The CBCL Bipolar Profile and Attention, Mood, and Behavior Dysregulation

Abstract

Biederman and colleagues reported that a CBCL profile identified youngsters who were diagnosed with bipolar disorder. Some studies found that this CBCL profile does not reliably identify children who present with bipolar disorder, but nonetheless this CBCL does identify youngsters with severe dysfunction. However, the nature of the impairment of youngsters who fit this profile is unclear. The goal of this study was to describe the clinical characteristics of youngsters who fit this CBCL profile. The sample included 310 youngsters referred to an outpatient psychopharmacology clinic. There were 55 youngsters who fit the CBCL profile. These youngsters were compared to 255 youngsters who did not fit the CBCL profile. Measures included the CBCL, standardized measures of aggression and ADHD symptoms, youngsters’ self-reported depression, DSM-IV diagnoses, and child and adolescent psychiatrists’ ratings of impairment and functioning. Compared to youngsters who did not fit the CBCL bipolar disorder profile, youngsters who fit the profile had significantly higher scores on all but one CBCL scale and significantly higher levels of aggression. Youngsters who fit the CBCL profile also had greater psychosocial impairment and more DSM-IV diagnoses than youngsters who did not fit the profile. Youngsters who fit the CBCL profile exhibit severe dysregulation across multiple domains of functioning including attention, affective, and behavioral dysregulation that are not easily nor efficiently captured by extant DSM-IV diagnoses. These youngsters are not uncommon and comprise slightly less than 1 in 5 referrals to a child psychiatry clinic

SDQ Dysregulation Profile and Its Relation to the Severity of Psychopathology and Psychosocial Functioning in a Sample of Children and Adolescents With ADHD

“…Of increasing scientific interest is the study of DP in population with ADHD (Bellani, Negri, & Brambilla, 2012). Authors suggest a greater likelihood of displaying a DP among ADHD samples compared with other childhood psychiatric disorders (Doerfler, Connor, & Toscano, 2011; Halperin, Rucklidge, Powers, Miller, & Newcorn, 2011; Holtmann, Buchmann, et al, 2011). In addition, children and adolescents with ADHD who show high levels of DP have higher rates of anxiety and disruptive behavior disorders (Spencer et al, 2011) when compared with those with low levels of DP (Biederman, 1995).…”

Do ADHD Children With and Without Child Behavior Checklist–Dysregulation Profile Have Different Clinical Characteristics, Cognitive Features, and Treatment Outcomes?

“…In clinical samples, CBCL-DP has been associated with disruptive behaviors, severity of ADHD symptoms, and impaired psychosocial functioning (Doerfler, Connor, & Toscano, 2010;Holtmann et al, 2008;Volk & Todd, 2007. Moreover, this psychometric profile has shown great stability over the childhood years (Boomsma et al, 2006) and has been found to have specific genetic correlates (Doyle et al, 2010;McGough et al, 2008). Notwithstanding its potential utility, the construct measured by CBCL-DP still needs to be clarified, in particular its relationship with the clinical constructs of severe mood dysregulation or temper dysregulation with dysphoria, which characterize patients with severe nonepisodic irritability and hyperarousal (Stringaris et al, 2010).…”

Dysregulation in children: Origins and implications from age 5 to age 28

“…Dysregulation has been found to be relatively stable over time, highly heritable (approximately 54%–68% additive genetic factors), and to have fairly substantial shared environmental factors (approximately 18%–30%; Althoff, Rettew, Faraone, Boomsma, & Hudziak, 2006; Boomsma et al, 2006; Hudziak, Althoff, Derks, Faraone, & Boomsma, 2005). Recent studies have also demonstrated positive associations between dysregulation and risk for suicidality (Althoff et al, 2006, 2010; Ayer et al, 2009; Holtmann et al, 2011; Mbekou, Gignac, MacNeil, Mackay, & Renaud, 2014; Volk & Todd, 2007), bipolar disorder (Althoff et al, 2010; Biederman et al, 2009; Diler et al, 2009), aggression (Doerfler, Connor, & Toscano, 2010), oppositional defiant disorder, conduct disorder, attention deficit hyperactivity disorder (Volk & Todd, 2007), anxiety (Althoff et al, 2010), and substance use disorders (Holtmann et al, 2011). Particular combinations of the widely used anxious/depressed, attention, and aggression subscales (AAA; Achenbach, 1991) are often used to index dysregulation because of the associations between elevation on these scales and psychiatric outcomes and impairment (Ayer et al, 2009).…”