Clinical Outcomes of Laboratory-Observed Preschool Behavioral Disinhibition at Five-Year Follow-up

Abstract

Objective-"Behavioral disinhibition" refers to a temperamental tendency to exhibit boldness, approach, and spontaneity in unfamiliar situations. We previously found it to be associated with childhood disruptive behavior and mood disorders as well as with parental bipolar disorder. In the present study, our objective was to examine the diagnostic outcome in middle childhood of behavioral disinhibition assessed at preschool-age among offspring at risk for anxiety and mood disorders.Method-The sample consisted of 284 children including offspring of parents with panic disorder or major depression and comparison offspring of parents without these disorders, who had been assessed with laboratory observations of temperament at ages 21 months-6 years. We reassessed 215 of the children (77%) at 5-year follow-up (mean age 9.6 years) with structured diagnostic interviews.Results-Compared with non-inhibited, non-disinhibited controls, behaviorally disinhibited children had higher lifetime rates of comorbid mood plus disruptive behavior disorders, and higher current rates of any disruptive behavior disorder and of oppositional defiant disorder.Conclusion-Behavioral disinhibition appears to be a temperamental antecedent of disruptive behavior disorders and their comorbidity with mood disorders in middle childhood, which may be targeted for preventive intervention.

The nature of individual differences in inhibited temperament and risk for psychiatric disease: A review and meta-analysis

“…Inhibited temperament has been the main focus of studies of temperament given its association with anxiety disorders and depression; however, uninhibited temperament is also associated with psychopathology, including attention deficit hyperactivity disorder (ADHD), bipolar disorder, and substance use disorders (Hirshfeld-Becker et al, 2007, 2003, 2002). Much remains unknown about the genetic and neural basis of uninhibited temperament and how these differences may confer risk for psychopathology.…”

“…Another important point is that most studies compare individuals with an inhibited temperament to those with an uninhibited temperament. while this extreme groups approach provides statistical power, it does raise questions about whether the uninhibited control group is the same as a standard “healthy control group”, since uninhibited children are at risk for developing externalizing disorders (Hirshfeld-Becker et al, 2007, 2003, 2002). To understand the potential impact of using extreme temperament groups, we have recently examined two different datasets.…”

Longitudinal stability of temperamental exuberance and social–emotional outcomes in early childhood.

“…Similarly, teacher ratings of surgency have been associated with greater peer ratings of girls’ “wild behavior” in kindergarten (Berdan, Keane, & Calkins, 2008). Furthermore, studies of disinhibition (i.e., novelty-seeking and impulsivity) have found associations with externalizing/antisocial diagnoses (Hirshfeld-Becker, Biederman, Faraone, Violette, Wrightsman & Rosenbaum, 2002; Hirshfeld-Becker, Biederman, Henin, Faraone, Cayton & Rosenbaum, 2006; Hirshfeld-Becker et al, 2007). …”

Anger and Approach Motivation in Infancy: Relations to Early Childhood Inhibitory Control and Behavior Problems

“…Hirshfeld-Becker and colleagues (Hirshfeld-Becker et al, 2007) have found approach to be directly related to externalizing disorders such as oppositional disorder. In addition, however, combinations of approach and inhibitory control have also been linked to problem behavior.…”