Background
The Child Behavior Checklist (CBCL) has been used to provide a quantitative description
of childhood bipolar disorder (BPAD). Many have reported that children in the clinical
range on the Attention Problems (AP), Aggressive Behavior (AGG), and Anxious-Depressed
(A/D) syndromes simultaneously are more likely to meet the criteria for childhood
BPAD. The purpose of this study was to determine if Latent Class Analysis (LCA) could
identify heritable phenotypes representing the CBCL-Juvenile Bipolar (CBCL-JBD) profile
and whether this phenotype demonstrates increased frequency of suicidal endorsement.
Methods
The CBCL data were received by survey of mothers of twins in two large twin samples,
the Netherlands Twin Registry. The setting for the study was the general community
twin sample. Participants included 6246 10-year-old Dutch twins from the Netherlands
Twin Registry. The main outcome measure consisted of the LCA on the items comprising
the AP, AGG, and A/D subscales and means from the suicidal items #18 and #91 within
classes.
Results
A 7 class model fit best for girls and an 8 class fit best for boys. The most common
class for boys or girls was one with no symptoms. The CBCL-JBD phenotype was the least
common—about 4%–5% of the boys and girls. This class was the only one that had significant
elevations on the suicidal items of the CBCL. Gender differences were present across
latent classes with girls showing no aggression without the CBCL-JBD phenotype and
rarely showing attention problems in isolation. Evidence of high heritability of these
latent classes was found with odds ratios.
Conclusions
In a general population sample, LCA identifies a CBCL-JBD phenotype latent class that
is associated with high rates of suicidality, is highly heritable, and speaks to the
comorbidity between attention problems, aggressive behavior, and anxious/depression
in children.
Key Words
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References
- Manual for the Child Behavior Checklist/4–18 and 1991 Profile.University of Vermont Department of Psychiatry, Burlington, Vermont1991
- A comparison of syndromes derived from the Child Behavior Checklist for American and Dutch boys aged 6–11 and 12–16.J Child Psychol Psychiatry. 1987; 28: 437-453
- Family, twin, adoption, and molecular genetic studies of juvenile bipolar disorder.Bipolar Disord. 2005; 7: 598-609
- Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed.American Psychiatric Association, Washington, DC1994
- Co-occurrence of aggressive behavior and rule-breaking behavior at age 12: Multi-rater analyses.Behav Genet. 2003; 33: 607-621
- When adolescents disagree with their mothers: CBCL-YSR discrepancies related to maternal depression and adolescent self-esteem.Child Care Health Dev. 2003; 29: 207-213
- CBCL clinical scales discriminate prepubertal children with structured interview-derived diagnosis of mania from those with ADHD.J Am Acad Child Adolesc Psychiatry. 1995; 34: 464-471
- Twin registers in Europe: An overview.Twin Res. 1998; 1: 34-51
- Netherlands Twin Register: A focus on longitudinal research.Twin Res. 2002; 5: 401-406
- Risk factors for adolescent suicide.Arch Gen Psychiatry. 1988; 45: 581-588
- Manic symptoms in psychiatrically hospitalized children--what do they mean?.J Affect Disord. 1998; 51: 123-135
- Maximum likelihood from incomplete data via the EM algorithm.J R Statist Soc B. 1977; 39: 1-38
- Characterization of children of bipolar parents by parent report CBCL.J Psychiatr Res. 2002; 36: 337-345
- The CBCL predicts DSM bipolar disorder in children: A receiver operating characteristic curve analysis.Bipolar Disord. 2005; 7: 518-524
- Child and adolescent bipolar disorder: A review of the past 10 years.J Am Acad Child Adolesc Psychiatry. 1997; 36: 1168-1176
- Prepubertal and young adolescent bipolarity versus ADHD: Assessment and validity using the WASH-U-KSADS, CBCL and TRF.J Affect Disord. 1998; 51: 93-100
- A zygosity questionnaire for young twins: A research note.Behav Genet. 1991; 21: 257-269
- Exploratory latent structure analysis using both identifiable and unidentifiable models.Biometrika. 1974; 61: 215-231
- Confirmation that Child Behavior Checklist clinical scales discriminate juvenile mania from attention deficit hyperactivity disorder.J Paediatr Child Health. 1999; 35: 199-203
- Prevalence and genetic architecture of Child Behavior Checklist-juvenile bipolar disorder.Biol Psychiatry. 2005; 58: 562-568
- Latent class and factor analysis of DSM-IV ADHD: A twin study of female adolescents.J Am Acad Child Adolesc Psychiatry. 1998; 37: 848-857
- Latent class analysis of Child Behavior Checklist attention problems.J Am Acad Child Adolesc Psychiatry. 1999; 38: 985-991
- Defining clinical phenotypes of juvenile mania.Am J Psychiatry. 2003; 160: 430-437
- Bipolar disorder during adolescence and young adulthood in a community sample.Bipolar Disord. 2000; 2: 281-293
- A preliminary meta-analysis of the child behavior checklist in pediatric bipolar disorder.Biol Psychiatry. 2003; 53: 1021-1027
- Latent class analysis of ADHD and comorbid symptoms in a population sample of adolescent female twins.J Child Psychol Psychiatry. 2001; 42: 933-942
- Evaluation of ADHD typology in three contrasting samples: A latent class approach.J Am Acad Child Adolesc Psychiatry. 1999; 38: 25-33
- Replication of the latent class structure of Attention-Deficit/Hyperactivity Disorder (ADHD) subtypes in a sample of Australian twins.J Child Psychol Psychiatry. 2002; 43: 1018-1028
- Familial clustering of latent class and DSM-IV defined attention-deficit/hyperactivity disorder (ADHD) subtypes.J Child Psychol Psychiatry. 2004; 45: 589-598
- Comparison of male adolescent-report of attention-deficit/hyperactivity disorder (ADHD) symptoms across two cultures using latent class and principal components analysis.J Child Psychol Psychiatry. 2002; 43: 797-805
- Heritability of attention problems in children: I.Am J Med Genet. 2003; 117B: 102-113
- Heritability of attention problems in children: Longitudinal results from a study of twins, age 3 to 12.J Child Psychol Psychiatry. 2004; 45: 577-588
- Zygosity diagnosis in young twins by parental report.Twin Res. 2000; 3: 134-141
- Factor and latent class analysis of DSM-IVADHD symptoms in a school sample of Brazilian adolescents.J Am Acad Child Adolesc Psychiatry. 2001; 40: 711-718
- Discrepancies between mothers' and fathers' perceptions of sons' and daughters' problem behaviour: A longitudinal analysis of parent-adolescent agreement on internalising and externalising problem behaviour.J Child Psychol Psychiatry. 1998; 39: 687-697
- Attention-deficit/hyperactivity disorder and comorbidity.Pediatr Clin North Am. 1999; 46 (, vii): 915-927
- Mutational analysis of the nicotinic acetylcholine receptor alpha 4 subunit gene in attention deficit/hyperactivity disorder: Evidence for association of an intronic polymorphism with attention problems.Mol Psychiatry. 2003; 8: 103-108
- Familiality and heritability of subtypes of attention deficit hyperactivity disorder in a population sample of adolescent female twins.Am J Psychiatry. 2001; 158: 1891-1898
- Causes of stability of aggression from early childhood to adolescence: A longitudinal genetic analysis in Dutch twins.Behav Genet. 2003; 33: 591-605
- Classes of disruptive behaviour in a sample of young elementary school children.J Child Psychol Psychiatry. 2003; 44: 377-387
- A comparison of syndromes derived from the child behavior checklist for American and Dutch girls aged 6–11 and 12–16.J Child Psychol Psychiatry. 1988; 29: 879-895
- Latent GOLD User's Guide.Statistical Innovations, Belmont, Massachusetts2000
- Latent class analysis of child behavior checklist anxiety/depression in children and adolescents.J Am Acad Child Adolesc Psychiatry. 2001; 40: 106-114
- Prevalence of psychopathology in children of a bipolar parent.J Am Acad Child Adolesc Psychiatry. 2001; 40: 1094-1102
- Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data.Lancet. 2004; 363: 1341-1345
- The clinical characteristics of unipolar vs. bipolar major depression in ADHD youth.J Affect Disord. 2004; 82: S59-S69
Article info
Publication history
Published online: May 02, 2006
Accepted:
February 10,
2006
Received in revised form:
February 10,
2006
Received:
May 16,
2005
Identification
Copyright
© 2006 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
