Abstract: Factor Structure of Dysregulation Syndrome in Toddlers with Prenatal Cocaine/Polydrug Exposure (Society for Social Work and Research 23rd Annual Conference - Ending Gender Based, Family and Community Violence)

399P Factor Structure of Dysregulation Syndrome in Toddlers with Prenatal Cocaine/Polydrug Exposure

Friday, January 18, 2019
Continental Parlors 1-3, Ballroom Level (Hilton San Francisco)
* noted as presenting author
June-Yung Kim, MA, Research Fellow, Case Western Reserve University, Cleveland, OH
Sonia Minnes, PhD, Associate Professor, Case Western Reserve University, Cleveland, OH
Lynn Singer, PhD, Professor, Case Western Reserve University, OH
Background and Purpose: Toddlers with co-occurring problems in regulating affect and behavior, i.e., dysregulation syndrome (DS), can be identified with the Anxious/Depressed, Withdrawn, Aggressive, and Destructive Behavior scales of the Child Behavior Checklist for ages 2 and 3(CBCL/2-3). Growing evidence suggests that DS is a developmental marker for risk behaviors. However, there is no consensus conceptualization and operationalization of DS in high-risk toddlers. Thus, we identified the factor structure of DS in toddlers with prenatal cocaine/polydrug exposure and validate the factor structure by associating it with school-age behavioral outcomes.   

Methods: Participants were 336 toddlers(50% girls), primarily African-American, of low socioeconomic status, participating in a prospective longitudinal study of prenatal cocaine/polydrug exposure since birth. Children’s affective and behavioral regulation at age 2 were assessed by caregivers using the CBCL/2-3. We used items from 4 syndrome scales that compose the Internalizing(Anxious/Depressed; Withdrawn) and Externalizing(Aggressive; Destructive Behaviors) broadband scales. Items, assessing symptoms in the last 2 month, were rated on a 3-point scale. Higher scores indicate greater symptoms. Raw scores were used for analyses. 

To identify a factor structure of DS, confirmatory factor analyses(CFA) were conducted in Mplus 8 using weighted least squares estimator with mean and variance adjustments(WLSMV) estimator due to the polytomous nature of the data. Three competing models were examined, with chi-square difference tests to compare the nested models: bifactor model where items loaded on a general DS and specific syndrome factors; four-syndrome-factor oblique model; and unidimensional model. To examine the construct validity of the factor structure, the following external criteria were entered into the model and regression paths were computed: 7 DSM-IV diagnostic categories from the Dominic Interactive(DI) self-reported at age 6; early substance use(≤12yrs) from the Assessment of Liability and Exposure to Substance Use and Antisocial Behavior Scale(ALEXSA); and sexual intercourse(<15yrs) from Youth Self Report.

Results: The bifactor model best fits the data, Chi-square=4040.335(406), p<.001; CFI=0.90; RMSEA=0.056(90%CI=0.005-0.062); WRMR=1.243. All standardized factor loadings for DS were statistically significant and substantial(≥.30). Factor loadings on DS were generally stronger than scale-specific loadings. Scale-specific factor loadings on Anxious/Depressed(6-items), Withdrawn(7-items), and Destructive Behavior(7-items) were all significant. Scale-specific factor loadings were relatively low for Aggressive Behavior, and 4 of 9 were not significant. Anxious/Depressed increased the odds of sexual intercourse before 15yrs(OR=1.44, p<.001). Withdrawn decreased the odds of attention deficit hyperactivity(OR=0.74, p<.04) and separation anxiety(OR=0.78, p<.02) disorders. Aggressive Behavior increased the odds of alcohol use by 12yrs(OR=1.36, p<.04). Destructive Behavior marginally increased the odds of oppositional defiant disorder(OR=1.27, p<.06). The DS factor increased the odds of tobacco use by 12yrs(OR=1.33, p<.04).

Conclusions and Implications: In toddlers with prenatal cocaine/polydrug exposure, optimal model fit was found for a bifactor model with a broad DS and specific syndrome factors, which evidenced distinctive patterns of external correlates. These findings support the conceptualization of DS in high-risk toddlers as a broad syndrome of dysregulation that exists in addition to specific anxious/depressed, withdrawn, aggressive, and destructive behavior syndromes. Future research should further establish whether DP in toddlerhood can be deemed as a reliable developmental risk marker by incorporating various proximal and distal outcomes.