Latent Class Analysis Shows Strong Heritability of the Child Behavior Checklist–Juvenile Bipolar Phenotype

Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Biological Psychiatry (Impact Factor: 10.26). 12/2006; 60(9):903-11. DOI: 10.1016/j.biopsych.2006.02.025
Source: PubMed


The Child Behavior Checklist (CBCL) has been used to provide a quantitative description of childhood bipolar disorder (BPAD). Many have reported that children in the clinical range on the Attention Problems (AP), Aggressive Behavior (AGG), and Anxious-Depressed (A/D) syndromes simultaneously are more likely to meet the criteria for childhood BPAD. The purpose of this study was to determine if Latent Class Analysis (LCA) could identify heritable phenotypes representing the CBCL-Juvenile Bipolar (CBCL-JBD) profile and whether this phenotype demonstrates increased frequency of suicidal endorsement.
The CBCL data were received by survey of mothers of twins in two large twin samples, the Netherlands Twin Registry. The setting for the study was the general community twin sample. Participants included 6246 10-year-old Dutch twins from the Netherlands Twin Registry. The main outcome measure consisted of the LCA on the items comprising the AP, AGG, and A/D subscales and means from the suicidal items #18 and #91 within classes.
A 7 class model fit best for girls and an 8 class fit best for boys. The most common class for boys or girls was one with no symptoms. The CBCL-JBD phenotype was the least common--about 4%-5% of the boys and girls. This class was the only one that had significant elevations on the suicidal items of the CBCL. Gender differences were present across latent classes with girls showing no aggression without the CBCL-JBD phenotype and rarely showing attention problems in isolation. Evidence of high heritability of these latent classes was found with odds ratios.
In a general population sample, LCA identifies a CBCL-JBD phenotype latent class that is associated with high rates of suicidality, is highly heritable, and speaks to the comorbidity between attention problems, aggressive behavior, and anxious/depression in children.

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    • "Hudziak et al (2005) estimated that in their sample of Dutch twins, the prevalence of this phenotype occurs in approximately 1% of children of all ages sampled (7, 10 & 12 years). When a Latent class analysis (LCA) approach was used, 4% of girls and 5% of boys were found to be consistent with this phenotype (Althoff et al., 2006). This research group has also shown stability of the phenotype across time (Boomsma et al., 2006), with genetic factors accounting for the majority of the variance in stability (Boomsma et al., 2006). "
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    ABSTRACT: To assess the late adolescent psychiatric outcomes associated with a positive Child Behavior Checklist-Juvenile Bipolar Disorder Phenotype (CBCL-JBD) in children diagnosed with ADHD and followed over a 9-year period. Parents of 152 children diagnosed as ADHD (ages 7-11 years) completed the CBCL. Ninety of these parents completed it again 9 years later as part of a comprehensive evaluation of Axis I and II diagnoses as assessed using semi-structured interviews. As previously proposed, the CBCL-JBD phenotype was defined as T-scores of 70 or greater on the Attention Problems, Aggression, and Anxiety/Depression subscales. The CBCL-JBD phenotype was found in 31% of those followed but only 4.9% of the sample continued to meet the phenotype criteria at follow-up. Only two of the sample developed Bipolar Disorder by late adolescence and only one of those had the CBCL-JBD profile in childhood. The proxy did not predict any Axis I disorders. However, the CBCL-JBD proxy was highly predictive of later personality disorders. Only a subgroup of the original childhood sample was followed. Given this sample was confined to children with ADHD, it is not known whether the prediction of personality disorders from CBCL scores would generalize to a wider community or clinical population. A positive CBCL-JBD phenotype profile in childhood does not predict Axis I Disorders in late adolescence; however, it may be prognostic of the emergence of personality disorders.
    Journal of Affective Disorders 11/2010; 130(1-2):155-61. DOI:10.1016/j.jad.2010.10.019 · 3.38 Impact Factor
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    • "LCA is a statistical procedure that allows the investigator to test empirically for the existence of discrete groups who endorse similar patterns of symptoms (Hudziak et al., 1998). In a general population Dutch twin sample, we have conducted LCA on maternal reports of the attention problems, aggressive behavior, and anxious/depressed subscales of the CBCL (Althoff et al., 2006). A class that approximated the Dysregulation Profile was the least common -about 4–5% of the boys and girls by maternal report. "
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    ABSTRACT: The Dysregulation Profile (DP) of the Child Behavior Checklist (CBCL) (previously called the CBCL-Juvenile Bipolar Disorder or CBCL-JBD profile) characterized by elevated scores on CBCL attention problems, aggressive behavior, and anxious/depressed scales is associated with severe psychopathology and suicidal behavior. The stability of this profile across informants has not been established. In this study, agreement across parent, teacher, and self-reports was examined for the Dysregulation Profile phenotype derived using latent class analysis of a national probability sample of 2031 children aged 6-18. The Dysregulation Profile latent class was found for each informant and accounted for 6-7% of the sample. There was mild to fair agreement on the Dysregulation Profile latent class between parents and youth (Kappa=0.22-0.25), parents and teachers (Kappa=0.14-0.24) and youth and teachers (Kappa=0.19-0.28). When parents and youth reports both placed children into the Dysregulation Profile latent class, 42% of boys and 67% of girls reported suicidal thoughts or behavior. We conclude that the Dysregulation Profile latent class is identified across informants although agreement of specific individuals is mild. Children in this class as identified by parental and youth reports have a very high risk for suicidal thoughts and behaviors.
    Psychiatry Research 08/2010; 178(3):550-5. DOI:10.1016/j.psychres.2010.05.002 · 2.47 Impact Factor
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    • "However, data from our latent class analysis (Althoff et al., 2006) and behavior genetics studies (Boomsma et al., 2006; Hudziak, Althoff, Derks, Faraone, & Boomsma, 2005) have demonstrated that the AAA Profile is distinct from each of its components either alone or in tandem (i.e., attention problems, anxious/depression, and aggression). Given the body of literature suggesting that the AAA Profile is indicative of neither JBD (Kahana et al., 2003; Youngstrom et al., 2006), nor ADHD, Internalizing, or Aggression (Althoff et al., 2006; Boomsma et al., 2006; Hudziak et al., 2005), there remain two viable answers to the question, 'What is the AAA Profile?': (1) comorbid attention, behavior, and mood problems, or (2) a syndrome unto itself. If it is a distinct, identifiable syndrome, the use of the AAA Profile in clinical and research settings may significantly augment the assessment and treatment of severe psychopathology in youth, including suicidal behavior, which is challenging to predict and treat (Paris, 2006). "
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    ABSTRACT: The Child Behavior Checklist Juvenile Bipolar Disorder (CBCL-JBD) profile and Posttraumatic Stress Problems (CBCL-PTSP) scale have been used to assess juvenile bipolar disorder (JBD) and posttraumatic stress disorder (PTSD), respectively. However, their validity is questionable according to previous research. Both measures are associated with severe psychopathology often encompassing multiple DSM-IV diagnoses. Further, children who score highly on one of these scales often have elevated scores on the other, independent of PTSD or JBD diagnoses. We hypothesized that the two scales may be indicators of a single syndrome related to dysregulated mood, attention, and behavior. We aimed to describe and identify the overlap between the CBCL-JBD profile and CBCL-PTSP scales. Two thousand and twenty-nine (2029) children from a nationally representative sample (1073 boys, 956 girls; mean age = 11.98; age range = 6-18) were rated on emotional and behavior problems by their parents using the CBCL. Comparative model testing via structural equation modeling was conducted to determine whether the CBCL-JBD profile and CBCL-PTSP scale are best described as measuring separate versus unitary constructs. Associations with suicidality and competency scores were also examined. The CBCL-JBD and CBCL-PTSP demonstrated a high degree of overlap (r = .89) at the latent variable level. The best fitting, most parsimonious model was one in which the CBCL-JBD and CBCL-PTSP items identified a single latent construct, which was associated with higher parental endorsement of child suicidal behavior, and lower functioning. The CBCL-JBD profile and CBCL-PTSP scale overlap to a remarkable degree, and may be best described as measures of a single syndrome. This syndrome appears to be related to severe psychopathology, but may not conform to traditional DSM-IV classification. These results contribute to the ongoing debate about the utility of the CBCL-JBD and CBCL-PTSP profiles, and offer promising methods of empirically based measurement of disordered self-regulation in youth.
    Journal of Child Psychology and Psychiatry 06/2009; 50(10):1291-300. DOI:10.1111/j.1469-7610.2009.02089.x · 6.46 Impact Factor
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