34.2 DEVELOPING AN EMPIRICAL DEFINITION OF IMPULSIVE AGGRESSION AND MOOD LATENT PROFILES IN CHILDREN AND ADOLESCENTS WITH EXTERNAL VALIDATION ACROSS THREE OUTPATIENT SAMPLES

Abstract

Aggression that is impulsive and reactive (AIR) may distinguish a subset of youth from those with attention problems, oppositional behavior, or a mood disorder. However, DSM-5 and ICD-10 do not include a diagnosis that adequately captures impulsive aggression (IA). Our objective was to empirically group youths into profiles based on their IA, manic, depressive, rule-breaking, and self-harm behaviors, and to characterize sets defined by symptom profiles on demographic and clinical features. Principal component analysis (PCA) created dimensional scores of AIR, manic, depressive, rule-breaking, and self-harm behaviors in 3 samples (n = 679; n = 392; n = 634). Latent profile analysis (LPA) classified youth using PCA scores. χ2 and regressions tested set differences in diagnoses, sex, race, age, functioning, and mood severity. PCA identified an AIR dimension distinct from manic, depressive, rule-breaking, hyperactive, or self-injurious behaviors. PCA scores were only modestly correlated and showed significantly different associations with diagnoses, family history, and other criteria. Seven profiles replicated across all 3 samples: 1) high AIR and self-harm, lower depressive and manic scores; 2) high AIR, manic symptoms, and self-harm; 3) high depression; 4, 5, 6) smaller sets with elevations on both manic and depressive symptoms and moderate AIR; and 6, 7) high rates of bipolar diagnoses. Sets differed (p < 0.0005) for diagnostic and functioning criteria and age, with large effect sizes; 2 sets (5, 6) that were high on both AIR and mood symptoms had the most impairment and comorbidity. Results suggest that AIR is distinct from mood symptoms. Profiles defined by AIR and mood symptom levels differed in demographics, diagnoses, and functioning. A profile with high AIR yet low mood indicators showed high rates of ADHD and ODD, but not mood disorder. AIR is both transdiagnostic, with some clinical profiles showing it as an “associated feature,” yet it was also a defining feature for some symptom profiles.