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Reward Dysregulation and Mood Symptoms in an Adolescent Outpatient Sample

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Abstract

Research on bipolar spectrum disorders (BPSD) in adolescence has burgeoned in the last decade, but continued work is needed to identify endophenotypic markers associated with illness onset and course. The present study examined reward dysregulation—measured via the behavioral activation system (BAS)—as one putative marker of BPSD in adolescence. A diverse group of 425 outpatient adolescents between 11 and 17 years of age (52 % male) completed the Behavioral Inhibition and Activation Scale (BIS-BAS) scale to measure reward dysregulation. Semi-structured interviews determined diagnoses and severity of mood symptoms. Parent-reported BAS was associated with increased symptoms of mania, and parent and adolescent-reported BAS were associated with symptoms of depression. Parent-reported BIS scores were associated with increased symptoms of mania. Results held independent of diagnostic status. Furthermore, parent BIS/BAS reports were stronger predictors for manic symptoms compared to adolescent-reports. Results extend work in adults with BPSD, suggesting a transdiagnostic association between reward dysregulation and mood symptom severity in adolescence.

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Notes

  1. Due to low reliability of A-BIS/BAS scores, we removed adolescents indicated to be poor responders on self-report and interview data, and reliability coefficients did not significantly differ (Z ≤ −1.09, ps > 0.05). Moreover, examining median corrected item total scores, all BIS/BAS values were within an acceptable range (> 0.35; Steiner and Norman 1995).

  2. Fortunately, there were minimal missing data that made listwise deletion possible. There was no missing data for gender, age, and ethnicity, and very little missing for diagnostic group, parent and adolescent BIS/BAS scores, and KDRS/KMRS scores (< 3 %).

  3. We completed the same set of regressions using the Young Mania Rating Scale (YMRS) and Children’s Depression Rating Scale (CDRS) in place of the KMRS and KDRS respectively, and obtained parallel results. Moreover, KMRS and KDRS scores correlated r = 0.92 and r = 0.93 with YMRS and CDRS severity ratings, respectively. Because the KMRS and KDRS provide more comprehensive coverage of DSM-IV symptoms of mania and depression (Axelson et al. 2003), we opted to present results using these symptom variables in the final analyses.

  4. For the purposes of the current analyses, yes/no medication status was included because more detailed analysis of individual medications is beyond the scope of this paper. However, in an ideal world, research should aim to include matching and/or random assignment of participants on medication types and dosages. Because the present sample consisted of youths receiving services in the community, there is a lot of heterogeneity in the choice and combination of medications used.

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Acknowledgments

We thank the families who participated in this research. This work was supported in part by NIH R01 MH066647 to Eric Youngstrom. In the last 24 months, Dr. Findling receives or has received research support, acted as a consultant, received royalties from, and/or served on a speaker’s bureau for Abbott, Addrenex, Alexza, American Psychiatric Press, AstraZeneca, Biovail, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Forest, GlaxoSmithKline, Guilford Press, Johns Hopkins University Press, Johnson & Johnson, KemPharm Lilly, Lundbeck, Merck, National Institutes of Health, Neuropharm, Novartis, Noven, Organon, Otsuka, Pfizer, Physicians’ Post-Graduate Press, Rhodes Pharmaceuticals, Roche, Sage, Sanofi-Aventis, Schering-Plough, Seaside Therapeutics, Sepracore, Shionogi, Shire, Solvay, Stanley Medical Research Institute, Sunovion, Supernus Pharmaceuticals, Transcept Pharmaceuticals, Validus, WebMD and Wyeth.

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Authors and Affiliations

  1. Department of Psychology, Yale University, P.O. Box 208205, New Haven, CT, 06520, USA

    June Gruber & Kirsten E. Gilbert

  2. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Eric Youngstrom & Jennifer Kogos Youngstrom

  3. Case Western Reserve University, Cleveland, OH, USA

    Norah C. Feeny

  4. Johns Hopkins University, Baltimore, MD, USA

    Robert L. Findling

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  1. June Gruber
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Correspondence to June Gruber.

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Gruber, J., Gilbert, K.E., Youngstrom, E. et al. Reward Dysregulation and Mood Symptoms in an Adolescent Outpatient Sample. J Abnorm Child Psychol 41, 1053–1065 (2013). https://doi.org/10.1007/s10802-013-9746-8

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