Adult Outcomes of Childhood Dysregulation: A 14-year Follow-up Study

University of Vermont College of Medicine, Burlington, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 11/2010; 49(11):1105-16. DOI: 10.1016/j.jaac.2010.08.006
Source: PubMed


Using a general population sample, the adult outcomes of children who presented with severe problems with self-regulation defined as being concurrently rated highly on attention problems, aggressive behavior, and anxious-depression on the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) were examined.
Two thousand seventy-six children from 13 birth cohorts 4 to 16 years of age were drawn from Dutch birth registries in 1983. CBCLs were completed by parents at baseline when children from the different cohorts were 4 to 16 years of age and sampled every 2 years for the next 14 years. At year 14 the CBCL and DSM interview data were collected. Logistic regression was used to compare and contrast outcomes for children with and without dysregulation, as measured by the latent-class-defined CBCL-DP. Sex and age were covaried and concurrent DSM diagnoses were included in regression models.
Presence of childhood CBCL-DP at wave 1 was associated with increased rates of adult anxiety disorders, mood disorders, disruptive behavior disorders, and drug abuse 14 years later. After controlling for co-occurring disorders in adulthood, associations with anxiety and disruptive behavior disorders with the CBCL-DP remained, whereas the others were not significant.
A child reported to be in the CBCL-DP class is at increased risk for problems with regulating affect, behavior, and cognition in adulthood.

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    • "This has been previously found in preschool children (Briggs- Gowan et al. 2006). Studies in school-age children have shown that co-occurrence of internalizing and externalizing problems is a very strong risk factor for adult psychopathology (Althoff et al. 2010; Sourander et al. 2007). These findings suggest that prevention and intervention strategies should target those children with co-occurring internalizing and externalizing problems to prevent them from developing severe psychopathology later in life. "
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    ABSTRACT: This study examined the stability of internalizing and externalizing problems from age 1.5 to 6 years, while taking into account developmental changes in the presentation of problems. The study comprised a population-based cohort of 7,206 children (50.4 % boys). At ages 1.5, 3, and 6 years, mothers reported on problem behavior using the Child Behavior Checklist/1.5-5 (CBCL/1.5-5). At each age we performed latent profile analysis on the CBCL/1.5-5 scales. Latent transition analysis (LTA) was applied to study the stability of problem behavior. Profiles of problem behavior varied across ages. At each age, 82-87 % of the children did not have problems whereas approximately 2 % showed a profile of co-occurring internalizing and externalizing problems. This profile was more severe (with higher scores) at 6 years than at earlier ages. A predominantly internalizing profile only emerged at 6 years, while a profile with externalizing problems and emotional reactivity was present at each age. LTA showed that, based on profiles at 1.5 and 3 years, it was difficult to predict the type of profile at 6 years. Children with a profile of co-occurring internalizing and externalizing problems early in life were most likely to show problem behavior at 6 years. This study shows that the presentation of problem behavior changes across the preschool period and that heterotypic continuity of problems is very common among preschoolers. Children with co-occurring internalizing and externalizing problems were most likely to show persisting problems. The use of evidence-based treatment for these young children may prevent psychiatric problems across the life course.
    Journal of Abnormal Child Psychology 04/2015; DOI:10.1007/s10802-015-9993-y · 3.09 Impact Factor
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    • "c o m / l o c a t e / e a r l h u m d e v starting point of a trajectory of dysregulation through time of domainrelated age-appropriate constructs towards a mature phenotype. Early problems with regulation may be the starting point for persistent RP leading to later domain related regulation of age appropriate behaviours, e.g., the control of sustained attention or behaviour in challenging situations [21] [22]. Most of the studies on associations between RP and subsequent ADHD had limitations such as small sample size, referred samples, use of retrospective design, or limited (or no) control for potential confounders such as family adversity [15]. "
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    ABSTRACT: Background: Early regulatory problems (RP), i.e., excessive crying, feeding, and sleeping difficulties, have been reported to be predictors of cognitive and attention-deficit/hyperactivity problems. However, previous studies had limitations such as small sample size or retrospective design. Aim: To investigate whether persistent RP from infancy until preschool age are precursors of ADHD problems and cognitive deficits at school age. Study design: A prospective study from birth to 8.5years of age. Subjects: 1120 infants born at risk. Measures: RP were assessed at 5months (i.e., excessive crying, feeding, and sleeping problems), 20, and 56months (i.e., eating and sleeping problems) via parent interviews and neurological examination. At 8.5years of age, IQ was assessed by a standard test (K-ABC), and ADHD problems by direct observations in the test situation and by the Mannheimer Parent Interview (MPI, DSM-IV diagnosis of ADHD). Results: 23.8% of the sample born at risk had RP at least at two measurement points until preschool age. Persistent RP predicted lower IQ (β=-.17; 95% CI (-.21; -.10)), behaviour problems (β=-.10; 95% CI (-.15; -.03)), attention (OR 2.43; 95% CI (1.16; 5.09)) and hyperactivity problems (OR 3.10; 95% CI (1.29; 7.48)), and an ADHD diagnosis (OR 3.32; 95% CI (1.23; 8.98)) at school age, even when controlled for psychosocial and neurological confounders. Conclusions: Early persistent RP increased the odds of ADHD and associated problems at school age, indicating a cascade model of development, i.e., infant behaviour problems provide the starting point of a trajectory of dysregulation through time.
    Early Human Development 08/2014; 90(8):399-405. DOI:10.1016/j.earlhumdev.2014.05.001 · 1.79 Impact Factor
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    • "The first was to address current ambiguities in the relationship between conduct problems in youth as a precursor of adult depression, with some studies suggesting an association,3-5 but others failing to find a link.6 It is probably as a result of this uncertainty that, despite increasing interest in early antisocial behaviours, depression is only rarely addressed as one of its outcomes.7 "
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    ABSTRACT: Pathways from early-life conduct problems to young adult depression remain poorly understood. To test developmental pathways from early-life conduct problems to depression at age 18. Data (n = 3542) came from the Avon Longitudinal Study of Parents and Children (ALSPAC). Previously derived conduct problem trajectories (ages 4-13 years) were used to examine associations with depression from ages 10 to 18 years, and the role of early childhood factors as potential confounders. Over 43% of young adults with depression in the ALSPAC cohort had a history of child or adolescent conduct problems, yielding a population attributable fraction of 0.15 (95% CI 0.08-0.22). The association between conduct problems and depression at age 18 was considerable even after adjusting for prior depression (odds ratio 1.55, 95% CI 1.24-1.94). Early-onset persistent conduct problems carried the highest risk for later depression. Irritability characterised depression for those with a history of conduct problems. Early-life conduct problems are robustly associated with later depressive disorder and may be useful targets for early intervention.
    The British journal of psychiatry: the journal of mental science 04/2014; 205(1). DOI:10.1192/bjp.bp.113.134221 · 7.99 Impact Factor
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