Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill.
Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill.
JAMA Netw Open. 2023 Apr 3;6(4):e2310059. doi: 10.1001/jamanetworkopen.2023.10059.
Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children.
To characterize children's emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022.
Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities.
Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression).
The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks' gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005).
In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.
儿童早期的情绪和行为失调与成年后的严重精神、行为和认知障碍有关。确定持续的情绪和行为失调的最早前因可以为风险检测实践提供信息，并为有风险的儿童提供有针对性的干预措施，以促进适应性的发展轨迹。
描述儿童情绪和行为调节轨迹，并研究与整个儿童早期持续失调相关的风险因素。
设计、地点和参与者：本队列研究分析了来自 20 个美国队列的数据，这些队列参与了环境对儿童健康结果的影响研究，其中包括 1990 年至 2019 年期间的 3934 对母婴（单胎出生）。统计分析于 2022 年 1 月至 8 月进行。
标准化的自我报告和医疗数据确定了母亲、儿童和环境特征，包括产前物质暴露、早产和多种心理社会逆境。
18 至 72 个月时用儿童行为检查表照顾者报告，使用失调量表（CBCL-DP=焦虑/抑郁、注意力和攻击性的总和）。
该样本包括 3934 对在 18 至 72 个月时进行研究的母婴对。其中，718 名（18.7%）母亲为西班牙裔，275 名（7.2%）母亲为非西班牙裔亚裔，1220 名（31.8%）母亲为非西班牙裔黑人，1412 名（36.9%）母亲为非西班牙裔白人；3501 名（89.7%）母亲分娩时至少 21 岁。在儿童中，2093 名（53.2%）为男性，1178 名（55.0%）有心理社会逆境指数（PAI）数据的儿童经历了多种心理社会逆境，1148 名（29.2%）儿童在产前至少接触过 1 种精神活性物质，3066 名（80.2%）为足月出生（≥37 周妊娠）。增长混合物模型描述了 CBCL-DP 轨迹模型的 3 个类别：高且递增（2.3%[n=89]）、边界且稳定（12.3%[n=479]）和低且递减（85.6%[n=3366]）。处于高和边界失调轨迹的儿童的母亲心理挑战更为普遍（29.4%-50.0%）。多项逻辑回归分析表明，早产的儿童更有可能处于高失调轨迹（调整后的优势比[aOR]，2.76；95%置信区间[CI]，2.08-3.65；P<0.001）或边界失调轨迹（aOR，1.36；95% CI，1.06-1.76；P=0.02），而不是低失调轨迹。与低失调轨迹相比，高失调轨迹的儿童中女孩的比例较低（aOR，0.60；95% CI，0.36-1.01；P=0.05），而 PAI 较低的儿童（aOR，1.94；95% CI，1.51-2.49；P<0.001）则较少。PAI 和产前物质暴露的联合增加与高与边界失调的几率增加相关（aOR，1.28；95% CI，1.08-1.53；P=0.006），而与低与高失调的几率降低相关（aOR，0.77；95% CI，0.64-0.92；P=0.005）。
在本行为失调轨迹的队列研究中，发现了与早期风险因素的关联。这些发现可能为有风险的儿童中观察到的持续失调的早期前兆的筛查和诊断实践提供信息。
