Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems

Abstract

Transdiagnostic models of psychopathology suggest that disorders may share common features that could influence their severity. Attention problems and psychomotor restlessness are included in the diagnostic criteria for several disorders, including disorders on the internalizing spectrum, but their transdiagnostic significance has received little attention. The present study identifies patterns of attention problems and restlessness among youth with internalizing problems, in order to understand their clinical significance in terms of internalizing symptom severity and response to cognitive behavioral therapy (CBT). Participants were 142 adolescents age 11–18 clinically referred for mood and/or anxiety problems. Latent class analysis was used to identify patterns of self-reported attention problems and psychomotor restlessness, and classes were compared on internalizing, depression, and anxiety severity. Differences in treatment response were examined in a subset of youth (n = 82; age 14–18) who participated in group CBT. Youth in the Attention Problems class (42% of sample) and youth in the Restless class (15% of sample) endorsed significantly more internalizing, depression, and anxiety problems than youth with Low Symptoms of attention problems or psychomotor restlessness (43% of sample). Youth in the Restless class responded significantly better to CBT than youth in the Low Symptoms of attention problems or psychomotor restlessness class in terms of decrease in overall internalizing problems. Attention problems and psychomotor restlessness appear to be important transdiagnostic markers of severity across the internalizing spectrum; however, they do not limit the effectiveness of CBT and, in the case of psychomotor restlessness, may forecast a good treatment response.

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Data Availability

As data are from clinical participants, they will not be deposited.

Code Availability

Data analysis scripts will be posted on osf.io.

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Acknowledgement

Dr. Aitken’s research is supported by the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health. Dr. Andrade’s research is supported by the Canadian Institutes of Health Research and in the past by the Canadian Child Health Clinician Scientist Program, Ontario Mental Health Foundation, and American Psychological Foundation. We thank Marcos Sanches for his guidance on the statistical analyses. The authors have declared that they have no competing or potential conflicts of interest.

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This study did not receive any external funding.

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MA conceived and wrote the manuscript with input from BFA, and performed the analyses. BFA provided critical input regarding study design, analysis, and interpretation. Both authors contributed to manuscript editing and approved the final version of the manuscript.

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Correspondence to Madison Aitken.

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Aitken, M., Andrade, B.F. Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems. Res Child Adolesc Psychopathol (2021). https://doi.org/10.1007/s10802-021-00797-x

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Keywords

  • Internalizing
  • Depression
  • Anxiety
  • Attention Problems
  • Psychomotor Restlessness
  • Cognitive Behavioral Therapy