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Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood

OBJECTIVES: In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for...

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Autores principales: Wiggins, Jillian Lee, Ureña Rosario, Ana, Zhang, Yudong, MacNeill, Leigha, Yu, Qiongru, Norton, Elizabeth, Smith, Justin D., Wakschlag, Lauren S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654830/
https://www.ncbi.nlm.nih.gov/pubmed/37723907
http://dx.doi.org/10.1002/mpr.1989
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author Wiggins, Jillian Lee
Ureña Rosario, Ana
Zhang, Yudong
MacNeill, Leigha
Yu, Qiongru
Norton, Elizabeth
Smith, Justin D.
Wakschlag, Lauren S.
author_facet Wiggins, Jillian Lee
Ureña Rosario, Ana
Zhang, Yudong
MacNeill, Leigha
Yu, Qiongru
Norton, Elizabeth
Smith, Justin D.
Wakschlag, Lauren S.
author_sort Wiggins, Jillian Lee
collection PubMed
description OBJECTIVES: In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at‐risk infant‐toddlers. METHODS: Data comprised N = 350 diverse infant‐toddlers and their mothers assessed at ∼14 months old for irritability (Multidimensional Assessment Profiles‐ Temper Loss‐Infant/Toddler (MAPS‐TL‐IT) and impairment (Early Childhood Irritability‐Related Impairment Interview, E‐CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow‐up surveys assessed impairment (FLIS) over the following year. RESULTS: Stepwise logistic regression indicated that 5 MAPS‐TL‐IT items were most informative for differentiating concurrent impairment on the FLIS: “frustrated about small things”; “hit, bite, or kick during tantrums”; “trouble cheering up when grumpy”; “grumpy during fun activities” and “tantrums in public”. With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E‐CRI indicated good classification accuracy for (Area under the curve = 0.755, p < 0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS‐TL‐IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR = 4.37; Confidence intervals = 2.40–7.97, p < 0.001). CONCLUSIONS: Our findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers.
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spelling pubmed-106548302023-09-18 Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood Wiggins, Jillian Lee Ureña Rosario, Ana Zhang, Yudong MacNeill, Leigha Yu, Qiongru Norton, Elizabeth Smith, Justin D. Wakschlag, Lauren S. Int J Methods Psychiatr Res Original Articles OBJECTIVES: In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at‐risk infant‐toddlers. METHODS: Data comprised N = 350 diverse infant‐toddlers and their mothers assessed at ∼14 months old for irritability (Multidimensional Assessment Profiles‐ Temper Loss‐Infant/Toddler (MAPS‐TL‐IT) and impairment (Early Childhood Irritability‐Related Impairment Interview, E‐CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow‐up surveys assessed impairment (FLIS) over the following year. RESULTS: Stepwise logistic regression indicated that 5 MAPS‐TL‐IT items were most informative for differentiating concurrent impairment on the FLIS: “frustrated about small things”; “hit, bite, or kick during tantrums”; “trouble cheering up when grumpy”; “grumpy during fun activities” and “tantrums in public”. With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E‐CRI indicated good classification accuracy for (Area under the curve = 0.755, p < 0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS‐TL‐IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR = 4.37; Confidence intervals = 2.40–7.97, p < 0.001). CONCLUSIONS: Our findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers. John Wiley and Sons Inc. 2023-09-18 /pmc/articles/PMC10654830/ /pubmed/37723907 http://dx.doi.org/10.1002/mpr.1989 Text en © 2023 The Authors. International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Wiggins, Jillian Lee
Ureña Rosario, Ana
Zhang, Yudong
MacNeill, Leigha
Yu, Qiongru
Norton, Elizabeth
Smith, Justin D.
Wakschlag, Lauren S.
Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood
title Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood
title_full Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood
title_fullStr Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood
title_full_unstemmed Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood
title_short Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood
title_sort advancing earlier transdiagnostic identification of mental health risk: a pragmatic approach at the transition to toddlerhood
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654830/
https://www.ncbi.nlm.nih.gov/pubmed/37723907
http://dx.doi.org/10.1002/mpr.1989
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