Increasing Effectiveness of Cognitive Behavioral Therapy for Conduct Problems in Children and Adolescents: What Can We Learn from Neuroimaging Studies?

Lower digit length ratio and aggression in adolescents and young adults with boxer's fracture: A case-control study

Recent evidence shows that a lower second-to-fourth digit ratio (2D:4D), which is a sexually dimorphic trait and the indicator of prenatal testosterone exposure, may be associated with aggressive behaviors. In this cross-sectional, case-control study, we investigated: (1) Are the aggression and impulsivity levels and emotional problems higher? (2) Is the 2D:4D ratio lower in adolescents and young adults who presented with a fifth metacarpal neck fracture (boxer's fracture) compared to controls? (3) Is the digit ratio correlated with aggressive measures in individuals with a fifth metacarpal neck fracture? Seventy-one consecutive patients presented with a fifth metacarpal neck fracture within the age range of 11-25 years old comprised the study group. The control group consisted of 71 age and sex-matched subjects without a history of aggression-related injury. The aggression, impulsiveness, and psychosocial well-being were measured by self-reported questionnaires. 2D:4D was measured by conventional radiography. The 2D:4D ratio was similar between groups, however, when the analyses were conducted separately for sex, females in the study group showed lower 2D:4D than females in the control group (p = 0.001). The aggression level of the study group, measured by the Buss-Perry Aggression Questionnaire was higher than the control group (p = 0.014). The impulsiveness scores on the Barratt Impulsiveness Scale-11 were similar (p = 0.60) and the total difficulty score on the Strengths and Difficulties Questionnaire was higher in the study group (p = 0.009). A lower 2D:4D ratio significantly predicted verbal and total aggression scores (p = 0.036, p = 0.032, respectively). Our findings suggest that females with a history of aggression-related injury have lower 2D:4D, and a lower 2D:4D is correlated with higher aggression levels in both sexes. Understanding and addressing aggression in these patients may help prevent further self-inflicted injuries.

Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy

In cognitive behavioral therapy (CBT) children and adolescents with conduct problems learn social problem-solving skills that enable them to behave in more independent and situation appropriate ways. Empirical studies on psychological functions show that the effectiveness of CBT may be further improved by putting more emphasis on (1) recognition of the type of social situations that are problematic, (2) recognition of facial expressions in view of initiating social problem-solving, (3) effortful emotion regulation and emotion awareness, (4) behavioral inhibition and working memory, (5) interpretation of the social problem, (6) affective empathy, (7) generation of appropriate solutions, (8) outcome expectations and moral beliefs, and (9) decision-making. To improve effectiveness, CBT could be tailored to the individual child's or adolescent's impairments of these psychological functions which may depend on the type of conduct problems and their associated problems.