Dimensional foundations toward a novel nosology addressing comorbidity: Preadolescent syndrome profiles

Abstract

Traditional categorical systems for diagnosing psychopathological symptoms, such as the DSM-5, face limitations including high comorbidity rates and insufficient support for transdiagnostic treatment protocols. Dimensional, person-centered approaches can address these limitations by focusing on cross-cutting psychiatric symptoms. This study leverages data from the Adolescent Brain Cognitive Development_ Study (ABCD Study�) to develop dimensional models of preadolescent psychopathology, focusing on a large, diverse sample of youths aged 9-10. We used latent profile analysis (LPA) on Child Behavior Checklist (CBCL) syndrome scales collected from an elevated symptomatology subsample to delineate subgroups for targeted interventions. Four distinct profiles emerged: "Mildly Elevated" and "Highly Elevated" (on both internalizing and externalizing), "Moderately Elevated - Rule-Breaking," and "Moderately Elevated - Internalizing & Thought Problems." These profiles differed significantly across sociodemographic, neurocognitive, and life experience characteristics. The "Highly Elevated" group showed the highest levels of risk, including greater trauma exposure and higher rates of parental psychopathology. In contrast, the "Mildly Elevated" group demonstrated lower levels of risk factors and higher fluid intelligence compared to the other groups. The two Moderately Elevated profiles were largely similar across most risk indicators, though the Internalizing & Thought Problems group had a slightly higher proportion of parents with a college education. These profiles offer the beginnings of a foundation for classifying symptom co-occurrence and highlight the need for developmentally specific nosologies to improve risk detection and intervention strategies. Future research should further validate these profiles and explore their stability across developmental stages to inform targeted interventions.