Julie A. Hofheimer, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill
Monica McGrath, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Rashelle Musci, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Guojing Wu, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Sarah Polk, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Courtney K. Blackwell, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Annemarie Stroustrup, Division of Neonatology, Department of Pediatrics, Cohen Children's Medical Center at Northwell Health, New Hyde Park, New York
Robert D. Annett, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque
Judy Aschner, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York; Hackensack Meridian School of Medicine, Nutley, New Jersey
Brian S. Carter, Department of Pediatrics, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City
Jennifer Check, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
Elisabeth Conradt, Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
Lisa A. Croen, Division of Research, Kaiser Permanente Northern California, Oakland, California
Anne L. Dunlop, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
Amy J Elliott, Avera Research Institute, Sioux Falls, South Dakota; Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
Andrew Law, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Leslie D. Leve, Prevention Science Institute, University of Oregon, Eugene
Jenae M. Neiderhiser, Department of Psychology, Penn State University, State College, Pennsylvania
T Michael O'Shea, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
Amy L. Salisbury, School of Nursing, Virginia Commonwealth University, Richmond
Sheela Sathyanarayana, Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle
Rachana Singh, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
Lynne M. Smith, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
Andréa Aguiar, Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana-Champaign; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana-Champaign
Jyoti Angal, Avera Research Institute, Sioux Falls, South Dakota
Hannah Carliner, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
Cindy McEvoy, Department of Pediatrics, Oregon Health & Science University, Doernbecher Children's Hospital, Portland
Steven J. Ondersma, Division of Public Health, Michigan State University, East Lansing; Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
Barry Lester, Brown Center for the Study of Children at Risk, Women & Infants Hospital, Brown University Alpert School of Medicine, Providence
Program Collaborators for Environmental influences on Child Health Outcomes

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IMPORTANCE: Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children.

OBJECTIVE: To characterize children's emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022.

EXPOSURES: Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities.

MAIN OUTCOMES AND MEASURES: Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression).

RESULTS: The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks' gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005).

CONCLUSIONS AND RELEVANCE: In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.

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JAMA Netw Open







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