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Objective: To estimate the genetic and environmental contributions to oppositional defiant behavior (ODB) from mother, father, and teacher report using the Conners Revised Short Forms in a large twin sample. Method: ODB data were collected from 1,595 mothers, 1,114 fathers, and 793 teachers of 7-year-old twin pairs from the Netherlands Twin Registry in the 1990-1992 cohort with an 80% response rate. Models were fit for each informant to determine the genetic, environmental, gender, and informant influences on ODB. Results: Genetic analyses of the ODB quantitative scale showed additive genetic (A) by mother (55%), by father (57%), and by teacher (21% girls, 38% boys) unique environmental (E) (mother, 22%; father, 29%; teacher, 48% girls, 39% boys) and shared environmental (C) (mother, 14%; father, 23%; teacher, 31% girls, 23% boys) influences. Conclusions: Additive genetic and unique environmental factors account for the majority of the influences on ODB for boys and girls by all informants.

A study of the adult outcomes of children who exhibited severe problems with self-regulation defined as being concurrently rated highly on the Child Behavior Checklist-Dysregulation Profile (CBCL-DP) is presented. The manifestation of CBCL-DP at wave 1 was linked to increased rates of adult anxiety disorders, disruptive behavior disorders, mood disorders, and drug abuse 14 years later.

The relationship between polymorphism in the catechol-O-methyltransferase gene and aggressive behavior and attention problems in youth are studied. Youth carrying a methionine allele are associated with higher average aggressive behavior scores.

Methods of characterizing children with dysregulated behavior are discussed. Psychiatrists should be characterizing them using the Child Behavior Checklist-Dysregulation Profile and severe mood dysregulation.

The study applies latent profiles analysis to a group of children and adolescents to test temperament phenotypes in order to examine their association to wellness and psychopathology. One of the results concluded that lifetime disorder was lower in the steady class as compared to moderate class.

Objective: Self-injurious thoughts and behaviors (SITB) among preteen children have risen to the attention of researchers, practitioners, and policymakers. To shed light on potential treatment/prevention targets, we sought to identify empirically derived emotional and behavioral problem profiles of preteens with SITB, and to determine whether these profiles differ by age, gender and society., Method: Caregivers of 46,719 children aged 6 to 12 years from 42 societies across the world completed the Child Behavior Checklist for ages 6-18 (CBCL/6-18). There were 1,656 children whose caregivers indicated that their child experienced SITB. We conducted a latent profile analysis (LPA) using scores from eight CBCL/6-18 problem scales to derive problem profiles of children with SITB. Multilevel modelling was used to estimate differences in the profiles by SITB, society, sex, and age., Results: A 4-profile model provided the best fit to the data, with profiles reflecting low problems (39.7%), mild problems (42.6%), moderate problems (15.4%), and rule-breaking/thought problems (2.3%). The low problems profile had CBCL problem scale scores nearly indistinguishable from those of children without SITB. Children in the rule-breaking/thought problems group were mostly female, whereas children in the other profile groups were mostly male. Children with the rule-breaking/thought problems profile also were most likely to have both suicidal thoughts and self-harm behaviors., Plain Language Summary: In this study, authors analyzed emotional and behavioral profile of preteens who experienced self-injurious thoughts and behaviors (SITB). Caregivers of over 46,000 children aged 6-12 from 42 countries completed the Child Behavior Checklist. The authors found that most preteens with SITB had low levels of other mental health problems. This study highlights the needs to screen all children for SITBs, not just those who have have significant mental health problems., Conclusion: Problem profiles of preteens with SITB are heterogeneous, with most having relatively low levels of other psychopathology. Selectively screening only children with clinically significant mental health problems for suicidal thoughts and self-harm behaviors (eg, asking about suicidal thoughts only among children with depression) risks missing many children experiencing SITB., (Copyright © 2024 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking., Method: The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis., Results: Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses., Conclusion: Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed., (Copyright © 2022 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Dysregulated children experience significant impairment in regulating their affect, behavior, and cognitions and are at risk for numerous adverse sequelae. The unclear phenomenology of their symptoms presents a barrier to evidence-based diagnosis and treatment., Method: The cognitive, behavioral, and psychophysiological mechanisms of dysregulation were examined in a mixed clinical and community sample of 294 children ages 7-17 using the Research Domain Criteria constructs of cognitive control and frustrative nonreward., Results: Results showed that caregivers of dysregulated children viewed them as having many more problems with everyday executive function than children with moderate or low levels of psychiatric symptoms; however, during standardized assessments of more complex cognitive control tasks, performance of dysregulated children differed only from children with low symptoms on tests of cognitive flexibility. In addition, when frustrated, dysregulated children performed more poorly on the Go/No-Go Task and demonstrated less autonomic flexibility as indexed by low respiratory sinus arrhythmia and pre-ejection period scores., Conclusion: The findings of this study suggest that autonomic inflexibility and impaired cognitive function in the context of frustration may be mechanisms underlying childhood dysregulation., (Copyright © 2022 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Irritable mood, a common and impairing symptom in psychopathology, has been proposed to underlie the developmental link between oppositional problems in youth and depression in adulthood. We examined the neural correlates of adolescent irritability in IMAGEN, a sample of 2,024 14-year-old adolescents from 5 European countries., Method: The Development and Well-Being Assessment (DAWBA) was used to assess attention-deficit/hyperactivity disorder, major depressive disorder, oppositional defiant disorder, and generalized anxiety disorder. Three items from the DAWBA, selected as close matches to the Affective Reactivity Index, were used to assess irritability. Structural magnetic resonance imaging was examined using whole-brain voxel-based morphometry analysis, and functional magnetic resonance imaging was examined during a stop signal task of inhibitory control. Imaging data were included in structural equation models to examine the direct and indirect associations between irritable mood and comorbid DSM diagnoses., Results: Whole-brain voxelwise analysis showed that adolescent irritable mood was associated with less gray matter volume and less neural activation underlying inhibitory control in frontal and temporal cortical areas (cluster-correction at p < .05). Structural equation models suggested that part of the observed smaller gray matter volume was exclusively driven by irritability separate from direct relationships between generalized anxiety disorder (or attention-deficit/hyperactivity disorder, major depressive disorder, or oppositional defiant disorder) and gray matter volume., Conclusion: This study identifies adolescent irritability as an independent construct and points to a neurobiological correlate to irritability that is an important contributing feature to many psychopathological disorders., (Copyright © 2020. Published by Elsevier Inc.)

Objective: To characterize the structural and functional neurobiology of a large group of adolescents exhibiting a behaviorally and emotionally dysregulated phenotype., Method: Adolescents aged 14 years from the IMAGEN study were investigated. Latent class analysis (LCA) on the Strengths and Difficulties Questionnaire (SDQ) was used to identify a class of individuals with elevated behavioral and emotional difficulties ("dysregulated"; n = 233) who were compared to a matched sample from a low symptom class (controls, n = 233). Whole-brain gray matter volume (GMV) images were compared using a general linear model with 10,000 random label permutations. Regional GMV findings were then probed for functional differences from three functional magnetic resonance imaging (fMRI) tasks. Significant brain features then informed mediation path models linking the likelihood of psychiatric disorders (DSM-IV) with dysregulation., Results: Whole-brain differences were found in the right orbitofrontal cortex (R.OFC; p < .05; k = 48), with dysregulated individuals exhibiting lower GMV. The dysregulated group also exhibited higher activity in this region during successful inhibitory control (F 1,429  = 7.53, p < .05). Path analyses indicated significant direct effects between the likelihood of psychopathologies and dysregulation. Modeling the R.OFC as a mediator returned modest partial effects, suggesting that the path linking the likelihood of an anxiety or conduct disorder diagnoses to dysregulation is partially explained by this anatomical feature., Conclusion: A large sample of dysregulated adolescents exhibited lower GMV in the R.OFC relative to controls. Dysregulated individuals also exhibited higher regional activations when exercising inhibitory control at performance levels comparable to those of controls. These findings suggest a neurobiological marker of dysregulation and highlight the role of the R.OFC in impaired emotional and behavioral control., (Copyright © 2019 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Courtney and colleagues 1 point out, in this issue of the Journal, that as the depth and complexity of the literature on children's mental health has grown, the challenges in synthesizing this literature and extracting its implications for science, practice, and policy have become more complicated. The vastness of our literature is breathtaking. Authors of the six review articles included in this issue of the Journal assessed a total of over 2,700 articles to construct their reviews. Although the ability to search our literature remains a critical core competency, our need for review articles has never been greater., (Copyright © 2018 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: We used latent class analysis (LCA) to examine the prevalence and characteristics of the Dysregulation Profile (DP) based on data from the Youth Self-Report (YSR). The DP comprises elevated scores on the Anxious/Depressed, Attention Problems, and Aggressive Behavior syndromes and thus reflects significant problems in self-regulation of affect, attention, and behavior., Method: We examined YSR data for 38,070 adolescents (48.1% male) in 34 societies. Participants ranged in age from 11 to 16 years. Researchers in 31 societies used translations of the YSR (not in Jamaica, Australia, or the United States)., Results: The various statistical indices for good LCA model fit (entropy, bootstrapped parametric likelihood ratio test, adjusted Bayesian Information Criterion, and probability of correct assignment) were not always consistent but generally supported a DP class in every society. However, prevalence of the DP ranged from 1% to 26% and the T score syndrome profile for the DP class in many societies featured elevations on all scales. In every society, the DP class had significantly higher scores than the pooled non-DP classes on all 3 DP syndromes, with large d values., Conclusion: Because model fit, the number of classes, and the prevalence of the DP class varied across societies, and because the DP "3-peak" profile was relatively uncommon, results for the DP based on adolescents' ratings in 34 societies must be considered as mixed., (Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: More than 75,000 articles have been published on internalizing and externalizing problems. To advance clinical and research applications of internalizing/externalizing concepts and data, our objectives were as follows: to provide an overview of recent research on internalizing/externalizing problems assessed at ages 1½ to 18 years; to identify issues raised by methods for assessing such problems; and to develop recommendations for more precise, consistent, informative, and productive assessment of such problems., Method: A total of 4,870 peer-reviewed articles published from January 1, 2012 through December 31, 2014 were systematically reviewed and identified by the search terms "internalizing" or "externalizing," followed by detailed coding of 693 articles that reported use of measures meeting criteria for methodologically sound assessment of internalizing/externalizing problems., Results: Many articles reported data based on measures that did not meet criteria for methodologically sound assessment of internalizing/externalizing problems. The 693 articles that used measures meeting criteria for methodological soundness and that qualified for detailed coding reported findings for 649,457 children living in 65 societies on all inhabited continents. Data were obtained from parents, teachers, children, clinicians, caregivers, and others. Samples included general population, clinical, school, at-risk, multicultural, welfare, and various ethnic/racial and socioeconomic groups. Many analytic methods were used to test associations of diverse variables with internalizing/externalizing problems., Conclusion: The diverse procedures used to assess internalizing/externalizing problems pose challenges for clinical and research applications. To meet the challenges, recommendations are provided for using assessment instruments supported by published standardization, reliability, validity, and normative data to advance clinical services and research., (Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Little is known about the longitudinal genetic and environmental association between juvenile irritability and symptoms of anxiety and depression. This study's goal was to assess the relationship between these constructs across a critical developmental period spanning childhood to young adulthood., Method: Parents (n = 1,348 twin pairs) from the Swedish Twin Study of Child and Adolescent Development completed the Child/Adult Behavior Checklist (CBCL/ABCL) about their twin children. Data were collected during a prospective, 4-wave study starting in childhood (ages 8-9 years) and ending in young adulthood (ages 19-20 years). An irritability score and an anxious/depressed score were computed from CBCL/ABCL item endorsements. Genetically informative cross-lagged models were used to estimate the genetic and environmental relationship between these 2 constructs across time., Results: Our models suggested that irritability more strongly predicted anxious/depressed symptoms than vice versa, consistent with a causal role of irritability on anxiety/depression at older ages. This relationship was significant only in late childhood/early adolescence. Additive genetic and unique environmental factors were significant contributors to both irritability and anxious/depressed symptoms and were both specific to and shared between these 2 constructs. The same common environmental factors influenced both constructs, although these factors accounted for a smaller amount of variance than genetic or unique environmental factors., Conclusion: This study adds to our understanding of the developmental relationship between irritability and anxious/depressed symptoms and the contribution of genes and environmental factors to their association across development. Findings suggest the need to monitor for emergence of internalizing symptoms in irritable children and their potential need for therapeutic intervention., (Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Children with co-occurring internalizing and externalizing problems have higher levels of impairment and worse outcomes later in life, but it is unclear whether these children can be distinguished validly from children who have problems in a single domain. We used a person-centered statistical approach to examine whether a group of children with co-occurring internalizing and externalizing problems can be identified in a general-population sample of young children., Method: This study included a population-based sample of 6,131 children, aged 5 through 7 years. Mothers (92.6%) reported emotional and behavioral problems using the Child Behavior Checklist/1.5-5 (CBCL). A latent profile analysis was performed on the CBCL syndrome scales. Identified classes were compared on early socioeconomic and parental risk factors using multinomial logistic regression., Results: We identified 4 classes, as follows: a class scoring high on all internalizing and externalizing scales (1.8%); a class with internalizing problems (5.3%); a class with externalizing problems and emotional reactivity (7.3%); and a class without problems (85.6%). The first class, with co-occurring problems, was associated with higher levels of maternal and paternal affective symptoms and hostility than the other 3 classes., Conclusions: The class with co-occurring internalizing and externalizing problems appears to be highly similar to the CBCL Dysregulation Profile described in older children. This empirically based dysregulation profile offers a promise to the study of the development of poor self-regulation., (Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Although oppositional defiant disorder (ODD) is usually considered the mildest of the disruptive behavior disorders, it is a key factor in predicting young adult anxiety and depression and is distinguishable from normal childhood behavior. In an effort to understand possible subsets of oppositional defiant behavior (ODB) that may differentially predict outcome, we used latent class analysis of mother report on the Conners' Parent Rating Scales Revised Short Forms (CPRS-R:S)., Method: Data were obtained from mother report for Dutch twins (7 years old, n = 7,597; 10 years old, n = 6,548; and 12 years old, n = 5,717) from the Netherlands Twin Registry. Samples partially overlapped at ages 7 and 10 years (19% overlapping) and at ages 10 and 12 years (30% overlapping), but not at ages 7 and 12 years. Oppositional defiant behavior was measured using the six-item Oppositional subscale of the CPRS-R:S. Multilevel LCA with robust standard error estimates was performed using the Latent Gold program to control for twin-twin dependence in the data. Class assignment across ages was determined and an estimate of heritability for each class was calculated. Comparisons with maternal report Child Behavior Checklist (CBCL) scores were examined using linear mixed models at each age, corrected for multiple comparisons., Results: The LCA identified an optimal solution of four classes across age groups. Class 1 was associated with no or low symptom endorsement (69-75% of the children); class 2 was characterized by defiance (11-12%); class 3 was characterized by irritability (9-11%); and class 4 was associated with elevated scores on all symptoms (5-8%). Odds ratios for twins being in the same class at each successive age point were higher within classes across ages than between classes. Heritability within the two "intermediate" classes was nearly as high as for the class with all symptoms, except for boys at age 12. Children in the Irritable class were more likely to have mood symptoms on the CBCL scales than children in the Defiant class but demonstrated similar scores on aggression and externalizing scales. Children in the All Symptoms class were higher in both internalizing and externalizing scales and subscales., Conclusions: The LCA indicates four distinct latent classes of oppositional defiant behavior, in which the distinguishing feature between the two intermediate classes (classes 2 and 3) is the level of irritability and defiance. Implications for the longitudinal course of these symptoms, association with other disorders, and genetics are discussed., (Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: To test for empirically defined temperament phenotypes and to investigate their associations with psychopathology and wellness., Method: The sample included 447 children (259 boys, 188 girls; mean age 11.0 years) recruited for a family study in the northeastern United States. Temperament was measured with the Juvenile Temperament and Character Inventory, and indicators of wellness and psychopathology were assessed with the Child Behavior Checklist from both parents and the Teacher Report Form. Latent profiles analysis was performed with the resulting class membership serving as the dependent variables for multinomial regression analyses., Results: Latent profiles analysis identified three classes as the best fitting solution consisting of a moderate class that had average levels of all four traits, a steady class that had low novelty seeking and high persistence and a disengaged class that had higher novelty seeking and harm avoidance but lower reward dependence and persistence. Regressions demonstrated strong links between the steady class, higher functioning, and lower levels of psychopathology, whereas the disengaged class showed the opposite associations. These findings held across informants of psychopathology and wellness., Conclusions: Profile analyses of temperament may be illuminative in identifying children with similar constellations of traits across many dimensions. Membership in these groups appears to be strongly related to both positive and negative outcomes.