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The Child Behavior Checklist-Dysregulation Profile predicts substance use, suicidality, and functional impairment: a longitudinal analysis

Authors

  • Martin Holtmann,

    1. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
    2. Ruhr-University Bochum, LWL-University Hospital Hamm for Child and Adolescent Psychiatry, Germany
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  • Arlette F. Buchmann,

    1. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
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  • Guenter Esser,

    1. Department of Psychology, University of Potsdam, Potsdam, Germany
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  • Martin H. Schmidt,

    1. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
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  • Tobias Banaschewski,

    1. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
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  • Manfred Laucht

    1. Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
    2. Department of Psychology, University of Potsdam, Potsdam, Germany
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  • Conflict of interest statement: Prof. Holtmann served in an advisory or consultancy role for Lilly, Novartis, and Bristol-Myers Squibb, and received conference attendance support or was paid for public speaking by AstraZeneca, Janssen-Cilag, Lilly, Neuroconn, Novartis and Shire. Prof. Banaschewski served in an advisory or consultancy role for Desitin, Lilly, Medice, Novartis, Pfizer, Shire, UCB and Viforpharma. He received conference attendance support or received speaker’s fee by Lilly, Janssen McNeil, Medice, Novartis, UCB. He received unrestricted grants for organizing a CME conference by Lilly, Janssen McNeil, Medice, Novartis, Shire, UCB. He is/has been involved in clinical trials conducted by Lilly, Shire and Novartis. The present work is unrelated to the above grants and relationships. The other authors have no conflicts of interest.

Abstract

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.

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