Department of Psychiatry, University of Toronto, Toronto, Canada.
Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Canada.
Res Child Adolesc Psychopathol. 2021 Aug;49(8):1069-1082. doi: 10.1007/s10802-021-00797-x. Epub 2021 Mar 23.
Transdiagnostic models of psychopathology suggest that disorders may share common features that could influence their severity. Attention problems and psychomotor restlessness are included in the diagnostic criteria for several disorders, including disorders on the internalizing spectrum, but their transdiagnostic significance has received little attention. The present study identifies patterns of attention problems and restlessness among youth with internalizing problems, in order to understand their clinical significance in terms of internalizing symptom severity and response to cognitive behavioral therapy (CBT). Participants were 142 adolescents age 11-18 clinically referred for mood and/or anxiety problems. Latent class analysis was used to identify patterns of self-reported attention problems and psychomotor restlessness, and classes were compared on internalizing, depression, and anxiety severity. Differences in treatment response were examined in a subset of youth (n = 82; age 14-18) who participated in group CBT. Youth in the Attention Problems class (42% of sample) and youth in the Restless class (15% of sample) endorsed significantly more internalizing, depression, and anxiety problems than youth with Low Symptoms of attention problems or psychomotor restlessness (43% of sample). Youth in the Restless class responded significantly better to CBT than youth in the Low Symptoms of attention problems or psychomotor restlessness class in terms of decrease in overall internalizing problems. Attention problems and psychomotor restlessness appear to be important transdiagnostic markers of severity across the internalizing spectrum; however, they do not limit the effectiveness of CBT and, in the case of psychomotor restlessness, may forecast a good treatment response.
精神病理学的跨诊断模型表明，各种障碍可能具有共同的特征，这些特征可能影响其严重程度。注意问题和精神运动不安被包括在几种障碍的诊断标准中，包括内化谱中的障碍，但它们的跨诊断意义尚未得到重视。本研究旨在确定具有内化问题的年轻人中注意问题和不安的模式，以便了解它们在内化症状严重程度和对认知行为疗法（CBT）的反应方面的临床意义。参与者是 142 名年龄在 11 至 18 岁之间的临床转介有情绪和/或焦虑问题的青少年。使用潜在类别分析来识别自我报告的注意问题和精神运动不安模式，并比较类别在内化、抑郁和焦虑严重程度上的差异。在一组参加小组 CBT 的青少年（n=82；年龄 14-18 岁）中检查了治疗反应的差异。注意问题类别的青少年（样本的 42%）和不安类别的青少年（样本的 15%）比注意问题或精神运动不安症状低的青少年（样本的 43%）报告了更多的内化、抑郁和焦虑问题。在整体内化问题减少方面，不安类别的青少年对 CBT 的反应明显优于注意问题或精神运动不安症状低的青少年。注意问题和精神运动不安似乎是内化谱中严重程度的重要跨诊断标志物；然而，它们并不限制 CBT 的有效性，而且在精神运动不安的情况下，可能预示着良好的治疗反应。
