Considering Treatment Sensitivity of the Dysregulation Profile with Young Adolescents with ADHD

• In Event: Poster Session 02
  In Poster Session: PS 02 Topic - Prevention and Interventions

Abstract

In an attempt to identify meaningful indices of emotion and behavioral dysregulation, investigators have examined a composite score calculated from the Child Behavior Checklist (CBCL, Achenbach & Rescorla, 2001) referred to as the Dysregulation Profile (Althoff et al., 2010). The DP score is calculated by summing the T-scores of the aggression, anxiety/depression, and attention problems subscales of the CBCL and studies have documented associations with concurrent and future problems related to psychopathology, substance use, social problems, and delinquency (Aebi et al., 2020; Biederman et al., 2012). Studies examining long-term stability and prediction of the DP score began their evaluation with participant ages near puberty. Developmentally, this may be an appropriate time to intervene to try to improve the regulation of emotions and behavior in order to improve the long-term trajectories of these youth. It is important to determine if DP scores change in response to treatment that produces change in related outcomes. In addition, it is important to determine if the DP score changes as a unitary score or whether change appears to be primarily driven by a subset of the factors that comprise it.
In this study, we examined DP scores as an outcome measure for 326 young adolescents with ADHD enrolled in a large randomized controlled trial of the Challenging Horizons Program (CHP). Participants were randomly assigned to two treatment conditions of a school-based treatment with one providing a large dose of CHP, the other a small dose, and the remaining third of the participants assigned to community care. Results indicated moderate effect size improvements compared to those in the control condition in parent-rated organization skills, homework problems, and inattention symptoms, and with small but significant improvements in grade point average for the high-dose group (Evans et al., 2016). Analyses of the parent-rated DP scores collected at baseline, post-treatment, and follow-up revealed a significant group by time interaction for the total DP score, attention problems factor, and anxiety/depression factor, but not the aggressive behavior factor. Participants were classified as exhibiting a dysregulated profile if their DP score exceeded the 210 cutoff proposed by Biederman and colleagues (2012) or if an individual factor score was greater than 70 (defined as clinical range of CBCL). Results indicated that 21% of the sample assigned to the high dose condition met criteria for DP at baseline and the portion meeting that threshold diminished to 16% at post-treatment, and 10% at follow-up indicating that the DP score was sensitive to treatment. However, in this study, this effect was largely impacted by improvement in the attention factor (see Figure 1). Overall, the findings suggest that the DP score is sensitive to treatment; however, the individual factor scores may differentially impact this change depending on the nature of the treatment and the presenting problems. Although the attention problems score appears most relevant in this study, in other studies, such as those with depressed or anxious youth, other factors may drive the change in the DP scores and need to be considered individually in the analyses.

Authors

• Lukas Whittamore, Ohio State University
  Presenting Author

• Steven W Evans, Ohio University
  Non-Presenting Author

• George DuPaul, Lehigh University
  Non-Presenting Author

• Joshua Langberg, Virginia Commonwealth University
  Non-Presenting Author