Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
University of Notre Dame, Notre Dame, IN; Vrije Universiteit, Amsterdam, the Netherlands.
J Am Acad Child Adolesc Psychiatry. 2017 Aug;56(8):678-686. doi: 10.1016/j.jaac.2017.05.019. Epub 2017 Jun 29.
Irritable and oppositional behaviors are increasingly considered as distinct dimensions of oppositional defiant disorder. However, few studies have explored this multidimensionality across the broader spectrum of disruptive behavior problems (DBPs). This study examined the presence of dimensions and distinct subgroups of childhood DBPs, and the cross-sectional and longitudinal associations between these dimensions.
Using factor mixture models (FMMs), the presence of dimensions and subgroups of DBPs was assessed in the Generation R Study at ages 6 (n = 6,209) and 10 (n = 4,724) years. Replications were performed in two population-based cohorts (Netherlands Twin Registry, n = 4,402, and Swedish Twin Study of Child and Adolescent Development, n = 1,089) and a clinical sample (n = 1,933). We used cross-lagged modeling in the Generation R Study to assess cross-sectional and longitudinal associations between dimensions. DBPs were assessed using mother-reported responses to the Child Behavior Checklist.
Empirically obtained dimensions of DBPs were oppositional behavior (age 6 years), disobedient behavior, rule-breaking behavior (age 10 years), physical aggression, and irritability (both ages). FMMs suggested that one-class solutions had the best model fit for all dimensions in all three population-based cohorts. Similar results were obtained in the clinical sample. All three dimensions, including irritability, predicted subsequent physical aggression (range, 0.08-0.16).
This study showed that childhood DBPs should be regarded as a multidimensional phenotype rather than comprising distinct subgroups. Incorporating multidimensionality will improve diagnostic accuracy and refine treatment. Future studies need to address the biological validity of the DBP dimensions observed in this study; herein lies an important opportunity for neuroimaging and genetic measures.
易激惹和对立行为越来越被认为是对立违抗性障碍的不同维度。然而，很少有研究在更广泛的破坏性行为问题（DBP）范围内探讨这种多维性。本研究探讨了儿童 DBP 的维度和不同亚组的存在，以及这些维度之间的横断面和纵向关联。
使用因子混合模型（FMM），在 Generation R 研究中评估了 DBP 的维度和亚组在 6 岁（n=6209）和 10 岁（n=4724）时的存在。在两个基于人群的队列（荷兰双胞胎登记处，n=4402，和瑞典儿童和青少年发展双胞胎研究，n=1089）和一个临床样本（n=1933）中进行了复制。我们使用 Generation R 研究中的交叉滞后模型来评估维度之间的横断面和纵向关联。DBP 使用母亲对儿童行为检查表的报告来评估。
DBP 的经验获得维度为对立行为（6 岁）、不服从行为、违反规则行为（10 岁）、身体攻击和易怒（两个年龄）。FMM 表明，对于所有三个基于人群的队列中的所有维度，单类解决方案的模型拟合度最好。在临床样本中也得到了类似的结果。所有三个维度，包括易怒，都预测了随后的身体攻击（范围，0.08-0.16）。
本研究表明，儿童 DBP 应被视为一种多维表型，而不是由不同的亚组组成。纳入多维性将提高诊断准确性并细化治疗。未来的研究需要解决本研究中观察到的 DBP 维度的生物学有效性；神经影像学和遗传学措施为此提供了一个重要机会。
