A Precision Mental Health Model for Predicting Stability of 4-year-olds' Attention Deficit/Hyperactivity Disorder Symptoms to Age 6 Diagnostic Status.

OBJECTIVE: Estimates of the stability of a preschooler's diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) into early elementary school vary greatly. Identified factors associated with diagnostic instability provide little guidance about the likelihood a particular child will have ADHD in elementary school. This study examined an approach to predicting age 6 ADHD-any subtype (ADHD-any) from preschoolers' demographics and ADHD symptoms. METHOD: Participants were 796 preschool children (Mage = 4.44; 51% boys; 54% White, non-Hispanic) recruited from primary pediatric care and school settings. Parents completed ADHD Rating Scales at child ages 4 and 5 years, and a structured diagnostic interview (DISC-YC) at ages 4 and 6. Classification tree analyses (CTAs) examined the predictive utility of demographic and symptom variables at ages 4 and 5 years for age 6 ADHD. RESULTS: Over half (52.05%) of preschoolers meeting diagnostic criteria for ADHD-any at age 4 did not meet those criteria at age 6; more than half (52.05%) meeting criteria for ADHD-any at age 6 had not met those criteria at age 4. A CTA conducted at age 4 predicted age 6 ADHD-any diagnosis 65.82% better than chance; an age 5 CTA predicted age 6 ADHD-any 70.60% better than chance. At age 4, likelihood of age 6 ADHD-any diagnosis varied from <5% to >40% across CTA tree branches and from <5% to >78% at age 5. CONCLUSIONS: Parent-reported patterns of preschool-age symptoms may differentially predict ADHD-any at age 6. Psychoeducation regarding these patterns may aid in decision about pursuing multidisciplinary evaluations or initiating treatment.

A Multi-level Longitudinal Model of Risk Factors for Generalized and Separation Anxiety Symptoms in a Community Sample of 6-year-olds.

The current longitudinal study examined the relations between variables in four domains-contextual (SES, family conflict, stress), parent (caretaker depression), parenting (support hostility, autonomy granting), and child (negative affect, effortful control, sensory regulation, attachment)-and both the presence of generalized and separation anxiety symptoms at age 6 in a community sample of 796 children and the change in these anxiety symptoms from ages 4 to 6. Anxiety was highly stable over time. Specific results revealed both direct and indirect pathways between age 4 and age 5 variables, and age 6 anxiety. Caretaker depression and the child variables of attachment, effortful control, negative affect, and sensory regulation were directly related to anxiety symptoms at age 6. Contextual variables (SES) at age 4 were indirectly related to age 6 anxiety through parent depression at age 5. Parent depression was indirectly related to age 6 anxiety through age 5 child negative affect. Child negative affect at age 4 was indirectly related to age 6 anxiety through age 5 effortful control and age 4 effortful control was indirectly related to age 6 anxiety through age 5 negative affect. With the exception of attachment, there was a reduction in the impact of other variables when initial levels of anxiety symptoms were included in the model. Implications of results for early intervention and further study are discussed.

Multidomain risk factors in early childhood and depression symptoms in 6-year-olds: A longitudinal pathway model.

This study examined effects of risk factors in multiple domains measured in preschool and kindergarten on age 6 depression symptoms, and on changes in symptom levels between ages 4 and 6. Two models were examined in a large, diverse (N = 796) community sample of children and parents. Risk variables included SES, stress, conflict, parental depression, parental hostility, support, scaffolding, child negative affect (NA), effortful control (EC), sensory regulation (SR), and attachment security. Model 1 included effects of risk factors at ages 4 and 5 on child depression symptoms at age 6. Model 2 also included depression symptoms at all three ages to examine changes in these symptoms. Model 1 revealed that age 4 and 5 parental depression, NA, EC, and SR predicted age 6 child depression levels, Several age 4 variables had indirect pathways to age 6 depression via age 5 EC. Model 2 revealed that preschool depression was the only age 4 variable, and EC and SR were the only age 5 variables that significantly predicted increases in age 6 depression. These findings highlight the role of self-regulation in child depression and suggest that targeting self-regulation may be an effective prevention and intervention strategy.

Age 4 Predictors of Oppositional Defiant Disorder in Early Grammar School.

Our ability to predict which children will exhibit oppositional defiant disorder (ODD) at the time of entry into grammar school at age 6 lags behind our understanding of the risk factors for ODD. This study examined how well a set of multidomain risk factors for ODD assessed in 4-year-old children predicted age 6 ODD diagnostic status. Participants were a diverse sample of 796 4-year-old children (391 boys).The sample was 54% White, non-Hispanic; 16.8% African American, 20.4% Hispanic; 2.4% Asian; and 4.4% Other or mixed race. The classification accuracy of two models of multidomain risk factors, using either a measure of overall ODD symptoms or dimensions of ODD obtained at age 4, were compared to one another, to chance, and to a parsimonious model based solely on parent-reported ODD using Automated Classification Tree Analysis. Effect Strength for Sensitivity (ESS), a measure of classification accuracy, indicated a multidomain model including a general measure of ODD symptoms at age 4 yielded a large effect (56.29%), a 13.7% increase over the ESS for the parsimonious model (ESS = 42.9%). The ESS (51.23%) for a model including two ODD dimensions (behavior and negative affect) was smaller than that for the model including a measure of overall ODD symptoms. The Classification Tree Analysis approach showed a small but distinct advantage that would be useful in screening for which children would most likely meet criteria for age 6 ODD.

The relation between social support, anxiety and distress symptoms and maternal fetal attachment.

OBJECTIVE: The aims of this study were to: (1) examine the relation between social support, trait anxiety, symptoms of maternal distress (including stress, depression and anxiety) and maternal-fetal attachment; and (2) to determine if social support buffers the relation between trait anxiety, symptoms of distress and maternal-fetal attachment. DESIGN: Ninety-four pregnant women completed five self-report questions. Two hierarchical regression analyses were conducted to examine the influence of trait anxiety, symptoms of distress, and social support on two factors of maternal-fetal attachment, quality and intensity/frequency. RESULTS: In the first model with the dependent measure as the maternal-fetal attachment quality score, trait anxiety (ß = -.24, p < .05) and social support (ß = .30, p < .01) were significant predictors, accounting for 18% of the variance. In the second model with the dependent measure as the maternal-fetal attachment intensity/frequency score, trait anxiety (ß = -.23, p < .05) and social support (ß = .32, p < .01) were significant predictors, accounting for 23% of the variance. In addition, the interaction term contributed a significant 4% of the variance, indicating that when social support is high, the relation between anxiety and maternal-fetal attachment intensity/frequency is attenuated. CONCLUSIONS: This study demonstrates that prenatal attachment is related to trait anxiety and social support. These findings suggest that interventions to decrease anxiety and increase social support could enhance maternal-fetal attachment.

Parenting and Anxiety: Bi-directional Relations in Young Children.

Developmental psychopathologists have long posited a reciprocal relation between parenting behaviors and the development of child anxiety symptoms. Yet, little empirical research has utilized a longitudinal design that would allow exploration of this bi-directional influence. The present study examined the reciprocal relations between parental respect for autonomy, parental hostility, and parental support, and the development of childhood anxiety during a critical developmental period-the transition from preschool to kindergarten and then first grade. Study participants included a community sample of 391 male and 405 female socioeconomically, racially and ethnically diverse 4 to 6-7 year olds. 54 % of the sample was White, non-Hispanic, 16.8 % was African American, 20.4 % was Hispanic, 2.4 % were Asian and 4.4 % self-identified as Other or mixed race. Parent report and observational methodology were used. Parenting and anxiety were found to interact reciprocally over time. Higher levels of age 4 anxiety led to reduced respect for child autonomy at age 5. At age 4 higher levels of parental hostility led to small increases in age 5 anxiety, and increased age 5 anxiety led to increased levels of age 6 parent hostility. Parental support at age 5 resulted in decreased anxiety symptoms at age 6-7 while higher age 5 anxiety levels were associated with reductions in age 6-7 parental support. No relations were found between these variables at the younger ages. Although the magnitude of these findings was small, they suggest that early treatment for childhood anxiety should include both parent intervention and direct treatment of the child's anxiety symptoms.

Multi-domain Predictors of Attention Deficit/Hyperactivity Disorder Symptoms in Preschool Children: Cross-informant Differences.

Numerous studies indicated that agreement between parent and teacher ratings of symptoms of attention-deficit/hyperactivity disorder in children of all ages is poor, but few studies have examined the factors that may be associated with rater differences. The present study examined the contextual, parent, parenting, and child factors associated with rater differences in a community sample of 4-year-old children. Parents and teachers of 344 4-year-olds recruited from preschools and pediatric practices completed the preschool versions of the Child Symptom Inventory. Measures of socioeconomic status, family stress and conflict, caretaker depression, parental hostility, support-engagement, and scaffolding skills, and child negative affect (NA), sensory regulation (SR), effortful control (EC), inhibitory control, and attachment security were obtained either by parental report or observational measures. χ 2 difference tests indicated that child factors of EC and SR, and contextual factor of stress and conflict, contributed more to parent-ratings of ADHD-I and ADHD-HI than to teacher-ratings of those same types of symptoms. Two factors contributed more to teacher-than to parent-rated ADHD-I, NA and caretaker depression. Results indicate there are differences in factors associated with ADHD symptoms at home and school, and have implications for models of ADHD.

Relations Between Nonverbal and Verbal Social Cognitive Skills and Complex Social Behavior in Children and Adolescents with Autism.

Although there is an extensive literature on domains of social skill deficits in individuals with Autism Spectrum Disorders (ASD), little research has examined the relation between specific social cognitive skills and complex social behaviors in daily functioning. This was the aim of the present study. Participants were 37 (26 male and 11 female) children and adolescents aged 6-18 years diagnosed with ASD. To determine the amount of variance in parent-rated complex social behavior accounted for by the linear combination of five directly-assessed social cognitive variables (i.e., adult and child facial and vocal affect recognition and social judgment) after controlling for general intellectual ability, a hierarchical regression analysis was performed. The linear combination of variables accounted for 35.4 % of the variance in parent-rated complex social behavior. Vocal affect recognition in adult voices showed the strongest association with complex social behavior in ASD. Results suggest that assessment and training in vocal affective comprehension should be an important component of social skills interventions for individuals with ASD.

A multidomain cascade model of early childhood risk factors associated with oppositional defiant disorder symptoms in a community sample of 6-year-olds.

The present study examined a cascade model of age 4 and 5 contextual, parent, parenting, and child factors on symptoms of oppositional defiant disorder (ODD) at age 6 in a diverse community sample of 796 children. Contextual factors include socioeconomic status, family stress, and conflict; parent factors included parental depression; parenting factors included parental hostility, support, and scaffolding skills; child factors included child effortful control (EC), negative affect (NA), and sensory regulation. Direct effects of age 5 conflict, hostility, scaffolding, EC, and NA were found. Significant indirect, cascading effects on age 6 ODD symptom levels were noted for age 4 socioeconomic status via age 5 conflict and scaffolding skills; age 4 parental depression via age 5 child NA; age 4 parental hostility and support via age 5 EC; age 4 support via age 5 EC; and age 4 attachment via age 5 EC. Parenting contributed to EC, and the age 5 EC effects on subsequent ODD symptom levels were distinct from age 5 parental contributions. Scaffolding and ODD symptoms may have a reciprocal relationship. These results highlight the importance of using a multidomain model to examine factors associated with ODD symptoms early in the child's grammar school years.

Deficits in auditory processing contribute to impairments in vocal affect recognition in autism spectrum disorders: A MEG study.

OBJECTIVE: The primary aim of this study was to examine whether there is an association between magnetoencephalography-based (MEG) indices of basic cortical auditory processing and vocal affect recognition (VAR) ability in individuals with autism spectrum disorder (ASD). METHOD: MEG data were collected from 25 children/adolescents with ASD and 12 control participants using a paired-tone paradigm to measure quality of auditory physiology, sensory gating, and rapid auditory processing. Group differences were examined in auditory processing and vocal affect recognition ability. The relationship between differences in auditory processing and vocal affect recognition deficits was examined in the ASD group. RESULTS: Replicating prior studies, participants with ASD showed longer M1n latencies and impaired rapid processing compared with control participants. These variables were significantly related to VAR, with the linear combination of auditory processing variables accounting for approximately 30% of the variability after controlling for age and language skills in participants with ASD. CONCLUSIONS: VAR deficits in ASD are typically interpreted as part of a core, higher order dysfunction of the "social brain"; however, these results suggest they also may reflect basic deficits in auditory processing that compromise the extraction of socially relevant cues from the auditory environment. As such, they also suggest that therapeutic targeting of sensory dysfunction in ASD may have additional positive implications for other functional deficits.

Dimensions of oppositional defiant disorder in young children: model comparisons, gender and longitudinal invariance.

Identifying the latent structure of Oppositional Defiant Disorder (ODD) may have important clinical and research implications. The present study compared existing dimensional models of ODD for model fit and examined the metric and scalar invariance of the best-fitting model. Study participants were a diverse (38.8% minority, 49.1% boys) community sample of 796 children. Parents completed the Child Symptom Inventory and the DISC-YC ODD scales at child ages of 4, 5 and 6-7 years. When comparing single-factor (DSM-IV model), two-factor (oppositional behavior, negative affect), and three-factor models (one with dimensions of oppositional behavior, negative affect, antagonistic behavior; a second with dimensions of irritable, hurtful, and headstrong), the two-factor model showed the best fit. The two-factor model showed configural, metric and scalar invariance across gender and age. Results suggest that, among existing models, ODD is best characterized as two separate dimensions, one behavioral and one affective, which are comparable for both boys and girls in these age groups.

Multi-domain predictors of oppositional defiant disorder symptoms in preschool children: cross-informant differences.

Existing research suggests that parent and teacher reports of children's behavior problems are often discrepant. The current study examined whether contextual (stress and family conflict), parent (depression), parenting (hostility, support, and scaffolding), and child factors (receptive vocabulary; negative affect, NA; effortful control, EC; inhibitory control, IC; attachment; and sensory regulation, SR) are related to parent-teacher reporting discrepancies. Participants included a community sample of 344 4-year-old children. A multi-informant approach was used to assess contextual, parent, parenting, and child factors. Parents and teachers completed the Oppositional Defiant Disorder (ODD) scale of the Child Symptom Inventory. Consistent with previous data, there was poor agreement between parents and teachers (r = .17). After correcting for multiple comparisons, child effortful control, parent hostility, and family conflict were significant predictors of parent-rated symptoms of ODD symptoms but not teacher-rated ODD symptoms. Only family conflict was a significant predictor of discrepancies in parent and teacher ratings.

Bidirectional influences of anxiety and depression in young children.

Anxiety and depression tend to co-occur in children. Studies indicate that higher levels of anxiety are associated with subsequent higher levels of depression, while depression may inhibit subsequent anxiety. It is important to increase our understanding of the temporal sequencing of these disorders and, particularly, to determine if suppression effects account for the inhibitory association. In addition, further information about these relationships in young children is needed. Participants were a diverse (20.4 % Hispanic, 16.7 % African American; 49.1 % boys) community sample of 796 children with data available at ages 4, 5, and 6-7 years. Anxiety and depression symptoms were assessed using the Child Symptom Inventory and symptom count measures from the Diagnostic Interview Schedule for Children-Parent Scale -Young Child version. The results indicated: (a) anxiety and depression were relatively stable over time; (b) anxiety at age 4 and 5 was a significant positive predictor of subsequent depression; (c) while an inhibitory effect of depression on subsequent anxiety was found, that inhibitory effect was due to negative suppression, and higher levels of depression were actually associated with subsequent anxiety; (e) consistent with a significant suppression effect, when depression was included as a predictor, the association between anxiety at ages 4 and 5 and anxiety one year later increases in magnitude. Both anxiety and depression are associated with higher levels of one another in the subsequent year. Implications for prevention are discussed.

Dimensions of Oppositional Defiant Disorder in young children: heterotypic continuity with anxiety and depression.

There are distinct dimensions of Oppositional Defiant Disorder (ODD) that have been associated with symptoms of other disorders (heterotypic continuity). The present study compared the heterotypic continuity of a two-factor (Pitt-2) model and the three-factor model incorporated into DSM-5 with symptoms of anxiety and depression. Participants were a diverse community sample of 796 children (38.8 % minority, 49.1 % boys) assessed at ages 4, 5 and 6 years. Symptoms were assessed with the dimensional scales of the Diagnostic Interview Schedule for Children-Young Child version and the Child Symptom Inventory. Dimensions of both the two- and three-factor DSM-5 models were associated with later symptoms of anxiety and depression. The association, however, was weak when accounting for initial levels of internalizing symptoms: thus there was little evidence for the unique contributions of ODD dimensions to symptoms of subsequent internalizing disorders for either model.

Gene × environment effects of serotonin transporter, dopamine receptor D4, and monoamine oxidase A genes with contextual and parenting risk factors on symptoms of oppositional defiant disorder, anxiety, and depression in a community sample of 4-year-old children.

Genetic factors can play a key role in the multiple level of analyses approach to understanding the development of child psychopathology. The present study examined gene-environment correlations and gene × environment interactions for polymorphisms of three target genes, the serotonin transporter gene, the D4 dopamine receptor gene, and the monoamine oxidase A gene in relation to symptoms of anxiety, depression, and oppositional behavior. Saliva samples were collected from 175 non-Hispanic White, 4-year-old children. Psychosocial risk factors included socioeconomic status, life stress, caretaker depression, parental support, hostility, and scaffolding skills. In comparison with the short forms (s/s, s/l) of the serotonin transporter linked polymorphic repeat, the long form (l/l) was associated with greater increases in symptoms of oppositional defiant disorder in interaction with family stress and with greater increases in symptoms of child depression and anxiety in interaction with caretaker depression, family conflict, and socioeconomic status. In boys, low-activity monoamine oxidase A gene was associated with increases in child anxiety and depression in interaction with caretaker depression, hostility, family conflict, and family stress. The results highlight the important of gene-environment interplay in the development of symptoms of child psychopathology in young children.

Multi-domain models of risk factors for depression and anxiety symptoms in preschoolers: evidence for common and specific factors.

Relatively few studies have examined multiple pathways by which risk factors from different domains are related to symptoms of anxiety and depression in young children; even fewer have assessed risks for these symptoms specifically, rather than for internalizing symptoms in general. We examined a theoretically- and empirically-based model of variables associated with these symptom types in a diverse community sample of 796 4-year-olds (391 boys, 405 girls) that included factors from the following domains: contextual (SES, stress and family conflict); parent characteristics (parental depression); parenting (support/engagement, hostility and scaffolding); and child characteristics including negative affect (NA) effortful control (EC) sensory regulation (SR), inhibitory control (IC) and attachment. We also compared the models to determine which variables contribute to a common correlates of symptoms of anxiety or depression, and which correlates differentiate between those symptom types. In the best-fitting model for these symptom types (a) SES, stress and conflict had indirect effects on both symptom types via long-chain paths; (b) caregiver depression had direct effects and indirect ones (mediated through parenting and child effortful control) on both symptom types; (c) parenting had direct and indirect effects (via temperament and SR); and temperament had direct effects on both symptom types. These data provide evidence of common risk factors, as well as indicate some specific pathways/mediators for the different symptom types. EC was related to anxiety, but not depression symptoms, suggesting that strategies to improve child EC may be particularly effective for treatment of anxiety symptoms in young children.

Direct and indirect effects of contextual factors, caregiver depression, and parenting on attachment security in preschoolers.

The aim of this study was to develop a multiple-level-of-analysis model of preschool attachment security and to determine the processes (direct and indirect) whereby factors from different domains (e.g., stress and parenting) are related to attachment during this period. This study examined the direct and indirect effects of stress, family conflict, caregiver depression symptoms, and parenting on attachment security in a large (N = 796) and diverse sample of 4-year-olds. This study used the 3-Boxes Task to assess aspects of parenting critical to sensitivity in the preschool period, labeling this construct sensitivity/scaffolding. Parent-report questionnaires were used to assess stress, conflict, caregiver depressive symptoms, parent support/engagement, and parent hostility/coercion. Direct observation (3-Boxes Task) was used to assess sensitivity/scaffolding and attachment (Attachment Q-Sort) based on a 2½-3 hour home visit. Results of structural equation modeling indicated a good overall fit for the model. Among the parenting variables, sensitivity/scaffolding had the strongest effect on attachment. Depressive symptoms had both direct and indirect effects (mediated by parenting). The effects of stress and family conflict were mediated by caregiver depression symptoms and parenting. These data show that a developmentally appropriate measure of sensitivity plays a significant role in attachment security in preschoolers. Thus, strategies designed to enhance sensitivity/scaffolding may increase child resilience by enhancing attachment security.

A comparison of social cognitive profiles in children with autism spectrum disorders and attention-deficit/hyperactivity disorder: a matter of quantitative but not qualitative difference?

The aim of this study was to compare social cognitive profiles of children and adolescents with Autism Spectrum Disorders (ASD) and ADHD. Participants diagnosed with an ASD (n = 137) were compared to participants with ADHD (n = 436) on tests of facial and vocal affect recognition, social judgment and problem-solving, and parent- and teacher-report of social functioning. Both groups performed significantly worse than the normative sample on all measures. Although the ASD group had more severe deficits, the pattern of deficits was surprisingly similar between groups, suggesting that social cognitive deficit patterns may be more similar in ASD and ADHD than previously thought. Thus, like those with ASDs, individuals with ADHD may also need to be routinely considered for treatments targeting social skills.

Mother-teacher agreement on preschoolers' symptoms of ODD and CD: does context matter?

The aims of this study were to examine mother-teacher agreement on oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms and diagnoses in preschool children; to determine if context is a source of disagreement; and to explore if sex, referral status, and age moderated agreement rates. Participants included 158 male and 139 female 3- to 5-year old preschool children, their mothers, and teachers. A structured interview, the Kiddie-Disruptive Behavior Disorder Schedule was used for maternal report and teachers completed the Early Childhood Inventory. Results indicated that mothers reported more symptoms and diagnoses of ODD and CD than teachers, and mother-teacher agreement on both ODD and CD symptoms and diagnoses was low. Level of mother-teacher agreement increased when reporting on behavior in the same context; however, the rates remain modest. Referral status increased the likelihood of mother and teacher agreement on several ODD and CD symptoms, as well as ODD and CD diagnosis. These data suggest that context plays a role in mother-teacher agreement in the assessment of young children's ODD and CD symptoms.

A multi-domain model of risk factors for ODD symptoms in a community sample of 4-year-olds.

Few studies have been designed to assess the pathways by which risk factors are associated with symptoms of psychopathology across multiple domains, including contextual factors, parental depression, parenting, and child characteristics. The present study examines a cross-sectional model of risk factors for symptoms of Oppositional Defiant Disorder (ODD) in a diverse community sample of 796 four-year-old children. In the best-fitting model: (a) SES had indirect effects on contextual factors of stress and conflict, parental depression, and parenting factors including hostility, support, and scaffolding; (b) stress and conflict had both direct effects on ODD symptoms, and indirect effects via parental depression and parenting; (c) parenting had direct effects on ODD symptoms and indirect effects via child effortful control (EC), negative affect (NA) and sensory regulation (SR); (c) NA, EC, and SR had direct effects on symptom frequency, and attachment had indirect effects via EC, and SR. These results highlight the importance of using a multi-domain model to examine risk factors for symptoms of ODD, and also provide information about areas to target in treatment.