Behavioral dysregulation in infancy predicts later child mental health

1. Infants classified as having moderately or severely unsettled behavioral regulation at 12 months of age had greater odds of having a positive behavioral screen for mental disorder at 11 years compared to settled infants.

2. Odds of reporting clinically significant mental health concerns appeared to increase over time for infants with moderately or severely unsettled behavioral regulation.

Evidence Rating Level: 2 (Good)

Study Rundown: In this prospective cohort study, researchers recruited mothers of infants in Australia to complete questionnaires about child demographic, health, and behavioral characteristics at 12 months, and followed with further questionnaires as well as a behavioral survey screening for mental disorder at 5 and 11 years. Infants were classified by behavioral regulation profile at 12 months of age based on degree of sleep, crying, temper tantrums, temperament, and feeding problems, and profiles were compared on rates mental health concerns later in childhood. Infants classified as having severely or severely unsettled behavioral regulation at 12 months of age had greater odds of having a positive behavioral screen for mental disorder at 11 years compared to settled infants; severely unsettled infants also had greater odds of screening positive at 5 years. Odds of reporting clinically significant mental health concerns appeared to increase over time for infants with moderately or severely unsettled behavioral regulation.

These findings are limited by questionnaire data that are only suggestive, not diagnostic for mental disorders. Only mothers, not children themselves, gave responses in this study. Nonetheless, the study is strengthened by its large sample and longitudinal, prospective design. For physicians, these findings highlight the importance of identifying infants with behavioral dysregulation early and enacting targeted interventions and referring to support services given their increased risk of later mental health concerns.

Click to read the study, published today in Pediatrics

Relevant reading: Long-term Outcomes of Infant Behavioral Dysregulation

In-Depth [prospective cohort]: Researchers collected questionnaire data on child demographic, health, and behavioral factors from 1759 mothers attending 8-month well-child appointments at child ages 8 to 10 months in 2003 and 2004, and follow-up questionnaire data at 12 months, 5 years, and 11 years. The parent-report Strengths and Difficulties Questionnaire (SDQ) was used to measure child behavioral characteristics at 5 and 11 years. Researchers used latent class analysis and linear and logistic regression models to relate infant behavioral regulation at 12 months of age to social, emotional, and behavioral outcomes at 5 and 11 years.

At 12 months of age, children were classified by infant regulation profile as settled (36.8%), isolated temper tantrums (21.3%), sleep problems (25.4%), moderately unsettled (13.2%), and severely unsettled (3.4%) based on degree of sleep, crying, temper tantrums, temperament, and feeding problems. Moderately unsettled children at 12 months were significantly more likely to score in the SDQ clinical range for total difficulties (odds ratio [OR] 2.85; 95% confidence interval [CI]: 1.28 to 6.36) at 11 years of age, and severely unsettled children had higher odds of scoring in the SDQ clinical range at 5 years of age (OR 9.35; 95%CI: 2.49 to 35.11) and 11 years of age (OR 10.37; 95%CI: 3.74 to 28.70).

Image: PD

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