Dysregulation in Childhood and Adolescence: Measurement, Development and Correlates

Abstract

The notion that disorders co-occur at higher rates than to be expected by chance (Angold, Costello, & Erkanli, 1999;Caron & Rutter, 1991), has led to a growing line of studies on comorbidity in both children and adolescents as well as adults. Despite this surge in research, little is known about the meaning behind the high rates of co-occurrence of different forms of psychopathology. For example, it could be that different forms of psychopathology co-occur because they share symptom overlap, because one form of psychopathology increases or causes risk for developing another form or because multiple forms of psychopathology share common etiology and risk factors. It is important that we know how we can measure such cooccurrence of different forms of psychopathology to ultimately better understand the nature of co-occurring psychopathology patterns and intervene as effectively as possible.Recently, children like Jimmy, who present symptoms of anxiety, attention problems and aggression, have been labeled 'dysregulated'; referring to their concurrent self-regulatory problems in multiple domains, including affective, behavioral, and cognitive self-regulation (the 'ABCs of self-regulation'; Althoff, Verhulst, Rettew, Hudziak, & van der Ende, 2010). The Dysregulation Profile (DP) has emerged as a useful measure of co-occurring psychopathology patterns and can be operationalized using the well-known and widely used questionnaires of the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach, 2009) such as the Child Behavior Checklist (CBCL). The DP uses scores on three main forms of psychopathology, specifically using the ASEBA syndrome scales: Anxious/Depressed (part of the Internalizing scale), Aggressive Behavior (part of the Externalizing scale), and Attention Problems (part of the Externalizing scale for 1.5-5-year-old children, but not for 6-to-18-year-old children). These three scales are jointly referred to as the AAA-scales (Ayer et al., 2009). The DP thus captures a large part of child clinical populations. The AAA-scales are generally strongly related, suggesting that some common factors might be explaining all these forms of psychopathology, although no previous studies had examined this.The overall aim of this dissertation is to increase knowledge of co-occurring psychopathology patterns by focusing on how to measure and understand the DP. We strive to advance theory formation on dysregulation in childhood and adolescence by conducting research into conceptualization and operationalization, stability and change, antecedents, outcomes and psychophysiological correlates of the DP. This dissertation is centered around three main research questions: (1) how to conceptualize and operationalize the DP? (2) how stable is the DP over time and how can the normative developmental course of the DP from age 4 to age 17 in the general population be described? and (3) what are early childhood antecedents, adolescent outcomes and psychophysiological correlates of the DP? 20C h a pte r 1 this would benefit our k...