A developmental approach to dimensional expression of psychopathology in child and adolescent offspring of parents with bipolar disorder

Abstract

The aim of this is to describe psychopathology, functioning and symptom dimensions accounting for subthreshold manifestations and developmental status in child and adolescent offspring of parents with bipolar disorder ("high-risk offspring"). The study population comprised 90 high-risk offspring (HR-offspring) and 107 offspring of community control parents (CC-offspring). Direct clinical observations and parental and offspring reports based on selected standardized clinical scales were used to assess offspring threshold and subthreshold diagnoses, symptoms and functioning. All outcomes were compared between the whole HR-offspring and CC-offspring samples and then by developmental status. After controlling for potential confounders, HR-offspring showed significantly poorer adjustment for childhood (r = 0.18, p = 0.014) and adolescence (r = 0.21, p = 0.048) than CC-offspring, as well as more emotional problems (r = 0.24, p = 0.001) and higher depression scores (r = 0.16, p = 0.021). As for differences in lifetime categorical diagnoses (threshold and subthreshold) between HR-offspring and CC-offspring, the prevalence of disruptive disorders was higher in pre-pubertal HR-offspring (OR 12.78 [1.45-112.42]), while prevalence of mood disorders was higher in post-pubertal HR-offspring (OR 3.39 [1.14-10.06]). Post-pubertal HR-offspring presented more prodromal (r = 0.40, p = 0.001), negative (r = 0.38, p = 0.002), manic (r = 0.22, p = 0.035) and depressive (r = 0.23, p = 0.015) symptoms than pre-pubertal HR-offspring, as well as more peer relationship problems (r = 0.31, p = 0.004), poorer childhood adjustment (r = 0.22, p = 0.044) and worse current psychosocial functioning (r = 0.27, p = 0.04). Externalizing psychopathology is more prevalent in pre-pubertal HR-offspring, while depressive and prodromal symptoms leading to functional impairment are more prominent in post-pubertal HR-offspring. Developmental approaches and dimensional measures may be useful for identifying children at high risk of developing bipolar disorder and help guide specific preventive strategies.

Psychopathology in 7‐year‐old children with familial high risk of developing schizophrenia spectrum psychosis or bipolar disorder – The Danish High Risk and Resilience Study ‐ VIA 7, a population‐based cohort study

“…Studies on psychopathology in child offspring of parents with schizophrenia and bipolar disorder, as opposed to adult offspring, are vital because they provide knowledge on early developmental psychopathology long before onset of the fullblown disorders. Indeed, earlier studies have found a high prevalence of a broad spectrum of Axis I disorders and dimensional psychopathology in FHR-SZ children [8][9][10][11][12][13][14][15] as well as FHR-BP children 12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] . However, many previous clinical studies have weaknesses, such as small sample sizes, use of convenience samples, inclusion of children from different age groups, or lack of a proper control group.…”

Towards understanding and acting on risk factors for developmental psychopathology

“…Evidence supports the role of both genetic and epigenetic alterations as mediators of the intergenerational transmission of mental disorders [11]. Offspring studies also make it possible to monitor the prevalence and developmental changes of subtle expressions of psychopathology, including emotional and behavioural dysregulation, that are more prevalent among these children than in the general population [12]. The expression of psychopathology changes over time and also depends on pubertal status [12].…”

“…Offspring studies also make it possible to monitor the prevalence and developmental changes of subtle expressions of psychopathology, including emotional and behavioural dysregulation, that are more prevalent among these children than in the general population [12]. The expression of psychopathology changes over time and also depends on pubertal status [12]. Although biological research is accruing [13] researchers have yet to validate with sufficient reliability biomarkers to serve as screening tools for prevention in younger and older offspring of parents with mental disorders.…”

Cognitive reserve and its correlates in child and adolescent offspring of patients diagnosed with schizophrenia or bipolar disorder

“…Nevertheless, previous reports in SZ-off and BD-off have documented lower school performance [50][51][52], poorer peer relationships [51,53], lower verbal IQ [54,55], and some childhood developmental difficulties [8], all of which are variables considered to contribute to CR. Although studies comparing SZoff and BD-off in each of these variables are also scarce, some studies have pointed to the fact that SZ-off may experience more difficulties than BD-off in some of these domains [8,52].…”