Lauren S. Wakschlag

Linking Informant Discrepancies to Observed Variations in Young Children’s Disruptive Behavior

Prior work has not tested the basic theoretical notion that informant discrepancies in reports of children’s behavior exist, in part, because different informants observe children’s behavior in different settings. We examined patterns of observed preschool disruptive behavior across varying social contexts in the laboratory and whether they related to parent-teacher rating discrepancies of disruptive behavior in a sample of 327 preschoolers. Observed disruptive behavior was assessed with a lab-based developmentally sensitive diagnostic observation paradigm that assesses disruptive behavior across three interactions with the child with parent and examiner. Latent class analysis identified four patterns of disruptive behavior: (a) low across parent and examiner contexts, (b) high with parent only, (c) high with examiner only, and (d) high with parent and examiner. Observed disruptive behavior specific to the parent and examiner contexts were uniquely related to parent-identified and teacher-identified disruptive behavior, respectively. Further, observed disruptive behavior across both parent and examiner contexts was associated with disruptive behavior as identified by both informants. Links between observed behavior and informant discrepancies were not explained by child impairment or observed problematic parenting. Findings provide the first laboratory-based support for the Attribution Bias Context Model (De Los Reyes and Kazdin Psychological Bulletin 131:483–509, 2005), which posits that informant discrepancies are indicative of cross-contextual variability in children’s behavior and informants’ perspectives on this behavior. These findings have important implications for clinical assessment, treatment outcomes, and developmental psychopathology research.

Interaction of prenatal exposure to cigarettes and MAOA genotype in pathways to youth antisocial behavior

Genetic susceptibility to antisocial behavior may increase fetal sensitivity to prenatal exposure to cigarette smoke. Testing putative gene × exposure mechanisms requires precise measurement of exposure and outcomes. We tested whether a functional polymorphism in the gene encoding the enzyme monoamine oxidase A (MAOA) interacts with exposure to predict pathways to adolescent antisocial behavior. We assessed both clinical and information-processing outcomes. One hundred seventy-six adolescents and their mothers participated in a follow-up of a pregnancy cohort with well-characterized exposure. A sex-specific pattern of gene × exposure interaction was detected. Exposed boys with the low-activity MAOA 5′ uVNTR (untranslated region variable number of tandem repeats) genotype were at increased risk for conduct disorder (CD) symptoms. In contrast, exposed girls with the high-activity MAOA uVNTR genotype were at increased risk for both CD symptoms and hostile attribution bias on a face-processing task. There was no evidence of a gene–environment correlation (rGE). Findings suggest that the MAOA uVNTR genotype, prenatal exposure to cigarettes and sex interact to predict antisocial behavior and related information-processing patterns. Future research to replicate and extend these findings should focus on elucidating how gene × exposure interactions may shape behavior through associated changes in brain function.

Observational Assessment of Preschool Disruptive Behavior, Part II: validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS).

OBJECTIVE To examine the reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. METHOD The DB-DOS is a structured clinic-based assessment designed to elicit clinically salient behaviors relevant to the diagnosis of disruptive behavior in preschoolers. Child behavior is assessed in three interactional contexts that vary by partner (parent versus examiner) and level of support provided. Twenty-one disruptive behaviors are coded within two domains: problems in Behavioral Regulation and problems in Anger Modulation. A total of 364 referred and nonreferred preschoolers participated: interrater reliability and internal consistency were assessed on a primary sample (n = 335) and test-retest reliability was assessed in a separate sample (n = 29). RESULTS The DB-DOS demonstrated good interrater and test-retest reliability. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of disruptive behavior. CONCLUSIONS The DB-DOS is a reliable observational tool for clinic-based assessment of preschool disruptive behavior. This standardized assessment method holds promise for advancing developmentally sensitive characterization of preschool psychopathology.

Research Review: 'Ain't misbehavin': Towards a developmentally-specified nosology for preschool disruptive behavior

There is increasing consensus that disruptive behavior disorders and syndromes (DBDs) are identifiable in preschool children. There is also concomitant recognition of the limitations of the current DBD nosology for distinguishing disruptive behavior symptoms from the normative misbehavior of early childhood. In particular, there appears to be substantial insensitivity to heterotypic manifestations of this developmental period and problems in identifying meaningful heterogeneity. As a result, the developmental basis for much of the current nosology may be called into question. To address these and other critical issues, this paper reviews the foundational elements of clinical and developmental science pertinent to developmental differentiation of disruptive behavior in the preschool period as paradigmatic for developmental specification across the lifespan and generates an agenda for future research. We begin by reviewing evidence of the validity of DBDs in preschool children. This is followed by an outline of key developmental concepts and a review of the corollary evidence from developmental science. These provide a basis for conceptualizing disruptive behavior in reference to developmental deviation in four core dimensions hypothesized to mark the core features of disruptive behavior syndromes. Finally, we propose a program of research to establish an empirical basis for determining the incremental utility of a developmentally specified nosology. Central to this approach is a contention that the benefits of developmental specification are extensive and outweigh any disadvantages. This is because a developmentally specified approach holds substantial promise for increasing sensitivity and specificity for differentiating disruptive behavior from normative misbehavior and from other related syndromes as well as for improving prediction. Further, more precisely defined, developmentally based phenotypes are likely to elucidate distinct mechanisms within translational studies and to serve as a catalyst for the generation of novel treatments.

Defining the developmental parameters of temper loss in early childhood: implications for developmental psychopathology

BACKGROUND Temper modulation problems are both a hallmark of early childhood and a common mental health concern. Thus, characterizing specific behavioral manifestations of temper loss along a dimension from normative misbehaviors to clinically significant problems is an important step toward identifying clinical thresholds. METHODS Parent-reported patterns of temper loss were delineated in a diverse community sample of preschoolers (n = 1,490). A developmentally sensitive questionnaire, the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), was used to assess temper loss in terms of tantrum features and anger regulation. Specific aims were: (a) document the normative distribution of temper loss in preschoolers from normative misbehaviors to clinically concerning temper loss behaviors, and test for sociodemographic differences; (b) use Item Response Theory (IRT) to model a Temper Loss dimension; and (c) examine associations of temper loss and concurrent emotional and behavioral problems. RESULTS Across sociodemographic subgroups, a unidimensional Temper Loss model fit the data well. Nearly all (83.7%) preschoolers had tantrums sometimes but only 8.6% had daily tantrums. Normative misbehaviors occurred more frequently than clinically concerning temper loss behaviors. Milder behaviors tended to reflect frustration in expectable contexts, whereas clinically concerning problem indicators were unpredictable, prolonged, and/or destructive. In multivariate models, Temper Loss was associated with emotional and behavioral problems. CONCLUSIONS Parent reports on a developmentally informed questionnaire, administered to a large and diverse sample, distinguished normative and problematic manifestations of preschool temper loss. A developmental, dimensional approach shows promise for elucidating the boundaries between normative early childhood temper loss and emergent psychopathology.

Clinical Significance and Correlates of Disruptive Behavior in Environmentally At-Risk Preschoolers

Examines the clinical significance and correlates of disruptive behavior disorder symptoms (DBDSX) in preschoolers. Participants were 129 predominantly minority preschoolers (21/2 to 51/2) residing in low-income environments, half of whom were clinic-referred for disruptive behavior. Children with higher levels of DBDSX were more impaired in parent-child, preschool and clinic contexts. Correlates of DBDSX included both prenatal and infancy risks (low soothability as infants, prenatal exposure to cigarettes) and concurrent parenting factors (harshness, low levels of behavioral responsiveness, and parenting stress). In general, the clinical and risk profile of DBDSX in preschoolers at environmental risk appears to be similar to that of older children. Based on the results of this study, etiologic and prevention research on disruptive behavior disorders should begin in the first few years of life.

Women who remember, women who do not: a methodological study of maternal recall of smoking in pregnancy.

INTRODUCTION Retrospective recall of smoking during pregnancy is assumed to be substantially biased, but this has rarely been tested empirically. METHODS We examined the validity of an interview-based retrospective recall more than a decade after pregnancy, in a cohort with repeated, multimethod characterization of pregnancy smoking (N = 245). Retrospective smoking patterns were examined in relation to prospective reported and biological estimates of overall and trimester-specific smoking status and intensity. We also compared characteristics of women whose smoking status was misclassified by either prospective or retrospective measures with women whose status was congruent for nonsmoking across timepoints. RESULTS In general, sensitivity and specificity of recalled smoking were excellent relative to both prospective self-reported and cotinine-validated smoking status and trimester-specific intensity. However, measures were less congruent for amount smoked for women who recalled being heavy smokers. Further, retrospective measures captured some smokers not identified prospectively due to smoking that occurred prior to assessments. Women who would have been misclassified as nonsmokers based on either prospective or retrospective assessment differed significantly from congruently classified nonsmokers in a number of maternal, family, and neighborhood, but not child behavior, characteristics. DISCUSSION When epidemiological studies of the impact of smoking in pregnancy use retrospective methods, misclassification may not be a significant problem if prenatal smoking is assessed in terms of the pattern across pregnancy. This type of interview-based recall of pregnancy smoking may be relatively accurate, although optimal measurement should combine retrospective and prospective self-report and biological assays, as each provide unique information and sources of error.

The psychosocial context of pregnancy smoking and quitting in the Millennium Cohort Study

Background: Although pregnancy is a time when women have increased motivation to quit smoking, approximately half of female smokers persist in smoking throughout their pregnancies. Persistent pregnancy smokers are known to be more nicotine dependent and to have greater sociodemographic disadvantage. Less is known about the psychosocial context of persistent pregnancy smokers and factors that distinguish them from pregnancy quitters. Methods: A cross-sectional study was conducted within the UK Millennium Cohort Study. Participants were 18 225 women, including 13.3% quitters, 12% light smokers and 8% heavy smokers. Data were collected when the infants were 9 months old. Maternal psychosocial problems were assessed in three domains: interpersonal, adaptive functioning and health-related behaviours. Results: In general, psychosocial problems in all domains increased across the pregnancy smoking continuum (non-smoker, quitter, light smoker, heavy smoker). All three psychosocial domains added incremental utility to prediction of pregnancy smoking status, after adjustment for sociodemographic risk. Conclusion: Problems in multiple psychosocial domains systematically distinguish women along a pregnancy smoking gradient, with heavy smokers having the most problematic psychosocial context. This subgroup of pregnant smokers is unlikely to be able to benefit from usual-care antenatal cessation interventions, which rely on women’s capacity for self-initiation, self-control and social resources. Consideration should be given to tiered interventions that provide more intensive and targeted interventions to pregnant women unable to quit with usual care.

Meaningful differences in maternal smoking behaviour during pregnancy: implications for infant behavioural vulnerability

Background: Smoking during pregnancy has been consistently associated with risk of problem behaviour in offspring. There is debate about whether this association reflects a teratological effect or is a marker for problematic maternal characteristics. We test these “competing” hypotheses by examining whether (1) exposure is associated with an early risk pathway by testing its association with infant temperamental difficultness, and (2) whether pregnancy quitting is associated with an early protective pathway, testing its association with easy infant temperament. Methods: We used the 9-month-old sweep of the Millennium Cohort Study, a cohort of over 18 000 infants born in 2000–2. Mothers were classified as pregnancy non-smokers, quitters and light or heavy smokers. Temperamental positive mood, receptivity to novelty and regularity were assessed with the Carey Infant Temperament Scale. Results: Pregnancy quitters had infants with the highest scores of easy temperament and heavy smokers had infants with the lowest scores (F = 28.51, p<0.001). Pregnancy smoking also predicted difficult temperament: heavy smoking was associated with increased risk of low positive mood (OR = 1.17, p = 0.09). In contrast, pregnancy quitting exerted a protective effect with decreased risk of distress to novelty (OR = 0.79, p<0.01) and irregularity (OR = 0.89, p = 0.02) in these infants. Conclusions: Pathways from pregnancy smoking to offspring behaviour are complex and multi-determined. These findings suggest that both exposure and maternal characteristics associated with pregnancy smoking status contribute to offspring behavioural patterns. Research that characterises differences between quitters and persistent smokers and examines the role of these differences in prediction of early vulnerabilities and problems in adaptation over time will be important for elucidating these pathways.

SMOKING IN PREGNANCY AND DISRUPTIVE BEHAVIOUR IN 3-YEAR OLD BOYS AND GIRLS: AN ANALYSIS OF THE UK MILLENNIUM COHORT STUDY

Background: Maternal smoking during pregnancy has been consistently associated with disruptive behaviour in male offspring; however, results for girls are inconsistent and little is known about emergent patterns in young children. Additionally, it is unclear whether maternal smoking is independently associated in offspring with hyperactivity–inattention or only when it co-occurs with conduct problems. Further, few studies have controlled for a broad range of maternal psychosocial problems. Methods: Associations between self-reported smoking in pregnancy and maternal reports of externalising behaviour were analysed in more than 13 000 3-year-old boys and girls in the UK Millennium Cohort Study. Conduct and hyperactivity–inattention problems were assessed using the Strength and Difficulties Questionnaire. Results: Boys whose mothers persistently smoked throughout pregnancy were at significant risk of conduct and hyperactivity–inattention problems compared with sons of non-smokers: the effect was stronger for heavy smokers. After excluding children with co-occurring problems, conduct-only problems remained a significant risk for sons of heavy smokers, OR 1.92 (95% CI 1.29 to 2.86); and hyperactivity–inattention only for sons of light or heavy smokers, OR 1.79 (95% CI 1.27 to 2.51) and 1.64 (1.10 to 2.46). Daughters of light or heavy smokers were at significant risk of conduct-only problems, OR 1.73 (95% CI 1.14 to 2.61) and 1.73 (1.06 to 2.83). Relative to non-smokers, daughters of pregnancy quitters had significantly reduced odds of having conduct 0.61(0.39 to 0.97) or co-occurring problems 0.26(0.08 to 0.82), although only 79 and 20 girls met these criteria, respectively. All findings were robust to controlling for key social and psychosocial factors. Conclusions: Associations between maternal smoking during pregnancy and disruptive behaviour in 3-year-old children vary by sex, smoking status and whether or not conduct or hyperactivity problems occur together or separately.