Biosocial Influences on the Family: A Decade Review

The past decade brought a remarkable increase in the number and quality of biosocial studies of family processes. The current review summarizes recent advances in biosocial family research by providing key exemplars of emerging research paradigms. Research in the past decade has substantiated the claim in the previous Decade Review (Booth, Carver, & Granger, 2000) that bidirectional influences between all levels of analysis are paramount. There is an emerging consensus that integrating factors at multiple biological and social levels is highly informative. Because ignoring biological factors often will underestimate mediating or moderating mechanisms, the review provides recommendations for biosocial family research. We also highlight the need for researchers who understand complex family environments to lend their expertise to biosocial studies.

Etiology and measurement of relational aggression: A multi-informant behavior genetic investigation

Although the study of relational aggression is gaining attention in the literature, little is known about the underlying causes of this behavior and the relative validity of various informants. These issues were addressed in a sample of 1,981 6- to 18-year-old twin pairs (36% female, 34% male, 30% opposite-sex). Relational aggression was assessed via maternal and self-report using a structured interview. Univariate models estimated genetic and environmental influences by informant and examined evidence for gender differences. A psychometric model combined data from both informants to estimate etiologic influences that were both common to the informants and informant specific. In both sexes, the latent variable reflecting the mother's and child's shared perception of the child's relational aggression was substantially influenced by both additive genetic (63%) and shared environmental (37%) influences, although this latent variable accounted for much greater variance in the maternal report (66%) than it did in the youth report (9%). In addition, informant-specific additive genetic and shared environmental influences were found only for the youth report, with all remaining variance in the mother's report attributed to nonshared environmental influences. Results are discussed in the context of measuring relational aggression and the importance of multiple informants.

Associations between father absence and age of first sexual intercourse

Children raised without a biological father in the household have earlier average ages of first sexual intercourse than children raised in father-present households. Competing theoretical perspectives have attributed this either to effects of father absence on socialization and physical maturation or to nonrandom selection of children predisposed for early sexual intercourse into father-absent households. Genetically informative analyses of the children of sister dyads (N = 1,382, aged 14-21 years) support the selection hypothesis: This association seems attributable to confounded risks, most likely genetic in origin, which correlated both with likelihood of father absence and early sexual behavior. This holds implications for environmental theories of maturation and suggests that previous research may have inadvertently overestimated the role of family structure in reproductive maturation.

Predictive validity of a continuous alternative to nominal subtypes of attention-deficit/hyperactivity disorder for DSM-V

Three subtypes of attention-deficit/hyperactivity disorder (ADHD) based on numbers of symptoms of inattention (I) and hyperactivity-impulsivity (HI) were defined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) to reduce heterogeneity of the disorder, but the subtypes proved to be highly unstable over time. A continuous alternative to nominal subtyping is evaluated in a longitudinal study of 129 four- to six-year-old children with ADHD and 130 comparison children. Children who met criteria for all subtypes in Year 1 continued to exhibit greater functional impairment than comparison children during Years 2 to 9. Among children with ADHD in Year 1, I and HI symptoms differentially predicted teacher-rated need for treatment and reading and mathematics achievement scores over the next 8 years in controlled analyses. Consistent with other studies, these findings suggest that the use of diagnostic modifiers specifying the numbers of I and HI symptoms could reduce heterogeneity and facilitate clinical intervention, prognosis, and research.

Psychometrics of a self-report version of the Child and Adolescent Dispositions Scale

Lahey and Waldman (2003, 2005) proposed a model in which three dispositions-sympathetic response to others; negative emotional response to threat, frustration, and loss; and positive response to novelty and risk-transact with the environment to influence risk for conduct disorder (CD). To test this model, the Child and Adolescent Dispositions Scale (CADS) was developed to measure these dispositions using parent ratings of the child. Here we report psychometric evaluations of a parallel youth self-report version (CADS-Y). Exploratory factor analysis of CADS-Y items among 832 9- to 17-year-olds yielded a 3-factor structure that was consistent with the model and invariant across sex and informants. In 1,582 pairs of 9- to 17-year-old twins, confirmatory factor analyses supported the CADS-Y 3-factor model. Each CADS-Y dimension was associated with CD and related personality dimensions as predicted.

Developmental structure of genetic influences on antisocial behavior across childhood and adolescence

It is necessary to determine if causal influences on developing antisocial behavior change with age to guide both research and theory on its origins. The extent to which the same genetic factors influence antisocial behavior across 4-17 years of age was estimated using 2,482 sibling pairs of varying genetic relatedness. Assessments of antisocial behavior by mothers (4-9 years), mothers and youth (10-13 years), and youth (14-17 years) reflected the changing validity of informants across development. Genetic influences on antisocial behavior at 14-17 years were entirely shared with those on antisocial behavior at 10-13 years according to both informants. Genetic influences on antisocial behavior at 14-17 years were distinct from those at 4-9 years, however. These age differences in genetic influences cannot be fully distinguished from informant differences across age, but the present findings indicate that youth reported to be persistently antisocial during childhood and adolescence are influenced by one set of genetic factors influencing parent-report conduct problems in childhood and a second set of genetic influences on youth-reported delinquency that come into play around the time of the pubertal transition.

Population density and youth antisocial behavior

Theoretical models concerning how neighborhood contexts adversely influence juvenile antisocial behavior frequently focus on urban neighborhoods; however, previous studies comparing urban and rural areas on the prevalence of youth antisocial behavior have yielded mixed results. The current study uses longitudinal data on the offspring of a nationally representative sample of mothers (N = 4,886) in the US. There was no relation between density and mother-reported child conduct problems across ages 4-13 years, but youth living in areas of greater population density exhibited more youth self-reported delinquency across 10-17 years. Families often moved to counties with greater or lesser population density, but longitudinal analyses treating population density as a time-varying covariate did not support the hypothesis that living in densely populated counties influenced youth delinquency. Rather, the association between population density and delinquency appears to be due to unmeasured selection variables that differ between families who live in more or less densely populated counties.

Maternal age at childbirth and offspring disruptive behaviors: testing the causal hypothesis

BACKGROUND

Recent studies suggest that the association between maternal age at childbearing (MAC) and children's disruptive behaviors is the result of family factors that are confounded with both variables, rather than a casual effect of environmental factors specifically related to MAC. These studies, however, relied on restricted samples and did not use the strongest approach to test causal influences.

METHODS

Using data on 9,171 4-9-year-old and 6,592 10-13-year-old offspring of women from a nationally representative sample of US households, we conducted sibling-comparison analyses. The analyses ruled out all genetic factors that could confound the association, as well as all environmental confounds that differ between unrelated nuclear families, providing a strong test of the causal hypothesis that the environments of children born at different maternal ages influence mother- and self-reported disruptive behaviors.

RESULTS

When these genetic and environmental confounds were ruled out as alternative explanations, the relation between environments within nuclear families specifically associated with MAC and disruptive behaviors was robust, with the association being stronger for second- and third-born children.

CONCLUSIONS

Environmental factors specifically associated with early MAC within nuclear families account for increased risk of offspring disruptive behaviors, especially in later-born children.

A quasi-experimental analysis of the association between family income and offspring conduct problems

The study presents a quasi-experimental analysis of data on 9,194 offspring (ages 4-11 years old) of women from a nationally representative U.S. sample of households to test the causal hypotheses about the association between family income and childhood conduct problems (CPs). Comparison of unrelated individuals in the sample indicated a robust inverse association, with the relation being larger at higher levels of income and for male offspring, even when statistical covariates were included to account for measured confounds that distinguish different families. Offspring also were compared to their siblings and cousins who were exposed to different levels of family income in childhood to rule out unmeasured environmental and genetic factors confounded with family income as explanations for the association. In these within-family analyses, boys exposed to lower family income still exhibited significantly higher levels of CPs. When considered in the context of previous studies using different designs, these results support the inference that family income influences CPs, particularly in males, through causal environmental processes specifically related to earnings within the nuclear family.

Public health significance of neuroticism

The personality trait of neuroticism refers to relatively stable tendencies to respond with negative emotions to threat, frustration, or loss. Individuals in the population vary markedly on this trait, ranging from frequent and intense emotional reactions to minor challenges to little emotional reaction even in the face of significant difficulties. Although not widely appreciated, there is growing evidence that neuroticism is a psychological trait of profound public health significance. Neuroticism is a robust correlate and predictor of many different mental and physical disorders, comorbidity among them, and the frequency of mental and general health service use. Indeed, neuroticism apparently is a predictor of the quality and longevity of our lives. Achieving a full understanding of the nature and origins of neuroticism, and the mechanisms through which neuroticism is linked to mental and physical disorders, should be a top priority for research. Knowing why neuroticism predicts such a wide variety of seemingly diverse outcomes should lead to improved understanding of commonalities among those outcomes and improved strategies for preventing them.

Few girls with childhood attention-deficit/hyperactivity disorder show positive adjustment during adolescence

Employing data from 140 prospectively followed girls with attention-deficit/hyperactivity disorder (ADHD) and 88 age- and ethnicity-matched comparison girls, we adopted a person-centered analytic approach to assess rates of adolescent positive adjustment (PA) across six domains: ADHD symptoms, externalizing symptoms, internalizing symptoms, social skills, peer acceptance, and school achievement. During adolescence, between 19.8% and 61.1% of the girls with childhood ADHD met criteria for PA when the six domains were considered independently. A total of 16.4% of the ADHD sample showed PA in at least five of six domains, versus 86.4% of the comparison girls. Results were similar when PA was examined excluding the ADHD symptom domain. Most girls did not "grow out of" the symptoms and impairments related to their ADHD.

Atypical empathic responses in adolescents with aggressive conduct disorder: a functional MRI investigation

Because youth with aggressive conduct disorder (CD) often inflict pain on others, it is important to determine if they exhibit atypical empathic responses to viewing others in pain. In this initial functional magnetic resonance imaging (fMRI) study, eight adolescents with aggressive CD and eight matched controls with no CD symptoms were scanned while watching animated visual stimuli depicting other people experiencing pain or not experiencing pain. Furthermore, these situations involved either an individual whose pain was caused by accident or an individual whose pain was inflicted on purpose by another person. After scanning, participants rated how painful the situations were. In both groups the perception of others in pain was associated with activation of the pain matrix, including the ACC, insula, somatosensory cortex, supplementary motor area and periaqueductal gray. The pain matrix was activated to a specific extent in participants with CD, who also showed significantly greater amygdala, striatal, and temporal pole activation. When watching situations in which pain was intentionally inflicted, control youth exhibited signal increase in the medial prefrontal cortex, lateral orbitofrontal cortex, and right temporo-parietal junction, whereas youth with CD only exhibited activation in the insula and precentral gyrus. Furthermore, connectivity analyses demonstrated that youth with CD exhibited less amygdala/prefrontal coupling when watching pain inflicted by another than did control youth. These preliminary findings suggest that youth with aggressive CD exhibit an atypical pattern of neural response to viewing others in pain that should be explored in further studies.

Using epidemiologic methods to test hypotheses regarding causal influences on child and adolescent mental disorders

Epidemiology uses strong sampling methods and study designs to test refutable hypotheses regarding the causes of important health, mental health, and social outcomes. Epidemiologic methods are increasingly being used to move developmental psychopathology from studies that catalogue correlates of child and adolescent mental health to designs that can test rival hypotheses regarding causal genetic and environmental influences. A two-part strategy is proposed for the next phase of epidemiologic research. First, to facilitate the most informed tests of causal hypotheses, it is necessary to develop and test models of the structure of hypothesized genetic and environmental influences on mental health phenotypes. This will involve testing the related hypotheses that there are both (a) dimensions of psychopathology that are distinct in the sense of having at least some unique genetic and/or environmental influences, and (b) higher-order domains of correlated dimensions that are all apparently influenced in part by the same genetic and/or environmental factors. The resulting causal taxonomy would organize tests of causal hypotheses regarding both factors that may broadly increase risk for multiple dimensions of psychopathology and factors that may specifically increase risk for each individual dimension. Second, it is necessary to make greater use of a number of powerful epidemiologic designs that allow rigorous tests of rival hypotheses regarding genetic and environmental causes.

Are oppositional-defiant and hyperactive-inattentive symptoms developmental precursors to conduct problems in late childhood?: genetic and environmental links

Inattentive-hyperactive and oppositional behavior have been hypothesized to be developmental precursors to conduct problems. We tested these hypotheses using a longitudinal sample of 6,466 offspring of women selected from nationally representative US households. Conduct problems across 8-13 years were robustly predicted by conduct problems at 4-7 years, but also were independently predicted to a small extent by both inattentive-hyperactive and oppositional behaviors at 4-7 years. Longitudinal multivariate behavior genetic analyses revealed that the genetic and environmental factors that influence conduct problems at both 4-7 and 8-13 years also influence the putative precursors at 4-7 years. After genetic and environmental influences on conduct problems at 4-7 years were taken into account, however, inattentive-hyperactive and oppositional behavior at 4-7 years shared causal influences with conduct problems 8-13 years to a negligible extent. These findings suggest that after early conduct problems are controlled, little is gained in terms of prediction or understanding genetic and environmental influences on later child conduct problems by treating early inattentive-hyperactive and oppositional behavior as developmental precursors to later conduct problems.

Temperament and parenting during the first year of life predict future child conduct problems

Predictive associations between parenting and temperament during the first year of life and child conduct problems were assessed longitudinally in 1,863 offspring of a representative sample of women. Maternal ratings of infant fussiness, activity level, predictability, and positive affect each independently predicted maternal ratings of conduct problems during ages 4-13 years. Furthermore, a significant interaction indicated that infants who were both low in fussiness and high in predictability were at very low risk for future conduct problems. Fussiness was a stronger predictor of conduct problems in boys whereas fearfulness was a stronger predictor in girls. Conduct problems also were robustly predicted by low levels of early mother-report cognitive stimulation when infant temperament was controlled. Interviewer-rated maternal responsiveness was a robust predictor of conduct problems, but only among infants low in fearfulness. Spanking during infancy predicted slightly more severe conduct problems, but the prediction was moderated by infant fussiness and positive affect. Thus, individual differences in risk for mother-rated conduct problems across childhood are already partly evident in maternal ratings of temperament during the first year of life and are predicted by early parenting and parenting-by-temperament interactions.

Psychometric characteristics of a measure of emotional dispositions developed to test a developmental propensity model of conduct disorder

Lahey and Waldman proposed a developmental propensity model in which three dimensions of children's emotional dispositions are hypothesized to transact with the environment to influence risk for conduct disorder, heterogeneity in conduct disorder, and comorbidity with other disorders. To prepare for future tests of this model, a new measure of these dispositions was tested. Exploratory factor analysis of potential items was conducted in a sample of 1,358 participants 4 to 17 years of age. Confirmatory factor analyses then confirmed the three dispositional dimensions in a second sample of 2,063 pairs of 6- to 17-year-old twins. Caretaker ratings of the dispositional dimensions were associated as predicted with symptoms of conduct disorder and other psychopathology. In a third sample, caretaker ratings of each disposition correlated uniquely with relevant observational measures of child behavior and unintentional injuries. These findings provide initial support for the new dispositional measure.

A practical measure of impairment: psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples

Assessing impairment is an explicit component of current psychiatric diagnostic systems. A brief parent and teacher rating scale for assessing impairment was developed and studied using attention deficit hyperactivity disorder (ADHD) as an exemplar disorder. The psychometric properties of the Impairment Rating Scale (IRS) were measured in 4 samples. Two included ADHD and matched comparison children and the other 2 a school sample. Overall, IRS ratings exhibited very good temporal stability. They correlated with other impairment ratings and behavioral measures and displayed evidence of convergent and discriminant validity. The IRS was highly effective in discriminating between children with and without ADHD. Evidence that the parent and teacher IRS accounted for unique variance beyond ratings of ADHD symptoms is also presented. The scale is brief, practical, and in the public domain. The results of the studies and implications for the assessment of impairment are discussed.

Specification, testing, and interpretation of gene-by-measured-environment interaction models in the presence of gene-environment correlation

Purcell (Twin Res 5:554-571, 2002) proposed a bivariate biometric model for testing and quantifying the interaction between latent genetic influences and measured environments in the presence of gene-environment correlation. Purcell's model extends the Cholesky model to include gene-environment interaction. We examine a number of closely related alternative models that do not involve gene-environment interaction but which may fit the data as well as Purcell's model. Because failure to consider these alternatives could lead to spurious detection of gene-environment interaction, we propose alternative models for testing gene-environment interaction in the presence of gene-environment correlation, including one based on the correlated factors model. In addition, we note mathematical errors in the calculation of effect size via variance components in Purcell's model. We propose a statistical method for deriving and interpreting variance decompositions that are true to the fitted model.

Should relational aggression be included in DSM-V?

OBJECTIVE

Relational aggression was introduced more than a decade ago as a female-typical form of aggression and has become widely used in developmental psychopathology research. In considering whether relational aggression should be included in DSM-V disruptive behavior disorders, we provide data on the reliability and validity of relational aggression when reported by the informants most commonly used to generate clinical diagnoses (parents and youth), the degree of overlap between relational aggression and DSM-IV oppositional defiant disorder (ODD) and conduct disorder (CD), and the amount of variance in impairment explained by relational aggression controlling for ODD and CD.

METHOD

Data were collected on 9- to 17-year-old girls and boys participating in the population-based Georgia Health and Behavior Study.

RESULTS

Reliability and validity of youth and parent reports were adequate. Relational aggression was moderately correlated with symptoms of ODD and CD, and substantial overlap was observed between high levels of relational aggression and meeting symptom criteria for ODD or CD. Relational aggression explained a small but significant amount of unique variance in impairment, controlling for ODD and CD symptoms. At clinically significant levels of impairment, however, there was no additional variance explained by relational aggression.

CONCLUSIONS

Some additional information about girls' and boys' functioning is gained by assessing relational aggression using parents and youth as informants, but perhaps not a sufficient amount to warrant inclusion in the nomenclature.

Academic achievement over 8 years among children who met modified criteria for attention-deficit/hyperactivity disorder at 4-6 years of age

The predictive validity of symptom criteria for different subtypes of ADHD among children who were impaired in at least one setting in early childhood was examined. Academic achievement was assessed seven times over 8 years in 125 children who met symptom criteria for ADHD at 4-6 years of age and in 130 demographically-matched non-referred comparison children. When intelligence and other confounds were controlled, children who met modified criteria for the predominantly inattentive subtype of ADHD in wave 1 had lower reading, spelling, and mathematics scores over time than both comparison children and children who met modified criteria for the other subtypes of ADHD. In some analyses, children who met modified criteria for the combined type had somewhat lower mathematics scores than comparison children. The robust academic deficits relative to intelligence in the inattentive group in this age range suggest either that inattention results in academic underachievement or that some children in the inattentive group have learning disabilities that cause secondary symptoms of inattention. Unexpectedly, wave 1 internalizing (anxiety and depression) symptoms independently predicted deficits in academic achievement controlling ADHD, intelligence, and other predictors.

Few preschool boys and girls with ADHD are well-adjusted during adolescence

To estimate the prevalence of being well-adjusted in adolescence, boys and girls with (n = 96) and without (n = 126) attention-deficit/hyperactivity disorder (ADHD) were assessed seven times in eight years starting when they were 4-6 years of age. Symptoms of ADHD, ODD/CD, and depression/anxiety in addition to social skills and social preference were gathered using multiple methods and informants. Being well-adjusted was defined by surpassing thresholds in at least four of the five domains. At the 7- and 8-year follow-up, when youth were 11-14 years old, probands were significantly less likely to be well-adjusted relative to age- and ethnicity-matched control children. Only a minority of children with ADHD was well-adjusted in adolescence when emotional, behavioral, and social domains were considered simultaneously. Even when their ADHD symptoms improved over time, most probands exhibited significant impairment 7-8 years after their initial assessment.

Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology

Confirmatory factor analyses were conducted of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptoms of common mental disorders derived from structured interviews of a representative sample of 4,049 twin children and adolescents and their adult caretakers. A dimensional model based on the assignment of symptoms to syndromes in DSM-IV fit better than alternative models, but some dimensions were highly correlated. Modest sex and age differences in factor loadings and correlations were found that suggest that the dimensions of psychopathology are stable across sex and age, but slightly more differentiated at older ages and in males. The dimensions of symptoms were found to be hierarchically organized within higher-order "externalizing" and "internalizing" dimensions, which accounted for much of their variance. Major depression and generalized anxiety disorder were substantially correlated with both the "externalizing" dimension and the "internalizing" dimension, however, suggesting the need to reconceptualize the nature of these higher-order dimensions.

Are there sex differences in the predictive validity of DSM-IV ADHD among younger children?

We assessed the predictive validity of attention-deficit/hyperactivity disorder (ADHD) in 20 girls and 98 boys who met the Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for ADHD at 4 to 6 years of age compared to 24 female and 102 male comparison children. Over the next 8 years, both girls and boys who met criteria for ADHD in Year 1 exhibited more ADHD symptoms and impairment than same-sex comparison children. Effect sizes were consistently large, indicating that the diagnosis of ADHD at 4 to 6 years of age has predictive validity for both sexes. Both girls and boys with ADHD in Year 1 also exhibited higher levels of symptoms of conduct disorder, major depression, and anxiety disorders in early adolescence than same-sex comparison children, controlling levels of the same symptoms in Year 1. This indicates both substantial homotypic and heterotypic continuity for ADHD in both sexes, but significant interactions with time indicated that childhood ADHD predicts more steeply rising symptoms of anxiety and depression during early adolescence in girls than in boys.

Adolescent Conduct Disorder and Interpersonal Callousness as Predictors of Psychopathy in Young Adults

Unfortunately, very little research has examined the link between antisocial personality traits in childhood and adult psychopathy. This study used data from a clinic-referred sample of 177 boys, assessed annually from recruitment (ages 7 to 12) through age 19. Parent and teacher ratings of interpersonal callousness (IC) were tested at predictors of psychopathy ratings at 18 and 19. In regression models, conduct disorder (CD) and teacher-rated IC both predicted both Factor 1 (interpersonal and affective items) and Factor 2 (impulsivity and antisocial behavior items) of the Psychopathy Checklist-Revised, as did child IQ. Prenatal tobacco exposure and cortisol measured in adolescence predicted only Factor 1. When each factor was included in the prediction of the other, CD and IC no longer predicted Factor 1 but remained significant predictors of Factor 2.

Sex differences in the causes of self-reported adolescent delinquency

Sex differences in the causes of self-reported adolescent delinquency were examined in full and half siblings born to a nationally representative sample of women in the United States. Qualitative sex differences in the genes that influence delinquency were not detected. Similarly, the proportions of variance in both aggressive and nonaggressive delinquency attributable to genetic and environmental influences did not differ significantly between girls and boys. Nonetheless, total variance in delinquency was greater among boys, and a scalar sex-differences model suggested that genetic and environmental influences on delinquency have less effect on population variation in delinquency among girls. Similarly, a test of the polygenic multiple threshold model suggested that girls require greater causal liability for the expression of delinquency than boys.

Association of dopamine transporter genotype with disruptive behavior disorders in an eight-year longitudinal study of children and adolescents

Associations between dopamine transporter (DAT1) variable number tandem repeats (VNTR), genotypes, and disruptive behavior were examined in an 8-year longitudinal study of children (n = 183). Half of the children met criteria for attention-deficit/hyperactivity disorder (ADHD) at 4-6 years and half were non-referred comparison children. Consistent with several studies, the non-additive association for the 10-repeat allele was significant for hyperactivity-impulsivity (HI) symptoms. However, consistent with other studies, exploratory analyses of the non-additive association of the 9-repeat allele of DAT1 with HI and oppositional defiant disorder (ODD) symptoms also were significant. The inconsistent association between DAT1 and child behavior problems in this and other samples may reflect joint influence of the 10-repeat and 9-repeat alleles.

Testing descriptive hypotheses regarding sex differences in the development of conduct problems and delinquency

Accurate descriptions of sex differences in the development of childhood conduct problems and adolescent delinquency will inform theories of their causes in fundamentally important ways. Using data on 4,572 offspring of a national sample of women, we tested descriptive hypotheses regarding sex differences. As predicted, the magnitude of sex differences varied with age, suggesting that multiple processes differentially influence levels of these behaviors in females and males across development. During childhood, boys scored lower on measures of cognitive ability and exhibited lower sociability and compliance and greater hyperactivity, oppositional behavior, and conduct problems. Most of these variables were associated with childhood conduct problems and adolescent delinquency equally in females and males, but maternal delinquency and early childhood sociability were correlated more strongly with childhood conduct problems in males and childhood compliance predicted adolescent delinquency more strongly in females. Both sexes exhibited both childhood-onset and adolescent-onset trajectories of delinquency. Although more males followed a childhood-onset trajectory, there were few sex differences in the early childhood risk correlates of either delinquency trajectory.

Maternal depression and early positive parenting predict future conduct problems in young children with attention-deficit/hyperactivity disorder

Children with attention-deficit/hyperactivity disorder (ADHD) are at risk for adverse outcomes such as substance abuse and criminality, particularly if they develop conduct problems. Little is known about early predictors of the developmental course of conduct problems among children with ADHD, however. Parental psychopathology and parenting were assessed in 108 children who first met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ADHD at 4-7 years old. When demographic variables and baseline ADHD and conduct problems were controlled, maternal depression predicted conduct problems 2-8 years following the initial assessment, whereas positive parenting during the structured parent- child interaction task predicted fewer future conduct problems. These findings suggest that maternal depression is a risk factor, whereas early positive parenting is a protective factor, for the developmental course of conduct problems among children with ADHD.

Testing the Model Minority Stereotype: Youth Behaviors across Racial and Ethnic Groups

Using data from a large nationally representative sample of adolescents attending school, this study tests the stereotype that youth of Asian Pacific Islander ethnicity (API) are the model minority. The results suggest that, except for substance use, API American youth do not report fewer delinquent behaviors than white youth; in fact, API American youth report slightly higher numbers of aggressive offenses than white youth, and female API American youth report greater numbers of nonaggressive offenses than white female youth. Also, API American youth report higher rates of nonaggressive offenses and substance use than do black youth. The mental health and social service needs of API American youth are thus at least as great as those of white youth. The need for such services increases with the length of residency in the United States.

Predictive validity of ICD-10 hyperkinetic disorder relative to DSM-IV attention-deficit/hyperactivity disorder among younger children

BACKGROUND

Little is known about the predictive validity of hyperkinetic disorder (HKD) as defined by the Diagnostic Criteria for Research for mental and behavioral disorders of the tenth edition of the International Classification of Diseases (ICD-10; World Health Organization, 1993), particularly when the diagnosis is given to younger children.

METHODS

The predictive validity of HKD was evaluated over a 6-year period and compared to the predictive validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) in 95 4-6-year-old children who met full criteria for at least ADHD and 122 demographically-matched nonreferred comparison children. Diagnoses were based on structured assessments of both parents and teachers.

RESULTS

All children who met full criteria for HKD also met full DSM-IV criteria for ADHD, but only 26% of ADHD children met criteria for HKD. Children who met criteria for HKD (N = 24), children who would have met criteria for HKD but were excluded from the diagnosis because they concurrently met criteria for an anxiety disorder or depression (N = 16), and the remaining children who met DSM-IV criteria for ADHD (N = 55) all exhibited significantly more symptoms of ADHD and greater social and academic impairment during years 2-7 than nonreferred comparison children. Unlike the two other diagnostic groups, however, children who met strict criteria for HKD were not more likely than comparison children to be injured unintentionally or to be placed in special education.

CONCLUSIONS

Both ICD-10 HKD and DSM-IV ADHD exhibit predictive validity over 6 years, but ICD-10 HKD appears to under-identify children with persistent ADHD symptoms and related impairment. Children who met criteria for DSM-IV ADHD but not HKD exhibited at least as much functional impairment over time as hyperkinetic children.

Developmental transitions among affective and behavioral disorders in adolescent boys

BACKGROUND

This paper expands upon recent efforts to advance beyond the examination of concurrent comorbidity between affective and behavioral disorders by testing developmental sequences among disorders. Doing so allows for improved tests of theories, such as Capaldi and Patterson's failure model of Conduct Disorder (CD) and depression. Furthermore, Oppositional Defiant Disorder (ODD) is rarely considered distinctly from CD, minimizing the ability to identify distinct effects among behavioral disorders.

METHODS

This paper used data from the Developmental Trends Study, a clinic-referred cohort of 177 boys, along with their parents, who were assessed regularly using a structured clinical interview and a comprehensive set of other measures. Boys were recruited when they were between the ages of 7 and 12, and were reassessed annually until age 18. Predictive regression models tested the continuities among disorders, with depression, overanxious disorder, Attention Deficit Hyperactivity Disorder (ADHD), ODD and CD examined separately as outcomes.

RESULTS

Each disorder showed homotypic continuity, but a clear developmental sequence of heterotypic continuity also emerged. ADHD was predicted by no other disorders, and exclusively predicted ODD. CD was predicted only by ODD. However, ODD was also directly predictive of future anxiety and depression, and anxiety predicted future depression as well. A specific test of the failure model of CD and depression supported that model.

CONCLUSIONS

ODD appears as a pivotal developmental disorder in young males, in that ODD is notably influential in both subsequent behavioral and affective disorders. CD influences later depression only indirectly, through psychosocial impairment. Anxiety precedes depression, and ADHD is not predicted by other disorders.

Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school

CONTEXT

The DSM-IV definition of attention-deficit/hyperactivity disorder (ADHD) distinguished 3 subtypes that had not been extensively studied.

OBJECTIVE

To determine whether the ADHD subtypes are stable enough over time to be valid.

DESIGN

Longitudinal study with a greater-than 89% retention rate in 7 assessments over 8 years.

SETTING

Outpatient clinics.

PARTICIPANTS

Volunteer sample of 118 4- to 6-year-olds who met DSM-IV criteria for ADHD, including impairment in 2 settings in at least 1 assessment.

MAIN OUTCOME MEASURE

Meeting DSM-IV criteria for the subtypes of ADHD during years 2 through 8.

RESULTS

The number of children who met criteria for ADHD declined over time, but most persisted. Children who met criteria for the combined subtype (CT, n = 83) met criteria for ADHD in more subsequent assessments than children in the predominantly hyperactive-impulsive subtype (HT, n = 23). Thirty-one (37%) of 83 CT children and 6 (50%) of 12 children in the predominantly inattentive subtype (IT) met criteria for a different subtype at least twice in the next 6 assessments. Children of the HT subtype were even more likely to shift to a different subtype over time, with HT children who persisted in ADHD mostly shifting to CT in later assessments. The subtypes exhibited consistently different mean levels of hyperactive-impulsive symptoms during years 2 through 8 that corresponded with their initial subtype classifications, but initial subtype differences in inattention symptoms diminished in later years.

CONCLUSIONS

In younger children, the CT and IT may be stable enough to segregate groups for research, but they seem too unstable for use in the clinical assessment of individual children. Children rarely remain in the HT classification over time; rather, they sometimes desist from ADHD but mostly shift to CT in later years. Using continuous ratings of hyperactivity-impulsivity symptoms as a diagnostic qualifier should be considered as an alternative to classifying nominal subtypes of ADHD in DSM-V.

Mood and hormone responses to psychological challenge in adolescent males with conduct problems

BACKGROUND

Relations between stress hormones and antisocial behavior are understudied.

METHODS

A subsample (n = 335) of at-risk males recruited in first grade for a longitudinal study were recruited at approximately 16 years of age for a laboratory study, including two psychological challenges: describing their worst experience on videotape, and a task in which a loud tone could be avoided. Measures of affect, urine, and saliva were collected multiple times before and after challenges.

RESULTS

Negative affect increased following the worst-event challenge and decreased following the avoidance challenge. Mean conduct problems (CP) across ages 7-17 years were positively related to negative affect and inversely related to positive affect. CP were inversely related to post-challenge urinary epinephrine (E) levels when baseline E and potential confounds were controlled. Cortisol concentrations in saliva collected soon after the first challenge were positively related to CP in a post hoc subset of youths with extreme CP.

CONCLUSIONS

Key findings A) associated persistent CP with more negative affectivity and less positive affectivity, B) replicated and extended prior findings of an inverse association of CP and urinary E, and C) suggested provocative hypotheses for future study relating CP, trauma history, trauma recall, and cortisol reactivity.

Is Depression Best Viewed as a Continuum or Discrete Category? A Taxometric Analysis of Childhood and Adolescent Depression in a Population-Based Sample

The authors examined the latent structure of depression in a population-based sample of children and adolescents. Youth's self-reports and parents' reports of the youth's Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) major depressive symptoms were assessed via a structured clinical interview. The authors used Meehl's (1995) taxometric procedures to discern whether youth depression is dimensional or categorical. Taxometric analyses that explicitly took into account the skewness of depressive symptoms suggested that depression is a dimensional, not categorical, construct. The dimensional structure of depression was obtained for all of the DSM-IV major depressive symptoms as well as for different domains of depression (emotional distress symptoms and vegetative, involuntary defeat symptoms), youth and parent reports, and different subsamples (i.e., boys vs. girls and younger vs. older youth).

Predicting Future Antisocial Personality Disorder in Males From a Clinical Assessment in Childhood

It is essential to identify childhood predictors of adult antisocial personality disorder (APD) to target early prevention. It has variously been hypothesized that APD is predicted by childhood conduct disorder (CD), attention-deficit/hyperactivity disorder (ADHD), or both disorders. To test these competing hypotheses, the authors used data from a single childhood diagnostic assessment of 163 clinic-referred boys to predict future APD during early adulthood. Childhood Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) CD, but not ADHD, significantly predicted the boys' subsequent APD. An interaction between socioeconomic status (SES) and CD indicated that CD predicted APD only in lower SES families, however. Among children who met criteria for CD, their number of covert but not overt CD symptoms improved prediction of future APD, controlling for SES.

Three-year predictive validity of DSM-IV attention deficit hyperactivity disorder in children diagnosed at 4-6 years of age

OBJECTIVE

Predictive validity is a fundamental consideration in evaluating the DSM-IV diagnostic criteria for attention deficit hyperactivity disorder (ADHD), particularly for younger children.

METHOD

The authors conducted four annual assessments of ADHD and functional impairment using multiple informants in 255 probands and matched comparison children who were 4-6 years old in wave 1.

RESULTS

Nearly all children who met full criteria for ADHD in wave 1 met full criteria for ADHD over the next 3 years and continued to display marked functional impairment relative to comparison children, even when intelligence, co-occurring psychopathology, and demographic characteristics were controlled.

CONCLUSIONS

These findings support the validity of the DSM-IV diagnosis of ADHD in younger children by demonstrating that the symptoms and associated impairment are likely to persist well into elementary school.

The structure of child and adolescent psychopathology: generating new hypotheses

To begin to resolve conflicts among current competing taxonomies of child and adolescent psychopathology, the authors developed an interview covering the symptoms of anxiety, depression, inattention, and disruptive behavior used in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), the International Statistical Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1992), and several implicit taxonomies. This interview will be used in the future to compare the internal and external validity of alternative taxonomies. To provide an informative framework for future hypothesis-testing studies, the authors used principal factor analysis to induce new testable hypotheses regarding the structure of this item pool in a representative sample of 1,358 children and adolescents ranging in age from 4 to 17 years. The resulting hypotheses differed from the DSM-IV, particularly in suggesting that some anxiety symptoms are part of the same syndrome as depression, whereas separation anxiety, fears, and compulsions constitute a separate anxiety dimension.

Commentary: Role of Temperament in Developmental Models of Psychopathology

The articles in this special section provide exciting and useful perspectives on the role of temperament in the development of child and adolescent psychopathology. These articles are valuable both in summarizing what is known and in highlighting issues that must be addressed before further progress can be made. In the future, it will be essential to distinguish between the constructs of temperament and psychopathology in ways that are both scientifically valid and useful to the study of developmental psychopathology. In particular, because existing measures of temperament were not designed to study relations between temperament and psychopathology, new measures are needed that focus on relevant aspects of temperament and are not confounded by the inclusion of items that are close synonyms and antonyms of psychopathology. If circular and mentalistic thinking can be avoided, important advances can be expected from studies of temperament and psychopathology in the context of development.

Gun Carrying and Conduct Disorder: A Highly Combustible Combination?

OBJECTIVES

To examine concealed gun carrying between the ages of 12 and 17 years in a population of clinic-referred boys, many of whom qualified for a disruptive behavior disorder, including conduct disorder (CD); to identify factors and diagnoses related to concealed gun carrying; and to examine the extent to which gun carrying is associated with crime in adulthood.

DESIGN

Longitudinal follow-up study.

SETTING

Pittsburgh, Pa, and Athens and Atlanta, Ga.

PARTICIPANTS

One hundred seventy-seven clinic-referred boys, first assessed between the ages of 7 and 12 years and followed up yearly until the age of 19 years.

MAIN OUTCOME MEASURES

Violence, property offenses, and drug charges in adulthood.

RESULTS

Between the ages of 12 and 17 years, 1 in 5 participants carried a concealed gun, and the annual prevalence increased linearly with age. More than half (61.1%) carried a gun for 1 year only. Gun carrying was significantly (incident rate ratio, 3.93%; 95% confidence interval, 1.60-9.60) associated with CD. Conduct disorder, maternal psychopathy, victimization, and parental monitoring increased the risk of gun carrying by a factor of 8. Adult crime was best predicted by gun carrying, CD, and parental monitoring. Gun carrying predicted drug charges, but not violence or property offenses.

CONCLUSIONS

Even though the carrying of handguns by juveniles is prohibited, young men with symptoms of CD are more likely to carry guns than young men without CD. The findings are discussed in terms of the need for the inclusion of gun carrying among the symptoms of CD.

Psychopathology and substance abuse in parents of young children with attention-deficit/hyperactivity disorder

OBJECTIVE

To compare the prevalence of psychological disorders in parents of young children with and without attention-deficit/hyperactivity disorder (ADHD) and comorbid disruptive behavior disorders (DBD).

METHOD

Subjects included 98 three- to seven-year-old children with DSM-IV ADHD (68 with ADHD and comorbid oppositional defiant or conduct disorder [ADHD+ODD/CD]) and 116 non-ADHD comparison children recruited in 1995-96 during the first wave of a longitudinal study. Biological mothers were administered interviews to assess ADHD and DBD in their children and mood, anxiety, and substance use disorders in themselves. In addition, they were queried about symptoms of childhood ADHD and DBD, and antisocial personality disorder in themselves and their children's biological fathers.

RESULTS

Child ADHD was associated with increased rates of maternal and paternal childhood ADHD relative to comparison children. Child ADHD+ODD/CD was associated with maternal mood disorders, anxiety disorders, and stimulant/cocaine dependence, and paternal childhood DBD. Mothers of children with ADHD+ODD/CD also reported increased drinking problems in their children's fathers.

CONCLUSIONS

These findings indicate that many young children with ADHD, particularly those with comorbid ODD/CD, require comprehensive services to address both their ADHD and the mental health needs of their parents.

Developing strategies for psychopharmacological studies in preschool children

OBJECTIVE

To identify the obstacles and special challenges-ethical, practical, scientific, and regulatory-faced by investigators who attempt to conduct psychopharmacological studies in preschoolers.

METHOD

In a workshop held at the 47th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, featuring interactive sessions designed to elicit discussion of the theory and feasibility of research in this young population, several key domains were identified: diagnosis and assessment, ethics, research design, special considerations for preschoolers, regulatory/industry issues, and education/training.

RESULTS

A Pediatric Psychopharmacology Initiative is needed to consolidate recommendations from this and other workshops and current federal, research, and regulatory committees. A scholarly review and a guide for institutional review boards and investigators should be prepared on issues related to preschoolers. Developmental specialists provide valuable expertise that can strengthen studies of pediatric psychopharmacology. "N of 1" case studies can provide valuable information to clinicians. Only preschoolers with severe symptoms that occur in several interpersonal contexts should be entered into trials. Indications for the study of symptom complexes (e.g., aggression) rather than specific diagnoses should be examined and considered for regulatory activities. Psychopharmacology practice parameters for preschoolers are needed.

CONCLUSIONS

With preschoolers being increasingly treated with psychopharmacological agents, the need for investigations to address the safety and efficacy of these medications is becoming a central issue for researchers from many disciplines.

Sex differences in young children who meet criteria for attention deficit hyperactivity disorder

Examined sex differences in a mostly clinic-referred sample of 127 children (22 girls, 105 boys) who met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; [DSM-IV], American Psychiatric Association, 1994) criteria for attention deficit hyperactivity disorder (ADHD) and 125 comparison children (24 girls, 101 boys) matched on age, sex, and race-ethnicity. Children in both groups ranged in age from 3 years, 10 months to 7 years, 0 months. Both girls and boys who met criteria for ADHD were more impaired than same-sex controls on a variety of measures when intelligence and other types of psychopathology were controlled. Teachers reported that boys with ADHD were more inattentive and more hyperactive/impulsive than girls with ADHD. These findings suggest that the diagnosis of ADHD is valid for both girls and boys in this young age range. Young girls and boys who meet DSM-IV criteria for ADHD are more similar than different, but boys tend to display more symptoms of ADHD, particularly in school.

Waxing and waning in concert: dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 7 years among clinic-referred boys

Six waves of structured diagnostic assessments were conducted of 168 clinic-referred 7- to 12-year-olds, over 7 years. Wave-to-wave changes in the number of conduct disorder (CD) behaviors were paralleled by correlated changes in the numbers of symptoms of oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. In addition, CD in Wave 1 predicted levels of ODD, ADHD, depression, and anxiety in later waves when initial levels of those symptoms were controlled, but only ODD in Wave 1 predicted CD in later waves when initial CD levels were controlled. These findings indicate a striking degree of dynamic comorbidity between CD and other types of psychopathology and provide an initial empirical framework for needed developmental models of comorbidity.

Adolescent outcomes of childhood conduct disorder among clinic-referred boys: predictors of improvement

Much remains to be learned about the adolescent outcomes of clinic-referred boys whose childhood conduct problems are serious enough to meet diagnostic criteria for conduct disorder (CD). Six structured diagnostic assessments were conducted over 7 years of 73 clinic-referred 7-12-year-old boys who met criteria for CD in Wave 1. There were substantial individual differences in the adolescent outcomes of CD, ranging from worsening to sustained recovery, with most boys showing persistent, but fluctuating levels of CD. Improvement in CD was not accounted for by treatment or incarceration, but more positive outcomes over Waves 2-7 were predicted prospectively with substantial accuracy, using a combination of baseline predictors: less initial severity of CD, fewer symptoms of attention-deficit hyperactivity disorder, higher child verbal intelligence, greater family socioeconomic advantage, and not having antisocial biological parents.

What are adolescent antecedents to antisocial personality disorder?

BACKGROUND

This paper fills a gap because there are very few studies that prospectively predict antisocial personality disorder (APD) from psychopathology earlier in life in clinic-referred samples of young males.

METHOD

The paper addresses the continuity between conduct disorder (CD) and other forms of psychopathology during ages 13 17 and modified APD at ages 18 and 19 (modified to remove the DSM-IV requirement of pre-existing CD by age 15) in the Developmental Trends Study.

RESULTS

The results show that 82 90% of APD cases met criteria for CD at least once during ages 13 17, and very few youths who met criteria for ODD during this period progressed to APD without intermediate CD. While CD is a strong predictor of modified APD, when other factors were accounted for in regression analyses, the best predictors were callous/unemotional behaviour, depression and marijuana use. ADHD during ages 13 17 was not significant in the final model. Males with CD during adolescence who progressed to APD tended to commit more violence, as evident from their court records.

CONCLUSIONS

Implications are discussed for the conceptualization of developmental models leading to APD, the strengthening of relevant symptoms of CD predictive of APD, and preventive and remedial interventions.

A question for DSM-V: which better predicts persistent conduct disorder--delinquent acts or conduct symptoms?

BACKGROUND

Conduct disorder (CD), a psychiatric index of antisocial behaviour, shares similarities with delinquency, a criminological index. This study sought to examine which factors in childhood predict a repeated diagnosis of CD in adolescence, and whether self-reported delinquent acts enhance the utility of symptoms of CD in predicting later persistent CD.

METHOD

Longitudinal data used in this paper come from a clinic-referred sample of 177 boys, along with their parents and teachers, who were assessed using a structured clinical interview. The boys also reported on their delinquent behaviours, as well as a broad range of other family and life events.

RESULTS

Before age 13, 77 boys met criteria for CD according to their parent, 69 according to their own report, and 36 reported three or more delinquent acts. Forty-eight boys (29%) met criteria for CD three or more times between 13 and 17. In childhood, delinquency overlapped, but was distinct from CD. Both were present in 28 cases, while 41 cases had CD without delinquency, and eight had delinquency without CD. When tested as predictors of later persistent CD, child-reported CD was the strongest predictor of later persistent CD, but self-reported delinquency was stronger than parent-reported CD. A final model of significant predictors included child-reported CD, delinquency, poor child communication with parents, and maternal prenatal smoking.

CONCLUSIONS

It appears that delinquency does add uniquely to the prediction of persistent CD. It may be useful to expand the diagnostic criteria for CD accordingly.

Prevalence and correlates of antisocial behaviors among three ethnic groups

Using data from the MECA Study, this report examines the prevalence of Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), and various levels of antisocial behavior and their correlates among three ethnic groups: Hispanics, subdivided into Island Puerto Ricans and Mainland Hispanics; African Americans; and Mainland Non-Hispanic, Non-African Americans. Correlates considered include stressful life events, birth defects, low birth weight, learning difficulties, teen mothers, family environment, marital adjustment, social competence, parental monitoring, and family relationships. Logistic regression was used to determine the association of outcomes with individual correlates and of interaction terms with ethnicity. Differences between adjusted rates and observed rates of disorders and levels of antisocial behaviors are compared to estimate the extent to which each correlate explains the group differences in rates. Island Puerto Ricans had a lower prevalence of CD, ODD, and various levels of antisocial behavior than mainland Hispanics, African Americans, and non-Hispanic Whites. The lower prevalence appears to be associated with differences in the extent to which a number of these correlates are found on the island, the most salient being better family relations between the target children and their parents and siblings.

Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation

OBJECTIVE

To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts.

METHOD

The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study.

RESULTS

Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting.

CONCLUSION

Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.