Developing Empirical Latent Profiles of Impulsive Aggression and Mood in Youths across Three Outpatient Samples

ABSTRACT

Objective

Aggression with impulsivity and reactivity (AIR) may distinguish a subset of youth from those with attention problems, rule-breaking behavior, or mood disorders, potentially with differential treatment response. Yet, DSM-5 and ICD-10 do not include an AIR diagnosis. Thus, we empirically grouped youths into profiles based on AIR, manic, depressive, rule-breaking, and self-harm behaviors; examined which profiles replicated across three samples; and characterized profile sets on demographic and clinical features.

Method

After harmonizing data from three samples (n = 679, n = 392, n = 634), Latent Profile Analysis (LPA) assigned youth to profiles based on caregiver-reported measures of AIR, manic, depressive, rule-breaking, and self-harm behaviors. Profiles from each sample were grouped into sets based on profile similarity. Analyses tested differences in diagnoses, sex, and race, age, functioning, and mood severity.

Results

Eight-profile solutions fit best. Seven profiles replicated across samples: high AIR and self-harm, lower depressive and manic scores; high AIR, manic symptoms, and self-harm; high depression symptoms; three smaller sets with high manic and depressive symptoms and moderate AIR; and two high rates of bipolar diagnoses and family bipolar history. Two sets were high on both AIR and mood symptoms, were the most impaired, and had the highest comorbidity.

Conclusions

Analyses support an empirical definition of AIR, separate from mood disorders. Profile sets distinguished by level of AIR and mood symptoms differed in demographic and diagnostic characteristics as well as functioning. Importantly, a set emerged with high AIR but low mood indicators and with high rates of ADHD and ODD, but not mood disorder.

Disclosure statement

Dr. Youngstrom has received royalties from the American Psychological Association and Guilford Press, and consulted about psychological assessment with Pearson, Lundbeck, Janssen, Joe Startup Technologies, and Western Psychological Services. He is the founder and Executive Director of Helping Give Away Psychological Science (HGAPS.org).

Dr. Young has received research support from the Brain and Behavior Research Foundation, Supernus Pharmaceuticals, and Psychnostics, LLC. She has served as a consultant to NIH, PCORI, and the University of Montana's American Indian/Alaska Native Clinical & Translational Research Program.

Dr. Van Eck has received research support from the CDC, HRSA, NIH, and Supernus Pharmaceuticals.

Dr. Stepanova has received research support from the NIMH, Supernus Pharmaceuticals, and Psychnostics, LLC.

Mr. Langfus has no COI to disclose.

Dr. Carlson has funding from NIMH and PCORI, and her spouse is on DSMBs for Lundbeck and Pfizer.

Dr. Findling receives or has received research support, acted as a consultant and/or has received honoraria from Acadia, Adamas, Aevi, Akili, Alcobra, Alkermes, Allergan, Amerex, American Academy of Child & Adolescent Psychiatry, American Psychiatric Press, Arbor, Axsome, Daiichi-Sankyo, Genentech, KemPharm, Luminopia, Lundbeck, MedAvante-ProPhase ,Merck, NIH, Neurim, Noven, Nuvelution, Otsuka, PCORI, PaxMedica,Pfizer, Physicians Postgraduate Press, Q BioMed, Receptor Life Sciences, Roche, Sage, Signant Health, Sunovion, Supernus Pharmaceuticals, Syneos, Syneurx, Takeda, Teva, Tris, TouchPoint, and Validus.

Additional information

Funding

This work was supported by the National Institute of Mental Health [R01MH066647, R01MH073801, R01MH073816, R01MH073967, R01MH73953]; Stanley Medical Research Institute [2000-27].