Evidence for a Multi-Dimensional Latent Structural Model of Externalizing Disorders
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Strong associations between conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (SUD) seem to reflect a general vulnerability to externalizing behaviors. Recent studies have characterized this vulnerability on a continuous scale, rather than as distinct categories, suggesting that the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) take into account the underlying continuum of externalizing behaviors. However, most of this research has not included measures of disorders that appear in childhood [e.g., attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD)], nor has it considered the full range of possibilities for the latent structure of externalizing behaviors, particularly factor mixture models, which allow for a latent factor to have both continuous and categorical dimensions. Finally, the majority of prior studies have not tested multidimensional models. Using lifetime diagnoses of externalizing disorders from participants in the Fast Track Project (n = 715), we analyzed a series of latent variable models ranging from fully continuous factor models to fully categorical mixture models. Continuous models provided the best fit to the observed data and also suggested that a two-factor model of externalizing behavior, defined as (1) ODD+ADHD+CD and (2) SUD with adult antisocial behavior sharing common variance with both factors, was necessary to explain the covariation in externalizing disorders. The two-factor model of externalizing behavior was then replicated using a nationally representative sample drawn from the National Comorbidity Survey-Replication data (n = 5,692). These results have important implications for the conceptualization of externalizing disorders in DSM-5.
KeywordsExternalizing Classification Mixture modeling Substance abuse Substance dependence
This work was supported by National Institute of Mental Health (NIMH) grants R18 MH48043, R18 MH50951, R18 MH50952, R18 MH50953, and by National Institute on Drug Abuse (NIDA) grant 1 RC1 DA028248-01. The Center for Substance Abuse Prevention and NIDA also provided support for Fast Track through a memorandum of agreement with the NIMH. This work was also supported in part by Department of Education grant S184U30002, NIMH grants K05MH00797 and K05MH01027, and NIDA grants DA16903, DA015226 and DA017589.
Katie Witkiewitz is now at the University of New Mexico. 1 University of New Mexico MSC03-2220, Albuquerque, NM 87131, (505) 277-4121, firstname.lastname@example.org
Members of the Conduct Problems Prevention Research Group, in alphabetical order, include Karen L. Bierman, Department of Psychology, Pennsylvania State University; John D. Coie, Duke University; Kenneth A. Dodge, Center for Child and Family Policy, Duke University; Mark T. Greenberg, Department of Human Development and Family Studies, Pennsylvania State University; John E. Lochman, Department of Psychology, the University of Alabama; Robert J. McMahon, Department of Psychology, Simon Fraser University, and the Child & Family Research Institute; and Ellen E. Pinderhughes, Department of Child Development, Tufts University.
Drs. Bierman, Coie, Dodge, Greenberg, Lochman, and McMahon are the developers of the Fast Track curriculum and have a publishing agreement with Oxford University Press. Dr. Greenberg is an author on the PATHS curriculum and has a royalty agreement with Channing-Bete, Inc. Dr. Greenberg is a principal in PATHS Training, LLC. Dr. McMahon is a coauthor of Helping the Noncompliant Child and has a royalty agreement with Guilford Publications, Inc.; he is also a member of the Treatments That Work Scientific Advisory Board with Oxford University Press.
The authors are grateful for the collaboration of the school districts that participated in the Fast Track Project as well as the hard work and dedication of the many staff members who implemented the project, collected the evaluation data, and assisted with data management and analyses. For additional information concerning Fast Track, see http://www.fasttrackproject.org.
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