Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age

• Authors: Julie A Hofheimer, University of North Carolina at Chapel Hill; Monica Mcgrath, Johns Hopkins Bloomberg School of Public Health; Rashelle Musci, Johns Hopkins Bloomberg School of Public Health; Guojing Wu, Johns Hopkins Bloomberg School of Public Health; Sarah Polk, Johns Hopkins School of Medicine; Courtney K Blackwell, Northwestern University Feinberg School of Medicine; Annemarie Stroustrup, Cohen Children’s Medical Center at Northwell Health; Robert D Annett, University of New Mexico Health Sciences Center; Judy Aschner, Albert Einstein College of Medicine of Yeshiva University; Brian S Carter, University of Missouri-Kansas City; Jennifer Check, Wake Forest University School of Medicine; Elisabeth Conradt, Duke University; Lisa A Croen, Kaiser Permanente Division of Research; Anne Dunlop, Emory University; Anne J Elliott, Avera Research Institute; Andrew Law, Johns Hopkins Bloomberg School of Public Health; Leslie D Leve, University of Oregon; Jenae M Neiderhiser, Pennsylvania State University; Michael T O'shea, UNC School of Medicine; Amy L Salisbury, Virginia Commonwealth University; Sheela Sathyanarayana, University of Washington; Rachana Singh, Tufts University School of Medicine; Lynne M Smith, Harbor-UCLA Medical Center; Andréa Aguiar, University of Illinois Urbana-Champaign; Jyoti Angal, Avera Research Institute; Hannah Carliner, Vagelos College of Physicians and Surgeons; Cindy Mcevoy, Doernbecher Children's Hospital; Steven J Ondersma, Michigan State University; Barry Lester, The Warren Alpert Medical School
• Journal Title: JAMA Network Open
• Volume: Volume 6, Number 4
• Publisher: JAMA Network Open. | 2023-04-26, Pages E2310059-E2310059
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1001/jamanetworkopen.2023.10059
• Subjects: Health Sciences, Mental Health
• Keywords: Female; Pregnancy; Humans; Male; Infant, Newborn; Child, Preschool; United States; Cohort Studies; Premature Birth; Mothers; Risk Factors; Depression

Abstract

Importance: 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. Objective: 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. Exposures: Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities. Main Outcomes and Measures: Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression). Results: 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). Conclusions and Relevance: 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.