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The Child Behavior Checklist Dysregulation Profile in Preschool Children: A Broad Dysregulation Syndrome

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Objective

Children with concurrent impairments in regulating affect, behavior, and cognition can be identified with the Anxious/Depressed, Aggressive Behavior, and Attention Problems scales (or AAA scales) of the Child Behavior Checklist (CBCL). Jointly, these scales form the Dysregulation Profile (DP). Despite persuasive evidence that DP is a marker for severe developmental problems, no consensus exists on the preferred conceptualization and operationalization of DP in preschool years. We addressed this concern by testing and validating the factor structure of DP in a group of predominantly clinically referred preschool children.

Method

Participants were 247 children (195 boys and 52 girls), aged 3.5 to 5.5 years. Children were assessed at baseline and 18 months later, using parent and teacher reports, a clinical interview with parents, behavioral observations, and neuropsychological tasks.

Results

Confirmatory factor analysis showed that a bifactor model, with a general DP factor and 3 specific factors representing the AAA scales, fitted the data better than a second-order model and a one-factor model for both parent-reported and teacher-reported child problem behavior. Criterion validity analyses showed that the DP factor was concurrently and longitudinally associated with markers of dysregulation and clinically relevant criteria, whereas the specific factors representing the AAA scales were more differentially related to those criteria.

Conclusion

DP is best conceptualized as a broad syndrome of dysregulation that exists in addition to the specific syndromes as represented by the AAA scales. Implications for researchers and clinicians are discussed.

Section snippets

Factorial Structure of DP

DP was originally proposed as a proxy for juvenile bipolar disorder12; however, subsequent research has indicated that the profile does not serve well as an indicator for this disorder.13 Currently, there is an ongoing debate on how DP is best conceptualized. Some argue that DP represents a single syndrome of dysregulation that is not included in dominant nosologies of child problem behavior.2, 4 Others postulate that phenotypic manifestations of dysregulation represent comorbid disorders.14

Participants

General practitioners, pediatricians, and well-baby clinics in the province of Utrecht, the Netherlands, were invited to refer children 3.5 to 5.5 years of age with externalizing behavior problems for clinical assessment at the Outpatient Clinic for Preschool Children with Behavioral Problems, Department of Child and Adolescent Psychiatry, University Medical Centre Utrecht. Clinically referred children (n = 189) were included when they scored at or above the 90th percentile on the Attention

Correlations and Factorial Structure of DP

Correlations between the AAA scales were 0.619 and 0.679 (Aggressive Behavior and Attention Problems), 0.501 and 0.388 (Aggressive Behavior and Anxious/Depressed), and 0.371 and 0.324 (Anxious/Depressed and Attention Problems) for parent- and teacher-reported problem behavior, respectively.

The results of the factor analyses are shown in Table 1. The results were similar for parent- and teacher-reported problem behavior. The model showed a very good fit to the data, and the fit significantly

Discussion

Previous research has provided compelling evidence indicating that DP is valuable in identifying children who are seriously at risk in their development.6, 7 Yet, to date, there is no consensus on the conceptual meaning and preferred operationalization of DP, although this could substantially increase its clinical and scientific usefulness. We addressed this concern by testing and validating the factor structure of parent- and teacher-reported DP in a sample of predominantly clinically referred

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    Clinical guidance is available at the end of this article.

    Disclosure: Prof. Espy has received research support from the National Institute of Mental Health and the National Institute on Drug Abuse. Ms. Geeraerts recently became part of the Consortium on Individual Development (NWO grant number 024.001.003), which is funded through the Gravitation program of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research. Prof. Deković, Dr. Bunte, Dr. Schoemaker, Prof. Prinzie, Prof. van Baar, Prof. Matthys, and Ms. Deutz report no biomedical financial interests or potential conflicts of interest.

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