The Child Behavior Checklist-Dysregulation Profile predicts substance use, suicidality, and functional impairment: a longitudinal analysis.
BACKGROUND
Recent studies have identified a Child Behavior Checklist profile that characterizes children with severe affective and behavioral dysregulation (CBCL-dysregulation profile, CBCL-DP). In two recent longitudinal studies the CBCL-DP in childhood was associated with heightened rates of comorbid psychiatric disorders, among them bipolar disorder, an increased risk for suicidality, and marked psychosocial impairment at young-adult follow-up. This is the first study outside the US that examines the longitudinal course of the CBCL-DP.


METHODS
We studied the diagnostic and functional trajectories and the predictive utility of the CBCL-DP in the Mannheim Study of Children at Risk, an epidemiological cohort study on the outcome of early risk factors from birth into adulthood. A total of 325 young adults (151 males, 174 females) participated in the 19-year assessment.


RESULTS
Young adults with a higher CBCL-DP score in childhood were at increased risk for substance use disorders, suicidality and poorer overall functioning at age 19, even after adjustment for parental education, family income, impairment and psychiatric disorders at baseline. Childhood dysregulation was not related to bipolar disorder in young adulthood. The CBCL-DP was neither a precursor of a specific pattern of comorbidity nor of comorbidity in general.


CONCLUSIONS
Children with high CBCL-DP values are at risk for later severe, psychiatric symptomatology. The different developmental trajectories suggest that the CBCL-DP is not simply an early manifestation of a single disease process but might rather be an early developmental risk marker of a persisting deficit of self-regulation of affect and behavior.
Holtmann
Martin
M
Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany. martin.holtmann@wkplwl.org
Buchmann
Arlette F
AF
Esser
Guenter
G
Schmidt
Martin H
MH
Banaschewski
Tobias
T
Laucht
Manfred
M
D000293:Adolescent; D000367:Age Factors; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology; D057189:Checklist / Q000706:statistics & numerical data; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D010556:Personality Tests / Q000592:standards; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000592:standards; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult