Abstract
Recent proposals suggest early adversity sets in motion particularly chronic and neurobiologically distinct trajectories of internalizing symptoms. However, few prospective studies in high-risk samples delineate distinct trajectories of internalizing symptoms from preschool age onward. We examined trajectories in a high-risk cohort, oversampled for internalizing symptoms, several preschool risk/maintenance factors, and school-age outcomes. Parents of 325 children completed the Strengths and Difficulties Questionnaire on up to four waves of data collection from preschool (3-5 years) to school age (8-9 years) and Preschool Age Psychiatric Assessment interviews at both ages. Multi-informant data were collected on risk factors and symptoms. Growth mixture modelling identified four trajectory classes of internalizing symptoms with stable low, rising low-to-moderate, stable moderate, and stable high symptoms. Children in the stable high symptom trajectory manifested clinically relevant internalizing symptoms, mainly diagnosed with anxiety disorders/depression at preschool and school age. Trajectories differed regarding loss/separation experience, maltreatment, maternal psychopathology, temperament, and stress-hormone regulation with loss/separation, temperament, maternal psychopathology, and stress-hormone regulation (trend) significantly contributing to explained variance. At school age, trajectories continued to differ on symptoms, disorders, and impairment. Our study is among the first to show that severe early adversity may trigger a chronic and neurobiologically distinct internalizing trajectory from preschool age onward.
Highlights
To determine the presence/ absence of DSM-IV diagnoses, we interviewed one of the parents (85%–93% mothers) using the Preschool Age Psychiatric Assessment (PAPA; Egger & Angold, 2004) at preschool age (Wave 2) and again at elementary school age (Wave 4; this assessment served as outcome)
We examined internalizing symptoms rated by fathers and preschool teachers at preschool age to assess concordance between informants, as well as presence/absence of anxiety disorder/depression assessed with clinical interviews to inform clinical relevance
We examined life events relating to the loss of/separation from a significant person and experience of maltreatment before the age of 3, while maternal mental health problems, child temperament, and stress reactivity were assessed at preschool age
Summary
In previous work on distinct internalizing trajectories, community samples are overrepresented as compared to selected high-risk samples. This raises the question of whether results apply to a clinically relevant range. Several studies examine potential risk factors predicting class memberships and outcomes of trajectory classes. To fill these research gaps, the first objective of this study was to examine trajectories of internalizing symptoms from preschool to school age in a high-risk community sample oversampled for internalizing symptoms. We anticipated three to four distinct trajectory classes with stable low, moderate, and high internalizing symptoms, and possibly, one group with increasing internalizing symptoms. We examined the presence of anxiety disorders/depression derived from clinical interviews to inform clinical relevance at preschool age
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