On the Spectrum

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Cognitive functioning in children with internalizing, externalizing and dysregulation problems and Muthen 2000). Previously, we applied a Latent Profile Analysis (LPA) to quantitative behavioral and emotional symptom data of more than 6,000 children to identify four broad, but exclusive classes with different patterns of symptoms (Basten, Althoff, Tiemeier, Jaddoe, Hofman et al. 2013). Three of these classes included children with problem behavior: a class of children with predominantly externalizing symptoms, a class with predominantly internalizing symptoms and a small class with both internalizing and externalizing symptoms that bears a resemblance to the CBCL Dysregulation Profile, a phenotype of high comorbidity that is associated with a broad range of later psychopathology (Althoff, Verhulst, Rettew, Hudziak and van der Ende 2010). In this population-based cohort, the majority of children belonged to a class without psychopathology. The three classes of problem behavior have so far only been related to a general, global measure of non-verbal intelligence (Basten, van der Ende, Tiemeier, Althoff, Rijlaarsdam et al. 2014). Here, we aimed to further specify these differences by assessing more specific cognitive sub-domains using an extensive neuropsychological test battery that covers five domains of neurocognitive ability: attention/executive functioning, language, memory, sensorimotor functioning and visuospatial ability. In the current study, we assessed the relation between cognition and psychiatric symptoms in more than 1,000 school-aged children. In line with recommendations of the RDoC initiative, we used continuous measures of internalizing and externalizing symptoms to capture the full spectrum of symptom severity, including subclinical symptoms (Insel, Cuthbert, Garvey, Heinssen, Pine et al. 2010). However, these measures were strongly correlated, so to identify unique patterns of impairment across different symptom types, we used the previously identified problem classes representing more homogeneous groups in terms of symptomatology. Based on the literature, we hypothesized that children with externalizing symptoms show poorer performance on the attention/executive functioning domain. Further, we hypothesized that children with internalizing symptoms would show moderately impaired test performance in the domains of language, memory and attention. In the class of children with high levels of both internalizing and externalizing symptoms, we expected widespread impairment, since they likely reflect the most severely affected group. Additionally, we tested if any impairments were independent of demographic and maternal factors or autistic symptoms. Finally, we explored whether any observed differences reflect global cognitive impairment or more specific deficits by adjusting for IQ. 6 METHODS Participants This study included a subgroup of children from the Generation R Study, a multi-ethnic population-based cohort, investigating children’s health, growth and development from 137
Chapter 6 fetal life onwards in Rotterdam, the Netherlands. An overview of the Generation R Study design and population is provided elsewhere (Jaddoe, van Duijn, Franco, van der Heijden, van IJzendoorn et al. 2012). As part of a previously described sub-study (White, El Marroun, Nijs, Schmidt, van der Lugt et al. 2013), 1,307 participants completed a neuropsychological test battery. In this substudy, children with specific traits (including autistic traits and externalizing disorders), were oversampled (see Supplementary Fig. 1 for a consort diagram). Oversampling of children with problem behavior increased the variability, which improved power of the analyses and helped in achieving a more normal distribution of psychopathology symptoms, which are generally strongly right skewed in the general population. One hundred thirty children had missing information on problem behavior and were excluded, resulting in a study sample of 1,177 children. The study was approved by the Medical Ethics Committee (METC) of the Erasmus Medical Centre. Written informed consent was obtained from the parents of all participants. Internalizing and externalizing symptoms When the children were approximately 6 years of age, mothers of 6,131 children completed the Child Behavior Checklist (CBCL/1.5-5). The CBCL is a widely used instrument has been shown to have good reliability and validity (Achenbach 2000) and is generalizable across 23 societies (Ivanova, Achenbach, Rescorla, Harder, Ang et al. 2010). It measures childhood psychiatric symptoms quantitatively, both in the clinical and non-clinical range and thereby captures the full range of severity. It contains internally consistent Internalizing and Externalizing broadband scales that globally correspond to mood and anxiety disorders and disruptive behavior disorders, respectively (Petty et al. 2008). The Internalizing and Externalizing broadband scales are able to measure broad behavioral constructs in early childhood that have been shown to predict later, more specific psychopathology (Mesman and Koot 2001; Kroes, Kalff, Steyaert, Kessels, Feron et al. 2002). The Internalizing scale consists of the following four scales: Emotionally Reactive; Anxious/Depressed; Somatic Complaints; and Withdrawn. The Externalizing scale contains two scales: Attention Problems and Aggressive Behavior (Basten et al. 2013). In our first approach, we related the continuous broadband scores to cognitive functioning. Secondly, to explore specific cognitive problems of internalizing and externalizing symptoms, we defined four classes of children with distinct patterns of behavioral and emotional symptoms that were obtained by a latent profile analysis performed on T-scores of CBCL syndrome scales that constitute the internalizing and externalizing broadband scales. These included a class of children without problems, a class with predominantly internalizing symptoms; a class with externalizing symptoms and emotional reactivity, further referred to as ‘externalizing’; and a class with high scores on both the internalizing and externalizing scales. This class is referred to as the dysregulation 138
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On the Spectrum the neurobiology of
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ISBN: 978-94-6233-336-9 © Laura Bl
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PROMOTIECOMMISSIE Promotoren Overig
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MANUSCRIPTS THAT FORM THE BASIS OF
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Chapter 1 10
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Chapter 1 Cuthbert, Garvey, Heinsse
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Chapter 1 folding of the brain into
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Chapter 1 beneficial for treatment
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Chapter 1 REFERENCES Achenbach, T.
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Chapter 1 Sonuga-Barke, E. J. S.
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IPart I: The neurobiology of autist
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Chapter 2 ABSTRACT Objective: Recen
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Chapter 2 Hardan 2010) and right pa
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Chapter 2 Statistical analysis To i
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Chapter 2 Gyrification Six regions
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Chapter 2 The association remained
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Chapter 2 Table 4. Autistic traits
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Chapter 2 While we found widespread
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Chapter 2 REFERENCES Amaral, D. G.,
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Chapter 2 Wallace, G. L., P. Shaw,
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Chapter 2 South-West of the Netherl
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Chapter 2 Supplementary Figure 1. F
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Chapter 2 Supplementary Figure 5. C
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Chapter 2 Supplementary Table 1. No
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Chapter 2 Supplementary Table 3. Ca
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3 A Prospective Study of Fetal Head
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A Prospective Study of Fetal Head G
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Chapter 4 ABSTRACT Background: Auti
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Chapter 4 An important trend concep
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Chapter 4 the 18-item abbreviated v
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Chapter 4 data were aligned into a
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IIIPart III
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Chapter 8 190
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Chapter 8 stable relationships, and
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Chapter 8 gyrification changes in p
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Chapter 8 genetic or environmental
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Chapter 8 diseases, according to th
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Chapter 8 ability may be even more
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Chapter 8 symptoms could be more sp
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Chapter 8 association of maternal v
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Chapter 8 REFERENCES Abrahams, B. S
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Chapter 8 Goddard, M. N., S. van Ri
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Chapter 8 Sebat, J., B. Lakshmi, D.
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SSummary Samenvatting
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Summary SUMMARY Despite evidence fr
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Summary along a continuum were used
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Samenvatting SAMENVATTING Genetisch
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Samenvatting jonge kinderen die zic
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Addendum Mous SE, Schoemaker NK, Bl
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Addendum Zoeken in andere databases
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Addendum School of Women’s and In
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Addendum Graag wil ik Dr. Marion Sm
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Addendum hebben. Dank in het bijzon
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On the Spectrum

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