Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
1
Abstract
To establish which social interactive behaviours predict later psychiatric diagnosis, we examined
180 videos of a parent-infant interaction when children were aged one year, from within the Avon
Longitudinal Study of Parents and Children (ALSPAC) cohort. Sixty of the videos involved
infants who were later diagnosed with a psychiatric disorder at seven years, and 120 were a
randomly selected sex-matched control group. Interactive behaviours for both the caregiver and
the one year old infant were coded from the videos according to eight holistic categories of
interpersonal engagement: Well-being, Contingent Responsiveness, Cooperativeness,
Involvement, Activity, Playfulness, Fussiness, and Speech. Lower levels of adult activity and
speech in interaction at one year significantly predicted overall diagnosis of child psychiatric
disorder.
Keywords: Autism, conduct disorder, ADHD, disruptive behaviour disorder, depression, anxiety,
developmental, infancy, mother-infant interactions; parenting; parent-child; parent
psychopathology.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
2
Introduction
Atypicalities in interpersonal behaviours in early adult-infant interaction have been
associated with childhood diagnosis of psychopathology, including disruptive behaviour disorders
(DBDs), pervasive developmental disorder (PDD) and emotional disorders (Field, Healy,
Goldstein, Perry, Bendell, Schanberg et al., 1988; Kubicek, 1980; Trevarthen & Aitken, 2001;
Morrell & Murray, 2003; Halligan, Murray, Martins, & Cooper, 2007; Webb & Jones, 2009;
Murray, Marwick, & Arteche, 2010; Saint-Georges et al., 2011). Parenting styles and
environment are indicated, in addition to genetic vulnerabilities, to be risk markers in relation to
the development of DBDs, including attention deficit hyperactivity disorder (ADHD),
Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) (Zahn-Waxler, Iannotti,
Cummings, & Denham, 1990; Campbell, Pierce, March, & Ewing, 1991; Latimer et al., in press).
Bidirectional influences between observable child behaviour problems and parent-child
interactions are reported (Lifford, Harold, & Thapar, 2008), with early infant ‘difficult’
temperament found to contribute to irritable parenting style, and low maternal responsiveness in
combination with infant temperament predicting conduct problems (Shaw, Owens, Vondra, &
Keenan, 1996; Guerin, Gottfried, & Thomas, 1997; Lahey et al., 2008). Children with ADHD are
more likely to be reported by their mothers to have been fussy, irritable and active as infants
(Weiss & Hechtman, 1993), with higher activity levels seen as early as the first months of life
(Rothbart, 1989; Auerbach et al., 2005) and within the first year (Auerbach, Atzaba-Poria,
Berger, & Landau, 2004; Auerbach et al., 2008). Compared to controls, mothers of children with
ADHD are found to be generally more directive, negative and less socially interactive, and
children with ADHD less compliant and more negative (Cunningham & Barkley, 1979; Barkley,
Karlsson, & Pollard, 1985; Campbell, Breaux, Ewing, Szumowski, & Pierce, 1986; Jacobvitz &
Sroufe, 1987; DuPaul, McGoey, Eckert, & VanBrakle, 2001; Olson, Bates, Sandy, & Schilling,
2002).
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
3
Early intervention can support parenting behaviours and environmental adaptations to help
to optimise positive developmental outcomes for infants (Guralnick, 2004; Landry, Smith, &
Swank, 2006; Dawson, 2008), and intervention at a later point can be ineffective (Shaw, Bell, &
Gilliom, 2000). Reliable identification of predictors in early care-giver and infant interactions of
later child psychopathology are likely to be of value in the targeting of early intervention and
support but research into the relations between psychopathology and the parent–infant
relationship within a longitudinal non-clinical context has been sparse (Thompson et al., 2010).
Additionally, previous studies have been disorder specific, often using an ‘at risk’ group, which
has not enabled comparison between disorders, nor consideration of early risk markers of cooccurring disorders. Several studies have used adult or child reported perceptions as their
assessment measure, which does not have the objectivity of independent or prospective
observation. A longitudinal population based cohort study affords prospective analysis, using
systematic observational assessment, of early interactive behaviours for both adults and infants in
relation to a range of later diagnosed disorders, and based on a contemporary birth cohort, we
examined whether there are particular social interactive behaviours which predict later diagnosis
of a range of psychiatric disorders.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
4
Method
Participants
The sample consists of participants from the Avon Longitudinal Study of Parents and
Children (ALSPAC). ALSPAC is an ongoing population-based study investigating a wide range
of environmental and other influences on the health and development of children. Pregnant
women resident in the former Avon Health Authority in south-west England, having an estimated
date of delivery between 1 April 1991 and 31 December 1992 were invited to take part, resulting
in a ‘core’ cohort of 13,988 singletons/twins alive at 12 months of age (Golding, Pembrey, Jones,
& the ALSPAC Study Team, 2001).
Ethical approval for the study was obtained from the ALSPAC Law and Ethics Committee
and the Local Research Ethics Committees. All adult participants gave their informed consent
prior to their inclusion in the study.
The present study examined video footage from a sub sample of the core ALSPAC cohort
who were invited to attend Children in Focus clinics after birth. A range of measures was
collected at the clinic visits, including regular questionnaires completed by the parents, medical
assessments and biological samples collected for biochemical and genetic analyses. When the
children were 12 months old the clinic session for the 1240 participating families (usually
mother/infant dyads) included the Thorpe Interaction Measure (TIM) (Thorpe, Rutter, &
Greenwood, 2003). The TIM involves a caregiver and child sharing a picture book, and the adult
is asked to engage the child in this activity as they would at home. The same ‘living room’ style
environment in the clinic was used for all interactions, and the interaction was video-recorded.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
5
Sixty of the infants from the Children in Focus cohort later received diagnoses of one or
more psychiatric disorders using the Development and Wellbeing Assessment (DAWBA)
(Goodman, Ford, Richards, Gatward, & Meltzer, 2000) which was administered to all children
remaining in the cohort at 91 months of age. The DAWBA is a structured diagnostic assessment
which relies on parental report as well as teacher reports (Goodman et al., 2000), but final
diagnoses are assigned by a child psychiatrist. The TIM videos of these 60 case infants were
analysed in the current study, and the TIM videos of a further 120 infants from the cohort were
randomly selected for analysis to comprise a sex-matched control group.
Within the case infant group there were 26 cases of any oppositional-conduct disorder (of
which there were 19 “pure” cases without ADHD comorbidity), 35 cases of disruptive behaviour
disorders (28 without comorbidity), five cases of conduct disorder alone (3 without comorbidity),
six cases of pervasive developmental disorder (autism), and 25 and five infants diagnosed
respectively with any anxiety (15 without comorbidity) or any depressive disorder (1 without
comorbidity). There were 16 infants diagnosed with any form of ADHD (nine without
comorbidity), of which five had inattentive ADHD.
The majority (89%) of the caregivers in the videos analyses were mothers. The mean duration of
these caregiver-infant interactions was 211 (SD 84.5) seconds with a range from 60 to 510
seconds.
Procedure
Assessors were blind to the case or control status of the children in the videos. Interactive
behaviours for both the caregiver and the one year old infant were coded from the videos
according to a holistic measure using eight categories, namely: well-being, contingent
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
6
responsiveness, cooperativeness, involvement, activity, playfulness, fussiness and speech. All
parent and child scores in each category are on a scale of 1 to 5 of overall extent of occurrence
(see Appendix A for Holistic Measure). This system is adapted from the categories of
interpersonal interaction developed by Marwick and Trevarthen (1982, 1986), to reflect elements
of mood, engagement, attentional focus, interpersonal supportiveness, and expressiveness in
adult-infant interaction, which are key in typical social communicative development, concordant
inter-subjectivity, and interpersonal well-being (Trevarthen, 2001; Marwick & Murray, 2008;
Marwick, in press), and which encompass the altered interpersonal behaviours noted previously to
be associated with later diagnosed psychiatric disorder.
Statistical Methods
All subjects with available holistic interaction scores were used in the analyses. Initial
descriptive statistics were generated across the eight holistic categories for both caregiver and
infant, with all scores on a scale of 1 to 5. Inter-rater reliability tests using weighted kappa
statistics and rank correlations were carried out for all holistic measures, from a randomly
selected sample of n=29 adult-infant pairs. To check that the reliability sample was representative
of the whole group, Wilcoxon tests were used to compare holistic categories between adult-infant
pairs with and without reliability records. To reduce the variable set into smaller meaningful
groups of holistic measures, a scree plot was used to assess the number of latent factors to pursue,
after which maximum likelihood factor analysis was applied. Varimax rotation was used, though
similar results were obtained when using a promax rotation. Factor scores were derived by
summing those holistic scores with an absolute factor loading of more than 0.5 (after reversing
any measures with a large negative loading). These factor scores were then used in predictive
models of case and control status overall and within the following sub-diagnostic groups; any
ADHD; inattentive ADHD; any emotional disorder (anxiety and depression); PDD; DBD; any
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
7
oppositional conduct disorder; conduct disorder alone; oppositional defiant and/or DBD-NOS;
pure oppositional conduct disorder. The low prevalence seen for some of the outcomes made it
necessary to use Firth's penalised-likelihood logistic regression method (Frith, 1993) for odds
ratio (OR) estimates and corresponding 95% confidence intervals (CI) and p-values, implemented
using the “logistf” package for R (Ploner, Dunkler, Southworth, & Heinze, 2010). Models were
adjusted either for the sex of the infant alone, or for the sex of the infant and the depression and
anxiety scores of the mother at 32-40 weeks gestation and 8 months postnatal.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
8
Results
Holistic assessments were made on 178 infants and their parents’ behaviour during the
videos, with two videos excluded due to poor video quality. Table 1 shows the mean and
standard deviation of each holistic interaction score, for caregivers and infants, overall and for the
cases and controls separately. Appendix Table B.1 provides the number and percentage of videos
with each possible score from 1 to 5, for cases and controls. Many scales showed little variation
with the majority of videos given the same score.
(Table 1. to be inserted here).
No significant differences were observed between adult-infant pairs with and without
reliability records (data not shown). Appendix Table B.2a shows reliability statistics for the 16
individual variables. Adult involvement and fussiness scores showed little variability and were
therefore removed from subsequent factor analysis. Despite high proportions for agreement
levels for most individual scores, scales with little variation resulted in low weighted kappa
statistics.
A scree plot derived from the 14 remaining scores (Appendix Figure B.1) suggested four
latent variables. Factor loadings are shown in Table 2, with items grouped according to the factor
to which they were most strongly loaded. With the exception of infant wellbeing, no item had a
loading of more than ±0.5 on more than one factor. Four items (adult contingency and infant
involvement, speech and activity) did not load highly on any factor. Intuitively, factors 1, 3 and 4
are comprised largely of variables paired on adult and infant scores for cooperativeness,
wellbeing and playfulness respectively. Factor 2 comprised adult speech and activity. Reliability
statistics for factor scores derived from these four groups of items, shown in Appendix Table
B.2b, showed improved reliability compared to that of scores on individual measures.
(Table 2 to be inserted here).
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
9
Table 3 shows summaries of the case sub-diagnostic groups, with low prevalence noted for
inattentive ADHD, pervasive development disorder, depression and conduct disorders.
(Table 3 to be inserted here).
Table 4 shows means (SD) for factor analysis derived scores, Factor 1 and Factor 2, and
ORs for caseness and all case subgroups with 95% CIs and p-values, adjusted for the sex of the
infant and maternal depression and anxiety at 32-40 weeks gestation and 8 months postnatal.
Factor 1 was not significantly associated with any outcomes, although when adjusted for sex only
it was associated with pure oppositional-conduct disorder (OR=0.64, p=0.047). Across all models
adjusted for the sex of the infant and maternal mental state, Factor 2 (adult speech and activity)
showed strong associations with overall caseness and within all sub-diagnostic groups except
pervasive development disorder and pure oppositional conduct disorder. For every one standard
deviation increase in the combined adult verbal/activity score, the odds of being a case infant was
reduced by 43% (95% CI: 20%, 60%; p=0.001). Adjusting for the sex of the infant alone slightly
weakened the associations between the outcomes and Factor 2, with the result that the
associations with conduct disorder alone (OR=0.47, p=0.069) and oppositional defiant and/or
DBD NOS (OR=0.64, p=0.067) were no longer significant. Factor groups 3 and 4 did not
associate significantly with overall caseness or any sub-diagnostic group.
(Table 4 to be inserted here).
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
10
Discussion
Our holistic analysis of interpersonal behaviours within early social interaction has shown
adult activity and adult speech in combination to strongly predict later psychiatric diagnosis in the
child at seven years of age. Specifically, lower levels of adult activity and lower levels of adult
speech significantly predicted caseness and the diagnostic groups of: any ADHD, inattentive
ADHD, any emotional disorder, any anxiety disorder, DBDs, oppositional defiant and/or DBDNOS, and CD at seven years of age. No predictors were found in the interactive behaviours of the
child.
Several studies have found associations between caregiver behaviour, developmental
outcomes and later child psychiatric diagnosis (Jacobvitz & Sroufe, 1987; Campbell et al., 1991;
Belsky, Hsieh, & Crnic, 1998; Olson et al., 2002; Beebe et al., 2011). These findings highlight
the inverse relationship between maternal responsiveness during the first year of life and future
child conduct problems (Shaw et al., 1996; Kochanska, 1997; Wakschlag & Hans, 1999; Olson,
Bates, Sandy, & Lanthier, 2000), with maternal postnatal depression also associated with adverse
cognitive, behavioural and emotional development in the child (Cogill, Caplan, Alexandra,
Robson, & Kumar, 1986; Murray, Kempton, Woolgar, & Hooper, 1993; Halligan et al., 2007;
Cooper, Murray, & Halligan, 2010; Murray, Halligan, & Cooper, 2010), and maternal ADHD
symptoms being negatively associated with positive parenting (Murray & Johnston, 2006;
Chronis-Tuscano et al., 2008; Semple, Mash, Ninowski, & Benzies, 2011). The association
between lower levels of adult activity and speech and child psychopathology that we have
observed is concordant with previous studies. Low maternal initiation and responsiveness have
been related to the development of behavioural problems (Gardner, 1994), and reported also in
mothers of children with ADHD (Cunningham & Barkley, 1979; Mash & Johnston, 1982; Harvey
et al., 2003; Murray & Johnston, 2006; Chen & Johnston, 2007; Chronis-Tuscano et al., 2008;
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
11
Banks, Ninowski, Mash, & Semple, 2008). Vocalisations of depressed mothers in early
interactions have a slower response time and show less length variation with infant age (Bettes,
1988; Reissland, Shepherd, & Herrera, 2003). However, in our analysis the predictive strength of
the adult activity and speech scores was not explained by depression or anxiety of the adults.
The prospective non-clinical cohort design of the ALSPAC study has enabled us to confirm
that the same two categories of parental behaviour at one year predict diagnosis of a wide range of
later attention, conduct and emotional psychopathologies in the child. This finding lends some
support to the suggestion that parental ADHD symptoms may be a non-specific risk factor for
multiple dimensions of child psychopathology (Humphreys, Mehta, & Lee, 2010).
Given previous evidence of negativity and irritability found in parenting behaviours in
relation to conduct problems and DBDs (Barkley, Anastopoulos, Guevremont, & Fletcher, 1992)
it is of note that factors involving adult behaviour categories of well-being, contingent
responsiveness, cooperativeness, and playfulness were not found in this study to be significant
predictors of later child psychopathy. The lack of predictive association found for variables other
than adult activity and speech may reflect the situational context of the reading task in which the
adult and infant dyads were participating, with the caregiver asked to share a picture book with
their infant and to engage their child in this activity as they would at home. The structure of the
reading activity can be understood to accentuate the facilitating role of the adult in ‘framing’ and
directing the task activity, and to reduce the social demand of the context in comparison to, for
example, an unstructured play situation where ideas for activities have to be generated and
negotiated. Additionally, sessions were terminated when the child lost interest in the activity, or
showed signs of upset. Adults were not required to refocus the child, meaning parenting
approaches in relation to dealing with child distress or potential non-compliance were not filmed.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
12
The context of the reading task situation may also explain the finding that no infant
behaviour category predicted later development of psychopathology. Previous studies have
indicated differences in the behaviours of infants who are later diagnosed with a
psychopathology, such as negative emotionality, fussiness and hyperactivity (Weiss & Hechtman,
1993; Guerin et al., 1997; Shaw et al., 1996; Auerbach et al., 2005), however, our study found no
significant differences in the overall activity of the infants, nor evidence of infant emotionality
being a predictor of later disorder. The structured focus of the task may have served to modulate
the child’s activity, with the interpersonal behaviour range of the child being more limited by the
scaffolding measures adopted in the task by the caregiver, and, with sessions being terminated
when the child lost interest in the book or became upset, strong negative emotionality would not
have been present. Nevertheless, previous research has also indicated that in relation to ADHD
and hyperactivity symptoms in the early years, ‘non-optimal caregiving’ behaviour could not be
attributed to observed infant behaviour (Jacobvitz & Sroufe, 1987; Carlson, Jacobvitz, & Sroufe,
1995; Morrell & Murray, 2003).
No predictors in the interpersonal behaviours of adult or child were found for PDD, which
may have been a consequence of low power due to small sample sizes in this group of disorder
(n=6). A second explanation may be the object focussed structure and reduced interpersonal
demand of the task context.
Limitations
A limitation of the present study is the structured context of the activity, which was object
centred and may have reduced the social demand of the interaction, possibly ‘masking’ or
preventing behaviours that would otherwise take place in a context in which the infant and adult
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
13
could generate ideas for activity and negotiate shared and individual intentions. The visual
content of the videos was also limited at times. The camera recording the mother-infant
interaction had been placed in an upper corner of the room, resulting in the faces of the
participants not always being visible. Additionally, small sample sizes in relation to particular
disorders may have led to type 2 errors and there are potentially cases within the control group in
the present study, and vice versa (Foreman, Foreman, Prendergast, & Minty, 2001; Sayal,
Goodman, & Ford, 2006); both under-diagnosis and over-diagnosis which routinely occur in
ADHD (Angold, Erkanli, Egger, & Costello, 2000; Reid, Hakendorf, & Prosser, 2002).
Strengths of the Study
The primary strength of the present study is that we used data from a prospective
longitudinal non-clinically based population cohort study. This has allowed us to apply the same
assessment measures to the interactions of case and control dyads in relation to a range of
psychiatric disorders, enabling comparison of predictors between and amongst disorders and
consideration of predictors of co-occurring disorders. Unlike many other studies which have been
retrospective, it does not have to rely on parental reports which can be subject to memory recall
problems.
Another strength of the present study is that all the children involved underwent psychiatric
assessment at age 7 years using the DAWBA (Goodman et al., 2000) with all case children
receiving assessment of data by a child psychiatrist. Lastly, the present study also made a partial
adjustment for caregiver psychopathology via the maternal anxiety and depression ratings data,
which is important to strengthen the conclusions we draw from our findings given that there is
much evidence indicating the impact of parental psychopathology on infant cognitive and
psychological development.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
14
Clinical Implications
The finding in early parenting behaviour at one year of two risk markers for later attention,
behaviour and emotional psychopathologies in the child indicates these behaviours as areas of
focus for early screening research, and supports the involvement of parents in interventions
(McLaughlin & Harrison, 2006; Johnston & Jassy, 2007; Burke, Pardini, & Loeber, 2008).
Interventions focused on promoting parental responsiveness and infant cognitive stimulation have
resulted in parenting changes and improvements in the infant’s developmental outcomes in the
preschool years (van den Boom, 1995; Landry et al., 2006), and the identification of caregiver
activity and speech levels as predictors of a range of later child psychopathology will further
inform the formulation of targeted interventions.
Future research
Our results have shown that at 12 months, two categories of parental behaviours in a
structured book reading context can be identified which predict later attention, conduct and
emotional disorders in the child. Interactive context is known to influence interpersonal
behaviours (Wilson et al., 2011) and future research in a prospective population cohort should
examine parent and infant behaviours in other observational contexts to investigate the
identification of additional risk markers of later child pathology.
Conclusion
Holistic analysis of early caregiver-child interaction at one year has shown lower levels of
parental activity and speech to predict diagnosis of a range of later psychopathologies in the child.
As key risk markers within early interaction, these parental behaviours could inform the
development of a focused observational screening tool, accessible to clinicians and health
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
practitioners.
15
The commonality of these risk markers to a range of attention, conduct and
emotional disorders, indicates that targeted intervention programmes could also be developed to
support these parental interactive behaviours.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
16
Table Captions
Table 1. Mean (SD), for Holistic Adult and Infant interaction scores, overall and by case-control
status.
Table 2. Factor analysis of the 14 holistic variables, assuming 4 latent factors. Loadings
exceeding ± 0.5 shown in
bold.
Table 3. Number of cases overall and number and percentage within each sub-diagnostic group,
overall and by gender.
Table 4. Mean (SD) of predictors 'Factor 1' and 'Factor 2', within controls, cases overall and case
sub-diagnostic groups. Sex-adjusted OR's estimates for caseness associated with a 1 SD increase
in predictors, 95% confidence intervals and p-values.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
17
References
Angold, A., Erkanli, A., Egger, H. L., & Costello, E. J. (2000). Stimulant treatment for children:
A community perspective. Journal of the American Academy of Child and Adolescent
Psychiatry, 39, 975-984.
Auerbach, J. G., Atzaba-Poria, N., Berger, A., & Landau, R. (2004). Emerging developmental
pathways to ADHD: Possible path markers in early infancy. Neural Plasticity, 11, 29-43.
Auerbach, J. G., Landau, R., Berger, A., Arbelle, S., Faroy, M., & Karplus, M. (2005). Neonatal
behavior of infants at familial risk for ADHD. Infant Behavior and Development, 28, 220224.
Auerbach, J. G., Berger, A., Atzaba-Poria, N., Arbelle, S., Cypin, N., Friedman, A., & Landau, R.
(2008). Temperament at 7, 12, and 25 months in children at familial risk for ADHD. Infant
and Child Development, 17, 321-338.
Banks, T., Ninowski, J. E., Mash, E. J., & Semple, D. (2008). Parenting behavior and cognitions
in a community sample of mothers with and without symptoms of attentiondeficit/hyperactivity disorder. Journal of Child and Family Studies, 17, 28–43.
Barkley, R. A., Karlsson, J., & Pollard, S. (1985). Effects of age on the mother child interactions
of ADD-H and normal boys. Journal of Abnormal Child Psychology, 13, 631-637.
Barkley, R. A., Anastopoulos, A. D., Guevremont, D. C., & Fletcher, K. E. (1992). Adolescents
with attention deficit hyperactivity disorder: mother-adolescent interactions, family beliefs
and conflicts, and maternal psychopathology. Journal of Abnormal Child Psychology, 20,
263-88.
Beebe, B., Steele, M., Jaffe, J., Buck, K., Chen, H., Cohen, P., Kaitz, M., Markese, S., Andrews,
H., Margolis, A., & Feldstein, S. (2011). Maternal anxiety symptoms and mother–infant
self- and interactive contingency. Infant Mental Health Journal, 32,174-206.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
18
Belsky, J., Hsieh, K. H., & Crnic, K. (1998). Mothering, fathering, and infant negativity as
antecedents of boys’ externalising problems and inhibition at age 3 years: differential
susceptibility to rearing experience? Development and Psychopathology, 10, 301-320.
Bettes, B. A. (1988). Maternal depression and motherese: temporal and intonational features.
Child Development, 59, 1089-96.
Burke, J. D., Pardini, D. A., & Loeber, R. (2008). Reciprocal relationships between parenting
behavior and disruptive psychopathology from childhood through adolescence. Journal of
Abnormal Child Psychology, 36, 679-692.
Campbell, S. B., Breaux, A. M., Ewing, L. J., Szumowski, E. K., & Pierce, E. W. (1986). Parent
identified problem preschoolers - mother-child interaction during play at intake and 1-year
follow-up. Journal of Abnormal Child Psychology, 14, 425-440.
Campbell, S. B., Pierce, E. W., March, C. L., & Ewing, L. J. (1991). Noncompliant behavior,
overactivity, and family stress as predictors of negative maternal control with preschool
children. Development and Psychopathology, 3, 175–190.
Carlson, E. A., Jacobvitz, D., & Sroufe, L. A. (1995). A developmental investigation of
inattentiveness and hyperactivity. Child Development, 66, 37-54.
Chen, M., & Johnston, C. (2007). Maternal inattention and impulsivity and parenting behaviors.
Journal of Clinical Child and Adolescent Psychology, 36, 455–468.
Chronis-Tuscano, A., Raggi, V. L., Clarke, T. L., Rooney, M. E., Diaz, Y., & Pian, J. (2008).
Associations between maternal attention-deficit/hyperactivity disorder symptoms and
parenting. Journal of Abnormal Child Psychology, 36, 1237–1250.
Cogill, S., Caplan, H., Alexandra, H., Robson, K., & Kumar, R. (1986). Impact of maternal
postnatal depression on the cognitive development of young children. British Medical
Journal, 292, 1165–1167.
Cooper, P., Murray, L., & Halligan, S. (2010). Treatment of Postpartum Depression.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
19
Encyclopedia on Early Childhood Development. Published online May 18, 2010. Website
accessed on the 28th of September 2011.
Cunningham, C. E., & Barkley, R. A. (1979). Interactions of normal and hyperactive-children
with their mothers in free play and structured tasks. Child Development, 50, 217-224.
Dawson, G. (2008). Early behavioral intervention, brain plasticity, and the prevention of autism
spectrum disorder. Development and Psychopathology, 20, 775-803.
DuPaul, G. J., McGoey, K. E., Eckert, T. L., & VanBrakle, J. (2001). Preschool children with
attention-deficit/hyperactivity disorder: Impairments in behavioral, social, and school
functioning. Journal of the American Academy of Child and Adolescent Psychiatry, 40,
508-515.
Field, T., Healy, B., Goldstein, S., Perry, S., Bendell, D., Schanberg, S., Zimmerman, E.A., &
Kuhn, C. (1988). Infants of depressed mothers show "depressed" behavior even with
nondepressed adults. Child Development, 59, 1569-79.
Firth, D. (1993). Bias reduction of maximum likelihood estimates. Biometrika, 80, 27–38.
Foreman, D., Foreman, D., Prendergast, M., & Minty, B. (2001). Is clinic prevalence of ICD-10
hyperkinesis underestimated? Impact of increasing awareness by a questionnaire. European
Child and Adolescent Psychiatry, 10, 130-134.
Gardner, F. E. M. (1994). The quality of joint activity between mothers and their children with
behavior problems. Journal of Child Psychology and Psychiatry, 35, 935-948.
Golding, J., Pembrey, M., Jones, R., & the ALSPAC Study Team. (2001). ALSPAC – the Avon
Longitudinal Study of Parents and Children: I. Study methodology. Paediatric and
Perinatal Epidemiology, 15, 74–87.
Goodman, R., Ford, T., Richards, H., Gatward, R., & Meltzer, H. (2000). The Development and
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
20
Well-Being Assessment: Description and initial validation of an integrated assessment of
child and adolescent psychopathology. Journal of Child Psychology and Psychiatry, 41,
645-655.
Guerin, D. W., Gottfried, A. W., & Thomas, C. W. (1997). Difficult temperament and behaviour
problems: A longitudinal study from 1.5 to 12 years. International Journal of Behavioral
Development, 21, 71–90.
Guralnick, M. J. (2004). Family investments in response to the developmental challenges of
young children with disabilities. In Kalil, A., & Deleire, T. (Eds.), Family investments in
children’s potential: Resources and parenting behaviors that promote success (pp. 119–137).
Mahwah, NJ: Erlbaum.
Halligan, S. L., Murray, L., Martins, C., & Cooper, P. J. (2007). Maternal depression and
psychiatric outcomes in adolescent offspring: a 13-year longitudinal study. Journal of
Affective Disorders, 97, 145-154.
Harvey, E., Danforth, J. S., Eberhad, T., McKee, T., Ulaszek, W. R., & Friedman, J. L. (2003).
Parenting of children with attention deficit/hyperactivity disorder (ADHD): The role of
parental ADHD symptomatology. Journal of Attention Disorders, 7, 31–42.
Humphreys, K. L., Mehta, N., & Lee, S. S. (2010). Association of parental ADHD and depression
with externalizing and internalizing dimensions of child psychopathology. Journal of
Attention Disorders, 2010 Dec 20. [Epub ahead of print].
Jacobvitz, D., & Sroufe, L. A. (1987). The early caregiver-child relationship and attention-deficit
disorder with hyperactivity in kindergarten - A prospective-study. Child Development, 58,
1496-1504.
Johnston, C., & Jassy, J. S. (2007). Attention-deficit/hyperactivity disorder and
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
21
oppositional/conduct problems: links to parent-child interactions. Journal of the Canadian
Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de
psychiatrie de l'enfant et de l'adolescent, 16, 74-79.
Kochanska, G. (1997). Mutually responsive orientation between mothers and their young
children: Implications for early socialization. Child Development, 68, 94–112.
Kubicek, L. F. (1980). Organisation in two mother-infant interactions involving a normal infant
and his fraternal twin brother who was later diagnosed as autistic. In T. Field, S. Goldberg,
D Stein, & A. Sostek (Eds.). High risk infant and children: Adult and peer interactions. New
York: Academic Press.
Lahey, B. B., Van Hulle, C. A., Keenan, K., Rathouz, P. J., D'Onofrio, B. M., Rodgers, J. L., &
Waldman, I. D. (2008). Temperament and parenting during the first year of life predict
future child conduct problems. Journal of Abnormal Child Psychology, 36, 1139-1158.
Landry, S. H., Smith, K. E., & Swank, P. R. (2006). Responsive parenting: Establishing early
foundations for social, communication, and independent problem-solving skills.
Developmental Psychology, 42, 627–642.
Latimer, K., Thompson, L., Kemp, J., Wilson, P., Gillberg, C., & Minnis, H. (in press). Attention
Deficit Hyperactivity Disorder, Conduct Disorder and other Disruptive Behaviour
Disorders: A systematic review of antenatal and early years risk factors. Child: Care,
Health and Development.
Lifford, K. J., Harold, G. T., & Thapar, A. (2008). Parent-child relationships and ADHD
symptoms: A longitudinal analysis. Journal of Abnormal Child Psychology, 36, 285-296.
Marwick, H., & Murray, L. (2008). The effects of maternal depression on the ‘musicality’ of
infant directed speech and conversational engagement. In Malloch, S., & Trevarthen, C.
(Eds.). Communicative Musicality: Narratives of Expressive Gesture and Being Human. (p.
281 -300). Oxford: Oxford University Press.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
22
Marwick, H. (in press). Augmentative Communication. Language Learning Support of Children
with Profound and Multiple Learning Difficulties (PMLD). In Handicap, Education and
Participation – Encyclopaedia of Special Education. Stuttgart: Kohlhammer.
Mash, E. J., & Johnston, C. (1982). A comparison of the mother–child interactions of younger
and older hyperactive and normal children. Child Development, 53, 1371–1381.
McLaughlin, D. P., & Harrison, C. A. (2006). Parenting practices of mothers of children with
ADHD: The role of maternal and child factors. Child and Adolescent Mental Health, 11,
82-88.
Morrell, J., & Murray, L. (2003). Parenting and the development of conduct disorder and
hyperactive symptoms in childhood: a prospective longitudinal study from 2 months to 8
years. Journal of Child Psychology and Psychiatry, 44, 489-508.
Murray, L., Kempton, C., Woolgar, M., & Hooper, R. (1993). Depressed mothers' speech to their
infants and its relation to infant gender and cognitive development. Journal of Child
Psychology and Psychiatry, 34, 1083-1101.
Murray, C., & Johnston, C. (2006). Parenting in mothers with and without attentiondeficit/hyperactivity disorder. Journal of Abnormal Psychology, 115, 52–61.
Murray, L., Marwick, H., & Arteche, A. (2010). Sadness in mothers' 'baby-talk' predicts affective
disorder in adolescent offspring. Infant Behavior and Development, 33, 361-4.
Murray, L., Halligan, S. L., & Cooper, P.J. (2010). Chapter 8. Effects of postnatal depression on
mother-infant interactions, and child development. In: Wachs T, Bremner G, eds.
Handbook of Infant Development. Volume 2, Second Edition. Malden, MA: WileyBlackwell.
Olson, S. L., Bates, J. E., Sandy, J. M., & Lanthier, R. (2000). Early developmental precursors of
externalizing behavior in middle childhood and adolescence. Journal of Abnormal Child
Psychology, 28, 119–133.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
23
Olson, S. L., Bates, J. E., Sandy, J. M., & Schilling, E. M. (2002). Early developmental precursors
of impulsive and inattentive behavior: from infancy to middle childhood. Journal of Child
Psychology and Psychiatry, 43, 435-447.
Ploner, M., Dunkler, D., Southworth, H., Heinze, G. (2010). logistf: Firth's bias reduced logistic
regression.
Reid, R., Hakendorf, P., & Prosser, B. (2002). Use of psychostimulant medication for ADHD in
South Australia. Journal of the American Academy of Child and Adolescent Psychiatry, 41,
906-913.
Reissland, N., Shepherd, J., & Herrera, E. (2003). The pitch of maternal voice: a comparison of
mothers suffering from depressed mood and non-depressed mothers reading books to their
infants. Journal of Child Psychology and Psychiatry, 44, 255-61.
Rothbart, M. K. (1989). Temperament in childhood: A framework. In Kohnstamm, G. A., Bates,
J. E., & Rothbart, M. K., Ed.(s). Temperament in childhood (pp. 59–73). NY:Wiley.
Saint-Georges, C., Mahdhaoui, A., Chetouani, M., Cassel, R. S., Laznik, M. C., Apicella, F.,
Muratori, P., Maestro, S., Muratori, F., & Cohen, D. (2011). Do parents recognize autistic
deviant behavior long before diagnosis? Taking into account interaction using
computational methods. PLoS One, 6, e22393. Epub 2011 Jul 27.
Sayal, K., Goodman, R., & Ford, T. (2006). Barriers to the identification of children with
attention deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 47,
744-750.
Semple, D. L., Mash, E. J., Ninowski, J. E., & Benzies, K. M. (2011). The relation between
maternal symptoms of attention-deficit/hyperactivity disorder and mother-infant interaction.
Journal of Child and Family Studies, 20, 460-472.
Shaw, D. S., Owens, E. B., Vondra, J. I., & Keenan, K. (1996). Early risk factors and pathways in
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
24
the development of early disruptive behavior problems. Development and Psychopathology,
8, 679-699.
Shaw, D. S., Bell, R. Q., & Gilliom, M. (2000). A truly early starter model of antisocial behavior
revisited. Clinical Child and Family Psychology Review, 3, 155–172.
Thompson, L., Kemp, J., Wilson, P., Pritchett, R., Minnis, H., Toms-Whittle, L., Puckering, C.,
Law, J., Gillberg, C. (2010). What have birth cohort studies asked about genetic, pre- and
peri-natal exposures and child and adolescent onset mental health outcomes? A systematic
review. European Child and Adolescent Psychiatry, 19, 1-15.
Thorpe, K., Rutter, M., & Greenwood, R. (2003). Twins as a natural experiment to study the
causes of mild language delay: II: Family interaction risk factors. Journal of Child
Psychology and Psychiatry, 44, 342-355.
Trevarthen, C., & Marwick, H. (1982). Cooperative Understanding in Infancy. Project report to
the Spencer Foundation, Chicago. University of Edinburgh.
Trevarthen, C., & Marwick, H. (1986). Signs of motivation for speech in infants, and the nature of
a mother's support for the development of language. In Lindblom, B., & Zetterstrom, R.
(eds.). Precursors of Early Speech. p. 279-308. New York: Stockholm Press.
Trevarthen, C. (2001). Intrinsic motives for companionship in understanding: Their origin,
development, and significance for infant mental health. Infant Mental Health Journal, 22,
95-131.
Trevarthen, C., & Aitken, K. J. (2001). Infant intersubjectivity: Research, theory, and clinical
applications. Journal of Child Psychology and Psychiatry, 42, 3-48.
van den Boom, D. C. (1995). Do first-year intervention effects endure? Follow-up during
toddlerhood of a sample of Dutch irritable infants. Child Development, 66, 1798–1816.
Wakschlag, L. S., & Hans, S. L. (1999). Relation of maternal responsiveness during infancy to the
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
25
development of behavior problems in high-risk youths. Developmental Psychology,35, 569579.
Webb, S. J., & Jones, J. H. (2009). Early identification of autism: early characteristics, onset of
symptoms, and diagnostic stability. Infant Young Child, 22, 100-118.
Weiss, G., & Hechtman, L. T. (1993). Hyperactive boys grown up: ADHD in children
adolescents, and adults. New York: Guildford Press.
Wilson, P., Puckering, C., McConnachie, A., Marwick, H., Reissland, N., & Gillberg, C. (2011).
Inexpensive video cameras used by parents to record social communication in
epidemiological investigations in early childhood—A feasibility study. Infant Behaviour
and Development, 34, 63 – 71.
Zahn-Waxler, C., Iannotti, R.J., Cummings, M. E., & Denham, S. (1990). Antecedents of
problems behaviors in children of depressed mothers. Development and Psychopathology,
2, 271–291.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
26
Appendix A
Holistic Measure (Coded Manually)
All categories rated for adult and infant separately on a 5 point scale of extent of occurrence.
1. Overall well-being
Definition: a judgment on the overall positive emotional state of the infant and adult throughout
the segment (is each happy and relaxed?). Rated on a 5 point scale.
2. Overall contingent responsiveness
Definition: a judgment of the overall contingent responsiveness of infant and adult to each other
throughout the segment (are they responsive to each other’s expressiveness and communication?).
Rated on a 5 point scale.
3. Overall co-operativeness
Definition: a judgment on the overall co-operativeness of infant and adult in relation to each other
throughout the segment (do they comply with each other’s wishes and coordinate their actions?).
Rated on a 5 point scale.
4. Overall involvement
Definition: a judgment of the overall involvement of infant and adult in the task or focus of
activity throughout the segment (is each engaged in the activity?).
5. Overall Activity Levels
Rated on a 5 point scale.
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
27
Definition: a judgment on the overall activity levels of infant and adult throughout the segment (is
there energy and movement?). Rated on a 5 point scale.
6. Overall playfulness
Definition: a judgment on the overall playfulness of infant and adult throughout the segment (is
there fun, games, smiling and laughter?). Rated on a 5 point scale.
7. Overall fussiness
Definition: a judgment on the overall fussiness of infant and adult throughout the segment (is
there restlessness, negativity and lack of compliance with each other’s wishes?). Rated on a 5
point scale.
8. Overall Speech
Definition: a judgment on the overall speech or vocalisation levels of infant and adult throughout
the segment (is there vocal expressiveness?). Rated on a 5 point scale.
Appendix B
Table B.1. Number and percentage of case and control videos by score for holistic adult and infant interaction variables.
Control
Case
Scores
1
2
3
4
5
1
2
3
4
5
Wellbeing adult
0
0
2(2%)
19(16%)
98(82%)
0
0
2(3%)
15(25%)
42(70%)
Wellbeing infant
0
1(1%)
10(8%)
31(26%)
77(64%)
0
0
5(8%)
19(32%)
35(58%)
Contingency adult
0
0
8(7%)
38(32%)
73(61%)
0
0
9(15%)
20(33%)
30(50%)
Contingency infant
0
8(7%)
33(28%)
46(38%)
32(27%)
0
7(12%)
13(22%)
28(47%)
11(18%)
Cooperativeness adult
0
2(2%)
2(2%)
33(28%)
82(68%)
0
5(8%)
15(25%)
39(65%)
5(8%)
Cooperativeness infant
0
1(1%)
11(9%)
35(29%)
72(60%)
0
0
6(10%)
21(35%)
32(53%)
Involvement adult
0
0
0
6(5%)
113(94%)
0
0
1(2%)
4(7%)
54(90%)
Involvement infant
1(1%)
8(7%)
36(30%)
54(45%)
20(17%)
0
7(12%)
21(35%)
21(35%)
10(17%)
Activity adult
0
3(2%)
20(17%)
88(73%)
8(7%)
1(2%)
2(3%)
19(32%)
33(55%)
4(7%)
Activity infant
2(2%)
2(2%)
23(19%)
82(68%)
10(8%)
0
0
12(20%)
42(70%)
5(8%)
Playfulness adult
75(62%)
36(30%)
7(6%)
1(1%)
0
39(65%)
17(28%)
3(5%)
0
0
Playfulness adult
83(69%)
30(25%)
5(4%)
1(1%)
0
42(70%)
14(23%)
3(5%)
0
0
Fussiness adult
117(98%)
2(2%)
0
0
0
58(97%)
1(2%)
0
0
0
Fussiness infant
96(80%)
16(13%)
7(6%)
0
0
44(73%)
13(22%)
2(3%)
0
0
Speech adult
0
8(7%)
24(20%)
83(69%)
4(3%)
1(2%)
8(13%)
20(33%)
27(45%)
3(5%)
Speech infant
13(11%)
54(45%)
39(32%)
12(10%)
1(1%)
6(10%)
28(47%)
21(35%)
4(7%)
0
Table B.2a. Proportion agreement levels, inter-rater reliabilities and rank correlations
of the 16 holistic variables.
% agreement
Inter-rater
Inter-rater
weighted Kappa rank correlation
Involvement Infant Score
0.60
0.73
Wellbeing Infant Score
0.80
0.66
Contingency Infant Score
0.40
0.59
Fussiness Infant Score
0.80
0.40
Speech Infant Score
0.50
0.49
Cooperativeness Adult Score
0.67
0.49
Speech Adult Score
0.80
0.59
Playfulness Adult Score
0.67
0.44
Cooperativeness Infant Score
0.57
0.32
Playfulness Infant Score
0.83
0.24
Activity Adult Score
0.83
0.18
Activity Infant Score
0.70
0.19
Contingency Adult Score
0.57
0.12
Wellbeing Adult Score
0.73
0.04
Involvement Adult Score
0.93
-0.04
Fussiness Adult score*
0.97
0.00
*n/a for fussiness adult score as all values=1 for one of the raters.
0.75
0.73
0.58
0.55
0.55
0.51
0.43
0.42
0.38
0.37
0.31
0.21
0.07
0.04
-0.04
n/a
Table B.2b. Inter-rater reliabilities and rank correlations of the 4 holistic factor
analysis latent variables.
Factor 1
Factor 2
Factor 3
Factor 4
Inter-rater
weighted Kappa
Inter-rater
rank correlation
0.53
0.66
0.61
0.47
0.64
0.62
0.46
0.40
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
30
Figure B.1. Scree plot of eigenvalues from 14 holistic variables (adult involvement
and fussiness removed). The shaded area shows a 95% confidence band for
eigenvalues from 100 simulated random (uncorrelated) data sets, with the number
(dimension) of non-trivial factors indicated by the number of eigenvalues exceeding
the random eigenvalues
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
31
Table 1.
Table 1. Mean (SD), for Holistic Adult and Infant interaction scores, overall and by
case-control status.
Total
Group
Control
Case
Wellbeing Adult Score
4.76 (0.48)
4.81 (0.44)
4.68 (0.54)
Wellbeing Infant Score
4.53 (0.67)
4.55 (0.69)
4.51 (0.65)
Contingency Adult Score
4.48 (0.67)
4.55 (0.62)
4.36 (0.74)
Contingency Infant Score
3.81 (0.90)
3.86 (0.90)
3.73 (0.91)
Cooperativeness Adult Score
4.62 (0.62)
4.64 (0.61)
4.58 (0.65)
Cooperativeness Infant Score
4.48 (0.69)
4.50 (0.70)
4.44 (0.68)
Involvement Adult Score
4.93 (0.27)
4.95 (0.22)
4.90 (0.36)
Involvement Infant Score
3.66 (0.88)
3.71 (0.86)
3.58 (0.91)
Activity Adult Score
3.78 (0.63)
3.85 (0.56)
3.63 (0.74)
Activity Infant Score
3.83 (0.63)
3.81 (0.68)
3.88 (0.53)
Playfulness Adult Score
1.43 (0.63)
1.45 (0.65)
1.39 (0.59)
Playfulness Infant Score
1.35 (0.60)
1.36 (0.61)
1.34 (0.58)
Fussiness Adult Score
1.02 (0.13)
1.02 (0.13)
1.02 (0.13)
Fussiness Infant Score
1.26 (0.55)
1.25 (0.56)
1.29 (0.53)
Speech Adult Score
3.60 (0.73)
3.70 (0.65)
3.39 (0.85)
Speech Infant Score
2.43 (0.82)
2.45 (0.85)
2.39 (0.77)
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
32
Table 2.
Table 2. Factor analysis of the 14 holistic variables, assuming 4 latent factors.
Loadings exceeding ± 0.5 are shown in bold.
Item
Factor 1
Factor 2
Factor 3
Factor 4
Cooperativeness Infant
Cooperativeness Adult
Contingency Infant
0.91
0.58
0.54
0.04
-0.03
0.05
0.04
0.12
0.17
0.01
0.09
0.05
Speech Adult
Activity Adult
0.01
-0.02
0.90
0.88
0.08
0.03
0.07
0.10
Wellbeing Infant
Fussiness Infant
Wellbeing Adult
0.53
-0.46
0.44
0.01
-0.01
0.14
0.73
-0.62
0.52
0.10
0.01
0.05
Playfulness Infant
Playfulness Adult
0.13
0.05
0.05
0.23
0.11
0.14
0.98
0.75
Involvement Infant
Contingency Adult
Speech Infant
Activity Infant
0.44
0.21
0.01
-0.11
0.08
0.46
0.12
0.27
0.41
0.16
0.35
0.32
0.07
0.15
0.21
0.10
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
33
Table 3.
Table 3. Number of available cases overall and number and percentage within each
sub-diagnostic group, overall and by gender.
Total
Gender
Female
Male
Nobs
178
56
122
Ncases
59
18
41
16 (27%)
2 (11%)
14 (34%)
Inattentive ADHD
5 (8%)
2 (11%)
3 (7%)
Pervasive development disorder
6 (10%)
1 (5%)
5 (12%)
Any emotional disorder
27(45%)
12 (63%)
15 (37%)
Any anxiety disorder
25 (42%)
12 (63%)
13 (32%)
5 (8%)
2 (11%)
3 (7%)
Disruptive behaviour disorders (DBD)
35 (60%)
8 (45%)
27 (66%)
Any oppositional-conduct disorder
26 (44%)
6(33%)
20 (49%)
5 (8%)
1(5%)
4 (10%)
Oppositional defiant and/or DBD NOS
21 (37%)
5 (28%)
16 (39%)
Pure oppositional conduct disorder
19 (33%)
6 (33%)
13 (32%)
N (%) of cases
Any ADHD
Any depressive disorder
Conduct disorder alone
Running head: EARLY PREDICTORS OF CHILDHOOD PSYCHOPATHOLOGY
34
Table 4.
Table 4. Mean (SD) of predictors 'Factor 1' and 'Factor 2', within controls, cases
overall and case sub-diagnostic groups. OR estimates for caseness associated with a 1
SD increase in predictors, 95% confidence intervals and p-values, adjusted for the sex
of the infant and pre- and post-natal maternal depression and anxiety.
Factor 1
N
Mean (SD)
Factor 2
OR (95% CI)
Mean
per SD; p-value (SD)
OR (95% CI) per
SD; p-value
Control
120 13.0 (1.8)
-
7.5 (1.1) -
Case
59
12.7 (1.8)
0.84 (0.61,
1.17); p=0.310
7.0 (1.5)
Any ADHD
disorder
16
12.8 (1.8)
0.88 (0.52,
1.57);
p=0.657
0.42 (0.23, 0.70);
6.6 (1.9) p=0.001
12.0 (1.9)
0.68 (0.34,
1.43);
p=0.281
0.19 (0.04, 0.56);
5.4 (2.2) p=0.001
0.56 (0.24, 1.43);
7.2 (1.0) p=0.212
Inattentive ADHD 5
0.57 (0.40, 0.80);
p=0.001
Pervasive
development
disorder
6
13.3 (1.8)
1.23 (0.54,
3.58);
p=0.659
Any emotional
disorder
27
13.3 (1.7)
1.15 (0.70,
1.98);
p=0.588
6.9 (1.8)
0.51 (0.31, 0.80);
p=0.003
Any anxiety
disorder
25
13.3 (1.7)
1.13 (0.67,
1.97);
p=0.654
6.8 (1.8)
0.47 (0.28, 0.75);
p=0.001
12.4 (1.9)
0.75 (0.52,
1.09);
p=0.132
6.9 (1.6)
0.53 (0.34, 0.79);
p=0.001
Any oppositional26
conduct disorder
12.4 (1.8)
0.76 (0.50,
1.17);
p=0.208
7.0 (1.3)
0.50 (0.31, 0.80);
p=0.004
Conduct disorder
5
alone
12.2 (1.6)
0.70 (0.32,
1.56);
p=0.361
6.6 (1.3)
0.37 (0.12, 0.98);
p=0.045
Oppositional
defiant and/or
DBD Nos
21
12.5 (1.9)
0.80 (0.50,
1.30);
p=0.359
7.0 (1.4)
0.53 (0.31, 0.89);
p=0.016
Pure oppositional
19
conduct disorder
12.1 (1.9)
0.66 (0.42,
1.05);
p=0.076
7.2 (1.3)
0.63 (0.37, 1.09);
p=0.094
Disruptive
behaviour
disorders
35