The Role of Reactive Aggression in the Link Between Hyperactive-Impulsive Behaviors and Peer Rejection in Adolescents

The Role of Diet and the Gut Microbiota in Reactive Aggression and Adult ADHD-An Exploratory Analysis

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition, of-ten persistent into adulthood and accompanied by reactive aggression. Associations of diet and the gut-microbiome with ADHD as well as emotional behaviors suggest potential clinical rele-vance of both. However, studies on diet and the gut-microbiome in human reactive aggression are lacking, and should investigate the interaction between diet and the gut-microbiome leading to behavioral changes to assess their potential clinical relevance. In this study, we investigated the interaction of diet and gut-microbiota with adult ADHD and reactive aggression in 77 adults with ADHD and 76 neurotypical individuals. We studied the relationships of ADHD and reactive ag-gression with dietary patterns, bacterial community and taxonomic differences of 16S-sequenced fecal microbiome samples, and potential mediating effects of bacterial genus abundance on signifi-cant diet-behavior associations. The key findings include: (1) An association of high-energy intake with reactive aggeression scores (pFDR = 4.01 × 10-02); (2) Significant associations of several genera with either reactive aggression or ADHD diagnosis with no overlap; and (3) No significant mediation effects of the selected genera on the association of reactive aggression with the high-energy diet. Our results suggest that diet and the microbiome are linked to reactive aggression and/or ADHD individually, and highlight the need to further study the way diet and the gut-microbiome inter-act.

How are irritability and anhedonia symptoms linked? A network approach

BACKGROUND

Anhedonia and irritability are two prevalent symptoms of major depressive disorder (MDD) that predict greater depression severity and poor outcomes, including suicidality. Although both symptoms have been proposed to result from paradoxical reward processing dysfunctions, the interactions between these symptoms remain unclear. Anhedonia is a multifaceted symptom reflecting impairments in multiple dimensions of reward processing (e.g., pleasure, desire, motivation, and effort) across distinct reward types (e.g., food, sensory experiences, social activities, hobbies) that may differentially interact with irritability. This study investigated the complex associations between anhedonia and irritability using network analysis.

METHOD

Participants (N = 448, Mage = 33.29, SD = 14.58) reported their symptoms of irritability on the Brief Irritability Test (Holtzman et al., 2015) and anhedonia (i.e., pleasure, desire, motivation, and effort dimensions across four reward types) on the Dimensional Anhedonia Rating Scale (Rizvi et al., 2015). A regularized Gaussian Graphical Model was built to estimate the network structure between items.

RESULTS

Irritability was negatively related to willingness to expand effort to obtain food/drinks (estimate = -0.18), social activities (-0.13), and hobbies (-0.12) rewards. Irritability was positively associated with a desire for food/drinks (0.12).

LIMITATIONS

Only a small proportion (5.8%) of our sample was clinical and the study design was cross-sectional.

CONCLUSION

A specific link between irritability and the effort dimension of the hedonic response across three reward types was identified. Investigating effort expenditure deficits with experimental paradigms may help us understand the mechanisms underlying the comorbidity between irritability and anhedonia in the context of MDD.

Reduced grey matter volume in adolescents with conduct disorder: a region-of-interest analysis using multivariate generalized linear modeling

BACKGROUND

Conduct disorder (CD) involves a group of behavioral and emotional problems that usually begins during childhood or adolescence. Structural brain alterations have been observed in CD, including the amygdala, insula, ventrolateral and medial prefrontal cortex, anterior cingulate cortex, and fusiform gyrus. The current study developed a multivariate generalized linear model (GLM) to differentiate adolescents with CD from typically developing (TD) adolescents in terms of grey matter volume (GMV).

METHODS

The whole-brain structural MRI data were collected from 96 adolescents with CD (mean age = [Formula: see text] years; mean IQ = [Formula: see text]; 63 males) and 90 TD individuals (mean age = [Formula: see text] years; mean IQ = [Formula: see text]; 59 males) matched on age, IQ, and sex. Region-wise GMV was extracted following whole-brain parcellation into 68 cortical and 14 subcortical regions for each participant. A multivariate GLM was developed to predict the GMV of the pre-hypothesized regions-of-interest (ROIs) based on CD diagnosis, with intracranial volume, age, sex, and IQ serving as the covariate.

RESULTS

A diagnosis of CD was a significant predictor for GMV in the right pars orbitalis, right insula, right superior temporal gyrus, left fusiform gyrus, and left amygdala (F(1, 180) = 5.460-10.317, p < 0.05, partial eta squared = 0.029-0.054). The CD participants had smaller GMV in these regions than the TD participants (MCD-MTD = [- 614.898] mm3-[- 53.461] mm3).

CONCLUSIONS

Altered GMV within specific regions may serve as a biomarker for the development of CD in adolescents. Clinical work can potentially target these biomarkers to treat adolescents with CD.

The Relationship Between Hostile Intent Attribution and Aggression in Japanese Children

Previous studies showed that hostile intent attribution (HIA) was significantly correlated with and contributed to the development of aggression in children. Studies that directly examined the factors that explained the relationship between HIA and aggression are lacking. Hence, this study investigated (a) the correlation between HIA and aggression and (b) the variables (hyperactivity, prosociality, and collaborative problem-solving) that mediated the relationship between HIA and aggression in Japanese children aged 4-9 years. The participants were 180 children and their caregivers. First, the caregivers reported their children's aggression, hyperactivity, prosociality, and collaborative problem-solving through questionnaires. Next, the children worked on an HIA task. The results showed a weak positive correlation between HIA and aggression. Furthermore, significant indirect effects were observed among all the mediation models. The model that contained all three mediators yielded the smallest Akaike Information Criterion value. In this model, the indirect effect was significant only for the path with hyperactivity as the mediator. These findings provide several suggestions for revealing the mechanism of the relationship between HIA and aggression during childhood. Notably, children's hyperactivity was suggested to play a particularly important role in the relationship between HIA and aggression.

Reduced Grey Matter Volume in Adolescents with Conduct Disorder: A Region-of-Interest Analysis Using Multivariate Generalized Linear Modeling

Background

Conduct disorder (CD) involves a group of behavioral and emotional problems that usually begins during childhood or adolescence. Structural brain alterations have been observed in CD, including the amygdala, insula, ventrolateral and medial prefrontal cortex, anterior cingulate cortex, and fusiform gyrus. The current study developed a multivariate generalized linear model (GLM) to differentiate adolescents with CD from typically developing (TD) adolescents in terms of grey matter volume (GMV).

Methods

The whole-brain structural MRI data were collected from 96 adolescents with CD (mean age = years; mean IQ = ; 63 males) and 90 TD individuals (mean age = years; mean IQ = ; 59 males) matched on age, IQ, and sex. Region-wise GMV was extracted following whole-brain parcellation into 68 cortical and 14 subcortical regions for each participant. A multivariate GLM was developed to predict the GMV of the pre-hypothesized regions-of-interest (ROIs) based on CD diagnosis, with intracranial volume, age, sex, and IQ serving as the covariate.

Results

A diagnosis of CD was a significant predictor for GMV in the right pars orbitalis, right insula, right superior temporal gyrus, left fusiform gyrus, and left amygdala (F(1, 180) = 5.460 - 10.317, p < 0.05, partial eta squared = 0.029 - 0.054). The CD participants had smaller GMV in these regions than the TD participants (MCD - MTD = [-614.898] mm3 - [-53.461] mm3).

Conclusions

Altered GMV within specific regions may serve as a biomarker for the development of CD in adolescents. Clinical work can potentially target these biomarkers to treat adolescents with CD.

Aggression Is Associated With Social Adaptive Functioning in Children With ASD and Anxiety

Social adaptive functioning is notably compromised and may be further impaired by aggressive behavior in children with autism spectrum disorder (ASD). This study examined the association between aggressive behavior and social adaptive skills in children with ASD and the contribution of aggressive behavior to social adaptive skills in a combined sample of children with and without ASD. Participants consisted of children, ages 8 to 15 years, with ASD (n = 52) and who were typically developing (n = 29). Results indicate that aggressive behavior is negatively associated with social adaptive skills in children with ASD and that it contributes to reduced social adaptive functioning above and beyond ASD diagnosis. Findings underscore the importance of considering the role of aggressive behavior when evaluating and promoting social functioning in children with ASD.

Consequences of Victimization on Perceived Friend Support during Adolescence

Victimization can harm youth in various ways and negatively affect their friendships with peers. Nevertheless, not all victimized youth are impacted similarly, and the literature is unclear regarding why some victims are more likely than others to experience friendship-based consequences. Using five waves of data on 901 adolescents (6th grade at wave 1; 47% male; 88% White) and a subsample of 492 victimized youth, this study assessed (1) whether victimization leads to decreases in perceived friend support, and (2) the factors that explain which victimized youth are most likely to experience decreases in perceived friend support. Explanatory factors included subsequent victimization, victims' social network status (self-reported number of friends, number of friendship nominations received), and victims' risky behaviors (affiliating with deviant friends, delinquency, aggression, binge drinking). Random effects regressions revealed that, among the full sample, victimization was linked to decreases in friend support. Among victimized youth, subsequent victimization and deviant friends decreased friend support. Having more friends was associated with increased friend support among victims, though this association weakened as the number of friends increased. The results emphasize that victimized youth are a heterogeneous group with varying risks of experiencing friendship-based consequences.

A symptom level perspective on reactive and proactive aggressive behaviours and ADHD symptoms in childhood

OBJECTIVE

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent childhood disorders, affecting around 3.4% of children worldwide. A common and impairing correlate of ADHD is aggressive behaviour. ADHD symptoms and aggression are both heterogeneous and it has been speculated that certain symptoms of ADHD might be more important in aggressive behaviours of different types than others. This study uses a symptom-level analysis to investigate the concurrent and temporal links between ADHD symptoms and aggressive behaviours.

METHODS

Using Gaussian Graphical Models and Graphical Vector Autoregression Models, longitudinal and cross-sectional networks of ADHD symptoms and aggressive behaviours, measured using parent-reported Social Behaviour Questionnaires, were estimated. Participants included 1,246 children taking part in the longitudinal Swiss z-proso cohort study at ages 7, 9 and 11.

RESULTS

The longitudinal network highlighted that ADHD symptoms and aggressive behaviours share a multitude of reciprocal temporal relations, with inattentive ADHD symptoms preceding both reactive and proactive aggression. Cross-sectional networks suggested that hyperactive/impulsive symptoms were predominantly connected to reactive aggressive behaviours but also to a form of proactive aggression, namely dominating other children.

CONCLUSION

Findings provide preliminary evidence which specific symptoms are the most promising targets for reducing aggressive behaviours in children with ADHD. They also highlight the potential importance of targeting feedback loops resulting from aggressive behaviours. Future research is needed to better understand the mechanisms through which ADHD and aggressive behaviours become linked.

Neural Correlates of Reactive Aggression in Adult Attention-Deficit/Hyperactivity Disorder

Despite not being part of the core diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), emotion dysregulation is a highly prevalent and clinically important component of (adult) ADHD. Emotionally dysregulated behaviors such as reactive aggression have a significant impact on the functional outcome in ADHD. However, little is known about the mechanisms underlying reactive aggression in ADHD. In this study, we aimed to identify the neural correlates of reactive aggression as a measure of emotionally dysregulated behavior in adults with persistent ADHD during implicit emotion regulation processes. We analyzed associations of magnetic resonance imaging-based whole-brain activity during a dynamic facial expression task with levels of reactive aggression in 78 adults with and 78 adults without ADHD, and also investigated relationships of reactive aggression with symptoms and impairments. While participants with ADHD had higher reactive aggression scores than controls, the neural activation patterns of both groups to processing of emotional faces were similar. However, investigating the brain activities associated with reactive aggression in individuals with and without ADHD showed an interaction of diagnosis and reactive aggression scores. We found high levels of activity in the right insula, the hippocampus, and middle and superior frontal areas to be particularly associated with high reactive aggression scores within the ADHD group. Furthermore, the limbic activity was associated with more hyperactivity/impulsivity symptoms. These results suggest a partly differential mechanism associated with reactive aggression in ADHD as compared to controls. Emotional hyper-reactivity in the salience network as well as more effortful top-down regulation from the self-regulation network might contribute to emotionally dysregulated behavior as measured by reactive aggression.

Reactive and proactive aggression in clinical adolescents with attention-deficit/hyperactivity disorder: The moderating role of gender and comorbidities

Aggression is well-known problem in adolescent with Attention-Deficit/Hyperactivity Disorder (ADHD), but the precise relation of reactive and proactive aggression by gender and comorbidities has not been characterized in this population. The aim of this study was to assess the level of reactive and proactive aggression in adolescents with ADHD and in matched non-ADHD clinical controls. The level of aggression was assessed by the Reactive and Proactive Aggression Questionnaire in 391 adolescents with ADHD and in 391 matched non-ADHD clinical controls. The selection of adolescents with ADHD was representative for a three-year-long period in Vadaskert Child Psychiatry Hospital. General Linear Model was used to assess the difference by ADHD, gender, and comorbidities on the level of reactive and proactive aggression. The presence of ADHD was associated with higher levels of reactive and proactive aggression. In girls, the effect of ADHD on reactive aggression was more profound. The presence of oppositional defiant disorder or conduct disorder in both groups resulted in higher levels of aggression. Our data suggest that adolescents with ADHD have higher level of aggressive behavior, and girls are especially vulnerable in terms of reactive aggressive behavior.

Correlations of impulsivity and aggressive behaviours among adolescents in Shanghai, China using bioecological model: cross-sectional data from Global Early Adolescent Study

OBJECTIVE

To examine the correlations between impulsivity and aggressive behaviours among Chinese adolescents.

DESIGN

A school-based cross-sectional study.

SETTING

Three primary middle schools located in less developed communities of Shanghai.

PARTICIPANTS

1524 adolescents aged 11-16 years.

MEASURES

The impulsivity was measured by Barratt Impulsivity Scale, and the aggressive behaviours were determined by self-reports. Data were collected through computer-assisted self-interview using tablets. Multivariate Firth logistic regression model was conducted to examine correlations between total, attentional, motor, and non-planning impulsivity and aggressive behaviours, respectively.

RESULTS

Totally, 7.48% of participants reported aggressive behaviours toward others during the past 6 months. The proportion of aggressors among boys and girls was 10.60% and 4.18%, respectively. Results of the multivariate regression suggested the risk of aggressive behaviours was significantly increased among those with the highest tertile of total impulsivity (adjusted OR (aOR)_boys=3.14, 95% CI: 1.48 to 6.65; aOR_girls=3.74, 95% CI: 1.10 to 12.76) and motor impulsivity (aOR_boys=2.91, 95% CI: 1.46 to 5.82; aOR_girls=3.57, 95% CI: 1.25 to 10.20.), comparing with those with the lowest tertile, for boys and girls, respectively. Besides, younger age, lower social cohesion and being bullied within 6 months were associated with a higher risk of aggressive behaviours among girls. Less family caring and being bullied within 6 months were associated with the risk among boys.

CONCLUSIONS

The present study indicates a positive association between impulsivity and aggressive behaviours, with a more salient correlation between motor impulsivity subtrait and aggressive behaviour among both boys and girls. Furthermore, adolescents' aggressive behaviours were affected by multiple factors from individuals, family, peers and community. Comprehensive intervention strategies such as controlling the aggressor's impulsivity, helping them better channel their anger, creating a better family, school and neighbourhood environment, and providing support and services for victims of violence are needed.

Association between attention deficit hyperactivity disorder and aggression subscales in adolescents

INTRODUCTION

The aim of this study is to identify the association between Attention Deficit Hyperactivity Disorder (ADHD) proneness and aggressive propensity in adolescents.

METHODS

A quantitative, large-scale, cross-sectional study was performed from April to May 2016 in Korea. The survey questionnaire included overall health behaviors, as well as scales for assessing ADHD proneness (revised short form of the Conners-Wells Adolescent Self-Report Scale; CASS[S]) and aggressive behavior (Buss-Perry Aggression Questionnaire; BPAQ) in adolescents. Area under the receiver operator characteristic (AUROC) curves was constructed to determine the cut-off value of total aggression score for discriminating ADHD proneness.

RESULTS

A total of 2,432 students participated in the survey, and 1,872 of them completed the questionnaire, indicating a response rate of 77.0%. Based on CASS(S), 33 (1.8%) subjects were classified as the ADHD group. AUROC curve analysis showed that a score of 68.5 points had higher sensitivity (83.3%) and specificity (69.4%) to discriminate ADHD proneness. ADHD proneness was significantly associated with higher aggression subdomain scores (physical, verbal, anger, and hostility). Especially, anger and hostility had a stronger relationship with ADHD proneness than did physical and verbal aggression. A multivariable analysis demonstrated that ADHD proneness was significantly related to body mass index in the top 10% of the study population, alcohol consumption, gastrointestinal trouble, daytime sleepiness, and total aggression score of 68.5 points or higher. Adolescents who had total aggression scores of 68.5 points or higher showed a 9.8-fold (95% confidence interval [CI] 3.3-28.8) higher risk of ADHD compared with those who had scores less than 68.5 points.

CONCLUSIONS

Our results demonstrated that ADHD proneness was significantly associated with aggression propensity. In particular, anger and hostility were more closely associated with ADHD proneness than were other aggression subdomains.

Catechol-O-Methyltransferase Gene Val158Met Polymorphism Moderates the Effect of Social Exclusion and Inclusion on Aggression in Men: Findings From a Mixed Experimental Design

Accumulating research has identified the interactive effects of catechol-O-methyltransferase (COMT) gene Val158Met polymorphism and environmental factors on aggression. However, available evidence was mainly based upon correlational design, which yields mixed findings concerning who (Val vs. Met carriers) are more affected by environmental conditions and has been challenged for the low power of analyses on gene–environment interaction. Drawing on a mixed design, we scrutinized how COMT Val158Met polymorphism (between-group variable) impacts on aggression, assessed by hostility, aggressive motivation, and aggressive behavior, under different social conditions (exclusion vs. inclusion, within-group variable) in a sample of 70 Chinese male undergraduate students. We found that both Val/Val homozygote and Met alleles carriers showed differences in the feelings of hostility and aggressive motivation under conditions of exclusion versus inclusion, but these differences were more pronounced for Met allele carriers. These findings implied that COMT Val158Met polymorphism did not respond to environmental stimuli in an all-or-none way and shed light on the importance of examining the gene–environment interaction using a mixed design.

Developmental Relations Between ADHD Symptoms and Reactive Versus Proactive Aggression Across Childhood and Adolescence

Objective: Past research has provided some preliminary evidence that ADHD and reactive aggression have overlapping neurocognitive bases. Based on this, we tested the hypothesis that ADHD symptoms are closely coupled in developmental terms with reactive aggression, more so than with proactive aggression with which it has been postulated to be only indirectly linked. Method: We used latent growth curve analysis to estimate the developmental relations between ADHD symptoms and subtypes of aggressive behavior in a normative sample of 1,571 youth (761 female, 810 male) measured from ages 7 to 15. Results: Individual ADHD trajectories were significantly and substantially correlated with individual trajectories in both aggressive subtypes; however, consistent with our hypothesis, the relation with reactive aggression was significantly stronger. Conclusion: Our study provides some of the first evidence for a differential relation between ADHD symptoms and aggression subtypes not only cross-sectionally but also in terms of their longitudinal developmental trajectories.

Dual Pathways from Reactive Aggression to Depressive Symptoms in Children: Further Examination of the Failure Model

The failure model posits that peer rejection and poor academic performance are dual pathways in the association between early aggressive behavior and subsequent depressive symptoms. We examined this model using an accelerated longitudinal design while also incorporating proactive and reactive aggression and gender moderation. Children in 1st, 3rd, and 5th grades (n = 912; ages 6-12; 48% female) were rated three times annually by their primary teachers on measures of proactive and reactive aggression, peer rejection, academic performance, and depressive symptoms. Using Bayesian cross-classified estimation to account for nested and planned-missing data, path models were estimated to examine whether early reactive aggression predicted subsequent peer rejection and academic performance, and whether these, in turn, predicted subsequent depressive symptoms. From 1st to 3rd grade, reactive aggression predicted peer rejection (not academic performance), proactive aggression predicted academic performance (not peer rejection), and academic performance and peer rejection both predicted depressive symptoms. From 3rd to 5th grade, however, neither peer rejection nor academic performance predicted subsequent depressive symptoms. Results were not moderated by gender. Overall, these findings provide mixed and limited support for the failure model among school-age children. Early reactive aggression may be a key risk factor for social problems, whereas proactive aggression may be linked to improved academic functioning. The "dual pathways" of peer rejection and academic performance may operate during early but not later elementary school. Limitations and implications are discussed.

[Observation and comparison of social abilities in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder children]

OBJECTIVES

Different studies centered on social relationship issues among ADHD children struggled to provide a unicist explanation between primary social cognition process alteration on the one hand and a mere symptomatic outcome of the disorder triad on the other. Some authors support the idea of a potential "social phenotype" shared at a different intensity by Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). The point of the study is to characterize this possible social disability in a French ADHD population and compare it to control subjects and subjects with Autism Spectrum Disorder (ASD).

METHODS

Three groups, composed of 319 subjects aged 6 to 12 years, were recruited in Bordeaux: 88 untreated ADHD subjects, 24 ASD subjects and 207 control subjects. The main measure was the social skill disruption through the rating of the Social Responsiveness Scale (SRS). The ADHD-RS-IV, WFIRS-P and CBCL scales were also used.

RESULTS

Asignificant alteration in social abilities in ADHD children in comparison with controls was noted, with an average raw total SRS score intermediary between the control group and the ASD group (respectively 65.31±20.99, 37.15±16.37 and 95 75±30.83, P<0.05). When the 5 sub-scores of the SRS were taken into account, if the ASD subjects showed the highest average scores, the alteration pattern appeared qualitatively similar between the ADHD and TSA groups, with also an intermediate dispersion for the ADHD group between the control group and the group with ASD. Finally, more severe impairment of social skills in children with ADHD was associated with increased severity of the disorder (on ADHD-RS-IV scale cotation), higher daily functional impact (WFIRS-P scale), and more frequent behavioral issues (according to CBCL).

CONCLUSIONS

Our results suggest the presence of social disturbances in ADHD and characterize a symptomatic profile qualitatively similar to that of ASD, but of less intensity. Overall results promote a need for a systematic dimensional assessment of social disability in ADHD.

Examining ODD/ADHD Symptom Dimensions as Predictors of Social, Emotional, and Academic Trajectories in Middle Childhood

The goal of this article is to investigate the symptom dimensions of oppositional defiant disorder (ODD; irritability, defiance) and attention deficit/hyperactivity disorder (ADHD; inattention, hyperactivity-impulsivity) as predictors of academic performance, depressive symptoms, and peer functioning in middle childhood. Children (N = 346; 51% female) were assessed via teacher-report on measures of ODD/ADHD symptoms at baseline (Grades K-2) and academic performance, depressive symptoms, peer rejection, and victimization on 7 occasions over 4 school years (K-2 through 3-5). Self-report and grade point average data collected in Grades 3-5 served as converging outcome measures. Latent growth curve and multiple regression models were estimated using a hierarchical/sensitivity approach to assess robustness and specificity of effects. Irritability predicted higher baseline depressive symptoms, peer rejection, and victimization, whereas defiance predicted higher baseline peer rejection; however, none of these ODD-related effects persisted 3 years later to Grades 3-5. In contrast, inattention predicted persistently poorer academic performance, persistently higher depressive symptoms, and higher baseline victimization; hyperactivity-impulsivity predicted subsequent peer rejection and victimization in Grades 3-5. In converging models, only inattention emerged as a robust predictor of 3-year outcomes (viz., grade point average, depressive symptoms, peer rejection, and relational victimization). Broadly, ODD dimensions-particularly irritability-may be linked to acute disturbances in social-emotional functioning in school-age children, whereas ADHD dimensions may predict more persistent patterns of peer, affective, and academic problems. By examining all 4 ODD/ADHD symptom dimensions simultaneously, the present analyses offer clarity and specificity regarding which dimensions affect what outcomes, and when. Findings underscore the importance of multidimensional approaches to research, assessment, and intervention.

Borderline Personality Features Mediate the Association Between ADHD, ODD, and Relational and Physical Aggression in Girls

OBJECTIVE

This study investigates borderline personality features (BPF) as a mediator of the association between ADHD and ODD symptoms and aggression in girls.

METHOD

Parents of 118 girls ( M_age = 11.40 years old) with and without ADHD completed ratings of ADHD and ODD severity, and parents and youth provided ratings of physical and relational aggression.

RESULTS

ADHD, ODD, and their subfactors were significantly correlated with BPF, and these variables were associated with aggression measures. BPF fully mediated the association between total ODD symptom severity and relational and physical aggression by parent and youth report. At the subfactor level, BPF fully mediated the association between hyperactivity/impulsivity and oppositional behavior and physical and relational aggression.

CONCLUSION

These findings add to a growing literature showing the relevance of BPF as a risk factor for poor social functioning in youth and point to the importance of continued work examining BPF among girls with ADHD and ODD.

Aggression Predicts Changes in Peer Victimization that Vary by Form and Function

Peer victimization is predictive of serious problems in adjustment, especially among children who are both victimized and aggressive. This study investigated how different types of aggression contribute to later victimization. Specifically, we examined prospective relationships between the types of aggression that children perpetrated and the types that they experienced at the hands of others. Trained observers coded schoolyard behavior of 553 children in grades 3-6 during the initial year of a bullying intervention program. Both observed aggression and victimization were specified by form (direct, indirect) and function (proactive, reactive). Total hourly rates of victimization were highest in the upper grades. Direct-reactive aggression uniquely predicted increases in victimization, while direct-proactive aggression predicted decreases, particularly in direct-proactive victimization. Indirect-proactive aggression (e.g., derogatory gossip) predicted increases in indirect-proactive victimization only in the control group. Indirect-reactive aggression and victimization occurred too rarely to detect change. Aggression-victimization relationships did not differ for boys and girls. Discussion considers why children might risk direct reactive aggression in the face of increased victimization. Different sequelae for different forms and functions of aggression highlight the need to resolve theoretical ambiguities in defining proactive and reactive aggression.

Testing the exacerbation and attenuation hypotheses of the role of anxiety in the relation between ADHD and reactive/proactive aggression: A 10-year longitudinal study

Both anxiety and aggression commonly co-occur with ADHD symptoms. Two competing hypotheses describing the role of anxiety in aggression associated with ADHD symptoms have previously been advanced. The exacerbation hypothesis proposes that the presence of anxiety increases the risk of aggression in the context of ADHD symptoms. The attenuation hypothesis proposes that the presence of anxiety protects against aggression in the context of ADHD symptoms. We tested these hypotheses using moderated cross-lagged panel models in the Zurich project on social development from childhood to adulthood (z-proso) sample using both self-report (3 waves) and informant-report (8 waves) data spanning ages 7-17. We found evidence that anxiety protects against both reactive and proactive aggression; however, the effect was direct: there was no evidence for anxiety moderating the strength of ADHD symptom-aggression links. Results suggest that anxiety likely plays an important role in inhibiting aggression but does not interact with ADHD symptoms in the manner predicted by either the exacerbation or attenuation hypothesis.

Does level of attention deficit-hyperactivity disorder symptoms predicts poor transition into adulthood?

OBJECTIVES

Transition into adulthood is a risky period for young people with attention deficit-hyperactivity disorder (ADHD), but empirical studies on this topic are scarce. This study investigated the association between the level of ADHD symptoms and transition into adulthood.

METHODS

Data were collected in the Cohort Study of Substance Use and Risk Factors among a representative sample of young Swiss men (n = 4681) over three waves. Measures included the level of ADHD symptoms and emerging adulthood assessed with the Inventory of the Dimensions of Emerging Adulthood and indicators of successful transition into adulthood.

RESULTS

The level of ADHD symptoms was associated with a lower success in the transition into adulthood. Young people with high level of ADHD symptoms had a reduced increase in indicators of successful transition over time. Inattention symptoms were more strongly associated with emerging adulthood measures in comparison with hyperactive symptoms.

CONCLUSIONS

The level of ADHD symptoms may delay the transition into adulthood, especially inattentive symptoms. Providing tailored interventions to emerging adults with ADHD symptoms may decrease the substantial impairments adults with ADHD experience in life.

Social-emotional competence and early adolescents' peer acceptance in school: Examining the role of afternoon cortisol

The present study investigated the role of afternoon cortisol in social-emotional competence and peer acceptance in early adolescence. To date, research on basal cortisol activity and social development in childhood and adolescence has predominately focused on understanding maladjustment and dysfunction in development. The degree to which basal cortisol is also involved in positive adjustment and social functioning remains largely unexplored. A total of 154 early adolescents (46% female; Mean age = 11.26; SD = .65) from diverse ethnic backgrounds provided self-reports of perspective taking, peer reports of acceptance by classmates, peer reports of prosocial behaviors, and saliva samples to assess basal cortisol. As expected and in alignment with previous research, afternoon cortisol, perspective taking, prosocial behaviors, and peer acceptance were all positively correlated. Path analyses followed by bootstrapping analyses revealed that the direct path from higher afternoon cortisol to higher levels of prosocial behavior was fully mediated by perspective taking skills. The direct path from higher afternoon cortisol to peer acceptance was fully mediated by perspective taking skills and prosocial behavior. The findings are discussed within the broader context of previous research on cortisol and social adjustment in childhood and early adolescence. The practical relevance of the findings is considered.

Testing a Higher Order Model of Internalizing and Externalizing Behavior: The Role of Aggression Subtypes

This study assessed how the forms and functions of aggression fit into a higher order model of internalizing and externalizing behavior, for children in early childhood (N = 332, M age = 47.11 months, SD = 7.32). The lower order internalizing factors were depressed affect, anxious-fearfulness, and asocial behavior (i.e., social withdrawal) and the lower order externalizing factors were deception and hyperactivity. The forms and functions of aggression were crossed to create four factors: reactive relational, reactive physical, proactive relational, and proactive physical aggression. Seven confirmatory factor models were tested. Results supported a two-factor externalizing model where reactive and proactive relational aggression and deception loaded on one externalizing factor and reactive and proactive physical aggression and hyperactivity loaded on another externalizing factor.

Moral Disengagement as Mediator and Moderator of the Relation Between Empathy and Aggression Among Chinese Male Juvenile Delinquents

The link between empathy and aggression is well documented; yet, studies examining potential mechanisms that explain this association are limited. In the present study, we tested the relation between empathy and aggression and examined both the mediating and moderating effects of moral disengagement on this relation among Chinese male juvenile delinquents. Three hundred and fifty-seven male juvenile delinquents from one Chinese juvenile correctional facility completed the interpersonal reactivity index, the moral disengagement scale and the aggression questionnaire. The results indicated that moral disengagement partially mediated the influence of empathy on aggression. Moreover, moral disengagement moderated the relation between empathy and aggression. Specifically, there was a significant negative relation between empathy and aggression at low levels of moral disengagement. However, at high levels of moral disengagement, the relation between empathy and aggression was non-significant. The significance and limitations of the results are discussed.

Social Functioning in Children With or At Risk for Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Considerable work has demonstrated significant impairment in social functioning for children with attention deficit/hyperactivity disorder (ADHD). The social functioning profiles of children with ADHD are marked by impairments across diverse domains as they tend to experience greater rates of peer rejection, have lower levels of social skills, and have impaired social cognitions. The purpose of this study was to (a) quantitatively examine the association between ADHD and deficits across several domains of social functioning (peer functioning, social skills, social information processing), (b) examine differences in the magnitude of such associations, and (c) examine the effect of potential moderators. A meta-analysis of 109 studies (n = 104,813) revealed that children with ADHD have the most impairment within the peer functioning domain (weighted effect size [ES] r = .33) followed by significantly smaller effects within the social skills (weighted ES r = .27) and social information-processing domains (weighted ES r = .27). When examining potential moderators, results revealed that the association between ADHD and deficits within the social skills domain was weaker among studies that controlled for co-occurring conduct problems (CP). Studies that utilized sociometric and teacher reports of peer status reported the largest effects within the peer functioning domain. In addition, studies that utilized the "gold standard" approach to diagnosing ADHD documented the largest effects within both the social skills and peer functioning domains. Last, studies utilizing younger samples revealed the largest effects for deficits within the peer functioning domain. Theoretical and clinical implications are discussed.

The Moderating Effect of Physical Activity on the Association Between ADHD Symptoms and Peer Victimization in Middle Childhood

Previous research has demonstrated that symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with higher levels of victimization, but little is known about protective factors. The purpose of the study was to examine whether physical activity attenuated the associations among ADHD symptoms and physical and relational victimization 1.5 years later. Participants included 168 s through fourth grade students (M age = 8.43; 52.4 % boys) who completed self-reports of physical activity and victimization; teachers provided ratings of ADHD symptoms. ADHD symptoms predicted subsequent increases in physical, but not relational, victimization among children who reported engaging in moderate/high levels of physical activity, especially out of the school context (moderate: β = .26, p = .03; high: β = .55, p < .001). Findings suggest that children with ADHD symptoms may benefit from being taught the skills necessary to appropriately engage in physical activity and from being monitored while engaging in activity in order to limit physical victimization that they might experience.

Self-Reported Emotion Reactivity Among Early-Adolescent Girls: Evidence for Convergent and Discriminant Validity in an Urban Community Sample

Emotion reactivity, measured via the self-report Emotion Reactivity Scale (ERS), has shown unique associations with different forms of psychopathology and suicidal thoughts and behaviors; however, this limited body of research has been conducted among adults and older adolescents of predominantly White/European ethnic backgrounds. The present study investigated the validity of ERS scores for measuring emotion reactivity among an urban community sample of middle-school-age girls. Participants (N = 93, ages 11-15, 76% African-American, 18% Latina) completed the ERS and measures of emotion coping, internalizing problems, proactive and reactive aggression, negative life events, and lifetime suicidal ideation and substance use. As hypothesized, ERS scores were significantly associated with internalizing problems, poor emotion coping, negative life events, reactive aggression, and suicidal ideation (evidence for convergent validity), but showed little to no association with proactive aggression or lifetime substance use (evidence for discriminant validity). A series of logistic regressions were conducted to further explore the associations among internalizing problems, emotion reactivity, and suicidal ideation. With depressive symptoms included in the model, emotion reactivity was no longer uniquely predictive of lifetime suicidal ideation, nor did it serve as a moderator of other associations. In conjunction with previous research, these findings offer further support for the construct validity and research utility of the ERS as a self-report measure of emotion reactivity in adolescents.

Impulsive Aggression as a Comorbidity of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

OBJECTIVE

This article examines the characteristics of impulsive aggression (IA) as a comorbidity in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), focusing on its incidence, impact on ADHD outcomes, need for timely intervention, and limitations of current treatment practices.

METHODS

Relevant literature was retrieved with electronic searches in PubMed and PsycINFO using the search strategy of "ADHD OR attention deficit hyperactivity disorder" AND "impulsive aggression OR reactive aggression OR hostile aggression OR overt aggression" AND "pediatric OR childhood OR children OR pre-adolescent OR adolescent" with separate searches using review OR clinical trial as search limits. Key articles published before the 2007 Expert Consensus Report on IA were identified using citation analysis.

RESULTS

More than 50% of preadolescents with ADHD combined subtype reportedly display clinically significant aggression, with impulsive aggression being the predominant subtype. Impulsive aggression is strongly predictive of a highly unfavorable developmental trajectory characterized by the potential for persistent ADHD, increasing psychosocial burden, accumulating comorbidities, serious lifelong functional deficits across a broad range of domains, delinquency/criminality, and adult antisocial behavior. Impulsive aggression, which triggers peer rejection and a vicious cycle of escalating dysfunction, may be a key factor in unfavorable psychosocial outcomes attributed to ADHD. Because severe aggressive behavior does not remit in many children when treated with primary ADHD therapy (i.e., stimulants and behavioral therapy), a common practice is to add medication of a different class to specifically target aggressive behavior.

CONCLUSIONS

Impulsive aggression in children and adolescents with ADHD is a serious clinical and public health problem. Although adjunctive therapy with an aggression-targeted agent is widely recommended when aggressive behaviors do not remit with primary ADHD therapy, empirical evidence does not currently support the use of any specific agent. Randomized controlled trials are needed to identify aggression-targeted agents with favorable benefit-risk profiles.

Control your anger! The neural basis of aggression regulation in response to negative social feedback

Negative social feedback often generates aggressive feelings and behavior. Prior studies have investigated the neural basis of negative social feedback, but the underlying neural mechanisms of aggression regulation following negative social feedback remain largely undiscovered. In the current study, participants viewed pictures of peers with feedback (positive, neutral or negative) to the participant's personal profile. Next, participants responded to the peer feedback by pressing a button, thereby producing a loud noise toward the peer, as an index of aggression. Behavioral analyses showed that negative feedback led to more aggression (longer noise blasts). Conjunction neuroimaging analyses revealed that both positive and negative feedback were associated with increased activity in the medial prefrontal cortex (PFC) and bilateral insula. In addition, more activation in the right dorsal lateral PFC (dlPFC) during negative feedback vs neutral feedback was associated with shorter noise blasts in response to negative social feedback, suggesting a potential role of dlPFC in aggression regulation, or top-down control over affective impulsive actions. This study demonstrates a role of the dlPFC in the regulation of aggressive social behavior.