MAPping affective dimensions of behavior: Methodologic and pragmatic advancement of the Multidimensional Assessment Profiles scales

Dimensional foundations toward a novel nosology addressing comorbidity: Preadolescent syndrome profiles

OBJECTIVE

Traditional categorical systems for diagnosing psychopathological symptoms, such as the DSM-5, face limitations including high comorbidity rates and insufficient support for transdiagnostic treatment protocols. Dimensional, person-centered approaches can address these limitations by focusing on cross-cutting psychiatric symptoms.

METHOD

This study leverages data from the Adolescent Brain Cognitive Development℠ Study (ABCD Study®) to develop dimensional models of preadolescent psychopathology, focusing on a large, diverse sample of youths aged 9-10. We used latent profile analysis (LPA) on Child Behavior Checklist (CBCL) syndrome scales collected from an elevated symptomatology subsample to delineate subgroups for targeted interventions.

RESULTS

Four distinct profiles emerged: "Mildly Elevated" and "Highly Elevated" (on both internalizing and externalizing), "Moderately Elevated - Rule-Breaking," and "Moderately Elevated - Internalizing & Thought Problems." These profiles differed significantly across sociodemographic, neurocognitive, and life experience characteristics. The "Highly Elevated" group showed the highest levels of risk, including greater trauma exposure and higher rates of parental psychopathology. In contrast, the "Mildly Elevated" group demonstrated lower levels of risk factors and higher fluid intelligence compared to the other groups. The two Moderately Elevated profiles were largely similar across most risk indicators, though the Internalizing & Thought Problems group had a slightly higher proportion of parents with a college education.

CONCLUSIONS

These profiles offer the beginnings of a foundation for classifying symptom co-occurrence and highlight the need for developmentally specific nosologies to improve risk detection and intervention strategies. Future research should further validate these profiles and explore their stability across developmental stages to inform targeted interventions.

Capturing the complexity of child behavior and caregiver-child interactions in the HEALthy Brain and Child Development (HBCD) Study using a rigorous and equitable approach

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. This article outlines methodological considerations and the decision-making process for measurement selection for child behavior, parenting/caregiver-child interactions, and the family/home environment for HBCD. The decision-making process is detailed, including formation of a national workgroup (WG-BEH) that focused on developmentally appropriate measures that take a rigorous and equitable approach and aligned with HBCD objectives. Multi-level-observational and caregiver-report measures were deemed necessary for capturing the desired constructs across multiple contexts while balancing the nuance of observational data with pragmatic considerations. WG-BEH prioritized developmentally sensitive, validated assessments with psychometrics supporting use in diverse populations and focused on mechanistic linkages and prediction of desired constructs. Other considerations included participant burden and retention, staff training needs, and cultural sensitivity. Innovation was permitted when it was grounded in evidence and filled key gaps. Finally, this article describes the rationale for the selected constructs (e.g., temperament, social-emotional development, parenting behaviors, family organization) and corresponding measures chosen for HBCD visits from early infancy through 17 months of age.

Early Childhood Aggression in Autistic and Non-Autistic Preschoolers: Prevalence, Topography, and Relationship to Emotional Reactivity

Objective

Despite heightened rates of aggressive behaviors among older autistic youth relative to non-autistic peers, less is known about these behaviors during early childhood. This study included 3 objectives to address this gap: (1) to establish the prevalence and topography (frequency, severity, type, context) of aggressive behaviors in a large sample of preschool-aged children using a developmentally sensitive parent-report measure; (2) to identify clinical correlates of aggression; and (3) to investigate whether different subgroups of autistic children can be identified based on their profiles of aggression, emotional reactivity, and autism traits.

Method

Data were analyzed from parents of 1,199 children 2 to 5 years of age (n = 622 autistic children) who completed the Multidimensional Assessment Profiles Scales (MAPS) aggression subscale and the Emotion Dysregulation Inventory-Young Child (EDI-YC) reactivity subscale.

Results

Autistic preschoolers had 2 to 6 times higher odds of experiencing frequent aggression (more days than not) compared with non-autistic preschoolers. Hierarchical multiple regression analyses revealed that autism diagnosis, traits, and suspected and diagnosed attention-deficit/hyperactivity disorder (ADHD) were positively associated with aggression; however, heightened emotional reactivity explained the greatest degree of added variance in aggression total scores. Machine learning clustering techniques revealed 3 distinct subgroups of autistic preschoolers, with cluster membership driven primarily by aggression and reactivity scores, and less so by autism traits.

Conclusion

Autistic preschoolers display more frequent parent-reported aggressive behaviors, and emotional reactivity may play an important role in aggressive behavior presentation. Future developmental screening and early intervention tailoring for aggression may benefit from assessing reactivity early in development.

Diversity & Inclusion Statement

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. 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.

A vision for implementing equitable early mental health and resilience support in pediatric primary care: A transdiagnostic, developmental approach

INTRODUCTION

Primary care is at the forefront of addressing the pediatric mental health (MH) crisis due to its broad reach to young children and prevention and health promotion orientation. However, the promise of the delivery system for population impact remains unrealized due to several barriers, including pragmatic screening, decisional uncertainty, and limited access to evidence-based services.

METHOD

This article lays the conceptual foundations for the articles in this Special Section on Mental Health, Earlier in Pediatric Primary Care, which all apply a translational mindset to proposed strategies and solutions to overcome the barriers that have limited the potential of pediatric primary care for improving the MH and wellbeing of all children.

RESULTS

Valid, pragmatic, transdiagnostic, developmentally-based screening measures to identify children at heightened risk are needed. Risk screening for MH problems should assess and empirically weight socioecological risk and protective factors, as well as the child's own assets for resilience to determine probabilistic risk. Pediatric clinicians require clear clinical cutoffs and guidelines for action when risk for MH problems is identified.

DISCUSSION

These strategies-a developmentally-based screener with associated risk calculator that offers clear guidance to pediatric clinicians-address decisional uncertainty regarding when to worry and when to act. The communication of probabilistic risk requires additional client-centered communication skills to overcome different types of biases (e.g., implicit, benevolent, and cognitive) that contribute to MH inequities and decisional uncertainty in acting on identified risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Affective Side of Disruptive Behavior: Toward Better Understanding, Assessment, and Treatment

Historically, much of the progress made in youth mental health research can be classified as focusing on externalizing problems, characterized by disruptive behavior (e.g. aggression, defiance), or internalizing problems, characterized by intense negative affect (e.g. depression, anxiety). Until recently, however, less attention has been given to topics that lie somewhere in between these domains, topics that we collectively refer to as the affective side of disruptive behavior. Like the far side of the moon, the affective side of disruptive behavior captures facets of the phenomenon that may be less obvious or commonly overlooked, but are nonetheless critical to understand. This affective side clarifies socially disruptive aspects of traditionally "externalizing" behavior by elucidating proximal causation via intense negative affect (traditionally "internalizing"). Such problems include irritability, frustration, anger, temper loss, emotional outbursts, and reactive aggression. Given a recent explosion of research in these areas, efforts toward integration are now needed. This special issue was developed to help address this need. Beyond the present introductory article, this collection includes 4 empirical articles on developmental psychopathology topics, 4 empirical articles on applied treatment/assessment topics, 1 evidence base update review article on measurement, and 2 future directions review articles concerning outbursts, mood, dispositions, and youth psychopathology more broadly. By deliberatively investigating the affective side of disruptive behavior, we hope these articles will help bring about better understanding, assessment, and treatment of these challenging problems, for the benefit of youth and families.

What I see, what you say: How cross-method variation sharpens characterization of irritability in early childhood

OBJECTIVES

Identification of clinically significant irritability in preschool age is important to implement effective interventions. However, varying informant and measurement methods display distinct patterns. These patterns are associated with concurrent and future mental health concerns. Patterns across multi-informant methods in early-childhood irritability may have clinical utility, identifying risk for impaired psychosocial functioning.

METHODS

Using data from the Multidimensional Assessment of Preschoolers Study (N = 425), latent profile analysis identified irritability patterns through the parent-reported Multidimensional Assessment Profile Scales-Temper Loss (MAPS-TL), parent-reported interviewer-rated Preschool Age Psychiatric Assessment (PAPA), and observer-rated Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). These profiles were characterized on protective factors, global functioning, and mental health syndromes, concurrently and at early school age and preadolescent follow-up.

RESULTS

Fit indices favored a five-class model: Low All, High Observation with Examiner (high DB-DOS Examiner Context), High All, High Parent Report (high MAPS-TL/PAPA), and Very High Parent Report (very high MAPS-TL/PAPA). Whereas Low All and High Observation with Examiner exhibited strong psychosocial functioning, remaining profiles showed impaired psychosocial functioning, with the Very High Parent Report group showing higher impairment at follow-ups, ds = 0.37-1.25.

CONCLUSIONS

Multi-informant measurements of irritability may have utility for clinical prediction, and future studies should test utility for diagnostic precision.

Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening

OBJECTIVES

Developmentally specified measures that identify clinically salient irritability are needed for early school-age youth to meaningfully capture this transdiagnostic risk factor for psychopathology. Thus, the current study modeled the normal:abnormal irritability spectrum and generated a clinically optimized screening tool for this population.

METHODS

The irritability spectrum was modeled via the youth version of the Multidimensional Assessment Profile Scales-Temper Loss Scale (MAPS-TL-Youth) in children (n = 474; 6.0-8.9 years) using item response theory (IRT). Both cross-cutting core irritability items from the early childhood version and new developmentally specific items were included. Items uniquely associated with impairment were identified and used to derive a brief, clinically optimized irritability screener. Longitudinal data were then utilized to test the predictive utility of this clinically optimized screener in preadolescence (n = 348; 8.0-12.9 years).

RESULTS

Most children exhibit irritability regularly, but daily occurrence was rare. Of the top 10 most severe items from the IRT analyses, 9 were from the developmentally specific items added for the MAPS-TL Youth version. Two items associated with concurrent impairment were identified for the clinically optimized irritability screener ("Become frustrated easily" and "Act irritable"). The MAPS-TL-Youth clinically optimized screener demonstrated good sensitivity (69%) and specificity (84%) in relation to concurrent DSM 5 irritability-related diagnoses. Youth with elevated scores on the screener at early school age (ESA) had more than 7x greater odds of irritability-related psychopathology at pre-adolescence.

CONCLUSIONS

The MAPS-TL-Youth characterized the developmental spectrum of irritability at ESA and a clinically optimized screener showed promise at predicting psychopathology risk. Rigorous testing of clinical applications is a critical next step.

Prevalence, stability, and predictive utility of the Multidimensional Assessment of Preschoolers Scales clinically optimized irritability score: Pragmatic early assessment of mental disorder risk

OBJECTIVES

Characterizing the scope and import of early childhood irritability is essential for real-world actualization of this reliable indicator of transdiagnostic mental health risk. Thus, we utilize pragmatic assessment to establish prevalence, stability, and predictive utility of clinically significant early childhood irritability.

METHODS

Data included two independent, diverse community samples of preschool age children (N = 1857; N = 1490), with a subset enriched for risk (N = 425) assessed longitudinally from early childhood through preadolescence (∼4-9 years old). A validated, brief (2-item) scale pragmatically assessed clinically significant irritability. In the longitudinal subsample, clinical interviews assessed internalizing/externalizing disorders.

RESULTS

One in five preschool-age children had clinically significant irritability, which was independently replicated. Irritability was highly stable through preadolescence. Children with versus without clinically significant early childhood irritability had greater odds of early onset, persistent internalizing/externalizing disorders. The pragmatic assessment effectively screened out low-risk children and identified 2/3 of children with early-onset, persistent psychopathology.

CONCLUSIONS

Clinically significant early childhood irritability prevalence is akin to the pediatric obesity epidemic and may warrant similar universal screening/intervention. Also, irritability's stability demonstrates the common guidance "they'll grow out of it" to be false. Finally, pragmatic irritability assessment has transdiagnostic predictive power and addresses a need for feasible measures to flag risk.