Progression of externalizing disorders into anxiety disorders: Longitudinal transitions in the first three decades of life

Early markers of adult symptoms of depression and anxiety in the Raine Study

BACKGROUND

Early intervention offers the potential to mitigate adult mental illness; however, trials spanning decades present significant challenges, necessitating predictive early markers useable in trial settings. We hypothesised that parent evaluation using the child behaviour checklist (CBCL) total problem score at age two years predicted adult depressive and anxious symptoms and explored other potential parent ratings.

METHODS

We recruited participants in a pregnancy cohort, The Raine Study, with information on age one Infant Temperament Scale (ITS) and infant monitoring questionnaire (IMQ), or age two CBCL and IMQ. Linear mixed effects models tested the association of these parent ratings on age 20-27 self-reporting of depression and anxiety assessed by the Depression, Anxiety and Stress Scale (DASS). Multivariable modelling, parental self-evaluation and teacher ratings were used to control for bias.

RESULTS

A total of 1400 participants had available data for at least one association of interest. Primarily, early markers predicted depression with 1SD higher CBCL total problem T-score increasing the odds of moderate DASS depression symptoms by 32 % (p = 0.006). Significant but diminished effects were found in exploratory analysis of CBCL externalising and internalising scores and for ITS "Intensity of reaction" and "Distractability". The IMQ at ages one and two had no predictive value. We did not find influential familial evaluative bias or attrition bias.

CONCLUSIONS

CBCL total problem scores at two years of age are imprecise, but partial markers of adult depression symptoms. Lacking a feasible alternative, we cautiously propose their utility as outcomes for low-cost early intervention trials.

The Depression Anxiety Stress Scales for Youth (DASS-Y): evidence of validity and cross-national and gender measurement invariance

The Depression Anxiety Stress Scales for Youth (DASS-Y) is a recently developed measure of unpleasant emotional experiences for children and adolescents; however, the evidence for its validity is still limited. The present study evaluated the evidence for the structural, convergent, and incremental validity of the DASS-Y on a sample of Serbian adolescents aged 15-19 years (N = 421; 48% female, mean age = 16.86). Measurement invariance across gender and two countries (Serbia and Australia) was also tested. The findings supported the bifactor exploratory structural equation modeling (bifactor-ESEM) representation of the DASS-Y, which includes the General factor of negative affect/emotional distress, and three specific factors of Depression, Anxiety, and Stress. The DASS-Y factors showed evidence of incremental validity in predicting global externalizing symptoms and demonstrated convergent validity in relation to measures of global internalizing and externalizing symptoms as well as subjective well-being. The bifactor-ESEM model of the DASS-Y was found to be invariant across gender and two countries. The present study findings highlight the importance of distinguishing between general and specific components of unpleasant emotional states.

Environmental enrichment reduces adgrl3.1-Related anxiety and attention deficits but not impulsivity

Environmental factors play a role in the development and severity of neuropsychiatric disorders. Externalizing disorders are characterized by disruptive, impulsive, and often aggressive behaviors, including difficulties with self-control, rule-breaking, and a tendency to act out in ways that may harm oneself or others. Externalizing disorders frequently co-occur with internalizing disorders, such as anxiety. Individuals experiencing both externalizing/internalizing disorders are often among the most likely to seek healthcare services, as this co-occurrence is associated with more severe symptomatology and greater functional impairment. Here, we investigated the impact of environmental enrichment (EE) on adgrl3.1, a gene associated with impulsivity and attention deficits in zebrafish (Danio rerio). This gene encodes a receptor involved in cell adhesion and signaling and has been linked to susceptibility to externalizing disorders. Zebrafish were reared in either standard or enriched environments (from 15 days-post fertilization), and attention, impulsivity, and anxiety-related phenotypes were assessed at adult stages (4 months-post fertilization) using the open field test and a 5-choice serial reaction time task. EE mitigated anxiety-related behaviors in adgrl3.1 knockouts, normalizing locomotor patterns and decreasing thigmotaxis. Although attention deficits were reduced in adgrl3.1-/- fish reared in EE, impulsive behaviors were not. Together, these findings suggest that while environmental enrichment (EE) mitigates externalizing and internalizing symptoms in adgrl3.1 mutants, impulsivity remains less responsive to EE used in this study, indicating its distinct resistance to modulation.

Relations Between Academic and Behavioral Adaptations: The Antecedent Effects of Executive Function

Using a large sample (n = 1163) from the National Institute of Child Health and Development Study of Early Child Care and Youth Development, the Random Intercept Cross-Lagged Panel Model was employed to unpack the between-person and within-person aspects in the relations between children's academic performance and externalizing/internalizing behaviors during primary school and examined the predictive role of early executive function. Results showed that the reciprocal relations between state-level fluctuations in children's behavioral problems and academic performance were largely unsupported. Children with more advanced early executive function were found to have better academic performance and fewer behavioral problems throughout primary school, supporting the antecedent role of early executive function. These findings suggest that fostering executive function skills early on could be a key strategy for improving both academic outcomes and behavioral adjustment in children.

Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorder Interview Schedule- Autism Spectrum Addendum (ADIS-ASA) in Autistic Youth

PURPOSE

Examine the concurrent validity of specific Anxiety Disorders Section of the Anxiety Disorder Interview Schedule for DSM-IV-Autism Spectrum Addendum (ADIS-ASA)-Parent Interview in a sample of 167 autistic youth who met diagnostic criteria for an anxiety-related disorder (Mage = 9.91; 78.4% male; 82% non-Hispanic; 77.67% White).

METHODS

Concurrent validity of Diagnostic and Statistical Manual (DSM)-defined ADIS-ASA anxiety disorder diagnostic caseness was examined via relations with (a) parent-reported dimensions of youth anxiety symptomology and (b) dimensional measures of youth anxiety-related functional impairment, respectively, using logistic regression models and point-biserial correlations.

RESULTS

Significant relations were found between separation anxiety disorder and social anxiety disorder (but not generalized anxiety disorder nor obsessive-compulsive disorder) caseness, respectively, and theoretically consistent facets of dimensional youth anxiety symptomology. Relations between ADIS-ASA diagnostic caseness and youth functional impairment-related variables revealed that only separation anxiety disorder demonstrated robust evidence of convergent validity.

CONCLUSION

Despite mixed findings concerning relations between ADIS-ASA anxiety disorder diagnostic caseness and dimensional measures of anxiety severity and anxiety-related impairment, the present findings provide further support for the status of the ADIS-ASA as a gold standard for assessment of anxiety in autistic youth. This work also highlights the importance of continuing to improve precision in measurement of anxiety symptomology in autistic youth, with implications for clinical assessment.

Associations of Symptoms of ADHD and Oppositional Defiant Disorder (ODD) in Adolescence With Occupational Outcomes and Incomes in Adulthood

OBJECTIVE

The purpose of this study was to examine the associations of ADHD and ODD symptoms in adolescence with occupational outcomes and incomes in adulthood within the Northern Finland Birth Cohort 1986 (NFBC1986).

METHOD

ADHD symptoms were evaluated at ages 15 to 16 years using the Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) scale. ODD symptoms were assessed using a 7-point scale, like the SWAN assessment.

RESULTS

Symptoms of ADHD and ADHD + ODD were associated with elevated rates of unemployment, increased sick days, and lower annual incomes compared to controls for both sexes. Symptoms of ODD were associated with higher unemployment and more sick days for males, although these associations did not reach statistical significance in their association with annual incomes.

CONCLUSION

Symptoms of ADHD were associated with adverse occupational outcomes and lower incomes. Furthermore, symptoms of ODD were associated with occupational outcomes but not with incomes.

Mental disorders in former street-working boys

The continuity of mental disorders in street-working children is rarely studied. This study therefore investigated homotypic continuity, recurrence of the same disorder, and heterotypic continuity, when a new disorder follows on the previous, of mental disorders from childhood to adulthood in street-working boys from Duhok City, Kurdistan Region of Iraq. Mental disorders were assessed by structured diagnostic interviews in 40 street-working boys in 2004-2005 and again in 2021, when the participants' mean ages were 12.1 (SD 1.8) and 29.7 (SD 2.3), respectively. Mental disorders were common; 24 participants (60%) satisfied the criteria for at least one diagnosis at baseline and 28 (70%) at follow-up. Comorbidity increased from 1.2 (SD 1.4) disorders initially to 2.5 (SD 1.8) at follow-up. Only anxiety disorders showed homotypic continuity. Depressive disorders exhibited the greatest increase over time whereas externalizing disorders exhibited a decreasing tendency. The number of mental disorders in adulthood was related to the number of mental disorders in childhood but not to the number of childhood traumas experienced, having previously worked for more than two hours per day, having worked for over two years on the streets, or having at least one dead parent as a child. Parental ratings on the Child Behaviour Check List (CBCL) from childhood were also unrelated to the number of adult disorders. More longitudinal studies with bigger samples of both genders are needed to fully evaluate the continuity of mental disorders in street-working children and to determine whether the number of mental disorders in childhood is a stronger predictor of being mentally disordered in adult life than psychosocial risk factors or experiences of internalizing or externalizing symptoms in childhood.

The relationship of separation anxiety with the age of onset of panic disorder

AIM

This study aimed to investigate whether separation anxiety (SA) constitutes a dimension related to age at onset of panic disorder (PD), in homogeneous subgroups of outpatients with PD, based on their age of onset and symptom severity.

METHODS

A sample of 232 outpatients with PD was assessed with the Panic Disorder Severity Scale (PDSS) and the Sheehan Disability Scale (SDS) for functional impairments. Separation anxiety was evaluated using structured interviews and questionnaires. We applied a K-Means Cluster Analysis based on the standardized "PD age of onset" and "the PDSS total score" to identify distinct but homogeneous groups.

RESULTS

We identified three groups of patients: group 1 ("PD early onset/severe", N = 97, 42%, onset 23.2 ± 6.7 years), group 2 ("PD early onset/not severe", N = 76, 33%, onset 23.4 ± 6.0 years) and group 3 ("PD adult onset/not severe", N = 59, 25%, onset 42.8 ± 7.0 years). Patients with early onset/severe PD had significantly higher scores on all SA measures than PD late-onset/not severe. Regression analyses showed that SA scores, but not PDSS scores, were predictive of impairment in SDS work/school, social life, and family functioning domains.

CONCLUSIONS

Our data indicate a significant relationship between SA and PD with an earlier age of onset and an impact on individual functioning. This may have important implications for implementing preventive interventions targeting early risk factors for the subsequent onset of PD.

[Anxiety level and physiological response to invasive dental treatments. a longitudinal study]

Objective

To determine the relationship between the level of anxiety and the physiological response to invasive dental treatments.

Materials and methods

A convenience sample of 180 patients was formed (73 men and 107 women) ≥18 years (range: 18-58) undergoing treatment with local anesthetics from three private dental offices in the city of Lima. Measurements were made before, during and after treatment on anxiety according to the IDARE questionnaire of 40 questions (20 trait and 20 state) and their physiological response was evaluated according to oxygen saturation (OS), pulse and blood pressure (BP) measured. with digital pulse oximeter and blood pressure monitor. The Friedman and Spearman correlation tests were used, working with a value of P<0.05.

Results

Most patients had a medium level of anxiety before dental treatment (state 49.4% and trait 55.6%). OS, pulse and BP increased after application of the anesthetic and decreased at the end of treatment, with significant differences (P<0.05). Anxiety scores were significantly correlated only with pulse (state: r=0.238-0.564; trait: r=0.174-0.323) and BP (state: r=0.429-0.699; trait: r=0.312-0.465) (P<0.05).

Conclusion

State-trait anxiety had a positive relationship with the physiological dimensions of blood pressure and pulse before dental treatment with local anesthetics.

Future Directions in Youth Irritability Research

Research on irritability in children and adolescents has proliferated over the last 20 years. The evidence shows the clinical and developmental significance of irritable mood and behavior in youth, and it has led to significant changes in mental health classification, diagnosis, and services. At the same time, this research (including our own) has led to relatively little new in terms of practical, empirically based guidance to improve interventions and outcomes. In this article, we briefly summarize some of these developments and current evidence-based practices. We then put forth two key substantive challenges (the "whats") for future research to address: (a) the need for more effective treatments, especially evaluating and adapting evidence-based treatments that are already well-established for problems related to irritability (e.g., cognitive-behavioral therapies for internalizing and externalizing problems); and (b) the need for a better mechanistic understanding of irritability's phenomenology (e.g., phasic vs. tonic irritability, how frustration unfolds) and putative underlying mechanisms (e.g., cognitive control, threat and reward dysfunction). Lastly, we suggest three methodological approaches (the "hows") that may expedite progress in such areas: (a) ecological momentary assessment, (b) digital health applications, and (c) leveraging existing datasets. We hope this article will be useful for students and early-career researchers interested in tackling some of these important questions to better meet the needs of severely irritable youth.