother-infant interactions from a very young age. Several negative interactive features and correlations between child behavior and maternal behavior were found in clinical samples. The effects of these features add up and probably strengthen each other, thus leading to interactive difficulties from a very young age. More attention should be paid to early parent-child interactions in case of child behavioral problems. The recognition of these interactive dysfunctions is discussed in terms of clinical implications for therapeutic interventions.

Child and environmental risk factors predicting readiness for learning in children at high risk of dyslexia

We investigate the role of distal, proximal, and child risk factors as predictors of reading readiness and attention and behavior in children at risk of dyslexia. The parents of a longitudinal sample of 251 preschool children, including children at family risk of dyslexia and children with preschool language difficulties, provided measures of socioeconomic status, home literacy environment, family stresses, and child health via interviews and questionnaires. Assessments of children's reading-related skills, behavior, and attention were used to define their readiness for learning at school entry. Children at family risk of dyslexia and children with preschool language difficulties experienced more environmental adversities and health risks than controls. The risks associated with family risk of dyslexia and with language status were additive. Both home literacy environment and child health predicted reading readiness while home literacy environment and family stresses predicted attention and behavior. Family risk of dyslexia did not predict readiness to learn once other risks were controlled and so seems likely to be best conceptualized as representing gene-environment correlations. Pooling across risks defined a cumulative risk index, which was a significant predictor of reading readiness and, together with nonverbal ability, accounted for 31% of the variance between children.

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism.

Early attention and negative emotionality predict later cognitive and behavioural function

Negative emotionality and poor attention may combine or interact as risk factors in development. Negative emotionality is considered a challenge for self-regulation, whereas good attention is a potential means of self-regulation. In the current study, composites of 1- and 2-year maternal ratings of negative emotionality and global ratings of observed attentiveness were predictors for 3.5-year cognitive and behavioural outcome for 75 children. Results of variable-based regression analyses indicated that early negativity and attentiveness predicted IQ and scores on a hyperactivity index; only negativity predicted a global measure of behaviour problems. Results of person-based analyses for groups formed by median splits on negativity and attention suggested that the More Negative/Less Attentive group had significantly poorer outcome than the other three groups combined (those with one or none of the two risk factors). Comparisons of mean differences also suggested a protective effect of greater attentiveness for more negative as opposed to less negative children for all outcomes. The results extend prior work in providing longitudinal data over the first 3 years and including both cognitive and behavioural outcomes.

Negative Affectivity Moderates Associations between Cumulative Risk and At-Risk Toddlers' Behavior Problems

This study examined cumulative risk, temperament traits, and their interplay as predictors of internalizing, externalizing, and sleep problems in at-risk toddlers. Participants were 104 low-income mother-toddler dyads recruited from Women, Infants, and Children (WIC) sites in a large city. The sample was primarily African American, and mothers were 21 years of age or younger at the child's birth. The dyads were assessed when the toddlers were approximately 18 months old and again at 24 months of age. Though all toddlers were from low-income families with young mothers, the families varied in the degree to which other contextual risk factors were present. A cumulative risk index was calculated based on five contextual factors: maternal education, neighborhood dangerousness, social support, household overcrowding and single parenting. In multiple regressions, cumulative risk predicted sleep and externalizing problems. In addition, negative affectivity predicted all three domains of problem behaviors, effortful control predicted fewer externalizing problems, and surgency predicted fewer internalizing problems. Moreover, low negative affectivity buffered the association between cumulative risk and both internalizing and sleep problems. These findings suggest that it is important to consider children's temperament traits in conjunction with the constellation of family risks when designing prevention programs to reduce the prevalence of behavior problems early in life.

Socialization in the Context of Risk and Psychopathology: Maternal Emotion Socialization in Children of Incarcerated Mothers

Children of incarcerated mothers are at increased risk for psychological, social, and emotional maladaptation. This research investigates whether perceived maternal socialization of sadness and anger may moderate these outcomes in a sample of 154 children (53.9% boys, 61.7% Black, M age = 9.38, range: 6 - 12), their 118 mothers (64.1% Black), and 118 caregivers (74.8% female, 61.9% grandparents, 63.2% Black). Using mother, caregiver, and child report, seven maternal socialization strategies were assessed in their interaction with incarceration-specific risk experiences predicting children's adjustment. For sadness socialization, the results indicated that among children reporting maternal emotion-focused responses, incarceration-specific risk predicted increases in psychological problems, depressive symptoms, increased emotional lability, and poorer emotion regulation. For children who perceived a problem-focused response, incarceration-specific risk did not predict outcomes. There were no significant interactions with incarceration-specific risk and perceived maternal anger socialization strategies. These results indicate a critical need to examine how socialization processes may operate differently for children raised in atypical socializing contexts.

Effects of the MAOA gene and levels of exposure to violence on antisocial outcomes

BACKGROUND

The monoamine oxidase A (MAOA) gene has been shown to moderate the impact of maltreatment on antisocial behaviour. Replication efforts have, however, yielded inconsistent results.

AIMS

To investigate whether the interaction between the MAOA gene and violence is present across the full distribution of violence or emerges at higher levels of exposure.

METHOD

Participants were 327 male members of the Québec Longitudinal Study of Kindergarten Children. Exposure to violence comprised retrospective reports of mother's and father's maltreatment, sexual and physical abuse. Conduct disorder and antisocial personality symptoms were assessed in semi-structured interviews and partner violence, property-violent crimes and arrest were self-reported.

RESULTS

Non-linear interactions between the MAOA gene and violence were detected, suggesting that the genetic moderation may come about once a certain level of violence is experienced.

CONCLUSIONS

Future studies should investigate the mechanisms translating substantial violence exposure, which could, subsequently, trigger the expression of genetically based differences in antisocial behaviour.

The Return of Lombroso? Ethical Aspects of (Visions of) Preventive Forensic Screening

The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting individuals at risk for future criminal behaviour has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualize an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy.

Improved child behavioural and emotional functioning after Circle of Security 20-week intervention

This study examined the efficacy of the attachment-based Circle of Security 20-week intervention in improving child behavioural and emotional functioning. Participants were 83 parents of children (1-7 years) referred to a clinical service with concerns about their young children's behaviour. Parents (and teachers, when available) completed questionnaires assessing child protective factors, behavioural concerns, internalizing and externalizing problems, prior to and immediately after the intervention. The following were considered as potential moderators: child gender and age, parent representations, reflective functioning, child attachment indices and severity of presenting problems, prior to treatment. Results showed significant improvement for parent ratings of child protective factors, behavioural concerns, internalizing and externalizing symptoms, all ps < .05, and children with more severe problems showed most improvement. Teachers also reported improvements, but change was significant only for externalizing problems (p = .030). Findings suggest Circle of Security is effective in improving child behavioural and emotional functioning in clinically referred children aged 1-7 years.

The role of anxiety in the development, maintenance, and treatment of childhood aggression

The majority of aggressive children exhibit symptoms of anxiety, yet none of our developmental models of aggression incorporate the role of anxiety, and our treatments ignore this comorbidity. This article outlines a novel theoretical model that specifies three hypotheses about comorbid anxious and aggressive children: (a) unpredictable parenting induces anxiety in children that in turn triggers aggressive behavior; (b) prolonged periods of anxiety deplete children's capacity to inhibit impulses and trigger bouts of aggression, and aggression in turn functions to regulate levels of anxiety; and (c) minor daily stressors give rise to anxiety while cognitive perseveration maintains anxious moods, increasingly disposing children to aggress. Little or no research has directly tested these hypotheses. Extant research and theory consistent with these claims are herein reviewed, and future research designs that can test them specifically are suggested. The clinical implications most relevant to the hypotheses are discussed, and to improve the efficacy of treatments for childhood aggression, it is proposed that anxiety may need to be the primary target of treatment.

Cumulative childhood risk and adult functioning in abused and neglected children grown up

This paper examines the relationship between childhood exposure to cumulative risk and three indicators of psychosocial adjustment in adulthood (educational attainment, mental health, and criminal behavior) and tests three different models (linear, quadratic, and interaction). Data were collected over several time points from individuals who were part of a prospective cohort design study that matched children with documented cases of abuse and/or neglect with children without such histories and followed them into adulthood. Hierarchical multiple regressions compared linear and quadratic models and then examined potential moderating effects of child abuse/neglect and gender. Exposure to a greater number of childhood risk factors was significantly related to fewer years of education, more anxiety and depression symptomatology, and more criminal arrests in adulthood. The relationship between cumulative risk and years of education demonstrated a curvilinear pattern, whereas the relationship between cumulative risk and both mental health and criminal arrests was linear. Child abuse/neglect did not moderate these relationships, although there were direct effects for both child abuse/neglect and gender on criminal arrests, with more arrests for abused/neglected individuals than controls and more for males than females. Gender interacted with cumulative risk to impact educational attainment and criminal behavior, suggesting that interventions may be more effective if tailored differently for males and females. Interventions may need to be multifaceted and designed to address these different domains of functioning.

Emotional and behavioural resilience to multiple risk exposure in early life: the role of parenting

Ecological and transactional theories link child outcomes to neighbourhood disadvantage, family poverty and adverse life events. Traditionally, these three types of risk factors have been examined independently of one another or combined into one cumulative risk index. The first approach results in poor prediction of child outcomes, and the second is not well rooted in ecological theory as it does not consider that distal risk factors (such as poverty) may indirectly impact children through proximal risk factors (such as adverse life events). In this study, we modelled simultaneously the longitudinal effects of these three risk factors on children's internalising and externalising problems, exploring the role of parenting in moderating these effects. Our sample followed 16,916 children (at ages 3, 5 and 7 years; N = 16,916; 49% girls) from the UK Millennium Cohort Study. Parenting was characterised by quality of parent-child relationship, parental involvement in learning and parental discipline. Neighbourhood disadvantage, family poverty and adverse events were all simultaneously related to the trajectories of both outcomes. As expected, parenting moderated risk effects. Positive parent-child relationship, rather than greater involvement or authoritative discipline, most consistently 'buffered' risk effects. These findings suggest that a good parent-child relationship may promote young children's emotional and behavioural resilience to different types of environmental risk.

Cumulative risk effects for the development of behaviour difficulties in children and adolescents with special educational needs and disabilities

Research has identified multiple risk factors for the development of behaviour difficulties. What have been less explored are the cumulative effects of exposure to multiple risks on behavioural outcomes, with no study specifically investigating these effects within a population of young people with special educational needs and disabilities (SEND). Furthermore, it is unclear whether a threshold or linear risk model better fits the data for this population. The sample included 2660 children and 1628 adolescents with SEND. Risk factors associated with increases in behaviour difficulties over an 18-month period were summed to create a cumulative risk score, with this explanatory variable being added into a multi-level model. A quadratic term was then added to test the threshold model. There was evidence of a cumulative risk effect, suggesting that exposure to higher numbers of risk factors, regardless of their exact nature, resulted in increased behaviour difficulties. The relationship between risk and behaviour difficulties was non-linear, with exposure to increasing risk having a disproportionate and detrimental impact on behaviour difficulties in child and adolescent models. Interventions aimed at reducing behaviour difficulties need to consider the impact of multiple risk variables. Tailoring interventions towards those exposed to large numbers of risks would be advantageous.

Gender disparities among the association between cumulative family-level stress & adolescent weight status

OBJECTIVE

To investigate precursors to gender-related obesity disparities by examining multiple family-level stress indices.

METHODS

Analyses was based on adolescents born between 1975 and 1991 to women from the 1979 National Longitudinal Study of Youth data set (N=4762). Three types of family-level stressors were captured from birth to age 15: family disruption and conflict, financial strain, and maternal risky health behaviors, along with a total cumulative risk index. Body mass index was constructed on reference criteria for children outlined by the Centers for Disease Control. Multivariate logistic regressions were conducted for the three types of family stressors and for the total cumulative index.

RESULTS

The accumulation of family disruption and conflict and financial stress was positively related to female adolescents being overweight/obese. Childhood exposure to maternal risky health behaviors was positively associated with higher weight status for male adolescents. Total cumulative stress was related to overweight/obesity for females, but not males.

CONCLUSION

Different family-level stress indices are associated with the weight status of female and male adolescents. Combining types of family-level stress into one cumulative index appears to mask these differences.

An attachment-based intervention for parents of adolescents at risk: mechanisms of change

Mechanisms that account for treatment effects are poorly understood. The current study examined processes that may underlie treatment outcomes of an attachment-based intervention (Connect) for parents of pre-teens and teens with serious behavior problems. Parents (N = 540) in a non-randomized trial reported on their teen's functioning prior to and following treatment. Results confirmed significant decreases in parents' reports of teens' externalizing and internalizing symptoms, replicating prior evaluations of this program. Reductions in parents' reports of teen attachment avoidance were associated with decreases in externalizing symptoms, while reductions in parents' reports of teen attachment anxiety were associated with decreases in internalizing symptoms. Parents' reports of improved teen affect regulation were also associated with decreases in both internalizing and externalizing symptoms. Results were comparable across gender and for parents of teens with pre-treatment externalizing symptoms in the clinical versus sub-clinical range. A model of therapeutic change in attachment-based parenting programs is discussed.

Social stress and the oxytocin receptor gene interact to predict antisocial behavior in an at-risk cohort

Polymorphisms in the oxytocin receptor gene are commonly associated with prosocial behaviors in the extant literature, yet their role in antisocial behaviors has rarely been explored, particularly during the transition from adolescence to early adulthood. We examined a prospective cohort (N = 404), collecting youth, mother, and clinician reports of conduct-disordered and antisocial behavior at ages 15 and 20. The oxytocin receptor gene rs53576 polymorphism was hypothesized to interact with social stress to predict antisocial outcomes. Structural equation modeling results revealed a significant main effect at age 15 (p = .025); those with the G allele exhibited higher levels of conduct problems. Structural equation modeling revealed a significant Gene × Environment interaction at age 20 (p = .029); those with the G allele who experienced high social stress exhibited higher levels of antisocial behavior. Heterozygous (AG) grouping models were compared, and parameter estimations supported G dominant groupings. These novel findings suggest that rs53576 polymorphisms may influence social salience and contribute to risk for antisocial outcomes, particularly under conditions of high social stress.

Mexican American adolescents' profiles of risk and mental health: a person-centered longitudinal approach

Although Mexican American adolescents experience multiple risk factors in their daily lives, most research examines the influences of risk factors on adjustment independently, ignoring the additive and interactive effects of multiple risk factors. Guided by a person-centered perspective and utilizing latent profile analysis, this study identified Mexican American fifth graders' (N = 749) risk profiles based on family, peer, and socio-cultural risk factors and examined the relations of these risk profiles to mental health symptomatology in seventh grade. Results revealed three distinct profiles that differed quantitatively and qualitatively. Profiles were then linked to levels of mental health symptomatology, with youth in the highest risk profile displaying the most symptoms. Youth in two other risk profiles displayed lower levels. The findings suggest that Mexican American youth develop within distinct risk contexts that differ in their relations to adjustment. Such findings inform prevention/intervention efforts aimed at reducing mental health problems in adolescence.

When there seem to be no predetermining factors: early child and proximal family risk predicting externalizing behavior in young children incurring no distal family risk

The main objective of the current study was to examine the impact of two child risk factors, i.e. personality and inhibition, and two proximal family risk factors, i.e. parenting and attachment, and the impact of their cumulative effect on later externalizing behavior among young children incurring no distal family risk. Data were collected in a longitudinal two-wave design from 161 non-referred and referred children aged three to five years at the onset of the study. All of the children were raised in families of middle to high socio-economic status, i.e. their parents were educated to a middle to high level, had access to the job market and lived together as couples. The four risk domains were assessed at the onset of the study, while EB was rated both at the onset of the study and in the 24-month follow-up. Results confirmed that the four risk domains were each both correlates of EB and efficient at discriminating non-referred from referred children; that their combination regardless of their content (cumulative risk) provided a strong prediction of both later EB and non-referred vs referred sample membership. The results are discussed both for research and clinical purposes.

Aggression as an equifinal outcome of distinct neurocognitive and neuroaffective processes

Early onset aggression precipitates a cascade of risk factors, increasing the probability of a range of externalizing and internalizing psychopathological outcomes. Unfortunately, decades of research on the etiological contributions to the manifestation of aggression have failed to yield identification of any risk factors determined to be either necessary or sufficient, likely attributable to etiological heterogeneity within the construct of aggression. Differential pathways of etiological risk are not easily discerned at the behavioral or self-report level, particularly in young children, requiring multilevel analysis of risk pathways. This study focuses on three domains of risk to examine the heterogeneity in 207 urban kindergarten children with high levels of aggression: cognitive processing, socioemotional competence and emotion processing, and family context. The results indicate that 90% of children in the high aggression group could be characterized as either low in verbal ability or high in physiological arousal (resting skin conductance). Children characterized as low verbal, high arousal, or both differed in social and emotional competence, physiological reactivity to emotion, and aspects of family-based contextual risk. The implications of this etiologic heterogeneity of aggression are discussed in terms of assessment and treatment.

Fathers' coping resources and children's socioemotional adjustment among children with learning disabilities

This study examined a cumulative model of vulnerability and protective factors at the individual level (children's attachment relationships with father and children's sense of coherence) and at the family level as manifested by fathers' coping resources (fathers' sense of coherence, fathers' active and avoidant coping strategies) in helping to explain differences in socioemotional and behavioral adjustment among children at the age 8 to 12 years with learning disabilities (LD) and or with typical development. The sample included 205 father-child dyads: 107 fathers and their children having LD and 98 fathers and their children with typical development, from the same public elementary schools. Preliminary analyses indicated significant group differences on all the children's measures as well as on fathers' avoidant coping strategies. Path analysis examined the multidimensional risk model for the LD and non-LD groups. The study found a high fit between the theoretical model and the empirical findings as well as a different pattern of relationship between the model's components for the two populations studied. Discussion focuses on understanding the unique value of vulnerability and protective factors at the individual and family levels on children's well-adjusted functioning.

Traumatic and stressful events in early childhood: can treatment help those at highest risk?

OBJECTIVE

This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs).

METHODS

Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs).

RESULTS

For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group.

CONCLUSIONS

The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well.

PRACTICE IMPLICATIONS

Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's treatment may be particularly effective in the treatment of young children exposed to multiple risks.

Get them before they get you: Trust, trustworthiness, and social cognition in boys with and without externalizing behavior problems

Economic exchange games have rarely been applied to examine psychopathology in youth. In the current study we adapted a trust game to investigate the relations between externalizing behavior problems, trust, and trustworthiness. We were particularly interested in the differential modulating impact of “known identity” (vs. anonymous) condition of the task. Second, we examined whether anomalies in trust behavior would correspond to social cognition manifested in children with externalizing problems. A total of 171 (79 age-matched pairs) boys (mean age = 12.84; SD = 1.80) were recruited from community groups where social networks and relationships amongst peers have been established. A trust game was played under two conditions: an anonymous version where the identity of the trust game partner was not known and a “known identity” version where identities were revealed. Results supported the conclusion that boys with externalizing behavior problems are generally less trustworthy, but not less trusting and that this was true especially for the known identity version of the game. Moreover, anomalies in trust behavior were associated with hostile intentions, but not reflective of a general theory of mind deficit. This study contributes to an emerging literature using economic exchange games to investigate real-time, real-life exchanges in relation to psychopathology.

Modeling multiple risks during infancy to predict quality of the caregiving environment: contributions of a person-centered approach

The primary goal of this study was to compare several variable-centered and person-centered methods for modeling multiple risk factors during infancy to predict the quality of caregiving environments at six months of age. Nine risk factors related to family demographics and maternal psychosocial risk, assessed when children were two months old, were explored in the understudied population of children born in low-income, non-urban communities in Pennsylvania and North Carolina (N = 1047). These risk factors were (1) single (unpartnered) parent status, (2) marital status, (3) mother's age at first child birth, (4) maternal education, (5) maternal reading ability, (6) poverty status, (7) residential crowding, (8) prenatal smoking exposure, and (9) maternal depression. We compared conclusions drawn using a bivariate approach, multiple regression analysis, the cumulative risk index, and latent class analysis (LCA). The risk classes derived using LCA provided a more intuitive summary of how multiple risks were organized within individuals as compared to the other methods. The five risk classes were: married low-risk; married low-income; cohabiting multiproblem; single low-income; and single low-income/education. The LCA findings illustrated how the association between particular family configurations and the infants' caregiving environment quality varied across race and site. Discussion focuses on the value of person-centered models of analysis to understand complexities of prediction of multiple risk factors.

Childhood bullying as a predictor for becoming a teenage mother in Finland

The aim of this study is to examine the association between bullying behaviour at the age of 8 and becoming a mother under the age of 20. This birth cohort study included 2,867 Finnish girls at baseline in 1989. Register-based follow-up data on births was collected until the end of 2001. Information, both on the main exposure and outcome, was available for 2,507 girls. Both bullies and victims had an increased risk of becoming a teenage mother independent of family-related risk factors. When controlled for childhood psychopathology, however, the association remained significant for bullies (OR 2.2, 95% CI 1.2-4.1) and bully-victims (OR 1.8, 95% CI 1.05-3.2), but not for pure victims. Reports of bullying and victimisation from the girls themselves, their parents and their teachers were all associated with becoming a teenage mother independent of each other. There is a predictive association between being a bully in childhood and becoming a mother in adolescence. It may be useful to target bullies for teenage pregnancy prevention.

Posttraumatic stress among young urban children exposed to family violence and other potentially traumatic events

This study examines the relationship between the number of types of traumatic events experienced by children 3 to 6 years old, parenting stress, and children's posttraumatic stress (PTS). Parents and caregivers provided data for 154 urban children admitted into community-based mental health or developmental services. By parent and caregiver report, children experienced an average of 4.9 different types of potentially traumatic events. Nearly one quarter of the children evidenced clinically significant PTS. Posttraumatic stress was positively and significantly related to family violence and other family-related trauma exposure, nonfamily violence and trauma exposure, and parenting stress. Additionally, parenting stress partially mediated the relationship between family violence and trauma exposure and PTS. This study highlights the need for early violence and trauma exposure screening in help-seeking populations so that appropriate interventions are initiated.

Predicting child abuse potential: an empirical investigation of two theoretical frameworks

This study investigated two theoretical risk models predicting child maltreatment potential: (a) Belsky's (1993) developmental-ecological model and (b) the cumulative risk model in a sample of 610 caregivers (49% African American, 46% European American; 53% single) with a child between 3 and 6 years old. Results extend the literature by using a widely accepted and valid risk instrument rather than occurrence rates (e.g., reports to child protective services, observations). Results indicated Belsky's developmental-ecological model, in which risk markers were organized into three separate conceptual domains, provided a poor fit to the data. In contrast, the cumulative risk model, which included the accumulation of risk markers, was significant in predicting child abuse potential.

Modeling the interplay of multilevel risk factors for future academic and behavior problems: a person-centered approach

This study identified profiles of 13 risk factors across child, family, school, and neighborhood domains in a diverse sample of children in kindergarten from four US locations (n = 750; 45% minority). It then examined the relation of those early risk profiles to externalizing problems, school failure, and low academic achievement in Grade 5. A person-centered approach, latent class analysis, revealed four unique risk profiles, which varied considerably across urban African American, urban White, and rural White children. Profiles characterized by several risks that cut across multiple domains conferred the highest risk for negative outcomes. Compared to a variable-centered approach, such as a cumulative risk index, these findings provide a more nuanced understanding of the early precursors to negative outcomes. For example, results suggested that urban children in single-parent homes that have few other risk factors (i.e., show at least average parenting warmth and consistency and report relatively low stress and high social support) are at quite low risk for externalizing problems, but at relatively high risk for poor grades and low academic achievement. These findings provide important information for refining and targeting preventive interventions to groups of children who share particular constellations of risk factors.

Effectiveness of an attachment-focused manualized intervention for parents of teens at risk for aggressive behaviour: The Connect Program

Aggressive, violent and antisocial behaviour in children and adolescents is a growing concern across the globe. Targeting parent-teen relationships is critical in reducing problem behaviour. 'Connect' is a manualized ten-week program for parents or alternative caregivers of at-risk teens that focuses on the building blocks of secure attachment: parental sensitivity, cooperation, reflective capacity, and effective dyadic affect regulation. Through didactic and experiential activities, parents develop the competence necessary to identify, understand and respond to the needs of their teen in a manner that provides structure and safety while safeguarding the quality of the parent-teen relationship. In Study 1, twenty parents reported significant increases in perceived parenting satisfaction and efficacy and reductions in adolescents' aggression, antisocial behaviour and other mental health problems following completion of Connect as compared to a waitlist control period. These effects were sustained and additional small effects were noted in decreases in conduct problems, depression and anxiety at a 12-month follow-up. The program was then transported to 17 communities serving 309 parents through standardized training and supervision of group leaders. Study 2 summarizes significant pre- to post-treatment reductions in teen externalizing and internalizing problems; enhanced social functioning; and improvements in affect regulation. Parents also reported significant increases in parenting satisfaction and perceived efficacy and reductions in caregiver burden.

Parental engagement and barriers to participation in a community-based preventive intervention

This study examined parent characteristics and barriers to participation in a community-based preventive intervention with a sample of 201 parents from low-income and predominantly ethnic minority backgrounds. Person-centered analyses revealed five subgroups of parents who demonstrated variability in their parent characteristics, which included psychological resources and level of parental involvement in education. Group membership was associated with differences in school involvement and use of the psychoeducational intervention at home, after accounting for the number of barriers to engagement. For the intervention attendance variable, greater number of barriers was associated with decreased attendance only for parents in the resilient subgroup and the psychologically distressed subgroup. Attendance remained constant across levels of barriers for the other three subgroups of parents. The results of the study inform theory and practice regarding how to tailor preventive interventions to accommodate subgroups of parents within populations that experience barriers to accessing mental health services.

Viewing preschool disruptive behavior disorders and attention-deficit/hyperactivity disorder through a developmental lens: what we know and what we need to know

Empirical investigation into disruptive behavior disorders (DBDs) and attention deficit/hyperactivity disorder (ADHD) in early childhood has expanded considerably during the past decade. Although there have been considerable gains in the understanding of the presentation and course of these psychiatric disorders in early childhood, the lack of a developmental framework to guide nosologic issues likely impedes progress in this area. The authors propose that enhanced developmental sensitivity in defining symptoms of DBDs and ADHD may shed light on outstanding issues in the field. In particular, developmental specification may enhance specificity, sensitivity, and stability of DBDs and ADHD symptoms as well as inform our understanding of which type of treatment works best for whom. This article provides an overview of these critical issues.

Stress parental, soutien social, comportements de l’enfant et fréquentation des services de garde

Cette étude examine les taux de problèmes de comportement internalisés et externalisés des enfants et des indices de stress parental et du réseau de soutien social rapportés par les parents d’un échantillon d’enfants et de familles en fonction du type de service de garde fréquenté par les enfants. Elle vise aussi à identifier si les mêmes variables diffèrent en fonction de l’utilisation de divers types de services de garde et de la présence de divers facteurs de risques psychosociaux (0, 1, 2, 3) dans la famille, et ce, tout en contrôlant les effets reliés à l’âge et la santé des enfants ainsi qu’au pays d’origine et à l’âge de la mère. À cette fin, nous utilisons les données de trois cueillettes de données transversales de l’évaluation de l’initiative 1,2,3GO!. L’échantillon comporte 1245 enfants et familles provenant de 10 territoires de la grande région de Montréal. Les enfants sont âgés de 20 à 42 mois. Nous mesurons les comportements des enfants à l’aide du Child Behaviour Checklist (CBCL). Nous utilisons aussi la version abrégée du Parenting Stress Index pour mesurer le stress parental et la taille du réseau de soutien social (Barrera). Les parents répondent à un questionnaire sur le type de garde utilisé pour leur enfant. Les résultats indiquent que la fréquentation d’un service de garde est associée à moins de problèmes de comportements internalisés chez les enfants ainsi qu’à un plus grand réseau de soutien social chez les parents. Il n’y a pas de différences significatives pour ce qui est des scores de comportements externalisés chez les enfants et de l’indice de stress parental chez leurs parents. Ce sont les enfants et leurs parents qui utilisent des services structurés (CPE, garderies et services de garde en milieu familial) qui obtiennent les meilleurs scores relativement aux comportements internalisés des enfants et à la taille du réseau de soutien social des parents. Nos résultats soulignent également que les enfants qui ne fréquentent aucun service de garde présentent des taux supérieurs de comportements internalisés problématiques et externalisés limites à ce qu’on retrouve dans la population en général. Il en est de même pour les parents qui ne recourent à aucun service de garde, c’est-à-dire qu’ils présentent des taux plus élevés de stress parental et plus faibles de soutien social que la population en général. La discussion fait le lien entre les résultats de cette étude et d’autres résultats obtenus récemment. La conclusion propose de poursuivre l’accroissement du réseau afin de mieux répondre aux besoins des familles vulnérables.

Predicting family burden following childhood traumatic brain injury: a cumulative risk approach

OBJECTIVE

To examine the utility of a cumulative risk index (CRI) in predicting the family burden of injury (FBI) over time in families of children with traumatic brain injury (TBI).

PARTICIPANTS

One hundred eight children with severe or moderate TBI and their families participated in the study.

MEASURES

The measures used in the study include the Socioeconomic Composite Index, Life Stressors and Social Resources Inventory--Adult Form, Vineland Adaptive Behavior Scales, Child Behavior Checklist, Children's Depression Inventory, McMaster Family Assessment Device, Brief Symptom Inventory, and Family Burden of Injury Interview. In addition, information on injury-related risk was obtained via medical charts.

METHODS

Participants were assessed immediately, 6, and 12 months postinjury and at a 4-year extended follow-up.

RESULTS

Risk variables were dichotomized (ie, high- or low-risk) and summed to create a CRI for each child. The CRI predicted the FBI at all assessments, even after accounting for autocorrelations across repeated assessments. Path coefficients between the outcome measures at each time point were significant, as were all path coefficients from the CRI to family burden at each time point. In addition, all fit indices were above the recommended guidelines, and the chi statistic indicated a good fit to the data.

CONCLUSIONS

The current study provides initial support for the utility of a CRI (ie, an index of accumulated risk factors) in predicting family outcomes over time for children with TBI. The time period immediately after injury best predicts the future levels of FBI; however, cumulative risk continues to influence the change across successive postinjury assessments. These results suggest that clinical interventions could be proactive or preventive by intervening with identified "at-risk" subgroups immediately following injury.

Configurations of common childhood psychosocial risk factors

BACKGROUND

Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors.

METHODS

Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class structure was retested in a representative population sample of 1420 children aged 9 to 13. In each sample, the child and one parent were interviewed with the Child and Adolescent Psychiatric Assessment. Concurrent psychiatric status was used to validate class membership.

RESULTS

LCA identified five latent classes in both samples: two low risk classes; two moderate risk classes both involving family poverty configured with various other risk factors; and a high risk class characterized by family relational dysfunction and parental risk characteristics. Of the primary sample, 48.6% were categorized as low risk, 42.8% as moderate risk, and 8.6% as high risk. Moderate risk classes differed in their prediction of disruptive and emotional disorders depending on their specific risk factor configurations. High risk youth had the highest levels of both emotional and disruptive disorders. Combining our latent classes with a cumulative risk approach best accounted for the effects of risk factors on psychopathology in our primary sample.

CONCLUSIONS

Particular risk configurations have specific associations with psychiatric disorders. Configurational approaches are an important asset for large-scale epidemiological studies that integrate information about patterns of risk and disorders.