Dysregulation in Childhood and Adolescence: Measurement, Development, and Correlates

Abstract

Many children and adolescents referred to clinical mental health institutions present a complex picture of co-occurring internalizing problems (e.g. anxiety) and externalizing problems (e.g. aggressive behavior). These ‘dysregulated’ children have problems with regulating affect, behavior and cognition, and are at increased risk for maladaptive outcomes. The DP has emerged as a reliable and valid measure of the complex phenotype of dysregulation and is generally defined by elevated scores on three syndrome scales of the Child Behavior Checklist (CBCL), namely the Anxious/Depressed, Aggressive Behavior and Attention Problems (or AAA-)scales. The CBCL is a well-known and widely used parent-reported instrument to chart behavioral and emotional problems of children and adolescents. In this dissertation, five empirical studies on the DP are presented, utilizing four different data sets from three countries (Belgium, Canada, United States). A multi-method and multi-informant approach were adopted. The first aim was to examine the conceptualization and measurement of the DP. Results from factor analyses revealed that a bifactor model best described the profile structure of the AAA-scales that comprise the DP. A bifactor model is a hierarchical model where items (symptoms) load on both on a general underlying factor of Dysregulation as well as one of three specific factors of Anxiety/Depression, Aggressive Behavior or Attention Problems. The same result was found across samples, instruments (CBCL and Strengths and Difficulties Questionnaires), developmental periods (early childhood, middle childhood and adolescence), and reporters (mothers, fathers, teachers, youth themselves). As such, this dissertation provides robust evidence that the DP can best be conceptualized as a broad syndrome of dysregulation which exists over and above specific problems related to affect, behavior, and cognition. This bifactor model bears strong resemblance to models of a ‘general factor of psychopathology’ (GP or ‘p factor’), and integration of both fields of literature is thus warranted. The second aim was to examine stability and change of the DP. Findings showed that across different samples, relative stability of the DP (i.e., the extent to which the relative differences in the DP among children remain the same over time) was strong for parent-reported DP and moderate for teacher-reported DP. The specific factors such as Anxiety/Depression were only weak to moderately stable. This suggests that while dysregulation, as a general vulnerability for developing different forms of psychopathology, is more stable than its specific manifestations. While homotypic continuity (e.g., dysregulation predicting dysregulation at a later time point) was strongest, there was also evidence for heterotypic continuity. This indicates that specific manifestations of psychopathology (e.g., anxiety/depression) increase risk of comorbid psychopathology (i.e., dysregulation) across time and vice versa. Furthermore, in this general population sample, the DP was found to follow a nonlinear developmental course, peaking in early adolescence. Specifically, DP scores increased from age 4 to 11, and then decreased (which looks like an inverted U-shape). The third aim was to investigate early childhood antecedents, adolescent outcomes and psychophysiological correlates of the DP. This dissertation further established the DP as a broad risk marker, as we found that the DP predicted a range of negative outcomes including personality pathology, mental health problems, and psychosocial maladjustment. We added to a scarce body of research on antecedents by showing that the DP is predicted by early temperament and self-control, and family factors including maternal depression and parenting. Exploratory findings showed that the DP was linked to higher resting heart rate, reflecting chronic overarousal.