SDQ Dysregulation Profile and Its Relation to the Severity of Psychopathology and Psychosocial Functioning in a Sample of Children and Adolescents With ADHD

The role of cognitive disengagement syndrome in non-suicidal self-injury among adolescents with attention deficit hyperactivity disorder

AIMS

We aimed to investigate the relationship between Cognitive Disengagement Syndrome (CDS) and non-suicidal self injury (NSSI) in adolescents with attention deficit hyperactivity disorder (ADHD).

METHODS

A semi-structured psychiatric interview and an NSSI screening questionnaire were conducted. Questionnaires assessing CDS (with daydreamer, sleepy, and slow subdimensions), depression, anxiety, self-esteem, emotion regulation, coping strategies, and loneliness were administered.

RESULTS

Among 104 participants (n: 63, 60.6% girls), the combined type of ADHD was the most common (66.3%), and 35 adolescents (27 girls) were in the NSSI+ group. Although only depression and ADHD were found to be predictors of NSSI in ADHD, CDS was associated with many risk factors of NSSI in ADHD: depression, anxiety, emotion dysregulation, low self-esteem, and emotion-oriented coping ways. After controlling for the effects of cognitive problems/inattentiveness, depression, and anxiety, CDS still correlated with low self-esteem and emotion dysregulation. The daydreamer and slow sub-dimensions of CSD differed between NSSI+ and NSSI- groups, while sleepy did not.

CONCLUSIONS

CDS is associated with several relevant factors, indirectly relating it to self-harm in ADHD. CDS increases the vulnerability to mental health changes that could lead to NSSI in adolescence with ADHD.

Measuring Children's Reward and Punishment Sensitivity: An Initial Psychometric Evaluation of the Contingency Response Rating Scale

Existing research shows that children's responses to rewards and punishments are essential for understanding attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and callous-unemotional traits. The present study developed the Contingency Response Rating Scale (CRRS) to fulfill the need for a reliable and valid measure of children's contingency response style that is brief, easy to use in applied settings, and provides additional information to existing clinical measures. We examined the psychometric properties of the CRRS in a sample of 196 children (ages 5-12), most of whom were referred to evaluate attention and behavior problems in an outpatient clinic. Using principal axis factoring, we identified five factors: (a) punishment ineffectiveness, (b) reward ineffectiveness, (c) punishment dysregulation, (d) reward dysregulation, and (e) contingency insensitivity. The subscales based on these factors showed acceptable test-retest and internal consistency reliability, and scale intercorrelations varied from low to moderate. The subscales also captured significant variance not explained by child or parent demographics and were associated with measures of psychopathology and impairment. The results provide preliminary evidence that the CRRS may be a helpful tool for assessing reward and punishment sensitivity in children with attention and behavior problems.

The Strengths and Difficulties Questionnaire Dysregulation Profile Teacher-Report: Psychometric Properties and Associations with Aspects of School Experience

Emotional, cognitive, and behavioral dysregulation is a risk factor for severe outcomes, calling for reliable measures to assess it, including the Strengths and Difficulties Questionnaire Dysregulation Profile (SDQ-DP) defined by 5 or 15 items. This study explored for the first time the factor structure, internal consistency, and test-retest reliability of the SDQ-DPs teacher-report in a sample of Italian children (N = 1000; age 7-12 years). The gender invariance of the SDQ-DPs, construct validity, and associations with school variables were also evaluated. A first-order model for the SDQ-DP 5-item and a bifactor model for the SDQ-DP 15-item best fitted the data. Full measurement invariance across gender was confirmed only for the 15-item scale. Internal and test-retest reliabilities were weaker for the 5-item scale. Both SDQ-DPs were similarly associated with a measure of emotion regulation skills and some school variables. This study provides indications for a more conscious use of the two scales.

Screening for disruptive behavior in adolescents at risk using the strengths and difficulties questionnaire

Disruptive behavior in adolescents is burdensome and may continue into adulthood if left unidentified. The strengths and difficulties questionnaire (SDQ) can screen for disruptive behavior, but its psychometric properties in high-risk samples and ability to predict delinquency warrant further investigation. In 1022 adolescents, we investigated the predictive validity (on average 1.9 years after screening) of the self-reported SDQ on disruptive behavior disorders and delinquency, measured with multi-informant questionnaires and structured interviews. We compared three scoring methods: total, subscale, and dysregulation profile scoring. In this high-risk sample, SDQ subscale scores predicted disruptive behavior outcomes best. Predictive values for the specific types of delinquency were small. Concluding, the SDQ can be used in high-risk settings for early identification of youth with disruptive behavior.

Contemporary diagnosis and treatment of conduct disorder in youth

INTRODUCTION

Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories.

AREAS COVERED

The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators.

EXPERT OPINION

Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.

Predictors of mental health service utilization as adolescents with attention deficit hyperactivity disorder transition into adulthood

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) symptoms may persist into adulthood and are likely to cause great problems in young adults. To date, few studies have explored the characteristics of patients diagnosed with ADHD that might influence the utilization of adult mental health services (AMHS). We aimed to examine and identify predictive symptoms of AMHS.

METHODS

We analysed data from 114 participants diagnosed with ADHD from a cohort of adolescents recruited at the age of 12-17 years, who, at the time of data analysis, were over 18 years old.

RESULTS

Among AMHS users, hyperactivity/impulsivity measures were significantly more severe (t = 2.668, df = 112, p < .001), ADHD combined subtype diagnosis (χ²  = 4.66, df = 1, p = .031) was more frequent and dysregulation profile in the SDQ-P was also significantly higher (t = -2.497, df = 109, p = .014). However, the dysregulation profile did not remain statistically significant after controlling for type of AMHS contact.

CONCLUSIONS

Our findings suggest that adolescents with ADHD are more likely continue their care under AMHS if they present more severe symptoms of hyperactivity/impulsivity and emotional dysregulation. The better characterization of the patient profile will help clinicians to early identify groups at-risk and to tailor interventions and prevention strategies.

The Role of Parenting, Dysregulation and Self-Esteem in Adolescents' Problematic Social Network Site Use: A Test of Parallel and Serial Mediation Models in a Healthy Community Sample

The study addresses some gaps in the current understanding of adolescents' Problematic Social Network Site Use (PSNSU) by exploring the role of parenting as a precursor, and dysregulation and self-esteem as possible mediators. The sample includes 148 parents (15% fathers) and their adolescent offspring (23% male, age ranging from 14 to 18 years old, M = 15.96, SD = 1.36). Parent-reported dysregulation and positive/negative parenting style and adolescent-reported PSNSU and self-esteem were collected. As to positive parenting, simple parallel mediations were fully supported: positive parenting was associated with less dysregulation and higher self-esteem and both conditions independently predicted adolescents' PSNSU. Additionally, a serial mediation model was confirmed, suggesting that positive parenting is associated with less PSNSU by means of the sequential effect of dysregulation on self-esteem. As to negative parenting, results only support one simple mediation: negative parenting predicted PSNSU through dysregulation. Self-esteem was not impacted by negative parenting, interrupting the indirect pathways. The direct effect of negative parenting on PSNSU was significant, suggesting a partial mediation. Findings deepen the current understanding of teens' PSNSU and highlight the importance of targeting parenting when implementing interventions to prevent and treat PSNSU.

The Strengths and Difficulties Questionnaire as a Valuable Screening Tool for Identifying Core Symptoms and Behavioural and Emotional Problems in Children with Neuropsychiatric Disorders

The Strengths and Difficulties Questionnaire (SDQ) is a worldwide questionnaire used for the early identification of behavioural/emotional symptoms in children and adolescents with neuropsychiatric disorders. Although its prognostic power has been studied, it has not yet been tested whether SDQ: (i) can identify pathognomonic symptoms across a variety of neurodevelopmental and neuropsychiatric disorders, (ii) can capture emotional and behavioural problems associated with the main diagnosis, as well as shared transdiagnostic dimensions, and (iii) can detect changes in symptomatology with age. The present study evaluated nearly 1000 children and adolescents overall with Global Developmental Delay (GDD), Intellectual Disability (ID), Language Disorder (LD), Specific Learning Disorder (SLD), Autism Spectrum Disorder (ASD), Attention Deficit/Hyperactivity Disorder (ADHD), Mood Disorder (MD), Anxiety Disorder (AD), and Eating Disorders (ED). We found that SDQ: (i) can identify the core symptoms in children with ASD, ADHD, MD, and AD via specific subscales; (ii) can capture the associated emotional and behavioural symptoms in children with LD, GDD, ID, SLD, and ED; and (iii) can detect changes in the symptomatology, especially for GDD, LD, ASD, ADHD, and AD. SDQ is also able to recognise the transdiagnostic dimensions across disorders. Our results underscore the potential of SDQ to specifically differentiate and identify behavioural/emotional profiles associated with clinical diagnosis.

Parenting practices and dysregulation profile in a sample of Italian children

BACKGROUND

emotional dysregulation is a transdiagnostic factor linked to a heightened risk for psychopathology. A dysregulation profile (DP) derived from the Strenght and Difficulties Questionnaire (SDQ) is often used to indirectly assess emotional dysregulation in children and adolescents. Theoretical models account for parenting as a causal and maintaining factor for emotional dysregulation. Notwithstanding, empirical data are scant.

METHODS

547 students (47.5% males) aged between 9 and 11 years of age (mean age = 9.66, SD = 0.64) were assessed with the SDQ-DP (teacher and parent-reported) and their parents self-reported on their own parenting practices with the Alabama Parenting Questionnaire.

RESULTS

as expected, SDQ-DP teacher-rated was positively associated with maternal and paternal negative parenting practices; SDQ-DP mother and father-rated were both negatively associated with maternal and paternal positive parenting and positively associated with maternal and paternal negative parenting practices.

LIMITATION

the age range is limited to pre-adolescents. The cross-sectional nature of the study precludes inferences on causality.

CONCLUSIONS

youth's emotional dysregulation is linked to parenting practices. These findings support the need to include families in the intervention for emotionally dysregulated youths.

Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED.

METHODS

Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder).

DISCUSSION

Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population.

TRIAL REGISTRATION

Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017.

Psychometric Properties of the Strengths and Difficulties Questionnaire-Dysregulation Profile in Italian Early Adolescents

Emotional dysregulation is of great cause for concern because it is associated with severe outcomes. Currently, the identification of youths with signs of emotional and behavioral dysregulation is obtained through the assessment of a Dysregulation Profile (DP), including the Strengths and Difficulties Questionnaire-DP (SDQ-DP). Despite its increasingly frequent use in research, studies exploring the SDQ-DP properties are still limited, and no study with Italian samples is currently available. The current study aimed to explore the psychometric properties of the SDQ-DP parent-report and its association with difficulties in the school context in a sample of 332 Italian early adolescents. Results showed that the SDQ-DP parent-report is a single-factor measure with good internal consistency. Also, in both males and females, the SDQ-DP parent-report was associated with higher teacher-reported Internalizing (e.g., anxious symptoms) and Externalizing Problems (e.g., hyperactivity, conduct problems) and lower Prosocial Behavior. This study added further evidence about the utility of the SDQ-DP in the assessment, prevention, and treatment of emotional dysregulation.

Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents

BACKGROUND

Self-harm (SH) in adolescence has previously been shown to significantly overlap with both attention deficit hyperactivity disorder (ADHD) and emotional dysregulation (ED). Our objective as such was to investigate the relationship between self-harm and ADHD in our population and consider its clinical relevance.

METHODS

This case series analysis examined 124 presentations of SH in 13- to 17 year-olds to Accident and Emergency Departments in South West London (97F:27M). Strength and Difficulties Questionnaires (SDQs) were used to screen for ADHD/hyperactivity and ED, and scores were compared with reference data obtained from Meltzer et al. (1999, International Review of Psychiatry (Abingdon, England), 15, 185).

RESULTS

Mean SDQ ADHD/hyperactivity scores were significantly higher in our SH sample compared to reference data (p < .0001). Furthermore, significantly greater ED scores were found in our sample compared with the control reference data.

CONCLUSION

Our findings contribute to the evidence for an important link between ADHD and clinical presentations of SH and suggest there to be value in screening girls presenting to A&E with self-harm for ADHD. We speculate that ED plays a role in the evolution of SH in dysregulated ADHD. We recommend that clinicians assessing adolescents have self-harmed to be aware of possible ADHD symptoms and screen as appropriate; however, future research examining the temporal association between ADHD, emotional dysregulation and self-harm is required to establish causal direction.

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

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

REAC neuromodulation treatments in subjects with severe socioeconomic and cultural hardship in the Brazilian state of Pará: a family observational pilot study

PURPOSE

The purpose of this preliminary observational study was to evaluate the usefulness of a humanitarian initiative, aimed at improving the neuropsychological and behavioral attitude of children with severe socioeconomic and cultural hardship, in the Brazilian state of Pará. This humanitarian initiative was realized through the administration of two neuromodulation protocols, with radioelectric asymmetric conveyor (REAC) technology. During several years of clinical use, the REAC neuromodulation protocols have already proved to be effective in countering the effects of environmental stress on neuropsycho-physical functions.

PATIENTS AND METHODS

After the preliminary medical examination, all subjects were investigated with the Strengths and Difficulties Questionnaire (SDQ), including the impact supplement with teacher's report. After the SDQ, they received the neuromodulation treatment with REAC technology named neuro postural optimization (NPO), to evaluate their responsiveness. Subsequently, every 3 months all subjects underwent a treatment cycle of neuropsycho-physical optimization (NPPO) with REAC technology, for a total of three cycles. At the end of the last REAC-NPPO treatment cycle, all subjects were investigated once again with the SDQ. For the adequacy of the data, the Wilcoxon and the Signs tests were used. For the subdivision into clusters, the Kruskal-Wallis test was applied for the adequacy of the procedure. For all the applied tests, a statistical significance of p<0.5 was found.

RESULTS

The results showed that the REAC-NPO and REAC-NPPO neuromodulation protocols are able to improve the quality of life, the scholastic and socialization skills, and the overall state of physical and mental health in children of a family with severe socioeconomic and cultural hardship.

CONCLUSION

The REAC-NPO and REAC-NPPO neuromodulation protocols, due to their non-invasive characteristics, painlessness, and speed of administration, can be hypothesized as a treatment to improve the overall state of physical and mental health in a large number of people with socioeconomic and cultural discomfort.