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      Structure of Psychopathology in Romanian Preschool-Aged Children in an Epidemiological and a High-Risk Sample

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          Abstract

          Objective:

          Research on bifactor models of psychopathology in early childhood is limited to community samples with little longitudinal follow-up. We examined general and specific forms of psychopathology within 2 independent samples of preschool-aged Romanian children. Within a sample with children exposed to psychosocial deprivation, we also examined antecedents and longitudinal outcomes of the general factor.

          Method:

          One sample consisted of 350 Romanian children (mean age = 39.7 months, SD = 10.9) from an epidemiological study; the second sample consisted of 170 Romanian children (mean age = 55.6 months, SD = 1.9) exposed to severe early-life deprivation, as well as community comparison children, with longitudinal follow-up at 8 and 12 years. Psychopathology symptoms were assessed through caregiver-reported structured clinical interviews.

          Results:

          An SI-1 bifactor model of psychopathology was supported in both samples and included specific factors for externalizing, internalizing, and disturbed relatedness symptoms. In the second sample, longer duration of psychosocial deprivation and lower-quality caregiving were associated with higher scores on the general and all specific factors. Higher scores on the general factor were associated with later cognitive function, competence, and psychopathology symptoms. Considering all factors together, only the general factor explained variance in later childhood outcomes and was slightly stronger compared to a total symptom count for some, but not all, outcomes.

          Conclusion:

          General psychopathology in early childhood explains meaningful variance in child outcomes across multiple domains of functioning in later childhood. However, important questions remain regarding its clinical utility and usefulness, given complex measurement and limited explanatory power beyond the more accessible approach of a total symptom count.

          Clinical trial registration information:

          The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.

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          Most cited references48

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          New Effect Size Rules of Thumb

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            The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies.

            The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures. (PsycINFO Database Record
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              The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders?

              Mental disorders traditionally have been viewed as distinct, episodic, and categorical conditions. This view has been challenged by evidence that many disorders are sequentially comorbid, recurrent/chronic, and exist on a continuum. Using the Dunedin Multidisciplinary Health and Development Study, we examined the structure of psychopathology, taking into account dimensionality, persistence, co-occurrence, and sequential comorbidity of mental disorders across 20 years, from adolescence to midlife. Psychiatric disorders were initially explained by three higher-order factors (Internalizing, Externalizing, and Thought Disorder) but explained even better with one General Psychopathology dimension. We have called this dimension the p factor because it conceptually parallels a familiar dimension in psychological science: the g factor of general intelligence. Higher p scores are associated with more life impairment, greater familiality, worse developmental histories, and more compromised early-life brain function. The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders. Transdiagnostic approaches may improve research.
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                Author and article information

                Journal
                9918627288306676
                52631
                JAACAP Open
                JAACAP Open
                JAACAP open
                2949-7329
                10 March 2024
                November 2023
                19 July 2023
                18 March 2024
                : 1
                : 3
                : 173-183
                Affiliations
                Dr. Guyon-Harris is with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Drs. Plamondon and Wade are with the University of Toronto, Toronto, Ontario, Canada. Dr. Plamondon is also with Université Laval, Quebec, Canada. Drs. Humphreys, Gleason, and Zeanah are with Tulane University School of Medicine, New Orleans, Louisiana. Dr. Humphreys is also with Vanderbilt University, Nashville, Tennessee. Dr. Gleason is also with Eastern Virginia Medical School, Norfolk, Virginia. Dr. Tibu is with Stefan cel Mare University of Suceava, Suceava, Romania. Dr. Nelson is with Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts, and Harvard Graduate School of Education, Boston, Massachusetts. Dr. Fox is with the University of Maryland, College Park, College Park, Maryland.
                Author notes

                Dr. Plamondon served as the statistical expert for this research.

                Author Contributions

                Conceptualization: Guyon-Harris, Humphreys, Gleason

                Data curation: Guyon-Harris, Tibu

                Formal analysis: Guyon-Harris, Plamondon

                Funding acquisition: Gleason, Nelson, Fox, Zeanah

                Methodology: Wade

                Project administration: Gleason, Tibu

                Supervision: Humphreys, Zeanah

                Writingoriginal draft: Guyon-Harris

                Writingreview and editing: Guyon-Harris, Plamondon, Humphreys, Wade, Gleason, Tibu, Nelson, Fox, Zeanah

                Correspondence to Katherine Guyon-Harris, PhD, University of Pittsburgh school of Medicine, Department Pediatrics, 3414 5 th Ave., CHOB 3 rd floor, Pittsburgh, PA 15213; guyonharriskl@ 123456upmc.edu
                Author information
                http://orcid.org/0000-0001-5990-6892
                http://orcid.org/0000-0002-1169-2669
                http://orcid.org/0000-0002-5715-6597
                http://orcid.org/0000-0001-6843-9579
                http://orcid.org/0000-0003-0873-1097
                http://orcid.org/0000-0002-4723-247X
                http://orcid.org/0000-0002-7004-6819
                Article
                NIHMS1973388
                10.1016/j.jaacop.2023.06.004
                10947222
                38500494
                6e1831e3-ed8e-47c2-807e-8ad2373c9410

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                Categories
                Article

                general psychopathology,preschool,bifactor modeling,psychosocial deprivation

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