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Bi X, Liu Z, Su W, Ou K, Cui H, Gao T, Shi K, Ma Y. Exploring the relationship between negative life events and emotional symptoms in adolescents using a network analysis. Sci Rep 2025; 15:16307. [PMID: 40348808 PMCID: PMC12065814 DOI: 10.1038/s41598-025-00044-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Accepted: 04/24/2025] [Indexed: 05/14/2025] Open
Abstract
This study used network analysis to explore the association between negative life events and emotional symptoms in Chinese adolescents, with a focus on depression, anxiety, and their comorbid mechanisms. The Adolescent Self-Reporting Life Events Scale (ASLES), the Center for Epidemiological Studies Depression Scale (CES-D), and the Self-Rating Anxiety Scale (SAS) were used to assess 1083 adolescents. Based on the data, three networks were constructed: the negative life events-depression network, the negative life events-anxiety network, and a integrated negative life events-depression-anxiety network. In the depression network, "Depressive mood," "Sadness," and "People dislike me" were core nodes, reflecting emotional and social sensitivity. In the anxiety network, "Panic," "Fear," and "Dizziness" emerged as core nodes, highlighting the role of physiological responses. The integrated network identified "Depressed mood" and "Panic" as key nodes, revealing the overlap and interaction between depression and anxiety. "Academic stress" and "Interpersonal relationships" were consistent bridge nodes across networks, linking negative life events to emotional symptoms and contributing to comorbid mechanisms. These findings suggest that targeting core symptoms and bridge nodes may reduce depression, anxiety, and their comorbidities. This study provides insights into adolescent emotional symptom networks, supporting targeted and comprehensive interventions.
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Affiliation(s)
- Xiaoyan Bi
- School of Education, Guangzhou University, Guangzhou, China
| | - Zihan Liu
- School of Education, Guangzhou University, Guangzhou, China
| | - Wenxiu Su
- School of Education, Guangzhou University, Guangzhou, China
| | - Kangting Ou
- School of Education, Guangzhou University, Guangzhou, China
| | - Hongbo Cui
- School of Education, Guangzhou University, Guangzhou, China
- Mental Health Education and Counseling Center, Guangzhou University, Guangzhou, China
| | - Tao Gao
- School of Education, Guangzhou University, Guangzhou, China
- Guangdong Industry Polytechnic University, Guangzhou, China
| | - Keke Shi
- School of Education, Guangzhou University, Guangzhou, China
- Department of Chinese Language and Literature, Guangzhou Xinhua University, Guangzhou, China
| | - Yankun Ma
- School of Education, Guangzhou University, Guangzhou, China.
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Wong DR, Anderson KG. Life Course Models of Child Maltreatment: Effects on General Psychopathology Outcomes in a Longitudinal Sample. CHILD MALTREATMENT 2025; 30:318-330. [PMID: 39102298 DOI: 10.1177/10775595241270076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
The study compared life course models (LCM; accumulation, recency, and sensitive period) of child maltreatment and general psychopathology in a large, national longitudinal data set of 1354 youth ages birth-16 years (657 boys, 53.2% Black, 59.7% <$40K caregiver income). Previous research has supported the accumulation and recency models, albeit with shorter or fewer time periods of outcome measurement. We extend this work by modeling the impact of combined abuse and neglect allegations on a general psychopathology factor (dysregulation profile). Cross-sectional structural equation models were constructed using LCMs and tested across two-year periods from 4-16 years old and compared using Akaike Information Criterion weights. The recency variable generally explained the greatest proportion of variance in psychopathology. Notably, maltreatment more proximal to the time of outcome measurement had the strongest effect, suggesting that more recent maltreatment may have stronger effects on general psychopathology. These results lend support to a recency effect of maltreatment on psychopathology outcomes, although substantive overlaps with the accumulation model are noted.
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Affiliation(s)
- Dylan R Wong
- Department of Psychology, Reed College, Portland, OR, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Cooper TR, Sukhawathanakul P. The adolescent dysregulation profile and its association with educational, occupational, and substance use outcomes in emerging adulthood. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2025; 49:277-287. [PMID: 40352582 PMCID: PMC12065604 DOI: 10.1177/01650254241308468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2025]
Abstract
The dysregulation profile (DP) in youth is characterized by severe emotional, cognitive, and behavioral dysregulation and is associated with an increased risk for psychiatric disorders. Adolescent self-regulation has important implications for adulthood outcomes, yet this association is understudied in the context of the DP in emerging adults. Using a Canadian adolescent sample (N = 662; M age = 15.52), a dimensional approach to the DP was taken and associations between adolescent DP scores and educational, occupational and substance use outcomes in emerging adulthood (M age = 25.77) were examined. Latent profile analysis revealed: a highly problematic group with elevated DP scores (n = 59; 8.9%); an average problems group with average DP scores (n = 285; 43.1%); and a low problems group with below average DP scores (n = 318; 48%). The highly problematic group reported the lowest occupational statuses, and the highest prevalence of unemployment and substance dependencies. These results demonstrate the impact of subthreshold adolescent DP scores on emerging adulthood outcomes.
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Șipoș R, Văidean T, Predescu E. Risk Factors and Clinical Predictors of Suicidal Behaviors and Non-Suicidal Self-Injury Among Pediatric Psychiatry Emergency Admissions Pre- and Post-Pandemic: A Retrospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2025; 12:81. [PMID: 39857912 PMCID: PMC11764410 DOI: 10.3390/children12010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 01/03/2025] [Accepted: 01/09/2025] [Indexed: 01/27/2025]
Abstract
BACKGROUND Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues. METHODS This retrospective cohort study analyzed data from 341 adolescents (aged 6-18 years) presenting to a Romanian pediatric psychiatry emergency department during the years 2019 (pre-pandemic) and 2022 (post-pandemic). All participants underwent a thorough psychiatric assessment, and, together with their caregivers, were questioned on a wide range of potentially relevant issues, such as family, social, school, and life history factors. Logistic regression and random forest models were used to identify predictors of SB and NSSI. RESULTS SB was significantly predicted in regression models based on a prior suicidal ideation (OR = 68.410; p < 0.001), having a parent living abroad (OR = 11.438; p = 0.020), depression (OR = 6.803; p < 0.001), and conflicts with peers (OR = 0.325, p = 0.042), teachers (OR = 0.119, p = 0.024), or both (OR = 0.166, p = 0.012). The random forest model featured a slightly different order of the main predictors and highlighted the importance of additional predictors, such as prior suicide attempts, gender, and past non-suicidal self-injury. NSSI was mainly predicted by a history of self-harm (OR = 52.437; p < 0.001), the number of comorbid psychiatric disorders (OR = 1.709; p = 0.003), and conduct disorder (OR = 0.184; p < 0.001), to which are added, according to random forest models, new predictors, such as borderline personality disorder, suicidal ideation, and school performance. Post-pandemic increases were observed in depression, suicidal ideation, and possible psycho-traumatic negative life event exposure. CONCLUSIONS This study underscores the complex interplay of individual, familial, and societal factors influencing adolescent self-harm. Comprehensive interventions are needed, with early intervention crucial for those with a history of self-harm. Further research using prospective designs is recommended.
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Affiliation(s)
- Roxana Șipoș
- Department of Neuroscience, Psychiatry and Pediatric Psychiatry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 57 Republicii Street, 400489 Cluj-Napoca, Romania
| | - Tudor Văidean
- Department of Neuroscience, Psychiatry and Pediatric Psychiatry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 57 Republicii Street, 400489 Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, Babeş-Bolyai University, 37 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Elena Predescu
- Department of Neuroscience, Psychiatry and Pediatric Psychiatry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 57 Republicii Street, 400489 Cluj-Napoca, Romania
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Reyentanz E, Basedow LA, Roessner V, Golub Y. PTSD, dysregulation profile and substance use: exploring differences in a sample of adolescents in an outpatient clinic. FRONTIERS IN CHILD AND ADOLESCENT PSYCHIATRY 2024; 3:1421486. [PMID: 39816592 PMCID: PMC11732090 DOI: 10.3389/frcha.2024.1421486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 11/25/2024] [Indexed: 01/18/2025]
Abstract
Introduction Experiencing traumatic events (TEs), especially interpersonal TEs, is related to an increased risk of developing post-traumatic stress disorder (PTSD). Both TEs and PTSD are associated with a higher risk of substance use and problems in emotion regulation. Little is known about the associations between specific types of TEs, problems with general self-regulation (including cognitive and behavioral components) and substance use severity in adolescents. Knowledge on these associations could provide important approaches for prevention and therapy for adolescents with a history of trauma. Methods This study investigated associations between different types of TEs and PTSD, self-regulation and substance use severity. Moreover, participants were categorized into three groups according to their trauma status: (I) no history of TEs (noTEs), (II) history of TEs but no PTSD diagnosis (TEs), and (III) history of TEs and PTSD diagnosis (PTSD). Differences between the three groups were analyzed in terms of self-regulation and substance use severity. Our sample consisted of N = 89 adolescents aged 12 to 18 years in a child and adolescent psychiatric outpatient clinic in Germany. Substance use severity was only assessed in a smaller subsample (n = 37). Data were obtained from standardized diagnostic procedures and included information on types of TEs and PTSD diagnosis according to ICD-10, problems in self-regulation assessed with the Child Behavior Checklist (CBCL)/ Youth Self Report (YSR) Dysregulation Profile (DP), and substance use severity measured with the Drug Use Disorders Identification Test (DUDIT). Results We found that interpersonal TEs were significantly associated with higher rates of PTSD diagnosis compared to non-interpersonal TEs. We found no significant associations between different types of TEs and both problems in self-regulation and substance use severity. Moreover, our findings do not indicate differences in both self-regulation and substance use severity between trauma statuses (noTEs, TEs, PTSD). Discussion Future studies should consider other characteristics of TEs such as timing and duration when investigating associations with self-regulation. Longitudinal studies are needed to investigate developmental pathways, as a better understanding of the role of characteristics of TEs and self-regulation in the development of PTSD and substance use problems would provide opportunities for prevention and therapy for trauma-exposed patients.
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Affiliation(s)
- Emely Reyentanz
- Department of Child and Adolescent Psychiatry, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Lukas A. Basedow
- Fachbereich Psychologie, Klinische Psychologie und Psychotherapie, Phillips Universität Marburg, Marburg, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Department of Child and Adolescent Psychiatry, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Wichstrøm T, Wichstrøm L. Childhood Predictors of Nonsuicidal Self-Injury in Adolescence: A Birth Cohort Study. J Am Acad Child Adolesc Psychiatry 2024; 63:1114-1122. [PMID: 38423281 DOI: 10.1016/j.jaac.2023.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/18/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Nonsuicidal self-injury (NSSI) is rare in childhood but becomes prevalent in adolescence, which suggests that early intervention might be indicated. As childhood predictors of NSSI in adolescence are largely unknown, identifying these predictors was the aim of this study. METHOD In a birth cohort sample (n = 759) of Norwegian children, NSSI at 12, 14, or 16 years of age was regressed on predictors of NSSI at age 6 (parental factors: depression, parenting stress, negativity/hostility, emotional availability to the child; child factors: temperamental negative affectivity, emotion regulation, symptoms of emotional and behavioral disorders; external events: victimization from bullying, serious negative life events). Semistructured clinical interviews with adolescents and their parents were used to assess DSM-5-defined NSSI and NSSI disorder. RESULTS NSSI during the preceding 12 months at 12, 14, or 16 years of age was reported by 81 adolescents (10.0%, 95% CI 8.2-11.9), and NSSI disorder was reported by 20 adolescents (2.7%, 95% CI 1.9-3.8). In multivariable logistic regression analysis, female gender (odds ratio 11.6, 95% CI 4.0-33.5), parenting stress (odds ratio 4.8, 95% CI 1.4-16.5), and parental negativity/hostility (odds ratio 1.8, 95% CI 1.2-2.7) predicted NSSI, whereas child factors and external events were not predictive. CONCLUSION Parental factors when the child is 6 years of age-parenting stress and negativity/hostility toward the child-predict NSSI in adolescence. Universal and indicated programs targeting these aspects of parenting during childhood might reduce NSSI in adolescence. PLAIN LANGUAGE SUMMARY Almost 1 in 4 adolescents engage in deliberate self-harm without wanting to die from it. However, childhood predictors of nonsuicidal self-injury are largely unknown. This study from Norway followed 759 children from birth until adolescence. The authors found that children who perceived their parents as more negative and hostile at 6 years old were at increased risk of engaging in self-injury when they became adolescents. Children whose parents reported more stress in the parenting role were also at increased risk of engaging in self-harm during adolescence. The authors conclude alleviating parental stress and improving parent-child relations at an early age might decrease the risk of adolescent self-harm. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. 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.
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Affiliation(s)
- Tove Wichstrøm
- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Lars Wichstrøm
- Norwegian University of Science and Technology, Trondheim, Norway; St. Olavs Hospital, Trondheim, Norway
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Ametti MR, Cheaito A, Frering HE, Ades PA, David C, Althoff RR. Associations Between Dysregulation and Metabolic Syndrome in Youth and Adults. JAACAP OPEN 2024; 2:161-169. [PMID: 39552819 PMCID: PMC11562418 DOI: 10.1016/j.jaacop.2023.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 11/19/2024]
Abstract
Objective Metabolic syndrome is a serious and costly health condition that is increasingly prevalent in the United States. Current treatment standards, which include lifestyle modification and medication, do not consistently yield sustainable improvements. High rates of co-occurrence with psychiatric disorders suggest that understanding psychological factors associated with metabolic syndrome may be important for enhancing interventions. The current study examines the relations between the psychological construct of "dysregulation" and metabolic risk in children, adolescents, and adults. Method Participants were 95 family triads comprising 158 youth aged 7 to 17 years and 127 biological parents. Dysregulation was measured using a bifactor model comprising symptoms from the Anxious/Depressed, Attention Problems, and Aggressive Behavior subscales of the Child Behavior Checklist and Adult Self Report for children and adults, respectively. Metabolic risk was measured using confirmatory factor analysis, which included waist circumference, mean arterial pressure, insulin resistance, and triglyceride-to-HDL ratio. Results Higher levels of dysregulation were associated with increased metabolic risk in adults. In children, this association was moderated by age, such that dysregulation and metabolic risk were positively associated only for older youth. Conclusion The findings of this study suggest that the association between dysregulation and metabolic risk may become stronger with age and development. This highlights that early detection and intervention of dysregulation may help prevent metabolic comorbidities later in life.
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Affiliation(s)
- Merelise R. Ametti
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Aya Cheaito
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Hannah E. Frering
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Philip A. Ades
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Christopher David
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Robert R. Althoff
- Larner College of Medicine at the University of Vermont, Burlington, Vermont
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Sood NT, Godfrey C, Youn S, Chavez Arana C, Anderson V, Payne JM, Catroppa C. The decision-making task: Development and evaluation in a paediatric traumatic brain injury population. Neuropsychol Rehabil 2024; 34:919-937. [PMID: 37542710 DOI: 10.1080/09602011.2023.2242618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/21/2023] [Indexed: 08/07/2023]
Abstract
Assessment measures that quantify decision-making abilities in children and adolescents are limited. In the current study, a novel computerized Decision-Making Task (DMT), which identifies the process that is involved in decision-making, was developed based on an existing information-boards paradigm. The overall aim was to validate the DMT in a paediatric TBI population. This prospective study investigated the performance on the DMT for children post-TBI (n = 49; 7-15 years) compared to typically developing controls (n = 22; 7-15 years), and investigated the psychometric properties of the DMT by examining internal consistency-related reliability, convergent validity (measures of decision-making, working memory, functional outcomes, and behaviour), and divergent validity (vocabulary). Significant differences were detected for performance on the DMT between children post-TBI and the control group. Psychometric properties of the DMT were acceptable, with variable findings for convergent validity (working memory, functional outcomes, and behaviour). This is the first study to develop and investigate a novel computerised task to assess decision-making skills in a paediatric TBI population. Results cautiously suggest that the DMT is a valid and a reliable measure of decision-making in our clinical sample.
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Affiliation(s)
- Nikita Tuli Sood
- Murdoch Children's Research Institute, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Celia Godfrey
- Murdoch Children's Research Institute, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Sarah Youn
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Clara Chavez Arana
- Department of Psychology, Education, & Child Studies, Erasmus School of Social and Behavioural Sciences, Rotterdam, Netherlands
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Jonathan M Payne
- Murdoch Children's Research Institute, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Tsai CJ, Lin HY, Gau SSF. Correlation of altered intrinsic functional connectivity with impaired self-regulation in children and adolescents with ADHD. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01787-y. [PMID: 38906983 DOI: 10.1007/s00406-024-01787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 02/16/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) has a high prevalence of co-occurring impaired self-regulation (dysregulation), exacerbating adverse outcomes. Neural correlates underlying impaired self-regulation in ADHD remain inconclusive. We aimed to investigate the impact of dysregulation on intrinsic functional connectivity (iFC) in children with ADHD and the correlation of iFC with dysregulation among children with ADHD relative to typically developing controls (TDC). METHODS Resting-state functional MRI data of 71 children with ADHD (11.38 ± 2.44 years) and 117 age-matched TDC were used in the final analysis. We restricted our analyses to resting-state networks (RSNs) of interest derived from independent component analysis. Impaired self-regulation was estimated based on the Child Behavioral Checklist-Dysregulation Profile. RESULTS Children with ADHD showed stronger iFC than TDC in the left frontoparietal network, somatomotor network (SMN), visual network (VIS), default-mode network (DMN), and dorsal attention network (DAN) (FWE-corrected alpha < 0.05). After adding dysregulation levels as an extra regressor, the ADHD group only showed stronger iFC in the VIS and SMN. ADHD children with high dysregulation had higher precuneus iFC within DMN than ADHD children with low dysregulation. Angular gyrus iFC within DMN was positively correlated with dysregulation in the ADHD group but negatively correlated with dysregulation in the TDC group. Functional network connectivity showed ADHD had a greater DMN-DAN connection than TDC, regardless of the dysregulation level. CONCLUSIONS Our findings suggest that DMN connectivity may contribute to impaired self-regulation in ADHD. Impaired self-regulation should be considered categorical and dimensional moderators for the neural correlates of altered iFC in ADHD.
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Affiliation(s)
- Chia-Jui Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan.
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Levantini V, Camodeca M, Gelati C. The Strengths and Difficulties Questionnaire Dysregulation Profile Teacher-Report: Psychometric Properties and Associations with Aspects of School Experience. Child Psychiatry Hum Dev 2024; 55:831-840. [PMID: 36227387 PMCID: PMC11061053 DOI: 10.1007/s10578-022-01441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Valentina Levantini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy.
| | - Marina Camodeca
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Carmen Gelati
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
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Neufeld SAS, St Clair M, Brodbeck J, Wilkinson PO, Goodyer IM, Jones PB. Measurement Invariance in Longitudinal Bifactor Models: Review and Application Based on the p Factor. Assessment 2024; 31:774-793. [PMID: 37350099 PMCID: PMC11092300 DOI: 10.1177/10731911231182687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Bifactor models are increasingly being utilized to study latent constructs such as psychopathology and cognition, which change over the lifespan. Although longitudinal measurement invariance (MI) testing helps ensure valid interpretation of change in a construct over time, this is rarely and inconsistently performed in bifactor models. Our review of MI simulation literature revealed that only one study assessed MI in bifactor models under limited conditions. Recommendations for how to assess MI in bifactor models are suggested based on existing simulation studies of related models. Estimator choice and influence of missing data on MI are also discussed. An empirical example based on a model of the general psychopathology factor (p) elucidates our recommendations, with the present model of p being the first to exhibit residual MI across gender and time. Thus, changes in the ordered-categorical indicators can be attributed to changes in the latent factors. However, further work is needed to clarify MI guidelines for bifactor models, including considering the impact of model complexity and number of indicators. Nonetheless, using the guidelines justified herein to establish MI allows findings from bifactor models to be more confidently interpreted, increasing their comparability and utility.
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Kil H, Longpré C, Mageau GA. Dysregulation profile in children of ethnoracially diverse at-risk families: Factor structure and longitudinal correlates. Dev Psychopathol 2024; 36:787-798. [PMID: 36847250 PMCID: PMC10464460 DOI: 10.1017/s095457942300007x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The present work sought to confirm the factor structure and examine longitudinal strengths-based and mental health correlates of the dysregulation profile (DP) in children of at-risk fragile families of diverse ethnoracial backgrounds. The data came from the Fragile Families and Child Wellbeing Study (N = 2125 families). Mothers (Mage = 25.3) were mostly unmarried (74.6%), and children (51.4% boys) were identified as Black (47.0%), Hispanic (21.4%), White (16.7%), or multiracial or other backgrounds. Childhood DP was constructed using mother reports of the Child Behavior Checklist at age 9. Mothers' in-home parent-child interactions and depressive symptoms were assessed at child age 5. At age 15, children responded about their own mental health, social skills, and other strengths-focused outcomes. A bifactor DP structure fit well to the data, with the DP factor representing difficulties in self-regulation. Using SEM, we found that mothers who were more depressed and used less warm parenting at child age 5 had children who presented with higher DP at age 9. DP was in turn associated with less social skills, perseverance, optimism, and more anxiety, depression, and impulsivity at adolescence. Childhood DP appears to be relevant and applicable for at-risk, diverse families, and may also impede on children's future positive functioning.
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Affiliation(s)
- Hali Kil
- Department of Psychology, Simon Fraser University, Burnaby, Canada
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Fine SL, Blum RW, Bass JK, Lulebo AM, Pinandari AW, Stones W, Wilopo SA, Zuo X, Musci RJ. A latent class approach to understanding patterns of emotional and behavioral problems among early adolescents across four low- and middle-income countries. Dev Psychopathol 2023; 35:1684-1700. [PMID: 35635213 PMCID: PMC9708939 DOI: 10.1017/s0954579422000384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Early adolescents (ages 10-14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (51% female) living in the Democratic Republic of Congo (DRC), Malawi, Indonesia, and China, and explore the extent to which these patterns varied by country and sex. LCA was used to identify and classify patterns of emotional and behavioral problems separately by country. Within each country, measurement invariance by sex was evaluated. LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into the following subgroups: Well-Adjusted (40-62%), Emotional Problems (14-29%), Behavioral Problems (15-22%; not present in China), and Maladjusted (4-15%). Despite the consistency of these patterns, there were notable contextual differences. Further, tests of measurement invariance indicated that the prevalence and nature of these classes differed by sex. Findings can be used to support the tailoring of interventions targeting psychosocial adjustment, and suggest that such programs may have utility across diverse cross-national settings.
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Affiliation(s)
- Shoshanna L. Fine
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert W. Blum
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith K. Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aimée M. Lulebo
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Anggriyani W. Pinandari
- Center for Reproductive Health, Faculty of Medicine, University of Gadjah Mada, Yogyakarta, Indonesia
| | - William Stones
- Center for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Siswanto A. Wilopo
- Center for Reproductive Health, Faculty of Medicine, University of Gadjah Mada, Yogyakarta, Indonesia
| | - Xiayun Zuo
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Rashelle J. Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Tein JY, Wang FL, Oro V, Kim H, Shaw D, Wilson M, Lemery-Chalfant K. The role of early intervention for adolescent mental health and polydrug use: Cascading mediation through childhood growth in the general psychopathology (p) factor. Dev Psychol 2023; 59:1484-1495. [PMID: 37199932 PMCID: PMC10524853 DOI: 10.1037/dev0001543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
This study is a secondary data analysis that extends knowledge about the effects of the early childhood Family Check-Up (FCU) intervention to trajectories of general psychopathology problems (p factor) across early and middle childhood, and effects on adolescent psychopathology and polydrug use. The Early Steps Multisite study (ClinicalTrials.gov Identifier NCT00538252) is a randomized controlled trial of the FCU and consists of a large, racially and ethnically diverse sample of children who grew up in low-income households in Pittsburgh, Pennsylvania; Eugene, Oregon; and Charlottesville, Virginia (n = 731; 49% female; 27.6% African American, 46.7% European American, 13.3% Hispanic/Latinx). To represent a comorbid presentation of internalizing and externalizing problems, we fit a bifactor model that included a general psychopathology (p) factor at eight ages in early childhood (ages 2-4), middle childhood (ages 7.5-10.5), and adolescence (age 14). Latent growth curve modeling was conducted to examine trajectories of the p factor across ages within the developmental periods of early and middle childhood. The effects of FCU on the reductions in growth in the childhood p factor had cascading effects on adolescent p factor (i.e., within-domain effect) and polydrug use (i.e., across-domain effect). Findings underscore the utility of the early FCU in preventing a host of maladaptive adolescent outcomes across diverse settings and populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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15
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Favole I, Davico C, Marcotulli D, Sodero R, Svevi B, Amianto F, Ricci FS, Arduino GM, Vitiello B. Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay. Sleep Med 2023; 105:45-52. [PMID: 36963320 DOI: 10.1016/j.sleep.2023.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Sleep disturbance and emotional dysregulation (ED) are common and often functionally impairing in young children with neurodevelopmental disorders (NDD). This study investigated the relationship between sleep disturbance and ED in a sample of preschoolers with ASD, intellectual disability, or global developmental delay, and examined possible predictors of their persistence over time. METHODS All children under 6 years of age clinically referred between July 2018 and May 2022 to two neuropsychiatric specialized centers for NDD received a comprehensive diagnostic evaluation, including the Child Behavior Checklist 1.5-5 (CBCL), the Autism Diagnostic Observation Schedule-2 (ADOS-2), and standardized tests of cognitive and global development. Sleep disturbances were assessed with the CBCL-sleep score, and ED with the CBCL Attention, Aggression, and Anxious/Depressed scales (CBCL-AAA). A reassessment of sleep and ED was conducted after 6 months or longer, including the Child Sleep Habits Questionnaire (CSHQ). Multivariate analyses and mixed linear regression models were conducted. RESULTS A total of 136 children, 75.7% male, median age 38.27 months, IQR 15.39, 41.2% with global developmental disorder (GDD) or intellectual disability (ID) participated in the study. Of them, 64.7% were diagnosed with autism spectrum disorder (ASD) and 35.3% with other NDD (w/o ASD). Sleep disturbances (CBCL-Sleep) and ED (CBCL-AAA) were positively correlated (p < 0.001), after accounting for age, ID/GDD and autism symptom severity, in both the entire sample and separately in each diagnostic group (ASD and NDD w/o ASD). Seventy-five children (55%) were reassessed a mean 17.2 months afterwards. There was persistence of the positive correlation between sleep problems and ED (p < 0.001) in both the entire sample and each diagnostic group. The longitudinal mixed linear model showed that ED at follow-up was predicted by baseline sleep problems (p = 0.008), ED (p < 0.001), and ASD severity (p = 0.015). CONCLUSIONS Sleep disturbances are significantly associated with ED in young children with NDD, either with or without ASD, both cross-sectionally and prospectively over time. Sleep problems represent an important comorbidity and a potential treatment target for improving emotional stability in NDD.
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Affiliation(s)
- Irene Favole
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Daniele Marcotulli
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy.
| | - Roberta Sodero
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Barbara Svevi
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, University of Turin, 10100, Turin, Italy
| | - Federica S Ricci
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - G Maurizio Arduino
- Autism Center, Developmental Psychology and Psychopathology, ASL CN1, Cuneo, Italy
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
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16
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González-García C, Vassiliadis E, Moreno-Manso JM, Alcántara M, del Valle JF, Bravo A. Changes in Mental Health of Children and Young People in Residential Care: Outcomes and Associated Factors. INTERVENCION PSICOSOCIAL 2023; 32:11-19. [PMID: 37361630 PMCID: PMC10268551 DOI: 10.5093/pi2022a16] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 06/28/2023]
Abstract
Several studies have evidenced that children in out-of-home care (OOHC), including foster family care and residential care, reveal high levels of mental health disorders (ranging from 40% to 88%). This study examines the outcomes in mental health reported by key residential workers in a group of children and youth (N = 492) between 8-17 years old who were in residential child care (RCC) in Spain. The research also aims to explore the relationship between mental health outcomes and the provision of mental health services (i.e., receiving any mental health treatment) as well as the influence of child, family, and placement factors. The design of this study includes two measures: a baseline (T1) and a follow-up two years later (T2). The results indicated that 29.9% of young people enjoyed sustained mental health; 26% meaningful improvement in their mental health; 23.5% meaningful deterioration; and the remaining 20.5% showed no meaningful change. One of the main findings was that receiving mental health treatment had a significant impact on mental health outcomes. It is crucial to establish protocols and systematic detection tools to assess mental health and ensure detection and referral to proper treatment.
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Affiliation(s)
| | | | - Juan M. Moreno-Manso
- Universidad de ExtremaduraBadajozSpainUniversidad de Extremadura, Badajoz, Spain;
| | - Mavi Alcántara
- University of MurciaMurciaSpainUniversity of Murcia, Spain
| | | | - Amaia Bravo
- University of OviedoOviedoSpainUniversity of Oviedo, Spain
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17
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Astenvald R, Frick MA, Neufeld J, Bölte S, Isaksson J. Emotion dysregulation in ADHD and other neurodevelopmental conditions: a co-twin control study. Child Adolesc Psychiatry Ment Health 2022; 16:92. [PMID: 36443776 PMCID: PMC9706824 DOI: 10.1186/s13034-022-00528-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Emotion dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD) and often results in adverse outcomes. However, ED has been suggested as a transdiagnostic construct, why the specific association between ADHD and ED when adjusting for other mental health conditions needs further investigation. It is also important to determine the aetiological basis of the association between ADHD and ED to inform the theoretical conceptualization of ADHD. METHOD This study used a co-twin control design, including a sample of dizygotic (DZ) and monozygotic (MZ) twins (N = 389; 45.8% females, age = 8-31 years, MZ twin pairs 57.6%). ED was assessed using the dysregulation profile from the parent-rated Child Behaviour Checklist and its adult version. Regression analyses were used across individuals and within the pairs, while adjusting for diagnoses of autism, intellectual disability, other neurodevelopmental conditions and affective conditions. RESULTS ADHD was significantly associated with ED, even when adjusting for age, sex, attention problems and other mental health conditions, and was the diagnosis most strongly associated with ED. Within-pair analyses revealed that twins with ADHD had higher levels of ED compared to their co-twin without ADHD. This association remained within DZ twins and was non-significant in the MZ subsample, with non-overlapping confidence intervals between the DZ and MZ estimates. CONCLUSION ADHD is strongly and in part independently linked to ED, stressing the importance of early detection and treatment of emotional difficulties within this group. The findings from the within-pair analyses indicate a genetic influence on the association between ADHD and ED.
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Affiliation(s)
- Rebecka Astenvald
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Matilda A Frick
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Department of Psychology, Division of Emotion Psychology, Uppsala University, Uppsala, Sweden
| | - Janina Neufeld
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden
| | - Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
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18
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Stargel LE, Lewis T, LaBrenz CA, Holzman JBW. Predicting children's differential trajectories of emotion dysregulation: A study on the intergenerational transmission of child and caregiver maltreatment. CHILD ABUSE & NEGLECT 2022; 132:105816. [PMID: 35932658 DOI: 10.1016/j.chiabu.2022.105816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/17/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Child maltreatment and caregiver history of abuse is negatively associated with the development of emotion regulation, and maltreatment in early childhood may be particularly disruptive. OBJECTIVE We examined patterns of emotion dysregulation and the contribution of caregiver victimization and early maltreatment history on the development of distinct emotion dysregulation trajectories. PARTICIPANTS The current study sample (n = 1354) came from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a longitudinal study of the antecedents and consequences of child maltreatment. Children had a varied risk of maltreatment from high risk but not referred to child protective services to children who were removed from parental care. METHOD We employed a growth mixture modeling approach to model differential trajectories of children's emotion dysregulation from age four to age ten and assessed whether children's experiences of maltreatment prior to age four and caregiver histories of abuse were associated with children's probable class membership in the identified trajectories. RESULTS We identified three classes of emotion dysregulation trajectories: Well-Regulated, Increasingly Dysregulated, and Highly Dysregulated. Early experiences of multiple maltreatment types and caregiver history of abuse were associated with higher odds that children would be in the Increasingly Dysregulated and Highly Dysregulated classes compared to the Well-Regulated class. CONCLUSION The current study extends the literature on the negative associations of caregiver histories of abuse and child experiences of multiple maltreatment types to children's emotion dysregulation, which may be long-lasting. Furthermore, our findings highlight the need for intervening early as a crucial component of breaking the intergenerational impact of maltreatment.
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Affiliation(s)
- Lauren E Stargel
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, CO, United States of America.
| | - Terri Lewis
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado Anschutz Medical Center, Aurora, CO, United States of America
| | - Catherine A LaBrenz
- School of Social Work, University of Texas at Arlington, Arlington, TX, United States of America
| | - Jacob B W Holzman
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
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19
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Biederman J, DiSalvo M, Vaudreuil C, Wozniak J, Uchida M, Woodworth KY, Green A, Faraone SV. Disentangling the heterogeneity of emotional dysregulation in referred youth using the Child Behavior Checklist attending to age and sex effects. J Affect Disord 2022; 309:259-265. [PMID: 35460738 PMCID: PMC10026696 DOI: 10.1016/j.jad.2022.04.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/28/2022] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the utility of the Child Behavior Checklist (CBCL) to identify meaningful subtypes of emotional dysregulation in an outpatient pediatric psychiatry clinic. METHODS The sample consisted of 417 newly referred youth 6-18 years of age. Parents completed the CBCL and rating scales measuring executive function deficits, social functioning, and quality of life. Patients were stratified into subtypes of emotional dysregulation and compared on clinical correlates based on the A-A-A profile consisting of the CBCL Anxious/Depressed, Aggressive Behavior, and Attention Problems (A-A-A) scales. RESULTS 67% of youth had emotional dysregulation (CBCL A-A-A T-score ≥ 180) and of these, 39% had a positive CBCL-Bipolar (BP) profile (A-A-A T-score ≥ 210), 24% had depression without the BP profile (CBCL Anxious/Depressed and/or Withdrawn/Depressed T-scores ≥70 and A-A-A T-score ≥ 180 and 〈210), and 37% had emotional impulsivity (A-A-A T-score ≥ 180 and <210) with normal CBCL Anxious/Depressed and Withdrawn/Depressed T-scores. Patients with the CBCL-BP profile were significantly more impaired on all measures of social and executive functioning compared to the other two groups. LIMITATIONS Since our findings relied on the CBCL, other instruments may have led to different results. Because we included youth from a single clinic, largely Caucasian and referred, our findings may not generalize to other ethnic groups or settings. CONCLUSIONS The CBCL can aid in the identification of subtypes of emotional dysregulation affecting youth seeking mental health services.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Carrie Vaudreuil
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mai Uchida
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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20
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Ametti MR, Crehan ET, O’Loughlin K, Schreck MC, Dube SL, Potter AS, Sigmon SC, Althoff RR. Frustration, Cognition, and Psychophysiology in Dysregulated Children: A Research Domain Criteria Approach. J Am Acad Child Adolesc Psychiatry 2022; 61:796-808.e2. [PMID: 35074486 PMCID: PMC9275749 DOI: 10.1016/j.jaac.2021.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/30/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
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.
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21
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Yao A, Shimada K, Kasaba R, Tomoda A. Beneficial Effects of Behavioral Parent Training on Inhibitory Control in Children With Attention-Deficit/Hyperactivity Disorder: A Small-Scale Randomized Controlled Trial. Front Psychiatry 2022; 13:859249. [PMID: 35573335 PMCID: PMC9094443 DOI: 10.3389/fpsyt.2022.859249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to examine whether the beneficial effects of behavioral parent training (BPT), as an indirect type of psychosocial treatment, are extended to cognitive manifestations beyond behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Although previous studies of community families have shown an association between parenting quality and a child's cognitive functions, little is known about the effects of BPT on cognitive manifestations in children with ADHD. In this study, we focused on inhibitory control among cognitive domains, which is considered to be the most malleable to direct types of psychosocial treatment for ADHD. We hypothesized that inhibitory control is affected by BPT, which uses parents as the primary agents of change to help their children. Thirty school-age children (6-12 years old) with ADHD and their parents (mothers) participated and were randomly assigned to either the standard BPT or waitlist control group. Using two objective laboratory-based tasks of inhibitory control (i.e., go/no-go and single response selection tasks), we assessed baseline and post-treatment response inhibition to suppress task-irrelevant responses and response selection to select task-relevant responses. In addition to decreased ADHD symptoms and negative parenting, the BPT group exhibited significantly improved performance in the single response selection task, but not in the go/no-go task, compared with the waitlist control group. Although tentative, these findings partially support our hypothesis that BPT has beneficial effects on the cognitive inhibitory control of ADHD, highlighting the potential for supportive environmental modifications to advance cognitive development in children with ADHD.
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Affiliation(s)
- Akiko Yao
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Koji Shimada
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Ryoko Kasaba
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
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22
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Asmussen J, Skovgaard AM, Bilenberg N. Trajectories of dysregulation in preschool age. Eur Child Adolesc Psychiatry 2022; 31:313-324. [PMID: 33386524 DOI: 10.1007/s00787-020-01689-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Dysregulation of emotions, behaviour and attention is involved in several areas of childhood psychopathology, but knowledge about early developmental trajectories remains scarce. This study aims to explore continuity and associations of dysregulation in preschool age. Dysregulation was measured at age 2½ years and again at 5 years in a community-based birth cohort of 1099 children using the Child Behavior Checklist, preschool version (CBCL1½-5), answered by mothers. Based on the Dysregulation Profile (CBCL-DP) score, we defined four trajectory groups, using the 75th percentile from the Danish norm material as a cut-off. Associations between the four CBCL-DP trajectory groups and potential covariates, including child, parental and family factors, were analysed using univariate and multiple multinomial logistic regression. Nearly half (54%) of the children showed persistent low scores of CBCL-DP, 17% displayed continuing dysregulation problems, 13% had problems that increased from 2½ years to 5 years, whereas 16% of the children showed reduced problems across preschool age. Persistent dysregulation was associated with maternal postpartum depressive symptoms RRR = 2.20 (95% CI 1.29-3.75), low maternal educational level RRR = 1.69 (95% CI 1.08-2.66), and mothers' smoking during pregnancy RRR = 2.87 (95% CI 1.09-7.55). Persistent problems of emotional, behavioural and attention regulation in children aged 2½ years to 5 years is influenced by maternal educational level and post-partum depression symptoms. The study draws clinical attention to early symptoms of dysregulation and to the importance of addressing the specific needs of mentally vulnerable parents in intervention planning.
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Affiliation(s)
- Jette Asmussen
- Research Unit of Child and Adolescent Mental Health, Department of Clinical Research, University of Southern Denmark, J.B Winsløws Vej 16, indgang 228, 5000, Odense C, Denmark.
| | - Anne Mette Skovgaard
- Faculty of Health Sciences, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Niels Bilenberg
- Research Unit of Child and Adolescent Psychiatry Odense, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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23
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Sood NT, Godfrey C, Chavez Arana C, Anderson V, Catroppa C. Paediatric traumatic brain injury and the dysregulation profile: The mediating role of decision-making. Neuropsychol Rehabil 2022; 33:440-453. [PMID: 35040743 DOI: 10.1080/09602011.2022.2025861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Decision-making is often impacted by paediatric traumatic brain injury (TBI). However, there are few tools available to assess these skills in children, with even less research on the consequences of decision-making deficits on dysregulation following TBI. This prospective preliminary study investigated whether decision-making mediated the effect of TBI on dysregulation in children. The performance of school-aged children aged between 7 and 15 years with TBI (n = 49) and that of typically developing controls (n = 22) was compared on The Decision-making Task, and on parent ratings of the dysregulation profile as characterized by the Child Behaviour Checklist-Dysregulation Profile. Relative to the Control group, the TBI group performed more poorly on the decision-making task, and parents of the TBI group rated their children to be more poorly on the dysregulation profile. Mediation analyses indicated that decision-making mediated the relationship between TBI and the dysregulation profile. Our preliminary findings suggest the need for further research in the area of decision-making, and its impact on dysregulated behaviours in children following TBI.
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Affiliation(s)
- Nikita Tuli Sood
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Celia Godfrey
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Clara Chavez Arana
- Department of Psychology, Education, & Child Studies, Erasmus School of Social and Behavioural Sciences, Rotterdam, Netherlands
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Wang B, Becker A, Kaelble C, Rothenberger A, Uebel-von Sandersleben H. Dysregulation profile (DP) as a transdiagnostic psychopathological factor in clinically referred children - comparisons between disorders and latent structure. Nord J Psychiatry 2022; 76:71-79. [PMID: 34126841 DOI: 10.1080/08039488.2021.1936167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dysregulation Profile (DP) describes the psychopathological construct of concurrent impairments in the ability to regulate emotion, behaviour, and cognition measured by the Child Behaviour Checklist (CBCL). Such transdiagnostic dimensions of psychopathology play an important role in addition to core symptoms of psychiatric diagnosis in clinical practice. Evaluation of DP in children with different mental disorders may improve our understanding and treatment of both contents. METHODS 911 clinically referred children between 6 and 18 years were investigated. The sample consisted of five 'pure' disorders groups, that is, tic disorder (TIC), anxiety disorder, obsessive compulsive disorder, depression, Attention Deficit Hyperactivity Disorder (ADHD), and two comorbid disorder group, that is, ADHD + TIC and ADHD + oppositional defiant disorder (ODD). DP level and latent structure were compared across groups. RESULTS The rate of severe/abnormal dysregulation rates varied from 15% to 44% when the 210 cut-off was used, and 5% to 18% when stringent cut-off was used (i.e. ≥70 on all DP-subscales). The most affected population were children with comorbid ADHD with ODD/TIC, while least were those with TIC only. Five different latent phenotypes of DP were found. CONCLUSION DP above clinical cut-off level widely exists in clinically referred children in parallel to core symptoms of their diagnosis, especially among children with comorbidities. During clinical assessment it would be worth to clarify the role of DP-related problems within the general psychosocial impairment of the patient to improve a personalized approach.
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Affiliation(s)
- Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Christina Kaelble
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Henrik Uebel-von Sandersleben
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
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Psychometric Properties of the Strengths and Difficulties Questionnaire-Dysregulation Profile in Italian Early Adolescents. CHILDREN 2021; 8:children8121123. [PMID: 34943319 PMCID: PMC8700491 DOI: 10.3390/children8121123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
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.
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26
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Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health 2021; 26:303-309. [PMID: 33939246 DOI: 10.1111/camh.12471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
| | - Sarah Curran
- South West London and St George's Mental Health NHS Trust, London, UK
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Tsai CJ, Lin HY, Tseng IWY, Gau SSF. White matter microstructural integrity correlates of emotion dysregulation in children with ADHD: A diffusion imaging tractography study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110325. [PMID: 33857524 DOI: 10.1016/j.pnpbp.2021.110325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Emotion dysregulation (ED) is prevalent in youths with attention-deficit hyperactivity disorder (ADHD) and causes more social impairment and poor adaptive function. Alterations in the integrity of white matter (WM) tracts might have important implications for affective processing related to ED. However, little is known about the WM correlates underpinning ED in ADHD. METHODS Using diffusion spectrum image tractography, we obtained generalized fractional anisotropy (GFA) values of 76 WM tracts in 77 children with ADHD and 105 typically developing controls (TDC). ED severity was defined by the dysregulation profile from the child behavior checklist. Canonical correlation analysis (CCA) was performed to identify modes that relate WM microstructural property to ED severity and cognitive measures. RESULTS The application of CCA identified one significant mode (r = 0.638, FWE-corrected p = 0.046) of interdependencies between WM property patterns and diagnosis, ADHD total symptom levels, dysregulation by diagnosis interaction, and full-scale intellectual quotient (FIQ). GFA values of 19 WM tracts that were linked to affective-processing, sensory-processing and integration, and cognitive control circuitry were positively correlated with ED severity in TDC but negatively correlated with ED severity in ADHD. ADHD symptom severity and diagnosis were negatively associated with the GFA patterns of this set of tract bundles. In contrast, FIQ was positively correlated with this set of tract bundles. CONCLUSIONS This study used the CCA to show that children with ADHD and TDC had distinct multivariate associations between ED severity (diagnosis by ED interaction) and microstructural property in a set of WM tracts. These tracts interconnect the cortical regions that are principally involved in emotion processing, integration, and cognitive control in multiple brain systems. The WM microstructure integrity impairment might be an essential correlate of emotion dysregulation in ADHD.
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Affiliation(s)
- Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Wen-Yih Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences and Department of Psychology, National Taiwan University, Taipei, Taiwan.
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28
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Tsai CJ, Lin HY, Tseng IWY, Gau SSF. Brain voxel-based morphometry correlates of emotion dysregulation in attention-deficit hyperactivity disorder. Brain Imaging Behav 2021; 15:1388-1402. [PMID: 32700253 DOI: 10.1007/s11682-020-00338-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) has a high prevalence of co-occurring with emotion dysregulation (ED). Youths with ADHD and ED are more likely to have increased functional impairment. There is accumulating research on defining the features, behavioral, and physiological manifestations of ED, but there are currently few studies elucidating neuroanatomical correlations of ED in ADHD. Structural magnetic resonance imaging data from 118 children (aged 7-18 years) with ADHD (50 ADHD+high ED, 68 ADHD+low ED), and 104 typically developing controls (TDC) were processed using voxel-based morphometry. We used both dichotomous and continuous indices of ED to examine the possible correspondence between ED and ADHD. Relative to ADHD+high ED, ADHD+low ED had greater gray matter (GM) volumes over the left anterior prefrontal cortex (PFC). ADHD+low ED and ADHD+high ED shared a negative association of ED levels with the left middle temporal pole GM volume. TDC and ADHD+low ED also shared negative relationships of ED levels with the right temporal volume, and positive relationships with the left dorsolateral PFC volume. Besides, ED-by-group interactions were also noted. Specifically, medial PFC GM volumes increased and decreased with ED severity in ADHD+low ED and ADHD+high ED, respectively; and left cerebellum Crus GM volumes decreased and increased with ED severity in ADHD+low ED and ADHD+high ED, respectively. Our findings add to the evidence that some specific neural correlates are underpinning ED across ADHD and TDC. These findings suggest the importance of incorporating ED problems when considering heterogeneity in studies of ADHD.
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Affiliation(s)
- Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Wen-Yih Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- Graduate Institute of Brain and Mind Sciences and Department of Psychology, National Taiwan University, Taipei, Taiwan.
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Abstract
Explosive outbursts (EO) by students are an intensely distressing experience for that student as well as for all school staff and students present during the outburst. These EO are characterized by rapid escalations, usually far out of proportion to precipitating events, may include significant verbal and/or physical aggression, require intensive staff intervention, are often difficult for the student to process, and are typically recurrent. These explosions cross multiple psychiatric and educational diagnostic categories and require diverse interventions to address behavioral, emotional, impulsive, and sensory components. Interventions for each stage of an EO can be used to deescalate these events.
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Affiliation(s)
- Jeff Q Bostic
- Department of Psychiatry, MedStar Georgetown University Hospital, 2115 Wisconsin Avenue, Northwest, Suite 200, Washington, DC 20007, USA.
| | | | - D Cunningham
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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30
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Masi G, Lupetti I, D’Acunto G, Milone A, Fabiani D, Madonia U, Berloffa S, Lenzi F, Mucci M. A Comparison between Severe Suicidality and Nonsuicidal Self-Injury Behaviors in Bipolar Adolescents Referred to a Psychiatric Emergency Unit. Brain Sci 2021; 11:brainsci11060790. [PMID: 34203874 PMCID: PMC8232570 DOI: 10.3390/brainsci11060790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Severe suicide ideation or attempts and non-suicidal self-injury (NSSI) present both differences and relevant overlaps, including frequent co-occurrence and shared risk factors. Specific categorical diagnoses, namely bipolar disorder (BD), may affect clinical features and natural histories of suicidal or not suicidal self-harm behaviour. Our study aimed to compare suicidality (severe suicidal ideation or suicidal attempts) and NSSI in referred bipolar adolescents. Methods: The sample included 95 bipolar adolescents (32 males, 63 females) aged 11 to 18 years. Thirty adolescents with suicide attempts/suicidal ideation and BD (SASIB) were compared with structured measures to 35 adolescents with NSSI and BD, without suicidal ideation or attempts (NSSIB), and to 30 adolescents with BD, without suicidal ideation or attempts or NSSI (CB). Results: Compared to CB, suicidality and NSSI were both associated with female sex, borderline personality disorder and self-reported internalizing disorders, anxiety/depression and thought disorders. The NSSI were specifically associated with somatic problems. Severe suicidal ideation and suicide attempts were associated with adverse life events, immigration, bullying, eating disorders, social problems, depressive feelings, performance and social anxiety, and feelings of rejection. Conclusions: Both shared and differential features between suicidal and not suicidal adolescents may represent possible targets for diagnostic and preventative interventions.
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Biederman J, DiSalvo M, Vaudreuil C, Wozniak J, Uchida M, Woodworth KY, Green A, Farrell A, Faraone SV. The child behavior checklist can aid in characterizing suspected comorbid psychopathology in clinically referred youth with ADHD. J Psychiatr Res 2021; 138:477-484. [PMID: 33965736 PMCID: PMC9069333 DOI: 10.1016/j.jpsychires.2021.04.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the utility of the Child Behavior Checklist (CBCL) to aid in the identification of comorbid psychopathological conditions affecting referred youth with suspected ADHD prior to the evaluation. The CBCL is an easy-to-use assessment tool that may provide invaluable information regarding the severity and characteristics of the presenting complaints. METHODS The sample included 332 youths consecutively referred to an ADHD program for the assessment of suspected ADHD. Parents completed the CBCL, parent-rated ADHD Self-Report Scale (ASRS), Social Responsiveness Scale (SRS), and Behavior Rating Inventory of Executive Function (BRIEF). Because of the established association between the CBCL Attention Problems scale and a structured diagnostic interview of ADHD, all youths analyzed had abnormal Attention Problems T-scores (≥60). RESULTS Seventy-six percent of youths with elevated Attention Problems T-scores had ≥3 additional abnormal CBCL scales, suggesting they were likely affected with multiple comorbid psychopathological conditions. Moreover, 44% had ≥1 CBCL clinical scale with a T-score more severe than their Attention Problems T-score, suggesting the putative comorbid condition was more severe than the ADHD symptoms. Additional CBCL scale elevations were associated with more severe functional impairments as assessed by the ASRS, SRS, BRIEF, and CBCL competence scales. CONCLUSION The CBCL obtained before the clinical assessment identified high rates of comorbid psychopathology in youths referred for the assessment of ADHD. It provided detailed information about the types and severity of suspected psychopathological conditions impacting a particular youth, which is critical to guide the assessing clinician on likely differing needs of the affected child.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Carrie Vaudreuil
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Janet Wozniak
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mai Uchida
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - K. Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Abigail Farrell
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen V. Faraone
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA, USA,Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Greenlee JL, Stelter CR, Piro-Gambetti B, Hartley SL. Trajectories of Dysregulation in Children with Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:858-873. [PMID: 33872096 DOI: 10.1080/15374416.2021.1907752] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: This study determined whether child and family environment factors are associated with differences in developmental trajectories of emotional and behavioral dysregulation in children with autism spectrum disorder (ASD).Method: Participants included 186 families of a child with ASD (5-12 years old at baseline; 86% male; 83% non-Hispanic Caucasian; 35% comorbid intellectual disability). At each of the four time points (each spaced 12 months apart), mothers and fathers within each family completed well-validated measures on their own mental health, their child's dysregulation, their parent-child relationship, and their parent couple relationship. Longitudinal multi-level modeling was used to describe trajectories of dysregulation across 3 years and test whether parent depression, closeness in the parent-child relationship, and positive parent dyadic coping were associated with differences in child trajectories.Results: On average, child dysregulation decreased across time. Closer mother-child and father-child relationship quality was associated with lower baseline dysregulation. More severe child restricted and repetitive behaviors, fewer maternal depression symptoms, and more positive parent dyadic coping were associated with declines in child dysregulation over time.Conclusions: On average, children with ASD become less dysregulated across time. However, there is important variability in dysregulation trajectories of children with ASD. Children with ASD who have a high (versus low) severity of restricted and repetitive behaviors appear to be at risk for greater dysregulation. The family environment, and specifically a closer parent-child relationship, better maternal mental health, and more positive couple coping, may contribute to a pattern of improved child regulation across time in ASD.
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Benton TD, Muhrer E, Jones JD, Lewis J. Dysregulation and Suicide in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:389-399. [PMID: 33743946 DOI: 10.1016/j.chc.2020.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Suicide rates continue to rise among children and adolescents; suicide is the second leading cause of death in the United States. Although research studies have identified factors associated with suicide risks for youths, none distinguishes those who have suicidal ideation from those who most likely will make an attempt or die by suicide. Most studies focus on psychiatric diagnoses associated with suicide risks. Recent studies suggest that cross-cutting symptom profiles may be a stronger predictor of risks for suicide than diagnosis. This article provides an overview of emotional dysregulation as it relates to suicidal ideation, intent, and behaviors for youth.
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Affiliation(s)
- Tami D Benton
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Eli Muhrer
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA
| | - Jason D Jones
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jason Lewis
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 3440 Market Street, Suite 410, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Abstract
This article highlights the breadth of measures available for measuring emotion dysregulation, or facets thereof, in children and adolescents, and reviews in detail a subset of these measures. We describe broadband measures and measures that are specific to emotion dysregulation, including observational tools, clinical interviews, and rating scales. Furthermore, we discuss the strengths, weaknesses, and psychometric properties of each approach and specific contexts or populations in which certain methods may be particularly useful. Finally, recommendations for thorough assessment of emotion dysregulation in future studies are provided.
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Fumero A, Marrero RJ, Pérez-Albéniz A, Fonseca-Pedrero E. Adolescents' Bipolar Experiences and Suicide Risk: Well-being and Mental Health Difficulties as Mediators. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063024. [PMID: 33804197 PMCID: PMC7998787 DOI: 10.3390/ijerph18063024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 12/22/2022]
Abstract
Bipolar disorder is usually accompanied by a high suicide risk. The main aim was to identify the risk and protective factors involved in suicide risk in adolescents with bipolar experiences. Of a total of 1506 adolescents, 467 (31%) were included in the group reporting bipolar experiences or symptoms, 214 males (45.8%) and 253 (54.2%) females. The mean age was 16.22 (SD = 1.36), with the age range between 14 and 19. Suicide risk, behavioral and emotional difficulties, prosocial capacities, well-being, and bipolar experiences were assessed through self-report. Mediation analyses, taking gender as a moderator and controlling age as a covariate, were applied to estimate suicide risk. The results indicated that the effect of bipolar experiences on suicide risk is mediated by behavioral and emotional difficulties rather than by prosocial behavior and subjective well-being. Specifically, emotional problems, problems with peers, behavior problems, and difficulties associated with hyperactivity were the most important variables. This relationship was not modulated by gender. However, the indirect effects of some mediators varied according to gender. These results support the development of suicide risk prevention strategies focused on reducing emotional difficulties, behavioral problems, and difficulties in relationships with others.
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Affiliation(s)
- Ascensión Fumero
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, 38200 La Laguna, Tenerife, Spain;
- Correspondence: ; Tel.: +34-922-317-960
| | - Rosario J. Marrero
- Department of Clinical Psychology, Psychobiology and Methodology, University of La Laguna, 38200 La Laguna, Tenerife, Spain;
| | - Alicia Pérez-Albéniz
- Department of Educational Sciences, University of La Rioja, 26002 Logroño, La Rioja, Spain; (A.P.-A.); (E.F.-P.)
| | - Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, 26002 Logroño, La Rioja, Spain; (A.P.-A.); (E.F.-P.)
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36
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Carmichael P, Butler G, Masic U, Cole TJ, De Stavola BL, Davidson S, Skageberg EM, Khadr S, Viner RM. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One 2021; 16:e0243894. [PMID: 33529227 PMCID: PMC7853497 DOI: 10.1371/journal.pone.0243894] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In adolescents with severe and persistent gender dysphoria (GD), gonadotropin releasing hormone analogues (GnRHa) are used from early/middle puberty with the aim of delaying irreversible and unwanted pubertal body changes. Evidence of outcomes of pubertal suppression in GD is limited. METHODS We undertook an uncontrolled prospective observational study of GnRHa as monotherapy in 44 12-15 year olds with persistent and severe GD. Prespecified analyses were limited to key outcomes: bone mineral content (BMC) and bone mineral density (BMD); Child Behaviour CheckList (CBCL) total t-score; Youth Self-Report (YSR) total t-score; CBCL and YSR self-harm indices; at 12, 24 and 36 months. Semistructured interviews were conducted on GnRHa. RESULTS 44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months. All had normal karyotype and endocrinology consistent with birth-registered sex. All achieved suppression of gonadotropins by 6 months. At the end of the study one ceased GnRHa and 43 (98%) elected to start cross-sex hormones. There was no change from baseline in spine BMD at 12 months nor in hip BMD at 24 and 36 months, but at 24 months lumbar spine BMC and BMD were higher than at baseline (BMC +6.0 (95% CI: 4.0, 7.9); BMD +0.05 (0.03, 0.07)). There were no changes from baseline to 12 or 24 months in CBCL or YSR total t-scores or for CBCL or YSR self-harm indices, nor for CBCL total t-score or self-harm index at 36 months. Most participants reported positive or a mixture of positive and negative life changes on GnRHa. Anticipated adverse events were common. CONCLUSIONS Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD.
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Affiliation(s)
- Polly Carmichael
- Gender Identity Development Service (GIDS), Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Gary Butler
- Gender Identity Development Service (GIDS), Tavistock and Portman NHS Foundation Trust, London, United Kingdom
- Paediatric Endocrine Service, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Una Masic
- Gender Identity Development Service (GIDS), Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Tim J. Cole
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Bianca L. De Stavola
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Sarah Davidson
- Gender Identity Development Service (GIDS), Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Elin M. Skageberg
- Gender Identity Development Service (GIDS), Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Sophie Khadr
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Russell M. Viner
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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37
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Funkhouser CJ, Chacko AA, Correa KA, Kaiser AJE, Shankman SA. Unique longitudinal relationships between symptoms of psychopathology in youth: A cross-lagged panel network analysis in the ABCD study. J Child Psychol Psychiatry 2021; 62:184-194. [PMID: 32399985 PMCID: PMC7657959 DOI: 10.1111/jcpp.13256] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The network theory suggests that psychopathology may reflect causal relationships between individual symptoms. Several studies have examined cross-sectional relationships between individual symptoms in youth. However, these studies cannot address the directionality of the temporal relationships hypothesized by the network theory. Therefore, we estimated the longitudinal relationships between individual internalizing, externalizing, and attention symptoms in youth. METHODS Data from 4,093 youth participants in the Adolescent Brain Cognitive Development (ABCD) study were used. Symptoms were assessed using the Brief Problem Monitor, which was administered at three time points spaced six months apart. Unique longitudinal relationships between symptoms at T1 and T2 were estimated using cross-lagged panel network modeling. Network replicability was assessed by comparing this network to an identically estimated replication network of symptoms at T2 predicting symptoms at T3. RESULTS After controlling for all other symptoms and demographic covariates, depressed mood, inattention, and worry at T1 were most predictive of other symptoms at T2. In contrast, threats of violence and destructiveness at T2 were most prospectively predicted by other symptoms at T1. The reciprocal associations between depressed mood and worthlessness were among the strongest bivariate relationships in the network. Comparisons between the original network and the replication network (correlation between edge lists = .61; individual edge replicability = 64%-84%) suggested moderate replicability. CONCLUSIONS Although causal inferences are precluded by the observational design and methodological considerations, these findings demonstrate the directionality of relationships between individual symptoms in youth and highlight depressed mood, inattention, and worry as potential influencers of other symptoms.
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Affiliation(s)
- Carter J. Funkhouser
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Kelly A. Correa
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ariela J. E. Kaiser
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stewart A. Shankman
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Masi G, Scullin S, Narzisi A, Muratori P, Paciello M, Fabiani D, Lenzi F, Mucci M, D’Acunto G. Suicidal Ideation and Suicidal Attempts in Referred Adolescents with High Functioning Autism Spectrum Disorder and Comorbid Bipolar Disorder: A Pilot Study. Brain Sci 2020; 10:brainsci10100750. [PMID: 33080887 PMCID: PMC7603180 DOI: 10.3390/brainsci10100750] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 12/28/2022] Open
Abstract
Suicidal ideation and attempts in adolescents are closely associated to bipolar disorders (BD). Growing evidence also suggests that high functioning autism spectrum disorders (HF-ASD) are at increased risk for suicidal ideation and behaviors. Although BD and HF-ASD are frequently comorbid, no studies explored suicidality in these individuals. This exploratory study addressed this issue in a clinical group of inpatient adolescents referred to a psychiatric emergency unit. Seventeen adolescents with BD and HF-ASD and severe suicidal ideation or attempts (BD-ASD-S), were compared to 17 adolescents with BD and HF-ASD without suicidal ideation or attempts (BD-ASD-noS), and to 18 adolescents with BD and suicidal ideation or attempts without ASD (BD-noASD-S), using a structured assessment methodology. Individuals with BD-ASD-S had a higher intelligence quotient, more severe clinical impairment, more lethality in suicide attempts, more internalizing symptoms, less impulsiveness, and lower social competence. Severity of ASD traits in individuals and parents did not correlate with suicidal risk. Some dimensions of resilience were protective in terms of repulsion by life and attraction to death. Main limitations are the small sample size, the lack of a control group of typically developing adolescents. However, a better understanding of the specificities of bipolar HF-ASD individuals with suicidality may improve prevention and treatment strategies.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
- Correspondence:
| | - Silvia Scullin
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Antonio Narzisi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Pietro Muratori
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Marinella Paciello
- Faculty of Psychology, Università Telematica Internazionale Uninettuno, 00186 Rome, Italy;
| | - Deborah Fabiani
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Francesca Lenzi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Maria Mucci
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
| | - Giulia D’Acunto
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Pisa, Italy; (S.S.); (A.N.); (P.M.); (D.F.); (F.L.); (M.M.); (G.D.)
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Wang B, Eastwood PR, Becker A, Isensee C, Wong JWY, Huang RC, Runions KC, Stewart RM, Meyer T, Brüni LG, Rothenberger A, Zepf FD. Concurrent developmental course of sleep problems and emotional/behavioral problems in childhood and adolescence as reflected by the dysregulation profile. Sleep 2020; 42:5231982. [PMID: 30521022 DOI: 10.1093/sleep/zsy243] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/04/2018] [Accepted: 12/03/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Longitudinal data on the course and relationship of concurrent psychopathology in youth are scarce but are of need for better practical patient care and prevention. This study explores the course of (and relationships over time) between sleep problems and concurrent dimensional difficulties relating to anxiety/depression, attention deficiency, and aggressive behaviors in childhood and adolescence. The latter three may jointly form a broad syndrome, the dysregulation profile. METHODS Young people from the Raine Study, a large community cohort sample (N = 1625) were followed from age 5 to 17 years. Developmental courses of sleep problems and its concurrent regulatory difficulties were estimated separately and jointly. RESULTS The majority of adolescents reported low levels of problems and which appeared to be stable over time, while a small group (rates between 7.8% and 10.1%) reported enduring problematic developmental courses. Sleep problems and regulatory difficulties shared a strong association in their development over time (individual's probabilities of having the same courses, i.e. low-low and high-high, were between 89.8% and 92.3%). Furthermore, having persistent sleep problems over time was associated with an increased risk of having regulatory difficulties by approximately 10 times, and vice versa. CONCLUSION Findings from this study provide empirical evidence for a strong mutual association in the development of sleep problems and difficulties of dysregulation with emotion, cognition, and aggression. It may be suggested that a positive screening of one such psychopathological dimension should lead to a careful assessment, not only to reduce the problem in question but also to prevent the youth from further problems.
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Affiliation(s)
- Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Peter R Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Corinna Isensee
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Janice W Y Wong
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia
| | | | - Kevin C Runions
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Richard M Stewart
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Goettingen, Goettingen, Germany
| | - L G Brüni
- Child and Adolescent Psychiatry, Psychiatry Services Thurgau, Weinfelden, Switzerland
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Germany
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40
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Zaidman-Zait A, Zwaigenbaum L, Duku E, Bennett T, Szatmari P, Mirenda P, Smith I, Vaillancourt T, Volden J, Waddell C, Kerns C, Elsabbagh M, Georgiades S, Ungar WJ, Fombonne E, Roberts W. Factor analysis of the children's sleep habits questionnaire among preschool children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 97:103548. [PMID: 31901672 DOI: 10.1016/j.ridd.2019.103548] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 11/17/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep problems are prevalent among young children with autism spectrum disorders (ASD). The Children's Sleep Habits Questionnaire (CSHQ) is commonly used for assessment, but there are outstanding questions regarding its optimal measurement model. AIMS To examine the factor structure of the CSHQ in preschool children with ASD, and relationships between CSHQ factors and children's emotional, cognitive, and behavioral dysregulation. METHODS AND PROCEDURES Participants included 4- to 5-year-olds with ASD (n = 281). Confirmatory factor analysis was used to examine whether two previously reported CSHQ factor structures provided adequate fit to the sample data. Exploratory Factor Analysis (EFA) was used examine alternative models. Regression analyses were used to examine how CSHQ factor scores explained variance in dysregulation symptoms, measured by the Child Behavior Checklist. RESULTS Previously reported factor models in children with ASD were not confirmed, but a novel five-factor model identified using EFA provided excellent fit to the sample data. Sleep factors were generally not correlated with autism symptoms but were associated with aggression, anxiety/depression and attention problems, with evidence of specificity in these relationships. CONCLUSIONS The proposed CSHQ five-factor model may be useful in future studies of sleep problems in young children with ASD.
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Affiliation(s)
| | | | - Eric Duku
- McMaster University & Offord Centre for Child Studies
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, University of Toronto
| | | | | | | | | | | | | | | | | | | | | | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto
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Laceulle OM, Chung JM, Vollebergh WAM, Ormel J. The wide-ranging life outcome correlates of a general psychopathology factor in adolescent psychopathology. Personal Ment Health 2020; 14:9-29. [PMID: 31407875 PMCID: PMC7140177 DOI: 10.1002/pmh.1465] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The structure of psychopathology has been much debated within the research literature. This study extends previous work by providing comparisons of the links between psychopathology and several life outcomes (temperamental, economic, social, psychological and health) using a three-correlated-factors model, a bifactor model, a revised-bifactor model and a higher-order model. METHODS Data from a sample of Dutch adolescents were used (n = 2 230), and psychopathology factors were modelled using self-reported and parent-reported longitudinal data from youth across four assessments during adolescence, from ages 11 to 19. Outcome variables were assessed at age 22 using adolescent-reports and parent-reports and more objective measures (e.g. body mass index). RESULTS While no measurement model was clearly superior, we found modest associations between the psychopathology factors and life outcomes. Importantly, after taking into account a general factor, the associations with life outcomes decreased for the residual parts of thought problems (across all domains) and internalizing problems (for temperamental and psychological outcomes), but not for externalizing problems, compared with the traditional three-correlated-factors model. Patterns were similar for adolescent-reported and parent-reported data. CONCLUSIONS Findings suggest that a general factor is related to psychopathology and life outcomes in a meaningful way. Results are discussed in terms of individual differences in propensity to psychopathology and more broadly in light of recent developments concerning the structure of psychopathology. © 2019 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Odilia M Laceulle
- Department of Developmental Psychology, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands
| | - Joanne M Chung
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road, Mississauga, ON, L5L1C6, Canada
| | - Wilma A M Vollebergh
- Department of Interdisciplinary Social Science, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, The Netherlands
| | - Johan Ormel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
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42
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Deutz MHF, Geeraerts SB, Belsky J, Deković M, van Baar AL, Prinzie P, Patalay P. General Psychopathology and Dysregulation Profile in a Longitudinal Community Sample: Stability, Antecedents and Outcomes. Child Psychiatry Hum Dev 2020; 51:114-126. [PMID: 31359330 DOI: 10.1007/s10578-019-00916-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The general factor of psychopathology (GP, or p factor) and the Dysregulation Profile (DP) are two conceptually similar, but independently developed approaches to understand psychopathology. GP and DP models and their stability, antecedents and outcomes are studied in a longitudinal sample of 1073 children (49.8% female). GP and DP models were estimated at ages 8 and 14 years using the parent-reported Child Behavior Checklist (CBCL) and Youth Self Report (YSR). Early childhood antecedents and adolescent outcomes were derived using a multi-method multi-informant approach. Results showed that the general GP and DP had similar key symptoms and were similarly related to early-childhood antecedents (e.g., lower effortful control, higher maternal depression) and adolescent outcomes (e.g., reduced academic functioning, poorer mental health). This study demonstrates that GP and DP are highly similar constructs in middle childhood and adolescence, both describing a general vulnerability for psychopathology with (emotional) dysregulation at its core. Scientific integration of these approaches could lead to a better understanding of the structure, antecedents and outcomes of psychopathology.
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Affiliation(s)
- Marike H F Deutz
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands. .,Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Sanne B Geeraerts
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Jay Belsky
- University of California, Davis, CA, USA
| | - Maja Deković
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Anneloes L van Baar
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Peter Prinzie
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Rescorla LA, Jordan P, Zhang S, Baelen-King G, Althoff RR, Ivanova MY, International Aseba Consortium. Latent Class Analysis of the CBCL Dysregulation Profile for 6- to 16-Year-Olds in 29 Societies. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:551-564. [PMID: 31914322 DOI: 10.1080/15374416.2019.1697929] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
| | - Phoebe Jordan
- Department of Educational Psychology, University of Wisconsin
| | - Susu Zhang
- Department of Statistics, Columbia University
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Heinrich H, Gevensleben H, Becker A, Rothenberger A. Effects of neurofeedback on the dysregulation profile in children with ADHD: SCP NF meets SDQ-DP - a retrospective analysis. Psychol Med 2020; 50:258-263. [PMID: 30674360 DOI: 10.1017/s0033291718004130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND As children with attention-deficit/hyperactivity disorder (ADHD) usually show psychopathological signs beyond their core symptoms (e.g. elevated scores of the dysregulation profile (DP) in 30-40%), treatments with a broader approach to self-regulation skills may be supportive. Neurofeedback (NF) may reflect such an option. Aim of the present analysis was to compare the effects of slow cortical potential (SCP) NF and θ/β NF on the DP using data from a previous trial. METHODS Thirty children with ADHD (aged 8-12 years) and a DP score in the Strengths and Difficulties Questionnaire (SDQ-DP) ⩾ 3 were included. NF treatment consisted of one block of SCP NF and one block of θ/β NF (18 units per block) allowing an intraindividual comparison. Effects of the NF protocols were also contrasted to a control group (n = 18) that completed an attention skills training (between-group analysis). RESULTS Regarding the SDQ-DP, SCP NF was superior to θ/β NF and the control condition. Effects of SCP NF and θ/β NF on ADHD symptom severity were not significantly different. The SDQ-DP score did not correlate with EEG-related measures previously found to be predictors for SCP NF on ADHD symptoms. CONCLUSIONS SCP NF may reflect a more general approach to improve cognitive, emotional and behavioral self-regulation skills. If confirmed in a larger sample, the SDQ-DP score could be used as an indication criterion and contribute to the individualization of NF in ADHD. Overall, the differential effect provides further evidence for the specificity of NF effects.
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Affiliation(s)
- Hartmut Heinrich
- Department of Child & Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
- kbo-Heckscher-Klinikum, Munich, Germany
- Research Institute Brainclinics, Nijmegen, The Netherlands (Research Fellow)
| | - Holger Gevensleben
- Department of Child & Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Becker
- Department of Child & Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Aribert Rothenberger
- Department of Child & Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
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Spechler PA, Chaarani B, Orr C, Mackey S, Higgins ST, Banaschewski T, Bokde ALW, Bromberg U, Büchel C, Quinlan EB, Conrod PJ, Desrivières S, Flor H, Frouin V, Gowland P, Heinz A, Ittermann B, Martinot JL, Nees F, Orfanos DP, Poustka L, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Garavan H, Althoff RR. Neuroimaging Evidence for Right Orbitofrontal Cortex Differences in Adolescents With Emotional and Behavioral Dysregulation. J Am Acad Child Adolesc Psychiatry 2019; 58:1092-1103. [PMID: 31004740 DOI: 10.1016/j.jaac.2019.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/15/2019] [Accepted: 04/11/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To characterize the structural and functional neurobiology of a large group of adolescents exhibiting a behaviorally and emotionally dysregulated phenotype. METHOD Adolescents aged 14 years from the IMAGEN study were investigated. Latent class analysis (LCA) on the Strengths and Difficulties Questionnaire (SDQ) was used to identify a class of individuals with elevated behavioral and emotional difficulties ("dysregulated"; n = 233) who were compared to a matched sample from a low symptom class (controls, n = 233). Whole-brain gray matter volume (GMV) images were compared using a general linear model with 10,000 random label permutations. Regional GMV findings were then probed for functional differences from three functional magnetic resonance imaging (fMRI) tasks. Significant brain features then informed mediation path models linking the likelihood of psychiatric disorders (DSM-IV) with dysregulation. RESULTS Whole-brain differences were found in the right orbitofrontal cortex (R.OFC; p < .05; k = 48), with dysregulated individuals exhibiting lower GMV. The dysregulated group also exhibited higher activity in this region during successful inhibitory control (F1,429 = 7.53, p < .05). Path analyses indicated significant direct effects between the likelihood of psychopathologies and dysregulation. Modeling the R.OFC as a mediator returned modest partial effects, suggesting that the path linking the likelihood of an anxiety or conduct disorder diagnoses to dysregulation is partially explained by this anatomical feature. CONCLUSION A large sample of dysregulated adolescents exhibited lower GMV in the R.OFC relative to controls. Dysregulated individuals also exhibited higher regional activations when exercising inhibitory control at performance levels comparable to those of controls. These findings suggest a neurobiological marker of dysregulation and highlight the role of the R.OFC in impaired emotional and behavioral control.
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Affiliation(s)
- Philip A Spechler
- University of Vermont, Burlington; Vermont Center on Behavior and Health, University of Vermont, Burlington.
| | - Bader Chaarani
- University of Vermont, Burlington; Vermont Center on Behavior and Health, University of Vermont, Burlington
| | | | | | - Stephen T Higgins
- University of Vermont, Burlington; Vermont Center on Behavior and Health, University of Vermont, Burlington
| | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arun L W Bokde
- School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Uli Bromberg
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Erin Burke Quinlan
- Centre for Population Neuroscience and Stratified Medicine (PONS) and MRC-SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Sylvane Desrivières
- Centre for Population Neuroscience and Stratified Medicine (PONS) and MRC-SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Herta Flor
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; School of Social Sciences, University of Mannheim, Mannheim, Germany
| | | | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, UK
| | - Andreas Heinz
- Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry", University Paris Sud - University Paris Saclay, France
| | - Frauke Nees
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Luise Poustka
- University Medical Centre Göttingen, Germany, and the Clinic for Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | | | | | - Henrik Walter
- Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Gunter Schumann
- Centre for Population Neuroscience and Stratified Medicine (PONS) and MRC-SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Hugh Garavan
- University of Vermont, Burlington; Vermont Center on Behavior and Health, University of Vermont, Burlington
| | - Robert R Althoff
- University of Vermont, Burlington; Vermont Center on Behavior and Health, University of Vermont, Burlington
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Marino C, Riva V, Mornati G, Piazza C, del Giudice R, Dionne G, Molteni M, Cantiani C. Postnatal maternal symptoms of depression and child emotion dysregulation: The mediation role of infant EEG alpha asymmetry. Infant Behav Dev 2019; 57:101321. [DOI: 10.1016/j.infbeh.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 04/11/2019] [Accepted: 04/13/2019] [Indexed: 11/27/2022]
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Keefer A, Singh V, Kalb LG, Mazefsky CA, Vasa RA. Investigating the factor structure of the child behavior checklist dysregulation profile in children and adolescents with autism spectrum disorder. Autism Res 2019; 13:436-443. [DOI: 10.1002/aur.2233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 08/30/2019] [Accepted: 09/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Amy Keefer
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore Maryland
| | - Vini Singh
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
| | - Luther G. Kalb
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
- Johns Hopkins University School of Public Health Baltimore Maryland
| | - Carla A. Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - Roma A. Vasa
- Center for Autism and Related DisordersKennedy Krieger Institute Baltimore Maryland
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine Baltimore Maryland
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Leaving A Mark, An Animal-Assisted Intervention Programme for Children Who Have Been Exposed to Gender-Based Violence: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214084. [PMID: 31652894 PMCID: PMC6862676 DOI: 10.3390/ijerph16214084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 12/04/2022]
Abstract
Gender-based violence is one of the most serious social and health problems faced by women around the world. Importantly, it has a negative impact not only on the woman’s physical and mental health, but also on all members of the family system in which it takes place. The aims of this study were to implement Leaving a Mark, an animal-assisted intervention (AAI) programme for children who have been exposed to gender-based violence, and to examine its effect on their associated clinical symptoms. The participants were 19 children (13 boys and 6 girls; Mage = 8.89, SD = 2.23) who had been exposed to domestic violence perpetrated either by their father or their mother’s intimate partner. Clinical symptoms were assessed using the Child Behaviour Checklist (CBCL). After taking part in the AAI programme, the children showed a reduction in internalizing symptoms and in symptoms associated with post-traumatic stress disorder. However, no significant changes were observed in externalizing symptoms or in affective and behavioural dysregulation (CBCL-Dysregulation Profile). These results provide preliminary support for the use of the Leaving a Mark programme with children who have been exposed to domestic violence. However, further studies with a larger sample and more rigorous design are required.
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Tonacci A, Billeci L, Calderoni S, Levantini V, Masi G, Milone A, Pisano S, Muratori P. Sympathetic arousal in children with oppositional defiant disorder and its relation to emotional dysregulation. J Affect Disord 2019; 257:207-213. [PMID: 31301625 DOI: 10.1016/j.jad.2019.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emotional dysregulation (ED) is a trans-nosographical condition characterized by mood instability, severe irritability, aggression, temper outburst, and hyper-arousal. Pathophysiology of emotional dysregulation and its potential biomarkers are an emerging field of interest. A Child Behaviour Checklist (CBCL) profile, defined as Dysregulation Profile (DP), has been correlated to ED in youth. We examined the association between the CBCL-DP and indices of sympathetic arousal in children with Oppositional Defiant Disorder (ODD) and healthy controls. METHOD The current study sought to compare the arousal level measured via electrodermal activity in response to emotional stimuli in three non-overlapping groups of children: (1) ODD+CBCL-DP (n = 28), (2) ODD without CBCL-DP (n = 35), and (3) typically developing controls (n = 25). RESULTS Analyses revealed a distinct electrodermal activity profile in the three groups. Specifically, children with ODD+CBCL-DP presented higher levels of sympathetic arousal for anger and sadness stimuli compared to the other two groups. LIMITATIONS The relatively small sample and the lack of assessing causality limit the generalizability of this study which results need to be replicated in larger, different samples. CONCLUSION The CBCL-DP was associated to higher levels of arousal for negative emotions, consistently with previous reports in individuals with depression and anxiety. Further work may identify potential longitudinal relationships between this profile and clinical outcomes.
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Affiliation(s)
- Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy, (CNR), Via Moruzzi 1, 56124, Pisa, Italy
| | - Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy, (CNR), Via Moruzzi 1, 56124, Pisa, Italy.
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valentina Levantini
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Gabriele Masi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Annarita Milone
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Simone Pisano
- Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy
| | - Pietro Muratori
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
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Constantinou MP, Goodyer IM, Eisler I, Butler S, Kraam A, Scott S, Pilling S, Simes E, Ellison R, Allison E, Fonagy P. Changes in General and Specific Psychopathology Factors Over a Psychosocial Intervention. J Am Acad Child Adolesc Psychiatry 2019; 58:776-786. [PMID: 30768397 DOI: 10.1016/j.jaac.2018.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/16/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Recent research suggests that comorbidity in child and adolescent psychiatric symptoms can be summarized by a single latent dimension known as the p factor and more specific factors summarizing clusters of symptoms. This study investigated within- and between-person changes in general and specific psychopathology factors over a psychosocial intervention. METHOD A secondary analysis was conducted of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy with those of management as usual for decreasing antisocial behavior in 684 adolescents (82% boys; 11-18 years old at baseline) over an 18-month period. The general p factor and specific antisocial, attention, anxiety, and mood factors were estimated from a symptom-level analysis of a set of narrowband symptom scales measured repeatedly during the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model. RESULTS A revised bi-factor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. Although the factor structure was multidimensional, the p factor accounted for most of the variance in total scores. The p factor, anxiety, and antisocial factors predicted within-person variation in external outcomes. Furthermore, the p factor and antisocial factors showed within-person declines, whereas anxiety showed within-person increases, over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change. CONCLUSION The bi-factor model is useful for teasing apart general and specific therapeutic changes that are conflated in standard analyses of symptom scores. CLINICAL TRIAL REGISTRATION INFORMATION START (Systemic Therapy for At Risk Teens): A National Randomised Controlled Trial to Evaluate Multisystemic Therapy in the UK Context; http://www.isrctn.com; ISRCTN77132214.
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Affiliation(s)
| | | | - Ivan Eisler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, University College London, UK
| | - Stephen Butler
- University of Prince Edward Island, Charlottetown, Canada
| | - Abdullah Kraam
- University of Leeds and Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, UK
| | - Elizabeth Simes
- Division of Psychology and Language Sciences, University College London, UK
| | - Rachel Ellison
- Division of Psychology and Language Sciences, University College London, UK
| | - Elizabeth Allison
- Division of Psychology and Language Sciences, University College London, UK
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, UK
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