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Disentangling Heterogeneity of Childhood Disruptive Behavior Problems Into Dimensions and Subgroups - 26/07/17

Doi : 10.1016/j.jaac.2017.05.019 
Koen Bolhuis, MD a, Gitta H. Lubke, PhD b, c, Jan van der Ende, MSc a, Meike Bartels, PhD c, Catharina E.M. van Beijsterveldt, PhD c, Paul Lichtenstein, PhD d, Henrik Larsson, PhD d, e, Vincent W.V. Jaddoe, MD, PhD a, Steven A. Kushner, MD, PhD f, Frank C. Verhulst, MD, PhD a, Dorret I. Boomsma, PhD c, Henning Tiemeier, MD, PhD a,
a Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands 
b University of Notre Dame, Notre Dame, IN 
c Vrije Universiteit, Amsterdam, the Netherlands 
d Karolinska Institutet, Stockholm, Sweden 
e Örebro University, Örebro, Sweden 
f Erasmus Medical Center, Rotterdam, the Netherlands 

Correspondence to Henning Tiemeier, MD, PhD, Department of Child and Adolescent Psychiatry, Erasmus MC, P.O. Box 2060, 3000CB Rotterdam, the NetherlandsDepartment of Child and Adolescent PsychiatryErasmus MC, P.O. Box 20603000CB Rotterdamthe Netherlands

Abstract

Objective

Irritable and oppositional behaviors are increasingly considered as distinct dimensions of oppositional defiant disorder. However, few studies have explored this multidimensionality across the broader spectrum of disruptive behavior problems (DBPs). This study examined the presence of dimensions and distinct subgroups of childhood DBPs, and the cross-sectional and longitudinal associations between these dimensions.

Method

Using factor mixture models (FMMs), the presence of dimensions and subgroups of DBPs was assessed in the Generation R Study at ages 6 (n = 6,209) and 10 (n = 4,724) years. Replications were performed in two population-based cohorts (Netherlands Twin Registry, n = 4,402, and Swedish Twin Study of Child and Adolescent Development, n = 1,089) and a clinical sample (n = 1,933). We used cross-lagged modeling in the Generation R Study to assess cross-sectional and longitudinal associations between dimensions. DBPs were assessed using mother-reported responses to the Child Behavior Checklist.

Results

Empirically obtained dimensions of DBPs were oppositional behavior (age 6 years), disobedient behavior, rule-breaking behavior (age 10 years), physical aggression, and irritability (both ages). FMMs suggested that one-class solutions had the best model fit for all dimensions in all three population-based cohorts. Similar results were obtained in the clinical sample. All three dimensions, including irritability, predicted subsequent physical aggression (range, 0.08–0.16).

Conclusion

This study showed that childhood DBPs should be regarded as a multidimensional phenotype rather than comprising distinct subgroups. Incorporating multidimensionality will improve diagnostic accuracy and refine treatment. Future studies need to address the biological validity of the DBP dimensions observed in this study; herein lies an important opportunity for neuroimaging and genetic measures.

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Key words : disruptive behavior disorder, classification, DSM-5, irritable mood, factor mixture model


Plan


 Clinical guidance is available at the end of this article.
 This study has received funding from the European Union Seventh Framework Program (FP7/2007-2013): ACTION: Aggression in Children: Unravelling gene-environment interplay to inform Treatment and InterventiON strategies (grant number 602768). The Generation R Study data collection is made possible by financial support from the Erasmus Medical Centre, Rotterdam; Erasmus University Rotterdam; The Netherlands Organization for Health Research and Development (ZonMw). The Netherlands Twin Registry (NTR) is supported by the Netherlands Organisation for Scientific Research (NWO 480-04-004; ZonMw 912-10-020; NWO 480-15-001). The Swedish Twin Study on Child and Adolescent Development (TCHAD) is supported by the Swedish Research Council for Health, Working Life and Welfare and the Swedish Research Council. Further support was obtained from the Netherlands Organization for Scientific Research: NWO-grant 016.VICI.170.200 to H.T.
 Dr. Lubke and Mr. van der Ende served as the statistical experts for this research.
 The Generation R Study is conducted by the Erasmus Medical Centre (Rotterdam) in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam; the Municipal Health Service Rotterdam area, Rotterdam; the Rotterdam Homecare Foundation, Rotterdam; and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond, Rotterdam. The authors gratefully acknowledge the contribution of all children and parents, general practitioners, hospitals, midwives, and pharmacies involved in the different cohorts used in the present study.
 Disclosure: Dr. Larsson has served as a speaker for Eli Lilly and Co. and Shire and has received research grants from Shire. Dr. Verhulst has received remuneration as distributor of the Dutch translations of the Achenbach System of Empirically Based Assessment (ASEBA). Drs. Bolhuis, Lubke, Bartels, van Beijsterveldt, Lichtenstein, Jaddoe, Kushner, Boomsma, Tiemeier, and Mr. van der Ende report no biomedical financial interests or potential conflicts of interest.


© 2017  American Academy of Child and Adolescent Psychiatry. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 56 - N° 8

P. 678-686 - août 2017 Retour au numéro
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