Emotional and behavioral dysregulation in middle childhood: a pilot study of functional impairment and clinical correlates

Introduction: Severe emotional and behavioral dysregulation is a trans-diagnostic condition common in children from clinical samples. These children show significant impairments in multiple domains of self-regulation and are particularly at risk for psychopathology. The Child Behavior Checklist Dysregulation Profile (CBCL-DP) is a useful marker of severe dysregulation and risk for future major psychopathology in children and may identify children requiring early intervention. Some studies have defined the CBCL-DP as the sum of T-scores 210 on the Anxious/Depressed, Attention Problems and Aggressive Behavior subscales. The aim of this study is to examine the extent of emotional and behavioral dysregulation using the CBCL-DP in children aged 7-11 years referred to a children's hospital for clinical assessment of emotional and behavioral difficulties, and to explore functional impairment and the clinical correlates of symptomatology. Methods: All children were assessed using the CBCL/6-18, completed independently by parents. In addition, parents, teachers, and children completed the Conners 3 Rating Scales (CRS). Results: A preliminary analysis was conducted on N= 13 (69,2% boys) of 20 subjects. Children with DP-210 accounted for almost half of the sample (46%) and received the following DSM-5 diagnoses: ADHD (16.7%), anxiety-depression problems and learning difficulties (16.7%), depressive disorders (33.3%) and conduct disorder (33.3%). Significant associations were found between the DP-210 and the CBCL Problems Scales. Compared to the non-DP-210 group, the parent/teacher ratings also differed with respect to the presence of symptoms and functional impairment. Finally, DP-210 symptoms in children show significant associations with CRS content scales, symptom scales and impairment scales. Discussion: DP-210 children are frequent, show high rates of comorbidity between internalizing and externalizing disorders, and significant functional impairment in peer relations and academic domains. Exploratory data also suggest that clinical correlates could help to discriminate between children with and without emotional and behavioral dysregulation. This study draws clinical attention to the presence of severe dysregulation across nosological categories in order to identify children with high symptom severity and functional impairment who require early intervention.