Temperamental Characteristics of Withdrawn Behavior Problems in Children.

Withdrawn/depressed behavior (WD) as defined by the Child Behavior Checklist (CBCL) relates to various outcomes in developmental psychopathology such as depression, pervasive developmental disorders, and suicide. We sought to examine the temperamental characteristics of children who concurrently endorse symptoms of WD. Junior Temperament and Characteristic Inventory (JTCI) and CBCL data were collected from 397 children's parents in a family study in the northeastern United States. Linear mixed models were used to test the relations between WD and temperament dimensions (Novelty Seeking, Harm Avoidance, Reward Dependence, Persistence) on the JTCI, while controlling for age, sex, item overlap, and co-occurring aggression and attention problems. When controlling for definitional artifact and CBCL aggressive behavior and attention scores, high harm avoidance and low reward dependence were both significant predictors of childhood withdrawn behavior. This study marks the first characterization of a temperamental profile associated with WD in children and adolescents.

Internet Inspired Self-Diagnosis: A New Phenomenon Calling for an Old Approach.

Recently, it seems like youth are presenting for their initial psychiatry appointment with a clear self-diagnosis in mind. For years, parents have come to appointments with hopes that I might rubber stamp their suspicions about a bipolar or attention-deficit/hyperactivity disorder diagnosis. The use of this approach from youth themselves is newer.

Widening Our Lane: How Child and Adolescent Psychiatrists Can Embrace the Full Spectrum of Mental Health.

The majority of a psychiatrist's training and clinical attention is devoted to mental illness rather than mental health. This article suggests a broader understanding and application of mental well-being that can benefit both those already struggling with mental health challenges and those trying to stay well. Recommendations for being a well-being-oriented psychiatrist include increasing one's knowledge about well-being and health promotion and adjusting one's practice to incorporate these principles. Recommendations at the level of the field of psychiatry include revising the definition of a psychiatrist, increasing research on well-being and health promotion, improving financial incentives, expanding efforts in schools and community settings, and providing additional training.

Candidate gene associations with withdrawn behavior.

BACKGROUND: Social withdrawal is a core neuropsychiatric phenomenon in developmental psychopathology. Its presence predicts psychopathology across many domains, including depression, psychosis, autism, anxiety, and suicide. Withdrawn behavior is highly heritable, persistent, and characteristically worsens without intervention. To date, few studies have successfully identified genetic associations with withdrawn behavior, despite the abundance of evidence of its heritability. This may be due to reliance of categorical over dimensional measures of the behaviorally inhibited phenotype. The aim of this study is to identify associations between known psychiatric candidate genes and a dimensionally derived measure of withdrawn behavior. METHODS: Genetic information was collected on 20 single-nucleotide polymorphisms (SNPs) from a custom-designed SNP chip and TAQMAN arrays of 4 variable number of tandem repeat (VNTR) genes for 551 individuals from 187 families. Linear mixed modeling was employed to examine the relationship between genotypes of interest and Child Behavior Checklist (CBCL) Withdrawn Behavior Subscale Score (WBS) while controlling for gender and age through multiple linear regressions. RESULTS: Withdrawn behavior was highly associated with polymorphism rs6314 of the serotonin receptor 2A (HTR2A) [p = .009, estimate = 0.310 (bootstrap 95% CI 0.155-0.448), bootstrap p = .001] and rs1800544 of the alpha 2-adrenergic (ADRA2A) [p = .001, estimate = -0.310 (bootstrap 95% CI -0.479 to -0.126), bootstrap p = .001] genes after correction for gender and age. The association between withdrawn behavior and ADRA2A was stronger for younger children. CONCLUSIONS: HTR2A and ADRA2A genes are associated with withdrawn behavior. This reinforces the role of catecholaminergic genes in the heritability of withdrawn behavior.

Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization.

OBJECTIVE: Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization. METHODS: This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization. RESULTS: The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01). CONCLUSIONS: Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types.

Protective Associations between Supportive Environment and Suicidality among Minority and Majority Adolescents.

OBJECTIVE: To examine the association between supportive environments and adolescent suicidal behavior, especially among marginalized minority groups. METHODS: Participants included 12,196 middle and 16,981 high school students who completed the 2019 Vermont Youth Risk Behavior Survey. Multiple logistic regression models were used to assess the association between three protective factors that were part of a supportive environment (feeling like they matter to people in their community, usually eating dinner at home, having a trusted adult) and suicidality (plan or attempt), controlling for key demographics (sex, sexual orientation, gender identity, and race/ethnicity). Moderating effects of demographics were also explored. RESULTS: All supportive environment variables were protective of making a suicide plan and making a suicide attempt (ORs < 0.75, p-values < 0.005). Students of minority identities were significantly more likely to make a suicide plan (middle school ORs: 1.34-3.51, p-values < 0.0005; high school ORs: 1.19-3.38, p-values < 0.02) and attempt suicide (middle school ORs: 1.42-3.72, p-values < 0.006; high school ORs: 1.38-3.25, p-values < 0.0005) compared to students with majority demographic characteristics. Generally, the associations between having a supportive environment and suicidality did not vary within sexual orientation, gender identify, or race/ethnicity subgroups, suggesting that these supportive environment factors were more universally protective. However, a few associations were stronger among students in the majority demographic groups. CONCLUSIONS: These data suggest that having a supportive environment is protective of suicidality for adolescents from both majority and minority demographic groups.HIGHLIGHTSA supportive environment is protective of adolescent suicide plan and attempt.Minority sexual, gender, and racial identities are risk factors for suicidality.Minority and majority students are protected by supportive environments.

Temperamental profiles of dysregulated children.

It is crucial to characterize self-regulation in children. We compared the temperamental profiles of children with the Child Behavior Checklist (CBCL) Dysregulation Profile (CBCL-DP) to profiles associated with other CBCL-derived syndromes. 382 children (204 boys; aged 5-18) from a large family study were examined. Temperamental profiles were based on the Juvenile Temperament and Character Inventory. Children with the CBCL-DP had a temperamental profile characterized by high Novelty Seeking, high Harm Avoidance, low Reward Dependence and low Persistence. Linear mixed models and regression-based models demonstrated that the CBCL-DP was associated with a "disengaged" temperamental profile. This profile is similar to the profile seen in adult disorders of self-regulation, including cluster B personality disorders. These results support the hypothesis that the CBCL-DP measures poor self-regulation.

Bullying: An Update.

Bullying is a complex and widespread public health issue that affects children of all ages and adults. For decades, childhood bullying has been viewed as an unpleasant but generally harmless rite of passage that carries with it few long-term consequences. Research has increasingly documented the serious and long-term behavioral and health consequences of bullying. This article addresses several features of bullying including epidemiology, psychological and physical impact, and the role of health care providers in bullying detection, intervention, and prevention.

Psychometric Properties of a New Stress-Related Personality Scale: The Virtual Inventory of Behavior and Emotions (VIBE).

BACKGROUND: Personality traits are important factors with regard to the tendency to experience and response to stress. This study introduces and tests a new stress-related personality scale called the Virtual Inventory of Behavior and Emotions (VIBE). METHODS: Two samples totaling 5512 individuals (with 66% between the ages of 18 and 34) completed the VIBE along with other measures of personality, stress, mood, and well-being. RESULTS: Exploratory factor analyses revealed a four-factor structure for the instrument with dimensions labeled: 1) stressed; 2) energetic; 3) social; and 4) disciplined. Confirmatory factor analytic procedures on the final 23-item version showed good psychometric properties and data fit while machine learning analyses demonstrated the VIBE's ability to distinguish between groups with similar patterns of response. Strong convergent validity was suggested through robust correlations between the dimensions of the VIBE and other established rating scales. CONCLUSION: Overall, the data suggest that the VIBE is a promising tool to help advance understanding of the relations between stress, personality, and related constructs.

Correction: Personality trait predictors of adjustment during the COVID pandemic among college students.

[This corrects the article DOI: 10.1371/journal.pone.0248895.].

Personality trait predictors of adjustment during the COVID pandemic among college students.

Personality traits have been found to be related to a variety of health outcomes. The aim of this study was to examine how personality traits were associated with adjustment to the COVID pandemic in college students. The sample included 484 first-year university students (76% female) attending a northeastern university who completed the Big Five Inventory (BFI) personality assessment at the beginning of a semester that was disrupted by the COVID pandemic. Using a phone-based app, students completed daily ratings of mood, perceived stress levels, and engagement in a number of health promotion activities (exercise, mindfulness, adequate sleep, etc.) throughout the semester both before and after the onset of the pandemic (e.g., a within-person longitudinal design). Results, as expected, showed that mood and wellness indices generally declined during the COVID period, although stress levels actually decreased. Further, irrespective of COVID, improved mood, less perceived stress and greater participation in health promotion activities were significantly associated with a number of personality traits including neuroticism (lower), extraversion (higher), agreeableness (higher), and conscientiousness (higher). Of primary interest, mixed-effects models were used to test how major personality traits interacted with any changes in daily ratings from the pre-COVID to COVID period. Significant interactions terms were found suggesting differential impacts of the COVID epidemic for students with low versus high levels of particular traits. Higher levels of extraversion, for example, were found to be related to decreases in mood as the pandemic progressed in contrast to those with lower extraversion, for whom there was a slight increase in mood over time. These data support the conclusion that personality traits are related to mental health and can play a role in a person's ability to cope with major stressful events. Different traits may also be more adaptive to different types of stressors.

Cross-informant agreement of the Dysregulation Profile of the Child Behavior Checklist.

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.

Editorial: Beyond the Prior Authorization: Multimodal Efforts to Reduce Antipsychotic Medication Prescribing in Foster Care Youth.

When it comes to efforts to reduce the overprescribing of psychiatric medications, the first thing that comes to mind for many clinicians is burdensome prior authorizations or generic letters from insurance companies telling you things you already know. Most psychiatrists and primary care clinicians are well aware of the potential risks associated with drugs such as antipsychotic medications, and many wonder if these intrusions into the doctor-patient relationship go beyond saving money and actually contribute to improved care.

Symptom Level Associations Between Attention-Deficit Hyperactivity Disorder and School Performance.

Attention-deficit hyperactivity disorder (ADHD) is associated with reduced school performance. To determine which ADHD symptoms and subtypes have the strongest association, we used type and frequency of symptoms on the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA) to create symptom scores for inattention and hyperactivity-impulsivity and define subtypes (ADHD-Inattentive [ADHD-I], ADHD-Hyperactive-Impulsive, ADHD-Combined [ADHD-C]). Regression methods were used to examine associations between symptoms and subtype and a composite measure of school performance. Children with ADHD-C and ADHD-I had higher adjusted odds of having reduced overall school performance (ADHD-C = 5.8, 95% confidence interval [CI] = 3.1-10.9; ADHD-I = 5.5, 95% CI = 3.1-10.1) compared with children without ADHD. All inattentive symptoms were significantly related to reduced school performance in reading, writing, and handwriting, while 6 of 9 symptoms were significantly associated in mathematics. Children with ADHD-I were significantly more likely than children with other ADHD subtypes to receive a school-based Individualized Education Program or 504 Plan. ADHD-I symptoms may be broadly linked to reduced school performance.

Latent class analysis of the Child Behavior Checklist Obsessive-Compulsive Scale.

The Obsessive-Compulsive Scale (OCS) of the Child Behavior Checklist (CBCL) predicts obsessive-compulsive disorder and is highly heritable. Latent class analysis (LCA) of the OCS was used to identify profiles within this 8-item scale and to examine heritability of those profiles. The LCA was performed on maternal CBCL reports of their 6- to 18-year-old children from 2 US nationally representative samples from 1989 (n = 2475, 50% male) and 1999 (n = 2029, 53% male) and from Dutch twins in the Netherlands Twin Registry at ages 7 (n = 10 194, 49.3% male), 10 (n = 6448, 48.1% male), and 12 (n = 3674, 48.6% male) years. The heritability of the resultant classes was estimated using odds ratios of twin membership across classes. A 4-class solution fitted all samples best. The resulting classes were a "No or Few Symptoms" class, a "Worries and Has to Be Perfect" class, a "Thought Problems" class, and an "OCS" class. Within-class odds ratios were higher than across-class odds ratios and were higher for monozygotic than dizygotic twins. We conclude that LCA identifies an OCS class and that class is highly heritable using across-twin comparisons.

Better than Better: The New Focus on Well-Being in Child Psychiatry.

Training and practice within child psychiatry has focused predominantly on mental illness rather than mental health. A growing body of evidence, however, is demonstrating the importance for clinicians also to be able to focus directly on enhancing positive traits and emotions and increasing well-being and health promotion in their patients. This complementary aspect of mental health care has been called well-being and positive psychiatry, among other terms. Being able to apply these principles to standard practice requires new knowledge, skills, and attitudes that are not part of traditional psychiatric training.

Teaching Well-Being: From Kindergarten to Child Psychiatry Fellowship Programs.

Psychiatric training for medical students, residents, and fellows can integrate well-being principles to improve mental health. From preschool to college, principles of wellness and health promotion are increasingly prevalent and are showing promising results. Courses on happiness and well-being have been embraced at colleges and universities. Well-being is now a required component of child and adolescent psychiatry training. Training residents and fellows in emotional and behavioral well-being requires incorporation into clinical supervision and the overall culture and infrastructure of the training program.

Latent profiles of temperament and their relations to psychopathology and wellness.

OBJECTIVE: To test for empirically defined temperament phenotypes and to investigate their associations with psychopathology and wellness. METHOD: The sample included 447 children (259 boys, 188 girls; mean age 11.0 years) recruited for a family study in the northeastern United States. Temperament was measured with the Juvenile Temperament and Character Inventory, and indicators of wellness and psychopathology were assessed with the Child Behavior Checklist from both parents and the Teacher Report Form. Latent profiles analysis was performed with the resulting class membership serving as the dependent variables for multinomial regression analyses. RESULTS: Latent profiles analysis identified three classes as the best fitting solution consisting of a moderate class that had average levels of all four traits, a steady class that had low novelty seeking and high persistence and a disengaged class that had higher novelty seeking and harm avoidance but lower reward dependence and persistence. Regressions demonstrated strong links between the steady class, higher functioning, and lower levels of psychopathology, whereas the disengaged class showed the opposite associations. These findings held across informants of psychopathology and wellness. CONCLUSIONS: Profile analyses of temperament may be illuminative in identifying children with similar constellations of traits across many dimensions. Membership in these groups appears to be strongly related to both positive and negative outcomes.

Latent class analysis shows strong heritability of the child behavior checklist-juvenile bipolar phenotype.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Longitudinal stability of the CBCL-juvenile bipolar disorder phenotype: A study in Dutch twins.

BACKGROUND: The Child Behavior Checklist-juvenile bipolar disorder phenotype (CBCL-JBD) is a quantitative phenotype that is based on parental ratings of the behavior of the child. The phenotype is predictive of DSM-IV characterizations of BD and has been shown to be sensitive and specific. Its genetic architecture differs from that for inattentive, aggressive, or anxious-depressed syndromes. The purpose of this study is to assess the developmental stability of the CBCL-JBD phenotype across ages 7, 10, and 12 years in a large population-based twin sample and to examine its genetic architecture. METHODS: Longitudinal data on Dutch mono- and dizygotic twin pairs (N = 8013 pairs) are analyzed to decompose the stability of the CBCL-JBD phenotype into genetic and environmental contributions. RESULTS: Heritability of the CBCL-JBD increases with age (from 63% to 75%), whereas the effects of shared environment decrease (from 20% to 8%). The stability of the CBCL-JBD phenotype is high, with correlations between .66 and .77 across ages 7, 10, and 12 years. Genetic factors account for the majority of the stability of this phenotype. There were no sex differences in genetic architecture. CONCLUSIONS: Roughly 80% of the stability in childhood CBCL-JBD is a result of additive genetic effects.