Abstract
BackgroundThe terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective (anger) and a behavioral component (aggression). Due to early onset, high prevalence and persistence, as well as developmental comorbidity, AD in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions. AD is especially prevalent in children in the youth welfare service. Despite continuous research, there remains a substantial need for diagnostic approaches and optimization of individualized treatment strategies in order to improve outcomes and reduce the subjective and economic burden.MethodsThe ADOPT (Affective Dysregulation – Optimizing Prevention and Treatment) Consortium integrates internationally established, highly experienced and interdisciplinary research groups. The work program encompasses (a) epidemiology, including prevalence of symptoms and disorders, (b) development and evaluation of screening and assessment tools, (c) stepped care approaches for clinically useful personalized medicine, (d) evaluation of an easily accessible and cost-effective online intervention as indicated prevention (treatment effects, moderation/mediation analysis), and (e) evaluation of an intensive personalized modular outpatient treatment in a cohort of children with AD who live with their parents and in a cohort of children with AD who live in out-of-home care (treatment effects, moderation/mediation analysis).DiscussionThe results will lead to significant recommendations for improving treatment within routine clinical care in two cohorts of children with AD and coexisting conditions, especially oppositional-defiant disorder, conduct disorder and disruptive mood dysregulation disorder.Trial registrationTrial registration ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963. Registered 27 June 2018.Trial registration ADOPT Treatment: German Clinical Trials Register (DRKS) DRKS00013317. Registered 27 September 2018.Trial registration ADOPT Institution: German Clinical Trials Register (DRKS) DRKS00014581. Registered 04 July 2018.
Highlights
The terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective and a behavioral component
AD or irritability is a criterion for many diagnoses in children in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [3] and the 10th revision of the International Classification of Diseases (ICD-10) [4], including mood and anxiety disorders, attention-deficit/hyperactivity disorders (ADHD), conduct disorders (CD), and oppositional defiant disorders (ODD)
Children will be selected for inclusion via a screening instrument (Diagnostic Tool for Affective Dysregulation in Children – Screening Questionnaire; Diagnostikum für Affektive Dysregulation bei Kindern (DADYS)-Screen) [Görtz-Dorten et al, 2018, unpublished manuscript; Otto et al, 2018, unpublished manuscript] which will be developed by ADOPT Epidemiology
Summary
Predictors/moderators of treatment outcome on AD symptoms and impairment As predictors/moderators of treatment outcome on AD symptoms and impairment, the following variables will be analyzed: (1) gender, (2) age of patients and parents/ foster parents, (3) recruitment process (community cohort vs outpatient sample; in ADOPT Online/ADOPT Treatment); (4) chronicity of AD symptoms, (5) severity of AD symptoms, (6) severity of comorbid symptoms, (7) AD symptoms and other psychopathology of the participating parent/foster parent, (8) positive and negative parenting practices, (9) receipt of social welfare assistance by the family, (10) socioeconomic status of the family/foster family, (11) early childhood neglect of the patient, (12) adverse childhood experiences of the patient, (13) family climate according to the child’s perception, (14) social support and (15) personal resources of the child These parameters will be assessed at T1 and/or at T2. The decision will be made by all principal investigators as well as the principal coordinator
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