Victoria C. Smith

DSM-5 disruptive mood dysregulation disorder: correlates and predictors in young children.

BACKGROUND Despite the inclusion of disruptive mood dysregulation disorder (DMDD) in DSM-5, little empirical data exist on the disorder. We estimated rates, co-morbidity, correlates and early childhood predictors of DMDD in a community sample of 6-year-olds. METHOD DMDD was assessed in 6-year-old children (n = 462) using a parent-reported structured clinical interview. Age 6 years correlates and age 3 years predictors were drawn from six domains: demographics; child psychopathology, functioning, and temperament; parental psychopathology; and the psychosocial environment. RESULTS The 3-month prevalence rate for DMDD was 8.2% (n = 38). DMDD occurred with an emotional or behavioral disorder in 60.5% of these children. At age 6 years, concurrent bivariate analyses revealed associations between DMDD and depression, oppositional defiant disorder, the Child Behavior Checklist - Dysregulation Profile, functional impairment, poorer peer functioning, child temperament (higher surgency and negative emotional intensity and lower effortful control), and lower parental support and marital satisfaction. The age 3 years predictors of DMDD at age 6 years included child attention deficit hyperactivity disorder, oppositional defiant disorder, the Child Behavior Checklist - Dysregulation Profile, poorer peer functioning, child temperament (higher child surgency and negative emotional intensity and lower effortful control), parental lifetime substance use disorder and higher parental hostility. CONCLUSIONS A number of children met DSM-5 criteria for DMDD, and the diagnosis was associated with numerous concurrent and predictive indicators of emotional and behavioral dysregulation and poor functioning.

Preschool Irritability: Longitudinal Associations With Psychiatric Disorders at Age 6 and Parental Psychopathology

OBJECTIVE There is increasing scientific and clinical attention to chronic irritability in youth. However, little is known about the predictive validity and clinical significance of chronic irritability during early childhood. This prospective, longitudinal study examined associations of chronic irritability with psychiatric disorders and parental psychopathology in a large community sample of preschoolers. METHOD Four hundred sixty-two preschool-age children were assessed at 3 and 6 years of age. Child psychopathology was assessed at baseline (3 years) and follow-up (6 years) using a diagnostic interview, the Preschool Age Psychiatric Assessment, with parents. Items from the Preschool Age Psychiatric Assessment were used to create a dimensional measurement of chronic irritability. Parental psychopathology was assessed with a diagnostic interview at baseline. RESULTS Chronic irritability was concurrently associated with a wide range of psychiatric disorders and functional impairment at 3 and 6 years of age. Irritability at 3 years predicted depression, oppositional defiant disorder, and functional impairment at 6 years after controlling for baseline disorders. Irritability also was associated with parental depression and anxiety. CONCLUSIONS Findings underscore the central role of irritability in early-emerging mental health problems. They are consistent with longitudinal studies in older youth indicating that chronic irritability predicts later depression and anxiety and support the importance of early detection and interventions targeting preschool irritability.

Early Exposure to Parental Depression and Parenting: Associations with Young Offspring’s Stress Physiology and Oppositional Behavior

Hypothalamic-pituitary-adrenal (HPA) axis reactivity to stress is posited to play a role in the intergenerational transmission of risk for psychopathology and other negative outcomes in the offspring of depressed parents. We tested the hypothesis that the joint, interactive effects of exposure to parental depression during early childhood and parental hostility impact the development of young children’s stress physiology and early emerging behavior problems. A sample of 165 preschool-age children (81 boys, 84 girls), of whom 103 had a parent with a history of depression, was exposed to a stress-inducing laboratory task, and five salivary cortisol samples were obtained. Parents completed clinical interviews and an observational parent–child interaction task. We found that the offspring exposed to maternal depression during early childhood and whose parents displayed hostile parenting behaviors during an observational task evidenced high and increasing cortisol levels in response to a laboratory stressor. In addition, the total amount of exposure to maternal depression over the child’s life exerted a dose–response effect on the positive relation between parental hostility and child observed oppositional behavior. This study underscores the importance of the early rearing environment on young children’s stress physiology and early emerging behavior problems.

Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine

BACKGROUND Little is known about the predictive validity and clinical significance of chronic irritability during early childhood. This prospective, longitudinal study examined associations of preschool chronic irritability with psychiatric disorders, functional impairment, and service use at age nine in a large community sample. METHODS Four hundred and forty-six children were assessed at age three and again at age nine. Child psychopathology and functional impairment were assessed at age three with the Preschool Age Psychiatric Assessment (PAPA) with parents and at age nine with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. Items from the PAPA were used to create a dimensional measure of chronic irritability at age three. At age nine, mothers, fathers, and youth completed the Child Depression Inventory (CDI) and the Screen for Anxiety Related Disorders (SCARED). RESULTS Chronic irritability at age three predicted any current and lifetime anxiety disorders at age nine, current and lifetime generalized anxiety disorder, and current separation anxiety, after controlling for baseline anxiety disorders. In addition, preschool irritability predicted increases in anxiety and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive and anxiety symptoms on the CDI and SCARED. Lastly, preschool irritability predicted greater functional impairment and outpatient treatment use, even after controlling for all psychiatric disorders at baseline. CONCLUSIONS Findings underscore the central role of irritability in developmental psychopathology and support the importance of early detection and interventions targeting preschool irritability.

Noisy spit: parental noncompliance with child salivary cortisol sampling.

Studies assessing hypothalamic-pituitary-adrenal (HPA) axis functioning in young children commonly involve parental collection of salivary cortisol in ambulatory settings. However, no data are available on the compliance of parents in collecting ambulatory measures of childrens salivary cortisol. This study examined the effects of parental compliance on the cortisol awakening response (CAR) and diurnal cortisol slopes in a sample of preschool-age children (ages 3-5). Eighty-one parents were instructed to collect their childs salivary cortisol samples upon their childs waking, 30 and 45 min post-waking and before bedtime on two weekdays. Subjective parental compliance was assessed using parent-report, and objective parental compliance was assessed using an electronic monitoring device. Rates of compliance were higher based on parent-report than electronic monitoring. Parental noncompliance as indicated by electronic monitoring was associated with higher waking cortisol and lower CAR. Findings suggest the need to incorporate electronic monitoring of parental compliance into developmental neuroendocrine research, especially when assessing the CAR.

Disruptive mood dysregulation disorder at the age of 6 years and clinical and functional outcomes 3 years later.

BACKGROUND Little is known about the predictive validity of disruptive mood dysregulation disorder (DMDD). This longitudinal, community-based study examined associations of DMDD at the age of 6 years with psychiatric disorders, functional impairment, peer functioning and service use at the age of 9 years. METHOD A total of 473 children were assessed at the ages of 6 and 9 years. Child psychopathology and functional impairment were assessed at the age of 6 years with the Preschool Age Psychiatric Assessment with parents and at the age of 9 years with the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS) with parents and children. At the age of 9 years, mothers, fathers and youth completed the Child Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders, and teachers and K-SADS interviewers completed measures of peer functioning. Significant demographic covariates were included in all models. RESULTS DMDD at the age of 6 years predicted a current diagnosis of DMDD at the age of 9 years. DMDD at the age of 6 years also predicted current and lifetime depressive disorder and attention-deficit/hyperactivity disorder (ADHD) at the age of 9 years, after controlling for all age 6 years psychiatric disorders. In addition, DMDD predicted depressive, ADHD and disruptive behavior disorder symptoms on the K-SADS, and maternal and paternal reports of depressive symptoms on the CDI, after controlling for the corresponding symptom scale at the age of 6 years. Last, DMDD at the age of 6 years predicted greater functional impairment, peer problems and educational support service use at the age of 9 years, after controlling for all psychiatric disorders at the age of 6 years. CONCLUSIONS Children with DMDD are at high risk for impaired functioning across childhood, and this risk is not accounted for by co-morbid conditions.

The Parent-Child Sleep Interactions Scale (PSIS) for Preschoolers: Factor Structure and Initial Psychometric Properties

STUDY OBJECTIVES Given the high prevalence of sleep problems in early childhood and the significant impact of parenting on childrens sleep, the current study aimed to determine the factor structure and psychometric properties of a new measure for assessing sleep-related parenting behaviors and interactions among preschool-aged children-The Parent-Child Sleep Interactions Scale (PSIS). METHODS Data was collected among parents of 209 preschool-aged children in two diverse metropolitan areas. All parents completed demographic questionnaires, the Parent-Child Sleep Interaction Scale (PSIS), and the Child Behavior Checklist (CBCL). A subset of parents completed structured interviews using the Preschool Age Psychiatric Assessment (PAPA). Following data reduction procedures, exploratory factor analysis (EFA) using principal axis extraction and oblique rotation was conducted, and internal consistency was assessed. Associations between PSIS scores and sleep problems based on the CBCL and PAPA as well as child sleep problems during infancy were examined. Differences based on demographic variables including race/ethnicity were also investigated. RESULTS EFA revealed a three-factor solution explaining 60% of the variance in total PSIS scores. Individual factors based on 12 items were labeled Sleep Reinforcement, Sleep Conflict, and Sleep Dependence. Internal consistency for all subscales and total PSIS scores was acceptable. PSIS subscales were positively correlated with both CBCL and PAPA Sleep Problems. Sleep problems during the first year of life were associated with Sleep Conflict and total PSIS scores. Significant differences in PSIS scores based on race/ ethnicity were found. CONCLUSIONS The PSIS shows promise as a valid measure of sleep-related parent/child behaviors and interactions among preschoolers.

Parent-child adrenocortical concordance in early childhood: The moderating role of parental depression and child temperament

This study examined biological concordance between parent and child morning cortisol and whether parent and child-level risk factors for depression moderated this association. Participants included 136 parents and their preschool-aged children. Parents and children obtained salivary cortisol samples at waking, and 30 and 45min post-waking across two days to assess the cortisol awakening response. Parental lifetime depression was assessed using a clinical interview and child temperamental negative emotionality (NE) and positive emotionality (PE) were assessed using an observational laboratory-based assessment. Results indicated significant parent-child concordance between both average cortisol levels and cortisol fluctuations across waking. Greater concordance was observed for dyads with parents with a lifetime history of depression and with children high in NE and PE. These parent- and child-level moderators were associated with different indices of concordance. Findings highlight the need to examine the role of parent and child risk factors for depression on parent-child adrenocortical concordance.

Children's cortisol responses to a social evaluative laboratory stressor from early to middle childhood.

This study examined the stability of childrens cortisol responses to a social evaluative laboratory stressor from early to middle childhood. Ninety-six children (51 males) completed stress-inducing laboratory tasks and provided five salivary cortisol samples in early (W1) and middle (W2) childhood. Although W1 cortisol responses did not predict W2 cortisol responses, childrens cortisol responses demonstrated change: compared to their W1 cortisol responses, childrens W2 cortisol responses demonstrated an increased slope and more negative quadratic curvature. Furthermore, child psychiatric symptoms at W1 moderated the stability of childrens cortisol responses. Children with fewer preschool psychiatric symptoms demonstrated greater inter-individual and intra-individual stability, whereas children with higher preschool psychiatric symptoms and comorbidity demonstrated systematic inter-individual and intra-individual instability in cortisol responses over time. Findings suggest a developmental shift toward increasing cortisol stress responses from early to middle childhood and highlight preschool psychopathology as a moderator of stability in childrens cortisol responses over time.

Stability and Predictive Validity of the Parent–Child Sleep Interactions Scale: A Longitudinal Study Among Preschoolers

Little research has examined the processes underlying children’s persistent sleep problems and links with later psychopathology. The current study examined the stability of parent–child sleep interactions as assessed with the parent-reported Parent–Child Sleep Interactions Scale (PSIS) and examined whether sleep interactions in preschool-age children predict sleep problems and psychiatric symptoms later in childhood. Participants included 108 preschool-age children (50% female) and their parents. Parents completed the PSIS when children were 3–5 years (T1) and again when they were 6–9 years (T2). The PSIS includes three subscales—Sleep Reinforcement (reassurance of child sleep behaviors), Sleep Conflict (parent–child conflict at bedtime), Sleep Dependence (difficulty going to sleep without parent)—and a total score. Higher scores indicate more problematic bedtime interactions. Children’s sleep problems and psychiatric symptoms at T1 and T2 were assessed with a clinical interview. PSIS scores were moderately stable from T1 to T2, and the factor structure of the PSIS remained relatively consistent over time. Higher total PSIS scores at T1 predicted increases in children’s sleep problems at T2. Higher PSIS Sleep Conflict scores at T1 predicted increases in oppositional defiant disorder symptoms at T2. Children with more sleep problems and higher PSIS Sleep Reinforcement scores at T1 showed increases in attention deficit/hyperactivity disorder, depressive, and anxiety symptoms at T2. These findings provide evidence for the predictive validity of the PSIS and highlight the importance of early parent–child sleep interactions in the development of sleep and psychiatric symptoms in childhood. Parent–child sleep interactions may serve as a useful target for interventions.