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Masi G, Carucci S, Muratori P, Balia C, Sesso G, Milone A. Contemporary diagnosis and treatment of conduct disorder in youth. Expert Rev Neurother 2023; 23:1277-1296. [PMID: 37853718 DOI: 10.1080/14737175.2023.2271169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories. AREAS COVERED The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators. EXPERT OPINION Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.
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Affiliation(s)
- Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Sara Carucci
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Pietro Muratori
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Carla Balia
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Gianluca Sesso
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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Aebi M, Haynes M, Bessler C, Hasler G. Associations of interpersonal trust with juvenile offending/conduct disorder, callous-unemotional traits, and criminal recidivism. Sci Rep 2022; 12:7594. [PMID: 35534545 PMCID: PMC9085823 DOI: 10.1038/s41598-022-11777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Interpersonal trust has been described as a core dimension of cooperative, mutually beneficial interpersonal relationships but it is unclear if it is related to antisocial behaviours in youth. The present study aimed at analysing a subsample of male juveniles who committed serious violent offenses and met criteria of conduct disorder (JO/CD), and a subsample of healthy controls (HC) using a series of trust games (TGs). Twenty-four male JO/CD and 24 age matched male HC performed a series of eight one-shot TGs against different unknown human respectively computer opponents. Mixed model analyses found a non-significant trend that JO/CD invested less points than HC during TGs. In the subsample of JO/CD, the overall investment in TGs was found to be negatively associated with self-reported uncaring behaviours and officially reported general re-offenses. Our findings suggest some indication of an impaired ability of JO/CD to initiate mutually trusting relationships to others that should be addressed in further research. Trust is a promising factor to predict general criminal recidivism and can be a target for treatment of juveniles who committed violent offenses, for example through the building of stable relationships to care givers. This study encourages future studies to investigate the effects of trust-increasing psychosocial interventions.
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Affiliation(s)
- Marcel Aebi
- Research and Development, Corrections and Rehabilitation, Department of Justice and Home Affairs, Canton of Zurich, Hohlstr. 552, 8090, Zurich, Switzerland. .,Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich/University of Zurich, Zurich, Switzerland.
| | - Melanie Haynes
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy Bern, Bern, Switzerland
| | - Cornelia Bessler
- Research and Development, Corrections and Rehabilitation, Department of Justice and Home Affairs, Canton of Zurich, Hohlstr. 552, 8090, Zurich, Switzerland.,Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich/University of Zurich, Zurich, Switzerland
| | - Gregor Hasler
- Unit of Psychiatry Research, University of Fribourg, Fribourg, Switzerland
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Barra S, Turner D, Müller M, Hertz PG, Retz-Junginger P, Tüscher O, Huss M, Retz W. ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders. Eur Arch Psychiatry Clin Neurosci 2022; 272:257-269. [PMID: 32780159 PMCID: PMC8866272 DOI: 10.1007/s00406-020-01181-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 02/07/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and co-existing psychiatric/psychological impairments as well as adverse childhood experiences (ACEs) are common among young offenders. Research on their associations is of major importance for early intervention and crime prevention. Intermittent explosive disorder (IED) warrants specific consideration in this regard. To gain sophisticated insights into the occurrence and associations of ADHD, IED, ACEs, and further psychiatric/psychological impairments in young (male and female) offenders, we used latent profile analysis (LPA) to empirically derive subtypes among 156 young offenders who were at an early stage of crime development based on their self-reported ADHD symptoms, and combined those with the presence of IED. We found four distinct ADHD subtypes that differed rather quantitatively than qualitatively (very low, low, moderate, and severe symptomatology). Additional IED, ACEs, and further internalizing and externalizing problems were found most frequently in the severe ADHD subtype. Furthermore, females were over-represented in the severe ADHD subtype. Finally, ACEs predicted high ADHD symptomatology with co-existing IED, but not without IED. Because ACEs were positively associated with the occurrence of ADHD/IED and ADHD is one important risk factor for on-going criminal behaviors, our findings highlight the need for early identification of ACEs and ADHD/IED in young offenders to identify those adolescents who are at increased risk for long-lasting criminal careers. Furthermore, they contribute to the debate about how to best conceptualize ADHD regarding further emotional and behavioral disturbances.
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Affiliation(s)
- Steffen Barra
- Institute for Forensic Psychology and Psychiatry, Saarland University Hospital, Kirrberger Str. 100, 66421, Homburg, Germany.
| | - Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus Müller
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Priscilla Gregorio Hertz
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University Hospital, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University Hospital, Kirrberger Str. 100, 66421, Homburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Barra S, Aebi M, d’Huart D, Schmeck K, Schmid M, Boonmann C. Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1227. [PMID: 35162246 PMCID: PMC8835310 DOI: 10.3390/ijerph19031227] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/20/2022]
Abstract
Despite high rates of adverse childhood experiences (ACEs) and personality-related disturbances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowledge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or juvenile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime.
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Affiliation(s)
- Steffen Barra
- Institute for Forensic Psychology and Psychiatry, Saarland University Hospital, Kirrberger Str. 100, 66421 Homburg, Germany
| | - Marcel Aebi
- Research & Development, Corrections and Rehabilitation, Department of Justice and Home Affairs, Hohlstrasse 552, 8090 Zurich, Switzerland;
- Child and Adolescent Psychiatry, Medical Faculty, University of Zurich, Neumuensterallee 3, 8032 Zurich, Switzerland
| | - Delfine d’Huart
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Delfine.d' (D.d.); (K.S.); (M.S.); (C.B.)
- Department of Forensic Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
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Gregório Hertz P, Müller M, Barra S, Turner D, Rettenberger M, Retz W. The predictive and incremental validity of ADHD beyond the VRAG-R in a high-risk sample of young offenders. Eur Arch Psychiatry Clin Neurosci 2022; 272:1469-1479. [PMID: 34860261 PMCID: PMC9653327 DOI: 10.1007/s00406-021-01352-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/08/2021] [Indexed: 12/26/2022]
Abstract
The VRAG-R is a well-established actuarial risk-assessment instrument, which was originally developed for assessing violent recidivism risk in adult male offenders. Whether or not the VRAG-R can also predict violent recidivism in young offenders is unclear so far. In the emergence of juvenile offending, attention-deficit/hyperactivity disorder (ADHD) seems to be of major importance suggesting that it could be relevant for risk assessment as well. Thus, we examined the predictive accuracy of the VRAG-R in a high-risk sample of N = 106 (M = 18.3 years, SD = 1.8) young offenders and assessed the incremental predictive validity of ADHD symptomatology beyond the VRAG-R. Within a mean follow-up time of M = 13 years (SD = 1.2), n = 65 (62.5%) young offenders recidivated with a violent offense. We found large effect sizes for the prediction of violent and general recidivism and re-incarcerations using the VRAG-R sum scores. Current ADHD symptomatology added incremental predictive validity beyond the VRAG-R sum scores concerning the prediction of general recidivism but not of violent recidivism. The results supported the use of the VRAG-R for predicting violent recidivism in young offenders. Because ADHD symptomatology improves the predictive performance of the VRAG-R regarding general recidivism, we argue that addressing ADHD symptoms more intensively in the juvenile justice system is of particular importance concerning a successful long-term risk management in adolescents and young adults.
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Affiliation(s)
- Priscilla Gregório Hertz
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany.
| | - Marcus Müller
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - Steffen Barra
- Institute for Forensic Psychology and Psychiatry, University Hospital, Homburg, Saarland Germany
| | - Daniel Turner
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
| | - Martin Rettenberger
- Centre for Criminology, Kriminologische Zentralstelle-KrimZ, Wiesbaden, Germany ,grid.5802.f0000 0001 1941 7111Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Wolfgang Retz
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany ,Institute for Forensic Psychology and Psychiatry, University Hospital, Homburg, Saarland Germany
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Barra S, Turner D, Retz-Junginger P, Hertz PG, Rösler M, Retz W. Mental Health in Young Detainees Predicts Perpetration of and Desistance From Serious, Violent and Chronic Offending. Front Psychiatry 2022; 13:893460. [PMID: 35782447 PMCID: PMC9240463 DOI: 10.3389/fpsyt.2022.893460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Mental health problems are common among young offenders but their role in predicting criminal recidivism is still not clear. Early identification and treatment of young offenders at risk of serious, violent, and chronic (SVC) offending is of major importance to increase their chances to develop into a healthy and non-criminal future and protect society from further crime. In the present study, we assessed mental health among 106 young offenders while incarcerated and analyzed their criminal careers up to 15 years after release. We found high rates of mental health issues, especially externalizing problems, but also concerning illegal substance and alcohol use patterns as well as personality disorders. Rule-breaking behavior and internalizing problems were negatively related to incarceration time until study assessment, but withdrawal and internalizing problems were positively associated with remaining time to release. Whereas, SVC status before assessment and after release were not statistically dependent, mental health issues predicted perpetration of and desistance from SVC offending after release. Alarming alcohol use appeared to be of specific importance in this regard. Findings indicate that young offenders at risk of future SVC offending may benefit from mental health treatment with specific focus on problematic alcohol consumption to prevent ongoing crime perpetration.
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Affiliation(s)
- Steffen Barra
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Germany
| | - Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Germany
| | - Priscilla Gregorio Hertz
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Rösler
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Germany
| | - Wolfgang Retz
- Institute for Forensic Psychology and Psychiatry, Saarland University, Homburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Köck P, Meyer M, Elsner J, Dürsteler KM, Vogel M, Walter M. Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders - A Narrative Review. Front Psychiatry 2022; 13:827658. [PMID: 35280170 PMCID: PMC8907594 DOI: 10.3389/fpsyt.2022.827658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Adolescence and emerging adulthood are often referred to as youth. Transitional psychiatry addresses this target group, which considers patients between 15 and 25 years of age. Substance use usually begins and peaks at this stage of life. Psychiatric disorders, foremost attention-deficit/hyperactivity disorder, and affective disorders, conduct disorders, and first-episodes psychosis frequently appear in early life stages. This review aims to provide a broad overview of transitional-aged youth's most common psychiatric comorbidities with substance use disorders. A literature search was conducted in Embase and Pubmed, and the main findings are described narratively. We present main findings for the following comorbidities: attention-deficit/hyperactivity disorder, conduct disorder, personality disorders, affective disorders, psychotic disorders, and the phenomena of overdose and suicidality. In conclusion, co-occurring mental health disorders are common and appear to facilitate the development of substance use disorders and exacerbate their overall course. Substance use also affects the severity and course of comorbid psychiatric disorders. Overall, data on transition-age youth with substance use disorders are highly inconsistent. Universal screening and treatment guidelines do not yet exist but should be aimed for in the future.
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Affiliation(s)
- Patrick Köck
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Maximilian Meyer
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Julie Elsner
- University Psychiatric Clinics Basel, Clinic for Children and Adolescents, University of Basel, Basel, Switzerland
| | - Kenneth M Dürsteler
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Marc Vogel
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Division of Substance Use Disorders, Psychiatric Clinic, Psychiatric Services of Thurgovia, Münsterlingen, Switzerland
| | - Marc Walter
- Department of Addictive Disorders, University Psychiatric Clinics Basel, Basel, Switzerland.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
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Georgiou SN, Charalambous K, Stavrinides P. The mediating effects of adolescents’ internalizing and externalizing problems on the relationship between emotion regulation, mindfulness and bullying/victimization at school. SCHOOL PSYCHOLOGY INTERNATIONAL 2021. [DOI: 10.1177/01430343211035420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was two-fold: to investigate the relationship between emotion regulation, dispositional mindfulness and bullying/victimization experiences at school, and to examine the mediating effects of internalizing and externalizing problems on this relationship. Self-reports measuring the above variables were completed by 444 adolescents (mean age 15.3) who attended high school in Cyprus. Data were collected at three points in time. Specifically, data were collected during the second week of October, 2018 (T1), the third week of January, 2019 (T2) and the first week of June, 2019 (T3). It was found that mindfulness at T1 had a significant negative effect on both internalizing and externalizing symptoms and through these variables, it had an indirect negative effect on both bullying and victimization at T3. Similarly, adaptive emotion regulation at T1 had an indirect effect on victimization, fully mediated by internalizing problems. In contrast, maladaptive emotion regulation had a positive, direct effect on both bullying and victimization.
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