Cross-Domain Symptom Development Typologies and Their Antecedents: Results From the UK Millennium Cohort Study
Journal of the American Academy of Child and Adolescent Psychiatry
Objective. Typologies of symptom development have been used to identify individuals with different symptom development in the externalising and internalising domains of child psychopathology separately -albeit the domains' high comorbidity and shared common aetiological risk. This study identifies typologies of development across both symptom domains in childhood, investigates their associated antecedents with a specific focus on the comparisons between overall severity of symptoms, and symptom
... mptoms, and symptom expression in one or the other domain. Method. Latent class analysis identified groups based on emotional and behavioural symptoms assessed at ages 3,5,7, and 11 in the UK Millennium Cohort Study (N=15,439). A range of socio-demographic, family structure and environment, birth, infancy, and early childhood antecedents are examined. Results. Five groups were identified: 1. low symptoms (57%), 2. moderate behavioural (21%), 3. moderate emotional (12.5%), 4. high emotional-moderate behavioural (5.5%), and 5. high behavioural-moderate emotional (4%). Higher symptoms are predicted by greater numbers of antecedents and risk factors, both when compared to the low symptom group and when comparing groups with moderate and high levels of symptoms in either domain (groups 5v2 and 4v3). Comparisons of groups with similar overall symptom levels but different dominant symptom domain (groups 2v3 and 4v5) indicate that apart from gender and ethnicity, there are few unique antecedents of whether children mainly internalise or externalise their symptoms. Conclusion. It is possible and useful to define groupings or typologies jointly across both externalising and internalising symptom development in childhood. Although numerous antecedents predict the experience of symptoms, there are few unique antecedents that differentiate between individuals with similarly high levels of overall symptoms expressed in M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 2 internalising or externalising domains. Identification of at-risk children and delivery of early intervention might benefit from a reduced focus on symptom domain with possible downstream effects through the lifecourse for most common psychiatric disorders.