Elsevier

Biological Psychiatry

Volume 62, Issue 6, 15 September 2007, Pages 565-572
Biological Psychiatry

Original Article
Clinical Outcomes of Laboratory-Observed Preschool Behavioral Disinhibition at Five-Year Follow-up

https://doi.org/10.1016/j.biopsych.2006.10.021Get rights and content

Background

Behavioral disinhibition refers to a temperamental tendency to exhibit boldness, approach, and spontaneity in unfamiliar situations. We previously found it to be associated with childhood disruptive behavior and mood disorders, as well as with parental bipolar disorder. In the present study, our objective was to examine the diagnostic outcome in middle childhood of behavioral disinhibition assessed at preschool age among offspring at risk for anxiety and mood disorders.

Methods

The sample consisted of 284 children, including offspring of parents with panic disorder or major depression and comparison offspring of parents without these disorders, who had been assessed with laboratory observations of temperament at ages 21 months to 6 years. We reassessed 215 of the children (77%) at 5-year follow-up (mean age 9.6 years) with structured diagnostic interviews.

Results

Compared with noninhibited, nondisinhibited control subjects, behaviorally disinhibited children had higher lifetime rates of comorbid mood plus disruptive behavior disorders and higher current rates of any disruptive behavior disorder and of oppositional defiant disorder.

Conclusions

Behavioral disinhibition appears to be a temperamental antecedent of disruptive behavior disorders and their comorbidity with mood disorders in middle childhood, which may be targeted for preventive intervention.

Section snippets

Subjects

This study is a 5-year follow-up of a sample originally recruited between 1993 and 1998. As described in earlier reports (Biederman et al 2001a, Rosenbaum et al 2000), we recruited three groups: 1) 131 parents treated for panic disorder and their 227 children (of these parents, 113 either had comorbid panic and major depression [n = 102] or a spouse with major depression [n = 11]); 2) 39 parents with major depression without panic disorder or agoraphobia and their 67 children; and 3) 61

Attrition and Demographic Characteristics

Of the 281 children assessed for temperament at baseline, 215 were reassessed diagnostically at follow-up (77%). As seen in Table 1, children who were and were not reassessed did not differ on demographic variables (age, sex, SES, intactness of family, race), temperament (BD), or parental diagnoses (presence of parental panic disorder or depression). At follow-up, children ranged in age from 6 to 15 years (mean, SD: 9.61, 1.92).

As seen in Table 2, children with BD (n = 75), behavioral

Discussion

This study provides prospective evidence that behavioral disinhibition measured in early childhood predicted the presence, 5 years later, of current disruptive behavior disorders in general and oppositional defiant disorder in particular, even after considering the contribution of parental psychopathology and low socioeconomic status. Moreover, the study suggests that preschool BD represents a risk factor for the development of comorbid mood plus disruptive behavior disorder by middle childhood.

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