International Comparisons of the Dysregulation Profile Based on Reports by Parents, Adolescents, and Teachers

Stage 2 Registered Report: The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach

OBJECTIVE

Youth with symptoms of emotion dysregulation are at risk for a multitude of psychiatric diagnoses later in life. However, few studies have focused on the underlying neurobiology of emotion dysregulation. This study assessed the bidirectional relationship between emotion dysregulation symptoms and brain morphology throughout childhood and adolescence.

METHOD

A combined total of 8,235 children and adolescents drawn from 2 large population-based cohorts, the Generation R Study and Adolescent Brain Cognitive Development (ABCD) Study, were included. Data were acquired in 3 waves in Generation R (mean [SD] age = 7.8 [1.0] wave 1 [W1]; 10.1 [0.6] W2; 13.9 [0.5] W3) and in 2 waves in ABCD (mean [SD] age = 9.9 [0.6] W1; 11.9 [0.6] W2). Cross-lagged panel models were used to determine the bidirectional relationships between emotion dysregulation symptoms and brain morphology. The study was preregistered before performing analyses.

RESULTS

In the Generation R sample, emotion dysregulation symptoms at W1 preceded lower hippocampal (β = -.07, SE = 0.03, p = .017) and temporal pole (β = -.19, SE = 0.07, p = .006) volumes at W2. Emotion dysregulation symptoms at W2 preceded lower fractional anisotropy in the uncinate fasciculus (β = -.11, SE = 0.05, p = .017) and corticospinal tract (β = -.12, SE = 0.05, p = .012). In the ABCD sample, emotion dysregulation symptoms preceded posterior cingulate (β = .01, SE = 0.003, p = .014) and nucleus accumbens volumes (left hemisphere: β = -.02, SE = 0.01, p = .014; right hemisphere: β = -.02, SE = 0.01, p = .003).

CONCLUSION

In population-based samples, with relatively low psychopathology symptoms in the majority of children, symptoms of emotion dysregulation can precede differential development of brain morphology. This provides the foundation for future work to assess to what extent optimal brain development can be promoted through early intervention.

STUDY REGISTRATION INFORMATION

The Bidirectional Relationship Between Brain Features and the Dysregulation Profile: A Longitudinal, Multimodal Approach; https://doi.org/10.1016/j.jaac.2022.03.008.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure that the study questionnaires were prepared in an inclusive way. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Discrepancies in Mother-Child Reports of Child's Exposure to Intimate Partner Violence: Associations With Externalizing Symptoms

The type and frequency of children's exposure to intimate partner violence (IPV) are considered as key variables in understanding children's heightened risk of externalizing symptoms. Notably, children's exposure to IPV has been primarily measured using mothers' reports of their own victimization. However, mothers and children might differently perceive children's exposure to physical IPV. To date, no research has investigated multi-rater reporting discrepancies in child's exposure to physical IPV and whether such discrepancies would be linked to externalizing symptoms. This study aimed to identify patterns of mother-child discrepancies in child's exposure to physical IPV and examine whether those patterns would be associated with children's externalizing symptoms. Participants were mothers who have experienced police-reported male-perpetrated IPV and their children (n = 153; 4-10 years). Latent profile analysis identified three profiles of mother-child discrepancies: a concordant group reporting high IPV exposure; a discordant group with mothers and children reporting high and low child's IPV exposure, respectively; a second discordant group with mothers and children reporting low and moderate IPV exposure, respectively. Profiles of mother-child discrepancies were differentially associated with children's externalizing symptoms. Findings suggest that discrepancies among informants' ratings of children's IPV exposure might have important implications for measurement, assessment, and treatment.

Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies

BACKGROUND

Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies.

METHODS

Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects.

RESULTS

Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects.

CONCLUSIONS

Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

Co-developmental Trajectories of Defiant/Headstrong, Irritability, and Prosocial Emotions from Preschool Age to Early Adolescence

This study ascertains how the proposed subtypes and specifiers of oppositional defiant disorder (ODD) based on irritability and prosocial emotions co-develop and describes the clinical characteristics of the resultant classes. A sample of 488 community children was followed up from ages 3 to 12 years and assessed with categorical and dimensional measures answered by parents and teachers. Latent class growth analysis for three parallel processes [defiant/headstrong, irritability, and limited prosocial emotions (LPE)] identified a 4-class model with adequate entropy (.912) and posterior probabilities of class membership (≥ .921). Class 1 (n = 38, 7.9%) was made up of children with defiant/headstrong with chronic irritability and LPE. Class 2 (n = 128, 26.3%) was comprised of children with defiant/headstrong with chronic irritability and typical prosocial emotions. Class 3 (n = 101, 20.7%) clustered children with LPE without defiant/headstrong and without irritability. Class 4 (n = 220, 45.1%) included children with the lowest scores in all the processes. The classes were distinguishable and showed different clinical characteristics through development. These findings support the validity of ICD-11 ODD subtypes based on chronic irritability and may help to guide clinicians' decision-making regarding treating oppositionality in children.

Frustration, Cognition, and Psychophysiology in Dysregulated Children: A Research Domain Criteria Approach

OBJECTIVE

Dysregulated children experience significant impairment in regulating their affect, behavior, and cognitions and are at risk for numerous adverse sequelae. The unclear phenomenology of their symptoms presents a barrier to evidence-based diagnosis and treatment.

METHOD

The cognitive, behavioral, and psychophysiological mechanisms of dysregulation were examined in a mixed clinical and community sample of 294 children ages 7-17 using the Research Domain Criteria constructs of cognitive control and frustrative nonreward.

RESULTS

Results showed that caregivers of dysregulated children viewed them as having many more problems with everyday executive function than children with moderate or low levels of psychiatric symptoms; however, during standardized assessments of more complex cognitive control tasks, performance of dysregulated children differed only from children with low symptoms on tests of cognitive flexibility. In addition, when frustrated, dysregulated children performed more poorly on the Go/No-Go Task and demonstrated less autonomic flexibility as indexed by low respiratory sinus arrhythmia and pre-ejection period scores.

CONCLUSION

The findings of this study suggest that autonomic inflexibility and impaired cognitive function in the context of frustration may be mechanisms underlying childhood dysregulation.

Emotional Dysregulation in Adults from 10 World Societies: An Epidemiological Latent Class Analysis of the Adult-Self-Report

Background/Objective

Method

Results

Conclusions

Irritability, Defiant and Obsessive-Compulsive Problems Development from Childhood to Adolescence

Little is known about the coexistence of oppositionality and obsessive-compulsive problems (OCP) in community children and how it affects their development until adolescence to prevent possible dysfunctions. The co-development of oppositional defiant dimensions and OCP is studied in 563 children (49.7% female) from ages 6 to 13 years, assessed yearly with measures answered by parents and teachers. A 4-class model based on Latent Class Growth Analysis for three parallel processes (irritability, defiant, and OCP) was selected, which showed adequate fitting indexes. Class 1 (n = 349, 62.0%) children scored low on all the measures. Class 2 (n = 53, 9.4%) contained children with high OCP and low irritability and defiant. Class 3 (n = 108, 19.2%) clustered children with high irritability and defiant and low OCP. Class 4 (n = 53, 9.4%) clustered comorbid irritability, defiant, and OCP characteristics. The classes showed different clinical characteristics through development. The developmental co-occurrence of irritability and defiant plus obsessive-compulsive behaviors is frequent and adds severity through development regarding comorbidity, peer problems, executive functioning difficulties, and daily functioning. The identification of different classes when combining oppositional problems and OCP may be informative to prevent developmental dysfunctions and to promote good adjustment through development.

Latent Class Analysis of the CBCL Dysregulation Profile for 6- to 16-Year-Olds in 29 Societies

Objective: We used latent class analysis (LCA) to examine the prevalence and characteristics of the Dysregulation Profile (DP) based on data from the Child Behavior Checklist for Ages 6-18. The DP comprises elevated scores on the Anxious/Depressed, Attention Problems, and Aggressive Behavior syndromes and thus reflects significant problems in self-regulation of mood, attention, and behavior.Method: We examined CBCL data for 56,666 children ages 6 to 16 in 29 societies, many of which are countries but some of which are not (e.g., Hong Kong, Puerto Rico). The 29 societies varied widely in race/ethnicity, religion, geographic location, political/economic system, and population size.Results: The various statistical indices for good LCA model fit, while not always consistent, supported a DP class in every society. The omnicultural mean probability of assignment to the DP class (mean of the societal means) was 93% (SD = 2.4%). Prevalence of the DP class ranged from 2% to 18% across societies, with an omnicultural mean prevalence of 9%. In every society, the DP class had significantly higher scores than the pooled non-DP classes on all three DP syndromes. The 8-syndrome T score profile for the DP class in many societies featured elevations on all eight CBCL syndromes.Conclusions: Although the same instrument, analytic procedures, and decision rules were used in these 29 samples, model fit, the number of classes, and the prevalence of the DP class varied across societies. High scores on the three DP syndromes often co-occurred with high scores on most other CBCL syndromes.

Effects of society and culture on parents' ratings of children's mental health problems in 45 societies

To improve international needs assessment for child mental health services, it is necessary to employ standardized assessment methods that can be easily administered and scored, can be interpreted by practitioners and researchers with various kinds of training, and that perform similarly across many societies. To this end, we tested the effects of both society and culture on parents' ratings of children's problems. We used hierarchical linear modeling as well as analyses of variance to analyze parents' Child Behavior Checklist ratings of 72,493 6- to 16-year-olds from 45 societies. The 45 societies were nested within 10 culture clusters based on the Global Leadership and Organizational Behavior Effectiveness (GLOBE) taxonomy. Societal differences accounted for 3.8-10.7% of variance in various kinds of problems, while differences between culture clusters (e.g., Anglo vs. Confucian) accounted for 0.1-10.0%. By contrast, differences associated with parents' ratings of individual children accounted for 85.5-93.3% of variance. Averaged across 17 problem scales, society plus culture cluster accounted for about 10% of the variance in parents' ratings of children's problems, whereas individual differences and other possible variables accounted for about 90%. These findings indicate that parents' standardized ratings can be used to assess effects associated with individual differences in child and adolescent psychopathology, over and above differences associated with societies and culture clusters.

Quality of life in children and adolescents in Central Kenya: associations with emotional and behavioral problems

Purpose

To assess the quality of life (QoL) of children and adolescents in Kenya as rated by parents and youth themselves, and examine how QoL is related to emotional and behavioral problems (EBP).

Method

QoL and EBP reports were obtained from 1022 Kenyan parents and 533 adolescents living in the country’s Central Province. Parents with children between 6 and 18 years completed the Pediatric Quality of Life Inventory (PedsQL) and the Child Behavior Checklist, while the adolescents (12–18) completed the PedsQL and the Youth Self-Report.

Results

Parent-reported QoL in Kenyan youth was somewhat above that of US standardization samples, while levels of adolescent self-reports were well within the range of those from most high- and middle-income countries. Average adolescent girls’ self-reports were lower on all QoL scales than boys. QoL in children/adolescents with clinical to borderline levels of EBP (cf. multicultural norms, Achenbach and Rescorla, 2007) was lower than QoL in agemates with normal levels of EBP. Regression analyses indicated unique associations of QoL with parent-reported withdrawn/depressed, somatic complaints, attention problems, and aggressive behavior, and with adolescent self-reported somatic complaints, attention problems, and rule-breaking behavior.

Conclusion

QoL levels were well within ranges of other countries. Moreover, associations of QoL with EBP indicated that those with borderline/clinical levels of EBP had a much lower QoL most notable for those with somatic complaints and attention problems. Mental health providers might focus on interventions that reduce EBP in Kenyan children and adolescents and simultaneously reduce the risk of lowered QoL.