Affective decision-making and externalizing behaviors: the role of autonomic activity

The relationship between mental health and risky decision-making in children and adolescents: a scoping review

BACKGROUND

Evidence from studies on adult participants and clinical samples of children suggest an association between risky decision-making and mental health problems. However, the extent and nature of this association in the general youth population remains unknown. Therefore, this scoping review explores the current evidence on the relationship between mental health (internalising and externalising symptoms) and risky decision-making in the general youth population.

METHODS

A three-step search strategy was followed and applied to four databases. Selection criteria included participants < 18 years representative of the general population, and information on both risky decision-making (assessed using gambling tasks) and internalising /externalising symptoms. Data were extracted and synthesised for study and participant characteristics, aspects and measures for the main variables, and key findings.

RESULTS

Following screening, twenty-one studies were retrieved. Non-significant associations were more frequent than significant associations for both internalising and externalising symptoms, particularly for social difficulties and broad externalising symptoms. Among the significant associations, hyperactivity/inattention and conduct problems appeared to be positively associated with risk-taking and negatively associated with quality of decision-making. However, patterns were less clear for links between risky decision-making and internalising symptoms, especially between risk-taking and anxiety symptoms.

CONCLUSIONS

The present review suggests predominantly a lack of relationship between risky decision-making and mental health problems, and outlines several possible reasons for it. However, when specificity is considered carefully there seems to be a link between risk-taking and specific externalising problems. Future research should employ study designs aimed at disentangling the direction of this relationship and identifying specific aspects of mental health and risky decision-making that could be eventually addressed by tailored interventions.

The role of primary school composition in affective decision-making: a prospective cohort study

PURPOSE

School-level characteristics are known to be associated with pupils' academic and cognitive ability but also their socioemotional development. This study examines, for the first time, whether primary school characteristics are associated with pupils' affective decision-making too.

METHODS

The sample included 3,141 children participating in the Millennium Cohort Study with available data on their school's characteristics, according to the National Pupil Database, at age 7 years. Decision-making was measured using the Cambridge Gambling Task at age 11 years. We modelled data using a series of sex-stratified linear regression analyses of decision-making (risk-taking, quality of decision-making, risk adjustment, deliberation time, and delay aversion) against four indicators of school composition (academic performance and proportions among pupils who are native speakers of English, are eligible for free school meals and have special educational needs).

RESULTS

After adjustment for individual and family-level confounding, schools with a higher average academic performance showed more delay aversion among males, and among females, higher deliberation time and lower risk-taking. Schools with proportionally more native English speakers had higher deliberation time among males. Schools with proportionally more pupils eligible for free school meals showed lower scores on quality of decision-making among males. Schools with proportionally more children with special educational needs showed better quality of decision-making among males and lower risk-taking among females.

CONCLUSION

The findings of this study can be used to target support for primary schools. Interventions aiming to support lower-achieving schools and those with less affluent intakes could help to improve boys' affective decision-making.

Conduct problems among children in low-income, urban neighborhoods: A developmental psychopathology- and RDoC-informed approach

Conduct problems are associated with numerous negative long-term psychosocial sequelae and are among the most frequent referrals for children's mental health services. Youth residing in low-income, urban communities are at increased risk for conduct problems, but not all youth in these environments develop conduct problems, suggesting heterogeneity in risk and resilience processes and developmental pathways. The present study used a developmental psychopathology- and Research Domain Criteria (RDoC)-informed approach for conceptualizing risk and resilience for conduct problems among children from low-income, urban neighborhoods. Participants were 104 children (M = 9.93 ± 1.22 years; 50% male; 96% African American, 4% Latinx). We assessed four constructs reflecting cognitive and neurobiological processes associated with conduct problems using multiple levels of analysis and informants: autonomic nervous system reactivity, limbic system/orbitofrontal cortical functioning, dorsolateral prefrontal cortical functioning, and conduct problems. Latent profile analysis identified four profiles: typically developing (TD, n = 34); teacher-reported conduct problems (TCP, n = 14); emotion processing (EP, n = 27); and emotion expression recognition (EER, n = 29). External validation analyses demonstrated that profiles differed on various indices of conduct problems in expected ways. The EP profile exhibited lower levels of emotional lability and callous–unemotional behaviors, and higher levels of prosocial behavior. The TD profile demonstrated elevated emotional lability. Implications for etiological and intervention models are presented.

Community Violence Exposure and Youth Aggression: The Moderating Role of Working Memory

Community violence exposure (CVE) is associated with aggression among youth, particularly those who reside in low-income, urban neighborhoods. However, not all youth who experience CVE exhibit aggression. Working memory (WM) difficulties may interfere with attributions or retrieval of nonaggressive responses, suggesting that individual differences in WM may contribute to proactive and/or reactive aggression among youth who experience CVE. Participants were 104 low-income, urban youth (M = 9.92 ± 1.22 years old; 50.5% male; 95% African American). Youth reported on frequency of direct victimization and witnessing of violence in the community and completed two WM tasks. Teachers reported on youth proactive and reactive aggression. WM moderated the relation between direct victimization and proactive and reactive aggression, and between witnessing violence and reactive aggression. Among youth reporting less frequent victimization and witnessing, lower WM was associated with higher levels of proactive and reactive aggression. Among youth reporting more frequent direct victimization, lower WM was associated with higher levels of proactive aggression. Proactive and reactive aggression levels were similar among youth reporting more frequent witnessing regardless of WM levels. WM represents a potential target for early identification and intervention efforts to reduce reactive and proactive aggression among low-income, urban youth who are at elevated risk for CVE.

Which Child Will Benefit From a Behavioral Intervention for ADHD? A Pilot Study to Predict Intervention Efficacy From Individual Reward Sensitivity

Objective: This article aims to assess whether individual differences in reward sensitivity can be used to predict which children with attention-deficit/hyperactivity disorder (ADHD) will benefit most from behavioral interventions that include reinforcement. Methods: A 12-week behavioral intervention was offered to 21 children with ADHD and their parents. Reward sensitivity was assessed prior to the intervention using a combination of psychological and physiological measures. ADHD symptoms were assessed pre- and posttreatment using the Strengths and Weaknesses of ADHD and Normal behavior (SWAN) rating scale. Results: Lower scores on one of the questionnaire scales were associated with greater pre/posttreatment differences in ADHD symptoms. Conclusion: We found that pre/posttreatment change was associated with one measure of parent-rated reward sensitivity. Children with low impulsive negative behavior toward gaining reward improved most during treatment. This result suggests that aspects of reward-related behaviors in ADHD may be useful to predict the effectiveness of treatment.

Disentangling ADHD's Presentation-Related Decision-Making-A Meta-Analytic Approach on Predominant Presentations

Background: Deficient decision-making (DM) in attention deficit/hyperactivity disorder (ADHD) is marked by altered reward sensitivity, higher risk taking, and aberrant reinforcement learning. Previous meta-analysis aggregate findings for the ADHD combined presentation (ADHD-C) mostly, while the ADHD predominantly inattentive presentation (ADHD-I) and the predominantly hyperactive/impulsive presentation (ADHD-H) were not disentangled. The objectives of the current meta-analysis were to aggregate findings from DM for each presentation separately. Methods: A comprehensive literature search of the PubMed (Medline) and Web of Science Database took place using the keywords "ADHD," "attention-deficit/hyperactivity disorder," "decision-making," "risk-taking," "reinforcement learning," and "risky." Random-effects models based on correlational effect-sizes were conducted. Heterogeneity analysis and sensitivity/outlier analysis were performed, and publication biases were assessed with funnel-plots and the egger intercept. Results: Of 1,240 candidate articles, seven fulfilled criteria for analysis of ADHD-C (N = 193), seven for ADHD-I (N = 256), and eight for ADHD-H (N = 231). Moderate effect-size were found for ADHD-C (r = 0.34; p = 0.0001; 95% CI = [0.19, 0.49]). Small effect-sizes were found for ADHD-I (r = 0.09; p = 0.0001; 95% CI = [0.008, 0.25]) and for ADHD-H (r = 0.1; p = 0.0001; 95% CI = [-0.012, 0.32]). Heterogeneity was moderate for ADHD-H. Sensitivity analyses show robustness of the analysis, and no outliers were detected. No publication bias was evident. Conclusion: This is the first study that uses a meta-analytic approach to investigate the relationship between the different presentations of ADHD separately. These findings provide first evidence of lesser pronounced impairment in DM for ADHD-I and ADHD-I compared to ADHD-C. While the exact factors remain elusive, the current study can be considered as a starting point to reveal the relationship of ADHD presentations and DM more detailed.

Approach and avoidance patterns in reward learning across domains: An initial examination of the Social Iowa Gambling Task

The current study examines learning patterns in response to both monetary and social incentives through both approach and avoidance behaviors using modified versions of the Iowa Gambling Task. Specifically, we investigated learning in response to both positive and negative feedback in a sample of 191 undergraduate students. The social task was a novel paradigm, and social feedback were images of faces displaying positive and negative emotions. We examined internal validity of the tasks through modeling changes in approach and avoidance. We also explored associations between approach and avoidance learning and individual differences in anxiety and social anxiety, depression and well-being, general anhedonia and social closeness, and fun-seeking, using multilevel models (MLMs). Results showed that both the monetary and social tasks demonstrated learning as shown by decreases in plays on disadvantageous decks across the task. Additionally, we found that overall task performance on the monetary task was associated with fun-seeking and overall task performance on the social task was associated with fun-seeking and depressive symptoms. Initial findings suggest promise for the novel task in the examination of social avoidance learning.

Peer problems, bullying involvement, and affective decision-making in adolescence

We investigated, using a cross-lagged design, the longitudinal association of bullying involvement and peer problems with affective decision-making in adolescence (ages 11 and 14 years) in 13,888 participants of the Millennium Cohort Study. Affective decision-making (risk-taking, quality of decision-making, risk adjustment, deliberation time, and delay aversion) was measured with the Cambridge Gambling Task, bullying involvement (bully, bully-victim, victim, or 'neutral' status) with self-report measures, and peer problems with the parent-reported Strengths and Difficulties Questionnaire. In general, peer problems were associated with decision-making in the unadjusted model but not after controlling for confounding. However, bullying involvement was related to decision-making even after adjustment. Compared to 'neutral' males, bullies and bully-victims improved over time in risk adjustment, and bully-victims in deliberation time, too. In both sexes, bullies showed more risk-taking compared to their 'neutral' counterparts. It seems that bullies are more sensitive to reward (or less sensitive to punishment) than those not involved in bullying. The finding that male bullies show improvement in decision-making warrants further research. Statement of contribution What is already known on this subject? In adults, decision-making deficits and social exclusion or rejection are linked In youth, only two studies have explored this link with gambling tasks measuring real-world difficulties in decision-making. Both studies were cross-sectional and small-scale. What does this study add? We explore this link in adolescence, using a large, general population longitudinal sample and the Cambridge Gambling Task. Bullies were more sensitive to reward (or less sensitive to punishment) than those not involved in bullying. Male bullies improved over time in risk adjustment, a finding that warrants further research.

Learning Process During Risk Detection in Adolescents With ADHD

OBJECTIVE

To evaluate and describe the performance during the learning process of risk-detection versus risk-benefit processing in adolescents diagnosed with ADHD.

METHOD

Thirty-five adolescents with ADHD and 26 paired controls participated. The tests applied are Iowa-type children version paradigm and Stroop test.

RESULTS

Adolescents with ADHD exhibited lower risk-benefit processing capacity and lower ability to detect risk selections; main findings also indicate that adolescents with ADHD were slower to learn to avoid risk choices. In addition, they also presented a deficient inhibitory control.

CONCLUSION

Results confirm the presence of a deficit in advantageous choice in adolescents with ADHD. By providing a measure of risk choice-and not only a net score-we show that adolescents with ADHD also fail to avoid risk choices. This deficit is mainly because they are slower in learning how to avoid risk choices, and not simply deficient. Literature is scarce concerning studies with Iowa-type paradigms in samples intregated exclusively by adolescents. More research is needed to clarify the nature of these deficiencies.

The role of intelligence in decision-making in early adolescence

This study investigated the role of intelligence and its development across childhood in decision‐making in adolescence (age 11 years). The sample was 12,514 children from the UK's Millennium Cohort Study, followed at ages 3, 5, 7, and 11 years. Decision‐making (risk‐taking, quality of decision‐making, risk adjustment, deliberation time, and delay aversion) was measured with the Cambridge Gambling Task. Even after adjustment for confounding, intelligence was positively associated with risk adjustment and quality of decision‐making in both boys and girls. Furthermore, in girls risk adjustment was related positively to IQ gains. Our findings suggest that there are important, substantively, associations between intelligence and adapting behaviour to risk at the cusp of adolescence, the period when the response to risk can shape life trajectories.

Clinical features and subjective/physiological responses to emotional stimuli in the presence of emotion dysregulation in attention-deficit hyperactivity disorder

INTRODUCTION

Emotion dysregulation (ED) has long been recognized in clinical descriptions of attention-deficit hyperactivity disorder (ADHD), but a renewed interest in ED has advanced research on the overlap between the two entities. Autonomic reactivity (AR) is a neurobiological correlate of emotion regulation; however, the association between ADHD and AR remains unclear. Our aim was to explore the clinical differences, AR, and subjective emotional responses to visual emotional stimuli in ADHD children with and without ED.

METHOD

School-aged ADHD children with (n = 28) and without (n = 20) ED, according to the definition of deficiency in emotional self-regulation (DESR), and healthy controls (n = 22) were interviewed by using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime version (K-SADS-PL) to screen frequent psychopathologies for these ages. All subjects were evaluated with Child Behavior Checklist 6-18 (CBCL), the Strengths and Difficulties Questionnaire (SDQ), the McMaster Family Assessment Device (FAD), the School-Age Temperament Inventory (SATI), and Conners' Parent Rating Scale (CPRS-48), which were completed by parents. To evaluate emotional responses, the International Affective Picture System (IAPS) and the subjective and physiological responses (electrodermal activity and heart rate reactivity) to selected pictures were examined.

RESULTS

Regarding clinically distinctive features, the ADHD+ED group differed from the ADHD-ED and the control groups in terms of having higher temperamental negative reactivity, more oppositional/conduct problems, and lower prosocial behaviors. In the AR measures, children in the ADHD+ED group rated unpleasant stimuli as more negative, but they still had lower heart rate reactivity (HRR) than the ADHD-ED and control groups; moreover, unlike the two other groups, the ADHD+ED group showed no differences in HRR between different emotional stimuli.

CONCLUSION

The presented findings are unique in terms of their ability to clinically and physiologically differentiate between ADHD children with and without ED.

Pre-ejection period reactivity to reward is associated with anhedonic symptoms of depression among adolescents

Pre-ejection period (PEP) reactivity to reward has been posited as a specific index of behavioral approach and incentive motivation, suggesting it might be uniquely associated with the affective and motivational deficits of anhedonia. This study evaluated PEP reactivity to a reward task as a predictor of depressive symptoms among adolescents, examining global depressive symptoms as well as specific anhedonic and nonanhedonic symptoms clusters. Participants included 76 adolescents, ages 11-15 years (52% female). This study found marginal support for an association between PEP reactivity to reward and concurrent anhedonia symptoms, but no association with nonanhedonic or the global scale. Findings are discussed in terms of potential associations between peripheral psychophysiological measures and dopaminergic functioning and also the utility of this measure for future research on anhedonia.

Positive association between trait impulsivity and high gambling-related cognitive biases among college students

The present study examined whether people with high gambling-related cognitive bias are more likely to have higher levels of impulsivity than are those with low gambling-related cognitive bias. We used Barratt Impulsiveness Scale version 11, Zuckerman-Kuhlman Personality Questionnaire and the Iowa gambling task to explore differences in impulsivity between high and low gambling-related cognitive bias groups. Extreme group design was applied. 110 participants (high gambling related cognition group=58, low one=52) were recruited to complete the gambling related cognition scale, impulsivity self-rating scales and Iowa gambling task. Impulsivity self-rating scores were higher among subjects with high than among those with low gambling-related cognitive bias. Compared with individuals with low gambling-related cognitive bias, those with high levels of such bias showed greater degrees of trait impulsivity. We are unable to identify group differences on IGT. State and trait impulsivity may be dissociated.

Reduced prefrontal activation during performance of the Iowa Gambling Task in patients with bipolar disorder

The Iowa Gambling Task (IGT) is a complex decision-making task in which monetary wins and losses guide the development of strategies. The objective of this study was to evaluate hemodynamic responses of patients with bipolar disorder (BD) during performance of the IGT using near-infrared spectroscopy (NIRS). Participants comprised 13 patients and 15 healthy control subjects who were matched for age, sex, handedness, and intelligence quotient. Relative changes in oxygenated and deoxygenated hemoglobin (oxy-Hb and deoxy-Hb) levels in the frontal region were measured using a 46-channel NIRS system. All subjects were evaluated using NIRS during a verbal fluency task (VFT) and the IGT. During performance of the IGT, BD patients showed significantly decreased oxy-Hb levels in the bilateral orbitofrontal cortex (OFC) and left prefrontal cortex (PFC) compared with normal control subjects. However, during the VFT, patients with BD showed no significant changes in oxy-Hb levels compared with control subjects. Changes in oxy-Hb levels in the bilateral OFC and the PFC during the IGT were negatively correlated with total scores on the Hamilton Rating Scale for Depression (HAM-D). Although the IGT was useful for differentiating patients with BP from control subjects, no significant differences in autonomic activity were observed.

Evaluating the Iowa Gambling Task as a Direct Assessment of Impulsivity with Low-Income Children

This study examined performance on the Iowa Gambling Task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994) as a measure of low-income school-aged children's affective decision-making and considered its utility as a direct indicator of impulsivity. One hundred and ninety-three 8-11 year olds performed a computerized version of the Iowa Gambling Task, a validated measure of decision-making. Multi-level modeling was used to examine children's performance over the course of the task, with age, gender, and teachers' ratings of child impulsivity (BIS-11; Patton, Stanford, & Barratt, 1995) used to predict children's Iowa Gambling performance. Higher impulsivity scores predicted a decrease in slope of Iowa Gambling performance, indicating students rated higher on impulsivity chose more disadvantageously across the task blocks. Results support evidence of the validity of the Iowa Gambling Task as a measure of impulsivity in low-income minority children.

Impaired self-awareness in pathological gamblers

Lack of self-awareness of one's decisions remains an understudied and elusive topic in the addiction literature. The present study aimed at taking a first step towards addressing this difficult subject through the use of a combination of behavioral procedures. Here, we explored the association between a metacognitive process (the ability to reflect and evaluate the awareness of one's own decision) and poor performance on the Iowa Gambling Task (IGT) in a group of pathological gamblers (PG; n = 30), and in a comparison group (n = 35). This metacognitive process was assessed during the IGT with the post-decision wagering procedure, while a number of potential confounds (i.e., reward/loss sensitivity, dual-tasking) were controlled for. Results showed that: (1) Initial performance enhancement of the control group on IGT occurred without explicit knowledge of the task, thus confirming its implicit character; (2) compared to controls, performance of PG on the IGT failed to increase during the task; (3) taking into account increased reward sensitivity and decreased loss sensitivity as well as poorer dual-tasking in pathological gamblers, PG tended to exhibit a bias in evaluating their own performance on the IGT by maximizing their wagers independently of selecting advantageous decks. Our findings suggest that biased metacognition may affect pathological gamblers, leading to disadvantageous post-decision wagering, which is in turn linked to impaired decision making under ambiguity. Perhaps this deficit reflects the impaired insight and self-awareness that many addicts suffer from, thus providing a novel approach for capturing and measuring this impairment, and for investigating its possible causes.

Neural mechanisms mediating association of sympathetic activity and exploration in decision-making

The somatic marker hypothesis asserts that decision-making can be guided by feedback of bodily states to the brain. In line with this hypothesis, the present study tested whether sympathetic activity shows an association with a tonic dimension of decision-making, exploratory tendency represented by entropy in information theory, and further examined the neural mechanisms of the association. Twenty participants performed a stochastic reversal learning task that required decision-making in an unstable and uncertain situation. Regional cerebral blood flow was evaluated using (15)O-water positron emission tomography (PET), and cardiovascular indices and concentrations of catecholamine in peripheral blood were also measured, during the task. In reversal learning, increased epinephrine during the task positively correlated with larger entropy, indicating a greater tendency for exploration in decision-making. The increase of epinephrine also correlated with brain activity revealed by PET in the somatosensory cortices, anterior insula, dorsal anterior cingulate cortex, and the dorsal pons. This result is consistent with previously reported brain matrixes of representation of bodily states and interoception. In addition, activity of the anterior insula specifically correlated with entropy, suggesting possible mediation of this brain region between peripheral sympathetic arousal and exploration in decision-making. These findings shed a new light about a role of bodily states in decision-making and underlying neural mechanisms.

Associations between attention deficit hyperactivity disorder symptom domains and DSM-IV lifetime substance dependence

BACKGROUND AND OBJECTIVES

Most studies of attention deficit hyperactivity disorder (ADHD) in the substance dependence literature have assessed ADHD as a single, categorical entity. This approach limits characterization across the spectrum of ADHD symptomatology and may mask differences across the two core domains of ADHD symptoms-hyperactive-impulsive (HI) and inattention (IN). Further, it is unclear whether relations of HI and IN symptoms to substance dependence extend across drug classes and to the general population.

METHODS

This cross-sectional study investigated associations of lifetime ADHD HI and IN symptom levels to individual classes of lifetime substance dependence (alcohol, nicotine, depressants, opioids, stimulants, cannabis, hallucinogens, polysubstance) in a population-based sample of 34,653 American adults.

RESULTS

HI and IN were associated with the majority of dependence diagnoses in a linear pattern, such that each additional symptom was associated with a proportional increase in odds of dependence. After adjusting for the overlap between symptom domains, both HI and IN uniquely associated with alcohol, nicotine, and polysubstance dependence, but only HI uniquely associated with dependence on illicit substances.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

These findings suggest that individuals in the general population with elevated levels of ADHD (particularly HI) symptoms are at risk for various forms of substance dependence and could benefit from preventive interventions.

Instantiating the multiple levels of analysis perspective in a program of study on externalizing behavior

During the last quarter century, developmental psychopathology has become increasingly inclusive and now spans disciplines ranging from psychiatric genetics to primary prevention. As a result, developmental psychopathologists have extended traditional diathesis-stress and transactional models to include causal processes at and across all relevant levels of analysis. Such research is embodied in what is known as the multiple levels of analysis perspective. We describe how multiple levels of analysis research has informed our current thinking about antisocial and borderline personality development among trait impulsive and therefore vulnerable individuals. Our approach extends the multiple levels of analysis perspective beyond simple Biology × Environment interactions by evaluating impulsivity across physiological systems (genetic, autonomic, hormonal, neural), psychological constructs (social, affective, motivational), developmental epochs (preschool, middle childhood, adolescence, adulthood), sexes (male, female), and methods of inquiry (self-report, informant report, treatment outcome, cardiovascular, electrophysiological, neuroimaging). By conducting our research using any and all available methods across these levels of analysis, we have arrived at a developmental model of trait impulsivity that we believe confers a greater understanding of this highly heritable trait and captures at least some heterogeneity in key behavioral outcomes, including delinquency and suicide.

Dimensional brain-behavior relationships in children with attention-deficit/hyperactivity disorder

BACKGROUND

Emerging neuroscientific and genetic findings emphasize the dimensional rather than the categorical aspects of psychiatric disorders. However, the integration of dimensional approaches within the current categorical diagnostic framework remains unclear. Here, we used resting state functional magnetic resonance imaging to examine whether dimensional measures of psychiatric symptomatology capture brain-behavior relationships unaccounted for by categorical diagnoses. Additionally, we examined whether dimensional brain-behavior relationships are modified by the presence of a categorically defined illness, attention-deficit/hyperactivity disorder (ADHD).

METHODS

Resting state functional magnetic resonance imaging scans were collected from 37 typically developing children (aged 10.2 ± 2; 21 female subjects) and 37 children meeting DSM-IV Text Revision criteria for ADHD (9.7 ± 2; 11 female subjects). Parent-rated Child Behavior Checklist Externalizing and Internalizing scores served as dimensional measures in our analyses of default network (DN) resting state functional connectivity (RSFC).

RESULTS

Regardless of diagnosis, we observed several significant relationships between DN RSFC and both internalizing and externalizing scores. Increased internalizing scores were associated with stronger positive intra-DN RSFC, while increased externalizing scores were associated with reduced negative RSFC between DN and task-positive regions such as dorsal anterior cingulate cortex. Several of these brain-behavior relationships differed depending on the categorical presence of ADHD.

CONCLUSIONS

Our findings suggest that while categorical diagnostic boundaries provide an inadequate basis for understanding the pathophysiology of psychiatric disorders, psychiatric illness cannot be viewed simply as an extreme of typical neural or behavioral function. Efforts to understand the neural underpinnings of psychiatric illness should incorporate both categorical and dimensional clinical assessments.

Mismatch or cumulative stress: toward an integrated hypothesis of programming effects

This paper integrates the cumulative stress hypothesis with the mismatch hypothesis, taking into account individual differences in sensitivity to programming. According to the cumulative stress hypothesis, individuals are more likely to suffer from disease as adversity accumulates. According to the mismatch hypothesis, individuals are more likely to suffer from disease if a mismatch occurs between the early programming environment and the later adult environment. These seemingly contradicting hypotheses are integrated into a new model proposing that the cumulative stress hypothesis applies to individuals who were not or only to a small extent programmed by their early environment, while the mismatch hypothesis applies to individuals who experienced strong programming effects. Evidence for the main effects of adversity as well as evidence for the interaction between adversity in early and later life is presented from human observational studies and animal models. Next, convincing evidence for individual differences in sensitivity to programming is presented. We extensively discuss how our integrated model can be tested empirically in animal models and human studies, inviting researchers to test this model. Furthermore, this integrated model should tempt clinicians and other intervenors to interpret symptoms as possible adaptations from an evolutionary biology perspective.

Developmental Psychopathology and the Diagnosis of Mental Health Problems among Youth

Recent years have evidenced a tremendous increase in research using a developmental psychopathology framework to examine clinical diagnoses among youth. Despite this increase, a relative dearth of literature systematically examines the development of co-occurring conditions among youth. In this introduction to the Special Issue on comorbidity among youth, we suggest that a developmental psychopathology perspective can provide an important foundation for the diagnosis of mental health problems among youth. As a potential framework for future investigations, we consider several developmental psychopathology principles that can inform assessment and diagnosis among youth psychological disorders. We use these principles as a foundation for considering co-occurring psychological disorders and provide potential explanations for comorbidity that can be addressed in future research that uses a developmental psychopathology perspective.

The role of teacher behavior management in the development of disruptive behaviors: an intervention study with the good behavior game

The role of teacher behavior management for children's disruptive behavior development (hyperactive and oppositional behavior) was investigated using a universal classroom preventive intervention study. Five-hundred seventy children were followed from second to third grade of elementary school. Observations of teacher behavior management and children's on-task and off-task classroom behavior and peer reports of hyperactive and oppositional behavior were available. Results showed that the reduced use of negative remarks of intervention teachers predicted children's increase in on-task behavior and decrease in talking-out behavior. These improved children's classroom behaviors in turn mediated the impact of the intervention on the development of hyperactive and oppositional behavior over the studied period. These results were similar for girls and boys. The results underscore the role of teachers' classroom management strategies in improving children's classroom behavior, which, in turn is an important component in the reduction of disruptive behavior development.

Impaired decision making in oppositional defiant disorder related to altered psychophysiological responses to reinforcement

BACKGROUND

When making decisions, children with oppositional defiant disorder (ODD) are thought to focus on reward and ignore penalty. This is suggested to be associated with a state of low psychophysiological arousal.

METHODS

This study investigates decision making in 18 children with oppositional defiant disorder and 24 typically developing control subjects. Children were required to choose between three alternatives that carried either frequent small rewards and occasional small penalties (advantageous), frequent large rewards and increasing penalties (seductive), or frequent small rewards and increasing penalties (disadvantageous). Penalties in the seductive and disadvantageous alternatives increased either in frequency or magnitude in two conditions. Heart rate (HR) and skin conductance responses to reinforcement were obtained.

RESULTS

In the magnitude condition, children with ODD showed an increased preference for the seductive alternative (carrying large rewards); this was not observed in the frequency condition. Children with ODD, compared with typically developing children, displayed greater HR reactivity to reward (more HR deceleration) and smaller HR reactivity to penalty. Correlation analyses showed that decreased HR responses to penalty were related to an increased preference for large rewards. No group differences were observed in skin conductance responses to reward or penalty.

CONCLUSIONS

The findings suggest that an increased preference for large rewards in children with ODD is related to a reduced cardiac reactivity to aversive stimuli. This confirms notions of impaired decision making and altered reinforcement sensitivity in children with ODD and adds to the literature linking altered autonomic control to antisocial behavior.

Autonomic functioning moderates the relations between contextual factors and externalizing behaviors among inner-city children

Although previous research has identified various child-specific and contextual risk factors associated with externalizing behaviors, there is a dearth of literature examining child x context interactions in the prospective prediction of externalizing behaviors. To address this gap, we examined autonomic functioning as a moderator of the relation between contextual factors (i.e., neighborhood cohesion and harsh parental behaviors) and externalizing behaviors. Participants were an ethnic minority, inner-city sample of first through fourth grade children (N = 57, 50% male) and their primary caregivers who participated in two assessments approximately 1 year apart. Results indicated that baseline sympathetic functioning moderated the relation between (a) neighborhood cohesion and externalizing behaviors and (b) harsh parental behaviors and externalizing behaviors. Post-hoc probing of these interactions revealed that higher levels of neighborhood cohesion prospectively predicted (a) higher levels of externalizing behaviors among children with heightened baseline sympathetic functioning, and (b) lower levels of externalizing behaviors among children with attenuated baseline sympathetic functioning. In addition, among children with heightened baseline sympathetic functioning, higher levels of harsh parental behaviors prospectively predicted higher levels of externalizing behaviors.